Immunomodulatory strategies for celiac disease

Celiac disease (CD), is the most common food-sensitive enteropathy in humans, caused by the lack of immune tolerance (oral tolerance) to gluten. The identification of gluten-specific T cells in the lamina propria of celiacs and the strong association with HLA-DQ2 and-DQ8 genes, support a central role of CD4+ T cells in CD pathogenesis. The studies focused on the modulation of autoimmunity in different experimental models highlight possible immune therapeutic protocols useful also for the management of CD. On the basis of these observations, a series of strategies have been designed: some of them are based on the identification of immunogenic epitopes and their suppression via enzymatic treatment or by using peptide analogues; others rely on the delivery of unmodified antigen through the nasal route or co-administered together with down-regulatory cytokines. Studies are very beginning, but encouraging in the perspective to provide an alternative treatment to diet for celiacs.