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Z Gastroenterol 2018; 56(02): 151-164
DOI: 10.1055/s-0043-121345
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Medikamentöse Therapie der Zöliakie – „from bench to bedside“

Drug therapy in coeliac disease – “from bench to bedside”
Jürgen Stein
1   Gastroenterologie/Ernährungsmedizin, DGD Kliniken Sachsenhausen, Frankfurt am Main, Deutschland
2   Interdisziplinäres Crohn-Colitis-Centrum Rhein-Main, Frankfurt am Main, Deutschland
,
Jörg-Dieter Schulzke
3   Medizinische Klinik für Gastroenterologie, Rheumatologie und Infektiologie, Bereich Ernährungsmedizin und Klinische Physiologie, Charité Centrum 13, Campus Benjamin Franklin, Berlin, Deutschland
,
Detlef Schuppan
4   Institut für Translationale Immunologie, Universitätsmedizin Mainz, Deutschland
5   Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
› Author Affiliations
Further Information

Publication History

09 March 2017

08 October 2017

Publication Date:
07 November 2017 (online)

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Zusammenfassung

Die Zöliakie ist eine der weltweit häufigsten Erkrankungen mit einer geschätzten Prävalenz von etwa 0,5 – 1 %. Die Erkrankung entsteht als Folge einer Kombination von Umweltfaktoren (Glutenproteine von Weizen, Roggen oder Gerste) und genetischen Faktoren (hauptsächlich humane Leukozytenantigene HLA-DQ2 oder -DQ8). Aktuell stellt eine strikte glutenfreie Diät (GFD) die einzige Therapiemöglichkeit dar. Allerdings ist die Einhaltung dieser Diät schwierig, nicht zuletzt deshalb, weil Gluten in vielen Fertignahrungsmitteln enthalten ist. Folglich kann die konsequente Vermeidung von Gluten tiefe Einschnitte sowohl in der Nahrungsauswahl als auch im Sozialleben zur Folge haben. Zudem führt die GFD auch bei völlig adhärenten Patienten nicht in jedem Fall zu einer klinischen und histologischen Normalisierung. Deshalb ist das Interesse an (adjunktiven) nicht-diätischen Therapieansätzen für die Zöliakie groß. Ziel dieser Arbeit ist es, basierend auf pathophysiologischen Konzepten zur Zöliakie neueste pharmakologische Therapieansätze vorzustellen und zu diskutieren.

Abstract

Coeliac disease is one of the most common diseases worldwide, with an estimated global prevalence of 0.5 – 1 %. The disease is triggered by a combination of environmental (gluten proteins from wheat, rye or barley) and genetic factors (mainly the human leucocyte antigens HLA-DQ2 or -DQ8). At present, a strict gluten-free diet (GFD) represents the only treatment option. However, strict adherence to a GFD is challenging, since even highly motivated patients may be subject to inadvertent or background exposure to gluten. Thus, rigorous avoidance of gluten necessitates extensive constraint of patients’ food choices and social interactions. Moreover, even in fully adherent patients, a GFD may fail to induce clinical or histological normalisation. New (adjunctive) non-dietary therapeutic strategies for patients with coeliac disease are therefore of great interest. In this review, on the basis of the current understanding of its pathophysiology, we examine and discuss novel pharmacological approaches for the treatment of coeliac disease.

Schlüsselwörter

Adhäsionsmoleküle - Autoimmunität - Autoantigen - Zytokine - Enzymtherapie - Gewebstransglutaminase - gluteninduzierte Enteropathie - HLA - Inhibitor - IL-15 - Malabsorption - T-Zelle - therapeutisches Vakzin - Transglutaminase-Inhibitoren - Zöliakie - Zonulin

Key words

Adhesion molecules - autoantigen - autoimmunity - coeliac disease - cytokine - enzyme therapy - gluten-sensitive enteropathy - HLA - inhibitor - IL-15 - malabsorption - pharmacotherapy - T-cell - therapeutic vaccine - tissue transglutaminase - transglutaminase inhibitors - zonulin
 

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