Upcoming Treatments in Celiac Disease: From Luminal Enzymes to Oral Immune Tolerance

Abstract

Celiac disease (CeD) is a chronic autoimmune enteropathy triggered by dietary gluten in genetically predisposed individuals. Currently, a gluten-free diet (GFD) is the only available treatment, being effective in improving mucosal health and symptoms. However, a considerable percentage of celiacs continue to exhibit residual mucosal damage and symptoms. In addition, dietary lapses, and social and nutritional problems pose difficulties with the GFD. Hence, there is an unmet need for new treatments in CeD, driving the development of pharmacologic interventions, with several new drugs in various stages of clinical development. These drugs target distinct steps in the immune pathology of CeD and are intended for patients who continue to experience symptoms despite trying to follow a GFD. Also, the treatment should heal the defective small intestinal mucosa, which is believed to be linked to the risk of long-term complications. This review summarizes emerging CeD therapies, covering trial progress, mechanisms, and potential clinical applications.