Resistance of Trypanosoma evansi to quinapyramine, suramin, stilbamidine and tryparsamide and analysis of cross-resistance

Drug resistance in animal trypanosomiases: Epidemiology, mechanisms and control strategies

Animal trypanosomiasis (AT) is a complex of veterinary diseases known under various names such as nagana, surra, dourine and mal de caderas, depending on the country, the infecting trypanosome species and the host. AT is caused by parasites of the genus Trypanosoma, and the main species infecting domesticated animals are T. brucei brucei, T. b. rhodesiense, T. congolense, T. simiae, T. vivax, T. evansi and T. equiperdum. AT transmission, again depending on species, is through tsetse flies or common Stomoxys and tabanid flies or through copulation. Therefore, the geographical spread of all forms of AT together is not restricted to the habitat of a single vector like the tsetse fly and currently includes almost all of Africa, and most of South America and Asia. The disease is a threat to millions of companion and farm animals in these regions, creating a financial burden in the billions of dollars to developing economies as well as serious impacts on livestock rearing and food production. Despite the scale of these impacts, control of AT is neglected and under-resourced, with diagnosis and treatments being woefully inadequate and not improving for decades. As a result, neither the incidence of the disease, nor the effectiveness of treatment is documented in most endemic countries, although it is clear that there are serious issues of resistance to the few old drugs that are available. In this review we particularly look at the drugs, their application to the various forms of AT, and their mechanisms of action and resistance. We also discuss the spread of veterinary trypanocide resistance and its drivers, and highlight current and future strategies to combat it.

Treatment and follow-up of the first case of human trypanosomiasis caused by Trypanosoma evansi in India

The first reported human case of trypanosomiasis caused by Trypanosoma evansi was treated using suramin. Patient follow-up indicates that the drug and specific regimen used were well tolerated. Clinical, serological and parasitological investigations at 6 months indicate complete cure of the patient. Suramin should be considered in the treatment of other cases of human T. evansi infection, if they occur.

Characterisation of cloned lines of Trypanosoma brucei expressing stable resistance to MelCy and suramin

Two cloned drug-sensitive stocks of Trypanosoma brucei (STIB 247 and STIB 386) were each used to generate cloned lines expressing resistance to the melaminophenyl arsenical drug cymelarsan (247MelCyR and 386MelCyR) and to suramin (247SurR and 386SurR). The drug-resistance phenotypes were stable after passaging in mice in the absence of drug pressure and three of the lines were transmitted through tsetse flies with no alteration of drug-resistance. There was no evidence of cross-resistance between melCy and suramin in vivo. Twenty-four hour growth inhibition assays were conducted on bloodstream and procyclic forms in axenic in vitro cultures. Suramin-resistance was expressed in bloodstream forms but not in the procyclic stage, while the melCy-resistant lines expressed melCy-resistance in both stages. No cross-resistance between melCy and suramin was observed. Cross-resistance between melCy and another arsenical drug, melB (melarsoprol), was observed in vivo, but to only a very limited extent in vitro. We propose that this difference between the in vivo and in vitro results for melB may indicate that an alteration in a surface adenosine transporter responsible for reduced melCy uptake was bypassed by melB over 24 hours in vitro.

Chemotherapy and delivery systems: haemoparasites

Chemotherapy of haemoparasitic diseases in domestic animals is dependent on a limited number of compounds, many of which are chemically closely related. In this review, a summary is given of each of the drugs currently available for treatment and prophylaxis of trypanosomosis and the tick-borne diseases theileriosis, babesiosis, anaplasmosis and cowdriosis. In contrast to the situation with the drugs used for tick-borne diseases, drug resistance appears to be becoming an increasing problem associated with the compounds used for trypanosomosis. The literature that has been reviewed, therefore, is that which relates to the methods used to identify and quantify drug resistance in trypanosome populations, reports of resistance to trypanocides, and cross-resistance between trypanosome populations, reports of resistance to trypanocides, and cross-resistance between trypanocides. The possible reason(s) for the apparent lack of development of resistance to the compounds used for treatment of tick-borne diseases is also discussed. Local toxicity at the site of injection is a problem that is particularly associated with many of the trypanocides when used on a long-term basis in individual animals. Various alternative preparations of the currently used trypanocides therefore have been evaluated in an attempt to reduce this toxicity, and are summarised. Finally, future developments in haemoparasitic chemotherapy are considered and, for trypanosomosis, highlight the importance of integrating chemotherapeutic and chemoprophylactic programmes with control of the vector when drug resistance becomes a significant constraint.

Differential susceptibility to DL-alpha-difluoromethylornithine in clinical isolates of Trypanosoma brucei rhodesiense

DL-alpha-Difluoromethylornithine is an enzyme-activated inhibitor of ornithine decarboxylase and an antagonist of polyamine metabolism that has been successful in clinical trials against West African sleeping sickness caused by Trypanosoma brucei gambiense. Its potential for use against the more virulent East African form of the disease, caused by T. brucei rhodesiense, is not certain. We examined 14 East African clinical isolates from the Kenya Trypanosomiasis Research Institute strain bank plus 2 established isolates for susceptibility to DL-alpha-difluoromethylornithine and to standard trypanocides. Seven of 16 strains were partially or totally refractory to DL-alpha-difluoromethylornithine in our test system. Four strains were also refractory to arsenical drugs, and five were refractory to diamidines. The results indicate that other novel agents or combinations of established agents may be needed for chemotherapy of East African disease.