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

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.

The Drugs of Sleeping Sickness: Their Mechanisms of Action and Resistance, and a Brief History

With the incidence of sleeping sickness in decline and genuine progress being made towards the WHO goal of eliminating sleeping sickness as a major public health concern, this is a good moment to evaluate the drugs that 'got the job done': their development, their limitations and the resistance that the parasites developed against them. This retrospective looks back on the remarkable story of chemotherapy against trypanosomiasis, a story that goes back to the very origins and conception of chemotherapy in the first years of the 20 century and is still not finished today.

[Human african trypanosomiasis: A history of its therapies and their failures]

This paper gives an overview of the treatment of Human African Trypanosomiasis from the early 20th century until today.

A simplified method for identifying subspecies and strain groups in Trypanozoon by isoenzymes

To characterize trypanosomes from the subgenus Trypanozoon, 272 stocks in 111 zymodemes were analysed by the polymorphisms seen in a rationalized range of nine enzymes, resolved by electrophoresis, mostly on cellulose acetate. Several highly polymorphic or invariant enzymes used previously were omitted, while two new enzymes, NHD and SOD were included; the isoenzymes seen for SOD were interpreted as two separate enzymes, SODA and SODB. Isoenzyme band patterns were analysed by two complementary numerical methods to elucide taxonomic relationships within the subgenus; groups of zymodemes corresponding to subspecies and strain groups were defined, which agreed closely with previous studies. Except for one zymodeme, Trypanosoma evansi could not be clearly distinguished from the bouaflé strain group. This strain group had enzymic features that overlapped to some extent those of the busoga group. Trypanosoma brucei gambiense and the zambezi, kakumbi, kiboko and sindo groups were clearly defined. Eight zymodemes could not be classified. A rapid identification system using a limited number of enzymes is presented.

Differential sensitivity of Trypanosoma brucei rhodesiense isolates to in vitro lysis by arsenicals

Clinical isolates of Trypanosoma brucei rhodesiense, which were resistant to arsenical drugs in murine infections, were examined for resistance in vitro. A rapid lysis assay was developed which was able to predict in vivo sensitivity to melarsoprol (Mel B, Arsobal) and melarsen oxide. The assay was based on the finding that long slender bloodforms of drug-sensitive isolates would lyse in the presence of arsenicals upon incubation in heat-inactivated fetal bovine serum. On the basis of plots of decrease in the absorbance of trypanosome suspensions vs time of incubation with drug, L50 values, reflecting the drug concentration necessary for lysis of 50% of the cells within 30 min. were calculated for five strains. These values ranged from less than 30 microM for arsenical-sensitive strains to greater than 75 microM in proven arsenic refractory isolates. Calcium was essential for lysis, and the presence of the Ca2+ chelator EGTA (10 mM) in serum delayed lysis of sensitive strains. Ca2+ channel antagonists (Verapamil, Diltiazem), however, did not enhance lysis of refractory isolates when used at 20 to 30 microM. Intracellular concentrations of reduced trypanothione, the apparent target of arsenicals, were similar for all isolates, approximately 1.02 +/- 0.28 nmol/10(8) cells, as detected by monobromobimane derivitization and HPLC analysis. Uptake of melarsen oxide was found to be reduced in arsenical refractory strains. Uptake was judged by reduction of free reduced trypanothione as a result of formation of the trypanothione-arsenic complex Mel T. Little change was found in arsenical-resistant strains, but sensitive strains had 50 to 70% reductions in trypanothione levels after incubation with a low (1 microM) level of melarsen oxide.

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.

Malic enzyme type VII isoenzyme as an indicator of suramin resistance in Trypanosoma evansi

This study analysed the suramin sensitivity of 29 stocks of Trypanosoma evansi isolated from Egypt, Sudan, and Indonesia and compared the results with the isoenzyme banding patterns of 20 soluble enzymes in these stocks of T. evansi. The results showed that the type VII banding pattern of malic enzyme was found only in T. evansi stocks which were highly resistant to suramin.

In vitro drug sensitivity of Trypanosoma gambiense isolates

Drug sensitivities of seven Trypanosoma b. gambiense isolates from patients in the Ivory Coast were measured for Mel B, suramin and lomidine using an in vitro incorporation test. Bloodstream forms were isolated from Mastomys natalensis, incubated in serial drug dilutions in a microtiter plate, after 24 h, radiolabeled hypoxanthine was added, and the plate incubated for another 15 h. Trypanosomes were then harvested onto glass fiber filters with a cell harvester and incorporation of label was determined in a liquid scintillation counter. From the incorporation inhibition curves IC50 and IC75 values were calculated. IC50 values for Mel B ranged from 0.5 to 4.6 ng/ml, for suramin from 7.2 to 30.5 micrograms/ml, and for lomidine from 2.1 to 7.0 ng/ml. Isolate TH-1/78E(031) was the least sensitive to all three drugs while TH-1/78E(020), TH-64/78E(020) and TH-31/78E(025) were the most sensitive to the drugs used. THDAL 1030R, an isolate from a patient who relapsed after three consecutive Mel B treatments, showed an IC50 value for Mel B of 1.20 ng/ml. The in vitro drug sensitivity test gave reproducible results for the T b. gambiense isolates tested.

In vitro drug sensitivity test for Trypanosoma brucei subgroup bloodstream trypomastigotes

An in vitro test has been developed to determine drug sensitivities of bloodstream trypomastigotes of Trypanosoma (T.) brucei isolates. The incorporation of [14C]leucine, [3H]thymidine and [3H]hypoxanthine into bloodstream forms in vitro was compared and different sensitivity test procedures with trypanocidal drugs were evaluated. Bloodstream forms were added to a microtiter plate with serial dilutions of trypanocidal drugs containing a cell-free culture medium supplemented with a mammalian serum, which allows continuous cultivation of the bloodstream stages. After a preincubation period of 16 h, [3H]hypoxanthine was added, and after another 8 h, the cells were harvested with a cell harvester. The glass fiber filters on which the cells were collected were counted in a liquid scintillation counter and the percent inhibition determined as percentage of the control counts. This method gave accurate, reproducible results for T. (T.) brucei isolates tested with the trypanocidal drugs suramin, berenil, samorin, lomidine and Mel W.

Treatment of gambiense sleeping sickness in the Sudan with oral DFMO (DL-alpha-difluoromethylornithine), an inhibitor of ornithine decarboxylase; first field trial

Difluoromethylornithine (DFMO), a specific, irreversible inhibitor of polyamine biosynthesis shown to be curative in animal models inoculated with various Trypanosoma spp., was evaluated in the Southern Sudan in a preliminary open clinical field trial in patients infected with Trypanosoma brucei gambiense. 20 patients were studied including 18 with late-stage disease involving the central nervous system, 16 of whom were refractory to arsenical treatment. In late-stage disease monotherapy with oral DFMO doses of about 400 mg/kg/day for five to six weeks was associated with disappearance of parasites from cerebrospinal fluid (CSF), decreased CSF WBC counts and protein concentrations and reversal of clinical signs. Side effects associated with this dose regimen included diarrhoea, abdominal discomfort and anaemia, but were seldom sufficiently severe to prompt discontinuing therapy. In early-stage patients about 200 mg/kg/day for six weeks appears adequate to eliminate parasites and reverse clinical symptoms and is well tolerated. Three cases of late-stage sleeping sickness and two of early-stage disease followed up for approximately one and a half to two years after treatment indicated that DFMO monotherapy can be curative. Additional studies are needed to define optimal posology. Inhibition of polyamine biosynthesis is a promising new approach to therapy of trypanosomiasis.