Helminths as an alternative therapy for intestinal diseases

Abstract

Animal models and clinical studies have shown that helminth infections exert immunomodulatory activity, altering intestinal permeability and providing a potential beneficial action on autoimmune and inflammatory disorders in human beings, such as inflammatory bowel disease (IBD) and celiac disease. This is consistent with the theory that intestinal microbiota is responsible for shaping human immunological responses. With the arrival of the immunobiologic era and the use of antibodies, we propose a distinctive pathway for treating patients with IBD and celiac disease. We have some evidence about the safety and tolerability of helminth use, but evidence about their impact on disease activity is lacking. Using worms to treat diseases could be a possible way to lower treatment costs, since the era of immunobiologic agents is responsible for a significant rise in expenses. Some questions remain to be investigated regarding the use of helminths in intestinal disease, such as the importance of the specific species of helminths used, appropriate dosing regimens, optimal timing of treatment, the role of host genetics, diet, environment, and the elucidation of the exact mechanisms of action. One promising approach is the use of helminth-derived anti-inflammatory molecules as drugs. Yet there are still many challenges with this method, especially with regard to safety. Studies on intestinal permeability point to Strongyloides stercoralis as a useful nematode for these purposes.

Keywords: Helminths, Strongyloidiasis, Immunology, Inflammation, Inflammatory bowel diseases, Intestinal diseases, Intestinal permeability, Celiac disease

Core tip: Inflammatory bowel disease and celiac disease are immune-mediated pathologies that remain a treatment challenge for gastroenterologists. Despite the recent introduction of novel therapies, notably biological agents and newer management strategies, there are still many patients who do not respond, or have a poor response to current treatments. Helminth therapy seems a promising pathway to newer drugs, because it has been proven to alter intestinal permeability, altering the host’s immune response to a Type 2 cytokine-mediated response in animal models and pre-clinical studies. This editorial aims to stimulate further research in this field, hoping for better care for our patients.