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WORM! WORM! all the way

Crohn's disease and ulcerative colitis, often grouped together under inflammatory bowel disease or IBD, are disorders of modern, industrialized nations with stringent standards of public hygiene.

Overzealous cleaning of the environment prevents the human immune system from interacting with worms, bacteria and other pathogens necessary for it to develop properly...Yes! Doctors at the University of Iowa are testing whether a treatment regimen of worms may help patients with Crohn's disease and ulcerative colitis.

The worm research represents perhaps the most extreme example of a field known as probiotics: the use of living organisms to treat diseases of the gastrointestinal tract and other organs.

Dr. Joel Weinstock and colleagues conducted a study wherein 20 to 30 patients were given a mixture of 1,500 eggs of the helminth or parasitic worm.

Most of the patients did so well on the therapy they were able to throw away their other drugs, including steroids, which can have serious side effects. The symptoms returned when the patients stopped drinking the mixture said Weinstock, professor of internal medicine.

The importance of contact with environmental organisms is supported by studies of mice specially bred to be germ-free, said Dr. Fergus Shanahan, of the National University of Ireland, Cork. Their gut movements are slower and the blood supply to that area differs from that seen in normal mice.

A recent study of 50 people who had undergone a colostomy, or removal of part of the colon, to treat severe ulcerative colitis. They developed infections in the remaining area of the colon.

Doctors got the infections under control and then gave 30 patients a mixture consisting of four different strains of bacteria. The other 20 patients got a placebo. Within nine months, all 20 patients on the placebo experienced a resurgence of their infection compared to only three of those who received the bacteria mixture.
< br> Shanahan predicted some day scientists would create organisms genetically engineered to produce vaccines and drugs to treat IBD and other diseases. Weinstock said even genetically engineered helminths are a possibility.

But doctors face at least two potential hurdles before probiotics with genetically modified organisms becomes a reality: controlling the reproduction of the organisms once they are in the body, and preventing them from producing too much of the drug or vaccine they are engineered to make...there is no question helminths play an important if not essential role in the maintenance of human health.

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