Cytokine induction and exploitation in schistosome infections

Schistosome parasites, despite being multicellular organisms several millimetres in length, can survive in the bloodstream of mammalian hosts for decades. The remarkable and complex adaptation exemplified in the host-parasite relationship in schistosomiasis may include not only immune evasion by the parasite, but also immune exploitation. While the developmental and adult stages of the parasite are by and large invisible to the immune response, the parasite egg induces a granulomatous reaction which not only protects the host from a diffusible parasite toxin, but also is required for normal transmission of parasite eggs from the host to the external environment. Other possible mechanisms of immune exploitation by schistosomes are discussed including skewing of cytokine responses, effects of cytokines on worm fecundity, exploitation of endothelial cell adherence, and induction of IgE.