Does immunosuppression promote drug resistance in malaria?
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Comment↗
Biomedical subjects
M J Doenhoff
Publications and source records attributed to M J Doenhoff.
Immune-dependent chemotherapy of schistosomiasis.
Host immune responses have been shown to enhance the efficacy of several schistosomicidal drugs. The evidence derives mainly from experiments on Schistosoma mansoni infections in the mouse with their immune status variously modulated; this review emphasises praziquantel (PZQ), which is now the main drug used for treatment of human schistosomiasis. Electron microscopy and indirect immunofluorescence indicate that PZQ disrupts the integrity of the surface membranes of S. mansoni, particularly those covering the dorsal tubercles of adult male worms, and this causes antigens which are the targets of antibody attack to be revealed. We review the evidence that two S. mansoni antigens in particular are implicated in the immune-dependent action of PZQ: a 200 kDa glycoprotein and a 27 kDa antigen with non-specific esterase activity. Consistent with the involvement of the latter antigen, increased non-specific esterase activity was demonstrated histochemically on the surface of intact PZQ-treated male worms, and we describe a chromogenic substrate assay for quantifying the amount of esterase activity that is exposed after drug treatment. The potential relevance of these observations for enhancing the efficacy of drugs currently used to treat human schistosomiasis, and for devising novel therapeutic strategies, is discussed.
Animals↗
Hypothesis: impaired immunity as a factor which contributes to the spread of drug-resistance.
Evidence has accrued to indicate that host defence mechanisms enhance the efficacy of many of the drugs used to treat infectious diseases. Because of this, and also because of the likelihood of increased pathogen loads in immunoincompetent hosts, some infections are less likely to be completely cured by normal regimens of chemotherapy in individuals with drastically impaired immune responsiveness. In such circumstances natural selection could result in the accelerated emergence of drug-resistance pathogens.
Animals↗
Preface: positive interactions between anti-infection drugs and the immune response: an emerging paradigm.
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Animals↗
The susceptibility of adult schistosomes to immune attrition.
Mouse infection models are described that demonstrate reduction of egg production in Schistosoma haematobium infections and both worm loss and reduced fecundity in S. bovis infections. Neither phenomenon could be shown in S. mansoni infected mice. The immunological basis for these anti-adult responses was inferred by comparison with infections in T-cell deprived mice and by serum transfer of the ability to reduce a S. bovis worm burden into immunocompromised hosts. Vaccination with irradiation attenuated parasites was also shown to have consequences for the adults of a challenge infection of S. haematobium and S. bovis specifically. Prior vaccination resulted in an abrogation of the anti-fecundity and adult worm elimination that occurred in non-vaccinated similarly infected mice. These models are being used to define the targets and mechanisms involved in anti-adult attrition. A serological assay, quantitation of a circulating antigen (CAA) has been assessed for its ability to measure worm burdens of different species of schistosome in mice. This assay will be used to question whether anti-adult immunity contributes to the pattern of infection with S. mansoni and S. haematobium in man.
Animals↗
The immune dependence of chemotherapy.
In this review, Mike Doenhoff and colleagues discuss the immune dependency of chemotherapy and the consequences for drug resistance. They also consider the implications for the control of infections that are relatively unresponsive to drugs, such as opportunistic infections in immunosuppressed patients.
Journal Article↗
The purification, characterization, serological activity and hepatotoxic properties of two cationic glycoproteins (alpha 1 and omega 1) from Schistosoma mansoni eggs.
T cell-deprived mice acutely infected with S. mansoni suffer microvesicular hepatocyte damage which is not seen in infected, immunological intact animals. A cationic fraction (CEF6) of the PBS-soluble portion of S. mansoni eggs (SEA) induces antibodies which, on passive transfer, prevent hepatocyte damage. CEF6 contains 2 antigens, omega 1 and alpha 1, and has also been shown to be a useful serodiagnostic reagent. This paper describes the purification and characterization of the 2 antigens present in CEF6. omega 1 is a monomeric glycoprotein with a pI greater than 9.0 and a molecular weight of 31 kDa. Alpha 1 consists of two immunologically cross-reactive dimers, 41 and 36 kDa in non-reducing conditions, each of which consists of one unique and one common glycoprotein subcomponent. In ELISA with mouse and human infection sera omega 1 is shown to be S. mansoni specific and is better able to distinguish S. mansoni infections from other schistosome infections than are unfractionated SEA, CEF6 or alpha 1. Passive transfer of monospecific anti-omega 1 sera into S. mansoni infected, T cell-deprived mice completely prevented the occurrence of microvesicular hepatocyte damage in these animals. Monospecific anti-alpha 1 serum had no hepatoprotective capacity.
Animals↗
Effect of acute phase proteins, especially alpha 2-macroglobulin, on granuloma formation around Schistosoma mansoni eggs in the rat.
A new model for the study of granuloma formation in the liver is described. Rats received an injection of 20,000 Schistosoma mansoni eggs in the portal vein and granuloma formation was evaluated at 3, 5 and 7 weeks post-injection. Liver collagen was estimated at the same time and serum procollagen III peptide, a marker of collagenesis, weekly. With this model, wherein the number of S. mansoni eggs and the time of injury are standardized, the effect of high levels of acute phase proteins especially alpha 2-macroglobulin on granuloma formation was studied. It appeared that in rats with high levels of alpha 2-macroglobulin the mean size of granulomas was significantly greater at 3 and 5 weeks compared with controls. In both groups an increase in liver collagen was observed during this period, reaching a peak at 5 weeks in the acute phase group. This model facilitates the study of the effects of S. mansoni eggs on granuloma formation.
Acute-Phase Proteins↗
Proteases in the schistosome life cycle: a paradigm for tumour metastasis.
Cancers and parasites have a number of properties in common, particularly those that relate to their respective capacities to evade host defence mechanisms. This review highlights the similarities between metastatic tumours and schistosomes in particular, and describes the role that proteases may have in the migration, growth, survival and transmission of the different stages of the schistosome life-cycle in the vertebrate host. An elastase-like serine protease of schistosome larvae has been particularly well characterized, and its substrate profile and other properties are indicative of a role in facilitating migration of the parasite through skin tissue early after infection. The primary structures of a cathepsin B-like enzyme, and a putative 'haemoglobinase' found in adult worms have also recently been derived, these enzymes being responsible for degradation of haemoglobin in erythrocytes upon which the adults feed. Adult schistosome worms reside and produce eggs intravascularly, and the processes that mediate the extravasation and subsequent migration of the egg through host tissue are dependent on both blood platelets and the immune response. Fibrino(geno)lytic enzymatic activity that is present in the egg could modulate the thrombogenic potential that eggs might have as a result of their capacity to cause platelet aggregation in vitro and in vivo. The roles of other proteases and peptidases that have been found in schistosome larvae, worms and eggs are less clear. Some of these enzymes may modulate immunological and haemostatic defence mechanisms and thus prolong survival of the parasite, and the consequences of the interactions between schistosomes and host protease inhibitors could also be immune modulatory.
Animals↗
Immune dependence of schistosomicidal chemotherapy: an ultrastructural study of Schistosoma mansoni adult worms exposed to praziquantel and immune serum in vivo.
This study examines the immune-dependence of praziquantel (PZQ) for the treatment of Schistosomiasis mansoni in mice. We have shown elsewhere from worm recovery data that the efficacy of PZQ is significantly enhanced when mice are treated concomitantly with antisera raised against antigens released from adult schistosomes, even though such antisera show no intrinsic helminthotoxic activity (Doenhoff et al. 1987, Doenhoff, Modha & Lambertucci 1988). Moreover, indirect immunofluorescence assays have shown that male worms exposed to the dual treatment regime in vivo bind antiserum to their dorsal surfaces in a pattern that seems to follow the outline of the dorsal tubercles. Scanning and transmission electron microscopy have now been used to further define the features of damage inflicted upon worms through exposure to antiserum alone, drug alone, or the two treatments in combination. Such investigations revealed that the antiserum induces a classical membrane repair process in worms of both sexes, but little other damage. PZQ causes the formation of spherical protuberances on the dorsal tubercles of male worms, while the dual treatment regime induces both kinds of damage in male schistosomes, but with much enhanced severity. The protuberances show evidence of explosion and some regions of the tegument become completely destroyed. Regions other than the dorsal surfaces of the male worms do not exhibit comparable trauma, and neither do the females. These data are discussed in relation to the known schistosomicidal activity of PZQ, the notion that male and female worms exhibit regional and sexual differences in susceptibility, documented evasive strategies of the parasite and the interdependence of immuno- and chemotherapy.
Animals↗
Blood platelets and schistosome egg excretion.
The eggs of helminths of the Schistosoma genus require to be extravasated in order to continue the life cycle of the parasite. The possible mode by which this takes place was investigated in a mouse model. Suppression of platelet activity in Schistosoma mansoni-infected mice by administering rabbit anti-mouse platelet serum or a selection of "antiplatelet drugs" resulted in a significant reduction of parasite egg excretion. This reduction was best achieved when antiplatelet agents were administered just before the onset of parasite egg excretion. The association between parasite eggs and platelets was illustrated in vivo and in vitro where platelet aggregates on egg surfaces were seen in both light and electron microscopy. In addition, eggs that had been isolated from infected mouse tissues induced platelet aggregation in whole mouse blood, and this was inhibited by preincubation with the beta-lactam antibiotic, ticarcillin. Isolated eggs were also capable of inducing ex vivo platelet aggregation in mice, which was dependent on presensitization with eggs. These data suggest a role for platelets in the extravasation and excretion of parasite eggs in schistosomiasis.
Animals↗
Schistosoma bovis as an immunological analogue of S. haematobium.
The host-parasite relationships of Schistosoma bovis and S. haematobium have been compared in normal and T-cell-deprived mice, and have been found to contrast with that of S. mansoni. Deprived mice infected with either of the former two schistosome species survived as long as, or longer than, comparably infected immunologically intact controls, and hepatocytes of infected deprived mice were not damaged in the absence of granuloma formation. S. mansoni-infected deprived mice, however, die earlier than intact controls, and suffer extensive hepatocellular abnormalities. A high degree of cross-reactivity between S. bovis, S. haematobium and S. mansoni antibodies and antigens was noted in immunoprecipitation but a greater degree of homology between S. haematobium and S. bovis egg antigens was demonstrated by enzyme immunoassay (ELISA). S. haematobium and S. bovis thus resemble each other more closely than either resembles S. mansoni, and in view of the apparent antigenic similarities between S. haematobium and S. bovis and the relatively greater ease with which the S. bovis life-cycle can be maintained in the laboratory, the animal parasite may be useful in providing material for further immunological studies of the human infection.
Animals↗
Specific cross-protection between Schistosoma bovis and S. haematobium induced by highly irradiated infections in mice.
Significant levels of resistance against Schistosoma haematobium challenge were developed by mice exposed to highly irradiated (20 krad) cercariae of the homologous species (46-53%) or of the closely related species, S. bovis (34-56%) but not of S. mansoni (-6-28%). This ability to cross-protect reflects the phylogenetic relationships between these species; S. mansoni and S. bovis, as well as S. mansoni and S. haematobium, failed to cross-protect. The cross-protection demonstrated between S. bovis and S. haematobium in mice was non-reciprocal.
Animals↗
The immune-dependence of chemotherapy in experimental schistosomiasis.
Experimental evidence indicates that immune effector mechanisms can enhance the activity of schistosomicidal drugs. Praziquantel, oxamniquine, hycanthone and antimony were less effective against Schistosoma mansoni infections in mice immunosuppressed by T cell-deprivation, than against comparable infections in normal mice. The schistosomicidal activities of praziquantel, oxamniquine and antimony have been experimentally enhanced by the synergistic action of immune sera. In passive serum transfer experiments a S. mansoni antigen of Mr 27kD with non-specific esterase activity was identified as a potentially sensitive target for the antibodies that interact with praziquantel. Indirect immunofluorescence indicated that this antigen was exposed on the worm surface as a result of praziquantel treatment.
Animals↗
Immunological identification of Schistosoma mansoni peptidases.
Precipitin arcs formed after immunoelectrophoresis of Schistosoma mansoni egg, worm and cercarial antigens with polyspecific rabbit antisera have been 'stained' at neutral pH with chromogenic enzyme substrates specific for proteases and peptidases. A total of 7 antigenically distinct enzymes with peptidolytic properties were identified. An enzyme which hydrolyzed phenylalanine naphthyl ester bonds was found in adult worm extracts, but appeared to be host-derived in so far as it was also immunoprecipitable from the same extracts by rabbit anti-normal mouse plasma. Three more phenylalanine naphthyl esterases were found, all stage-specific; one was in cercarial homogenates and two were in egg homogenates. A leucine naphthylamidase was also found in egg extracts, and it was antigenically distinct from, and did not react on dipeptide substrates that were hydrolyzed by two other leucine aminopeptidases present in extracts of all three stages of S. mansoni. The method provides a simple means of distinguishing constituents of complex mixtures of antigens by a combination of their immunological and biochemical properties.
Aminopeptidases↗
Schistosome proteases.
While studies of schistosome antigens have proceeded rapidly over the past ten years, studies of schistosome enzymes have also been increasing apace. Now the two `lines' of research are coming together. Parasites such as schistosomes hardly present antigens merely to stimulate a host immune response, so it is not surprising that many antigens turn out to have functions, for example, as enzymes. One type of antigenic schistosome enzyme - glutathione S-transferase - already shows promise as a vaccine candidate. Here, Jim McKerrow and Mike Doenhoff review another important class of enzyme, many of which are clearly antigenic, the schistosome proteases.
Journal Article↗
The host-parasite relationship of Schistosoma haematobium in CBA mice.
The host-parasite relationships of two geographical isolates of Schistosoma haematobium in CBA mice are described and compared to previous reports on this parasite in other experimental hosts and in man. The mean percentage establishment of worms in mice was 17% and was not affected by the age or sex of the host. Adult worm burdens remained constant over 20 weeks, but were reduced after 18 months of infection. Male and female worms reached mean maximum lengths of 4.78 and 5.9 mm respectively. Egg laying commenced 9.5 weeks after infection and eggs accumulated in the tissues throughout the period of infection. A large increase in the rate of egg accumulation occurred coincidental with the appearance of eggs in the bladder of some mice. Faecal eggs were first observed in some mice at 12.5 weeks and most mice excreted a few eggs by 17 weeks p.i. (post-infection). Eggs were not found in the urine of infected mice. Excreted eggs and eggs isolated from the livers of infected mice hatched, but the resulting miracidia were unable to infect appropriate snail hosts. The development of hepatic granulomas and egg-induced pathology in the bladder of mice is described.
Age Factors↗
An association between schistosomes and contrapsin, a mouse serine protease inhibitor (serpin).
An antigen in homogenates of adult Schistosoma mansoni worms grown in mice, and immunoprecipitated by polyspecific rabbit antiserum, has been identified as contrapsin, a mouse serine protease inhibitor (serpin). In the serum of some mice infected with S. mansoni contrapsin was found with altered immunoelectrophoretic characteristics when compared with contrapsin from uninfected mice.
Animals↗