Myc-induced nuclear antigen constrains a latent intestinal epithelial cell-intrinsic anthelmintic pathway

Expulsion of parasitic gastrointestinal nematodes requires diverse effector mechanisms coordinated by a Th2-type response. The evolutionarily conserved JmjC protein; Myc Induced Nuclear Antigen (Mina) has been shown to repress IL4, a key Th2 cytokine, suggesting Mina may negatively regulate nematode expulsion. Here we report that expulsion of the parasitic nematode Trichuris muris was indeed accelerated in Mina deficient mice. Unexpectedly, this was associated not with an elevated Th2- but rather an impaired Th1-type response. Further reciprocal bone marrow chimera and conditional KO experiments demonstrated that retarded parasite expulsion and a normal Th1-type response both required Mina in intestinal epithelial cells (IECs). Transcriptional profiling experiments in IECs revealed anti-microbial α-defensin peptides to be the major target of Mina-dependent retention of worms in infected mice. In vitro exposure to recombinant α-defensin peptides caused cytotoxic damage to whipworms. These results identify a latent IEC-intrinsic anthelmintic pathway actively constrained by Mina and point to α-defensins as important effectors that together with Mina may be attractive therapeutic targets for the control of nematode infection.

Intestinal Epithelial Cell-Intrinsic Deletion of Setd7 Identifies Role for Developmental Pathways in Immunity to Helminth Infection

The intestine is a common site for a variety of pathogenic infections. Helminth infections continue to be major causes of disease worldwide, and are a significant burden on health care systems. Lysine methyltransferases are part of a family of novel attractive targets for drug discovery. SETD7 is a member of the Suppressor of variegation 3-9-Enhancer of zeste-Trithorax (SET) domain-containing family of lysine methyltransferases, and has been shown to methylate and alter the function of a wide variety of proteins in vitro. A few of these putative methylation targets have been shown to be important in resistance against pathogens. We therefore sought to study the role of SETD7 during parasitic infections. We find that Setd7-/- mice display increased resistance to infection with the helminth Trichuris muris but not Heligmosomoides polygyrus bakeri. Resistance to T. muris relies on an appropriate type 2 immune response that in turn prompts intestinal epithelial cells (IECs) to alter differentiation and proliferation kinetics. Here we show that SETD7 does not affect immune cell responses during infection. Instead, we found that IEC-specific deletion of Setd7 renders mice resistant to T. muris by controlling IEC turnover, an important aspect of anti-helminth immune responses. We further show that SETD7 controls IEC turnover by modulating developmental signaling pathways such as Hippo/YAP and Wnt/β-Catenin. We show that the Hippo pathway specifically is relevant during T. muris infection as verteporfin (a YAP inhibitor) treated mice became susceptible to T. muris. We conclude that SETD7 plays an important role in IEC biology during infection.

Sickness behaviour associated with non-lethal infections in wild primates

Non-lethal parasite infections are common in wildlife, but there is little information on their clinical consequences. Here, we pair infection data from a ubiquitous soil-transmitted helminth, the whipworm (genus Trichuris), with activity data from a habituated group of wild red colobus monkeys (Procolobus rufomitratus tephrosceles) in Kibale National Park, Uganda. We use mixed-effect models to examine the relationship between non-lethal parasitism and red colobus behaviour. Our results indicate that red colobus increased resting and decreased more energetically costly behaviours when shedding whipworm eggs in faeces. Temporal patterns of behaviour also changed, with individuals switching behaviour less frequently when whipworm-positive. Feeding frequency did not differ, but red colobus consumption of bark and two plant species from the genus Albizia, which are used locally in traditional medicines, significantly increased when animals were shedding whipworm eggs. These results suggest self-medicative plant use, although additional work is needed to verify this conclusion. Our results indicate sickness behaviours, which are considered an adaptive response by hosts during infection. Induction of sickness behaviour in turn suggests that these primates are clinically sensitive to non-lethal parasite infections.

Trichuris dysentery syndrome: Do we learn enough from case studies?

Trichuris Dysentery Syndrome (TDS) is a severe persistent trichuriasis associated with heavy worm build-up in the colon that continues to be neglected and underestimated in endemic countries. Trichuriasis is most prevalent in children in tropical countries, and that increases the risk of TDS. We reported a series of four preschool children of both genders chronically having TDS over a period ranging from several months to years presenting with anaemia. The hemoglobin levels ranged from 4.6 to 9.1 g/dl on first admissions. Despite treatment, the cases were reported to have failure to thrive with persistent anaemia. It was concluded that TDS should be considered in endemic areas among children presenting with chronic bloody diarrhea and anaemia.

Growth reduction among primary schoolchildren with light trichuriasis in Malaysia treated with albendazole

We studied asymptomatic primary schoolchildren in northeastern Malaysia with light to moderate trichuriasis to determine the effect of albendazole treatment on growth rates and TNF-alpha levels. Thirty-seven schoolchildren aged 6-7 years with stool samples positive for Trichuris trichiura and negative for other geohelminths and protozoa were randomized to receive albendazole 400 mg or a placebo daily for 2 days. Anthropometric parameters at baseline, 3, 6 and 12 months were compared between the 2 groups. The placebo group had a significantly greater increase in height (p = 0.04) than the albendazole treatment group. There were no significant differences in urinary TNF-alpha levels (p = 0.8) between the 2 groups and no significant changes between baseline and 1 month post-treatment levels. Further studies are needed to determine the etiology of this apparent association between the albendazole treatment group and the delay in growth rate at 6 months post-treatment.

The mannose receptor binds Trichuris muris excretory/secretory proteins but is not essential for protective immunity

Trichuris muris is a natural mouse model of the human gastrointestinal nematode parasite Trichuris trichiura and it is well established that a T helper type 2-dominated immune response is required for worm expulsion. Macrophages accumulate in the large intestine of mice during infection and these cells are known to express the mannose receptor (MR), which may act as a pattern recognition receptor. The data presented here show for the first time that T. muris excretory/secretory products (E/S) induce bone-marrow-derived macrophages (BMDM) to produce several cytokines and have MR-binding activity. Using alternatively activated BMDM from MR knockout mice it is shown that the production of interleukin-6 partially depends on the MR. Infection of MR knockout mice with T. muris reveals that this receptor is not necessary for the expulsion of the parasite because MR knockout mice expel parasites with the same kinetics as wild-type animals and have similar cytokine responses in the mesenteric lymph nodes. Furthermore, despite acting to reduce serum levels of proinflammatory mediators, absence of the MR does not lead to increased gut inflammation after T. muris infection when assessed by macrophage influx, goblet cell hyperplasia and crypt depth. This work suggests that, despite binding components of T. muris E/S, the MR is not critically involved in the generation of the immune response to this parasite.

CD4+ T cell-mediated immunological control of enterochromaffin cell hyperplasia and 5-hydroxytryptamine production in enteric infection

BACKGROUND

Enterochromaffin (EC) cells are dispersed throughout the gastrointestinal (GI) mucosa and are the main source of 5-hydroxytryptamine (5-HT) in the gut. 5-HT has been implicated in the pathophysiology of several GI disorders, but the mechanisms regulating 5-HT production in the gut are unknown.

AIM

To investigate the role of CD4(+) T cells in the production of 5-HT using a model of enteric parasitic infection.

METHODS AND RESULTS

Severe combined immunodeficient (SCID) mice and their wild-type controls were infected with the nematode Trichuris muris and killed on various days after infection to study colonic EC cells and 5-HT production. The number of EC cells and the amount of 5-HT produced were significantly higher in infected wild-type mice than in non-infected mice. The number of EC cells and the amount of 5-HT after infection were significantly lower in SCID mice after infection than in wild-type mice. The number of EC cells and the amount of 5-HT was significantly increased after reconstitution of SCID mice with CD4(+) T cells from infected mice and this was accompanied by an upregulation of colonic CD3 T cells and T helper 2 (Th2) cytokines. Laser capture microdissection-based molecular and immunofluorescence techniques revealed the presence of interleukin 13 receptor alpha1-chain on EC cells.

CONCLUSION

These results show an important immunoendocrine axis in the gut, where secretory products from CD4(+) T cells interact with EC cells to enhance the production of 5-HT in the gut via Th2-based mechanisms. These results show new insights into the mechanisms of gut function, which may ultimately lead to improved therapeutic strategies in functional and inflammatory disorders of the GI tract.

An increase in epithelial cell apoptosis is associated with chronic intestinal nematode infection

It is well established that homeostasis of the intestinal epithelium becomes dysregulated during gastrointestinal helminth infection and is under immune control. An increase in both enterocyte proliferation and the subsequent generation of crypt hyperplasia are hallmarks of chronic infection with Trichuris muris, a large intestinal dwelling nematode. The effect of this parasitic infection on apoptosis induction in the large intestine and its regulation has been neglected. To address this, mice of resistant and susceptible phenotypes were infected with different doses of T. muris, and the levels of epithelial cell apoptosis were determined. It is clear that apoptosis is induced during chronic T. muris infection. This occurs mainly at the base of the cecal crypt, within the stem cell region. The level of apoptosis induced is independent of worm number, suggesting that it is not a consequence of worm-induced damage but rather a mechanism for controlling cell number within the crypt. Neutralization of both gamma interferon and tumor necrosis factor alpha caused a significant reduction in the levels of apoptosis, showing that proinflammatory cytokines generated in response to chronic infection play an important role in apoptosis induction in this system. It is proposed that the generation of proinflammatory cytokines during chronic T. muris infection may play a positive role, by promoting intestinal epithelial cell apoptosis, to counter infection-induced epithelial hyperplasia.

Amphiregulin, a TH2 cytokine enhancing resistance to nematodes

Although type 2 immune responses contribute to allergy and asthma, these responses are essential for clearing intestinal helminth infestations by mechanisms that include increased epithelial shedding. We show that T helper 2 cells (T(H)2), but not other T cell subsets, express amphiregulin, a member of the epidermal growth factor (EGF) family. EGF receptor ligands directly induce epithelial cell proliferation, and lack of amphiregulin delayed expulsion of the nematode Trichuris muris. This newly recognized link between T(H)2 cells and epithelial proliferation should help in planning therapeutic interventions for helminth infections and other diseases that involve both cell proliferation and allergy, such as asthma.

The innate immune responses of colonic epithelial cells to Trichuris muris are similar in mouse strains that develop a type 1 or type 2 adaptive immune response

Trichuris muris resides in intimate contact with its host, burrowing within cecal epithelial cells. However, whether the enterocyte itself responds innately to T. muris is unknown. This study investigated for the first time whether colonic intestinal epithelial cells (IEC) produce cytokines or chemokines following T. muris infection and whether divergence of the innate response could explain differentially polarized adaptive immune responses in resistant and susceptible mice. Increased expression of mRNA for the proinflammatory cytokines gamma interferon (IFN-gamma) and tumor necrosis factor and the chemokine CCL2 (MCP-1) were seen after infection of susceptible and resistant strains, with the only difference in expression being a delayed increase in CCL2 in BALB/c IEC. These increases were ablated in MyD88-/- mice, and NF-kappaB p65 was phosphorylated in response to T. muris excretory/secretory products in the epithelial cell line CMT-93, suggesting involvement of the MyD88-NF-kappaB signaling pathway in IEC cytokine expression. These data reveal that IEC respond innately to T. muris. However, the minor differences identified between resistant and susceptible mice are unlikely to underlie the subsequent development of a susceptible type 1 (IFN-gamma-dominated) or resistant type 2 (interleukin-4 [IL-4]/IL-13-dominated) adaptive immune response.

Pathology of Trichuris suis infection in pigs fed an inulin- and a non-inulin-containing diet

Pathology of the colon in pigs infected with Trichuris suis and fed an inulin and a non-inulin containing diet was studied to investigate the inflammatory response induced and the influence of inulin on this. Twenty-nine pigs were allocated into four groups (N-7, I-7, N-9 and N/I-9). Groups N-7, N-9 and N/I-9 were given a diet with non-fermentable carbohydrates, and group I-7 was fed a diet including fermentable carbohydrates (inulin). After 2 weeks, all pigs were inoculated with 2000 T. suis eggs. Seven weeks post-infection (p.i.), groups N-7 and I-7 were killed and group N/I-9 changed to inulin diet to study the influence of inulin on already established T. suis. Nine weeks p.i., groups N-9 and N/I-9 were killed. Trichuris suis were collected from the colon for enumeration. Tissues from the colon of each pig were taken for histological and immunohistochemical quantitative and semi-quantitative evaluations of heterophils, eosinophils, mast cells, IgA(+), IgG(+), IgM(+) and CD3(+) cells. The findings were compared with tissues from seven uninfected pigs of the same age. Pigs fed inulin had significantly fewer worms compared with pigs on the non-fermentable carbohydrate diet. The number of inflammatory cells in the colonic mucosa was increased in all T. suis-infected pigs compared with uninfected controls. The numbers of eosinophils, mast cells, IgA(+), IgG(+) and CD3(+) cells were significantly lower in pigs fed inulin than pigs fed non-fermentable carbohydrate. Whether this is a direct effect of inulin or a secondary effect due to the lower parasitic burden in inulin fed pigs is not known.

The role of Th2 cytokines, chemokines and parasite products in eosinophil recruitment to the gastrointestinal mucosa during helminth infection

Trichinella spiralis and Trichuris muris are nematode parasites of the mouse, dwelling in the small and large intestines, respectively: worm expulsion requires development of a Th2 immune response. The chemokine CCL11 is agonist for the chemokine receptor CCR3 and acts in synergy with IL-5 to recruit eosinophils to inflammatory sites. The role of CCL11 in gastrointestinal helminth infection has not been previously studied. We challenged wild-type (WT) BALB/c, CCL11 single knockout (SKO) and CCL11 IL-5 double knockout (DKO) mice with either T. spiralis muscle larvae or T. muris eggs in order to examine eosinophil recruitment to the small and large intestine during helminth infection. A peripheral eosinophilia was seen in WT and SKO mice during T. spiralis infection but not with T. muris. Gastrointestinal eosinophilia was markedly reduced but not ablated in SKO mice -- and negligible in DKO mice -- infected with either nematode. The residual eosinophilia and up-regulation of CCL24 mRNA in the gastrointestinal tract of SKO mice infected with either nematode, together with the presence of an eosinophil-active factor in T. spiralis and T. muris products, suggest that CCL11 is the salient but not the sole eosinophil chemoattractant of biological significance during gastrointestinal helminth infection.

The effect of dietary carbohydrates and Trichuris suis infection on pig large intestine tissue structure, epithelial cell proliferation and mucin characteristics

Two experiments (Exps. 1 and 2) were performed to study the influence of Trichuris suis infection and type of dietary carbohydrates on large intestine morphology, epithelial cell proliferation and mucin characteristics. Two experimental diets based on barley flour were used; Diet 1 was supplemented with resistant carbohydrates from oat hull meal, while Diet 2 was supplemented with fermentable carbohydrates from sugar beet fibre and inulin. In Experiment 1, 32 pigs were allocated randomly into four groups. Two groups were fed Diet 1 and two groups Diet 2. Pigs from one of each diet group were inoculated with a single dose of 2000 infective T. suis eggs and the other two groups remained uninfected controls. In Experiment 2, 12 pigs were allocated randomly into two groups and fed Diet 1 or Diet 2, respectively, and inoculated with a single dose of 2000 infective T. suis eggs. All the pigs were slaughtered 8 weeks post inoculation (p.i.). The worm counts were lower in pigs fed Diet 2 in both experiments, but not significantly so. Both diet and infection status significantly influenced the tissue weight of the large intestine. In both experiments, pigs fed Diet 2 had heavier large intestines than pigs fed Diet 1 and in Experiment1 the infected pigs of both diets had heavier large intestines than their respective control groups. Diet and infection also significantly affected the morphological architecture and mucin production in both experiments. Pigs fed Diet 1 had larger crypts both in terms of area and height than pigs fed Diet 2 and T. suis infected pigs on both diets in Experiment 1 had larger crypts than their respective control groups. The area of the mucin granules in the crypts constituted 22-53% of the total crypt area and was greatest in the T. suis infected pigs fed Diet 1. Epithelial cell proliferation was affected neither by diet nor infection in any of the experiments. The study showed that both T. suis infection and dietary carbohydrates significantly influence the morphological architecture and the production and composition of mucins in the large intestine of pigs and suggests that both factors are important in large intestine function and that carbohydrates may play a role in the susceptibility to intestinal helminth infections.

Computed tomographic findings of trichuriasis

In this report, we present computed tomographic findings of colonic trichuriasis. The patient was a 75-year-old man who complained of abdominal pain, and weight loss. Diagnosis was achieved by colonoscopic biopsy. Abdominal computed tomography showed irregular and nodular thickening of the wall of the cecum and ascending colon. Although these findings are nonspecific, they may be one of the findings of trichuriasis. These findings, confirmed by pathologic analysis of the biopsied tissue and Kato-Katz parasitological stool flotation technique, revealed adult Trichuris. To our knowledge, this is the first report of colonic trichuriasis indicated by computed tomography.

Iatrogenic Trichuris suis infection in a patient with Crohn disease

We report a case of biopsy-proven iatrogenic infection by the pig whipworm Trichuris suis in a patient with Crohn disease. The deliberate therapeutic ingestion of T suis ova has been adopted as an experimental approach to the treatment of Crohn disease in an effort to promote a switch from the T helper subtype 1 to T helper subtype 2 inflammatory phenotype in vivo. This report examines the morphology of the immature and adult T suis, the effects of this intervention on the immunophenotype of the bowel mucosa, and it also raises the possibility of persistent active infection in man.

The characterization of intraepithelial lymphocytes, lamina propria leukocytes, and isolated lymphoid follicles in the large intestine of mice infected with the intestinal nematode parasite Trichuris muris

Despite a growing understanding of the role of cytokines in immunity to the parasitic helminth Trichuris muris, the local effector mechanism culminating in the expulsion of worms from the large intestine is not known. We used flow cytometry and immunohistochemistry to characterize the phenotype of large intestinal intraepithelial lymphocytes (IEL) and lamina propria leukocytes (LPL) from resistant and susceptible strains of mouse infected with T. muris. Leukocytes accumulated in the epithelium and lamina propria after infection, revealing marked differences between the different strains of mouse. In resistant mice, which mount a Th2 response, the number of infiltrating CD4+, CD8+, B220+, and F4/80+ IEL and LPL was generally highest around the time of worm expulsion from the gut, at which point the inflammation was dominated by CD4+ IEL and F4/80+ LPL. In contrast, in susceptible mice, which mount a Th1 response, the number of IEL and LPL increased more gradually and was highest after a chronic infection had developed. At this point, CD8+ IEL and F4/80+ LPL were predominant. Therefore, this study reveals the local immune responses underlying the expulsion of worms or the persistence of a chronic infection in resistant and susceptible strains of mouse, respectively. In addition, for the first time, we illustrate isolated lymphoid follicles in the large intestine, consisting of B cells interspersed with CD4+ T cells and having a central zone of rapidly proliferating cells. Furthermore, we demonstrate the organogenesis of these structures in response to T. muris infection.

Dendritic cell expansion occurs in mesenteric lymph nodes of B10.BR mice infected with the murine nematode parasite Trichuris muris

Dendritic cells (DCs) are a crucial element in the immune system and bridge innate and adaptive immunity. CD11c+ B220- DCs residing in Peyer's patches (PPs) have the ability to produce interleukin 10 (IL-10) and induce T helper (Th2) development. Evidence suggests that CD11c+ B220- DCs maintain the gut environment by suppressing Th1 responses with IL-10, resulting in a Th2-dominat gut environment. Th2 effectors are required for protection against the murine nematode parasite Trichuris muris, and thus CD11c+ B220- DCs may be involved in the induction of Th2 cells in T. muris infection. In the present study, the kinetics of CD11c+ B220- DCs were analyzed in mesenteric lymph nodes of B10.BR mice infected with the E-J isolate of T. muris, and the cellular expansion of CD11c+ B220- DCs was also observed. As well, the DC expansion was consistent with the occurrence of worm expulsion augmented by IL-4 and IL-13. The evidence here suggests the involvement of CD11c+ B220- DCs in protective Th2 responses to T. muris infection.

Isolates of Trichuris muris elicit different adaptive immune responses in their murine host

The J and S isolates of Trichuris muris have different infection profiles in C57BL/6 mice; J worms are expelled, S worms survive to chronicity. Building on this, the ability of the J and S isolates to survive, and the quality of the immune response induced was explored in three different strains of mouse. The resistant BALB/c mouse mounted a strong Th2 response against both isolates, which were quickly expelled. The susceptible AKR host mounted a Th1 response and retained both isolates. Despite equivalent worm exposure, mesenteric lymph node cells from AKR mice infected with the S isolate produced significantly higher levels of IL-12 and the intestinal mastocytosis was reduced. IgG1 and IgG2a from S-infected AKR mice recognized low molecular weight antigens not recognized by J-infected mice. Differential expulsion kinetics was observed in the slower-responding C57BL/6 strain; J worms were expelled but S isolate worms were retained. Survival of the S isolate was again associated with elevated IL-12 and decreased Th2 responses. In resistant mouse strains, the outcome of infection is thus dominantly influenced by host genetics. However, in the slower-responding host, isolate-derived factors may play a role in shaping the quality of the adaptive immune response, thus influencing parasite survival.

The IL-27 receptor (WSX-1) is an inhibitor of innate and adaptive elements of type 2 immunity

Although previous studies have investigated the role of IL-27/WSX-1 interactions in the regulation of Th1 responses, little is known about their role in regulating Th2-type responses. Studies presented in this work identify a direct role for IL-27/WSX-1 interactions in the negative regulation of type 2 responses independent of effects on type 1 cytokines. WSX-1-/- mice infected with the gastrointestinal helminth Trichuris muris displayed accelerated expulsion of parasites and the development of exaggerated goblet cell hyperplasia and mastocytosis in the gut due to increased production of Th2 cytokines. Enhanced mast cell activity in the absence of WSX-1 was consistent with the ability of wild-type mast cells to express this receptor. In addition, IL-27 directly suppressed CD4+ T cell proliferation and Th2 cytokine production. Together, these studies identify a novel role for IL-27/WSX-1 in limiting innate and adaptive components of type 2 immunity at mucosal sites.

Absence of CC chemokine ligand 2 results in an altered Th1/Th2 cytokine balance and failure to expel Trichuris muris infection

Despite a growing understanding of the role of cytokines in immunity to intestinal helminth infections, the importance of chemokines has been neglected. As a chemokine with both chemoattractive properties and an ability to shape the quality of the adaptive immune response, CC chemokine ligand 2 (CCL2) was investigated as an attractive candidate for controlling resistance to these types of infection, which require highly polarized Th cell responses. We show here for the first time that CCL2 plays an important role in the development of resistance to infection by the gastrointestinal nematode Trichuris muris. Thus, in the absence of CCL2, worm expulsion does not occur, and the lymph node draining the site of infection becomes a Th1-promoting environment. Elevated levels of IL-12 are produced by polarizing APCs, and the composition of the APC environment itself is perturbed, with reduced numbers of macrophages.

Enhancement of disease and pathology by synergy of Trichuris suis and Campylobacter jejuni in the colon of immunologically naive swine

Campylobacterjejuni, a leading cause of bacterial gastroenteritis, has different age distribution and disease expression in developing and developed countries, which may be due to the endemnicity of infection and the age of acquisition of immunity. Differences in disease expression are not solely dependent on the C. jejuni strain or virulence attributes. Another modulating factor in developing countries may be endemic nematode infections such as Trichuris, which drive type 2 cytokine responses and down-regulate type 1 immune responses. In this study, three-day-old germ-free pigs given dual infections with Trichuris suis and C. jejuni had more frequent, more severe diarrhea and severe pathology than pigs given no pathogens, only T. suis, or only C. jejuni. These pigs had significant hemorrhage and inflammatory cell infiltrates in the proximal colon where adult worms were found, and abscessed lymphoglandular complexes in the distal colon with intracellular C. jejuni. Pigs given only C. jejuni had mild clinical signs and pathology, and bacteria in feces or extracellular sites. Pigs given T. suis or no pathogens had no disease and minimal pathology. Thus, these agents synergized to produce significant disease and pathology, which was site specific.

Enhancement of disease and pathology by synergy of Trichuris suis and Campylobacter jejuni in the colon of immunologically naive swine

Campylobacter jejuni, a leading cause of bacterial gastroenteritis, has different age distribution and disease expression in developing and developed countries, which may be due to the endemnicity of infection and the age of acquisition of immunity. Differences in disease expression are not solely dependent on the C jejuni strain or virulence attributes. Another modulating factor in developing countries may be endemic nematode infections such as Trichuris, which drive type 2 cytokine responses and down-regulate type 1 immune responses. In this study, three-day-old germ-free pigs given dual infections with Trichuris suis and C jejuni had more frequent, more severe diarrhea and severe pathology than pigs given no pathogens, only T. suis, or only C jejuni. These pigs had significant hemorrhage and inflammatory cell infiltrates in the proximal colon where adult worms were found, and abscessed lymphoglandular complexes in the distal colon with intracellular C jejuni. Pigs given only C jejuni had mild clinical signs and pathology, and bacteria in feces or extracellular sites. Pigs given T. suis or no pathogens had no disease and minimal pathology. Thus, these agents synergized to produce significant disease and pathology, which was site specific.

Differential requirement for NF-kappa B family members in control of helminth infection and intestinal inflammation

The NF-kappaB family of transcription factors is critical in controlling the expression of a wide range of immune response genes. However, whether individual family members perform specific roles in regulating immunity and inflammation remains unclear. Here we investigated the requirement for NF-kappaB1, NF-kappaB2, and c-Rel in the expression of Th2 cytokine responses, development of host protective immunity, and regulation of intestinal inflammation following infection with the gut-dwelling helminth parasite Trichuris muris. While mice deficient in c-Rel mounted sufficient Th2 responses to expel infection, NF-kappaB1 knockout (KO) and NF-kappaB2 KO mice developed chronic infections associated with elevated production of Ag-specific IFN-gamma. However, only infected NF-kappaB1 KO mice exhibited polarized IFN-gamma responses associated with the loss of intestinal goblet cells and the development of destructive colitis-like pathology. Furthermore, blockade of IL-12 (previously shown to confer resistance in susceptible strains) recovered Ag-specific IL-13 responses and resistance to infection in NF-kappaB2 KO, but not NF-kappaB1 KO mice. Therefore, unique infection, immunological, and pathological outcomes were observed in different NF-kappaB KO strains. Taken together, these results provide direct evidence of nonoverlapping functions for NF-kappaB family members in the development of Th2 cytokine-mediated resistance to T. muris and the control of infection-induced intestinal inflammation.

Trichuriasis: localized inflammatory responses in the colon

Most patients with trichuriasis have light worm burdens. Data regarding the inflammatory response to Trichuris worms in the colon of lightly infected persons are scant. Nine patients whose Trichuris infection was found by colonoscopy had biopsies taken from a site adjacent to visible worms and from a second site some 20 cm distally. The biopsies were studied by routine and immunohistochemical methods. None of the biopsies showed mucosal ulceration, significant congestion, fibrosis, gland distortion or goblet cell mucin depletion. There was no difference between worm and worm-free sites in terms of edema, lymphoid follicles or epithelial slough. Worm sites had higher numbers of eosinophils, neutrophils and total inflammatory cells and lower numbers of plasma cells. However there was no difference in lymphocyte, mast cell, and B- and T-cell counts between the two sites. This suggests that the T. trichiura worm incites a local inflammatory response involving eosinophils and neutrophils, even when the colon has only a light burden of worms.

IL-10 is critical for host resistance and survival during gastrointestinal helminth infection

Resistance to many intestinal nematodes is dependent on the induction of polarized type 2 cytokine responses, whereas type 1 responses can exacerbate these infections. The contributions of IL-4 and IL-13 to the development of resistance have been well described for a variety of intestinal parasites; however, the role of IL-10 has not been previously investigated. In this study we infected IL-10-, IL-10/IL-4-, IL-10/IL-12-, IL-4-, and IL-12-deficient mice with Trichuris muris to determine whether IL-10 contributes to the development of immunity. Interestingly, T. muris-infected IL-10-, IL-4-, and IL-10/IL-4-deficient mice failed to expel the parasite, and animals deficient in IL-10 displayed marked morbidity and mortality. In contrast, double IL-10/IL-12-deficient mice were completely resistant and mounted a highly polarized type 2 cytokine response, demonstrating that the increased susceptibility of IL-10-deficient mice was dependent on IL-12. Further study suggested that the susceptibility of IL-10- and IL-10/IL-4-deficient mice was probably attributable to a marked increase in type 1 cytokine production in those animals. The mortality observed in T. muris-infected IL-10- and IL-10/IL-4-deficient mice correlated with increased inflammation, loss of Paneth cells, and absence of mucus in the cecum. Interestingly, survival was enhanced in T. muris-infected IL-10/IL-4-deficient mice if a broad spectrum antibiotic was administered, suggesting that an outgrowth of opportunistic bacteria was contributing to the high degree of morbidity and mortality. Overall, these studies reveal a critical role for IL-10 in the polarization of Th2 responses, development of resistance during T. muris infection, and maintenance of barrier function in the colon.

Parenteral nutrition in the management of a dog with lymphocytic-plasmacytic enteritis and severe protein-losing enteropathy

Management of lymphocytic-plasmacytic enteritis in a dog with whipworm infestation, hypoproteinemia, and ascites is described. Short-term parenteral nutrition hastened normalization of serum proteins, resolution of diarrhea, and weight gain. A description of the potential benefits, limitations, and possible complications of parenteral nutrition in refractory inflammatory bowel disease is given.

[Massive trichuriasis in an adult diagnosed by colonoscopy]

A case of massive trichuriasis in a 37-year-old female from a rural locality of the Metropolitan Region of Chile, with antecedents of alcoholism, chronic hepatic damage and portal cavernomatosis, is presented. Since 12 year ago she has had geophagia. In the last six months she has frequently presented liquid diarrhea, colic abdominal pains, tenesmus and sensation of abdominal distention. Clinical and laboratory tests confirmed her hepatic affection associated with a celiac disease with anemia and hypereosinophilia. Within a week diarrhea became worse and dysentery appeared. A colonoscopy revealed an impressive and massive trichuriasis. The patient was successfully treated with two cures of 200 mg tablets of mebendazole twice daily for three days with a week interval. After the first cure she evacuated a big amount of Tricuris trichiura, fecal evacuations became normal, geophagia disappeared and recovered 4 kg of body weight.

Trichuris muris: host intestinal epithelial cell hyperproliferation during chronic infection is regulated by interferon-gamma

Chronic infection with the intestinal nematode Trichuris muris is associated with an inappropriate type 1 cytokine response (production of predominantly IFN-gamma), whereas resistance to infection requires the induction of a protective type 2 response with the production of interleukin (IL)-4, IL-5, IL-9, and IL-13. T. muris inhabits an intracellular niche within murine intestinal epithelial cells of the caecum and in common with other intestinal helminth infections is associated with gross morphological changes in gut architecture. The purpose of this study was to characterise cytokine production during chronic infection in AKR and severe-combined-immunodeficient (SCID) mice and investigate what effect the anti-parasite response had on epithelial cell proliferation and so regulation of intestinal pathology. Pulse labeling with tritiated thymidine is employed to generate a sensitive cell position-linked proliferation index of the intestinal epithelium at various times postinfection. Infection in AKR mice is characterized by a marked elevation in antigen specific IFN-gamma production from restimulated mesenteric lymph node cells and a significant increase in proliferation of pluripotent epithelial stem cells and transit cells within the crypts. Similarly, elevated IFN-gamma production was observed in the mesenteric lymph nodes and intestinal mucosa of infected SCID mice, with epithelial cell hyperproliferation and the development of crypt hyperplasia in the caecum. Critically, in vivo depletion of IFN-gamma during infection in SCID mice resulted in no significant increase in epithelial cell proliferation and effectively precluded the development of crypt hyperplasia without altering infection outcome. Taken together, the data provides the first detailed cell position linked analysis of epithelial dysregulation during chronic T. muris infection and identifies a critical role for IFN-gamma, either directly or indirectly, in regulation of epithelial cell proliferation during the chronic intestinal inflammation associated with infection.

Production of an interferon-gamma homologue by an intestinal nematode: functionally significant or interesting artefact?

Chronic infection is a prominent feature of many intestinal nematode infections in man and animals. It is also clear that in such situations host immunity is activated but is unable to induce a protective response. A great deal of work has shown that genetic control of host immunity contributes to the variation in worm burdens often observed in the field. There is increasing appreciation, however, of the capability of infectious agents themselves to modulate the host immune response and potentiate their own survival. Using an immunologically well defined model of intestinal nematode infection in mice (Trichuris muris) we have shown that parasite derived molecules share cross reactive epitopes with the host cytokine interferon-gamma using cytokine specific monoclonal antibodies in ELISA, Western blotting and immunoprecipitation assays. Furthermore, the parasite molecules can be shown to bind to the interferon-gamma receptor and induce change in lymphoid cells similar to those induced by murine interferon-gamma. The functional activity of the molecule in vivo remains to be determined. Previous studies have established that interferon-gamma is critical for progression to chronic T. muris infection in mice and, therefore, it raises the distinct possibility that the production of an interferon-gamma homologue by the worm may be one mechanism whereby the parasite is able to interfere with the regulation of the host immune response and potentiate its own survival.

Comparative studies on immune responses to infection in susceptible B10.BR mice infected with different strains of the murine nematode parasite Trichuris muris

A comparison of immune responses to infection between groups of B10.BR mice infected with different strains of T. muris, S strain (isolated in Sobreda, Portugal), E strain (isolated in Edinburgh), and E-J strain (originally E strain, which has been maintained in our laboratory, Japan), was performed. In mice infected with E and E-J strains, most of the worms were expelled by day 32 after infection, though the expulsion was faster in E-J strain-infected mice. In contrast, no expulsion was observed in S strain-infected mice by day 32 and egg production occurred on day 32. IL-4 production occurred in concanavalin A (Con-A)-stimulated mesenteric lymph node cells (MLNC) from B10.BR mice infected with E and E-J strains, whereas no IL-4 production was observed in S strain-infected mice. IL-4 production did not occur in normal mice. In comparison with normal mice, high levels of IFN-gamma production by Con A-stimulated MLNC were detected in mice infected with every strain of T. muris. IFN-gamma production in S strain-infected mice was greater, occurred earlier and was more persistent than in mice infected with E and E-J strains. IgG1 and IgG2a antibodies to T. muris excretory/ secretory antigens were observed in B10.BR mice infected with every strain of T. muris. Antibody production showed similar kinetics. These differences in the expulsion kinetics and IL-4 production in B10.BR mice infected with S, E, and E-J strains suggest the involvement of IL-4 in protection against T. muris infection, and confirm the previous conclusion by Else et al.

[The pathomorphological changes in the kidneys of white mice with experimental trichocephaliasis and after the use of anthelmintic preparations]

The experiments were carried out with 170 white mice divided into 4 groups. The first group consisted on 72 intact animals, administered subcutaneous ivomek (0.01 ml/kg) and oxfendasole (10 mg/kg) per os; Group 2 consisted of 15 animals with induced trichocephaliasis, administered no anthelmintics. The third group, 72 animals, were infected with Trichocephalus muris invasion eggs and administered anthelminthic agents on day 46 postinfection. The fourth group consisted of 11 intact animals, neither infected, nor treated (reference group). The animals were decapitated 3, 12, 24 and 72 h after the drug administration and histologic examination of the kidneys was carried out. The findings evidence that the morphologic changes in the kidneys of mice with trichocephaliasis are characterized by alternating proliferative processes. Both the drugs used were found characterized by a more or less pronounced nephrotoxicity. Ivomek induced the most marked structural changes in the kidneys of intact animals. The changes in the kidneys of intact mice were more manifest after the drugs administration than in intact animals.

Expression of pokeweed lectin binding in murine intestinal Paneth cells

Pokeweed (Phytolacca americana) lectin was found to stain the secretory granules in epithelial Paneth cells of small intestine in mice and rats. The distribution of Paneth cells stained with this lectin was identical to that obtained by another immunohistochemical marker for lysozyme. However, in comparison with other immunohistochemical markers, Pokeweed lectin is a more robust method for identifying Paneth cells in histological sections and for studying their secretory granules. Co-expression of the Pokeweed lectin binding sites in some oligomucous cells within the crypts suggested a close developmental link between these two cell types. Only one other non-epithelial cell type was stained by this lectin, and these were migratory lymphocytes found within the villus epithelium and lamina propria. Approximately 20% of these lymphocyte cells were also positive for the expression of CD3+. Pokeweed lectin was therefore used to study changes in the frequency of Paneth cells and intra-epithelial lymphocytes in normal and immunologically compromised animals (following infection with a parasite worm Trichuris muris and in a model of graft-versus-host rejection). This study confirmed that the population of Paneth cells turns over slowly even during conditions of inflammation.

[Inflammatory-type malignant fibrohistiocytoma of the mesocolon associated with colonic parasitosis due to Trichocephalus]

A case of inflammatory malignant fibrous histiocytoma of the mesocolon is reported. The lesion presented as a right lower quadrant abdominal mass, located at the mesocolon, with obstructive symptoms and accompanied by a severe infestation by Trichuris trichiura. It had a benign histologic appearance and was considered initially as an inflammatory and necrotic process with severe tissue eosinophilia secondary to the severe parasitosis. The tumor relapsed 13 months later at the anastomotic site and the patient died. Diagnostic, prognostic and therapeutic aspects of this rare tumor are discussed.

Immediate hypersensitivity in colon of children with chronic Trichuris trichiura dysentery

There are few data on mucosal immune responses to intestinal helminths in human beings, especially those involving the IgE system, which is thought to be important in parasite expulsion. We sought evidence of an immediate hypersensitivity reaction in the colon of children with chronic dysentery due to Trichuris trichiura. 28 children with Trichuris dysentery syndrome (TDS) were compared with 16 control children (with no TDS or worms visible on colonoscopy). All children were aged 1-11 years. Rectal biopsy samples were taken before and after expulsion of the worms by means of mebendazole treatment. Children with TDS had significantly greater numbers than controls of mast cells (mean [SD] 10.9 [1.3] vs 3.9 [0.6]% of all cells; p less than 0.0003) and of cells with surface IgE (median [range] 11.1 [7.5-11.6] vs 1.0 [0-1.5]%; p less than 0.001) in the subepithelial region of the mucosa. On electronmicroscopy, degranulating mast cells were prominent in parasitised children. In culture, rectal biopsy samples from parasitised children showed high rates of spontaneous histamine release, but only low rates of antigen-specific release. After treatment, spontaneous histamine release was significantly reduced and antigen-specific histamine release could be provoked. Thus, an IgE-mediated immune mucosal response to a helminth infection does occur in human beings but is not sufficient to cause appreciable parasite expulsion.

[A morphological and histochemical study of the large intestine of white mice with experimental trichocephaliasis and after the action of some anthelmintic preparations]

Administration of levamisole, oxphendasole in dose 10 mg/kg and especially of ivomeck in dose 0.01 ml/kg of body weight damages the large intestine mucosa of intact mice and of mice with experimental T. muris infection. Epithelial cells dystrophy, the goblet cells destruction and the diffuse leucocytes infiltration of the intestinal wall, maximal 12 hours after the drugs administration, were most marked in animals treated with ivomeck. Pathomorphological changes in the gut mucosa after the drug administration to infected animals were significantly higher than in intact ones. That permits to conclude that the damage of the intestinal wall is due to the toxicity of the drugs, and perhaps with the damage of mucosa by the nonspecific (allergic) response to the chemotherapy.

Histopathology and immunohistochemistry of the caecum in children with the Trichuris dysentery syndrome

Caecal biopsy specimens from Jamaican children with the Trichuris dysentery syndrome (TDS) and age matched Jamaican controls were investigated by immunohistochemistry and by light microscopy. Biopsy specimens from all children (with TDS and controls) showed a mild to moderate increase in inflammatory cells. Except in the vicinity of the worm, where the epithelium was flattened, there was no other epithelial abnormality. Compared with controls, children with TDS had increased IgM lamina propria plasma cells and decreased intraepithelial T cells. There was also an increase in crypt epithelial cell proliferation. Lamina propria T cells (both activated and non-activated) were no more common in children with the Trichuris syndrome than controls. Epithelial cell HLA-DR and VLA-1 expression (which are increased in other colitides) were the same in both groups. Despite the presence of large worm burdens and chronic dysentery, therefore, only minor changes were seen in the caecal mucosa of children with TDS.

[Susceptibility of the Chinese hamster (Cricetulus griseus) to parasitic infection (3). Experimental infection with Hymenolepis nana or Trichuris muris to the cortisone treated Chinese hamster]

Susceptibility of Chinese hamster (Cricetulus griseus) of Asahikawa Colony (CHA) to Hymenolepis nana or Trichuris muris infection was compared in the feces-egg examination with that of mice as the control animals. Though CHA were resistant to the infection of H. nana, they were found to become susceptible to H. nana by the treatment with cortisone. A half number of CHA was infected with H. nana and the eggs were detected from each animal only in 4 or 6 days in the periods of examination more than 40 days. Mice with or without cortisone treatment were equally susceptible to H. nana infection. In another experiment, CHA with or without cortisone treatment were completely resistant to Trichuris muris infection. Mice, as the control animals, were found to be infected with T. muris in both of cortisone-treated and non-treated groups. Results from the fecal examination, it was confirmed that T. muris were expelled naturally from the animals on the weeks of 11 to 33 after infection.

Concurrent infection of a Patas monkey (Erythrocebus patas) by Citrobacter freundii and Trichuris trichiura

Concurrent infection of Citrobacter freundii and Trichuris trichiura in a Patas monkey (Erythrocebus patas) is reported. A synergistic effect of both organisms contributing to host mortality in this case is suggested.

Infection of man with Trichuris vulpis, the whipworm of dogs

A gravid female Trichuris was found in histopathologic sections of an appendix in a post-mortem examination, and a posterior extremity of a male Trichuris was recovered from the unsectioned portion of the same appendix. These parasites were identified as T. vulpis, the whipworm of dogs.

Pathophysiology of swine trichuriasis

Infection of pigs by the whipworm (Trichuris suis) resulted in profuse diarrhea on postinfection days 17 to 21. Anorexia, retardation of growth, dehydration, and emaciation were observed in infected pigs. Scanning electron micrography showed nematodes embedded in the mucosa of the cecum and colon, with resultant disruption of the mucosa. Infected pigs had decreased values of albumin, amylase, calcium and creatine phosphokinase, but increased values of alpha-, beta-, and gamma- globulins, total iron-binding capacity, copper, potassium, uric acid, and aspartate aminotransferase.