Bacterial and viral infections initiate classical type-1 immune responses. Together, pathogen-specific CD8+ cytotoxic T cells, CD4+ T helper 1 (Th1) cells, and classically activated macrophages cooperate to kill and eliminate infected cells. After pathogen clearance, the type-1 response resolves. Resolution of a classical inflammatory response is critical to host health. The importance of limiting inflammation after pathogen clearance is evident from the association of chronic type-1 inflammation with diverse diseases ranging from inflammatory bowel disease, chronic obstructive pulmonary disease, diabetes, and Alzheimer's disease [1-4].
While optimal for protection against viruses and bacteria, type-1 inflammation is not effective at controlling large extracellular helminths. These worms are orders of magnitude larger than viruses and bacteria, preventing classical macrophage clearance and phagocytosis of infected cells. If such a response was mounted, the inability of the host to clear the worms would lead to persistent type-1 inflammation. As stated above, such persistence of type-1 inflammation would ultimately be detrimental to the host. To avoid this, mammals have evolved the ability to mount a type-2 immune response to combat extracellular worm infections [5, 6]. Unlike type-1-driven immunity, which is focused on the direct killing and clearance of infected cells, type-2 inflammation is centered on the recruitment of innate immune cells to the site of infection; limiting nutrient availability during feeding by walling off the attachment site (wound healing response); and clearing of the worm through mucus production and smooth muscle contraction (weep and sweep). Also important, type-2 inflammation suppresses classical type-1 inflammation. These processes occur in multiple tissues infected by these parasites including the lung.
However, type-2 inflammation can also be detrimental to the host. If a type-2 response is evoked in the presence of a normally inert protein (allergen), it can be associated with allergic disease. In the context of the lung, type-2 inflammation to allergens is defined as allergic asthma [7]. Interestingly, the pathobiology associated with soil-transmitted helminth infection, as they migrate through the lung, closely resembles the pathobiology seen in the lungs of asthmatics. In both cases, the classical hallmarks of type-2 inflammation are evident: eosinophilia, goblet cell hyperplasia and mucus production, and elevated immunoglobulin-E, IgG1, and IgG4.
These classical hallmarks of type-2 inflammation are driven in large part by the production of type-2 cytokines—interleukin-4, IL-5, and IL-13 [8]. IL-4 is critical for the class-switching of B cells to IgE and IgG1. IL-5 mobilizes eosinophils from the bone marrow. IL-13 drives both the induction of goblet cell hyperplasia and mucus production as well as smooth muscle contractility. The critical