13 results on '"Beatrice Volpe"'
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2. Immune antibodies and helminth products drive CXCR2-dependent macrophage-myofibroblast crosstalk to promote intestinal repair.
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Julia Esser-von Bieren, Beatrice Volpe, Duncan B Sutherland, Jérôme Bürgi, J Sjef Verbeek, Benjamin J Marsland, Joseph F Urban, and Nicola L Harris
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Immunologic diseases. Allergy ,RC581-607 ,Biology (General) ,QH301-705.5 - Abstract
Helminth parasites can cause considerable damage when migrating through host tissues, thus making rapid tissue repair imperative to prevent bleeding and bacterial dissemination particularly during enteric infection. However, how protective type 2 responses targeted against these tissue-disruptive multicellular parasites might contribute to homeostatic wound healing in the intestine has remained unclear. Here, we observed that mice lacking antibodies (Aid-/-) or activating Fc receptors (Fcrg-/-) displayed impaired intestinal repair following infection with the murine helminth Heligmosomoides polygyrus bakeri (Hpb), whilst transfer of immune serum could partially restore chemokine production and rescue wound healing in Aid-/- mice. Impaired healing was associated with a reduced expression of CXCR2 ligands (CXCL2/3) by macrophages (MΦ) and myofibroblasts (MF) within intestinal lesions. Whilst antibodies and helminths together triggered CXCL2 production by MΦ in vitro via surface FcR engagement, chemokine secretion by intestinal MF was elicited by helminths directly via Fcrg-chain/dectin2 signaling. Blockade of CXCR2 during Hpb challenge infection reproduced the delayed wound repair observed in helminth infected Aid-/- and Fcrg-/- mice. Finally, conditioned media from human MΦ stimulated with infective larvae of the helminth Ascaris suum together with immune serum, promoted CXCR2-dependent scratch wound closure by human MF in vitro. Collectively our findings suggest that helminths and antibodies instruct a chemokine driven MΦ-MF crosstalk to promote intestinal repair, a capacity that may be harnessed in clinical settings of impaired wound healing.
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- 2015
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3. Antibodies trap tissue migrating helminth larvae and prevent tissue damage by driving IL-4Rα-independent alternative differentiation of macrophages.
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Julia Esser-von Bieren, Ilaria Mosconi, Romain Guiet, Alessandra Piersgilli, Beatrice Volpe, Fei Chen, William C Gause, Arne Seitz, J Sjef Verbeek, and Nicola L Harris
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Immunologic diseases. Allergy ,RC581-607 ,Biology (General) ,QH301-705.5 - Abstract
Approximately one-third of the world's population suffers from chronic helminth infections with no effective vaccines currently available. Antibodies and alternatively activated macrophages (AAM) form crucial components of protective immunity against challenge infections with intestinal helminths. However, the mechanisms by which antibodies target these large multi-cellular parasites remain obscure. Alternative activation of macrophages during helminth infection has been linked to signaling through the IL-4 receptor alpha chain (IL-4Rα), but the potential effects of antibodies on macrophage differentiation have not been explored. We demonstrate that helminth-specific antibodies induce the rapid trapping of tissue migrating helminth larvae and prevent tissue necrosis following challenge infection with the natural murine parasite Heligmosomoides polygyrus bakeri (Hp). Mice lacking antibodies (JH (-/-)) or activating Fc receptors (FcRγ(-/-)) harbored highly motile larvae, developed extensive tissue damage and accumulated less Arginase-1 expressing macrophages around the larvae. Moreover, Hp-specific antibodies induced FcRγ- and complement-dependent adherence of macrophages to larvae in vitro, resulting in complete larval immobilization. Antibodies together with helminth larvae reprogrammed macrophages to express wound-healing associated genes, including Arginase-1, and the Arginase-1 product L-ornithine directly impaired larval motility. Antibody-induced expression of Arginase-1 in vitro and in vivo occurred independently of IL-4Rα signaling. In summary, we present a novel IL-4Rα-independent mechanism of alternative macrophage activation that is antibody-dependent and which both mediates anti-helminth immunity and prevents tissue disruption caused by migrating larvae.
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- 2013
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4. Microbial regulation of intestinal motility provides resistance against helminth infection
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Mati Moyat, Luc Lebon, Olaf Perdijk, Lakshanie C. Wickramasinghe, Mario M. Zaiss, Ilaria Mosconi, Beatrice Volpe, Nadine Guenat, Kathleen Shah, Gillian Coakley, Tiffany Bouchery, and Nicola L. Harris
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Mice ,Nematospiroides dubius ,parasitic diseases ,Immunology ,Helminthiasis ,Animals ,Immunology and Allergy ,Intestinal Diseases, Parasitic ,Gastrointestinal Motility ,Strongylida Infections - Abstract
Soil-transmitted helminths cause widespread disease, infecting ~1.5 billion people living within poverty-stricken regions of tropical and subtropical countries. As adult worms inhabit the intestine alongside bacterial communities, we determined whether the bacterial microbiota impacted on host resistance against intestinal helminth infection. We infected germ-free, antibiotic-treated and specific pathogen-free mice, with the intestinal helminth Heligmosomoides polygyrus bakeri. Mice harboured increased parasite numbers in the absence of a bacterial microbiota, despite mounting a robust helminth-induced type 2 immune response. Alterations to parasite behaviour could already be observed at early time points following infection, including more proximal distribution of infective larvae along the intestinal tract and increased migration in a Baermann assay. Mice lacking a complex bacterial microbiota exhibited reduced levels of intestinal acetylcholine, a major excitatory intestinal neurotransmitter that promotes intestinal transit by activating muscarinic receptors. Both intestinal motility and host resistance against larval infection were restored by treatment with the muscarinic agonist bethanechol. These data provide evidence that a complex bacterial microbiota provides the host with resistance against intestinal helminths via its ability to regulate intestinal motility.
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- 2022
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5. β-Glucan receptors on IL-4 activated macrophages are required for hookworm larvae recognition and trapping
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Tiffany Bouchery, Beatrice Volpe, Rory Doolan, Gillian Coakley, Mati Moyat, Julia Esser‐von Bieren, Lakshanie C Wickramasinghe, Margaret L Hibbs, Javier Sotillo, Mali Camberis, Graham Le Gros, Nemat Khan, David Williams, and Nicola L Harris
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Ancylostomatoidea ,Larva ,Macrophages ,Immunology ,parasitic diseases ,Nippostrongylus Brasiliensis ,Glucan ,Hookworms ,Recognition ,Trapping ,Immunology and Allergy ,Animals ,Lectins, C-Type ,Cell Biology ,Interleukin-4 ,Receptors, Immunologic - Abstract
Recent advances in the field of host immunity against parasitic nematodes have revealed the importance of macrophages in trapping tissue migratory larvae. Protective immune mechanisms against the rodent hookworm Nippostrongylus brasiliensis (Nb) are mediated, at least in part, by IL-4-activated macrophages that bind and trap larvae in the lung. However, it is still not clear how host macrophages recognize the parasite. An in vitro co-culture system of bone marrow-derived macrophages and Nb infective larvae was utilized to screen for the possible ligand-receptor pair involved in macrophage attack of larvae. Competitive binding assays revealed an important role for β-glucan recognition in the process. We further identified a role for CD11b and the non-classical pattern recognition receptor ephrin-A2 (EphA2), but not the highly expressed β-glucan dectin-1 receptor, in this process of recognition. This work raises the possibility that parasitic nematodes synthesize β-glucans and it identifies CD11b and ephrin-A2 as important pattern recognition receptors involved in the host recognition of these evolutionary old pathogens. To our knowledge, this is the first time that EphA2 has been implicated in immune responses to a helminth.
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- 2022
6. Author response for 'Immune serum‐activated human macrophages coordinate with eosinophils to immobilize Ascaris suum larvae'
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Beatrice Volpe, Nicola L. Harris, J Esser‐von Bieren, Wgc Horsnell, Kathleen Shah, Gillian Coakley, Peter Geldhof, Mark Hatherill, A Butler, and Tiffany Bouchery
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Larva ,Biology ,biology.organism_classification ,Immune sera ,Ascaris suum ,Microbiology - Published
- 2020
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7. The Study of Host Immune Responses Elicited by the Model Murine HookwormsNippostrongylus brasiliensisandHeligmosomoides polygyrus
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Graham LeGros, Luc Lebon, Tiffany Bouchery, Nicola L. Harris, Kara J. Filbey, Beatrice Volpe, and Kathleen Shah
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0301 basic medicine ,biology ,fungi ,General Medicine ,biology.organism_classification ,Necator americanus ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Immune system ,Ancylostoma duodenale ,Immunity ,Hookworm Infections ,parasitic diseases ,Immunology ,Heligmosomoides polygyrus ,Nippostrongylus brasiliensis ,Hookworm infection ,030215 immunology - Abstract
Hookworm infections (Necator americanus or Ancylostoma duodenale) represent a major neglected tropical disease, affecting approximately 700 million people worldwide, and can cause severe morbidity due to the need for these worms to feed on host blood. N. brasiliensis and H. polygrus, both rodent parasites, are the two most commonly employed laboratory models of experimental hookworm infection. Both parasites evoke type 2 immune responses, and their use has been instrumental in generating fundamental insight into the molecular mechanisms of type-2 immunity and for understanding how the immune response can control parasite numbers. Here we provide a complete set of methods by which to investigate the natural progression of infection and the host immunological responses in the lung and intestine of H. polygyrus- and N. brasiliensis-infected mice. Detailed information is included about the most important parasitological and immunological measurements to perform at each time point. © 2017 by John Wiley & Sons, Inc.
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- 2017
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8. Immune serum-activated human macrophages coordinate with eosinophils to immobilize Ascaris suum larvae
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Julia Esser-von Bieren, Nicola L. Harris, Peter Geldhof, Tiffany Bouchery, Beatrice Volpe, Mark Hatherill, Kathleen Shah, William G. C. Horsnell, Gillian Coakley, and Alana Butler
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0301 basic medicine ,trichinella-spiralis ,Swine ,receptor ,protective immunity ,Leukocyte Count ,Mice ,0302 clinical medicine ,neutrophils ,Macrophage ,antibodies ,infections ,helminth ,Ascaris suum ,Swine Diseases ,Ascariasis ,Vaccines ,Antibodies ,Eosinophils ,Helminth ,Immune Serum ,Larva ,Ascaris lumbricoides ,Antibody ,030231 tropical medicine ,Immunology ,Trichinella spiralis ,Antibodies, Helminth ,macrophage ,Biology ,in-vitro ,resistance ,03 medical and health sciences ,Immune system ,parasitic diseases ,expression ,Animals ,Humans ,lumbricoides ,Ascaris ,Immune Sera ,Macrophages ,fungi ,Chemokine CCL24 ,biology.organism_classification ,030104 developmental biology ,immune serum ,Antibody Formation ,biology.protein ,Parasitology ,th2 cytokines ,CCL24 - Abstract
Helminth infection represents a major health problem causing approximately 5 million disability-adjusted life years worldwide. Concerns that repeated anti-helminthic treatment may lead to drug resistance render it important that vaccines are developed but will require increased understanding of the immune-mediated cellular and antibody responses to helminth infection. IL-4 or antibody-activated murine macrophages are known to immobilize parasitic nematode larvae, but few studies have addressed whether this is translatable to human macrophages. In the current study, we investigated the capacity of human macrophages to recognize and attack larval stages of Ascaris suum, a natural porcine parasite that is genetically similar to the human helminth Ascaris lumbricoides. Human macrophages were able to adhere to and trap A suum larvae in the presence of either human or pig serum containing Ascaris-specific antibodies and other factors. Gene expression analysis of serum-activated macrophages revealed that CCL24, a potent eosinophil attractant, was the most upregulated gene following culture with A suum larvae in vitro, and human eosinophils displayed even greater ability to adhere to, and trap, A suum larvae. These data suggest that immune serum-activated macrophages can recruit eosinophils to the site of infection, where they act in concert to immobilize tissue-migrating Ascaris larvae.
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- 2020
9. NMR spectroscopy of single sub-nL ova with inductive ultra-compact single-chip probes
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Beatrice Volpe, Armin Beck, Marco Grisi, Nicola L. Harris, Giovanni Boero, Roberto Guidetti, and F. Vincent
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0301 basic medicine ,Single chip ,Detection limit ,spectroscopy ,zygote ,Multidisciplinary ,Materials science ,sub-nL ,Nuclear magnetic resonance spectroscopy ,Microcoil ,Article ,NMR ,Low noise ,03 medical and health sciences ,030104 developmental biology ,Nuclear magnetic resonance ,Planar ,Spectroscopy ,oocyte ,single ,Living matter - Abstract
Nuclear magnetic resonance (NMR) spectroscopy enables non-invasive chemical studies of intact living matter. However, the use of NMR at the volume scale typical of microorganisms is hindered by sensitivity limitations, and experiments on single intact organisms have so far been limited to entities having volumes larger than 5 nL. Here we show NMR spectroscopy experiments conducted on single intact ova of 0.1 and 0.5 nL (i.e. 10 to 50 times smaller than previously achieved), thereby reaching the relevant volume scale where life development begins for a broad variety of organisms, humans included. Performing experiments with inductive ultra-compact (1 mm2) single-chip NMR probes, consisting of a low noise transceiver and a multilayer 150 μm planar microcoil, we demonstrate that the achieved limit of detection (about 5 pmol of 1H nuclei) is sufficient to detect endogenous compounds. Our findings suggest that single-chip probes are promising candidates to enable NMR-based study and selection of microscopic entities at biologically relevant volume scales.
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- 2017
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10. Parasite Proximity Drives the Expansion of Regulatory T Cells in Peyer's Patches following Intestinal Helminth Infection
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Joanna Massacand, Ilaria Mosconi, Beatrice Volpe, Luc Lebon, Mario M. Zaiss, Nicola L. Harris, Lalit Kumar Dubey, and Julia Esser-von Bieren
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medicine.medical_treatment ,Immunology ,Helminthiasis ,Priming (immunology) ,Real-Time Polymerase Chain Reaction ,Microbiology ,T-Lymphocytes, Regulatory ,Mice ,Peyer's Patches ,Th2 Cells ,Antigen ,parasitic diseases ,medicine ,Helminths ,Mesenteric lymph nodes ,Animals ,Secretion ,Intestinal Diseases, Parasitic ,Strongylida Infections ,Nematospiroides dubius ,Host Response and Inflammation ,biology ,medicine.disease ,biology.organism_classification ,Flow Cytometry ,Mice, Inbred C57BL ,Disease Models, Animal ,Infectious Diseases ,Cytokine ,medicine.anatomical_structure ,Parasitology ,Heligmosomoides polygyrus - Abstract
Helminth infections are typically chronic in nature; however, the exact molecular mechanisms by which these parasites promote or thwart host immunity remain unclear. Worm expulsion requires the differentiation of CD4 + T cells into Th2 cells, while regulatory T cells (Tregs) act to dampen the extent of the Th2 response. Priming of T cells requires drainage or capture of antigens within lymphoid tissues, and in the case of intestinal helminths, such sites include the mucosa-associated Peyer's patches (PPs) and the draining mesenteric lymph nodes (MLN). To gain insight into when and where the activation of the adaptive T cell response takes place following intestinal helminth infection, we analyzed Th2 and Treg responses in the PPs and MLN following infection with the murine intestinal helminth Heligmosomoides polygyrus bakeri . Protective Th2 responses were observed to be largely restricted to the MLN, while a greater expansion of Tregs occurred within the PPs. Interestingly, those PPs that formed a contact with the parasite showed the greatest degree of Treg expansion and no evidence of type 2 cytokine production, indicating that the parasite may secrete products that act in a local manner to selectively promote Treg expansion. This view was supported by the finding that H. polygyrus bakeri larvae could promote Treg proliferation in vitro . Taken together, these data indicate that different degrees of Treg expansion and type 2 cytokine production occur within the PPs and MLN following infection with the intestinal helminth H. polygyrus bakeri and indicate that these organs exhibit differential responses following infection with intestinal helminths.
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- 2015
11. Antibody-Mediated Trapping of Helminth Larvae Requires CD11b and Fc gamma Receptor I
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Duncan B. Sutherland, Beatrice Volpe, Nicola L. Harris, Benjamin J. Marsland, J. Sjef Verbeek, Romain Guiet, Julia Esser-von Bieren, Arne Seitz, and Manuel Kulagin
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Infectious Disease and Host Response ,Immunology ,Antibodies, Helminth ,Gene Expression ,Complement receptor ,Models, Biological ,Immunoglobulin G ,Microbiology ,Downregulation and upregulation ,Helminths ,parasitic diseases ,Animals ,Immunology and Allergy ,Receptor ,Mice, Knockout ,CD11b Antigen ,Arginase ,biology ,Immune Sera ,Interleukins ,Macrophages ,Receptors, IgG ,Complement System Proteins ,Macrophage Activation ,Interleukin-33 ,biology.organism_classification ,Receptors, Interleukin-4 ,Integrin alpha M ,Larva ,biology.protein ,Heligmosomoides polygyrus ,Helminthiasis, Animal ,Antibody ,Signal transduction ,Protein Binding ,Signal Transduction - Abstract
Infections with intestinal helminths severely impact on human and veterinary health, particularly through the damage that these large parasites inflict when migrating through host tissues. Host immunity often targets the motility of tissue-migrating helminth larvae, which ideally should be mimicked by anti-helminth vaccines. However, the mechanisms of larval trapping are still poorly defined. We have recently reported an important role for Abs in the rapid trapping of tissue-migrating larvae of the murine parasite Heligmosomoides polygyrus bakeri. Trapping was mediated by macrophages (MΦ) and involved complement, activating FcRs, and Arginase-1 (Arg1) activity. However, the receptors and Ab isotypes responsible for MΦ adherence and Arg1 induction remained unclear. Using an in vitro coculture assay of H. polygyrus bakeri larvae and bone marrow–derived MΦ, we now identify CD11b as the major complement receptor mediating MΦ adherence to the larval surface. However, larval immobilization was largely independent of CD11b and instead required the activating IgG receptor FcγRI (CD64) both in vitro and during challenge H. polygyrus bakeri infection in vivo. FcγRI signaling also contributed to the upregulation of MΦ Arg1 expression in vitro and in vivo. Finally, IgG2a/c was the major IgG subtype from early immune serum bound by FcγRI on the MΦ surface, and purified IgG2c could trigger larval immobilization and Arg1 expression in MΦ in vitro. Our findings reveal a novel role for IgG2a/c-FcγRI–driven MΦ activation in the efficient trapping of tissue-migrating helminth larvae and thus provide important mechanistic insights vital for anti-helminth vaccine development.
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- 2015
12. Immune antibodies and helminth products drive CXCR2-dependent macrophage-myofibroblast crosstalk to promote intestinal repair
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Joseph F. Urban, Duncan B. Sutherland, Jérôme Bürgi, Nicola L. Harris, Benjamin J. Marsland, J. Sjef Verbeek, Beatrice Volpe, and Julia Esser-von Bieren
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Chemokine ,QH301-705.5 ,Immunology ,Antibodies, Helminth ,Microbiology ,Receptors, Interleukin-8B ,Mice ,Immune system ,Virology ,parasitic diseases ,Genetics ,Animals ,Humans ,CXC chemokine receptors ,Biology (General) ,Myofibroblasts ,Molecular Biology ,Strongylida Infections ,Mice, Knockout ,Nematospiroides dubius ,biology ,Macrophages ,RC581-607 ,biology.organism_classification ,ddc ,Intestines ,CXCL2 ,Chemokine secretion ,biology.protein ,Parasitology ,Heligmosomoides polygyrus ,Antibody ,Immunologic diseases. Allergy ,Wound healing ,Research Article - Abstract
Helminth parasites can cause considerable damage when migrating through host tissues, thus making rapid tissue repair imperative to prevent bleeding and bacterial dissemination particularly during enteric infection. However, how protective type 2 responses targeted against these tissue-disruptive multicellular parasites might contribute to homeostatic wound healing in the intestine has remained unclear. Here, we observed that mice lacking antibodies (Aid-/-) or activating Fc receptors (Fcrg-/-) displayed impaired intestinal repair following infection with the murine helminth Heligmosomoides polygyrus bakeri (Hpb), whilst transfer of immune serum could partially restore chemokine production and rescue wound healing in Aid-/- mice. Impaired healing was associated with a reduced expression of CXCR2 ligands (CXCL2/3) by macrophages (MΦ) and myofibroblasts (MF) within intestinal lesions. Whilst antibodies and helminths together triggered CXCL2 production by MΦ in vitro via surface FcR engagement, chemokine secretion by intestinal MF was elicited by helminths directly via Fcrg-chain/dectin2 signaling. Blockade of CXCR2 during Hpb challenge infection reproduced the delayed wound repair observed in helminth infected Aid-/- and Fcrg-/- mice. Finally, conditioned media from human MΦ stimulated with infective larvae of the helminth Ascaris suum together with immune serum, promoted CXCR2-dependent scratch wound closure by human MF in vitro. Collectively our findings suggest that helminths and antibodies instruct a chemokine driven MΦ-MF crosstalk to promote intestinal repair, a capacity that may be harnessed in clinical settings of impaired wound healing., Author Summary To complete their lifecycles, helminth parasites have to migrate through tissues such as the skin, lung, liver and intestine. This migration causes severe tissue damage, resulting in the need for rapid repair to restore the integrity and function of damaged tissues. Protective type 2 immune responses against helminths can repair acute lung damage, but they can also promote liver fibrosis. However, how protective immune mechanisms might contribute to wound healing during enteric nematode infection has remained unclear. Here we show that during a protective antibody response, where helminth larvae are trapped in the intestinal mucosa, macrophages and myofibroblasts secrete chemokines, which promote the repair of helminth-caused lesions. Chemokine secretion by macrophages was triggered by antibodies and helminth products, whilst myofibroblasts produced chemokines directly in response to innate recognition of helminth products. The same chemokines that instructed intestinal repair in mice were also secreted by human macrophages, when co-cultured with immune serum and helminths. Finally, human myofibroblasts closed in vitro scratch wounds more rapidly, when stimulated with the chemokine secretions of helminth-antibody activated human macrophages. Thus, our findings reveal a novel mechanism, by which a protective antibody response can promote the repair of intestinal injury during helminth infection.
- Published
- 2015
13. Hookworms Evade Host Immunity by Secreting a Deoxyribonuclease to Degrade Neutrophil Extracellular Traps
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Theodora-Dorita Tsourouktsoglou, Nicola L. Harris, Luke Becker, Javier Sotillo, Tiffany Bouchery, Solomon Silverstein, Gillian Coakley, Arne Seitz, Alfonso J Schmidt, Romain Guiet, Alex Loukas, Manuel Kulagin, Venizelos Papayannopoulos, Mati Moyat, Graham Le Gros, Beatrice Volpe, Mali Camberis, Kathleen Shah, Paul R. Giacomin, Swiss National Science Foundation, and National Health and Medical Research Council (Australia)
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Immune-evasion ,Ancylostomatoidea ,Neutrophils ,Skin infection ,Neutrophil extracellular traps ,Extracellular Traps ,Mice ,0302 clinical medicine ,vaccine ,Nippostrongylus brasiliensis ,0303 health sciences ,biology ,integumentary system ,3. Good health ,DNAse II ,infective larvae ,Nippostrongylus ,Hookworm ,evasion ,Microbiology ,Article ,Necator americanus ,Host-Parasite Interactions ,03 medical and health sciences ,Immune system ,Virology ,invitro ,parasitic diseases ,medicine ,Helminth ,innate ,Helminths ,Animals ,capture ,Hookworm infection ,030304 developmental biology ,Immune Evasion ,Strongylida Infections ,Endodeoxyribonucleases ,Host (biology) ,fungi ,biology.organism_classification ,medicine.disease ,netosis ,candida-albicans ,Parasitology ,escape ,030217 neurology & neurosurgery - Abstract
Hookworms cause a major neglected tropical disease, occurring after larvae penetrate the host skin. Neutrophils are phagocytes that kill large pathogens by releasing neutrophil extracellular traps (NETs), but whether they target hookworms during skin infection is unknown. Using a murine hookworm, Nippostrongylus brasiliensis, we observed neutrophils being rapidly recruited and deploying NETs around skin-penetrating larvae. Neutrophils depletion or NET inhibition altered larvae behavior and enhanced the number of adult worms following murine infection. Nevertheless, larvae were able to mitigate the effect of NETs by secreting a deoxyribonuclease (Nb-DNase II) to degrade the DNA backbone. Critically, neutrophils were able to kill larvae in vitro, which was enhanced by neutralizing Nb-DNase II. Homologs of Nb-DNase II are present in other nematodes, including the human hookworm, Necator americanus, which also evaded NETs in vitro. These findings highlight the importance of neutrophils in hookworm infection and a potential conserved mechanism of immune evasion. This work was supported by the Swiss National Science Foundation ( SNF310030_156517 ), the Health Research Council of New Zealand , and the Marjorie Barclay Trust , New Zealand. N.L.H. is supported by a National Health and Medical Research Council (NHMRC) of Australia SRF-B fellowship. Sí
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