title: Susceptibility versus resistance in alveolar echinococcosis (larval infection with Echinococcus multilocularis).
abstract: Epidemiological studies have demonstrated that the majority of human individuals exposed to infection with Echinococcus spp. eggs exhibit resistance to disease as shown by either seroconversion to parasite--specific antigens, and/or the presence of 'dying out' or 'aborted' metacestodes, not including hereby those individuals who putatively got infected but did not seroconvert and who subsequently allowed no development of the pathogen. For those individuals where infection leads to disease, the developing parasite is partially controlled by host immunity. In infected humans, the type of immune response developed by the host accounts for the subsequent trichotomy concerning the parasite development: (i) seroconversion proving infection, but lack of any hepatic lesion indicating the failure of the parasite to establish and further develop within the liver; or resistance as shown by the presence of fully calcified lesions; (ii) controlled susceptibility as found in the "conventional" alveolar echinococcosis (AE) patients who experience clinical signs and symptoms approximately 5-15 years after infection, and (iii) uncontrolled hyperproliferation of the metacestode due to an impaired immune response (AIDS or other immunodeficiencies). Immunomodulation of host immunity toward anergy seems to be triggered by parasite metabolites. Beside immunomodulating IL-10, TGFβ-driven regulatory T cells have been shown to play a crucial role in the parasite-modulated progressive course of AE. A novel CD4+CD25+ Treg effector molecule FGL2 recently yielded new insight into the tolerance process in Echinococcus multilocularis infection.
authors.affiliation: Institute of Parasitology, Vetsuisse Faculty and Faculty of Medicine, University of Bern, Switzerland. Electronic address: bruno.gottstein@vetsuisse.unibe.ch.
authors.forename: Bruno
authors.initials: B
authors.lastname: Gottstein
authors.affiliation: Institute of Parasitology, Vetsuisse Faculty and Faculty of Medicine, University of Bern, Switzerland.
authors.forename: Junhua
authors.initials: J
authors.lastname: Wang
authors.affiliation: Institute of Parasitology, Vetsuisse Faculty and Faculty of Medicine, University of Bern, Switzerland.
authors.forename: Ghalia
authors.initials: G
authors.lastname: Boubaker
authors.affiliation: Institute of Parasitology, Vetsuisse Faculty and Faculty of Medicine, University of Bern, Switzerland.
authors.forename: Irina
authors.initials: I
authors.lastname: Marinova
authors.affiliation: Institute of Parasitology, Vetsuisse Faculty and Faculty of Medicine, University of Bern, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Spiliotis
authors.affiliation: Institute of Parasitology, Vetsuisse Faculty and Faculty of Medicine, University of Bern, Switzerland.
authors.forename: Norbert
authors.initials: N
authors.lastname: Müller
authors.affiliation: Institute of Parasitology, Vetsuisse Faculty and Faculty of Medicine, University of Bern, Switzerland.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hemphill
mesh_terms: D000818:Animals; D004198:Disease Susceptibility / Q000276:immunology*; D004443:Echinococcosis; D004444:Echinococcosis, Hepatic / Q000276:immunology*; D048210:Echinococcus multilocularis / Q000276:immunology*; D006801:Humans; D056747:Immunomodulation
keywords: Alveolar echinococcosis; Em18-ELISA; FGL2; PET-CT; Regulatory T cells; Resistance; Susceptibility; TGF-beta