A Peculiar Solution for Celiac Disease—Hookworms

Celiac disease is a serious digestive disease that involves degradation of the intestinal lining in response to gluten. People with celiac disease must vigilantly avoid gluten in order to steer clear of severe digestive symptoms and intestinal damage. A strict gluten-free diet can be difficult to follow, so researchers have been trying to discover a way for celiacs to be able to eat the dreaded gluten without experiencing the harmful effects.

In a recent study published in the Journal of Allergy and Clinical Immunology, 12 patients with celiac disease were infected with hookworm larvae and gradually given increasing amounts of gluten over the course of a year, beginning with one-tenth of a gram (less than a one-inch segment of spaghetti) increasing up to three grams (75 spaghetti noodles).

“By the end of the trial, the worms onboard, the trial subjects were eating the equivalent of a medium-sized bowl of spaghetti with no ill effects,” noted Paul Giacomin, PhD. “That’s a meal that would normally trigger a debilitating inflammatory response, leaving a celiac patient suffering symptoms diarrhea, cramps, and vomiting.”

Although eight participants did not finish the trial for reasons mostly unrelated to gluten, the eight remaining participants were able to eat the equivalent of a bowl of spaghetti without symptoms. They were able to increase their gluten tolerance by a factor of 60. That’s impressive.

If you are scratching your head about this strange treatment, you are probably not alone. But the therapy works, mostly because the worms help to reduce the human immune response, which allows them to survive while not compromising their ability to fight other diseases. The researchers found that certain immune cells known as T cells within the intestine were converted from inflammatory to anti-inflammatory cells.

They believe that proteins secreted by the hookworms are responsible for their effects, and they plan to study these compounds further so that they can isolate the proteins and not need to infect people with the parasite. “We do recognize that a protein pill will have broader market appeal than a dose of worms.” Indeed.

As a testament to the efficacy of the treatment, all of the participants refused drugs that that would eliminate the hookworms at the end of the trial, even though they were told to resume a gluten-free diet.

I look forward to future developments of this study. I hope that they will also be applied to people with gluten sensitivity, which is a milder form of celiac disease. Until then, a strict gluten-free diet is the best—and only—treatment for celiac disease.