• Parasitology / Volume 138 / Issue 02 / February 2011, pp 139-159
  • Copyright © Cambridge University Press 2010 The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence <http://creative>. The written permission of Cambridge University Press must be obtained for commercial re-use.
  • DOI: (About DOI), Published online: 15 October 2010

Review Article

Acquired immune heterogeneity and its sources in human helminth infection

C. D. BOURKEa1 c1, R. M. MAIZELSa1 and F. MUTAPIa1

a1 Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, West Mains Road, EH9 3JT


Similarities in the immunobiology of different parasitic worm infections indicate that co-evolution of humans and helminths has shaped a common anti-helminth immune response. However, recent in vitro and immuno-epidemiological studies highlight fundamental differences and plasticity within host-helminth interactions. The ‘trade-off’ between immunity and immunopathology inherent in host immune responses occurs on a background of genetic polymorphism, variable exposure patterns and infection history. For the parasite, variation in life-cycle and antigen expression can influence the effector responses directed against them. This is particularly apparent when comparing gastrointestinal and tissue-dwelling helminths. Furthermore, insights into the impact of anti-helminthic treatment and co-infection on acquired immunity suggest that immune heterogeneity arises not from hosts and parasites in isolation, but also from the environment in which immune responses develop. Large-scale differences observed in the epidemiology of human helminthiases are a product of complex host-parasite-environment interactions which, given potential for exposure to parasite antigens in utero, can arise even before a parasite interacts with its human host. This review summarizes key differences identified in human acquired immune responses to nematode and trematode infections of public health importance and explores the factors contributing to these variations.

(Received July 12 2010)

(Revised July 18 2010)

(Accepted July 18 2010)

(Online publication October 15 2010)


c1 Corresponding author: Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, West Mains Road, Edinburgh, EH9 3JT. Tel: +44 (0)131 6505445. E-mail: