Immunogenetic factors involved in the pathogenesis of distinct clinical manifestations of schistosomiasis japonica in the Philippine population

Immunogenetic factors were studied in 60 patients with schistosomiasis japonica in the Philippines, of whom 15 were characterized by marked hepatosplenic lesions and 45 characterized by cerebral symptoms. Immune responsiveness of the patients to schistosomal antigen was measured by T cell proliferation in vitro, and their HLA-A and -B specificities were typed. All but one hepatosplenic patients showed strong immune responsiveness to the schistosomal antigen, whereas both low and high responders were observed in the cerebral patients. A significant association between HLA-B40 and high responders to the schistosomal antigen was observed ( P = 0·0458), and this HLA specificity was increased in frequency in the hepatosplenic patients. HLA-B16 was not observed in the hepatosplenic patients, but was common in the cerebral patients (26·5%) ( P = 0·0255), and this HLA specificity was commoner in the low responders than in the high responders. These observations suggest that an HLA-linked gene governs the clinical manifestations of human schistosomiasis japonica by controlling immune responsiveness of the infected hosts to the schistosomal antigen.