Liver cystic echinococcosis and human host immune and autoimmune follow-up: A review

Abstract

Cystic echinococcosis (CE) is an infectious disease caused by the larvae of parasite Echinococcus granulosus (E. granulosus). To successfully establish an infection, parasite release some substances and molecules that can modulate host immune functions, stimulating a strong anti-inflammatory reaction to carry favor to host and to reserve self-survival in the host. The literature was reviewed using MEDLINE, and an open access search for immunology of hydatidosis was performed. Accumulating data from animal experiments and human studies provided us with exciting insights into the mechanisms involved that affect all parts of immunity. In this review we used the existing scientific data and discuss how these findings assisted with a better understanding of the immunology of E. granulosus infection in man. The aim of this study is to point the several facts that challenge immune and autoimmune responses to protect E. granulosus from elimination and to minimize host severe pathology. Understanding the immune mechanisms of E. granulosus infection in an intermediate human host will provide, we believe, a more useful treatment with immunomodulating molecules and possibly better protection from parasitic infections. Besides that, the diagnosis of CE has improved due to the application of a new molecular tool for parasite identification by using of new recombinant antigens and immunogenic peptides. More studies for the better understanding of the mechanisms of parasite immune evasion is necessary. It will enable a novel approach in protection, detection and improving of the host inflammatory responses. In contrast, according to the “hygiene hypothesis”, clinical applications that decrease the incidence of infection in developed countries and recently in developing countries are at the origin of the increasing incidence of both allergic and autoimmune diseases. Thus, an understanding of the immune mechanisms of E. granulosus infection is extremely important.

Keywords: Lymphocytes, Dendritic cells, Immunity, Autoimmunity, Cytokines, Echinococcus granulosus

Core tip: The most common location of a hydatid echinococcal cyst is in the liver. The survival of Echinococcus within host tissues, despite the development of specific antibodies, is possible due to specific immunomodulation induced by parasites. Perpetual survival of parasites indicating multi-level systematic evasion against host protective reaction to persist their growth and spreading. Complement modulation, a metabolic adaptation to the host microenvironment, plentiful thermostable immunogenic antigen B in the cystic fluid, and induction of CD4⁺CD8⁺FOXP3⁺ T cells allows the persistence of the parasites. Parasites influence dendritic cell (DC) maturation and impair activation by toll-like receptor. It seems that DC-parasite interaction is pivotal in triggering and regulating parasite induced immunity.