Andrea L. Graham

Decomposing health: tolerance and resistance to parasites in animals.

Plant biologists have long recognized that host defence against parasites and pathogens can be divided into two conceptually different components: the ability to limit parasite burden (resistance) and the ability to limit the harm caused by a given burden (tolerance). Together these two components determine how well a host is protected against the effects of parasitism. This distinction is useful because it recognizes that hosts that are best at controlling parasite burdens are not necessarily the healthiest. Moreover, resistance and tolerance can be expected to have different effects on the epidemiology of infectious diseases and host–parasite coevolution. However, studies of defence in animals have to date focused on resistance, whereas the possibility of tolerance and its implications have been largely overlooked. The aim of our review is to (i) describe the statistical framework for analysis of tolerance developed in plant science and how this can be applied to animals, (ii) review evidence of genetic and environmental variation for tolerance in animals, and studies indicating which mechanisms could contribute to this variation, and (iii) outline avenues for future research on this topic.

Ecological rules governing helminth–microparasite coinfection

Coinfection of a host by multiple parasite species has important epidemiological and clinical implications. However, the direction and magnitude of effects vary considerably among systems, and, until now, there has been no general framework within which to explain this variation. Community ecology has great potential for application to such problems in biomedicine. Here, metaanalysis of data from 54 experiments on laboratory mice reveals that basic ecological rules govern the outcome of coinfection across a broad spectrum of parasite taxa. Specifically, resource-based (“bottom-up”) and predator-based (“top-down”) control mechanisms combined to determine microparasite population size in helminth-coinfected hosts. Coinfection imposed bottom-up control (resulting in decreased microparasite density) when a helminth that causes anemia was paired with a microparasite species that requires host red blood cells. At the same time, coinfection impaired top-down control of microparasites by the immune system: the greater the helminth-induced suppression of the inflammatory cytokine interferon (IFN)-γ, the greater the increase in microparasite density. These results suggest that microparasite population growth will be most explosive when underlying helminths do not impose resource limitations but do strongly modulate IFN-γ responses. Surprisingly simple rules and an ecological framework within which to analyze biomedical data thus emerge from analysis of this dataset. Through such an interdisciplinary lens, predicting the outcome of coinfection may become tractable.

Fitness Correlates of Heritable Variation in Antibody Responsiveness in a Wild Mammal

Self-Recognition and Survival Soay sheep are a remnant of an ancient breed of sheep that, although intensively studied for many years, live unmanaged on the remote Scottish island of St. Kilda. Life is harsh on the island, and the numbers of sheep show cycles of winter population crashes and high exposure to infection. Graham et al. (p. 662; see the Perspective by Martin and Coon) measured levels of self-reactive antibodies in the sheep called antinuclear antibodies (ANA). Having high ANA levels was a heritable trait that reflected generally high levels of immunoglobulin in individuals and of specific antibodies to parasitic worms. Female sheep with high levels of ANAs survived better during crash years, but had fewer births. If these sheep did reproduce, although the lambs tended to be small, they tended to have higher rates of early survival. Thus, maintaining high antibody levels apparently reflected investment in immunity and greater survival, but doing so was also associated with reduced reproductive success. In Soay sheep, self-reactive antibodies are indicators of an evolutionary trade-off between survival and reproduction. A functional immune system is important for survival in natural environments, where individuals are frequently exposed to parasites. Yet strong immune responses may have fitness costs if they deplete limited energetic resources or cause autoimmune disease. We have found associations between fitness and heritable self-reactive antibody responsiveness in a wild population of Soay sheep. The occurrence of self-reactive antibodies correlated with overall antibody responsiveness and was associated with reduced reproduction in adults of both sexes. However, in females, the presence of self-reactive antibodies was positively associated with adult survival during harsh winters. Our results highlight the complex effects of natural selection on immune responsiveness and suggest that fitness trade-offs may maintain immunoheterogeneity, including genetic variation in autoimmune susceptibility.

Animal Defenses against Infectious Agents: Is Damage Control More Important Than Pathogen Control?

The ability of hosts to withstand a given number of pathogens is a critical component of health. Now playing catch-up with plant biologists, animal biologists are starting to formally separate this form of defense from classical resistance.

Malaria-Filaria Coinfection in Mice Makes Malarial Disease More Severe unless Filarial Infection Achieves Patency

Coinfections are common in natural populations, and the literature suggests that helminth coinfection readily affects how the immune system manages malaria. For example, type 1-dependent control of malaria parasitemia might be impaired by the type 2 milieu of preexisting helminth infection. Alternatively, immunomodulatory effects of helminths might affect the likelihood of malarial immunopathology. Using rodent models of lymphatic filariasis (Litomosoides sigmodontis) and noncerebral malaria (clone AS Plasmodium chabaudi chabaudi), we quantified disease severity, parasitemia, and polyclonal splenic immune responses in BALB/c mice. We found that coinfected mice, particularly those that did not have microfilaremia (Mf(-)), had more severe anemia and loss of body mass than did mice with malaria alone. Even when controlling for parasitemia, malaria was most severe in Mf(-) coinfected mice, and this was associated with increased interferon- gamma responsiveness. Thus, in Mf(-) mice, filariasis upset a delicate immunological balance in malaria infection and exacerbated malaria-induced immunopathology.

Early recruitment of natural CD4+Foxp3+ Treg cells by infective larvae determines the outcome of filarial infection

Human helminth infections are synonymous with impaired immune responsiveness indicating suppression of host immunity. Using a permissive murine model of filariasis, Litomosoides sigmodontis infection of inbred mice, we demonstrate rapid recruitment and increased in vivo proliferation of CD4+Foxp3+ Treg cells upon exposure to infective L3 larvae. Within 7 days post‐infection this resulted in an increased percentage of CD4+T cells at the infection site expressing Foxp3. Antibody‐mediated depletion of CD25+ cells prior to infection to remove pre‐existing ‘natural’ CD4+CD25+Foxp3+ Treg cells, while not affecting initial larval establishment, significantly reduced the number of adult parasites recovered 60 days post‐infection. Anti‐CD25 pre‐treatment also impaired the fecundity of the surviving female parasites, which had reduced numbers of healthy eggs and microfilaria within their uteri, translating to a reduced level of blood microfilaraemia. Enhanced parasite killing was associated with augmented in vitro production of antigen‐specific IL‐4, IL‐5, IL‐13 and IL‐10. Thus, upon infection filarial larvae rapidly provoke a CD4+Foxp3+ Treg‐cell response, biasing the initial CD4+ T‐cell response towards a regulatory phenotype. These CD4+Foxp3+ Treg cells are predominantly recruited from the ‘natural’ regulatory pool and act to inhibit protective immunity over the full course of infection.

The Coevolution of Virulence: Tolerance in Perspective

Coevolutionary interactions, such as those between host and parasite, predator and prey, or plant and pollinator, evolve subject to the genes of both interactors. It is clear, for example, that the evolution of pollination strategies can only be understood with knowledge of both the pollinator and the pollinated. Studies of the evolution of virulence, the reduction in host fitness due to infection, have nonetheless tended to focus on parasite evolution. Host-centric approaches have also been proposed—for example, under the rubric of “tolerance”, the ability of hosts to minimize virulence without necessarily minimizing parasite density. Within the tolerance framework, however, there is room for more comprehensive measures of host fitness traits, and for fuller consideration of the consequences of coevolution. For example, the evolution of tolerance can result in changed selection on parasite populations, which should provoke parasite evolution despite the fact that tolerance is not directly antagonistic to parasite fitness. As a result, consideration of the potential for parasite counter-adaptation to host tolerance—whether evolved or medially manipulated—is essential to the emergence of a cohesive theory of biotic partnerships and robust disease control strategies.

Evolution of parasite virulence when host responses cause disease

The trade-off hypothesis of virulence evolution rests on the assumption that infection-induced mortality is a consequence of host exploitation by parasites. This hypothesis lies at the heart of many empirical and theoretical studies of virulence evolution, despite growing evidence that infection-induced mortality is very often a by-product of host immune responses. We extend the theoretical framework of the trade-off hypothesis to incorporate such immunopathology and explore how this detrimental aspect of host defence mechanisms affects the evolution of pathogen exploitation and hence infection-induced mortality. We argue that there are qualitatively different ways in which immunopathology can arise and suggest ways in which empirical studies can tease apart these effects. We show that immunopathology can cause infection-induced mortality to increase or decrease as a result of pathogen evolution, depending on how it covaries with pathogen exploitation strategies and with parasite killing by hosts. Immunopathology is thus an important determinant of whether public and animal health programmes will drive evolution in a clinically beneficial or detrimental direction. Immunopathology complicates our understanding of disease evolution, but can nevertheless be readily accounted for within the framework of the trade-off hypothesis.

When T‐Helper Cells Don’t Help: Immunopathology During Concomitant Infection

Disease directly caused by immune system action is known as immunopathology. Many factors may lead the immune system to cause rather than cure disease, and autoimmune, allergic, and infection‐related immunopathological diseases affect millions of people worldwide. This review presents an analysis of T‐helper cell mediated, infection‐related immunopathology within the framework of evolutionary ecology. A proximate cause of infection‐related immunopathology is an error in the type of T‐helper response induced. Distinct subsets of T‐helper cells enable different effector mechanisms and therefore work optimally against different types of parasites (e.g., extracellular versus intracellular parasites). Immune responses that cure rather than cause disease require that the T‐helper subset be tailored to the parasite. It is thus critical for the immunophenotype to match the “environment” of the parasitic infection. As in other cases of adaptive plasticity, a mismatch between an organism’s phenotype and the selective environment can decrease fitness. T‐helper response induction may be confounded by coinfection of a single host by multiple parasite species. Because of normally adaptive feedback loops that tend to polarize T‐helper responses, it can become impossible for the immune system to mount effective, conflicting responses concurrently. Immunophenotype‐environment mismatches may thus be inevitable when simultaneous, conflicting immune responses are required. An ultimate cause of infection‐related immunopathology in a multiparasite selection regime is the T‐helper response polarization that can propagate response errors and constrain the ability of the immune system to resolve conflicting response requirements. A case study is used to illustrate how coinfection can exacerbate immunopathology and to frame testable predictions about optimal responses to coinfection (e.g., is the observed joint response to coinfection accurately predicted by the average of the component single‐infection optimal responses, where the single‐infection optima are weighted by the contribution of each to fitness). The case study includes immunological and pathological data from mice infected by Schistosoma mansoni alone and by S. mansoni in combination with Toxoplasma gondii. Such data can inform hypothesis tests of evolutionary ecological principles, and ecological analysis can in turn clarify assumptions about responses to coinfection for a greater understanding of the immune system. The synthesis of evolutionary ecology and immunology could therefore be of mutual benefit to the two disciplines.

IL-4 is required to prevent filarial nematode development in resistant but not susceptible strains of mice

The murine Litomosoides sigmodontis model of filarial infection provides the opportunity to elucidate the immunological mechanisms that determine whether these nematode parasites can establish a successful infection or are rejected by the mammalian host. BALB/c mice are fully susceptible to L. sigmodontis infection and can develop patent infection, with the microfilarial stage circulating in the bloodstream. In contrast, mice on the C57BL background are largely resistant to the infection and never produce a patent infection. In this study, we used IL-4 deficient mice on the C57BL/6 background to address the role of IL-4 in the development of L. sigmodontis parasites in a resistant host. Two months after infection, adult worm recovery and the percentage of microfilaraemic mice in infected IL-4 deficient mice were comparable with those of the susceptible BALB/c mice while, as expected, healthy adults were not recovered from wild type C57BL/6 mice. The cytokine and antibody responses reveal that despite similar parasitology the two susceptible strains (BALB/c and IL-4 deficient C57BL/6) have markedly different immune responses: wild type BALB/c mice exhibit a strong Th2 immune response and the IL-4 deficient C57BL/6 mice exhibit a Th1 response. We also excluded a role for antibodies in resistance through infection of B-cell deficient C57BL/6 mice. Our data suggest that the mechanisms that determine parasite clearance in a resistant/non-permissive host are Th2 dependent but that in a susceptible/permissive host, the parasite can develop in the face of a Th2 dominated response.