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  • Jefferson Adams
    Jefferson Adams

    Celiac Patients Tolerate Wheat Spaghetti After Hookworm Treatment

    Reviewed and edited by a celiac disease expert.

    Celiac.com 10/03/2014 - Celiac disease patients in Australia have shown a major improvement in gluten tolerance after receiving experimental hookworm treatments. The study is part of an effort to determine if parasitic helminths, such as hookworm, might help to treat inflammatory disorders, including celiac disease.

    Photo: Nnaluci--Wikimedia CommonsIn this case, the research team assessed the influence of experimental hookworm infection on the predicted outcomes of three escalating gluten challenges in volunteers with confirmed celiac disease.



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    The research team included John Croese, MD, Paul Giacomin, PhD, Severine Navarro, PhD, Andrew Clouston, MD, Leisa McCann, RN, Annette Dougall, PhD, Ivana Ferreira, BSc, Atik Susianto, MD, Peter O'Rourke, PhD, Mariko Howlett, MD, James McCarthy, MD, Christian Engwerda, PhD, Dianne Jones, BHSc, and Alex Loukas, PhD.

    They are variously affiliated with the Department of Gastroenterology and Hepatology at The Prince Charles Hospital, Brisbane, Australia, the Center for Biodiscovery and Molecular Development of Therapeutics at the Australian Institute of Tropical Health and Medicine of James Cook University in Cairns, Australia, Envoi Specialist Pathologists in Brisbane, Australia, QIMR Berghofer Medical Research Institute in Brisbane, Australia, the Royal Brisbane and Women's Hospital, and with Logan Hospital, Brisbane, Australia.

    This particular study followed twelve adult volunteers with diet-managed celiac disease. The volunteers were inoculated with 20 Necator americanus (hookworm) larvae, and then consumed increasing amounts of gluten in the form of spaghetti.

    The volunteers first received 10 to 50 milligrams for 12 weeks (microchallenge); they then received 25 milligrams daily + 1 gram twice weekly for 12 weeks (GC-1g); and finally 3 grams daily (60-75 straws of spaghetti) for 2 weeks (GC-3g).

    The subjects were then evaluated for symptomatic, serologic, and histological outcomes of gluten toxicity. They were also examined for regulatory and inflammatory T cell populations in blood and mucosa. Two gluten-intolerant subjects withdrew after micro-challenge. Ten completed GC-1g, and eight of these ten volunteers enrolled in and completed the full course of the study.

    Most celiacs who are exposed to gluten challenge will show adverse changes in the intestinal villi, which is measured in terms of villous height-to-crypt depth ratios. Also, such patients will usually show an increase in blood antibodies, such as IgA-tissue transglutaminase, indiucating an adverse reaction to gluten. However, the results here showed that median villous height-to-crypt depth ratios (2.60-2.63; P = .98) did not decrease as predicted after GC-1g. Moreover, mean IgA-tissue transglutaminase titers declined, contrary to the predicted rise after GC-3g.

    Other results showed that quality of life scores improved (46.3-40.6; P = .05); while celiac symptom indices (24.3-24.3; P = .53), intra-epithelial lymphocyte percentages (32.5-35.0; P = .47), and Marsh scores remained unchanged by gluten challenge.

    Intestinal T cells expressing IFNγ were reduced following hookworm infection (23.9%-11.5%; P = .04), with corresponding increases in CD4+ Foxp3+ regulatory T cells (0.19%-1.12%; P = .001).

    Hookworms in the form of Necator americanus promoted tolerance and stabilized, or improved, all tested measures of gluten toxicity in volunteers with celiac disease. So, after being voluntarily infected with 20 hookworms, these celiac disease volunteers were able to eat increasingly large amounts of gluten with none of the usual changes or adverse symptoms.

    Could hookworm treatments represent the future of treatment for celiac disease, and maybe other inflammatory conditions? Clearly, further tests are needed to determine exactly how safe it is for celiac patients receiving this treatment to eat gluten. So far, however, the future looks bright.

    What do you think? If swallowing a small dose of hookworms would eliminate your adverse reactions, and allow you to safely eat gluten, would you do it?

    The radio program Radiolab has an interesting segment on hookworm, which you can stream here: Radiolab

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    Absolutely, I would do this. I'd actually stay gluten free, but to guard against cross contamination, for sure. I've had three airborne glutenings in the last year, two in grocery stores where I was not near the bakery or flour aisle, one in a building where drywall was being used unbeknownst to me in another part of the building. Day to day life is dangerous for me right now, and if this makes it less so, give me a plate of hookworms, or anything!

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    First of all, ewww! I try to be open minded, but this one is stretching my limits. Secondly, I want to know what the hookworms are doing that prevents the usual response to gluten. What is it about hookworms that made the scientists think of them in the first place? And why is it that normally if one gets hookworms, doctors treat them for it? Do they have negative consequences? And lastly, I assume that the little beggars are going to reproduce. How many would one have residing in one's gut? This article needs lots more explanation.

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    Do you know the life cycle of the hookworm? The larvae burrow through the skin and enter the bloodstream. From there, they travel to the lungs -- which causes the host to cough them up and swallow them, resulting in an infestation of the bowels. It is my understanding that they sometimes travel the wrong way and end up in the brain. Yes, swallowing them is disgusting, but it might mitigate the risk of a parasite with poor direction. That being said, there has to be a better way.

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    I'm sorry, but 12 participants isn't big enough a sample population to warrant relevant results. Besides, hookworms cause other diseases (they don't call those little bastards "parasites" for nothing. I read that they cause intestinal bleeding. I have enough of a damaged intestine from Endometriosis. I don't want any more.

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    I have had hookworm infections as a child. I remember the side effects of that - no thank you. I am used to a gluten-free life style now. No amount of tasty pasta, or bread, or pizza, would be worth having worms to me. Who the hell thinks up these idiotic studies?

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    I think that people should seriously look into this a little deeper. Check out what hookworms can do. They can cause serious intestinal issues and anemia that can lead to heart failure among other things. It may be difficult being gluten-free, but is it really worth the damage you could do? ---The rating above is only rating the quality of the writing and information provided not in support of the ideas of the materials

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    Based on additional readings NO: If you have a hookworm infection that lasts a long time, you could become anemic. Anemia is characterized by a low red blood cell count, which can lead to heart failure in severe cases. Anemia results from hookworms feeding on your blood. You're more at risk of having severe anemia if you also don't eat well, are pregnant, or have malaria.

     

    Other complications that can develop from these infections include nutritional deficiencies and a condition known as ascites. This condition is caused by serious protein loss and results in fluid buildup in your abdomen.

     

    Children who have frequent hookworm infections can experience slow growth and mental development from losing a lot of iron and protein.

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    Heck no the worms could make us have something else we didn't want! Nope won't do it!

    The only negative side effect of hookworm is anemia. That only occurs if there are a large amount of hookworms in the gut. Anemia is slow to develop, easy to spot and easy to cure. Hookworms are easily eliminated by simple prescription drugs. Then, if desired, they can be reintroduced as desired.

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    Who wants hookworms living inside them? Sounds utterly grotesque! Maybe I missed something, but was there any mention of how long the hookworms squirm around in your intestines or side effects from them? Since a few dropped out of the study, I will take a guess that they became very ill from gluten exposure. I will take another guess that they are more sensitive to gluten than the other subjects and possibly have other intolerance as well. Lastly, since I was symptomatic from birth and I didn't have "problems" every day of my life until diagnosis (40+years) add in the "reliability factor" of testing (very poor) is it possible that the subjects that remained in the program in its entirety were actually still sick and worsening from their exposure but just don't realize it yet?

    Are hookworms any more disgusting than the thousands of bacteria in your gut? Side effects of small numbers of hookworm in the gut are minimal. Anemia is the only side effect, and then, only with large numbers of hookworms. Having 10-20 hookworms in the gut is essentially harmless. The benefits include the elimination of adverse gut reactions to gluten in celiac disease patients.

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  • About Me

    Jefferson Adams

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.


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    Celiac.com 11/16/2009 - Could unknown benefits from one of the oldest parasites of the human digestive tract hold the key to cure for celiac disease?
    Australian scientists think so. Encouraged by successful treatments of Crohn's and ulcerative colitis by American researchers using a pig whipworm (Trichuris sues), a team of Australian researchers is recruiting volunteers with celiac disease for trials using human hookworm (Necator americanus).
    The researchers have undertaken a similar preliminary study using a human hookworm in Crohn's patients.
    Researchers hypothesize that the disappearance of intestinal parasites from humans in developed countries may be responsible for the upsurge in many diseases including Celiac Disease, Crohn's, ulcerative colitis, asthma and hay fever.
    Using a small group of healthy people with celiac disease, the investigators will look to see if human hookworm interferes with the human immune reaction to gluten.
    Parasites survive partly by interfering with the host's immune response. The mechanisms they use to accomplish this are similar to those required by a person to regulate against the so-called autoimmune disorders, wherein the body begins to fight against itself.
    The investigators suspect that when parasites are excluded from the environment, some individuals become sufficiently self-reactive to develop an autoimmune disease.
    Using a small group of healthy people with celiac disease, the investigators will test if a human hookworm, Necator americanus, inhibits immune responsiveness to gluten.
    Specifically, they will examine whether hookworm infection will change the immune processes and suppress gluten sensitivity in people with celiac disease.
    Celiac disease is a good model for studying Crohn's disease because both involve similar immune changes. However, celiac patients are usually healthier overall, and, importantly, are not taking powerful immune suppressive drugs, and the provocative antigens (molecules that engage the immune system and provoke the disease) are well known and can be administered or cut out at will.
    In addition to directly benefitting celiac disease sufferers, this study may provide potential guidance in the use of hookworms to control inflammatory bowel disease.
    The study is open to people with proven celiac disease who reside in Brisbane, Australia. Those who enroll will be required to avoid gluten for six months.
    The blinded study will compare disease activity and immunity after a controlled break from the gluten-free diet in celiac patients, before and after hookworm infection.
    The team will use conventional and experimental methods to examine the disease severity and the immune system of celiac subjects before and after being inoculated with N. americanus.
    They will then compare immunity levels of the study subjects
    against those of matched, celiac control subjects (not infected with hookworm), before and after eating four pieces of standard white bread each day for three to five days.
    The initial study group will be small. The researchers will recruit ten subjects for each arm of the study, for a total of twenty.
    Initially, ten larvae will be placed on the skin under a light dressing for thirty minutes, followed by five more after twelve weeks.
    The researchers intend to asses whether the hookworm infection will change the immune processes and suppress gluten sensitivity in people with celiac disease. Outcomes to be measured will be those that reflect the activity of celiac disease.
    Stay tuned to see if hookworm therapy will be coming to a gastroenterologist near you! Tell us what you think. Would you sign up? Comment below.
    Source:
    ClinicalTrials.gov



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