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Despite the explosion of gluten-free foods in recent years, it is not easy to follow a GF diet prescribed by a doctor. Millions of people with celiac disease spend their lives worrying about cross-contamination in restaurants and scrutinizing labels. It's a lot of paranoia and watching others eat cake. Worse, even if you ask the servers what foods can be safely eaten, sometimes you are overworked.
For all these reasons, doctors and researchers who work with celiac patients know that following a gluten-free diet is not the simplest solution it seems to be. That's why a company called ImmusanT has developed an alternative: a vaccine.
We generally believe that vaccines are useful for fighting viruses, not for autoimmune diseases, but ImmusanT's Nexvax2 theory seems valid so far. As a normal shot, Nexvax2 exposes the patient's immune system to a small amount of what would otherwise be a dangerous substance. For standard vaccines, it's a virus, but for Nexvax2 it's gluten.
To really understand how it works, we have to dive a little deeper into what celiac really is, because contrary to popular belief, it's not an allergy. Allergies are basically an overreaction to something that your body is supposed to consider harmless. If you are allergic to milk, your immune system thinks that milk proteins are dangerous and will release a ton of histamines in response to their presence. This flow of histamines causes the symptoms of allergy (some so-called allergies are actually intolerances related to the fact that the intestine degrades certain foods, such as allium, without being of autoimmune nature). The immune system of patients with celiac disease has also wrongly described a protein, in this case gluten proteins, as dangerous, but instead of releasing a heap of histamines, it begins to attack.
When people with celiac eat gluten, they do not suffer from wheezing – they suffer from gastrointestinal distress when their immune system attacks their intestinal wall. If there is enough gluten, this reaction damages the delicate fingers called villi that normally absorb the nutrients contained in the food. Celiac patients with damaged villi may end up suffering from malnutrition if it lasts long enough.
All this attack is coordinated by T cells, a type of immune cell responsible for recognizing foreign invaders. People with celiac disease have T cells that have accidentally learned to identify gluten protein fragments as dangerous. ImmunsanT people wanted to know if you could teach T cells that gluten was acceptable.
The first step was to determine which parts of the gluten proteins triggered the T-cell response. It turns out that it's just a handful of places. They isolated these short peptide strands and essentially loaded them directly into a syringe and then injected them into the arms of celiac patients. With an initial dose too high, almost everyone had a classic reaction to gluten: nausea, vomiting, diarrhea, headache and fatigue. But in later trials, when they started with just three micrograms of gluten and gradually increased the dose, most people tolerated up to 900 micrograms, or 0,0009 grams, with little or no symptoms . Europeans and Americans consume on average between 10 and 14 grams of gluten a day, but eating it is not quite the same as pulling it directly into the veins; The ultimate goal of ImmusanT is to enable patients to benefit from a regular diet.
Unfortunately, people with celiac disease can not immediately get their dose of gluten and begin to enjoy a cake without worries. In future trials, ImmusanT has to prove that its vaccine is not only safe, but is actually more effective than currently available options (which will not be difficult, for now, a gluten-free diet). is your only option). Once the Phase 2 and 3 trials are complete, they will need approval from the Food & Drug Administration before patients can read them.
And there is another caveat: it's not for everyone. The parts of the gluten peptide recognized by the immune system of celiac patients are specific to the genetic mutations they carry. This vaccine is for people with the HLA-DQ2.5 mutation, as are 90% of people with celiac disease. Another five percent have a mutation on HLA-DQ8, and the last five have another unidentified mutation. At a conference on celiac disease at Columbia University in March 2018, ImmusanT Scientific Director Robert Anderson explained that he wanted to start with the most common genotype to help as many people as possible. people, but was also working on a genotype.
The hope is that celiac patients eventually develop a total tolerance to gluten and are able to follow an unrestricted diet, possibly accompanied by occasional boosters to ensure that tolerance persists. This future is still many years. Current Phase 2 trials will not be completed until 2019, then it will take a few more years for Phase 3 trials and FDA approval may take even longer, followed by drug manufacturing and distribution. But the possibility of long-term treatment of celiac disease is becoming more real and exciting.
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