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<title xml:lang="en">Regulatory Role of Interleukin-10 and Interferon-γ in Severe Hepatic Central and Peripheral Fibrosisin Humans Infected with
<italic>Schistosoma japonicum</italic>
<xref ref-type="fn" rid="FN1">1</xref>
</title>
<author>
<name sortKey="Arnaud, Violaine" sort="Arnaud, Violaine" uniqKey="Arnaud V" first="Violaine" last="Arnaud">Violaine Arnaud</name>
<affiliation>
<nlm:aff id="A1">Institut National de la Santé et de la Recherche Médicale, Unité 399, Marseille, F-13000, France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Aix Marseille Université, Faculté de Médecine, Marseille, F-13000, France</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Fu, Xiao" sort="Fu, Xiao" uniqKey="Fu X" first="Xiao" last="Fu">Xiao Fu</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Wang, Yuanyuan" sort="Wang, Yuanyuan" uniqKey="Wang Y" first="Yuanyuan" last="Wang">Yuanyuan Wang</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Mengzhi, Shi" sort="Mengzhi, Shi" uniqKey="Mengzhi S" first="Shi" last="Mengzhi">Shi Mengzhi</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Li, Jun" sort="Li, Jun" uniqKey="Li J" first="Jun" last="Li">Jun Li</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Hou, Xunya" sort="Hou, Xunya" uniqKey="Hou X" first="Xunya" last="Hou">Xunya Hou</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Luo, Xinsong" sort="Luo, Xinsong" uniqKey="Luo X" first="Xinsong" last="Luo">Xinsong Luo</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Dessein, Helia" sort="Dessein, Helia" uniqKey="Dessein H" first="Helia" last="Dessein">Helia Dessein</name>
<affiliation>
<nlm:aff id="A1">Institut National de la Santé et de la Recherche Médicale, Unité 399, Marseille, F-13000, France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Aix Marseille Université, Faculté de Médecine, Marseille, F-13000, France</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Jie, Zhou" sort="Jie, Zhou" uniqKey="Jie Z" first="Zhou" last="Jie">Zhou Jie</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Xin Ling, Yu" sort="Xin Ling, Yu" uniqKey="Xin Ling Y" first="Yu" last="Xin-Ling">Yu Xin-Ling</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="He, Hongbin" sort="He, Hongbin" uniqKey="He H" first="Hongbin" last="He">Hongbin He</name>
<affiliation>
<nlm:aff id="A1">Institut National de la Santé et de la Recherche Médicale, Unité 399, Marseille, F-13000, France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Aix Marseille Université, Faculté de Médecine, Marseille, F-13000, France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Mcmanus, Donald P" sort="Mcmanus, Donald P" uniqKey="Mcmanus D" first="Donald P." last="Mcmanus">Donald P. Mcmanus</name>
<affiliation>
<nlm:aff id="A4">Tropical Health Program, Australian Centre for International and Tropical Health and Nutrition, The Queensland Institute of Medical Research, 300 Herston Road, Herston, Brisbane, Queensland 4029, Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Li, Yuesheng" sort="Li, Yuesheng" uniqKey="Li Y" first="Yuesheng" last="Li">Yuesheng Li</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Dessein, Alain" sort="Dessein, Alain" uniqKey="Dessein A" first="Alain" last="Dessein">Alain Dessein</name>
<affiliation>
<nlm:aff id="A1">Institut National de la Santé et de la Recherche Médicale, Unité 399, Marseille, F-13000, France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Aix Marseille Université, Faculté de Médecine, Marseille, F-13000, France</nlm:aff>
</affiliation>
</author>
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<idno type="doi">10.1086/588826</idno>
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<title xml:lang="en" level="a" type="main">Regulatory Role of Interleukin-10 and Interferon-γ in Severe Hepatic Central and Peripheral Fibrosisin Humans Infected with
<italic>Schistosoma japonicum</italic>
<xref ref-type="fn" rid="FN1">1</xref>
</title>
<author>
<name sortKey="Arnaud, Violaine" sort="Arnaud, Violaine" uniqKey="Arnaud V" first="Violaine" last="Arnaud">Violaine Arnaud</name>
<affiliation>
<nlm:aff id="A1">Institut National de la Santé et de la Recherche Médicale, Unité 399, Marseille, F-13000, France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Aix Marseille Université, Faculté de Médecine, Marseille, F-13000, France</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Fu, Xiao" sort="Fu, Xiao" uniqKey="Fu X" first="Xiao" last="Fu">Xiao Fu</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Wang, Yuanyuan" sort="Wang, Yuanyuan" uniqKey="Wang Y" first="Yuanyuan" last="Wang">Yuanyuan Wang</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Mengzhi, Shi" sort="Mengzhi, Shi" uniqKey="Mengzhi S" first="Shi" last="Mengzhi">Shi Mengzhi</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Li, Jun" sort="Li, Jun" uniqKey="Li J" first="Jun" last="Li">Jun Li</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Hou, Xunya" sort="Hou, Xunya" uniqKey="Hou X" first="Xunya" last="Hou">Xunya Hou</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Luo, Xinsong" sort="Luo, Xinsong" uniqKey="Luo X" first="Xinsong" last="Luo">Xinsong Luo</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Dessein, Helia" sort="Dessein, Helia" uniqKey="Dessein H" first="Helia" last="Dessein">Helia Dessein</name>
<affiliation>
<nlm:aff id="A1">Institut National de la Santé et de la Recherche Médicale, Unité 399, Marseille, F-13000, France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Aix Marseille Université, Faculté de Médecine, Marseille, F-13000, France</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Jie, Zhou" sort="Jie, Zhou" uniqKey="Jie Z" first="Zhou" last="Jie">Zhou Jie</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Xin Ling, Yu" sort="Xin Ling, Yu" uniqKey="Xin Ling Y" first="Yu" last="Xin-Ling">Yu Xin-Ling</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="He, Hongbin" sort="He, Hongbin" uniqKey="He H" first="Hongbin" last="He">Hongbin He</name>
<affiliation>
<nlm:aff id="A1">Institut National de la Santé et de la Recherche Médicale, Unité 399, Marseille, F-13000, France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Aix Marseille Université, Faculté de Médecine, Marseille, F-13000, France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Mcmanus, Donald P" sort="Mcmanus, Donald P" uniqKey="Mcmanus D" first="Donald P." last="Mcmanus">Donald P. Mcmanus</name>
<affiliation>
<nlm:aff id="A4">Tropical Health Program, Australian Centre for International and Tropical Health and Nutrition, The Queensland Institute of Medical Research, 300 Herston Road, Herston, Brisbane, Queensland 4029, Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Li, Yuesheng" sort="Li, Yuesheng" uniqKey="Li Y" first="Yuesheng" last="Li">Yuesheng Li</name>
<affiliation>
<nlm:aff id="A3">Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Dessein, Alain" sort="Dessein, Alain" uniqKey="Dessein A" first="Alain" last="Dessein">Alain Dessein</name>
<affiliation>
<nlm:aff id="A1">Institut National de la Santé et de la Recherche Médicale, Unité 399, Marseille, F-13000, France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Aix Marseille Université, Faculté de Médecine, Marseille, F-13000, France</nlm:aff>
</affiliation>
</author>
</analytic>
<series>
<title level="j">The Journal of infectious diseases</title>
<idno type="ISSN">0022-1899</idno>
<idno type="eISSN">1537-6613</idno>
<imprint>
<date when="2008">2008</date>
</imprint>
</series>
</biblStruct>
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<front>
<div type="abstract" xml:lang="en">
<p id="P2">
<italic>Schistosoma japonicum</italic>
is the most pathogenic agent of hepatosplenic schistosomiasis that has killed millions of people in China. It causes extended fibrosis in the periportal space (PPF) and in the hepatic parenchyma (ParF). The deposition of the extracellular matrix proteins composing the fibrotic scar is regulated by cytokines and chemokines, the production of which may play a key role in disease progression. We investigated whether fibrosis and splenomegaly in fishermen living in an endemic region for
<italic>S. japonicum</italic>
were associated with abnormal cytokine/chemokine production by blood mononuclear cells. PPF and ParF were considered as separate fibrosis phenotypes. PPF was associated (by univariate analysis) with low levels of IL-10 (p=4 × 10
<sup>-4</sup>
), RANTES (p=4 × 10
<sup>-4</sup>
) and MIP-1α (p=7 × 10
<sup>-3</sup>
) production in cultures of blood leukocytes stimulated with schistosome egg antigens. Logistic regression that included exposure, anti-schistosome treatments and drinking habits as covariates showed that IL-10 exhibited the strongest association with PPF (p=1 × 10
<sup>-4</sup>
, OR=10.8, CI=3.2-38). Splenomegaly was associated with low levels of IL-10 production (p=4 × 10
<sup>-3</sup>
) even in the presence of PPF as covariate (p=0.01, OR=3.5, 1.3-8.9), indicating a probable direct relationship between IL-10 and splenomegaly. Furthermore, ParF was associated with low levels of production for IFN-γ (p=3.5 10
<sup>-3</sup>
; OR= 8.2; 2-33) but not for IL-10 or RANTES. These data are consistent with IL-10 playing a key role in the development of severe hepatic and spleen disease and differences in the cytokine-mediated control of PPF and ParF in humans infected with
<italic>S. japonicum.</italic>
</p>
</div>
</front>
</TEI>
<pmc article-type="research-article">
<pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-journal-id">0413675</journal-id>
<journal-id journal-id-type="pubmed-jr-id">4830</journal-id>
<journal-id journal-id-type="nlm-ta">J Infect Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">J. Infect. Dis.</journal-id>
<journal-title-group>
<journal-title>The Journal of infectious diseases</journal-title>
</journal-title-group>
<issn pub-type="ppub">0022-1899</issn>
<issn pub-type="epub">1537-6613</issn>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">18582197</article-id>
<article-id pub-id-type="pmc">2753300</article-id>
<article-id pub-id-type="doi">10.1086/588826</article-id>
<article-id pub-id-type="manuscript">UKMS27847</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Article</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Regulatory Role of Interleukin-10 and Interferon-γ in Severe Hepatic Central and Peripheral Fibrosisin Humans Infected with
<italic>Schistosoma japonicum</italic>
<xref ref-type="fn" rid="FN1">1</xref>
</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Arnaud</surname>
<given-names>Violaine</given-names>
</name>
<xref ref-type="aff" rid="A1">*</xref>
<xref ref-type="aff" rid="A2"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Fu</surname>
<given-names>Xiao</given-names>
</name>
<xref ref-type="aff" rid="A3"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Wang</surname>
<given-names>Yuanyuan</given-names>
</name>
<xref ref-type="aff" rid="A3"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Mengzhi</surname>
<given-names>Shi</given-names>
</name>
<xref ref-type="aff" rid="A3"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Li</surname>
<given-names>Jun</given-names>
</name>
<xref ref-type="aff" rid="A3"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Hou</surname>
<given-names>Xunya</given-names>
</name>
<xref ref-type="aff" rid="A3"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Luo</surname>
<given-names>Xinsong</given-names>
</name>
<xref ref-type="aff" rid="A3"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dessein</surname>
<given-names>Helia</given-names>
</name>
<xref ref-type="aff" rid="A1">*</xref>
<xref ref-type="aff" rid="A2"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Jie</surname>
<given-names>Zhou</given-names>
</name>
<xref ref-type="aff" rid="A3"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Xin-Ling</surname>
<given-names>Yu</given-names>
</name>
<xref ref-type="aff" rid="A3"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>He</surname>
<given-names>Hongbin</given-names>
</name>
<xref ref-type="aff" rid="A1">*</xref>
<xref ref-type="aff" rid="A2"></xref>
<xref ref-type="aff" rid="A3"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>McManus</surname>
<given-names>Donald P.</given-names>
</name>
<xref ref-type="aff" rid="A4">§</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Li</surname>
<given-names>Yuesheng</given-names>
</name>
<xref ref-type="aff" rid="A3"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dessein</surname>
<given-names>Alain</given-names>
</name>
<xref ref-type="author-notes" rid="FN2">2</xref>
<xref ref-type="aff" rid="A1">*</xref>
<xref ref-type="aff" rid="A2"></xref>
</contrib>
</contrib-group>
<aff id="A1">
<label>*</label>
Institut National de la Santé et de la Recherche Médicale, Unité 399, Marseille, F-13000, France</aff>
<aff id="A2">
<label></label>
Aix Marseille Université, Faculté de Médecine, Marseille, F-13000, France</aff>
<aff id="A3">
<label></label>
Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Huabanqiao Road, Yueyang, 414000, People’s Republic of China</aff>
<aff id="A4">
<label>§</label>
Tropical Health Program, Australian Centre for International and Tropical Health and Nutrition, The Queensland Institute of Medical Research, 300 Herston Road, Herston, Brisbane, Queensland 4029, Australia</aff>
<author-notes>
<corresp id="FN2">
<label>2</label>
Address correspondence and reprint request to Alain Dessein, INSERM UMR399, Faculty of Medicine La Timone, 27 bvd Jean Moulin, 13385 Marseilles cedex 5, France. Phone: 0491324453 Fax: 0491796063.
<email xlink:type="simple">alain.dessein@medecine.univ-mrs.fr</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted">
<day>24</day>
<month>9</month>
<year>2009</year>
</pub-date>
<pub-date pub-type="ppub">
<day>1</day>
<month>8</month>
<year>2008</year>
</pub-date>
<pub-date pub-type="pmc-release">
<day>28</day>
<month>9</month>
<year>2009</year>
</pub-date>
<volume>198</volume>
<issue>3</issue>
<fpage>418</fpage>
<lpage>426</lpage>
<abstract>
<p id="P2">
<italic>Schistosoma japonicum</italic>
is the most pathogenic agent of hepatosplenic schistosomiasis that has killed millions of people in China. It causes extended fibrosis in the periportal space (PPF) and in the hepatic parenchyma (ParF). The deposition of the extracellular matrix proteins composing the fibrotic scar is regulated by cytokines and chemokines, the production of which may play a key role in disease progression. We investigated whether fibrosis and splenomegaly in fishermen living in an endemic region for
<italic>S. japonicum</italic>
were associated with abnormal cytokine/chemokine production by blood mononuclear cells. PPF and ParF were considered as separate fibrosis phenotypes. PPF was associated (by univariate analysis) with low levels of IL-10 (p=4 × 10
<sup>-4</sup>
), RANTES (p=4 × 10
<sup>-4</sup>
) and MIP-1α (p=7 × 10
<sup>-3</sup>
) production in cultures of blood leukocytes stimulated with schistosome egg antigens. Logistic regression that included exposure, anti-schistosome treatments and drinking habits as covariates showed that IL-10 exhibited the strongest association with PPF (p=1 × 10
<sup>-4</sup>
, OR=10.8, CI=3.2-38). Splenomegaly was associated with low levels of IL-10 production (p=4 × 10
<sup>-3</sup>
) even in the presence of PPF as covariate (p=0.01, OR=3.5, 1.3-8.9), indicating a probable direct relationship between IL-10 and splenomegaly. Furthermore, ParF was associated with low levels of production for IFN-γ (p=3.5 10
<sup>-3</sup>
; OR= 8.2; 2-33) but not for IL-10 or RANTES. These data are consistent with IL-10 playing a key role in the development of severe hepatic and spleen disease and differences in the cytokine-mediated control of PPF and ParF in humans infected with
<italic>S. japonicum.</italic>
</p>
</abstract>
<kwd-group>
<kwd>Human</kwd>
<kwd>Parasitic helminths</kwd>
<kwd>Cytokines</kwd>
<kwd>Inflammation</kwd>
</kwd-group>
<funding-group>
<award-group>
<funding-source country="United Kingdom">Wellcome Trust : </funding-source>
<award-id>071657 || WT</award-id>
</award-group>
</funding-group>
</article-meta>
</front>
</pmc>
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