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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.

    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!

    Drywall? Can you please elaborate on drywall. We are about to begin removing the plaster walls in our 1840 home and replace them with drywall. Now you have me a bit worried. I am a 0 ppm celiac, I get sick like you from airborne glutenings. I also get the dermatitis (something the so-called experts say you don't get if you have the intestinal issues, wrong!) from airborne and contact glutenings.

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    Hook worms can kill you. No thanks.

    Hookworms cannot kill humans. 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. In places where there is no access to medical care, anemia can be life threatening, but that is extremely unlikely in a western medical setting.

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    It is no surprise that we don't have a cure for this by now. Every time an article shows up about a possible way to help people with celiac disease eat gluten again everybody comments how they would never in a million years try it. Gluten is evil and they love gluten-free food. You never see this with people who cannot eat peanut butter, shellfish, or any of the other million disorders out there.

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    It is no surprise that we don't have a cure for this by now. Every time an article shows up about a possible way to help people with celiac disease eat gluten again everybody comments how they would never in a million years try it. Gluten is evil and they love gluten-free food. You never see this with people who cannot eat peanut butter, shellfish, or any of the other million disorders out there.

    An excellent point.

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    Gross. I would never want hookworms OR gluten in my gut! I hate gluten and have NO desire to eat it, or even be around it. Gluten IS evil. It is not even good for you. I LOVE my gluten free food. And hookworms....really?! GROSS!

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    My instant reaction is that it is not worth eating gluten in order to swallow something that my have unknown consequences. The only benefit would be to alleviate cross contamination and be able to eat out with more ease. My question is that there had to be some information to make the doctors think in the first place that hookworms would help with celiac. What could they have previously discovered that would merit this study?

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    As someone who gets sick fairly regularly on a gluten free diet due to cross contamination and other trace gluten, I would love to be in a hookworm study just to not get sick.

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  • About Me

    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 2,000 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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