SuSanA Secretariat via Wikimedia Commons // CC BY 2.0
SuSanA Secretariat via Wikimedia Commons // CC BY 2.0

Parasitic Worms May Keep Inflammatory Bowel Disease at Bay

SuSanA Secretariat via Wikimedia Commons // CC BY 2.0
SuSanA Secretariat via Wikimedia Commons // CC BY 2.0

Scientists say people infected with parasitic worms may be better able to fend off autoimmune conditions like inflammatory bowel disease (IBD). Their study shows that the infection changes the balance of bacteria in a person’s gut, overpowering the species that cause inflammation. The findings were published last week in the journal Science.

In many ways, human beings are healthier than we’ve ever been before. In other ways … not so much. The lifespan of the average American is longer than ever, but that long life is also more likely to be marked with chronic illness. Among medical conditions on the rise are autoimmune diseases like allergies, type one diabetes, and IBD. Scientists have theorized that the increase in autoimmune diseases may be influenced by our relatively sterile way of life. This hygiene hypothesis, as it’s known, posits that some exposure to germs is good for our immune systems. Without this exposure, our immune systems essentially short-circuit, leaving us vulnerable.

If hand sanitizer and antibiotics are the problem, some people say that worms may be the answer. Experiments have found helminth therapy (as it's called) may help celiac disease, multiple sclerosis, and Crohn’s disease, a form of IBD. Still, researchers have been cautious. “Nobody got hurt, nobody’s eyes fell out,” gastroenterologist Joel Weinstock told Science News in 2014. “But it’s still too early to say, ‘Well golly gee, this is going to be better than apple pie.’”

Apple pie or no, some Americans with chronic conditions can’t stand to wait, and are already intentionally infecting themselves with worms. One man found the treatment so effective that he felt he had to alert parasitologist P’ng Loke.

“I was contacted by an individual who had deliberately infected himself with worms to treat his symptoms of IBD and was able to put his disease into remission,” Loke said in a recorded interview. Loke and his colleagues wondered what, exactly, the worms were doing and how it could be helpful. They suspected that the infection might cause a person’s gut bacteria to re-balance, thereby overpowering the Bacteroides, a genus of “bad” bacteria that can lead to bowel inflammation.

The researchers bred mice that would carry a gene associated with immune conditions, including IBD. They then infected the mice with juvenile whipworms. After the worms had matured, the scientists took bacteria samples from the rodents’ poop and intestines. Sure enough, they found decreased levels of Bacteriodes and increased levels of Clostridia—a species that can reduce inflammation. Helminth infection had swung the bacterial balance in a more constructive direction.

To be sure that these effects were not just a mouse thing, the researchers also tested the gut bacteria of two groups of people in Malaysia: people from a rural area known for having low rates of IBD and high rates of worm infection, and people from a nearby city, for whom the IBD/worm situation was reversed. Once again, the results revealed that the immune response triggered by worm infection seemed to defend the bacterial ecosystem against Bacteroides inflammation.

“Patient testimonials and anecdotes lead many to think that worms directly cure IBD, senior investigator Ken Caldwell said in a press statement, “while in reality, they act on the gut bacteria thought to cause the disease.”

Caldwell and his colleagues believe their findings offer a concrete explanation that may help lead to relief for patients. “Our study could change how scientists and physicians think about treating IBD.”

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The Body
10 Facts About the Appendix
Illustration by Mental Floss / Images: iStock
Illustration by Mental Floss / Images: iStock

Despite some 500 years of study, the appendix might be one of the least understood structures in the human body. Here's what we know about this mysterious organ.

1. THE ANCIENT EGYPTIANS CALLED IT THE "WORM" OF THE BOWEL.

The human appendix is small, tube-shaped, and squishy, giving ancient Egyptians, who encountered it when preparing bodies for funerary rites, the impression of a worm. Even today, some medical texts refer to the organ as vermiform—Latin for "worm-like."

2. THE APPENDIX SHOWS UP IN LEONARDO DA VINCI’S DRAWINGS.

The earliest description of a human appendix was written by the Renaissance physician-anatomist Jacopo Berengario da Carpi in 1521. But before that, Leonardo da Vinci is believed to drawn the first depiction of the organ in his anatomical drawings in 1492. Leonardo claimed to have dissected 30 human corpses in his effort to understand the way the body worked from mechanical and physiological perspectives.

3. IT'S ABOUT THE SIZE OF A PINKY FINGER.

The appendix is a small pouch connected to the cecum—the beginning of the large intestine in the lower right-hand corner of your abdomen. The cecum’s job is to receive undigested food from the small intestine, absorb fluids and salts that remain after food is digested, and mix them with mucus for easier elimination; according to Mohamad Abouzeid, M.D., assistant professor and attending surgeon at NYU Langone Medical Center, the cecum and appendix have similar tissue structures.

4. CHARLES DARWIN THOUGHT IT WAS A VESTIGIAL ORGAN …

The appendix has an ill-deserved reputation as a vestigial organ—meaning that it allegedly evolved without a detectable function—and we can blame Charles Darwin for that. In the mid-19th century, the appendix had been identified only in humans and great apes. Darwin thought that our earlier ancestors ate mostly plants, and thus needed a large cecum in which to break down the tough fibers. He hypothesized that over time, apes and humans evolved to eat a more varied and easier-to-digest diet, and the cecum shrank accordingly. The appendix itself, Darwin believed, emerged from the folds of the wizened cecum without its own special purpose.

5. … BUT THE APPENDIX PROBABLY EVOLVED TO HELP IMMUNE FUNCTION.

The proximity and tissue similarities between the cecum and appendix suggest that the latter plays a part in the digestive process. But there’s one noticeable difference in the appendix that you can see only under a microscope. “[The appendix] has a high concentration of the immune cells within its walls,” Abouzeid tells Mental Floss.

Recent research into the appendix's connection to the immune system has suggested a few theories. In a 2015 study in Nature Immunology, Australian researchers discovered that a type of immune cells called innate lymphoid cells (ILCs) proliferate in the appendix and seem to encourage the repopulation of symbiotic bacteria in the gut. This action may help the gut recover from infections, which tend to wipe out fluids, nutrients, and good bacteria.

For a 2013 study examining the evolutionary rationale for the appendix in mammal species, researchers at Midwestern University and Duke University Medical Center concluded that the organ evolved at least 32 times among different lineages, but not in response to dietary or environmental factors.

The same researchers analyzed 533 mammal species for a 2017 study and found that those with appendices had more lymphatic (immune) tissue in the cecum. That suggests that the nearby appendix could serve as "a secondary immune organ," the researchers said in a statement. "Lymphatic tissue can also stimulate growth of some types of beneficial gut bacteria, providing further evidence that the appendix may serve as a 'safe house' for helpful gut bacteria." This good bacteria may help to replenish healthy flora in the gut after infection or illness.

6. ABOUT 7 PERCENT OF AMERICANS WILL GET APPENDICITIS DURING THEIR LIFETIMES.

For such a tiny organ, the appendix gets infected easily. According to Abouzeid, appendicitis occurs when the appendix gets plugged by hardened feces (called a fecalith or appendicolith), too much mucus, or the buildup of immune cells after a viral or bacterial infection. In the United States, the lifetime risk of getting appendicitis is one in 15, and incidence in newly developed countries is rising. It's most common in young adults, and most dangerous in the elderly.

When infected, the appendix swells up as pus fills its interior cavity. It can grow several times larger than its average 3-inch size: One inflamed appendix removed from a British man in 2004 measured just over 8 inches, while another specimen, reported in 2007 in the Journal of Clinical Pathology, measured 8.6 inches. People with appendicitis might feel generalized pain around the bellybutton that localizes on the right side of the abdomen, and experience nausea or vomiting, fever, or body aches. Some people also get diarrhea.

7. APPENDECTOMIES ARE ALMOST 100 PERCENT EFFECTIVE FOR TREATING APPENDICITIS.

Treatment for appendicitis can go two ways: appendectomy, a.k.a. surgical removal of the appendix, or a first line of antibiotics to treat the underlying infection. Appendectomies are more than 99 percent effective against recurring infection, since the organ itself is removed. (There have been cases of "stump appendicitis," where an incompletely removed appendix becomes infected, which often require further surgery.)

Studies show that antibiotics produce about a 72 percent initial success rate. “However, if you follow these patients out for about a year, they often get recurrent appendicitis,” Abouzeid says. One 2017 study in the World Journal of Surgery followed 710 appendicitis patients for a year after antibiotic treatment and found a 26.5 percent recurrence rate for subsequent infections.

8. AN INFECTED APPENDIX DOESN’T ACTUALLY BURST.

You might imagine a ruptured appendix, known formally as a perforation, being akin to the "chestbuster" scene in Alien. Abouzeid says it's not quite that dramatic, though it can be dangerous. When the appendix gets clogged, pressure builds inside the cavity of the appendix, called the lumen. That chokes off blood supply to certain tissues. “The tissue dies off and falls apart, and you get perforation,” Abouzeid says. But rather than exploding, the organ leaks fluids that can infect other tissues.

A burst appendix is a medical emergency. Sometimes the body can contain the infection in an abscess, Abouzeid says, which may be identified through CT scans or X-rays and treated with IV antibiotics. But if the infection is left untreated, it can spread to other parts of the abdomen, a serious condition called peritonitis. At that point, the infection can become life-threatening.

9. SURGEONS CAN REMOVE AN APPENDIX THROUGH A TINY INCISION.

In 1894, Charles McBurney, a surgeon at New York's Roosevelt Hospital, popularized an open-cavity, muscle-splitting technique [PDF] to remove an infected appendix, which is now called an open appendectomy. Surgeons continued to use McBurney's method until the advent of laparoscopic surgery, a less invasive method in which the doctor makes small cuts in the patient's abdomen and threads a thin tube with a camera and surgical tools into the incisions. The appendix is removed through one of those incisions, which are usually less than an inch in length.

The first laparoscopic appendectomies were performed by German physician Kurt Semm in the early 1980s. Since then, laparoscopic appendectomies have become the standard treatment for uncomplicated appendicitis. For more serious infections, open appendectomies are still performed.

10. AN APPENDIX ONCE POSTPONED A ROYAL CORONATION.

When the future King Edward VII of Great Britain came down with appendicitis (or "perityphlitis," as it was called back then) in June 1902, mortality rates for the disease were as high as 26 percent. It was about two weeks before his scheduled coronation on June 26, 1902, and Edward resisted having an appendectomy, which was then a relatively new procedure. But surgeon and appendicitis expert Frederick Treves made clear that Edward would probably die without it. Treves drained Edward's infected abscess, without removing the organ, at Buckingham Palace; Edward recovered and was crowned on August 9, 1902.

11. THE WORLD'S LONGEST APPENDIX MEASURED MORE THAN 10 INCHES.

On August 26, 2006, during an autopsy at a Zagreb, Croatia hospital, surgeons obtained a 10.24-inch appendix from 72-year-old Safranco August. The deceased currently holds the Guinness World Record for "largest appendix removed."

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Sagar.jadhav01, Wikimedia Commons // ;CC BY-SA 4.0
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language
New 'Eye Language' Lets Paralyzed People Communicate More Easily
Sagar.jadhav01, Wikimedia Commons // ;CC BY-SA 4.0
Sagar.jadhav01, Wikimedia Commons // ;CC BY-SA 4.0

The invention of sign language proved you don't need to vocalize to use complex language face to face. Now, a group of designers has shown that you don't even need control of your hands: Their new type of language for paralyzed people relies entirely on the eyes.

As AdAge reports, "Blink to Speak" was created by the design agency TBWA/India for the NeuroGen Brain & Spine Institute and the Asha Ek Hope Foundation. The language takes advantage of one of the few motor functions many paralyzed people have at their disposal: eye movement. Designers had a limited number of moves to work with—looking up, down, left, or right; closing one or both eyes—but they figured out how to use these building blocks to create a sophisticated way to get information across. The final product consists of eight alphabets and messages like "get doctor" and "entertainment" meant to facilitate communication between patients and caregivers.

Inside of a language book.
Sagar.jadhav01, Wikimedia Commons // CC BY-SA 4.0

This isn't the only tool that allows paralyzed people to "speak" through facial movements, but unlike most other options currently available, Blink to Speak doesn't require any expensive technology. The project's potential impact on the lives of people with paralysis earned it the Health Grand Prix for Good at the Cannes Lions International Festival of Creativity earlier in June.

The groups behind Blink to Speak have produced thousands of print copies of the language guide and have made it available online as an ebook. To learn the language yourself or share it with someone you know, you can download it for free here.

[h/t AdAge]

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