It might not be a treatment for the most squeamish among us. But for certain patients battling Crohn’s disease, a concoction made from the eggs of an intestinal parasite could soon be just what the doctor orders.
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Researchers say the microscopic eggs of pig whipworm (or Trichuris suis) hold promise for treating severe cases of Crohn’s disease, an inflammatory bowel disease characterized by ulcers in the large and small bowel.
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Why (in the world) use pig whipworms?
The slightly icky science is actually based on a simple observation: Crohn’s disease is mainly seen in developed areas of the world, such as the United States and Europe. It’s hardly ever seen in underdeveloped countries where infection with parasitic worms in the gastrointestinal tract is commonplace.
This “hygiene hypothesis” has led researchers to suspect that this type of infection actually protects the gut. And that naturally begged the question, “Would giving Crohn’s patients worms benefit them?” The idea that swallowing the eggs of a nasty parasite might actually be safe and effective treatment is counterintuitive. But it’s one that has thus far been tested in multiple animal and human studies, including the recent TRUST-I trial.
The study enrolled 250 patients with moderate to severe Crohn’s disease who received either 7,500 whipworm eggs or placebo once every two weeks, for 12 weeks.
For these studies, doctors used pig whipworms rather than human whipworms because they can only survive in the human body a short time and don’t cause disease in humans, explains Cleveland Clinic gastroenterologist Bret Lashner, MD.
Preliminary studies have shown these worm eggs may be beneficial to Crohn’s patients. Scientists theorize that the parasites regulate the immune system enough to halt the body’s misguided attack on the intestinal lining. This may reduce Crohn’s symptoms such as diarrhea, bleeding and abdominal pain. Researchers also believe pig whipworms may be useful in treating other autoimmune disorders, such as ulcerative colitis and multiple sclerosis.
Getting past the “yuck” factor
This whipworm smoothie is no garden-variety, chocolate protein powder meal replacement. But exactly how is it prepared?
“They make a slurry out of it,” says Dr. Lashner, who headed Cleveland Clinic’s participation in the trial. “It doesn’t taste bad. If you think of it as worm eggs there is an ick factor there. But if you think of it like eating yogurt – which, of course, has live bacteria also – it’s nothing distasteful. The ick factor is minimal.”
That said, whipworm treatment is not ready for prime time just yet. Preliminary results from the pivotal TRUST-1 trial were released on Oct. 14, 2013. Researchers found that while the results were not conclusive overall, they were more encouraging in patients with severe Crohn’s disease.
The trial is no longer enrolling patients as results are further analyzed. Next, the U.S. FDA hopes to determine whether more data on the parasites’ effectiveness is required, including which Crohn’s patients might benefit the most from the therapy. If ultimately given the green light, whipworm therapy could hit the market in just a few years.
“I’m very curious to see what the details show,” Dr. Lashner says. “This therapy, while strange-sounding, could provide hope for those patients with severe Crohn’s disease that does not respond well to existing medical treatments.”