Is a New Treatment for Celiac Disease on the Horizon?
One study is looking at a type of bacteria with potential to change how the digestive system processes gluten.
Celiac disease is way more common (yet trickier to spot) than you might think. This chronic autoimmune condition affects 1% of the world’s population, and 2.5 million Americans remain undiagnosed. Symptoms range from gas and bloating to more serious abdominal pain and nutrient deficiencies. And if left untreated, research has shown that celiac disease can lead to serious complications, such as infertility or even cancer.
Thankfully, there is one well-known (and FDA-approved) way to feel better fast: a strict adherence to a gluten-free diet. This is becoming easier than ever these days, as gluten-free food becomes a staple on restaurant menus and in grocery stores. But no matter how diligent you are, cross-contamination with gluten is unavoidable sometimes, which can understandably be pretty scary.
“There are elements of the diet that you cannot control, particularly when you eat outside your household, you travel, or you go on vacation,” explains Alessio Fasano, M.D., director of the Center for Celiac Research at Massachusetts General Hospital in Boston, MA. A February 2018 study in the American Journal of Clinical Nutrition found that even when following a gluten-free diet, people with celiac disease are regularly exposed to low levels of gluten that can damage the intestinal tract.
That’s why researchers like Natália Ellen Castilho de Almeida, Ph.D., are working on new avenues to treat celiac disease. Almeida, a professor at the Federal Institute of Education, Science and Technology in São Paulo, Brazil, is one of the principal authors on a new study in the Journal of Agricultural and Food Chemistry, which looks at probiotics called Bifidobacteria that can break down gluten and potentially tame the body’s immune response to it. Almeida explains that the study may offer “a prospective treatment to bypass the effects triggered by gluten intake in patients with Celiac disease.”
In other words, it could help people with celiac disease digest gluten without their usual symptoms.
Bifidobacterium (try saying that five times fast) is a type of probiotic that lives inside your gut. It’s one of many microbes in your GI tract that help to regulate your digestion and metabolism, absorb nutrients, assist your immune system, and prevent disease.
Everyone’s gut microbiome is different, and its composition can change based on age, diet, lifestyle, and antibiotic and probiotic use. Almeida’s study noted that Bifidobacterium, a type of “good” bacteria that is commonly used in oral probiotics (and even as a treatment for IBD), appears to be lacking in many patients with celiac disease.
Interestingly, Almeida’s team found that this type of microbe possesses the ability to break down gluten and convert it to a less damaging format. “This study showed that the gut microbiota is definitely involved in gluten metabolism,” Almeida says. Now, her team plans to continue research on Bfidobacterium and other bacterial species that could potentially help with gluten digestion.
What Other Options for Treatment Are out There?
Research on celiac disease has been ongoing for many years, driven by the goal of finding an alternative treatment option for patients when a gluten-free diet is not enough. “There is a subgroup, roughly 10%, of people [with celiac disease], who despite their strictly gluten-free diet, their symptoms do not go away and the damage to the intestine won’t go away,” Dr. Fasano explains. He notes that an additional 30% of people with celiac disease stop showing symptoms when they go gluten-free, but their body still shows signs of inflammation.
One other thing that makes celiac disease so appealing to study is that it’s a well-defined condition with a clear trigger, explains Joe A. Murray, M.D., a research faculty member at Mayo Clinic who specializes in studying celiac and gluten sensitivity. “We know it’s caused by gluten, we know where the damage occurs, and we know what genes are required for it to occur.” He explains that treatments for celiac could potentially be used as a stepping-stone to develop treatments for other autoimmune disorders.
Here’s a breakdown of the latest celiac treatment research:
A pill taken just before meals – In August 2019, Innovate Biopharmaceuticals began human trials of a drug called larazotide acetate that may help keep the tight junctions in the bowel (part of the intestinal wall) closed, which would reduce inflammation and prevent damage to the intestine. Dr. Fasano explains that this would be taken as a pill, 10-15 minutes before eating a food that you’re worried may come in contact with gluten.
An injection that would introduce your body to gluten safely – A clinical trial out of Northwestern University is examining the concept of injecting gluten into the bloodstream inside a nanoparticle, which introduces it to the immune system in a friendly way. Dr. Murray says this type of approach can help tolerize the immune system to gluten on a long-term basis. “Celiac disease is an immune reaction to gluten,” he says, “and part of that immune reaction is memory, meaning the immune system retains that memory for decades.” This injection would help to rewrite your immune system’s standard response to gluten.
Specific probiotic formulations – Almeida and her team are working on a concept that many other researchers see as promising: add bacteria to the gut that can help break down gluten. “Bacteria and other microbes are really good at adapting to eat what we give them to eat,” Dr. Murray says. He notes that the Bifidobacteria paper aligns with this research approach. If certain probiotics prove to be useful, they could potentially be taken regularly to strengthen the body’s ability to break down gluten.
When Will These Methods Become Available?
Unfortunately, it’s impossible to say exactly when these treatments may hit the market. There are substantial challenges to doing this,” Dr. Murray explains. “These are very expensive studies, and to carry an entire program from the beginning to the end is quite challenging.” But he has hope that after the first successful treatment emerges, more will follow quickly behind it. And for people living with celiac disease, that’s music to the ears.
Bifidobacterium Study: Journal of Agricultural and Food Chemistry. (2020). “Digestion of Intact Gluten Proteins by Bifidobacterium Species: Reduction of Cytotoxicity and Proinflammatory Responses.” pubs.acs.org/doi/10.1021/acs.jafc.0c01421
Gluten Cross-Contamination: American Journal of Clinical Nutrition. (2018.) “Determination of gluten consumption in celiac disease patients on a gluten-free diet.” academic.oup.com/ajcn/article/107/2/201/4911450
Bifidobacterium in the Gut: Frontiers in Microbiology. (2016.) “Bifidobacteria and Their Role as Members of the Human Gut Microbiota.” ncbi.nlm.nih.gov/pmc/articles/PMC4908950/
Role of the Gut Microbiome: Current Opinion in Gastroenterology. (2016.) “The gut microbiome in health and in disease.” ncbi.nlm.nih.gov/pmc/articles/PMC4290017/
Composition of the Gut Microbiome: PeerJ. (2019.) “Factors affecting the composition of the gut microbiota, and its modulation.” ncbi.nlm.nih.gov/pmc/articles/PMC6699480/
Larazotide Acetate Trial: Celiac Disease Foundation. (2019.) “First Patient Dosed in First Ever Phase 3 Clinical Trial for Celiac Disease.” celiac.org/about-the-foundation/featured-news/2019/08/first-patient-dosed-in-first-ever-phase-3-clinical-trial-for-celiac-disease/
Nanoparticle Injection Trial: ScienceDaily. (2019.) “New treatment may reverse celiac disease.” sciencedaily.com/releases/2019/10/191022080723.htm