Voldsgaard A, Bager P, Garde E, Åkeson P, Leffers A, Madsen C, Kapel C, Roepstorff A, Thamsborg S, Melbye M, Siebner H, Søndergaard H, Sellebjerg F, Sørensen PS.Trichuris suis ova therapy in relapsing multiple sclerosis is safe but without signals of beneficial effect. Mult Scler. 2015. pii: 1352458514568173. [Epub ahead of print]
BACKGROUND: An observational study has suggested that relapsing-remitting multiple sclerosis patients with helminth infections have lower disease activity and progression than uninfected multiple sclerosis patients.
OBJECTIVE: To evaluate the safety and efficacy on MRI activity of treatment with TSO in relapsing MS.
METHODS:The study was an open-label, magnetic resonance imaging assessor-blinded, baseline-to-treatment study including ten patients with relapsing forms of multiple sclerosis. Median (range) age was 41 (24-55) years, disease duration 9 (4-34) years, Expanded Disability Status Scale score 2.5 (1-5.0), and number of relapses within the last two years 3 (2-5). Four patients received no disease modifying therapy, while six patients received IFN-β. After an observational period of 8 weeks, patients received 2500 ova from the helminth Trichuris suis orally every second week for 12 weeks. Patients were followed with serial magnetic resonance imaging, neurological examinations, laboratory safety tests and expression of immunological biomarker genes.
RESULTS: Treatment with Trichuris suis orally was well-tolerated apart from some gastrointestinal symptoms. Magnetic resonance imaging revealed 6 new or enlarged T2 lesions in the run-in period, 7 lesions in the early period and 21 lesions in the late treatment period. Two patients suffered a relapse before treatment and two during treatment. Eight patients developed eosinophilia. The expression of cytokines and transcription factors did not change.
CONCLUSIONS: In a small group of relapsing multiple sclerosis patients, Trichuris suis oral therapy was well tolerated but without beneficial effect.
Trichuris Suis is the pig whipworm and some neuros have been infecting MSers with them. The idea comes from people supporting the hygiene hypothesis so by infecting people with worm eggs it would drive a disease-causing TH1/Th17 response to an immunosuppressive Th2 response blocking MS. In this study the people infected produced eosinophils, which are a cell that kills parasites and is indicative of the Th2 type response. However, there was no evidence that MS was suppressed.
This study is not the only one ongoing and there are othersRosche B, Wernecke KD, Ohlraun S, Dörr JM, Paul F.Trichuris suis ova in relapsing-remitting multiple sclerosis and clinically isolated syndrome (TRIOMS): study protocol for a randomized controlled trial. Trials. 2013;14:112. doi: 10.1186/1745-6215-14-112.
Some claim benefit but is this "regression to the mean" Fleming JO, Isaak A, Lee JE, Luzzio CC, Carrithers MD, Cook TD, Field AS, Boland J, Fabry Z. Probiotic helminth administration in relapsing-remitting multiple sclerosis: a phase 1 study. Mult Scler. 2011;17(6):743-54
Studies in EAE have been used to build up the idea Th1 response bad, TH2 (&B cell response good. This may work with an immune response that only lasts 2-3 weeks and generates before pathogenic antibodies are around to cause problems as occurs in most EAE models. But we work with EAE that doesn't fizzle out after one attack and B cell responses become more prominent with time. The mantra we have worked to is TH1 bad and TH2 ( & B Cell) response bad too. We don't want either.
As I have said before and will say again, Throughout the 1980's and before, worm infections were common place in most University animal houses and there was no problem with animals getting EAE, so maybe worm eggs are not that good as immune modulators?