Between ~0.5 and 2% of a major part of the human population has more or less severe forms of celiac disease
[13]. Most of those diagnosed profit from a strict life-long gluten free diet which is extremely difficult to maintain, especially since even minor gluten contamination in foods which are omnipresent needs to be ruled out
[23]. One of the therapeutic strategies to counteract or prevent the deleterious effect of these minor amounts of dietary gluten focuses on proteolytic enzymes to aid in their degradation, thus preventing their antigenic presentation to and activation of intestinal T cells
[24],
[25]. The results presented in this manuscript indicate that unexpectedly such potent digestive enzymes are naturally associated with the upper GI tract, i.e., the oral cavity. Our studies on oral microbial proteases showed that: 1) the tripeptide YPQ which frequently occurs in gluten is preferentially targeted; 2) gliadin as well as two otherwise highly immunogenic and protease-resistant gliadin peptides are proteolytically degraded; 3) gliadin-degrading enzymes are active over a wide pH range (pH 3–10); and 4) most of the oral gliadin-degrading enzymes are acidic in nature, exhibiting IEP values of 2.5 to 4. The data presented suggest a potential role for the oral microbiome in gluten digestion. Furthermore, given the broad pH activity range and partial species overlap between oral, oesophageal and duodenal GI microbiomes, it is likely that gliadin-degrading activities extend well beyond the oral region.
While novel with respect to source, gliadin degrading enzymes have been discovered in nature and are being exploited for their potential therapeutic application as dietary supplements in celiac disease. One of the enzymes that is being considered for this purpose is EP-B2 which is a glutamine endoprotease produced from germinating wheat
[10]. Another group of enzymes capable of cleaving gluten are the prolyl endoproteases (PEP), specifically, PEP from
Aspergillus niger (AN-PEP)
[26] and PEP from
Sphingomonas capsulata (SC-PEP)
[27]. EP-B2, AN-PEP and SC-PEP have been studied as food additives, either alone or in combination
[28] and are in clinical phase I and IIa trials (Clinicaltrails.gov identifiers NCT00810654 and NCT00959114). An important difference between these enzymes and those found in the GI tract is the fact that the former enzymes originate from non-human associated sources, i.e. non-resident bacteria or plants. Resident gluten-degrading microorganisms described in the present manuscript are a viable source of novel enzyme(s) and offer the additional advantage to be potentially exploited as probiotic agents to generate more long lasting changes in GI gluten digestive capacity.
For the reasons pointed out above it will be of high interest to obtain the individual enzymes originating from oral bacterial sources that are cleaving gliadin. Human saliva contains >600 different microbial strains and careful selection strategies need to be applied to identify the most active organism(s). Studies in our laboratory are underway to identify and characterize which microorganisms in this microbial mixture exhibit gliadin degrading capacities. We have already identified four bacterial strains with cleavage activities far exceeding those of the mixture of bacteria that can be found in dental plaque (manuscript in preparation). Identification of such bacteria is a first step towards the isolation, cloning and full characterization of the gliadin-degrading enzymes, and subsequent evaluation of these enzymes in in vitro and in vivo gliadin detoxification assays.
Human saliva-derived basic PRPs and wheat-derived gliadins show noticeable similarities in their amino acid composition with proline and glutamine being the chief constituent amino acids. Since gliadins contain well defined T-cell stimulatory domains for patients carrying HLA-DQ2 or HLA–DQ8
[21],
[29],
[30] we studied to what extent these gliadin domains show structural overlap with salivary basic PRPs. While it would be highly unlikely that the exact immunogenic domains stimulating T cell in patients with celiac disease are present in basic PRPs, given the successful reversal of celiac symptoms by gluten elimination from the diet in most patients, it is of interest that some celiac patients are refractory to a gluten-free diet
[31]. The major basic salivary proline-rich proteins are encoded by
PRB1,
PRB2,
PRB3 and
PRB4 and contain multiple repeat domains of 20 or 21 amino acids
[32] (supplemental
Figure S2). The alignment of gliadin epitopes
[33] with selected regions in the basic PRP sequences is depicted in supplemental
Figure S3. The comparison revealed that gliadin epitopes are up to 50% homologous with basic PRP sequences. Due to the repeat domain structures in basic PRPs the gliadin-like domains are in some cases present in multiple copies. While the percentage overlap is substantial, it is evident from this analysis that no single point mutation in a basic PRP gene would generate a classical toxic gliadin epitope. Nevertheless, given the noted structural resemblances between these two protein families, and the fact that T-cell epitopes in gliadins typically cluster in regions with a high proline content
[34], it will be of interest to characterize the salivary PRP geno- and phenotype of celiac patients.
There must be a biological reason, perhaps a nutritional reason that human saliva contains proteins that are so similar in composition to dietary proteins. Both protein families enter the GI tract and come into contact with resident GI microorganisms. Per day about 0.8 L of saliva is produced, primarily by the major salivary glands, and swallowed. Of note, salivary PRPs constitute approximately 70% of all secreted salivary proteins
[35]. With an average WS protein concentration of 2 mg/ml of protein, it can be estimated that about 1 g of PRPs and derived peptides enter the GI system each day. In addition, the Western daily diet contains about 10–20 g of gluten proteins, which are cleaved in part and incompletely by human digestive enzymes and, as we hypothesize, are further fragmented by GI microbial proteases. The high numbers of proline/glutamine containing peptides from different sources continuously entering the gastro-intestinal lumen is an intriguing notion. In addition, glutamine endoprotease-producing microorganisms are also constantly being swallowed with saliva. It may be speculated that proline/glutamine peptide profiles and/or GI microbial glutamine endoprotease activities show differences between healthy and celiac patients, which could be important clinically.
Finally, our results lay the foundation for a further characterization of the oral bacteria that secrete gliadin (gluten) degrading enzymes as well as identification and purification of their most active gliadin-cleaving enzymes. Apart from interesting biological findings, these bacteria and enzymes may lead to novel and effective strategies to detoxify immunogenic gluten peptides prior to reaching the proximal small intestine.