International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: Editor-in-chief: Samasca Gabriel
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International Journal of Celiac Disease. 2018, 6(1), 4-6
DOI: 10.12691/ijcd-6-1-3
Open AccessEditorial

Enzyme Therapy that Can Digest the Toxic Motifs of Gluten as an Aid in the Management of Celiac Disease

Finlay Macrae AO1,

1Department of Medicine, University of Melbourne, The Royal Melbourne Hospital, Australia

Pub. Date: April 02, 2018

Cite this paper:
Finlay Macrae AO. Enzyme Therapy that Can Digest the Toxic Motifs of Gluten as an Aid in the Management of Celiac Disease. International Journal of Celiac Disease. 2018; 6(1):4-6. doi: 10.12691/ijcd-6-1-3


For the first time since discovery of celiac disease and introduction of gluten-free diet (GFD) there are some treatments that could be called adjuncts to the GFD for the management of celiac disease (CD) and dermatitis herpetiformis (DH). The most clinically advanced approaches are based on enzymatic detoxification of traces of gluten often present in seemingly gluten-free foods. Maintenance of GDF is difficult for many patients due to undeclared levels of gluten even in “gluten free” products. Enzyme supplementation enables detoxification of “hidden” gluten and guards against gluten before it can damage intestinal mucosa and stimulate the immune system. Controversy rests as to whether such advances should be encouraged for patients with celiac disease, whose behaviour then might impact on their commitment to maintain a gluten free diet.

celiac disease enzyme therapy gliadin peptides dermatitis herpetiformis caricain gluten clinical studies

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[1]  Halmos E. How gluten free is gluten free diet. (2016) The Australian Coeliac, December Issue. p.11-1.
[2]  Silano M, Dessi M, De Vincenzi M, Cornell H. In vitro tests indicate that certain varieties of oats may be harmful to patients with celiac disease. (2007)J GastroenterolHepatol 22; 528-531.
[3]  Lebwohl B.,Ludvigsson J.F, Green P.H.R. Celiac disease and non-celiac gluten sensitivity. (2016) Published online PMCID: PMC4596973.
[4]  Ludvigsson JF, Montgomery SM, Ekbom A, et al. Small-intestinal histopathology and mortality risk in celiac disease.(2009) JAMA302: 1171-8.
[5]  Cornell H. J., Stelmasiak T. The Significance of Key Amino Acid Sequences in the Digestibility and Toxicity of Gliadin Peptides in Celiac Disease. (2016) International Journal of Celiac Disease 4: 113-120.
[6]  Cornell, HJ. Partial in vitro digestion of active gliadin-related peptides in coeliac disease. (1998) J Protein Chem 17; 739-44.
[7]  Cornell, HJ, and Townley, RR. Investigation of possible intestinal peptidase deficiency in coeliac disease. (1973) Clinica Chimica Acta 43: 113-125.
[8]  Townley, RRW, Cornell, HJ, Bhathal, PS, and Mitchell, JD. Toxicity of wheat gliadin fractions in coeliac disease. (1973) Lancet 1(7816): 1363-4.
[9]  Buddrick O, Cornell HJ, Small DM. Reduction of toxic gliadin content of wholegrain bread by the enzyme caricain. (2015) Food Chem. 170:343-7.
[10]  Cornell, HJ, and Stelmasiak, T. A unified hypothesis of coeliac disease with implications for management of patients. (2015) Amino Acids 233: 43-9.
[11]  Cornell H J, Macrae F A, Melny J, Pizzey C, Cook F, Mason S, Bhathal P &Stelmasiak T. Enzyme therapy for management of coeliac disease. (2005) Scand. J. Gastroent. 40: 1304-1312.
[12]  Wungiranirun M, Kelly C.P. and Leffler D A. Current status of celiac disease drug development. (2016) J Gastroenterology.
[13]  Lahdeaho ML, Kaukinen K, Laurila K, et al. Glutenase ALV003 attenuates gluten-induced mucosal injury in patients with celiac disease. (2014) Gastroenterology 146: 1649-58.
[14]  Cornell H J,Czyzewska A , Macrae F A, Rydzewska G, Nasierowska-Gutmejer A, Bednarczuk A and Stelmasiak T. The Effect of Enzyme Supplementation on Symptoms and Duodenal Histology in Celiac Patients.(2016) International Journal of Celiac Disease. 4: 40-47.
[15]  Zebrowska A, Cornell HJ, Macrae FA, Sysa-Jedrzejowska A, Waszczykowska A, Stelmasiak T. The effect of enzyme therapy on skin symptoms and immune responses in patients with dermatitis herpetiformis. (2014) International Journal of Celiac Disease. 2: 58-63.
[16]  Lerner A. Is enzyme supplementation effective strategy to reduce the burden of gluten free diet in celiac disease? (2016) International Journal of Celiac Disease 4:38-39.