Tampere Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland.
Children's Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Nat Rev Gastroenterol Hepatol. 2021 Mar;18(3):181-195. doi: 10.1038/s41575-020-00378-1. Epub 2020 Nov 20.
Coeliac disease is a common enteropathy that occurs in genetically susceptible individuals in response to the ingestion of gluten proteins present in wheat, rye and barley. Currently, the only available treatment for the condition is a strict, life-long gluten-free diet that, despite being safe and often effective, is associated with several challenges. Due to the high cost, particularly restrictive nature and perception of decreased quality of life associated with the diet, some patients are continuously exposed to gluten, which prevents an adequate disease control. Moreover, a subgroup of patients does not respond to the diet adequately, and healing of the small-bowel mucosa can be incomplete. Thus, there is a need for alternative treatment forms. The increasingly understood pathogenetic process of coeliac disease has enabled the identification of various targets for future therapies. Multiple investigational therapies ranging from tolerogenic to immunological approaches are in the pipeline, and several drug candidates have entered phase II/III clinical trials. This Review gives a broad overview of the different investigative treatment modalities for coeliac disease and summarizes the latest advances in this field.
乳糜泻是一种常见的肠病，发生在对摄入小麦、黑麦和大麦中存在的麸质蛋白具有遗传易感性的个体中。目前，该疾病唯一可用的治疗方法是严格的、终生无麸质饮食，尽管这种饮食安全且通常有效，但它也存在一些挑战。由于成本高、饮食限制严格以及人们认为生活质量下降，一些患者持续接触麸质，从而无法进行充分的疾病控制。此外，还有一部分患者对饮食治疗反应不佳，小肠黏膜的愈合可能不完全。因此，需要替代治疗形式。对乳糜泻发病机制的日益深入了解使人们能够确定未来治疗的各种靶点。正在研发的治疗方法多种多样，从耐受原性到免疫方法都有涉及，并且有几种候选药物已经进入 II/III 期临床试验。这篇综述广泛概述了乳糜泻的不同治疗方法，并总结了该领域的最新进展。
