20/12/13 ΓιάνηςΔημολιάτης ΕπίκουροςκαθηγητήςΥγιεινήςΕπιδημιολογίας ΙατρικούΤμήματοςΠανεπιστημίουΙωανίνων Η"υπόθεση"(υπερ)καθαριότητα Thehygienehypothesis ΓιάνηςΔημολιάτης ΕπίκουροςκαθηγητήςΥγιεινήςΕπιδημιολογίας ΙατρικούΤμήματοςΠανεπιστημίουΙωανίνων ΣύγκρουσηΣυμφερόντων Δηλώνωότιδενέχωοποιαδήποτε συμφέροντα,οικονομικάήμη.όσαθα αναπτύξωπαρακάτωαποσκοπούνστην αλήθειακαιμόνοστηναλήθεια. 1 2 Όσο"πιο"πολλές"φωτογραφίες"τραβάμε," τόσο"λιγότερα"θυμόμαστε Πούήμουνκαιτιείδα Όσοπιοπολλέςφωτογραφίεςτραβάμε,τόσο λιγότεραθυμόμαστε Όσοπιοπολλέςφωτογραφίεςτραβάμε, τόσολιγότεραθυμόμαστε hbp://news.in.gr/science3technology/arhcle/?aid=1231279861!" Όσο"πιο"πολλές"φωτογραφίες"τραβάμε," τόσο"λιγότερα"θυμόμαστε?" Δύοομάδεςεθελοντώνκλήθηκανναπεριηγηθούνστο μουσείοκαιείτεναφωτογραφίζουνό,τιτουςάρεσε,είτε απλώςνακοιτάζουνταεκθέματα. Τηνεπόμενημέρα,τασχετικάτεστμνήμηςέδειξανότι όσοιτραβούσανσυνεχώςφωτογραφίες,θυμούντανκαι αναγνώριζανπολύλιγότεροταεκθέματα,σεσχέσημε όσουςείχανπεριοριστείνατακοιτάζουν. Σύμφωναμετουςερευνητές[μεεπικεφαλήςτηΔρΛίντα ΧένκελτουπανεπιστημίουFairfieldτουΚονέκτικατ],ημανία φωτογράφησηςπουέχεικαταλάβειτουςπάντεςχάρη στιςνέεςτεχνολογίες,εμποδίζει"τον"εγκέφαλο"να συγκεντρωθείσταγεγονότακαινασχηματίσειακριβείς καιδιαρκείςμνήμεςγιααυτά. 3 4 Όσο"πιο"πολλές"φωτογραφίες"τραβάμε," τόσο"λιγότερα"θυμόμαστε..." Συμπέρασμα1 " Εξωσωματική"ή"εσωσωματική"μνήμη";" 5 Συμφωνείτε; Αντισηπτικό=... 1.Διαφωνώαπόλυτα 2.Διαφωνώ 3.Μάλλονδιαφωνώ 4.Μάλλονσυμφωνώ 5.Συμφωνώ 6.Συμφωνώαπόλυτα 1."Δεν"το"έχω"δει"ποτέ"" 2."Το"έχω"δει"" Βρίσκεται α.στοσπίτιμου β.στοσχολείομου γ.στοφαρμακείο δ... 6 1
20/12/13 Βρίσκεται... μετίνοςαπόφασημεποιοσκεπτικόμεποιααποδοτικότητα(αποτελεσματικότηταέστω) Αρχήσοφίαςονομάτωνεπίσκεψις! AnOsepOcs(fromGreekἀντί:an#,'"against" [1] +σηπτικός: sēp#kos,"putrefachve" [2] )areanhmicrobialsubstances thatareappliedtolivinghssue/skintoreducethe possibilityofinfechon,sepsis,orputrefachon.anhsephcs aregenerallydishnguishedfroman#bio#csbythelaber's abilitytobetransportedthroughthelymphahcsystemto destroybacteriawithinthebody,andfromdisinfectants, whichdestroymicroorganismsfoundonnon\living"objects. Someanhsephcsaretruegermicides,capableofdestroying microbes(bacteriocidal),whileothersarebacteriostahc andonlypreventorinhibittheirgrowth. AnObacterialsareanhsephcsthathavetheprovenability toactagainstbacteria.microbicideswhichdestroyvirus parhclesarecalledviricidesoranhvirals. hbps://en.wikipedia.org/wiki/anhsephc 7 8 ΑνπάτεστοΕδιμβούργο... ByapplyingLouisPasteur'sadvancesin microbiology(germtheoryofputrefachon),he promotedtheideaofsterilesurgerywhile workingattheglasgow.listersuccessfully introducedcarbolicacid(nowknownas phenol)tosterilisesurgicalinstrumentsandto cleanwounds,whichledtoareduchoninpost3 operahveinfechonsandmadesurgerysaferfor" paoents. Thewidespreadintroduchonofanhsephc surgicalmethodsfollowedthepaper An#sep#c4Principle4of4the4Prac#ce4of4Surgeryin 1867byJosephLister,[...]advocatedtheuseof carbolicacid(phenol)asamethodofensuring thatany"germs"presentwerekilled. Sir"Joseph"Lister"" (1827 1912) hbps://en.wikipedia.org/wiki/joseph_lister,_1st_baron_lister 9 AclusterofEscherichiacoli bacteriamagnified10,000hmes hbps://en.wikipedia.org/wiki/microbe Συμφωνείτε; 1.Διαφωνώαπόλυτα 2.Διαφωνώ 3.Μάλλονδιαφωνώ 4.Μάλλονσυμφωνώ 5.Συμφωνώ 6.Συμφωνώαπόλυτα Μικρόβια:"ο"μεγαλύτερος"εχθρός"του"ανθρώπου." 10 Θάνατοςστουςεχθρούςμας! Στα"όπλα!Έχομεπόλεμο. "anobiooc,froman#+βιωτικός(biō#kos), whichcomesfromβίωσις(biōsis),andthat fromβίος(bios),"life.[hbps://en.wikipedia.org/wiki/anhbiohcs] Αντιβιοτικό=εναντίον"της"ζωής._" Ελευθεριά"(δική"μας!"από"τα"Μικρόβια)"ή"" Θάνατος"(όχι"δικός"μας!"των"Μικροβίων...)" 11 Καιμόνοτοάκουσματηςλέξηςόφειλενα κάνειτουςγιατρούςνασηκώνονταιοι τρίχεςτηςκεφαλήςτους... Αρχήσοφίαςονομάτωνπερίσκεψις! 12 2
20/12/13 1991 1991 hbps://dl.dropboxusercontent.com/u/7661680/pubdimoliahs/ eco/stacopulu_ikoloyia_mikrovion_iatrikahronika_1991.pdf hbps://dl.dropboxusercontent.com/u/7661680/pubdimoliahs/ eco/stacopulu_ikoloyia_mikrovion_iatrikahronika_1991.pdf 13 14 15 16 Γιαπαράδειγμα... Άλλοπαράδειγμα... 17 18 3
20/12/13 19 20 Πώςγίνεται; Οικολογία"μικροβίων..." μεγαλύ Συμπέρασμα2 " Εξωσωματικά"ή"εσωσωματικά"μικρόβια;" Ταβακτήριατουσώματος>απότακύτταρατουσώματος? 21 22 ΑξενικόήΦιλόξενο; Thestudyofanimalsintheabsenceof contaminahngmicroorganisms;i.e.,of 'germ3free'animals...origin:g. Gnotos,known,+bios,life,+logos, study hbps://dl.dropboxusercontent.com/u/7661680/pubdimoliahs/ eco/stacopulu_ikoloyia_mikrovion_iatrikahronika_1991.pdf 23?"Μήπως"μεγαλώσατε"σε"αξενικό"σπίτι";" 24 4
20/12/13 Άμυνατουοργανισμού 25 26 27 28 29 30 5
MAGAZINE OF THE TUFTS UNIVERSITY MEDICAL AND SACKLER ALUMNI ASSOCIATIONS VOL. 66 NO. 1 WINTER 2007 20/12/13 31 hbps://dl.dropboxusercontent.com/u/7661680/pubdimoliahs/ eco/stacopulu_ikoloyia_mikrovion_iatrikahronika_1991.pdf 32 CON WINTER 200 Αναπόσπαστοκαισπουδαίοτμήμα τουσώματος Συμπέρασμα3 " Αντι\βιοτικά"ή"ΥΠΕΡ\βιοτικά";" 33 MEDICINE Have we gone too far with hygiene? PLUS: A MUSTACHE CONTEST PERUVIAN RESCUE MY TEXAS HOME 35 Αμαυτόπούτοβάζεις; Χωρίςμικρόβιαθαείχαμε ψωμί;όχι!(μαγιά) κρασί;όχι!(ζύμωση) τυρί;γιαούρτι;όχι!(πυτιά) Χωρίςαποικοδομητέςθαυπήρχεζωή;Όχι! (hbps://el.wikipedia.org/wiki>αποικοδομητής) Χωρίς... Συμπέρασμα4" Τα"μικρόβια"και"τα"μάτια"μας!" 34 COVER STORY 22 The good worms Dr. Joel Weinstock argues that intestinal parasites may be essential to a healthy human immune system. illustrations by Ken Orvidas 36 FEATURES 6 Local h Barbara Tala years as chai helped to bu 8 Delivera by Joseph Do This guy bec 15 Close e of the h by Lisa Y. Liv How Tufts is effective doc 28 Deep in by Lauro F. C Aformer dea growing up o DEPARTMENTS 2 Letters 3 From the 4 Pulse I A s 34 On Camp 38 Universit 40 Beyond B 44 Alumni N 6
20/12/13?Πρόληψη=Προκατάληψη; r immune system Wormshavelostsomegroundlately.Starhnginthe to make It s not all theoretical. In Brazil recently, y invisible. The hypothesis 20thcentury,ithasbeentakenasageneralrule is doctors noticed that a group of children lation stems from amongpublichealthofficialsinindustrializednahons a cellular began suffering from asthma once they had gulatory pathways thateradicahngtheparasitesthroughbeberhygiene the been removed from their parasite-rich bioenvironment and purged of worms. When within the host. In effect, isasmartmove.wormshavesufferedfrombadpress the lid on the immune forever,andyoucanunderstandwhy.theycreep system s the children returned home and were once re up over infection, peopleout,andeverysoo en,theymakepeople holding more exposed to the processes of their check. retchingsick.but,accordingtoweinstock,the fecund natural milieu, the asthma went r off having these pathways, prevailingbiasagainstwormswasneverreallybased away.. Everything has to be onhardevidence.itwasmoreofaculturalhabitof kept in Many gastroenterologists have followed he immune system revulsioncarriedonunthinkingly. or it will Weinstock s work with keen interest. Dr. J. 37 avid Elliott, his colleague back Thomas Lamont, for one, sounds willing to rs. Turning to electricity for be persuaded. I think it s a very original and lliott describes the role of unique idea he has, says Lamont, chief of ost s body as supplying safety gastroenterology at Beth Israel Deaconess revent the immune system Medical Center in Boston and an associate Μαζίμεταξεράκαίγονταικαιτα χλωρά... muttering, You want to do what with these Andso,withthebestofintenhons,weasasocietyhaveroareddown thatanhsephcpath.beginningwithimmensepublicworksprojectsthat worms? but eventually the agency said encircledamericancihesaround1900,butevenmoreemphahcally sincethehygienecrazeofthe1950s,whenhouseholdgermsin yes, and studies Iowa began. suburbankitchenswereviewedasathreatakintocommunism,our In 1999, six patients with either Crohn s waterhasbeenfiltered,ourfoodpurifiedandoursanitahonimproved dramahcally.theoperahngroomofmodernlifehasbeenscrubbed disease or ulcerative colitis who had not clean. responded to conventional treatment volunteered to participate in an experiment at the Manyinfechousdiseaseshavebeendrashcallyreducedoraltogether wipedoutalongtheway.that sthegoodnews.butinahypothesisthat isatoncecounter3intuihveandqueasilyunexpected,weinstockargues Iowa lab. They were asked to swallow capsules containing a low dose of microscopic thatwemayhavegonetoofarwithourclean3upefforts.intheprocess ofriddingourselvesofstubbornlyresistant,evendeadlypathogens,he says,wehavealsoeliminatedabatchofnaturallyoccurringagentsthat whipworm eggs suspended in liquid. The playavitalroleinregulahngthehealthofourimmunesystems. helminth used in the study was carefully chosen for its benign characteristics: It could not penetrate the skin or multiply within the body, and had the capacity to colonize for several weeks at most. The hatched eggs were shed harmlessly in the stool. 38 ists have determined Οι4μεγάλοι that parasitic Οπρώτοςνόμοςτηςπαρασιτολογίας worms can ss allergy by inducing a class of immune cells known latory T cells, which interact with inflammatory Thebackgroundhereisominous.Forwhateverreason, somethingisclearlyoutofwhackwithimmune responseamongresidentsofindustrializednahons aroundtheworld. Ratesofoccurrenceforasthma,TypeIdiabetes, y sending mulhplesclerosisandinflammatoryboweldisease them off signals. (IBD,whichcomesintwoprincipalforms,Crohn s diseaseandulcerahvecolihs) thebigfourdiseases thatinvolveamalfunchoningimmunesystem have wire. There s your host s risensharplyinindustrializednahonsoverthepast surright there, in the implica- half3century. They vegoneuplikethis, says Medicine. If this idea has legs,it s going to editor of The New England Journal of Weinstock,flickingathumbtowardtheceiling,while last, loaded word. By remainingrareinthedevelopingworld. being be a breakthrough. lved with each other, both the 39 e host have improved their SOME WHIPWORM EGGS o see another day. Who would have figured a town in pastoral win-win. The parasite downmmune system for its own rowing into the niceties of the human eastern Iowa to be the locus for people bur- s Rick Maizels, an immunolniversity of Edinburgh in panned out because that s where our guy immune system? But that s the way things cal. In Brazil recently, muttering, You want to do what with these is a group familiar of children with Weinstock s worms? but happened eventually to the be, agency and he said soon got those asthma g so has once wider they ramifications, Καλήηθεωρία...μαστηνπράξη; had yes, and the around studies in him Iowa excited began. about his pet notion. dampens eir parasite-rich unrelated bioged h of as worms. allergic When responses. disease or bluntly, ulcerative referring colitis who to his had University not of Iowa immune In 1999, We six patients were first with to either Crohn s gate, says Weinstock home determined and were that once parasitic responded to colleagues. conventional No treatment one else volunteered to participate in an experiment at the was ready for this. e processes of their ppress allergy by inducing a Roughly 10 years ago, the Iowa team u, the asthma went Iowa lab. They were asked to swallow capsules Tcontaining (Weinstock, a low dose Summers of microscopic and Elliott, among e cells known as regulatory eract logists with have inflammatory followed whipworm cells others) eggs suspended began with in liquid. animal The studies, initially h keen off interest. signals. Dr. J. helminth used conducting the study experiments was carefully using mice and latory ne, sounds T cells willing may toexist chosen natut us for its pigs. benign These characteristics: studies It generally could confirmed it s a very from original suffering and autoimnot penetrate their skin working multiply hypothesis. within the The logical next says Lamont, chief of body, and had the capacity to colonize for, Maizels told a British step was human studies, which required eth Israel Deaconess several weeks at most. The hatched eggs ston ly. We and think an associate the mechanism were shed harmlessly approaching the the stool. FDA and winning the ng us from our immune sys- agency s approval through normal channels. One can only imagine some poor FDA administrator sitting at his or her desk and 41 tecting the parasite from our at. parasitic worms can class of immune cells known teract with inflammatory icine nals. winter 2007 Conversely,wherehelminthsareprevalent,theincidence ofibdisverylow. Considerthelowlyparasite.Thisisamini3creature could beaflea,ahckoranematode thatabachesitselftoa hostandreliesonthathostforsurvival.althoughin generalparlanceweputtheparasiteinalowerboxthan thehost,andshi ourtoneofvoicetosomething derogatorywheneverweubertheword,naturedoesn t reallyworkthatway.therelahonshipbetweenthetwois symbiohc.asweinstockexplains, Thefirstlawof Researchers found that the Crohn s disease advantagetothehost. Andthismakesperfectsense, got better in all six patients. For five parasitologysaysthattheparasitemustimpartasurvival patients, becauseevoluhonhasnothingjudgmentalaboutit. the disease went into remission for up to five months, while in the sixth, the 40 condition improved substantially but did not obtain clinical remission, according to Weinstock. The patients experienced no negative side effects from ingesting the worm eggs, and after about three weeks, when the patients gradually relapsed, their symptoms did not appear to be any worse than before ΟδύσπιστοςΘωμάς... the experiment. More recently, the University of Iowa team asked a group of 29 Crohn s patients to swallow whipworm eggs every three weeks for six months. Once again, these were patients for whom standard treatments had failed. Results were just as impressive as before. By the end of the study, all but one of the patients had shown improvement, with 21 reporting no symptoms at all. The results were published in Gut in 2004. For anyone who can t imagine anything 42 more repulsive than popping a vial of whipworm eggs into your mouth, bear in mind 7 England Journal of has legs,it s going to EGGS Researchers found that the Crohn s disease got better in all six patients. For five patients, the disease went into remission for up to five months, while in the sixth, the condition improved substantially but did
Bruce Morgan is editor of this magazine. nder duress. ohn s include ver, persistent d weight loss, s almost never nts to swallow se of how desmmers relates. s a chance, I ll published in roenterology?συγκριτικόδείγμα; Hepatology in 2005 further confirmed the merit of the Iowa team s approach. In this study, which involved 60 patients suffering from ulcerative colitis, those treated with whipworm eggs fared demonstrably better than those who took placebos. Summers, who believes that Weinstock s hypothesis may have important implications for other autoimmune diseases not related to gastroenterology, is more con-43vinced than ever of the gold that lies inside the mountain. Over the past decade, he has PubMed "TheHygieneHypothesis" 1692άρθρα(1831232013,23:01) 45 Scribner,2012 400pp ISBN:1439199388 47 For a homegrown example, he asks us to consider an American boy living in a small Midwestern town on a summer morning in 1872. The boy runs outside to play in the street. There are horse droppings and raw sewage there. He cuts through a field barefoot to reach a friend s house. Worms lie in wait along the earthen path. He races home for lunch. His sandwich and water, unscreened by any health agency or government office, are likely rife with parasites. Often on a microscopic scale, parasitic worms (or helminths) wriggle into their hosts directly through exposed skin or by being ingested in food and drink. There are about 90 relatively common species of helminths, many of which live in harmony with their hosts. Most worms have minimal negative effects, but there are a few really bad actors, Weinstock notes. The nasty batch includes tapeworms, which inhabit the human gut and may reach to around 1900, but even more emphatically him on the science of immune regulation 35 feet in length; ecchinococcus and schistomosa, which can parasihcwormscansuppressallergy cause significant liver household germs in suburban kitchens were thrown the baby out with the bathwater. since the hygiene craze of the 1950s, when by intestinal worms. We seem to have disease in their hosts; and onchocerca, known for blinding people in Africa and parts of South America, where the worms are transmitted by sand flies. seen more than 100 Iowa patients treated Worms have lost some ground lately. Starting in the 20th century, has been taken as a general rule among public effectively health officials with in industrialized nations helminth eggs without side that eradicating the parasites through better hygiene is a smart move. Worms have suffered from bad press forever, and you effects can of understand any why. They kind. creep people Asked if he knows of any out, and every so often, they make people retching sick. But, according to Weinstock, the prevailing bias against worms was refutation never really based on of hard evidence. the It was team s hypothesis from more of a cultural habit of revulsion carried on unthinkingly. He snatches a textbook off a shelf and experiments done anywhere, he answers shows a densely printed chapter in a current medical textbook that discusses intestinal worms in entirely negative terms. There, simply: he says. Not Look at that, indicating really. the three or four brief citations at chapter s end. There s not much data behind those assertions. Not that it ever mattered much to public health activists. The consensus has been, these things are awful we ve got to get rid of them, says Weinstock, who grew up in Michigan and retains a certain Midwestern openness, a willingness to be surprised, on his features. And so, with the best of intentions, we as a society have roared down that antiseptic path. Beginning with immense public works projects that encircled American cities viewed as a threat akin to communism, our water has been filtered, our food purified and our sanitation improved dramatically. The operating room of modern life has been scrubbed clean. Many infectious diseases have been drastically reduced or altogether wiped out along the way. That s the good news. But in a hypothesis that is at once counter-intuitive and queasily unexpected, Weinstock argues that we may have gone too far with our clean-up efforts. In the process of ridding ourselves of stubbornly resistant, even deadly pathogens, he says, we have also eliminated a batch of naturally occurring agents that play a vital role in regulating the health of our immune systems. We re not saying all worms are good, but the bad side might be overemphasized, especially for some worms, offers Dr. David Elliott, Ph.D., a former colleague of Weinstock s at the University of Iowa who has co-authored a number of articles with Scienhstshavedeterminedthatparasihcwormscansuppress allergybyinducingaclassofimmunecellsknownasregulatoryt cells,whichinteractwithinflammatorycellsbysendingthem 24 tufts medicine winter 2007 NOT DONE YET The world is waking up to the news. Maizels, off signals. the Scottish immunologist, has been a true believer since he came across Weinstock s papers on the topic of helminths and immune regulation a number of years ago. Maizels calls Weinstock, whom he has invited to speak at the University of Edinburgh, a leading force in the emerging field. The Σύμφωνα με την «υπόθεση της υγιεινής» two men joined Η to καθαριότητα organize «διευκολύνει» the first την international conference Σωστό" εκδήλωση της νόσου Αλτσχάιμερ on the topic last year, attracting 150 scientists to Germany, where the groundswell of excitement was palpable, according to Maizels. Could worms have a healing effect comparable to what they have already demonstrated in the treatment of Crohn s disease! and ulcerative colitis on other autoimmune disorders such as asthma, Type I diabetes and multiple sclerosis? For now, that s only one of many questions looming over the field. Gastroenterological treatments based on Weinstock s research are currently in development. In an expansive moment in his office, Weinstock wideruniversehasbeenshakenby suggests that worm therapy bylucrehus satomictheoryofmaber; stands a chance Copernicus sheliocenteredsolarsystem; to reduce the prevalence of Darwin sconstruchonoftheoriginofspecies; autoimmune disease in Western societies by as much as 90 Einstein sinsightintotheconstruchonofhmeandspace; percent. We ve done a lot of work over the past 10 years, and we re not done. It s not microbesintoourancestraleukaryohccellslongago. time to open the champagne yet, he cautions, but I don t think we re wrong. It s not too early to say, Yeah, these puppies have an effect, and they could play a role in the treatment of disease. Elliott, his Iowa colleague, rings the victory bell more forcefully, like someone calling the world s doctors and scientists to dinner from the farmhouse porch. You ve got all these diseases of developed countries, all these illnesses of development. Why? he asks rhetorically. Ours is the strongest explanation. It s the helminths, guys. 44 ΑκόμακαιστονκαθημερινόΤύπο! «υπόθεσητηςυγιεινής» =λάθοςμετάφραση... 54Σεπ.42013 hbp://health.in.gr/news/scienceprogress/arhcle/?aid=1231263821#ref=newsroombox 46 AnEpidemicofAbsenceReviewedbyPaulHPlotz Humankind sexcephonalistviewofitsplaceintheworldandthe Freud srecognihonofthesubconsciousasadriverofsenhentlife; therecognihonthatourgenehccodeissharedbyalllivingcreatures;and thediscoverythatmitochondrialdnaandsomesomahcdnamovedfrom The"realizaOon"that"we"cannot"separate"our"existence"from"the" microbial"world"that"coats"all"our"surfaces;"that"we"depend"on" those"commensals"and"recognize"many"aspects"of"our"lives" influenced"by"them;"and"that"those"commensals"also"depend"on" us"is"a"huge"idea"that"will"forever"alter"our"narcissisoc"isolaoon." 48 20/12/13 8
20/12/13 AclusterofEscherichiacoli bacteriamagnified10,000hmes hbps://en.wikipedia.org/wiki/microbe Συμφωνείτε; 1.Διαφωνώαπόλυτα 2.Διαφωνώ 3.Μάλλονδιαφωνώ 4.Μάλλονσυμφωνώ 5.Συμφωνώ 6.Συμφωνώαπόλυτα Μικρόβια:"ο"μεγαλύτερος"φίλος"του"ανθρώπου." ΓιάνηςΔημολιάτης:"Ηυπόθεση(υπερ)καθαριότητα"("Thehygienehypothesis") 49 that these are patients under duress. Common symptoms of Crohn s include abdominal pain, bloating, fever, persistent diarrhea, rectal bleeding and weight loss, among other torments. It was almost never a problem convincing patients to swallow the worm egg capsules because of how desperate they were for relief, Summers relates. They would say, Well, if it has a chance, I ll do it. A double-blind study published in Nature Clinical Practice Gastroenterology Hepatology in 2005 further confirmed the merit of the Iowa team s approach. In this study, which involved 60 patients suffering from ulcerative colitis, those treated with whipworm eggs fared demonstrably better than those who took placebos. Summers, who believes that Weinstock s hypothesis may have important implications for other autoimmune diseases not related to gastroenterology, is more convinced than ever of the gold that lies inside the mountain. Over the past decade, he has winter 2007 tufts medicine 27 Bruce Morgan is editor of this magazine. as much as 90 percent. We ve done a lot of work over the past 10 years, and we re not done. It s not time to open the champagne yet, he cautions, but I don t think we re wrong. It s not too early to say, Yeah, these puppies have an effect, and they could play a role in the treatment of disease. Elliott, his Iowa colleague, rings the victory bell more forcefully, like someone calling the world s doctors and scientists to dinner from the farmhouse porch. You ve got all these diseases of developed countries, all these illnesses of development. Why? he asks rhetorically. Ours is the strongest explanation. It s the helminths, guys. Weinstock suggests that worm therapy stands a chance to reduce the prevalence of autoimmune disease in Western societies by and ulcerative colitis on other autoimmune disorders such as asthma, Type I diabetes and multiple sclerosis? For now, that s only one of many questions looming over the field. Gastroenterological treatments based on Weinstock s research are currently in development. In an expansive moment in his office, Could worms have a healing effect comparable to what they have already demonstrated in the treatment of Crohn s disease two men joined to organize the first international conference on the topic last year, attracting 150 scientists to Germany, where the groundswell of excitement was palpable, according to Maizels. Maizels calls Weinstock, whom he has invited to speak at the University of Edinburgh, a leading force in the emerging field. The believer since he came across Weinstock s papers on the topic of helminths and immune regulation a number of years ago. seen more than 100 Iowa patients treated effectively with helminth eggs without side effects of any kind. Asked if he knows of any refutation of the team s hypothesis from experiments done anywhere, he answers simply: Not really. NOT DONE YET The world is waking up to the news. Maizels, the Scottish immunologist, has been a true believer since he came across Weinstock s papers on the topic of helminths and immune regulation a number of years ago. Maizels calls Weinstock, whom he has invited to speak at the University of Edinburgh, a leading force in the emerging field. The two men joined to organize the first international conference on the topic last year, attracting 150 scientists to Germany, where the groundswell of excitement was palpable, according to Maizels. Could worms have a healing effect comparable to what they have already demonstrated in the treatment of Crohn s disease and ulcerative colitis on other autoimmune disorders such as asthma, Type I diabetes and multiple sclerosis? For now, that s only one of many questions looming over the field. Gastroenterological treatments based on Weinstock s research are currently in development. In an expansive moment in his office, Weinstock suggests that worm therapy stands a chance to reduce the prevalence of autoimmune disease in Western societies by as much as 90 percent. We ve done a lot of work over the past 10 years, and we re not done. It s not time to open the champagne yet, he cautions, but I don t think we re wrong. It s not too early to say, Yeah, these puppies have an effect, and they could play a role in the treatment of disease. Elliott, his Iowa colleague, rings the victory bell more forcefully, like someone calling the world s doctors and scientists to dinner from the farmhouse porch. You ve got all these diseases of developed countries, all these illnesses of development. Why? he asks rhetorically. Ours is the strongest explanation. It s the helminths, guys. Bruce Morgan is editor of this magazine. Weinstock spivotalqueshontookthescienhficinquiryina hypothesis may have important implications for other autoimmune diseases not related to gastroenterology, is more convinced than ever of the gold that lies inside the mountain. Over the past decade, he has A double-blind study published in Nature Clinical Practice Gastroenterology winter 2007 tufts medicine 27 wholenewdirechon.thementalleapinvolvedhadtheeffect NOT DONE YET The world is waking up to the news. Maizels, the Scottish immunologist, has been a true seen more than 100 Iowa patients treated effectively with helminth eggs without side effects of any kind. Asked if he knows of any refutation of the team s hypothesis from experiments done anywhere, he answers simply: Not really. from ulcerative colitis, those treated with whipworm eggs fared demonstrably better than those who took placebos. Summers, who believes that Weinstock s Hepatology in 2005 further confirmed the merit of the Iowa team s approach. In this study, which involved 60 patients suffering diarrhea, rectal bleeding and weight loss, among other torments. It was almost never a problem convincing patients to swallow the worm egg capsules because of how desperate they were for relief, Summers relates. They would say, Well, if it has a chance, I ll do it. ofrenderinganegahveprintofafamiliarscene,wherebyblack goeswhiteandwhiteblack,reversingthefigureandground. that these are patients under duress. Common symptoms of Crohn s include abdominal pain, bloating, fever, persistent 50 Συμφιλίωσημετονμικρόκοσμο Προτιμώναπεθάνωπαράνατοπιω Ναι" " " " " " "ή"?"" Όχι hbps://en.wikipedia.org/wiki/ Helminthic_therapy InfechousNecatoramericanusL3larva.Invisibletothe nakedeye,from10to35areappliedtotheskinin therapy,eitherinasingledoseorinmulhplesmaller dosesoverthecourseoftwoorthreemonths 51 52 Why""hygiene"hypothesis "? SinceallergiesandotherCIDsarelargelydiseasesof thelast100yearsorso,the""hygiene""revoluoonof thelast200yearscameunderscruhnyasapossible cause.duringthe1800sradicalimprovementsto sanitahonandwaterqualityoccurredineuropeand NorthAmerica.Theintroduchonoftoiletsandsewer systemsandthecleanupofcitystreets,andcleaner foodwerepartofthisprogram.thisinturnledtoa rapiddeclineininfechousdiseases,parhcularly duringtheperiod190031950,throughreduced exposuretoinfechousagents. hbps://en.wikipedia.org/wiki/hygiene_hypothesis "hygiene""revoluoon"hypothesis"! 53 Αρχήσοφίαςονομάτωνεπίσκεψις! Hygiene" Hygieneistheavoidanceofinfechonorfood spoilingbyeliminahngmicroorganismsfromthe surroundings.[hbps://en.wikipedia.org/wiki/microbe] Washingone'shands,aformof hygiene,isthemosteffechveway topreventthespreadof infechousdisease. hbps://en.wikipedia.org/wiki/hygiene TheHygieneHypothesis= ΗΥπόθεση(υπερ)Καθαριότητα 54 9
consider n town on ide to play aw sewage a friend s for lunch. vernment nsensus has we ve got to k, who grew s a certain gness to be ntions, we as at antiseptic public works rican cities emphatically 1950s, when itchens were viewed as a threat akin to communism, our water has been filtered, our food purified and our sanitation improved dramatically. The operating room of modern life has been scrubbed clean. Many infectious diseases have been drastically reduced Συμπέρασμα! or altogether wiped out along the way. That s the good news. But in a hypothesis that is at once counter-intuitive and queasily unexpected, Weinstock argues that we may have gone too far with our clean-up efforts. In the process of ridding ourselves of stubbornly resistant, even Μήπωςτοπαρακάναμεμετηνκαθαριότητα;Μήπως deadly περάσαμεστοάλλοάκρο;απότηνυπο3στηνυπερ3 pathogens, he says, we have also καθαριότητα;στηνύβρη; eliminated a batch of naturally occurring agents that play a vital role in regulating the ΓιάνηςΔημολιάτης:"Ηυπόθεση(υπερ)καθαριότητα"("Thehygienehypothesis") 55 health of our immune systems. We re not saying all worms are good, but the bad side might be overemphasized, especially for some worms, offers Dr. David Βαθμολογήστετουςγονιούςαυτών Elliott, Ph.D., a former colleague of Weinstock s at τωνπαιδιών: the University of Iowa who has Χείριστα012345678910Άριστα co-authored a number of articles with him on the science of immune regulation by intestinal worms. We seem to have thrown the baby out with the bathwater. Επιστροφήστονεγκέφαλο! Αρχίσαμεμεεγκέφαλο(διαφάνεια3), αςτελειώσομεμεεγκέφαλο... ΓιάνηςΔημολιάτης:"Ηυπόθεση(υπερ)καθαριότητα"("Thehygienehypothesis") 56 20/12/13 Διότι... τουπουργείο προειδοποιεί!! ΓιάνηςΔημολιάτης:"Ηυπόθεση(υπερ)καθαριότητα"("Thehygienehypothesis") 57 ΓιάνηςΔημολιάτης:"Ηυπόθεση(υπερ)καθαριότητα"("Thehygienehypothesis") 58 Διότιτουπουργείο...τρομοκρατεί! ΗαγωγήτουΜήκαιτουΠρόσεχε! ΚάθεπαιδίπουέχειμεγαλώσειμετοΜήκαιμετο Πρόσεχε!... hbps://dl.dropboxusercontent.com/u/7661680/pubdimoliahs/e/_pacosmacos_se_1992.pdf hbps://dl.dropboxusercontent.com/u/7661680/pubdimoliahs/e/_pacosmacos_eekpay_1993.pdf ΓιάνηςΔημολιάτης:"Ηυπόθεση(υπερ)καθαριότητα"("Thehygienehypothesis") 59 ΓιάνηςΔημολιάτης:"Ηυπόθεση(υπερ)καθαριότητα"("Thehygienehypothesis") 60 10
20/12/13 Άλλοεγκέφαλοςάλλοανοσολογικό... hbps://dl.dropboxusercontent.com/u/7661680/ PubDimoliahs/E/_PacosMacos_SE_1992.pdf Δενμαθαίνειδιαφορετικάτοανοσολογικό! ΓιάνηςΔημολιάτης:"Ηυπόθεση(υπερ)καθαριότητα"("Thehygienehypothesis") 61 Οιτρειςβάσειςδεδομένωνμας Αυτήπουκληρονομήσαμε:DNA:δεν μπορούμενακάνομετίποτα,μ αυτήνθα πορευτούμε... Αυτήπουρυθμίζειτιςσχέσειςμαςμετην υπόλοιπηβιόσφαιρα:ανοσολογικό:αρκείνα τηγνωρίσει(τηβιόσφαιρα),ότανπρέπει, όπωςπρέπει,όσοπρέπει! Αυτήπουτρέχειτηνκαθημερινότητάμας: Εγκέφαλος:αρκείνατηγνωρίσει,όταν πρέπει,όπωςπρέπει,όσοπρέπει... ΓιάνηςΔημολιάτης:"Ηυπόθεση(υπερ)καθαριότητα"("Thehygienehypothesis") 62 ΑγωγήΥγείας!(καιόχιασθενείας...) Διότι,περίαυτούπρόκειται.Περίαγωγήςυγείας, καίσωματικής(ανοσολογικό) καίψυχικήςδιανοητικής(εγκέφαλος) Ευτυχώςπουκαιταδύοσυστήματα,ανοσολογικό καιεγκέφαλος,μαθαίνουνμετουςίδιουςκανόνες Ή...δυστυχώς:Οιγονείςκατά95%θέλουντοκαλό τουπαιδιούτους,αλλάκατά95%τοκάνουνμε λάθοςτρόπο ΥπόθεσηΥπερπροστασίας Ηυπόθεση(υπερ)καθαριότηταςστηνουσίατης είναιμιαυπόθεσηυπερπροστατίας Όχιτουεγκεφάλου:τουανοσολογικού Πουσυχνάεπιπλέκεταιμεμπίζνεςπρόληψη" (καιάντεμετάναταβγάλειςπέραμε συμφέροντα...) ΓιάνηςΔημολιάτης:"Ηυπόθεση(υπερ)καθαριότητα"("Thehygienehypothesis") 63 ΓιάνηςΔημολιάτης:"Ηυπόθεση(υπερ)καθαριότητα"("Thehygienehypothesis") 64 Μήπωςκρύβεταιμπίζνεςπρόληψη; 1.Διαφωνώαπόλυτα 2.Διαφωνώ 3.Μάλλονδιαφωνώ 4.Μάλλονσυμφωνώ 5.Συμφωνώ 6.Συμφωνώαπόλυτα 1."Δεν"το"έχω"δει"ποτέ"" 2."Το"έχω"δει"" Βρίσκεται α.στοσπίτιμου β.στοσχολείομου Αντισηπτικό=...Σώζει=... γ.στοφαρμακείο Ζωές=...Υγεία=...ΧέριαΜΑΣ... δ... 65 Την"Ύβριν"ακολουθεί"η"Νέμεσις" Υπέρ3=Ύβρις Τηνυπέρ3καθαριότηταακολουθούν"οι4 μεγάλοι"(asthma,typeidiabetes,mulhple sclerosis,inflammatoryboweldisease) καιέπονταιμικρότεροι... Τηνυπέρ3προστασίατουεγκεφάλουηισόβια αναπηρίατου... Ύβρις:hbps://el.wikipedia.org/wiki/>Ύβρις Νέμεση:hbps://el.wikipedia.org/wiki/>Νέμεσις 66 11