hookworms might cure celiac, coeliac disease

While hookworm research in the treatment of coeliac / celiac disease is old news to some, it has not been reported on in the gluten free pages, so I thought that I would give you the basics of the story here. There are several therapies being trialled to help people with celiac disease including a recent Australian celiac trial, however this is one of the more unusual methods out there.

In very basic terms, Australian researchers are looking at using hookworms to stimulate a celiacs auto immune system into giving them more ‘immunity’ to gluten side effects. The squeamish factor comes into it as the hookworm is encouraged to burrow through the test cases skin, enters the bloodstream before residing in the gut. The body’s reaction to this parasite is expected to give people an improved tolerance to gluten and wheat bread products etc.

The Queensland Institute of Medical Research provided a good snapshot of the research in September 2009. Apparently the human clinical trials are based on the following Immunomodulation concept: “With colleagues at GWU (George Washington University), we are identifying the proteins secreted by hookworms that allow them to evade immune clearance. In particular, we are isolating and characterising proteins that interact with host cells and skew the immune phenotype to promote parasite survival. With colleagues in Townsville and Brisbane, we are involved in a clinical trial assessing the therapeutic value of human hookworms in suppressing the inflammation associated with celiac disease. Studies in our laboratories are exploring the mechanisms by which hookworms can downmodulate immune responses directed towards them and other bystander antigens. The ultimate aim of this research is to identify proteins secreted by hookworms that can be used as therapeutic agents to treat a range of auto-immune disorders.” Ref 1

More details about the actual tests are provided by the US government which suggests that one of the initial studies was completed by January 2009. It says that their research into the hookworm trials were performed with the Sponsor “Princess Alexandra Hospital, Brisbane, Australia” Collaborators were listed as: The Broad Foundation, Townsville Hospital, James Cook University, Walter and Eliza Hall Institute of Medical Research & the Queensland Institute of Medical Research.

The purpose of the trial was the understanding 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.”  Ref 2

It goes further to suggest that when parasites are removed from the environment, people become sufficiently self-reactive to develop an autoimmune disease such as coeliac disease. Rather than just theory, this research is based on the successful treatment of other auto-immune diseases already. Namely Crohn’s disease and ulcerative colitis have been successfully treated with PIG whipworm.

In this specific coeliac research, researchers were testing a group of healthy people who had coeliac disease with a human hookworm Necator americanus to see if it inhibits immune responsiveness to gluten. The experiment was performed on healthy celiac people who had avoided gluten for at least six months prior to the trial. They recruited twenty people of which ten subjects were infected with the Necator americanus hookworm on each arm (hookworms placed on the skin and under a bandage). Initially this was done with ten larvae to each of the ten people, then five more larvae were introduced to these same ten people after twelve weeks.

The double blind experiment was aimed at testing the hookworm infected group's gluten immunity compared to the control group that was not infected. All subjects were tested before and after eating four pieces of standard white bread each day for three to five days.

Testing will include duodenal histology, rectal histology. The study was completed December 2008.

Brisbane gastroenterologist Dr James Daveson describes why he thinks that everyone should have these hookworms. “We think that the parasites alter the immune system in the body. We think they're supposed to be there. They enter through the skin and end up in the small bowel and that transit is protected. And we think we've co-evolved with them over millions of years and have a synergistic relationship with them and by removing them, which we've done over the last two to three generations, we've increased our risk of auto-immune diseases.” Ref 3

The only negative side effect is suspected to be slight blood loss that the worms consume, however James thinks the risk of complications are very low as Hookworms may consume ‘one unit of blood every three years in otherwise healthy individuals’.
While it appears that several of the celiac were able to eat wheat bread again with little side affects (gluten reactions) it is expected that it will take several years to run enough studies before hookworms are an accepted treatment for auto-immune illnesses such as coeliac disease.

CONCLUSION

While the research anecdotally is reported to have had very good results, we have been unable to find official postings of the clinical results. While only positive stories have been reported, people still have concerns about the possibility of anaemia and any other complications introduced by the inclusion of the Necator americanus hookworm.

If the theory is correct then it is precisely the disappearance of the parasite (mainly from wealthy Western cultures such as Australia) because of a heavy emphasis on cleanliness which has caused this celiac disease growth. It may well be the re-introduction of the worm that is the best way of reversing the trend of celiac disease and some other auto immune related diseases.

References

Ref 1  http://www.qimr.edu.au/research/labs/alexl/index.html

Ref 2   http://clinicaltrials.gov/ct2/show/study/NCT00671138?term=Trichuris&rank=5

Ref 3   http://www.abc.net.au/worldtoday/content/2009/s2721104.htm 

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