Weinstock Joel V
Division of Gastroenterology (Box 233), Tufts Medical Center, 800 Washington St., Boston, MA, 02111, USA.
Clin Rev Allergy Immunol. 2015 Oct;49(2):227-31. doi: 10.1007/s12016-014-8458-3.
Many immune-mediated diseases like inflammatory bowel disease, multiple sclerosis, type 1 diabetes, asthma, and food allergy appeared to have increased in frequency in developed countries in the latter part of the twentieth century. Reports from less developed countries suggest that the "epidemic" of immune-mediated diseases now is spreading into these regions as well. The "hygiene hypothesis" was developed to partly explain this phenomenon. It has been proposed that modern-day sanitary living has altered our exposure to organisms that provided protection from these diseases in the past. Alternations in the composition of our intestinal flora and fauna could play a role. Helminths are a group of worm-like parasitic organisms that have adapted to live in various regions of their hosts. Epidemiological and some clinical data suggest that these organisms can protect people from developing immune-mediated diseases. Animal experimentation has shown that helminths stimulate the production of regulatory cytokines, activate regulatory T cells, and induce regulatory dendritic cells and macrophages. This could be the mechanism by which they protect the host from these diseases. Early clinical studies also suggest that helminths may prove useful for treating immunological diseases. More sophisticated clinical studies are underway, testing live helminth agents as therapeutic agents. Also, a strong effort is ongoing to discover the agents produced by helminths that modulate host immune responses with an eye on developing new, highly effective immune modulatory therapeutic agent.
许多免疫介导的疾病，如炎症性肠病、多发性硬化症、1型糖尿病、哮喘和食物过敏，在20世纪后期在发达国家的发病率似乎有所上升。来自欠发达国家的报告表明，免疫介导疾病的“流行”现在也正在蔓延到这些地区。“卫生假说”的提出部分是为了解释这一现象。有人提出，现代的卫生生活方式改变了我们接触过去能为这些疾病提供保护的生物体的机会。我们肠道动植物群组成的改变可能起了作用。蠕虫是一类适应生活在宿主不同部位的类似蠕虫的寄生生物。流行病学和一些临床数据表明，这些生物可以保护人们免受免疫介导疾病的侵害。动物实验表明，蠕虫能刺激调节性细胞因子的产生，激活调节性T细胞，并诱导调节性树突状细胞和巨噬细胞。这可能是它们保护宿主免受这些疾病侵害的机制。早期临床研究也表明，蠕虫可能被证明对治疗免疫性疾病有用。更复杂的临床研究正在进行中，测试活蠕虫制剂作为治疗剂。此外，人们正在大力努力发现蠕虫产生的调节宿主免疫反应的物质，着眼于开发新的、高效的免疫调节治疗剂。
