INFLAMMATORY BOWEL DISEASE

Trichuris suis therapy in Crohn’s disease

R W Summers¹, D E Elliott¹, J F Urban, Jr², R Thompson¹ and J V Weinstock¹

¹ James A Clifton Center for Digestive Diseases, Department of Internal Medicine, University of Iowa Roy J and Lucille Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
² Nutrient Requirements and Functions Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, Maryland, USA

Correspondence to:
Correspondence to:
Dr R W Summers
James A Clifton Center for Digestive Diseases, Department of Internal Medicine, University of Iowa Roy J and Lucille A Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA; robert-summers{at}uiowa.edu

Background: Crohn’s disease is common in highly industrialised Western countries where helminths are rare and uncommon in less developed areas of the world where most people carry worms. Helminths diminish immune responsiveness in naturally colonised humans and reduce inflammation in experimental colitis. Thus exposure to helminths may help prevent or even ameliorate Crohn’s disease.

Aims: The aim of the study was to determine the safety and possible efficacy of the intestinal helminth Trichuris suis in the treatment of patients with active Crohn’s disease.

Patients: Twenty nine patients with active Crohn’s disease, defined by a Crohn’s disease activity index (CDAI) 220 were enrolled in this open label study.

Methods: All patients ingested 2500 live T suis ova every three weeks for 24 weeks, and disease activity was monitored by CDAI. Remission was defined as a decrease in CDAI to less than 150 while a response was defined as a decrease in CDAI of greater than 100.

Results: At week 24, 23 patients (79.3%) responded (decrease in CDAI >100 points or CDAI <150) and 21/29 (72.4%) remitted (CDAI <150). Mean CDAI of responders decreased 177.1 points below baseline. Analysis at week 12 yielded similar results. There were no adverse events.

Conclusions: This new therapy may offer a unique, safe, and efficacious alternative for Crohn’s disease management. These findings also support the premise that natural exposure to helminths such as T suis affords protection from immunological diseases like Crohn’s disease.

Abbreviations: CDAI, Crohn’s disease activity index; 6-MP, 6-mercaptopurine; DNBS, ditrinitrobenzene sulphonic acid; TNBS, trinitrobenzene sulphonic acid

Keywords: Crohn’s disease; inflammatory bowel disease; helminths; immunomodulatory; Trichuris suis

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