Table 1.
Selected milestones and gaps in coeliac disease
| Area of interest | Milestones | Challenges | Opportunities | Readiness |
|---|---|---|---|---|
| Pathogenesis | Key pathways revealed by animal models (MHC class II HLA-DQ2 or HLA-DQ8 and transgenic for IL-15) | Limited understanding of pathways of disease tolerance and tissue destruction, as well as different phenotypes of the disease |
Current knowledge of mechanisms generates opportunities in translational research Animal and organoid models are useful to investigate mechanisms for biomarker and drug discovery |
Tools available |
| Diagnosis | Once thought to afflict primarily children of Irish descent, coeliac disease is a common condition affecting nearly 1% of the worldwide population, and the incidence is increasing3 |
The reason for increasing incidence over time is unclear There are insufficient data to support mass screening There is disagreement on the need for duodenal biopsy to confirm coeliac disease |
Clinical trials on high-risk population using novel approaches such as HLA-DQ–gluten tetramer assays or IL-2 release to measure immune response | Tools available |
| Disease management | Novel tools to improve detection of gluten to improve disease management |
GFD is difficult to follow and a great proportion of those with coeliac disease remain symptomatic Histological recovery is inconsistent with clinical presentation and coeliac disease-specific serology Lack of coeliac disease academic research centres and experts No approved disease-specific therapy |
Identification of markers of preclinical disease and development of more accurate tools to assess disease activity, which could be tested in preclinical models Continuing education of community in coeliac disease Development of pharmacological therapies |
Needs development |
| Funding | Research efforts in coeliac disease have proved highly efficient, leading to a better understanding of the disease | Funding for research is lower than for other less prevalent conditions, such as Crohn’s disease55 | Increasing funding would catalyse and sustain coeliac disease research centres, supporting patients and generating new knowledge | Insufficient |
GFD, gluten-free diet.