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Parker W, Patel E, Jirků-Pomajbíková K, Laman JD. COVID-19 morbidity in lower versus higher income populations underscores the need to restore lost biodiversity of eukaryotic symbionts. iScience 2023; 26:106167. [PMID: 36785786 PMCID: PMC9908430 DOI: 10.1016/j.isci.2023.106167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
The avoidance of infectious disease by widespread use of 'systems hygiene', defined by hygiene-enhancing technology such as sewage systems, water treatment facilities, and secure food storage containers, has led to a dramatic decrease in symbiotic helminths and protists in high-income human populations. Over a half-century of research has revealed that this 'biota alteration' leads to altered immune function and a propensity for chronic inflammatory diseases, including allergic, autoimmune and neuropsychiatric disorders. A recent Ethiopian study (EClinicalMedicine 39: 101054), validating predictions made by several laboratories, found that symbiotic helminths and protists were associated with a reduced risk of severe COVID-19 (adjusted odds ratio = 0.35; p<0.0001). Thus, it is now apparent that 'biome reconstitution', defined as the artificial re-introduction of benign, symbiotic helminths or protists into the ecosystem of the human body, is important not only for alleviation of chronic immune disease, but likely also for pandemic preparedness.
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Affiliation(s)
| | | | - Kateřina Jirků-Pomajbíková
- Institute of Parasitology, Biology Centre, Czech Academy of Sciences, 370 05 České Budějovice, Czech Republic
- Faculty of Science, University of South Bohemia, 370 05 České Budějovice, Czech Republic
| | - Jon D. Laman
- Department of Pathology and Medical Biology, University Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Socio-medical studies of individuals self-treating with helminths provide insight into clinical trial design for assessing helminth therapy. Parasitol Int 2021; 87:102488. [PMID: 34737071 DOI: 10.1016/j.parint.2021.102488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/22/2022]
Abstract
The virtually complete loss of intestinal worms, known as helminths, from Western society has resulted in elimination of a range of helminth-induced morbidities. Unfortunately, that loss has also led to inflammation-associated deficiencies in immune function, ultimately contributing to widespread pandemics of allergies, autoimmunity, and neuropsychiatric disorders. Several socio-medical studies have examined the effects of intentional reworming, or self-treatment with helminths, on a variety of inflammation-related disorders. In this study, the latest results from ongoing socio-medical studies are described. The results point toward two important factors that appear to be overlooked in some if not most clinical trials. Specifically, (a) the method of preparation of the helminth can have a profound effect on its therapeutic efficacy, and (b) variation between individuals in the effective therapeutic dosage apparently covers a 10-fold range, regardless of the helminth used. These results highlight current limits in our understanding of the biology of both hosts and helminths, and suggest that information from self-treatment may be critical for clinical evaluation of the benefits and limits of helminth therapy.
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Parker W, Sarafian JT, Broverman SA, Laman JD. Authors' response to Graham Rook's commentary. Evol Med Public Health 2021; 9:206-207. [PMID: 34168879 PMCID: PMC8219120 DOI: 10.1093/emph/eoab012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- William Parker
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Joshua T Sarafian
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Sherryl A Broverman
- Department of Biology and the Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jon D Laman
- Department of BSCS, University Medical Center Groningen, Groningen, The Netherlands
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Parker W, Sarafian JT, Broverman SA, Laman JD. Between a hygiene rock and a hygienic hard place: Avoiding SARS-CoV-2 while needing environmental exposures for immunity. Evol Med Public Health 2021; 9:120-130. [PMID: 33732461 PMCID: PMC7928958 DOI: 10.1093/emph/eoab006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/01/2020] [Indexed: 12/13/2022] Open
Abstract
Suboptimal understanding of concepts related to hygiene by the general public, clinicians and researchers is a persistent problem in health and medicine. Although hygiene is necessary to slow or prevent deadly pandemics of infectious disease such as coronavirus disease 2019 (COVID-19), hygiene can have unwanted effects. In particular, some aspects of hygiene cause a loss of biodiversity from the human body, characterized by the almost complete removal of intestinal worms (helminths) and protists. Research spanning more than half a century documents that this loss of biodiversity results in an increased propensity for autoimmune disease, allergic disorders, probably neuropsychiatric problems and adverse reactions to infectious agents. The differences in immune function between communities with and communities without helminths have become so pronounced that the reduced lethality of severe acute respiratory syndrome coronavirus 2 in low-income countries compared to high-income countries was predicted early in the COVID-19 pandemic. This prediction, based on the maladaptive immune responses observed in many cases of COVID-19 in high-income countries, is now supported by emerging data from low-income countries. Herein, hygiene is subdivided into components involving personal choice versus components instituted by community wide systems such as sewage treatment facilities and water treatment plants. The different effects of personal hygiene and systems hygiene are described, and appropriate measures to alleviate the adverse effects of hygiene without losing the benefits of hygiene are discussed. Finally, text boxes are provided to function as stand-alone, public-domain handouts with the goal of informing the public about hygiene and suggesting solutions for biomedical researchers and policy makers. Lay Summary: Hygiene related to sewer systems and other technology can have adverse effects on immune function, and is distinct from personal hygiene practices such as hand washing and social distancing. Dealing with the drawbacks of hygiene must be undertaken without compromising the protection from infectious disease imposed by hygiene.
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Affiliation(s)
- William Parker
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Joshua T Sarafian
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Sherryl A Broverman
- Department of Biology and the Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jon D Laman
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, The Netherlands
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Villeneuve C, Kou HH, Eckermann H, Palkar A, Anderson LG, McKenney EA, Bollinger RR, Parker W. Evolution of the hygiene hypothesis into biota alteration theory: what are the paradigms and where are the clinical applications? Microbes Infect 2018; 20:147-155. [DOI: 10.1016/j.micinf.2017.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/30/2017] [Accepted: 11/02/2017] [Indexed: 12/26/2022]
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Intestinal worms eating neuropsychiatric disorders? Apparently so. Brain Res 2018; 1693:218-221. [PMID: 29402395 DOI: 10.1016/j.brainres.2018.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/15/2018] [Accepted: 01/19/2018] [Indexed: 01/05/2023]
Abstract
A number of factors in Western society, including inflammatory diets, sedentary lifestyles, vitamin D deficiency and chronic psychological stress, are known to induce inflammation and to be associated with neuropsychiatric disorders. One factor that is emerging as a potential inflammation inducing factor is biota depletion, or loss of biodiversity from the ecosystem of the human body as a result of industrialization. Originally known as the "hygiene hypothesis", biota alteration theory describes the effects of biota alteration on the human immune system. Work on this topic has pinpointed depletion of helminths as a key loss to the body's ecosystem in Western society, and suggests that some exposure to helminths, ubiquitous prior to the modern era, may be necessary for normal immune system development. Socio-medical studies of humans "self-treating" with helminths as well as limited studies in animal models strongly suggest that helminth therapy may be a productive approach toward treating a range of neuropsychiatric disorders, including chronic fatigue, migraine headaches, depression and anxiety disorders. However, helminth therapy faces some daunting hurdles, including the lack of a financial incentive for development, despite a tremendous potential market for the organisms. It is argued that benevolent donation for early trials as well as changes in regulatory policy to accommodate helminth therapy may be important for the field to develop. It is hoped that future success with some high-profile trials can propel the field, now dominated more by self-treatment than by clinical trials, forward into the main stream of medicine.
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Parker W. Not infection with parasitic worms, but rather colonization with therapeutic helminths. Immunol Lett 2017; 192:104-105. [DOI: 10.1016/j.imlet.2017.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/11/2017] [Indexed: 01/15/2023]
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Smyth K, Morton C, Mathew A, Karuturi S, Haley C, Zhang M, Holzknecht ZE, Swanson C, Lin SS, Parker W. Production and Use of Hymenolepis diminuta Cysticercoids as Anti-Inflammatory Therapeutics. J Clin Med 2017; 6:jcm6100098. [PMID: 29064448 PMCID: PMC5664013 DOI: 10.3390/jcm6100098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/04/2017] [Accepted: 10/17/2017] [Indexed: 12/22/2022] Open
Abstract
Helminthic therapy has shown considerable promise as a means of alleviating some inflammatory diseases that have proven resistant to pharmaceutical intervention. However, research in the field has been limited by a lack of availability to clinician scientists of a helminth that is relatively benign, non-communicable, affordable, and effectively treats disease. Previous socio-medical studies have found that some individuals self-treating with helminths to alleviate various diseases are using the rat tapeworm (cysticercoid developmental stage of Hymenolepis diminuta; HDC). In this study, we describe the production and use of HDCs in a manner that is based on reports from individuals self-treating with helminths, individuals producing helminths for self-treatment, and physicians monitoring patients that are self-treating. The helminth may fit the criteria needed by clinical scientists for clinical trials, and the methodology is apparently feasible for any medical center to reproduce. It is hoped that future clinical trials using this organism may shed light on the potential for helminthic therapy to alleviate inflammatory diseases. Further, it is hoped that studies with HDCs may provide a stepping stone toward population-wide restoration of the biota of the human body, potentially reversing the inflammatory consequences of biota depletion that currently affect Western society.
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Affiliation(s)
- Kendra Smyth
- University Program in Ecology, Duke University, Durham, NC 27708, USA.
| | - Claire Morton
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
| | - Amanda Mathew
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
| | - Sahil Karuturi
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
| | - Cliff Haley
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
| | - Min Zhang
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
| | - Zoie E Holzknecht
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
| | - Chelsea Swanson
- The Duke Brain Imaging & Analysis Center, Duke University Medical Center, Durham, NC 27710, USA.
- Mental Illness Research Education and Clinical Center for Post Deployment Mental Health, Durham VA Medical Center, Durham, NC 27710, USA.
| | - Shu S Lin
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
- Department of Immunology, Duke University Medical Center, Durham, NC 27710, USA.
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
| | - William Parker
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
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