It is every celiac’s dream: having a vaccine that allows them to eat normally, including foods containing gluten, without side effects. We have been working on it for some time and encouraging news has recently arrived. The phase 2 trial of the vaccine for celiac disease would give positive feedback. To the microphones of Virgilio News he spoke about it Marco Silano, expert of the Higher Institute of Health.
Medicines for celiac disease
In addition to the vaccine, new drugs are also being studied, which would have the value of a vaccine even though they are not equivalent in terms of type of action and administration.
But until a solution for the celiac population, that in Italy it is estimated to be 1% of the total, for a total of over 241,000 people?
Photo source: ANSAMarco Silano, senior researcher and director of the Department of Food, Nutrition and Health at the Department of Food Safety, Nutrition and Health of the Higher Institute of Health
The interview with Marco Silano
“To date, the only available and effective solution is only the gluten-free diet, this must be repeated. It is true that various trials are being worked on in the pharmaceutical field, but prudence is needed, in short, not the time to delude yourself that you have found a vaccine or that you are close to being able to have it”, he clarifies Marco Silano, senior researcher and Director of the Department of Food, Nutrition and Health at the Department of Food Safety, Nutrition and Health of the National Institute of Health.
Talk of the celiac disease vaccine has returned because the global biopharmaceutical company Takeda plans to launch three new therapies by 2025, which would allow an improvement in the quality of life of celiacs. What do we know at the moment?
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“The experimentation is still in level 2, therefore it will also be necessary to wait for phase 3 to be completed. This means that at the moment we have preliminary data. Above all, safety was investigated in a group of about sixty celiac patients, which is therefore very small. It is true that the results are promisingbut it will still take some time before we have effective drugs”.
How would new celiac disease drugs work? How could they “turn it off”?
“What is being worked on is a product capable of acting on the mechanism of the immune system that generates high levels of the protein interleukin 15involved in the response to gluten. It is the primary mediator of the inflammation that underlies the disease. The idea is to reduce its action so as not to generate the immune system’s reaction to gluten itself”.
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But how is it possible to achieve this goal and with what consequences?
“The fundamental point is precisely this. It is not a switch that can be turned on or off at will: if it is blocked at the intestinal level, it is necessary to keep in mind the consequences that this can also have on other physiological functions in which interleukin 15 is involved. In other words, since it is a protein that has the purpose of fighting viruses and other potentially harmful molecules for the body, involved in infectious diseases for example, if you block it, you risk important consequences in terms of lowering responses to inflammation in general.
This leads to caution, therefore. But is there a possibility of getting to a vaccine and who would it be for?
“It is difficult to make predictions on the timing at the moment, certainly work is being done to arrive at new therapies. We all hope to achieve effective results and safe as soon as possible. The goal remains that of having a drug for all celiacs, but caution is needed in order not to generate False hopes”.
In any case, would the drugs be therapeutic and different from a vaccine?
“Certainly. The focus is currently on possible drugs. The vaccine, although still intended for all people suffering from gluten intolerance, would act differently by blocking the toxic peptides of gliadin, the protein against which people with celiac disease have an immune response which results in the presence of IgA antibodies. It is a protein that is present, in fact, in almost all cereals and is derived from gluten”.
The number of people diagnosed with celiac disease is growing, but still underestimated. Those who complain of “sensitivity” to gluten are also increasing. What’s the difference?
“Let’s clarify that the so-called ‘gluten sensitivity’ does not exist and has nothing to do with celiac disease. This is a genetically based disease, which has a genetic predisposition as its cause and is combined with the presence of gluten in the diet. Different is the speech of those who are more sensitive to the nuisances that can be connected to other molecules, so-called FodMap”.
What is it about? Do they have to do with the FodMap diet (acronym of Fermentable Oligo-saccharides, Disaccharides, ed) which has been talked about a lot recently?
“Yes, they are foods rich in fermentable sugars which are the basis of intestinal discomfort such as swelling e abdominal pain, diarrhoea, constipation, etc”.
These are above all fructose, lactose, polyols, fructans and galacto-oligosaccharides, present for example in apples, pears, dehydrated fruit, watermelon, plums, peaches, apricots, cherries, wheat and rye, legumes, but also artichokes, mushrooms, leeks , onions, cauliflower. Does this mean they have nothing to do with celiac disease?
“Exact. There is a lot of talk about this diet lately: as often happens even those with a ‘scientific’ basis, diets are subject to fads”.
Photo source: ANSA