Parazitlerin alternatif tedavi yöntemi olarak kullanımları

Son yıllarda gelişen endüstri ve teknolojiyle birlikte bağışıklık sistemiyle ilgili hastalıklarda bir artış yaşanmaktadır. Özellikle hijyen ve sanitasyon kavramlarını bir yaşam biçimi haline getiren toplumlarda inflamatuar barsak hastalığı, multiple skleroz ve astım benzeri hastalıklarda bu artış belirgindir. Sanitasyonun artması parazitik hastalıklarda ise belirgin bir düşüşü beraberinde getirmiştir. Oysa yapılan epidemiyolojik çalışmalarda özellikle sestodlarla infekte kişilerde daha az immun sistem hastalıklarına rastlanmıştır. Farelerde yapılan çalışmalarda da helment infeksiyonuna sahip farelerin kolit, ensefalit, tip 1 diyabet ve astım gibi hastalıklara yakalanmadıkları gözlenmiştir. Benzeri klinik çalışmalarla da helment verilmesinin ülseratif kolit ve Crohn hastalığının aktivitesinde azalmaya neden olduğu gösterilmiştir. Bu makalede helmentlerle immun yanıt hastalıkları arasındaki ilişkinin tedavi edici düzeylerde olma olasılıklarını araştıran çalışmalar derlenmiştir. Ancak bu konuda hâlâ çok sayıda araştırmaya ihtiyaç bulunmaktadır.

Usage of parasites as alternative therapy

In recent years, with developing technologies and industrialization in most countries, a distinct increase was seen in auto-immune diseases. Especially, hygiene and sanitization concepts were considered where as a common life style, inflammatory bowel disease, multiple sclerosis and asthma become important public health problems. Also, hyper-sanitization eradicates most common gastrointestinal parasites in industrialized countries. In some epidemiological studies found certain evidences that especially in cestods infections are rare to get auto-immune diseases. In mice models, it is shown that in helminthic infections auto-immune diseases are always asymptomatic or in extinct mode. Similar evidences also found in human cases. It is also found that a dramatic healing is seen in ulcerative colitis and Crohns disease when helminthic ova are given by ingestion. In this review, the relation between auto-immune diseases and helminthic infections were investigated. Although there are more elaborated studies needed, helminthic therapy can be considered as an alternative therapy method for auto-immune diseases.

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1. Beer RJ. The relationship between Trichuris trichiura (Linnaeus 1758) of man and Trichuris suis (Schrank 1788) of the pig, Res Vet Sci 1976;20(1):47-54. PMid:1257627
2. Braman SS. The global burden of asthma, Chest 2006;130(1 Suppl):S4-12. http://dx.doi.org/10.1378/chest.130.1_suppl.4S PMid:16840363
3. Büning J, Homann N, von Smolinski D et al. Helminths as governors of inflammatory bowel disease, Gut 2008;57(8):1182-3. http://dx.doi.org/10.1136/gut.2008.152355 PMid:18628388
4. Correale J, Farez M. Association between parasite infection and immune responses in multiple sclerosis, Ann Neurol 2007;61(2):97-108. http://dx.doi.org/10.1002/ana.21067
5. Croese J, Oneil J, Masson J et al. A proof of concept study establishing Necator americanus in Crohns patients and reservoir donors, Gut 2006;55(1):136-7. http://dx.doi.org/10.1136/gut.2005.079129 PMid:16344586 PMCid:1856386
6. Elliott DE, Li J, Blum A et al. Exposure to schistosome eggs protects mice from TNBS-induced colitis, Am J Physiol Gastrointest Liver Physiol 2003;284(3):G385-91. http://dx.doi.org/10.1152/ajpgi.00049.2002 PMid:12431903
7. Elliott DE, Setiawan T, Metwali A, Blum A, Urban JF Jr, Weinstock JV. Heligmosomoides polygyrus inhibits established colitis in IL-l0-deficient mice, EurJ Immunol 2004;34(10):2690-8. http://dx.doi.org/10.1002/eji.200324833 PMid:15368285
8. Elliott DE, Urban JF JR, Argo CK, Weinstock JV. Does the failure to acquire helminthic parasites predispose to Crohns disease? FASEB J 2000;14(12):1848-55. http://dx.doi.org/10.1096/fj.99-0885hyp
9. Elliott DE, Weinstock JV. Helminthic therapy: Using worms to treat immune-mediated disease, Fallon PG (ed). Advances in Experimental Medicine and Biology: Pathogen-derived Immunomodulatory Molecules kitabında s.157-64, Springer Science LLC, New York (2009).
10. Fleming JO, Cook TD. Multiple sclerosis and the hygiene hypothesis, Neurology 2006;67(11):2085-6. http://dx.doi.org/10.1212/01.wnl.0000247663. 40297.2d PMid:17159130
11. Hunter MM, Wang A, McKay DM. Helminth infection enhances disease in a murine TH2 model of colitis, Gastroenterology 2007;132(4):1320-30. http://dx.doi.org/10.1053/j.gastro.2007.01.038 PMid:17408663
12. La Flamme AC, Ruddenklau K. Bäckström BT. Schistosomiasis decreases central nervous system inflammation and alters the progression of experimental autoimmune encephalomyelitis, Infect Immun 2003;71(9):4996-5004. http://dx.doi.org/10.1128/IAI.71.9.4996-5004.2003 PMid:12933842 PMCid:187318
13. Lakatos L, Mester G, Erdelyi Z et al. Striking elevation in incidence and prevalence of inflammatory bowel disease in a province of western Hungary between 1977-2001, World J Gastroenterol 2004;10(3):404-9. PMid:14760767
14. Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence and environmental influences, Gastroenterology 2004; 126(6):1504-17. http://dx.doi.org/10.1053/j.gastro.2004.01.063 PMid:15168363
15. Mangan NE, van Rooijen N, McKenzie AN, Fallon PG. Helminth-modified pulmonary immune response protects mice from allergen-induced airway hyperresponsiveness, J Immunol 2006;176(1):138-47. PMid:16365404
16. Mansfield LS, Gauthier DT, Abner SR et al. Enhancement of disease and pathology by synergy of Trichuris suis and Campylobacter jejuni in the colon of immunologically naive swine, Am J Trop Med Hyg 2003;68(3):70-80.
17. Marrie RA. Environmental risk factors in multiple sclerosis aetiology, Lancet Neurol 2004;3(12):709-18. http://dx.doi.org/10.1016/S1474-4422(04)00933-0
18. Maxwell C, Hussain R, Nutman TB et al. The clinical and immunologic responses of normal human volunteers to low dose hookworm (Necator americanus) infection, Am J Trop Med Hyg 1987; 37(1):126-34. PMid:3605493
19. Melendez AJ, Harnett MM, Pushparaj PN et al. Inhibition of Fc epsilon RI-mediated mast cell responses by ES-62, a product of parasitic filarial nematodes, Nat Med 2007;13(11):1375-81. http://dx.doi.org/10.1038/nm1654 PMid:17952092
20. Metwali A, Setiawan T, Blum AM et al. Induction of CD8 + regulatory T cells in the intestine by Heligmosomoides polygyrus infection, Am J Physiol Gastrointest Liver Physiol 2006;291(2):G253-9. http://dx.doi.org/10.1152/ajpgi.00409.2005 PMid:16825660
21. Mitreva M, Blaxter ML, Bird DM, McCarter JP. Comparative genomics of nematodes, Trends Genet 2005;21(10):573-81. http://dx.doi.org/10.1016/j.tig.2005.08.003 PMid:16099532
22. Mortimer K, Brown A, Feary J et al. Dose-ranging study for trials of therapeutic infection with Necator americanus in humans, Am J Trop Med Hyg 2006;75(5):914-20. PMid:17123987
23. Onkamo P, Vaananen S, Karvonen M, Tuomilehto J. Worldwide increase in incidence of type I diabetes-the analysis of the data on published incidence trends, Diabetologia 1999;42(12):1395-403. http://dx.doi.org/10.1007/s001250051309 PMid:10651256
24. Schnoeller C, Rausch S, Pillai S et al. A helminth immunomodulator reduces allergic and inflammatory responses by induction of IL-10 producing macrophages, J Immunol 2008;180(6):4265-72. PMid:18322239
25. Scrivener S, Yemaneberhan H, Zebenigus M et al. Independent effects of intestinal parasite infection and domestic allergen exposure on risk of wheeze in Ethiopia: a nested case-control study, Lancet 2001;358(9292):1493-9. http://dx.doi.org/10.1016/S0140-6736(01)06579-5
26. Sewell D, Qing Z, Reinke E et al. Immuno-modulation of experimental autoimmune encephalomyelitis by helminth ova immunization, Int Immunol 2003;15(1):59-69. http://dx.doi.org/10.1093/intimm/dxg012 PMid:12502726
27. Siegel CA, Hur C, Korzenik JR, Gazelle GS, Sands BE. Risks and benefits of infliximab for the treatment of Crohns disease, Clin Gastroenterol Hepatol 2006;4(8):1017-24. http://dx.doi.org/10.1016/j.cgh.2006.05.020 PMid:16843733
28. Summers RW, Elliott DE, Qadir K, Urban JF Jr, Thompson R, Weinstock JV. Trichuris suis seems to be safe and possibly effective in the treatment of inflammatory bowel disease, Am J Gastroenterol 2003;98(9):2034-41. http://dx.doi.org/10.1111/j.1572-0241.2003.07660.x PMid:14499784
29. Summers RW, Elliot DE, Urban JF Jr et al. Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial, Gastroenterology 2005; 128(4):825-32. http://dx.doi.org/10.1053/j.gastro.2005.01.005 PMid:15825065
30. van den Biggelaar AH, van Ree R, Rodrigues LC et al. Decreased atopy in children infected with Schistosoma haematobium: a role for parasite-induced interleukin-10, Lancet 2000;356(9243): 1723-7. http://dx.doi.org/10.1016/S0140-6736(00)03206-2
31. Zaccone P, Fehervari Z, Jones FM et al. Schisto-soma mansoni antigens modulate the activity of the innate immune response and prevent onset of type 1 diabetes, Eur J Immunol 2003;33(5):1439-49. http://dx.doi.org/10.1002/eji.200323910 PMid:12731071