Who Is Affected By Ulcerative Colitis
Ulcerative colitis is a disease that occurs in developed nations, and is more common in cities than in the countryside. Approximately 1 million people in the U.S. suffer from ulcerative colitis. Individuals with ulcerative colitis usually develop the disease between ages 15 and 25 although the disease may begin at any age. There seems to be a genetic component since ulcerative colitis is more common among relatives of individuals with ulcerative colitis. Caucasians and individuals of eastern European Jewish descent are more likely to develop ulcerative colitis.
Definition Of Ulcerative Colitis
Ulcerative Colitis is a bowel disorder characterized by inflammation of colonic cells and development of multiple ulcerations. Due to shedding of cells in the colon, bleeding may occur and abscesses may form. The highest prevalence of ulcerative colitis is noted among Caucasians and individuals of Jewish descent. Clinical manifestations of ulcerative colitis include lower quadrant abdominal pain, intermittent diarrhea, rectal bleeding and tenesmus .
Probiotic Treatment Of Ulcerative Colitis Patients With Trichuris Suis Ova
Previous studies with administration of Trichuris suis eggs , the whipworm of pigs, have in a smaller number of volunteers, shown that this treatment can reduce inflammation in patients with intestinal bowel diseases with few and mild side effects. It is known that TSO can re-program and normalize specific parts of the host immune defence that causes inflammation. The project also seeks to demonstrate a hypothesis that TSO will stimulate the natural gut microorganisms, in a way that they outcompete the bacteria known to be associated with the intestinal inflammation.
Patients are followed clinically for 24 weeks, during which period we will follow the immunological profile of the patients and perform detailed DNA mapping of the gut microbiome by next generation sequencing.
The TSO treatment is simply administered orally, and if the project is successful this probiotic treatment will represent a useful natural biological alternative to conventional treatment of IBD.
The project is approved by the Danish Medicinal Agency, The Danish Data Agency and Videnskabsetisk Komité
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Influence Of Nod2 Variants On Trichuris Suis Ova Treatment Outcome In Crohns Disease
- 1Dr. Margarete Fischer Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
- 2University of Tübingen, Tübingen, Germany
- 3Goethe University Frankfurt, Frankfurt, Germany
- 4Department of Internal Medicine I, University of Tübingen, Tübingen, Germany
- 5Department of Clinical Pharmacology, University of Tübingen, Tübingen, Germany
- 6Department of Pharmacy and Biochemistry, University of Tübingen, Tübingen, Germany
A recent randomized study of whipworm Trichuris suis ova in ileal Crohns disease failed to demonstrate a clinical benefit compared to placebo after 12 weeks. Nonetheless, it has recently been shown that the spontaneous small intestinal inflammatory changes in Nod2-/- mice could be substantially ameliorated when these mice were colonized by Trichuris muris. Those and complementary epidemiologic findings in humans lead to the hypothesis that helminths may be advantageous only in patients carrying defective NOD2 variants. Thus, 207 participants of the TSO trial were retrospectively genotyped for six functional NOD2 genetic variants to evaluate whether the treatment outcome differed in patients carrying NOD2 variants. We observed no significant association of the NOD2 variants or their haplotypes with clinical outcome after TSO treatment.
What Is Ulcerative Colitis
Large intestine ulcers, or ulcerative colitis , are caused by irritation and inflammation in the large intestine. The condition is part of the inflammatory bowel disease group. Symptoms include diarrhea, cramping, and urgency.
These symptoms can also wake you up in the middle of the night to use the bathroom. Inflammation and location determine the severity of UC. Each person experiences it differently.
Depending on the size of the colon or how severe the inflammation is, you could have severe inflammation in the rectum . Approximately half of all ulcerative colitis patients have mild symptoms.
In most cases, ulcerative colitis begins between the ages of 15 and 30, and significantly less frequently between the ages of 50 and 70. Women and men are equally affected.
It appears to run in families, with up to 20 percent of people with ulcerative colitis or Crohns disease having family members with the disease. About 20% of children are diagnosed with it before the age of 20 and it can even occur in toddlers.
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Drugs For Ulcerative Colitis
Therapy of ulcerative colitis intends to lower the swelling in the colon. The inflammation-reducing medications with one of the most considerable experience are the aminosalicylates, medications that belong to pain killers. If aminosalicylates are inefficient, corticosteroids are utilized. A 3rd sort of medicine that is utilized is immunomodulators, medications that lower the immune reaction and also thus the swelling. It might take numerous weeks to months for the medications to come to be maximally efficient. Biologics like adalimumab and also others target healthy proteins generated by the body immune system.
Trichuris Suis Detection By Pcr
Tissue samples were collected after euthanasia and immediately snap-frozen in N2. Samples were sent to IBR Inc for detection by PCR. Primers for the ITS2 gene were used . Primers are based on the T.suis specific internal transcribed spacers 1-5.8S-ITS2 segment of the ribosomal DNA. The ITS2 copy number is proportional to the number of T. suis larvae.
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Ulcerative Colitis In Children
Children with ulcerative colitis that is not controlled often grow more slowly than normal, and may end up shorter than they would have. This occurs because when there is active inflammation, appetite is reduced and an insufficient amount of food is eaten. It may be necessary to recommend high calorie diets or even augment the diet with supplements. Children with psycho-social problems because of their disease may need a therapist to help them develop strategies to cope with the disease.
Euthanasia And Organ Sampling
Euthanasia was performed on day 35 with 150mg/kg Pentobarbital i.v. in deeply sedated animals .
The abdominal cavity was exposed by a midline laparotomy and samples were collected from the ileum, jejunum, duodenum, caecum and colon. For RNA extraction and myeloperoxidase activity analysis, the excised samples were opened by a longitudinal incision and rinsed with cold PBS. One cm2 sections of the caecum were extensively washed with cold PBS until complete removal of the luminal content. The samples were immediately snap-frozen in liquid nitrogen and stored at 80°C until analysis. For histology, samples were collected. The samples were carefully washed and fixed with phosphate buffered 10% formalin solution. For RNA isolation, caecal samples were extensively washed with cold PBS and stored on ice in 5% BSA in PBS until further processing.
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Relative Efficacy And Side Effects Of Helminthic Therapy
The potential benefits of Helminthic Therapy are even more startling when taken in the context of the success rates and side-effects experienced by people on currently accepted medications that are immune-modulating and or anti-inflammatory. Success rates for helminthic therapy, as measured by the number of people achieving remission range from 56% for Ulcerative Colitis using TSO as the helminth, 72% for Crohn’s using TSO, and 100% for Crohn’s disease using hookworm. Contrast that with the remission rates for the new biologicals as described below, in one study sponsored by the drug maker, Humira achieved only a 52% remission rate in Crohn’s patients. As well, side effects of helminthic therapies are not universal and are temporary, usually lasting only two to four weeks. They consist of abdominal pain, cramping, gas, diarrhea and fatigue. The side effects of conventional immune-modulating drugs, such as Beta-interferon and Remicade, or of anti-inflammatories such prednisone, are much more severe and potentially harmful. As with any immunosuppressive therapies patients more susceptible to certain infectious diseases.
Living With Uc: Reducing Flares
There are few non-drug, controllable factors that can reduce the symptoms of ulcerative colitis. Stress reduction is important although it probably makes the symptoms seem less severe without actually reducing them. Of course, it is of utmost importance for patients to take their medications regularly and not miss doses. Although smoking can reduce the inflammation of ulcerative colitis, smoking cannot be recommended as treatment because of its many other detrimental effects.
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Worms The Natural Cure
In nature, whipworm infections usually spread areas with poor sanitation, when fecal matter gets back into the soil. Mild infections can be asymptomatic, but more severe cases usually result in bloody diarrhea, and in rare cases, a prolapsed rectum, said Loke. More than 20 percent of patients end up having a colectomy in which a portion of the colon must be removed.
While whipworm infection is endemic in Asia, Africa and Latin America, it is rare in North America and northern Europe, where sewage systems generally interrupt transmission. Colitis, on the other hand, is generally nonexistent in those regions with widespread exposure, leading researchers to hypothesize that childhood exposure to these parasites might offer gastrointestinal protection against inflammatory bowel disease.
So far, the research has supported this theory, though the long-term safety of actively infecting patients with the worm is still unknown.
Because current medications for colitis and other bowel disorders are harsh, expensive and can come with negative side effects, people may see whipworms as a more natural, gentle solution, Mullin said, but these parasites carry their own risks.
So while this patient’s case study serves as a valuable educational tool for researchers, a whipworm cocktail is not advised for people living with colitis, doctors warned.
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Living With Uc: Supplements
The bleeding caused by ulcerative colitis may lead to iron deficiency anemia due to the loss of the body’s store of iron in the red blood cells that are lost into the colon. Iron supplementation may be necessary. Medications used to treat ulcerative colitis may reduce the absorption of nutrients such as folic acid and calcium. Supplements of vitamins and minerals may be necessary.
New Hints On How Helminth Worms Heal Ulcerative Colitis
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A 34-year-old Northern California man with ulcerative colitis who decided to treat himself by swallowing parasitic worms has provided new information about how the worms might help to soothe and heal a variety of intestinal inflammations, researchers reported Wednesday. A growing body of evidence suggests that several different types of parasitic worms might be useful in treating such disorders, but there has been little evidence about how the worms might bring about positive changes. By allowing doctors to monitor changes in his immune system following ingestion of the worms, the man has provided the first clues about that mechanism.
After tests in mice, Weinstock and his colleagues had four patients with Crohns and two with ulcerative colitis drink a solution containing eggs of the pig whipworm , which frequently infects pig farmers but normally does not cause illness in humans. Five of the subjects went into remission and the sixth improved substantially.
In 2005, Weinstock published results from two clinical trials. In one, 23 of 29 Crohns patients responded positively to the worms and 21 went into complete remission. In the second, 13 of 30 ulcerative colitis patients improved after receiving the eggs.
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Helminth Characteristics Required For Use In Therapy
For use as a therapeutic agent, the specific helminth should meet all the following minimum requirements:
Man Doses Himself With A Parasite For Intestinal Problems
A California man doses himself with a parasite and cures his colitis.
Dec. 2, 2010& #151 — Catching an intestinal parasite is not usually considered desirable, but for a California man with severe gastrointestinal problems, dosing himself with worms was the answer to his prayers.
After reading preliminary research that suggested a whipworm found in pigs could help those with ulcerative colitis, the 34-year-old patient tracked down and ingested eggs from Trichuris trichiura, a similar roundworm that infects humans, in hopes of easing his own colitis.
After a few months, the abdominal pain and bloody diarrhea associated with the patient’s ulcerative colitis improved dramatically, and after a second “booster” dose of worm eggs, he remains in remission more than four years later.
In hopes of better understanding how certain parasitic worms can be used to heal, doctors at New York University Langone Medical Center ran extensive testing on this man, the results of which were published Wednesday in Science Translational Medicine.
“Essentially this patient has been in remission for several years, with no other medication. For this individual, the goal is to remain infected for the rest of his life, but it’s hard to know if that’s a viable strategy for everyone. We don’t have a good understanding of the risk,” said P’ng Loke, assistant professor of medical parasitology at NYU Langone Medical Center and lead author of the study.
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Living With Uc: Diet Changes
Although it has not been found that diet has an effect on ulcerative colitis, it generally is recommended that patients eliminate any foods that they find are making their symptoms worse. For example, milk in people with UC who are intolerant to the sugar in milk, lactose, may be causing gastrointestinal symptoms such as abdominal bloating, flatulence, and diarrhea, symptoms that may overlap with those of ulcerative colitis. Despite not being the cause of the ulcerative colitis, eliminating milk may improve gastrointestinal symptoms in these people. It is important to be sure that the diet is nutritionally adequate, and this may require the assistance of a dietician.
Study Design And Setting
This was a randomised, double-blind, placebo-controlled, multicentre Phase II study undertaken to evaluate the efficacy and safety of three different dosages of TSO versus placebo in mildly-to-moderately active CD patients. The study was performed during November 2010 to February 2014 at 53 hospitals or private practices in Austria , Czech Republic , Denmark , Germany , and Switzerland . The study was conducted in accordance with the International Conference on Harmonisation Guideline for Good Clinical Practice and was approved by independent ethics committees for each centre.
The study comprised a 710-day screening phase, a 12-week double-blind treatment phase with eight visits: Weeks 0 , 1, 2, 4, 6, 8, 10, and 12 , and a follow-up visit, which took place 4 weeks after the EoT visit.
The study was conducted with four treatment groups in the form of a parallel group comparison. The primary objective was to demonstrate the superiority of any of the three TSO dosing groups compared with placebo for the induction of clinical remission in CD.
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What Are The Risks
Over time, the worms may cause dangerous side effects. These include increased risk for anemia. A protein deficiency may also develop, leading to difficulty in the ability to think, and stunting physical growth in some patients.
Medications are available to offset these side effects. People undergoing helminthic therapy may also be prescribed iron supplements for anemia.
A 2017 study tested how whipworm affected 252 people with Crohns disease. The study showed that dosing study subjects over 12 weeks was safe, but there was no clinical difference in remission rates between the people who received the whipworm and the people who received the placebo.
Additional research is needed to determine to clearly establish the safety and effectiveness of this treatment.
Tso Influence The Faecal And Caecal Microbiota
The immune-effect of intestinal helminths has been linked to the modulation of intestinal microbiota Since T. suis resides in close contact with caecal commensal bacteria, we hypothesized that TSO administration might be associated with distinct changes in the bacterial community in the caecum and, as a consequence, in the faeces. We therefore assessed how T. suis influences the microbial community in healthy and colitic rabbits.
In faeces, DSS treatment caused a statistically significant decrease in both richness and Shannon diversity,. This loss of richness and diversity was significantly reduced by pre-treatment with TSO .
TSO partially prevents the DSS induced shift in gut microbiota composition. Microbiota richness in caecum and faeces as assessed by abundance based coverage estimator, . PCoA ordination based on Bray-Curtis dissimilarities show shifts in community composition for caecal and faecal samples in response to DSS treatment in immunocompetent animals. The percentage of variation explained is given in parentheses, Increasing distance in two-dimensional space represents increasingly dissimilar communities.*P< 0.05, one-sided p-Value, Mann-Whitney test relative to vehicle water control. Dots represent single animals n=78 animals per group, bars represent mean±SEM.
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