Is there a vaccine available for celiac disease?

No Vaccine Currently Available for Celiac Disease

There is currently no approved vaccine available for celiac disease, though research is underway to develop therapeutic vaccines that could potentially help patients tolerate gluten. 1, 2

Current Management of Celiac Disease

• The only effective treatment for celiac disease is strict, lifelong adherence to a gluten-free diet (GFD), which requires complete elimination of wheat, barley, and rye from the diet 2
• Adherence to a gluten-free diet is highly burdensome and requires long-term patient motivation, compliance, and follow-up 1
• Despite adherence to a GFD, a large proportion of adult patients fail to achieve complete histological healing of their small bowel mucosa 1

Vaccine Development Status

• A therapeutic vaccine called Nexvax2 has been in clinical development, designed to treat celiac disease by targeting gluten-specific CD4-positive T cells 3
• Nexvax2 is an adjuvant-free mix of three peptides that include immunodominant epitopes for gluten-specific CD4-positive T cells 3
• Phase 1 clinical trials showed that Nexvax2 modified immune responsiveness to gluten peptides without deterioration in duodenal histology 3
• The maximum tolerated dose of Nexvax2 was determined to be 150 μg for twice weekly intradermal administration over 8 weeks 3
• Initial doses of the vaccine caused transient, acute gastrointestinal adverse events similar to those caused by gluten ingestion 3

Other Therapeutic Approaches Under Investigation

• Novel treatments for celiac disease are being explored as alternatives or adjuncts to the gluten-free diet 1, 2
• Potential approaches include:
  • Immunotherapy (including hookworm exposure) 1
  • Glutenases (propyl endopeptidases) that can enzymatically cleave immunotoxic gluten peptides 1
  • Tight junction regulators to maintain intestinal barrier function 1
  • Modified (transamidated) gliadins that may reduce inflammatory responses 4

Vaccination Considerations in Celiac Patients

• There is no evidence showing any causative association between standard vaccines and celiac disease development 5
• Vaccinations may be administered according to national immunization schedules for celiac patients 5
• Celiac patients may require special attention regarding certain vaccines:
  • Hepatitis B vaccine: A booster dose is often required due to low or lost immune response in celiac patients 5, 6
  • Pneumococcal vaccines: May be beneficial in patients with advancing age at diagnosis and concomitant risk factors 5
  • Rotavirus vaccine: Some data suggests it may reduce the risk for development of celiac disease autoimmunity in early years of life 5

Future Directions

• The British Society of Gastroenterology has identified the development of a vaccine or other novel therapies to induce long-term remission without a GFD as a key area for future research 1
• Continued clinical development of therapeutic vaccines like Nexvax2 is supported by current research findings 3
• Other approaches being investigated include substituted, cyclic or dimeric peptide analogues as blockers to prevent HLA from binding to immunodominant gliadin epitopes 4

Clinical Implications

• Physicians should inform patients that currently, strict adherence to a gluten-free diet remains the only effective treatment for celiac disease 2
• Patients interested in emerging therapies should be advised that these are still in research phases and not yet approved for clinical use 1, 2
• Regular follow-up is essential to monitor response to GFD through serologic testing and, in some cases, repeat endoscopy with biopsy 2