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Celiac.com 07/26/2016 - What a gross title–it bothers me and I wrote it! It wasn't my idea originally. The research paper the data came from was entitled, "Experimental hookworm infection and gluten microchallenge promote tolerance in celiac disease" published recently in the Journal of Allergy and Clinical Immunology. It might be gross but the results were pretty darn interesting. Now don't try this at home, needless to say, but let's look at what these professional researchers discovered. The hookworm, also known as a parasitic helminth, is known to have beneficial effects in inflammatory disorders. Therefore the researchers decided to see what would occur if they induced a hookworm infection into known celiacs and fed them escalating amounts of gluten. A one year study was embarked upon with 12 consenting adults. They were given the hookworm larvae (Necator americanus–glad to know it was an "American" hookworm–joke) and increasing amounts of gluten, consumed as pasta were administered. The initial microchallenge consisted of a small 10 to 50 mg for 12 weeks, followed by 1 gram plus 25 mg given twice per week for an additional 12 weeks, and finally 3 grams daily, the equivalent of 60-75 straws of spaghetti, for 2 weeks. Symptoms, blood and tissue specimens from the small intestine were all utilized to ascertain gluten toxicity. The results were surprising even to the researchers. While two of the subjects withdrew after the initial microchallenge, the remaining 10 completed the next 1 gram phase with the final 8 completing the entire process and ingesting 3 grams of gluten daily. Lab results revealed no decrease in villi height, something one would suspect in a classic celiac who ingested gluten. The classic blood test that reveals damage occurring to the lining of the intestine, tTG did not rise, as expected, but levels actually declined, despite the 3 gram intake of gluten. A quality of life questionnaire showed improved quality of life scores, while a celiac symptom index, level of inflammation of the gut and Marsh scores evaluating degree of damage to the lining of the intestine were all unchanged. Additionally a substance known as interferon gamma that is produced by immune fighting cells was reduced following the hookworm infection, illustrating that the hookworm somehow caused the immune system to not "react" to the ingestion of gluten. Another group of immune cells called regulatory T cells increased, further supporting the theory that the immune system did not in any way react to the presence of the ingested gluten despite the patients having celiac disease. The researchers' conclusions were that our new best friend, hookworm Necator Americanus, promoted tolerance while stabilizing or improving all the gluten toxicity indexes evaluated in these 8 patients. Fascinating, isn't it? There are several questions that come to my mind that I would like answered: Are there any downsides to having a hookworm infection? If not, and the upsides are decreased inflammation and tolerance to gluten, how do we know if we have enough hookworms to get these benefits? Are the benefits local but not systemic? In other words we know that gluten can create problems in distant organs and systems. Does the hookworm infection successfully address these problems or not? If one has a leaky gut, for instance, does the hookworm infection help the condition? Is the hookworm a friendly beast that is designed to cohabitate in our guts, or will it naturally rid itself from our body if not reinocculated? There's obviously more we need to know about this, but I wanted to share this information. We should remember that our gut houses trillions of organisms that we call our microbiome or probiotic population, therefore it is not a "stretch" to consider that the presence of organisms in the gut is something that could be quite healthy and normal. Personally I like this idea far better than taking a drug with the ever-present side effects associated with putting a foreign substance in the body. While we are deciding if this little beast will be part of our population of friendly organisms and potentially solve our reactions to gluten, please let me know if there's any assistance you need in improving your health. Whether you have celiac disease, gluten sensitivity or some other issue that is continuing to compromise your health, consider contacting us for a FREE health analysis – call 408-733-0400. We are a destination clinic and we treat patients from across the country and internationally. We are here to help. I look forward to hearing from you! Reference: Journal of Allergy and Clinical Immunology, "Experimental hookworm infection and gluten microchallenge promote tolerance in celiac disease". Published Online: September 20, 2014. DOI: http://dx.doi.org/10.1016/j.jaci.2014.07.022
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. In 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 Source: Journal of Allergy and Clinical Immunology. DOI: http://dx.doi.org/10.1016/j.jaci.2014.07.022
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