Cerf-Bensussan Nadine, Matysiak-Budnik Tamara, Cellier Christophe, Heyman Martine
INSERM U793, Faculté de Médecine René Descartes, 156 rue de Vaugirard, 75730 Paris Cedex 15, France.
Gut. 2007 Feb;56(2):157-60. doi: 10.1136/gut.2005.090498. Epub 2006 Sep 1.
A life-long but constraining gluten-free diet is the only treatment currently available for coeliac disease. The human gastrointestinal tract does not possess the enzymatic equipment to efficiently cleave the gluten-derived proline-rich peptides driving the abnormal immune intestinal response in patients with coeliac disease. Oral therapy by exogenous prolylendopeptidases able to digest ingested gluten was therefore propounded as an alternative treatment to the diet. The feasibility of this approach is discussed by reviewing recent data on the intestinal transport of gliadin peptides, properties of available enzymes and preliminary clinical assays. Development of new enzymes or enzymatic cocktails offers potentially more potent therapeutic tools that, however, need meticulous evaluation based on clinical, biological and histological criteria.
终身严格遵循无麸质饮食是目前乳糜泻唯一可用的治疗方法。人类胃肠道不具备有效裂解麸质衍生的富含脯氨酸的肽的酶类，而这些肽会引发乳糜泻患者肠道异常免疫反应。因此，有人提出用能够消化摄入麸质的外源性脯氨酰内肽酶进行口服治疗，作为饮食疗法的替代方案。本文通过回顾近期关于麦醇溶蛋白肽肠道转运、现有酶的特性及初步临床检测的数据，探讨了该方法的可行性。开发新的酶或酶混合物可能会提供更有效的治疗工具，然而，这需要基于临床、生物学和组织学标准进行细致评估。
