Can celiac disease be treated with a vaccine?

November 12, 2018

If you were instructed to take a full hour to eat one small cookie, could you do it?  What about three times a day for three days in a row?

Up for the challenge?  Let’s take it to another level!

What if you didn’t know if those cookies contained gluten or not?  And what if you had been gluten free for over a year because you have celiac disease and the only treatment option is to avoid gluten?

Now, how do you feel about eating those cookies?  If you’ve gone through the challenge phase of an elimination diet, like the low FODMAP diet, or dared to eat at a restaurant again after you suspected it to be the cause of a case of food poisoning, you can probably relate.  Over one hundred brave volunteers ate those cookies as part of a phase I clinical trial for a new vaccine for celiac disease.

In celiac disease the body has an immune response to gluten, which is found in wheat, barley, and rye.  The T cells of the immune system see gluten as a harmful substance and trigger inflammation in the small intestine to remove the threat.  Over time, the lining of the small intestine is damaged, which leads to serious complications if not treated.  There is only one treatment option.  Avoid gluten!

Scientists at ImmusanT are working to change that.  They have developed a vaccine for celiac disease and are testing it in clinical trials now.  The vaccine Nexvax2 is a form of epitope-specific immunotherapy.  It uses small synthetically made protein segments that resemble gluten to modify the body’s T cells so that they do not recognize gluten as a threat and trigger an immune response.

Nexvax2 passed the phase I safety test and showed promising results!  Study participants who received the Nexvax2 vaccine and then completed the gluten containing cookie challenge (eating each cookie incredibly slowly) had a reduced inflammatory response as compared to before receiving the vaccine.  This means Nexvax2 may successfully change the T cells, so that they don’t respond to gluten!

Additional information about the effectiveness of Nexvax2 will come from the phase II clinical trial, which recently started.  The hope is that Nexvax2 will protect people with celiac disease from the harms of accidental gluten exposure.  Given that accidental exposure to gluten is practically unavoidable, Nexvax2 could be life changing for approximately 1% of the population.

It will take a few years before the results from the phase II trial are in.  If Nexvax2 proves to be effective, then it will need to go through a phase III clinical trial and be approved by the FDA.  While we wait for more news from ImmusanT, peruse the many gluten free recipes in the ETP recipe catalog.  Gluten free diets don’t have to be boring or dessert-less.  If you have a sweet tooth, check out the ETP recipes for buckwheat chocolate chip cookies or cardamom cookies.

If you’re interested in the details of the phase I clinical trial, check out the following scholarly journal article.

Goel G, King T, Daveson AJ, et al. Epitope-specific immunotherapy targeting CD4-positive T cells in coeliac disease: two randomised, double-blind, placebo-controlled phase 1 studies. Lancet Gastroenterol Hepatol. 2017;2(7):479-493.

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