Celiac disease, also known as celiac sprue or gluten sensitive enteropathy (GSE) is an autoimmune condition in which any food containing gluten – including wheat, barley, rye and many others – provokes an immune reaction. This reaction produces a toxin that damages the wall of the small intestine, where solid food is absorbed, thus leading to a malabsorption syndrome.
The result can be a wide range of gastrointestinal symptoms, including abdominal pain, bloating, and diarrhea or constipation, in addition to many other possible areas of involvement throughout the body.
While the gold standard (and only universally accepted) treatment is complete abstention from all gluten – made much easier these days with the advent of gluten-free offerings – other therapies are either under investigation or in use to combat the disorder. Below we consider three such efforts, aimed at allowing the patient to consume gluten without the consequent syndrome, by influencing the biochemical reactions involved.
What research is being done to allow people with celiac and gluten sensitivities to digest gluten by taking a digestive enzyme?
There is definitely interest in pursuing this route for possibly eliminating celiac pathology and symptoms, by providing the missing digestive enzymes necessary for complete processing of gluten; and it seems to show some benefits. The key is in their detoxification of gluten before it ever encounters the small intestine, and research looks somewhat promising.
In 2006, a new enzyme was reported, formerly used for commercial purposes, which appears to work much better and much faster than those tried previously. Around the same time, entomologists identified two peptides in mealworm larvae that have potential uses as digestive enzymes in celiac disease. This is absolutely an area that is progressing in its research efforts, with some enzymes already available, and others in the midst of or close to clinical trials, which hopefully means encouraging findings and more treatment options for sufferers.
Is there any research about an immunotherapy shot that would work to counteract the response to gluten?
Yes. Immunotherapy has been used for quite some time to attenuate allergic responses, and is now commonly used (or it being considered for use) in a range of autoimmune disorders. The idea is to find an antibody that will effectively promote or block certain reactions, thus producing or inhibiting the target substances as necessary, to prevent or treat disease.
In the case of celiac disease, the objective is to provide immunotherapy (via injection or sublingually) that will prevent the formation of the toxin that damages the lining of the intestine, by exploiting the immunological connection between the presence of gluten and toxin formation, impacting the reactions involved.
One such compound, which aims to reprogram the immune T-cells so as to prevent their reaction to gluten, was reported to have begun clinical trials in September of 2012. In addition, efforts are underway to identify more peptides involved in triggering the immune response, so that treatments may be developed, according to NIH (see this abstract and another study). It is hoped that successful trials of these and other drugs will allow celiac patients to once again consume gluten-containing foods safely, owing to an altered immune response.
Are there any research studies about worm treatments to help celiac and other autoimmune disease symptoms?
Yes. The idea behind worm therapy is that introducing the parasite into the GI system will, by virtue of its own metabolic processes, inhibit the autoimmune reaction that takes place in gluten sensitivity. For this purpose, the human hookworm is commonly used as an inoculating agent, and the immune reactivity of the patient or subject is assessed after administration. This type of therapy is also being examined for use with other autoimmune disease, such as colitis, with a study in monkeys.
Experimental hookworm infection has shown some promising results, although research has yielded a mixed bag, with some studies demonstrating no benefit on celiac pathology or symptoms. However, active research is being performed that seeks to improve on these results, for the treatment of celiac disease and other autoimmune conditions.
Questions for your doctor:
- Should I be taking digestive enzymes at this time? If so, where can I find them?
- Are there any existing immunotherapies or worm therapies that are currently available to the public for treatment?
- How can I find out about entering a clinical trial involving these agents?
- Is there any danger in attempting worm therapy, in terms of problems with infection or otherwise?
- What do I do if I have refractory celiac disease?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at [email protected].