Will the “pill” against coeliac disease eventually be available?
The therapeutic provision in the treatment of coeliac disease is a gluten-free diet, and it will remain so for some time to come. Despite active research work and exciting new approaches none of the alternative therapy options are ready for the market yet. Up until now one of the most advanced therapies is a supplement called Larazotid, which reduces the penetrability of the mucous membrane of the small intestine and at the same time the absorption of gluten. This can help get things under control for those patients who have a verified coeliac disease and still have some remaining symptoms despite a gluten-free diet. This supplement, however, is not suitable as an alternative to a gluten-free diet. Researches regarding a coeliac disease vaccination, more precisely a hyper-sensitising allergy vaccination against gluten proteins, also sound exciting. At the moment the vaccines are being tested in a clinical trial. Whether, after such a hyper-sensitisation, patients with coeliac disease will not have to stick to a gluten-free diet anymore is questionable. A further approach is the promotion of gluten depletion through enzymes taken in tablet form. In fact enzymes can deplete food gluten into fragments, which then will not cause an immune reaction. Such supplements, however, do not lead to a complete depletion of gluten from the food, so that this approach as a treatment for coeliac disease is unsuitable. It is not clear whether other gluten associated illnesses could profit from such enzymes, however, the usage for gluten sensitivity is conceivable. Gluten reducing enzymes are sold as dietary supplements, yet clinical trials, which justify a recommendation, are missing.
It is also interesting to see the development of genetically modified wheat which contains no gluten. In test tubes these genetic modifications are already quite advanced. The limiting factor, however, is that – although this wheat is free of alpha-gliadines, a central component of gluten – the immune reaction is still only reduced by 85%. This wouldn’t be enough for a coeliac disease treatment. Such gluten-reduced wheat is not available yet.