New hope for coeliac disease

12/12/2008

Results from two new studies present promising results and new hope for sufferers of coeliac disease. Research has shown that a new supplement degrades gluten, potentially allowing sufferers to avoid persistent small bowel damage and risk of osteoporosis and cancer.

The study's chief investigator Dr Gregor Brown, The Alfred's head of endoscopy, says despite the best efforts of sufferers to stick to a gluten free diet, small bowel damage is common, affecting about half of all sufferers.

"This persistent damage is presumably due to unintentional ingestion of small amounts of gluten," Gregor explained. 

"Small bowel damage is concerning as it is associated with a three to four-fold increased risk of long term complications such as osteoporosis and cancer."

It is estimated that as many as 1 in 100 people have coeliac disease, although many people go undiagnosed.

Two recent trials, involving The Alfred, Walter and Eliza Hall Institute, Burnet Institute, Nucleus Network (an early phase clinical trials company), and Nexpep P/L (a Melbourne based coeliac therapeutics company) tested the benefit of an enzyme preparation that degrades gluten.

The preparation - ALV003 - a mixture of two enzymes - are highly targeted to particular regions within gluten that cause toxicity and result in very effective degradation of toxic gluten fragments in the test tube. The study sought to discover whether the preparation, ingested at the same time as a meal contaminated by gluten, may potentially degrade the toxic gluten fragments and overcome the problems of unintentional gluten contamination.

The "very promising" study, conducted earlier this year at The Alfred, involved 20 coeliac disease volunteers from the Coeliac Society of Victoria.  Each volunteer participated in a three-day "gluten challenge".

"The majority of those who consumed placebo-treated gluten developed coeliac immune responses in their blood as expected, but none of the 10 participants that consumed ALV003-treated gluten developed any immune response," Gregor explained. "This result shows that this treatment can efficiently abolish the immune response to gluten ingestion in people with coeliac disease when used as a food processing aid, to pre-digest gluten.

"Gluten free diet supplements like this one are unlikely to allow a normal gluten containing meal to be consumed, but may "decontaminate" meals containing trace amounts of gluten," Gregor added.

Planning for the second stage of studies, which will involve a larger group of participants and assessment of small bowel biopsies will take place next year.