Can Celiac Disease Be Prevented?

Abstract

Celiac disease (CD) is an autoimmune disorder triggered by gluten in genetically susceptible individuals characterized by a variable combination of gluten-dependent symptoms, presence of specific autoantibodies and enteropathy. The health burden of CD is considerable, as it reduces quality of life and, at a societal level, has extensive negative economic consequences. Prevention strategies are based on the identification of at-risk subjects and identification and elimination of risk factors. A number of prospective observational and interventional studies conducted on the general population, and more often in subjects at-risk, have given important information on the natural history of the disease. Both genetic and environmental factors have been identified with the former, in particular histocompatibility genes, playing a major role. Environmental factors, some operating already before birth, have been identified, with feeding pattern in the first year of life (breast feeding, amount and time of introduction of gluten) and infections being the most relevant. Prospective studies have also allowed the identification of biomarkers predictive of the disease which in perspective could better define the population on which to intervene. Interventions have been so far limited to modifications of feeding patterns. However, as also learnt from diseases that share with CD genetic risk factors and mechanisms of damage, such as type 1 diabetes (T1D), future strategies may be envisaged based on protection from infections, manipulation of microbiota, intervention on T cells.

Evolutionary Medicine Perspectives: Helicobacter pylori, Lactose Intolerance, and 3 Hypotheses for Functional and Inflammatory Gastrointestinal and Hepatobiliary Disorders

“…IBD relapse after stopping infliximab is associated with gut dysbiosis (73). Several studies point to incitement of the autoimmune process underlying celiac disease by pediatric viral intestinal and respiratory infections (74).…”

Intervention strategies in early childhood to prevent celiac disease—a mini-review

“…Prospective birth cohort studies have found that 20% of the children carrying the DQ2 haplotypes followed from birth develop celiac disease by the age of 10 years (6). Albeit gluten is considered to be driving a higher prevalence of celiac disease in populations with higher frequencies of HLA-risk genotypes, additional environmental factors such as birth mode, season of birth, viral infections, and altered microbiome may facilitate and/or trigger the immune response to dietary gluten (9)(10)(11). Celiac disease can develop at any time over a life span, although the incidence peaks in early childhood (12).…”

Identifying celiac disease-related chemicals by transcriptome-wide association study and chemical-gene interaction analyses

“…CeD can be successfully treated with a gluten-free diet (GFD); however, this treatment strategy may considerably affect the quality of life (Vriezinga et al, 2015). Thus, biomarkers must be identified to determine the risk factors and develop potential interventions for high-risk groups (Auricchio and Troncone, 2021).…”