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Fernandes KA, Lim AI. Maternal-driven immune education in offspring. Immunol Rev 2024; 323:288-302. [PMID: 38445769 DOI: 10.1111/imr.13315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Maternal environmental exposures, particularly during gestation and lactation, significantly influence the immunological development and long-term immunity of offspring. Mammalian immune systems develop through crucial inputs from the environment, beginning in utero and continuing after birth. These critical developmental windows are essential for proper immune system development and, once closed, may not be reopened. This review focuses on the mechanisms by which maternal exposures, particularly to pathogens, diet, and microbiota, impact offspring immunity. Mechanisms driving maternal-offspring immune crosstalk include transfer of maternal antibodies, changes in the maternal microbiome and microbiota-derived metabolites, and transfer of immune cells and cytokines via the placenta and breastfeeding. We further discuss the role of transient maternal infections, which are common during pregnancy, in providing tissue-specific immune education to offspring. We propose a "maternal-driven immune education" hypothesis, which suggests that offspring can use maternal encounters that occur during a critical developmental window to develop optimal immune fitness against infection and inflammation.
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Affiliation(s)
| | - Ai Ing Lim
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, USA
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Gibbs LC, Oviedo JM, Ondigo BN, Fairfax KC. Maternal infection causes dysfunctional BCR signaling in male offspring due to aberrant Xist expression. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.13.528357. [PMID: 36824836 PMCID: PMC9948949 DOI: 10.1101/2023.02.13.528357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Infections during pregnancy with pathogens such as helminths correlate with altered immune responses to common childhood immunizations. However, the molecular mechanisms that underlie this remain unknown. Using our murine model of maternal schistosomiasis, when immunized, males from infected mothers had a lower frequency of antigen-specific germinal center B cells and downregulation of transcripts downstream of BCR signaling compared to males from uninfected mothers. This is driven by a reduction in developing B cell populations within the bone marrow of pups from infected mothers. Males from infected mothers were impacted to a greater extent than their female littermate counterparts. We found this defect to be caused by aberrant expression of the long non-coding RNA Xist in males leading to dysregulated Igα expression on developing B cells. This, for the first time, links dysfunctional BCR signaling with Xist expression, while also proposing a detrimental function for Xist expression in males.
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Affiliation(s)
- Lisa C. Gibbs
- Department of Pathology, University of Utah; Salt Lake City, UT, United States
| | - Juan M. Oviedo
- Department of Pathology, University of Utah; Salt Lake City, UT, United States
| | | | - Keke C. Fairfax
- Department of Pathology, University of Utah; Salt Lake City, UT, United States
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Avokpaho EFGA, Gineau L, Sabbagh A, Atindégla E, Fiogbé A, Galagan S, Ibikounlé M, Massougbodji A, Walson JL, Luty AJF, Garcia A. Multiple overlapping risk factors for childhood wheeze among children in Benin. Eur J Med Res 2022; 27:304. [PMID: 36572891 PMCID: PMC9791764 DOI: 10.1186/s40001-022-00919-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/29/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The African continent is currently facing an epidemiological transition characterized by a shift from communicable to non-communicable diseases. Prominent amongst the latter are allergies and asthma. In that context, wheeze has multiple potential contributory factors that could include some of the endemic helminth infections, as well as environmental exposures, such as household air pollution. We sought to determine the relative importance of these risk factors among children in Benin. METHODS We included 964 children aged 6-14 years living in the commune of Comé, south-west Benin. All children were participants in the longitudinal monitoring cohort of the DeWorm3 trial designed to evaluate multiple rounds of community mass treatment with albendazole for interruption of the transmission of soil transmitted helminths (STH). We administered a standard ISAAC questionnaire to determine the presence of wheeze. In addition, we assessed exposure to household air pollution and to other potential allergy-inducing factors, dietary intake and anthropometry. Using STH infection status assessed at the pretreatment baseline timepoint, we used multivariate statistical modelling, controlling for covariates, to investigate associations between wheeze and the different factors measured. RESULTS The prevalence of wheezing history was 5.2%, of current wheezing was 4.6% and of severe wheezing was 3.1%, while STH infections were found in 5.6% of children. These profiles did not vary as a function of either age or gender. Infection with Ascaris lumbricoides, but not hookworm species, was significantly associated with both current wheeze (adjusted Odds Ratio (aOR) = 4.3; 95% CI [1.5-12.0]) and severe wheeze (aOR = 9.2; 95% CI [3.1-27.8]). Significant positive associations with current wheeze, independent of each other and of STH infection status, were also found for (i) use of open cookstoves (aOR = 3.9; 95% CI [1.3-11.5]), (ii) use of palm cakes for fire lighting (aOR = 3.4; 95% CI [1.1-9.9]), (iii) contact with domestic animals and/or rodents (aOR = 2.5; 95% CI [1.1-6.0]), (iv) being overweight (aOR = 9.7; 95% CI [1.7-55.9]). Use of open cookstoves and being overweight were also independent risk factors for severe wheeze (aOR = 3.9; 95% CI [1.1-13.7]) and aOR = 10.3; 95% CI [1.8-60.0], respectively). CONCLUSIONS Children infected with A. lumbricoides appear to be at elevated risk of wheeze. Deworming may be an important intervention to reduce these symptoms. Improving cooking methods to reduce household air pollution, modifying dietary habits to avoid overweight, and keeping animals out of the house are all additional measures that could also contribute to reducing childrens' risk of wheeze. Policymakers in LMIC should consider tailoring public health measures to reflect the importance of these different risk factors.
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Affiliation(s)
- Euripide F. G. A. Avokpaho
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin ,grid.508487.60000 0004 7885 7602ED 393 Pierre Louis de Santé Publique, Université Paris Cité, Paris, France
| | - Laure Gineau
- grid.508487.60000 0004 7885 7602MERIT, IRD, Université Paris Cité, Paris, France
| | - Audrey Sabbagh
- grid.508487.60000 0004 7885 7602MERIT, IRD, Université Paris Cité, Paris, France
| | - Eloic Atindégla
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin
| | - Arnauld Fiogbé
- grid.463453.3Ministère de la Santé, Centre National Hospitalo-Universitaire de Pneumo- Phtisiologie, Cotonou, Bénin
| | - Sean Galagan
- grid.34477.330000000122986657DeWorm3, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
| | - Moudachirou Ibikounlé
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin ,grid.412037.30000 0001 0382 0205Centre de Recherche Pour La Lutte Contre Les Maladies Infectieuses Tropicales (CReMIT/TIDRC), Université d’Abomey-Calavi, Abomey-Calavi, Bénin
| | | | - Judd L. Walson
- grid.34477.330000000122986657DeWorm3, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
| | - Adrian J. F. Luty
- grid.508487.60000 0004 7885 7602MERIT, IRD, Université Paris Cité, Paris, France
| | - André Garcia
- grid.508487.60000 0004 7885 7602MERIT, IRD, Université Paris Cité, Paris, France
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López-Cervantes JP, Lønnebotn M, Jogi NO, Calciano L, Kuiper IN, Darby MG, Dharmage SC, Gómez-Real F, Hammer B, Bertelsen RJ, Johannessen A, Würtz AML, Mørkve Knudsen T, Koplin J, Pape K, Skulstad SM, Timm S, Tjalvin G, Krauss-Etschmann S, Accordini S, Schlünssen V, Kirkeleit J, Svanes C. The Exposome Approach in Allergies and Lung Diseases: Is It Time to Define a Preconception Exposome? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12684. [PMID: 34886409 PMCID: PMC8657011 DOI: 10.3390/ijerph182312684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 12/30/2022]
Abstract
Emerging research suggests environmental exposures before conception may adversely affect allergies and lung diseases in future generations. Most studies are limited as they have focused on single exposures, not considering that these diseases have a multifactorial origin in which environmental and lifestyle factors are likely to interact. Traditional exposure assessment methods fail to capture the interactions among environmental exposures and their impact on fundamental biological processes, as well as individual and temporal factors. A valid estimation of exposure preconception is difficult since the human reproductive cycle spans decades and the access to germ cells is limited. The exposome is defined as the cumulative measure of external exposures on an organism (external exposome), and the associated biological responses (endogenous exposome) throughout the lifespan, from conception and onwards. An exposome approach implies a targeted or agnostic analysis of the concurrent and temporal multiple exposures, and may, together with recent technological advances, improve the assessment of the environmental contributors to health and disease. This review describes the current knowledge on preconception environmental exposures as related to respiratory health outcomes in offspring. We discuss the usefulness and feasibility of using an exposome approach in this research, advocating for the preconception exposure window to become included in the exposome concept.
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Affiliation(s)
- Juan Pablo López-Cervantes
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway; (M.L.); (A.J.); (G.T.); (J.K.); (C.S.)
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
| | - Marianne Lønnebotn
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway; (M.L.); (A.J.); (G.T.); (J.K.); (C.S.)
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
| | - Nils Oskar Jogi
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; (F.G.-R.); (R.J.B.)
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (S.A.)
| | | | - Matthew G. Darby
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town 7925, South Africa;
| | - Shyamali C. Dharmage
- School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia; (S.C.D.); (J.K.)
| | - Francisco Gómez-Real
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; (F.G.-R.); (R.J.B.)
- Department of Obstetrics and Gynecology, Haukeland University Hospital, 5053 Bergen, Norway
| | - Barbara Hammer
- Department of Pulmonology, Medical University of Vienna, 1090 Vienna, Austria;
| | | | - Ane Johannessen
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway; (M.L.); (A.J.); (G.T.); (J.K.); (C.S.)
| | - Anne Mette Lund Würtz
- Danish Ramazzini Centre, Department of Public Health—Work, Environment and Health, Aarhus University, 8000 Aarhus, Denmark; (A.M.L.W.); (K.P.); (V.S.)
| | - Toril Mørkve Knudsen
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; (F.G.-R.); (R.J.B.)
| | - Jennifer Koplin
- School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia; (S.C.D.); (J.K.)
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Kathrine Pape
- Danish Ramazzini Centre, Department of Public Health—Work, Environment and Health, Aarhus University, 8000 Aarhus, Denmark; (A.M.L.W.); (K.P.); (V.S.)
| | - Svein Magne Skulstad
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
| | - Signe Timm
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark;
- Research Unit, Kolding Hospital, University Hospital of Southern Denmark, 6000 Kolding, Denmark
| | - Gro Tjalvin
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway; (M.L.); (A.J.); (G.T.); (J.K.); (C.S.)
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
| | | | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (S.A.)
| | - Vivi Schlünssen
- Danish Ramazzini Centre, Department of Public Health—Work, Environment and Health, Aarhus University, 8000 Aarhus, Denmark; (A.M.L.W.); (K.P.); (V.S.)
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark
| | - Jorunn Kirkeleit
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway; (M.L.); (A.J.); (G.T.); (J.K.); (C.S.)
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
| | - Cecilie Svanes
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway; (M.L.); (A.J.); (G.T.); (J.K.); (C.S.)
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
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Taylor M, Pillaye J, Horsnell WGC. Inherent maternal type 2 immunity: Consequences for maternal and offspring health. Semin Immunol 2021; 53:101527. [PMID: 34838445 DOI: 10.1016/j.smim.2021.101527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 02/08/2023]
Abstract
An inherent elevation in type 2 immunity is a feature of maternal and offspring immune systems. This has diverse implications for maternal and offspring biology including influencing success of pregnancy, offspring immune development and maternal and offspring ability to control infection and diseases such as allergies. In this review we provide a broad insight into how this immunological feature of pregnancy and early life impacts both maternal and offspring biology. We also suggest how understanding of this axis of immune influence is and may be utilised to improve maternal and offspring health.
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Affiliation(s)
- Matthew Taylor
- Institute of Immunology and Infection Research, Ashworth Laboratories, The Kings Buildings, University of Edinburgh, West Mains Road, Edinburgh, EH9 3JT, UK.
| | - Jamie Pillaye
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - William Gordon Charles Horsnell
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK; Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, Division of Immunology, Faculty of Health Science, University of Cape Town, Cape Town, 7925, South Africa.
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Lubyayi L, Mpairwe H, Nkurunungi G, Lule SA, Nalwoga A, Webb EL, Levin J, Elliott AM. Infection-exposure in infancy is associated with reduced allergy-related disease in later childhood in a Ugandan cohort. eLife 2021; 10:66022. [PMID: 34550875 PMCID: PMC8457824 DOI: 10.7554/elife.66022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/16/2021] [Indexed: 01/16/2023] Open
Abstract
Background Lack of early infection-exposure has been associated with increased allergy-related disease (ARD) susceptibility. In tropical Africa, little is known about which infections contribute to development of ARDs, and at which time. Methods We used latent class analysis to characterise the early infection-exposure of participants in a Ugandan birth cohort and assessed ARDs in later childhood. Results Of 2345 live births, 2115 children (90%) had data on infections within the first year of life while 1179 (50%) had outcome data at 9 years. We identified two latent classes of children based on first-year infection-exposure. Class 1 (32% membership), characterised by higher probabilities for malaria (80%), diarrhoea (76%), and lower respiratory tract infections (LRTI) (22%), was associated with lower prevalence of wheeze, eczema, rhinitis, and Dermatophagoides skin prick test (SPT) positivity at 9 years. Based on 5-year cumulative infection experience, class 1 (31% membership), characterised by higher probabilities for helminths (92%), malaria (79%), and LRTI (45%), was associated with lower probabilities of SPT positivity at 9 years. Conclusions In this Ugandan birth cohort, early childhood infection-exposure, notably to malaria, helminths, LRTI, and diarrhoea, is associated with lower prevalence of atopy and ARDs in later childhood. Funding This work was supported by several funding sources. The Entebbe Mother and Baby Study (EMaBS) was supported by the Wellcome Trust, UK, senior fellowships for AME (grant numbers 064693, 079110, 95778) with additional support from the UK Medical Research Council. LL is supported by a PhD fellowship through the DELTAS Africa Initiative SSACAB (grant number 107754). ELW received funding from MRC Grant Reference MR/K012126/1. SAL was supported by the PANDORA-ID-NET Consortium (EDCTP Reg/Grant RIA2016E-1609). HM was supported by the Wellcome's Institutional Strategic Support Fund (grant number 204928/Z/16/Z).
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Affiliation(s)
- Lawrence Lubyayi
- Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Johannesburg, South Africa
| | - Harriet Mpairwe
- Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gyaviira Nkurunungi
- Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Swaib A Lule
- Institute for Global Health, University College London, London, United Kingdom
| | - Angela Nalwoga
- Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Emily L Webb
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jonathan Levin
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Johannesburg, South Africa
| | - Alison M Elliott
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Cooper PJ, Chis Ster I, Chico ME, Vaca M, Oviedo Y, Maldonado A, Barreto ML, Platts‐Mills TAE, Strachan DP. Impact of early life geohelminths on wheeze, asthma and atopy in Ecuadorian children at 8 years. Allergy 2021; 76:2765-2775. [PMID: 33745189 PMCID: PMC8496980 DOI: 10.1111/all.14821] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Early-life exposures to geohelminths may protect against development of wheeze/asthma and atopy. OBJECTIVE To study the effect of maternal geohelminths and infections in children during the first 5 years on atopy, wheeze/asthma and airways reactivity/inflammation at 8 years. METHODS Birth cohort of 2404 neonates followed to 8 years in rural Ecuador. Data on wheeze/asthma were collected by questionnaire and atopy by skin prick test (SPT) reactivity to 9 allergens. We measured airways reactivity to bronchodilator, fractional exhaled nitric oxide (FeNO) and nasal eosinophilia. Stool samples were examined for geohelminths by microscopy. RESULTS 1933 (80.4%) children were evaluated at 8 years. Geohelminths were detected in 45.8% of mothers and 45.5% of children to 5 years. Frequencies of outcomes at 8 years were as follows: wheeze (6.6%), asthma between 5 and 8 years (7.9%), SPT (14.7%), airways reactivity (10%) and elevated FeNO (10.3%) and nasal eosinophilia (9.2%). Any maternal geohelminth was associated with reduced SPT prevalence (OR 0.72). Childhood Trichuris trichiura infections during the first 5 years were associated with reduced wheeze (OR 0.57) but greater parasite burdens with Ascaris lumbricoides at 5 years were associated with increased wheeze (OR 2.83) and asthma (OR 2.60). Associations between maternal geohelminths and wheeze/asthma were modified by atopy. Parasite-specific effects on wheeze/asthma and airways reactivity and inflammation were observed in non-atopic children. CONCLUSIONS Our data provide novel evidence for persistent effects of in utero geohelminth exposures on childhood atopy but highlight the complex nature of the relationship between geohelminths and the airways. Registered as an observational study (ISRCTN41239086).
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Affiliation(s)
- Philip J. Cooper
- Institute of Infection and Immunity St George's University of London London UK
- School of Medicine Universidad Internacional del Ecuador Quito Ecuador
- Fundacion Ecuatoriana Para La Investigacion en Salud Quito Ecuador
| | - Irina Chis Ster
- Institute of Infection and Immunity St George's University of London London UK
| | - Martha E. Chico
- Fundacion Ecuatoriana Para La Investigacion en Salud Quito Ecuador
| | - Maritza Vaca
- Fundacion Ecuatoriana Para La Investigacion en Salud Quito Ecuador
| | - Yisela Oviedo
- Fundacion Ecuatoriana Para La Investigacion en Salud Quito Ecuador
| | - Augusto Maldonado
- Fundacion Ecuatoriana Para La Investigacion en Salud Quito Ecuador
- Colegio de Ciencias de la Salud Universidad San Francisco de Quito Quito Ecuador
| | | | | | - David P. Strachan
- Population Health Research Institute St George's University of London London UK
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8
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Nkurunungi G, Nassuuna J, Mpairwe H, Kabagenyi J, Nampijja M, Sanya RE, Webb EL, Elliott AM. Allergen skin test reactivity and asthma are inversely associated with ratios of IgG4/IgE and total IgE/allergen-specific IgE in Ugandan communities. Clin Exp Allergy 2021; 51:703-715. [PMID: 33512036 PMCID: PMC7610822 DOI: 10.1111/cea.13834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/12/2020] [Accepted: 01/22/2021] [Indexed: 11/28/2022]
Abstract
Background Serum inhibition of allergen‐specific IgE has been associated with competing IgG4 and non‐specific polyclonal IgE. In allergen immunotherapy, beneficial responses have been associated with high IgG4/IgE ratios. Helminths potentiate antibody class switching to IgG4 and stimulate polyclonal IgE synthesis; therefore, we hypothesized a role for helminth‐associated IgG4 and total IgE in protection against atopic sensitization and clinical allergy (asthma) in tropical low‐income countries. Methods Among community residents of Ugandan rural Schistosoma mansoni (Sm)–endemic islands and a mainland urban setting with lower helminth exposure, and among urban asthmatic schoolchildren and non‐asthmatic controls, we measured total, Schistosoma adult worm antigen (SWA)–specific, Schistosoma egg antigen (SEA)–specific and allergen (house dust mite [HDM] and German cockroach)–specific IgE and IgG4 by ImmunoCAP® and/or ELISA. We assessed associations between these antibody profiles and current Sm infection, the rural‐urban environment, HDM and cockroach skin prick test (SPT) reactivity, and asthma. Results Total IgE, total IgG4 and SWA‐, SEA‐ and allergen‐specific IgE and IgG4 levels were significantly higher in the rural, compared to the urban setting. In both community settings, both Sm infection and SPT reactivity were positively associated with allergen‐specific and total IgE responses. SPT reactivity was inversely associated with Schistosoma‐specific IgG4, allergen‐specific IgG4/IgE ratios and total IgE/allergen‐specific IgE ratios. Asthmatic schoolchildren, compared with non‐asthmatic controls, had significantly higher levels of total and allergen‐specific IgE, but lower ratios of allergen‐specific IgG4/IgE and total IgE/allergen‐specific IgE. Conclusions and clinical relevance Our immuno‐epidemiological data support the hypothesis that the IgG4–IgE balance and the total IgE–allergen‐specific IgE balance are more important than absolute total, helminth‐ or allergen‐specific antibody levels in inhibition of allergies in the tropics.
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Affiliation(s)
- Gyaviira Nkurunungi
- Immunomodulation and Vaccines Programme, Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Jacent Nassuuna
- Immunomodulation and Vaccines Programme, Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Harriet Mpairwe
- Immunomodulation and Vaccines Programme, Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda.,Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Joyce Kabagenyi
- Immunomodulation and Vaccines Programme, Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Margaret Nampijja
- Immunomodulation and Vaccines Programme, Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Richard E Sanya
- Immunomodulation and Vaccines Programme, Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda.,College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emily L Webb
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Alison M Elliott
- Immunomodulation and Vaccines Programme, Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Zhang B, Gems D. Gross ways to live long: Parasitic worms as an anti-inflammaging therapy? eLife 2021; 10:65180. [PMID: 33526169 PMCID: PMC7853715 DOI: 10.7554/elife.65180] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/05/2021] [Indexed: 12/11/2022] Open
Abstract
Evolutionary medicine argues that disease can arise because modern conditions do not match those in which we evolved. For example, a decline in exposure to commensal microbes and gastrointestinal helminths in developed countries has been linked to increased prevalence of allergic and autoimmune inflammatory disorders (the hygiene hypothesis). Accordingly, probiotic therapies that restore ‘old friend’ microbes and helminths have been explored as Darwinian treatments for these disorders. A further possibility is that loss of old friend commensals also increases the sterile, aging-associated inflammation known as inflammaging, which contributes to a range of age-related diseases, including cardiovascular disease, dementia, and cancer. Interestingly, Crowe et al., 2020 recently reported that treatment with a secreted glycoprotein from a parasitic nematode can protect against murine aging by induction of anti-inflammatory mechanisms. Here, we explore the hypothesis that restorative helminth therapy would have anti-inflammaging effects. Could worm infections provide broad-spectrum protection against age-related disease?
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Affiliation(s)
- Bruce Zhang
- Institute of Healthy Ageing, and Research Department of Genetics, Evolution and Environment, University College London, London, United Kingdom
| | - David Gems
- Institute of Healthy Ageing, and Research Department of Genetics, Evolution and Environment, University College London, London, United Kingdom
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10
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Nampijja M, Lubyayi L, Tumusiime J, Nabulime J, Kizindo R, Kabuubi P, Sanya RE, Kabagenyi J, Akurut H, Muhangi L, Webb EL, Alcock K, Elliott AM. Effect of intensive versus standard anthelminthic treatment on growth and cognition among children living in a high Schistosoma mansoni transmission setting: a study nested within a cluster-randomised trial. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.16092.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Schistosomiasis and other worm infections have been associated with growth and cognitive impairments; however, whether treatment reverses these effects is uncertain. Moreover, mechanisms linking these infections to cognition are not clear. We aimed to compare growth and cognitive benefits of intensive versus standard anthelminthic treatment in school-aged-children and explore processes that might be involved. We hypothesised that intensive treatment would have greater benefits than standard treatment. Methods: The study was nested within a cluster-randomised trial of either quarterly single-dose praziquantel of 40mg/kg to treat Schistosoma mansoni plus triple dose albendazole of 400mg (intensive treatment) to treat soil-transmitted worms including Ascaris lumbricoides, hookworm and Trichuris trichiura, or annual single-dose praziquantel 40mg/kg plus six-monthly single-dose albendazole 400mg (standard treatment) conducted in the Koome islands in Lake Victoria, Uganda (ISRCTN47196031). Children aged 5-9 years (N=384) were assessed on primary outcomes (height, weight and eight measures of cognitive ability), worm infection, and proposed mediators of worm effects (cytokines, iron status, physical activity) at one year (intensive n=85; standard n=64) and at two years (intensive n=158; standard n=128) of the intervention. Linear regression was used to examine intervention effects on height, weight and cognitive performance. Linear mixed effects models were used to study changes in growth and cognitive performance between the two arms across the two time-points. Results: Intensive treatment resulted in lower Schistosoma mansoni prevalence than standard treatment (at one year, 41% versus 70%; adjusted odds ratio (aOR)=0.24, 95% CI: 0.12, 0.49; at two years, 39% versus 69%; aOR=0.27; 95% CI: 0.16, 0.43) but there were no significant differences in growth and cognitive outcomes at either time-point. Worms and treatment showed no consistent association with the proposed mediators of worm effects. Conclusion: Reduction in worm burden may not improve growth and cognitive outcomes in high S. mansoni transmission settings. Possible implications are discussed.
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11
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Nakanjako D, Zalwango F, Wairagala P, Luboga F, Andia Biraro I, Bukirwa VD, Mboowa MG, Cose S, Seeley J, Elliott A. Career development for infection and immunity research in Uganda: a decade of experience from the Makerere University - Uganda Virus Research Institute research and training programme. AAS Open Res 2020; 3:26. [PMID: 32734140 PMCID: PMC7372530 DOI: 10.12688/aasopenres.13066.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background: The Makerere University/Uganda Virus Research Institute (UVRI) Centre of Excellence for Infection & Immunity Research and Training (MUII) is a collaborative programme supporting excellence in Infection and Immunity (I&I) research in Uganda. Set up in 2008, MUII aims to produce internationally competitive Ugandan and East African I&I research leaders, and develop human and infrastructural resources to support research and training excellence. We undertook an internal evaluation of MUII’s achievements, challenges and lessons learned between 08-2008 and 12-2019, to inform programmes seeking to build Africa’s health research expertise. Methods: Quantitative data were abstracted from programme annual reports. Qualitative data were obtained in 03-04/2019: a cross-sectional evaluation was undertaken among a purposefully selected representative sample of 27 trainees and two programme staff. Qualitative data was analysed according to pre-determined themes of achievements, challenges, lessons learned and recommendations for improvement. Results: By 12-2019, MUII had supported 68 fellowships at master’s-level and above (50% female: 23 Masters, 27 PhD, 15 post-doctoral, three group-leaders) and over 1,000 internships. Fellows reported career advancement, mentorship by experts, and improved research skills and outputs. Fellows have published over 300 papers, secured grants worth over £20m, established over 40 international collaborations, and taken on research and academic leadership positions in the country. Key lessons were: i) Efficient administration provides a conducive environment for high quality research; ii) Institutions need supportive policies for procurement, including provisions for purchases of specific biological research reagents from international manufacturers; iii) Strong international and multi-disciplinary collaboration provides a critical mass of expertise to mentor researchers in development; and iv) Mentorship catalyses young scientists to progress from graduate trainees to productive academic researchers, relevant to society’s most pressing health challenges. Conclusions: Sustainable academic productivity can be achieved through efficient operational support, global collaboration and mentorship to provide solutions to Africa’s health challenges.
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Affiliation(s)
- Damalie Nakanjako
- Makerere University-Uganda Virus Research Institute Infection and Immunity (MUII), Uganda Virus Research Institute, Entebbe, Uganda.,Department of Medicine, School of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Flavia Zalwango
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit,, Uganda Virus Research Institute, Entebbe, Uganda
| | - Pamela Wairagala
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit,, Uganda Virus Research Institute, Entebbe, Uganda
| | - Fiona Luboga
- Makerere University-Uganda Virus Research Institute Infection and Immunity (MUII), Uganda Virus Research Institute, Entebbe, Uganda
| | - Irene Andia Biraro
- Makerere University-Uganda Virus Research Institute Infection and Immunity (MUII), Uganda Virus Research Institute, Entebbe, Uganda.,Department of Medicine, School of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Victoria Diana Bukirwa
- Makerere University-Uganda Virus Research Institute Infection and Immunity (MUII), Uganda Virus Research Institute, Entebbe, Uganda
| | - Mary Gorrethy Mboowa
- Makerere University-Uganda Virus Research Institute Infection and Immunity (MUII), Uganda Virus Research Institute, Entebbe, Uganda
| | - Steve Cose
- Makerere University-Uganda Virus Research Institute Infection and Immunity (MUII), Uganda Virus Research Institute, Entebbe, Uganda.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit,, Uganda Virus Research Institute, Entebbe, Uganda
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit,, Uganda Virus Research Institute, Entebbe, Uganda.,Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Alison Elliott
- Makerere University-Uganda Virus Research Institute Infection and Immunity (MUII), Uganda Virus Research Institute, Entebbe, Uganda.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit,, Uganda Virus Research Institute, Entebbe, Uganda
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12
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Prevalence of hookworm infection and associated factors among pregnant women attending antenatal care at governmental health centers in DEMBECHA district, north West Ethiopia, 2017. BMC Pregnancy Childbirth 2020; 20:457. [PMID: 32787866 PMCID: PMC7424972 DOI: 10.1186/s12884-020-03134-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hookworm infection is a major public health problem in developing countries. The main way people become infected with hookworm's larva is through direct skin contact with contaminated soil when walking on barefoot. It is one of a major cause of anemia in pregnant women. The objective was to assess the prevalence and associated factors of hookworm infection among pregnant women who attended antenatal care at governmental health centers in Dembecha district, Ethiopia, 2017. METHODS Institutional based cross sectional study was conducted on 306 pregnant women. Study participants were selected by systematic random sampling technique from February 1 to March 30, 2017. Data collectors and supervisors were trained. Semi-structured Amharic version questionnaire was used to collect data using face to face interview technique and stool sample was examined. Collected data were entered by using Epi data version 3.1 and exported to SPSS. The exported data was analyzed and presented by using descriptive summary statistics and tables. After bivariate logistic regression analysis, all variables with a p-value < 0.25 were entered into multivariate logistic regression and p value < 0.05 considered as significantly associated with the outcome variable. RESULTS Prevalence of hookworm infection was 32.0%. There was a positive association of hookworm infection with living in single room [AOR =2.8; 95% CI; 1.32-5.81], living with domestic animals [AOR = 3.4; 95% CI; 1.35-8.76], monthly income ≤1500 Ethiopian birr [AOR = 3.7; 95% CI; 1.76-7.64], unavailability of latrine [AOR = 2.2; 95% CI; 1.03-4.55], habit of walking on barefoot [AOR = 4.3; 95% CI; 2.17-8.48] and not habit of hand washing before meal [AOR = 3.4; 95 CI; 1.14-10.12]. CONCLUSION This study showed high prevalence of hookworm infection among pregnant women in the study area. Living in single room, living with domestic animals, monthly income ≤1500 Ethiopian birr, unavailability of latrine, habit of walking on barefoot and not habit of hand washing before meal had positive association with hookworm infection. Public health measure should focus on availability latrine and separation of humans and domestic animals room to decrease prevalence of hookworm infection among pregnant women.
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13
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Hookworm Infection among Pregnant Women at First Antenatal Visit in Lira, Uganda: A Cross-Sectional Study. Int J Reprod Med 2020; 2020:8053939. [PMID: 32685438 PMCID: PMC7341405 DOI: 10.1155/2020/8053939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background Hookworm infection in expectant mothers has adverse health effects on both the mothers and their unborn babies. Foetal effects are known to include intrauterine growth retardation and physical and mental growth retardation, while the mothers may develop anemia which could potentially result in death. Unfortunately, little is known about factors that may predispose a pregnant woman to infection by hookworm. In this study, we strived to determine not only the prevalence of hookworm infection among pregnant women attending their first antenatal visit during the current pregnancy in a local health center in northern Uganda but also factors that might predispose them to hookworm infection. Method This cross-sectional study was conducted among 346 pregnant women from Ogur Health Center IV located in Lira district, northern Uganda. Stool samples were collected from each study participant and analyzed for hookworms. The independent variables listed in this study (participant's sociodemographic characteristics, preconception care, and sanitation factors) were obtained using a structured questionnaire. Data analysis, including calculation of adjusted ratios, was performed using STATA software (version 14). Results Prevalence of hookworm infection among pregnant women who attended their first antenatal visit at Ogur Health Center IV was 11% (n = 38). After controlling for confounders, factors found to be significantly associated with this infection among pregnant women here were gardening barefooted (adjusted odds ratio (AOR), 3.4; 95% confidence interval (CI), 1.6 to 7.5; P < 0.001) and fetching unsafe water shared with animals for domestic uses (AOR, 2.8; 95% CI, 1.3 to 6.2; P value of 0.002). Conclusion Hookworm infection among pregnant women at Ogur Health Center IV in Lira district, at 11%, is a public health concern and significantly associated with barefoot gardening and fetching water from unsafe sources shared with animals. We, therefore, recommend that special emphasis during routine prenatal health education be placed on the use of protective footwear during farming and fetching water for domestic use from protected safe sources. Author Summary. Hookworm infection is a parasitic condition that more often goes unnoticed, yet it presents immense detrimental effects, especially to pregnant women and their unborn children. It is a chronic disease with accruing effects of blood depletion resulting in anemia. Anemia is, by far, one of the major causes of maternal morbidity and mortality in Uganda. Pregnant women are more prone to hookworm infection by virtue of their compromised immunity, secondary to the physiological process of pregnancy. We demonstrated here that hookworm infection still exists among pregnant women in Uganda. We also showed that gardening barefooted and fetching water for domestic uses from unsafe sources shared with animals were major factors associated with this helminthic infection. This study provides evidence necessary to influence decision making on prevention of hookworm infection in the study area.
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14
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Nakanjako D, Zalwango F, Wairagala P, Luboga F, Andia Biraro I, Bukirwa VD, Mboowa MG, Cose S, Seeley J, Elliott A. Career development for infection and immunity research in Uganda: a decade of experience from the Makerere University – Uganda Virus Research Institute research and training programme. AAS Open Res 2020; 3:26. [DOI: 10.12688/aasopenres.13066.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The Makerere University/Uganda Virus Research Institute (UVRI) Centre of Excellence for Infection & Immunity Research and Training (MUII) is a collaborative programme supporting excellence in Infection and Immunity (I&I) research in Uganda. Set up in 2008, MUII aims to produce internationally competitive Ugandan and East African I&I research leaders, and develop human and infrastructural resources to support research and training excellence. We undertook an internal evaluation of MUII’s achievements, challenges and lessons learned between August 2008 and December 2019, to inform programmes seeking to build Africa’s health research expertise. Methods: Quantitative data were abstracted from programme annual reports. Qualitative data were obtained in March and April 2019: a cross-sectional evaluation was undertaken among a purposefully selected representative sample of 27 trainees and two programme staff. Qualitative data was analysed according to pre-determined themes of achievements, challenges, lessons learned and recommendations for improvement. Results: By December 2019, MUII had supported 68 fellowships at master’s-level and above (50% female: 23 Masters, 27 PhD, 15 post-doctoral, three group-leader fellows) and over 1,000 internships. Fellows reported career advancement, mentorship by experts, and improved research skills and outputs. Fellows have published over 300 papers, secured grants worth over £20m, established over 40 international collaborations, and taken on research and academic leadership positions in the country. Key lessons for success include the following: efficient administration provides an enabling environment; institutions need supportive policies for procurement, including provisions for purchases of specific biological research reagents from international manufacturers; strong international, multi-disciplinary collaboration provides a critical mass of expertise to mentor researchers in development; and mentorship catalyses young scientists to progress from graduate trainees to productive academic researchers, relevant to society’s most pressing health challenges. Conclusions: Sustainable academic productivity can be achieved through efficient operational support, global collaboration and mentorship to provide solutions to Africa’s health challenges.
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15
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Maizels RM. Regulation of immunity and allergy by helminth parasites. Allergy 2020; 75:524-534. [PMID: 31187881 DOI: 10.1111/all.13944] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 12/26/2022]
Abstract
There is increasing interest in helminth parasite modulation of the immune system, both from the fundamental perspective of the "arms race" between host and parasite, and equally importantly, to understand if parasites offer new pathways to abate and control untoward immune responses in humans. This article reviews the epidemiological and experimental evidence for parasite down-regulation of host immunity and immunopathology, in allergy and other immune disorders, and recent progress towards defining the mechanisms and molecular mediators which parasites exploit in order to modulate their host. Among these are novel products that interfere with epithelial cell alarmins, dendritic cell activation, macrophage function and T-cell responsiveness through the promotion of an immunoregulatory environment. These modulatory effects assist parasites to establish and survive, while dampening immune reactivity to allergens, autoantigens and microbiome determinants.
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Affiliation(s)
- Rick M. Maizels
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunology and Inflammation University of Glasgow Glasgow UK
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16
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Ravn NH, Halling AS, Berkowitz AG, Rinnov MR, Silverberg JI, Egeberg A, Thyssen JP. How does parental history of atopic disease predict the risk of atopic dermatitis in a child? A systematic review and meta-analysis. J Allergy Clin Immunol 2019; 145:1182-1193. [PMID: 31887393 DOI: 10.1016/j.jaci.2019.12.899] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/06/2019] [Accepted: 12/11/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Parental history of atopic disease is a well-established risk factor for the development of atopic dermatitis (AD), but several aspects of this association remain unclear. OBJECTIVE We sought to determine the association of parental history of atopic disease with AD in offspring. METHODS We searched PubMed and EMBASE through June 2018 for relevant records and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled odds ratios (ORs) with 95% CI were calculated using random-effects models. RESULTS A total of 163 records covering 149 unique studies were included. Of these, 119 studies were included in the meta-analysis. Individuals with parental history of atopic disease had increased odds of AD (OR, 1.81; 95% CI, 1.65-1.99). Parental asthma (OR, 1.56; 95% CI, 1.18-2.05) and allergic rhinitis (OR, 1.68; 95% CI, 1.34-2.11) had a smaller effect than AD (OR, 3.30; 95% CI, 2.46-4.42). The effect of maternal and paternal history was comparable for all atopic diseases. An increase in odds was observed when comparing the effect of having 1 (OR, 1.30; 95% CI, 1.15-1.47) or 2 atopic parents (OR, 2.08; 95% CI, 1.83-2.36), as well as having a parent with 1 (OR, 1.49; 95% CI, 1.28-1.74) or more atopic diseases (OR, 2.32; 95% CI, 1.92-2.81). CONCLUSIONS This study provides evidence-based risk estimates that may guide physicians who counsel parents with a history of atopic disease about their children's risk of AD. This information is of particular importance for future efforts toward establishing prophylactic interventions for AD on a general population level.
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Affiliation(s)
- Nina H Ravn
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Anne-Sofie Halling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | | | - Maria R Rinnov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; National Allergy Research Centre, Herlev and Gentofte Hospital, Hellerup, Denmark.
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17
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Gyorkos TW, St-Denis K. Systematic review of exposure to albendazole or mebendazole during pregnancy and effects on maternal and child outcomes, with particular reference to exposure in the first trimester. Int J Parasitol 2019; 49:541-554. [DOI: 10.1016/j.ijpara.2019.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 12/18/2022]
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18
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Darby MG, Chetty A, Mrjden D, Rolot M, Smith K, Mackowiak C, Sedda D, Nyangahu D, Jaspan H, Toellner KM, Waisman A, Quesniaux V, Ryffel B, Cunningham AF, Dewals BG, Brombacher F, Horsnell WGC. Pre-conception maternal helminth infection transfers via nursing long-lasting cellular immunity against helminths to offspring. SCIENCE ADVANCES 2019; 5:eaav3058. [PMID: 31236458 PMCID: PMC6587632 DOI: 10.1126/sciadv.aav3058] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 04/24/2019] [Indexed: 06/01/2023]
Abstract
Maternal immune transfer is the most significant source of protection from early-life infection, but whether maternal transfer of immunity by nursing permanently alters offspring immunity is poorly understood. Here, we identify maternal immune imprinting of offspring nursed by mothers who had a pre-conception helminth infection. Nursing of pups by helminth-exposed mothers transferred protective cellular immunity to these offspring against helminth infection. Enhanced control of infection was not dependent on maternal antibody. Protection associated with systemic development of protective type 2 immunity in T helper 2 (TH2) impaired IL-4Rα-/- offspring. This maternally acquired immunity was maintained into maturity and required transfer (via nursing) to the offspring of maternally derived TH2-competent CD4 T cells. Our data therefore reveal that maternal exposure to a globally prevalent source of infection before pregnancy provides long-term nursing-acquired immune benefits to offspring mediated by maternally derived pathogen-experienced lymphocytes.
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Affiliation(s)
- Matthew G. Darby
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town 7925, South Africa
| | - Alisha Chetty
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town 7925, South Africa
| | - Dunja Mrjden
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town 7925, South Africa
| | - Marion Rolot
- Fundamental and Applied Research in Animals and Health (FARAH), Immunology-Vaccinology, Faculty of Veterinary Medicine (B43b), University of Liège, Liège, Belgium
| | - Katherine Smith
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town 7925, South Africa
- Institute of Infection and Immunity, University of Cardiff, Cardiff, UK
| | - Claire Mackowiak
- Laboratory of Molecular and Experimental Immunology and Neuro-genetics, UMR 7355, CNRS-University of Orleans and Le Studium Institute for Advanced Studies, Rue Dupanloup, 45000 Orléans, France
| | - Delphine Sedda
- Laboratory of Molecular and Experimental Immunology and Neuro-genetics, UMR 7355, CNRS-University of Orleans and Le Studium Institute for Advanced Studies, Rue Dupanloup, 45000 Orléans, France
| | - Donald Nyangahu
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town 7925, South Africa
| | - Heather Jaspan
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town 7925, South Africa
- Seattle Children’s Research Institute and Departments of Paediatrics and Global Health, University of Washington, Seattle, WA, USA
| | - Kai-Michael Toellner
- Institute of Immunology and Immunotherapy and School of Immunity and Infection, University of Birmingham, B15 2TT Birmingham, UK
| | - Ari Waisman
- Institute for Molecular Medicine, University of Mainz, Mainz, Germany
| | - Valerie Quesniaux
- Laboratory of Molecular and Experimental Immunology and Neuro-genetics, UMR 7355, CNRS-University of Orleans and Le Studium Institute for Advanced Studies, Rue Dupanloup, 45000 Orléans, France
| | - Bernhard Ryffel
- Laboratory of Molecular and Experimental Immunology and Neuro-genetics, UMR 7355, CNRS-University of Orleans and Le Studium Institute for Advanced Studies, Rue Dupanloup, 45000 Orléans, France
| | - Adam F. Cunningham
- Institute of Immunology and Immunotherapy and School of Immunity and Infection, University of Birmingham, B15 2TT Birmingham, UK
- Institute of Microbiology and Infection, University of Birmingham, B15 2TT Birmingham, UK
| | - Benjamin G. Dewals
- Fundamental and Applied Research in Animals and Health (FARAH), Immunology-Vaccinology, Faculty of Veterinary Medicine (B43b), University of Liège, Liège, Belgium
| | - Frank Brombacher
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town 7925, South Africa
- International Centre for Genetic Engineering and Biotechnology, Cape Town 7925, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - William G. C. Horsnell
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town 7925, South Africa
- Laboratory of Molecular and Experimental Immunology and Neuro-genetics, UMR 7355, CNRS-University of Orleans and Le Studium Institute for Advanced Studies, Rue Dupanloup, 45000 Orléans, France
- Institute of Microbiology and Infection, University of Birmingham, B15 2TT Birmingham, UK
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19
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Cooper PJ, Chico ME, Vaca MG, Sandoval CA, Loor S, Amorim LD, Rodrigues LC, Barreto ML, Strachan DP. Effect of Early-Life Geohelminth Infections on the Development of Wheezing at 5 Years of Age. Am J Respir Crit Care Med 2019; 197:364-372. [PMID: 28957644 DOI: 10.1164/rccm.201706-1222oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Exposures to geohelminths during gestation or early childhood may reduce risk of wheezing illness/asthma and atopy during childhood in tropical regions. OBJECTIVES To investigate the effect of maternal and early childhood geohelminths on development of wheeze/asthma and atopy during the first 5 years of life. METHODS A cohort of 2,404 neonates was followed to 5 years of age in a rural district in coastal Ecuador. Data on wheeze were collected by questionnaire and atopy was measured by allergen skin prick test reactivity to 10 allergens at 5 years. Stool samples from mothers and children were examined for geohelminths by microscopy. MEASUREMENTS AND MAIN RESULTS A total of 2,090 (86.9%) children were evaluated at 5 years. Geohelminths were observed in 45.5% of mothers and in 34.1% of children by 3 years. Wheeze and asthma were reported for 12.6% and 5.7% of children, respectively, whereas 14.0% had skin test reactivity at 5 years. Maternal geohelminths were associated with an increased risk of wheeze (adjusted odds ratio, 1.41; 95% confidence interval, 1.06-1.88), whereas childhood geohelminths over the first 3 years of life were associated with reduced risk of wheeze (adjusted odds ratio, 0.70; 95% confidence interval, 0.52-0.96) and asthma (adjusted odds ratio, 0.60; 95% confidence interval, 0.38-0.94) but not skin prick test reactivity. The effects on wheeze/asthma were greatest with later age of first infection, were observed only in skin test-negative children, but were not associated with parasite burden or specific geohelminths. CONCLUSIONS Although maternal exposures to geohelminths may increase childhood wheeze, childhood geohelminths during the first 3 years may provide protection through a nonallergic mechanism. Registered as an observational study (ISRCTN41239086).
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Affiliation(s)
- Philip J Cooper
- 1 Facultad de Ciencias Medicas, de la Salud y la Vida, Universidad Internacional del Ecuador, Quito, Ecuador.,2 Laboratorio de Investigaciones FEPIS, Quininde, Esmeraldas Province, Ecuador.,3 Institute of Infection and Immunity and
| | - Martha E Chico
- 2 Laboratorio de Investigaciones FEPIS, Quininde, Esmeraldas Province, Ecuador
| | - Maritza G Vaca
- 2 Laboratorio de Investigaciones FEPIS, Quininde, Esmeraldas Province, Ecuador
| | - Carlos A Sandoval
- 2 Laboratorio de Investigaciones FEPIS, Quininde, Esmeraldas Province, Ecuador
| | - Sofia Loor
- 2 Laboratorio de Investigaciones FEPIS, Quininde, Esmeraldas Province, Ecuador
| | - Leila D Amorim
- 4 Instituto de Saude Coletiva, Universidade Federal da Bahia, Salvador, Brazil; and
| | - Laura C Rodrigues
- 5 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mauricio L Barreto
- 4 Instituto de Saude Coletiva, Universidade Federal da Bahia, Salvador, Brazil; and
| | - David P Strachan
- 6 Population Health Research Institute, St. George's University of London, London, United Kingdom
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20
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Al-Afif KAM, Buraik MA, Buddenkotte J, Mounir M, Gerber R, Ahmed HM, Tallman AM, Steinhoff M. Understanding the Burden of Atopic Dermatitis in Africa and the Middle East. Dermatol Ther (Heidelb) 2019; 9:223-241. [PMID: 30850961 PMCID: PMC6522619 DOI: 10.1007/s13555-019-0285-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Indexed: 12/13/2022] Open
Abstract
Atopic dermatitis (AD) is a common inflammatory skin disease characterized by intensely pruritic lesions. The prevalence of atopic dermatitis is increasing in developing regions, including Africa and the Middle East. However, these regions are underrepresented in the dermatology literature, and a better understanding of the growing burden of atopic dermatitis in Africa and the Middle East is necessary. Herein, we summarize current knowledge on atopic dermatitis epidemiology, disease burden, and treatment options in Africa and the Middle East, highlighting the unmet needs of patients in these regions. With these needs in mind, we provide clinical recommendations for appropriate management of atopic dermatitis in Africa and the Middle East. FUNDING: Pfizer Inc. Plain language summary available for this article.
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Affiliation(s)
| | - Mohamad Ali Buraik
- Department of Dermatology, King Fahd Central Hospital, Jizan, Saudi Arabia
| | - Joerg Buddenkotte
- Department of Dermatology and HMC Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Mounir
- Departments of Inflammation and Immunology and Emerging Markets, Pfizer Inc, Dubai, United Arab Emirates
| | - Robert Gerber
- Departments of Outcomes and Evidence and Statistics, Pfizer Inc, Groton, CT, USA
| | - Haytham Mohamed Ahmed
- Departments of Inflammation and Immunology and Emerging Markets, Pfizer Inc, Jeddah, Saudi Arabia
| | | | - Martin Steinhoff
- Department of Dermatology and HMC Translational Research Institute, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar.,Qatar University, Doha, Qatar.,Department Of Dermatology, Weill Cornell University, New York, NY, USA
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21
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Dewals BG, Layland LE, Prazeres da Costa C, Horsnell WG. Maternal helminth infections and the shaping of offspring immunity. Parasite Immunol 2018; 41:e12599. [PMID: 30372527 DOI: 10.1111/pim.12599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/21/2018] [Accepted: 10/23/2018] [Indexed: 12/23/2022]
Abstract
Helminth infections leave a long-lasting immunological footprint on their hosts. Clinical studies have provided first evidence that maternal helminth infections can result in an altered immune profile in their offspring which can potentially shape how they respond to conditions throughout life. This can relate to changes in offspring induction of immune responses against other diseases. However, whether these changes result in actual changes in offspring ability to control disease is unclear. Our understanding of which immune mechanisms are altered and how they are changed is limited. In this review, we highlight what we know from human and mouse studies about this important context of helminth exposure. Moreover, we discuss how mechanisms such as antibody transfer, antigen exposure, maternal cell uptake, chimerism and epigenetics are all likely to be functional contributors to the striking changes that are seen in offspring born or nursed by helminth exposed mothers.
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Affiliation(s)
- Benjamin G Dewals
- Immunology-Vaccinology, Department of Infectious and Parasitic Diseases, Faculty of Veterinary Medicine-FARAH, University of Liège, Liège, Belgium
| | - Laura E Layland
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital of Bonn, Bonn, Germany.,German Centre for Infection Research (DZIF), Partner Site, Bonn-Cologne, Bonn, Germany
| | - Clarissa Prazeres da Costa
- Institute of Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
| | - William G Horsnell
- Division of Immunology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK.,Laboratory of Molecular and Experimental Immunology and Neurogenetics, UMR 7355, CNRS-University of Orleans and Le Studium Institute for Advanced Studies, Orléans, France
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22
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Mpairwe H, Amoah AS. Parasites and allergy: Observations from Africa. Parasite Immunol 2018; 41:e12589. [PMID: 30216486 PMCID: PMC6587767 DOI: 10.1111/pim.12589] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/15/2018] [Accepted: 09/10/2018] [Indexed: 12/17/2022]
Abstract
Population studies from the African continent have observed a marked increase in the prevalence of allergy‐related diseases over the past few decades, but the cause of this rise is not fully understood. The most investigated potential risk factor has been the relationship between exposure to helminths and allergy‐related outcomes. Immunologically, parallels exist between responses to helminths and to allergens as both are associated with elevated levels of immunoglobulin E, increased numbers of T helper 2 cells and other immune cells. However, epidemiological studies from the African continent have found inconsistent results. In this review, observations from population studies carried out in Africa over the last decade that focus on the relationship between helminth infections and allergy‐related outcomes are examined. How these findings advance our understanding of the complex interactions between helminths and allergies at the population level is also explored as well as some of the underlying immune mechanisms involved. This knowledge is important for better diagnosis, treatment and prevention of allergy‐related diseases and has wider global significance.
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Affiliation(s)
- Harriet Mpairwe
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Abena S Amoah
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
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23
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Korhonen L, Seiskari T, Lehtonen J, Puustinen L, Surcel H, Haapala A, Niemelä O, Virtanen SM, Honkanen H, Karjalainen M, Ilonen J, Veijola R, Knip M, Lönnrot M, Hyöty H. Enterovirus infection during pregnancy is inversely associated with atopic disease in the offspring. Clin Exp Allergy 2018; 48:1698-1704. [DOI: 10.1111/cea.13280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 08/12/2018] [Accepted: 09/01/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Laura Korhonen
- Department of Virology Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
- Department of Dermatology Tampere University Hospital Tampere Finland
- Allergy Centre Tampere University Hospital Tampere Finland
| | - Tapio Seiskari
- Department of Clinical Microbiology Fimlab Laboratories Ltd Tampere Finland
| | - Jussi Lehtonen
- Department of Virology Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | - Leena Puustinen
- Department of Virology Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | - Heljä‐Marja Surcel
- National Institute for Health and Welfare Oulu Finland
- Biobank Borealis of Northern Finland Oulu University Hospital Oulu Finland
| | - Anna‐Maija Haapala
- Department of Clinical Microbiology Fimlab Laboratories Ltd Tampere Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit Seinäjoki Central Hospital and University of Tampere Seinäjoki Finland
| | - Suvi M. Virtanen
- Unit of Nutrition National Institute for Health and Welfare Helsinki Finland
- Faculty of Social Sciences/Health Sciences University of Tampere Tampere Finland
- Center for Child Health Research University of Tampere Tampere University Hospital Tampere Finland
- The Science Center Pirkanmaa Hospital District Tampere Finland
| | - Hanna Honkanen
- Department of Virology Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | - Mira Karjalainen
- Department of Pediatrics PEDEGO Research Unit Medical Research Center Oulu University Hospital and University of Oulu Oulu Finland
| | - Jorma Ilonen
- Immunogenetics Laboratory Institute of Biomedicine University of Turku Turku Finland
- Clinical Microbiology Turku University Hospital Turku Finland
| | - Riitta Veijola
- Department of Pediatrics PEDEGO Research Unit Medical Research Center Oulu University Hospital and University of Oulu Oulu Finland
| | - Mikael Knip
- Children's Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
- Research Programs Unit, Diabetes and Obesity University of Helsinki Helsinki Finland
- Folkhälsan Research Center Helsinki Finland
- Department of Pediatrics Tampere University Hospital Tampere Finland
| | - Maria Lönnrot
- Department of Virology Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
- Department of Dermatology Tampere University Hospital Tampere Finland
- Allergy Centre Tampere University Hospital Tampere Finland
| | - Heikki Hyöty
- Department of Virology Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
- Department of Clinical Microbiology Fimlab Laboratories Ltd Tampere Finland
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24
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Sanya RE, Nkurunungi G, Andia Biraro I, Mpairwe H, Elliott AM. A life without worms. Trans R Soc Trop Med Hyg 2018; 111:3-11. [PMID: 28340138 PMCID: PMC5412073 DOI: 10.1093/trstmh/trx010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 02/27/2017] [Indexed: 12/14/2022] Open
Abstract
Worms have co-evolved with humans over millions of years. To survive, they manipulate host systems by modulating immune responses so that they cause (in the majority of hosts) relatively subtle harm. Anthelminthic treatment has been promoted as a measure for averting worm specific pathology and to mitigate subtle morbidities which may include effects on anaemia, growth, cognitive function and economic activity. With our changing environment marked by rapid population growth, urbanisation, better hygiene practices and anthelminthic treatment, there has been a decline in worm infections and other infectious diseases and a rise in non-communicable diseases such as allergy, diabetes and cardiovascular disease. This review reflects upon our age-old interaction with worms, and the broader ramifications of life without worms for vaccine responses and susceptibility to other infections, and for allergy-related and metabolic disease. We touch upon the controversy around the benefits of mass drug administration for the more-subtle morbidities that have been associated with worm infections and then focus our attention on broader, additional aspects of life without worms, which may be either beneficial or detrimental.
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Affiliation(s)
- Richard E Sanya
- MRC/UVRI Uganda Research Unit, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.,College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gyaviira Nkurunungi
- MRC/UVRI Uganda Research Unit, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | | | - Harriet Mpairwe
- MRC/UVRI Uganda Research Unit, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda
| | - Alison M Elliott
- MRC/UVRI Uganda Research Unit, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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25
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Nkurunungi G, Kabagenyi J, Nampijja M, Sanya RE, Walusimbi B, Nassuuna J, Webb EL, Elliott AM. Schistosoma mansoni-specific immune responses and allergy in Uganda. Parasite Immunol 2017; 40. [PMID: 29171863 PMCID: PMC5767746 DOI: 10.1111/pim.12506] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/15/2017] [Indexed: 12/13/2022]
Abstract
Low allergy‐related disease (ARD) prevalence in low‐income countries may be partly attributed to helminth infections. In the Schistosoma mansoni (Sm)‐endemic Lake Victoria islands (Uganda), we recently observed positive helminth‐allergy associations, despite low ARD prevalence. To understand how Sm‐induced cytokine and antibody profiles might influence allergic response profiles in this population, we assessed Schistosoma worm (SWA)‐ and egg antigen (SEA)‐specific Th1 (IFN‐γ), Th2 (IL‐5, IL‐13) and regulatory (IL‐10) cytokine profiles (n = 407), and total (n = 471), SWA‐, SEA‐ and allergen (house dust mite [HDM] and cockroach)‐specific (as)IgE and IgG4 profiles (n = 2117) by ELISA. Wheeze was inversely associated with SWA‐specific IFN‐γ (P < .001) and IL‐10 (P = .058), and SEA‐specific IL‐5 (P = .004). Conversely, having a detectable asIgE response was positively associated with SWA‐specific IL‐5 (P = .006) and IL‐10 (P < .001). Total, SWA‐, SEA‐ and allergen‐specific IgE and IgG4 responses were higher among Sm Kato‐Katz positive (SmKK+) and skin prick test (SPT)+ individuals compared to SmKK‐ and SPT‐ individuals. However, total and asIgG4/IgE ratios were lower among SPT+ and wheezing individuals. We conclude that, in this population, helminth‐induced antibody and cytokine responses may underlie individual positive helminth‐atopy associations, while the overall IgG4‐IgE balance may contribute to the low overall prevalence of clinical allergies in such settings.
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Affiliation(s)
- G Nkurunungi
- Immunomodulation and Vaccines Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda.,Department of Clinical research, London School of Hygiene and Tropical Medicine, London, UK
| | - J Kabagenyi
- Immunomodulation and Vaccines Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - M Nampijja
- Immunomodulation and Vaccines Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - R E Sanya
- Immunomodulation and Vaccines Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda.,College of Health Sciences, Makerere University, Kampala, Uganda
| | - B Walusimbi
- Immunomodulation and Vaccines Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - J Nassuuna
- Immunomodulation and Vaccines Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - E L Webb
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - A M Elliott
- Immunomodulation and Vaccines Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda.,Department of Clinical research, London School of Hygiene and Tropical Medicine, London, UK
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26
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Jõgi NO, Svanes C, Siiak SP, Logan E, Holloway JW, Igland J, Johannessen A, Levin M, Real FG, Schlunssen V, Horsnell WGC, Bertelsen RJ. Zoonotic helminth exposure and risk of allergic diseases: A study of two generations in Norway. Clin Exp Allergy 2017; 48:66-77. [PMID: 29117468 DOI: 10.1111/cea.13055] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/01/2017] [Accepted: 10/27/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Animal and human studies indicate that definitive host helminth infections may confer protection from allergies. However, zoonotic helminths, such as Toxocara species (spp.), have been associated with increased allergies. OBJECTIVE We describe the prevalence of Toxocara spp. and Ascaris spp. seropositivity and associations with allergic diseases and sensitization, in 2 generations in Bergen, Norway. METHODS Serum levels of total IgG4, anti-Toxocara spp. IgG4 and Ascaris spp. IgG4 were established by ELISA in 2 cohorts: parents born 1945-1972 (n = 171) and their offspring born 1969-2003 (n = 264). Allergic outcomes and covariates were recorded through interviews and clinical examinations including serum IgEs and skin prick tests. RESULTS Anti-Ascaris spp. IgG4 was detected in 29.2% of parents and 10.3% of offspring, and anti-Toxocara spp. IgG4 in 17.5% and 8.0% of parents and offspring, respectively. Among offspring, anti-Toxocara spp. IgG4 was associated with pet keeping before age 15 (OR = 6.15; 95% CI = 1.37-27.5) and increasing BMI (1.16[1.06-1.25] per kg/m2 ). Toxocara spp. seropositivity was associated with wheeze (2.97[1.45- 7.76]), hayfever (4.03[1.63-9.95]), eczema (2.89[1.08-7.76]) and cat sensitization (5.65[1.92-16.6]) among offspring, but was not associated with allergic outcomes among parents. Adjustment for childhood or current pet keeping did not alter associations with allergies. Parental Toxocara spp. seropositivity was associated with increased offspring allergies following a sex-specific pattern. CONCLUSIONS & CLINICAL RELEVANCE Zoonotic helminth exposure in Norway was less frequent in offspring than parents; however, Toxocara spp. seropositivity was associated with increased risk of allergic manifestations in the offspring generation, but not among parents. Changes in response to helminth exposure may provide insights into the increase in allergy incidence in affluent countries.
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Affiliation(s)
- N O Jõgi
- University of Tartu, Tartu, Estonia.,Centre for International Health, University of Bergen, Bergen, Norway
| | - C Svanes
- Centre for International Health, University of Bergen, Bergen, Norway.,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - E Logan
- University of Cape Town, Cape Town, South Africa
| | - J W Holloway
- Human Development & Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - J Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - A Johannessen
- Centre for International Health, University of Bergen, Bergen, Norway
| | - M Levin
- University of Cape Town, Cape Town, South Africa
| | - F G Real
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - V Schlunssen
- Aarhus University, Aarhus, Denmark.,National Research Centre for the Working Environment, Copenhagen, Denmark
| | - W G C Horsnell
- Institute of Infectious Disease and Molecular Medicine/Division of Immunology, University of Cape Town, Cape Town, South Africa.,Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK.,Laboratory of Molecular and Experimental Immunology and Neurogenetics, UMR 7355, CNRS-University of Orleans and Le Studium Institute for Advanced Studies, Orléans, France
| | - R J Bertelsen
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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27
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Namara B, Nash S, Lule SA, Akurut H, Mpairwe H, Akello F, Tumusiime J, Kizza M, Kabagenyi J, Nkurunungi G, Muhangi L, Webb EL, Muwanga M, Elliott AM. Effects of treating helminths during pregnancy and early childhood on risk of allergy-related outcomes: Follow-up of a randomized controlled trial. Pediatr Allergy Immunol 2017; 28:784-792. [PMID: 28892575 PMCID: PMC5765453 DOI: 10.1111/pai.12804] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Helminth infections, common in low-income countries, may protect against allergy-related disease. Early exposure may be a key. In the Entebbe Mother and Baby Study, treating helminths during pregnancy resulted in increased eczema rates in early childhood. We followed the cohort to determine whether this translated to increased asthma rates at school age. METHODS This randomized, double-blind, placebo-controlled trial, conducted in Entebbe, Uganda, had three interventions. During pregnancy, women were randomized, simultaneously, to albendazole vs placebo and to praziquantel vs placebo. Their children were independently randomized to quarterly albendazole vs placebo from age 15 months to 5 years. We here report follow-up to age 9 years. Primary outcomes at 9 years were recent reported wheeze, skin prick test positivity (SPT) to common allergens and allergen-specific IgE positivity to dust mite or cockroach. Secondary outcomes were doctor-diagnosed asthma and eczema rates between 5 and 9 years, recent eczema, rhinitis and urticaria at 9 years, and SPT and IgE responses to individual allergens. RESULTS 2507 pregnant women were enrolled; 1215 children were seen at age nine, of whom 1188 are included in this analysis. Reported wheeze was rare at 9 years (3.7%) while SPT positivity (25.0%) and IgE positivity (44.1%) were common. There was no evidence of a treatment effect for any of the three interventions on any of the primary outcomes. CONCLUSIONS Prenatal and early-life treatment of helminths, in the absence of change in other exposures, is unlikely to increase the risk of atopic diseases later in childhood in this tropical, low-income setting.
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Affiliation(s)
| | - Stephen Nash
- London School of Hygiene and Tropical Medicine, London, UK
| | - Swaib A Lule
- MRC/UVRI Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Moses Kizza
- MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | | | - Gyaviira Nkurunungi
- MRC/UVRI Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | | | - Emily L Webb
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Alison M Elliott
- MRC/UVRI Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
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28
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Global issues in allergy and immunology: Parasitic infections and allergy. J Allergy Clin Immunol 2017; 140:1217-1228. [PMID: 29108604 DOI: 10.1016/j.jaci.2017.09.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023]
Abstract
Allergic diseases are on the increase globally in parallel with a decrease in parasitic infection. The inverse association between parasitic infections and allergy at an ecological level suggests a causal association. Studies in human subjects have generated a large knowledge base on the complexity of the interrelationship between parasitic infection and allergy. There is evidence for causal links, but the data from animal models are the most compelling: despite the strong type 2 immune responses they induce, helminth infections can suppress allergy through regulatory pathways. Conversely, many helminths can cause allergic-type inflammation, including symptoms of "classical" allergic disease. From an evolutionary perspective, subjects with an effective immune response against helminths can be more susceptible to allergy. This narrative review aims to inform readers of the most relevant up-to-date evidence on the relationship between parasites and allergy. Experiments in animal models have demonstrated the potential benefits of helminth infection or administration of helminth-derived molecules on chronic inflammatory diseases, but thus far, clinical trials in human subjects have not demonstrated unequivocal clinical benefits. Nevertheless, there is sufficiently strong evidence to support continued investigation of the potential benefits of helminth-derived therapies for the prevention or treatment of allergic and other inflammatory diseases.
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29
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Gordon CA, Kurscheid J, Jones MK, Gray DJ, McManus DP. Soil-Transmitted Helminths in Tropical Australia and Asia. Trop Med Infect Dis 2017; 2:E56. [PMID: 30270913 PMCID: PMC6082059 DOI: 10.3390/tropicalmed2040056] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 12/21/2022] Open
Abstract
Soil-transmitted helminths (STH) infect 2 billion people worldwide including significant numbers in South-East Asia (SEA). In Australia, STH are of less concern; however, indigenous communities are endemic for STH, including Strongyloides stercoralis, as well as for serious clinical infections due to other helminths such as Toxocara spp. The zoonotic hookworm Ancylostoma ceylanicum is also present in Australia and SEA, and may contribute to human infections particularly among pet owners. High human immigration rates to Australia from SEA, which is highly endemic for STH Strongyloides and Toxocara, has resulted in a high prevalence of these helminthic infections in immigrant communities, particularly since such individuals are not screened for worm infections upon entry. In this review, we consider the current state of STH infections in Australia and SEA.
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Affiliation(s)
- Catherine A Gordon
- QIMR Berghofer Medical Research Institute, Molecular Parasitology Laboratory, Queensland 4006, Australia.
| | - Johanna Kurscheid
- Australian National University, Department of Global Health, Research School of Population Health, Australian Capital Territory 2601, Australia.
| | - Malcolm K Jones
- School of Veterinary Science, University of Queensland, Brisbane, QLD 4067, Australia.
| | - Darren J Gray
- Australian National University, Department of Global Health, Research School of Population Health, Australian Capital Territory 2601, Australia.
| | - Donald P McManus
- QIMR Berghofer Medical Research Institute, Molecular Parasitology Laboratory, Queensland 4006, Australia.
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30
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Breastfeeding and perinatal exposure, and the risk of asthma and allergies. Curr Opin Allergy Clin Immunol 2017; 16:231-6. [PMID: 27054317 DOI: 10.1097/aci.0000000000000266] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Exposures during the perinatal period, a phase of rapid development, may have a profound and sustained effect on disease risk. In particular, perinatal exposures may influence the development and maturation of the infant immune system and the risk of allergic disease. We aimed to summarize the current literature on perinatal exposures and the risk of asthma and allergic disease RECENT FINDINGS Increased risk of offspring wheeze or asthma was found for: maternal obesity and hypertension during pregnancy; febrile illness, gynaecological, and viral respiratory infections in pregnancy; exposure to bisphenol A and phthalates in pregnancy and childhood; exposure to smoking in utero; low birth weight; caesarean section and neonatal hyperbilirubinaemia. Reduced risk of offspring atopic eczema was found for hookworm infection in pregnancy and reduced risk of offspring wheeze was associated with increased pregnancy dietary intake of vitamin E and zinc. Higher levels of selenium in pregnancy were associated with less risk of asthma in genetically susceptible offspring. Early life pet ownership was associated with a decrease in atopic asthma but an increase in nonatopic asthma risk. SUMMARY A diverse range of exposures were associated with allergic disease risk, highlighting the susceptibility of children during the perinatal period. Clinicians should reinforce public health messages concerning maternal obesity, smoking, and breastfeeding. The infant gut microbiome is emerging as an important hypothesis, which may mediate the relationship between many perinatal exposures and allergic disease.
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31
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Fedorova OS, Janse JJ, Ogorodova LM, Fedotova MM, Achterberg RA, Verweij JJ, Fernández-Rivas M, Versteeg SA, Potts J, Minelli C, van Ree R, Burney P, Yazdanbakhsh M. Opisthorchis felineus negatively associates with skin test reactivity in Russia-EuroPrevall-International Cooperation study. Allergy 2017; 72:1096-1104. [PMID: 28032359 DOI: 10.1111/all.13120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Most studies on the relationship between helminth infections and atopic disorders have been conducted in (sub)tropical developing countries where exposure to multiple parasites and lifestyle can confound the relationship. We aimed to study the relationship between infection with the fish-borne helminth Opishorchis felineus and specific IgE, skin prick testing, and atopic symptoms in Western Siberia, with lifestyle and hygiene standards of a developed country. METHODS Schoolchildren aged 7-11 years were sampled from one urban and two rural regions. Skin prick tests (SPT) and specific IgE (sIgE) against food and aeroallergens were measured, and data on allergic symptoms and on demographic and socioeconomic factors were collected by questionnaire. Diagnosis of opisthorchiasis was based on PCR performed on stool samples. RESULTS Of the 732 children included, 34.9% had opisthorchiasis. The sensitization to any allergen when estimated by positive SPT was 12.8%, while much higher, 24.0%, when measured by sIgE. Atopic symptoms in the past year (flexural eczema and/or rhinoconjunctivitis) were reported in 12.4% of the children. SPT was positively related to flexural eczema and rhinoconjunctivitis, but not to wheezing. Opisthorchiasis showed association with lower SPT response, as well as borderline association with low IgE reactivity to any allergen. However, the effect of opisthorchiasis on SPT response was not mediated by IgE, suggesting that opisthorchiasis influences SPT response through another mechanism. Opisthorchiasis also showed borderline association with lower atopic symptoms. CONCLUSIONS There is a negative association between a chronic helminth infection and skin prick test reactivity even in a developed country.
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Affiliation(s)
- O. S. Fedorova
- Department of Faculty Pediatrics; Siberian State Medical University; Tomsk Russian Federation
| | - J. J. Janse
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
| | - L. M. Ogorodova
- Department of Faculty Pediatrics; Siberian State Medical University; Tomsk Russian Federation
| | - M. M. Fedotova
- Department of Faculty Pediatrics; Siberian State Medical University; Tomsk Russian Federation
| | - R. A. Achterberg
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
| | - J. J. Verweij
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
| | | | - S. A. Versteeg
- Department of Experimental Immunology; Academic Medical Center; Amsterdam The Netherlands
| | - J. Potts
- Department of Respiratory Epidemiology and Public Health; National Heart and Lung Institute; Imperial College London; London UK
| | - C. Minelli
- Department of Respiratory Epidemiology and Public Health; National Heart and Lung Institute; Imperial College London; London UK
| | - R. van Ree
- Department of Experimental Immunology; Academic Medical Center; Amsterdam The Netherlands
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam The Netherlands
| | - P. Burney
- Department of Respiratory Epidemiology and Public Health; National Heart and Lung Institute; Imperial College London; London UK
| | - M. Yazdanbakhsh
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
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Lule SA, Mpairwe H, Nampijja M, Akello F, Kabagenyi J, Namara B, Nkurunungi G, Kizito D, Kahwa J, Muhangi L, Nash S, Muwanga M, Webb EL, Elliott AM. Life-course of atopy and allergy-related disease events in tropical sub-Saharan Africa: A birth cohort study. Pediatr Allergy Immunol 2017; 28:377-383. [PMID: 28339128 PMCID: PMC5488189 DOI: 10.1111/pai.12719] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND In high-income countries, allergy-related diseases (ARDs) follow a typical sequence, the 'Atopic March'. Little is known about the life-course of ARDs in the markedly different, low-income, tropical environment. We describe ARDs in a tropical, African birth cohort. METHODS Ugandan children were followed from birth to 9 years. ISAAC questionnaires were completed at intervals; doctor-diagnosed ARDs were recorded throughout follow-up. Skin prick tests (SPTs) were performed at 3 and 9 years. Atopy was defined as ≥1 positive SPT. RESULTS Of the 2345 live-born children, 1214 (52%) were seen at 9 years. Wheeze and eczema were common in infancy, but by 9 years, only 4% reported recent wheeze, 5% eczema and 5% rhinitis. Between 3 and 9 years, atopy prevalence increased from 19% to 25%. Atopy at 3 or 9 years was associated with reported ARD events at 9 years, for example OR = 5.2 (95% CI 2.9-10.7) for atopy and recent wheeze at 9 years. Reported or doctor-diagnosed ARD events in early childhood were associated with the same events in later childhood, for example OR = 4.4 (2.3-8.4) for the association between reported wheeze before 3 years with reported recent wheeze at 9 years, but progression from early eczema to later rhinitis or asthma was not observed. CONCLUSION Allergen sensitization started early in childhood and increased with age. Eczema and wheeze were common in infancy and declined with age. Atopy was strongly associated with ARD among the few affected children. The typical Atopic March did not occur. Environmental exposures during childhood may dissociate atopy and ARD.
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Affiliation(s)
- Swaib A. Lule
- London School of Hygiene and Tropical MedicineLondonUK
- MRC/UVRI Uganda Research UnitEntebbeUganda
| | | | | | | | | | | | - Gyaviira Nkurunungi
- London School of Hygiene and Tropical MedicineLondonUK
- MRC/UVRI Uganda Research UnitEntebbeUganda
| | | | | | | | - Stephen Nash
- London School of Hygiene and Tropical MedicineLondonUK
| | | | - Emily L. Webb
- London School of Hygiene and Tropical MedicineLondonUK
| | - Alison M. Elliott
- London School of Hygiene and Tropical MedicineLondonUK
- MRC/UVRI Uganda Research UnitEntebbeUganda
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Smits HH, Hiemstra PS, Prazeres da Costa C, Ege M, Edwards M, Garn H, Howarth PH, Jartti T, de Jong EC, Maizels RM, Marsland BJ, McSorley HJ, Müller A, Pfefferle PI, Savelkoul H, Schwarze J, Unger WWJ, von Mutius E, Yazdanbakhsh M, Taube C. Microbes and asthma: Opportunities for intervention. J Allergy Clin Immunol 2016; 137:690-7. [PMID: 26947981 DOI: 10.1016/j.jaci.2016.01.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 01/06/2016] [Accepted: 01/19/2016] [Indexed: 02/08/2023]
Abstract
The worldwide incidence and prevalence of asthma continues to increase. Asthma is now understood as an umbrella term for different phenotypes or endotypes, which arise through different pathophysiologic pathways. Understanding the many factors contributing to development of the disease is important for the identification of novel therapeutic targets for the treatment of certain asthma phenotypes. The hygiene hypothesis has been formulated to explain the increasing prevalence of allergic disease, including asthma. This hypothesis postulates that decreased exposure at a young age to certain infectious agents as a result of improved hygiene, increased antibiotic use and vaccination, and changes in lifestyle and dietary habits is associated with changes in the immune system, which predispose subjects to allergy. Many microbes, during their coevolution with human subjects, developed mechanisms to manipulate the human immune system and to increase their chances of survival. Improving models of asthma, as well as choosing adequate end points in clinical trials, will lead to a more complete understanding of the underlying mechanisms, thus providing an opportunity to devise primary and secondary interventions at the same time as identifying new molecular targets for treatment. This article reports the discussion and conclusion of a workshop under the auspices of the Netherlands Lung Foundation to extend our understanding of how modulation of the immune system by bacterial, parasitic, and viral infections might affect the development of asthma and to map out future lines of investigation.
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Affiliation(s)
- Hermelijn H Smits
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Clarissa Prazeres da Costa
- Institute of Medical Microbiology, Immunology and Hygiene, Technische Universät München, Munich, Germany
| | - Markus Ege
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität of Munich, Munich, Germany
| | - Michael Edwards
- Department of Respiratory Medicine & Wright-Fleming Institute of Infection and Immunity, Imperial College London, London, United Kingdom
| | - Holger Garn
- Institute for Laboratory Medicine and Pathobiochemistry, Philipps University of Marburg, Marburg, Germany
| | - Peter H Howarth
- Academic Unit of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, United Kingdom
| | - Tuomas Jartti
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Esther C de Jong
- Department of Cell Biology and Histology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Rick M Maizels
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Ben J Marsland
- Faculty of Biology and Medicine, University of Lausanne, Service de Pneumologie, CHUV, Epalinges, Switzerland
| | - Henry J McSorley
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Anne Müller
- Institute of Molecular Cancer Research, University of Zurich, Zurich, Switzerland
| | - Petra I Pfefferle
- Comprehensive Biomaterial Bank Marburg (CBBMR), Philipps University Marburg, Marburg, Germany
| | - Huub Savelkoul
- Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
| | - Jürgen Schwarze
- MRC-Centre for Inflammation Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Wendy W J Unger
- Department of Paediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Erika von Mutius
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität of Munich, Munich, Germany
| | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Christian Taube
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
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Webb EL, Nampijja M, Kaweesa J, Kizindo R, Namutebi M, Nakazibwe E, Oduru G, Kabubi P, Kabagenyi J, Nkurunungi G, Kizito D, Muhangi L, Akello M, Verweij JJ, Nerima B, Tukahebwa E, Elliott AM, Sanya R, Mirembe B, Okello J, Levin J, Zziwa C, Tumusiime J, Sewankambo M, Nsubuga D, Cose S, Wammes L, Niwagaba E, Kabami G, Abayo E, Muwonge F, Abiriga D, Nannozi V, Kaweesa J. Helminths are positively associated with atopy and wheeze in Ugandan fishing communities: results from a cross-sectional survey. Allergy 2016; 71:1156-69. [PMID: 26918891 PMCID: PMC4949563 DOI: 10.1111/all.12867] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 01/15/2023]
Abstract
Background Parasitic helminths are potent immunomodulators and chronic infections may protect against allergy‐related disease and atopy. We conducted a cross‐sectional survey to test the hypothesis that in heavily helminth‐exposed fishing villages on Lake Victoria, Uganda, helminth infections would be inversely associated with allergy‐related conditions. Methods A household survey was conducted as baseline to an anthelminthic intervention trial. Outcomes were reported wheeze in last year, atopy assessed both by skin prick test (SPT) and by the measurement of allergen‐specific IgE to dust mites and cockroach in plasma. Helminth infections were ascertained by stool, urine and haemoparasitology. Associations were examined using multivariable regression. Results Two thousand three hundred and sixteen individuals were surveyed. Prevalence of reported wheeze was 2% in under‐fives and 5% in participants ≥5 years; 19% had a positive SPT; median Dermatophagoides‐specific IgE and cockroach‐specific IgE were 1440 and 220 ng/ml, respectively. S. mansoni, N. americanus, S. stercoralis, T. trichiura, M. perstans and A. lumbricoides prevalence was estimated as 51%, 22%, 12%, 10%, 2% and 1%, respectively. S. mansoni was positively associated with Dermatophagoides‐specific IgE [adjusted geometric mean ratio (aGMR) (95% confidence interval) 1.64 (1.23, 2.18)]; T. trichiura with SPT [adjusted odds ratio (aOR) 2.08 (1.38, 3.15)]; M. perstans with cockroach‐specific IgE [aGMR 2.37 (1.39, 4.06)], A. lumbricoides with wheeze in participants ≥5 years [aOR 6.36 (1.10, 36.63)] and with Dermatophagoides‐specific IgE [aGMR 2.34 (1.11, 4.95)]. No inverse associations were observed. Conclusions Contrary to our hypothesis, we found little evidence of an inverse relationship between helminths and allergy‐related outcomes, but strong evidence that individuals with certain helminths were more prone to atopy in this setting.
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Affiliation(s)
- E. L. Webb
- London School of Hygiene and Tropical Medicine London UK
| | - M. Nampijja
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - J. Kaweesa
- Vector Control Division Ministry of Health Kampala Uganda
| | - R. Kizindo
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - M. Namutebi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | | | | | - P. Kabubi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - J. Kabagenyi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - G. Nkurunungi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - D. Kizito
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - L. Muhangi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - M. Akello
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - J. J. Verweij
- Laboratory for Medical Microbiology and Immunology St Elisabeth Hospital LC Tilburg the Netherlands
| | - B. Nerima
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - E. Tukahebwa
- Vector Control Division Ministry of Health Kampala Uganda
| | - A. M. Elliott
- London School of Hygiene and Tropical Medicine London UK
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
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Elliott A, Nerima B, Bagaya B, Kambugu A, Joloba M, Cose S, Pantaleo G, Yazdanbakhsh M, Mabey D, Dunne D, Moffett A, Rwakishaya EK, Kaleebu P, Mbidde EK. Capacity for science in sub-Saharan Africa. Lancet 2015; 385:2435-7. [PMID: 26122054 DOI: 10.1016/s0140-6736(15)61111-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alison Elliott
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda; London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Bernard Bagaya
- Uganda Virus Research Institute, Entebbe, Uganda; Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew Kambugu
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Joloba
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stephen Cose
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda; London School of Hygiene & Tropical Medicine, London, UK
| | | | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - David Mabey
- London School of Hygiene & Tropical Medicine, London, UK
| | - David Dunne
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Ashley Moffett
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Eli Katunguka Rwakishaya
- Makerere University Directorate of Research and Graduate Studies, Kampala, Uganda; Kyambogo University, Kampala, Uganda
| | - Pontiano Kaleebu
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda; London School of Hygiene & Tropical Medicine, London, UK; Uganda Virus Research Institute, Entebbe, Uganda
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Kaleebu P, Kamali A, Seeley J, Elliott AM, Katongole-Mbidde E. The Medical Research Council (UK)/Uganda Virus Research Institute Uganda Research Unit on AIDS--'25 years of research through partnerships'. Trop Med Int Health 2014; 20:E1-10. [PMID: 25354929 PMCID: PMC4529486 DOI: 10.1111/tmi.12415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
For the past 25 years, the Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS has conducted research on HIV-1, coinfections and, more recently, on non-communicable diseases. Working with various partners, the research findings of the Unit have contributed to the understanding and control of the HIV epidemic both in Uganda and globally, and informed the future development of biomedical HIV interventions, health policy and practice. In this report, as we celebrate our silver jubilee, we describe some of these achievements and the Unit's multidisciplinary approach to research. We also discuss the future direction of the Unit; an exemplar of a partnership that has been largely funded from the north but led in the south.
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Affiliation(s)
- P Kaleebu
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) Uganda Research Unit on AIDS, Entebbe, Uganda; Uganda Virus Research Institute, Entebbe, Uganda; London School of Hygiene and Tropical Medicine, London, UK
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