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Cepon-Robins TJ, Mallott EK, Recca IC. Gildner TE. (2023). Evidence and potential drivers of neglected parasitic helminth and protist infections among a small preliminary sample of children from rural Mississippi. Am J Hum Biol DOI: 10.1002/ajhb.23889. (article link).

Gildner TE, Cepon-Robins TJ. (2023). Rural Embodiment and Child Health: An Anthropological Case Study on Biocultural Determinants of Infection Exposure and Immune System Development in the United States. Current Tropical Medicine Reports, (article link)

Cepon-Robins TJ, Mallott EK, Recca IC, Gildner TE (2022). Exploring biocultural determinants of intestinal health: Do resource access and parasite exposure contribute to intestinal inflammation among a preliminary sample of children in rural Mississippi? Am J Bio Anth DOI:10.1002/ajpa.24574. (article link)

Gildner TE, Cepon-Robins TJ, Urlacher SS (2022). Cumulative host energetic costs of soil-transmitted helminths. Trends Parasitol DOI: (article link)


Hear Dr. Theresa Gildner talk about this project on the Sausage of Science Podcast (Episode 99)

Check out Dr. Tara Cepon-Robins discussing the REACH Study and some interesting early findings on the Sausage of Science Podcast (Episode 118)


Rural Embodiment and Child Health (REACH) Study: Effects of resource access and macroparasite exposure on intestinal inflammation among children from rural Mississippi (link to poster)

TJ Cepon-Robins, EK Mallott, IC Recca, TE Gildner

Published in the American Journal of Biological Anthropology, 177.

Embodiment Theory describes how external environments and lived experiences shape internal physiology and health. Documented disparities in rates of intestinal inflammation and gastrointestinal cancers between Black and white Americans may be related to embodied experiences of psychosocial stress, unequal access to resources, and exposure to pathogens. Here we test relationships between resource access (household income level, measures of nutritional status [WHO-defined BMI-for-age/Height-for-age z-scores]), macroparasite infection status (measured using 18S rRNA gene amplification/sequencing), and fecal calprotectin concentrations (FC; a biomarker of intestinal inflammation measured using ELISA) among 24 children (ages 6 months to 14 years) from a predominantly Black community in rural Mississippi. Median FC in this sample was 140 ug/g. 83% of children had clinically elevated FC levels (>50 ug/g). Bootstrap linear regression and analysis of covariance tests were used to examine relationships between FC levels and lifestyle, anthropometric, and infection variables. Household income (p = 0.07; 95%CI = -86.93, -0.53) and BMI z-scores (p = 0.02; 95%CI = -180.92, -10.21) were negatively associated with FC levels. Several macroparasitic infections were discovered, including infections with nematodes (n = 2) and platyhelminths (n = 5). Children experiencing platyhelminth infections had higher FC (n = 5; p = 0.019; ηp2 = 0.283), though this appears to be driven by variables related to resource access. These findings suggest that embodied experiences associated with unequal resource access in rural environments may be contributing to elevated rates of intestinal inflammation among children, with implications for the development of chronic health conditions in adulthood.


Rural Embodiment and Child Health (REACH) Study: Macroparasite infection prevalence and associated immune responses among a preliminary sample of children from rural Mississippi (link to poster)

TJ Cepon-Robins, EK Mallott, IC Recca, TE Gildner

Published abstract in the American Journal of Human Biology, 34.

Infections caused by protozoa and helminths (i.e., worms) are often grouped with certain bacterial/viral infections as Neglected Tropical Diseases because they receive little research attention despite having notable impacts on immune system development and health. This classification leads to the incorrect assumption that non-tropical high-income nations like the United States are unaffected by these macroparasitic infections. Surveys from the 1930s through 1980s, however, suggest that macroparasites were endemic in the Southern U.S. We hypothesize that macroparasitic infection may still be relatively common, and thus affecting health, in regions like the Mississippi Delta due to climate and inequities in infrastructure and resource access. The present study uses 18S rRNA gene amplification and sequencing to assess macroparasite infection status from stool samples provided by 24 children (6 months to 14 years) from rural Mississippi. Biomarkers of nutritional status (hemoglobin) and immune response (White Blood Cell Count [WBCC]; Immunoglobulin E; C-reactive Protein; Fecal Calprotectin [FC]) were measured from finger-prick blood samples and stool samples. 10 (42%) children were infected with at least one parasite. Several types of helminths (platyhelminths [flatworms; n = 5]; nematodes [roundworms; n = 2]) and protozoa (n = 6) were detected. Bootstrap ANOVA indicated associations between protozoal infection and higher WBCC (p < 0.001; Eta-squared = 0.54). Platyhelminth infection was associated with lower hemoglobin (p = 0.07; Eta-squared = 0.17) and higher FC (p = 0.05; Eta-squared = 0.20). These findings suggest that macroparasitic infections are still common in the U.S., with implications for immune function and child health.


Demographic correlates of intestinal inflammation among adults from St. Louis, MO and Colorado Springs, CO


CJ Manthey-Pierce, TJ Cepon-Robins, S Weaver, A Zhang, J Delegar, TE Gildner


Elevated intestinal inflammation often goes undetected among populations with limited access to medical care, even though it may be indicative of serious health complications (e.g., Inflammatory Bowel Disease, gastrointestinal cancers). Little is known about the prevalence of clinically elevated intestinal inflammation among otherwise healthy populations. Here, we examine effects of several sociodemographic factors on biomarkers of intestinal inflammation. We hypothesized that biomarkers of intestinal inflammation would be elevated in association with female sex, older age, crowded homes, lower socioeconomic status, and atopic/autoimmune conditions. Fifty-six adults (50.05% female, 17.1% male, 32.4% non-specified) from Colorado Springs, CO and St. Louis, MO completed online surveys and provided stool samples to measure fecal calprotectin (FC; measured using the Quantum Blue reader [BUHLMANN Laboratories]) and Lactoferrin (LF; measured using TECHLAB rapid tests), biomarkers used to detect intestinal inflammation. 45% of individuals had elevated FC, while 12.5% were positive for LF. Chi-square tests indicated no significant relationship between sex (p = 0.401), number of pregnancies (p = 0.939), number of people living in the home (p = 0.693), allergies or asthmatic conditions (p = 0.779 and clinically elevated FC (FC > 50 ug/g). Income level was inversely associated with FC level (p = 0.038), with 64.7% of lower-income earners (≤$50,000/year) exhibiting elevated FC levels. These findings suggest resource availability may influence inflammatory state, possibly illuminating impacts of socioeconomic status on intestinal health. Research like this is important for understanding biocultural factors that may be contributing to inflammatory profiles in a non-clinical context.

Rural childhood health and life history in the southern United States: Lifestyle, immune function, and intestinal inflammation among children from Mississippi (link to poster)

TJ Cepon-Robins, IC Recca, TE Gildner

Published abstract in the American Journal of Human Biology, 32.

Children’s health and development remain understudied in several parts of the United States, with many children in rural and low socioeconomic status regions experiencing inadequate nutrition, stunted growth, obesity, and exposure to infectious diseases. The present study is part of an ongoing research project exploring relationships between rural lifestyles, infectious and chronic disease burden, and growth/health among children in communities in the American south. Preliminary data collection in rural Mississippi in 2019 yielded finger-prick blood samples, family interviews, and anthropometric measurements for 32 children (ages 3-15 years) from 17 families. Twenty children returned stool samples for intestinal inflammation analysis. 53% of families sampled reported incomes of <$10,000 per year, with 71% making <$20,000 per year. Preliminary analyses of stool samples for fecal calprotectin (FC), a measure of intestinal inflammation, documented clinically elevated levels (FC > 50 ug/g) in 18 children (90%). The prevalence of elevated FC in this sample is higher than in previous studies of otherwise healthy children around the world, which range from 5% to 23%. Intestinal inflammation was not related to age. The local nurse practitioner reported a high prevalence of active Helicobacter pylori infection, an often-inflammatory bacterial infection of the digestive tract, among children in this community. Further analyses test relationships between FC, biomarkers of inflammation (Interleukin-6, C-reactive protein) and adaptive immune responses to macroparasitic and bacterial/viral infections (Immunoglobulin E and G), and lifestyle factors related to pathogen exposure in order to understand what may be contributing to elevated inflammation among children in this rural community. 

Atopic conditions, IgE levels, and inflammation among children from rural Mississippi

TE Gildner, IC Recca, TJ Cepon-Robins

Immunoglobulin E (IgE) is critical in adaptive immune responses to macroparasites, yet also contributes to atopy (i.e., allergy/asthma). Limited immune stimulation during development may lead to dysregulated IgE activity and inflammation (e.g., high C-Reactive Protein [CRP] levels). However, this hypothesis remains poorly tested among low-income communities within wealthy nations, despite the fact that children in these settings likely face environmental exposures that vary substantially from nationally-representative samples. Here, we use preliminary data collected from 32 children (ages 3-15 years) in rural Mississippi to assess links between reported atopy and immune profiles. Concentrations of IgE and CRP were measured from dried blood spots using enzyme-linked immunosorbent assay analysis. Parent interviews indicated that 41% of children had an atopic condition. Bootstrap regression models assessed whether atopy was associated with IgE and CRP levels. No significant associations were observed. Participant IgE and CRP concentrations were compared to those of similarly aged children in the NHANES dataset (n = 2,364) using Wilcoxon rank-sum tests. A significant difference between the underlying distribution of IgE values was observed, with our sample displaying greater IgE levels (z = -6.73, p < 0.001). Although CRP values among our sample were comparatively low, the difference between the two samples was not significant (z = 1.92, p = 0.055). These findings suggest that children from low-income, rural U.S. communities exhibit immune profiles that may differ from nationally-representative samples. Additional work is needed using larger samples to determine whether variations in pathogen exposure, atopic disorders, or both drive this pattern. 

A critical evaluation of a point-of-care device for measuring intestinal inflammation in remote field settings

TJ Cepon-Robins, IC Recca, TE Gildner

Markers of inflammation are increasingly important in population-based research, shedding light on variation in immune function and health from evolutionary and life history perspectives. Because human biologists often work in environments with limited electricity and sample/supply storage space, more work should be devoted to evaluating point-of-care technologies for use in the field. Here, we present a preliminary evaluation of the Bühlmann Quantum Blue (QB) point-of-care device for measuring fecal calprotectin (FC; a marker of intestinal inflammation), comparing QB results to enzyme-linked immunosorbent assay (ELISA) results, and discussing applications for this technology in field settings. Stool samples were collected from 24 children in rural Mississippi. Results from the two methods were highly correlated (r = 0.931; p < 0.001). Mean FC from the QB (181 ug/g) was higher than from ELISA (159 ug/g). Based on QB results, 3 children showed no evidence of intestinal inflammation (FC < 50 ug/g), 12 showed mild elevation (FC = 50-200 ug/g), and 9 had high elevation (FC > 200 ug/g), compared to 4, 14, and 6, respectively based on ELISA. The QB may overestimate FC levels but could be useful for comparing elevation (> 50 ug/g) to no elevation (< 50 ug/g). The QB is lightweight, battery-powered, requires a small amount of sample , and quickly produces results. A vortex is useful (though not necessary) for sample preparation, although this requires electricity and a flat, stable surface. While less specific than ELISA, this point-of-care device could provide useful measurements of elevated intestinal inflammation in remote regions. 

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