Theory of the Leaky Intestine: Sex Differences in Intestinal Parasitic Infections, Cytoskeletal Wall Dysfunctions, and Hypertension

Abstract

BACKGROUND: Intestinal parasitic infections (IPIs) impact approximately 3.5 billion individuals globally. Protozoan IPIs may influence the intestinal microbiome. This research investigates IPI effects on intestinal wall thickness and their potential links to sex-specific hypertension. It also explores the impact of alterations in intestinal wall permeability on sodium and blood glucose levels. METHODS: The study enrolled 108 subjects, including 83 consecutive patients with confirmed symptomatic IPIs (48 males, 35 females) and 25 healthy volunteers used as controls (9 males, 16 females). B-mode ultrasound grayscale images of the duodenum and colon were taken with and without water contrast. RESULTS: Patients with parasites exhibited a higher BMI (mean = 28.9 ± 7.4) compared to controls (mean = 24.68 ± 7.2), F (1, 96) = 5.78, _p _< 0.05. IPI patients showed a tendency towards increased duodenal wall thickness (DUOTHICK = 0.88 ± 0.7 cm) versus controls (0.6 ± 0.1 cm), _p = _0.05. Additionally, IPI patients had significantly greater thickness in the ascending colon (ASCTHICK = 1.1 ± 0.3 cm) and descending colon (DSCTHICK = 1.2 ± 0.4 cm) compared to controls (ASCTHICK = 0.6 ± 0.2 cm, DSCTHICK = 0.6 ± 0.1 cm), _p _< 0.05. Men over 50 years exhibited greater DSCTHICK (1.25 ± 0.434 cm) than postmenopausal women (0.986 ± 0.389 cm), _p _< 0.05. DSCTHICK significantly predicted diastolic blood pressure (β = −0.295, _p _< 0.05) and blood sodium level (β = −0.300, _p _< 0.05). DUOTHICK in diabetic IPI patients exceeded that in nondiabetic patients. Effective antiparasitic and antidiabetic treatments induced changes in the echoanatomy of the intestinal wall, suggesting the sealing of ‘the leak’. CONCLUSIONS: IPIs disrupted the intestinal cytoskeleton, leading to “leaky gut syndrome” development.