Chapter 11 Therapeutic targets based on the modulation of immune function by gut bacteria

The only current therapy in celiac disease (CeD) is a lifetime gluten-free diet. Although this intervention is safe and effective in most patients, there are limitations that warrant the development of adjuvant therapies to improve clinical outcomes. Recent studies support the hypothesis that viral infections and bacterial opportunistic pathogens play a role in CeD by affecting inflammatory and metabolic pathways. Knowledge of mechanistic pathways may allow the development and use of microbial therapeutics that optimize microbial gluten metabolism, reduce proinflammatory events, or prevent infections through vaccination strategies. This chapter will focus on bacterial pathogen-driven mechanisms and the microbial therapeutic approaches that could arise from understanding the underlying mechanisms.