Coeliac disease: A review of the causative agents and their possible mechanisms of action

This review outlines the main theories for the aetiology of coeliac disease and presents in more detail the work carried out in an attempt to define the nature of the toxins in wheat gluten. This includes the results of work with synthetic peptides and a discussion of the various assays used. Evidence is presented for an enzyme deficiency in coeliac disease which leads to abnormally high concentrations of certain peptides in the small bowel. These peptides can bring about damage by direct toxic action and by immunological mechanisms. Investigations of activity of synthetic peptides based on the structure of A-gliadin appear to be making good progress and point to certain regions of that molecule as being responsible for toxicity. Certain key sequences of amino acids appear to be of fundamental importance to these studies.