Review Article: Future Research on Coeliac Disease -- A Position Report From the European Multistakeholder Platform on Coeliac Disease (CDEUSSA)

R. Troncone; A. Ivarsson; H. Szajewska; M. L. Merin; Also On Behalf Of The Members Of The European Multidtakeholder Platform On Cd (Cdeussa)

Disclosures

Aliment Pharmacol Ther. 2008;27(11):1030-1043. 

In This Article

Summary and Introduction

Background: CDEUSSA is a Specific Support Action project from the Sixth Framework Programme Priority of the European Union (EU). Its aim is to bring together basic and applied research in the area of coeliac disease (CD). This paper reviews the main issues that are a result of the CDEUSSA initiative.
Aim: To identify the major issues in need of investigation in the areas of clinical aspects, treatment, prevention and public health.
Methods: Key stakeholders, representing a wide range of knowledge with crucial importance for CD research and practice, have participated in two workshops aimed at identifying and proposing to the EU, as high priority research, topics in the areas of clinical aspects, treatment, prevention and public health.
Results: In public health, the overall goal should be to improve quality of life of the European population by implementing primary prevention strategies, early diagnosis and improved treatments for CD. New treatment strategies need to be developed. The option of primary prevention should be fully explored, which requires combined epidemiological, clinical and basic scientific research efforts. Such studies should also consider the importance of gene-environment interactions in the development of CD. Increased knowledge is needed on the natural history of CD. Diagnostic criteria need to be revised.
Conclusions: To achieve these goals, a collaboration of the stakeholders is fundamental, including research and patient organizations, as well as industries within both diagnostics and food production.

Coeliac disease (CD) is generally defined as a gluten-dependent enteropathy, but is actually a multiorgan inflammatory disorder with large negative health consequences for many of those affected. It is not, as previously thought, a rare disease of childhood, but can have its onset at any age, and has lately emerged as a worldwide public health problem.

CD has a multifactorial aetiology. With regard to disease development, both genes and the environment and interactions between the two of them influence immunological responses and may confer either increased or reduced CD risk. CD has a genetic basis,[1] illustrated by family clustering with a prevalence of about 10% in first-degree relatives[2] and a 75% concordance in monozygotic twins,[3] a rate higher than in any other condition with a multifactorial basis. The principal determinants of genetic susceptibility are the highly variable human leukocyte antigen (HLA) class II DQA and DQB genes located in the major histocompatibility complex at chromosome 6. The combination of HLA-DQA1*0501 and DQB1*02 alleles encode the HLA-DQ2 class II protein molecule, which presents gluten peptides to CD4 positive cells.[4] However, it is clear that additional factors are critical for the development of CD as up to 30% of persons of North European ancestry, most of whom eat wheat, express HLA-DQ2, but CD develops in only a small proportion of these carriers. Altered processing of gluten by intraluminal enzymes and changes in intestinal permeability precede the activation of innate and adaptive immune responses.

Considerable research has been devoted to CD over the last decades. CDEUSSA is a Specific Support Action project from the Sixth Framework Programme Priority of the European Union. Its aim is to bring together basic and applied research in the area of CD. The CDEUSSA process was initiated by selecting and inviting key stakeholders representing a wide range of knowledge with crucial importance for CD research and practice. Thereafter, the call to join has been open with the aim to expand successively the platform to ensure representation of a wide range of stakeholders and to increase its usefulness also in future exchange of information. CDEUSSA now forms a platform, mobilizing key stakeholders from research, the food industry, the European public health field and patient associations. So far, 103 professionals from 27 countries, representing a large range of organizations and disciplines, have adhered to the CDEUSSA initiative. More information on CDEUSSA is available on the web (http://www.cdeussa.com/). As part of the process, two workshops were organized in 2006 and participants identified four CD topics - clinical aspects, treatment, prevention and public health - that need to be investigated during the next few years. These research areas and related topics have been proposed to the European Union as high priority research to improve the health status of the European population. This paper reviews the main issues that emerged during the two workshops, and is thus a result of the CDEUSSA initiative.

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