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Mules TC, Lavender B, Maclean K, Vacca F, Noble SL, Yumnam B, Te Kawa T, Cait A, Tang J, O’Sullivan D, Gasser O, Stanley J, Le Gros G, Camberis M, Inns S. Controlled Hookworm Infection for Medication-free Maintenance in Patients with Ulcerative Colitis: A Pilot, Double-blind, Randomized Control Trial. Inflamm Bowel Dis 2024; 30:735-745. [PMID: 37318363 PMCID: PMC11063543 DOI: 10.1093/ibd/izad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Human hookworm has been proposed as a treatment for ulcerative colitis (UC). This pilot study assessed the feasibility of a full-scale randomized control trial examining hookworm to maintain clinical remission in patients with UC. METHODS Twenty patients with UC in disease remission (Simple Clinical Colitis Activity Index [SCCAI] ≤4 and fecal calprotectin (fCal) <100 ug/g) and only on 5-aminosalicylate received 30 hookworm larvae or placebo. Participants stopped 5-aminosalicylate after 12 weeks. Participants were monitored for up to 52 weeks and exited the study if they had a UC flare (SCCAI ≥5 and fCal ≥200 µg/g). The primary outcome was difference in rates of clinical remission at week 52. Differences were assessed for quality of life (QoL) and feasibility aspects including recruitment, safety, effectiveness of blinding, and viability of the hookworm infection. RESULTS At 52 weeks, 4 of 10 (40%) participants in the hookworm group and 5 of 10 (50%) participants in the placebo group had maintained clinical remission (odds ratio, 0.67; 95% CI, 0.11-3.92). Median time to flare in the hookworm group was 231 days (interquartile range [IQR], 98-365) and 259 days for placebo (IQR, 132-365). Blinding was quite successful in the placebo group (Bang's blinding index 0.22; 95% CI, -0.21 to 1) but less successful in the hookworm group (0.70; 95% CI, 0.37-1.0). Almost all participants in the hookworm group had detectable eggs in their faeces (90%; 95% CI, 0.60-0.98), and all participants in this group developed eosinophilia (peak eosinophilia 4.35 × 10^9/L; IQR, 2.80-6.68). Adverse events experienced were generally mild, and there was no significant difference in QoL. CONCLUSIONS A full-scale randomized control trial examining hookworm therapy as a maintenance treatment in patients with UC appears feasible.
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Affiliation(s)
- Thomas C Mules
- Malaghan Institute of Medical Research, Wellington, New Zealand
- Department of Medicine, Otago University, Wellington, New Zealand
| | | | - Kate Maclean
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Francesco Vacca
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Sophia-Louise Noble
- Malaghan Institute of Medical Research, Wellington, New Zealand
- Department of Medicine, Otago University, Wellington, New Zealand
| | - Bibek Yumnam
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Tama Te Kawa
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Alissa Cait
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Jeffry Tang
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | | | - Olivier Gasser
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - James Stanley
- Biostatistics Group, Otago University, Wellington, New Zealand
| | - Graham Le Gros
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Mali Camberis
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Stephen Inns
- Malaghan Institute of Medical Research, Wellington, New Zealand
- Department of Medicine, Otago University, Wellington, New Zealand
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Mules TC, Tang JS, Vacca F, Yumnam B, Schmidt A, Lavender B, Maclean K, Noble SL, Waugh C, van Ginkel R, Camberis M, Le Gros G, Inns S. Modulation of intestinal epithelial permeability by chronic small intestinal helminth infections. Immunol Cell Biol 2024; 102:396-406. [PMID: 38648862 DOI: 10.1111/imcb.12749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024]
Abstract
Increased permeability of the intestinal epithelial layer is linked to the pathogenesis and perpetuation of a wide range of intestinal and extra-intestinal diseases. Infecting humans with controlled doses of helminths, such as human hookworm (termed hookworm therapy), is proposed as a treatment for many of the same diseases. Helminths induce immunoregulatory changes in their host which could decrease epithelial permeability, which is highlighted as a potential mechanism through which helminths treat disease. Despite this, the influence of a chronic helminth infection on epithelial permeability remains unclear. This study uses the chronically infecting intestinal helminth Heligmosomoides polygyrus to reveal alterations in the expression of intestinal tight junction proteins and epithelial permeability during the infection course. In the acute infection phase (1 week postinfection), an increase in intestinal epithelial permeability is observed. Consistent with this finding, jejunal claudin-2 is upregulated and tricellulin is downregulated. By contrast, in the chronic infection phase (6 weeks postinfection), colonic claudin-1 is upregulated and epithelial permeability decreases. Importantly, this study also investigates changes in epithelial permeability in a small human cohort experimentally challenged with the human hookworm, Necator americanus. It demonstrates a trend toward small intestinal permeability increasing in the acute infection phase (8 weeks postinfection), and colonic and whole gut permeability decreasing in the chronic infection phase (24 weeks postinfection), suggesting a conserved epithelial response between humans and mice. In summary, our findings demonstrate dynamic changes in epithelial permeability during a chronic helminth infection and provide another plausible mechanism by which chronic helminth infections could be utilized to treat disease.
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Affiliation(s)
- Thomas C Mules
- Malaghan Institute of Medical Research, Wellington, New Zealand
- University of Otago, Wellington, New Zealand
| | - Jeffry S Tang
- Malaghan Institute of Medical Research, Wellington, New Zealand
- High-Value Nutrition National Science Challenge, Auckland, New Zealand
| | - Francesco Vacca
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Bibek Yumnam
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Alfonso Schmidt
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | | | - Kate Maclean
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | | | | | | | - Mali Camberis
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Graham Le Gros
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Stephen Inns
- Malaghan Institute of Medical Research, Wellington, New Zealand
- University of Otago, Wellington, New Zealand
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Lavender B, Hooker C, Frampton C, Williams M, Carson S, Paterson A, McGregor R, Moreland NJ, Gell K, Priddy FH, Wiig K, Le Gros G, Ussher JE, Brewerton M. Robust immunogenicity of a third BNT162b2 vaccination against SARS-CoV-2 Omicron variant in a naïve New Zealand cohort. Vaccine 2023; 41:5535-5544. [PMID: 37516574 DOI: 10.1016/j.vaccine.2023.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 07/31/2023]
Abstract
The ability of a third dose of the Pfizer-BioNTech BNT162b2 SARS-CoV-2 vaccine to stimulate immune responses against subvariants, including Omicron BA.1, has not been assessed in New Zealand populations. Unlike many overseas populations, New Zealanders were largely infection naïve at the time they were boosted. This adult cohort of 298 participants, oversampled for at-risk populations, was composed of 29% Māori and 28% Pacific peoples, with 40% of the population aged 55+. A significant proportion of the cohort was obese and presented with at least one comorbidity. Sera were collected 28 days and 6 months post second vaccination and 28 days post third vaccination. SARS-CoV-2 anti-S IgG titres and neutralising capacity using surrogate viral neutralisation assays against variants of concern, including Omicron BA.1, were investigated. The incidence of SARS-CoV-2 infection, within our cohort, prior to third vaccination was very low (<6%). This study found a third vaccine significantly increased the mean SARS-CoV-2 anti-S IgG titres, for every demographic subgroup, by a minimum of 1.5-fold compared to titres after two doses. Diabetic participants experienced a greater increase (∼4-fold) in antibody titres after their third vaccination, compared to non-diabetics (increase of ∼ 2-fold). This corrected for the deficiency in antibody titres within diabetic participants which was observed following two doses. A third dose also induced a neutralising response against Omicron variant BA.1, which was absent after two doses. This neutralising response improved regardless of age, BMI, ethnicity, or diabetes status. Participants aged ≥75 years consistently had the lowest SARS-CoV-2 anti-S IgG titres at each timepoint, however experienced the greatest improvement after three doses compared to younger participants. This study shows that in the absence of prior SARS-CoV-2 infection, a third Pfizer-BioNTech BNT162b2 vaccine enhances immunogenicity, including against Omicron BA.1, in a cohort representative of at-risk groups in the adult New Zealand population.
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Affiliation(s)
- Brittany Lavender
- Vaccine Alliance Aotearoa New Zealand and Malaghan Institute of Medical Research, PO Box 7060, Wellington 6242, New Zealand
| | - Caitlin Hooker
- Vaccine Alliance Aotearoa New Zealand and Malaghan Institute of Medical Research, PO Box 7060, Wellington 6242, New Zealand
| | - Chris Frampton
- University of Otago, 2 Riccarton Ave, Christchurch 8011, New Zealand
| | - Michael Williams
- Pacific Clinical Research Network, 1289 Haupapa St, Rotorua 3010, New Zealand
| | - Simon Carson
- Pacific Clinical Research Network, 1289 Haupapa St, Rotorua 3010, New Zealand
| | - Aimee Paterson
- School of Medical Sciences, The University of Auckland, 2 Park Rd, Grafton, Auckland 1023, New Zealand
| | - Reuben McGregor
- School of Medical Sciences, The University of Auckland, 2 Park Rd, Grafton, Auckland 1023, New Zealand
| | - Nicole J Moreland
- School of Medical Sciences, The University of Auckland, 2 Park Rd, Grafton, Auckland 1023, New Zealand
| | - Katie Gell
- Vaccine Alliance Aotearoa New Zealand and Malaghan Institute of Medical Research, PO Box 7060, Wellington 6242, New Zealand
| | | | - Kjesten Wiig
- Vaccine Alliance Aotearoa New Zealand and Malaghan Institute of Medical Research, PO Box 7060, Wellington 6242, New Zealand
| | - Graham Le Gros
- Vaccine Alliance Aotearoa New Zealand and Malaghan Institute of Medical Research, PO Box 7060, Wellington 6242, New Zealand
| | - James E Ussher
- Vaccine Alliance Aotearoa New Zealand and University of Otago, 362 Leith St, Dunedin 9016, New Zealand
| | - Maia Brewerton
- Vaccine Alliance Aotearoa New Zealand and Malaghan Institute of Medical Research, PO Box 7060, Wellington 6242, New Zealand; Department of Clinical Immunology & Allergy, Auckland City Hospital, 2 Park Rd, Grafton, Auckland 1023, New Zealand.
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Priddy FH, Williams M, Carson S, Lavender B, Mathieson J, Frampton C, Moreland NJ, McGregor R, Williams G, Brewerton M, Gell K, Ussher J, Le Gros G. Immunogenicity of BNT162b2 COVID-19 vaccine in New Zealand adults. Vaccine 2022; 40:5050-5059. [PMID: 35868948 PMCID: PMC9273612 DOI: 10.1016/j.vaccine.2022.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 01/07/2023]
Abstract
Background There is very little known about SARS-CoV-2 vaccine immune responses in New Zealand populations at greatest risk for serious COVID-19 disease. Methods This prospective cohort study assessed immunogenicity in BNT162b2 mRNA vaccine recipients in New Zealand without previous COVID-19, with enrichment for Māori, Pacific peoples, older adults ≥ 65 years of age, and those with co-morbidities. Serum samples were analysed at baseline and 28 days after second dose for presence of quantitative anti-S IgG by chemiluminescent microparticle immunoassay and for neutralizing capacity against Wuhan, Beta, Delta, and Omicron BA.1 strains using a surrogate viral neutralisation assay. Results 285 adults with median age of 52 years were included. 55% were female, 30% were Māori, 28% were Pacific peoples, and 26% were ≥ 65 years of age. Obesity, cardiac and pulmonary disease and diabetes were more common than in the general population. All participants received 2 doses of BNT162b2 vaccine. At 28 days after second vaccination, 99.6% seroconverted to the vaccine, and anti-S IgG and neutralising antibody levels were high across gender and ethnic groups. IgG and neutralising responses declined with age. Lower responses were associated with age ≥ 75 and diabetes, but not BMI. The ability to neutralise the Omicron BA.1 variant in vitro was severely diminished but maintained against other variants of concern. Conclusions Vaccine antibody responses to BNT162b2 were generally robust and consistent with international data in this COVID-19 naïve cohort with representation of key populations at risk for COVID-19 morbidity. Subsequent data on response to boosters, durability of responses and cellular immune responses should be assessed with attention to elderly adults and diabetics.
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Affiliation(s)
- Frances H Priddy
- Vaccine Alliance Aotearoa New Zealand and Malaghan Institute of Medical Research, PO Box 7060, Wellington 6242, New Zealand.
| | - Michael Williams
- Pacific Clinical Research Network, 1289 Haupapa St, Rotorua 3010, New Zealand
| | - Simon Carson
- Pacific Clinical Research Network, 1289 Haupapa St, Rotorua 3010, New Zealand
| | - Brittany Lavender
- Vaccine Alliance Aotearoa New Zealand and Malaghan Institute of Medical Research, PO Box 7060, Wellington 6242, New Zealand
| | - Julia Mathieson
- Pacific Clinical Research Network, 1289 Haupapa St, Rotorua 3010, New Zealand
| | - Chris Frampton
- University of Otago, 2 Riccarton Ave, Christchurch 8011, New Zealand
| | - Nicole J Moreland
- University of Auckland, 2 Park Rd, Grafton Auckland 1023, New Zealand
| | - Reuben McGregor
- University of Auckland, 2 Park Rd, Grafton Auckland 1023, New Zealand
| | - Georgia Williams
- Pacific Clinical Research Network, 1289 Haupapa St, Rotorua 3010, New Zealand
| | - Maia Brewerton
- Vaccine Alliance Aotearoa New Zealand and Malaghan Institute of Medical Research, PO Box 7060, Wellington 6242, New Zealand; Department of Clinical Immunology & Allergy, Auckland City Hospital, 2 Park Rd, Grafton Auckland 1023, New Zealand
| | - Katie Gell
- Vaccine Alliance Aotearoa New Zealand and Malaghan Institute of Medical Research, PO Box 7060, Wellington 6242, New Zealand
| | - James Ussher
- Vaccine Alliance Aotearoa New Zealand and University of Otago, 362 Leith St, Dunedin 9016 New Zealand
| | - Graham Le Gros
- Vaccine Alliance Aotearoa New Zealand and Malaghan Institute of Medical Research, PO Box 7060, Wellington 6242, New Zealand
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Matthews S, Lavender B, Margara R, Trew G. R-101. Intracytoplasmic sperm injection versus in-vitro fertilization, with normal semen parameters: outcome is no better with ICSI in cycles with previous poor fertilization. Hum Reprod 1999. [DOI: 10.1093/humrep/14.suppl_3.324-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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