scholarly journals New Insights into Non-Dietary Treatment in Celiac Disease: Emerging Therapeutic Options

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2146
Author(s):  
Verónica Segura ◽  
Ángela Ruiz-Carnicer ◽  
Carolina Sousa ◽  
María de Lourdes Moreno
Keyword(s):  
Celiac Disease ◽  
Dietary Treatment ◽  
Immunological Tolerance ◽  
Phase Iii ◽  
Intestinal Lumen ◽  
Intestinal Damage ◽  
Gluten Free ◽  
Response Modulation ◽  
Immune Response Modulation

To date, the only treatment for celiac disease (CD) consists of a strict lifelong gluten-free diet (GFD), which has numerous limitations in patients with CD. For this reason, dietary transgressions are frequent, implying intestinal damage and possible long-term complications. There is an unquestionable need for non-dietary alternatives to avoid damage by involuntary contamination or voluntary dietary transgressions. In recent years, different therapies and treatments for CD have been developed and studied based on the degradation of gluten in the intestinal lumen, regulation of the immune response, modulation of intestinal permeability, and induction of immunological tolerance. In this review, therapeutic lines for CD are evaluated with special emphasis on phase III and II clinical trials, some of which have promising results.

Novel Treatments for Celiac Disease: Glutenases and Beyond

2015 ◽  
Vol 33 (2) ◽  
pp. 277-281 ◽  
Author(s):  
Katri Kaukinen ◽  
Katri Lindfors
Keyword(s):  
Celiac Disease ◽  
Dietary Treatment ◽  
Gluten Free Diet ◽  
Intestinal Lumen ◽  
Gluten Free ◽  
Novel Treatments ◽  
Gluten Peptides ◽  
Downstream Effects ◽  
Complete Digestion ◽  
Novel Drug

Currently, the only effective treatment for celiac disease is a strict lifelong gluten-free diet. However, gluten-free dieting is restrictive, difficult to maintain and nutritionally less than optimal. The improved knowledge on celiac disease pathogenesis has enabled researchers to suggest alternative strategies to treat the disorder. The drug development poses a challenge as any novel drug for celiac disease should be simultaneously effective and as safe as the gluten-free diet. The rationale behind enzyme supplementation therapy as a future treatment option for celiac patients lies in the fact that gluten is only poorly digested by gastrointestinal proteases. Due to incomplete degradation in the gastrointestinal tract, fairly long gluten peptides enter the small-intestinal lumen and come into contact with the mucosal epithelium, and in celiac disease patients this encounter launches deleterious downstream effects. Enzyme supplement therapy using either bacterial or fungal endopeptidases or proteases from germinating cereals has been proposed to promote complete digestion of prolamins and destroy disease-inducing gluten peptides. A major advantage of these glutenases is that they work in the lumen of the small intestine and do not themselves take part in the immunological cascade of events in the lamina propria, thus being unlikely to cause harmful side effects to the host. Studies to test this rationale, e.g. with Aspergillus niger prolyl endoprotease and a combination enzyme product ALV003, are already ongoing. The development of a novel medication for celiac disease is still in its early days, and thus the conventional dietary treatment will hold its place for the time being.

scholarly journals Nutritional Status in Spanish Adults with Celiac Disease Following a Long-Term Gluten-Free Diet Is Similar to Non-Celiac

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1626
Author(s):  
Catalina Ballestero-Fernández ◽  
Gregorio Varela-Moreiras ◽  
Natalia Úbeda ◽  
Elena Alonso-Aperte
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Celiac Disease ◽  
Vitamin E ◽  
Nutritional Status ◽  
Bone Mineral ◽  
Biochemical Parameters ◽  
Gluten Free ◽  
Mineral Density

The only available treatment for celiac disease is life-long gluten exclusion. We conducted a cross-sectional age- and gender-matched study in 64 celiac adults on a long-term (>1 year) gluten-free diet and 74 non-celiac volunteers from Spain, using dietary, anthropometric, and biochemical parameters, as well as assessing bone mineral density and physical activity. Celiac adults had deficient intake (below 2/3 of the recommended intake) for folates, vitamin E, and iodine and low intake of calcium (below 80% of the recommended intake). Iron intake was also below 2/3 of the recommended intake in celiac women. Vitamin D intake was extremely low, and 34% of celiac patients had moderately deficient plasma levels. According to bone mineral density, celiac women may be more prone to osteopenia and osteoporosis. However, we found a perfectly analogous nutritional status scenario in celiac as compared to healthy volunteers, with the dietary deviations found being similar to those of the Spanish population, i.e., both groups followed a high-lipid, high-protein, and low-carbohydrate diet. Values for biochemical parameters were found within the reference ranges. Celiac disease had no influence on body weight, but body fat in celiac patients tended to be higher. According to our results, vitamin D, calcium, folates, vitamin E, iodine, and iron nutritional status should be specifically assessed and monitored in the celiac population.

scholarly journals Rationale for Timing of Follow-Up Visits to Assess Gluten-Free Diet in Celiac Disease Patients Based on Data Mining

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 357
Author(s):  
Alfonso Rodríguez-Herrera ◽  
Joaquín Reyes-Andrade ◽  
Cristina Rubio-Escudero
Keyword(s):  
Data Mining ◽  
Celiac Disease ◽  
Cultural Context ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Adherence To Diet ◽  
And Gender ◽  
Few Data

The assessment of compliance of gluten-free diet (GFD) is a keystone in the supervision of celiac disease (CD) patients. Few data are available documenting evidence-based follow-up frequency for CD patients. In this work we aim at creating a criterion for timing of clinical follow-up for CD patients using data mining. We have applied data mining to a dataset with 188 CD patients on GFD (75% of them are children below 14 years old), evaluating the presence of gluten immunogenic peptides (GIP) in stools as an adherence to diet marker. The variables considered are gender, age, years following GFD and adherence to the GFD by fecal GIP. The results identify patients on GFD for more than two years (41.5% of the patients) as more prone to poor compliance and so needing more frequent follow-up than patients with less than 2 years on GFD. This is against the usual clinical practice of following less patients on long term GFD, as they are supposed to perform better. Our results support different timing follow-up frequency taking into consideration the number of years on GFD, age and gender. Patients on long term GFD should have a more frequent monitoring as they show a higher level of gluten exposure. A gender perspective should also be considered as non-compliance is partially linked to gender in our results: Males tend to get more gluten exposure, at least in the cultural context where our study was carried out. Children tend to perform better than teenagers or adults.

A Phase I Study to Determine Safety, Tolerability and Bioactivity of Nexvax2® in HLA DQ2+ Volunteers With Celiac Disease Following a Long-Term, Strict Gluten-Free Diet

2011 ◽  
Vol 140 (5) ◽  
pp. S-437-S-438 ◽  
Author(s):  
Gregor J. Brown ◽  
James Daveson ◽  
Joanne K. Marjason ◽  
Rose A. Ffrench ◽  
Danielle Smith ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Phase I ◽  
Phase I Study ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Hla Dq2

S2041 Improved Performance of Celiac Disease-Related Serology Tests in Predicting the Degree of Patients' Compliance With Long-Term Gluten-Free Diet. New Cut-Offs are Necessary

2010 ◽  
Vol 138 (5) ◽  
pp. S-307
Author(s):  
Fabio D. Nachman ◽  
Emilia Sugai ◽  
Horacio Vázquez ◽  
Andrea F. Gonzalez ◽  
Paola J. Andrenacci ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Improved Performance

Persistent Duodenal Intraepithelial Lymphocytosis Despite a Long-Term Strict Gluten-Free Diet in Celiac Disease

2012 ◽  
Vol 107 (10) ◽  
pp. 1563-1569 ◽  
Author(s):  
Ilus Tuire ◽  
Lähdeaho Marja-Leena ◽  
Salmi Teea ◽  
Haimila Katri ◽  
Partanen Jukka ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Intraepithelial Lymphocytosis

Urinary nitric oxide metabolites in children with celiac disease after long-term consumption of oats-containing gluten-free diet

2014 ◽  
Vol 49 (11) ◽  
pp. 1311-1317 ◽  
Author(s):  
Dimitrios Tapsas ◽  
Karin Fälth-Magnusson ◽  
Lotta Högberg ◽  
Tony Forslund ◽  
Tommy Sundqvist ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Celiac Disease ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Nitric Oxide Metabolites

scholarly journals The Evolving Landscape of Biomarkers in Celiac Disease: Leading the Way to Clinical Development

2021 ◽  
Vol 12 ◽  
Author(s):  
Glennda Smithson ◽  
Jenifer Siegelman ◽  
Toshihiko Oki ◽  
Joseph R. Maxwell ◽  
Daniel A. Leffler
Keyword(s):  
Celiac Disease ◽  
Peripheral Blood Cell ◽  
Clinical Development ◽  
Intestinal Damage ◽  
Gluten Free ◽  
Histological Changes ◽  
Specific Patient ◽  
Cell Responses ◽  
Immune Mediated ◽  
Duodenal Biopsies

Celiac disease is a common immune-mediated disease characterized by abnormal T-cell responses to gluten. For many patients, symptoms and intestinal damage can be controlled by a gluten-free diet, but, for some, this approach is not enough, and celiac disease progresses, with serious medical consequences. Multiple therapies are now under development, increasing the need for biomarkers that allow identification of specific patient populations and monitoring of therapeutic activity and durability. The advantage of identifying biomarkers in celiac disease is that the underlying pathways driving disease are well characterized and the histological, cellular, and serological changes with gluten response have been defined in gluten challenge studies. However, there is room for improvement. Biomarkers that measure histological changes require duodenal biopsies and are invasive. Less invasive peripheral blood cell and cytokine biomarkers are transient and dependent upon gluten challenge. Here, we discuss established biomarkers and new approaches for biomarkers that may overcome current limitations.

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