When Weinstock smiles, his face takes on a playful, almost mischievous expression. Weinstock likes to say that science is based on curiosity and research. “I’m still twelve years old,” he says. He has a slow, unhurried manner of speech. Weinstock often begins his speeches with a statement that at first glance is made offhand, but in fact has a deep meaning: judging by the weight, human feces are 60% made up of live bacteria. He never mentions the consequences: despite the unprecedented computing power of our brains, our ability to travel in outer space, our attempts to analyze the laws that govern the Universe — at some level we are still nothing more than machines that generate and distribute microbes.
“We are part of our environment; we are inseparable from it,” Weinstock once told me. “And we can’t be separated from it.”
I’m used to hearing such nice vague platitudes from conservationists and environmentalists. But the head of the Department of gastroenterology at tufts University medical center? These words take on a certain weight, not least because in the late ‘ 90s, Weinstock began to look for a way to restore, so to speak, the original parasitic fauna of the human gut. He began to search for a helminth suitable for conducting experiments with human participation.
At that time, animal experiments showed that helminths can prevent not only inflammatory bowel diseases, but also other inflammatory and autoimmune diseases. Mice that were first injected with schistosome eggs became invulnerable to artificially induced colitis. After the introduction of helminths, inflammatory bowel diseases did not develop even in mice with a genetic predisposition to them. In addition, the protective effects of parasites spread far beyond the intestines: they could even prevent the mouse version of multiple sclerosis. From the laboratory of Anne cook, a researcher at the University of Cambridge in the UK, a report has been received: schistosome egg extract prevents autoimmune diseases in mice with artificially induced diseases of this kind.
It was time to conduct clinical trials in humans, and Weinstock knew that it was necessary to proceed cautiously. It took a lot of effort and time to destroy helminths in the United States. Although the sewer system prevented the spread of parasites among people, Weinstock knew that even the slightest possibility of infection would ruin the entire project. He needed a helminth that would not only not cause even minor symptoms, but would not be able to spread on its own. These criteria from the very beginning excluded the possibility of using most types of helminths that have adapted to humans. After analyzing the possible options, Weinstock turned his attention to the pigs.
The state of Iowa, which ranks first in the United States for raising pigs, had about 15.5 million of these animals. In 2000, the state’s population was almost three million people — there were five piglets for every resident. Pig farmers regularly encounter a type of pig whipworm — the pig whipworm (Trichuris suis). (Humans have their own species of whipworm, Trichuris trichiura.) Apparently, this helminth does not cause almost any symptoms in humans. T. suis does not move through human tissues — one advantage. Although this parasite may colonize the human digestive system for some time, the internal organs of humans and pigs differ sufficiently that the pig’s whipworm does not reach sexual maturity for one reason or another. After about two months of being in the human intestine, these worms are dying. Weinstock thought that the spread of infection was out of the question.
In 1999, Weinstock, Elliott, and summers began safety trials involving seven patients, four of whom had Crohn’s disease and three had ulcerative colitis. The volunteers drank a glass of Gatorade with the addition of 2,500 whipworm eggs. For the next twelve weeks, the researchers tracked the severity of the disease in these patients. For four weeks, the symptoms subsided, and then began to worsen. In about ten weeks, all the test participants returned to their previous state, in which they were tormented by inflammation.
Weinstock changed the Protocol, ordering patients to take up to 2,500 eggs once every three weeks. Constant dosed intake ensured the maintenance of the disease in remission. Since inflammatory bowel diseases are very painful and difficult to treat, the researchers were able to easily attract two more groups of volunteers (thirty people each) to participate in the trials, ready to swallow thousands of whipworm eggs.
Since the beginning of 2004, participants in this experiment have been drinking Gatorade soda with the addition of 2,500 microscopic T. suis eggs at three-week intervals. After six months, 23 of the 29 participants in the trial with Crohn’s disease improved (almost 80%). 21 participants (almost three-quarters) went into complete remission. The first trial was not “blind”: the researchers knew who would get the helminth eggs and who would get the placebo. However, in a follow-up double-blind study involving patients with ulcerative colitis, remission occurred in 13 out of 30 patients. The condition of two out of every five participants in the trial improved. In each of these studies, no side effects were found.
After publishing the results of his research in 2005, Weinstock officially left the path that was formed under the influence of microbial theory, which was followed by modern medicine. He abandoned this black-and-white view to pave a new path — a path that involves the introduction and use of ambiguous biological connections that require a more nuanced approach. (Can a parasite be considered a parasite if it benefits the host?)
Weinstock took an idea that had been in the air for some time (that human diseases must be viewed through the lens of human evolution) and turned it into a practical approach to treating an unexplained illness. His work has opened up prospects not only for relatively safe treatments for diseases such as inflammatory bowel disease, but also for preventing these diseases. If inflammatory diseases occur due to the absence of certain stimuli, then such a disorder can be prevented by replacing these stimuli at an early age. With sufficient foresight and planning, we could (theoretically) prevent these terrible diseases in the future.
But we are ahead of the curve.