Every two weeks, Alex drinks a strange juice mixed with 20 to 30 hymenolepis nana larvae. The larvae in the juice are invisible to the naked eye and have no taste. They are wrapped in tiny bags and look like sperm under the microscope. When Alex swallows these larvae, they will swim in his intestines and die after about 10 to 14 days. This treatment of eating worm eggs is called worm therapy, and autistic people like Alex are the main targets of this treatment. His mother, Judy Chinitz, believes that worm therapy has alleviated Alex's autism symptoms.
Alex has also suffered from inflammatory bowel disease since childhood, which makes him weak and needs to take steroid drugs regularly, sometimes taking six different drugs at a time. Alex often isolates himself from his surroundings and sits alone for a day. He never got rid of IBD and autism when he was growing up, but when they chose worm therapy, his family saw signs of improvement, and Alex became the epitome of the lives of many autistic patients.
Intestinal bacteria and brain
In a survey of 20 17, researchers from Duke University observed 700 users of worm therapy, and more than half of them suffered from autism. Most of them used this therapy and achieved good results. So far, many studies have shown that the microbial population of autistic children has changed compared with normal children. However, scientists don't know whether this difference in microbial population leads to autism.
In order to solve this problem, some researchers conducted experiments in animal models. This year, California Institute of Technology microbiologist Sarkis Mazmanian and his colleagues extracted feces from autistic children and injected these samples into mice lacking microbial flora. Compared with the control group, the mice in the experimental group showed behaviors similar to autism. They make little noise, spend less time interacting with other mice and do some repetitive behaviors.
Mazmanian said that the research results show that these microbial groups help to produce behaviors similar to autism. The research team also analyzed the chemicals produced by the metabolism of these microorganisms, which may play a role in the connection between the brain and the intestine. In a study of 20 13, Mazmanian found that a special chemical called 4EPS can cause anxiety. In his recent research, he found that two other molecules seem to reduce repetitive behaviors of mice and make them more sociable.
Alex takes hymenolepis eggs regularly. Image source: Wikipedia.
Mauro Costa-Mattioli, a professor of neuroscience at Baylor College of Medicine in Houston, focuses on the intestinal bacteria Lactobacillus Roy, which is used in the manufacture of yogurt and commercial probiotics. Last year, Mattioli introduced Lactobacillus reuteri into mice without microbial flora, and then these bacteria restored the social behavior of mice under certain conditions. "We were very surprised to find that when we cut off the vagus nerve, bacteria could no longer reverse the lack of social behavior," Mattioli said. If the oxytocin receptor in the mouse brain is knocked out, there will be no reaction. Mattioli speculated that Lactobacillus reuteri produced a metabolite which could activate vagus nerve and promote oxytocin secretion. This hormone activates the brain's social behavior reward center.
From bacteria to metabolites, to vagus nerve, to oxytocin receptor, any step in this process will damage the social ability of animals, but Mattioli pointed out that other microorganisms may also produce the same factors or metabolites. "I don't want to say that this is the only intestinal microorganism that affects the brain," he said. Even if there is a single microorganism or microbial product that changes the social behavior of mice, it may not be completely applicable to humans, because human brain, behavior and intestinal bacteria are much more complicated.
An experiment that is still controversial
However, these studies have also been questioned by industry experts. For example, it was pointed out that in Mazmanian's research, animals' behaviors were very different and their responses were inconsistent. For example, the behavior of some mice injected with autism feces is no different from that of the control mice. Others pointed out that there may be statistical errors in the analysis.
Nevertheless, Mazmanian believes that overall, this study shows that metabolites produced by bacteria can affect the brain and individual behavior, at least in mice. Moreover, the current data is only the tip of the iceberg. He and his colleagues found many other metabolites that may be related to the brain and intestines, but they didn't study them carefully. He said: "It took us seven years to study 4EPS alone."
Supporters of worm therapy believe that intestinal microorganisms are closely related to the brain, because in the history of human evolution, there have been many bacteria, viruses and worms in the human body, and our immune system will start and keep working because of these microorganisms. However, due to the widespread use of antibiotics and the invasion of various pollutants, microorganisms have decreased from our lives. At least in theory, our immune system will become different, which will lead to autoimmune diseases, allergies and some brain diseases. Autism is not usually considered as an immune disease, but there is evidence that immune disorders and inflammation also play a role in the development of the disease.
In 20 17, there was a small study that transplanted the feces of healthy children into 18 autistic children. "It is exciting that after 10 weeks of fecal transplantation, the gastrointestinal flora of autistic children has improved and autistic behavior has decreased. These changes still exist after 18 weeks. " Krajmalnik-Brown, a professor of civil and environmental engineering at Arizona State University, said. A follow-up study in April this year showed that even after two years of fecal transplantation, autistic children still retained many improvements.
However, there are some problems in this study, such as small scale and simple control conditions. Brown's research team is conducting a larger double-blind trial in which half of the participants will receive treatment and the other half will receive a placebo. They hope to recruit more than 80 adults with autism to participate in the experiment.
Silent worm therapy
Only a few years ago, the idea that microorganisms would affect the brain was unthinkable. Although the pace of research in related fields has been accelerated at present, drugs based on microorganisms have not yet appeared. Many biotechnology companies are trying to design, cultivate and even manipulate the perfect mixture of intestinal microorganisms to treat autism and other brain-related diseases.
So far, pharmaceutical companies have shown little interest in microbial therapy. Although FDA has approved fecal microbial transplantation under close supervision to treat patients infected with Clostridium, it does not stipulate that fecal transplantation can be used for other diseases. This also makes it difficult to market worm therapy. Few companies have been interested in trichuriasis since the clinical trial of 20 14 Crohn's disease failed.
However, this has not dispelled the public's enthusiasm for worm therapy. Many patients' parents and clinicians did not choose to wait for pharmaceutical companies to launch worm products. More and more people are trying special diets, trying to use probiotics, fecal microbial transplantation and worms to improve autism.
However, due to the lack of formal control, these treatments will be expensive, with unpredictable consequences and even life-threatening risks. For example, self-produced fecal microbial transplantation and worms may lead to fatal infection, and the FDA has also issued a safety warning about fecal microbial transplantation. In addition, according to data from Facebook and other websites, some worms are effective for specific diseases, while others can cause side effects such as rash, pain and diarrhea. In addition, some worms are expensive to treat. Alex initially chose to take whipworm, but because of the cost, he stopped taking whipworm after only receiving initial treatment.
At the same time, Alex tried another relatively cheap worm, Nematoda americana. Unlike whipworms and hymenolepis nana's larvae, the larvae of this worm dig holes in the skin and settle at the junction of the small intestine and the large intestine. In order to get these worms, Alex's family went to Mexico under the supervision of doctors, but in the end Alex gave up treatment because of a serious rash. Now they have found a hymenolepis nana that is more suitable for Alex in cost and effect.
During these days of taking worms, Alex's diet is normal, and the symptoms of IBD have been alleviated for more than ten years. Now he also goes out to eat, listen to music and travel. Chinitz said that he was a "very happy young man". Of course, every two weeks, there will still be special bug drinks on his menu.
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