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	<title>Waiting for the Cure &#187; Nottingham trial</title>
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	<link>http://waitingforthecure.com/I</link>
	<description>... a day in the life of Crohn's disease ...</description>
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		<title>eosinophilia: significance?</title>
		<link>http://waitingforthecure.com/I/2009/02/11/eosinophilia-significance/</link>
		<comments>http://waitingforthecure.com/I/2009/02/11/eosinophilia-significance/#comments</comments>
		<pubDate>Wed, 11 Feb 2009 14:56:40 +0000</pubDate>
		<dc:creator>I</dc:creator>
				<category><![CDATA[egg count]]></category>
		<category><![CDATA[helminth immunology]]></category>
		<category><![CDATA[trials]]></category>
		<category><![CDATA[dose ranging study]]></category>
		<category><![CDATA[egg count studies]]></category>
		<category><![CDATA[helminth immunology worm burden]]></category>
		<category><![CDATA[hookworm dosing]]></category>
		<category><![CDATA[Nottingham trial]]></category>

		<guid isPermaLink="false">http://waitingforthecure.com/I/?p=504</guid>
		<description><![CDATA[There are very few studies on the effect of helminths on humans. As a patient trying this therapy, there are few immune markers we have on hand to check immune response. We have measures of inflammation, like CRP and SED rates, but only in the research setting can one measure IL-10, the T 1 and [...]]]></description>
			<content:encoded><![CDATA[<p>There are very few studies on the effect of helminths on humans.   As a patient trying this therapy, there are  few immune markers we have on hand to check immune response.  We have measures of inflammation, like CRP and SED rates, but only in the research setting can one measure IL-10, the T 1 and T2 arms, etc.  All we have is eosinophilia and standard stool tests to assess worm burden.</p>
<p>Eosinophils rise in response to hookworm infection, seeming to peak between weeks 3-10.  This study describes that eosiniphils peak between days 38-64 :</p>
<p><a href="http://www.ajtmh.org/cgi/content/abstract/37/1/126">http://www.ajtmh.org/cgi/content/abstract/37/1/126</a></p>
<p>Peaks between weeks 3-9:</p>
<p><a href="http://www.ajtmh.org/cgi/content/full/75/5/914#F5">http://www.ajtmh.org/cgi/content/full/75/5/914#F5</a></p>
<p>Starts to be elevated at days 14-21, peaked on day 42 and declined to<br />
a persistently elevated level:</p>
<p><a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1809522">http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1809522</a></p>
<p>Peaked week 5, declined by week 20:<br />
&#8220;In the CD cohort, blood eosinophilia developed from week 5 (mean<br />
2.60Ã—109/l (1.89) v week 1 0.18Ã—109/l (0.10) v week 20 0.59 (0.20)). &#8221;</p>
<p><a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1856386">http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1856386</a></p>
<p>But my favorite study, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/17230481">MS study in Argentina</a>, where they tracked 12 MS patients already infected with helminths and compared them to 12 other MS patients over a 4.6 year period, only recruited the helminth infected patients if their eosinophelia was high, (800-1800 mm3) and it stayed that way for the duration of the study.   Their quantitative egg counts were also high: between 1,180 and 9,340 eggs/gram.</p>
<p>Eosinophils reflect parasitic infection, and the higher the number, usually the larger the worm burden. One indication that one has lost their worm infection would be having an elevated EOS for an extended length of time, then having it fall to baseline.  Obviously, stool tests would confirm this, as well as symptom regression.  In the <a href="http://www.ajtmh.org/cgi/content/full/75/5/914#F5">dose-ranging trial</a>, the higher doses resulted in higher EOS counts, though they did not test longer than 12 weeks.</p>
<p>I only tested my EOS at baseline and 18 weeks, so I never tracked a rise and fall.  Baseline values were 74 cells/mcL and only rose to 192 post infection.  (Normal is 15-550).  Remember, I added worms from weeks 10-18, which may have provoked an immune response that curtailed the new worms from attaching, and possibly displaced some of the first 10, like t<a href="http://www.ncbi.nlm.nih.gov/sites/entrez">his capsule endoscopy study</a> shows.  So by week 18, perhaps I had very few worms&#8230;</p>
<p>I will be testing EOS at weeks 3, 6, 9, and 12 to see how they respond to 10 larvae.    I don&#8217;t think 10 hookworms are going to be enough to cause persistent eosinophilia.  And like the MS study, it seems important to get and maintain a large enough worm burden to stimulate eosinophilia, and maintain a higher egg count.  I&#8217;m very curious what my results will be this time&#8230;</p>
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		<item>
		<title>Nottingham&#8217;s Trial Notes</title>
		<link>http://waitingforthecure.com/I/2009/01/23/nottinghams-trial-notes/</link>
		<comments>http://waitingforthecure.com/I/2009/01/23/nottinghams-trial-notes/#comments</comments>
		<pubDate>Fri, 23 Jan 2009 14:56:00 +0000</pubDate>
		<dc:creator>I</dc:creator>
				<category><![CDATA[trials]]></category>
		<category><![CDATA[Crohn's]]></category>
		<category><![CDATA[egg count]]></category>
		<category><![CDATA[Nottingham trial]]></category>

		<guid isPermaLink="false">http://waitingforthecure.com/I/?p=355</guid>
		<description><![CDATA[Just found the on-line protocol for the Crohn&#8217;s study at Nottingham University. For those of you with Crohn&#8217;s experimenting with hookworms, though most of the immune blood tests will be unavailable to us, it might be nice to follow some of the other protocol. The CRP and SED rate are taken at baseline, then at [...]]]></description>
			<content:encoded><![CDATA[<p>Just found the <a href="http://74.125.47.132/search?q=cache:j8Oev9n1f94J:www.nottingham.ac.uk/shared/shared_wddc/documents/HW_protocol_version_2.2_23032006.doc+hookworms+have+you+tried+IBd&amp;hl=en&amp;ct=clnk&amp;cd=20&amp;gl=us&amp;client=firefox-a">on-line protocol </a>for the Crohn&#8217;s study at Nottingham University.  For those of you with Crohn&#8217;s experimenting with hookworms, though most of the immune blood tests will be unavailable to us, it might be nice to follow some of the other protocol.  The CRP and SED rate are taken at baseline, then at weeks 3, 6, 9, and 12.  (They eradicate the hookworms at week 12, but follow up for another month.)  <a href="http://cal.vet.upenn.edu/projects/parasit06/website/mcmaster.htm">Fecal egg counts</a> are done at week 12.  Of course, there&#8217;s also the <a href="http://www.ibdjohn.com/cdai/">CDAI</a>, the <a href="http://en.wikipedia.org/wiki/Crohn's_Disease_Activity_Index">Harvey Bradshaw Index (HBI)</a>, and <a href="http://en.wikipedia.org/wiki/Crohn's_Disease_Activity_Index#Inflammatory_Bowel_Disease_Questionnaire">quality of life IBD questionairre (IBDQ)</a>.</p>
<p>One of the frustrations I have in experimenting with this therapy, and of AIT, is the lack of diagnostic pursuit of patient&#8217;s effects.  Most patients are not doing before and after screening, and often aren&#8217;t even communicating about their long-term effects from hookworms.  Patient&#8217;s doses, frequency of doses, and clinical response are only known by AIT and none of the rest of us are able to access that data to learn from.  I wish there was an anonymous database accessible online that would list the diseases, patient&#8217;s blood scores at baseline, side effects within the first 4 months, and when efficacy began, if it did.  Although each person&#8217;s reaction to hookworm is different, the more we quantify and correlate our response, the more patterns might emerge that would help future patients.  But alas, it&#8217;s not my business, so I am correlating what I find here, and when I redose in a few weeks, will try to take my own advice and do all I can to track my response to help future people wishing to experiment outside the trials.</p>
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