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NEWSLETTER 11 (MAY, 2009)

 

REPORTS OF THE DIFFERENT REPRESENTATIVES OF IBS

 

KOSTA Y. MUMCUOGLU (PRESIDENT)

IBS matters
The EC decided to continue the charity status of our Society in the UK, and that the fund of our Society (currently £2,144), be held in a Lloyds Bank account in the UK. Eventually the fund will be transferred to USA and will be managed by the new treasurer, Ronald Sherman.

 

Next international IBS conference
Ron Sherman, Aletha Tippett , Theodore Cherbuliez, and the president of the Society are making every effort to organize the Eighth International Conference on Biotherapy in the USA in the year 2010 or 2011.

 

Representatives
In order to advance the cause of biotherapy worldwide, to gather and disseminate knowledge about recent developments in different aspects of biotherapy, it was decided that each of the EC member of our Society would represent a given region or be responsible for a given subject. This person will write an annual report about the activities in his region or the subject of his interest, which will be published in a Newsletter on our website. The representatives are as follows:
- Olga Gilyeva: Hirudotherapy
- Christopher Kim: Bee-venom therapy
- Theodor Cherbuliez: Apitherapy
- Sagiv Ben-Yakir: Biotherapy in veterinary medicine
- Ron Sherman and Aletha Tippett: MDT in N. America
- Alicia Fonseca Munoz: MDT in S. America
- Wim Fleischmann: MDT in Europe
- John Church: MDT in Africa
- Enrico Ragaza MDT in Philippines, N. Zealand and Australia
- Kosta Mumcuoglu: MDT in Near East

 

MDT in Israel
In 2008, our team in collaboration with a large number of physicians from 5 hospitals in Israel, treated ca. 60 patients by applying over 170 treatments. Most of the treatments were applied in the Hadassah Medical Center, Jerusalem, and in the Beit Meir Hospital in Kfar Sava. At least 6 imminent leg amputations were canceled as a result of MDT.

 

Apitherapy in Israel
On February 2008 the Israeli Apitherapy Organization organized the First National Apitherapy Congress in Sheba Hospital, Tel Hashomer. Eleven lecturers gave presentations on apitherapy and bee-venom therapy in the country. I was invited to give the following presentation: Mumcuoglu, K.Y. Apitherapy in the frame of the International Biotherapy Society.

 

Hirudotherapy in Israel
In addition to our group in Hadassah Hospital, Jerusalem, physicians in the Sourasky Medical Center in Tel-Aviv (Dr. I. Kirschfeld) and Soroka Hospital in Beer-Sheva (Prof. L. Rosenberg), are applying hirudotherapy in the Plastic Surgery Departments of their hospitals. There are an additional 3-4 biotherapists (mainly immigrants from Russia and Ukraine), who treat patients with leeches. Regarding hirudotherapy in the veterinary medicine, see the report of Sagiv Ben-Yakir.

 

Publications
Daeschlein, G., K.Y. Mumcuoglu, O. Assadian, B. Hoffmeister & A. Kramer. 2007.
        In vitro antibacterial activity of Lucilia sericata maggot secretions. Skin Pharmacol. Physiol. 20:112–115 (DOI: 10.1159/000097983).

Huberman, L., N. Gollop, K.Y. Mumcuoglu, C. Blockc & R. Galun. 2007.
        Antibacterial properties of the whole body extracts and hemolymph of Lucilia sericata maggots. J. Wound Care 16: 123-127.

Huberman, L., N. Gollop, K.Y. Mumcuoglu, E. Breuer, S.R. Bhusare, Y. Shai & R. Galun. 2007.
        Antibacterial substances of low molecular weight isolated from Lucilia sericata (Diptera: Muscidae). Med. Vet. Entomol. 21: 127-131.

Taylan-Ozkan, A. & K.Y. Mumcuoglu. 2007.
        Maggot debridement therapy for the treatment of a venous stasis ulcer (in Turkish). Turkish Bull. Hyg. Exp. Biol. 64: 31-34.

Mumcuoglu, K.Y., L. Huberman, R. Cohen, V. Temper, A. Adler, R. Galun & C. Block. 2009.
        Elimination of symbiotic Aeromonas spp. from the intestinal tract of the medicinal leech, Hirudo medicinalis using ciprofloxacin feeding. Clin. Microbiol. Infect. (in press).

 

Presentations
Lectures/seminars on MDT were given to physicians and nurses of the Beit Meir Hospital in Kfar Sava and Tel Hashomer Hospital, Ramat Gan, Israel.

 

Interviews
An interview was given to a Brazilian TV (Record TV, reaching more than 100 million viewers daily), which is going to be shown in Brazil and other South American countries. This will be in the form of a documentary on MDT in Israel.

 

Correspondence
There has been a weekly (sometimes more often) Email correspondence with students, biotherapists, physicians and scientists from Israel and abroad, who had questions regarding MDT and hirudotherapy.

 

Research
At present we are working on the excretions and pheromones of Lucilia sericata maggots.

 

Internet
In order to inform physicians on the theoretical and practical aspects of MDT, KYM wrote two articles on the biggest website for physicians in Israel (Reshet Refuah (http://www.mednet.co.il/)

 

MDT in Egypt
The team of Tantawi et al. is treating patients with MDT in Alexandria, Egypt. Tantawi TI, Gohar YM, Kotb MM, Beshara FM, El-Naggar MM. Clinical and microbiological efficacy of MDT in the treatment of diabetic foot ulcers. J Wound Care. 2007 Oct;16(9):379-83 (Department of Zoology, Faculty of Science, Alexandria University, Alexandria, Egypt; tantawi2egy@yahoo.com)

 

Biotherapy in Turkey
Dr. Erdal Polat (Clinical Microbiology Department) and Prof. Turgut Ipek (Department of Surgery) from the Cerrahpasa Medical Center, Istanbul, Turkey, visited our laboratories in Jerusalem during the period 17-22.2.2007 and received instruction on sterile maggot production and MDT. Shortly after, with the financial help of Tubitac, they opened a laboratory for MDT in their hospital. By September 2008, when I visited the new installations, I learned that in the meantime dozens of patients had been treated with maggots and a student started her MSc thesis on this subject.

Tanyuksel, M. & E. Araz. 2007. Maggot treatment (in Turkish).
In Ozcel’in Tibbi Parasit Hastaliklari (Ozcel, A. ed.). Turkish Parasitology Society, Izmir, pp. 883-890.

Ozcelik, S. Leeches and human health (in Turkish).
In Ozcel’in Tibbi Parasit Hastaliklari (Ozcel, A. ed.). Turkish Parasitology Society, Izmir, pp. 895-898.

Taylan-Ozkan, A. & K.Y. Mumcuoglu. 2007. Maggot debridement therapy for the treatment of a venous stasis ulcer (in Turkish).
Turkish Bull. Hyg. Exp. Biol. 64: 31-34.

 

 

SAGIV BEN-YAKIR (SECRETARY)

In 2008, I had the pleasure to lecture for thousands of veterinarians and biotherapists globally about the different options biotherapy is providing us (veterinarians) in treating animals for different conditions:

1)   "North American Veterinary Conference" (NAVC) - Jan 2008, Orlando, Florida, USA (25th year). I lectured there for some 10 hrs about veterinary hirudotherapy and veterinary bee venom therapy etc.

2)   "American Veterinary Medical Association" (AVMA) 142nd annual convention - July 2008, New Orleans, Louisiana, USA. I lectured there for some 8 hrs about veterinary hirudotherapy and veterinary bee venom therapy etc.

3)   "2nd Academic Conference of Asian Society for Traditional Veterinary Medicine" - Sept 2008, Taipei, Taiwan. Presenting different aspects of Vet Biotherapy.

4)   "The 34th Annual Congress of The International Veterinary Acupuncture Society" - Sept 2008, Keystone, Colorado, USA. I presented different aspects of Veterinary Biotherapy.

5)   Seminar in Equilibre – Zentrum for Ganzheitliche Medicine, Frankfurt/Main, Germany, November 15-16, 2008. Difficult Cases in Holistic Veterinary Medicine Acupuncture - TCVM– Homoopathy – Homoosiniatry (see details of the program).

6)   Veterinarians and medical team members are getting lectures + labs routinely about the different aspects of veterinary biotherapy in the 2 yrs course for Complementary and Alternative Veterinary Medicine at Zinman College, Wingate Institute, Israel (I am the academic manager of the course).

7)   Promoting veterinary biotherapy routinely on 2 different Web veterinary discussion groups.

8)   2 lectures for The Israeli Medical Association - its acupuncture section, about veterinary hirudotherapy and veterinary bee venom therapy.

9)   Article in Germany - ”Veterinarmedizinische Bienengift-Therapie” in Zeitschrift fur Ganzheitliche Tiermedizin, 2008; vol 22:30-32.

10)   I think that due to my activities in the veterinary communities we add some tens of veterinarians that did registration to IBS as new members.

 

 

RONALD SHERMAN (TREASURER) AND ALETHA TIPPETT (MEMBER AT LARGE)

Biotherapy Progress in North America, 2008 - Report to IBS

In the U.S., the year 2008 marks numerous advancements in Biotherapy, especially maggot debridement therapy (MDT), leech therapy and apitherapy.

Education
Maggot therapy was the subject of several lectures, both locally and at national conferences. Dr. Tippett lectured on maggot therapy at the Ohio hospice conference, and at the national AAHPM conference. The BioTherapuetics, Education & Research (BTER) Foundation lectured at the Soughtwest Regional Conference of the Wound, Ostomy and Continence Nurses Society (Carmel, CA; March 27-28), and presented maggot therapy workshops at the Symposium on Advanced Wound Care (San Diego, CA, April 24-27), the Undersea & Hyperbaric Medical Society (June 25; Salt Lake City, UT), the American Podiatric Medical Association Conference (Honolulu, HI, July 24-27), and Wild on Wounds (Orlando, Florida Sept 18). The BTER Foundation also met directly with the diabetes patient and care-giver community, exhibiting at Diabetes Expo, Los Angeles (Long Beach, CA; May 3). The BTER Foundation circulated draft guidelines for leech therapy in 2008; final Policy and Procedure template should be out in 2009. The Policies and Procedures address only those indications that received marketing clearance by FDA in 2004: to relieve venous congestion, such as after transplantation or replantation surgery.

Research
A phase I clinical study of bacteriophage therapy safety in venous stasis ulcers was completed in 2008; results should be available (published) in 2009.

Publications
Since Publications are really international, I assume that they will be listed separately. If not, let us know and we will list those publications out of the U.S. and Canada that we are aware of.

Clinical & Commercial Biotherapy
Monarch Labs began its 3rd year of commercial production and distribution of medicinal maggots. Medicinal maggots were distributed to over 800 therapists and centers in North America. Among maggot therapists, veterinarians and animal handlers are becoming more prominent, especially equine practitioners. Maggot therapy for chronic laminitis, navicular abscesses and other foot and leg wounds is more common then ever before. Additionally, Monarch Labs received FDA marketing clearance for a new patented maggot therapy dressing – a single-piece hinged maggot cage dressing (“Le Flap”) which should be simpler to apply than the current method of constructing cage dressings at the bedside from hydrocolloid pads, netting and adhesives. The dressing is expected to be on the market in early 2009. There is probably an increase in leech therapy use, but no numbers are available. We are aware of several therapists who are adding leech therapy to their tool bag (including Dr. Tippett). Two well-established leech suppliers continue to do business in the U.S.: Leeches USA (distributor of Ricarimpex leeches from France), and Carolina Biological Supply (distributor of Biopharm leeches, UK). Several patients sought Helmintherapy this year for their immunologic and autoimmune illnesses (i.e., Crohn’s Disease), through Autoimmunetherapies. As therapeutic helminthes are not legally marketed in the U.S., these American patients received their treatments in Mexico. To our knowledge, there are no known clinical studies of helmintherapy in the U.S. at the present time. Payment for biotherapy can be an impediment for many patients and therapists in the U.S., because there is no system in place for universal health care, and even products with FDA clearance (such as medicinal maggots and leeches) may not always be reimbursed by health insurance companies. The BTER Foundation petitioned the American Medical Association and spoke at a public hearing in April before a Medicare Panel, to argue in favor of insurance coding that would improve the chances of reimbursement for maggot therapy through Medicare and private insurance. A coding guidance document was issued 6 months later, and it is hoped that reimbursement in 2009 will be easier for all.

Media
On the media front, biotherapy was featured in several documentaries and national television programs in 2008. Demi Moore brought a lot of attention to leech therapy, as she related her experience with hirudotherapy to David Letterman. The media also promoted maggot therapy when they announced that one of the 100 winners of the Medical Device & Diagnostic Industry “Most Notable People for 2008” awards was credited with advancing maggot therapy (http://www.devicelink.com/mddi/archive/08/06/002.html).

Biotherapy Support Organizations
Both the BTER Foundation (www.BTERFoundation.org) and the American Apitherapy Society (www.apitherapy.org) are expanding their membership offerings, and began talks to combine efforts in the advancement of biotherapy in the U.S. Talks will continue during 2009; hopefully with a solid plan to bring the International Biotherapy Conference to the U.S. within 2 years.

 

 

LETTER TO BMJ REGARDING MAGGOT THERAPY

This following letter was recently published in the BMJ as a reactions to the article of Dumville et al. 2009 (http://www.bmj.com/cgi/eletters/338/mar19_2/b773#213657)

Maggot Therapy: Apparently a good treatment despite poor study and inadequate analysis
Ronald A Sherman, Retired, Assistant Researcher, University of California Irvine, CA 92617, Kosta Y. Mumcuoglu, PhD

Dear Editor:

We read with interest the publication by Dumville et al. (1), describing a prospective, randomized study of maggot debridement therapy (MDT) that followed subjects through to the point of wound healing. Evidence of effective and efficient maggot debridement abounds, and the authors contributed to that evidence by demonstrating maggot debridement to be 2-5 times faster than their standard non-surgical therapy. Many policy-makers have postponed embracing maggot therapy until there was proof that wounds debrided by medicinal maggots would ultimately heal as well as conventionally debrided wounds. Thanks to Dumville and colleagues, their wait is now over.

Given the expertise of the study team, we were surprised by the poor study design and inadequate analysis. A few points will reveal the magnitude of these deficiencies and may even suggest testable hypotheses to explain why the quickly-debrided MDT wounds did not heal faster than the conventionally treated wounds. More importantly, only by addressing the problems with this study will the next clinical investigation answer the questions that still remain: is debridement beneficial in the healing of venous stasis ulcers, and how should that debridement be carried out.

The study objective was reportedly to evaluate the efficacy and safety of maggot-induced wound healing, but the administration of larval dressings was limited to the initial debridement only. Having used maggot therapy as a debridement tool in this way, the primary endpoint should have been debridement efficacy, with wound closure as the secondary endpoint. To test the effect of maggot therapy on wound healing, the investigators should have done two additional steps: monitored the need for repeated debridement or growth promotion, and permitted the re- application of maggot therapy --- either routinely or at least for wounds that were not healing “adequately” (however they wished to define it). This is the way it is used clinically for wound healing.

Since the 1930’s, clinicians have noted that wounds treated with MDT beyond the point of complete debridement heal faster than wounds whose larval therapy terminated once the wound is clean (2). The waning of maggot therapy’s growth-stimulating and antimicrobial benefits has been demonstrated by several recent studies. (3-4).

The wound-healing benefits of maggot therapy may cease shortly after stopping maggot therapy because the maggots themselves are no longer physically stimulating the wound bed, and because their secretions are no longer bathing the tissue. Maggots and their secretions have been shown in vivo and/or in vitro to be antimicrobial (5-11), to promote tissue growth (12-19), to increase local perfusion (3) and to dissolve and inhibit the formation of biofilm (20). After larval therapy is stopped, the wound could become susceptible again to microbial attack, biofilm formation, necrosis, inflammation and ultimately impaired healing. Intermittent maggot therapy is now recognized as a form of “maintenance debridement;” it is also the accepted method of administering maggot therapy when the goal is to stimulate wound healing.

Since the wounds were digitally photographed weekly, it would be simple to determine when and where the healing time saved by maggot therapy’s rapid debridement was lost. As others have done in the past (12- 14), the authors should have plotted the wound dimensions or “rates of wound closure” over time. In this way it may have been possible to determine if there was no growth-promoting effect at all, or if there was indeed hastened wound closure for some period of time after maggot debridement, which was then lost. Prior studies have suggested the loss of wound healing and antimicrobial effects occurs 2-3 weeks after discontinuing larval therapy (4).

A design flaw even more egregious was the withholding of compression therapy during treatment of maggot-treated subjects. This, alone, put the maggot-treated group at a significant disadvantage. Touted as a study of “maggot therapy vs hydrogel,” the study actually compared maggot therapy to hydrogel with optimized compression therapy. This unfair handicap is particularly shocking given the authors’ long research experience documenting that (in their own words) “compression increases ulcer healing rates compared with no compression” (21).

In light of this biased study design, the authors should have been impressed that the maggot-debrided wounds healed as quickly as control wounds. But instead, they were highly critical of maggots and those who choose to use them, because maggot-debrided wounds did not heal significantly faster than control wounds. How did the researchers define “significantly faster” healing?

In their VenUS I study (22), the authors sought a 15% benefit in wound healing to conclude that one method of compression therapy was better than another. This VenUS II study was designed to detect a benefit of maggot therapy only if healing occurred in less than 64% of the time it took control wounds to heal. In other words, for maggots to prove their worth in the current study, the researchers demanded a 37% benefit compared to hydrogel and compression therapy. This target is far more demanding than what most therapists or policy makers would consider as being of clinical benefit. Again, those who designed this study required from larval therapy more than twice what they accept as “significant benefit” in their studies of conventional modalities.

Other critical details also were not completely discussed or disclosed. For example, readers are not informed of the frequency of maggot treatments, even though this is a crucial element in comparing this study to earlier studies and crucial to interpreting the resulting speed and efficiency of debridement.

We are told that “the median time to healing in the larvae group was 236 days (95% confidence interval 147 to 292) and in the hydrogel group was 245 days (166 to upper limit not estimable).” But why was the upper limit not estimable? Did some of the hydrogel-treated wounds not heal? If so, how many? What was the longest period of time that they were observed not to have healed? Was there any significance between the number of non- healed wounds in the hydrogel group and the number in the maggot therapy group (all wounds appear to have healed in the larval therapy group)? Were the non-healed wounds at least getting smaller, or were they stagnant, non -healing?

Bagged and loose larvae were repeatedly grouped together in maggot-vs-hydrogel comparisons, but the evidence to support that grouping was poorly presented. For example, we are told that debridement with bagged larvae took twice as long (28 vs 14 days) as with loose larvae, but we are told that “after adjustment” the difference was found not to be significant. Therefore, the authors compared the combined speed of maggot debridement with hydrogel debridement (median time to debridement 72 days) and stated that MDT was only twice as fast as hydrogel. The fact that the difference between loose and bagged larvae failed to achieve statistical significance is no reason to avoid mentioning that loose larvae actually debrided wounds 5 times as fast as hydrogel! Why was this comparison not made in the text? The difference likely achieved statistical significance; if it did not, we believe the authors would have noted that. It was wrong to compare the combined “maggot-treated debridement” groups vs hydrogel without comparing the individual loose maggot- and bagged maggot-treated groups with the hydrogel group, especially if each of these “pure” treatment arms were associated with debridement rates significantly different from the hydrogel control.

One of the few pieces of data that received thorough discussion was treatment-associated pain: “significantly more pain was experienced by participants in both larvae groups” than the hydrogel group, during “the 24 hours before removal of the first debridement treatment.” Since larvae were left on the wounds for three to four days, “24 hours before removal would mean the pain began at least 48 hours after the larvae were placed. The package insert (data card) clearly states that “[some patients] have reported an increase in wound pain following their application . . . . “ The manufacturer recommends adequate analgesia and removing the maggots at 48 hours. Earlier publications also have warned therapists that the most common adverse event associated with maggot therapy is pain, usually occurring about 24-36 hours into therapy (23). It has long been an accepted part of maggot therapy to provide liberal access to analgesia for the 5-30% of individuals who report pain (they are identifiable in advance since they are the patients who already experience pain with their dressing changes) and to halt their treatment as soon as pain is not adequately controlled, usually within 30 to 48 hours (23).

Why would the researchers not heed these warnings to protect their study subjects from unnecessary and avoidable pain? Was it purely lack of experience with maggot therapy by the authors who described their shock over the fact that these spine-covered larvae could even cause pain when they get big and crawl (scratch) over sensitive wounds? By warning readers against using maggot therapy, even for debridement, because of “significant pain” (pain which had no impact on quality of life scores), the authors make the serious error of confusing statistical significance with clinical significance. It is unfair to describe the pain in this way when it occurred only once during the entire study and made no impact on the quality of life scores. It is unfair to warn readers about the pain of maggot therapy without also warning that this pain occurred because the researchers had not followed prescribing guidelines.

The authors noted that some of their results were contrary to that of many earlier studies and expert opinion, but explained that difference primarily by asserting that their study was bigger and better. They failed to acknowledge many earlier controlled and even prospective studies, and they failed to adequately discuss many of the factors that we elucidated in this critique. It was valid for the authors to question the value of debridement in general, not just maggot debridement; but without evidence that the wounds received adequate debridement throughout the entire period of wound healing, this study fails to provide any more evidence about the value of debridement than it does about the value of maggot therapy for wound healing.

The true significance of this study may be in demonstrating that the time saved by larval debridement --- and possibly many of the benefits seen with other debridement modalities --- may be lost if we do not continue to address the quality of the wound and its response to treatment throughout the entire healing process. The fact that subjects in all three study arms failed to heal as quickly as expected further supports our contention that this study design was not consistent with good clinical practice. Eight months to heal a 12 square cm wound must not be accepted as our “standard of care.”

References:

1. Dumville et al, 2009, Larval therapy for leg ulcers (VenUS II): randomised controlled trial BMJ. 338:b773

2. Baer WS, 1931. The treatment of chronic osteomyelitis with the maggot (larva of the blow fly). J Bone Joint Surg. 13:438-75.

3. Wollina U et al, 2002. Biosurgery supports granulation and debridement in chronic wounds—clinical data and remittance spectroscopy measurement. Int J Dermatol. 41:635-9.

4. Sherman RA and Shimoda KJ, 2004. Presurgical maggot debridement of soft tissue wounds is associated with decreased rates of postoperative infection. Clin Infect Dis. 39:1067-70.

5. Thomas S et al, 1999. The anti-microbial activity of maggot secretions: results of a preliminary study. J Tissue Viability. 9:127-32.

6. Mumcuoglu KY et al, 2001. Destruction of bacteria in the digestive tract of the maggot of Lucilia sericata (Diptera: Calliphoridae). J Med Entomol. 38:161-6.

7. Bexfield A et al, 2004. Detection and partial characterization of two antibacterial factors from the excretions/secretions of the medicinal maggot Lucilia sericata and their activity against methicillin-resistant Staphylococcus aureus (MRSA). Microbes Infect. 6:1297-304.

8. Armstrong DG et al, 2005. Maggot therapy in "lower-extremity hospice" wound care: fewer amputations and more antibiotic-free days. J Am Podiatr Med Assoc. 95:254-7.

9. Huberman L et al, 2007. Antibacterial properties of whole body extracts and haemolymph of Lucilia sericata maggots. J Wound Care. 16:123-7.

10. Tantawi TI et al, 2007. Clinical and microbiological efficacy of MDT in the treatment of diabetic foot ulcers. J Wound Care. 16:379-83.

11. Bowling FL et al, 2007. Larval therapy: a novel treatment in eliminating methicillin-resistant Staphylococcus aureus from diabetic foot ulcers. Diabetes Care. 30:370-1.

12. Sherman RA et al, 1995, Wyle F, Vulpe M. Maggot therapy for treating pressure ulcers in spinal cord injury patients.J Spinal Cord Med. 18:71-4.

13. Sherman RA, 2002. Maggot versus conservative debridement therapy for the treatment of pressure ulcers. Wound Repair Regen. 10:208-14.

14. Sherman RA, 2003. Maggot therapy for treating diabetic foot ulcers unresponsive to conventional therapy. Diabetes Care. 26:446-51.

15. Sherman RA et al, 2007. Maggot Therapy for Problematic Wounds: Uncommon and Off-label Applications. Adv Skin Wound Care. 20:602-610.

16. Prete PE, 1997. Growth effects of Phaenicia sericata larval extracts on fibroblasts: mechanism for wound healing by maggot therapy. Life Sci.;60:505-10.

17. Horobin AJ et al, 2005. Maggots and wound healing: an investigation of the effects of secretions from Lucilia sericata larvae upon the migration of human dermal fibroblasts over a fibronectin-coated surface. Wound Repair Regen. 13:422-33.

18. Horobin AJ et al, 2006. Promotion of human dermal fibroblast migration, matrix remodelling and modification of fibroblast morphology within a novel 3D model by Lucilia sericata larval secretions. J Invest Dermatol. 126:1410-8.

19. Smith AG et al, 2006. Greenbottle (Lucilia sericata) larval secretions delivered from a prototype hydrogel wound dressing accelerate the closure of model wounds. Biotechnol Prog. 22:1690-6.

20. van der Plas MJ et al, 2008. Maggot excretions/secretions are differentially effective against biofilms of Staphylococcus aureus and Pseudomonas aeruginosa. Journal of Antimicrobial Chemotherapy. 61:117–122.

21. O'Meara S et al, 2009. Compression for venous leg ulcers. Cochrane Database Syst Rev. (1):CD000265; update of Cochrane Database Syst Rev. 2001; (2):CD000265.

22. Nelson EA et al, 2004. Randomized clinical trial of four-layer and short-stretch compression bandages for venous leg ulcers (VenUS I). Br J Surg. 91:1292-9.

23. Sherman RA, 2002. Maggot therapy for foot and leg wounds. Int J Low Extrem Wounds. 1:135-42.

Authors: Ronald A. Sherman, MD, MSc, DTM&H (London) Retired, Assistant Researcher, University of California, Irvine; 92617 Director, BioTherapeutics, Education & Research Foundation Laboratory Director, Monarch Labs Clinic Physician, Orange County Health Care Agency, Santa Ana, CA

Kosta Y. Mumcuoglu, PhD Senior Research Scientist, Department of Parasitology Hebrew University-Hadassah Medical School, Jerusalem, Israel.

Competing interests: Disclosures: Both authors have conducted clinical and laboratory studies of maggot therapy over the past 15+ years, and both have laboratories that produce medical grade maggots. Dr. Sherman is Director of the BioTherapeutics, Education & Research Foundation; Dr. Mumcuoglu is President of the International Biotherapy Society. Both of these organizations provide educational and material support to therapists, patients, and the public at large to help understand and advance maggot therapy, leech therapy, phage therapy, and other “biotherapeutic” modalities using live organisms.

 

 

NEW LITERATURE IN BIOTHERAPY

A. MAGGOT DEBRIDEMENT THERAPY
B. HIRUDOTHERAPY
C. BEE-VENOM THERAPY


Copyright © 2007 Hebrew University, Jerusalem, Israel
Last modified: 01/06/09