Helminthic therapy clinical trials

    From Helminthic Therapy wiki

    This page, which is still under construction, aims to explain the ins and outs of clinical trials of helminth therapy, listing both those trials that have already been carried out and those that would be interesting to perform.

    Clinical trials by disease[edit | edit source]

    Allergic rhinitis[edit | edit source]

    Asthma[edit | edit source]

    Autism[edit | edit source]

    • 2014-2015 - TSO - 0522-12-HMO - Jerusalem, Israel - TSO in Pediatric Autistic Spectrum Disorders (TSO). Treatment: T. suis 2500 or 7500 ova or placebo orally every 2 wks for 16 wks. Results: study terminated due to lack of available study agent

    Coeliac / celiac disease[edit | edit source]

    Crohn's disease[edit | edit source]

    Diabete type 2[edit | edit source]

    Food Allergies[edit | edit source]

    • 2010-2011 - TSO - Phase 1 - 2009P000414 - Boston (USA) - Trichuris Suis Ova Therapy for Mild to Moderate Peanut and Tree Nut Allergy in Adults and Children

    Multiple sclerosis[edit | edit source]

    • 2012-2017 - TSO - Phase 2 - TRIOMS - Berlin La Charité - Trichuris Suis Ova (TSO) in Recurrent Remittent Multiple Sclerosis and Clinically Isolated Syndrome (TRIOMS) - study protocol. Treatment : Oral inoculation (2,500 ova) every 2 weeks for 12 months. Placebo group included. Total study (n = 50) Results:
    • 2011-2016 - NA - WIRMS - University of Nottingham - Worms for Immune Regulation of Multiple Sclerosis (WIRMS). Treatment: Single dermal inoculation (25 larvae) at week 0 (n = 36). Placebo group included. Results: 2020 Jun 15 Hookworm Treatment for Relapsing Multiple Sclerosis -- Full text (While the primary statistical endpoint of this trial - the cumulative number of new/enlarging T2 and new enhancing T1 lesions at month 9 - was not significantly different between the hookworm group (154) and the placebo group (164), a closer examination of the data reveals that more than half the patients given hookworms did not have any new lesions. “The findings of the research… show that infecting MS patients with a safe dose of… Necator americanus induces immunoregulatory responses and boosts the number of cells which help keep the immune system under control.” [3] The trial’s lead researcher concluded, “I think there would be a niche for this approach - for individuals with mild disease who don't want to take immunomodulating drugs for life and would prefer a more natural approach.” [4])
    • 2011 Apr - The impact of parasite infections on the course of multiple sclerosis. Treatment: Prospective clinical monitoring study of parasite-infected patients with relapsing-remitting disease (n = 12). Four patients received anti-parasitic treatment over the monitoring period. Results: After antiparasitic treatment, patients presented with increased numbers of exacerbations. This was met with a decrease in IL-10- and TGFβ-secreting cells
    • 2008 - NA - WIRMS-1 - University of Nottingham - Immunoregulation by Controlled Parasite Exposure in Multiple Sclerosis. (WIRMS-1). Treatment: Single dermal inoculation (25 larvae) at week 0. Placebo group included. Results: Withdrawn prior to enrollment, superceded by similar study
    • 2007 Feb - Association between parasite infection and immune responses in multiple sclerosis -- PDF (Also reported by Science Daily [5] and the BBC. [6]) This was the first study to explore the effect of helminth infection on immune response and the natural course of Relapsing Remitting Multiple Sclerosis. It showed that MS progressed much more slowly in patients who hosted intestinal worms. Treatment: Prospective clinical monitoring study of parasite-infected patients (n = 12) and non-infected patients (n = 12). Results: Parasite-infected patients presented with fewer numbers of exacerbations. A significant increase in IL-10 and TGFβ and a decrease in IL-12 and IFNγ observed in self-reactive cells

    Psoriasis[edit | edit source]

    Comment by William Parker:
    Quotein.gif
    The report by Williams and colleagues in the August issue of Immunology Letters describes a case in which a scientist exposed himself/herself to a helminth well-known among the veterinary community, the porcine whipworm. The intention was to observe the effects of exposure to the helminth on the scientist’s immune disorder and to monitor the fate of the organisms following that exposure. The scientist saw improvement in his or her psoriasis (...) Fortunately, Williams used a lower pH formulation (produced in-house using the ParaTech protocol and stored at pH 1). [7] (PDF)
    The authors of this report also claimed that, during their study, they made "the first definitive observations that T. suis can mature to adult size and reproduce in humans". However, patent infection was claimed solely on the basis of colonoscopic examination and the passage of unembryonated whipworm eggs in the subject’s faeces, neither of which provides definitive proof of species. The subject had in fact previously hosted the human whipworm, Trichuris trichiura (TT), which was assumed by those conducting the study to have been eradicated following the administration of mebendazole. However, the use of mebendazole to eradicate TT is not reliable unless 100mg of the drug is taken twice daily for at least 3-5 days (see Terminating a human whipworm infection) so, in spite of the bold claim by the researchers that they were the first to report a patent TS infection in a human volunteer undergoing TSO treatment, it is likely that the adult whipworms observed in this case were TT and not TS, and that the eggs were TTO and not TSO.

    Rheumatoid arthritis[edit | edit source]

    • 2011 - TSO - TSORA. Immanuel Krankenhouse in Berlin. Trichuris suis ova (TSO) as a additional therapy for rheumatoid arthritis patients with insufficient response to methotrexate. A prospective, double-blind, randomized, controlled monocenter study. Treatment: Oral inoculation (2,500 ova) every 2 weeks for 24 weeks. Placebo group included. Total study (n = 50). Results : "Prematurely Ended"

    Ulcerative colitis[edit | edit source]

    • 2012-2015 - TSO - MUCUS - NYU Langone Health (USA) - Mucosal Immunity of Ulcerative Colitis Patients Undergoing Therapy With Trichuris Suis Ova - Treatment: Two arms. First arm, oral inoculation (2,500 ova) at 2-week intervals for 12 weeks followed by placebo for 12 weeks. Second arm, placebo for 12 weeks followed by oral inoculation (2,500 ova) at 2-weeks intervals for 12 weeks. Results: No study results posted

    Well people[edit | edit source]

    • 2024-2026 - NA - HiBiSki - Leiden (NLD) - Investigating the Local Immune Responses in the Skin After Repeated Hookworm Infection
    • 2015-2026 - NA - SVI-CH-01 - Leiden (NLD) - An Experimental Infection Study of Dermally-applied Infectious Necator Americanus Hookworm Larvae in Hookworm-naïve Adults
    • 2018-2019 - NA ITCHHI - Leiden (NLD) - Immunisation, Treatment and Controlled Human Hookworm Infection
    • 2012-2012 - TSO - NCT03079700 - Denmark - Mucosal and Systemic Immune Modulation From Trichuris Suis in a Self-infected Individual. "The included volunteer is a researcher within parasitology with main focus on Trichuris trichiura and Trichiura suis. He planned to infect himself and contacted our department with the purpose of being monitored during this infection for safety (medical supervision) and research reasons. The only clinical criterion for his inclusion in the study was that he was healthy."

    Defective clinical trials[edit | edit source]

    Due to a number of significant issues with the design of many of the trials using live helminths, specifically those trials the results from which were published between 2011 and 2018, the conclusions drawn by the authors of these studies cannot be relied upon.

    The design flaws in question are elaborated in Problems with clinical trials using live helminths, below.

    Coronado Biosciences (Fortress Biotech) / Dr. Falk Pharma GmbH clinical trials[edit | edit source]

    See Press Release for more details.

    NB. The TSO product used in all the Coronado Biosciences / Dr. Falk Pharma clinical trials was stored at a pH of 5.0.

    Comment by William Parker:
    Quotein.gif
    ... the field suffered more than a catastrophic failure when Ovamed, the owner of the TSO technology, shut down clinical trials in mid-2015 due to a lack of effectiveness. But failure of a helminth in a clinical trial, more so than failure of a precisely characterized pharmaceutical, is not necessarily a sign that potential is low. Our socio-medical studies (2) suggest that storage of TSO at a pH above 4, the standard used in the Ovamed-sponsored trials, may impede the therapeutic effect of the organisms in humans. [8] (PDF)

    Autism

    • 2014-2015 - CNDO 201-101 - Efficacy and Safety of Trichuris Suis Ova (TSO) as Compared to Placebo in Autism Spectrum Disorder. Treatment: T. suis 2500 ova or placebo orally every 2 wks for 4 wks followed by 7500 ova every 2 wks for 12 wks, 4-week washout, then crossover. Results: Study terminated prior to enrollment.

    Crohn's disease

    • 2010-2014 - TSO - Phase 2 - TRUST-2 - Trichuris Suis Ova (TSO) Suspension Versus Placebo in Active Crohn's Disease (TRUST-2). Treatment: Oral inoculation (low, medium, and high-dose ova) with placebo group included. Results: study results unknown
    • 2012-2014 - TSO - Phase 2 - TRUST-I Phase 2 : Efficacy and Safety of Trichuris Suis Ova (TSO) as Compared to Placebo (TRUST-I). Treatment: Oral inoculation (7,500 ova) at 2-week intervals for 10 weeks. Placebo group included. Results: "In the overall patient population, response rate of patients on TSO did not separate from that of placebo" [10]. "The company later canceled a European Phase 2 study due to lack of efficacy, the London School of Hygiene and Tropical Medicine's Helmby wrote in BMC Immunology" [11]
    • 2011-2012 - TSO - Phase 1 - CNDO 201-002 - A Sequential Dose-Escalation, Double-Blind, Placebo-Controlled, Phase I Study to Evaluate the Safety and Tolerability of Single Doses of 3 Different Doses of Oral CNDO 201 Trichuris Suis Ova Suspension (Tso) in Patients With Crohn's Disease. Treatment: Sequential dose escalation (500, 2,500, and 7,500 ova) given orally (n = 27). Placebo group included (n = 9). Results: Minor adverse events seen in both placebo and treatment groups. Infection resulted in no obvious benefit to pathology. Seven thousand five hundred ova dose was safe and well tolerated

    Relapsing-remitting multiple sclerosis

    Psoriasis

    • 2014-2015 - CNDO 201-201 - TSO for Plaque Psoriasis. Treatment: Three arms. First arm, oral inoculation (7,500 ova) every 2 weeks for 10 weeks. Second arm, oral inoculation (15,000 ova) every 2 weeks for 10 weeks. Third arm, placebo comparator. Results: Withdrawn
    • 2013-2014 - TSOPSO13 - Tufts (USA) - Efficacy Study of Trichuris Suis Ova to Treat Chronic Plaque Psoriasis. Treatment: Oral inoculation (7,500 ova) every 2 weeks for 14 weeks. Results: Lack of efficacy
    • 2013-2014 - GCO 12-188 - Mount Sinai (USA) - Safety and Effectiveness of CNDO 201Trichuris Suis Ova (TSO) for the Treatment of Moderate to Severe Plaque Psoriasis. Treatment: Two arms. First arm, oral inoculation (2,500 ova) every 2 weeks for 10 weeks. Second arm, oral inoculation (7,500 ova) every 2 week for 10 weeks. Total study (n = 8). Resuts: Study results unknown

    Ulcerative Colitis

    • 2013-2015 - TSO - CNDO 201 - A Prospective, Randomized, Double-blind, Placebo-controlled Phase II Clinical Study of Trichuris Suis Ova Treatment in Left-sided Ulcerative Colitis and Its Effects on Mucosal Immune State and Microbiota

    ParaTech A/S[edit | edit source]

    ParaTech is a danish company that produce TSO.

    Ulcerative Colitis

    NB. Subjects in the treatment arm of this trial received a dose of 7,500 TSO every second week for 24 weeks. This was a significant deviation from the much lower level of dosing that had been established empirically by the Tufts Medical Center team involved in the early clinical trials of TSO [14] [15] [16] [17] and which had been further confirmed as the optimal level for dosing with this organism during more than a decade of use by thousands of customers of Ovamed, who marketed the product from 2003 onwards, and, later, Tanawisa.
    This collective experience had shown that a course of 10 fortnightly doses of 2,500 TSO would frequently produce disease remission in ulcerative colitis and that, if remission were not achieved by this means, a further course of 10 fortnightly doses of 2,500 TSO would often prove to be effective. Only in the few cases where this second course of treatment has failed to produce complete remission is there any need to escalate the dosage, first to 5,000 TSO every two weeks, and then, if necessary, to 7,500 TSO fortnightly.
    Starting with 7,500 ova at the outset of treatment, as was done in the PROCTO trial, is not only inadvisable on the grounds of cost, but also pointless from the therapeutic perspective. Moreover, it is possible that commencing with this unnecessarily excessive dose may trigger a more aggressive immune response by the host to the live TSO product, which might result in a greater loss of organisms than would have been the case with a lower dose, potentially resulting in a reduction in therapeutic effect.
    There is also uncertainly about the pH of the solution used to store the TSO product used in this trial since there is no mention of the formulation’s details in the published paper. If a pH any higher than the 2.4 that was used successfully in the early Tuft’s trials was employed in this later study, this would cast further doubt on the reliability of the conclusions drawn by its authors. (See: Problems with clinical trials using live helminths, below.) The study's supervising author has been approached for clarification on the product's pH.

    Problems with clinical trials using live helminths[edit | edit source]

    Randomised controlled trials] (RCTs) are considered to be the "gold standard" experimental method for assessing medical treatments, but the evidence produced by many of the RCTs that have looked at the efficacy of helminthic therapy has been starkly at odds with the many independent lines of evidence that have converged to demonstrate the significant health benefits of hosting helminths.

    An extensive body of data from epidemiologic studies, clinical observations, and investigations using animal models, has pointed very clearly to the idea that humans need exposure to helminths in order to enjoy optimal immune function, [18] and many hundreds of reports by helminthic therapy self-treaters that are featured in this wiki and elsewhere attest to the therapeutic benefits of re-worming. [19]

    So why is there such a chasmic divergence between the results from the majority of RCTs and the evidence from other sources of data? One possible explanation has been put forward by a team of socio-medical researchers.

    Quotein.gif
    Unfortunately, for a variety of economic, regulatory, and practical issues surrounding the conduct of clinical trials, mainstream trials have thus far been unable to accommodate the nuances of helminth therapy. Foremost among the issues that clinical trials must address before they can effectively test the potential for helminth therapy are (a) details in formulation of the helminth product that affect efficacy, and (b) the very wide range of doses typically needed within a cohort of individuals. [20]

    Trials of pig whipworm ova (TSO)[edit | edit source]

    
The first helminth to be systematically investigated by researchers was TSO, the ova of the pig whipworm, Trichuris suis, and results from early trials of TSO carried out in the first few years of the 21st century were very encouraging. [21] [22] [23] But a raft of twelve trials carried out by a different research team between 2008 and 2017, to investigate the effect of TSO in five diseases, produced such universally lacklustre results that all but three of them were discontinued prematurely. [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35]

    The researchers involved in this unprecedented project made two critical errors in their study design, the first of which was to use a trial length of only 12 weeks. While this is the standard trial period used in pharmaceutical research, it is not appropriate for studies of live helminths such as TSO, which typically only begins to deliver benefits after 8 weeks, and remission only after 20 weeks, with even longer waits experienced by some patients with severe or chronic disease.

    Arguably the most critical mistake was the use of a novel TSO formulation with a pH of 5.0, even though the investigators were advised against this by the product’s manufacturer, who knew from his own product development work that TSO is most effective when formulated with a pH of 2.4, the formulation used in the earlier, more successful trials. [36] (No abstract | Full text PDF)

    Other significant errors in the design of these trials included the use of a single dose size for all participants, when it is known that the helminth dosage requirements of individuals can vary by as much as a factor of 10. Poor subject selection was also revealed by the high rate of improvement in the placebo group in some of the trials.

    With so few clinical trials of helminthic therapy having been carried out previously, the sheer number of these “failed” studies overwhelmed the existing helminthic therapy research base to deliver a body blow to the therapy’s reputation that set back progress by at least 20 years. The number of published scientific papers relating to helminthic therapy, which had climbed steadily from just 5 in 2000 to peak at almost 100 during 2017, fell into a steep decline after this, as scientists lost interest in therapy using living worms.

    Other researchers began referencing the twelve TSO trials in support of assertions that this species is ineffective as a therapeutic agent. For example, four of these trials were included in a meta-analysis of six studies which concluded that TSO therapy showed no statistical benefit for IBD patients. [37] Apart from the issues with the product's pH, only one of the trials reviewed in this analysis had lasted for longer than 12 weeks, and the remit of that particular study was only to assess the safety and tolerability (not efficacy) of a single dose of TSO.

    Trialing the human hookworm (NA)[edit | edit source]

    TSO is not the only living helminth to have failed to impress when tested using methods that were developed to assess the efficacy of pharmaceutical products.

    In 2007, Correale and Farez had revealed that patients with multiple sclerosis who were hosting a variety of helminths, including hookworms, experienced a reduced number of disease exacerbations compared with patients who were helminth-free. [38] And socio-medical research has shown that NA is extremely effective in the treatment of MS, with a success rate of approximately 50% for the progressive form of the disease and more than 90% for relapsing-remitting MS. (PDF)

    However, when researchers at Nottingham University carried out a randomized double-blinded placebo-controlled trial in which patients with RRMS were experimentally colonised by the hookworm, Necator americanus (NA), they concluded that this helminth appeared to be ineffective against this disease because the particular statistical endpoint determined for the trial had not been reached, [39] even though the data revealed that more than half the patients given NA had not developed any new lesions. [40]

    In order to avoid repeating the design errors made by the teams responsible for previous trials, future studies exploring the therapeutic potential of NA need to take into account the following issues.

    1. For any form of helminthic therapy to be effective, it is essential to maintain continuing exposure to the selected organism. Unfortunately, the period of survival of a helminth varies considerably between individual hosts, and the experience of self-treaters has shown that, in the case of NA, survival of the organism ranges from several years to as little as two months. (See Hookworm lifespan.)
    2. There is more than a 10-fold difference in the level of helminth dosing required to achieve disease remission in different human hosts. Until such time as there are tests capable of providing guidance about the extent of dosing that might be required by each individual, determination of the optimum dosing regimen (the number of larvae in, and the intervals between, each dose) will require the employment by each self-treater of an individualised dose-finding protocol, which can be a lengthy process in the case of NA. (See Long-term dosing is based on individual user experience.)
    3. The benefits derived from hosting NA can take a long time to develop in some cases. While some benefits may appear within weeks, these do not become consistent until at least 12 weeks, and more typically only appear between 3 and 6 months after the initial inoculation. In a few cases, benefits can take up to two years before making their first appearance, and there have even been rare cases in which clear benefits only appeared during the third year. (See Consistent improvement can begin anytime from 3 to 24 months.)
    How the above three factors relate to the therapeutic use of NA is explained in detail on the Hookworm dosing and response page of this wiki.
    4. A further factor that can limit the extent of any therapeutic benefit produced by NA is the potential for certain substances to adversely affect, or even kill, this organism in some individuals. Exactly how it is affected in this way is explained in the Human helminth care manual.
    To take the example of oregano, some NA hosts who ingest this herb may experience reduced benefit from their helminths, possibly even losing their entire colony if they eat a sufficiently large quantity of the plant, consume a concentrated extract or tincture of oregano, or take an oregano oil supplement.
    A more complex situation is found with coconut products, some of which are harmless to NA, while others have been reported to have caused varying levels of harm up to, and including, the total eradication of entire colonies.
    Beyond being dependent on the form in which the substance is encountered, and the dose level, the adverse effect of such substances differs widely between hosts. Users of NA are therefore advised to avoid these, and a few other substances, until they are seeing clear and consistent benefits from the therapy, and then to begin gradually to reintroduce them to assess any effects. This way, the hookworm self-treater is able to learn which, if any, of the potentially risky foods, drugs and other substances they might need to avoid in the long term.
    5. The viability of NA larvae has been shown to decrease rapidly over time from a mean of 85% to < 70% within 14 days. [41] Larval age is therefore another crucial variable that needs to be taken into consideration in future clinical trials, and may perhaps explain some of the inconsistencies in previously reported studies.

    Citizen scientists lead the way[edit | edit source]

    Unless the scientists conducting trials to investigate the effects of hosting helminths are able to devise methods to assess them as living organisms rather than pharmaceutical products, and to take into account the unique and dynamic nature of each individual helminth/host relationship, it is likely that clinical trials will continue to fail to reflect the reality regarding helminthic therapy. Until then, the best evidence will continue to come from the collated experience of self-treaters, as documented extensively in this wiki.

    Quotein.gif
    … at the present time, systematic data gathering from individuals self-treating may be the most practical and effective means of evaluating the effects of helminth therapy. [42]

    The reintroduction to the digestive tract of a controlled number of specially domesticated, mutualistic helminths (intestinal worms) in the form of microscopic eggs or larvae to reconstitute a depleted biome to treat or prevent chronic inflammation, autoimmune disease and other immune-related disorders, including allergy.

    A helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.

    a change which is a result or consequence of an action or other cause.

    the human hookworm, Necator americanus

    the ova (eggs) of the porcine (pig) whipworm, Trichuris suis

    A helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.

    The introduction of an infectious agent into an organism. Helminth inoculation

    Also known as regional enteritis, this is an inflammatory disease of the intestines that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhea (which may be bloody if inflammation is severe), vomiting or weight loss, but may also cause complications outside the gastrointestinal tract such as skin rashes, arthritis, inflammation of the eye, tiredness and lack of concentration.

    A helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.

    Inflammatory bowel disease is a group of conditions affecting the gastrointestinal (GI) tract, particularly the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis (UC).

    A helminth with a tapering whiplike body that lives in the colon. In helminthic therapy, the microscopic eggs of either the human Trichuris trichiura (TTO) or pig Trichuris suis (TSO) are taken in a drink.

    Ulcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD) which specifically affects the large intestine, or colon, causing characteristic ulcers, or open sores. The main symptom of active disease is constant diarrhea mixed with blood, of gradual onset.

    The active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state.

    Multiple sclerosis (also known as disseminated sclerosis) is a chronic, typically progressive disease involving damage to the sheaths of nerve cells in the brain and spinal cord, whose symptoms may include numbness, impairment of speech and of muscular coordination, blurred vision and severe fatigue.

    The species of human hookworm used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.

    An organism that lives in or on another organism (its host) and benefits at the host’s expense. (The organisms used in helminthic therapy are, strictly speaking, not parasites, but mutualists, because they have a mutually beneficial symbiotic relationship with their hosts.)

    An organism that lives in or on another organism (its host) and benefits at the host’s expense. (The organisms used in helminthic therapy are, strictly speaking, not parasites, but mutualists, because they have a mutually beneficial symbiotic relationship with their hosts.)

    An organism that lives in or on another organism (its host) and benefits at the host’s expense. (The organisms used in helminthic therapy are, strictly speaking, not parasites, but mutualists, because they have a mutually beneficial symbiotic relationship with their hosts.)

    An intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. Wikipedia:Helminths

    The human whipworm used in helminthic therapy and taken periodically as microscopic eggs (TTO) in a drink.

    the human whipworm, Trichuris trichiura

    the porcine (pig) whipworm, Trichuris suis

    A helminth with a tapering whiplike body that lives in the colon. In helminthic therapy, the microscopic eggs of either the human Trichuris trichiura (TTO) or pig Trichuris suis (TSO) are taken in a drink.

    the ova (eggs) of the human whipworm, Trichuris trichiura

    The porcine (pig) whipworm used in helminthic therapy and taken as microscopic eggs (TSO) in a drink every two weeks.

    Ulcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD) which specifically affects the large intestine, or colon, causing characteristic ulcers, or open sores. The main symptom of active disease is constant diarrhea mixed with blood, of gradual onset.

    An intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. Wikipedia:Helminths

    the degree to which something is successful in producing a desired result; success.

    the ability to produce a desired or intended result.

    An intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. Wikipedia:Helminths

    Helminth-Induced Immunomodulation Therapy. This term was adopted by researchers investigating the effects of TSO in patients with MS. [43]

    Microorganisms that are believed to provide health benefits when consumed.

    Ulcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD) which specifically affects the large intestine, or colon, causing characteristic ulcers, or open sores. The main symptom of active disease is constant diarrhea mixed with blood, of gradual onset.

    The reintroduction to the digestive tract of a controlled number of specially domesticated, mutualistic helminths (intestinal worms) in the form of microscopic eggs or larvae to reconstitute a depleted biome to treat or prevent chronic inflammation, autoimmune disease and other immune-related disorders, including allergy.

    Reintroducing worms to a helminth-deficient biome.

    Someone who treats their own disease or condition without medical assistance.

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