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      Worms and the Treatment of Inflammatory Bowel Disease: Are Molecules the Answer?

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          Abstract

          The lack of exposure to helminth infections, as a result of improved living standards and medical conditions, may have contributed to the increased incidence of IBD in the developed world. Epidemiological, experimental, and clinical data sustain the idea that helminths could provide protection against IBD. Studies investigating the underlying mechanisms by which helminths might induce such protection have revealed the importance of regulatory pathways, for example, regulatory T-cells. Further investigation on how helminths influence both innate and adaptive immune reactions will shed more light on the complex pathways used by helminths to regulate the hosts immune system. Although therapy with living helminths appears to be effective in several immunological diseases, the disadvantages of a treatment based on living parasites are explicit. Therefore, the identification and characterization of helminth-derived immunomodulatory molecules that contribute to the protective effect could lead to new therapeutic approaches in IBD and other immune diseases.

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          Most cited references80

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          Innate immunity.

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            Family size, infection and atopy: the first decade of the 'hygiene hypothesis'

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              Trichuris suis therapy in Crohn's disease.

              Crohn's disease is common in highly industrialised Western countries where helminths are rare and uncommon in less developed areas of the world where most people carry worms. Helminths diminish immune responsiveness in naturally colonised humans and reduce inflammation in experimental colitis. Thus exposure to helminths may help prevent or even ameliorate Crohn's disease. The aim of the study was to determine the safety and possible efficacy of the intestinal helminth Trichuris suis in the treatment of patients with active Crohn's disease. Twenty nine patients with active Crohn's disease, defined by a Crohn's disease activity index (CDAI) > or =220 were enrolled in this open label study. All patients ingested 2500 live T suis ova every three weeks for 24 weeks, and disease activity was monitored by CDAI. Remission was defined as a decrease in CDAI to less than 150 while a response was defined as a decrease in CDAI of greater than 100. 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. 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.
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                Author and article information

                Journal
                Clin Dev Immunol
                CDI
                Clinical and Developmental Immunology
                Hindawi Publishing Corporation
                1740-2522
                1740-2530
                2008
                21 May 2008
                : 2008
                : 567314
                Affiliations
                1Laboratory of Experimental Medicine and Pediatrics, Division of Gastroenterology, University of Antwerp, 2610 Antwerp, Belgium
                2Division of Infectious Diseases, Queensland Institute of Medical Research, Brisbane, QL 4029, Australia
                3Laboratory of Pharmacology, University of Antwerp, 2610 Antwerp, Belgium
                4Division of Gastroenterology and Hepatology, University Hospital of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
                Author notes

                Recommended by Jiri Mestecky

                Article
                10.1155/2008/567314
                2396220
                18509490
                13d295b1-008a-4875-a441-2d0f3e242803
                Copyright © 2008 Nathalie E. Ruyssers et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 5 March 2008
                : 21 April 2008
                Categories
                Review Article

                Immunology
                Immunology

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