1) The document discusses the use of helminths (parasitic worms) in treating autoimmune diseases. 2) Helminth therapy involves inoculating patients with hookworms or pig whipworm eggs to modulate the immune system. 3) Side effects of helminth therapy can include rashes, nausea, diarrhea, and abdominal pain. However, helminths must not cause disease or transmit other pathogens to be used therapeutically. 4) The document specifically discusses using helminth therapy to treat Crohn's disease, an inflammatory bowel disease where helminths may help reduce inflammation.

1. ‫استعمال الديدان في عالج أمراض المناعة الذاتية‬
Designed by:
Ahmed Kamal Abdel Aziz
Faculty Of Pharmacy
Helwan University
Department Of Microbiology And
Immunology

2. Content:
 What is the Autoimmunity?
 What is the Helminthes therapy ?
 Helminthes characteristics required for use in therapy.
 Side Effects of Helminthes therapy.
 Cohn's disease.

3. What is the Autoimmunity?
 Autoimmunity: is a disease in which the immune
system mistakenly recognizes self tissues as foreign,
and attacks them.
By Nessma Mohamed

4. Autoimmune disease, where ?
north america europe asia pacific row
8%
20% 42%
30%

5. TOLERANCE
 TOLERANCE CLASSIFIED TO:
1-TOLERANCE TO SELF ANTIGENS :
AS AUTOIMMUNE DISEASE
2-TOLERANCE TO NON- SELF ANTIGENS

7. GENERAL CLASSIFICATION
 an organ-specific category
 a non-organ-specific category

9. What is the Helminthes therapy ?
By Marwa Said

10. What is the Helminthes therapy ?
There are currently two closely related treatments available, either
 1)inoculation with Necator americanus, commonly known as
Hookworms,
 2)trichuris Suis Ova, commonly known as Pig Whipworm Egg.

11. table
Mechanism of action

12. Do All Helminthes Can Be Used
??????

13. Helminth characteristics required
for use in therapy
 should not have the potential to cause disease in man at
therapeutic doses
 should not be a potential vector for other parasites, viruses,
or bacteria
 should not be easily transmissible from the host to other
people
 should be compatible with a patient's existing medication
 should have a significant period of residence in the host
 must be easily eradicated from the host, if required

14. Side Effect:
a rash at the inoculation site,
nausea,
diarrhea,
gas,
bloating,
cramping,
epigastric pain and episodes of fatigue.
In extreme cases, the diarrhea can be debilitating
and the epigastric pain intense, causing termination
of therapy.

15. Crohn's disease
Burrill B. Crohn
By Ahmed Kamal

16. content
 What Is Crohn's Disease?
 What Are The Symptoms Of Crohn’s Disease ?
 What Causes Crohn’s Disease ?
 How Is Crohn‘s Disease Diagnosed?
 Can This Condition Be Prevented?
 Treatment (Drugs).
 Surgical Therapy.
 Helminthes Therapy .
 Videos
(interview with patients experiment the helminthes therapy)

17. What is Crohn's Disease?
Crohn's disease: is a form of inflammatory bowel
disease that begins with localized inflammatory
collections and aphthous ulcers in the bowel mucosa
progressing to inflammation through the bowel wall.
Where ?
It tends to be localized in the terminal part of
the ileum and right colon.
Crohn's also has the tendency to be fistulizing
(the formation of tracts, called fistules). Anatomic distribution of Crohn’s disease

18.  Inflammatory bowel disease (IBD) encompasses two
idiopathic, chronic, inflammatory diseases:
Crohn’s disease.
Ulcerative colitis.
Inflammatory bowel disease subsets.

19. Anatomic distribution of Crohn’s
disease and ulcerative colitis.

20. Comparison of the appearance of normal, Crohn’s, and ulcerative colitis mucosa;
gross (top); histological (center); endoscopic (bottom).

21. Geographic distribution of Crohn’s
disease.

22. Incidence of Crohn Disease at Specific
Locales Over Time

23. Types of Crohn’s disease:
A, stenosing;
B, inflammatory;
C, fistulizing;
D, radiographic image of fistula.

24. What are the symptoms of
Crohn’s disease ?
predominant symptoms:
Diarrhea,
cramping abdominal pain,
weight loss .
These complaints may be vague for
the first few months or years..
Other symptoms associated with Crohn's:
fever,
anorexia,
abdominal tenderness. Extraintestinal manifestations of Crohn’s
disease

25. What causes Crohn’s disease ?

26. Genetic Factors
Familial empiric risk of inflammatory bowel disease

28. Immune System
Protective and hostile factors in Crohn’s disease; A, protective
factors emphasized; B, hostile factors emphasized.

29. How is Crohn’s disease
diagnosed?

30. How is Crohn’s disease diagnosed?
Barium contrast x-rays and
CT scans (computerized tomography) are
the least invasive methods and are usually
performed first.
Flexible sigmoidoscopy and
colonoscopy with biopsies
demonstrate focal inflammation and sometimes
granulomas even when there are no gross
findings. Radiographic Diagnosis

31. Endoscopic Diagnosis
Patient positioning for sigmoidoscopy and
colonoscopy
A, Sigmoidoscope position in the colon;
B, tip of sigmoidoscope;
C, endoscopic image.

32. Colonoscopy
A, Position of the colonoscope in the colon;
B, endoscopic view;
Biopsy of colonic mucosa. C, colonoscope tip

33. Can this condition be prevented?
 Because heredity plays and important role
in this disease, barring the advent of
genetic engineering,
prevention is not an option.
But,
Early detection with flexible sigmoidoscopy
and colonoscopy, however, is a viable option in
families who are genetically predisposed.

34. By Ahmed Fathi

35. Medical Therapy
 Anti-Inflammatory Drugs.
 Antibiotics.
 Steroid Drugs.
 Immunomodulator Drugs.
 Biologic Therapies .
 Surgical Therapy.
 Helminthes therapy .
Therapeutic Pyramid.

36. Treatment (cont.)
Anti-Inflammatory Drugs
Aminosalicylates
Sulfasalazine and 5-ASA preparations
inhibit the function of lymphocytes,
monocytes, and plasma cell production of
immunoglobulins
Sites of 5-aminosalicylic acid (5-ASA) activity

37. Treatment (cont.)
Antibiotics
 Ciprofloxacin has been used in
combination with metronidazole
for ileal and perianal disease.
Ciprofloxacin

38. Treatment (cont.)
Steroid Drugs
Adrenocorticosteroids
(e.g., prednisone 40–60 mg/d),
in combination with other anti-inflammatory
drugs
(e.g., sulfasalazine or mesalamine),
Patients with predominantly ileal involvement
are the most responsive
Sites of steroid activity.

39. Immunomodulator Drugs
 Glucocorticoids,
 Azathioprine,
 Infliximab,
 Cyclosporine,
 Methotrexate.

40. Immunomodulator Drugs (cont.)
 Immunomodulator therapy (azathioprine and
6-mercaptopurine [6-MP])
Two or three months of therapy are usually
needed before results are seen.
azathioprine
Recommended dosage adjustment for 6-MP and azathioprine according
to TPMT-metabolising type (Krynetsky & Evans, Pharmacology 61:136,
2000; Brockmöller et al, Eur J Clin Pharacol 64:133, 2008).

41. Immunomodulator Drugs (cont.)
 potent T cell inhibitor, cyclosporine, has
demonstrated rapid onset of action.

42. Immunomodulator Drugs (cont.)
Methotrexate(IM),
is effective for 9–12 months

43. Surgical therapy
By Ahmed Kamal

44. Surgical therapy
A, Resection of the cecum and ileum;
B, with ileocolonic anastomosis.

45. Abscesses and Fistulae
A, Resection of the cecum and ileum; B,
ileorectal anastomosis.

46. Obstruction
A, Ileal obstruction; B, repaired with
ileocolonic anastomosis.

47. Colectomy
Proctocolectomy and Brooke ileostomy.

48. In cases of Crohn’s colitis with rectal sparing, colectomy
with ileorectal anastomosis is the procedure of choice
A,B, Ileal obstruction;
C-E, stricturoplasty

49. Helminthes therapy
 Necator Americanus,
Commonly Known As Hookworms,
 Trichuris Suis Ova,
Commonly Known As Pig Whipworm Egg.

50. Hook-worm

51. Time to Improvement for,
Trichuris Suis -Responsive
Patients With Ulcerative Colitis as
Measured by the Simple Clinical
Colitis Activity Index (SCCAI)

52. Pooled Response Rates for Patients With
Ulcerative Colitis Treated With,
Placebo or Trichuris Suis .

53. Teamwork
 Ahmed Kamal Abdel Aziz
 Ahmed Fathi Abdel Samia
 Marwa Said
 Nessma Mohamed