The resistance to human plasma of Trypanosoma brucei, T. rhodesiense and T. gambiense. I. Analysis of the composition of trypanosome strains

The continental atlas of tsetse and African animal trypanosomosis in Nigeria

Tsetse-transmitted trypanosomosis remains a major animal health problem in Nigeria, in a context where changes in land cover, climate and control interventions are modifying its epidemiological patterns. Evidence-based decision making for the progressive control of the disease requires spatially-explicit information on its occurrence and prevalence, as well as on the distribution and abundance of the tsetse vector. In the framework of the continental Atlas of tsetse and African animal trypanosomosis (AAT), a geo-referenced database was assembled for Nigeria, based on the systematic review of 133 scientific publications (period January 1990 - March 2019). The three main species of trypanosomes responsible for the disease (i.e. Trypanosoma vivax, T. congolense and T. brucei) were found to be widespread, thus posing a national-level problem. Their geographic distribution extends beyond the tsetse-infested belt, owing to the combined effect of animal movement and mechanical transmission by non-tsetse vectors. T. simiae, the major trypanosomal pathogen in pigs, T. godfreyi and the human-infective T. brucei gambiense were also reported. AAT was reported in a number of susceptible host species, including cattle, sheep, goats, pigs, camels, horses, donkeys and dogs, while no study on wildlife was identified. Estimates of prevalence are heavily influenced by the sensitivity of the diagnostic techniques, ranging from an average of 3.5% for blood films to 31.0% for molecular techniques. Two riverine tsetse species (i.e. Glossina palpalis palpalis and G. tachinoides) were found to have the broadest geographical range, as they were detected in all six geopolitical zones of Nigeria. By contrast, the distribution of savannah species (i.e. G. morsitans submorsitans and G. longipalpis) appears to be highly fragmented, and limited to protected areas. Very little information is available for forest species, with one single paper reporting on G. fusca congolensis and G. nigrofusca nigrofusca in the Niger Delta region. The future development of a national Atlas of tsetse and AAT, relying on both published and unpublished information, could improve on the present review and provide further epidemiological evidence for decision making.

The effect of normal human serum on the mouse trypanosome Trypanosoma musculi in vitro and in vivo

Trypanosoma musculi, a common blood flagellate found in mice, is similar in morphology and life cycle to the rat trypanosome T. lewisi. Both species belong to the subgenus Herpetosoma, and as T. lewisi has recently been shown to be a zoonotic pathogen, there is concern that T. musculi could also be potentially infective to humans. To test this hypothesis, a well-established method, the normal human serum (NHS) incubation test, was carried out which distinguishes human and non-human infective trypanosomes. We found that T. musculi could grow in 0.31% NHS in vitro, and even kept their infectivity to mice after incubation with 10% NHS for 24 h. In in vivo experiments, T. musculi were only slightly affected by NHS injection, confirming that it was less sensitive to the NHS than T. b. brucei, but more sensitive than T. lewisi. This resistance probably does not rely on a restricted uptake of ApoL-1. Due to this partial resistance, we cannot definitively confirm that T. musculi has the potential for infection to humans. As resistance is less than that of T. lewisi, our data suggest that it is unlikely to be a zoonotic pathogen although we would advise caution in the case of immunocompromised people such as AIDS and cancer patients.

In vitro generation of human high-density-lipoprotein-resistant Trypanosoma brucei brucei

The host range of African trypanosomes is influenced by innate protective molecules in the blood of primates. A subfraction of human high-density lipoprotein (HDL) containing apolipoprotein A-I, apolipoprotein L-I, and haptoglobin-related protein is toxic to Trypanosoma brucei brucei but not the human sleeping sickness parasite Trypanosoma brucei rhodesiense. It is thought that T. b. rhodesiense evolved from a T. b. brucei-like ancestor and expresses a defense protein that ablates the antitrypanosomal activity of human HDL. To directly investigate this possibility, we developed an in vitro selection to generate human HDL-resistant T. b. brucei. Here we show that conversion of T. b. brucei from human HDL sensitive to resistant correlates with changes in the expression of the variant surface glycoprotein (VSG) and abolished uptake of the cytotoxic human HDLs. Complete transcriptome analysis of the HDL-susceptible and -resistant trypanosomes confirmed that VSG switching had occurred but failed to reveal the expression of other genes specifically associated with human HDL resistance, including the serum resistance-associated gene (SRA) of T. b. rhodesiense. In addition, we found that while the original active expression site was still utilized, expression of three expression site-associated genes (ESAG) was altered in the HDL-resistant trypanosomes. These findings demonstrate that resistance to human HDLs can be acquired by T. b. brucei.

African Trypanosomes: Intracellular Trafficking of Host Defense Molecules

Trypanosoma brucei brucei is the causative agent of Nagana in cattle and can infect a wide range of mammals but is unable to infect humans because it is susceptible to the innate cytotoxic activity of normal human serum. A minor subfraction of human high-density lipoprotein (HDL), containing apolipoprotein A-I (APOA1), apolipoprotein L-I (APOL1) and haptoglobin-related protein (HPR) provides this innate protection against T. b. brucei infection. Both HPR and APOL1 are cytotoxic to T. b. brucei but their specific activities for killing increase several hundred-fold when assembled in the same HDL. This HDL is called trypanosome lytic factor (TLF) and kills T. b. brucei following receptor binding, endocytosis, and lysosomal localization. Trypanosome lytic factor is activated in the acidic lysosome and facilitates lysosomal membrane disruption. Lysosomal localization is necessary for T. b. brucei killing by TLF. Trypanosoma brucei rhodesiense, which is indistinguishable from T. b. brucei, is resistant to TLF killing and causes human African sleeping sickness. Human infectivity by T. b. rhodesiense correlates with the evolution of a human serum resistance associated protein (SRA) that is able to ablate TLF killing. When T. b. brucei is transfected with the SRA gene it becomes highly resistant to TLF and human serum. In the SRA transfected cells, intracellular trafficking of TLF is altered and TLF mainly localizes to a subset of SRA containing cytoplasmic vesicles but not to the lysosome. These findings indicate that the cellular distribution of TLF is influenced by SRA expression and may directly determine susceptibility.

Rapid identification of isometamidium-resistant stocks of Trypanosoma b. brucei by PCR-RFLP

Analyses were made on the adenosine transporter-1 gene in Trypanosoma brucei (TbAT1), encoding a P2-like nucleoside transporter, from T. brucei brucei field stocks to investigate a possible link between the presence of mutations in this gene and isometamidium resistance. We have analysed the gene from 11 isometamidium-sensitive field stocks isolated from cattle in Uganda, two sensitive reference clones and two resistant reference clones. A sequence alignment showed that the isometamidium-sensitive T. b. brucei contained the wild-type sequence patterns. In contrast, the isometamidium-resistant T. b. brucei stocks showed the mutant-type sequence patterns with six point mutations that had previously been reported in a laboratory-derived arsenical-resistant T. brucei strain. To analyse the restriction fragment length polymorphism pattern of a fragment of TbAT1 (nucleotides 430-1108), the 677-bp polymerase chain reaction products from eight of the isometamidium-sensitive and two of the isometamidium-resistant T. b. brucei were subjected to digestion with Sfa NI. The results revealed two different banding patterns: the digest resulted in fragment sizes of 566 and 111 bp in the case of TbAT1 from isometamidium-sensitive stocks, whereas it produced fragment sizes of 435 and 242 bp in the case of TbAT1 from isometamidium-resistant stocks. Thus, the isometamidium-sensitive and isometamidium-resistant T. b. brucei could be successfully distinguished by digestion with the restriction endonuclease Sfa NI.

Population genetic structure and cladistic analysis of Trypanosoma brucei isolates

Using a novel multilocus DNA marker analysis method, we studied the population genetic structure of Trypansoma brucei stocks and derived clones isolated from animal and rhodesiense sleeping sickness patients during a national sleeping sickness control program in Mukono district, Uganda. We then performed a cladistic analysis to trace relationships and evolution, using stocks and clones recovered from geographically and temporally matched hosts, including inter-strain comparisons with T. b. gambiense stocks and clones. Our results show that while there was close genetic relatedness among parasite populations from the same geographical region, micro-heterogeneities exist between different stocks. Data are presented that indicate that not every human sleeping sickness focus may be associated with a particular human-infective trypanosome strain responsible for long-term stability of the reference focus. We provide evidence of genetic sub-structuring among type 1 T. b. gambiense stocks, which has potentially important implications for molecular epidemiology of T. brucei.

Will the real Trypanosoma brucei rhodesiense please step forward?

The sleeping sickness trypanosomes Trypanosoma brucei rhodesiense and T. brucei gambiense are morphologically indistinguishable from each other and from T. brucei brucei, which does not infect humans. The relationships between these three subspecies have been controversial. Several years ago, the characterization of T. brucei gambiense was reviewed in an attempt to clarify and draw together the results, and to put them in the context of the biology of the organism. The discovery of a gene associated with human-serum resistance in T. brucei rhodesiense and the consequent reappraisal of the identity of this trypanosome prompt this companion article.

Natural immunity to human African trypanosomiasis: trypanosome lytic factors and the blood incubation infectivity test

This review focuses on the epidemiology of human African trypanosomiasis: why it occurs in humans, the current methods of surveillance, and the drugs available to treat it. Emphasis is placed on the identification of human-infective trypanosomes by the blood incubation infectivity test. This test distinguishes between trypanosomes that are non-infective for humans and those that are potentially infective. Currently the test requires incubation of parasites with human serum before injection into mice; any surviving parasites are considered human-infective. The factors in serum that kill all non-human-infective parasites are known as trypanosome lytic factors. The paper details the biochemistry of these factors and recommends standardization of the test based on current knowledge. This test can be used to screen animals with trypanosomiasis, in order to evaluate their role during endemic and epidemic human African trypanosomiasis.

Expression and localization of serum resistance associated protein in Trypanosoma brucei rhodesiense

The trypanosome lytic factor (TLF) is a primate specific innate defense mechanism that restricts the host range of African trypanosomes. Trypanosoma brucei rhodesiense, the causative agent of the acute form of human sleeping sickness, is resistant to the cytolytic action of TLF. By differential display PCR we have identified a gene in T. b. rhodesiense that is preferentially expressed in cell lines resistant to TLF. The protein sequence predicted from the gene shows homology to the trypanosome variable surface glycoprotein (VSG) gene family and in particular, to the previously reported human serum resistance associated gene (SRA). The amount of SRA mRNA is over 1000-fold higher in TLF resistant cells relative to TLF sensitive trypanosomes. Treatment of TLF sensitive trypanosomes with increasing concentrations of TLF in mice results in the selection of parasites that have reverted back to the TLF resistant phenotype. These trypanosomes also showed high levels of SRA mRNA. Antibodies against recombinant SRA react with a 59 kDa protein on western blots of total cell protein from TLF resistant trypanosomes but not TLF sensitive cells. Indirect immunofluorescence revealed that SRA is a cell surface protein present only in TLF resistant trypanosomes. These results suggest that TLF resistance in human sleeping sickness trypanosomes is a consequence of the selective, high level expression of a cell surface molecule(s). In addition, these studies support the role of TLF as a major factor in human serum mediated killing of susceptible trypanosomes.

History of sleeping sickness in East Africa

The history of human sleeping sickness in East Africa is characterized by the appearance of disease epidemics interspersed by long periods of endemicity. Despite the presence of the tsetse fly in large areas of East Africa, these epidemics tend to occur multiply in specific regions or foci rather than spreading over vast areas. Many theories have been proposed to explain this phenomenon, but recent molecular approaches and detailed analyses of epidemics have highlighted the stability of human-infective trypanosome strains within these foci. The new molecular data, taken alongside the history and biology of human sleeping sickness, are beginning to highlight the important factors involved in the generation of epidemics. Specific, human-infective trypanosome strains may be associated with each focus, which, in the presence of the right conditions, can be responsible for the generation of an epidemic. Changes in agricultural practice, favoring the presence of tsetse flies, and the important contribution of domestic animals as a reservoir for the parasite are key factors in the maintenance of such epidemics. This review examines the contribution of molecular and genetic data to our understanding of the epidemiology and history of human sleeping sickness in East Africa.

Mechanism of resistance of African trypanosomes to cytotoxic human HDL

Trypanosoma brucei brucei, the causative agent of ngana in cattle, is non-infectious to humans because of its sensitivity to the cytolytic activity of normal human serum. The toxin in normal human serum is human haptoglobin-related protein (Hpr) which is found either as an apolipoprotein associated with a minor subclass of high-density lipoprotein (HDL), named trypanosome lytic factor (TLF1), or as an unstable, high-molecular-mass protein complex known as TLF2 (refs 5, 9-12). TLF-mediated lysis of T. b. brucei requires binding, internalization and lysosomal targeting. The human sleeping-sickness trypanosome, Trypanosoma brucei rhodesiense is resistant to TLF. Our studies reveal that resistant trypanosomes fail to endocytose TLF yet continue to bind TLF through cell-surface receptors. On the basis of these results, we conclude that one mechanism of resistance of human sleeping-sickness trypanosomes to human serum is decreased internalization of receptor-bound TLF.

High-density-lipoprotein-independent killing of Trypanosoma brucei by human serum

The cattle pathogen Trypanosoma brucei brucei is morphologically indistinguishable from the human pathogens T.b. rhodesiense and T.b. gambiense. However, unlike the human pathogens, T.b. brucei is lysed by normal human serum (NHS). The trypanolytic factor in NHS co-purifies with high-density lipoproteins (HDL), but its precise nature is unknown. Using a new fluorescence-based viability assay to assess T.b. brucei killing, we find that the HDL-deficient sera from two patients with Tangier disease are as trypanolytic as NHS. Fractionation of the Tangier sera by density ultracentrifugation revealed that the activity resides only in lipoprotein-depleted fractions. Tangier and NHS were also subjected to molecular sieving chromatography, and the activity profiles were identical. Lytic fractions to T. brucei (but not to T. rhodesiense) appeared under two distinct peaks of 100-600 kDa and > 1000 kDa. Neither peak coincided with the position of the major serum lipoproteins, as determined by cholesterol titrations. The high-molecular-mass peak did not contain the HDL-associated apolipoprotein-A1. Further, we did not find that purified apolipoproteins A1 or J are lytic for the trypanosomes. We conclude that the killing of T. brucei by human serum can be independent of HDL.

Analysis of a genetic cross between Trypanosoma brucei rhodesiense and T. b. brucei

Two trypanosome clones, representing East and West African homozygotes at 2 isoenzyme loci (T. b. rhodesiense MHOM/ZM/74/58 [CLONE B] and T. b. brucei MSUS/CI/78/TSW 196 [CLONE A]), were cotransmitted through tsetse flies and the resulting trypanosome populations checked for the presence of non-parental karyotypes by pulsed-field gel electrophoresis. Ten clones isolated from these populations proved to have 5 different recombinant genotypes by analysis of nuclear and kinetoplast DNA (kDNA) polymorphisms. It is inferred that genetic exchange occurred between the 2 trypanosome clones in the fly, as previously reported for 2 other T. brucei spp. clones by Jenni and colleagues. For the most part, the hybrid clones shared many characteristics with both parents and their genotypes were consistent with segregation and reassortment of parental alleles. The least amount of genetic material exchanged was kDNA alone. Regarding the mechanism of genetic exchange, several hybrid clones had identical and unique nuclear DNA polymorphisms, but different kDNA type. Assuming that the same reassortment of nuclear markers is unlikely to occur by chance, these clones most probably arose from a predecessor carrying both types of kDNA.

Identification of a trypanocidal factor against Trypanosoma equiperdum in normal human serum

Normal human serum (HS) contains trypanolytic activity and agglutinins to Trypanosoma equiperdum, while such activities are not found in sera from a range of animals susceptible to infection. HS given to T. equiperdum-infected mice caused a rapid decrease in the number of circulating trypanosomes and protection from lethal infection. Trypanolytic activity of human serum was found to be associated, after DEAE chromatography and Sephadex G-200 gel filtration, with the fraction containing 19S antibodies. Immunofluorescence assays confirmed a binding of human IgM and C1q complement component onto the surface of T. equiperdum. Anti-T. equiperdum activity of HS was specifically directed to T. equiperdum surface components and not to some mouse serum components adsorbed on parasites during the growth in the host, because HS adsorbed in vivo in CD-1 mice retained full protective and agglutinating properties. Trypanocidal activity appears in human serum about the 7th month after birth and persists until late in life. On the contrary, human purified high-density lipoprotein had no significant in vitro or in vivo trypanocidal activity. In conclusion, strong natural anti-T. equiperdum activity in human serum was mainly mediated by natural antibodies of the IgM class. The presence of natural IgM active against T. equiperdum in HS could represent one of the natural mechanisms of resistance of refractory hosts against trypanosome infections. This phenomenon provides further evidence that host specificity of trypanosomes may be partly conditioned by the presence of natural antibodies.

Human serum resistance of metacyclic forms of Trypanosoma brucei brucei, T. brucei rhodesiense and T. brucei gambiense

Resistance against the lytic action of human serum has been tested among metacyclic and bloodstream forms of Trypanosoma brucei brucei, T.b. rhodesiense and T.b. gambiense stocks and clones. The resistance was determined by applying an in vitro human serum resistance test. Whereas the majority of T.b. gambiense metacyclic forms exhibited stable human serum resistance, T.b. rhodesiense metacyclics showed inconsistent resistance within a minority of parasites, which tended to diminish completely with prolonged passages in rodents. Infection of tsetse flies with in vivo or in vitro selected human serum resistant forms did not significantly increase the proportion of resistant parasites among extruded metacyclic forms. In a T.b. rhodesiense stock which never showed human serum resistance in the metacyclic forms, human serum resistance reappeared after a 2-day cultivation period in the presence of a mammalian serum. These results reflect important phenotypic dynamics and may lead to a better understanding of the epidemiology of African human sleeping sickness.

Arsenic and old taxa: subspeciation and drug sensitivity in Trypanosoma brucei

Resistance to the trypanocidal drugs atoxyl and tryparsamide was traditionally considered to be a diagnostic feature of rhodesian sleeping sickness and, consequently, of Trypanosoma rhodesiense. In examining the tryparsamide sensitivity of 13 isoenzymically defined stocks of the subgenus Trypanozoon, typical West African stocks showed no greater drug sensitivity than did those of East and Central Africa. The greatest resistance to tryparsamide was shown by two stocks isolated in the Ivory Coast. There was no evidence of strain differences in drug sensitivity to melarsoprol (Mel B) among 26 tested populations; none the less, differential melarsoprol sensitivity was evident in clones from a single mixed population. By contrast, isoenzymically defined West African stocks appeared to be less sensitive to pentamidine and diminazene aceturate (Berenil) than were typical East African stocks. Drug sensitivity was measured in a novel in vivo test designed to minimize the influence of host-parasite interactions, in particular trypanosome penetration of drug-inaccessible sites and host-antibody induced remission of parasitaemia. Drug effect was expressed as the DS0.1, the dose required to suppress parasitaemia to 0.1% of that in untreated control mice.

Resistance to lysis by human serum of pathogenic Entamoeba histolytica

A comparison was made of susceptibility to lysis by human sera among five non-pathogenic and 11 pathogenic strains of Entamoeba histolytica already characterized into zymodemes. The nonpathogenic strains were found to be uniformly susceptible to lysis. Nine of 11 pathogenic strains, including five strains isolated from liver abscesses, were found to be resistant to lysis by serum under identical conditions. Resistance to complement-mediated lysis may be an inherent property of most pathogenic strains and may prove to be a necessary virulence factor for dissemination.

The sheep as a potential reservoir of human trypanosomiasis in the Republic of the Congo

The identical electrophoretic isoenzyme patterns of a human-plasma-resistant Trypanozoon stock from a sheep and of two other stocks from trypanosomiasis patients in the Congo Republic indicated that the sheep stock was probably infective to man. These, and one further human stock from the Congo, closely resembled stocks isolated from man in Liberia and Ivory Coast.

Interaction of high-density lipoprotein with Trypanosoma brucei: effect of membrane stabilizers

The specific lysis of bloodstream trypanosomes by serum from a nonpermissive mammalian host is the result of interaction between the serum trypanocidal factor (high-density lipoprotein) and the trypanosome surface. The studies described in this paper attempt to define further the mode of action of this cytotoxic lipoprotein. The binding of high-density lipoprotein to Trypanosoma brucei was instantaneous at 4 degrees C and readily reversible. Binding was not mediated by the surface glycoprotein as removal of the surface coat enhanced binding at 4 degrees C, and no stable glycoprotein-lipoprotein complex could be detected. Pretreatment of trypanosomes with the cross linker dimethylsuberimidate rendered cells resistant to lysis. Addition of membrane-stabilizing drugs, such as cytochalasins C, D, and E, and local anesthetics (dibucaine, tetracaine, and procaine), also inhibited high-density lipoprotein-induced cell lysis. The data presented support the idea that at 37 degrees C lateral diffusion of the variant surface glycoprotein, an integral membrane protein, allows maximal high-density lipoprotein-cell interaction in serum-sensitive cells, and that altered properties of the plasma membrane induced by low temperature or the addition of cytochalasins, local anesthetics, or zinc inhibit this interaction, possibly by increasing the shielding of the plasma membrane by more rigidly anchored surface glycoprotein molecules.

The resistance to human plasma of Trypanosoma brucei, T. rhodesiense and T. gambiense: III. Clones of two plasma-resistant strains

Tests for resistance to human plasma were made on six clones of a stabilate of Trypanosoma rhodesiense (LUMP 10) which was calculated to contain about 3,000 resistant trypanosomes per million. Two of the clones were not resistant and four were only subresistant. Tests were also made on 12 lines (clones) of a stabilate of polymorphic trypanosomes isolated from tsetse flies. One of them, ETAT 10, had infected a laboratory worker and was found to be fully resistant to human plasma; the other lines showed only low or moderate resistance. Resistance of a strain to human plasma often depends upon a small minority of resistant trypanosomes. Strains of polymorphic trypanosomes may be classified as fully resistant, moderately resistant, subresistant, or sensitive to human plasma, if they contain respectively, all, some (e.g. one per hundred), very few (e.g. one per million) or no individuals which are resistant.

The resistance to human plasma of Trypanosoma brucei, T. rhodesiense and T. gambiense. II. Survey of strains from East Africa and Nigeria

Tests were made in vivo of the sensitivity or resistance to human plasma of many strains of polymorphic trypanosomes. Five strains of T. gambiense from Nigeria were tested and all were highly resistant. Fifteen strains of T. rhodesiense (isolated from man in East Africa) were tested and they showed great variation in their degree of resistance from high resistance (five strains) to only subresistance (two strains). Forty strains of T. brucei (isolated from animals or tsetse flies) were tested; 20 were sensitive, nine were doubtful (probably sensitive) and 10 were subresistant (i.e., probably only one of a million trypanosomes in them was resistant). One strain (ETAT 10, isolated from tsetse flies) was highly resistant. During this work, tests were made on 14 stains of T. brucei (isolated from animals or fly) which were recorded as having been tested on human volunteers. Six of these strains were sensitive to human plasma and none had infected volunteers. Seven strains were subresistant, and three had infected volunteers. One strain was highly resistant and had infected a laboratory worker. For practical purposes it is advisable to consider that if a strain of polymorphic trypanosomes is plasmasensitive, it is probably not infective for man; if a strain is at all plasma-resistant it is potentially infective for man; and if a strain is highly resistant then it is almost certainly infective for man.