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The Impact of Helminth Infection on the Incidence of Metabolic Syndrome: A Systematic Review and Meta-Analysis

re: double century

Co-evolving over millions of years, it only makes sense that parasitic worms (helminths) would have a role to play in the human body, including a symbiosis of sorts (in addition to causing problems too).

The Impact of Helminth Infection on the Incidence of Metabolic Syndrome: A Systematic Review and Meta-Analysis

2021-08-12

...is growing support for the idea that controlled infection with live parasitic worms offers a novel strategy for the treatment of metabolic disorders caused by the chronic inflammation induced by obesity...

...Currently the benefit of live helminth infection to individuals with central obesity and at least one MetS risk factor is being assessed in a double-blind, placebo-controlled clinical trial. Patients will be infected with 40 larvae of the human hookworm Necator americanus and changes in insulin sensitivity, body mass index and waist circumference will be measured over a 2-year period (ACTRN12617000818336) (38). Despite the limitations of our meta-analysis, the overall results clearly showed that infection with intestinal worms, such as hookworm, was less efficacious than the tissue dwelling parasites S. mansoniand O. viverrini.

... Despite the limitations of our meta-analysis, the overall results clearly showed that infection with intestinal worms, such as hookworm, was less efficacious than the tissue dwelling parasites S. mansoniand O. viverrini. In all cases where an outcome could be compared, the impact of intestinal parasites was underwhelming, with no effect on HbAIc (505456) or HOMA-IR (2656), only a modest effect on fasting blood glucose (26), and except for one study (47), either no effect or an increase in T2D (4849). In contrast, for every outcome, infection with S. mansoni, resulted in a significant positive effect (51).

The choice of hookworm [Necator americanus] for a clinical trial is based primarily on the lack of pathology that results from infection with this parasite. Other than a mild itch as the larval worms enter the body through the skin, for doses of up to 40 larvae, no discomfort has been reported in previous human safety trials (7375). This parasite resides in the intestine of its human host where it attaches to the intestinal epithelium and feeds on blood. For a low dose/controlled infection, this has little pathological consequence, unlike with high doses where intestinal hemorrhage and iron deficiency anemia are common (76). Although S. mansoni also infects its human hosts through the skin, it resides in the mesenteric blood vessels, where the adult male and female worms mate to produce eggs that are then excreted from the body in order for the life cycle of the parasite to continue. While infection is rarely fatal, it can result in significant morbidities and loss of quality-of-life (77). Eggs that are not correctly secreted from the body can become trapped in the liver leading to the formation of granulomas and fibrosis which can result in portal hypertension and congestive splenomegaly (78). Liver enlargement and periportal fibrosis are commonly associated with advanced chronic infection. Children that are repeatedly infected can develop anemia and malnutrition which lead to significant developmental defects. Such outcomes clearly preclude the consideration of this parasite for live helminth therapy.

...

Combining these observations with the current meta-analysis, strongly support the proposal that helminth parasites have the capacity to regulate obesity driven inflammation to mediate a positive effect on metabolic outcomes. However, consideration for the variations between different parasites and a deeper understanding of the mechanisms involved is required before helminth-based therapies can progress to the clinic. This advancement would be greatly supported if future studies in the field included an accurate diagnosis of the parasite infection, information on the immunological and inflammatory status of patients, and consistent measures of metabolic outcomes. As this type of information is expanded and underscored with enhanced knowledge of the biochemistry and function of parasite-derived molecules, there is every possibility that helminth-derived therapy will be a clinical reality for patients with MetS.

WIND: would like you some hookworms (Necator americanus) with your Metformin? Because blood flukes create some issues.

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