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Ecology and epidemiology of Echinococcus multilocularis in Europe.

Human alveolar echinococcosis (AE), caused by the larval stage of Echinococcus multilocularis has a high mortality rate in untreated patients. The life-cycle of E. multilocularis in Europe predominantly involves foxes as definitive hosts. However, experimental studies demonstrated a comparable biotic potential of E. multilocularis in dogs and raccoon dogs but an insignificant potential in cats. AE occurs in central and eastern Europe at low incidence rates. Recent studies in foxes have shown that E. multilocularis has a wider geographic range (including Italy) than previously thought. In recent years, increases in fox populations have been observed in many European countries, especially in urban areas. As a result, the E. multilocularis cycle is now established in the urban environment. This presents an increased risk of infection for a large human population. Based on these facts and new epidemiological data, possible intervention strategies are presented.

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Arginine-dependent generation of reactive nitrogen intermediates is instrumental in the in vitro killing of protoscoleces of Echinococcus multilocularis by activated macrophages.

The interaction between protoscoleces of Echinococcus multilocularis and activated murine macrophages was examined in this study. Marked protoscolicidal activity was displayed by peritoneal macrophages (PM) activated with interferon-gamma (IFN-gamma), or IFN-gamma plus lipopolysaccharide. Pretreatment of the parasites with heat-inactivated specific murine infection serum, but not with normal serum rendered them more susceptible to PM killing. NG-monomethyl-L-arginine, a competitive inhibitor of L-arginine completely inhibited the killing activity of activated PM, while reconstitution of arginine-free medium with L-arginine restored the killing properties of the activated PM. The results show that activated PM have the ability to kill E. multilocularis protoscoleces in vitro and suggest that reactive nitrogen intermediates (RNI) play an important role in the mechanism. An oxygen-mediated mechanism did not appear to play a role because scavengers of reactive oxygen species did not reduce the killing activity. The arginine-dependent killing mechanism was enhanced by superoxide dismutase (SOD), probably because SOD might prolong the effect of nitric oxide. Secretion of RNI by activated macrophages may be capable of a significant role in preventing of the dissemination of E. multilocularis infection in vivo.

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Cloning and characterisation of an immunodominant major surface antigen of Echinococcus multilocularis.

A lambda gt11 cDNA expression library from mRNA of Echinococcus multilocularis protoscolices has been constructed in Escherichia coli Y1090. Immunoscreening with pooled sera obtained from patients suffering from E. multilocularis disease revealed 5 reactive clones. By partial DNA sequence comparison all clones proved to encode the same gene. The complete cDNA sequence of the clone pEM10 with the largest insert of 2.2 kb was determined and an open reading frame of 1.7 kb could be described. The derived amino acid sequence shares 42.6% identity with human microvillar cytovillin found in the membranes of placenta and carcinoma tissues. The coding region of the cDNA of pEM10 was amplified by polymerase chain reaction (PCR) and cloned in frame into expression vector pGEX-3X. Immunoblot analysis revealed the expression of a recombinant antigen of 65 kDa and a protein with the same molecular weight was also found in the lysate of E. multilocularis protoscolices. In contrast, the protein was absent from hydatid fluid or larvae of Echinococcus granulosus. By means of immunofluorescence studies this immunodominant antigen could be located in the germinal layer of brood capsules and in the tegument of E. multilocularis protoscolices. The fusion protein was purified and used for diagnostic purposes in immunoblot. The diagnostic value of this antigen is discussed.

Amino Acid Sequence↗

Suppression of T-cell proliferation by CD8+ T cells induced in the presence of protoscolices of Echinococcus multilocularis in vitro.

Immunoregulatory influences of protoscolices (PSC) of Echinococcus multilocularis on murine T-lymphocyte functions have been examined in an in vitro system. Proliferative responses of spleen cells stimulated with concanavalin A (ConA) or anti-CD3 monoclonal antibodies were depressed by the addition of PSC. In the presence of PSC, both interleukin-2 (IL-2) production and IL-2 receptor (IL-2R) expression by lymphocytes stimulated with ConA were significantly reduced. However, exogenous IL-2 reconstituted both the ConA-stimulated proliferative responses and IL-2R expression. These findings suggest that PSC of E. multilocularis can suppress lymphoid cell responses via influences on IL-2 production. Indeed, addition of CD(8+)-enriched cells from cultures stimulated with ConA plus PSC to fresh spleen cells showed marked suppression of the ConA responses. IL-2 production as well as IL-2R expression on the spleen cells so treated were suppressed. These findings reveal a suppressive immunologic function induced by E. multilocularis PSC that involves inhibition of IL-2 production and reduction of IL-2R expression. The PSC-induced CD8+ cells appear to play a key role in the suppressive regulation of host immune responses against E. multilocularis.

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Isolation of polymorphic microsatellite loci from the tapeworm Echinococcus multilocularis.

Two microsatellites were isolated from a genomic library of Echinococcus multilocularis. The microsatellites, designated EMms1 and EMms2, consist of tandem repeats of CAC-trinucleotide unit. Southern blot hybridization suggests that each of them is a single locus. Using fox-derived wild tapeworms (N=104), PCR-amplification of microsatellites was performed to assess the usefulness of these loci. We found four alleles of EMms1 and two alleles of EMms2. The heterozygosities observed were 10.6% in EMms1 and 7.7% in EMms2. The result suggests that both selfing and outcrossing occur in the adult stage of E. multilocularis.

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[In vivo inhibition by ethyloxanilates of alkaline phosphatases of the cestode Echinococcus multilocularis].

Alkaline phosphatases (E.C.3.1.3.1), membranous enzymes of the cestode Echinococcus multilocularis have been studied in the parasite and in the experimental host liver. Synthetic inhibitors interaction with metacestode alkaline phosphatases is reported. In regard to the alkaline phosphatases inhibition, the ethyloxanilate 2 is more efficient in the cestode itself than in the host liver.

Alkaline Phosphatase↗

Effect of amphotericin B on larval growth of Echinococcus multilocularis.

Alveolar echinococcosis is caused by the parasitic cestode Echinococcus multilocularis. Benzimidazoles, namely, mebendazole and albendazole, are the only drugs available for the treatment of inoperable alveolar echinococcosis. At present, no therapeutic alternative is available for patients with progressive disease under treatment or for patients who are unable to tolerate the side effects of the benzimidazoles. In addition, benzimidazoles are only parasitostatic for E. multilocularis. Thus, new therapeutic options are of paramount importance. In the present study we examined the in vitro effect of amphotericin B on E. multilocularis larvae. E. multilocularis metacestodes grown in the peritoneal cavities of Mongolian gerbils were transferred into a culture system. Vesicles budded from the tissue blocks and increased in number and size during the first 5 weeks. After 6 weeks drugs were added and deleterious effects on the vesicles were observed macroscopically and microscopically. By use of this in vitro tissue culture model we demonstrated that amphotericin B effectively inhibits the growth of E. multilocularis metacestodes. This destructive effect was significantly more rapid with amphotericin B than with the benzimidazoles. Cyclic treatment was effective in suppressing parasite growth. However, amphotericin B appears to be parasitostatic for E. multilocularis larvae, and regrowth occurs even after extended periods. In summary, amphotericin B constitutes the first promising alternative for the treatment of alveolar echinococcosis in cases of intolerance or resistance to benzimidazoles. It holds promise as an effective treatment option for otherwise fatal courses of disease.

Amphotericin B↗

Monoclonal antibodies specific to carbohydrates of Echinococcus multilocularis.

To investigate the complexity of epitopes presented on Echinococcus multilocularis (E.m.) metacestode carbohydrates, a panel of monoclonal antibodies (MoAbs) was generated and characterized. Thirty of the clones were obtained and classified into three types (types I to III) based on Western blotting (WB) and dot-ELISA. One MoAb (type I) appeared to react with one of the carbohydrate antigens (C-antigens) located at 30-35 kDa, and was the most effective diagnostic antigen for human alveolar hydatid disease (AHD) in Hokkaido, Japan. The second group (15 clones) of MoAb (type II) reacted with another C-antigen; one which also induced antibody response in AHD patients. The third group (14 clones) of MoAb (type III) reacted with other C-antigens both in ELISA and dot-ELISA, but did not react in WB. Cross-reaction to the antigens of Echinococcus granulosus was faintly observed in only the type I-MoAb by dot-ELISA. In the immunohistological studies, all of the MoAbs reacted strongly with the laminated layer though not with protoscoleces in metacestode tissue prepared from experimentally infected cotton rats. Tissue sections treated with sodium periodate lost their immunoreactivity, suggesting that these MoAbs recognized carbohydrate epitopes of the E.m. metacestode.

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An improved test system for PCR-based specific detection of Echinococcus multilocularis eggs.

For the sensitive detection of eggs of Echinococcus multilocularis in fox faeces by PCR we have evaluated a method based on the previous concentration of helminth eggs by a combination of sequential sieving of faecal samples and flotation of the eggs in zinc chloride solution. The eggs were microscopically detected in the fractions retained in 40 and 20 microns mesh sieves. DNA of the taeniid eggs retained in the 20 microns sieve was obtained after alkaline lysis and PCR was performed using E. multilocularis species-specific primers. Compared to the parasitological findings after examination of the small intestines of the foxes, the specificity of the PCR was 100% (no false-positive result with 20 foxes free of E. multilocularis) and the sensitivity was 94% (33 positive results from total 35 foxes proven to be infected with E. multilocularis). Both false-negative results were obtained with faeces from foxes harbouring immature worms. Using faecal volumes between 2 and 20 ml, no inhibition of PCR was observed as was demonstrated by the amplification of size-modified target in parallel reactions. The tests were undertaken with fresh faeces stored in 70% ethanol, but egg detection by PCR was also possible after inactivation of eggs by freezing the faeces at -80 degrees C for one week or by incubation at +70 degrees C for 2 h.

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Synthetic studies on glycosphingolipids from the parasite Echinococcus multilocularis.

Novel neutral glycosphingolipids isolated from the metacestodes of Echinococcus multilocularis by Persat, may be expected to be involved in host-parasite interactions. We have synthesized these glycosphingolipid analogues containing 2-branched fatty alkyl residues in place of ceramide. The glycosylation of galactosyl donors 4 and 5 with each of the acceptors 2 and 11 in the presence of N-iodosuccinimide (NIS)/TfOH, and the glycosylation of fucosyl donor 13 with acceptors 12 and 20 in the presence of dimethyl(methylthio)sulfonium triflate (DMTST) gave the desired oligosaccharide derivatives at good yield. The fully per-O-acylated 2-(trimethylsilyl)ethyl glycosides 6, 15, 21, and 26 were converted to glycosylimidates 7, 16, 22, and 27, which were condensed with 2-(tetradecyl)hexadecanol and subsequently deacylated give four target glycosphingolipid analogues.

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Echinococcus multilocularis: in vitro interactions between protoscolices and Kupffer cells.

Echinococcus multilocularis protoscolices collected from experimentally infected jirds were incubated for 2 weeks in rat hepatic cell cultures cocultivated with or without feeder cells (BALB/c 3T3 and IAR 20). Scanning and transmission electron microscopy studies were performed during the course of the culture period. Kupffer cells (Kc) were seen adhering to the anterior and posterior ends of the protoscolices. Some protoscolices were fixed to the cell monolayer by a cluster of Kc adhering to the posterior end of the parasite. These cells were phagocytosing the glycocalyx and the electron-dense distal end of the microthrix of the protoscolex tegument. An alteration in the superficial tegumental cytoplasm with extensive mitochondrial damage was also noted. The properties expressed by Kc against protoscolices in vitro might also be relevant for proliferation of metacestodes in vivo.

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[Experimental imaginal Echinococcus multilocularis infestation of golden hamsters].

The imago stage of Echinococcus multilocularis development (prior to maturation of parasite oocysts) has been described in the intestine of golden hamsters infected by parenteral penetration of an Alveococcus agent and given hydrocortisone subcutaneously for 3 days before the infection and on the day of the infection, mean total drug dose being about 250 mg/kg. The number of helminths developed on days 8-35 of postinvasion ranged from 432 to 1863, their length was 1.0 to 4.0 mm and the number of segments did not exceed 2. Oocyst maturation was noted on day 20 of postinvasion. High oocyst invasiveness was confirmed by a biological test on 32 cotton rats aged 1-1.5 months who were administered parenterally 2-3 helminths containing 86 to 284 oocysts. All the rats died of severe hepatic alveococcosis on days 24-43 of postinfection.

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Proliferation and metastases formation of larval Echinococcus multilocularis. II. Ultrastructural investigations.

The larval stage (metacestode) of Echinococcus multilocularis was studied by means of electron microscopy (SEM, TEM) before and after subcutaneous transplantation to jirds (Meriones unguiculatus) and in their lymph nodes and lungs with parasite metastases. It was found that the metacestode consists of a network of solid, cellular protrusions (buds) of the germinal layer which transform to tube-like and cystic structures devoid or with a laminated layer. Proliferation of the metacestode apparently occurs by protruding filamentous solid cell columns (buds) from the germinal layer. Their tips have diameters of only one cell: they are covered with a smooth syncytial tegument without microtriches and are filled with undifferentiated cells which contain a nucleus with a large nucleolus. The tegument is constantly enlarged by fusion with the underlying undifferentiated cells that divide repeatedly. At some distance from the tip a cavity develops inside the protrusion, thus finally giving rise to a tube-like structure which may transform to a cystic expansion. Simultaneously, the surface of the protrusion changes by the formation of microtriches and the occurrence of an amorphous laminated layer. The latter is concentrically covered by connective tissue cells and large amounts of collagen. Within cyst-brood capsules, finally protoscoleces are formed from accumulations of undifferentiated cells beneath the tegument. The study has unequivocally proven the cestode nature of the cellular protrusions, and it is assumed that detachment of cells from these structures and their subsequent distribution via the circulation may play a role in the formation of metastases. The origin of the laminated layer is discussed.

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Echinococcus multilocularis identified in Indiana, Ohio, and east-central Illinois.

Echinococcus multilocularis was identified in a coyote in Indiana in January 1990. Subsequently, 300 wild canids (red foxes, gray foxes, coyotes) were collected from Indiana, Ohio, Illinois, Michigan, and Kentucky and examined for this parasite. Of these, 41 (13.7%) were infected with E. multilocularis. Infected animals were from northern and central Indiana, northwestern Ohio, and east-central Illinois. Twenty-nine of 162 (17.9%) animals from northern and central Indiana were positive, versus 0 of 83 from southern Indiana. Infected animals from northern and central Indiana included 16 of 71 (22.5%) red foxes and 13 of 70 (18.6%) coyotes. In Ohio, 6 of 22 (27.3%) red foxes were infected, and in Illinois, 6 of 17 (35.3%) coyotes were positive. Mean intensity of infection for red foxes was 372 worms (range, 2-3, 640), and for coyotes, 6,579 worms (range, 1-52,000). These findings constitute new state and distribution records for E. multilocularis and a significant range extension for this parasite species in central North America.

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In vitro parasiticidal effect of Nitazoxanide against Echinococcus multilocularis metacestodes.

When humans serve as inadvertent intermediate hosts for Echinococcus multilocularis, disease (alveolar echinococcosis [AE]) may result from the expanding parasite metacestode in visceral organs, mostly in the liver. Benzimidazole carbamate derivatives such as mebendazole and albendazole are used for chemotherapeutic treatment of AE. However, these treatments are, in most cases, parasitistatic rather than parasiticidal. As treatment is discontinued, a recurrence of parasite growth has been observed in many AE patients with nonradical resections. The only curative treatment for AE is radical surgical resection of the parasite tissue and support by chemotherapy. As there is a need for new treatment options for AE, the in vitro efficacy of nitazoxanide (NTZ), a broad-spectrum drug used against intestinal parasites and bacteria, was investigated. We showed that in vitro treatment of E. multilocularis metacestodes with NTZ induced high levels of alkaline phosphatase activity in the medium. Concurrently, distinct morphological and ultrastructural alterations were detected. Most significantly, two distinct types of alterations were observed as soon as after 3 h of NTZ treatment. At first, the drug induced a peripheral output of membranous vesicles from the tegumental membrane into the laminated layer. Simultaneously, germinal layer-associated undifferentiated cells produced large vacuoles filled with lipid-like and often electron-dense membranous segments. Other alterations were observed at later time points, including vacuolization of the germinal layer, accumulation of lipid droplets, and lastly, loss of microtriches and separation of the laminated and germinal layers. The pattern of damage induced by NTZ was different from the alterations earlier observed in albendazole sulfoxide-treated vesicles. The nonviability of NTZ-treated metacestodes was confirmed through bioassay, i.e., inoculation of treated and untreated parasites into mice. These experiments demonstrate the in vitro parasiticidal effect of NTZ on E. multilocularis metacestodes.

Alkaline Phosphatase↗

Distribution and ecology of Echinococcus multilocularis in Central Asia.

Much of Central Asia is characterized by an arid landscape. Foci of Echinococcus multilocularis have a very patchy distribution. This is due to a significant deficiency of moisture in the superficial layers of the ground and is related to the types of animal colonies. In the plain, the abundance of endemic foci increases in a direction from the sandy deserts to steppe. In mountains the highest levels of infection of animals are observed in the eastern part of region. In arid regions, E. multilocularis is typically located in humid mesophilous biotopes. Here there is sufficient moisture in the spring to promote survival of eggs and there is a close interrelation between the definitive and intermediate hosts.

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Isolation and characterization of a secretory component of Echinococcus multilocularis metacestodes potentially involved in modulating the host-parasite interface.

Echinococcus multilocularis metacestodes are fluid-filled, vesicle-like organisms, which are characterized by continuous asexual proliferation via external budding of daughter vesicles, predominantly in the livers of infected individuals. Tumor-like growth eventually leads to the disease alveolar echinococcosis (AE). We employed the monoclonal antibody (MAb) E492/G1, previously shown to be directed against a carbohydrate-rich, immunomodulatory fraction of Echinococcus granulosus, to characterize potentially related components in E. multilocularis. Immunofluorescence studies demonstrated that MAb E492/G1-reactive epitopes were found predominantly on the laminated layer and in the periphery of developing brood capsules. The respective molecules were continuously released into the exterior medium and were also found in the parasite vesicle fluid. The MAb E492/G1-reactive fraction in E. multilocularis, named Em492 antigen, was isolated by immunoaffinity chromatography. Em492 antigen had a protein/carbohydrate ratio of 0.25, reacted with a series of lectins, and is related to the laminated layer-associated Em2(G11) antigen. The epitope recognized by MAb E492/G1 was sensitive to sodium periodate but was not affected by protease treatment. Anti-Em492 immunoglobulin G1 (IgG1) and IgG2 and, at lower levels, IgG3 were found in sera of mice suffering from experimentally induced secondary, but not primary, AE. However, with regard to cellular immunity, a suppressive effect on concanavalin A- or crude parasite extract-induced splenocyte proliferation in these mice was observed upon addition of Em492 antigen, but trypan blue exclusion tests and transmission electron microscopy failed to reveal any cytotoxic effect in Em492 antigen-treated spleen cells. This indicated that Em492 antigen could be modulating the periparasitic cellular environment during E. multilocularis infection through as yet unidentified mechanisms and could be one of the factors contributing to immunosuppressive events that occur at the host-parasite interface.

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Modified sugar centrifugal flotation technique for recovering Echinococcus multilocularis eggs from soil.

Among soil-transmitted parasitic diseases, alveolar hydatidosis due to the ingestion of Echinococcus multilocularis eggs is becoming a serious problem in Hokkaido, the northern most island of Japan. Dissemination of the infection far from the endemic areas can occur if motor vehicles transmit soil contaminated with eggs. No appropriate and validated method for recovering the taeniid eggs from soil is available. A modified sugar centrifugal flotation technique, using a sucrose solution of specific gravity 1.27 and 0.05% Tween-80, was evaluated as a method to successfully recover eggs from soil. Contamination levels as low as 10 eggs per gram could be detected. This method may be useful to determine the prevalence of E. multilocularis, its transmission, and the potential for by monitoring soil contamination with eggs.

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