RESUMEN
The pathogenesis of neuroschistosomiasis is largely unknown. Available evidence suggests that it depends on the presence of parasite eggs in the nervous tissue and on the host's immune response. We investigated the presence of immune complexes (ICs) in the cerebrospinal fluid (CSF) of four patients with spinal cord schistosomiasis (SCS), and performed their characterization. ICs containing soluble egg antigen of Schistosoma mansoni (SEA) were found in the CSF of all the SCS patients. To our knowledge, this is the first evidence of ICs containing schistosomal antigens in the CSF of patients with SCS. Further studies are necessary to confirm our findings and investigate the possible roles of ICs in the pathogenesis of this disease.
Asunto(s)
Complejo Antígeno-Anticuerpo/líquido cefalorraquídeo , Antígenos Helmínticos/líquido cefalorraquídeo , Neuroesquistosomiasis/líquido cefalorraquídeo , Esquistosomiasis mansoni/líquido cefalorraquídeo , Enfermedades de la Médula Espinal/líquido cefalorraquídeo , Complejo Antígeno-Anticuerpo/inmunología , Antígenos Helmínticos/inmunología , Western Blotting , Electroforesis en Gel de Poliacrilamida , Humanos , Neuroesquistosomiasis/inmunología , Esquistosomiasis mansoni/inmunología , Enfermedades de la Médula Espinal/inmunologíaRESUMEN
The involvement of the central nervous system (CNS) by schistosomes may or may not determine clinical manifestations. When symptomatic, neuroschistosomiasis (NS) is one of the most severe presentations of schistosome infection. Considering the symptomatic form, Schistosoma mansoni causes almost always spinal cord disease. Cerebral and spinal cord disorders in S. mansoni infections are inflammatory conditions of the CNS that cause mild-moderate impairment of the blood-brain barrier and intrathecal synthesis of antibodies against schistosomal antigens. Little is known about the pathogenesis of NS, but available evidence strongly suggests that it depends basically on the presence of parasite eggs in the nervous tissue and on the host's immune response against the trapped eggs. Numerous eggs surrounded by granulomas lodged together in circumscribed areas of the CNS damage the nervous tissue by both the mass effect and the egg-induced inflammatory reaction. Vasculitis of immune etiology, which causes isquemic lesions, may also play an important role in the genesis of the neurological symptoms. Although the mechanisms involved in the immunophatogenesis of NS are largely unknown, initial investigations on cerebrospinal fluid (CSF) and serum cytokine profiles suggest the occurrence of inflammation as well as a skewed Th2 immune response that probably occur both locally and systemically.
Asunto(s)
Neuroesquistosomiasis/inmunología , Neuroesquistosomiasis/patología , Schistosoma mansoni/inmunología , Esquistosomiasis mansoni/complicaciones , Esquistosomiasis mansoni/inmunología , Animales , Encefalopatías/parasitología , Encefalopatías/patología , Humanos , Enfermedades de la Médula Espinal/parasitología , Enfermedades de la Médula Espinal/patologíaRESUMEN
Schistosomal myeloradiculopathy (SMR) is the most common neurological form of Schistosoma mansoni infection. In this study we investigated the expression of chemokines and Th2 cytokines in serum and cerebral spinal fluid (CSF) of SMR patients. SMR patients presented increased serum levels of CCL11/eotaxin and CCL24/eotaxin-2 when compared to controls. SMR patients also had higher levels of IL-13 in CSF. Thus, SMR patients present enhancement of both IL-13 and CCR3 acting chemokines, both of which may facilitate the expression of a Th2 response and Th2-dependent damage to the spinal cord. As this cytokine is responsible for promoting Th2 responses, this finding is in accordance to the view that Th2 cells are important in the immunological process against the S. mansoni.
Asunto(s)
Quimiocinas/sangre , Quimiocinas/líquido cefalorraquídeo , Citocinas/sangre , Citocinas/líquido cefalorraquídeo , Neuroesquistosomiasis/inmunología , Schistosoma mansoni/inmunología , Células Th2/inmunología , Adolescente , Adulto , Animales , Femenino , Humanos , Masculino , Neuroesquistosomiasis/sangre , Neuroesquistosomiasis/líquido cefalorraquídeoRESUMEN
We investigate the cytokine profile in the cerebrospinal fluid (CSF) and serum of patients with spinal cord schistosomiasis (SCS). Increased levels of IL-1beta, IL-4, IL-6 and IL-10 and low concentrations of TNF-alpha and IFN-gamma were observed in both CSF and serum. CSF showed higher levels of IL-4 and IL-6 when compared to the paired serum samples. A negative correlation between the concentrations of IL-10 and IFN-gamma was observed in the CSF. These findings suggest an inflammatory as well as a skewed type-2 immune response that probably occur both locally and systemically and may be involved in the pathogenesis of SCS.
Asunto(s)
Líquido Cefalorraquídeo/inmunología , Líquido Cefalorraquídeo/parasitología , Citocinas/líquido cefalorraquídeo , Neuroesquistosomiasis/líquido cefalorraquídeo , Neuroesquistosomiasis/inmunología , Enfermedades de la Médula Espinal/líquido cefalorraquídeo , Enfermedades de la Médula Espinal/inmunología , Animales , Citocinas/análisis , Citocinas/sangre , Regulación hacia Abajo/inmunología , Humanos , Interferón gamma/análisis , Interferón gamma/sangre , Interferón gamma/líquido cefalorraquídeo , Interleucinas/análisis , Interleucinas/sangre , Interleucinas/líquido cefalorraquídeo , Mielitis/líquido cefalorraquídeo , Mielitis/inmunología , Mielitis/parasitología , Neuroesquistosomiasis/diagnóstico , Valor Predictivo de las Pruebas , Schistosoma mansoni/inmunología , Enfermedades de la Médula Espinal/parasitología , Factor de Necrosis Tumoral alfa/análisis , Factor de Necrosis Tumoral alfa/líquido cefalorraquídeo , Regulación hacia Arriba/inmunologíaRESUMEN
By analogy with other infections of the central nervous system (CNS), it is believed that schistosomal myeloradiculopathy (SMR) is an entity that may involve a mild-to-moderate degree of impairment of the blood-brain barrier along with intrathecal synthesis of antibodies. The first of these aspects is obvious but the second has not been clearly demonstrated. This study was undertaken in Brazil with the aim of investigating the production of immunoglobulin G (IgG) within the CNS in patients with SMR, by the determination of the cerebrospinal fluid (CSF) IgG index. The study population included 54 patients with SMR, evaluated prospectively. The CSF IgG index was increased in 43 of them (80%). Preliminary results from our laboratory suggest that these antibodies are reactive against Schistosoma mansoni antigens. Thus, this finding also suggests that this index may be useful in the differential diagnosis of SMR.