Advances in Gluten Hypersensitivity: Novel Dietary-Based Therapeutics in Research and Development

Gluten hypersensitivity is characterized by the production of IgE antibodies against specific wheat proteins (allergens) and a myriad of clinical allergic symptoms including life-threatening anaphylaxis. Currently, the only recommended treatment for gluten hypersensitivity is the complete avoidance of gluten. There have been extensive efforts to develop dietary-based novel therapeutics for combating this disorder. There were four objectives for this study: (i) to compile the current understanding of the mechanism of gluten hypersensitivity; (ii) to critically evaluate the outcome from preclinical testing of novel therapeutics in animal models; (iii) to determine the potential of novel dietary-based therapeutic approaches under development in humans; and (iv) to synthesize the outcomes from these studies and identify the gaps in research to inform future translational research. We used Google Scholar and PubMed databases with appropriate keywords to retrieve published papers. All material was thoroughly checked to obtain the relevant data to address the objectives. Our findings collectively demonstrate that there are at least five promising dietary-based therapeutic approaches for mitigating gluten hypersensitivity in development. Of these, two have advanced to a limited human clinical trial, and the others are at the preclinical testing level. Further translational research is expected to offer novel dietary-based therapeutic options for patients with gluten hypersensitivity in the future.

A Narrative Mini Review on Current Status of Hypoallergenic Wheat Development for IgE-Mediated Wheat Allergy, Wheat-Dependent Exercise-Induced Anaphylaxis

Immunoglobulin E (IgE)-mediated food allergies to wheat that develop after school age typically shows a type of wheat-dependent exercise-induced anaphylaxis (WDEIA). At present, avoidance of wheat products or postprandial rest after ingesting wheat is recommended for patients with WDEIA, depending on the severity of the allergy symptoms. ω5-Gliadin has been identified as the major allergen in WDEIA. In addition, α/β-, γ-, and ω1,2-gliadins, high and low molecular weight-glutenins, and a few water-soluble wheat proteins have been identified as IgE-binding allergens in a small proportion of patients with IgE-mediated wheat allergies. A variety of approaches have been manufactured to develop hypoallergenic wheat products that can be consumed by patients with IgE-mediated wheat allergies. In order to analyze such approaches, and to contribute to the further improvement, this study outlined the current status of these hypoallergenic wheat productions, including wheat lines with a reduced allergenicity that are mostly constructed for the patients sensitized to ω5-gliadin, hypoallergenic wheat by enzymic degradation/ion exchanger deamidation, and hypoallergenic wheat by thioredoxin treatment. The wheat products obtained by these approaches significantly reduced the reactivity of Serum IgE in wheat-allergic patients. However, either these were not effective on some populations of the patients, or low-level IgE-reactivity to some allergens of the products was observed in the patients. These results highlight some of the difficulties faced in creating hypoallergenic wheat products or hypoallergenic wheat lines through either traditional breeding or biotechnology approaches in developing hypoallergenic wheat completely safe for all the patients allergic to wheat.

Ongoing applicative studies of plant thioredoxins

Studies triggered by the discovery of the function of thioredoxin (Trx) in photosynthesis have revealed its role throughout biology. Parallel biochemical and proteomic analyses have led to the identification of its numerous putative targets. Recently, to verify the biological significance of these targets, in vivo studies using transformants in which Trx is overexpressed or suppressed are in progress, and the transformants themselves that are being used in such studies show their potential applicative values. Moreover, Trx's mitigation of allergenicity for some proteins offers promising prospects in the food industry. Practical studies based on redox regulation, once only on the horizon, are now achieving new dimensions. This short review focuses on the industrial applications of Trx studies, the current situation, and future perspectives. The putative targets obtained by the proteomics approach in comparison with in vivo observations of the transformants are also examined. Applicative studies of glutathione, a counterpart of Trx, are also discussed briefly.

Role of non-prolamin proteins and low molecular weight redox agents in protein folding and polymerization in wheat grains and influence on baking quality parameters

The various enzyme systems and low molecular weight (LMW) redox agents are related to the folding and polymerization of prolamins in the ripening wheat grains and the formation of baking quality. Protein disulfide isomerases (PDIs) and cyclophylins accelerate "correct" folding of prolamins, which is most likely necessary for the subsequent formation of the macromolecular structure of the gluten protein matrix. PDIs are also involved in the polymerization of prolamins, catalyzing the oxidation of protein sulfhydryl groups. Molecular chaperone binding BiP protein facilitates folding of prolamins, with its role increasing in the stressful conditions. Reducing systems of thioredoxin and glutaredoxin, LMW redox pairs GSH/GSSG and Asc/DHAsc, thiol oxidases, and lipoxygenases (LOXs) regulate redox balance and the rate of polymerization of prolamins at the different stages of grain ripening. Additionally, LOX is probably involved in the protein-starch-lipid interactions between the starch granule and the protein matrix, mediated by puroindolines, determining the formation of grain texture. It is assumed that the high variability of baking quality in different environmental conditions is due to the interaction of labile enzyme systems with the storage proteins in the developing wheat caryopsis.

Improvements in the bread-making quality of gluten-free rice batter by glutathione

The wide prevalence of celiac disease and wheat allergy has led to a growing demand for gluten-free foods. Rice proteins do not possess the viscoelastic properties typically found in gluten, thus making rice flour unsuitable for the production of yeast-leavened products. In the present study, we found that the addition of glutathione to rice batter improves its gas-retaining properties. Glutathione was found to prevent the formation of the disulfide-linked macromolecular protein barrier, which is reported to confer resistance to the deformation of rice batter in the baking process. Also, glutathione appeared to gelatinize rice starch at lower temperatures. Microstructure analyses of glutathione-added rice bread revealed it to have a perforated structure like wheat bread but with a smoother-looking surface. These data collectively suggest that glutathione facilitates the deformation of rice batter, thus increasing its elasticity in the early stages of bread baking and the volume of the resulting bread.

The level of expression of thioredoxin is linked to fundamental properties and applications of wheat seeds

Work with cereals (barley and wheat) and a legume (Medicago truncatula) has established thioredoxin h (Trx h) as a central regulatory protein of seeds. Trx h acts by reducing disulfide (S-S) groups of diverse seed proteins (storage proteins, enzymes, and enzyme inhibitors), thereby facilitating germination. Early in vitro protein studies were complemented with experiments in which barley seeds with Trx h overexpressed in the endosperm showed accelerated germination and early or enhanced expression of associated enzymes (alpha-amylase and pullulanase). The current study extends the transgenic work to wheat. Two approaches were followed to alter the expression of Trx h genes in the endosperm: (1) a hordein promoter and its protein body targeting sequence led to overexpression of Trx h5, and (2) an antisense construct of Trx h9 resulted in cytosolic underexpression of that gene (Arabidopsis designation). Underexpression of Trx h9 led to effects opposite to those observed for overexpression Trx h5 in barley-retardation of germination and delayed or reduced expression of associated enzymes. Similar enzyme changes were observed in developing seeds. The wheat lines with underexpressed Trx showed delayed preharvest sprouting when grown in the greenhouse or field without a decrease in final yield. Wheat with overexpressed Trx h5 showed changes commensurate with earlier in vitro work: increased solubility of disulfide proteins and lower allergenicity of the gliadin fraction. The results are further evidence that the level of Trx h in cereal endosperm determines fundamental properties as well as potential applications of the seed.