Celiac disease future or investigational therapies: Difference between revisions
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{{Celiac disease}} | {{Celiac disease}} | ||
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==Overview== | ==Overview== | ||
Various other approaches are being studied that would reduce the need of dietary modification (gluten-free diet). All are still under development and include genetically engineered wheat, synthetic enzymes, | Various other approaches are being studied that would reduce the need of dietary modification (gluten-free diet). All are still under development and include genetically engineered wheat species, synthetic enzymes, gluten vaccination, biological agents, and inhibition of endogenous signaling protein. | ||
==Future or investigational therapies== | ==Future or investigational therapies== | ||
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**A combination of [[enzyme]]s ([[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 coeliac disease patients to consume gluten-containing products.<ref>{{cite journal | author = Siegel M, Bethune M, Gass J, Ehren J, Xia J, Johannsen A, Stuge T, Gray G, Lee P, Khosla C | title = Rational design of combination enzyme therapy for celiac sprue | journal = Chem Biol | volume = 13 | issue = 6 | pages = 649-58 | year = 2006 | id = PMID 16793522}}</ref> | **A combination of [[enzyme]]s ([[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 coeliac disease patients to consume gluten-containing products.<ref>{{cite journal | author = Siegel M, Bethune M, Gass J, Ehren J, Xia J, Johannsen A, Stuge T, Gray G, Lee P, Khosla C | title = Rational design of combination enzyme therapy for celiac sprue | journal = Chem Biol | volume = 13 | issue = 6 | pages = 649-58 | year = 2006 | id = PMID 16793522}}</ref> | ||
*Drugs that lowers the interstinal permeablity to gluten | *Drugs that lowers the interstinal permeablity to gluten | ||
*Induction of oral tolerance by | *Induction of oral tolerance by "gluten vaccination" | ||
*Use of biological agents modulating pro-inflammatory intestinal cytokines. | *Use of biological agents modulating pro-inflammatory intestinal cytokines. | ||
* 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.<ref>{{cite journal | author = Fasano A, Not T, Wang W, Uzzau S, Berti I, Tommasini A, Goldblum S | title = Zonulin, a newly discovered modulator of intestinal permeability, and its expression in coeliac disease | journal = Lancet | volume = 355 | issue = 9214 | pages = 1518–9 | year = 2000 | id = PMID 10801176}}</ref> | * 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.<ref>{{cite journal | author = Fasano A, Not T, Wang W, Uzzau S, Berti I, Tommasini A, Goldblum S | title = Zonulin, a newly discovered modulator of intestinal permeability, and its expression in coeliac disease | journal = Lancet | volume = 355 | issue = 9214 | pages = 1518–9 | year = 2000 | id = PMID 10801176}}</ref> |
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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]
Overview
Various other approaches are being studied that would reduce the need of dietary modification (gluten-free diet). All are still under development and include genetically engineered wheat species, synthetic enzymes, gluten vaccination, biological agents, and inhibition of endogenous signaling protein.
Future or investigational therapies
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]
- 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.
- Synthetic enzymes:
- Glutaneses: Glutaneses 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 coeliac disease patients to consume gluten-containing products.[2]
- Drugs that lowers the interstinal permeablity to gluten
- Induction of oral tolerance by "gluten vaccination"
- Use of biological agents modulating pro-inflammatory intestinal cytokines.
- 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.[3]
- Other treatments aimed at other well-understood steps in the pathogenesis of celiac disease include:
- the action of HLA-DQ2 (blocking antigen-presenting HLA-DQ2 i.e.-DQ8)
- tissue transglutaminase(use of specific transglutaminase 2 blockers to inhibit transglutaminase 2) and the MICA/NKG2D interaction that may be involved in the killing of enterocytes (bowel lining cells).
References
- ↑ Schuppan D, Zimmer KP (2013). "The diagnosis and treatment of celiac disease". Dtsch Arztebl Int. 110 (49): 835–46. doi:10.3238/arztebl.2013.0835. PMC 3884535. PMID 24355936.
- ↑ Siegel M, Bethune M, Gass J, Ehren J, Xia J, Johannsen A, Stuge T, Gray G, Lee P, Khosla C (2006). "Rational design of combination enzyme therapy for celiac sprue". Chem Biol. 13 (6): 649–58. PMID 16793522.
- ↑ Fasano A, Not T, Wang W, Uzzau S, Berti I, Tommasini A, Goldblum S (2000). "Zonulin, a newly discovered modulator of intestinal permeability, and its expression in coeliac disease". Lancet. 355 (9214): 1518–9. PMID 10801176.