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Front Pediatr. 2018 Nov 21;6:350. doi: 10.3389/fped.2018.00350. eCollection 2018.

Celiac Disease: A Review of Current Concepts in Pathogenesis, Prevention, and Novel Therapies.

Author information

1
Immunology Division, The Walter and Eliza Hall Institute, Parkville, VIC, Australia.
2
Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
3
Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
4
Centre for Food & Allergy Research, Murdoch Children's Research Institute, Parkville, VIC, Australia.
5
Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.
6
The Diabetes and Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.
7
Unit of Endocrinology and Gastroenterology, Department of Pediatrics, Skåne University Hospital, Malmö, Sweden.

Abstract

Our understanding of celiac disease and how it develops has evolved significantly over the last half century. Although traditionally viewed as a pediatric illness characterized by malabsorption, it is now better seen as an immune illness with systemic manifestations affecting all ages. Population studies reveal this global disease is common and, in many countries, increasing in prevalence. These studies underscore the importance of specific HLA susceptibility genes and gluten consumption in disease development and suggest that other genetic and environmental factors could also play a role. The emerging data on viral and bacterial microbe-host interactions and their alterations in celiac disease provides a plausible mechanism linking environmental risk and disease development. Although the inflammatory lesion of celiac disease is complex, the strong HLA association highlights a central role for pathogenic T cells responding to select gluten peptides that have now been defined for the most common genetic form of celiac disease. What remains less understood is how loss of tolerance to gluten occurs. New insights into celiac disease are now providing opportunities to intervene in its development, course, diagnosis, and treatment.

KEYWORDS:

T cells; celiac disease; gluten; microbiome; pathogenesis

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