Evidence for Immunotherapy in the form of Helminthic Therapy for the treatment of Autism
It is well documented that there is an association between autism and immune dysfunction (DelGuidice, 2003). Post-mortem brain tissues from 11 autistic patients have demonstrated the presence of an active and ongoing neuroinflammatory process in the cerebral cortex and white matter, and notably in the cerebellum. Cerebral Spinal Fluid (CSF) assays from patients with autism following developmental regression were found to have a proinflammatory profile of cytokines compared to a control group (Pardo et al., 2005; Zimmerman, 2006).
The details of what is going on are very complex, may vary amongst autistics, and are incompletely understood. So the use of helminths based on their anti-inflammatory effects is speculative and arose largely because of the observations and experiences of a father of an autistic boy, Stewart Johnson. After reading widely on the subject and trying various therapies, he settled upon using Trichuris suis ova (TSO) from Ovamed. TSO was the first commercially available helminthic therapy and can be obtained directly from this web site.
Johnson observed remarkably positive changes in his son, you can read about them here.
As a result of other parents’ experiences using TSO to treat their autistic children we were approached in the spring of 2007 by Judy Chinitz, whose account of her experiences appears below.
Hookworm was an attractive alternative to TSO to many parents because of the expense. Over the long term hookworm are potentially a great deal less expensive than TSO. We all believed it would provide similar or better results because with hookworm as opposed to TSO the organism is meant to live in humans and is therefore better adapted to reducing inflammation in humans. And as opposed to TSO there is not a cycle of dosing, response, die off, decline in the level of benefit from TSO. Instead the response was very different.
Hookworm infection appears to result in an improvement in cognitive function in those we have provided it to (see Judy’s account below). But it does not produce the kinds of benefits that TSO does, as described by Stewart Johnson. Hookworm do not result in an improvement in social function.
We have currently treated eight juvenile autistics, with varying severity of autism. All those far enough along with what has been a slow approach to infection with hookworm have shown some degree of increase in cognitive function, and we have learned a great deal about how to treat autistic children using hookworm safely. We have since changed the treatment protocol to accelerate treatment, having learned how to do so safely.
But we now believe, based on a recent research paper suggesting this, that a combination of helminths will produce better results, as is apparent in those using TSO and hookworm together. We have obtained a second helminth, Trichuris trichiura (the human equivalent of Trichuris suis marketed by Ovamed), to add to the treatment for autistic children.
We have not yet treated any of our current autistic population of clients with Trichuris trichiura, although we expect to start in May of 2009. We do not yet know what the results will be and expect that it will be early 2010 before we have a clear idea how effective this approach will be.
It is important to understand that while results with TSO and Hookworm, and potentially with Trichuris trichiura ova (TTO) are promising, they are not a magic bullet that is likely to restore any autistic child. Furthermore the experience of both hookworm and TSO is variable and cyclical, and is not straightforward. For instance use of IvIg therapy concurrent with hookworm is not recommended.
Please contact us to discuss the complex issues surrounding Autism and helminthic therapy. For autistic patients, and only for autistic patients, we offer both organisms for the price of hookworm alone, although this offer will be available only until we have learned what the benefits of combined therapy are.
Because Judy wrote such a well-referenced account we do not provide a separate section for science on this page.
Please note: if you are interested in exploring treatment options for autism we require that you complete a one hour consultation with Judy Chinitz at New Star Nutrition before approaching us. We have seen the financial impact of autism on too many families and are not as well equipped to counsel parents of autistic children as Judy is. Judy is person you can trust, she receives no financial compensation for referrals to AIT, and Judy is a published author on autism, mother of an autistic child, and is very experienced with all of the available treatments for autism. She has expertise with the Specific Carbohydrate Diet (SCD) and helminthic therapy in particular. Her fee is $175.00 for the consultation and her advice alone will probably save you 100 times her fee over the next ten years as you battle this terrible disease.
Autism and the immune system: a brief overview- by Judy Chinitz, MS, MS
In 1964, Dr. Bernard Rimland published his book , Infantile Autism: The Syndrome and Its Implication for a Neural Theory of Behavior, proving that autism was a physiological – as opposed to a psychological – condition. By the 1970s, researchers noted immune system abnormalities in these children. In the 1980s, researchers like Dr. Reed Warren clearly demonstrated that those with autism had abnormal lymphocyte responsiveness (that is, their white blood cells don’t respond normally to germs) and abnormal levels of various types of immune cells, including low levels of natural killer cells. (This means that children on the spectrum have a hard time fighting pathogens like yeast, viruses and bacteria.)
In 1998, Dr. Sudhir Gupta, of the University of California at Irvine, published a paper in the Journal of Neuroimmunolgy entitled, “Th1- and Th2-like cytokines in CD4+ and CD8+ cells in autism.” This paper states that the “…data suggest that an imbalance of Th1- and Th2-like cytokines in autism may play a role in the pathogenesis of autism.” His work has been replicated many times since.
What does this mean? Simply put, there are different parts of our immune system. The innate immune system causes an initial inflammatory response when a pathogen is introduced into our bodies. The adaptive immune system forms antibodies over the course of a few days – which, in turn, provides us ongoing immunity if those same pathogens make their way into our bodies at a later time. In autism, there are abnormalities in both these parts of the immune system. Some major immunological insult, sometime very early in life, has seriously disrupted the normal immune balance in children with ASD (autistic spectrum disorders).
A few of the specific abnormalities found in autism include:
About 60% of our immune system is in the mucus lining of our digestive (and nasal) passages. Many, if not most, children with autistic spectrum disorders have digestive symptoms if not outright gut pathology. One of the greatest bits of wisdom ever shared with me came from Dr. Sidney Baker, co-founder of the Defeat Autism Now! Team of clinicians and researchers. “Inflammation is inflammation.” It may sound so simple but the implications are vast. These chemicals of inflammation are not just affecting how these individuals respond (or don’t respond) to disease-causing microbes; they also affect the health of the digestive system and the function of the brain itself.
Dr. Martha Herbert, an Assistant Professor of Neurology at Harvard Medical School, a Pediatric Neurologist at the Massachusetts General Hospital in Boston, who is a foremost authority on autism, has stated over and over that the brain is downstream from the digestive system, meaning that if the latter is compromised, the former suffers. It’s also a fact that if the digestive system is compromised, the entire immune system is as well – and vice versa. The brain, the digestive system, the immune system are all one – and inflammation is inflammation.
Another well-established fact is that individuals with ASD have abnormal gut microbiota. What does this mean? The human body contains about 90 trillion microbes, a number that is nearly 10 times more than the cells in our body. No one really knows what we are meant to have and in what proportions. Certainly, this will have wide variance too, depending on what microbial populations are native to our environment. We do know though that there should be something like 500 different species of bacteria living in our intestines and amongst these should be species like acidophilus. Multiple researchers have now established that individuals with ASDs have not only abnormal amounts of bacteria living in their digestive systems, but also seemingly abnormal kinds as well. It’s a chicken and egg scenario: abnormal gut microbiota leads to abnormal gut conditions compromising the immune system, but the reverse is also true. Abnormal immune functioning will lead to abnormal microbiota.
There is a movement running through the medical community that believes that we have become “too sterile.” Better put, with the advent of germ theory 100 years ago (the recognition that many diseases arise from specific germs), we have concentrated our efforts on eradicating bacteria and the like before we really know what they do in the human body. H. pylori is a prime example of this. In 1984 it was identified as a cause of stomach ulcers and has also now been linked to cancer. The current treatment for stomach ulcers in which H. pylori has been implicated is a course of antibiotics. However…
Over 50 percent of people in the western world have H. pylori in their stomachs and only a tiny percentage develop ulcers. More than that, bacteria in our digestive systems are a vital part of our immunological defenses. In 1999, H. pylori was shown to secrete antimicrobial substances that kill potentially pathogenic bacteria.
So, where does this leave us? Yes, individuals with autism generally have very abnormal gut microbiotia and very abnormal immune functioning. How best to handle this is not yet known. Many doctors focus on killing off the bad stuff – antibiotics for bad bacteria, antifungals for Candida, etc. And this helps…sometimes. Another line of thought though is to shift the immune system and gut back into normalcy by ADDING good flora and fauna, rather than, or as well as, subtracting bad…especially when the lines between good and bad may be more blurred than originally thought.
As you will read elsewhere on this site, parasites were a normal part of the evolving humanoid species up until 75 or so years ago. We lived on and with the soil and thus, our intestines were filled with not only bacteria and yeasts, but protozoa and other parasites too – including helminths. Human hookworm, Necator Americanus, was a NORMAL part of our gut ecology.
With our current anti-germ way of thinking, many are immediately horrified when they first think about “infecting” themselves with parasites. “Aren’t parasites bad?” is the typical first question from those first learning about this form of therapy. Well, sure. Some parasites are bad. A 30 foot tape worm living in your intestines might be considered nasty (hookworm are one centimeter long fully grown and invisible to the naked eye at the time of treatment). Then again, we are all very well aware of the health benefits of yogurt – with its live, active cultures. That is, your yogurt is swarming with bacteria. Do you equate this with eating salmonella on purpose? Like bacteria, some parasites are good and some are bad. And like bacteria, some are meant to be in us. An absence of good bacteria in the gut will seriously compromise the health of the individual. More and more research suggests that an absence of good parasites does the same.
In 2007, Dr. Kevin Becker of the National Institute of Health, published an article in Medical Hypothesis entitled, “Autism, asthma, inflammation, and the hygiene hypothesis.” Dr. Becker concludes, “Altered patterns of infant immune stimulation may hypersensitize the early immune system not toward allergic sensitivity and bronchial hypersensitivity but to inflammatory or cytokine responses affecting brain structure and function leading to autism. It is well documented that immune cytokines play an important role in normal brain development as well as pathological injury in early brain development. It is hypothesized that immune pathways altered by hygiene practices in western society may effect brain structure or function contributing to the development of autism.”
Elsewhere on this site, there is more information on exactly what is currently known about the immunological effects of hookworm. So just briefly: they raise levels of regulatory cytokines (those chemicals that turn off inflammation) and they lower levels of inflammatory cytokines, including TNF-alpha and INF-gamma. That is, they do exactly what is needed to improve the immunological functioning of individuals on the spectrum.
Will they work though? It is too soon to say. There are so few children with autism currently inoculated with hookworm that there is very little by way of anecdotal reports, let alone any data from large-scale clinical trials.
However, over the last year, more and more parents have put their children on courses of TSO (trichuris suis) – porcine (from pigs) whip worms. As these are not native to humans, they live for only 2 to 3 weeks in the human gut. Anecdotal reports have been astounding, to say the least. The children are showing global improvements which are sometimes dramatic. The incidence of negative side effects is almost zero.
My son, Alex, is 14 years old and profoundly autistic. In 2002, an endoscopy/colonoscopy showed that he had horrific bowel disease and his immune system was so compromised that to live he required gamma globulin (human antibodies) IVs for 7 years. I first read of parasite therapy and the “hygiene hypothesis” (the idea that we are too sterile, too devoid of normal microbiota) in 1999, in an article in the New York Times, which described the work being done with TSO by Dr. Joel Weinstock, who was then at the University of Iowa. Dr. Weinstock had tested these worms in 7 individuals with inflammatory bowel disease, and had 6 of them entered remission. The 7th also dramatically improved. I tried to get the University of Iowa to treat Alex, but as he fit none of their criteria, they would not. It took me 8 years of waiting to be able to get TSO but when I finally did (in October, 2007) Alex’s response was as dramatic as I always knew it would be.
Within 10 weeks his perpetual stomach bloating began to disappear. His evening screaming attacks stopped as the pain from the gas subsided. His mood become more and more stable – he was happy almost all the time. The changes were remarkable, and this in a child who has rarely responded to any treatment.
At the time of writing this, many children with autism have responded extraordinarily well to TSO. However, TSO is so expensive at the moment that it is beyond the reach of many families, especially considering that it must be done continuously. I myself could not continue with it indefinitely so I needed to find an alternative – a reasonably priced substitute. This is how I came upon Autoimmune Therapies.
To anyone’s knowledge Alex is the first child with autism to have been (purposely) inoculated with hookworm. On April 21st, 2008, he received his first dose of 3 worms. At this time, Alex has 16 mature worms and has now been off TSO for 5 weeks. We have lost none of the behavioral and physical improvements he gained on TSO and in fact, since the introduction of hookworm Alex has shown distinct cognitive improvements, including academic gains (which he has never made in his life).
As of now, there is far more we don’t know than we do about the immunological causes of autism, the events that have triggered the abnormalities, and mostly the way to remediate the situation. Parasite therapy may seem radical to many, but after 12 ½ years of battling my son’s tremendous immune and digestive disorders, and after many months of research on the topic, I made the decision (the right one, as it turns out) to proceed. My philosophy was beautifully expressed by Dr. Herbert at the Autism One conference in Chicago, in May, 2008. I don’t remember the exact words, but what she said was, when faced with prolonged scientific uncertainty, use your best judgment.
Additional information regarding therapies for autism
You can read more by Judy Chinitz about her experiences with autism, TSO, and hookworm, and with the Specific Carbohydrate Diet (SCD) here.
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