Smallwood et.al

Helminthic Therapy; Could Worm Infections Help with Inflammatory Diseases?

By Brenna Graber 

Parasitic relationship with Social Constructs of Medicine

In the late 1980’s, researcher David P Strachan proposed a theory that claimed personal cleanliness has gone too far which has encouraged an increase in diagnosed allergies or inflammatory diseases (Strachan 1989). Since then this concept has been repeatedly studied and is now known as the “hygiene hypothesis”. One area where this hygiene hypothesis is readily studied today would be how humans have a co-evolutionary and beneficial relationship with small parasitic infections (Lorimer 2019).

            Previously,  parasites have resided in people for a long periods of time  with little to no serious medical issues (Smallwood et. al 2017). In western medicinal practices we have set a precedent that objectifies parasites to a strictly harmful and invasive relationship  when indeed human relationships with certain parasites are mutualistic (Lorimer 2019). A mindset like such, coupled with increased hygiene which reduces exposure to these organisms, has led to an absence of an important contender to the human microbial ecosystem.

Helminthic Therapy: How it works.

Today some researchers are beginning to discover that the administration of a small worm load of helminths can be beneficial in combating multiple different

inflammatory diseases such as allergies and arthritis (Lorimer 2019). Helminths can stimulate immune responses that aid in inflammation.

Within the immune system, there are two responses; (1) Th-1 and (2) Th-2. When the body gets infected with a helminth, it ignites a Th-2 immune. While in the human body, helminths secrete different materials that the body recognizes as non-self which then activates cytokines IL-4,IL-5,Il-10,and IL-13 (Smallwood et. al).Cytokines are numerous proteins that work together and communicate in order to activate an immune response from the body. At the same time, regulatory T-cell development is occurring which promotes a cloaking effect by releasing regulatory cytokines like IL-10 and transforming growth factor (Beta). The body defending itself against the helminth cloaks the inflammation process.

Helminths such as hookworms, specifically propagate the activation of total immunoglobulin-E and activation of the innate immune systems like mast cells basophils and eosinophils. Immunoglobulins are antibodies found in the body that work to disarm whatever is infecting the body, in this case it would be the hookworm. Meanwhile, both basophils and eosinophils are white blood cells which increase in numbers during an infection. All of these processes result in a decrease of  inflammation by way of disease because the immune system is distracted by the helminth’s presence (Smyth et. al 2017).

What helminths are or have been used for treatment?

            The phyla or different kinds of helminths include roundworms, flatworms and flukes (trematodes). Most of the helminths that are used to treat inflammatory diseases are the nematodes (roundworms) and hook worms (Smallwood et. al). Specific hookworms have been organized into a table per disease,  being treated (in people) by Smallwood et al. 2017:

Inflammatory bowel disease:

●      Schistosoma mansoni

●      Heligmosomoides polygyrus

●      S. cercariae

●      Schistosoma japonicum

●      S. mansoni

●      Anisakis simplex

●      Acanthocheilonema viteae

Multiple Sclerosis:

●      S.mansoni

●      T.spiralis

●      Fasciola hepatica

●      S. japonicum

Type 1 diabetes:

●      S.mansoni

Rheumatoid arthritis:

●      S.mansoni

●      S.japonicum

●      A.viteae

●      H.polygyrus

Systemic lupus erythematosus

●      A.viteae

From other articles (Lorimer 2019):

Allergies:

●      A. caninum

●      N.americanus

●      H.diminuta

What’s Next for Helminthic treatment?

Most recent research is working to synthesize the reaction the human body has when interacting with helminths. This would be administering a pill that contains synthetic molecules that replicate helminth ability. The idea is to reduce the risks, discomfort and chance of infection while still embracing the therapeutic benefit (Lorimer 2019).

Those Opposed?

Other researchers argue that by synthesizing this relationship, some benefits will be lost that are provided by the whole helminth organism. These same researchers claim that synthetics like pills could also lead to drug dependency and potentially resistance. Instead they encourage the safety and naturally occurring benefits of helminthic therapy through monitored and safe administration of the helminths (Lorimer 2019).

Conclusions

Helminths have, for a long time, been seen as an invader, an organism to be exterminated. Due to this relationship that has been created by western medicine coupled with the increase of hygiene in a developed country, helminthic therapy is not an accepted treatment by the Drug and Food Administration and therefore can’t be clinically practiced (Lorimer 2019 &). This is because of shipping regulations of the parasites when they are outside the body as well as lack of research on this form of therapy (Lorimer 2019 and Smyth et al. 2017).

The future of helminthic therapy is very open. More researchers are jumping on board with this practice. However, changing the social standards of such a developed country will not be easy (Lorimer 2019).

Literature cited

Lorimer, Jamie. 2019. Hookworms Make us Human: The Microbiome, Eco-Immunology, and a Probiotic Turn in Western Health Care. Medical Anthropology Quarterly 33(1): 60-79.

Smallwood, T.B.,P.R. Giacomin, A.Loukas, J.P. Mulvenna, R. Clark, and J.J. Miles. 2017. Helminth Immunomodulation in Autoimmune Disease. Frontiers in Immunology 8:453.

Smyth, K., C. Morton, A. Mathew, S. Karuturi, C. Haley, M. Shang, Z.E. Holzknecht, C. Swanson, S.S. Lin, and W. Parker. 2017. Production and Use of Hyenolepis diminuta Cysticercoids as Anti-Inflammatory Therapeutics. Journal of Clinical Medicine 6:98.

Strachan, David P.. 1989. Hay fever, hygiene, and household size. Department of Epidemiology and Population Science, London School of Hygiene and Tropical Medicine, London WC1E &HT.