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Environmental enteropathy is a subclinical disorder, defined by small intestinal inflammation, villous blunting, reduced absorptive capacity, and impaired barrier function. It is mainly observed in low-income countries in the context of adverse water/sanitation/hygiene (WASH) exposures. 

The aetiology of environmental enteropathy has yet to be elucidated, but a role of microbial exposure and nutritional status has been suggested. Microbial dysbiosis in the small intestine and chronic inflammation may exacerbate malnutrition which, affecting 165 million children globally, is a major contributor to child mortality. 

The reduced barrier function seen in children with environmental enteropathy is associated with increased microbial translocation, leading to increased lipopolysaccharide (LPS) levels in the circulation. LPS, a pathogen-associated molecular pattern stems from Gram-negative bacteria, may induce an inflammatory response upon binding to toll-like receptor 4 (TLR4) expressed by the host. This is why investigating the role of LPS and TLR4 in the induction of inflammation and villous blunting is a crucial step towards understanding the pathogenesis of environmental enteropathy. Researching the mechanisms linking anthropometric status with child mortality will be essential in tackling this global health problem.

Team (in collaboration with the CHAIN Consortium)

Oxford: Lisa Gartner, Kelsey Jones

Collaborators: Rosie Crane, Jay Berkley (Kilifi/Oxford), Nicolas Grassly (London), Sudhir Babji, Gagandeep Kang (Vellore)

Publications

Babji et al. NPJ Vaccines. 2020 Immune Predictors of Oral Poliovirus Vaccine Immunogenicity Among Infants in South India

Grassly et al. Lancet Infect Dis. 2016 The effect of azithromycin on the immunogenicity of oral poliovirus vaccine: a double-blind randomised placebo-controlled trial in seronegative Indian infants.