Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2024; 30(26): 3201-3205
Published online Jul 14, 2024. doi: 10.3748/wjg.v30.i26.3201
Digesting gluten with oral endopeptidases to improve the management of celiac disease
Katelin Durham, Mirac Nedim Ince
Katelin Durham, Mirac Nedim Ince, Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Iowa, Carver College of Medicine, and the Iowa City Veterans Affairs Medical Center, Iowa City, IA 52242, United States
Author contributions: Durham K and Ince MN designed the overall concept, outlined the manuscript, contributed to writing, editing and literature review; Ince MN made the illustration.
Supported by the VA Merit Award, 2I01BX002906-05.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4. 0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mirac Nedim Ince, MD, Associate Professor, Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Iowa, Carver College of Medicine, 4546 JCP, 200 Hawkins Drive, Iowa City, IA 52242, United States. m-nedim-ince@uiowa.edu
Received: March 18, 2024
Revised: June 4, 2024
Accepted: June 24, 2024
Published online: July 14, 2024
Processing time: 112 Days and 18.8 Hours
Abstract

In our editorial, we want to comment on the article by Stefanolo et al titled “Effect of Aspergillus niger prolyl endopeptidase in patients with celiac disease on a long-term gluten-free diet”. Celiac disease is an immune-mediated disorder triggered by dietary gluten in genetically predisposed individuals. Although avoiding gluten can permit patients to live symptom-free, ongoing voluntary or involuntary exposure to gluten is common and associated with persistent villous atrophy in small bowel mucosa. As villous atrophy predisposes patients to life threatening complications, such as osteoporotic fractures or malignancies, therapeutic adjuncts to gluten-free diet become important to improve patients’ quality of life and, if these adjuncts can be shown to improve villous atrophy, avoid complications. Oral administration of enzyme preparations, such as endopeptidases that digest gluten and mitigate its antigenicity to trigger inflammation, is one clinical strategy under investigation. The article is about the utility of one endopeptidase isolated from Aspergillus niger. We critique findings of this clinical trial and also summarize endopeptidase-based as well as other strategies and how they can complement gluten-free diet in the management of celiac disease.

Keywords: Celiac disease; Gluten-free diet; Endopeptidase; Villous atrophy; Aspergillus niger; Adjunct therapy

Core Tip: Patients with celiac disease may still be exposed to gluten despite earnest attempts at adhering to a strict gluten-free diet. Gluten-digesting endopeptidases have emerged as an adjunct therapy for celiac disease. Such endopeptidases digest gluten within the gut to prevent its uptake by antigen presenting cells which initiate small bowel inflammation and villous atrophy. The prolyl endopeptidase derived from Aspergillus niger has shown potential to reduce inadvertent dietary gluten exposure and improve patients’ quality of life.