Overview of Are new treatments for celiac disease on the horizon?
In this Science Friday segment, Ira Flatow speaks with Dr. Maureen Leonard of Mass General Hospital for Children and Harvard Medical School about celiac disease, why it develops, and why new treatment options are generating excitement. The discussion explains how gluten triggers immune damage in people with celiac disease, why the condition can appear later in life, and how several therapies in development could one day go beyond the current standard of a strict gluten-free diet.
Key Takeaways
- Celiac disease is an immune-mediated disorder triggered by gluten in people with the right genetic susceptibility.
- Gluten is not fully digestible by anyone, and in people with celiac disease it can pass through the intestinal lining and trigger inflammation and damage in the small intestine.
- Symptoms and complications can be serious, including abdominal pain, diarrhea, anemia, osteoporosis, and intestinal ulcers or perforations.
- No drug is currently approved to treat celiac disease directly, but several therapies are in development and showing promise.
- Diagnosis matters because future treatments will likely require a confirmed celiac diagnosis, usually through blood testing and biopsy.
How Celiac Disease Works
What triggers the disease
Dr. Leonard explains that celiac disease develops when gluten interacts with the immune system in genetically predisposed people. The exact reason it “turns on” at different times in life is still unclear.
Possible triggers being studied
Researchers are exploring whether onset is influenced by:
- gluten exposure patterns
- viral infections
- antibiotic use
- microbiome changes
- other environmental factors
Promising Treatments in Development
TEV-408 and related immune-blocking drugs
One highlighted candidate is TEV-408, an IL-15 monoclonal antibody. It works downstream in the disease process by trying to block inflammation after gluten has already crossed into the body and activated the immune system.
In a phase 2 trial:
- patients received the drug or placebo
- then underwent a gluten challenge
- those given the drug showed less intestinal worsening and some improvement in inflammatory markers
Other treatment strategies in the pipeline
The episode also mentions several broader approaches:
- Enzymes that break down gluten before it reaches the small intestine
- Drugs that reduce intestinal permeability, aiming to stop gluten from crossing the gut barrier
- Other immune-targeting agents designed to reduce the inflammatory response
Research on Why Celiac Disease Starts
Dr. Leonard describes a long-running birth cohort study of more than 600 infants with a family history of celiac disease. The study follows children from birth through age five and tracks:
- blood markers
- stool samples and microbiome changes
- diet and household environment
- viral exposures
Early signals found in the study
Her team has already found that in children who later develop celiac disease:
- the gut microbiome changes about two years before diagnosis
- intestinal permeability increases about 1.5 years before loss of gluten tolerance
- stool metabolites shift very early, suggesting the disease process begins well before symptoms
The long-term goal is to identify early warning markers and eventually develop prevention strategies.
What Patients and Families Should Know
Testing and diagnosis
- People with celiac symptoms should be evaluated by a gastroenterologist
- Diagnosis should be confirmed with blood tests and biopsy
- It’s important to be eating gluten during testing, or results may be inaccurate
Family screening
- First-degree relatives of someone with celiac disease should be tested
- The key screening blood test mentioned is tissue transglutaminase (tTG)
Diet and management
- A gluten-free diet remains the current standard treatment
- Once gluten is removed, symptoms often improve, blood tests normalize, and the intestine can heal in most patients
Why This Matters
This conversation highlights a major shift in celiac research: after decades with only dietary management, the field may be nearing the first true medications for celiac disease. These treatments could improve quality of life, expand options for patients who struggle with strict gluten avoidance, and change how doctors monitor and manage the condition in the future.