Vol. 6, Issue 7 (2017)

Author(s):
S Shivani, MD Vissath Eeman, MD Afroz and T Praveen Kumar

Abstract:
Celiac disease (CD) is a common autoimmune disorder characterized by an immune response to ingested gluten and has a strong HLA association with HLADQ2 and HLA-DQ8 molecules, but human HLA-DQ risk factors do not explain the entire genetic susceptibility to gluten intolerance. CD is caused by the lack of immune tolerance (oral tolerance) to wheat gluten. The expression of soluble HLA-G in CD molecule plays an important role in the induction of immune tolerance. At present, strict and lifelong gluten free diet is the only effective treatment for celiac disease. Even small amounts of gluten (50mg/day) can be immunogenic; therefore all food and food items and drugs that contain gluten and its derivatives must be eliminated completely from the diet. In recent times, a number of targets to halt the process of immunological injury have been explored to find out alternative treatment for celiac disease. These targets include exploration of ancient wheat if they are less immunogenic, intra-luminal digestion of gluten using prolylendo peptidases, pretreatment of whole gluten with bacterial-derived peptidase before ingestion; prevention of passage of immunogenic peptides through the tight junctions such as zonulin antagonists, Blocking of HLA-DQ2 to prevent binding of immunogenic peptides, inhibition of transglutaminase-2, immune-modulation and induction of tolerance to gluten using gluten tolerating vaccines, use of gluten-sequestering polymers, use of anti-inflammatory drugs (glucocorticoides, budesonides) and anti-cytokines such as anti TNF-α, and anti-interleukin-15.