- Open Access
Cytokine and chemokine responses to helminth and protozoan parasites and to fungus and mite allergens in neonates, children, adults, and the elderly
- Christian J Lechner†1,
- Karl Komander†1,
- Jana Hegewald1,
- Xiangsheng Huang1,
- Richard G Gantin1, 2,
- Peter T Soboslay1, 2,
- Abram Agossou4,
- Meba Banla3 and
- Carsten Köhler1Email author
© Lechner et al.; licensee BioMed Central Ltd. 2013
- Received: 15 January 2013
- Accepted: 29 June 2013
- Published: 15 July 2013
In rural sub-Saharan Africa, endemic populations are often infected concurrently with several intestinal and intravascular helminth and protozoan parasites. A specific, balanced and, to an extent, protective immunity will develop over time in response to repeated parasite encounters, with immune responses initially being poorly adapted and non-protective. The cellular production of pro-inflammatory and regulatory cytokines and chemokines in response to helminth, protozoan antigens and ubiquitous allergens were studied in neonates, children, adults and the elderly.
In children schistosomiasis prevailed (33%) while hookworm and Entamoeba histolytica/E. dispar was found in up to half of adults and the elderly. Mansonella perstans filariasis was only present in adults (24%) and the elderly (25%). Two or more parasite infections were diagnosed in 41% of children, while such polyparasitism was present in 34% and 38% of adults and the elderly. Cytokine and chemokine production was distinctively inducible by parasite antigens; pro-inflammatory Th2-type cytokine IL-19 was activated by Entamoeba and Ascaris antigens, being low in neonates and children while IL-19 production enhanced “stepwise” in adults and elderly. In contrast, highest production of MIP-1delta/CCL15 was present in neonates and children and inducible by Entamoeba-specific antigens only. Adults and the elderly had enhanced regulatory IL-27 cytokine responses, with Th2-type chemokines (MCP-4/CCL13, Eotaxin-2/CCL24) and cytokines (IL-33) being notably inducible by helminth- and Entamoeba-specific antigens and fungus-derived allergens. The lower cellular responsiveness in neonates and children highlighted the development of a parasite-specific cellular response profile in response to repeated episodes of exposure and re-infection.
Following repeated exposure to parasites, and as a consequence of host inability to prevent or eliminate intestinal helminth or protozoa infections, a repertoire of immune responses will evolve with lessened pro-inflammatory and pronounced regulatory cytokines and chemokines; this is required for partial parasite control as well as for preventing inadequate and excessive host tissue and organ damage.
- Parasite infection
- Cellular response
- Age groups
Parasitic infections are common in countries with poor hygienic conditions, where a lack of sanitation and health care facilitates the transmission and the spread of helminths like Ascaris lumbricoides, Schistosoma spp., hookworms, and protozoa like Entamoeba histolytica/dispar. Approximately two billion people are infected with helminth parasites worldwide, and some intestinal parasites may affect up to 70% of an endemic population . The dispersion of parasites often overlaps, and individuals living in such areas acquire multiple infections during their lifetime and are infected concurrently with several parasite species . The encounter with parasite species elicits distinct and specific immune responses in their host; cytokines and chemokines are key players which regulate and polarize cellular reactivity and antibody responses to antigens and allergens. Helminth infections associate with an initial Th1 immune response during pre-patency, while during patency a Th2-type response prevails [3, 4]. Generally with chronic helminth parasite infections Th2-type cytokine responses predominate , while Th1-type cytokine responses are important for protection against protozoa, e.g. amoebiasis  or Plasmodium falciparum malaria .
A specific, balanced and, to an extent, protective immunity develops over time in response to repeated parasite encounter, with immune responses initially being poorly adapted and non-protective [8, 9]. Such incapability can result in parasite persistence and host tissue damage as a result of inappropriate inflammatory reactivity. With repeated episodes of infection, parasite clearance, and re-infection, immune responses to foreign antigens become increasingly specific and effective; however, the development of such immunity with increasing age is not well understood. Cytokines and chemokines may enhance, suppress, and regulate the expression of immunity to intravascular and intestinal parasites; moreover, they particularly promote chemotaxis and the activation of effecter cells in parasite-invaded tissues and cells.
Monocyte chemoattractive proteins such as MCP-4 recruit effecter cells  and inflammatory proteins such as MIP-1delta/CCL15 and Eotaxin2/CCL24 activate eosinophil granulocytes, monocytes, and lymphocytes and so contribute to inflammation [11–13]. Cytokines released as “alarmins” and mediators of inflammation, examples being IL-19 and IL-33, may enhance Th2 type immune reactions during infections with intestinal nematodes [14–17], while IL-19 promotes chemotaxis of neutrophil granulocytes and the production of IL-6 and TNF-alpha [18, 19]. Regulatory cytokines such as IL-27 limit exacerbating Th17 and Th2 responses  and decrease immune pathology during malaria infection [21, 22]. While with several cytokines and chemokines their role in parasitic infections has not yet been investigated, others like Eotaxins were found to be important for effecter cell recruitment during helminth infection.
In order to further clarify the extent to which these immune mediators become activated or suppressed during early life parasite exposure, and also with a view to later life chronic pathogen persistence, we studied the cellular production of pro-inflammatory and regulatory cytokines and chemokines in neonates, children, adults, and the elderly in response to helminth and protozoa infectious challenge and to ubiquitous allergen exposure. Distinctive production levels were observed between these groups, highlighting the development of a parasite-specific cellular responsiveness to repeated episodes of exposure and re-infection.
Helminth and protozoa parasite infections in children, adults, and the elderly
Prevalence of parasite infections and parasite co-infections in children, adults and elderly
Schistosoma haematobium/S. mansoni
Entamoeba histolytica/E. dispar
Single parasite infection
Multiple parasite infections
Cellular cytokine responses to helminth and protozoa parasite antigens in neonates, children, adults, and the elderly
Cytokines and Chemokines in response to parasite antigens
692 * (507/877)
726 * (544/909)
340 *** (102/577)
63 ** (49/78)
Cellular chemokine release to helminth and protozoan parasite antigens in neonates, children, adults, and the elderly
Cellular production of MCP-4/CCL13, MIP-1delta/CCL15 and Eotaxin-2/CCL24 by UCBC and PBMC following stimulation with helminth- and protozoa-specific antigens is shown in Table 2 (Data not shown for Asc and Ov). Parasite antigen-induced MCP-4/CCL13 production by UCBC from neonates did not differ from spontaneous release. In children, baseline MCP-4/CCL13 production did not enhance when their PBMC were cocultured with Eh, Ov and Pf antigens. Similarly, in adults and the elderly, Eh and Pf antigens did not heighten MCP-4/CCL13 production, while Asc- and Ov-specific antigens strongly activated MCP-4/CCL13 by PBMC (p<0.01, when compared to Base).
Production of the pro-inflammatory Eotaxin-2/CCL24 was low in neonates and children, irrespective of the antigens used for cell stimulation. In adults, Ascaris and also Onchocerca and Plasmodium antigen extracts enhanced Eotaxin-2/CCL24 release (p<0.01 for Ascaris when compared to Base), while stimulation with Entamoeba antigen significantly reduced Eotaxin-2/CCL24 levels (p<0.01 compared to Base). In the elderly, Eotaxin-2/CCL24 production enhanced in response to Ascaris (p<0.05), while depressed in response to Entamoeba antigen (p<0.001). Highest levels of MIP-1delta/CCL15 were produced by UCBC and PBMC from neonates and children, with no significant differences between the individual antigen stimulations. Overall MIP-1delta/CCL15 production was lower in adults (mean children 62 pg/ml, mean adults 25 pg/ml); only Entamoeba antigens slightly increased MIP-1delta/CCL15 production, with this Entamoeba antigen-specific activation being significant in PBMC from the elderly (p<0.01). All other parasite antigens elicited MIP-1delta/CCL15 production levels around baseline levels (Table 2).
Helminth antigen-induced cellular production of cytokines (IL-19, IL-27, IL-33) and chemokines (MCP-4/CCL13, MIP-1delta/CCL15, Eotaxin-2/CCL24)
O. volvulus antigen-specific production of IL-19 while low in neonates was found to be enhanced “stepwise” in children, adults, and the elderly (Figure 1B). UCBC and PBMC from neonates and children produced lower amounts of IL-27 than did PBMC from adults and the elderly. Mean levels of IL-33 as produced by UCBC and PBMC from neonates, adults, and the elderly were similar; only IL-33 production was decreased in children in response to Ov antigen. Production of MCP-4/CCL13 and Eotaxin-2/CCL24 was lowest in neonates and children, while PBMC from adults and the elderly produced significantly enhanced amounts of both chemokines (p<0.01, compared to neonates and children). In contrast, the production levels of MIP-1delta/CCL15 were highest in neonates and children, and significantly lower in adults and the elderly (p<0.01, compared to neonates and children) (Figure 1B).
Fungus and mite allergen-induced cellular production of cytokines and chemokines in neonates, children, adults, and the elderly
Cytokines and chemokines in response to Aspergillus fumigatus allergen extract
Cytokines and chemokines in response to Dermatophagoides farinae/pteronyssinus allergen extracts
421 ** (328/514)
411 ** (321/501)
Allergen-stimulated production of IL-19 and IL-27 was lowest in UCBC from neonates, while IL-19 production levels were found to be enhanced in adults and the elderly (for mite allergens p<0.01, compared to neonates). Cellular production of mite allergen-induced IL-27 was lowest in neonates but highly elevated in children. Both fungus (Af) and mite (Df) allergen induced cellular production of IL-33 were strongly elevated in children (p<0.01 and p<0.001), compared to neonates, adults, and the elderly). Allergen stimulation did not induce cellular MCP-4/CCL13, Eotaxin-2/CCL24 or MIP-1 delta/CCL15 production above baseline levels.
Immune memory and cellular effector responses against parasites may develop and take shape gradually with repeated exposure, pathogen persistence or their clearance, and also with re-infection. In the present work, cellular responsiveness in neonates and children was low while adults and the elderly had enhanced regulatory IL-27 cytokine responses, with Th2-type chemokines (MCP-4/CCL13, Eotaxin-2/CCL24) and cytokines (IL-19, IL-33) being inducible by parasite-specific antigens and allergens.
The pro-inflammatory Th2-type cytokine IL-19 while low in neonates and children was enhanced “stepwise” in adults and the elderly; IL-19 was predominantly activated by Entamoeba and Ascaris antigens and allergens also, signifying repeated encounter with protozoan and helminth parasites and environmental allergens – such responsiveness was not yet developed in neonates and children. High IL-19 levels were observed in patients with asthma and also in an allergen-inducible asthma animal model . IL-19 was found to enhance IL-1beta, IL-6, and CXCL8/IL-8 release and to attract granulocytes [18, 19]; such mobilized and activated effecter cells may then adhere and attack tissue-infiltrating and migrating helminth larvae of Ascaris and hookworm. Furthermore, antigens of Ascaris suis and E. histolytica elicited strong chemotaxis and production of superoxide anions in neutrophil granulocytes [23, 24]. IL-19 is a member of the IL-10 family; secreted by monocytes, epithelial cells and B cells [25–27], it exerts regulatory effects and, in mice, protects against colonic inflammation  and induces Th2 responses . Inducible cellular IL-19 production in adults and elderly could therefore mirror an adaptation to intestinal protozoan and metazoan parasite challenge and allergen exposure over time. Similarly to IL-19, low amounts of IL-33 were detected in neonates; only Ascaris antigen activated IL-33 in children, suggesting early life priming by intestinal helminths. As a member of the IL-1 family, IL-33 promotes the generation of Th2 immune responses by inducing secretion of IL-4, IL-5 and IL-13 by T cells . High levels of IL-33 were detected in patients with asthma or allergic rhinitis [31, 32]. The “Alarmin” IL-33 is released by injured epithelia and endothelia following hookworm infection so as to attract leukocytes to the site of inflammation [33, 34]; moreover, IL-33 supports reduction and expulsion of the intestinal helminths Heligmosomoides pylorus, Trichuris muris or Nippostrongylus brasiliensis from infected mice [17, 35, 36]. A recent study  has disclosed the importance of IL-33 during murine hookworm infection: in IL-33 gene knockout mice infected with N. brasiliensis, cellular production of the Th2-type cytokine IL-13 was lessened and eosinophil recruitment reduced, and accompanied by a delayed worm expulsion in these animals.In the present work, allergens of mite and fungus activated IL-33 in children, suggesting that such increase in IL-33 reflects an initial responsiveness which, in later life and after repeated parasite exposure, is attenuated by regulatory cytokines like IL-27.
IL-27 production was low in neonates and children but gradually enhanced in adults and the elderly, with no difference between baseline and the antigen stimulation (Table 2). Mite allergen-induced production levels of IL-27 were highest in children, whereas in neonates, adults and the elderly, allergen stimulation did not induce IL-27 production above baseline levels (Tables 3 and 4). A member of the IL-12 family, IL-27 has been found to act as initiator and attenuator of immune responses [37, 38], blocking both Th2- and Th17-type cytokines [37, 39]. IL-27 exerts regulatory functions, mostly by inducing and regulating IL-10 and IL-17 [37, 40]. Severe malaria tropica in children and non-healing Leishmania major infection in mice were accompanied by depressed levels of IL-27, despite high IL-10 [40, 41]. IL-27R-deficient mice were able to control Toxoplasma gondii infection initially, but later succumbed due to inflammatory immune responses ; these mice will develop severe lung inflammation, elevated IgE levels, and eosinophilia . Still, these regulatory properties of IL-27 cannot be adopted universally, as disruption of the IL-27 signaling pathway did not alter egg-induced immunopathology in an experimental schistosomiasis model . While no differences in IL-27 production were observed following stimulation with parasite antigens between the age groups, enhanced IL-27 in adults and the elderly may reflect the stabilization of a regulatory cytokine network in response to repeated parasite encounter.
Cytokines and chemokines are key players in regulating and polarizing cellular reactivity and antibody responses to pathogens and allergens. Helminth antigens induced Eotaxin-2/CCL24 and MCP-4/CCL13 production in adults and the elderly but not in neonates and children, as similarly observed for IL-19 and IL-33. Eotaxin-2/CCL24 activates Th2-type cytokines and chemoattracts eosinophil and basophil granulocytes. Elevated Eotaxin-2/CCL24 levels have been found in experimental helminth infections  and in acutely infected S. mansoni patients [12, 46], and high Eotaxin-2/CCL24 levels were associated with increased liver damage in S. mansoni-infected mice. Following treatment of onchocerciasis patients with ivermectin, Eotaxin-2/CCL24 and MCP-4/CCL13 enhanced suggesting that these chemokines facilitated clearance of O. volvulus microfilariae by monocytes and eosinophil granulocytes . Interestingly, protozoan Entamoeba-specific antigens depressed both Eotaxin-2/CCL24 and MCP-4/CCL13 in adults and the elderly, but not in children and neonates; such depressed responsiveness might support control E. histolytica infection, as elevated levels of Eotaxins were observed in mice with persistent E. histolytica infection . The chemokine MCP-4/CCL13 attracts granulocytes, monocytes, and T cells, and it has been proposed as a biomarker in asthma  being up-regulated during both Th1- and Th2-type hyper-responses . In the present work, MCP-4/CCL13 and Eotaxin-2/CCL24 were not produced in neonates, but were inducible by helminth antigens in adults and the elderly – an observation pointing to the gradual expansion of the parasite-specific immune response repertoire.
In stark contrast to the above studied cytokines and chemokines, the highest production of MIP-1delta/CCL15 was found in neonates and children, whereas MIP-1delta/CCL15 was low in adults and the elderly (Table 2). Cellular MIP-1delta/CCL15 release in response was not inducible by allergens in any group above baseline levels (Tables 3 and 4). The pro-inflammatory chemokine MIP-1delta/CCL15 attracts neutrophil granulocytes, T cells and monocytes . In the present study MIP-1delta/CCL15 was inducible by Entamoeba-specific antigens only. Exposure of human monocytes to live microfilaria of Brugia malayi enhanced CCL15 mRNA expression, which was also present in IL-4 induced alternative activated macrophages . With an expiring O. volvulus infection, low levels of MIP-1delta/CCL15 were detected in patients , while the reduced MIP-1delta/CCL15 observed in adults and the elderly may represent an immune adaptation towards lessened inflammatory responses against E. histolytica. Similarly, cellular reactivity towards allergens was highest in neonates and significantly reduced in adults and the elderly.
In summary, helminth and protozoan antigens distinctly activated in adults Th2-type cytokines, effector cell-attracting chemokines and regulatory components, notably IL-27, while such responsiveness was not yet present in neonates and children. Following repeated exposure to parasites and as a consequence of host inability to prevent or eliminate intestinal helminth or protozoa infections, a repertoire of immune responses evolves with lessened pro-inflammatory and pronounced regulatory cytokines and chemokines – this is required for partial parasite control and also to prevent inadequate and excessive host tissue and organ damage.
The study was conducted at the Centre Hospitalier Regional (CHR) in the Central Region of Togo and approved and authorized by the Togolese Ministry of Health (292/99/MS/CAB, 0407/2007/MMSCAB/DGS, MS/DGS/DRS/RC/No. 220 and No. 261) and by the Ethics Committee of the University Clinics of Tübingen, Germany (No. 188/2008/BO2). A total of 152 individuals were included in the study and grouped by age: neonates (n= 36), children (10-13 yrs, n=35), adults (18-45 yrs, n= 39) and elderly (50-80 yrs, n=42). The children were all attending primary schools in suburban areas of the town of Sokodé (Prefecture Tchaoudjo). Adults were from the village of Bouzalo, near the city of Sokodé. Written consent was obtained from the childrens’ parents prior to participation. Peripheral Blood Mononuclear Cells (PBMC) or else Umbilical Cord Blood Cells (UCBC) was collected from all study participants. Blood, stool and urine samples were collected from children and from adults. Umbilical Cord Blood was obtained from mothers giving birth in the Central Hospital of Sokodé. Written informed consent was obtained from all mothers after thoroughly explaining to them the procedures and risks of this study; to ensure understanding, explanations were given in the local language by the medical stuff during prenatal consultations at the CHR. Pregnant women received antiparasite treatment in line with the national health guidelines of Togo both during prenatal consultations (PC) and after partition. All pregnant women received antimalaria prophylaxis as recommended by national health guidelines - receiving either chloroquine at 300 mg/week, which was taken until partition, or a single dose of sulfadoxine/pyrimethamine at the end of the second trimester of pregnancy as well as a further dose at the beginning of the third. In the 4th month of pregnancy, all women received antihelminth treatment (albendazole, single dose 400 mg) and, after partition, they were treated against intestinal protozoan parasites (metronidazole) in line with the national health guidelines.
Isolation of peripheral blood mononuclear cells (PBMC) and umbilical cord blood cells (UCBC) and cell culture experiments
Isolation of PBMC was carried out as described earlier [51, 52]. In brief, 5-9 ml of venous blood was collected and PBMC were then isolated using Ficoll Density Centrifugation at 340 g for 35 minutes. Cells were collected, washed twice in Roswell Park Memorial Institute (RPMI) media supplemented with 100 U/ml penicillin, 100 μg/ml streptomycin and 0.25 μg/ml amphotericin B (Sigma, St. Louis, MO, USA). Cells were counted and cultured at a concentration of 1×106 cells per well, supplemented in RPMI with 5% heat inactivated Fetal Calf Serum (FCS, Biochrom, Berlin, Germany). Umbilical cord blood was obtained from the placentas of healthy, full-term infants, after the placentas were delivered and separated from same. Blood samples were diluted 1:2 with RPMI (Gibco; Eching, Germany) supplemented with 25 mM HEPES buffer, 100 U/ml penicillin and 100 μg/ml streptomycin, 0.25 μg/ml amphotericin B (as above). Umbilical cord mononuclear blood cells (UCBC) were isolated by Ficoll-Paque density gradient centrifugation at 340 g for 35 min at room temperature. UCBC were collected, washed twice in RPMI (as above) at 1400 rpm for 15 min and adjusted to 1×106/ml in RPMI (as above) supplemented with 10% heat inactivated FCS (as above). Freshly isolated UCBC or PBMC were cultured in 48 well plates in 5% CO2 at 37°C and saturated humidity in the presence or absence (baseline) of the following antigens/allergens: Onchocerca volvulus antigen (OvAg, final concentration in cell culture 20 μg/ml, ), Ascaris lumbricoides antigen (AscAg, final conc. 5 μg/ml), Entamoeba histolytica antigen (EhAg, final conc. 10 μg/ml), Plasmodium falciparum schizonts (PfAg, final conc. 1×108 schizonts/ml), Dermatophagoides pteronyssinus (Dp, final conc. 20 μg/ml), Dermatophagoides farinae (Df, final conc. 20 ug/ml), Aspergillus fumigatus (Af, final conc. 20 μg/ml), Candida albicans (Ca, final conc. 20 μg/ml), for 48 hours at 37°Celsius, 5% CO2 and saturated humidity. Cells and cell culture supernatant were then harvested and stored at -20°Celsius for further use.
Preparation of antigens and allergens
E. histolytica antigen (EhAg; trophozoites; strain HM-1 axenic culture) was a gift from Dr. Brigitte Walderich (formerly: Institute for Tropical Medicine, University Clinics of Tübingen, Germany). A. lumbricoides or O. volvulus adult worms were isolated as described previously , then washed in phosphate-buffered saline (PBS) before being transferred into a Ten-Broek tissue grinder and homogenized extensively on ice. The homogenate was then sonicated twice (30% intensity) for 3 min on ice and centrifuged at 16,000 g for 30 min at 4°C. The supernatants were collected and sterile-filtered (0.22 μm), and the protein concentration was then determined by BCA protein assay (Pierce, Rockford, USA). D. pteronyssinus (Dp), D. farinae (Df), A. fumigatus (Af) extracts were all purchased from Allergopharma (Rheinbeck, Germany). Crude antigen extracts of P. falciparum schizonts were kindly gifted by Dr. A. Luty and Dr. K. Brustoski (formerly: Institute for Tropical Medicine, University of Tübingen, Germany).
Analysis for helminth and protozoan infections was carried out as previously described [51, 52]. Briefly, fresh stool samples were mixed with saline, dispersed on 2 microscope slides and analyzed for intestinal helminth eggs as well as protozoan cysts and trophozoites. All stool samples were examined using the Kato-Katz technique for quantification of helminth eggs per gram of stool (helm-TEST; Labmaster). Schistosoma haematobium eggs were detected by filtration of 10 ml urine (polycarbonate membrane, pore size 12 μm; Whatman). Microfilaria stages of Mansonella perstans were detected by microscopic analysis after Ficoll density centrifugation. Malaria Rapid Test (OptiMal™, TCS Biosciences, Birmingham UK) was used to determine infection with P. falciparum. Children showing signs of malaria (positive thick blood smears for Plasmodium spp. and fever or Malaria Rapid Test-positive) and diarrhea were excluded from the study. None of the children presented with E. histolytica trophozoites ingested with red blood cells in stool samples, bloody stools or clinical signs of invasive amoebiasis.
Cytokine and chemokine determination by enzyme-linked immunosorbent assay (ELISA)
Cell culture supernatants were tested for IL-19, IL-27, IL-33, Eotaxin-2/CCL24, MCP-4/CCL13 and MIP-1 delta/CCL15 using ELISA Assay Kits (R&D Systems). Assays were performed according to guidelines supplied by the manufacturer. Conversion of optical densities (OD) to final concentrations (pg/ml) was calculated by cytokine specific standard curves. Assay detection limits were 30 pg/ml for IL-19, 150 pg/ml for IL-27, 20 pg/ml for IL-33, 8 pg/ml for MCP-4/CCL13, 30 pg/ml for Eotaxin-2/CCL24 and 15 pg/ml for MIP-1 delta/CCL15.
Statistical data analysis
The statistical package JMP 9.0 (SAS Institute) was used to analyze significant differences between the studied groups. Significant differences in cytokine and chemokine concentrations between studied groups were determined by Analysis of Variance (ANOVA) and Tukey’s Test. Due to multiple comparisons, the level of significance was adjusted by Bonferroni-Holm-method.
We thank all participants, but chiefly the children and their parents. For expert assistance rendered, we also thank the medical assistants, nurses and midwifes at the Centre Hospitalier Regional (CHR) in Sokodé (Togo). Our work was supported by the research program of the Bundesministerum für Bildung und Forschung (BMBF grant 01KA1008). We also acknowledge support from the Deutsche Forschungsgemeinschaft (DFG) and the Open Access Publishing Fund of Tubingen University.
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