Immune Helminthic Therapy of Inflammatory Bowel Disease using Tricuris Suis Ova.


Team members:

Yasmeen Salah

Nada Nasser

May Ahmed

Sumaya Ahmed

Abdel Rahman Safaa Elden


Supervised By Head of Parasitology Department: Dr Heba Abdel Aty.

College of Medicine, MUST







Background: Inflammatory bowel diseases (IBD) include ulcerative colitis and Crohn’s disease. It is a disease with idiopathic aetiology with Th1 predominant immune reaction.  The study of immune modulation mechanisms by parasites is becoming a multidisciplinary topic with a number of cross-links to other areas of research. Knowledge of the intricacies of immune modulation, combined with prolonged research into the underlying mechanisms of autoimmune diseases, has directed present-day studies towards focusing on what is generally termed "Helminthic Therapy" and recently described as one type of immune therapy.

Objectives: To raise a research question whether induced helminthic infections in certain intensity as immune therapy can be effective in treating autoimmune IBD.

Methods: Literature search of this question which is the subject of many recent studies. Recorded research in this area included experimental studies and clinical trials on the efficacy and safety of the treatment of IBD using certain number of non-human porcine Trichuris Suis Ova (TSO).

Results and conclusion: Studies and clinical trials showed a high degree of efficacy and a positive response to treatment among participants. TSO have proved useful by some research projects which investigated the possibilities of treatment and prevention of inflammatory bowel disease (Crohn's disease) and now produced by some drug companies as in Thailand. However, the safety of this treatment in immunosuppressed patients must be further investigated.

TSO treatment, immune modulation, Crohn's disease, Hygiene hypothesis, helminthic therapy, immune therapy







Aim of the work: to raise the question of whether induced helminthic infections can be effective in treating autoimmunity- induced diseases

According to the hygiene hypothesis, the increasing incidence of Inflammatory

Bowel diseases (IBD) in industrialized countries suggests that the environment

Plays a critical role in the development of both ulcerative colitis (UC) and Crohn’s

Disease (CD). Among various factors, a clear inverse correlation exists between the

Prevalence of IBD and soil-transmitted helminthic infections.

Consequently, helminthic therapy, particularly, Trichuris Suis Ova (TSO) have been

Tested for therapeutic application in IBD.


Hyperactive immune response may be to a pathogen which exceeds normal limits

Crohns disease increase Th1 which causes impaired function, own cell destruction, on the opposite side TSO therapy stimulateTh2 cytokines release (IL4, IL13)

Which generate regulatory substances as growth factor B, IL10, PGE2 which decrease pathogenesis, mucosal homeostasis.



Experimental studies were conducted to evaluate the efficacy and safety of TSO on Humans by clinical trials since 2003. Crohn's Disease Activity Index (CDAI) or

Mayo Score for Ulcerative Colitis were used to define response or remission

Induced by administration of the treatment. Open-label studies showed generally

Positive results. The first clinical trial was conducted by Summers et al. and

Reported in the American Journal of Gastroenterology in 2003. A drink with

Roughly 2,500 ova of Trichuris Suis taken twice monthly decreased symptoms

Markedly in many patients. Accordingly, patients showed response and remission.

TSO consequently promised a unique, safe, and efficacious alternative for Crohn’s

Disease management. In 2013, 36 patients were enrolled in a sequential dose-

Escalation (500, 2500 and 7500 viable embrocated TSO), randomized, double-

Blind, placebo-controlled study to evaluate the safety of a single dose of oral

Suspension TSO in patients with Crohn’s disease. It was concluded that a single

Dose of TSO up to 7500 ova was well tolerated and did not result in short- or long-

Term treatment-related side effects.




Ibd seems to be emerging, after being rare in Middle East.

In 100 ibd patients: uc is 86% & cd is 14%, with ratio of 6:1.

Marked increase in frequency of both is noticed decrease crowns disease and increase ulcerative colitis




The study of immune modulation by parasites is becoming a multi disciplinary topic with a number of cross links to other areas of research.

Knowledge of intricacies of immune modulation, combined with prolonged research into the underlying mechanisms of autoimmune diseases has directed present-day study towards “helminthic therapy”.

Available dose sizes:

1.      Children of 3 years & over will take (low doses): TSO500

2.      Children of 8 years & over will take One dose of TSO500 every 14 days

3.      Adults will take One dose of TSO1000 every 14 days

4.      Elderly & long term illness will take One dose of TSO2500 every 14 days   

Result of treatment


Cdai is used to define remission or response to treatment.

Greatly positive results.

A drink of 2500tso twice monthly decreased symptoms markedly below baseline.




-“Helminthic therapy & nutritional deficiencies” Retrieved 2017-03-27.

- Pritchard, d, L (2011). “Worm therapy for or against? “Journal of helminthology.

- “The safety of TSO”. Retrieved 2017-03-27


- Summers RW, Elliott DE, Urban JFJ, Thompson R, Wenstock JV. “Tricuris suis therapy in crohn disease.”2005.

- 22 Scholmerich J,et al A Randomised,Double-blind,Placebo-contralled Trial of Tricuris suis ova in Active Crohn disease.2017.