Effect of hookworm infection on wheat challenge in celiac disease - A randomised double-blinded placebo controlled trial

Daveson, A. James, Jones, Dianne M., Gaze, Soraya, McSorley, Henry, Clouston, Andrew, Pascoe, Andrew, Cooke, Sharon, Speare, Richard, Macdonald, Graeme A., Anderson, Robert, McCarthy, James S., Loukas, Alex and Croese, John (2011) Effect of hookworm infection on wheat challenge in celiac disease - A randomised double-blinded placebo controlled trial. PLoS One, 6 3, Article number e17366: e17366-1-e17366-9. doi:10.1371/journal.pone.0017366

Author Daveson, A. James
Jones, Dianne M.
Gaze, Soraya
McSorley, Henry
Clouston, Andrew
Pascoe, Andrew
Cooke, Sharon
Speare, Richard
Macdonald, Graeme A.
Anderson, Robert
McCarthy, James S.
Loukas, Alex
Croese, John
Title Effect of hookworm infection on wheat challenge in celiac disease - A randomised double-blinded placebo controlled trial
Journal name PLoS One   Check publisher's open access policy
ISSN 1932-6203
Publication date 2011-03
Sub-type Article (original research)
DOI 10.1371/journal.pone.0017366
Open Access Status DOI
Volume 6
Issue 3, Article number e17366
Start page e17366-1
End page e17366-9
Total pages 9
Place of publication San Francisco, CA, U.S.A
Publisher Public Library of Science
Collection year 2012
Language eng
Formatted abstract
Background and Aims:
The association between hygiene and prevalence of autoimmune disease has been attributed in part to enteric helminth infection. A pilot study of experimental infection with the hookworm Necator americanus was undertaken among a group of otherwise healthy people with celiac disease to test the potential of the helminth to suppress the immunopathology induced by gluten.

In a 21-week, double-blinded, placebo-controlled study, we explored the effects of N. americanus infection in 20 healthy, helminth-naïve adults with celiac disease well controlled by diet. Staged cutaneous inoculations with 10 and 5 infective 3rd stage hookworm larvae or placebo were performed at week-0 and -12 respectively. At week-20, a five day oral wheat challenge equivalent to 16 grams of gluten per day was undertaken. Primary outcomes included duodenal Marsh score and quantification of the immunodominant α-gliadin peptide (QE65)-specific systemic interferon-γ-producing cells by ELISpot pre- and post-wheat challenge.

Enteric colonisation with hookworm established in all 10 cases, resulting in transiently painful enteritis in 5. Chronic infection was asymptomatic, with no effect on hemoglobin levels. Although some duodenal eosinophilia was apparent, hookworm-infected mucosa retained a healthy appearance. In both groups, wheat challenge caused deterioration in both primary and several secondary outcomes.


Experimental N. americanus infection proved to be safe and enabled testing its effect on a range of measures of the human autoimmune response. Infection imposed no obvious benefit on pathology. Trial Registration: ClinicalTrials.gov NCT00671138. © 2011 Daveson et al.
Keyword Autoimmune
Hygiene Hypothesis
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
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Created: Sun, 27 Mar 2011, 00:02:39 EST