Gut. Published Online First: 1 September 2006. doi:10.1136/gut.2005.090498
Leading Article (commissioned only) |
Oral proteases: a new approach to managing coeliac disease
1 INSERM U793, Paris, France
* To whom correspondence should be addressed. E-mail: cerf{at}necker.fr.
Accepted 2 August 2006
Abstract
A constraining life-long gluten-free-diet is the only current treatment for celiac disease. The human gastrointestinal tract does not possess the enzymatic equipment to efficiently cleave the gluten-derived proline-rich peptides driving the abnormal immune intestinal response in coeliac patients. Oral therapy by exogenous prolyl-endopeptidases able to digest ingested gluten was therefore propounded as an alternative treatment to the diet. The feasibility of this approach is discussed by confronting recent data on the intestinal transport of gliadin peptides, properties of available enzymes and preliminary clinical assays. Development of new enzymes or enzymatic cocktail offers potentially more potent therapeutic tools that need however meticulous evaluation based on clinical, biological and histological criteria.
Keywords: coeliac disease, enzyme therapy, gluten, transepithelial transport
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