Immune Helminthic Therapy of Inflammatory Bowel Disease using Tricuris Suis Ova.
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.
METHOD and EXPERIMENTAL STUDIES
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.