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Clinical Review Science, medicine, and the future


BMJ 2003; 326 doi: (Published 25 January 2003) Cite this as: BMJ 2003;326:207
  1. Achim Hoerauf (, head of departmenta,
  2. Dietrich W Büttner, professor emeritusa,
  3. Ohene Adjei, professorc,
  4. Eric Pearlman, associate professorb
  1. a Bernhard Nocht Institute for Tropical Medicine, Department of Helminthology, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
  2. b Departments of Medicine and Ophthalmology, Case Western Reserve University SOM W137, 2109 Adelbert Road, Cleveland, OH 44106, USA
  3. c Department of Microbiology, School of Medical Sciences, University of Science and Technology, Kumasi, Ghana
  1. Correspondence to: A Hoerauf

    Endosymbiotic Wolbachia bacteria in the worms are targets for a new therapeutic approach

    Onchocerciasis, or river blindness, caused by the filaria Onchocerca volvulus, affects more than 17 million people in Africa, Latin America, and Yemen. The microfilaricidal agent ivermectin is the principal means of controlling the disease, through mass treatment. Wolbachia endosymbiotic bacteria in filarias have emerged as a new target for treatment with drugs that lead to long term sterilisation of adult female filarias. Participants at recent international meetings have agreed that anti-Wolbachia chemotherapy with doxycycline (currently for six weeks) could be used to treat infected individuals. This approach holds promise for new developments based on registered antibiotics that are affordable in resource poor settings, as extensive registration processes are not needed. Recent experimental findings also indicate that endotoxin-like molecules from Wolbachia have a role in the pathogenesis of the disease and in adverse reactions after treatment.

    Summary points

    Onchocerciasis is a major cause of blindness

    Current strategies rely on mass distribution of ivermectin by a community directed distribution system

    New chemotherapeutic strategies need to be developed to kill adult worms or sterilise them in the long term

    Wolbachia symbiotic endobacteria in filarias are essential for fertility and offer novel targets for treatment

    Anti-wolbachial treatment with 100 mg/day doxycycline for six weeks can be used to treat onchocerciasis

    Wolbachia have been implicated in the induction of adverse effects of microfilaricidal drugs and may have a role in the development of pathology, including keratitis


    This review is based on information from World Health Organization publications on onchocerciasis 1 2; on recent conferences, such as the WHO-cosponsored Hamburg conference on filariasis in September 2001 and the conference on the eradicability of onchocerciasis organised by the Carter Center and the WHO in Atlanta, USA, in January 2002 3 4; and …

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