Biomedical subjects
Publications and source records attributed to W F Piessens.
The pathogenesis of lymphatic filariasis has been a matter of debate for many decades. Here, Gerusa Dreyer and colleagues propose a dynamic model of bancroftian filariasis, integrating clinical, parasitological, surgical, therapeutic, ultrasonographic and histopathological data. This model has profound implications for filariasis control programs and the management of the individual patient.
Infection with Wuchereria bancrofti, Brugia malayi, or B. timori not only affects the structure and function of lymphatic vessels but is also associated with extralymphatic pathology and disease. Because it is now possible to detect living adult worms by ultrasonography, much emphasis is placed on lymphatic pathology. However, the finding of renal damage in asymptomatic microfilaremic carriers has led to increased recognition of the importance of extralymphatic clinical manifestation in bancroftian filariasis. The authors present a number of clinical syndromes that may be manifestations of extralymphatic filarial disease and discuss possible mechanisms that cause these conditions. The main purpose of this paper is to raise the awareness of students and physicians of the prevalence and the importance of extralymphatic disease in bancroftian filariasis so that it is diagnosed and treated properly and also to alert for the need of additional research in this area.
AIM: To determine whether immunization with recombinant filarial chitinase or a fragment containing the epitope recognized by McAbMF1 and SXP-1 could protect jirds against microfilaremia resulting from infection with B. malayi. METHODS: Test jirds were immunized with the following recombinant parasite antigens: filarial chitinase, the c-terminal fragments F7R2 or F8R2 of r-chitinase, filarial SXP-1, myosin or maltose binding protein (MBP). Employing immunochemical techniqe (SDS-PAGE, Western Blotting) and serology (ELISA) measured antifilarial antibodies level. RESULTS: Immunization of jirds with recombinant chitinase induced partial protection against microfilaremia resulting from subsequent infection with B. malayi, but did not reduce adult worm burdens. Vaccination was much less effective when administered during the prepatent stage of infection and was ineffective when given to microfilaremic jirds. Immunization of jirds with SXP-1, an antigen present in multiple worm stages also reduced microfilaremia and, in some experiments, adult worm burdens. CONCLUSION: The recombinant chitinase, fragments F7R2 and F8R2 and SXP-1 could provide partial protection against microfilaremia in jirds.
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Prior studies indicate that a microfilarial stage-specific chitinase is a possible candidate antigen for a transmission-blocking vaccine against Brugian filariasis. The antigen is a functional enzyme that progressively appears as microfilariae mature and become able to infect and develop in a susceptible mosquito vector. It is recognized by a monoclonal antibody that reduces microfilaremia in infected animals and by a subset of sera from infected persons who remain amicrofilaremic. Immunization of jirds with recombinant chitinase induced partial protection against microfilaremia resulting from subsequent infection with Brugia malayi, but did not reduce adult worm burdens. Vaccination was much less effective when administered during the prepatent stage of infection and was ineffective when given to microfilaremic jirds. The protective epitope appears to be located close to the carboxy terminus of the chitinase molecule. Immunization of jirds with SXP1, an antigen present in multiple worm stages, also reduced microfilaremia and, in some experiments, adult worm burdens, but hyperimmunization with a recombinant filarial myosin was not protective. These observations indicate that the relative timing of immunization and infection is an important factor in the efficacy of antimicrofilarial vaccines.
In many parasitic infections, dominant T helper cell (Th) type-2 CD4+ T cell responses exacerbate the disease. We have previously demonstrated that lacto-N-fucopentaose-III (LNFPIII), a sugar found on soluble egg antigens (SEA) of Schistosoma mansoni, stimulates splenic B cells from parasite-infected mice to proliferate and produce IL-10, a cytokine that promotes the generation of Th2 immune responses. In the present study, we extend our observations on ligand-specific activation of IL-10 producing B cells to leishmaniasis and lymphatic filariasis. We report here that infection with Leishmania major increases the splenic B220+ B cell subset in BALB/c mice, but not BALB/c. xid (lacking B-1 cells and carrying defective B-2 cells). In addition, these B cells secrete large amounts of IL-10 in vitro in response to stimulation with soluble leishmanial extract (LSE), LNFPIII, or SO4-Lewis(x). We also observed that injection of LSE increased the level of peritoneal exudate (PeC) B-1 cells (CD5+B220+) in BALB/c mice, but not C57BL/6, as compared to buffer-injected controls. Further, LSE elicited PeC B cells secreted IL-10 in response to LSE as well as to the sugars tested. A similar differential secretion of IL-10 by splenic B cells from BALB/c and BALB/c.xid was seen after S. mansoni infection. Likewise, injection of soluble microfilarial extract (MFX) resulted in an increase in percentage of PeC B-1 cells in BALB/c mice, but not C57BL/6, and these cells secreted IL-10 in response to stimulation with MFX or phosphorylcholine (PC). Collectively, these results suggest a correlation between expansion of ligand-specific IL-10 producing B and B-1 cells with dominance of Th2-type T cells in mice with the susceptible phenotype for these diseases.
We examined the periodicity and intravascular distribution of Wuchereria bancrofti microfilariae (mf) and determined the effect of these parasite properties on the accuracy of blood filming and filtration methods for diagnosis of bancroftian filariasis in the endemic area of Recife, Brazil. Microfilariae in both venous and capillary blood exhibited a nocturnal periodicity pattern with a relatively high amplitude. Overall, capillary blood contained approximately 1.25 times the number of mf present at the same time in the same volume of venous blood. However, the ratio of mf present in capillary and venous blood varied over a 24-hour period, so that the fewest mf were present in the capillary bed of the skin at the time when biting activity of the local Culex vector is the lowest. Twenty or 60 microliters blood films did not reliably detect carriers with fewer than 100 or 60 mf/ml venous blood, respectively, and were thus inadequate for the identification of low density mf carriers. In contrast, all carriers with > 1 mf/20 or 60 microliters blood smear at night could be identified during daytime hours by filtration of 1 micromilligram venous blood.
We examined the immunogenicity of various connective tissue proteins in patients with chronic onchocercal dermatitis and the effect of filarial proteases on this host-parasite interaction. Sera from patients with onchocerciasis reacted strongly with cuticular collagens from filarial parasites and with mammalian laminin. Some sera also contained antibodies to elastin and collagen type IV, but none reacted with collagen types I-III or fibronectin. This pattern of reactivity was characteristic for onchocerciasis: sera from patients with mansonellosis reacted strongly with collagen type IV but only weakly with laminin. Reactivity with mammalian laminin or collagen could not be absorbed with cuticular proteins from filarial worms and vice versa. Digestion fragments of laminin treated with filarial proteases retain antigenic determinants recognized by sera from patients with onchocerciasis. In contrast, proteases from Onchocerca volvulus adults and microfilariae drastically decreased the reactivity of the same sera with collagen type IV. These results indicate that filarial proteases may contribute to the pathogenesis of chronic onchocercal dermatitis, directly, by enzymatically destroying connective tissue of the skin, and indirectly, by triggering autoimmune responses to self-determinants on connective tissue proteins that are normally hidden within the supramolecular structure of the extracellular matrix complex.
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We evaluated the performance of Dot-enzyme-linked immunosorbent assays designed to detect species- and stage-specific antigens of Paragonimus westermani in sera with monoclonal antibodies as serodiagnostic tests for active paragonimiasis. Sera from all donors with parasitologically confirmed infections with P. westermani contained adult worm antigens, as did a high proportion of sera from persons suspected to be infected with this parasite. A smaller proportion of these sera also contained metacercarial stage-specific antigens. Sera from donors with other helminth infections, with confirmed pulmonary tuberculosis, or from healthy Chinese donors were nonreactive in the assay. Treatment of experimentally infected animals with praziquantel triggered a marked but transient increase in serum levels of adult P. westermani antigens, which then gradually disappeared within the next two months. The results of our studies indicate that the antigen-detection assay we have developed is a highly specific and sensitive diagnostic test for active infections with P. westermani.
We compared the effect of a single dose of ivermectin (100 micrograms/kg) with that of a standard course of diethylcarbamazine (DEC) (6 mg/kg) on several parameters of the host's antifilarial immune response in 60 patients with bancroftian filariasis enrolled in a double-blind drug trial. All participants had measurable serum levels of antifilarial antibodies and parasite antigens. Drug-induced clearance of microfilaremia was associated with a temporary increase in HC11 antigenemia and a decrease in serum levels of antibodies to soluble filarial antigens. Antigenemia progressively declined in patients who remained a microfilaremic after treatment, but declined and then rose in persons with recurrent microfilaremia. Treatment triggered a sustained increase in serum levels of IL-1, IL-6, TNF alpha and IFN gamma in all patients. Although Ivermectin and DEC are believed to exert their antiparasite activity via different mechanisms, the same pattern of serological changes was observed in patients treated with either drug.
Brugia malayi is a parasitic nematode that causes lymphatic filariasis in humans. The monoclonal antibody MF1, which mediates clearance of peripheral microfilaremia in a gerbil infection model, recognizes two stage-specific proteins, p70 and p75, in B. malayi microfilariae. cDNA coding for the MF1 antigen was sequenced, and the predicted protein sequence shows significant similarities to chitinases from bacteria and yeast. When microfilarial extracts and purified preparations of the MF1 antigen were tested for chitinase activity, strong bands of chitin-degrading activity comigrated in SDS/PAGE with p70 and p75 and showed a reduction-dependent mobility shift characteristic of the MF1 antigen. Thus, the MF1 antigen is microfilarial chitinase, which may function to degrade chitin-containing structures in the microfilaria or in its mosquito vector during parasite development and transmission.
We have isolated and characterized a gene encoding a novel GTP-binding protein of the GTPase superfamily in the filarial parasites Brugia malayi and Onchocerca volvulus. The deduced amino acid sequence of the cloned molecule has approximately 30% overall homology to ras proteins and approximately 90% homology to the 'ras-like' nuclear proteins TC4, ran and Spil. Rabbit antisera to bacterially expressed filarial protein detect a 24-22 kDa doublet in extracts of adult B. malayi and mature microfilariae, which is absent from immature microfilariae. Increased expression of the native parasite protein occurs when worms are cultured in the presence of epidermal growth factor.
By differentially screening an adult Brugia malayi cDNA library with sera from microfilaremic and amicrofilaremic donors infected with Wuchereria bancrofti, we have identified a novel parasite antigen denoted SXP-1. Recombinant SXP-1 filarial antigen is preferentially recognized by sera from microfilaremic persons with bancroftian filariasis and from skin snip-positive patients with onchocerciasis. Antibodies to SXP-1 are restricted to the IgG4 subclass and gradually decline after treatment with diethylcarbamazine. These findings indicate that it may be possible to replace microscopic examination of night blood films with a serological test designed to detect antibodies to a mix of SXP-1 and other suitable antigens for the diagnosis of microfilaremia due to bancroftian filariasis.
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Infectivity rates of insect vectors are the best criteria by which to assess the transmission of filarial parasites and the efficacy of filariasis control programs. Currently available DNA probes can be used to estimate the proportion of vectors containing larvae of a given filarial species but provide no information on three other important variables in the transmission dynamics of filarial nematodes: the developmental stage, the location and the actual number of larvae that are present in the vector, all of which can be reliably determined by microscopy. However, species identification is often difficult and sometimes impossible by conventional microscopy, which requires morphologically intact specimens. DNA is tough and DNA probing can identify worms that are dead and that have lost morphologic integrity; it also permits multiple analyses of the same specimen with different probes and has the potential for simultaneous processing of very large numbers of samples. Here, Senaroth Dissonoyake and Willy Piessens outline the route to the development of species- and life cycle stage-specific DNA/RNA probing reagents, and simple, reliable and quantitative technologies that can supplement and ultimately replace microscopic dissection.
We compared the efficacy of a single dose of ivermectin with that of a standard course of deithylcarbamazine (DEC) for the control of microfilaremia in 60 patients with banrroftian filariasis who had developed recurrent microfilaremia after each of three or more prior treatments with DEC. The study was done as a randomized, double-blind trial. Complete, but transient clearance of microfilaremia was observed in both treatment groups. One year later, recurrent microfilaremia was present in 7 patients treated with ivermectin and in 5 treated with DEC. Pretreatment levels of microfilaremia were significantly higher in patients who relapsed within one year after treatment than in those who remained amicrofilaremia. Side effects of either treatment were common but mild. Febrile reactions were more frequent in the ivermectin group: while localized reactions consistent with a flare up of acute filarial disease occurred mostly in the DEC group. We conclude that ivermectin is an effective and practical alternative to DEC for treatment of recurrent microfilaremia due to bancroftian filariasis.
We compared the chemical and immunological properties of cuticular collagens from four species of filarial nematodes, Onchocerca volvulus, O. gutturosa, Brugia malayi, and Dirofilaria immitis. The electrophoretic mobility of the major polypeptides extracted from adult worms is characteristic for each species studied. Cuticular collagens from adult worms and infective larvae differ in their susceptibility to proteases that cleave vertebrate collagens and to collagenases prepared from different developmental stages of filarial parasites. The overall amino acid composition of filarial collagens resembles that of vertebrate interstitial collagens and differs from that reported for collagens from free-living or intestinal nematodes. However, cuticular proteins of the four filarial species studied significantly differed in amino acid composition and in their reactivity with antisera to interstitial and basement membrane collagens of vertebrates.