Celiac treatments, adjuvant thera-pies and alternatives to the gluten-free diet

• Autores: Justin L. McCarville, Alberto Caminero Fernández, Elena F. Verdú
• Localización: Advances in the Understanding of Gluten related Pathology and the Evolution of Gluten-Free Foods / Eduardo Arranz Sanz (ed. lit.), Fernando Fernández Bañares (aut.), Cristina M. Rosell (aut.), Luis Rodrigo Sáez (aut.), Amado Salvador Peña (aut.), 2015, ISBN 978-84-943418-2-3, págs. 223-254
• Idioma: inglés
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  • Texto Completo Libro
• Resumen

  • Celiac disease (CD) is a chronic enteropathy triggered by exposureto dietary gluten in genetically susceptible individuals. The onlycurrently accepted therapy for CD is a lifetime gluten-free diet (GFD).Although a GFD has proven to be a safe and effective in most celiacpatients, there are limitations that warrant new adjuvant therapies forthe treatment of CD. The therapies in development for CD fall intothe following categories 1) Gluten detoxification 2) Luminal therapies3) Intestinal barrier enhancing therapies 4) Immune targeted therapiesand 5) Experimental therapies. Gluten detoxification includes alteringgluten proteins in foods before commercialization. Luminal therapiesaim at neutralizing gluten in the lumen of the small intestine. Theseinclude enzymatic digestion therapy, probiotics and gluten binders.Barrier enhancing therapies decrease the leaky intestinal conditionassociated with the disease, which could enhance translocation ofgluten peptides, or of other harmful antigens, into the lamina propria.Immune targeted therapies include TG2 blockers, HLA blockers, T celltargeted therapies, alteration of inflammatory mediators and vaccinetherapy. Finally, experimental therapies comprise compounds orbiological strategies in discovery phase. Of these, Elafin was recentlyproposed to play a role in CD and have potential therapeuticapplications in an animal model. To date, none of the discussedtherapies have been approved for clinical use and are at differentstages of development. However, adjuvant therapies to the GFD willlikely become a reality to the coming years and will increase thequality of life of patients living with gluten-related disorders.