THERE鈥橲 a glimmer of hope for the millions of people with coeliac disease, who can鈥檛 eat food containing gluten.
Nearly 1 in 200 people have to eat a gluten-free diet to avoid problems such as malnutrition, anaemia and bowel damage. But various groups are now homing in on the precise bits of gluten proteins that cause an immune reaction in those with the disease.
That could make it possible to 鈥渢olerise鈥� people to gluten and even prevent genetically susceptible children from developing the disease in the first place. We could also modify wheat to lack the peptides responsible.
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Robert Anderson of the Royal Melbourne Hospital has been testing coeliac patients鈥� reactivity to hundreds of gluten peptides. He will tell a meeting in Adelaide this week that he has identified a number of short sequences 鈥� around 10 amino acids long 鈥� that trigger the immune response, and has been able to arrange them in hierarchies according to the strength of the response.
These peptides probably trigger an immune response because susceptible people had a gut infection when they were first exposed to gluten. The immune system mistakenly learned to see the peptides as a sign of an attack.
By giving people small doses of the key peptides, Anderson hopes to teach the immune system to tolerate gluten. Tolerisation therapy has been used for decades to treat immune disorders such as hay fever. But it hasn鈥檛 always worked very well because it depends on knowing the precise peptide that triggers the response.
鈥淐oeliac disease is the first human disease where we can give antigen-specific therapy a try,鈥� Anderson says. Last week Oxford University, where Anderson carried out the initial work, licensed the technology to the British technology company BTG.
But it鈥檚 not clear how long the tolerisation will last. People may require regular 鈥渕aintenance鈥� injections. And the approach may not prevent a response to the gluten-related proteins found in barley and rye, Anderson says.
Last month, Chaitan Khosla鈥檚 team at Stanford University published a paper in Science suggesting a piece of a gluten protein 33 amino acids long was the main culprit. The researchers proposed that giving coeliacs an enzyme that breaks this peptide down could allow them to eat some wheat foods.
But Anderson warns that there鈥檚 also evidence that the immune reaction could begin in the mouth.