Celiac disease future or investigational therapies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]

Various approaches are being studied that would reduce the need of dietary modification (gluten-free diet). Most of them are still under development and include genetically engineered wheat species, enzymes, gluten vaccination, biological agents, and inhibition of endogenous signaling protein.

Various other approaches are being studied that would reduce the need of dietary modification (gluten-free diet). All are still under development and potential approach include:^[1][2]

• Genetically engineered wheat species, or wheat species that have been selectively bred to be minimally immunogenic. This, however, could interfere with the effects that gliadin has on the quality of dough.
• Enzymes:
  • Glutenases: Glutenases degrades immune-dominant gluten peptides which do not not undergo proteolytic degradation in the intestinal lumen.
  • A combination of enzymes; prolyl endopeptidase and a barley glutamine-specific cysteine endopeptidase (EP-B2): These enzymes degrade the putative 33-mer peptide in the duodenum. This combination would enable celiac disease patients to consume gluten-containing products.^[3]
• Drugs that lowers the interstinal permeablity of gluten: Inhibition of zonulin, an endogenous signaling protein linked to increased permeability of the bowel wall and hence increased presentation of gliadin to the immune system.^[4]
• Induction of oral tolerance by “gluten vaccination”
• Use of biological agents modulating pro-inflammatory intestinal cytokines.
• Other treatments aimed at other well-understood steps in the pathogenesis of celiac disease include:
  • Blocking antigen-presenting HLA-DQ2 (-DQ8)
  • Tissue transglutaminase and the MICA/NKG2D interaction that may be involved in the killing of enterocytes (bowel lining cells).
  • Use of specific transglutaminase 2 blockers to inhibit transglutaminase 2

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