Celiacs have a pretty rough deal. They can’t eat (normal) pizza or cake, or even drink beer, and at the moment it seems like the most promising treatment involves giving them worms. Yes, scientists have been deliberately infecting patients with parasitic worms.
That might sound disgusting and downright weird, but there is method behind the madness, and it seems to be working. A small Australian trial published earlier this year, for example, resulted in celiacs being able to eat as much gluten as found in a bowl of spaghetti, a food that would normally bring on a nasty bout of vomiting and diarrhea. Because of the success, the trial has now been granted a big chunk of cash to extend it to a larger group of people, this time involving 40 participants.
So where is the science in this? Celiac disease is a condition in which the body mistakenly sees gluten – an inoffensive multi-protein complex found in some cereals – as a threat and tries to attack it. In doing so, the immune system drives an inflammatory reaction that causes damage to the small intestine. Diseases in which the body attacks itself, celiac disease included, are referred to as autoimmune disorders.
The key to the worms’ success in the treatment of this disease is in the inflammation. Autoimmune diseases typically involve a type of white blood cell called Th1, or T helper type 1, which drive pro-inflammatory responses; if uncontrolled, these reactions can lead to severe tissue damage. The other type of T helper cell, Th2, actually generates anti-inflammatory responses, and is associated with parasitic worm, or helminth, infections.
This knowledge led to an intriguing proposition: could the presence of worms in celiacs drive a Th2 response that would dampen down the Th1 reaction? There has actually been a substantial amount of evidence in favor of this idea, with studies of helminth infections showing that Th2 responses can offer an anti-inflammatory environment.
Putting this to the test, researchers from James Cook University alongside doctors at The Prince Charles Hospital in Brisbane enrolled 12 celiacs and infected them with 20 hookworm larvae, administered under a bandaid. Apparently, it felt like having hot sauce on your skin. Hookworms don’t actually reproduce inside humans, so there was no risk of the infection getting out of control, and they die in a few years.
Participants were then given gluten in slowly increasing doses, starting off with the equivalent of a 2 centimeter (0.8 inch) piece of spaghetti, ending up with roughly the same amount as would be found in a medium-sized spaghetti portion. This time around, the 40 new volunteers will be challenged with much higher amounts of gluten.
It must be noted that this still isn’t a “cure,” for celiac disease, but if further trials prove as successful, the improvement in quality of life it could potentially offer sufferers would be significant. It’s also worth pointing out that scientists still aren’t sure what precisely is driving this effect, but the researchers would like to examine worm components more closely in the hope of finding out more. If it turns out to be a specific molecule or group of molecules, perhaps it would be possible to use these as a form of treatment, rather than having to actually infect patients.
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