Bioengineered Liver Cell Models of Hepatotropic Infections

Hepatitis viruses and liver-stage malaria are within the liver infections causing higher morbidity and mortality rates worldwide. The highly restricted tropism of the major human hepatotropic pathogens-namely, the human hepatitis B and C viruses and the Plasmodium falciparum and Plasmodium vivax parasites-has hampered the development of disease models. These models are crucial for uncovering the molecular mechanisms underlying the biology of infection and governing host-pathogen interaction, as well as for fostering drug development. Bioengineered cell models better recapitulate the human liver microenvironment and extend hepatocyte viability and phenotype in vitro, when compared with conventional two-dimensional cell models. In this article, we review the bioengineering tools employed in the development of hepatic cell models for studying infection, with an emphasis on 3D cell culture strategies, and discuss how those tools contributed to the level of recapitulation attained in the different model layouts. Examples of host-pathogen interactions uncovered by engineered liver models and their usefulness in drug development are also presented. Finally, we address the current bottlenecks, trends, and prospect toward cell models' reliability, robustness, and reproducibility.

Co-infection HBV and malaria: a striking association

BACKGROUND

Many geographical areas are highly endemic for infectious tropical diseases, although in disproportional fashion. Various infections often overlap in terms of presentation of various epidemiological and clinical manifestations that are linked to the mutual influence of pathogens. The epidemiological and clinical aspects of hepatitis B virus and malaria co-infection remain little known because there have not been many studies until recently.

METHODS

We performed a systematic search of the epidemiology of HBV/malaria co-infection, in particular, their overlapping clinical and histological features and their reciprocal conditioning. We examined published data regarding HBV and malaria.

RESULTS

The data we obtained varied substantially. The interaction between malarial parasites and HBV viruses, both in chronic HBV hepatitis patients and in carriers, did not vary or change the clinical evolution of either infection. The diversity of epidemiological and clinical results depended both on the geographical areas in which the studies were carried out and on the various stages of the infections at the time of the study.

CONCLUSION

Strategies to improve currently available diagnostic techniques, and studies dealing with vector control procedures and other operational tools and approaches are needed for better understanding of this health problem.

A massive invasion of Parafasciolopsis fasciolaemorpha in elk (Alces alces) in Lublin Province, Poland

Liver fluke Parafasciolopsis fasciolaemorpha is a parasite typical of elk (Alces alces). The present study describes the identification of a massive invasion of the liver fluke P. fasciolaemorpha in an elk in the Sobibór Landscape Park, Eastern Poland. In February 2016, samples of liver and faeces were collected from the elk during postmorte examination. A section of liver tissue and three grams of faeces were examined for the presence of flukes or fluke eggs by decantation. In total, 11,150 juvenile and mature flukes of P. fasciolaemorpha were found in the examined liver. Multiple cavities with distinct walls, filled with dark liquid, trematodes, fluke eggs and cellular detritus were seen in the cross section of the parenchyma. Additionally, some of the bile ducts were plugged with calcerous deposits. The three grams of examined faeces were found to contain 322 grey and golden-coloured eggs of P. fasciolaemorpha. The presence of such a massive infection of P. fasciolaemorpha in the examined elk has a significant impact on the health of the individual. We can assume P. fasciolaemorpha has a significant influence on the health and abundance of the entire elk population in Poland.

KEY WORDS

Parafasciolopsis fasciolaemorpha, elk, Sobibór Landscape Park, Poland.

Feasibility study of high intensity focused ultrasound (HIFU) for the treatment of hydatid cysts of the liver

This study evaluates the feasibility of using high intensity focused ultrasound (HIFU) for the treatment of hydatid cysts of the liver. HIFU ablation was carried out in 62 patients with echinococcosis of the liver. The mean age of patients was 40.76±14.84 (range: 17-72 years). The effectiveness of the treatment was monitored in real-time by changes in the gray-scale, and by morphological studies, computed tomography, magnetic resonance imaging, and ultrasound. Criteria for evaluating the effectiveness of treatment in real time were outlines. Cytomorphological picture of destructive changes of parasitic elements was presented as well. Loss of embryonic elements of the parasite was observed at the subcellular level after HIFU-ablation and underlines the effectiveness of HIFU.

Treatment of liver alveococcosis with high-intensity focused ultrasound

This study evaluates the feasibility of using high intensity focused ultrasound (HIFU) for the treatment of liver alveococcosis. HIFU ablation was carried out in 36 patients with alveococcosis of the liver. The median age of patients was 39.24±12, 93 years (range: 20-66 years). The efficiency of treatment was monitored in real time with morphological evaluation, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), and with morphological cytological and electron microscopy studies. HIFU ablation has shown effectiveness in destroying the protoscolexes, laminar and cell elements of the cuticular and germinal membrane of the alveococcosis larvocyst, causing the death of the cells of initial metamorphosis of alveococcosis, which is responsible for the dissemination of the parasite in the liver. Therefore HIFU-therapy is a promising and effective treatment for liver alveococcosis.

Enhanced Neutrophil Apoptosis in Neutropenic Patients with Hepatosplenic Schistosomiasis: Evidence of Serum Fas Ligand

Enhanced neutrophil apoptosis has been reported in neutropenic hepatosplenic schistosomiasis. The shortening of neutrophil survival via apoptosis may explain the neutropenia that occur in these patients. However, the regulation of neutrophil apoptosis in hepatosplenic schistosomiasis has not been clearly defined. Neutrophils harvested from neutropenic patients with hepatosplenic (HS) schistosomiasis, (n=25), non-neutropenic patients with hepatointestinal (HI) schistosomiasis (n=10), and age-/gender-matched healthy control subjects (n=10) were incubated with autologous serum. Neutrophils apoptosis was quantified by flow cytometry through determination of propidium iodide nuclear staining and confirmed by DNA gel electrophoresis at 0 (i.e. fresh neutrophils), 4 and 24 h culture. Neutrophils from healthy subjects were also incubated with either 10% heterologous normal or neutropenic serum, with and without anti-Fas ligand antibody. Fas expression was assessed in fresh neutrophils using flow cytometry. Compared with normal healthy neutrophils, and HI neutrophils, neutropenic neutrophils demonstrated greater apoptosis in the presence of autologous serum (P<0.01, 0.05, respectively). Furthermore, compared with normal neutrophils exposed to heterologous normal serum, those exposed to heterologous neutropenic serum exhibited higher apoptosis rates ( P<0.01). Moreover, anti-Fas L antibody attenuated the neutropenic serum-induced neutrophil apoptosis in normal neutrophils. Fas expression was significantly higher in the neutropenic group when compared to both HI and normal healthy controls (P<0.05). In addition, Fas expression by neutrophils was paralleled by high neutrophil apoptosis. On the other hand, neutrophil apoptosis was not correlated to the size of spleen in neutropenic group. In conclusion, the rate of neutrophil apoptosis is accelerated in patients with neutropenic hepatosplenic schistosomiasisis. These findings suggest that the enhanced neutrophil apoptosis that occurs in neutropenic HS patients is triggered by a serum factor, which is mostly a Fas ligand.

Preneoplastic conditions underlying bile duct cancer

BACKGROUND

Malignancies arising from the biliary tract can arise from the epithelial lining of the biliary tract and surrounding tissues. Conditions that predispose to malignancy as well as preneoplastic changes in biliary tract epithelia have been identified. In this overview, we discuss preneoplastic conditions of the biliary tract and emphasize their clinical relevance.

RESULTS

Chronic biliary tract inflammation predisposes to cancer in the biliary tract. Biliary tract carcinogenesis involves a multistep process as a consequence of chronic biliary epithelial injury or inflammation. Reminiscent of other gastrointestinal epithelial malignancies such as gastric, colon, and pancreatic cancer, biliary tract cancers may evolve via multistep progression from epithelial hyperplasia and dysplasia to malignant transformation. The potential role of initiating cells is also becoming recognized.

CONCLUSIONS

In spite of improved risk factor recognition, and advances in diagnostic tools, the early diagnosis of pre-malignant or malignant biliary tract conditions is extremely challenging, and there is a paucity of evidence on which to base their management. As a result, the role of pre-emptive surgery remains largely undefined.

[Effects of signal transducers and activators of transcription 4 and 6 on development of worms and granuloma formation in mice infected with Schistosoma japonicum]

OBJECTIVE

To explore the effects of STAT4 and STAT6 on the development of worms and granuloma formation in mice infected with Schistosoma japonicum.

METHODS

All the intact BALB/cJ mice and STAT4(-/-), STAT6(-/-) mice with the same genetic background were infected with 25 S. japonicum cercariae. All the mice were sacrificed on the 42nd day after infection and the worms were collected. The total number of worms and the mean number of worm pairs were counted. The liver of each mouse was removed for the count of eggs, the histological examination and the determination of the size of single-egg granulomas in the liver.

RESULTS

No significant differences were found in the total number of worms, the number of worm pairs and the number of eggs per pair of worms in the liver among STAT4(-/-), STAT6(-/-) and BALB/cJ mice. The size of single-egg granulomas in the liver of STAT6(-/-) mice (213.3 +/- 68.6) microm was significantly smaller than that in the liver of normal BALB/cJ mice (319.5 +/- 71.9) microm (P < 0.05). The liver granulomas were not well formed and the liver fibrosis decreased in STAT6(-/-) mice.

CONCLUSIONS

STAT4 or STAT6 deficiency has no conspicuous effect on the development and fecundity of S. japonicum. STAT6 plays an important role for the granuloma formation and liver fibrosis.

Redundant and pathogenic roles for IL-22 in mycobacterial, protozoan, and helminth infections

IL-22 is a member of the IL-10 cytokine family and signals through a heterodimeric receptor composed of the common IL-10R2 subunit and the IL-22R subunit. IL-10 and IL-22 both activate the STAT3 signaling pathway; however, in contrast to IL-10, relatively little is known about IL-22 in the host response to infection. In this study, using IL-22(-/-) mice, neutralizing Abs to IL-22, or both, we show that IL-22 is dispensable for the development of immunity to the opportunistic pathogens Toxoplasma gondii and Mycobacterium avium when administered via the i.p. or i.v. route, respectively. IL-22 also played little to no role in aerosol infections with Mycobacterium tuberculosis and in granuloma formation and hepatic fibrosis following chronic percutaneous infections with the helminth parasite Schistosoma mansoni. A marked pathogenic role for IL-22 was, however, identified in toxoplasmosis when infections were established by the natural oral route. Anti-IL-22 Ab-treated mice developed significantly less intestinal pathology than control Ab-treated mice even though both groups displayed similar parasite burdens. The decreased gut pathology was associated with reduced IL-17A, IL-17F, TNF-alpha, and IFN-gamma expression. In contrast to the prior observations of IL-22 protective effects in the gut, these distinct findings with oral T. gondii infection demonstrate that IL-22 also has the potential to contribute to pathogenic inflammation in the intestine. The IL-22 pathway has emerged as a possible target for control of inflammation in certain autoimmune diseases. Our findings suggest that few if any infectious complications would be expected with the suppression of IL-22 signaling.

Regulation of Fibroblast Functions by Products of Schistosomal Egg Granulomas: Potential Role in the Pathogenesis of Hepatic Fibrosis

Recent observations suggest a molecular link between granuloma formation and hepatic fibrosis in schistosomiasis. Egg granulomas isolated from Schistosoma mansoni-infected mice, when cultured in serum-free medium, produce a variety of biologically active molecules that affect fibroblast function. One group of molecules--proteins with an estimated relative molecular mass (Mr) of 30 000--stimulate fibroblast proliferation in vitro. These molecules have interleukin (IL)-1-like activity when assayed in thymocyte cultures but are biochemically distinct from previously characterized murine IL-1. Fibroblast mitogenic activity is also produced by macrophages isolated from granulomas and by extracts of S. mansoni eggs. The egg-derived activity is distinct from the granuloma cell-derived material on the basis of Mr and isoelectric point determinations. Egg extracts also contain concanavalin A-binding substances which are not directly mitogenic for fibroblasts but can stimulate spleen cells from infected mice to produce fibroblast mitogenic activity in vitro. A large chemoattractant molecule (greater than 200 000 Mr) for fibroblasts has also been identified in supernatants from granuloma cultures and in supernatants from macrophages isolated from granulomas. This activity is abolished by treatment with anti-fibronectin antibody, suggesting that it is fibronectin or a cleavage product thereof. Molecules similar to or identical with the fibroblast mitogenic factors from the granulomas have been identified, and they inhibit the contraction of fibroblast-populated collagen lattices. These activities may be important in the pathogenesis of hepatic fibrosis in schistosomiasis, and pharmacological modification of their production or of their effects on target fibroblasts might theoretically prevent hepatic fibrosis in this disease.

Remodeling of hepatic vascular changes after specific chemotherapy of schistosomal periportal fibrosis

Hepatosplenic schistosomiasis was the first human disease in which the possibility of extensive long standing hepatic fibrosis being degraded and removed has been demonstrated. When such changes occurred, the main signs of portal hypertension (splenomegaly, esophageal varices) progressively disappeared, implying that a profound vascular remodeling was concomitantly occurring. Hepatic vascular alterations associated with advanced schistosomiasis have already been investigated. Obstruction of the intrahepatic portal vein branches, plus marked angiogenesis and compensatory hyperplasia and hypertrophy of the arterial tree are the main changes present. However, there are no data revealing how these vascular changes behave during the process of fibrosis regression. Here the mouse model of pipestem fibrosis was used in an investigation about these vascular alterations during the course of the infection, and also after treatment and cure of the disease. Animals representing the two polar hepatic forms of the infection were included: (1) "isolated granulomas" characterized by isolated periovular granulomas sparsely distributed throughout the hepatica parenchyma; and (2) 'pipestem fibrosis' with periovular granulomas and fibrosis being concentrated within portal spaces, before and after treatment, were studied by means of histological and vascular injection-corrosion techniques. Instances of widespread portal vein obstruction of several types were commonly found in the livers of the untreated animals. These obstructive lesions were soon repaired, and completely disappeared four months following specific treatment of schistosomiasis. Treatment was accomplished by the simultaneous administration of praziquantel and oxamniquine. The most impressive results were revealed by the technique of injection of colored masses into the portal system, followed by corrosion in strong acid. The vascular lesions of non-treated pipestem fibrosis were represented in the plastic casts by considerable diminution of the fine peripheral portal vein radicles, plus dilatation of periportal collaterals. Four months after treatment, this last picture appeared replaced by tufts of newly interwoven vessels formed along the main portal vein branches, disclosing a strong angiomatoid reparative change. Understanding about the cellular elements at play during fibro-vascular repairing changes of hepatic schistosomiasis represents a matter of considerable scientific and conceptual importance. At present time one may only speculate about the participation of some type of natural stem-cell capable of restoring the diseased liver back to normal once the cause of the disorder has been eliminated.

Efficacy of garlic extract on hepatic coccidiosis in infected rabbits (Oryctolagus cuniculus): histological and biochemical studies

The rabbits were divided into three groups, of 12 rabbits each. G1 was the (non-infected non-treated) as control, G2 was the (infected-non treated), and G3 was the (infected and treated) rabbits. Each rabbit in the infected groups were given (10(3)) sporuleted oocysts of Eimeria stiedae per rabbit after forty five days exactly. Faecal sample of rabbits from each group were examined each day post infection till oocysts appeared in faeces. The treatment was given by using suitable dosage of garlic according to body weight. After 15, 21, 28, & 35 days post-treatment faecal oocysts were output. Biochemical parameters as serum liver function (ALT, AST, GGT & ALP) that denoted the he-patic cells injury. The results showed a significant differences in the mean values of oocysts shedding and their mean number in bile ducts between Gs 2 &3 from the 15th day post infection (PI) (mean +/-SD:40.33 +/- 16.72 & 25.17 +/- .56 respectively) till the experimental end on the 35th day (55.75 +/- 19.79 & 0.94 +/- 1.43 respectively). The histopathological alterations were in liver of G2 at the experimental end. Coccidiosis in G2 induced histopathological alterations in liver tissue, marked cytoplasmic vacuolations in hepatocytes with clear signs of karyolysis, and dilatation of sinusoids with increase in Kupffer cells. Leukocytic infiltration around congested blood vessels was noticed. Efficacy of garlic on E. stiedae in infected Gs was resident. The liver of G3 regained almost normal appearance compared to control.

IL-10 Regulates Movement of Intestinally Derived CD4+T Cells to the Liver

Diseases that affect the intestine may have hepatic manifestations, but the mechanisms involved in establishing hepatic disease secondarily remain poorly understood. We previously reported that IL-10 knockout (KO) mice developed severe necrotizing hepatitis following oral infection with Trichinella spiralis. In this study, we used this model of intestinal inflammation to further examine the role of IL-10 in regulating hepatic injury. Hepatic damage was induced by migrating newborn larvae. By delivering the parasite directly into the portal vein, we demonstrated that an ongoing intestinal immune response was necessary for the development of hepatitis. Intestinally derived CD4+ cells increased in the livers of IL-10 KO mice, and Ab-mediated blockade of MAdCAM-1 inhibited the accumulation of CD4+alpha(4)beta(7)+ cells in the liver. Moreover, adoptive transfer of intestinally primed CD4+ T cells from IL-10 KO mice caused hepatitis in infected immunodeficient animals. Conversely, transfer of wild-type donor cells reduced the severity of hepatic inflammation in IL-10 KO recipients, demonstrating regulatory activity. Our results revealed that IL-10 prevented migration of intestinal T cells to the liver and inhibited the development of hepatitis.

Prophylactic effect of the anti-inflammatory drug diclofenac in experimental schistosomiasis mansoni

OBJECTIVES

This study was a trial to demonstrate the prophylactic effect of diclofenac, a widely used anti-inflammatory drug (diclofenac potassium, CAS-15307-81-0, Ciba Geigy, 334.2) in experimental schistosomiasis mansoni. Two different dose regimens were used to explore the effects upon worm load, tissue egg load, and hepatic granuloma size.

METHODS

In this study, a group of 50 Swiss albino mice was used. This group was divided into five subgroups: subgroup I constituted infected untreated control mice; subgroup II, infected mice given 0.5 mg diclofenac orally 24 h post infection, then sacrificed three weeks later; subgroup III, infected mice given 0.5 mg diclofenac orally six weeks post infection and sacrificed one week later; subgroup IV, infected mice administered 1mg diclofenac orally 24 h post infection and sacrificed three weeks later; and subgroup V, infected mice given 1mg of the drug orally six weeks post infection and sacrificed one week later.

RESULTS

Mice given the high dose regimen (1mg orally/mouse) 24 h post infection, then sacrificed three weeks later, demonstrated a significant reduction in the immature worms recovered, compared to the untreated controls. Animals receiving the high dose of the drug six weeks post infection, then sacrificed one week later, revealed a drop in the number of mature worms and in the tissue egg load (hepatic and intestinal), and the smallest hepatic granuloma measurement compared to the untreated controls. These findings were less conspicuous in animals given the low dose regimen.

CONCLUSION

Diclofenac could be used successfully as a preventive agent against schistosomiasis mansoni infection in endemic areas.

Vaccination of mice with a 30 kDaSchistosomaantigen with and without human adjuvant induces high protection againstS. mansoniinfection

A 30 kDa antigen was characterized as a hydrophobic polypeptide containing 16 amino acids and evaluated as a potential candidate vaccine against infection bySchistosoma mansoni. CD1 albino mice immunized at 0, 14, and 21 days with 25 or 50 μg of the 30 kDa antigen per mouse with and without alum developed high levels of IgG antibodies (predominantly IgG2a and IgG2b isotypes). When immunized mice were infected with 200S. mansonicercariae, the highest protection levels (61% and 65% reduction in worm burden in two separate experiments) were obtained using the 50-μg antigen without alum adjuvant. The granuloma size decreased to 10%, a non-significant level in mice immunized using alum adjuvant. The results demonstrate the ability of the 30 kDa antigen with and without alum adjuvant to protect mice againstS. mansoniinfection.

Radiology corner. Answer to last month's radiology case and images: Schistosomiasis japonicum involving the liver and colon

Abdominal radiography showed subtle curvilinear densities overlying the left lower quadrant and central within the pelvis (Fig. 1a). This was confirmed on intravenous contrast-enhanced abdominopelvic CT to be caused by thin mucosal surface calcifications within the descending and sigmoid colons (Fig. 1b, c). Incidental note is made of thin right hepatic lobe capsule calcifications (Fig. 1d). These colonic and hepatic calcifications are characteristic of Schistosomiasis infection of the gastrointestinal tract. Liver biopsy confirmed Schistosomiasis japonicum infection.

Immunomodulation of the hepatic egg granuloma in Schistosoma japonicum-infected pigs

Immunomodulation of perioval granulomas is a well-known phenomenon in schistosome-infected mice, but only little is known about granuloma modulation in other animal models of human schistosomiasis. In the present study, we explored immunomodulation of egg granulomas in the liver in a pig model of schistosomiasis japonica. Granuloma size was measured and T cells, B cells and IgG(+) plasma cells in granulomas were quantified in pigs at 9, 12 and 21 weeks post infection (wpi) with Schistosoma japonicum. Granulomas were largest at 9 wpi, had decreased significantly in size at 12 wpi and remained small at 21 wpi (9 vs. 12 and 21 wpi: P < 0.05). The size of granulomas containing mature and immature eggs, respectively, did not differ significantly. The density of T (CD3epsilon(+)) cells and IgG(+) plasma cells in granulomas was the same, irrespective of granuloma size and time points. B (CD79alpha(+)) cells were rare in granulomas. The results indicate that in pigs, S. japonicum egg granulomas in the liver are immunomodulated at an early stage of infection, and that not only mature but also immature eggs induce a marked granulomatous reaction in this species.

[Histology of liver lesions due to Schistosoma mekongi. About six cases with severe portal hypertension operated in Cambodia]

Schistosomiasis mekongi was shown to be endemic, along the Mekong River, in northern Cambodia, affecting many patients with portal hypertension. Surgical procedures were proposed to some patients with digestive haemorrhage history to avoid fatal recurrence. The aim of our study was to evaluate the intensity of the liver fibrosis among these patients. During surgical treatment, liver biopsies were collected, fixed in Bouin or in formalin and processed at the Institut Pasteur of Cambodia. Sections were stained by H&E, Masson's trichrome, PAS, Ziehl-Neelsen's method and Congo Red. A total of six biopsies from patients aged 16-36 were analysed. There was complete disorganization of hepatic architecture with fibrous enlargement of portal tracts and some portal-portal bridging fibrosis, but there was no cirrhosis. In portal areas, there was blood vessel congestion and thrombosis with inflammation. Bile ducts were normal. In the parenchyma, congestion of sinusoidal capillaries was combined with focal mononuclear inflammatory infiltrate. There was no steatosis, no necrosis, no cholestasis, no iron accumulation and no amyloidosis. Numerous eggs of Schistosoma mekongi were observed in five cases, mostly in fibrous areas and more rarely in the parenchyma. Eggs were round or oval, measuring 60 x 40 microns with an acid-fast thin hyaline wall. Some eggs were surrounded by epithelioid and giant cell reaction. In conclusion, our findings illustrated a surprisingly high degree of fibrosis among young adults which contrasts with other schistosomiasis.

Pathogenesis of septal fibrosis of the liver. (An experimental study with a new model.)

Septal fibrosis is an important, frequent, and non-specific type of fibrosis associated with chronic liver diseases, but its pathogenesis is still poorly understood. An interesting model of septal fibrosis occurs in rats infected with the nematode Capillaria hepatica. This model was used to investigate the pathogenesis, site of origin, structure, and cell-types of septal fibrosis. Forty young adult Wistar rats were inoculated with 800 embryonated eggs of C. hepatica. Daily liver samples were obtained from the 20th to the 39th day after inoculation to cover the critical period when septal fibrosis usually starts. Routine histology, electron microscopy, immunohistochemistry, and indirect immunofluorescence were applied to the study of liver sections. Septal blood vessels were demonstrated by India ink perfusion of the portal vein system. Prominent angiogenesis was observed to precede collagen deposition. Besides angiogenesis and mesenchymal-cell mobilization, septal fibrosis was seen to originate from portal spaces and to course through acinar zone I in between sinusoids, inducing no alterations in them, with no evident participation of stellate hepatic cells. Septal fibrosis appeared as an adaptative type of response of the liver to chronic injury, which resulted in a new structure that is normal to other species and creates accessory vessels that drain portal blood into hepatic sinusoids.

Strobilocercus fasciolaris infection with hepatic sarcoma and gastroenteropathy in a Wistar colony

Tapeworm cysts were identified in liver of Wistar rats and it induced fibrosarcoma in liver and gastroenteropathy in stomach and intestine. The tapeworm larva was confirmed as Strobilocercus fasciolaris by PCR linked mitochondrial DNA sequencing. Light microscopy, special staining (masson trichrome) and immunoflouresence supported the diagnosis of fibrosarcoma. Infiltration of plasma cells, macrophages and eosinophils were observed in the liver section. Gastric mucosal hyperplasia, dilation of gastric glands with secretion, intestinal mucosal cell hyperplasia, proliferation of duodenal submucosal glands were confirmed by light microscopy and supported by PAS, AB staining. The concomitant development of hepatic sarcoma and gastroenteropathy by larvae of Taenia taeniaeformis (S. fasciolaris) infection is very rare and is the first reported case in Wistar rats to our knowledge.

The Schistosoma mansoni hepatic egg granuloma provides a favorable microenvironment for sustained growth of Leishmania donovani

Parasitic co-infections are prevalent in many parts of the world. However, relatively little is known about how an underlying infection may impact on the host's ability to control a newly acquired parasite, especially if both infect the same organ. We have studied this using an experimental co-infection model in C57BL/6 mice involving Schistosoma mansoni and Leishmania donovani, two important human pathogens affecting the liver. We show that mice with established S. mansoni infections fail to control L. donovani growth in the liver and spleen. The failure occurs despite the development of a functional anti-L. donovani Th1 response that can mediate granuloma formation and effective clearance of amastigotes from foci of infection in the hepatic parenchyma. Instead, anti-leishmanial immunity fails within the S. mansoni egg granuloma, consistent with a lack of L. donovani granuloma assembly in this tissue microenvironment and consequent lack of NO production. Persisting amastigote replication in the S. mansoni egg granulomas may thus explain the increased L. donovani burden in the liver and spleen. These results may have implications for human S. mansoni and L. donovani co-infections and also demonstrate that granulomatous tissue responses to helminth organisms can form a discrete niche facilitating survival of intracellular pathogens.

Four whole-istic aspects of schistosome granuloma biology: fractal arrangement, internal regulation, autopoietic component and closure

This paper centers on some whole-istic organizational and functional aspects of hepatic Schistosoma mansoni granuloma, which is an extremely complex system. First, it structurally develops a collagenic topology, originated bidirectionally from an inward and outward assembly of growth units. Inward growth appears to be originated from myofibroblasts derived from small portal vessel around intravascular entrapped eggs, while outward growth arises from hepatic stellate cells. The auto-assembly of the growth units defines the three-dimensional scaffold of the schistosome granulomas. The granuloma surface irregularity and its border presented fractal dimension equal to 1.58. Second, it is internally regulated by intricate networks of immuneneuroendocrine stimuli orchestrated by leptin and leptin receptors, substance P and Vasoactive intestinal peptide. Third, it can reach the population of +/- 40,000 cells and presents an autopoietic component evidenced by internal proliferation (Ki-67+ Cells), and by expression of c-Kit+ Cells, leptin and leptin receptor (Ob-R), granulocyte-colony stimulating factor (G-CSF-R), and erythropoietin (Epo-R) receptors. Fourth, the granulomas cells are intimately connected by pan-cadherins, occludin and connexin-43, building a state of closing (granuloma closure). In conclusion, the granuloma is characterized by transitory stages in such a way that its organized structure emerges as a global property which is greater than the sum of actions of its individual cells and extracellular matrix components.

Disagreement between ultrasound and magnetic resonance imaging in the identification of schistosomal periportal fibrosis

Abdominal ultrasound (US) has been widely used in the evaluation of patients with schistosomiasis mansoni. It represents an important indirect method of diagnosis and classification of the disease, and it has also been used as a tool in the evaluation of therapeutic response and regression of fibrosis. We describe the case of a man in whom US showed solid evidence of schistosomal periportal fibrosis and magnetic resonance imaging revealed that periportal signal alteration corresponded to adipose tissue which entered the liver together with the portal vein.

[Immune response and immunopathology in inducible costimulatory molecule (ICOS) transgenic mice infected with Schistosoma japonicum]

OBJECTIVE

To establish the ICOS transgenic mice schistosomiasis japonica model and to observe the immune response and immunopathology of the model.

METHODS

The transgenic mice were infected with Schistosoma japonicum. Spleen cells and sera of mice were harvested at week 4, 6, and 8 after infection. The cytokines IFN-gamma and IL-4 were measured in culture supernatans by ELISA. The serum IgG, IgGI and IgG2a were measured by ELISA at different period of infection. Liver tissue sections were prepared with HE staining. Liver granuloma formation was observed under microscope.

RESULTS

The expression level of IFN-y showed no significant difference between ICOS transgenic mice and control, while that of IL-4 in ICOS transgenic mice was significantly up-regulated to 20.81+/-1.95 and 25.31+/-3.37 pg/ml at week 6 and 8 respectively (P<0.01). The serum IgG and IgGl in ICOS transgenic mice were also significantly higher than those in control. Th2 differentiation index and lgC1/IgG2a were used to evaluate the immune regulation balance of Thl/Th2, and results showed that Th2 response in ICOS transgenic mice was significantly stronger than that of the control. The egg granuloma response in ICOS transgenic mice was also significantly stronger than that in control (P<0.01). The rate of egg granuloma enlargement was 24.48% and 26.37% at week 6 and 8 respectively.

CONCLUSION

The findings suggest that there is stronger Th2 type response in ICOS transgenic mice infected with Schistosoma japonicum and ICOS may play an important role in the egg granuloma formation of Schistosoma japonicum.

Cutting edge: STAT1 and T-bet play distinct roles in determining outcome of visceral leishmaniasis caused by Leishmania donovani

T-bet and STAT1 regulate IFN-gamma gene transcription in CD4+ T cells, which mediate protection against Leishmania. Here we show that T-bet and STAT1 are required for the induction of an efficient Th1 response during Leishmania donovani infection, but they play distinct roles in determining disease outcome. Both STAT1(-/-) and T-bet(-/-) mice failed to mount a Th1 response, but STAT1(-/-) mice were highly resistant to L. donovani and developed less immunopathology, whereas T-bet(-/-) mice were highly susceptible and eventually developed liver inflammation. Adoptive cell transfer studies showed that RAG2(-/-) recipients receiving STAT1(+/+) or STAT1(-/-) T cells developed comparable liver pathology, but those receiving STAT1(-/-) T cells were significantly more susceptible to infection. These unexpected findings reveal distinct roles for T-bet and STAT1 in mediating host immunity and liver pathology during visceral leishmaniasis.

Nematode infection of the liver mimicking metastasis of malignant melanoma

BACKGROUND

The differential diagnoses of a circumscribed mass of the liver are varied. Especially if a malignant tumor, capable of setting metastases to the liver, is known in a patient's medical history, there might be difficulties in differentiating the tumor's entity. CASUISTRY: We report a case of a 40-year-old male with a history of malignant melanoma in whom follow-up investigations revealed a mass in the liver.

RESULTS

The histopathological and microbiological results, however, showed an infestation of liver tissue with nematodes. Malignant tumor cells could not be detected.

CONCLUSIONS

Roundworm-infections of the liver can present as lesions suspicious of being malignant. Therefore, along with e.g. microhamartoma, microabscesses and hepatocellular carcinoma, infestation with nematodes should be taken into consideration.

Ultrastructural aspects of hepatic coccidiosis caused by Goussia lusca n. sp. (Apicomplexa: Coccidia) infecting Trisopterus luscus (Gadidae) from the NE Atlantic Ocean

Goussia lusca n. sp. is described from the liver of pouting Trisopterus luscus from the NE Atlantic Ocean in Ibero-Atlantic Portuguese and Spanish waters. Mature oocysts were 31.7 (28.8 to 35.4) microm in diameter. Each oocyst contained 4 ellipsoidal sporocysts arranged in an aleatory position, and measuring approximately 13.7 x 9.2 microm. Each sporocyst contained 2 sporozoites. Ultrastructurally, the sporocyst wall consisted of a dense inner layer 115 nm thick, transversely striated, regularly intercalated by thin grooves with electron-lucent spaces, and separated from the outer layer by a thin, light (electron-lucent) space. The outer layer was multilamellated and consisted of parallel dense bands alternating with light spaces. These lamellae formed filamentous extensions of the wall. The dehiscence suture, a characteristic feature of the genus, was present in the sporocysts. No external clinical signs were observed in the host fish. Parasites observed in the liver tissue were often enveloped in a yellowish-brown matrix, generally known as 'yellow bodies'. Sometimes sporocysts were observed in direct contact with the liver cells. Parasites in degeneration and aggregations of amylopectin granules were frequently observed surrounded by host inflammatory cells. In severe infections, we observed large agglomerations of oocysts encapsulated by layers of concentrically arranged connective tissue forming large granulomas, which caused significant replacement of the host liver parenchyma by the parasite.

Hepatic involvement in larva migrans of Toxocara canis: report of a case with pathological and radiological findings

Patients with the clinical syndrome of visceral larva migrans as a result of Toxocara species, have typical lesions in the liver consisting of granulomas that contain numerous eosinophils and often Charcot-Leyden crystals. This syndrome is rarely taken into account in patients with cholestatic syndrome, especially when hypereosinophilic reaction is absent. We report the case of a 47-year-old immunocompetent woman who presented with abdominal pain, in whom multiple focal liver lesions were discovered. She had come in contact with dogs. Diagnosis of toxocariasi was done. A good clinical response has been obtained by treating with thiabendazole. We present the findings of various imaging studies of the patient. This report shows that visceral larva migrans may be the cause of a chronic liver disease and should be suspected also in patients without fever and hypereosinophilia with cryptogenic cholestatic and focal liver lesions.

Visceral Leishmania donovani infection in interleukin-13-/- mice

Leishmania donovani-infected interleukin-13-/- BALB/c mice showed impaired initial gamma interferon secretion and incomplete granuloma assembly at parasitized liver foci. Nonetheless, control of early parasite replication, resolution of liver infection, and responsiveness to antileishmanial chemotherapy were intact. By itself, interleukin-13 does not appear to materially influence acquired resistance in this intracellular infection.

Significance of bile-duct changes in schistosomiasis

Lesions involving the intra-hepatic biliary ducts in schistosomiasis have been reported in the literature, both in mice and man, but there are no data concerning their quantitative, evolutionary or post curative chemotherapeutic aspects on record. In order to obtain such data an investigation on this subject was attempted. Mice infected with 50 Schistosoma mansoni cercariae were submitted to a liver biopsy at the 9th week post-infection, and treated with 400 mg/bw praziquantel immediately afterwards. Infected and non-infected controls were submitted to the same procedures. By 19 weeks from cercarial exposure all surviving animals were sacrificed. The biliary ducts were counted on histological sections and the results were expressed as biliary ducts/portal spaces. This quantitative evaluation was compared with that from normal controls and revealed hyperplasia as the main biliary duct change (p<0.007) in schistosomiasis. Hyperplastic changes underwent only mild partial and not statistically significant regression after specific chemotherapy (p>0.05). Infected and untreated animals presented ductal changes that did not differ from those of the treated group. Measurements of serum bilirubin (total and direct), and gamma-glutamyl-transpeptidase (gamma-GT) did not reveal significant differences when animals from the several groups were compared. Thus, bile ducts exhibit a proliferative response in relation to neighboring S. mansoni injury to portal areas, but although these lesions are histopathologically impressive, they lack a functional or prognostic significance.

Hepatic and intestinal schistosomiasis after orthotopic liver transplant

Schistosomiasis affects 200 to 250 million people worldwide. Hepatic schistosomiasis is a well-recognized cause of chronic liver disease and portal hypertension. There are no previous reports of schistosomiasis post liver transplantation. We report on 2 cases of schistosomiasis in liver transplant recipients--a case of gastric schistosomiasis and a case of hepatic schistosomiasis. A discussion of the pathology of schistosomal infection and a rationale for screening potential liver transplant recipients from endemic areas follows.

Kinetoplastid Membrane Protein-11 DNA Vaccination Induces Complete Protection against Both Pentavalent Antimonial-Sensitive and -Resistant Strains ofLeishmania donovaniThat Correlates with Inducible Nitric Oxide Synthase Activity and IL-4 Generation: Evidence for Mixed Th1- and Th2-Like Responses in Visceral Leishmaniasis

The emergence of an increasing number of Leishmania donovani strains resistant to pentavalent antimonials (SbV), the first line of treatment for visceral leishmaniasis worldwide, accounts for decreasing efficacy of chemotherapeutic interventions. A kinetoplastid membrane protein-11 (KMP-11)-encoding construct protected extremely susceptible golden hamsters from both pentavalent antimony responsive (AG83) and antimony resistant (GE1F8R) virulent L. donovani challenge. All the KMP-11 DNA vaccinated hamsters continued to survive beyond 8 mo postinfection, with the majority showing sterile protection. Vaccinated hamsters showed reversal of T cell anergy with functional IL-2 generation along with vigorous specific anti-KMP-11 CTL-like response. Cytokines known to influence Th1- and Th2-like immune responses hinted toward a complex immune modulation in the presence of a mixed Th1/Th2 response in conferring protection against visceral leishmaniasis. KMP-11 DNA vaccinated hamsters were protected by a surge in IFN-gamma, TNF-alpha, and IL-12 levels along with extreme down-regulation of IL-10. Surprisingly the prototype candidature of IL-4, known as a disease exacerbating cytokine, was found to have a positive correlation to protection. Contrary to some previous reports, inducible NO synthase was actively synthesized by macrophages of the protected hamsters with concomitant high levels of NO production. This is the first report of a vaccine conferring protection to both antimony responsive and resistant Leishmania strains reflecting several aspects of clinical visceral leishmaniasis.

Angiogenesis and schistosomal granuloma formation

An increasing amount of evidences points to angiogenesis as playing a paramount role in fibrosis development. However granulomas in general, and periovular schistosomal granulomas in particular, are considered avascular structures, although they usually result in dense areas of focal fibrosis. In order to clarify this apparent paradox, the presence of blood vessels was systematically searched in hepatic schistosomal granulomas of mice, during different stages of the infection, and at different stages of granuloma evolution, by means of vascular injections of colored masses, demonstration of laminin in vascular basement membranes and by ultra structural analysis. Vascular proliferation appeared evident at the early stages of granuloma formation, gradually decreasing thereafter, older granulomas becoming almost avascular structures, sometimes delimited at the periphery by a rich vascular network.

Accelerated neutrophil apoptosis in neutropenic patients with hepatosplenic schistosomiasis is induced by serum Fas ligand

Neutropenia in patients with hepatosplenic (HS) schistosomiasis may stem from enhanced neutrophil apoptosis. However, the molecular mechanism of neutrophil apoptosis has not been clearly defined. Neutrophils harvested from neutropenic patients with HS schistosomiasis (n = 25), non-neutropenic patients with hepatointestinal (HI) schistosomiasis (n = 10), and age- and sex-matched healthy control subjects (n = 10) were examined for the degree of apoptosis after incubation with autologous sera. Neutrophil apoptosis was quantified by flow cytometry through determination of propidium iodide nuclear staining and confirmed by DNA gel electrophoresis at 0 time (fresh neutrophil), 4 and 24 h culture. Neutrophils from healthy subjects were also incubated with either 10% heterologous normal or neutropenic serum, with and without anti-Fas ligand antibody. Serum Fas ligand levels were assessed in sera of patient groups and healthy controls by ELISA. Compared with normal controls and HI, HS group demonstrated greater neutrophil apoptosis in the presence of autologous serum (P < 0.01, < 0.05, respectively). Furthermore, compared with normal neutrophils exposed to heterologous normal serum, those exposed to heterologous neutropenic serum exhibited higher apoptosis rates (P < 0.01). The apoptotic effect of neutropenic sera is attenuated by anti-Fas ligand. Fas expression was significantly higher in HS group as compared to both HI and normal healthy controls (P < 0.05). Serum Fas ligand levels were significantly higher among HS group as compared to both HI and control groups (P < 0.01 for both). Neutrophil apoptosis was not correlated to the size of spleen in HS group. In conclusion, the rate of neutrophil apoptosis is accelerated in neutropenic HS schistosomiasis. These findings suggest that enhanced neutrophil apoptosis demonstrated in HS patients is triggered by soluble Fas ligand, which is mostly derived from spleen.

MR Findings in Eosinophilic Infiltration of the Liver

OBJECTIVE

This study describes the findings of magnetic resonance imaging (MRI) of focal eosinophilic infiltration of the liver.

METHODS

Contrast-enhanced MR images of 8 patients with focal hepatic eosinophilic infiltration were reviewed retrospectively. We evaluated the signal intensity of focal lesions in T1-weighted and T2-weighted images and the pattern of enhancement in a dynamic contrast study.

RESULTS

A total 22 focal hepatic lesions were observed; the lesions were isointense (55%) or hypointense (45%) on T1-weighted images and isointense (14%) or hyperintense (86%) on T2-weighted images. The arterial phase of the contrast study revealed 11 hyperintense lesions (50%). During the portal and delayed phases, 18 (82%) and 17 lesions (77%) were hyperintense, respectively.

CONCLUSION

The focal eosinophilic infiltrations showed homogeneous enhancement in the portal and delayed phases in the dynamic contrast MR study. These findings should help to distinguish focal eosinophilic infiltration, especially from metastasis in patients with malignancy.

Enhanced egg-induced immunopathology correlates with high IFN-gamma in murine schistosomiasis: identification of two epistatic genetic intervals

The genetic basis of dissimilar immunopathology development among mouse strains infected with Schistosoma mansoni is not known. We performed a multipoint parametric linkage analysis on a cohort of F(2) mice, offspring of brother-sister mating between (high pathology CBA x low pathology BL/6)F(1) mice, to examine whether the observed differences in the type of immune response or the extent of hepatic immunopathology are linked to any particular genomic intervals. The F(2) mice exhibited cytokine responses and immunopathologies that revealed a statistically significant correlation between prominent egg Ag-stimulated IFN-gamma production by mesenteric lymph node cells and hepatic egg granuloma size. Increased IFN-gamma production showed suggestive linkage to a dominant CBA locus on chromosome 1 and a recessive CBA locus on chromosome 5; significantly, there was an epistatic interaction between the two IFN-gamma loci. An additional locus with suggestive linkage to granuloma formation and a CBA-recessive mode of inheritance was mapped to centromeric chromosome 13. Our analysis identified the first three genetic regions that appear to influence the immunopathology in murine schistosomiasis; however, further congenic dissection studies will furnish a more precise understanding of the genetic control of this disease.

Immunological tolerance to pig-serum partially inhibits the formation of septal fibrosis of the liver in Capillaria hepatica-infected rats

Systhematized septal fibrosis of the liver can be induced in rats either by repeated intraperitoneal injections of pig-serum or by Capillaria hepatica infection. The relationship between these two etiological factors, as far as hepatic fibrosis is concerned, is not known, and present investigation attempts to investigate it. C. hepatica-induced septal fibrosis of the liver was considerably inhibited in rats previously rendered tolerant to pig-serum. Pig-serum-tolerant rats developed antibodies against pig-serum when infected with C. hepatica, but this did not happen when the infection occurred in normal rats. On the other hand, anti-C. hepatica antibodies failed to recognize any epitope in pig-serum, by Western blot. However, no evidence of an immunological cross reactivity was found, at least at the humoral level. Alternatively, cell-mediated mechanisms may be involved, and further investigations are warranted.

[Pathological changes of liver in infection of Fasciola hepatica]

Pathological changes of liver in infection of Fasciola hepatica. Fasciolosis caused by Fasciola hepatica is a hepatic parasitic infection that affects numerous mammal species, mainly ruminants, in several countries of Europe, Asia and America. The economic significance of fasciolosis is mainly due to direct losses caused by a decrease of weight rate, milking capacity and the confiscation of altered livers in slaughterhouse. In this review we present mechanisms of damaging of host liver during invasion of Fasciola hepatica. Parasites digest hepatic tissue and cause extensive parenchymal destruction with intensive haemorrhagic lesions and immunological reactions. Mechanical liver damage is due to migrating juvenile fluke. Macerated hepatic cells have been observed inside the oral sucker and pharynx. Moreover, the process of ulceration of liver tissue was observed in regions adjacent to the spiny body of fluke tegument. On the other hand, the injury of the liver can be induced chemically by factors produced or induced by the fluke. Probably, fluke proteases and other tissue-degrading enzymes can be responsible for negative effect on liver parenchyma. There is no evidence to link fluke-enzymes with tissue penetration. The consequences of liver damage resulting from the migrating flukes compromises liver function which is reflected in changes of plasma protein concentration (albumin, globulin). Additianally, changes of levels of hepatic enzymes released into the blood as a result of damage of liver tissue are used to monitor the progress of the infection in a variety of Fasciola hepatica hosts and as a sensitive diagnostic aid in field infection.

Hepatic pathology in AIDS: a pathological study from Mumbai, India

OBJECTIVES

To assess the spectrum of hepatic disorders in AIDS, liver specimens from 171 patients (155 autopsies and 16 biopsies) were reviewed.

METHODS

A retrospective and prospective study of 171 autopsy and biopsy specimens was carried out at a tertiary level hospital in Mumbai, India.

RESULTS

Of the patients included in the study, 127 (74%) were male and 44 (26%) were female. The heterosexual route was the predominant mode of HIV transmission, identified in 163 (95%) patients. A total of 99 of 171 patients (58%) showed significant pathological lesions, and the most common pathological processes involving the liver appeared to be secondary to infections. None of our patients showed isolated infectious diseases of the liver. The spectrum of liver diseases identified was as follows: tuberculosis in 70 patients (41%), cryptococcosis in eight (5%), cytomegalovirus infection in six (3%), hepatitis B infection in five (3%), candidiasis in one (0.5%), malaria in one (0.5%), cirrhosis in six (3%), amyloidosis in one (0.5%) and primary hepatic lymphoma in one (0.5%).

CONCLUSIONS

AIDS patients were found to have a high prevalence of underlying hepatic abnormalities. The spectrum of disease among patients with AIDS in India differs from that in developed countries. Our results suggest that hepatic tuberculosis is more common in AIDS than previously recognized, and that liver specimens should be examined routinely for the presence of acid-fast bacilli.

Schistosomal hepatopathy

Gross anatomical features and a complex set of vascular changes characterize schistosomal hepatopathy as a peculiar form of chronic liver disease, clinically known as "hepatosplenic schistosomiasis". It differs from hepatic cirrhosis, although clinical and pathological aspects may sometimes induce confusion between these two conditions. Intrahepatic portal vein obstruction and compensatory arterial hypertrophy render the hepatic parenchyma vulnerable to ischemic insult. This may lead to focal necrosis, which may give place to focal post-necrotic scars. These events are of paramount importance for the clinico-pathological evolution of schistosomal hepatopathy. Although portal fibrosis due to schistosomiasis sometimes reveals numerous myofibroblasts, it does not mean that such fibrosis belongs to a peculiar type. Damage to the muscular walls of the portal vein may be followed by dissociation of smooth muscle cells and their transition toward myofibroblasts, which appear only as transient cells in schistosomal portal fibrosis. Studies made with plastic vascular casts, especially those with the murine model of "pipestem" fibrosis have helped to reveal the mechanisms involved in systematized portal fibrosis formation. However, the factors involved in the pathogenesis of hepatosplenic disease remain poorly understood. A process of chronic hepatitis is a common accompaniment of portal fibrosis in schistosomiasis. Most of the times it is caused by concomitant viral infection. However, no special interaction seems to exist between schistosomal hepatopathy and viral hepatitis.

Lesions in the liver of guinea-pigs infected with the swine lungworm, Metastrongylus apri

Clear spot lesions were formed on the liver surface in guinea-pigs repeatedly infected with swine lungworm, Metastrongylus apri. The largest lesion, measuring 0.25 cm in diameter, was hard and yellow and showed a large granuloma in the lobule. The nematode larva was located at the centre of the lesion. This finding is likely to be an example of erratic parasitism in guinea-pigs with metastrongylidiasis.

Hypertensive portal colopathy in schistosomiasis mansoni: proposal for a classification

Portal hypertension is a frequent complication of chronic liver disease, detected not only in schistosomiasis, but also in cirrhosis of any etiology. Vascular alterations in the colonic mucosa are a potential source for acute or chronic bleeding and have been observed in patients with portal hypertension. The purpose of this prospective study was to describe and propose a classification for the vascular alterations of portal hypertension in the colonic mucosa among patients with hepatosplenic schistosomiasis mansoni. One or more alterations of portal colopathy were observed in all patients and they were classified according to their intensity, obeying the classification proposed by the authors. Portal colopathy is an important finding in hepatosplenic schistosomiasis and might be the cause of lower gastrointestinal bleeding in patients with severe portal hypertension.

The pathogenesis of schistosomiasis is controlled by cooperating IL-10-producing innate effector and regulatory T cells

IL-10 reduces immunopathology in many persistent infections, yet the contribution of IL-10 from distinct cellular sources remains poorly defined. We generated IL-10/recombination-activating gene (RAG)2-deficient mice and dissected the role of T cell- and non-T cell-derived IL-10 in schistosomiasis by performing adoptive transfers. In this study, we show that IL-10 is generated by both the innate and adaptive immune response following infection, with both sources regulating the development of type-2 immunity, immune-mediated pathology, and survival of the infected host. Importantly, most of the CD4(+) T cell-produced IL-10 was confined to a subset of T cells expressing CD25. These cells were isolated from egg-induced granulomas and exhibited potent suppressive activity in vitro. Nevertheless, when naive, naturally occurring CD4(+)CD25(+) cells were depleted in adoptive transfers, recipient IL-10/RAG2-deficient animals were more susceptible than RAG2-deficient mice, confirming an additional host-protective role for non-T cell-derived IL-10. Thus, innate effectors and regulatory T cells producing IL-10 cooperate to reduce morbidity and prolong survival in schistosomiasis.