Teduglutide
From PeptidePlaza, the free peptide reference · Entry #038 · Recovery · Hand-curated entry · Editorial standards
Teduglutide (also known as Gattex, Revestive, ALX-0600, [Gly2]GLP-2) is a recovery research peptide. A single amino acid substitution turns GLP-2 from a 7-minute hormone into a drug that regrows intestinal villi. The only approved peptide that makes the gut physically bigger.
Teduglutide is a 33-amino-acid analogue of glucagon-like peptide-2 in which the alanine at position 2 is replaced with glycine ([Gly2]GLP-2), rendering it resistant to DPP-4 cleavage and extending the half-life from roughly 7 minutes to approximately 2 hours. GLP-2 is secreted by intestinal L-cells alongside GLP-1 and is the body's primary intestinotrophic signal: it increases villus height and crypt depth, enhances mucosal blood flow, reduces gastric secretion and motility, and improves intestinal barrier function. Teduglutide (Gattex in the US, Revestive in Europe) was approved in 2012 for short bowel syndrome with intestinal failure, where it reduces or eliminates dependence on parenteral nutrition by improving fluid and nutrient absorption in the remnant bowel. Its therapeutic mechanism is also its principal risk: a drug that stimulates intestinal crypt cell proliferation carries a theoretical and monitored risk of neoplasia, and colonoscopy before initiation and periodically thereafter is required.
1 Mechanism of action
Agonises the GLP-2 receptor on intestinal subepithelial myofibroblasts and enteric neurons, triggering release of IGF-1, KGF and other mediators that drive crypt cell proliferation and villus growth. Increases mucosal surface area, splanchnic blood flow and barrier integrity while slowing gastric emptying and reducing gastric acid secretion.
Primary targets: GLP-2R
2 Reported effects
Effects below are those reported in the published literature cited on this page. They are not claims of clinical benefit and not medical advice.
2.1 Reported benefits
- Increases villus height and crypt depth — genuine mucosal growth
- Reduces or eliminates parenteral nutrition dependence in short bowel syndrome
- Improves intestinal fluid and nutrient absorption
- Enhances intestinal barrier function and mucosal blood flow
- Slows gastric emptying and reduces gastric acid secretion
2.2 Side effects
- Abdominal pain and distension
- Nausea and vomiting
- Injection site reactions
- Stoma complications in patients with a stoma
- Fluid overload — congestive heart failure has been reported
- Biliary and pancreatic disease (cholecystitis, cholangitis, pancreatitis)
- Intestinal obstruction
3 Chemical and physical properties
| CAS number | 197922-42-2 |
|---|---|
| Molar mass | 3752.1 g/mol |
| Purity (typical) | >99% |
| Half-life | ~2 hours (SC injection; once-daily dosing) |
| Storage | −20 °C, lyophilised powder, desiccated |
| Solubility | Sterile water / bacteriostatic water |
| Receptors / targets | GLP-2R |
3.1 Amino acid sequence
His-Gly-Asp-Gly-Ser-Phe-Ser-Asp-Glu-Met-Asn-Thr-Ile-Leu-Asp-Asn-Leu-Ala-Ala-Arg-Asp-Phe-Ile-Asn-Trp-Leu-Ile-Gln-Thr-Lys-Ile-Thr-Asp-OH
4 Research dosages
0.05 mg/kg subcutaneously once daily — the approved clinical dose for short bowel syndrome.
5 Research studies (7)
- Teduglutide Reduces Need for Parenteral Support in Short Bowel Syndrome (STEPS)
Gastroenterology (2012) · RCT · N=8624-week phase 3 placebo-controlled trial of teduglutide 0.05 mg/kg/day in short bowel syndrome with intestinal failure.Key finding: 63% of teduglutide-treated patients achieved ≥20% reduction in parenteral support volume vs 30% on placebo. - Use of teduglutide in adults with short bowel syndrome-associated intestinal failure.
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition (2024) · ReviewShort bowel syndrome (SBS) is a rare gastrointestinal disorder associated with intestinal failure (SBS-IF) and poor health-related outcomes. - [Review of real-life teduglutide experience].
Nutricion hospitalaria (2023) · Meta-AnalysisBackground: teduglutide is an agonist of glucagon-related peptide (aGLP2) effective as a treatment for patients with short bowel syndrome (SBS), an entity that affects quality of life, usually requires home... - Use of Teduglutide in Children With Intestinal Failure: A Systematic Review.
Frontiers in nutrition (2022) · Systematic ReviewTeduglutide appears safe and effective in reducing PN requirements and improving EA in the pediatric population. - Teduglutide for pediatric short bowel syndrome patients.
Expert review of gastroenterology & hepatology (2021) · ReviewIntroduction: The goal for pediatric short bowel syndrome (SBS) patients is intestinal adaptation. - Teduglutide for short bowel syndrome.
Australian prescriber (2020) · Review - Teduglutide: A Review in Short Bowel Syndrome.
Drugs (2017) · ReviewSubcutaneous teduglutide (Revestive®), a glucagon-like peptide-2 analogue that increases intestinal absorption, is approved in the EU for the treatment of short bowel syndrome (SBS) in patients aged ≥1 year...
6 Safety and risk profile
6.1 Regulatory status
Teduglutide is currently classified as FDA approved. Approval applies to specific clinical indications and dosing; research-grade material is not the approved product.
Safety score: 68/100 — moderate concern. Derived from clinical data volume, known risks and regulatory status.
6.2 Contraindications
Conditions and populations in which use is contraindicated:
- Active gastrointestinal malignancy
- Colorectal polyps not removed before initiation
- Active hepatobiliary or pancreatic disease (relative)
- Pregnancy or lactation
- Known hypersensitivity to teduglutide or trace tetracycline residues
6.3 Drug interactions
| Drug or class | Interaction | Risk |
|---|---|---|
| Oral medications (all classes) | Increased intestinal absorption may raise systemic exposure of orally administered drugs — benzodiazepines, psychotropics and narrow-index drugs may need dose reduction. | High |
| Parenteral nutrition / IV fluids | Absorption improves progressively; parenteral support must be reduced to avoid fluid overload. | High |
| Diuretics | Changing fluid absorption alters volume status and electrolyte balance. | Moderate |
6.4 Long-term risks
- Colorectal neoplasia risk from sustained crypt cell proliferation
- Biliary tract and pancreatic disease with chronic use
- Fluid overload and cardiac decompensation
- Loss of effect on discontinuation — mucosal changes regress
6.5 Research best practices
- Colonoscopy before initiation; repeat surveillance per protocol
- Store lyophilised at 2–8 °C (or −20 °C for research material); reconstitute immediately before use
- Reduce parenteral support progressively as absorption improves
- Monitor bilirubin, alkaline phosphatase, lipase and amylase
7 Frequently asked questions
- How is GLP-2 different from GLP-1?
- They are cleaved from the same proglucagon precursor and co-secreted by L-cells, but act on different receptors and produce different effects. GLP-1 handles insulin secretion and appetite; GLP-2 is trophic to the intestinal mucosa — it grows villi, increases absorptive surface area and strengthens the barrier.
- Why does teduglutide require colonoscopy monitoring?
- Because it stimulates crypt cell proliferation, the same mechanism that repairs the gut could in principle promote neoplastic growth. Regulatory labelling requires colonoscopy before starting and at defined intervals thereafter, with removal of any polyps found.
- Is it useful for general "gut healing"?
- That is not what it was approved for or studied in. Its evidence base is short bowel syndrome with intestinal failure — a setting of catastrophic absorptive loss. Extrapolation to intestinal permeability or general gut complaints is unsupported and carries the same proliferative risk without the demonstrated benefit.
8 References
- Use of teduglutide in adults with short bowel syndrome-associated intestinal failure. PubMed (2024). Pironi L, et al.. View source
- [Review of real-life teduglutide experience]. PubMed (2023). Campos Martín C, et al.. View source
- Use of Teduglutide in Children With Intestinal Failure: A Systematic Review. PubMed (2022). Gigola F, et al.. View source
- Teduglutide for pediatric short bowel syndrome patients. PubMed (2021). Rosete BE, et al.. View source
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