Can Hookworms Help Cure Celiac Disease?
Celiac disease is an autoimmune condition characterized by an inappropriate immune response to gluten. While it is known primarily as gastrointestinal condition, this disorder often has wide ranging systemic effects including an adverse impact on fertility and pregnancy. The only effective treatment is the complete elimination of gluten from the diet. Given the ubiquitous nature of gluten in our foods, this represents a costly, lifetime burden for these patients.
In a recent study published in the Journal of Allergy and Clinical Immunology, researches demonstrated the effectiveness of a unique two pronged approach to help alleviate this autoimmune condition. They first infected subjects with the parasitic human hookworm (Necator americanus [NA]) and then initiated a 12 week course of low-dose oral gluten (micro-challenge). After this treatment, subjects were able to tolerate up to 3 grams of daily gluten without any sign of gluten toxicity. Remarkably, they also reported an improved quality of life during and following this treatment regime.
The use of hookworms as a therapy to help mitigate autoimmune conditions was born from the “hygiene hypothesis” first proposed by David Strachan in an article published in 1989 in the British Medical Journal, an excellent, comprehensive review of this theory was popularized in the recent book “An Epidemic of Absence” by Moises Velasquez-Manoff (NY Times Review). The hygiene hypothesis postulates that exposure to infection protects against atopy (predisposition toward developing certain allergic hypersensitivity reactions) and autoimmune conditions. Our immune systems evolved in an environment that was teaming with a great bio-diversity of micro-organisms and parasites. The modern “sanitization” of our environment has led our immune to run astray, resulting in the marked increase in allergies and autoimmune conditions ranging from food allergies and hay fever to diabetes, ulcerative colitis and Crohn’s disease. Thus was born the concept of using parasites, in this case hookworms, to act as a biologic immuno-modulator or parabiotic in the treatment of autoimmune conditions.
The results of this study are certainly intriguing and one wonders if these parasites could be put to good use with other autoimmune conditions including recurrent pregnancy loss or unexplained implantation failure. Despite the safety of clinical infections with hookworm, most patients would likely find the concept of using it as therapy is quite distasteful.
Croese, John, Giacomin, Paul, Navarro, Severine, Clouston, Andrew, McCann, Leisa, Dougall, Annette, Ferreira, Ivana, Susianto, Atik, O’Rourke, Peter, Howlett, Mariko, McCarthy, James, Engwerda, Christian, Jones, Dianne, and Loukas, Alex. Experimental hookworm infection and gluten microchallenge promote tolerance in celiac disease. Journal of Allergy and Clinical Immunology. Journal of Allergy and Clinical Immunology . 12-1-0014. Elsevier. 11-25-2014.
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