Crohn's Disease &
Helminthic Immunotherapy

Evidence for the use of the immunotherapy known as helminthic therapy to treat Crohn's Disease

Crohn's Disease involves chronic severe inflammation of the digestive system and can occur anywhere from the anus to the mouth. For those with the worst cases it can ruin their lives and their health. The most extreme cases end with bowel resections resulting in Total Parenteral Nutrition.All of the modern drugs used to treat Crohn's are immunotherapies, just as helminthic therapy is also an immunotherapy.

The earliest cases of Crohn's Disease described in the medical literature appear in the 1930's, neatly coinciding with period of the first programs in the United States to eliminate helminths, allowing for a few years for the impact of that effort to be felt.

Interestingly, helminths downregulate the inflammatory response so that, for instance, anaphylaxis does not occur in anyone hosting hookworms. Anaphylaxis is one of the most extreme inflammatory responses, often killing those in which it occurs. Manipulation of the immune system to produce a desired outcome is the definition of immunotherapy.

That is not evidence enough to suggest that Crohn's Disease could be combatted effectively using helminthic therapy. Fortunately there is a lot of preliminary scientific evidence that it is effective in treating Crohn's Disease (see below).

Besides that, we have our experiences with our clients, and although the number we have helped with Crohn's is not statistically reliable, nor are our methods of observation and information gathering as exacting as required for scientific research, they do support the observations made in the scientific papers below.

We believe that almost everyone, although perhaps not all, with Crohn's will benefit to a great degree from immunotherapy based on helminthic therapy, and that it is a safe option. Nor is that our opinion alone (see below again).

Having said that, it is important to realize that immunotherapy of this type for Crohn's disease is not a magic bullet. The results, while very good, are dependent upon continued hosting of the probiotic helminth, hookworm. Nor are the results miraculous. For many immunotherapy based on helminthic therapy for Crohn's Disease will be one, perhaps the most effective, treatment option. Meaning that to achieve full remission many will continue to use modern drugs, if at reduced levels.

To review the evidence for yourself please review the science section below. The full text of papers are available by contacting us

Personal Accounts

To protect the privacy of our clients we use pseudonyms unless given permission in writing to do otherwise. To speak with references please contact us and we will put you in touch with some of our clients who have been treated for Crohn's disease using hookworm or whipworm.


A personal account of treatment with hookworm
for Crohn’s Disease

I picked up 30 hookworm early last fall (editor's note: Fall of 2008) to treat my Crohn's and have been most impressed with the results.

I was diagnosed with Crohn’s two years ago after several months in and out of the hospital with infected pockets in my intestines and an ilium so swollen my doc mistakenly scheduled me for an appendectomy. The CAT scan showed what looked more like classic Crohn’s centered in the ilium and I went in for a colonoscopy to confirm.

That procedure showed skip lesions throughout my digestive track, serious ulcers where the colon met the rectum and an ilium that was almost strictured shut. At the time I was taking large doses of prednisone to get the inflammation under control.

After about a year trying the different treatments prescribed by my gastroenterologist, I started doing some research to see if there were any better options out there than a life time of suppressing my immune system with TNS-Alpha blockers like Remicade or Humira, etc. and destroying my bone density with steroids.

I was skeptical about the helminthic therapy, though reading the research behind the "hygiene hypothesis" it did seem logical. I brought the idea up with both my doc and my specialist and they had pretty negative reactions. I was surprised on further questioning, however, to learn that neither really knew anything about the research with helminthic therapy or even how hookworms reproduced. My doc did say one thing that really got me thinking, though. When I told him that the folks on this chat site mostly wrote in complaining about how much they were suffering and were not promoting the treatment, he said that I really should not pay a whole lot of attention to the complainers.  According to his experience with medical research, it is only the folks who don't respond positively to the treatment that are motivated to keep blogging. Those of us who see real results, want to forget about our past suffering and have no reason to blog in search of answers.

With that in mind I went ahead and made my appointment with Autoimmune Therapies and Jasper Lawrence. I had an easy experience with the hookworm from the very first with little itching, diarrhea or coughing. I did not notice marked improvement for several months, but when the worms did kick in, the improvement was dramatic. I first figured out what was happening when I ran out of my Cortafoam, a topical steroid I had using in enema form for almost a year.

I had tried to get off the stuff before because the side effects are so terrible, but the pain and bleeding came back with a vengeance when I skipped doses. This time I went a couple of days without using the stuff and experience no sudden return of symptoms. A couple of weeks later I had a little bleeding and used the foam for a day. Then I was able to go a month without dosing. Seeing such improvement with the Crohn’s that was attacking the lower part of my digestive tract, I decided to take my Entocort down a level. This is a steroid that dissolves in the ilium for maximum impact with minimum absorption system wide. I was able to reduce to two Entocort easily. Since then I continue to see my condition improve. Most days I have one regular bowel movement, a miracle after a lifetime of running to the bathroom several times a day. I have had one bout of nausea in five months, but other than that no major flares.

The biggest difference I notice is that I no longer have the bloating and stomach pain I had come to accept as the normal part of every evening.  This weekend I started training for a half marathon and enjoyed a ninety minute run with no frantic searches for a bathroom.  I have been a runner for many years, but have always had to plan my routes around public restrooms before. I am picking up another 20 hookworms with the goal of being medication free by the fall.

If you are battling Crohn’s, I urge you to consider hookworms. A year ago I had resigned myself to a future of surgeries, weak bones, a compromised immune system, and a less active life style. I was even considering quitting my job because the stress was aggravating my Crohns. I feel like I have my life back.

Thank you Jasper Lawrence and Autoimmune Therapies.

Brittany’s account of treatment with hookworm for Crohn’s Disease

You can read Brittany's account on the Yahoo forum, her post is here. Brittany was treated in June of 2008 and is still well now.

Immunotherapy based on Helminthic Therapy & Crohn's Disease: Science

For a copy of the full text of any papers here, and many others, please contact us, being sure to name the disease, or subject, you would like to investigate.

Will Worms (Helminthic Therapy) Really Cure Crohn's Disease?

Abstract

Treatment of Crohn’s disease patients with the intestinal helminth Trichuris suis appears safe and effective in the short term, even with concurrent immunosuppressive therapy.

There are a wealth of data that support an immunoregulatory role for helminth infection in animal models and the human host. Recently, this concept has been utilised therapeutically for the treatment of patients with inflammatory bowel disease (IBD). Specifically, Summers and colleagues report the results of their open study of live Trichuris suis ova therapy in 29 patients with Crohn’s disease (CD) in this issue of Gut(see page 87). Treatment with T. suis appears safe and effective in the short term, even with concurrent immunosuppressive therapy. Extension of this concept into the "hygiene hypothesis" may seem increasingly attractive in terms of an explanation for some epidemiological observations in patients with IBD, in particular the north-south gradient for IBD prevalence in both North America and Europe, and the lack of IBD in developing nations.

Please contact us for the full text of this article. Or, you can access it here (payment required to access full text):BMJ


Trichuris suis therapy (helminthic therapy) in Crohn’s disease

Abstract

At week 24, 23 patients (79.3%) responded (decrease in CDAI .100 points or CDAI, 150) and 21/29 (72.4%) remitted (CDAI, 150). Mean CDAI of responders decreased 177.1 points below baseline. Analysis at week 12 yielded similar results. There were no adverse events. Conclusions: This new therapy may offer a unique, safe, and efficacious alternative for Crohn’s disease management. These findings also support the premise that natural exposure to helminths such as T suis affords protection from immunological diseases like Crohn’s disease.exposuretohelminthssuchasTsuisaffords protection from immunological diseases like Crohn’s disea.

Please contact us for the full text of this article. Or, you can access it here (payment required to access full text):BMJ


The use of Trichuris suis and other helminth therapies to treat Crohn’s disease

Abstract

Infections with gastrointestinal (GI) nematodes are prevalent worldwide, despite the fact that anti-helminthic medications are regarded as safe, efficient, and widely available globally. In this review, we highlight the potential therapeutic benefits that may be realized through the clinical use of Trichuris suis and other helminths for Crohn’s disease (CD). Long-lived helminthic parasites are remarkable in their ability to down-regulate host immunity, protecting themselves from elimination, and also minimize severe pathological host changes. This review summarizes what is known about the underlying mechanisms that may account for the observed patterns in humans treated with helminths for CD. The Th2 arm of the immune system is emphasized as a component of primary importance in the association between the host immune system and GI nematode infections. Although GI nematode infections in humans cause significant morbidity and mortality, the existence and nature of protective mechanisms these helminths may confer remain largely unclear.

Please contact us for the full text of this article. Or, you can access it here (payment required to access full text):Springerlink (Parasitology research)


Helminths as therapeutic agents (Helminthic Therapy) for inflammatory bowel disease

Abstract

Over the last decade major advances have been made in our understanding of the mechanisms and mediators of inflammation that hold the promise of the development of new therapies for inflammatory disease. While much is to be gleaned from the application of new technologies, assessment of the age-old host–parasite relationship may also provide insights on how to counter pathological inflammatory events. In the case of inflammatory bowel disease [particularly Crohn’s disease, which is associated with T helper 1 (Th1) events] it is proposed that infection with parasitic helminths would be beneficial: the paradigm being that of immune deviation, where Th2 cytokines mobilized in response to the helminth will prevent or antagonize the disease-promoting Th1 events in the gut. The situation is unlikely to be this simple. Here we review and critique the data in support of helminth therapy for inflammatory bowel disease, drawing attention to the gaps in knowledge and presenting a view on how the field may be advanced. While the concept of helminth therapy may be superficially unappealing, this review may convince the reader of the value of more extensive analyses of the impact of helminth infection on enteric inflammation.

Please contact us for the full text of this article. Or, you can access it here (payment required to access full text): Interscience (Wiley)


Helminths and the Modulation of Mucosal Inflammation

Abstract

This article summarizes some of the evidence that inflammatory bowel disease (IBD) results from an excessive immune response, reviews regulatory factors that control intestinal inflammation, shows that an environmental change permits development of IBD, and explains why the loss of exposure to helminths may be important for the emergence of IBD. The article also reviews some of our recent studies showing that helminths can inhibit or reverse colitis in animal models of IBD and that patients with IBD improve when exposed to Trichuris suis. Full Text Free Online


Helminths and Harmony

Abstract

Mounting evidence suggests that helminths help regulate mucosal inflammation: The frequency of Crohn’s disease (CD) has increased substantially over the last 50 years. It is most prevalent in highly industrialised temperate regions. CD and ulcerative colitis (UC) are rare in less developed countries. This suggests that critical environmental factors affect the worldwide distribution of inflammatory bowel disease (IBD). The‘‘IBD hygiene hypothesis’’ states that raising children in extremely hygienic environments negatively affects immune development which predisposes them to immuno- logical diseases such as IBD.1 It is also postulated that the modern day lack of exposure to helminths due to our hygienic practices is an important environmental factor contributing to IBD. Until modern times, nearly all children and most adults harbored intestinal helminths. Helminths and the immune system of Homo sapiens co-evolved in close proximity over many 1000s of years. Helminths regulate their host’s immune system and prevent excessive inflammatory responses, which could underlie the mechanism of protection.

Please contact us for the full text of this article. Or, you can access it here (payment required to access full text): BMJ (Gut)


Gastrointestinal Parasites: Potential Therapy (Helminthic Therapy) for Refractory Inflammatory Bowel Diseases

Abstract

Crohn’s disease and ulcerative colitis are chronic relapsing inflammatory bowel diseases (IBDs). Different pharmacological agents are currently used in several combinations to control the inflammatory process. Recently, antibodies against the proinflammatory cytokine tumor necrosis factor-alpha appeared to be very effective in treating patients with Crohn’s disease. However, due to the fact that the pathogen causing IBD is still unknown, no causative treatment is currently available that is able to make the disease disappear. Recently, the hygiene hypothesis of the development of immunological diseases was proposed, stating that raising children in extremely hygienic environments with less exposure to parasite infections may negatively affect the development of the immune system, predisposing them to immunologic diseases such as IBD. This hypothesis is supported by experimental data showing that helminthic parasites protect against T helper (TH) type 1 cell-mediated gastrointestinal inflammations like Crohn’s disease. Both TH-2 cells and regulatory T-cells may be involved in this immunomodulatory mechanism. Here, we review the experimental and clinical studies in favor of the hygiene hypothesis, opening perspectives on new therapies for IBD.

Please contact us for the full text of this article. Or, you can access it here (payment required to access full text): Interscience (Wiley)


Does the failure to acquire helminthic parasites predispose to Crohn’s disease?

Abstract

Two polarized patterns (Th1 and Th2) of cytokines regulate inflammatory responses. Each cytokine pattern inhibits production of the opposing pattern. Lymphocytes from inflamed intestine due to Crohn’s disease secrete a Th1 pattern of cytokines. Crohn’s disease is most prevalent in highly industrialized countries with temperate climates. It occurs rarely in tropical third world countries with poor sanitation. We propose that exposure to an environmental agent predisposes individuals to Crohn’s disease. Parasitic worms (helminths) are common in tropical climates and in populations subject to crowding and poor sanitation. Children are most subject to helminthic colonization. Many helminths live within or migrate through the human gut where they interact with the mucosal immune system. The host mounts a mucosal response that includes Th2 cytokine production limiting helminthic colonization. Helminths and their eggs probably are the most potent stimulators of mucosal Th2 responses. The Th2 response provoked by parasitic worms can modulate immune reactions to unrelated parasitic, bacterial, and viral infections. Many people in developed countries now live in increasingly hygienic environments, avoiding exposure to helminths. Perhaps failure to acquire these parasites and experience mucosal Th2 conditioning predisposes to Crohn’s disease, which is an overly active Th1 inflammation.

Please contact us for the full text of this article. Or, you can access it here (payment required to access full text): PubMed


Helminths as Governors of Inflammatory Bowel Disease

Abstract

The incidence of the inflammatory bowel diseases (IBD) ulcerative colitis (UC) and Crohn's disease (CD) markedly increased in industrialized countries during the last decades. In contrast to these countries where helminths are rare, IBD si still uncommon in global areas where most people carry worms. Thus lack of exposure to parasites may critically contribute to the risk of IBD. In a recent article in Gut, Summers et al. demonstrated efficacy of treatment with Trichuris suis in active CD. Trichuris suis was additionally show to be effective in UC in a randomized trial carried out by the same group. Both studies did not address mechanisms of action. Here we present a real life scenario, which supports the impact of helminths in the prevention of IBD, and provide a rationale for the mechanisms of action.

Please contact us for the full text of this article. Or, you can access it here (payment required to access full text): BMJ (Gut)


A proof of concept study: establishing necator americanus (hookworm) in Crohn's patients and reservoir donors

Abstract

Our pilot study has established a potential for hookworm, already a fact of life for many millions, as a candidate parasite to inoculate those with autoimmune disease. The natural advantages are lifecycle and migration predictability, ability to control the size of and eliminate a colony, and the parasite’s longevity. Inoculation proved safe, even in immune suppressed patients. Our hope that NA would suppress autoreactivity sufficiently to allow immune suppressive therapy to be stopped was unrealistic. Recent and compelling evidence has shown that IBD is self sustaining. Auto-reinfection, direct person to person infection, aberrant migration, and hypobiosis do not occur. Adult worms live in the host small intestine for an average of five years. Infection can be easily terminated with an anthelminthic. Anaemia is the only disease of consequence but is an unusual outcome in properly nourished individuals.

Please contact us for the full text of this article. Or, you can access it here (payment required to access full text): BMJ (Gut)