Gliadin peptide specific intestinal T cells in coeliac disease

Can modification of wheat gliadin peptides be used for immunotherapy in coeliac disease? Despite its heterogeneous clinical appearance, coeliac disease has a remarkable uniform human leucocyte antigen (HLA) association. The majority of coeliac disease patients carry a certain variant of HLA-DQ2, the rest carry HLA-DQ8.1,2 As the physiological role of the HLA system is to present peptide fragments of antigens to T cells, it would seem logical that the HLA-DQ2 and HLA-DQ8 molecules predispose to coeliac disease by presenting peptides to T cells in the intestinal mucosa. The peptides these T cells recognise could derive form gluten peptides as coeliac disease is precipitated by intestinal exposure to wheat gluten and related proteins of other cereals. In fact, this simple concept has gained substantial experimental evidence in recent years.1,2 A paper in this issue of Gut 3 adds further credence to this model [see page 212] . The small intestinal lesion is characterised by inflammation and infiltration of T cells both in the lamina propria and epithelium. Intraepithelial T cells are …