Celiac disease: Should we care about microbes?

The prevalence of celiac disease has increased in the last decades suggesting a role for environmental factors in addition to gluten. Several cohort studies have shown that different gastrointestinal infections increase CeD risk. However, the mechanisms by which microbes participate in CeD have been remained elusive. Recently, using animal models, both viral and bacterial opportunistic pathogens were shown to induce immune activation relevant for CeD. The hypothesis that viral and or bacterial infections can contribute to immune activation and breakdown of tolerance towards gluten in genetically susceptible individuals, is thus reinforced. Here, we discuss the evidence regarding the role of microbes in promoting CeD, and the specific pathways triggered by microbes that could participate in CeD pathogenesis. Understanding these pathways will allow us to develop optimal microbiota modulating strategies to help prevent CeD.