Novel treatment offers hope to those with immune diseases, such
as Crohn’sHere, swallow these worms.
Most patients receiving
that advice would find another doctor. However, 15 Orlando,
Fla.-area residents have volunteered to be first in line for a
clinical study investigating a novel worm treatment for Crohn’s
disease, an autoimmune disorder that causes chronic intestinal
Though a hard concept to swallow, worm therapy may ultimately
provide a remedy for a host of other immune diseases, from asthma to
multiple sclerosis, said Dr. Ira Shafran. The Winter Park, Fla.,
gastroenterologist is conducting one of three worm trials approved
by the Food and Drug Administration.
The notion of infesting patients with worms was prompted by the observation that autoimmune diseases have soared as our environment became cleaner.
“These diseases were unheard of in the early 1900s,” said Dr. Joel Weinstock, chief of gastroenterology and professor of immunology at Tufts University, and one of the pioneers in the study of therapeutic worms. “At the end of the 20th century they were commonplace in America.”
The corollary gave way to what he and other scientists call the hygiene hypothesis.
As an example, Weinstock said, in the 1950s, inflammatory bowel disease affected about one in 10,000 people. Now it’s closer to one in 250. Better diagnostics account for only a small part of that, and genetics don’t change that fast. The culprit, Weinstock says, is the environment.
Better hygiene, cleaner water and refrigeration have a downside: Worms disappear as water, food and soil get cleaner.
In undeveloped countries, where parasitic infestation is high, the incidence of most autoimmune diseases is low, Weinstock said. “Based on what we know about evolution, that would indicate that some parasites should impart some survival advantage to their host.”
Since making that connection in the 1990s, he and others have conducted worm studies on mice and humans, which appear promising. Weinstock cited three, small human studies that have indicated worms have a beneficial effect on multiple sclerosis; others have shown promise in the treatment of allergies. Other targets could be rheumatoid arthritis and type 1 diabetes.
In the case of Crohn’s and other inflammatory bowel diseases, an overzealous immune system goes too far in attacking the bacteria in the digestive track, most of which is healthy, and also attacks healthy tissue. Parasites interfere with that chain of events, and appear to confer protection and regulate the immune response or put the brakes on it, said Shafran.
“Both in the test tube and in early clinical trials, we have established that we can control that autoimmune response with parasites,” he said. Existing drug therapies for Crohn’s fail 50 percent of the time, and raise the risk for infections and cancer. Four out of five patients require colon surgery. A new remedy would be welcome.
When Nick Margone, a 32-year-old student and part-time caregiver from Mount Dora, Fla., heard about the trial, he didn’t hesitate to sign on. Diagnosed with Crohn’s seven years ago, Margone went on steroids and other prescription drugs to calm the flare-ups.
“I missed a lot of work, had to put my education on hold and my social life took a hit,” he said. “It’s not something people want to talk about.”
As for being on the front lines of the research, he said, “I’m a little happy and a little concerned. I’m happy because I will be a part of a therapy that has a lot of potential to help me and others. I’m concerned because the thought of actually ingesting worm eggs is rather frightening.”
Next month Margone and other study participants will swallow a single dose of several hundred pig whipworm eggs, delivered via two tablespoons of liquid. Pig whipworms cause disease in pigs but are not harmful to humans.
From there, the eggs will travel to the intestine where they will attach and hatch into larvae. “Because pig whipworms prefer pigs, they don’t stick around in humans,” Shafran said. Within two months, they pass on, before they turn into worms, but not before they’ve created lasting changes in the gut.
“Once physicians who treat autoimmune disease get past the yuck factor, they are open to the idea” of using worms in treatment, said Dr. Bill Sanborn, chief of gastroenterology at the University of California, San Diego, who is not involved with any worm studies.
“This started out as an interesting story, and now the data suggest it might really be beneficial. I’m pleased with how the science is moving forward, methodically, and with FDA oversight,” said Sanborn. “What I would not want is to see patients trying to treat themselves by getting worms from questionable sources.”
None of the worms-as-therapy proponents is advocating for a return to filth and no refrigerators.
Drinking polluted water can cause hepatitis, cholera and typhoid. Poor food handling can cause botulism, salmonella and other food poisoning.
“Yet, if we all moved into a completely sterile environment, we would die,” said Weinstock. Germs — and worms — help keep us alive.
continue to next page of zapper