Celiac disease: a review of current concepts in pathogenesis, prevention and novel therapies
- 1Walter and Eliza Hall Institute of Medical Research, Australia
- 2Royal Melbourne Hospital, Australia
- 3The University of Melbourne, Australia
- 4Murdoch Childrens Research Institute, Australia
- 5McMaster University, Canada
- 6Department of Clinical Sciences, Faculty of Medicine, Lund University, Sweden
- 7Skåne University Hospital, Sweden
Our understanding of celiac disease and how it develops has evolved significantly over the last half century. Although traditionally viewed as a pediatric illness characterized by malabsorption, it is now better seen as an immune illness with systemic manifestations affecting all ages. Population studies reveal this global disease is common and, in many countries, increasing in prevalence. These studies underscore the importance of specific HLA susceptibility genes and gluten consumption in disease development and suggest that other genetic and environmental factors could also play a role. The emerging data on viral and bacterial microbe-host interactions and their alterations in celiac disease provides a plausible mechanism linking environmental risk and disease development. Although the inflammatory lesion of celiac disease is complex, the strong HLA association highlights a central role for pathogenic T cells responding to select gluten peptides that have now been defined for the most common genetic form of celiac disease. What remains less understood is how loss of tolerance to gluten occurs. Our understanding of celiac disease is now providing opportunities to intervene in its development, course, diagnosis and treatment.
Keywords: Celiac Disease, gluten, T cells, microbiome, Pathogenesis, Transglutaminase, gene environment interaction
Received: 22 Aug 2018;
Accepted: 29 Oct 2018.
Edited by:Ron Shaoul, Rambam Health Care Campus, Israel
Reviewed by:Tudor L. Pop, Iuliu Hațieganu University of Medicine and Pharmacy, Romania
Gianfranco Meloni, University of Sassari, Italy
Copyright: © 2018 Tye-Din, Galipeau and Agardh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr. Jason A. Tye-Din, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, firstname.lastname@example.org