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The effects of helminth infections against type 2 diabetes

  • Immunology and Host-Parasite Interactions - Review
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Abstract

Type 2 diabetes mellitus (T2D) is a prevalent inflammation-related disease characterized by insulin resistance and elevated blood glucose levels. The high incidence rate of T2D in Western societies may be due to environmental conditions, including reduced worm exposure. In human and animal models, some helminths, such as Schistosoma, Nippostrongylus, Strongyloides, and Heligmosomoides, and their products reportedly ameliorate or prevent T2D progression. T2D induces adaptive immune pathways involved in the inhibition of type 1 immune responses, promotion of type 2 immune responses, and expansion of regulatory T cells and innate immune cells, such as macrophages, eosinophils, and group 2 innate lymphoid cells. Among immune cells expanded in T2DM, type 2 immune cells and macrophages are the most important and may have synergistic effects. The stimulation of host immunity by helminth infections also promotes interactions between the innate and adaptive immune systems. In this paper, we provide a comprehensive review of intestinal helminths’ protective effects against T2D.

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References

  • Allen JE, Maizels RM (2011) Diversity and dialogue in immunity to helminths. Nat Rev Immunol 11:375–388

    Article  CAS  PubMed  Google Scholar 

  • Aravindhan V, Mohan V, Surendar J, Muralidhara Rao M, Pavankumar N, Deepa M, Rajagopalan R, Kumaraswami V, Nutman TB, Babu S (2010) Decreased prevalence of lymphatic filariasis among diabetic subjects associated with a diminished pro-inflammatory cytokine response (CURES 83). PLoS Negl Trop Dis 4:e707

    Article  PubMed  PubMed Central  Google Scholar 

  • Berbudi A, Surendar J, Ajendra J, Gondorf F, Schmidt D, Neumann AL, Wardani AP, Layland LE, Hoffmann LS, Pfeifer A, Hoerauf A, Hübner MP (2016) Filarial infection or antigen administration improves glucose tolerance in diet-induced obese mice. J Innate Immun 8(6):601–616

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bhargava P, Li C, Stanya KJ, Jacobi D, Dai L, Liu S, Gangl MR, Harn DA, Lee CH (2012) Immunomodulatory glycan LNFPIII alleviates hepatosteatosis and insulin resistance through direct and indirect control of metabolic pathways. Nat Med 18:1665–1672

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Brestoff JR, Kim BS, Saenz SA, Stine RR, Monticelli LA, Sonnenberg GF, Thome JJ, Farber DL, Lutfy K, Seale P, Artis D (2015) Group 2 innate lymphoid cells promote beiging of white adipose tissue and limit obesity. Nature 519:242–246

    Article  CAS  PubMed  Google Scholar 

  • Chen Y, Lu J, Huang Y, Wang T, Xu Y, Xu M, Li M, Wang W, Li D, Bi Y, Ning G (2013) Association of previous schistosome infection with diabetes and metabolic syndrome: a cross-sectional study in rural China. J Clin Endocrinol Metab 98:283–287

    Article  Google Scholar 

  • Cleenewerk L, Garssen J, Hogenkamp A (2020) Clinical use of schistosoma mansoni antigens as novel immunotherapies for autoimmune disorders. Front Immunol 11:1821

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Colley DG, Bustinduy AL, Secor WE, King CH (2014) Human schistosomiasis. Lancet 383:2253–2264

    Article  PubMed  PubMed Central  Google Scholar 

  • Das UN (2021) Genes, genetic polymorphism, diet, soluble mediators, and their role in the pathobiology of type 2 diabetes mellitus and hypertension. Am J Hypertens 8:hpab006

    Google Scholar 

  • de Ruiter K, Tahapary DL, Sartono E, Soewondo P, Supali T, Smit JWA, Yazdanbakhsh M (2017). Helminths, hygiene hypothesis and type 2 diabetes. Parasite Immunol 39(5)

  • Duan Q, Xiong L, Liao C, Liu Z, Xiao Y, Huang R, Tan T, Ouyang Y, Cai J, Xiao M, Xu H, Chen Z, Chen L, Yang T, Huang H (2018) Population based and animal study on the effects of Schistosoma japonicum infection in the regulation of host glucose homeostasis. Acta Trop 180:33–41

    Article  PubMed  Google Scholar 

  • Fairfax K, Nascimento M, Huang SC, Everts B, Pearce EJ (2012) Th2 responses in schistosomiasis. Semin Immunopathol 34:863–871

    Article  PubMed  Google Scholar 

  • Fujisaka S (2020) The role of adipose tissue M1/M2 macrophages in type 2 diabetes mellitus. Diabetol Int 12(1):74–79

    Article  PubMed  Google Scholar 

  • Gao YR, Chen WW, Li W, Zou HL (2018) Treg/Th17 balance and immunology of schistosome infection: a review. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 30(5):588–591

    Google Scholar 

  • Greenwood BM, Herrick EM, Voller A (1970) Suppression of autoimmune disease in NZB and (NZB×NZW) F1 hybrid mice by infection with Malaria. Nature 226:266–267

    Article  CAS  PubMed  Google Scholar 

  • Guigas B, Molofsky AB (2015) A worm of one’s own: how helminths modulate host adipose tissue function and metabolism. Trends Parasitol 31:435–441

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Guzmán-Flores JM, Ramírez-Emiliano J, Pérez-Vázquez V, López-Briones S (2020) Th17 and regulatory T cells in patients with different time of progression of type 2 diabetes mellitus. Cent Eur J Immunol 45(1):29–36

    Article  PubMed  PubMed Central  Google Scholar 

  • Hams E, Bermingham R, Wurlod FA, Hogan AE, O’Shea D, Preston RJ, Rodewald HR, McKenzie AN, Fallon PG (2016) The helminth T2 RNase ω1 promotes metabolic homeostasis in an IL-33- and group 2 innate lymphoid cell-dependent mechanism. FASEB J 30(2):824–835

    Article  CAS  PubMed  Google Scholar 

  • Hays R, Esterman A, Giacomin P, Loukas A, McDermott R (2015) Does Strongyloides stercoralis infection protect against type 2 diabetes in humans? Evidence from Australian Aboriginal adults. Diabetes Res CLin Pract 107:355–361

    Article  PubMed  Google Scholar 

  • Hays R, Thompson F, Esterman A, McDermott R (2016) Strongyloides stercoralis, eosinophilia, and type 2 diabetes mellitus: the predictive value of eosinophilia in the diagnosis of S stercoralis infection in an endemic community. Open Forum Infect Dis 3(1):ofw029

    Article  PubMed  PubMed Central  Google Scholar 

  • Hussaarts L, García-Tardón N, van Beek L, Heemskerk MM, Haeberlein S, van der Zon GC, Ozir-Fazalalikhan A, Berbée JF, Willems van Dijk K, van Harmelen V, Yazdanbakhsh M, Guigas B (2015) Chronic helminth infection and helminth-derived egg antigens promote adipose tissue M2 macrophages and improve insulin sensitivity in obese mice. FASEB J 29:3027–3039

    Article  CAS  PubMed  Google Scholar 

  • Jackson-Thompson BM, Torrero M, Mitre BK, Long J, Packiam M, Mitre E (2020) Axenic Caenorhabditis elegans antigen protects against development of type-1 diabetes in NOD mice. J Transl Autoimmun 3:100065

    Article  PubMed  PubMed Central  Google Scholar 

  • Kang SA, Choi JH, Baek KW, Lee DI, Jeong MJ, Yu HS (2021) Trichinella spiralis infection ameliorated diet-induced obesity model in mice. Int J Parasitol 51(1):63–71

    Article  CAS  PubMed  Google Scholar 

  • Liu L, Hu J, Wang Y, Lei H, Xu D (2021) The role and research progress of the balance and interaction between regulatory T cells and other immune cells in obesity with insulin resistance. Adipocyte 10(1):66–79

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Löser S, Smith KA, Maizels RM (2019) Innate lymphoid cells in helminth infections-obligatory or accessory? Front Immunol 10:620

    Article  PubMed  PubMed Central  Google Scholar 

  • Lumb FE, Crowe J, Doonan J, Suckling CJ, Selman C, Harnett MM, Harnett W (2019) Synthetic small molecule analogues of the immunomodulatory Acanthocheilonema viteae product ES-62 promote metabolic homeostasis during obesity in a mouse model. Mol Biochem Parasitol 234:111232

    Article  CAS  PubMed  Google Scholar 

  • Luo X, Zhu Y, Liu R, Song J, Zhang F, Zhang W, Xu Z, Hou M, Yang B, Chen L, Ji M (2017) Praziquantel treatment after Schistosoma japonicum infection maintains hepatic insulin sensitivity and improves glucose metabolism in mice. Parasit Vectors 10(1):453

    Article  PubMed  PubMed Central  Google Scholar 

  • McLaughlin T, Liu LF, Lamendola C, Shen L, Morton J, Rivas H, Winer D, Tolentino L, Choi O, Zhang H, Hui Yen Chng M, Engleman E (2014) T-cell profile in adipose tissue is associated with insulin resistance and systemic inflammation in humans. Arterioscler Thromb Vasc Biol 34:2637–2643

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Morimoto M, Azuma N, Kadowaki H, Abe T, Suto Y (2017) Regulation of type 2 diabetes by helminth-induced Th2 immune response. J Vet Med Sci 78:1855–1864

    Article  PubMed  Google Scholar 

  • Mu SS, Yang JQ (2020) Relationship between parasitic infections and hygiene hypothesis: a review. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 32:203–207

    CAS  PubMed  Google Scholar 

  • Muthukumar R, Suttiprapa S, Mairiang E, Kessomboon P, Laha T, Smith JF, Sripa B (2020) Effects of Opisthorchis viverrini infection on glucose and lipid profiles in human hosts: a cross-sectional and prospective follow-up study from Thailand. Parasitol Int 75:102000

    Article  CAS  PubMed  Google Scholar 

  • Nazligul Y, Sabuncu T, Ozbilge H (2001) Is there a predisposition to intestinal parasitosis in diabetic patients? Diabetes Care 24:1503–1504

    Article  CAS  PubMed  Google Scholar 

  • Obi S, Shimokawa C, Katsuura M, Olia A, Imai T, Suzue K, Hisaeda H (2020) IL-33 is essential to prevent high-fat diet-induced obesity in mice infected with an intestinal helminth. Parasite Immunol 42(9):e12700

    Article  CAS  PubMed  Google Scholar 

  • Odegaard JI (2011) Chawla A (2011) Alternative macrophage activation and metabolism. Annu Rev Pathol Mech Dis 6:275–297

    Article  CAS  Google Scholar 

  • Pace F, Carvalho BM, Zanotto TM, Santos A, Guadagnini D, Silva KLC, Maria Carolina S, Mendes GZ, Rocha SM, Alegretti GA, Santos RR, Catharino RP, Folli F, Mário José A, Saad, (2018) Helminth infection in mice improves insulin sensitivity via modulation of gut microbiota and fatty acid metabolism. Pharmacol Res 132:33–46

    Article  CAS  PubMed  Google Scholar 

  • Pang J, Ding J, Zhang L, Zhang Y, Yang Y, Bai X, Liu X, Jin X, Guo H, Yang Y, Liu M (2020) Effect of recombinant serine protease from adult stage of Trichinella spiralis on TNBS-induced experimental colitis in mice. Int Immunopharmacol 86:106699

    Article  CAS  PubMed  Google Scholar 

  • Pierce D, Merone L, Lewis C, Rahman T, Croese J, Loukas A, McDonald M, Giacomin P, McDermott R (2019) Safety and tolerability of experimental hookworm infection in humans with metabolic disease: study protocol for a phase 1b randomised controlled clinical trial. BMC Endocr Disord 19(1):136

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Priya TK, Jayaseelan V, Krishnamoorthy Y, Sakthivel M, Majella MG (2020) Patient’s experiences and satisfaction in diabetes care and out-of-pocket expenditure for follow-up care among diabetes patients in urban Puducherry. South India J Patient Exp 7(6):1445–1449

    Article  CAS  PubMed  Google Scholar 

  • Rajamanickam A, Munisankar S, Bhootra Y, Dolla C, Thiruvengadam K, Nutman TB, Babu S (2019) Metabolic consequences of concomitant Strongyloides stercoralis infection in patients with type 2 diabetes mellitus. Clin Infect Dis 69(4):697–704

    Article  CAS  PubMed  Google Scholar 

  • Rajamanickam A, Munisankar S, Dolla C, Menon PA, Thiruvengadam K, Nutman TB, Babu S (2020) Helminth infection modulates systemic pro-inflammatory cytokines and chemokines implicated in type 2 diabetes mellitus pathogenesis. PLoS Negl Trop Dis 14(3):e0008101

    Article  PubMed  PubMed Central  Google Scholar 

  • Ricardo-Gonzalez RR, Red Eagle A, Odegaard JI, Jouihan H, Morel CR, Heredia JE, Mukundan L, Wu D, Locksley RM, Chawla A (2010) IL-4/STAT6 immune axis regulates peripheral nutrient metabolism and insulin sensitivity. Proc Natl Acad Sci U S A 107:22617–22622

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, Colagiuri S, Guariguata L, Motala AA, Ogurtsova K, Shaw JE, Bright D, Williams R, Diabetes Atlas Committee IDF (2019) Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Res Clin Pract 157:107843

    Article  PubMed  Google Scholar 

  • Shen SW, Lu Y, Li F, Shen ZH, Xu M, Yao WF, Feng YB, Yun JT, Wang YP, Ling W, Qi HJ, Tong DX (2015) The potential long-term effect of previous schistosome infection reduces the risk of metabolic syndrome among Chinese men. Parasite Immunol 37:333–339

    Article  CAS  PubMed  Google Scholar 

  • Shimokawa C, Obi S, Shibata M, Olia A, Imai T, Suzue K, Hisaeda H (2019) Suppression of obesity by an intestinal helminth through interactions with intestinal microbiota. Infect Immun 87(6):e00042-e119

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Su CW, Chen CY, Li Y, Long SR, Massey W, Kumar DV, Walker WA, Shi HN (2018) Helminth infection protects against high fat diet-induced obesity via induction of alternatively activated macrophages. Sci Rep 8(1):4607

    Article  PubMed  PubMed Central  Google Scholar 

  • Surendar J, Indulekha K, Hoerauf A, Hübner MP (2017) Immunomodulation by helminths: similar impact on type 1 and type 2 diabetes? Parasite Immunol 39(5)

  • Tahapary DL, de Ruiter K, Martin I, van Lieshout L, Guigas B, Soewondo P, Djuardi Y, Wiria AE, Mayboroda OA, Houwing-Duistermaat JJ, Tasman H, Sartono E, Yazdanbakhsh M, Smit JW, Supali T (2015) Helminth infections and type 2 diabetes: a cluster-randomized placebo controlled SUGARSPIN trial in Nangapanda, Flores, Indonesia. BMC Infect Dis 15:133

    Article  PubMed  PubMed Central  Google Scholar 

  • Tahapary DL, de Ruiter K, Martin I, Brienen EAT, van Lieshout L, Cobbaert CM, Soewondo P, Djuardi Y, Wiria AE, Houwing-Duistermaat JJ, Sartono E, Smit JWA, Yazdanbakhsh M, Supali T (2017a) Effect of anthelmintic treatment on insulin resistance: a cluster-randomized, placebo-controlled trial in Indonesia. Clin Infect Dis 65:764–771

    Article  CAS  PubMed  Google Scholar 

  • Tahapary DL, de Ruiter K, Martin I, Brienen EAT, van Lieshout L, Djuardi Y, Djimandjaja CC, Houwing-Duistermaat JJ, Soewondo P, Sartono E, Supali T, Smit JWA, Yazdanbakhsh M (2017b) Effect of anthelmintic treatment on leptin, adiponectin and leptin to adiponectin ratio: a randomized-controlled trial. Nutr Diabetes 7:e289

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Tang H, Liang YB, Chen ZB, Du LL, Zeng LJ, Wu JG, Yang W, Liang HP, Ma ZF (2017) Soluble egg antigen activates SM2 macrophages via the STAT6 and PI3K pathways, and Schistosoma japonicum alternatively activates macrophage polarization to improve the survival rate of septic mice. J Cell Biochem 118:4230–4239

    Article  CAS  PubMed  Google Scholar 

  • Tang CL, Liu ZM, Gao YR, Xiong F (2018) Schistosoma infection and schistosoma-derived products modulate the immune responses associated with protection against type 2 diabetes. Front Immunol 8:1990

    Article  PubMed  PubMed Central  Google Scholar 

  • Tang CL, Zou JN, Zhang RH, Liu ZM, Mao CL (2019a) Helminths protect against type 1 diabetes: effects and mechanisms. Parasitol Res 118(4):1087–1094

    Article  PubMed  Google Scholar 

  • Tang CL, Yu XH, Li Y, Zhang RH, Xie J, Liu ZM (2019b) Schistosoma japonicum soluble egg antigen protects against type 2 diabetes in Leprdb/db mice by enhancing regulatory T cells and Th2 cytokines. Front Immunol 10:1471

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • van der Zande HJP, Gonzalez MA, de Ruiter K, Wilbers RHP, García-Tardón N, van Huizen M, van Noort K, Pelgrom LR, Lambooij JM, Zawistowska-Deniziak A, Otto F, Ozir-Fazalalikhan A, van Willigen D, Welling M, Poles J, van Leeuwen F, Hokke CH, Schots A, Yazdanbakhsh M, Loke P, Guigas B (2021) The helminth glycoprotein omega-1 improves metabolic homeostasis in obese mice through type 2 immunity-independent inhibition of food intake. FASEB J 35(2):e21331

    Article  PubMed  PubMed Central  Google Scholar 

  • White MPJ, Johnston CJC, Grainger JR, Konkel JE, O’Connor RA, Anderton SM, Maizels RM (2020) The helminth parasite Heligmosomoides polygyrus attenuates EAE in an IL-4Ralpha-dependent manner. Front Immunol 11:1830

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wiria AE, Djuardi Y, Supali T, Sartono E, Yazdanbakhsh M (2012) Helminth infection in populations undergoing epidemiological transition: a friend or foe? Semin Immunopathol 34:889–901

    Article  PubMed  Google Scholar 

  • Wiria AE, Hamid F, Wammes LJ, Prasetyani MA, Dekkers OM, May L, Kaisar MM, Verweij JJ, Guigas B, Partono F, Sartono E, Supali T, Yazdanbakhsh M, Smit JW (2015) Infection with soil-transmitted helminths is associated with increased insulin sensitivity. PLoS ONE 10:e0127746

    Article  PubMed  PubMed Central  Google Scholar 

  • Wu D, Molofsky AB, Liang HE, Ricardo-Gonzalez RR, Jouihan HA, Bando JK, Chawla A, Locksley RM (2011) Eosinophils sustain adipose alternatively activated macrophages associated with glucose homeostasis. Science 332:243–247

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Yang Z, Grinchuk V, Smith A, Qin B, Bohl JA, Sun R, Notari L, Zhang Z, Sesaki H, Urban JF Jr, Shea-Donohue T, Zhao A (2013) Parasitic nematode-induced modulation of body weight and associated metabolic dysfunction in mouse models of obesity. Infect Immun 81:1905–1914

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

This work was supported by National Natural Science Foundation of China grant [grant number: 82070810, 2021], Science and Technology Research Project of Hubei Provincial Department of Education [grant number: B2019362, 2019), Research Projects of Hubei Provincial Health Commission [grant number: WJ2017X30, 2017] and Independent Research Talents Fund Project of City College, Wuhan University of Science and Technology [grant number: 2019CYBSKY002, 2019].

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Correspondence to Chun-lian Tang, Qun Pan or Peng Pen.

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Gao, Yr., Zhang, Rh., Li, R. et al. The effects of helminth infections against type 2 diabetes. Parasitol Res 120, 1935–1942 (2021). https://doi.org/10.1007/s00436-021-07189-6

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