1
|
Wang X, Gong Q, Nie H, Tu J, Fan W, Tan X. High level of C3 is associated with Th2 immune response and liver fibrosis in patients with schistosomiasis. Parasite Immunol 2024; 46:e13029. [PMID: 38465509 DOI: 10.1111/pim.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/10/2024] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Abstract
Long-term infection of schistosomiasis will seriously affect the liver health of patients. The serum of 334 chronic Schistosoma japonicum patients and 149 healthy volunteers was collected. Compared with heathy people, the level of C4 (complement 4) was increased, and the level of C3 (complement 3) was in an obvious skewed distribution. ELISA was performed to detect the serum cytokines, the results showed that the levels of IFN-γ (interferon-γ), IL (interleukin)-2 and TNF-α (tumour necrosis factor-α) were reduced, while the levels of Th2 cytokines (IL-4, IL-6 and IL-10) were increased. In the serum of patients with high C3, the secretion of HA (hyaluronic acid), LN (laminin), IV-C (type IV collagen) and PCIII (type III procollagen) were increased, the activation of hepatic stellate cells was promoted. Exogenous human recombinant C3 made mice liver structure of the mice damaged and collagen deposition. IFN-γ and IFN-γ/IL-4 were decreased, while HA, LN, PCIII and IV-C were increased, and the expressions of α-SMA and TGF-β1 in liver tissues were up-regulated. However, the addition of IFN-γ partially reversed the effect of C3 on promoting fibrosis. High level of C3 is associated with Th2 immune response and liver fibrosis in patients with schistosomiasis.
Collapse
Affiliation(s)
- Xianmo Wang
- Clinical Laboratory, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei Province, China
| | - Quan Gong
- Yangtze University, Jingzhou, Hubei Province, China
| | - Hao Nie
- Yangtze University, Jingzhou, Hubei Province, China
| | - Jiancheng Tu
- Clinical Laboratory, The Second Clinical College of Wuhan University, Wuhan, Hubei province, China
| | - Wen Fan
- Clinical Laboratory, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei Province, China
| | - Xiaoping Tan
- Gastroenterology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei Province, China
| |
Collapse
|
2
|
Efficacy and safety of transjugular intrahepatic portosystemic shunt for the treatment of schistosomiasis-induced portal hypertension: a retrospective case series. Eur J Gastroenterol Hepatol 2022; 34:1090-1097. [PMID: 36062499 DOI: 10.1097/meg.0000000000002433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM The aim of this study was to evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension caused by schistosomiasis. METHODS This study included 43 patients with schistosomiasis-induced portal hypertension treated with TIPS in our institution from December 2015 to May 2021. The demographic, imaging, clinical and follow-up data of patients were recorded retrospectively to evaluate the efficacy and safety of the procedure. RESULTS All patients were successfully implanted with stents to establish shunt, and 90.7% of the patients were in good postoperative condition with no complications. After TIPS, the Yerdel grade of portal vein thrombosis decreased, and the portal pressure gradient decreased from 27.0 ± 4.9 mmHg to 11.3 ± 3.8 mmHg (P < 0.001). Bleeding was effectively controlled, with a postoperative rebleeding rate of 9.3%, which was an 87.9% reduction from the preoperative rate. The cumulative incidence of postoperative refractory ascites, shunt dysfunction, overt hepatic encephalopathy (OHE) and death were all similar to those of TIPS for nonschistosomiasis portal hypertension. There were no differences in liver and kidney function and blood coagulation indexes before and 3 months after TIPS. Albumin was identified as an independent risk factor for mortality after TIPS for schistosomal liver fibrosis. CONCLUSION TIPS can be used as a well-tolerated and effective treatment for schistosomiasis-induced portal hypertension, effectively reduce portal pressure gradient and improve portal vein thrombosis.
Collapse
|
3
|
Nordmann T, Schlabe S, Feldt T, Gobbi F, Krieg A, Bode JG, Fuchs A, Kraef C, Praktiknjo M, Trebicka J, Ramharter M, Addo MM, Strassburg C, Lohse AW, Luedde T, Schmiedel S, Orth HM. TIPS and splenorenal shunt for complications of portal hypertension in chronic hepatosplenic schistosomiasis-A case series and review of the literature. PLoS Negl Trop Dis 2021; 15:e0010065. [PMID: 34932562 PMCID: PMC8726476 DOI: 10.1371/journal.pntd.0010065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/04/2022] [Accepted: 12/06/2021] [Indexed: 02/07/2023] Open
Abstract
Background Transjugular intrahepatic portosystemic shunt (TIPS) and shunt surgery are established treatment options for portal hypertension, but have not been systematically evaluated in patients with portal hypertension due to hepatosplenic schistosomiasis (HSS), one of the neglected tropical diseases with major impact on morbidity and mortality in endemic areas. Methods In this retrospective case study, patients with chronic portal hypertension due to schistosomiasis treated with those therapeutic approaches in four tertiary referral hospitals in Germany and Italy between 2012 and 2020 were included. We have summarized pre-interventional clinical data, indication, technical aspects of the interventions and clinical outcome. Findings Overall, 13 patients with confirmed HSS were included. 11 patients received TIPS for primary or secondary prophylaxis of variceal bleeding due to advanced portal hypertension and failure of conservative management. In two patients with contraindications for TIPS or technically unsuccessful TIPS procedure, proximal splenorenal shunt surgery in combination with splenectomy was conducted. During follow-up (mean follow-up 23 months, cumulative follow-up time 31 patient years) no bleeding events were documented. In five patients, moderate and transient episodes of overt hepatic encephalopathy were observed. In one patient each, liver failure, portal vein thrombosis and catheter associated sepsis occurred after TIPS insertion. All complications were well manageable and had favorable outcomes. Conclusions TIPS implantation and shunt surgery are safe and effective treatment options for patients with advanced HSS and sequelae of portal hypertension in experienced centers, but require careful patient selection. Hepatosplenic schistosomiasis is a severe form of chronic infection with various trematodes of the genus Schistosoma, characterized by portal venous fibrosis, splenomegaly with hypersplenism, and portal hypertension with subsequent life-threatening bleeding events. While effective anthelminthic treatment is available, portal fibrosis is only partially reversible. Portal hypertension with subsequent bleeding events as a complication is hitherto insufficiently addressed. Surgical techniques are currently the best established treatment option for HSS, despite their inherent complication risk and irreversibility. Interventional procedures like TIPS have rarely been assessed in HSS with mixed results. In a series of 13 cases with follow-up periods up to 99 months and a cumulative follow-up of 30.9 years, we demonstrate excellent bleeding prophylaxis and a low adverse event rate of TIPS and–if TIPS proves infeasible–splenorenal shunt surgery. Main complications of TIPS comprise transient hepatic encephalopathy and increase of liver enzymes, especially in patients with hepatic comorbidities. Due to necessary infrastructure and skills, TIPS implantation is currently limited to specialized centers. However, we think that our study can support the establishment and development of new treatment options for schistosomiasis and, in the medium term, also improve the prognosis of this neglected tropical disease in endemic regions.
Collapse
Affiliation(s)
- Tamara Nordmann
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel-Riems, Germany
| | - Stefan Schlabe
- University Hospital Bonn, Department of Internal Medicine I, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - Torsten Feldt
- University Hospital Düsseldorf, Department of Gastroenterology, Hepatology and Infectious Diseases, Düsseldorf, Germany
| | - Federico Gobbi
- Department of Infectious/Tropical diseases and Microbiology, IRCSS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Andreas Krieg
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf
| | - Johannes G. Bode
- University Hospital Düsseldorf, Department of Gastroenterology, Hepatology and Infectious Diseases, Düsseldorf, Germany
| | - Andre Fuchs
- Internal Medicine III–Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Germany
| | - Christian Kraef
- Centre of Excellence for Health, Immunity and Infections & Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
| | - Michael Praktiknjo
- University Hospital Bonn, Department of Internal Medicine I, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - Jonel Trebicka
- Department of Internal Medicine I, Goethe University Clinic Frankfurt, Germany
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel-Riems, Germany
| | - Marylyn M. Addo
- German Center for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel-Riems, Germany
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Department for Clinical Immunology of Infectious Diseases, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Christian Strassburg
- University Hospital Bonn, Department of Internal Medicine I, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - Ansgar W. Lohse
- German Center for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel-Riems, Germany
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tom Luedde
- University Hospital Düsseldorf, Department of Gastroenterology, Hepatology and Infectious Diseases, Düsseldorf, Germany
| | - Stefan Schmiedel
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Martin Orth
- University Hospital Düsseldorf, Department of Gastroenterology, Hepatology and Infectious Diseases, Düsseldorf, Germany
- * E-mail:
| |
Collapse
|
4
|
El-Kady AM, Ahmad AA, Hassan TM, El-Deek HEM, Fouad SS, Althagfan SS. Eugenol, a potential schistosomicidal agent with anti-inflammatory and antifibrotic effects against Schistosoma mansoni, induced liver pathology. Infect Drug Resist 2019; 12:709-719. [PMID: 30992676 PMCID: PMC6445185 DOI: 10.2147/idr.s196544] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Schistosomiasis is one of the most prevalent parasitic infections in developing countries. Although chemotherapy is one of the main strategies in controlling the disease, it is less effective in reversal of schistosome-induced pathology especially in the chronic and advanced stages of schistosomiasis. New strategies and prospective therapeutic agents with antifibrotic effects are needed. Eugenol has a wide anti-inflammatory effect. In the present study, we investigated the possible antischistosomal effect of eugenol on Schistosoma mansoni. Materials and methods The murine model of S. mansoni was established in three groups of adult male Balb-c mice; group I (infected non-treated group) and groups II and III (infected groups) treated orally with eugenol and praziquantel (PZQ), respectively. The expression of the sensitive immunohistochemical marker α-smooth muscle actin (α-SMA) in schistosome-infected tissues was determined. In addition, parasitological, biochemical, and histological parameters that reflect disease severity and morbidity were examined. Results Eugenol treatment showed significant reduction in total worm burden by 19.2%; however, the oogram pattern showed no marked difference compared to that of the PZQ group. Yet, eugenol significantly reduced the serum levels of hepatic enzymes: aspartate aminotransferase and alanine aminotransferase. Histopathological examination revealed a significant reduction in both numbers and diameters of hepatic granulomata, which was consistent with reduction in collagen fiber deposition. Additionally, the antifibrotic effect of eugenol was validated by its considerable reduction in the expression of the sensitive marker α-SMA in both eugenol- and PZQ-treated groups. Conclusion Although eugenol could not totally eradicate adults of S. mansoni, the significant amelioration of liver enzymes and hepatic fibrosis potentiate eugenol’s role as a promising antifibrotic and a complementary antischistosomal agent.
Collapse
Affiliation(s)
- Asmaa M El-Kady
- Department of Medical Parasitology, Faculty of Medicine, South Valley University, Qena 83523, Egypt,
| | | | - Tasneem M Hassan
- Department of Medical Parasitology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Heba E M El-Deek
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Samer S Fouad
- Department of Clinical Pathology, Faculty of Veterinary Medicine, South Valley University, Qena 83523, Egypt
| | - Sultan S Althagfan
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia
| |
Collapse
|
5
|
Ede CJ, Nikolova D, Brand M. Surgical portosystemic shunts versus devascularisation procedures for prevention of variceal rebleeding in people with hepatosplenic schistosomiasis. Cochrane Database Syst Rev 2018; 8:CD011717. [PMID: 30073663 PMCID: PMC6524620 DOI: 10.1002/14651858.cd011717.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hepatosplenic schistosomiasis is an important cause of variceal bleeding in low-income countries. Randomised clinical trials have evaluated the outcomes of two categories of surgical interventions, shunts and devascularisation procedures, for the prevention of variceal rebleeding in people with hepatosplenic schistosomiasis. The comparative overall benefits and harms of these two interventions are unclear. OBJECTIVES To assess the benefits and harms of surgical portosystemic shunts versus oesophagogastric devascularisation procedures for the prevention of variceal rebleeding in people with hepatosplenic schistosomiasis. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, Science Citation Index Expanded, LILACS, reference lists of articles, and proceedings of relevant associations for trials that met the inclusion criteria (date of search 11 January 2018). SELECTION CRITERIA Randomised clinical trials comparing surgical portosystemic shunts versus oesophagogastric devascularisation procedures for the prevention of variceal rebleeding in people with hepatosplenic schistosomiasis. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the trials and extracted data using methodological standards expected by Cochrane. We assessed risk of bias according to domains and risk of random errors with GRADE and Trial Sequential Analysis. We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS We found two randomised clinical trials including 154 adult participants, aged between 18 years and 65 years, diagnosed with hepatosplenic schistosomiasis. One of the trials randomised participants to proximal splenorenal shunt versus distal splenorenal shunt versus oesophagogastric devascularisation with splenectomy, and the other randomised participants to distal splenorenal shunt versus oesophagogastric devascularisation with splenectomy. In both trials the diagnosis of hepatosplenic schistosomiasis was made based on clinical and biochemical assessments. The trials were conducted in Brazil and Egypt. Both trials were at high risk of bias.We are uncertain as to whether surgical portosystemic shunts improved all-cause mortality compared with oesophagogastric devascularisation with splenectomy due to imprecision in the trials (risk ratio (RR) 2.35, 95% confidence interval (CI) 0.55 to 9.92; participants = 154; studies = 2). We are uncertain whether serious adverse events differed between surgical portosystemic shunts and oesophagogastric devascularisation with splenectomy (RR 2.26, 95% CI 0.44 to 11.70; participants = 154; studies = 2). None of the trials reported on health-related quality of life. We are uncertain whether variceal rebleeding differed between surgical portosystemic shunts and oesophagogastric devascularisation with splenectomy (RR 0.39, 95% CI 0.13 to 1.23; participants = 154; studies = 2). We found evidence suggesting an increase in encephalopathy in the shunts group versus the devascularisation with splenectomy group (RR 7.51, 95% CI 1.45 to 38.89; participants = 154; studies = 2). We are uncertain whether ascites and re-interventions differed between surgical portosystemic shunts and oesophagogastric devascularisation with splenectomy. We computed Trial Sequential Analysis for all outcomes, but the trial sequential monitoring boundaries could not be drawn because of insufficient sample size and events. We downgraded the overall certainty of the body of evidence for all outcomes to very low due to risk of bias and imprecision. AUTHORS' CONCLUSIONS Given the very low certainty of the available body of evidence and the low number of clinical trials, we could not determine an overall benefit or harm of surgical portosystemic shunts compared with oesophagogastric devascularisation with splenectomy. Future randomised clinical trials should be designed with sufficient statistical power to assess the benefits and harms of surgical portosystemic shunts versus oesophagogastric devascularisations with or without splenectomy and with or without oesophageal transection.
Collapse
Affiliation(s)
- Chikwendu J Ede
- University of the WitwatersrandDepartment of Surgery7 York RoadJohannesburgSouth Africa2193
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department
7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Martin Brand
- University of PretoriaDepartment of SurgeryPretoriaSouth Africa0001
| |
Collapse
|
6
|
Vascular endothelial growth factor promotes the activation of hepatic stellate cells in chronic schistosomiasis. Immunol Cell Biol 2017; 95:399-407. [DOI: 10.1038/icb.2016.109] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/21/2016] [Accepted: 10/26/2016] [Indexed: 12/12/2022]
|
7
|
Portal Hypertension Related to Schistosomiasis Treated With a Transjugular Intrahepatic Portosystemic Shunt. J Clin Gastroenterol 2016; 50:608-10. [PMID: 27159422 DOI: 10.1097/mcg.0000000000000545] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
8
|
Ede CJ, Brand M. Surgical portosystemic shunts versus devascularisation procedures for variceal bleeding due to hepatosplenic schistosomiasis. Hippokratia 2015. [DOI: 10.1002/14651858.cd011717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Chikwendu J Ede
- University of the Witwatersrand; Department of Surgery; 7 York Road Johannesburg Gauteng South Africa 2193
| | - Martin Brand
- University of the Witwatersrand; Department of Surgery; 7 York Road Johannesburg Gauteng South Africa 2193
| |
Collapse
|
9
|
Richter J, Bode JG, Blondin D, Kircheis G, Kubitz R, Holtfreter MC, Müller-Stöver I, Breuer M, Hüttig F, Antoch G, Häussinger D. Severe liver fibrosis caused by Schistosoma mansoni: management and treatment with a transjugular intrahepatic portosystemic shunt. THE LANCET. INFECTIOUS DISEASES 2015; 15:731-7. [PMID: 25769268 DOI: 10.1016/s1473-3099(15)70009-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Liver diseases are common in inhabitants and migrants of tropical countries, where the liver can be exposed not only to toxins but also to many viral, bacterial, fungal, and parasitic infections. Schistosomiasis--a common parasitic infection that affects at least 240 million people worldwide, mostly in Africa--is regarded as the most frequent cause of liver fibrosis worldwide. We present a case of a 19-year-old male refugee from Guinea with recurrent oesophageal variceal bleeding due to schistosomal liver fibrosis refractory to endoscopic therapy. This case was an indication for portosystemic surgery, which is a highly invasive non-reversible intervention. An alternative, less invasive, reversible radiological procedure, used in liver cirrhosis, is the placement of a transjugular intrahepatic portosystemic shunt (TIPS). After thorough considerations of all therapeutic options we placed a TIPS in our patient. In more than 3 years of observation, he is clinically well apart from one episode of hepatic encephalopathy related to an acute episode of viral gastroenteritis. Bleeding from oesophageal varices has not recurred. In this Grand Round, we review the diagnostic approaches and treatment options for portal hypertension due to schistosomal liver fibrosis.
Collapse
Affiliation(s)
- Joachim Richter
- Tropical Medicine Unit, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
| | - Johannes G Bode
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Dirk Blondin
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Gerald Kircheis
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Ralf Kubitz
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Martha C Holtfreter
- Tropical Medicine Unit, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Irmela Müller-Stöver
- Tropical Medicine Unit, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Matthias Breuer
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Falk Hüttig
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| |
Collapse
|
10
|
El Ridi R, Tallima H. Vaccine-Induced Protection Against Murine Schistosomiasis Mansoni with Larval Excretory–Secretory Antigens and Papain or Type-2 Cytokines. J Parasitol 2013; 99:194-202. [DOI: 10.1645/ge-3186.1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
|
11
|
Danso-Appiah A, Olliaro PL, Donegan S, Sinclair D, Utzinger J. Drugs for treating Schistosoma mansoni infection. Cochrane Database Syst Rev 2013; 2013:CD000528. [PMID: 23450530 PMCID: PMC6532716 DOI: 10.1002/14651858.cd000528.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Schistosoma mansoni is a parasitic infection common in the tropics and sub-tropics. Chronic and advanced disease includes abdominal pain, diarrhoea, blood in the stool, liver cirrhosis, portal hypertension, and premature death. OBJECTIVES To evaluate the effects of antischistosomal drugs, used alone or in combination, for treating S. mansoni infection. SEARCH METHODS We searched MEDLINE, EMBASE and LILACS from inception to October 2012, with no language restrictions. We also searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2012) and mRCT. The reference lists of articles were reviewed and experts were contacted for unpublished studies. SELECTION CRITERIA Randomized controlled trials of antischistosomal drugs, used alone or in combination, versus placebo, different antischistosomal drugs, or different doses of the same antischistosomal drug for treating S. mansoni infection. DATA COLLECTION AND ANALYSIS One author extracted data and assessed eligibility and risk of bias in the included studies, which were independently checked by a second author. We combined dichotomous outcomes using risk ratio (RR) and continuous data weighted mean difference (WMD); we presented both with 95% confidence intervals (CI). We assessed the quality of evidence using the GRADE approach. MAIN RESULTS Fifty-two trials enrolling 10,269 participants were included. The evidence was of moderate or low quality due to the trial methods and small numbers of included participants.Praziquantel: Compared to placebo, praziquantel 40 mg/kg probably reduces parasitological treatment failure at one month post-treatment (RR 3.13, 95% CI 1.03 to 9.53, two trials, 414 participants, moderate quality evidence). Compared to this standard dose, lower doses may be inferior (30 mg/kg: RR 1.52, 95% CI 1.15 to 2.01, three trials, 521 participants, low quality evidence; 20 mg/kg: RR 2.23, 95% CI 1.64 to 3.02, two trials, 341 participants, low quality evidence); and higher doses, up to 60 mg/kg, do not appear to show any advantage (four trials, 783 participants, moderate quality evidence).The absolute parasitological cure rate at one month with praziquantel 40 mg/kg varied substantially across studies, ranging from 52% in Senegal in 1993 to 92% in Brazil in 2006/2007. Oxamniquine: Compared to placebo, oxamniquine 40 mg/kg probably reduces parasitological treatment failure at three months (RR 8.74, 95% CI 3.74 to 20.43, two trials, 82 participants, moderate quality evidence). Lower doses than 40 mg/kg may be inferior at one month (30 mg/kg: RR 1.78, 95% CI 1.15 to 2.75, four trials, 268 participants, low quality evidence; 20 mg/kg: RR 3.78, 95% CI 2.05 to 6.99, two trials, 190 participants, low quality evidence), and higher doses, such as 60 mg/kg, do not show a consistent benefit (four trials, 317 participants, low quality evidence).These trials are now over 20 years old and only limited information was provided on the study designs and methods. Praziquantel versus oxamniquine: Only one small study directly compared praziquantel 40 mg/kg with oxamniquine 40 mg/kg and we are uncertain which treatment is more effective in reducing parasitological failure (one trial, 33 participants, very low quality evidence). A further 10 trials compared oxamniquine at 20, 30 and 60 mg/kg with praziquantel 40 mg/kg and did not show any marked differences in failure rate or percent egg reduction.Combination treatments: We are uncertain whether combining praziquantel with artesunate reduces failures compared to praziquantel alone at one month (one trial, 75 participants, very low quality evidence).Two trials also compared combinations of praziquantel and oxamniquine in different doses, but did not find statistically significant differences in failure (two trials, 87 participants). Other outcomes and analyses: In trials reporting clinical improvement evaluating lower doses (20 mg/kg and 30 mg/kg) against the standard 40 mg/kg for both praziquantel or oxamniquine, no dose effect was demonstrable in resolving abdominal pain, diarrhoea, blood in stool, hepatomegaly, and splenomegaly (follow up at one, three, six, 12, and 24 months; three trials, 655 participants).Adverse events were not well-reported but were mostly described as minor and transient.In an additional analysis of treatment failure in the treatment arm of individual studies stratified by age, failure rates with 40 mg/kg of both praziquantel and oxamniquine were higher in children. AUTHORS' CONCLUSIONS Praziquantel 40 mg/kg as the standard treatment for S. mansoni infection is consistent with the evidence. Oxamniquine, a largely discarded alternative, also appears effective.Further research will help find the optimal dosing regimen of both these drugs in children.Combination therapy, ideally with drugs with unrelated mechanisms of action and targeting the different developmental stages of the schistosomes in the human host should be pursued as an area for future research.
Collapse
Affiliation(s)
- Anthony Danso-Appiah
- International Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.
| | | | | | | | | |
Collapse
|
12
|
Abstract
Schistosoma mansoni cercariae penetrate mouse epidermis, detach the glycocalyx and transform into schistosomula, triggering innate immune responses by host keratinocytes and Langerhans cells. Schistosomula leave the dermis and enter blood capillaries, releasing excretory/secretory products (ESP), which induce readily detectable primary adaptive immunity responses, dominated by T helper (Th) 1 and 17 cytokines. Partial protection against murine schistosomiasis may be achieved using subunit antigens and Th1 cytokine-inducing adjuvants. Conversely, resistance to primary and/or secondary schistosomiasis in rats, mice and humans is associated with production of Th2 cytokines. Accordingly, we reasoned that effective vaccination against murine primary schistosomiasis might be achieved provided selection of an adjuvant capable of skewing the S. mansoni larval ESP-mediated Th1/Th17 immune responses towards a Th2 profile. In an aim to select such an adjuvant, we administered the prototypical Th1 and Th2, respectively, C57BL/6 and BALB/c mice with polyinosinic-polycytidylic acid (Poly I/C), peptidoglycan (PGN), or thymic stromal lymphopoietin (TSLP) before exposure to S. mansoni cercariae. Serum antibody reactivity and ex vivo spleen cells (SC) immune responses to larval ESP, in a recombinant or multiple antigen peptide form, were assessed 1 week after infection. Injection with Poly I/C failed to increase interleukin (IL)-4 and led to elevated gamma interferon (IFN-γ) levels released by unstimulated or ESP-stimulated SC. Treatment with PGN triggered hightened amounts of IL-4, IL-17 and IFN-γ released by unstimulated or ESP-stimulated C57BL/6 SC. In contrast, TSLP succeeded in directing the ESP-mediated immune responses towards a Th2-biased profile in prototypical Th1 and Th2 mice.
Collapse
Affiliation(s)
- R El Ridi
- Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt.
| | | |
Collapse
|
13
|
El Ridi RAF, Tallima HAM. Novel therapeutic and prevention approaches for schistosomiasis: review. J Adv Res 2012; 4:467-78. [PMID: 25685454 PMCID: PMC4293887 DOI: 10.1016/j.jare.2012.05.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 05/12/2012] [Accepted: 05/15/2012] [Indexed: 01/23/2023] Open
Abstract
Schistosomiasis is a debilitating disease affecting approximately 600 million people in 74 developing countries, with 800 million, mostly children at risk. To circumvent the threat of having praziquantel (PZQ) as the only drug used for treatment, several PZQ derivatives were synthesized, and drugs destined for other parasites were used with success. A plethora of plant-derived oils and extracts were found to effectively kill juvenile and adult schistosomes, yet none was progressed to pre- and clinical studies except an oleo-gum resin extracted from the stem of Commiphora molmol, myrrh, which action was challenged in several trials. We have proposed an essential fatty acid, a component of our diet and cells, the polyunsaturated fatty acid arachidonic acid (ARA) as a remedy for schistosomiasis, due to its ability to activate the parasite tegument-bound neutral sphingomyelinase, with subsequent hydrolysis of the apical lipid bilayer sphingomyelin molecules, allowing access of specific antibody molecules, and eventual worm attrition. This concept was convincingly supported using larval and adult Schistosoma mansoni and Schistosoma haematobium worms in in vitro experiments, and in vivo studies in inbred mice and outbred hamsters. Even if ARA proves to be an entirely effective and safe therapy for schistosomiasis, it will not prevent reinfection, and accordingly, the need for developing an effective vaccine remains an urgent priority. Our studies have supported the status of S. mansoni calpain, glutathione-S-transferase, aldolase, triose phosphate isomerase, glyceraldehyde 3-phosphate dehydrogenase, enolase, and 2-cys peroxiredoxin as vaccine candidates, as they are larval excreted-secreted products and, contrary to the surface membrane molecules, are entirely accessible to the host immune system effector elements. We have proposed that the use of these molecules, in conjunction with Th2 cytokines-inducing adjuvants for recruiting and activating eosinophils and basophils, will likely lead to development and implementation of a sterilizing vaccine in a near future.
Collapse
Affiliation(s)
- Rashika A F El Ridi
- Zoology Department, Faculty of Science, Cairo University, Cairo 12613, Egypt
| | - Hatem A-M Tallima
- Zoology Department, Faculty of Science, Cairo University, Cairo 12613, Egypt
| |
Collapse
|
14
|
Efficacy and mechanism of action of arachidonic acid in the treatment of hamsters infected with Schistosoma mansoni or Schistosoma haematobium. Int J Antimicrob Agents 2012; 39:232-9. [PMID: 22240411 DOI: 10.1016/j.ijantimicag.2011.08.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/28/2011] [Accepted: 08/30/2011] [Indexed: 01/22/2023]
Abstract
We have recently shown that in vitro and in vivo exposure of Schistosoma mansoni and Schistosoma haematobium to 5-10mM arachidonic acid (ARA) induces parasite surface membrane disintegration and eventual attrition. Here we report on the optimum ARA dose and post-infection treatment time for maximum schistosome demise in hamsters. A series of four experiments for each schistosome species indicated that oral administration of ARA after patency led to a highly significant (P<0.02 to <0.001) reduction in worm burden accompanied by a significant (P<0.05) decrease in worm egg load. ARA-mediated attrition in vivo appeared to be associated with high titres of serum antibodies to tegumental antigens. In support, serum antibodies from patently infected and ARA-treated hamsters readily bound to the surface membrane of ARA-exposed adult worms, as judged by indirect membrane immunofluorescence. More importantly, addition of serum antibodies and peripheral blood mononuclear cells significantly enhanced ARA-mediated adult worm attrition in vitro. These data together show that the schistosomicidal effect of ARA in laboratory animals is enhanced by immune effectors and is highly efficacious and entirely safe.
Collapse
|
15
|
Molecular pathogenesis of hepatic fibrosis and current therapeutic approaches. Chem Biol Interact 2011; 193:225-31. [PMID: 21803030 DOI: 10.1016/j.cbi.2011.07.001] [Citation(s) in RCA: 189] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 07/05/2011] [Accepted: 07/06/2011] [Indexed: 12/11/2022]
Abstract
The pathogenesis of hepatic fibrosis involves significant deposition of fibrilar collagen and other extracellular matrix proteins. It is a rather dynamic process of wound healing in response to a variety of persistent liver injury caused by factors such as ethanol intake, viral infection, drugs, toxins, cholestasis, and metabolic disorders. Liver fibrosis distorts the hepatic architecture, decreases the number of endothelial cell fenestrations and causes portal hypertension. Key events are the activation and transformation of quiescent hepatic stellate cells into myofibroblast-like cells with the subsequent up-regulation of proteins such as α-smooth muscle actin, interstitial collagens, matrix metalloproteinases, tissue inhibitor of metalloproteinases, and proteoglycans. Oxidative stress is a major contributing factor to the onset of liver fibrosis and it is typically associated with a decrease in the antioxidant defense. Currently, there is no effective therapy for advanced liver fibrosis. In its early stages, liver fibrosis is reversible upon cessation of the causative agent. In this review, we discuss some aspects on the etiology of liver fibrosis, the cells involved, the molecular pathogenesis, and the current therapeutic approaches.
Collapse
|
16
|
Liang YJ, Luo J, Yuan Q, Zheng D, Liu YP, Shi L, Zhou Y, Chen AL, Ren YY, Sun KY, Sun Y, Wang Y, Zhang ZS. New insight into the antifibrotic effects of praziquantel on mice in infection with Schistosoma japonicum. PLoS One 2011; 6:e20247. [PMID: 21629648 PMCID: PMC3101229 DOI: 10.1371/journal.pone.0020247] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 04/28/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Schistosomiasis is a parasitic disease infecting more than 200 million people in the world. Although chemotherapy targeting on killing schistosomes is one of the main strategies in the disease control, there are few effective ways of dealing with liver fibrosis caused by the parasite infection in the chronic and advanced stages of schistosomiasis. For this reason, new strategies and prospective drugs, which exert antifibrotic effects, are urgently required. METHODS AND FINDINGS The antifibrotic effects of praziquantel were assessed in the murine models of schistosomiasis japonica. Murine fibrosis models were established by cutaneous infection with 14 ± 2 Schistosoma japonicum cercariae. Then, the mice of both chronic (8 weeks post-infection) and advanced (15 weeks post-infection) schistosomiasis were treated by gavage of praziquantel (250 mg/kg, once daily for 3 days) to eliminate worms, and followed by praziquantel anti-fibrosis treatment (300 mg/kg, twice daily for 30 days). The fibrosis-related parameters assessed were areas of collagen deposition, content of hydroxyproline and mRNA expressions of Col1α1, Col3α1, α-SMA, TGF-β, MMP9, TIMP1, IL-4, IL-10, IL-13 and IFN-γ of liver. Spleen weight index, alanine aminotransferase activity and liver portal venous pressure were also measured. The results showed that anti-fibrosis treatment improved liver fibrosis, splenomegaly, hepatic function, as well as liver portal hypertension. In order to confirm the anti-fibrotic properties of praziquantel, we established a CCL(4)-induced model and revealed that CCL(4)-induced liver fibrosis was inhibited by PZQ treatment for 30 days. Furthermore, we analyzed the effects of praziquantel on mouse primary hepatic stellate cells (HSCs). It is indicated that mRNA expressions of Col1α1, Col3α1, α-SMA, TGF-β, MMP9 and TIMP1 of HSCs were all inhibited after praziquantel anti-parasite treatments. CONCLUSIONS The significant amelioration of hepatic fibrosis by praziquantel treatment validates it as a promising drug of anti-fibrosis and offers potential of a new chemotherapy for hepatic fibrosis resulting from schistosomiasis.
Collapse
Affiliation(s)
- Yue-Jin Liang
- Department of Pathogen Biology, Key Laboratory of Pathogen Biology of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jie Luo
- Department of Pathogen Biology, Key Laboratory of Pathogen Biology of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Quan Yuan
- Department of Pathogen Biology, Key Laboratory of Pathogen Biology of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Dan Zheng
- Department of Pathogen Biology, Key Laboratory of Pathogen Biology of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ya-Ping Liu
- Department of Pathogen Biology, Key Laboratory of Pathogen Biology of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Shi
- Department of Pathogen Biology, Key Laboratory of Pathogen Biology of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ying Zhou
- Department of Pathogen Biology, Key Laboratory of Pathogen Biology of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ai-Ling Chen
- Department of Pathogen Biology, Key Laboratory of Pathogen Biology of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yong-Ya Ren
- Department of Pathology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ke-Yi Sun
- Department of Microbiology and Immunology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yan Sun
- Department of Pathogen Biology, Key Laboratory of Pathogen Biology of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yong Wang
- Department of Pathogen Biology, Key Laboratory of Pathogen Biology of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhao-Song Zhang
- Department of Pathogen Biology, Key Laboratory of Pathogen Biology of Jiangsu Province, Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
17
|
Computational analysis and physico-chemical characterization of an inclusion compound between praziquantel and methyl-β-cyclodextrin for use as an alternative in the treatment of schistosomiasis. J INCL PHENOM MACRO 2010. [DOI: 10.1007/s10847-010-9852-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
de Jesus MB, Pinto LDMA, Fraceto LF, Magalhães LA, Zanotti-Magalhães EM, de Paula E. Improvement of the oral praziquantel anthelmintic effect by cyclodextrin complexation. J Drug Target 2009; 18:21-6. [DOI: 10.3109/10611860903131677] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
19
|
Shapira M, Shaoul R. A 16-year-old boy with hepatosplenomegaly. Pediatr Ann 2009; 38:545-9. [PMID: 19968191 DOI: 10.3928/00904481-20090918-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Moshe Shapira
- Maccabi Health Services, Neve-Shaanan Clinic, Haifa, Israel
| | | |
Collapse
|
20
|
Ha MH, Rao HY, Liu F, Pan XB, Feng B, Chen HS, Wei L. Increased expression of Collagen I and Collagen III induced by HBV in hepatic stellate cells. Shijie Huaren Xiaohua Zazhi 2008; 16:2031-2035. [DOI: 10.11569/wcjd.v16.i18.2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether HepG2.2.15 could induce expression of fibrosis-related factors in hepatic stellate cells in vitro and further to explore the mechanism of HBV inducing fibrogenesis.
METHODS: The hepatic stellate cells were co-cultured with HepG2 or HepG2.2.15 in vitro and the hepatic stellate cells cultured alone were used as control. For differentiation mRNA expression of Collagen I and III in hepatic stellate cells, real-time PCR was performed; for differentiation protein expression of Collagen I and III in hepatic stellate cells, Western blot analysis was performed.
RESULTS: Compared with the control and the hepatic stellate cells co-cultured with HepG2, mRNA expression of Collagen I and III were significantly higher in the hepatic stellate cells co-cultured with HepG2.2.15 and the most prominent effect was found at 72 h (P < 0.01); the protein expression of Collagen I and III were higher significantly in the hepatic stellate cells co-cultured with HepG2.2.15 and the most prominent effect was found at 48 h compared with control and the hepatic stellate cells co-cultured with HepG2 (P < 0.01).
CONCLUSION: The expression of fibrosis-related factors in hepatic stellate cells are increased greatly after being co-cultured with HepG2.2.15. HBV is capable of inducing fibrogenesis in vitro.
Collapse
|
21
|
Ha MH, Rao HY, Liu F, Pan XB, Feng B, Chen HS, Wei L. Hepatitis B virus induces expression of connective tissue growth factor and transforming growth factor-β1 in hepatic stellate cells. Shijie Huaren Xiaohua Zazhi 2008; 16:924-928. [DOI: 10.11569/wcjd.v16.i9.924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether HepG2.2.15 cell line induces the expression of connective tissue growth factor (CTGF) and transforming growth factor-β1 (TGF-β1) in hepatic stellate cells and the mechanism of hepatitis B virus (HBV) in inducing fibrogenesis.
METHODS: The hepatic stellate cells (LX-2) were co-cultured with HepG2 or HepG2.2.15 in vitro and the LX-2 cells cultured alone were used as controls. After culturing for 24, 48 and 72 h, real-time polymerase chain reaction (PCR) was performed to detect the expression of CTGF and TGF-β1 mRNA in LX-2 cells. Western-blot analysis was used to measure the expression of CTGF and TGF-β1 proteins in LX-2 cells.
RESULTS: After 24, 48, and 72 h, the expression of CTGF and TGF-β1 mRNA in LX-2 cells co-cultured with HepG2.2.15 were higher than those in the controls (CTGF: 1.7, 4.2, 9.6 times higher, P < 0.05; TGF-β1: 2.2, 6.1, 8.1 times higher, P < 0.01), and the most eminent effect was found at 72 h; however, CTGF and TGF-β1 mRNA expression in LX-2 cells co-cultured with HepG2 were 1.7, 1.2, 1.3 and 2.7, 1.9, 2.1 times higher than those in the controls (all P < 0.05). At the same time point, the protein expression of CTGF and TGF-β1 in LX-2 cells co-cultured with HepG2.2.15 (CTGF: 2.1, 2.6, 2.5 times higher, P < 0.05; TGF-β1: 1.7, 3.3, 3.1 times higher, P < 0.01) or HepG2 (CTGF: 1.6, 1.1, 0.9 times higher, P < 0.05; TGF-β1: 1.1, 1.4, 2.5 times higher, P < 0.05) were also higher than those in the control cells.
CONCLUSION: The expression of fibrosis-related factors in hepatic stellate cells are increased significantly after co-culturing with HepG2.2.15, which proves that HBV can induce fibrogenesis in vitro.
Collapse
|