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Pig worms to treat autoimmune diseases

4th September 2012

Swallowing the eggs of an intestinal parasite that usually affects pigs could be the next new treatment for auto-immune disorders like rheumatoid arthritis or Crohn's disease.

arthritis

A US company, Coronado Biosciences, has developed a medicine consisting of thousands of eggs harvested from pig manure belonging to the porcine whipworm, suspended in a tablespoon of saline solution.

The treatment makes use of the theory that parasites, now largely absent from the insides of humans in richer countries, once played a crucial role in educating our immune systems.

The whipworm eggs cannot take hold in humans, only in pigs, and may cause intestinal side-effects like diarrhoea. But they appear during that time to have the ability to modulate the immune system of someone suffering from one of the dozens of disorders that prompt the human immue system to attack the body's own tissues.

According to Joel Weinstock, chief of gastroenterology and hepatology at Tufts Medical Center in Boston and an adviser to Coronado, the new drug has the potential both to treat autoimmune conditions, and to further the advancement of medical knowledge.

Coronado's German partner, Dr. Falk Pharma GmbH, is about to begin a phase II clinical trial of the drug, known as trichuris suis ova (TSO), enrolling 220 patients with Crohn's disease to test the new treatment.

Half of the group will receive 7,500 pig whipworm eggs once a fortnight, while the other half will get a placebo.

If TSO is a success, it will enter a multibillion market niche already inhabited by Amgen and Abbott Laboratories.

Autoimmune drugs sales, which stood at US$34 billion in 2010, are projected to show strong growth over the next few years.

Crohn's disease is a bowel disorder affecting 700,000 people in the US alone, while rheumatoid arthritis affects a further 1.3 million. An estimated 7.5 million suffer from psoriasis.

Weinstock, along with a research team at the University of Iowa developed the idea for TSO based on the "hygiene hypothesis," which holds that higher hygiene standards in richer parts of the world have denied the human immune system contact with millions of different organisms, including viruses, bacteria and worms.

These enter the body and teach the immune system to recognise and fight disease, a process which is curtailed from birth in higher-income families at pains to create a germ-free environment.

According to medicine, microbiology and immunobiology professor Dennis Kasper, who was not involved in the study, microbes and humans have evolved together and adapted to each other, and are used by humans to stimulate our immune systems.

Nowadays, antibacterial soaps, detergents and sanitiser gels keep many of them beyond the reach of many people.

Previous research has identified a strong link between income levels in countries and social groups and a higher incidence of autoimmune disorders.

Weinstock and others believe that the rise in such disorders could be linked to the disappearance from the human gut of certain intestinal parasites, affecting people's ability to modulate their own immune systems.

Currently, Amgen's Enbrel and Abbott's Humira are the main injectable drugs available to patients with an autoimmune disease, but they depress the immune system and render those who take them vulnerable to other infections, and even some cancers.

According to Coronado's chief executive officer, Bobby Sandage Jr., the company's pig whipworm eggs result in no permanent infection and no long-lasting side-effects.

However, patients would theoretically need to keep taking TSO in order to maintain the effects.


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