Intestinal permeability before and after albendazole treatment in low and high socioeconomic status schoolchildren in Makassar, Indonesia

Aldian I Amaruddin,Lisette Van Lieshout,Ed J Kuijper,Kaatje Lenaerts,Erliyani Sartono,Anoecim R Geelen,Munawir Muhammad,Firdaus Hamid,Romy D Zwittink,Maria Yazdanbakhsh,Jan Pieter R Koopman,Sitti Wahyuni,Eric A T Brienen,Hans M H Van Eijk

doi:10.1038/s41598-022-07086-7

Aldian I Amaruddin, Lisette Van Lieshout + Show 12 more

Open Access

https://doi.org/10.1038/s41598-022-07086-7

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Abstract

Intestinal helminths are highly prevalent in low-SES children and could contribute to poor health outcomes either directly or via alteration of the gut microbiome and gut barrier function. We analysed parasitic infections and gut microbiota composition in 325 children attending high- and low-SES schools in Makassar, Indonesia before and after albendazole treatment. Lactulose/Mannitol Ratio (LMR, a marker of gut permeability); I-FABP (a surrogate marker of intestinal damage) as well as inflammatory markers (LBP) were measured. Helminth infections were highly prevalent (65.6%) in low-SES children. LMR and I-FABP levels were higher in low-SES children (geomean (95%CI): 4.03 (3.67–4.42) vs. 3.22 (2.91–3.57); p. adj < 0.001; and 1.57 (1.42–1.74) vs. 1.25 (1.13–1.38); p. adj = 0.02, respectively) while LBP levels were lower compared to the high-SES (19.39 (17.09–22.01) vs. 22.74 (20.07–26.12); p.adj = 0.01). Albendazole reduced helminth infections in low-SES and also decreased LMR with 11% reduction but only in helminth-uninfected children (estimated treatment effect: 0.89; p.adj = 0.01). Following treatment, I-FABP decreased in high- (0.91, p.adj < 0.001) but increased (1.12, p.adj = 0.004) in low-SES children. Albendazole did not alter the levels of LBP. Microbiota analysis showed no contribution from specific bacterial-taxa to the changes observed. Intestinal permeability and epithelial damage are higher while peripheral blood inflammatory marker is lower in children of low-SES in Indonesia. Furthermore, treatment decreased LMR in helminth-uninfected only.

Highlights

Intestinal helminths are highly prevalent in low-socioeconomic status (SES) children and could contribute to poor health outcomes either directly or via alteration of the gut microbiome and gut barrier function
There were no differences in age, sex, SES, or z-BMI between those who remained in the study and those who were lost to follow-up (Supplementary Table S1)
We demonstrated that intestinal barrier function, measured by lactulose/mannitol ratio (LMR), intestinal-fatty acid binding protein (I-FABP), and lipopolysaccharide binding protein (LBP) differs between low- and high-SES schoolchildren living in an urban center of Makassar, Indonesia

Summary

Introduction

Intestinal helminths are highly prevalent in low-SES children and could contribute to poor health outcomes either directly or via alteration of the gut microbiome and gut barrier function. We analysed parasitic infections and gut microbiota composition in 325 children attending high- and low-SES schools in Makassar, Indonesia before and after albendazole treatment. Lactulose/Mannitol Ratio (LMR, a marker of gut permeability); I-FABP (a surrogate marker of intestinal damage) as well as inflammatory markers (LBP) were measured. Albendazole reduced helminth infections in low-SES and decreased LMR with 11% reduction but only in helminth-uninfected children (estimated treatment effect: 0.89; p.adj = 0.01). I-FABP decreased in high- (0.91, p.adj < 0.001) but increased (1.12, p.adj = 0.004) in low-SES children. Intestinal permeability and epithelial damage are higher while peripheral blood inflammatory marker is lower in children of low-SES in Indonesia. Compromised intestinal epithelial integrity and epithelial cell damage can be assessed by measuring markers of intestinal injury such as intestinal-fatty acid binding protein (I-FABP)[10]

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