There is a need to expand safe and effective treatment options for patients with moderate to severe psoriasis. This article hypothesizes one promising novel treatment option: Trichuris Suis. Epidemiological, experimental, and clinical evidence suggest that Trichuris Suis therapy may be both applicable and advantageous in the treatment of psoriasis. Epidemiologically, the de-worming of developed nations has been correlated with the increased prevalence of immune-mediated disease such as psoriasis. Additionally, the mechanisms of helminth immune regulation should mitigate the underlying immunopathology in psoriasis. Finally, safety and efficacy of Trichuris Suis has been demonstrated in other immune-mediated diseases such as Crohn's, ulcerative colitis, and multiple sclerosis with clinical responses in as many as 80% of patients. Evidently, there is ample evidence to warrant the investigation of Trichuris Suis therapy as a novel psoriasis treatment.
SanderH.M., MorrisL.F., PhillipsC.M., HarrisonP.E., MenterA.The annual cost of psoriasis. J Am Acad Dermatol.1993. 28(3): p. 422–5.
2.
SuT.C.A scanning electron microscopic study on the parasite eggs in an ancient corpse from a tomb of Chu Dynasty, the Warring State, in Jiangling County, Hubei Province. J Tongji Med Univ.1987. 7(1): p. 63–4.
3.
ReinhardK.J., HevlyR.H., AndersonG.A.Helminth remains from prehistoric Indian coprolites on the Colorado Plateau. J Parasitol.1987. 73(3): p. 630–9.
4.
MaizelsR.M., YazdanbakhshM.Immune regulation by helminth parasites: cellular and molecular mechanisms. Nat Rev Immunol.2003. 3(9): p. 733–44.
5.
StrachanD.P.Hay fever, hygiene, and household size. BMJ.1989. 299(6710): p. 1259–60.
6.
MotomuraY., WangH., DengY., El-SharkawyR.T., VerduE.F., KhanW.I.Helminth antigen-based strategy to ameliorate inflammation in an experimental model of colitis. Clin Exp Immunol.2009. 155(1): p. 88–95.
7.
ElliottD.E., UrbanJ.F.Jr., ArgoC.K., WeinstockJ.V.Does the failure to acquire helminthic parasites predispose to Crohn's disease?FASEB J.2000. 14(12): p. 1848–55.
8.
Jjumba-MukasaO.R., GundersA.E.Changing pattern of intestinal helminth infections in Jerusalem. Am J Trop Med Hyg.1971. 20(1): p. 109–16.
9.
ShapiraM., TamirA.Crohn's disease and the Jews. J Clin Gastroenterol.1992. 15(4): p. 278–80.
10.
EnamandramM., KimballA.B.Psoriasis epidemiology: the interplay of genes and the environment. J Invest Dermatol.2013. 133(2): p. 287–9.
11.
ElliottD.E., SummersR.W., WeinstockJ.V.Helminths as governors of immune-mediated inflammation. Int J Parasitol.2007. 37(5): p. 457–64.
12.
ElliottD.E., WeinstockJ.V.Helminthic therapy: using worms to treat immune-mediated disease. Adv Exp Med Biol.2009. 666: p. 157–66.
13.
GauseW.C., UrbanJ.F.Jr, StadeckerM.J.The immune response to parasitic helminths: insights from murine models. Trends Immunol.2003. 24(5): p. 269–77.
14.
SabinE.A., AraujoM.I., CarvalhoE.M., PearceE.J.Impairment of tetanus toxoid-specific Th1-like immune responses in humans infected with Schistosoma mansoni. J Infect Dis.1996. 173(1): p. 269–72.
15.
BentwichZ., WeismanZ., MorozC., Bar-YehudaS., KalinkovichA.Immune dysregulation in Ethiopian immigrants in Israel: relevance to helminth infections?Clin Exp Immunol.1996. 103(2): p. 239–43.
16.
KullbergM.C., PearceE.J., HienyS.E., SherA., BerzofskyJ.A.Infection with Schistosoma mansoni alters Th1/Th2 cytokine responses to a non-parasite antigen. J Immunol.1992. 148(10): p. 3264–70.
17.
LedinghamD.L., McAlisterV.C., EhigiatorH.N., GiacomantonioC., ThealM., LeeT.D.Prolongation of rat kidney allograft survival by nematodes. Transplantation.1996. 61(2): p. 184–8.
18.
MosmannT.R., CoffmanR.L.TH1 and TH2 cells: different patterns of lymphokine secretion lead to different functional properties. Annu Rev Immunol.1989. 7: p. 145–73.
19.
FinkelmanF.D., PearceE.J., UrbanJ.F.Jr., SherA.Regulation and biological function of helminth-induced cytokine responses. Immunol Today.1991. 12(3): p. A62–6.
20.
ElliottD.E., WeinstockJ.V.Helminth-host immunological interactions: prevention and control of immune-mediated diseases. Ann N Y Acad Sci.2012. 1247: p. 83–96.
21.
ElliottD.E., MetwaliA., LeungJ.Colonization with Heligmosomoides polygyrus suppresses mucosal IL-17 production. J Immunol.2008. 181(4): p. 2414–9.
22.
WeinstockJ.V.Autoimmunity: The worm returns. Nature.2012. 491(7423): p. 183–5.
van BeelenA.J., TeunissenM.B., KapsenbergM.L., de JongE.C.Interleukin-17 in inflammatory skin disorders. Curr Opin Allergy Clin Immunol, 2007. 7(5): p. 374–81.
25.
Di CesareA., Di MeglioP., NestleF.O.The IL-23/Th17 axis in the immunopathogenesis of psoriasis. J Invest Dermatol.2009. 129(6): p. 1339–50.
26.
SummersR.W., ElliottD.E., QadirK., UrbanJ.F.Jr., ThompsonR., WeinstockJ.V.Trichuris suis seems to be safe and possibly effective in the treatment of inflammatory bowel disease. Am J Gastroenterol.2003. 98(9): p. 2034–41.
27.
SummersR.W., ElliottD.E., UrbanJ.F.Jr., ThompsonR., WeinstockJ.V.Trichuris suis therapy in Crohn's disease. Gut.2005. 54(1): p. 87–90.
28.
SummersR.W., ElliottD.E., UrbanJ.F.Jr., ThompsonR.A., WeinstockJ.V.Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial. Gastroenterology.2005. 128(4): p. 825–32.
29.
ElliottD.E., SummersR.W., WeinstockJ.V.Helminths and the modulation of mucosal inflammation. Curr Opin Gastroenterol.2005. 21(1): p. 51–8.
30.
SandbornW.J., ElliottD.E., WeinstockJ.Randomised clinical trial: the safety and tolerability of Trichuris suis ova in patients with Crohn's disease. Aliment Pharmacol Ther.2013. Aug; 38(3): 255–63.
31.
BagerP., ArnvedJ., RønborgS.Trichuris suis ova therapy for allergic rhinitis: a randomized, double-blind, placebo-controlled clinical trial. J Allergy Clin Immunol.2010. 125(1): p. 123–30e1–3.
32.
FlemingJ.O., IsaakA., LeeJ.E.Probiotic helminth administration in relapsing-remitting multiple sclerosis: a phase 1 study. Mult Scler.2011. 17(6): p. 743–54.
