*Celiac Disease, Management, and Follow-Up DOI: http://dx.doi.org/10.5772/intechopen.104652*

therapeutic options for CD can be broadly classified into one of the following strategies—(1) removal of toxic gluten peptides before reaching the intestinal tract, (2) regulation of the immunostimulatory effects of toxic gluten peptides, (3) modulation of intestinal permeability, (4) immune modulation and induction of gluten tolerance, and (5) restoration of imbalance in the intestinal microbiota (**Figure 1**).

### **Figure 1.**

*Clinical and preclinical trials in the development of new non-dietary therapies in CD. CD: celiac disease; PEP: prolyl endopeptidases; TNF: tumor necrosis factor; and tTG: tissue transglutaminase [128].*

To date, only larazotide acetate is in phase III studies. Larazotide is an oral peptide that modulates tight junctions and prevents the passage of gluten peptides to the lamina propria by closing the intercellular junctions of enterocytes. Therefore, it could help prevent the development of the immune cascade in patients with CD, showing a reduction in symptoms as well as a reduction in anti-tTG antibody levels. In addition, some very promising therapies are PRV-015 immunotherapy, the use of oral glutenases, as well as vaccine therapies (phase II). There are many other exciting drugs that are in the early stages of research, such as tTG inhibitors, HLA blockers, and probiotics [20, 117–128]. Similarly, some therapies are being evaluated in preclinical trials and are postulated as promising treatments for the pathogenesis of CD (**Figure 1**). Thus, we are faced with many promising and emerging options for the treatment of CD.
