Celiac.com 05/13/2020 - With the collapse of the Nexvax 2 'vaccine" for celiac disease, which was really more like allergy therapy, but which has been abandoned after poor results in clinical trials, the hope for an outright cure, or "silver bullet" treatment for celiac disease seems a far-off possibility. That means that people with celiac disease are unlikely to gain immunity to gluten, and start freely eating gluten any time soon.
Unlike a vaccine, which would theoretically make it possible for people with celiac disease to eat gluten, enzymes do not change the underlying celiac disease at all. People with celiac disease still have celiac disease, and need to follow a gluten-free diet to maintain optimal health. However, gluten-busting enzymes seem to hold the most promise for helping people with celiac disease to avoid accidental gluten ingestion, and to promote better overall health.
Arguments Against Enzymes
Arguments against enzymes include the idea that such enzymes might lead celiacs to deliberately consume gluten. There are good reasons why this viewpoint doesn't stand up too well to scrutiny. Anyone who would risk their health to deliberately consume gluten likely doesn't need an enzyme as an excuse to do so. Any extra protection against gluten contamination would seem to be a good idea for most celiacs, even those who willingly cheat on their diets, which some surveys put at over 20% of celiacs, especially in light of data that shows that many gluten-free people with celiac disease are accidentally, and unknowingly exposed to low levels of gluten that can trigger symptoms and cause gut damage.
Other studies show that adverse gluten reactions are common in people with celiac disease on a gluten-free diet. Eating away from home, especially at restaurants and other homes, carries the greatest risk for gluten exposure.
Arguments in Favor of Enzymes
Arguments in favor of enzymes often include the idea that enzymes are unlikely to harm patients, and could provide an extra measure of protection against minor accidental gluten ingestion by people with celiac disease. Especially in sensitive people, the argument goes, enzymes could offer some protection. That argument has been borne out by the studies showing that most gluten-free celiacs are regularly exposed to gluten in their diets.
There are currently numerous enzymes on the market that claim to break down gluten to one degree or another. Most of these enzymes target gluten in general, but one, AN-PEP, has been shown in several studies to break down gluten in the stomach before it gets to the intestine. This could be a crucial development in celiac disease treatment and management.
Enzymes that Claim to Break Down Gluten
AN-PEP, derived from the from aspergillus niger fungus, AN-PEP is one of the most promising enzymes. It has been clinically proven to break down gluten in the gut. There are several brands of aspergillum niger, including Gliadin-X.
Recent research shows that the kiwifruit produces enzymes that are great at breaking down gluten proteins, and could be effective supplements.
The product, called GluteGuard, is based on a papaya fruit enzyme called caricain. This papaya enzyme is shown to be helpful for celiac patients. A 2015 study showed adding caricain to bread dough reduced gluten toxicity to gluten by 90% for celiac patients.
Carnivorous Plant Enzymes
Remember all those cool plants, like Venus Flytraps and Pitcher Plants, that eat bugs? Enzymes from carnivorous plants are excellent at breaking down the proteins that make up the plant's diet. Studies show that these enzymes are also great at breaking down gluten proteins.
Celiac patients appear to show symptomatic and QOL benefit from using latiglutenase with meals.
Enzymes from Oral Bacteria
A recent study of oral bacteria concludes that gluten-degrading Rothia and food-grade Bacillus subtilisins are the "preferred therapy of choice for celiac disease," and that their exceptional enzymatic activity, along with their connection to natural human microbial colonizers, make them "worthy of further exploration for clinical applications in celiac disease and potentially other gluten-intolerance disorders."
Few Oral Enzymes Break Down Gluten in the Stomach
Oral enzymes that break down gluten in the gut offer the best hope for most celiac patients in the near term. One enzyme in particular, AN-PEP, which is derived from aspergillum niger, has been clinically shown to break down gluten in the stomach, before it reaches the intestine. Breaking down gluten proteins before they reach the intestine, and provoke an immune reaction in celiacs, is key to any oral enzyme. As such, AN-PEP seems to hold tremendous promise.
Gluten-Busting Enzymes Could Change Food Manufacturing
Researchers at Clemson University are working to produce active enzymes that can be added to products to make them gluten-free, in much the same way that lactase enzymes are used to make lactose-free milk. Obviously many hurdles need to be cleared, and much testing and refinement must happen, but, in theory, such products would be safe for people with celiac disease.
A growing body of evidence shows that enzymes may have a beneficial role to play in helping people with celiac disease to minimize potential damage from accidental gluten ingestion, which happens more frequently than previously thought. The key will be finding ways to deploy these enzymes that are proven to provide protection for people with celiac disease looking to follow a gluten-free diet, including oral enzymes that break down gluten in the gut, and possibly even in products that contain wheat, rye, or barley.
Stay tuned for more developments on the role of enzymes in celiac disease treatment and management.