A Comprehensive Review of Celiac Disease: Pathogenesis, Current Treatment Strategies, and the Therapeutic Potential of Medicinal Plants

Abstract

Celiac disease (CD) is a chronic, immune-mediated enteropathy triggered by gluten ingestion in genetically predisposed individuals, primarily involving the HLA-DQ2 and HLA-DQ8 haplotypes. The disease is characterized by intestinal inflammation, villous atrophy, and a wide spectrum of gastrointestinal and extraintestinal manifestations. While a strict lifelong gluten-free diet remains the cornerstone of therapy, it poses significant challenges related to dietary adherence, hidden gluten, and impact on quality of life.This thesis provides a comprehensive review of the pathogenesis of celiac disease, with a particular focus on the molecular and immunological mechanisms, including the role of gliadin peptides, zonulin-mediated intestinal permeability, and both innate and adaptive immune responses. Moreover, it outlines recent advances in therapeutic approaches beyond dietary restriction. These include enzyme-based gluten detoxification, transglutaminase 2 (TG2) inhibitors, immunomodulators, tight junction regulators, and probiotic and microbial therapies.In parallel, this work highlights the growing interest in medicinal plants as adjunct or alternative therapies. Notably, plant-derived compounds from green tea, cocoa, and turmeric demonstrate anti-inflammatory and immunomodulatory properties, with potential roles in preserving intestinal barrier integrity, reducing cytokine production, and modulating gut microbiota. Among them, curcumin stands out as a promising candidate due to its multifaceted biological activities targeting key mechanisms implicated in celiac disease pathogenesis.While these natural interventions show promise in preclinical studies, further clinical validation is necessary. This review underscores the importance of integrative approaches that combine conventional and evidence-based natural therapies to improve outcomes and quality of life for individuals with celiac disease.