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    A Sweet Pill For Celiacs to Swallow? Progress on Enzyme Therapy for Celiac Disease


    Jefferson Adams

    Celiac.com 02/07/2008 - Are we close to finding a way for people with gluten intolerance and celiac disease to safely break down and properly digest wheat gluten and protein? An article recently published in the medical journal Gut describes the results of laboratory experiments in which doctors duplicated a human digestive tract and isolated an enzyme that degrades wheat gluten and protein. Moreover, the results show that the enzyme also eliminated the toxic response to the wheat gluten and protein common in folks with gluten intolerance and celiac disease.


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    According to the researchers, if a full-scale trial confirms the results, people with gluten intolerance and celiac disease might be able to safely stray from their strict gluten-free diets on occasion.

    The enzyme is prolyl endoprotease isolated from Aspergillus niger and shows the power to quickly and effectively break down gluten peptides and proteins in a simulated human digestive tract. The enzyme has a similar pH level to that of the stomach, and remains intact in the stomach’s strongly acidic conditions.

    The research team, led by Dr. C. Mitea from Leiden University Medical Center in the Netherlands tested the enzyme in a controlled system built to function in way that is nearly identical with the human gastrointestinal tract.

    According to the report, the enzyme increased the digestion speed of the glutenins and gliadins that are found in white bread, and which people with gluten intolerance and celiac disease cannot properly break down. After 90 minutes, the gluten proteins treated with the enzyme were undetectable, whereas those glutens not treated with the enzyme, remained in the stomach for at least two hours.

    The research team obtained similar results when they repeated the test on a fast food meal rather than just white bread alone, and showed that the enzyme treated food samples also eliminated adverse T-cell stimulatory activity that occurred in untreated samples. The tests showed that, in the same amount of time that food normally remains in the stomach, the enzyme brought about the total elimination of T-cell stimulatory peptides of gliadins and glutenins.

    From the test results, the research team concluded that the enzyme is a solid choice for clinical trials to determine if it can eliminate 100% of gluten toxicity. They also noted that the enzyme is readily available in industrial quantities, and thus easy to tailor into a suitable treatment should trials prove fruitful.

    Gut, Jan 2008; 57: 25 - 32.

    Editor's Note: This is not a therapy that is designed to allow celiacs to eat gluten on a daily basis. At best it will allow them to not worry about cross-contamination when eating out.

    0


    User Feedback

    Recommended Comments



    The trial tests have already been done on Celiac's in the US. Just waiting for the final product and go ahead by the FDA for it to go on the market. Will be by prescription only when it does hit the shelves.

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    Guest gail zamberlin

    Posted

    This is wonderful news to hear as both my son and I are celiac , please let us know when the FDA has approved such an enzyme. Thank you again. Gail Zamberlin.

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    Guest valerie

    Posted

    Great news! I'll be first in line. Thank you.

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    Great news! I'm newly diagnosed, but am anxious to learn all I can about possible treatment. Keep up the good work.

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    Great article. Please keep informative articles like this coming, they are much appreciated.

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    This is great news. I have been a Celiac for 6 years so I am looking forward to it's availability.

    Thank you for this info.

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    Guest DIANE LEDES

    Posted

    VERY PROMISING, PLEASE FINALIZE AND EXPEDITE PRODUCTION AND DELIVERY. I HOPE IT IS RX. SO THAT EVERY TOM, DICK AND HARRY CAN'T GET IT, ONLY THE PEOPLE THAT HAVE CELIAC SHOULD BE ABLE TO GET IT AND MAYBE THOSE THAT HAVE DRUG PLANS CAN GET SOME ASSISTANCE, WE GET NONE ON THE SPECIAL FOOD WE HAVE TO EAT. HURRY UP OUT THERE, THERE ARE MANY PEOPLE ANXIOUSLY WAITING.

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    That is wonderful news--I have never heard it before. I hope the enzyme pill prescription will be available as soon as possible.

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    Guest Angela Fisher

    Posted

    Great article. I can't wait until it is

    available to us.

     

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    Guest Wife of a Celiac

    Posted

    Great news in your article! My husband has Celiac and it is a blessing just knowing that there is possibly a treatment in the very near future! Please keep us updated. Thank you!

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    As my daughter and I both have Celiac Disease, we are anxiously awaiting the pill. Please let me know if you need a tester in New England.

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    GOD is definately listening to our prayers.......

    Well done and a BIG THANKS to the researchers and CELIAC.COM

     

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    Guest Gillian Bramwell

    Posted

    I have a reaction to gluten within 5 minutes of ingesting it. Something that takes 90 minutes to work would not be much help.

     

    Perhaps this would be more useful for individuals who have genetic potential for celiac but haven't yet developed an active case.

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    Guest sandra bookbinder

    Posted

    I want to know more about this pill and when it will be on the market. I want to test it.

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    Guest Barry Pressman

    Posted

    It may or may not work, but is there any info regarding projected cost of the pills and whether or not they would be covered by insurance?

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    Guest Sherry-Ann Herman-Kalpoo

    Posted

    Very informative. My baby was diagnosed with celiac disease at 8 months and I am just trying to get all the possible ways to help her deal with it as she gets older. Keep up the good work and every little detail will be greatly appreciated.

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    Guest Susan Bigras

    Posted

    Great news indeed! In regards to Comment #8 - don't understand why 'only' those with celiac should have access. Why would anyone else want it? Also, gluten-free food is a write off on taxes. It is medically necessary - keep each and every receipt!! We celiacs pay a fortune for our foods! Someone needs to do something about THAT!!!

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    Guest Linda Gordon

    Posted

    Oh, how I would love to be able to eat out again!

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    Guest Helen Haas

    Posted

    Wonderful news I have had Celiac for only 3 years and I am able to eat rolled oats once a week things have been good for me as I did keep a very stick diet...good work

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    Guest Zack Arthur

    Posted

    Wow that is awesome...Can't wait to try it out!

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    Guest Betty Styger

    Posted

    This would make life much easier, as most products seem to have wheat in them. Would be willing to test it. thank you.

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    What does 'toxic response' mean? What about the *autoimmune* response? This seems like a drastic oversimplification of the disease. If I didn't know better, I'd read this and think celiac disease was essentially the same as lactose intolerance. For me, this article glosses over a lot of important technicalities and ignores some glaring potential problems.

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    Guest Rosemarie Nocera

    Posted

    Thanks for this informative article. In reading the responses I feel most of my fellow celiacs are miss understanding what you have said. This is NOT a therapy, but something to take when eating out to help with cross contamination. It is a first step though. I live for the day I can order a Sicilian pizza with everything or eat bread when I go out to dinner.

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    Jefferson Adams
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    Jefferson Adams
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    Jefferson Adams
    Celiac.com 05/09/2014 - Even though we now have cheap, readily available celiac blood screening tests, more than eight out of every ten people with celiac disease remain undiagnosed, and the average time to in diagnosis of symptomatic individuals with celiac disease ranges from about six to eleven years.
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    BMC Gastroenterology 2014, 14:42. doi:10.1186/1471-230X-14-42

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    Purée all ingredients together in a blender.
    Cover and refrigerate for at least 1 hour. 
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    Dr. Ron Hoggan, Ed.D.
    Celiac.com 06/15/2018 - There seems to be widespread agreement in the published medical research reports that stuttering is driven by abnormalities in the brain. Sometimes these are the result of brain injuries resulting from a stroke. Other types of brain injuries can also result in stuttering. Patients with Parkinson’s disease who were treated with stimulation of the subthalamic nucleus, an area of the brain that regulates some motor functions, experienced a return or worsening of stuttering that improved when the stimulation was turned off (1). Similarly, stroke has also been reported in association with acquired stuttering (2). While there are some reports of psychological mechanisms underlying stuttering, a majority of reports seem to favor altered brain morphology and/or function as the root of stuttering (3). Reports of structural differences between the brain hemispheres that are absent in those who do not stutter are also common (4). About 5% of children stutter, beginning sometime around age 3, during the phase of speech acquisition. However, about 75% of these cases resolve without intervention, before reaching their teens (5). Some cases of aphasia, a loss of speech production or understanding, have been reported in association with damage or changes to one or more of the language centers of the brain (6). Stuttering may sometimes arise from changes or damage to these same language centers (7). Thus, many stutterers have abnormalities in the same regions of the brain similar to those seen in aphasia.
    So how, you may ask, is all this related to gluten? As a starting point, one report from the medical literature identifies a patient who developed aphasia after admission for severe diarrhea. By the time celiac disease was diagnosed, he had completely lost his faculty of speech. However, his speech and normal bowel function gradually returned after beginning a gluten free diet (8). This finding was so controversial at the time of publication (1988) that the authors chose to remain anonymous. Nonetheless, it is a valuable clue that suggests gluten as a factor in compromised speech production. At about the same time (late 1980’s) reports of connections between untreated celiac disease and seizures/epilepsy were emerging in the medical literature (9).
    With the advent of the Internet a whole new field of anecdotal information was emerging, connecting a variety of neurological symptoms to celiac disease. While many medical practitioners and researchers were casting aspersions on these assertions, a select few chose to explore such claims using scientific research designs and methods. While connections between stuttering and gluten consumption seem to have been overlooked by the medical research community, there is a rich literature on the Internet that cries out for more structured investigation of this connection. Conversely, perhaps a publication bias of the peer review process excludes work that explores this connection.
    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
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    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023