I think we all know that the only current treatment for celiac disease is the gluten-free diet. Most days I think that it’s awesome that the only “thing” I have to do to treat my autoimmune disease is watch what I eat. I am grateful that I don’t have to take any pills, do self-injections, etc. But some days, especially when I travel or have to eat outside of my gluten-free home for an extended period of time, I don’t feel quite so enthusiastic about having celiac disease. I fear getting “glutened” when I am away from home. And it takes my body a good 2 to 4 weeks to totally recover every time I am accidentally exposed to gluten.
Recently reading about and reviewing some of the potential future treatments for celiac disease has given me some hope for a future life as a celiac with fewer “glutenings” and an improved quality of life.
According to a recent paper published in the journal Gastroenterology Report (see reference below), there are 3 main categories of potential treatments for celiac disease: gluten detoxification, intestinal permeability modulation, and modulation of the immune response to gluten. I’ll try my best to explain each in a bit of detail.
Gluten detoxification involves making some sort of modification or change to gluten so that it will not cause an immune response. Some of the research in this area has involved the genetic modification of wheat. The bulk of the research in this area, however, involves enzymes that break down gluten into small, non-toxic fragments that do not cause an immune response. The CeliAction Study, which I have previously written about, is phase 2 clinical trial of a drug called ALV003. ALV003 contains 2 enzymes (EP-B2 and SC PEP) that break down gluten into non-toxic fragments. Additional therapies currently being studied include probiotics, AN-PEP, and STAN1. These enzymes are all intended to augment, not replace, the gluten-free diet. ALV003 is also being studied as a treatment for nonresponsive celiac disease.
Intestinal permeability modification involves tightening up the gaps between the cells in our intestinal tissues. For those of us with celiac disease, ingesting even trace amounts of gluten can lead to an increase in intestinal permeability (also known as leaky gut) through the action of a protein called zonulin. Larazotide acetate, which is currently in phase 2 clinical trials, is the main celiac drug being studied to modulate this zonulin-induced increase in intestinal permeability after gluten ingestion. Like ALV003, larazotide acetate is anticipated to augment the gluten free diet and help prevent symptoms from gluten cross-contamination.
The third category of therapies modulate, or block, the gluten-induced immune response in celiac disease. Nexvax 2, also known as the “celiac vaccine,” contains 3 peptides (small portions) of gluten. Exposure to these small amounts of gluten in the vaccine induces a change in the immune system, preventing subjects from having reactions when they ingest gluten after receiving the vaccine. In other words, gluten tolerance develops. Based on the lecture on Nexvax 2 that I heard at the International Celiac Disease Symposium in 2013, this vaccine may actually eventually replace the gluten-free diet and celiac patients who receive the Nexvax 2 may be able to return to their pre-diagnosis diets containing gluten.
Additional therapies in the immune modulating category include parasites, such as whipworms and hookworms (see link), monoclonal antibodies like those used in inflammatory bowel disease, and CCX282-B (involves CCR-9 blockade and is so complicated that I am unable to fully understand it and explain it).
I look forward to the possibility of being able to take either ALV003 or larazotide acetate in the future to prevent symptoms from accidental gluten ingestion/cross-contamination while eating gluten-free outside of my home and travelling. I am unsure about the celiac vaccine. I understand that many of you dislike the notion of ever having to take a “celiac drug” and that is okay. I respect the fact that many of you would opt to decline these therapies if/when they become available and I hope that your doctors will do the same. I, for one, am excited though!
Castillo, N., Thimmaiah, G., Leffler, D. The present and the future in the diagnosis and management of celiac disease. Gastroenterology Report. 2014, 1-9.