Microarray assessment of N-glycan-specific IgE and IgG profiles associated with Schistosoma mansoni infection in rural and urban Uganda

Core β-1,2-xylose and α-1,3-fucose are antigenic motifs on schistosome N-glycans, as well as prominent IgE targets on some plant and insect glycoproteins. To map the association of schistosome infection with responses to these motifs, we assessed plasma IgE and IgG reactivity using microarray technology among Ugandans from rural Schistosoma mansoni (Sm)-endemic islands (n = 209), and from proximate urban communities with lower Sm exposure (n = 62). IgE and IgG responses to core β-1,2-xylose and α-1,3-fucose modified N-glycans were higher in rural versus urban participants. Among rural participants, IgE and IgG to core β-1,2-xylose were positively associated with Sm infection and concentration peaks coincided with the infection intensity peak in early adolescence. Responses to core α-1,3-fucose were elevated regardless of Sm infection status and peaked before the infection peak. Among urban participants, Sm infection intensity was predominantly light and positively associated with responses to both motifs. Principal component and hierarchical cluster analysis reduced the data to a set of variables that captured core β-1,2-xylose- and α-1,3-fucose-specific responses, and confirmed associations with Sm and the rural environment. Responses to core β-1,2-xylose and α-1,3-fucose have distinctive relationships with Sm infection and intensity that should further be explored for associations with protective immunity, and cross-reactivity with other exposures.

For example, anti-glycan antibody responses dominate the host humoral response to schistosome larvae and eggs [8][9][10] and Schistosoma soluble egg antigen (SEA)-mediated Th2-polarisation profoundly relies on glycosylation 11,12 . In a mouse model for periovular granuloma formation, periodate treatment of SEA-coated beads inhibited their granulomogenic activity 13 , further demonstrating the functional relevance of glycan-specific responses in Schistosoma-mediated immunity and pathology. A better understanding of the human immune response to the Schistosoma glycome may be beneficial to the current drive towards identification of better Schistosoma diagnostic markers and potent vaccine candidates [14][15][16][17][18] .
Core β2Xyl and α3Fuc modified schistosome egg N-glycoproteins induce potent Th2-type cellular responses 36 . In plants, core β2Xyl and α3Fuc may be the most common N-glycan epitopes targeted by human IgE 37,38 . It is plausible that N-glycan core substitutions play a major role in the glycan-dependent host response to chronic schistosomiasis. For example, most N-glycans on the SEA-derived glycoprotein omega-1 carry core α3Fuc motifs in combination with terminal LeX units 39 . Omega-1 drives both immunoregulatory 40 and Th2 responses 41 , the latter in a glycan-dependent manner 12 . Kappa-5, another major component of the Th2-polarising SEA 42 , expresses glycans modified with both core β2Xyl and core α3Fuc 43 . Whether protective immunity against Schistosoma infection and reinfection (long associated with host IgE responses 44,45 ) can be credited to these epitopes will require further investigations in animal and human studies.
The advent of glycan microarray technology enabled serum/plasma profiling of antibodies raised to a wide repertoire of N-glycan variants during schistosome infections. This technology has been employed in a small number of human studies. Recently, in Ghana, sera from a few S. haematobium infected schoolchildren showed elevated IgE responses to core β2Xyl modified N-glycans on a synthetic glycan microarray 46 , and in sera from a small cohort of Schistosoma mansoni (Sm)-infected children and adults near Lake Albert, Uganda, IgG1-4 subclass responses to core β2Xyl and α3Fuc motifs were examined using the same array 47 . Two other human studies employing shotgun microarrays constructed of complex native schistosome N-glycans showed strong anti-glycan IgG and IgM responses against a wider range of N-glycans during schistosome infections 48,49 . A better understanding of population-level immune responses to Schistosoma glycans is important for research and clinical applications, and requires larger, well-defined immuno-epidemiological studies in endemic settings. www.nature.com/scientificreports www.nature.com/scientificreports/ Fishing villages in the Lake Victoria islands of Koome, Uganda, have a high prevalence of Sm [50][51][52][53] , and have been surveyed as part of a portfolio of studies on helminth infections and allergy-related outcomes in Uganda. This setting provided a unique opportunity, within the context of a well-characterised large study 50 , to correlate epidemiological trends pertaining to Sm infection (and intensity) with microarray-detected plasma IgE and IgG responses to N-glycans with and without core α-1,3-fucosylation and/or β-1,2-xylosylation. Plasma from residents of nearby mainland urban communities with lower Sm exposure enabled us to make rural-urban comparisons of anti-glycan antibody responses.

Methods
Study design and population. Individuals included in the current investigation were randomly selected using a Stata program (StataCorp, College Station, USA) from participants of two cross-sectional surveys in rural and urban Uganda, who had a sufficient volume of stored plasma. The rural survey was the outcome survey (year three, September 2015-August 2016) of the Lake Victoria Island Intervention Study on Worms and Allergyrelated diseases (LaVIISWA; ISRCTN47196031) 50 , a cluster-randomised trial of community-based standard versus intensive anthelminthic intervention in 26 Sm-endemic fishing villages of Koome islands (Lake Victoria, Uganda). The trial description 50,53 and survey results after three years of intervention 52 have been published: briefly, standard intervention included annual, community-based, mass drug administration of praziquantel; intensive intervention included quarterly praziquantel. The urban survey (September 2016-September 2017) was conducted in the 24 sub-wards of Entebbe municipality, an area with lower helminth exposure, located on the northern shores of Lake Victoria (approximately 35 km from Koome). It was designed to collect data from an urban setting for comparison with the Sm-endemic rural survey.
In both surveys, intestinal helminth infections were assessed using the Kato-Katz (KK) method 54 on a single stool sample (prepared on two slides, read by different technicians). The remaining sample was stored at −80 °C and later investigated for Sm, Necator americanus and Strongyloides stercoralis infections using multiplex real-time PCR 55,56 . Mid-stream urine was also assessed for Sm circulating cathodic antigen (CCA) using a point-of-care test (Rapid Medical Diagnostics, Pretoria, South Africa). Schistosoma haematobium is not present in the surveyed areas 57 . Blood samples were processed to obtain plasma for immunological measurements, including N-glycan-specific IgE and IgG by microarray (detailed below) and Schistosoma egg [SEA]-and adult worm [SWA] antigen-specific IgE, IgG4 and IgG by ELISA (Supplementary Material).
The research ethics committees of the Uganda Virus Research Institute and the London School of Hygiene and Tropical Medicine, and the Uganda National Council for Science and Technology approved this work. All methods were performed in accordance with guidelines and regulations of these committees. Informed consent was obtained from all participants and/or their legal guardians and assent from children aged ≥8 years.

Microarray detection of N-glycan-specific IgE and IgG. Immunoglobulin E and G responses to
135 chemically synthesised glycans with and without core α-1,3-fucosylation and, or, β-1,2-xylosylation ( Supplementary Fig. S1) were assessed using a non-commercial microarray. Fluorescently-labeled bovine serum albumin (BSA) was included as an array printing control. Microarray construction procedures have been described in detail elsewhere 48,58 . The glycan antibody binding assay was adapted from existing procedures 17,46,49,59 , as follows: Nexterion H N-hydroxysuccinimide-coated microarray slides (Schott AG, Mainz, Germany) (pre-blocked with 50 mM ethanolamine in 50 mM sodium borate buffer pH 9.0, and stored at −20 °C) were thawed at room temperature (RT) and covered with silicone gaskets to create seven wells with printed microarrays per slide. Each microarray was incubated with 300 μl of a 1:30 plasma dilution in 1% BSA -0.01% Tween20 for one hour at RT while shaking. After sequential washes with PBS-0.05% Tween20 and PBS, the slides were incubated for 30 minutes at RT in the dark with PromoFluor 647-labelled anti-human IgE (diluted 1/150 in PBS-0.01% Tween20) and Cy3-labelled anti-human IgG (diluted 1/1000 in PBS-0.01% Tween20), while shaking. After a final wash with PBS-0.05% Tween20, PBS and deionised water, sequentially, the slides were dried and kept in the dark until scanning. The slides were scanned for fluorescence at a 10μm resolution with a G2565BA scanner (Agilent Technologies, CA, USA) using 633 nm and 532 nm lasers for detection of reactivity to glycan-specific IgE and IgG, respectively. Data analysis. Using GenePix Pro 7.0 software (Molecular Devices, CA, USA), a spot-finding algorithm was used to align and re-size fluorescence spots in the microarray images, without setting a composite pixel intensity threshold. Data on median fluorescence intensity (MFI) for each spot and the local background were then exported to Microsoft Excel software, where background MFI subtraction was done for each glycan structure, averaged over four spots. Further processing of IgG and IgE MFIs in Excel was done as described by Oyelaran et al. 60 and Amoah et al. 46 , respectively, to yield log 2 -transformed values.
Graphical representations of antibody responses and further data analyses were done using Stata 13.1 (College Station, Texas, USA), R (R foundation for Statistical Computing, Vienna, Austria) via the RStudio interface (version 1.1.383, RStudio, Inc. Boston, USA) and GraphPad Prism (version 6.0e, Fay Avenue, La Jolla, CA, USA). Schistosoma mansoni infection and the rural-urban environment were the main exposures of interest: we compared anti-glycan antibody responses between Sm infected and uninfected participants separately in the rural and urban survey, and thereafter between rural and urban participants. Initial analyses considered each anti-glycan antibody response independently, while further analyses combined antibody responses to reduce the dimensionality of the outcome data, as detailed below.
Rural-urban differences in Sm prevalence and Schistosoma-specific antibodies were assessed using survey design-based logistic and linear regression, respectively. Most log 2 -transformed anti-glycan IgE responses maintained a skewed distribution. Therefore, Mann-Whitney tests were used to assess differences in individual glycan structure-specific antibody responses between Sm infected and uninfected participants and between rural www.nature.com/scientificreports www.nature.com/scientificreports/ and urban participants. Most log 2 -transformed anti-glycan IgG responses were normally distributed and were assessed using unpaired t tests. The Kruskal-Wallis (IgE responses) and one-way ANOVA test (IgG responses) were also conducted to assess differences along the infection intensity gradient. Since many of the anti-glycan antibody responses were correlated, the above tests were conducted within a Monte Carlo simulation approach based on 1000 permutations, to generate empirical p-values corrected for multiple testing.
Given the large number of outcomes, two data reduction techniques were used to investigate associations between exposures and outcomes. First, principal component analysis (PCA) was run in Stata to transform groups of correlated anti-glycan responses into fewer, uncorrelated artificial variables (principal components, PCs), which were then compared by 1) survey setting, and 2) Sm infection and intensity status using survey design-based linear regression. Second, unsupervised hierarchical clustering analysis (HCA, complete linkage using Euclidean distance) was conducted in R to further identify homogeneous sets of N-glycan-specific responses. The resultant IgE and IgG clusters were then assessed for associations with survey setting and Sm infection using the global test 61-63 executed in R with the Globaltest package (version 5.33.0).
We recently reported that community-based intensive versus standard anthelminthic intervention in the rural survey reduced Sm infection intensity but had no effect on the overall Sm prevalence (measured using the urine CCA test) 52 . The current analysis found no evidence of an effect of intensive versus standard treatment on total IgE, SEA-or SWA-specific antibodies, or on antibody reactivity to any of the N-glycans on the microarray. Therefore, data from the rural survey were not stratified by trial treatment arm in the further analyses presented herein.

Associations between S. mansoni infection and IgE and IgG responses to individual core
β-1,2-xylosylated and core α-1,3-fucosylated N-glycans. In the rural survey, IgE and IgG responses to the β2Xyl modified Man 3 GlcNAc 2 core (G34) were significantly higher among Sm infected (KK and/or PCR, and CCA positive), compared to uninfected individuals, and were positively associated with Sm infection www.nature.com/scientificreports www.nature.com/scientificreports/  Table S1). Observations were similar for the N-glycan core carrying both β2Xyl and α3Fuc (G37). However, IgE and IgG responses to the N-glycan core carrying α3Fuc only (G73) were similar between Sm infected and uninfected rural individuals ( Fig. 2a-f), but positively associated with SWA-and SEA-specific IgE and IgG (Table S1).
In the urban survey, IgE and IgG reactivity to core β2Xyl and/or core α3Fuc modified glycans was also higher in Sm infected (KK and/or PCR) compared to uninfected individuals, although differences were not statistically significant (Fig. 2g-j). However, IgE reactivity to core α3Fuc and core α3Fuc + core β2Xyl modified glycans was significantly positively associated with SEA-and SWA-specific IgE (Table S1).
In the rural survey, Sm infection prevalence (and intensity) and median levels of Schistosoma-specific antibodies (except SEA-IgE) and β-1,2-xylosylated glycan (G34)-specific IgE and IgG were highest among 10-14-year old individuals (Fig. 3). However, IgE and IgG reactivity to glycans carrying either core α3Fuc (G73) or both core β2Xyl and core α3Fuc (G37) peaked earlier (in the 5-9-year age group), akin to SEA-specific IgE. Age-stratified antibody reactivity patterns were less clear in the urban survey.
Immunoglobulin E and G responses to other N-glycan structural variants with core β2Xyl or both core β2Xyl and core α3Fuc 48 were also higher in Sm infected versus uninfected individuals (Fig. S2). IgE and IgG reactivity to non-xylosylated and non-fucosylated glycans was not associated with Sm infection (data not shown), except for those glycans with antennae constructed of LDN-F (G90) and LeX (G89) units (Fig. S3).
Infection with other helminths, malaria or HIV was not associated with IgE or IgG reactivity to any glycans on the microarray (data not shown).

Principal component analysis of anti-glycan antibody responses. Antibody responses to individual
core modified N-glycans were strongly correlated. Principal component analysis (PCA) was conducted to summarise these responses, and to evaluate to what extent the resultant principal components (PCs) were associated with Sm infection.
Scatterplots of PC1 and PC2 loadings are shown in Fig. 4. In the rural survey, the first two IgE and IgG PCs each accounted for 37% of the total variance in the data (IgE: PC1 28.2%, PC2 8.8%; IgG: PC1 27.7%, PC2 9.7%). Principal component 1 was characterized by responses to core β2Xyl and/or α3Fuc modified glycans while PC2 was characterized by responses to non-xylosylated and non-fucosylated glycans (Fig. 4, panel a and b). Scores for IgE PC1, but not PC2, were higher among Sm infected (KK or PCR) compared to uninfected individuals (crude Figure 2. Associations between S. mansoni infection and IgE and IgG reactivity to N-glycans carrying nonmammalian core modifications. Plasma from S. mansoni infected and uninfected rural and urban individuals were assessed for IgE and IgG reactivity to N-glycan structural variants with and without α-1,3-fucosylation and β-1,2-xylosylation, on a microarray platform. Box-and-whisker plots show background-subtracted and log2transformed median fluorescence intensities (MFI) representing IgE (a-c,g,h) and IgG (d-f,i,j) reactivity to the Man 3 GlcNAc 2 core structure (G42) and to α3Fucand/or β2Xyl-carrying Man 3 GlcNAc 2 core structures (G34, G73 and G37). The plots show a horizontal line denoting the median, a box indicating the interquartile range (IQR), and whiskers drawn using the Tukey method (1.5 times IQR). Outliers (greater than 1.5 times IQR away from the median) are plotted as individual points. Mann-Whitney (IgE responses) and unpaired t test (IgG responses) were conducted within the framework of a Monte Carlo simulation algorithm based on 1000 permutations (in order to adjust for multiple testing), to assess differences between infected and uninfected individuals. The Kruskal-Wallis (IgE responses) and one-way ANOVA test (IgG responses) were also conducted using the permutation approach to assess differences along the infection intensity gradient (b and e) in the rural survey. # Infection prevalence and intensity was relatively low in the urban survey so analysis by Sm intensity is not shown for the urban setting. www.nature.com/scientificreports www.nature.com/scientificreports/ p = 0.028, age-and sex-adjusted p = 0.167). Similarly, IgG PC1 scores were higher among Sm infected (KK or PCR) compared to uninfected individuals (crude p = 0.009, adjusted p = 0.027). There were no differences in PC scores between CCA+ and CCA− individuals.
In the urban survey, the first two IgE and IgG PCs accounted for 31% and 35% of the total variance, respectively (IgE: PC1 19.4%, PC2 11.5%; IgG: PC1 24.2%, PC2 10.6%). Interestingly, most IgE responses to glycans carrying core β2Xyl without α3Fuc clustered with non-xylosylated and non-fucosylated glycans in PC2 while responses to glycans carrying both core β2Xyl and α3Fuc and those carrying core α3Fuc without β2Xyl clustered together in PC1 (Fig. 4, panel c). Akin to the rural survey, scores for IgE and IgG PC1 were higher among Sm infected compared to uninfected urban individuals.
Scores for PC1 were positively associated with SWA-and SEA-specific IgE and IgG in both surveys, while PC2 scores were inversely associated with the same Schistosoma-specific antibodies (Table S1).
In addition to PCA, we conducted HCA to further identify groups of anti-glycan IgE and IgG responses that might be jointly elicited in Sm infected versus uninfected individuals. Figure S4 shows clusters of IgE and IgG responses in the rural and urban survey, and the dominant core substitutions on the glycans in these clusters. Generally, antibody clusters comprising core β2Xyl modified glycans were positively associated with Sm infection and intensity in both surveys (Table S2).

Rural-urban comparisons of anti-glycan antibody responses. Immunoglobulin E responses to indi-
vidual core β2Xyl and/or α3Fuc modified glycans were higher among rural compared to urban participants, as exemplified in Fig. 5a. Principal component analysis of data combined from both surveys yielded distinct groups of anti-glycan responses (Fig. 5b,f): PC1 was characterized by responses to core β2Xyl and/or α3Fuc modified glycans while PC2 was characterized by responses to non-xylosylated and non-fucosylated glycans. Scores for IgE PC1 (Fig. 5c), but not PC2 (Fig. 5d), were higher among rural compared to urban individuals (p = 0.002). Differences in IgG PC1 scores were not statistically significant. However, IgG PC2 scores were lower among rural compared to urban individuals (p = 0.013).
Further assessment by HCA showed that clusters that comprised IgE responses to core β2Xyl and/or α3Fuc modified glycans (IgE-C1, IgE-C2 and IgE-C4; Fig. S5) were positively associated with the rural setting (Table S4), while IgE-C3 (characterised by very low responses, raised against non-xylosylated and non-fucosylated glycans) was positively associated with the urban setting. Immunoglobulin G response clusters were generally similar between rural and urban settings, except for IgG-C7 which comprised responses to non-xylosylated and non-fucosylated glycans and was positively associated with the urban setting. www.nature.com/scientificreports www.nature.com/scientificreports/

Discussion
By studying rural Sm-endemic Ugandan fishing communities and a proximate urban community, we have dissected antibody responses to core β2Xyl and α3Fuc modified N-glycans. Antibody responses to the core modified glycans were higher in the rural communities compared to a proximate urban community. In the urban community, IgE and IgG to both core β2Xyl and core α3Fuc were positively associated with Sm infection. In the rural communities, IgE and IgG to core β2Xyl were strongly positively associated with Sm infection while reactivity to core α3Fuc was elevated in both Sm infected and uninfected individuals. In the rural communities the concentration of antibodies to core α3Fuc modified N-glycans peaked ahead of the peak of Sm infection intensity, while the peak of antibodies to N-glycans with only core β2Xyl coincided with it.
The positive association between current Sm infection and IgE and IgG reactivity to N-glycans carrying only core α3Fuc in the urban, but not the rural communities, might reflect universal exposure to infection, and persistence of light infection despite treatment, in the rural setting. Core α3Fuc is abundant on N-glycans from Sm eggs but is not expressed by cercarial and adult worm N-glycans 19,20,24 . It is plausible that responses to core α3Fuc persist after active infection in high Sm exposure rural settings: in mice, eggs and hepatic granulomas persist long after clearance of worms 64 . Another explanation for elevated responses to α3Fuc in the rural communities, regardless of Sm infection status, is cross-reactivity. Core α-1,3-fucosylation and β-1,2-xylosylation are also present on certain plant and insect glycoproteins 29,30,65 , hence similar core α3Fuc responses in both Sm infected and uninfected individuals may also be explained by an exposure other than schistosomes, more prevalent in the rural than the urban setting, that carries core α3Fuc. The observation that antibodies to core β2Xyl were significantly higher among Sm infected individuals in both urban and rural settings implies a dominant role for core β2Xyl (compared to core α3Fuc) in Sm-specific humoral immunity, shown here for the first time. It also appears that www.nature.com/scientificreports www.nature.com/scientificreports/ responses only to core β2Xyl are more responsive to change in Sm exposure: core β2Xyl is abundant on cercarial N-glycans despite being absent in adult worms.
The prominent contribution of core β2Xyl and α3Fuc to cross-reactivity between schistosomes and other environmental exposures such as pollen, hymenoptera venom and vegetable foods 22,37,38 is a caveat against the use of core modified glycans in schistosome diagnostic tests. Cross-reactivity with other helminth infections might also occur, but only a few other helminth species [25][26][27][28] , none of which are prevalent in humans in our survey settings, have so far been demonstrated to express glycans with core β2Xyl and α3Fuc motifs. More extensive glycomic studies of other helminths in our survey settings (S. stercoralis, hookworm, T. trichiura, A. lumbricoides, M. perstans) are warranted. However, we did not find any significant associations between these infections and IgE or IgG reactivity to core modified glycans.
Our observations that IgE and IgG reactivity to N-glycans modified with antennae carrying LDNF and LeX units were associated with Sm infection in both surveys are consistent with previous studies in animal models and in humans 49,66 . No associations were observed with responses to glycans carrying unsubstituted LDN units.
Principal component analysis indicated strong correlations between antibody responses to β-1,2-xylosylated glycans and responses to α-1,3-fucosylated glycans in both surveys. Core β2Xyl and α3Fuc epitopes can be found on similar Sm antigens, where they may be expressed on the same glycoproteins and glycans (such as those expressed by SEA) 19 , inducing analogous immune responses 36 . Non-xylosylated and non-fucosylated glycans with antennae constructed of LDN, LDN-F or LeX units may be expressed on the same Sm antigens as glycans with core β2Xyl and α3Fuc motifs. Furthermore, these terminal antennary substitutions can occur on the same glycans as core β2Xyl and α3Fuc 19,39,43 . However, PCA showed that responses to non-core-substituted glycans with LDN, LDN-F or LeX units did not cluster with core β2Xyl/α3Fuc substituted glycans. Temporal changes in expression of glycans on Sm antigens have been reported 20,34 ; it is possible that these two groups of glycans are expressed at varying magnitudes during Sm antigen maturation. Positive associations between Sm infection and www.nature.com/scientificreports www.nature.com/scientificreports/ the first principal component (representing responses to core β2Xyl and α3Fuc) reflect the important role of these core substitutions in the glycan-dependent host response to Sm. To further evaluate their contribution to the host immune response to Sm, it will be important to compare their antibody reactivity with that of other highly antigenic terminal motifs absent from glycans on the array used in this study, such as multi-fucosylated LDN motifs 59 . It is important to note that while IgG is abundantly detected to many schistosome glycans, and is triggered by Sm infection, only to core β2Xyl and α3Fuc modified glycans is IgE abundantly detected 46,47,67 .
Notably in the urban survey, PCA showed that IgE responses to core β2Xyl modified glycans clustered with responses to non-xylosylated and non-fucosylated glycans (Fig. 4c), and IgG responses to core β2Xyl and α3Fuc separated out less distinctly (Fig. 4d) than in the rural survey. The observed β2Xyl clustering patterns may be attributed to the greater intensity of repeated exposure to schistosome cercariae (core β2Xyl) and sustained egg deposition (core β2Xyl and α3Fuc) among rural compared to urban participants. In other words, rural-urban differences in antibody responses to core modified glycans may be indicative of differences in the intensity of Sm infection and/or degree of exposure between the two settings. However, this study did not have sufficient power to assess statistical interactions between the rural and the urban setting. Rural-urban differences in antibody responses to core modified glycans may also be explained by exposures other than schistosomes (mentioned above), perhaps more prevalent in the rural than the urban setting; however, this is unlikely as we observed strong associations between Sm infection and reactivity to core modified N-glycans, particularly to those carrying core β2Xyl. It is also noteworthy that urban survey participants were significantly younger than rural participants; however, this disparity did not seem to influence the observed rural-urban differences in anti-glycan responses, as observed from test statistics before and after adjusting for age.
One of the key challenges in schistosomiasis vaccine development is the risk of allergic (IgE) sensitisation to candidate vaccine antigens 68 . Glycans are attractive vaccine candidates because they are generally considered to be benign as allergenic determinants 69,70 . There are a few known exceptions, such as the galactose-α-1,3-galactose (α-1,3-gal) epitope (found in non-primate mammalian proteins, and shown to elicit severe allergy) 71 , so assessment for any associations between IgE to antigenic Sm glycans and allergy-related phenomena are important. The case for consideration of core modified Sm glycans as Schistosoma vaccine candidates will also need definite proof for an association between reactivity to core modified glycans and protection from Sm infection/re-infection. Our data suggests that a protective role, if any, is more plausible for core β2Xyl than core α3Fuc: in the rural survey, antibody responses to core α3Fuc (G73 and G37, Fig. 3c,d) peaked in childhood, prior to the Sm infection peak in early adolescence, while responses to core β2Xyl (G34) coincided with the Sm infection peak (preceding the more 'protected' period in adulthood). However, concrete evidence is required from further population and mechanistic studies exploring the role of Sm N-glycans in protective immunity. For example, it may be important to assess antibodies to these core modifications (and other antigenic terminal motifs) in re-infection study cohorts evaluating the immunological characteristics of individuals who are Sm-resistant following anthelminthic treatment.
In conclusion, we provide an immuno-epidemiological description of IgE and IgG responses to N-glycans in rural and urban Uganda, highlighting the significance of core β2Xyl and core α3Fuc to the glycan-dependent host immune response during chronic schistosomiasis. Moreover, our data imply that IgE and IgG responses to core β2Xyl and α3Fuc modified N-glycans have distinctive relationships with Sm infection and intensity, which may reflect their different contributions towards protective immunity against Sm that need to be further explored using mechanistic animal and human studies.

Data Availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.