The role of environmental enteric dysfunction in the pathogenesis of Schistosoma mansoni-associated morbidity in school-aged children.
PLoS Negl Trop Dis 2022;
16:e0010837. [PMID:
36197916 PMCID:
PMC9576041 DOI:
10.1371/journal.pntd.0010837]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/17/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
Background
Studies have implicated schistosomiasis as a cause of intestinal barrier disruption, a salient feature of environmental enteric dysfunction (EED), as eggs translocate from the sterile bloodstream through the gut wall. We examined the longitudinal impact of praziquantel (PZQ) treatment on a) EED biomarkers and b) Insulin growth factor I (IGF-1), a key driver of childhood linear growth, since EED has been implicated in linear growth stunting.
Methodology
290 children infected with S. mansoni in Brazil were treated with PZQ at baseline. EED biomarkers lipopolysaccharide (LPS) and intestinal fatty acid binding-protein (I-FABP) were measured, as well as IGF-1 at baseline, 6 and 12-months. Multivariate regression analysis was applied to assess associations between S. mansoni intensity and plasma biomarkers (LPS, I-FABP, and IGF-1), controlling for potential confounding variables.
Principal findings
At baseline, S. mansoni infection intensities were 27.2% light, 46.9% moderate, and 25.9% heavy. LPS concentrations were significantly reduced at the 12-month visit compared to baseline (p = 0.0002). No longitudinal changes were observed for I-FABP or IGF-1 in the 6- or 12-month periods following baseline treatment. After 6-months, I-FABP concentration was significantly higher in high vs low intensity (p = 0.0017). IGF-1 concentrations were significantly lower among children with high and moderate vs low intensity infections at each study visit.
Conclusions/significance
We report that S. mansoni infection impacts LPS, I-FABP and IGF-1. These findings suggest a mechanistic role for EED in schistosomiasis-related morbidities, particularly linear growth.
Schistosoma mansoni is a tropical parasitic infection that causes intestinal schistosomiasis. In infected humans, the parasite worms shed eggs that migrate across the gut barrier, which damages intestinal structure and function. In children, intestinal schistosomiasis leads to anemia, undernutrition, and linear growth stunting. The mechanistic pathways between schistosomiasis and stunting are not fully understood, but this research explores the role of environmental enteric dysfunction (EED) in schistosomiasis-related morbidity. EED is an intestinal condition that affects children living in areas of poor water, sanitation, and hygiene and also leads to impaired growth and stunting. In a longitudinal cohort of Brazilian children infected with S. mansoni, we measured blood biomarkers of EED and linear growth at three time points over 12 months. All of the children were treated for schistosomiasis at baseline, and after 12 months, we observed a significant decrease in a marker of EED, suggesting improvement in gut integrity. We also found that children who had higher parasite egg burden at the baseline visit had lower levels of insulin-like growth factor-1, a hormone that drives growth in children. Our findings suggest that EED may play a role in schistosomiasis-related stunting and furthers our understanding for S. mansoni pathogenesis in children.
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