Helminthic therapy


Helminthic therapy
A larva under a microscope resembling a worm with one end across the other
Infectious Necator americanus L3 larva.
Invisible to the naked eye, from 10 to 35 are applied to the skin in therapy, either in a single dose or in multiple smaller doses over the course of two or three months.

Helminthic therapy, a type of immunotherapy, is the treatment of autoimmune diseases and immune disorders by means of deliberate infestation with a helminth or with the ova of a helminth. Helminths are parasitic worms such as hookworms and whipworms.

Helminthic therapy consists of the inoculation of the patient with specific parasitic intestinal nematodes (helminths). There are currently three closely related treatments available. Inoculation with Necator americanus,[1] commonly known as hookworms, or Trichuris suis ova (TSO),[2] commonly known as pig whipworm eggs, or inoculation with Trichuris trichiura ova,[1] commonly referred to as human whipworm eggs.

Current research and available therapy are targeted at, or available for, the treatment of Crohn’s disease, ulcerative colitis, inflammatory bowel disease (IBD), multiple sclerosis, asthma, eczema, dermatitis, hay fever and food allergies.

Helminthic infection has emerged as one possible explanation for the low incidence of autoimmune diseases and allergies in less developed countries, together with the significant and sustained increase in autoimmune diseases in industrialized countries.[3][4][5][6]

Contents

Incidence of autoimmune diseases and parasitic infestation

While it is recognized that there is probably a genetic disposition in certain individuals for the development of autoimmune diseases, the rate of increase in incidence of autoimmune diseases cannot be explained by genetics alone. There is evidence that one of the primary reasons for the increase in autoimmune diseases in the industrialized nations is the significant change in environmental factors over the last century. Environmental factors include exposure to certain artificial chemicals from industrial processes, medicines, farming and food preparation. It is posited that the absence of exposure to certain parasites, bacteria and viruses is playing a significant role in the development of autoimmune diseases in the more sanitized Western industrialized nations.[7][8]

Lack of exposure to naturally occurring pathogens and parasites may result in an increased incidence of autoimmune diseases. This is consistent with the hygiene hypothesis.[3][9] A complete explanation of how environmental factors play a role in autoimmune diseases has still not been proposed. However epidemiological studies, such as the meta analysis by Leonardi-Bee et al.,[3] have helped to establish the link between parasitic infestation and its protective role in autoimmune disease development.

Some recent research appears to confirm that the central tenet of the hygiene hypothesis is true — that parasites, and in particular helminths, have shaped the evolution of at least parts of the human immune system, and even the genes responsible for Crohn's disease, ulcerative colitis and celiac disease — and provides further evidence that it is the absence of parasites, and in particular helminths, that has caused a substantial portion of the increase in incidence of diseases of immune dysregulation and inflammation in industrialized countries in the last century.[10]

Theoretical explanation

Although the mechanism of autoimmune disease development is not fully defined, there is broad agreement that the majority of autoimmune diseases are caused by inappropriate immunological responses to innocuous antigens, driven by a branch of the immune system known as the TH1 type immune response. Extra-cellular antigens primarily trigger the TH2 response, as observed with allergies, while intracellular antigens trigger a TH1 response. The relationship between these two types of immune response is a central theme of the hygiene hypothesis, which suggests that there is a regulatory action between the two types of response. However, the observation that allergies and autoimmune response are increasing at a similar rate in the industrialized nations appears to undermine the hygiene hypothesis.

A refinement of the hygiene hypothesis, which overcomes this apparent contradiction, is the "old friends hypothesis."[11] The old friends hypothesis modifies the hygiene hypothesis by proposing that T regulator cells can only become fully effective if they are stimulated by exposure to microorganisms and parasites that have low levels of pathogenicity, and which have coexisted universally with human beings throughout our evolutionary history. This theory has recently been given more credibility by a study demonstrating the impact of infectious organisms, and helminths in particular, upon genes responsible for the production of various cytokines, some involved in the regulation of inflammation, in particular those associated with the development of Crohn's Disease, ulcerative colitis, and celiac disease.[10]

The hygiene hypothesis proposes that appropriate immune response is in part learned by exposure to these microorganisms and parasites, and in part regulated by their presence. In the industrialised nations, humans are exposed to somewhat lower levels of these organisms. The development of vaccines, hygienic practices, and effective medical care have diminished or eliminated the prevalence and impact of many parasitic organisms, as well as bacterial and viral infections. This has been of obvious benefit with the effective eradication of many diseases that have plagued human beings. However, while many severe diseases have been eradicated, humans' exposure to benign and apparently beneficial parasites has also been reduced commensurately. The central thrust of the theory is, therefore, that correct development of T regulator cells in individuals may depend on exposure to organisms such as lactobacilli, various mycobacteria, and helminths.[6] Lack of exposure to sufficient benign antigens, particularly during childhood, is sometimes suggested as a cause of the increase in autoimmune diseases and diseases for which chronic inflammation is a major component in the industrialized world.

Research

Helminthic therapy with both hookworm and TSO has been investigated in research published by the University of Nottingham[12] and University of Iowa.[13]

Helminthic therapy is currently being studied as a treatment for several (non-viral) auto-immune diseases including celiac disease,[14] Crohn's disease,[15][16][17][18] multiple sclerosis,[19] and ulcerative colitis.[20]

Hookworms have been found to reduce the risk of developing asthma, while Ascaris lumbricoides (roundworm infection) was associated with an increased risk of asthma.[3]

The authors of a study published in Science Magazine in April of 2011 suggest that there may be a link between the rising rates of metabolic syndrome in the developed worlds and the largely successful efforts of Westerners to eliminate intestinal parasites. The authors' work suggest that eosinophils (a type of white blood cell) in fat tissue play an important role in preventing insulin resistance by secreting interleukin 4, which in turn switches macrophages into "alternative activation." Alternatively activated macrophages are important to maintaining glucose homeostasis (i.e., blood sugar regulation). Helminth infection causes an increase in eosinophils. In the study, the authors fed rodents a high-fat diet in order to induce metabolic syndrome, and then injected them with helminths. Helminth infestation improved the rodents' metabolism. The authors concluded: "Although sparse in blood of persons in developed countries, eosinophils are often elevated in individuals in rural developing countries where intestinal parasitism is prevalent and metabolic syndrome rare. We speculate that eosinophils may have evolved to optimize metabolic homeostasis during chronic infections by ubiquitous intestinal parasites..."[21]

See also

References

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  2. ^ "Ovamed". http://www.ovamed.org/. Retrieved 2011-11-09. 
  3. ^ a b c d Leonardi-Bee, J.; Pritchard, D.; Britton, J. (2006). "Asthma and current intestinal parasite infection: systematic review and meta-analysis". American journal of respiratory and critical care medicine 174 (5): 514–523. doi:10.1164/rccm.200603-331OC. PMID 16778161.  edit
  4. ^ P Zaccone, * Z Fehervari, * J M Phillips, D W Dunne, and A Cooke (2006). "Parasitic worms and inflammatory diseases". Parasite Immunol 28 (10): 515–523. doi:10.1111/j.1365-3024.2006.00879.x. PMC 1618732. PMID 16965287. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1618732. 
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  6. ^ a b Weinstock JV, Summers R, Elliott DE. (2004). "Helminths and harmony". Gut 53 (1): 7–9. doi:10.1136/gut.53.1.7. PMC 1773927. PMID 14684567. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1773927. 
  7. ^ David E. Elliott; Robert W. Summers; Joel V. Weinstock. (2005). "Helminths and the Modulation of Mucosal Inflammation". Current Opinion in Gastroenterology 21 (2): 51–58. PMID 15687885. 
  8. ^ Mohan C. (2006). "Environment versus genetics in autoimmunity: a geneticist's perspective". Lupus 15 (11): 791–793. doi:10.1177/0961203306070005. PMID 17153852. 
  9. ^ Strachan D P. (2006). "Hay fever, hygiene, and household size". BMJ. 18 (299): 1259–1260. doi:10.1136/bmj.299.6710.1259. PMC 1838109. PMID 2513902. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1838109. 
  10. ^ a b Fumagalli M, Pozzoli U, Cagliani R, et al. (June 2009). "Parasites represent a major selective force for interleukin genes and shape the genetic predisposition to autoimmune conditions". The Journal of Experimental Medicine 206 (6): 1395–408. doi:10.1084/jem.20082779. PMC 2715056. PMID 19468064. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2715056. 
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  12. ^ Mortimer K, Brown A, Feary J, et al. (2006). "Dose-ranging study for trials of therapeutic infection with Necator americanus in humans". Am. J. Trop. Med. Hyg. 75 (5): 914–20. PMID 17123987. 
  13. ^ "UI Study Finds Worm Eggs Help Patients With Severe Bowel Disorders - University News Service - The University of Iowa". 24 May 2004. http://news-releases.uiowa.edu/2004/may/052104worms.html. Retrieved 2007-10-01. 
  14. ^ "Inoculating Celiac Disease Patients With the Human Hookworm Necator Americanus: Evaluating Immunity and Gluten-Sensitivity - Full Text View - ClinicalTrials.gov". http://clinicaltrials.gov/ct2/show/NCT00671138. Retrieved 2009-05-22. 
  15. ^ Hunter MM, McKay DM (2004). "Review article: helminths as therapeutic agents for inflammatory bowel disease". Aliment. Pharmacol. Ther. 19 (2): 167–77. doi:10.1111/j.0269-2813.2004.01803.x. PMID 14723608. 
  16. ^ Croese J, O'neil J, Masson J, Cooke S, Melrose W, Pritchard D, Speare R. (2006). "A proof of concept study establishing Necator americanus in Crohn's patients and reservoir donors". Gut 55 (1): 136–137. doi:10.1136/gut.2005.079129. PMC 1856386. PMID 16344586. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1856386. 
  17. ^ Summers RW, Elliott DE, Urban JF, Thompson R, Weinstock JV (2005). "Trichuris suis therapy in Crohn's disease". Gut 54 (1): 87–90. doi:10.1136/gut.2004.041749. PMC 1774382. PMID 15591509. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1774382. 
  18. ^ Summers RW, Elliott DE, Qadir K, Urban JF, Thompson R, Weinstock JV (2003). "Trichuris suis seems to be safe and possibly effective in the treatment of inflammatory bowel disease". Am. J. Gastroenterol. 98 (9): 2034–41. doi:10.1111/j.1572-0241.2003.07660.x. PMID 14499784. 
  19. ^ Correale J, Farez M. (2007). "Association between parasite infection and immune responses in multiple sclerosis". Annals of Neurology 61 (2): 97–108. doi:10.1002/ana.21067. PMID 17230481. 
  20. ^ Summers RW, Elliott DE, Urban JF, Thompson RA, Weinstock JV (2005). "Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial". Gastroenterology 128 (4): 825–32. doi:10.1053/j.gastro.2005.01.005. PMID 15825065. 
  21. ^ Wu, Davina; et al. (8). "Eosinophils Sustain Adipose Alternatively Activated Macrophages Associated with Glucose Homeostasis". Science Magazine 332: 243–247. http://sabre.ucsf.edu/docs/Science-2011-Wu-243-7.pdf. Retrieved 18 April 2011. 

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