Helminthic therapy safety

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Considering benefits and risks

Every practice - even the healthiest - has risks. For example, eating healthy food carries the risk of choking, and exercise may result in injury. But the risks of eating a healthy diet and exercising are clearly more than offset by the reduction in the risk of heart disease, cancers, and a very wide range of inflammatory diseases that are associated with these practices. Modern medicine also considers the risks of any drug alongside the risks of not taking the drug. By the same token, when considering the risks of helminthic therapyThe reintroduction of a controlled number of carefully selected benign intestinal worms in the form of larvae or eggs to reconstitute a depleted microbiome in order to treat or prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy., it is important to weight those against the risks of not engaging in this practice.

Current scientific understanding of the immune system’s development and function indicates that routine exposure to helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] is probably necessary for proper immune function.[1][2][3] In this view, the loss of helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] in Western society (known as loss of “old friends”, biome depletion, or biota alteration) as a result of necessary sanitation practices has left the ecosystems of our bodies highly susceptible to inflammatory disease. Consistent with this view, socio-medical studies indicate that self-treatmentMedication or treatment of one's own disease or condition without medical supervision. with helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] is effective for many people, probably even most people, in terms of alleviating inflammatory-related diseases.[4][5] These findings are supported by a few clinical trials and numerous studies in animal models.[6][7][8][9]

Many of the risks to human health from biota alteration are readily apparent, with a wide range of allergic and autoimmune conditions attributed to biota alteration[10]. Further, diseases not currently confirmed to be associated with biota alteration, including Parkinson’s disease and a variety of other cognitive problems, may be associated with biota alteration.[4][10][11][12] As described by Parker, “it seems highly likely that self-treatmentMedication or treatment of one's own disease or condition without medical supervision. with helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths], despite its unknown risks, varied and changing practices, and poorly defined outcomes, is more beneficial than harmful to the average practitioner.” Parker further argues that physicians violate the principle of primum non nocere (first, do no harm) when they arbitrarily discourage self-treatmentMedication or treatment of one's own disease or condition without medical supervision. with helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths].

In weighing the risks and benefits of helminthic therapyThe reintroduction of a controlled number of carefully selected benign intestinal worms in the form of larvae or eggs to reconstitute a depleted microbiome in order to treat or prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy., each individual must keep in mind that to remain helminthAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths]-free is a choice to maintain the body in a state of biota alteration which, based on the modern science described above, is pro-inflammatory and thus at risk.

Known and possible contraindications for the use of helminthic therapyThe reintroduction of a controlled number of carefully selected benign intestinal worms in the form of larvae or eggs to reconstitute a depleted microbiome in order to treat or prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy.

  • Patients with a serious, life-threatening infection such as HIV/AIDS, or who are severely immunosuppressed. However, this does not include those who are taking immunosuppressive medications to treat autoimmune, inflammatory or allergic diseases. For more on this see Combining helminthic therapy with drug treatments.
  • Patients with severe intestinal strictures. HookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. temporarily increase inflammation in the small intestine in the initial stages of colonisation and this might close a very narrow stricture.
  • Patients with bleeding or blood clotting disorders. See this support group post for more details.[13]
  • Patients with acute anaemia/anemia. HookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. have a potential to slightly lower hemoglobin levels, so it may be advisable to correct any existing anaemia before proceeding with the use of this species. For more details, see the Helminthic therapy and nutritional deficiencies page.
  • Patients with a latent viral infection such as herpes or tuberculosis may experience a temporary exacerbation of their condition following inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation]. See this support group post for more details.[14]
  • Patients who have had a diagnosis of cancer. Helminth providers may be reluctant to supply anyone in this situation, even if the cancer is in remission, although they may be willing to supply someone with a relatively benign cancer or one that is very easy to treat. See: Helminthic therapy and cancer.

See also:

The safety of TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis

TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis has passed all the evaluations required by the US Food and Drug Administration (FDA), the German Federal Institute for Drugs and Medical Devices (BfArm) and the appropriate medical agencies of Denmark, Switzerland, Austria and the Czech Republic. Gaining these safety approvals was a precondition for securing permission from these agencies to carry out phase 2 trials, which added further confirmation of TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis's safety.

The safety of HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta

HelminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] such as the human hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. (NAthe human hookworm, Necator americanus) and the porcine whipwormA helminth with a tapering whiplike body that lives in the colon. In helminthic therapy, the microscopic eggs of either the human Trichuris trichiura (TTO) or pig Trichuris suis (TSO) are taken in a drink. (TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis) have been tested for adverse side effects in published, controlled clinical trials. Unfortunately, the therapeutic effect of HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta has never been tested in a trial. However, William Parker and colleagues at Duke University have systematically compiled records of individuals self-treating with helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths].[4][5] Although these sociomedical studies are generally not designed to quantitatively assess the risk of adverse side effects, the Duke team has been able to obtain some semi-quantitative information from physicians who supervise patients self-treating with certain helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths], TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis and HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta in particular. When considering adult self-treaters, the Duke team has noted that adverse side effects from use of HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta are dose dependent and generally mild, involving temporary diarrhea following administration of a dose that is relatively high for a given individual. (Most individuals use therapeutic doses that are below their personal threshold for induction of diarrhea.)

A considerable number of cases of paediatric use of HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta were reported to the Duke team, and the quality and quantity of adverse side effects was different in this population than in the adult population. Most paediatric individuals using helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] in the Duke sociomedical studies were attempting to treat neuropsychiatric disorders (for example, ADHD associated with autism), which heavily biases the available information. Based on physicians’ reports to the Duke team, most individuals with autism experienced a slight but transient increase in hyperactivity following self-treatmentMedication or treatment of one's own disease or condition without medical supervision..[5] This was not considered a reason to discontinue therapy by most individuals, but rather was considered an early indicator that the HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta were having a beneficial effect. (Similar observations were made with TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis use in the paediatric population.)

More troublesome adverse reactions were noted in about 1% of the paediatric population taking HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta and were considered cause for cessation of therapy. Adverse reactions were of two types:[5] firstly, severe gastric pain associated with documented colonisation (adult helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] growing in the gut),[15] and, secondly, worsening of behavioral symptoms. These more troublesome effects were relieved by treatment with anthelminthic drugs. Behaviour usually returned to baseline in these cases within one to three weeks of treatment, based on physician’s reports to the Duke team. Based on available data, Parker estimates that the chance of having a very favourable reaction to HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta compared to a very negative reaction is about 25 to 1 (favouring a very positive reaction) in the paediatric population. However, again, this number is based on experiences of self-treaters with neuropsychiatric disorders and was obtained using a sociomedical study design that is semi-quantitative in nature. In the adult population, the Duke study suggests that the chances of a very negative reaction may be much less than in the paediatric population, but insufficient numbers have been obtained to reach any conclusions. (William Parker, personal communication February 2017 commenting on over 700 cases of self-treatmentMedication or treatment of one's own disease or condition without medical supervision. with HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta.)

The safety of NAthe human hookworm, Necator americanus

The safety of controlled infection with NAthe human hookworm, Necator americanus has been confirmed in studies at universities in the UK and Australia.

Only “light” hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. infections are used in helminthic therapyThe reintroduction of a controlled number of carefully selected benign intestinal worms in the form of larvae or eggs to reconstitute a depleted microbiome in order to treat or prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy., and the Centers for Disease Control and Prevention of the United States Government Department of Health and Human Services have determined that "light" hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. infections require no treatment.

In spite of the safety of NAthe human hookworm, Necator americanus having been established, there are four questions that occasionally concern those considering self-treatmentMedication or treatment of one's own disease or condition without medical supervision. with this species.

Can hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. act as a vector for pathogens?

The commercial providers of NAthe human hookworm, Necator americanus wash their larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. in an antimicrobial solution in order to clean them before they are shipped. Since helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] are living organisms, it is impossible to sterilise them completely without killing them, but a review of the literature found no reports of NAthe human hookworm, Necator americanus transmitting a secondary infection.

The providers also periodically test their reservoir donors for a range of communicable diseases such as HIV and hepatitis.

Do hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. cause anaemia/anemia?

NAthe human hookworm, Necator americanus is often wrongly blamed for causing excessive blood loss and consequent anaemia. This notion has arisen partly because NAthe human hookworm, Necator americanus is often confused with the other prevalent human hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin., Ancylostoma duodenale (ADAncylostoma duodenale. A species of roundworm, aka the Old World hookworm, that is not suitable for use in helminthic therapy. [https://en.wikipedia.org/wiki/Ancylostoma_duodenale Wikipedia:Ancylostoma_duodenale]), which causes nine times more blood loss than NAthe human hookworm, Necator americanus.[16] In the case of NAthe human hookworm, Necator americanus, there is arguably a greater risk of anaemia attached to diagnostic blood testing[17] and blood donation than there is from hosting this species of helminthAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths]. The 1.09 liters of blood that is estimated to be drawn each year by a colony of 100 NAthe human hookworm, Necator americanus (a single NAthe human hookworm, Necator americanus can take 30 microliters of blood per day[18]) is significantly less than the 2.88 liters of blood that an adult weighing 100 lbs or more is permitted to donate annually. For more detail, see Helminthic therapy and nutritional deficiencies.

Can hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. mis-migrate to organs outside the digestive tract?

There are no reports in the scientific literature describing mis-migration in humans by NAthe human hookworm, Necator americanus[19] and several authorities have made it clear that NAthe human hookworm, Necator americanus does not mis-migrate in our species.

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Over 700 million people remain infected with hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.... Auto-reinfection, direct person to person infection, aberrant migration, and hypobiosis do not occur.[20]
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Necator americanusThe species of human hookworm used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. migration in humans is predictable, via the lungs (larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state.) to the gastrointestinal tract (adults worms).[21]
Mis-migration can occur with some species of helminth that are not adapted to living in humans, such as the roundworm species[22] of dogs and raccoons, which are well known for migrating to the brain and eyes after entering a species to which they are not adapted.[23] And there may be an increased risk of mis-migration by these and other species in people who are severely immunocompromised, for example someone with HIV/AIDs. However, inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] with NAthe human hookworm, Necator americanus has been reported to be safe, even in patients who are immune-suppressed.[20]

Do hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. cause tissue damage?

When they feed, mature Necator americanusThe species of human hookworm used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. create a microscopic break in the surface of the mucous membrane lining the intestine which biologists refer to as "ulcers'", and a number of these sites will be produced by each worm as it moves to a new location every few hours. However, it is important to remember that an adult hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.’s mouth is a little narrower than its body and that its body is only the thickness of a human hair, so these "ulcers" really are tiny and they heal quickly thanks partly to the localised first aid administered at their feeding sites by the worms themselves in the form of healing secretions.

Moreover, these "injuries" caused by hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. are insignificant when compared with the massive operation of planned demolition and reconstruction that is going on throughout the bodies of humans at all times and which, for example, "destroys" more than 50 billion cells every day[24] and replaces them with new ones. This natural process of tissue breakdown and repair is what keeps humans alive for several decades, but the words that biologists use to describe these processes can cause concern to non-biologists whose viewpoint is inevitably much more subjective.

HookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. also cause what biologists refer to as tissue "damage" when they break through the blood capillary walls to enter the alveoli of the lung during their migration from the skin to the intestine, but the resulting holes are microscopic and heal very quickly thanks to repair mechanisms which deal automatically with such events. For example:

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The host uses its immune system to regulate the damage caused by the bacteria and the worms.[25]
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… AMP-activated protein kinase (AMPK), a key driver of cellular energy, regulates type 2 immunity and restricts lung injury following hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. infection.[26]
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Here, we analyze some of the studies regarding the role of AAMs in tissue repair during the tissue migration of helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths].[27]

References

  1. A prescription for clinical immunology: the pills are available and ready for testing.
  2. Parasitic worms and inflammatory diseases.
  3. Review series on helminths, immune modulation and the hygiene hypothesis: the broader implications of the hygiene hypothesis.
  4. 4.0 4.1 4.2 Overcoming evolutionary mismatch by self-treatment with helminths: current practices and experience.
  5. 5.0 5.1 5.2 5.3 Practices and outcomes of self-treatment with helminths based on physicians' observations.
  6. (Self-) infections with parasites: re-interpretations for the present.
  7. Parasite role reversal: worms on trial.
  8. Human helminth therapy to treat inflammatory disorders - where do we stand?
  9. Helminthic therapy: improving mucosal barrier function.
  10. 10.0 10.1 Evolutionary biology and anthropology suggest biome reconstitution as a necessary approach toward dealing with immune disorders.
  11. Reconstitution of the human biome as the most reasonable solution for epidemics of allergic and autoimmune diseases.
  12. Got worms? Perinatal exposure to helminths prevents persistent immune sensitization and cognitive dysfunction induced by early-life infection.
  13. Facebook Helminthic Therapy Support group post
  14. Facebook Helminthic Therapy Support group post
  15. Risk of HD maturation and persistence
  16. Ancylostoma/Necator
  17. Frequency of blood tests in heart surgery patients may lead to anemia, transfusions
  18. Parasitic infections. Treatment and developmental therapeutics. 1. Necatoriasis
  19. Yahoo Helminthic Therapy forum post 4330
  20. 20.0 20.1 A proof of concept study establishing Necator americanus in Crohn's patients and reservoir donors
  21. The hookworm pharmacopoeia for inflammatory diseases
  22. Wikipedia:Ascaris
  23. Yahoo Helminthic Therapy forum post 7254
  24. Programmed Cell Death and Inflammation: Winter Is Coming
  25. How the parasitic worm has turned
  26. Myeloid-Restricted AMPKα1 Promotes Host Immunity and Protects against IL-12/23p40-Dependent Lung Injury during Hookworm Infection
  27. Role of Macrophages in the Repair Process during the Tissue Migrating and Resident Helminth Infections
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