Maggots for Wound Healing
by Markus Haastert and Anne Kathrin Kuhlemann
Background: The history of maggots
We begin our story in Porto Novo, the capital of Benin. There, Pater Godfrey Nzamujo founded the Songhai center in 1986. The Nigeria born priest opened the center as a food production site, in which he attempted to put all generated waste back into the system to generate new value from it. Plant biomass became substrate for mushrooms, sewage became biogas, remains from food processing became food for animals and slaughterhouse waste was used to breed maggots.
The priest even constructed a “fly-hotel” in order to produce millions of maggots. These can then be used as a protein-rich food for fish and chickens. In that way, waste is used to generate value.1 It would also be possible to produce maggots on the incredible amount of slaughterhouse waste which is generated annually. Estimations of the European Commission indicate that each year more than 16 million tons of non-edible animal side-products are produced in the European Union alone.2
But maggots offer the potential for much more and have historically been used extensively in wound healing. Indeed, there have been relatively early observations that wounds which were colonized by maggots heal surprisingly well. In the 1930s, maggot-therapy was the state of the art in wound healing medicine. With the development of antibiotics, this method was however forgotten. In the 1990s however, when the first problems with bacterial resistances against antibiotics emerged, maggot-therapy found defenders once more. Also the Aborigines and other indigenous peoples are known to have used maggots to treat infected wounds.3
Innovation: Maggots for modern wound healing
There are many people in Europe who suffer from diseases which could be treated with maggots, the larvae of Lucilia Sericata – the common bluebottle or meat fly. According to doctors, more than three million people in Germany alone suffer from chronic wounds, with associated treatment costs of over five billion Euros.4 These people could be helped with a targeted maggot-therapy. Maggots have characteristics which help in the wound healing process. First, they clean the wound from infected tissue. And secondly, their excretions support the development of new tissue after the dead parts have been removed. Roughly 1,000 clinics in Europe and 300 in the US now regularly use maggots in their treatment of chronic wounds.5
The formerly widely spread believe that maggots only feed on dead tissue has been refuted.6 Thus, a continuous supervision by medicinal personnel is necessary when applying a maggot-therapy.
Side-effects of the therapy are practically non-existent when applied correctly. Mostly, patients have an itching feeling, if they feel anything at all. In case of an overdose, which means the use of too many maggots, healthy tissue can be affected which can lead to additional pain.7 In this case, the treatment has to be canceled straight away.
To avoid having to put maggots directly into open wounds, British Professor Stephen Britland and his team developed a way to extract enzymes from the maggots to create a cream which can be applied on wounds.8 However, creams made from maggot-enzymes are still prohibited in Europe, as the technology is not yet advanced enough. In 2008, the first antibiotic on maggot-basis was developed. As about 20 maggots were needed to produce one drop of the antibiotic, the efficiency was still low.9
At the moment, maggots are mostly put in teabag-like sachets, which are then put on the wound to stay there for a few days. After removal, the animals are often more than two hundred times as big as before.10According to studies, the sachets however reduce the efficiency of the therapy significantly.11 Pills on maggot-basis are not an option, as the proteins will be digested before they can successfully begin the treatment – and since blood does not always circulate in the wounded area, which is part of the healing problem.12
Maggots also have the potential to fight the threateningly fast increase in resistances against antibiotics. In worst-case scenarios, which US scientists have calculated, annual costs of up to 55 billion US$ could develop as a result of such resistances, 20 billion for medicinal costs and 35 billion for lost productivity.13 Through the reduced application of antibiotics, maggot-therapy has the potential to slow down this process. Reliable numbers to what extent antibiotics can be replaced by the use of maggots are however not yet available.
The momentarily most popular opinion among doctors is that maggot-therapy is an excellent way to clean wounds. It is however not proven that wounds indeed heal more quickly than with conventional medicine. Usually, this therapy is used as the ultima ratio, when conventional methods have failed and surgeries are unsuccessful. Especially patients with chronically infected wounds have often benefited from maggot-therapy. Also patients with rheumatism and diabetes can benefit from it.
Potential: Saving lives and boosting the economy
Research on the medicinal use of maggots has just begun. As the focus for many years lay on fighting maggots as a vector of diseases, this field of medicine still has to catch up. At the moment, the potential of maggots to cure diseases such as a malaria or cancer is being evaluated. More research is essential to discover the full potential of maggots.14
Of special interest in this context is the possibility to implement this therapy in developing countries with insufficient medical services. Maggots could be bred decentrally in villages and would be available quickly in case of accidents. This could save numerous human lives. Infected wounds which lead to a sepsis are still a common cause of death, both in developed and developing countries.15
Even better, if a simple technology could be found to extract the healing enzymes of the maggots, it would be possible to produce dearly needed medicine. A concentrated, locally produced cream from maggots, which were bred on waste and themselves serve as food for animals, could not only save human lives but also boost local economies.
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