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Q
A Vaccine for Celiac Disease?

I have heard there is a vaccine in the works for celiac disease. Can you tell me anything about it or provide information about treatment options other than a gluten-free diet?

A
Answer (Published 8/8/2013)

Celiac disease is an inherited, autoimmune disorder that is characterized by damage to the small intestine when the diet contains gluten, the protein in wheat that makes dough elastic. Gluten is also is found in rye, barley and, possibly, oats. Celiac disease affects about one percent of the U.S. population. It leads to the loss of villi, the tiny protrusions in the small intestines, which are essential to the proper absorption of nutrients from food. This can cause malnutrition, no matter how well an affected person eats. Celiac disease has a genetic component, and, like other autoimmune conditions, is often triggered by physical stress such as surgery, pregnancy, childbirth and viral infection. Severe emotional stress can also set it off.

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Celiac disease manifests differently from person to person, with many and varied symptoms both in and out of the gastrointestinal system. These include recurring abdominal bloating and pain, chronic diarrhea, weight loss, anemia, bone pain, fatigue, and in children and infants, delayed growth and failure to thrive.

The only reliable treatment thus far is going gluten-free for life. Consuming even a small amount of this protein can cause intestinal damage. However, I've read about two new approaches to treating celiac disease that are in development:

  • A vaccine that would target three components (peptides) of gluten that are believed to set off the reaction to the protein. The vaccine, called Nexvax2, is designed to train the immune system to tolerate the three peptides. According to the developers, initial study results indicate that they have identified the right components, and that Nexvax2 is safe to take. However, they report that since volunteers who have taken part in studies have been on gluten-free diets, it isn't yet clear how well the vaccine will work once people start to consume gluten. If the vaccine proves effective in celiac patients (or some subset of them), its success might lead to vaccines for other autoimmune diseases, such as type 1 diabetes and rheumatoid arthritis.

  • Pills to counteract accidental consumption of gluten by celiac disease patients. These approaches come from two different companies. One of the medications in development is aimed at a protein called zonulin, which is believed to contribute to "leaks" in the gut that allow gluten to get out of the GI tract. The other is designed to neutralize the effect of accidental ingestion of gluten by influencing an enzyme that breaks the protein into harmless particles before it reaches the gut. The developers report that little or no intestinal damage was seen in patients who tested the pill for six weeks while consuming gluten and that the symptoms of some participants improved during the study. Both companies are preparing for trials to test whether their drugs work in a larger population and at what dosage.

I discussed these new approaches to celiac disease with Gerard Mullin, M.D., associate professor of medicine and an integrative gastroenterologist at Johns Hopkins Hospital. He notes that the two pill approaches are designed to work with a gluten-free diet and wouldn't enable patients to eat normally. He adds that the most exciting option is a vaccine that can build the body's tolerance to gluten and retrain the immune system not to react to it. Since both of the new approaches are in early stages of testing, even if they work, I wouldn't expect them to be available for some years.

Andrew Weil, M.D.

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