Hookworms promote gluten tolerance

In a small Australian study, hookworms induced gluten tolerance in adult volunteers with celiac disease.

Before the advent of modern hygiene, many people tolerated intestinal parasites without experiencing serious health problems. Hookworms suppress the body’s immune response, so their hosts do not get sick as a result of harboring the parasites. This research followed eight celiac disease patients who were on a gluten-free diet. At the beginning of the study, researchers infected them with hookworms. Their gut tissue showed a subsequent drop in T-cells that provoke reaction to gluten and an increase in T-cells that reduce inflammation.

Over the course of a year, participants began consuming small amounts of wheat pasta, at first up to 50 mg of gluten daily to mimic accidental contamination. After returning to a gluten-free diet for 10 weeks, they undertook a more extreme challenge, gradually working up to 30 grams daily, or 60 to 75 spaghetti straws. The expected adverse reaction didn’t occur. Biopsies found no deterioration in the gut lining. Blood tests showed an unexpected decline instead of an increase in antibodies. The patients reported an improved quality of life.

The effect wasn’t strong enough to allow patients to resume a normal gluten-containing diet but could protect against the effects of small amounts that patients might accidentally consume through cross-contamination at home or at a restaurant. This approach may benefit refractory patients who respond poorly to conventional treatment. But a larger study will be required to assess the approach’s safety and effectiveness. Although the treatment might provoke squeamishness, the authors claim that participants with celiac disease consistently choose to keep their hookworms.

 

Croese, J.; Giacomin, P.; Navarro, S.; Clouston, A.; McCann, L.; Dougall, A.; Ferreira, I.; Susianto, A.; O’Rourke, P.; Howlett, M.; McCarthy, J.; Engwerda, C.; Jones, D.; and Loukas, A., “Experimental hookworm infection and gluten microchallenge promote tolerance in celiac disease,” Journal of Allergy and Clinical Immunology, Sept. 20, 2014, doi:10.1016/j.jaci.2014.07.022.