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The Bifacial Role of Helminths in Cancer: Involvement of Immune and Non-Immune Mechanisms

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The Bifacial Role of Helminths in Cancer: Involvement of Immune and Non-Immune Mechanisms http://informahealthcare.com/lab ISSN: 1040-8363 (print), 1549-781X (electronic) Crit Rev Clin Lab Sci, 2014; 51(3): 138–148 ! 2014 Informa Healthcare USA, Inc. DOI: 10.3109/10408363.2014.886180 REVIEW ARTICLE The bifacial role of helminths in cancer: Involvement of immune and non-immune mechanisms Katerina Oikonomopoulou1, Davor Brinc2, Andreas Hadjisavvas3, Georgios Christofi4, Kyriacos Kyriacou3, and Eleftherios P. Diamandis1,2 1Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada, 2Department of Clinical Biochemistry, University Health Network, Toronto, Ontario, Canada, 3Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus, and 4Department of Veterinary Services, Ministry of Agriculture, Natural Resources and Environment, Nicosia, Cyprus Abstract Keywords Infectious agents have been associated with cancer due to activation of pro-carcinogenic Cancer, helminths, immunity, infection, inflammatory processes within their host. Several reports, however, indicate that specific inflammation pathogens may be able to elicit anti-tumor immune responses that can lead to protection from tumorigenesis or cancer regression. Amongst these ‘‘beneficial’’ pathogens are some History helminthic parasites that have already been connected with prevention of autoimmune diseases and allergies, immune conditions increasingly associated with cancer. Even though Received 15 August 2013 helminths have co-existed with humans and their ancestors for millions of years, investigations Revised 11 December 2013 of their impact on human (patho)physiology are relatively new and the functions of Accepted 25 December 2013 components that can explain the helminth bi-directional influence on carcinogenesis are not Published online 3 March 2014 well understood. This review aims to discuss evidence for the helminth-induced immune, genetic, epigenetic, proteomic, hormonal and metabolic changes that may ultimately mediate the potential pro- or anti-carcinogenic role of helminths. This overview may serve future investigations in clarifying the tumorigenic role of the most common helminthic parasites. For personal use only. It may also inspire the development of anti-cancer regimens and vaccines, in parallel to ongoing efforts of using helminth-based components for the prevention and/or treatment of autoimmune diseases and allergies. Abbreviations: AID: activation-induced cytidine deaminase; APC: adenomatous polyposis coli; BCG: Bacillus Calmette-Gue´rin; CXCL8: CXC ligand 8, also known as interleukin 8 (IL-8); FDA: Food and Drug Administration; GST: glutathione-S-transferase; HDAC: histone deacetylases; IARC: International Agency for Research on Cancer; IBD: inflammatory bowel disease; IFNc: interferon gamma; IgG: immunoglobulin G; IL-10: interleukin 10; Myc: a regulator gene that encodes for a transcription factor; NF-iB: nuclear factor kappa-light-chain-enhancer of activated B cells is a DNA transcription factor; p53: tumor protein 53 is a tumour suppressor; RARb2: retinoic acid receptor b2 gene; KRas: Kirsten rat sarcoma oncogene; RET: oncogene encoding a receptor tyrosine kinase for members of the glial cell line-derived neurotrophic factor family; RNS: reactive nitrogen species; ROS: reactive oxygen species; SCFA: short-chain fatty acids; STAT3: signal transducer and activator of transcription 3; SHE: Syrian hamster embryo; T: Thomsen–Friedenreich mucin-type carbohydrate antigen; TGFb: transforming growth factor beta; Th cells: T helper cells; TLR: Toll-like receptors; Tn: precursor of Thomsen– Critical Reviews in Clinical Laboratory Sciences Downloaded from informahealthcare.com by University of Toronto on 01/23/15 Friedenreich antigen; TNFa: tumor necrosis factor alpha; Tregs: regulatory T cells; TSO: Trichuris suis ova; VIP: vasoactive intestinal polypeptide. Introduction Referee: Dr., Morley D. Hollenberg, Department of Physiology and Infections and pathogen-induced inflammation have generally Pharmacology, University of Calgary, Calgary, Alberta, Canada. been considered to favor carcinogenesis1,2, taking the blame Address for correspondence: Dr Eleftherios P. Diamandis, Department of 3 Pathology and Laboratory Medicine, Mount Sinai Hospital, 60 Murray for an estimated 15.6% of all cancer cases worldwide . Street, Room L6-201, Toronto, ON M5T 3L9, Canada. Tel: 416 586- Helminths are among the parasites investigated for their 8443. Fax: 416 619-5521. E-mail: [email protected] adverse carcinogenic effects on their hosts4,5. A strong Dr Katerina Oikonomopoulou, Department of Pathology and Laboratory association between Schistosoma haematobium and urinary Medicine, Mount Sinai Hospital, 60 Murray Street, Room L6-201, Toronto, ON M5T 3L9, Canada. Tel: 416 586-4800; ext. 8813. Fax: 416 bladder cancer has been historically reported as early as 1911 619-5521. E-mail: [email protected] and confirmed by later reports6. The possible relationship DOI: 10.3109/10408363.2014.886180 Helminths and Cancer 139 between helminthic infections and cancer also came under the More specifically, the immune response to helminths can spotlight with the famous observations by Johanes Fibiger on involve several innate and adaptive molecular and cellular the induction of gastric cancer in rats by the helminth components20,21. Host tissue responds to the parasite at the Spiroptera carcinoma, that awarded him a Nobel Prize in portal of entry (e.g. gastrointestinal mucosa); innate immune Physiology or Medicine in 19267. Even though Fibiger’s data cells (e.g. macrophages, dendritic cells, mast cells), as well as had been considered highly debatable and contradictory, non-immune parenchymal cells respond to parasites by according to later reports, they clearly inspired thinking about activation of antigen processing/presentation, cell migration the association of helminth infections with malignancy. and cytokine secretion. Response of local tissue, as well as In contrast to promoting cancer, a few reports have also tissue with specialized immune function (e.g. Payer’s patches provided evidence that certain types of pathogens can decrease in gastrointestinal mucosa, draining lymph nodes), leads to cancer risk or facilitate tumor regression2. In this regard, the engagement of T and B cells20,21. The fully developed hygiene hypothesis, which postulates that the rise of allergic response to parasites is often characterized as a Th1 or a Th2- and autoimmune pathologies in Western societies is the result type response, presenting as classical or alternative inflam- of reduced exposure to certain pathogens at a young age8–13, mation20–23. The overall immune response aims to achieve has also been re-evaluated to explain the increased number of parasite control and expulsion while, at the same time, some types of cancer in economically-developed countries1. regulating host pathology and supporting the pathogen life Specifically, helminths have been proposed as playing a cycle. This is often achieved by a balanced Th1/Th2 response central role in the formation of the hygiene hypothesis14. or by the activation of immune regulatory pathways involving Nowadays, the International Agency for Research on Tregs (e.g. CD4+CD25+Foxp3+), as well as immune regula- Cancer (IARC) recognizes the role of helminths in promoting tory cytokines (IL-10, TGFb)20–22. The Th1/Th2 balanced carcinogenesis15. However, reports about their potential anti- response that is accompanied by an immune regulatory carcinogenic role are still sparse. This review promotes the component is often described as a ‘‘modified’’ Th1 or Th2 idea that the influence of helminthic infections on their host response. The result is an attenuated host inflammatory may occur in a complex and context-dependent fashion that response, as well as a less effective adaptive immune may either promote or inhibit carcinogenesis. Our goal is to response. overview some of the helminth-induced mechanisms that The actual type of response can vary according to either directly, or through other pathways, influence cancer individual species of infectious agents and can also change genesis or progression. While the balance of the ideas during the course of an infection. For example, a Th1 discussed in this review tips in favor of the role of the immune response is followed by a Th2 response in Schistosoma system in the helminth-induced carcinogenic changes, other mansoni and Echinococcus granulosus infections; the Th2 potential inter-connected or independent mechanisms are also response predominates and is essential for worm expulsion in presented and discussed. Heligmosomoides polygyrus; and a mixed Th1/Th2 response 21,24 For personal use only. develops in Trichuris muris murine infections . Disease progression and treatment can also be associated with these Parallel-to-humans helminth evolution and changes: for example, in patients undergoing chemotherapy anti-helminth immunity for E. granulosus, a Th1 cytokine profile predominates, while Several interactions between various microorganisms and the in case of a relapse, the profile shifts to a Th2 dominance25,26. human host have occurred as the human population moved As discussed below, the host immune response to helminths from the hunter–gatherer lifestyle to the domestication of may be of relevance to cancer, as it may either locally or animals and the development of agriculture14. Taking advan- systemically modify long-term pro-inflammatory or anti- tage of these new settings, some
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