What it is
Teduglutide is a 33-amino-acid copy of glucagon-like peptide-2 (GLP-2), a hormone released by L-cells in the lower small intestine after a meal. It is sold as Gattex, approved in the US on 21 December 2012. It treats short bowel syndrome: what remains when surgery, Crohn's disease or loss of blood supply has taken away so much intestine that a person cannot absorb enough food and water and depends on intravenous feeding.
It is made by bacteria, not by chemical synthesis: the label describes production in a genetically modified strain of E. coli. Its molecular weight is 3,752 daltons.
The one-letter change
Laying the Gattex label's sequence beside the GLP-2 segment of human proglucagon (UniProt P01275, residues 146–178) shows 33 positions, 32 identical:
| Position | 1 | 2 | 3 | 4 | 5 … 33 |
|---|---|---|---|---|---|
| Human GLP-2 | H | A (alanine) | D | G | identical |
| Teduglutide | H | G (glycine) | D | G | identical |
Position 2 matters because DPP-4, an enzyme in blood, cuts peptides that carry an alanine there and inactivates natural GLP-2 quickly. Glycine resists it. The result, per the label: a half-life of about 2 hours, bioavailability under the skin of 88%, and a drug that works once a day.
How it works
GLP-2 and GLP-1 are cut from the same precursor protein, proglucagon, yet do different jobs. GLP-1 acts on appetite and insulin. GLP-2 acts on the gut itself: the Gattex label describes receptors on enteroendocrine cells, the myofibroblasts beneath the lining, and gut nerves, whose activation releases IGF-1, nitric oxide and keratinocyte growth factor. The label also notes that GLP-2 increases blood flow to the gut and reduces stomach acid. The net effect is a taller, more absorptive lining — more surface from the intestine that is left.
The evidence
| Study 1 (Gattex label) | Teduglutide (n = 43) | Placebo (n = 43) |
|---|---|---|
| Cut weekly IV feeding by ≥20% at weeks 20 and 24 | 63% | 30% |
| Mean weekly IV volume reduction at week 24 | 4.4 L (from 12.9 L) | 2.3 L (from 13.2 L) |
| Cut at least one infusion day per week | 54% | 23% |
The adults in the trial had depended on intravenous feeding for a mean of 6 years, with a mean 77 cm of small intestine left. The trial ran 24 weeks and then continued as an open-label extension. The drug reduces dependence on infusions; the label's trial does not claim it ends dependence for most patients.
Doses on the label
Reported as the Gattex label states it, not as guidance: 0.05 mg per kilogram, injected under the skin once daily, for adults and children. Each vial holds 5 mg of powder. The label advises against the 5 mg kit in children under 10 kg.
Safety
The label's lead warning is acceleration of neoplastic growth: a drug that grows gut tissue can also grow polyps and tumours, a concern backed by rodent carcinogenicity findings. It therefore requires colonoscopy and upper endoscopy with polyp removal within 6 months before adults start, repeated after 1 year and then at intervals; for children it starts with stool blood testing. Other warnings cover intestinal obstruction, gallbladder and pancreatic disease, and fluid overload. The commonest effects were abdominal pain, nausea, upper respiratory infection, abdominal distension and injection-site reactions.
Where it stands
FDA application data list the 5 mg kit as a current prescription product, with no generic (2026-09-28). ClinicalTrials.gov holds 50 records with teduglutide as an intervention; Europe PMC's MEDLINE index holds 348 records naming it, 22 tagged as randomised controlled trials.
Related reading
Teduglutide's closest relative hormone is GLP-1, whose drugs include the daily injection liraglutide and semaglutide; both hormones come from the same precursor as glucagon. For another gut-acting peptide in the library, see larazotide, an oral peptide tested to tighten the gut barrier in coeliac disease.