title: Future treatment strategies for celiac disease.
abstract: BACKGROUND
  Ingestion of dietary gluten in wheat, rye and barley by celiac patients leads to small-bowel mucosal villous atrophy, crypt hyperplasia and massive inflammation, often coupled with clinical symptoms and signs. Currently, the only effective treatment is a strict life-long gluten-free diet excluding all gluten-containing food products. In view of the extremely restricted nature of the diet, new treatment options would clearly be desirable.
  
  
  METHODS
  The improved understanding of celiac disease pathogenesis has enabled researchers to suggest alternative strategies to treat the disorder. This review covers current approaches toward developing an appropriate drug and discusses the possible problems associated with these approaches.
  
  
  CONCLUSIONS
  Phase II clinical trials are already ongoing to test the efficacy of novel alternative treatments for celiac disease. Before any of the candidates can enter Phase III trials, however, researchers must develop novel reliable non-invasive surrogate markers for intestinal injury and disease activity which also accurately reflect patient-related outcomes. Any novel medication for celiac disease should be as effective and safe as the gluten-free diet, and this constitutes a challenge for drug development. It is thus likely that the first medication entering the market will be supplementary to rather than substitute the gluten-free diet.
authors.affiliation: University of Tampere and Tampere University Hospital, School of Medicine, Pediatric Research Center, Finn-Medi 3, FIN-33014, Tampere, Finland. katri.lindfors@uta.fi
authors.forename: Katri
authors.initials: K
authors.lastname: Lindfors
authors.forename: Marja-Leena
authors.initials: ML
authors.lastname: Lähdeaho
authors.forename: Suvi
authors.initials: S
authors.lastname: Kalliokoski
authors.forename: Kalle
authors.initials: K
authors.lastname: Kurppa
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
mesh_terms: D000818:Animals; D002446:Celiac Disease / Q000517:prevention & control / Q000628:therapy*; D004032:Diet; D055050:Diet, Gluten-Free; D005983:Glutens / Q000009:adverse effects / Q000378:metabolism; D006801:Humans; D000085822:Prolyl Oligopeptidases; D012697:Serine Endopeptidases / Q000378:metabolism
chemical_list: D005983:Glutens; D012697:Serine Endopeptidases; C000705287:PREPL protein, human; D000085822:Prolyl Oligopeptidases