title: Regulatory T cell expansion in HTLV-1 and strongyloidiasis co-infection is associated with reduced IL-5 responses to Strongyloides stercoralis antigen.
abstract: BACKGROUND
  Human strongyloidiasis varies from a chronic but limited infection in normal hosts to hyperinfection in patients treated with corticosteroids or with HTLV-1 co-infection. Regulatory T cells dampen immune responses to infections. How human strongyloidiasis is controlled and how HTLV-1 infection affects this control are not clear. We hypothesize that HTLV-1 leads to dissemination of Strongyloides stercoralis infection by augmenting regulatory T cell numbers, which in turn down regulate the immune response to the parasite.
  
  
  OBJECTIVE
  To measure peripheral blood T regulatory cells and Strongyloides stercoralis larval antigen-specific cytokine responses in strongyloidiasis patients with or without HTLV-1 co-infection.
  
  
  METHODS
  Peripheral blood mononuclear cells (PBMCs) were isolated from newly diagnosed strongyloidiasis patients with or without HTLV-1 co-infection. Regulatory T cells were characterized by flow cytometry using intracellular staining for CD4, CD25 and FoxP3. PBMCs were also cultured with and without Strongyloides larval antigens. Supernatants were analyzed for IL-5 production.
  
  
  RESULTS
  Patients with HTLV-1 and Strongyloides co-infection had higher parasite burdens. Eosinophil counts were decreased in the HTLV-1 and Strongyloides co-infected subjects compared to strongyloidiasis-only patients (70.0 vs. 502.5 cells/mm(3), p = 0.09, Mann-Whitney test). The proportion of regulatory T cells was increased in HTLV-1 positive subjects co-infected with strongyloidiasis compared to patients with only strongyloidiasis or asymptomatic HTLV-1 carriers (median = 17.9% vs. 4.3% vs. 5.9 p<0.05, One-way ANOVA). Strongyloides antigen-specific IL-5 responses were reduced in strongyloidiasis/HTLV-1 co-infected patients (5.0 vs. 187.5 pg/ml, p = 0.03, Mann-Whitney test). Reduced IL-5 responses and eosinophil counts were inversely correlated to the number of CD4+CD25+FoxP3+ cells.
  
  
  CONCLUSIONS
  Regulatory T cell counts are increased in patients with HTLV-1 and Strongyloides stercoralis co-infection and correlate with both low circulating eosinophil counts and reduced antigen-driven IL-5 production. These findings suggest a role for regulatory T cells in susceptibility to Strongyloides hyperinfection.
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru. montes@bcm.edu
authors.forename: Martin
authors.initials: M
authors.lastname: Montes
authors.forename: Cesar
authors.initials: C
authors.lastname: Sanchez
authors.forename: Kristien
authors.initials: K
authors.lastname: Verdonck
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Lake
authors.forename: Elsa
authors.initials: E
authors.lastname: Gonzalez
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lopez
authors.forename: Angelica
authors.initials: A
authors.lastname: Terashima
authors.forename: Thomas
authors.initials: T
authors.lastname: Nolan
authors.forename: Dorothy E
authors.initials: DE
authors.lastname: Lewis
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gotuzzo
authors.forename: A Clinton
authors.initials: AC
authors.lastname: White
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000947:Antigens, Helminth / Q000276:immunology; D015704:CD4 Antigens / Q000032:analysis; D002478:Cells, Cultured; D005260:Female; D005434:Flow Cytometry; D051858:Forkhead Transcription Factors / Q000032:analysis; D015490:HTLV-I Infections / Q000150:complications* / Q000276:immunology*; D006801:Humans; D053645:Interleukin-2 Receptor alpha Subunit / Q000032:analysis; D015848:Interleukin-5 / Q000276:immunology*; D007963:Leukocytes, Mononuclear / Q000276:immunology; D008297:Male; D008875:Middle Aged; D017171:Strongyloides stercoralis / Q000276:immunology*; D013322:Strongyloidiasis / Q000150:complications* / Q000276:immunology*; D016176:T-Lymphocyte Subsets / Q000737:chemistry / Q000276:immunology; D050378:T-Lymphocytes, Regulatory / Q000276:immunology*; D055815:Young Adult
chemical_list: D000947:Antigens, Helminth; D015704:CD4 Antigens; C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors; C508599:IL5 protein, human; D053645:Interleukin-2 Receptor alpha Subunit; D015848:Interleukin-5