The effect of immunosuppression on secondary Echinococcus multilocularis infections in mice

Echinococcosis Is Associated with the Increased Prevalence of Intestinal Blastocystis Infection in Tibetans and Host Susceptibility to the Blastocystis in Mice

Blastocystis is a common human intestinal protozoan parasite. Little is known about its prevalence in echinococcosis. This study tested whether Echinococcus multilocularis infection would increase host susceptibility to Blastocystis. A total of 114 fecal samples (68 hydatid disease patients and 46 healthy people) were collected from Tibetans in the Qinghai province in China. The presence of Blastocystis was identified by sequencing of the small subunit (SSU) rRNA gene. Balb/c mice were co-infected with Blastocystis and E. multilocularis and tested for host susceptibility to Blastocystis. The overall Blastocystis prevalence was 12.3%; 16.2% in the patients and 4.4% in healthy people (p < 0.05). Sequence analysis identified three known Blastocystis genotypes, including ST1, ST2, and ST3, and one unknown genotype. Experimental dual infection significantly reduced mouse survival rate (20%), induced more severe signs, and increased intestinal damages with a higher intestinal colonization level of Blastocystis. The mouse model showed that E. multilocularis infection increases host susceptibility to Blastocystis. Our study shows a significantly higher prevalence of Blastocystis in patients with liver echinococcosis and reveals that non-intestinal E. multilocularis infection increases host susceptibility to the Blastocystis. Our results highlight that E. multilocularis infection is associated with Blastocystis. These findings remind us that more attention should be paid to the gut health of the patients with a helminth infection during clinical patient care.

Immunoregulation in larval Echinococcus multilocularis infection

Alveolar echinococcosis (AE) is a clinically very severe zoonotic helminthic disease, characterized by a chronic progressive hepatic damage caused by the continuous proliferation of the larval stage (metacestode) of Echinococcus multilocularis. The proliferative potential of the parasite metacestode tissue is dependent on the nature/function of the periparasitic immune-mediated processes of the host. Immune tolerance and/or down-regulation of immunity are a marked characteristic increasingly observed when disease develops towards its chronic (late) stage of infection. In this context, explorative studies have clearly shown that T regulatory (Treg) cells play an important role in modulating and orchestrating inflammatory/immune reactions in AE, yielding a largely Th2-biased response, and finally allowing thus long-term parasite survival, proliferation and maturation. AE is fatal if not treated appropriately, but the current benzimidazole chemotherapy is far from optimal, and novel options for control are needed. Future research should focus on the elucidation of the crucial immunological events that lead to anergy in AE, and focus on providing a scientific basis for the development of novel and more effective immunotherapeutical options to support cure AE by abrogating anergy, anticipating also that a combination of immuno- and chemotherapy could provide a synergistic therapeutical effect.

Immunology of Alveolar and Cystic Echinococcosis (AE and CE)

Cystic and alveolar echinococcosis are severe chronic helminthic diseases caused by the cystic growth or the intrahepatic tumour-like growth of the metacestode of Echinococcus granulosus or Echinococcus multilocularis, respectively. Both parasites have evolved sophisticated strategies to escape host immune responses, mainly by manipulating and directing this immune response towards anergy and/or tolerance. Recent research studies have revealed a number of respective immunoregulatory mechanisms related to macrophages and dendritic cell as well as T cell activities (regulatory T cells, Tregs). A better understanding of this complex parasite-host relationship, and the elucidation of specific crucial events that lead to disease, represents targets towards the development of novel treatment strategies and options.

Autonomy and integration in complex parasite life cycles

Complex life cycles are common in free-living and parasitic organisms alike. The adaptive decoupling hypothesis postulates that separate life cycle stages have a degree of developmental and genetic autonomy, allowing them to be independently optimized for dissimilar, competing tasks. That is, complex life cycles evolved to facilitate functional specialization. Here, I review the connections between the different stages in parasite life cycles. I first examine evolutionary connections between life stages, such as the genetic coupling of parasite performance in consecutive hosts, the interspecific correlations between traits expressed in different hosts, and the developmental and functional obstacles to stage loss. Then, I evaluate how environmental factors link life stages through carryover effects, where stressful larval conditions impact parasites even after transmission to a new host. There is evidence for both autonomy and integration across stages, so the relevant question becomes how integrated are parasite life cycles and through what mechanisms? By highlighting how genetics, development, selection and the environment can lead to interdependencies among successive life stages, I wish to promote a holistic approach to studying complex life cycle parasites and emphasize that what happens in one stage is potentially highly relevant for later stages.

Successful intestinal Echinococcus multilocularis oncosphere invasion and subsequent hepatic metacestode establishment in resistant RccHan™:WIST rats after pharmacological immunosuppression

Susceptibility/resistance to larval Echinococcus multilocularis infection varies greatly depending on host species and strains. Whereas several mice strains and non-human primates are highly susceptible to alveolar echinococcosis, rats and most of humans are considered as more resistant. In this study, we aimed to elucidate factors responsible for host resistance in rats (Experiments A–D). (A) The parasite establishment was not observed in immunocompetent Wistar rats orally inoculated with sodium hypochlorite resistant eggs with/without pig bile, or activated/non-activated oncospheres (NAO). Peritoneal inoculation with NAO or metacestode tissue allowed the parasite establishment in rats. (B) T-cell-deficient athymic nude rats showed complete resistance against the metacestode establishment after oral inoculation with parasite eggs. This finding suggests that T-cell-independent parasite clearance occurred in the animals during early phase of the parasite invasion. Finally, Wistar rats that received pharmacological immunosuppression using either dexamethasone (DMS) alone or methotrexate (MTX) i.p. alone or a combination of these compounds were orally inoculated with the parasite's eggs. As a result (D), successful establishment of metacestode with protoscoleces was observed in all 3 rats treated with DMS (s.c.) alone or in all 6 rats treated with DMS (s.c.) plus MTX but not in 8 rats with MTX alone, suggesting that factors affected by DMS treatment are responsible to regulate the parasite invasion and establishment.

Susceptibility versus resistance in alveolar echinococcosis (larval infection with Echinococcus multilocularis)

Epidemiological studies have demonstrated that the majority of human individuals exposed to infection with Echinococcus spp. eggs exhibit resistance to disease as shown by either seroconversion to parasite--specific antigens, and/or the presence of 'dying out' or 'aborted' metacestodes, not including hereby those individuals who putatively got infected but did not seroconvert and who subsequently allowed no development of the pathogen. For those individuals where infection leads to disease, the developing parasite is partially controlled by host immunity. In infected humans, the type of immune response developed by the host accounts for the subsequent trichotomy concerning the parasite development: (i) seroconversion proving infection, but lack of any hepatic lesion indicating the failure of the parasite to establish and further develop within the liver; or resistance as shown by the presence of fully calcified lesions; (ii) controlled susceptibility as found in the "conventional" alveolar echinococcosis (AE) patients who experience clinical signs and symptoms approximately 5-15 years after infection, and (iii) uncontrolled hyperproliferation of the metacestode due to an impaired immune response (AIDS or other immunodeficiencies). Immunomodulation of host immunity toward anergy seems to be triggered by parasite metabolites. Beside immunomodulating IL-10, TGFβ-driven regulatory T cells have been shown to play a crucial role in the parasite-modulated progressive course of AE. A novel CD4+CD25+ Treg effector molecule FGL2 recently yielded new insight into the tolerance process in Echinococcus multilocularis infection.

In vitro induction of lymph node cell proliferation by mouse bone marrow dendritic cells following stimulation with different Echinococcus multilocularis antigens

The immune response of mice experimentally infected with Echinococcus multilocularis metacestodes becomes impaired so as to allow parasite survival and proliferation. Our study tackled the question on how different classes of E. multilocularis antigens (crude vesicular fluid (VF); purified proteinic rec-14-3-3; purified carbohydrate Em2(G11)) are involved in the maturation process of bone-marrow-derived dendritic cells (BMDCs) and subsequent exposure to lymph node (LN) cells. In our experiments, we used BMDCs cultivated from either naïve (control) or alveolar echinococcosis (AE)-infected C57BL/6 mice. We then tested surface markers (CD80, CD86, MHC class II) and cytokine expression levels (interleukin (IL)-10, IL-12p40 and tumour necrosis factor (TNF)-α) of non-stimulated BMDCs versus BMDCs stimulated with different Em-antigens or lipopolysaccharide (LPS). While LPS and rec-14-3-3-antigen were able to induce CD80, CD86 and (to a lower extent) MHC class II surface expression, Em2(G11) and, strikingly, also VF-antigen failed to do so. Similarly, LPS and rec-14-3-3 yielded elevated IL-12, TNF-α and IL-10 expression levels, while Em2(G11) and VF-antigen didn't. When naïve BMDCs were loaded with VF-antigen, they induced a strong non-specific proliferation of uncommitted LN cells. For both, BMDCs or LN cells, isolated from AE-infected mice, proliferation was abrogated. The most striking difference, revealed by comparing naïve with AE-BMDCs, was the complete inability of LPS-stimulated AE-BMDCs to activate lymphocytes from any LN cell group. Overall, the presenting activity of BMDCs from AE-infected mice seemed to trigger unresponsiveness in T cells, especially in the case of VF-antigen stimulation, thus contributing to the suppression of clonal expansion during the chronic phase of AE infection.

Innovation in hepatic alveolar echinococcosis imaging: best use of old tools, and necessary evaluation of new ones

Hepatic Alveolar Echinococcosis (HAE), caused by larvae of Echinococcus multilocularis, is a rare but potentially lethal parasitic disease. The first diagnostic suspicion is usually based on hepatic ultrasound exam performed because of abdominal symptoms or in the context of a general checkup; HAE diagnosis may thus also be an incidental finding on imaging. The next step should be Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). They play an important role in the initial assessment of the disease; with chest and brain imaging, they are necessary to assess the PNM stage (parasite lesion, neighboring organ invasion, metastases) of a patient with AE. Performed at least yearly, they also represent key exams for long-term follow-up after therapeutic interventions. Familiarity of radiologists with HAE imaging findings, especially in the endemic regions, will enable earlier diagnosis and more effective treatment. Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is currently considered to be the only noninvasive, albeit indirect, tool for the detection of metabolic activity in AE. Delayed acquisition of images (3 hrs after FDG injection) enhances its sensitivity for the assessment of lesion metabolism and its reliability for the continuation/withdrawal of anti-parasite treatment. However, sophisticated equipment and high cost widely limit PET/CT use for routine evaluation. Preliminary studies show that new techniques, such as contrast-enhanced ultrasound (US), Dual Energy CT or Spectral CT, and Diffusion-Weighted MRI, might also be useful in detecting the blood supply and metabolism of lesions. However, they cannot be recommended before further evaluation of their reliability in a larger number of patients with a variety of locations and stages of AE lesions.

Hepatic gene expression profile in mice perorally infected with Echinococcus multilocularis eggs

Background

Alveolar echinococcosis (AE) is a severe chronic hepatic parasitic disease currently emerging in central and eastern Europe. Untreated AE presents a high mortality (>90%) due to a severe hepatic destruction as a result of parasitic metacestode proliferation which behaves like a malignant tumor. Despite this severe course and outcome of disease, the genetic program that regulates the host response leading to organ damage as a consequence of hepatic alveolar echinococcosis is largely unknown.

Methodology/Principal Findings

We used a mouse model of AE to assess gene expression profiles in the liver after establishment of a chronic disease status as a result of a primary peroral infection with eggs of the fox tapeworm Echinococcus multilocularis. Among 38 genes differentially regulated (false discovery rate adjusted p≤0.05), 35 genes were assigned to the functional gene ontology group <immune response>, while 3 associated with the functional group <intermediary metabolism>. Upregulated genes associated with <immune response> could be clustered into functional subgroups including <macrophages>, <APCs>, <lymphocytes, chemokines and regulation>, <B-cells> and <eosinophils>. Two downregulated genes related to <lymphocytes, chemokines and regulation> and <intermediary metabolism>, respectively. The <immune response> genes either associated with an <immunosupression> or an <immunostimulation> pathway. From the overexpressed genes, 18 genes were subsequently processed with a Custom Array microfluidic card system in order to assess respective expression status at the mRNA level relative to 5 reference genes (Gapdh, Est1, Rlp3, Mdh-1, Rpl37) selected upon a constitutive and stable expression level. The results generated by the two independent tools used for the assessment of gene expression, i.e., microarray and microfluidic card system, exhibited a high level of congruency (Spearman correlation rho = 0.81, p = 7.87e-5) and thus validated the applied methods.

Conclusions/Significance

Based on this set of biomarkers, new diagnostic targets have been made available to predict disease status and progression. These biomarkers may also offer new targets for immuno-therapeutic intervention.

Echinococcus multilocularis and its intermediate host: a model of parasite-host interplay

Host-parasite interactions in the E. multilocularis-intermediate host model depend on a subtle balance between cellular immunity, which is responsible for host's resistance towards the metacestode, the larval stage of the parasite, and tolerance induction and maintenance. The pathological features of alveolar echinococcosis. the disease caused by E. multilocularis, are related both to parasitic growth and to host's immune response, leading to fibrosis and necrosis, The disease spectrum is clearly dependent on the genetic background of the host as well as on acquired disturbances of Th1-related immunity. The laminated layer of the metacestode, and especially its carbohydrate components, plays a major role in tolerance induction. Th2-type and anti-inflammatory cytokines, IL-10 and TGF-β, as well as nitric oxide, are involved in the maintenance of tolerance and partial inhibition of cytotoxic mechanisms. Results of studies in the experimental mouse model and in patients suggest that immune modulation with cytokines, such as interferon-α, or with specific antigens could be used in the future to treat patients with alveolar echinococcosis and/or to prevent this very severe parasitic disease.

Echinococcus multilocularis: the parasite-host interplay

Alveolar echinococcosis (AE) is a severe chronic helminthic disease caused by the intrahepatic tumor-like growth of the metacestode of Echinococcus multilocularis. Metacestodes are fluid-filled, asexually proliferating vesicles, which are entirely covered by the laminated layer, an acellular carbohydrate-rich surface structure that protects the parasite from immunological and physiological reactions on part of the host. The E. multilocularis metacestode has acquired specific means of manipulating and using the immunological host response to its own advantage. These include the expression of distinct immunoregulatory parasite molecules that manipulate and interfere in the functional activity of macrophages and T cells. Recent research findings have led to a better understanding of the protein- and glycoprotein composition of the laminated layer and the E/S fraction of the metacestode, including Em2- and Em492-antigens, two metacestode antigen fractions that exhibit immunosuppressive or -modulatory properties. Understanding of the events taking place at the host-parasite interface is the key for development of novel immuno-therapeutical and/or chemotherapeutical tools.

Research on targeting sources of alveolar echinococcosis in Japan

Echinococcus multilocularis is a fatal zoonotic parasite in the Northern Hemisphere. Recently, it has become endemic in many countries in Asia, especially in the northern island of Hokkaido in Japan. The increasing threat of public health due to alveolar echinococcosis has compelled researches for sensitive diagnosis and effective control. This paper reviews on the epidemiology, diagnosis and control of echinococcosis specifically in Japan. International collaborative responses by researchers and government initiatives such as mandatory reporting system for veterinarians who diagnose echinococcosis in dogs are presented. Successful control measures in Japan using anthelmintic fortified baits for foxes are described. Assessment of prevalence rates during control campaigns is analyzed favoring the use of intravital diagnosis rather than the traditional necropsy method from hunting or trapping activities of wild foxes. The novel concept of "endogenous development" by local resident volunteers towards sustainable control of echinococcosis is stressed.

Survival strategy of Echinococcus multilocularis in the human host

As exemplified by "aborted" calcified liver lesions commonly found in patients from endemic areas, Echinococcus multilocularis metacestodes develop only in a minority of individuals exposed to infection with the papasite. Clinical research has disclosed some aspects of the survival strategy of E. multilocularis in human hosts. Clinical observations in liver transplantation and AIDS suggest that suppression of cellular/Th1-related immunity increases disease severity. Most of the studies have stressed a role for CD8+ T cells and for Interleukin-10 in the development of tolerance. A spontaneous secretion of IL-10 by the PBMC seems to be the immunological hallmark of patients with progressive forms of alveolar echinococcosis (AE). IL-10-induced inhibition of effector macrophages, but also of antigen-presenting dendritic cells, may be operating and allowing parasite growth and survival. The genetic correlates of susceptibility to infection with E. multilocularis are clearer in humans than in the mouse model. A significant link between MHC polymorphism and clinical presentation of AE has been shown, and the spontaneous secretion of IL-10 in patients with a progressive AE is higher in patients with the HLA DR3+, DQ2+ haplotype. Clustering of cases in certain families, in communities otherwise exposed to similar risk factors, also points to immuno-genetic predisposition factors that may allow the larva to escape host immunity more easily. The first stage of larval development may be crucial in producing "danger signals" stimulating the initial production of cytokines. Therapeutic use of Interferon alpha is an attempt to foil the survival strategy of E. multilocularis.

Echinococcus multilocularis laminated-layer components and the E14t 14-3-3 recombinant protein decrease NO production by activated rat macrophages in vitro

Echinococcus multilocularis and Echinococcus granulosus cause alveolar and cystic (unilocular) echinococcosis, respectively, in humans and animals. It is known that these parasites can affect, among other molecules, nitric oxide (NO) production by periparasitic host cells. Nevertheless, detailed dissection of parasite components specifically affecting cell NO production has not been done to date. We compare the effect of E. granulosus and E. multilocularis defined metacestode structural (laminated-layer associated) and metabolic (14-3-3 protein, potentially related with E. multilocularis metacestode tumor-like growth) components on the NO production by rat alveolar macrophages in vitro. Our results showed that none of these antigens could stimulate macrophage NO production in vitro. However, a reversed effect of some Echinococcus antigens on NO in vitro production was found when cells were previously exposed to LPS stimulation. This inhibitory effect was found when E. multilocularis laminated-layer (LL) or cyst wall (CW) soluble components from both species were used. Pre-stimulation of cells with LPS also resulted in a strong, dose-dependent reduction of NO and iNOS mRNA production after incubation of cells with the E14t protein. Thus, the E. multilocularis 14-3-3 protein appears to be one of the components accounting for the suppressive effect of the CW and LL metacestode extracts.

Echinococcosis and allergy

The larval stages of Echinococcus granulosus and E. multilocularis are involved in parasitic diseases in humans: cystic echinococcosis (CE) ("hydatid disease") and alveolar echinococcosis (AE), respectively. Both diseases and parasites have tight links with allergy because of the immunological characteristics that contribute to maintain the larvae in their human host as well as their potential in inducing clinical anaphylactic reactions in some patients. Clinical observations in patients and data obtained from mass screenings in various countries have identified both forms of echinococcosis as "polar diseases," i.e., diseases where immunological background of the patients was related to the clinical presentation and course. In particular, abortive cases (i.e., spontaneous cures) have been found in many subjects in endemic areas. On the other hand, immune suppression was associated with severe disease. AE especially might be considered as an opportunistic infection. Experimental and clinical studies have shown that Th1-related immune response was associated with protection and Th2-related response was associated with parasite growth. Genetic characteristics of the host are related to both occurrence and severity of AE and are associated with the extent of IL-10 secretion, which is a major feature of chronic progressing echinococcosis. Anaphylactic reactions, including urticaria, edema, respiratory symptoms, and anaphylactic shock due to spontaneous or provoked rupture of the parasitic cyst, are well known in CE. Anaphylactic reactions in AE are far less frequent, and have been observed in rare cases at time of metastatic dissemination of the parasitic lesions. Echinococcus-specific IgE is present in most of the patients and associated with severity. Specific histamine release by circulating basophils stimulated with E. granulosus antigens is present in all patients with CE and AE. Echinococcus allergens include (1) AgB 12-kDa subunit, a protease inhibitor and a potent Th2 inducer; (2) Ag5, a serine protease; (3) EA 21, a specific cyclophilin, with a homology with other types of cyclophilins; (4) Eg EF-1 beta/delta an elongation factor, with a homology with Strongyloides stercoralis EF that shares the same IgE epitope. A clinical cross-reaction with Thiomucase, a mucopolysaccharidase used in arthritis treatment, has recently been published. However, despite the potential risk of allergic reactions, the dogma "never puncture a hydatid cyst" is no longer valid. International experience of therapeutic technique of "puncture, aspiration, injection, re-aspiration" of hydatid cysts developed at the beginning of the 1980s has proved to be successful in a variety of selected indications that have been reviewed by WHO recommendations. A better understanding of the immunological background of echinococcosis in humans has led to new therapeutic developments, such as immunomodulation using interferon alpha. Th2-driven immunological response and IL-10-related tolerance state are common characteristics of atopic allergy and echinococcosis. The example of echinococcosis stresses the ambiguous links that exist between parasitic and allergic diseases, and show the usefulness of comparing these diseases to better understand how immune deviation may lead to pathological events and to find new therapeutic and.or preventive agents.

Effect of mouse strain variations and cortisone treatment on the establishment and growth of primary Echinococcus multilocularis hydatid cysts

The main purpose of this study was to determine the effects of cortisone on the number and size of primary Echinococcus multilocularis cysts developing in a moderately resistant strain of mice, i.e., C3H/HeJ. Computerized image analysis was used to measure the surface area occupied by hydatid cysts 10 wk after inoculation of the mice with E. multilocularis eggs. Our second objective was to compare the infectivity of primary E. multilocularis hydatid cysts in C57BL/6J-Ay/a (lethal yellow) mice with that in C57BL/6J-a/a (non-agouti black) mice. The data obtained show no difference between the C3H/HeJ and C57BL/6J-a/a strains of mice; yet, the image analysis method was able to detect a slight increase in the total cyst size within the Ay/a mutant of the C57BL/6J strain. Treatment of C3H/HeJ mice with cortisone drastically increased both the number of cysts and the average size of each cyst when the treatment occurred early in the infection.

The ambiguous role of immunity in echinococcosis: protection of the host or of the parasite?

In Echinococcus infection, at the metacestode stage, studies of the immune responses in the experimental murine model as well as in humans have shown that (1) cellular immunity induced by a Th1-type cytokine secretion was able to successfully kill the metacestode at the initial stages of development; (2) antigenic proteins and carbohydrates (and perhaps non-antigenic, mitogenic components) of the oncosphere/metacestode were able to interfere with antigen presentation and cell activation so that host lymphocytes and other immune cells could produce cytokines (especially IL-10) and other mediators able to inhibit the effector phase of cellular immune reaction; and (3) immunogenetic characteristics of the host were essential to this parasite-induced deviation of the immune response. In E. multilocularis infection, a combined Th1 and Th2 cytokine profile appears crucial for prolonged metacestode growth and survival. It may be hypothesized that Th1 cytokines promote the initial cell recruitment around the metacestode and are involved in the chronicity of the cell infiltrate leading to a fully organized periparasitic granuloma and its consequences, fibrosis and necrosis. The Th2 cytokines, on the other hand, could be responsible for the inhibition of a successful parasite killing especially because of the 'anti-inflammatory' potency of IL-10. This combination of various arms of the immune response results in a partial protection of both Echinococcus metacestode and host. However, it may also be considered responsible for several complications of the disease. The Th2-related IgE synthesis and mast cell activation, well known to be responsible for anaphylactic reactions in cystic echinococcosis, are more rarely involved in 'allergic' complications in alveolar echinococcosis (AE). However, the partial but chronic effects of the efficient Th1-related cellular immune response are responsible for cytotoxic events which both help metacestode growth and dissemination and lead to the central necrosis of the lesions and clinical complications of AE. Moreover, the Th-1 response is responsible for the major and irreversible fibrosis which leads to bile duct and vessel obstruction. In addition, the peri-parasitic fibrosis may be one of the reasons for the relative lack of efficacy of antiparasitic drugs. Modulation of the host immune response, by using Interferon alpha for instance, may be a new tool to generate an effective immune response against the parasite and to prevent AE and its complications.

Dendritic cells pulsed with unfractionated helminthic proteins to generate antiparasitic cytotoxic T lymphocyte

Dendritic cells (DC) are sentinels of immunity. We determined their role in the induction of immunity against alveolar echinococcosis, caused by the larval stage of the cestode Echinococcus multilocularis. Furthermore, we evaluated if unfractionated protein from E. multilocularis (Em-Ag) can be used as loading agent for DC (comparable to unfractionated tumour proteins) in order to generate antiparasitic cytotoxic T lymphocyte (CTL). Interestingly, immature DC did not mature in the presence of 1 microg/ml Em-Ag as analysed by FACS and mixed leucocyte reactions. Yet, their capacity to take up dextran was markedly reduced. Further maturation of immature Em-Ag pulsed DC could be induced by proinflammatory cytokines. These mature DC were slightly better inducers of T cell proliferation when compared with unpulsed mature DC. Importantly, by repetetive stimulation of autologous CD8+ lymphocytes with the Em-Ag pulsed mature DC, we were able to generate specifically proliferating CTL lines. Thus, immunotherapy with ex vivo generated Em-Ag pulsed DC might be of benefit for patients inheriting this incurable disease.

Nitric oxide-mediated immunosuppression following murine Echinococcus multilocularis infection

In some parasitic infections immunosuppression is a prominent characteristic of the host-parasite interplay. We have used a murine alveolar echinococcosis (AE) model in susceptible C57BL/6 mice to document a suppressed splenocyte proliferative response to concanavalin A (Con A) at the early (1-month) stage and to Echinococcus multilocularis-crude antigen (Emc-antigen) at the late (4-6-month) stage of chronic infection. Despite proliferative suppression, splenic cytokine production [interleukin-2 (IL-2), IL-4 and interferon-gamma (IFN-gamma)] in response to Con A or Emc-antigen stimulation was not suppressed at 1 month postinfection (p.i.). Infection resulted in a strong Mac-1+ cell infiltration of the peritoneal cavity and spleen. Peritoneal cells (PEC) from mice infected at the 1-month stage were rich in macrophages and expressed significantly higher levels of transcripts for the inflammatory cytokine IL-1beta and for tumour necrosis factor-alpha and inducible nitric oxide synthase (iNOS), when compared with PEC from non-infected control mice. Conversely, the IL-10 transcript level remained low and did not change during infection. Spleen cells supplemented with PEC from infected mice induced a marked increase in the levels of nitrite in response to Con A and Emc-antigen stimulation, and also a complete suppression of splenic proliferation. The spleen cells from late-stage infected mice expressed only background levels of IL-10 but greatly increased levels of iNOS, when compared with normal spleen cells. This observation correlated with the immunosuppression demonstrated at the late stage of murine AE. Furthermore, the suppressed splenic proliferative responses observed at the early and late stage were reversed to a large extent by the addition of NG-monomethyl-l-arginine and partially by anti-IFN-gamma. Thus, our results demonstrated that the immunosuppression observed in chronic AE was not primarily dependent on IL-10 but rather on nitric oxide production by macrophages from infected animals.

In vivo treatment with recombinant IL-12 protects C57BL/6J mice against secondary alveolar echinococcosis

Using an experimental model of hepatic Echinococcus multilocularis infection in C57BL/6J mice, intraperitoneal administration of 0.8 microgram of recombinant IL-12 to mice with an established infection was shown to reduce the parasite burden as soon as two weeks after the end of treatment. At that time, in vitro Echinococcus multilocularis-induced spleen T cell proliferative responses as well as IFN-gamma and IL-5 production were higher in IL-12 treated mice than in untreated mice. Administration of 0.8 microgram of IL-12 at the time of infection was shown to be without effect on the parasite establishment. However, this treatment greatly inhibited the subsequent metacestode development. Indeed, ten weeks after infection, it induced a complete healing in 37.5% of mice. At that time, the development of metastases was inhibited in 68.75% of IL-12-treated mice. This reduction of parasite burden was mainly associated with a strong proliferation of spleen cells to E. multilocularis antigen and with a high IFN-gamma production. Altogether, our results show that IL-12 is of crucial importance in inhibiting the larval growth after the metacestode establishment in the liver and suggest that this cytokine could be of potential value in the treatment of human alveolar echinococcosis.

Characterization of T-cell immune responses of Echinococcus multilocularis-infected C57BL/6J mice

Specific and non-specific parasite-induced changes in lymphocyte responses were analysed in C57/BL/6J mice after intrahepatic infection with Echinococcus multilocularis. Spleen cells harvested at selected times after infection were in vitro stimulated with mitogens or a crude soluble parasite extract (EmAg) at an optimized dose. Cell proliferative responses to Con-A were not modified by the infection over the first 22 weeks. In contrast, LPS-induced responses were decreased from the 13th week. A strong CD4+ proliferative T-cell response to the parasitic extract of infected mouse spleen cells was observed at the early stage of infection. This response then progressively decreased but remained significantly higher than that of control mice until the 19th week of infection. Cytokine production was investigated after in vitro EmAg stimulation of spleen cells. IFN-gamma, IL-2, IL-5 were produced within the first weeks after infection whereas the detection of IL-10 was slightly delayed. Thus, the promotion of the disease does not appear associated with the expansion of one rather than another T-cell subset in C57BL/6J mice. A general immunosuppression affecting both mitogenic and parasite-specific T-cell responses was observed at the end of the infection.

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.

The potential of vervet monkeys (Cercopithecus aethiops) and baboons (Papio anubis) as models for the study of the immunology of Echinococcus granulosus infections

Nine vervet monkeys and nine baboons were infected with eggs of Echinococcus granulosus per os. Six of the vervets and one of the baboons possessed hydatid cysts at autopsy, 15-28 months post-infection. The sequential IgG response to hydatid fluid and protoscolex antigens showed considerable inter-animal variation. Infected vervets and baboons became seropositive after an average of 8 months post-infection. Considerable fluctuation in the IgG response was observed, particularly to the hydatid fluid antigen which, in humans, may contribute to the existence of a significant proportion of seronegative individuals. Vervets, in particular, may be useful to study immunological events associated with exposure, development and resolution of hydatid disease in outbred human populations.

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.

Lymphocyte engraftment conveys immunity and alters parasite development in scid mice infected with Echinococcus multilocularis

Severe combined immune-deficient (scid) mice, which lack functional B- and T-lymphocytes, were infected with Echinococcus multilocularis larval tissue before or after reconstitution with lymphoid cells from immunocompetent donor mice. Untreated scid mice were highly susceptible to E. multilocularis infection, while scid mice reconstituted with purified lymphocytes derived from either infected or uninfected normal donor mice were capable of almost totally suppressing the growth of the larval cyst mass. The somatic development of the larval parasite varied according to the infection status of the cell donor, with protoscolices forming in scid mice reconstituted with cells from uninfected normal mice but not in those receiving cells from infected normal mice. These results confirm earlier findings that lymphocytes are important in suppressing the growth of E. multilocularis cysts in the intermediate host and also indicate that protoscolex development is influenced by lymphocytes or their products.

Secondary Echinococcus multilocularis infection in severe combined immunodeficient (scid) mice: biphasic growth of the larval cyst mass

E. multilocularis infection was suppressed in C.B-17 mice after intraperitoneal inoculation of protoscoleces, with larval cysts weighing no more than 1.0 g. In scid mice, which are genetically identical to C.B-17 except for a deficiency in functional lymphocytes, infection progressed and larval cysts reached a mass of 17.5 g at 15 weeks post-infection. The growth of the larval cyst mass in scid mice was similar to that in other susceptible mouse strains, with a biphasic pattern. Histological observations revealed giant cells and granulomatous inflammation in the C.B-17, but not in the scid mice. These results led to the conclusion that suppression of the growth of the larval cyst mass in the initial stage of infection in susceptible mice strains is caused by factors other than the host's lymphocytic immune response.

Cellular immunity in experimental Echinococcus multilocularis infection. I. Sequential and comparative study of specific in vivo delayed-type hypersensitivity against E. multilocularis antigens in resistant and sensitive mice

Species- or strain-related differences in receptivity of intermediate hosts to E. multilocularis larvae could be related to differences in specific cellular immune response of the host. In order to test this hypothesis, we assessed the delayed-type hypersensitivity (DTH) to E. multilocularis antigens (EmAg) in mice of three strains differing by their sensitivity (AKR and C57BL.6) or resistance (C57BL.10) to E. multilocularis infection. DTH was determined by measuring in vivo the foot-pad response 24 h after an EmAg antigenic challenge. The level of positive response was evaluated in immunized mice; however, a typical DTH response was only observed by immunizing mice with a strong adjuvant schedule. Course of DTH in the immunized mice was shown to be somewhat different in sensitive and resistant mice. The differences were much more marked in mice infected with proliferative E. multilocularis larvae. The levels of the footpad response was significantly higher in resistant mice, although the peak of the reaction was obtained later than in sensitive mice. DTH, expressed by the foot-pad response against EmAg, remained significant for the entire period of observation in sensitive as well as in resistant mice. There was no correlation between receptivity of the murine hosts and levels of specific antibodies against EmAg. These results suggest a relationship between resistance to E. multilocularis infection and intensity and/or course of DTH in mice. The resistance could be mediated by some particularities of the in situ cellular immune response in the periparasitic granuloma.

Immunology and molecular biology of Echinococcus infections

Echinococcus spp. are the etiological agents of hydatid disease in man and other intermediate hosts. Many questions regarding the factors which determine susceptibility/resistance to hydatid disease, and the factors which influence the viability and fertility of hydatid cysts, remain to be answered. Recent research into the effects of hydatid infection on the immune system of the host has provided some insights into the host-parasite relationships. Immunochemical and recombinant DNA techniques are being applied to improve diagnosis of hydatidosis in man and E. granulosus infection in dogs, and also in the development of vaccines against infection with taeniid cestode larvae. The successes which have been achieved in these areas are likely to provide valuable tools for the control of cystic hydatidosis in man. These recent studies in the areas of immunobiology, serological diagnosis and vaccination are reviewed.

Humoral and cellular immune response in mice and dogs induced by a recombinant Echinococcus multilocularis antigen produced by a Salmonella typhimurium vaccine strain

A gene fragment (II/3-10) from the cestode Echinococcus multilocularis coding for a species-specific antigen was expressed in the live attenuated Salmonella typhimurium vaccine strain LT2 M1C. The recombinant vaccine (S. typhimurium + pVM II/3-10) was assessed for its potential to induce both a humoral and cell-mediated immune response in mice and dogs. Both subcutaneous and peroral administration of the vaccine resulted in antibody synthesis and lymphocyte priming of C57BL/6J mice against S. typhimurium antigens as well as against the recombinant E. multilocularis antigen. Two vaccinated (subcutaneous and peroral) dogs showed a strong humoral immune response to S. typhimurium antigens and to the recombinant E. multilocularis antigen, but proliferation of peripheral blood lymphocytes was not detectable against the bacterial S. typhimurium antigens. Regarding the recombinant E. multilocularis antigen, borderline lymphocyte proliferation was demonstrated following subcutaneous and none following peroral administration of the recombinant vaccine to dogs.

Studies on the adhesion of protoscoleces from Echinococcus multilocularis and E. granulosus to artificial substrates and human endothelial cells in vitro

This paper describes experiments in vitro to investigate the interaction between isolated protoscoleces from Echinococcus granulosus and E. multilocularis and human endothelial cells in monolayer culture. During a maximum coculture period of 48 h neither protoscoleces nor endothelial cells showed evidence of cytotoxicity. However, protoscoleces adherent to either endothelial cells or artificial substrata developed a glycocalyx-like coat. Adherence of protoscoleces to endothelial cells requires serum (pooled human serum or foetal calf serum) in a dose-dependent fashion. However, protoscolex adhesion to artificial substrates such as glass with or without gelatin coating was markedly inhibited by serum. Thus, even 0.001% serum reduced adhesion by 46% compared with the control value. Whilst the chemical nature of the serum components have not been identified, these experiments show that serum contains both inhibitory and promoting factors for protoscolex adhesion, a finding of possible significance for the therapeutic prevention of systemic spread of established Echinococcus infections.

Echinococcus multilocularis: responses to infection in Mongolian gerbils

Mongolian gerbils (Meriones unguiculatus) inoculated intraperitoneally with three acephalic cysts of Echinococcus multilocularis were very susceptible to infection. Aspects of the responses of gerbils to this infection were examined to determine if they could be related to the progress of the infection. Hematologic changes observed during the infection included anemia, reticulocytosis, lymphocytopenia, neutrophilia, monocytosis, and eosinopenia; these changes were related to the size of the infection. Infected gerbils also produced specific protein-A binding antibodies to E. multilocularis. At 14 weeks after inoculation, infected gerbils showed splenomegaly and somewhat elevated serum transaminase levels, although serum 5'-nucleotidase levels were normal.

The immune response to Echinococcus granulosus: sequential histological observations of lymphoreticular and connective tissues during early murine infection

This paper describes the organ weight changes and the early (0 to 56 days) histological and ultrastructural changes in the lymphoid structures and injection sites after subcutaneous infection of Balb/c mice with Echinococcus granulosus protoscolices (psc). Local lymph nodes enlarged markedly, reaching maximal weight 5 to 14 days after infection (pi). Expansion of the thymus-dependent areas of draining lymph nodes was first recognized at 3 days pi and reached a maximum between 14 and 21 days pi. Lymphoproliferation within B-cell-dependent areas was less extensive and of shorter duration. Comparable, but diminished, changes were seen in contralateral lymph nodes and spleen. Lymphoid cell depletion was observed in T-dependent areas of lymphoid organs by 56 days pi. Local inflammatory reactions to psc, at the site of injection, were intense, involving neutrophils, eosinophils, macrophages and mast cells. Viable psc were present until at least 6 weeks pi. The central role of the T-lymphocyte in recognition of, and response, to E. granulosus psc is discussed.

Experimental alveolar echinococcosis. Suitability of a murine model of intrahepatic infection by Echinococcus multilocularis for immunological studies

An experimental model of human alveolar echinococcosis was developed, using intrahepatic injection of E. multilocularis larvae in mice differing by their sensitivity to this parasite; it seems to be suitable for studying the relationship between cell-mediated immunity and a) growth of the parasite, b) development of fibrosis.

Humoral and cellular immunity in patients with hepatic alveolar echinococcosis. A 2 year follow-up with and without flubendazole treatment

Parameters of humoral and cellular immunity were assessed in 12 patients with alveolar echinococcosis (AE) of the liver before, during and after discontinuation of treatment with flubendazole (FZ). In infected patients, before any medical treatment values of serum IgG, IgA, total haemolytic complement and C4 were significantly higher than those observed in control subjects; IgA levels were higher in jaundiced patients. Specific antibodies assayed by indirect haemagglutination and immunoelectrophoresis were present only in infected patients and were shown to decrease by the sixth month of treatment; however, similar fluctuations were observed without treatment. The percentage and absolute number of B lymphocytes, and total circulating lymphocytes, were significantly lower in patients with AE. An impairment of functional activity of T cells assayed by the leucocyte migration test, with PPD and Candidin as antigens, was demonstrated despite a normal percentage of SRBC rosettes. The 'score' of migration index still decreased during FZ treatment and returned to initial values after the year of follow-up without treatment. These results suggest that human AE is associated with important immunological disturbances. Changes in humoral immunity can be unequivocally considered to be a consequence of the parasite infection. The primary or secondary nature of the impairment of cellular immune responses and its mechanisms remain to be elucidated. Flubendazole could be responsible for an increase of cellular immune alterations in these patients.

Protection against experimental echinococcosis by non-specifically stimulated peritoneal cells

Infection of cotton rats with Echinococcus multilocularis or vaccination with BCG, or its cell walls, activates peritoneal cells to kill the protoscolices of the parasite in vitro and protects laboratory animals against the cestode. To determine whether other 'non-specific' stimuli would also protect against the parasite, cotton rat peritoneal cells were activated in vivo with PHA and transferred to recipients 3 days later. The recipients, controls and PHA-treated animals were then inoculated with the parasite; 3 days after inoculation other untreated infected animals received cells activated in vivo with PHA. PHA-activated cells, the PHA treatment itself and immunization with a homogenate of the parasite stimulated a leucocytosis and protected against infection by E. multilocularis; carrageenan abrogated protection in PHA-treated animals. The results of this study confirm that protection against echinococcosis can be induced non-specifically; these results suggest that immunity in hydatid disease may have an important component in the inflammatory reaction.

The effects of selective immunosuppression on resistance to Mesocestoides corti in strains of mice showing high and low initial susceptibility

Previous work has shown that C57BL/6 mice had the lowest initial susceptibility to Mesocestoides corti of six strains of mice examined. Parasite burdens in this strain and in CBA/H mice, a strain showing a higher initial susceptibility to M. corti, were compared following selective immunosuppressive treatments. Irradiation, splenectomy and the administration of cyclophosphamide and methyl prednisolone all resulted in higher parasite burdens in C57BL/6 mice. In contrast these treatments had a minimal effect on parasite burdens in CBA/H mice. In the light of these results the role of antibody in controlling parasite proliferation is discussed.

Cytotoxicity of Echinococcus granulosus cyst fluid in vitro

In a cytotoxicity assay, using rat spleen cells as target cells, Echinococcus granulosus cyst fluid from cattle exerted a marked degree of cytotoxicity in vitro. When trypan blue exclusion or [3H]thymidine incorporation by concanavalin A stimulated spleen cells was used as a measure of cell viability, dialyzed cyst fluid showed maximum cell destruction up to a 1:8 dilution. The effect was dose and time dependent, cells being affected by 24 h after exposure to cyst fluid. The components responsible for cytotoxicity of cyst fluid were heat stable and could be recovered using gel chromatography on Sephadex G 50 and G 15 as a single low molecular weight fraction. It is assumed that the toxic products released by the living parasite can readily penetrate through the cyst wall into the surrounding host tissue. The interference of such substances with immunocompetent cells might account for the long-term survival of the parasite in the intermediate host.

Pathogenesis and host response in subcutaneous alveolar hydatidosis. II. Intense plasmacellular infiltration in the paracortex of draining lymph nodes

Male C57L/J mice were infected subcutaneously in the left flank with 10 cysts of Echinococcus multilocularis. The draining and contralateral nodes were excised at weekly intervals, weighed, and examined histologically. Lymphoproliferation occurred in both the follicles and the paracortex (PCA) of the draining lymph nodes at one week postinfection (p.i.). Disorganization in the PCA of the draining nodes, was characterized by replacement of lymphocytes by plasma cells and the flattening of the endothelial cells lining the postcapillary venules. This began at three weeks p.i. and was completed by 12 weeks p.i. No comparable alterations occurred in the contralateral nodes during this period, but at 22 weeks p.i. these nodes were disorganized and histologically identical to the draining nodes. The growth and histogenesis of the subcutaneous alveolar cysts correlated with the expansion and disorganization of the PCA. The regulation of subcutaneous murine alveolar hydatidosis is discussed with reference to immune-deviation which is brought about by the antigenic load and plasmacellular infiltration in the draining lymph nodes.

Humoral response to sheep red blood cells in C57L/J mice during early and chronic stages of infection with Echinococcus multilocularis cysts

C57L/J male mice infected with Echinococcus multilocularis cysts were challenged intraperitoneally at 4, 8, and 12 weeks postinfection (p.i.) with 3 x 10(9) sheep erythrocytes. The direct plaque forming cells, 2-mercaptoethanol (2-ME) sensitive (4-day sera) and 2-ME-resistant (8-day sera) haemagglutinin responses were significantly elevated at eight and 12 weeks p.i. as compared to controls or the fourweeks postinfected mice. Possible mechanisms of immunopotentiation in the chronically infected mice is discussed in relation to the larval cyst mass, splenomegaly, and B cell hyperplasia in the lymphoid tissues during the course of infection.

Pathological changes in the lymphoreticular tissues of Swiss mice infected with Echinococcus granulosus cysts

Swiss mice infected intraperitoneally with approximately 1,500 protoscolices of Echinococcus granulosus and sacrificed at three and 13 months post infection yielded both viable and degenerated hydatid cysts. The mean cyst weights in the three and 13 months post infected mice were 0.13 and 2.1 g, respectively. Sections of spleens and lymph nodes in the three months post infected mice showed hyperplastic follicles and blastoid cells in thymus dependent areas. At 13 months post infection T cells from paracortex and periarterial areas were replaced by plasma cells and confluent sheets of histiocytes; follicles had retained germinal centres and medullary areas showed intense plasmacytosis and sinus histiocytosis. Failure of mice to control the histogenesis of hydatid cyst with reference to numerical reduction in T cells is discussed.