Pathogenesis of coeliac disease – a disorder driven by gluten-specific CD4+ T cells

The notion that CD4+ T cells play a central role in coeliac disease (CeD) became strong with the observation that gluten-reactive T cells selectively recognize gluten antigen in the context of the CeD-associated HLA class II allotypes. Today a whole body of evidence points to these gluten-specific CD4+ T cells as essential drivers of CeD pathology. The interaction of T cells with B cells seems to be particularly important as this leads to the formation of CeD-associated antibodies as well as to clonal expansion of T cells. Here we will discuss this and other key aspects of the CeD pathogenesis.