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a Division of Gastroenterology-Hepatology, Department of Internal Medicine, Tufts New England Medical Center, Boston, Massachusetts 02111, USA
Key Words: Crohn's disease • immune regulation • T cells • helminths • ulcerative colitis
Address for correspondence: Joel V. Weinstock, M.D., Division of Gastroenterology, Tufts New England Medical Center, 750 Washington Street, P.O. Box 233, Boston, MA 02111. Voice: 617-636-8387; fax: 617-636-4505. e-mail: jweinstock2{at}Tufts-NEMC.org
Geographic and ethnic variations in ulcerative colitis and Crohn's disease frequency suggest that environmental factors affect disease risk. Prevention of parasitic worms (helminths) through improved hygiene may be one factor leading to the increased disease prevalence. Helminths alter host mucosal and systemic immunity. Animals exposed to helminths are protected from experimental colitis and other immunological diseases, and helminthic colonization can be used to treat ongoing murine and human disease. Helminths induce mucosal T cells to make Th2 and regulatory cytokines. Helminth-induced mucosal IL4, TGF
 , and IL10 likely are part of the protective process. Helminths affect pathways of innate immunity like TLR4 expression and function. Worms also induce various regulatory-type T-cell subsets in the gut that limit effector T-cell growth and function. These effects of once ever-present helminths may have protected people from immune-mediated illnesses like inflammatory bowel disease.
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