Digesting gluten with oral endopeptidases to improve the management of celiac disease

Figure 1 Mechanism of gluten-dependent stimulation of T lymphocytes in intestinal mucosa. Undigested gluten is broken by antigen-presenting cells, such as dendritic cells in intestinal lamina propria, where small peptide products of gluten can initiate celiac disease-associated inflammation if they are presented bound to human leukocyte antigen-DQ2 or DQ8 to T lymphocytes. Inflammation in celiac disease is associated with an increase in intraepithelial lymphocytes, epithelial damage, villous atrophy, and a leaky gut. HLA: Human leukocyte antigen.