Department of Internal Medicine Will Worms Work? 5/27/2002 From the Cedar Rapids Gazette IOWA CITY - Mention worms and a wave of revulsion rolls over most people. Not so for a University of Iowa medical research team hot on the trail of a new method for treating two potentially painful and debilitating inflammatory bowel diseases - Crohn's and ulcerative colitis. UI researchers Dr. Joel V. Weinstock, Dr. Robert W. Summers, and Dr. David E. Elliott are using tiny parasitic worms in their search for a more effective way to combat the incurable maladies that affect more than 1 million Americans. "These diseases are chronic, inflammatory conditions of the intestines, where the bowel becomes very irritated and congested with white blood cells," said Summers, director of clinical activities in the UI Hospitals Center for Digestive Diseases, and principal investigator of the project. "Inflammatory Bowel Disease (IBD) causes many symptoms such as diarrhea, bleeding, abdominal pain, cramps, urgency and loss of energy," Summers said. Referring specifically to Crohn's disease and ulcerative colitis, he added: " These are not nice diseases. They are chronic, relapsing conditions that usually last a lifetime and often seriously impair the patient's quality of life." Both attack the lining of the digestive tract. While the exact cause of the diseases is unknown, Summers said a growing body of evidence suggests they result from an over-active and destructive immune reaction to naturally occurring bacteria in the digestive system. Summers said the " use of helminth parasites to reduce intestinal inflammation was developed at the University of Iowa in the laboratories of Drs. Weinstock and Elliott. Theirs is a very unique hypothesis that has attracted a lot of attention around the globe." Summers said: " It's important to recognize that throughout the history of mankind, people have had worms in their digestive system and thought nothing of it. They most likely came from the soil and were a natural part of the person's being. "Things began to change in the '30s and '40s," Summers said, "when many people in the industrial countries left the farms and moved into urban areas with paved streets, lived in a relatively cleaner environment, and led a nearly sterile lifestyle. "The incidence of inflammatory bowel disease has an inverse relationship with the elimination of worms from our environment," Summers said. Conversely, he said, there are still billions of people in the world who carry parasitic worms and in those areas - Central and South America, Africa and a large part of Asia - inflammatory bowel disease is almost unheard of. Summers said the diseases are not contagious and usually occur relatively early in life - teens, 20s and 30s. Five years ago, Weinstock and Elliott began introducing IBD in mice. "We were able to demonstrate that if you colonize mice with intestinal nematodes (worms) you can prevent them from getting the disease," Weinstock said. He explained that the worms have a natural property to dampen the immune system. The researchers' next step involved introducing worms into the digestive tract of seven patients - four with Crohn's disease and three with colitis. Their primary goal, Weinstock said, was to confirm the safety of the procedure. Summers said the results were " very encouraging. The patients have done extremely well and several have remained in complete remission for more than two years." Based on these results and those obtained in the laboratory, the UI research team received authorization to proceed with a statewide double blind trial in patients, first with Crohn's disease and now with colitis. Neither the patient nor the physician knows whether the solution used is the placebo or the active treatment. After three months, the recipients will switch substances. "It's a simple process for the patients," Summers said. "They just drink the substance, which is mixed with Gatorade. To ensure the blindness of the trial, we mix a little charcoal in with the liquid so that the worms can't be seen." Summers said that the larvae (immature worms) are released in the intestine, where they attach themselves. "The worm is called 'Trichuris suis,' or the pig whipworm, which is safer than the human variety. In a few weeks, however, the body rejects the pig worm so we have to keep giving additional eggs to the patient." If the trial is a success, Summers believes the worm concept might be extended to other autoimmune diseases including rheumatoid arthritis, collagen vascular diseases, allergic diseases such as asthma, and "even multiple sclerosis." Persons with Crohn's Disease or ulcerative colitis seeking information about the University of Iowa Helminth trials may contact participating clinics: Robin Thompson, Digestive Disease Center 4575 JCP, University of Iowa Hospitals and Clinics, Iowa City, IA 52244, (319) 356-3747 Gastroenterologists, P.C., 1948 First Ave. NE, Suite 2, Cedar Rapids, IA 52402-5356, (319) 366-8695 Internists, P.C., 115 Eighth Ave. NE, Cedar Rapids, IA 52401-1097, (319) 363-3565 The Iowa Clinic, 1215 Pleasant St., Suite 200, Des Moines, IA 50309, (515) 241-6102 Iowa Digestive Disease Center, PC, 2600 Grand Ave., Suite 400, Des Moines, IA 50312-5377, (515) 288-6097 Gastroenterology Associates of Iowa City, 540 E. Jefferson Suite 102, Iowa City, IA 52245, (319) 337-5997 Cedar Valley Medical Specialists, 1753 W. Ridge Way, Suite 104, Waterloo, IA 50701, (319) 833-5990 Worms turned life around for volunteer from Swisher Mon, 27 May 2002 'Horrendous." " Devastating." " Insidious." This is how Bernard Brown of Swisher describes an inflammatory bowel disease that dominated his life for 17 years until a batch of pig whipworms came to his rescue in 1999. Diagnosed with Crohn's disease in 1983, Brown, 61, suffered all of the symptoms common to the chronic disorder. " I experienced bouts of diarrhea and cramping, and generally felt tired all the time." Brown, who worked in law enforcement before retiring, volunteered for a University of Iowa research project three years ago and today he is "absolutely free of the symptoms." He participated in the first part of a two-part study undertaken by a research team in the UI Hospitals and Clinics' Gastroenterology/Hepatolology Division, a unit of the Center for Digestive Diseases. Dr. Robert Summers, principal clinical investigator in the study, said Brown's response " has been very gratifying. He has done extremely well." Brown was one of seven initially selected to determine if implanting eggs of the whipworms into the intestine would help control inflammatory bowel disease, and to ensure the safety of the procedure. Success of this study and promising results of tests on laboratory mice earned the UI team backing for a full-scale, double-blind study of the procedure. Brown said he went through the same procedure current trial participants are undergoing. " It's very easy for the most part," he said. " I drank a solution of Gatorade (containing the tasteless, almost invisible worm eggs) and that's all there was to it. I had absolutely no side effects." Brown said he began noting improvement in two to three weeks, " then it got a little bit better every week. In April 2000 I was no longer taking medication." Obviously delighted with the outcome, Brown continues taking the whipworm egg solution. |