Are intestinal worms nature’s anti-atherosclerosis vaccine?

Are intestinal worms nature’s anti-atherosclerosis vaccine? DISCUSSION FORUM European Heart Journal (2018) 39, 1653 doi:10.1093/eurheartj/ehy129 Are intestinal worms nature’s anti-atherosclerosis vaccine? 1 2 3 Michael D. Gurven *, Caleb E. Finch , and Lee S. Wann 1 2 Department of Anthropology, Integrative Anthropological Sciences Unit, University of California Santa Barbara, Santa Barbara, CA 93106, USA; Leonard Davis School of Gerontology & Dornsife College, 3715 McClintock Ave, University of Southern California, Los Angeles, CA 90089, USA; and Columbia St. Mary’s Hospital, Wisconsin Cardiovascular Group, 2350 N. Lake Drive, Milwaukee, WI 53211, USA Online publish-ahead-of-print 11 April 2018 This commentary refers to ‘Infections, atherosclerosis, and Other findings are consistent with potential athero-protective ef- coronary heart disease’, by N.V.K. Pothineni et al., 2017;38: fects of helminths (see Table 1, Ref. 2). For example, patients with 3195–3201. schistosomal infections had lower glycated haemoglobin, triglycerides and LDL. In Siberia, patients with Opisthochis felineus had smaller ath- Pothineni et al. provide an excellent up-to-date review of how bac- erosclerotic lesions in the thoracic and aortic arteries that varied in- terial and viral infections might promote atherosclerosis. versely with worm density. Additionally, we must consider that some pathogens such as hel- Throughout human history, helminth burdens have fluctuated, but minths might protect against atherosclerosis. Helminths, such as their current absence is specific to industrialized, urban environs. hookworm, roundworm, and some water-borne helminths, have co- Under novel conditions of obesogenic diets and physical inactivity existed with humans for millennia and represent a major feature of introduced in recent history, the absence of helminths may produce human disease ecology. The long-evolved strategies of intestinal hel- maladaptive outcomes. Exploring the role of helminths in the pro- minths include drawing metabolic resources from their host, includ- gression of atherosclerosis merits further attention. ing blood lipids and glucose, as well as modulating immune function . Conflict of interest: none declared. towards greater T 2 (anti-inflammatory) polarization. These . helminth-induced alterations may be factors in slowing atheroma . 2 . progression, and diminishing atherosclerotic plaque rupture. . References 1. Pothineni NVK, Subramany S, Kuriakose K, Shirazi LF, Romeo F, Shah PK, Mehta Ongoing studies with Tsimane forager-farmers of the Bolivian . JL. Infections, atherosclerosis, and coronary heart disease. Eur Heart J 2017;38: Amazon suggest possible cardioprotective effects of helminths. . 3195–3201. Tsimane have the lowest levels of coronary arterial calcification 2. Gurven MD, Trumble BC, Stieglitz J, Blackwell AD, Michalik DE, Finch CE, Kaplan HS. Cardiovascular disease and type 2 diabetes in evolutionary perspective: a crit- (CAC) ever reported. By age 80, Tsimane have 80% less CAC than . ical role for helminths? Evol Med Public Health 2016;2016:338–357. ‘healthy’ US adults from Multi-Ethnic Study of Atherosclerosis. 3. Kaplan H, Thompson RC, Trumble BC, Wann LS, Allam AH, Beheim B, However, Tsimane suffer chronic systemic inflammation from mul- Frohlich B, Sutherland ML, Sutherland JD, Stieglitz J, Rodriguez DE, Michalik DE,Rowan CJ,LombardiGP, Bedi R, Garcia AR, Min JK,NarulaJ,Finch CE, tiple infections, which are their main cause of morbidity and mortality. Gurven M, Thomas GS. Coronary atherosclerosis in indigenous South Serial measurements show elevated C-reactive protein (CRP), American Tsimane: a cross-sectional cohort study. Lancet 2017;389: interleukin-6 (IL-6), and other inflammatory markers. 1730–1739. . 4. Blackwell AD, Trumble BC, Maldonado Suarez I, Stieglitz J, Beheim BA, Snodgrass Most (70%) of Tsimane carry at least one helminth. Biomarkers of JJ, Kaplan H, Gurven M. Immune function in Amazonian horticulturalists. Ann Hum helminthic infection (IgE, eosinophils) vary inversely with total choles- Biol 2016;43:382–396. terol, low-density lipoprotein (LDL), and high-density lipoprotein. 5. Vasunilashorn S, Crimmins EM, Kim JK, Winking J, Gurven M, Kaplan H, Finch CE. . Blood lipids, infection, and inflammatory markers in the Tsimane of Bolivia. Am J Total cholesterol is almost 10 mg/dL (0.26 mmol/L) lower among Hum Biol 2010;22:731–740. those with elevated CRP and IL-6 and 19 mg/dL (0.49 mmol/L) lower with elevated IgE. * Corresponding author. Tel: þ1-805-893-2202, Fax: þ1-805-893-8707, Email: gurven@anth.ucsb.edu Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/18/1653/4967832 by Ed 'DeepDyve' Gillespie user on 21 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

Are intestinal worms nature’s anti-atherosclerosis vaccine?

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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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Abstract

DISCUSSION FORUM European Heart Journal (2018) 39, 1653 doi:10.1093/eurheartj/ehy129 Are intestinal worms nature’s anti-atherosclerosis vaccine? 1 2 3 Michael D. Gurven *, Caleb E. Finch , and Lee S. Wann 1 2 Department of Anthropology, Integrative Anthropological Sciences Unit, University of California Santa Barbara, Santa Barbara, CA 93106, USA; Leonard Davis School of Gerontology & Dornsife College, 3715 McClintock Ave, University of Southern California, Los Angeles, CA 90089, USA; and Columbia St. Mary’s Hospital, Wisconsin Cardiovascular Group, 2350 N. Lake Drive, Milwaukee, WI 53211, USA Online publish-ahead-of-print 11 April 2018 This commentary refers to ‘Infections, atherosclerosis, and Other findings are consistent with potential athero-protective ef- coronary heart disease’, by N.V.K. Pothineni et al., 2017;38: fects of helminths (see Table 1, Ref. 2). For example, patients with 3195–3201. schistosomal infections had lower glycated haemoglobin, triglycerides and LDL. In Siberia, patients with Opisthochis felineus had smaller ath- Pothineni et al. provide an excellent up-to-date review of how bac- erosclerotic lesions in the thoracic and aortic arteries that varied in- terial and viral infections might promote atherosclerosis. versely with worm density. Additionally, we must consider that some pathogens such as hel- Throughout human history, helminth burdens have fluctuated, but minths might protect against atherosclerosis. Helminths, such as their current absence is specific to industrialized, urban environs. hookworm, roundworm, and some water-borne helminths, have co- Under novel conditions of obesogenic diets and physical inactivity existed with humans for millennia and represent a major feature of introduced in recent history, the absence of helminths may produce human disease ecology. The long-evolved strategies of intestinal hel- maladaptive outcomes. Exploring the role of helminths in the pro- minths include drawing metabolic resources from their host, includ- gression of atherosclerosis merits further attention. ing blood lipids and glucose, as well as modulating immune function . Conflict of interest: none declared. towards greater T 2 (anti-inflammatory) polarization. These . helminth-induced alterations may be factors in slowing atheroma . 2 . progression, and diminishing atherosclerotic plaque rupture. . References 1. Pothineni NVK, Subramany S, Kuriakose K, Shirazi LF, Romeo F, Shah PK, Mehta Ongoing studies with Tsimane forager-farmers of the Bolivian . JL. Infections, atherosclerosis, and coronary heart disease. Eur Heart J 2017;38: Amazon suggest possible cardioprotective effects of helminths. . 3195–3201. Tsimane have the lowest levels of coronary arterial calcification 2. Gurven MD, Trumble BC, Stieglitz J, Blackwell AD, Michalik DE, Finch CE, Kaplan HS. Cardiovascular disease and type 2 diabetes in evolutionary perspective: a crit- (CAC) ever reported. By age 80, Tsimane have 80% less CAC than . ical role for helminths? Evol Med Public Health 2016;2016:338–357. ‘healthy’ US adults from Multi-Ethnic Study of Atherosclerosis. 3. Kaplan H, Thompson RC, Trumble BC, Wann LS, Allam AH, Beheim B, However, Tsimane suffer chronic systemic inflammation from mul- Frohlich B, Sutherland ML, Sutherland JD, Stieglitz J, Rodriguez DE, Michalik DE,Rowan CJ,LombardiGP, Bedi R, Garcia AR, Min JK,NarulaJ,Finch CE, tiple infections, which are their main cause of morbidity and mortality. Gurven M, Thomas GS. Coronary atherosclerosis in indigenous South Serial measurements show elevated C-reactive protein (CRP), American Tsimane: a cross-sectional cohort study. Lancet 2017;389: interleukin-6 (IL-6), and other inflammatory markers. 1730–1739. . 4. Blackwell AD, Trumble BC, Maldonado Suarez I, Stieglitz J, Beheim BA, Snodgrass Most (70%) of Tsimane carry at least one helminth. Biomarkers of JJ, Kaplan H, Gurven M. Immune function in Amazonian horticulturalists. Ann Hum helminthic infection (IgE, eosinophils) vary inversely with total choles- Biol 2016;43:382–396. terol, low-density lipoprotein (LDL), and high-density lipoprotein. 5. Vasunilashorn S, Crimmins EM, Kim JK, Winking J, Gurven M, Kaplan H, Finch CE. . Blood lipids, infection, and inflammatory markers in the Tsimane of Bolivia. Am J Total cholesterol is almost 10 mg/dL (0.26 mmol/L) lower among Hum Biol 2010;22:731–740. those with elevated CRP and IL-6 and 19 mg/dL (0.49 mmol/L) lower with elevated IgE. * Corresponding author. Tel: þ1-805-893-2202, Fax: þ1-805-893-8707, Email: gurven@anth.ucsb.edu Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/18/1653/4967832 by Ed 'DeepDyve' Gillespie user on 21 June 2018

Journal

European Heart JournalOxford University Press

Published: Apr 11, 2018

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