May 19, 2004 (New Orleans) -- Call it the medical edition of Fear Factor.
Researchers report they are using helminths -- intestinal worms -- to combat Crohn's disease, the miserable, incurable disorder of the intestine characterized by abdominal pain, diarrhea, rectal bleeding, weight loss, and fever.
In the study, about three-fourths of people with Crohn's disease given pig whipworm in a popular drink went into remission, reports Joel V. Weinstock, MD, professor of gastroenterology-hepatology and director of the Center for Digestive Diseases at the University of Iowa College of Medicine in Iowa City.
The study was presented at a major medical meeting of digestive disorders experts.
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Weinstock explains that there is solid logic behind the unconventional approach.
Giving Worms Back to the People
Crohn's disease, like many other disorders, is a disease of the 20th century, he says. And one of the major differences between "now" and then is that kids no longer get worms, Weinstock says.
"Children [in developed nations] are no longer exposed to helminths," he tells WebMD. "Worms used to be around in their gastrointestinal tract, in their bloodstream."
Helminths don't just sit around, he says; they help regulate the immune system. And Crohn's disease is caused by inflammation of the small intestine -- inflammation that appears to result from an inappropriate immune response to normal gut bacteria.
Those observations, Weinstock says, led to the thinking that the "deworming" of our children may be partly or fully responsible for the emergence of diseases like Crohn's. It follows, therefore, that giving the worms back to the people could re-educate the immune system, help regulate the response to inflammation, and wipe out the disease.
"We're the only people in history who have lived without worms," Weinstock says. "So we wanted to see if giving worms could be therapeutic."
Worms 'Easy to Take'
The study was easy, he says. The pig whipworms grow and colonize in people, but only for a short period of time, Weinstock says.
"They're real easy to take," he says. "You just swallow the eggs." The eggs were dissolved in a popular drink, which Weinstock declined to name for "fear of putting the company out of business."
Of the 29 people with Crohn's disease who agreed to drink the wormy cocktail for 24 weeks, 72% went into remission, he says.
"These were all people that had failed to respond to conventional treatments," he says.
There were no side effects or complications due to the therapy, although four patients dropped out of the study when their symptoms flared up and another withdrew due to pregnancy.
Basic Science Supports the Approach
Though Weinstock says he's confident worms will be an effective therapy for Crohn's disease, he says there's still more work to be done.
"Other helminths might be more potent," he says. "And we might be able to isolate the compounds in worms that are responsible for the beneficial effect and use them to create new synthetic agents."
James B. Lewis, MD, associate director of the Inflammatory Disease Program at the University of Pennsylvania in Philadelphia, says the results are "fascinating."
The approach "resets the whole inflammatory cascade and re-educates our immune system," he says.
However, "there are very interesting issues related to how this product would be regulated, produced, and distributed," Lewis tells WebMD. A synthetic or recombinant worm might be a better approach.