Pharmacological approaches in celiac disease

• The gluten-free diet is associated with clinical, economic and social issues.
• The most advanced therapies include gluten enzymatic digestion and barrier protection.
• New therapies target gluten toxicity, immune responses and the intestinal microbiota.
• Choice of therapy will depend on clinical phenotype and risk factors.

Celiac disease is an autoimmune enteropathy triggered by the ingestion of gluten, characterized by immune responses toward gluten constituents and the autoantigen transglutaminase 2. The only current treatment available for celiac disease is a gluten-free diet, however there are a plethora of therapies in development for the treatment of celiac disease (e.g. vaccine), management of symptoms while consuming gluten (e.g. Necator americanus) or adjuvant therapies in conjunction with the gluten-free diet (e.g. larazotide acetate). Current approaches in development target barrier function, immune responses, detoxifying gluten or sequestering gluten. Developing therapies include those targeting environmental factors, such as the microbiota or proteases.