No Simple Fluke: Schistosomiasis as an Emerging Regulator of Haematopoiesis.

Abstract

Schistosomiasis, or bilharzia, is a highly prevalent water-borne helminth infection that accounts for an estimated 1.5-1.7 billion disability-adjusted life years lost annually. Pathology driven by adult worms and eggs is accompanied by robust immunomodulation in the human host. Protective responses may promote worm elimination, limit bystander tissue injury caused by parasite migration and contain eggs within granulomatous lesions. However, evidence also suggests that schistosomes can actively or indirectly influence haematopoiesis, thereby reshaping downstream mature immune cell responses. This perspective reviews current literature on schistosome-dependent and host-derived regulation of haematopoiesis, the importance of preclinical modelling and the emerging relevance of controlled human challenge models. It also discusses bone marrow organoid models and their utility for recapitulating complex infection dynamics, with the aim of informing clinically relevant studies and therapeutic strategies.