Schistosome resistance to praziquantel: Fact or artifact?

Immunoinformatics analysis for design of multi-epitope subunit vaccine by using heat shock proteins against Schistosoma mansoni

The development of T cell and B cell that able provide long-term immune response against the schistosomiasisis to the people belongs to the epidemic area. Heat Shock Proteins (HSPs) are up-regulated in schistosomes as their environment changes owing to the developmental cycle, assisting the parasite in living with the adverse circumstances related with its life cycle. Schistosomiasis is still a severe health problem in the people of many countries in worldwide. In this work, to develop a chimeric antigen, we used an advanced and powerful immunoinformatics technique that targeted Schistosoma mansoni (S. mansoni) Heat shock protein (HSPs). Antigenicity, immunogenicity, allergenicity, and physicochemical characteristics were all assessed in silico for the developed subunit vaccine. The 3D structure of the vaccine was constructed and the stability of the vaccine construct was increased by using disulphide engineering. The protein-protein docking and simulation were performed between the vaccine construct and Toll-like receptor-4. The antigenicity probability value obtained for the vaccine construct was 0.93, which indicates that vaccine is non-allergenic and safe for human consumption. Communicated by Ramaswamy H. Sarma.

Dandelion (Taraxacum officinale) Improves the Therapeutic Efficiency of Praziquantel in Experimental Schistosomiasis

PURPOSE

Although praziquantel (PZQ) has a wide use as an anti-schistosome agent, many of its imperfections and side effects have been reported in many studies. The current study aims to evaluate the curative effect of a natural dandelion extract (Taraxacum officinale) on schistosomiasis either alone or in combination with PZQ based on parasitological, immunological, histopathological and molecular investigations.

METHODS

Mice were experimentally infected with Schistosoma mansoni cercariae and then divided into four groups, Schistosoma spp.-infected untreated group (IC group), Schistosoma spp.-infected group of mice treated with dandelion (I-Dn group), Schistosoma spp.-infected group of mice treated with PZQ (I-PZQ group), and Schistosoma spp.-infected group of mice treated with both PZQ and dandelion (I-PZQ + Dn group). Treatment started 45 days' post-infection. Besides, non-infected, non-treated mice served as the negative healthy control group (HC group).

RESULTS

The present results indicated that dandelion administration significantly reduced the worm burden, ova number, and the number and diameter of hepatic granulomas as compared to the untreated infected group. The results also showed that the levels of IL-6 and TNF-α were significantly decreased in the combined treatment group (I-PZQ + Dn) as compared to the I-PZQ group. Administration of dandelion-only remarkably reduced AST and ALT activities associated with schistosomiasis. Moreover, hepatic DNA damage assessed by comet assay was significantly inhibited in the combined treated group compared to the infected untreated and PZQ treated groups.

CONCLUSION

The results concluded that combined treatment of PZQ and dandelion extract improved immune response, decreased the number and diameter of granulomas, and inhibited DNA damage, indicating a reduction in liver fibrosis associated with schistosomiasis. The present study focused on the potential effect of dandelion as an adjunct medication for therapeutic properties of PZQ.

An immunoinformatics approach for the design of a multi-epitope subunit vaccine for urogenital schistosomiasis

Discovery of T and B memory cells capable of eliciting long-term immunity against schistosomiasisis is important for people in endemic areas. Changes in schistosomes environment due to developmental cycle, induces up-regulation of Heat Shock Proteins (HSPs) which assist the parasite in coping with the hostile conditions associated with its life cycle. This study therefore focused on exploring the role of HSPs in urogenital schistosomiasis to develop new multi-epitope subunit vaccine against the disease using immunoinformatic approaches. The designed subunit vaccine was subjected to in silico antigenicity, immunogenicity, allergenicity and physicochemical parameters analysis. A 3D structure of the vaccine construct was predicted, followed by disulphide engineering for stability, codon adaptation and in silico cloning for proper expression and molecular protein–protein docking of vaccine construct in the vector against toll-like receptor 4 receptor, respectively. Consequently, a 493 amino acid multi-epitope vaccine construct of antigenicity probability of 0.91 was designed. This was predicted to be stable, non-allergenic in nature and safe for human use.

Biomphalaria glabrata immunity: Post-genome advances

The freshwater snail, Biomphalaria glabrata, is an important intermediate host in the life cycle for the human parasite Schistosoma mansoni, the causative agent of schistosomiasis. Current treatment and prevention strategies have not led to a significant decrease in disease transmission. However, the genome of B. glabrata was recently sequenced to provide additional resources to further our understanding of snail biology. This review presents an overview of recently published, post-genome studies related to the topic of snail immunity. Many of these reports expand on findings originated from the genome characterization. These novel studies include a complementary gene linkage map, analysis of the genome of the B. glabrata embryonic (Bge) cell line, as well as transcriptomic and proteomic studies looking at snail-parasite interactions and innate immune memory responses towards schistosomes. Also included are biochemical investigations on snail pheromones, neuropeptides, and attractants, as well as studies investigating the frontiers of molluscan epigenetics and cell signaling were also included. Findings support the current hypotheses on snail-parasite strain compatibility, and that snail host resistance to schistosome infection is dependent not only on genetics and expression, but on the ability to form multimeric molecular complexes in a timely and tissue-specific manner. The relevance of cell immunity is reinforced, while the importance of humoral factors, especially for secondary infections, is supported. Overall, these studies reflect an improved understanding on the diversity, specificity, and complexity of molluscan immune systems.

A novel praziquantel solid lipid nanoparticle formulation shows enhanced bioavailability and antischistosomal efficacy against murine S. mansoni infection

Background

Schistosomiasis is responsible for a considerable global disease burden. This work aimed to improve the therapeutic outcome of the only available antischistosomal drug worldwide, praziquantel (PZQ), by incorporating it into a novel carrier, “solid lipid nanoparticles (SLNs)”, to enhance its solubility, bioavailability and efficacy. A simple, cost-effective method was used to prepare SLN-PZQ.

Results

Compared to market PZQ (M-PZQ), SLN-PZQ was more bioavailable, as denoted by higher serum concentrations in both normal and infected mice where elevated K_a, AUC_0–24, C_max, and t_1/2e with a decrease in k_el were demonstrated. The AUC_0–24 for SLN-PZQ in normal and Schistosoma mansoni-infected groups was almost nine- and eight-fold higher, respectively, than that for M-PZQ in corresponding groups. In normal and S. mansoni-infected mice, SLN-PZQ was detectable in serum at 24 h, while M-PZQ completely vanished 8 h post-treatment. Additionally, enhanced absorption with extended residence time was recorded for SLN-PZQ. Compared to M-PZQ, SLN-PZQ revealed superior antischistosomal activity coupled with enhanced bioavailability in all treated groups where higher percentages of worm reduction were recorded with all dosages tested. This effect was especially evident at the lower dose levels. The ED₉₅ of SLN-PZQ was 5.29-fold lower than that of M-PZQ, with a significantly higher reduction in both the hepatic and intestinal tissue egg loads of all treated groups and almost complete disappearance of immature deposited eggs (clearly evident at the low dose levels).

Conclusions

SLN-PZQ demonstrated enhanced PZQ bioavailability and antischistosomal efficacy with a safe profile despite the prolonged residence in the systemic circulation.

Insights into the mode of action of 1,2,6,7-tetraoxaspiro [7.11] nonadecane (N-89) against adult Schistosoma mansoni worms

Control of morbidity associated with schistosomiasis via chemotherapy largely relies on the drug praziquantel. Repeated therapy with praziquantel has created concerns about the possible selection of resistant worms and necessitated the search for novel drugs to treat schistosomiasis. Here, a murine model was infected with Schistosoma mansoni and treated with oral 1,2,6,7-tetraoxaspiro [7.11] nonadecane (N-89), which caused a significant reduction in fecundity and egg burden and reduced morbidity when administered at 5-weeks post-infection. The analysis showed that the mode of action occurred through the ingestion of activated N-89 by the worms, and that there was no direct external effect on the S. mansoni worms. Ultrastructural analysis of the treated worms showed disruptions in the gut lumen and the presence of large volumes of material, suggestive of undigested blood meals or red blood cells. In addition, there were reduced vitelline cells in female worms and damage to sub-tegmental musculature in male worms. Eggs recovered from the treated mice showed both damage to the eggs and the production of immature eggs. Expression of mRNA responsible for gut and digestive function and egg production was also significantly affected by N-89 treatment, whereas control genes for musculature showed no significant changes. Thus, N-89 drastically affected the total digestive function and egg production of S. mansoni worms. Physiological processes requiring heme uptake such as egg production and eggshell formation were subsequently affected, suggesting that the compound could be a possible therapeutic drug candidate for schistosomiasis control.

Schistosomiasis: Drugs used and treatment strategies

Neglected tropical diseases (NTDs) affect millions of people in different geographic regions, especially the poorest and most vulnerable. Currently NTDs are prevalent in 149 countries, seventeen of these neglected tropical parasitic diseases are classified as endemic. One of the most important of these diseases is schistosomiasis, also known as bilharzia, a disease caused by the genus Schistosoma. It presents several species, such as Schistosoma haematobium, Schistosoma japonicum and Schistosoma mansoni, the latter being responsible for parasitosis in Brazil. Contamination occurs through exposure to contaminated water in the endemic region. This parasitosis is characterized by being initially asymptomatic, but it is able to evolve into more severe clinical forms, potentially causing death. Globally, more than 200 million people are infected with one of three Schistosome species, including an estimated 40 million women of reproductive age. In Brazil, about 12 million children require preventive chemotherapy with anthelmintic. However, according to the World Health Organization (WHO), only about 15% of the at-risk children receive regular treatment. The lack of investment by the pharmaceutical industry for the development and/or improvement of new pharmaceutical forms, mainly aimed at the pediatric public, is a great challenge. Currently, the main forms of treatment used for schistosomiasis are praziquantel (PZQ) and oxaminiquine (OXA). PZQ is the drug of choice because it presents as a high-spectrum anthelmintic, used in the treatment of all known species of schistosomiasis and some species of cestodes and trematodes. OXA, however, is not active against the three Schistosome species. This work presents a literature review regarding schistosomiasis. It addresses points such as available treatments, the role of the pharmaceutical industry against neglected diseases, and perspectives for treatment.

Implications of Changing Temperatures on the Growth, Fecundity and Survival of Intermediate Host Snails of Schistosomiasis: A Systematic Review

Climate change has been predicted to increase the global mean temperature and to alter the ecological interactions among organisms. These changes may play critical roles in influencing the life history traits of the intermediate hosts (IHs). This review focused on studies and disease models that evaluate the potential effect of temperature rise on the ecology of IH snails and the development of parasites within them. The main focus was on IH snails of schistosome parasites that cause schistosomiasis in humans. A literature search was conducted on Google Scholar, EBSCOhost and PubMed databases using predefined medical subject heading terms, Boolean operators and truncation symbols in combinations with direct key words. The final synthesis included nineteen published articles. The studies reviewed indicated that temperature rise may alter the distribution, optimal conditions for breeding, growth and survival of IH snails which may eventually increase the spread and/or transmission of schistosomiasis. The literature also confirmed that the life history traits of IH snails and their interaction with the schistosome parasites are affected by temperature and hence a change in climate may have profound outcomes on the population size of snails, parasite density and disease epidemiology. We concluded that understanding the impact of temperature on the growth, fecundity and survival of IH snails may broaden the knowledge on the possible effects of climate change and hence inform schistosomiasis control programmes.

Universal Stress Proteins as New Targets for Environmental and Therapeutic Interventions of Schistosomiasis

In spite of various control measures and eradication methods that have been in progress, schistosomiasis still prevails as one of the most prevalent debilitating parasitic diseases, typically affecting the poor and the underprivileged that are predominantly concentrated in sub-Saharan Africa. The parasitic schistosome blood fluke responsible for causing the disease completes its complex developmental cycle in two hosts: humans and freshwater snails, where they physically undergo gross modifications to endure the different conditions associated with each host. Just like any other organism, the worm possesses mechanisms that help them respond to environmental insults. It has been hypothesized that a special class of proteins known as Universal Stress Proteins (USPs) are up-regulated during sudden environmental changes, thus assisting the worm to tolerate the unfavourable conditions associated with its developmental cycle. The position of praziquantel as the drug of choice against all schistosome infections has been deemed vulnerable due to mounting concerns over drug pressure and so the need for alternative treatment is now a matter of urgency. Therefore, this review seeks to explore the associations and possible roles of USPs in schistosomiasis as well as the functioning of these proteins in the schistosomulae stage in order to develop new therapeutic interventions against this disease.

Propolis enhances the effectiveness of praziquantel in experimental schistosomiasis: biochemical and histopathological study

Despite the wide current use of praziquantel (PZQ) in treatment of schistosomiasis, low cure rates have been recorded in many studies. The aim of this study was directed to evaluate the curative effect of propolis (Pps) alone or in combination with PZQ on biochemical, immunological, parasitological, and histological changes associated with experimental schistosomiasis in mice. Schistosoma mansoni-infected mice were divided into two experimental sets, each with four subgroups: (i) untreated, (ii) treated with Pps/day p.o for 4 weeks, (iii) treated with PZQ p.o 2 × 500 mg/kg bd wt, and (iv) treated with Pps + PZQ as in group ii and iii; all treatments started on the 8th week postinfection, in addition to uninfected group as control for the previous groups. Treatment of infected mice with Pps, although failed to eradicate the worm, significantly reduced the hepatic granuloma number, their lymphocytic infiltration and aggregation, hepatic and splenic myeloperoxidase (MPO) activity and plasma, and liver and thymus nitric oxide (NOx) levels together with normalization of plasma proteins and alleviation of oxidative stress in the examined tissues as evidenced by reduction of malondialdehyde (MDA) and normalization of glutathione (GSH). Promising results were obtained when Pps was given in combination with PZQ, where the anti-schistosomal activity of PZQ was markedly potentiated with complete alleviation and amelioration of the histological and biochemical alteration associated with schistosomiasis. This study highlights the potential usefulness of Pps as an adjunct to PZQ in schistosomiasis.

Efficacy of Praziquantel against Schistosoma haematobium in Dulshatalo village, western Ethiopia

Background

Praziquantel (PZQ) is the drug of choice for treatment of all human schistosomes. It is used in population based targeted or mass deworming strategies in several countries. The effect of PZQ on S. hematobium has not been studied in Ethiopia. The objective of this study was to determine the efficacy of PZQ against S. haematobium in Dulshatalo village, western Ethiopia.

Methods

A prospective study was conducted from October to December, 2007. Urine samples from 341 residents were collected and screened for haematuria and proteinuria using urinalysis dipstick. S. haematobium eggs were detected and quantified using filtration techniques. The participants who were positive for haematuria were treated with a standard dose of PZQ (40 mg/kg). Data on pre and 24 hours post treatment symptoms were collected via questionnaire. Urine samples were also collected 7 weeks after treatment and examined to assess the cure and the egg reduction rates.

Results

The prevalence of S. haematobium among the study participants was 57.8% (197/341). Haematuria was detected in 234 (68.6%) of the study participants. For PZQ efficacy asessment, 152 of the treated participants were considered. The presence of S. haemetaobium eggs showed statistically significant association (p < 0.05) with haematuria and proteinuria. Seven weeks post treatment, the extent of haematuria and proteinuria decreased from 100% to 40.8% and 94.07% to 48.7%, respectively. The cure and the parasitological egg reduction rates seven weeks post treatment were 86% and 85%, respectively. Post treatment symptoms revealed a wide range of side effects including straining, abdominal pain, nausea and headache.

Conclusions

There were marked cure and egg reduction rates, together with mild and short lived side effects of PZQ for treatment of S. haematobium, in this study.

Anthelmintic effects of alkylated diamines and amino alcohols against Schistosoma mansoni

Polyamines are substances involved in many aspects of cell growth, division, and differentiation. Because of the metabolic differences between host cells and parasite cells, polyamine metabolism has been considered as a potential target for the chemotherapy of parasitic diseases. The aim of this work was to evaluate the schistosomicidal activity of different N-alkylated diamines (3a-3h), amino alcohols (4a-4d), and glycosylated amino alcohols (10a-10d). Compounds were prepared by synthetic methods and submitted to in vitro evaluation against adult worms of Schistosoma mansoni. At 100 μM, 3b, 3e, and 3h as well as 4a, 4b, 4d, 10a, 10b, and 10d resulted in 100% mortality of adult schistosomes. Compound 3d (12.5 to 100 μM) caused the death of 100% of both male and female adult schistosomes, while 3f (12.5 to 100 μM) resulted in 100% mortality of only male adult worms, whereas no mortality in female worms was observed. Compounds 3d and 3f were also able to reduce viability and decrease production of developed eggs in comparison with the negative control group. Diamines 3d and 3f may represent useful lead compounds for further optimization in order to develop new schistosomicidal agents.

New approaches for understanding mechanisms of drug resistance in schistosomes

Schistosomes are parasitic flatworms that cause schistosomiasis, a neglected tropical disease that affects hundreds of millions worldwide. Treatment and control of schistosomiasis relies almost entirely on the single drug praziquantel (PZQ), making the prospect of emerging drug resistance particularly worrisome. This review will survey reports of PZQ (and other drug) resistance in schistosomes and other platyhelminths, and explore mechanisms by which drug resistance might develop. Newer genomic and post-genomic strategies that offer the promise of better understanding of how drug resistance might arise in these organisms will be discussed. These approaches could also lead to insights into the mode of action of these drugs and potentially provide markers for monitoring the emergence of resistance.

Novel therapeutic and prevention approaches for schistosomiasis: review

Schistosomiasis is a debilitating disease affecting approximately 600 million people in 74 developing countries, with 800 million, mostly children at risk. To circumvent the threat of having praziquantel (PZQ) as the only drug used for treatment, several PZQ derivatives were synthesized, and drugs destined for other parasites were used with success. A plethora of plant-derived oils and extracts were found to effectively kill juvenile and adult schistosomes, yet none was progressed to pre- and clinical studies except an oleo-gum resin extracted from the stem of Commiphora molmol, myrrh, which action was challenged in several trials. We have proposed an essential fatty acid, a component of our diet and cells, the polyunsaturated fatty acid arachidonic acid (ARA) as a remedy for schistosomiasis, due to its ability to activate the parasite tegument-bound neutral sphingomyelinase, with subsequent hydrolysis of the apical lipid bilayer sphingomyelin molecules, allowing access of specific antibody molecules, and eventual worm attrition. This concept was convincingly supported using larval and adult Schistosoma mansoni and Schistosoma haematobium worms in in vitro experiments, and in vivo studies in inbred mice and outbred hamsters. Even if ARA proves to be an entirely effective and safe therapy for schistosomiasis, it will not prevent reinfection, and accordingly, the need for developing an effective vaccine remains an urgent priority. Our studies have supported the status of S. mansoni calpain, glutathione-S-transferase, aldolase, triose phosphate isomerase, glyceraldehyde 3-phosphate dehydrogenase, enolase, and 2-cys peroxiredoxin as vaccine candidates, as they are larval excreted-secreted products and, contrary to the surface membrane molecules, are entirely accessible to the host immune system effector elements. We have proposed that the use of these molecules, in conjunction with Th2 cytokines-inducing adjuvants for recruiting and activating eosinophils and basophils, will likely lead to development and implementation of a sterilizing vaccine in a near future.

Anthelmintic tolerance in free-living and facultative parasitic isolates of Halicephalobus (Panagrolaimidae)

Studies on anthelmintic resistance in equine parasites do not include facultative parasites. Halicephalobus gingivalis is a free-living bacterivorous nematode and a known facultative parasite of horses with a strong indication of some form of tolerance to common anthelmintic drugs. This research presents the results of an in vitro study on the anthelmintic tolerance of several isolates of Halicephalobus to thiabendazole and ivermectin using an adaptation of the Micro-Agar Larval Development Test hereby focusing on egg hatching and larval development. Panagrellus redivivus and Panagrolaimus superbus were included as a positive control. The results generally show that the anthelmintic tolerance of Halicephalobus to both thiabendazole and ivermectin was considerably higher than that of the closely related Panagrolaimidae and, compared to other studies, than that of obligatory equine parasites. Our results further reveal a remarkable trend of increasing tolerance from fully free-living isolates towards horse-associated isolates. In vitro anthelmintic testing with free-living and facultative parasitic nematodes offers the advantage of observing drug effect on the complete life cycle as opposed to obligatory parasites that can only be followed until the third larval stage. We therefore propose Halicephalobus gingivalis as an experimental tool to deepen our understanding of the biology of anthelmintic tolerance.

Schistosoma mansoni: a method for inducing resistance to praziquantel using infected Biomphalaria glabrata snails

To elucidate the mechanisms of antischistosoma resistance, drug-resistant Schistosoma mansoni laboratory isolates are essential. We developed a new method for inducing resistance to praziquantel (PZQ) using successive drug treatments of Biomphalaria glabrata snails infected with S. mansoni. Infected B. glabrata were treated three times with 100 mg/kg PZQ for five consecutive days with a one-week interval between them. After the treatment, the cercariae (LE-PZQ) produced from these snails and the LE strains (susceptible) were used to infect mice. Forty-five days after infection, mice were treated with 200, 400 or 800 mg/kg PZQ. Thirty days post-treatment, we observed that the mean number of worms recovered by perfusion was significantly higher in the group of mice infected with the LE-PZQ isolate treated with 200 and 400 mg/kg in comparison to the LE strain with the same treatment. Moreover, there was a significant difference between the ED50 (effective dose required to kill 50% of the worms) of the LE-PZQ isolate (362 mg/kg) and the LE strain (68 mg/kg). In the in vitro assays, the worms of the LE-PZQ isolate were also less susceptible to PZQ. Thus, the use of infected snails as an experimental model for development of resistance to S. mansoni is effective, fast, simple and cheap.

Efficacy of praziquantel and artemisinin derivatives for the treatment and prevention of human schistosomiasis: a systematic review and meta-analysis

Background

Praziquantel has been used as first-line drug for chemotherapy of schistosomiasis since 1984. Besides praziquantel, artemether and artesunate have also been used for the control of this infectious disease since late 1990s. In this article, we conducted a systematic review and meta-analysis to evaluate the antischistosomal efficacy of different medication strategies including monotherapy or combination therapies of these drugs.

Results

A number of 52 trials from 38 articles published in peer-reviewed journals before July 2011 were selected for analysis after searching the following literature databases: the Cochrane Library, PubMed/Medline, ISI Web of Science, Chinese Biomedicine Literature Database, and China National Knowledge Infrastructure. Our meta-analyses showed that a dosage of 30-60 mg/kg praziquantel compared with placebo produced a protection rate of about 76% (95% CI: 67%-83%) for treating human schistosomiasis, which varied from 70% to 76% with no significant differences among the subspecies S. haematobium, S. japonicum or S. mansoni. Protection rates were higher when praziquantel doses were elevated, as concluded from the nRCTs results: the protection rate of praziquantel at 40 mg/kg was 52% (95% CI: 49%-55%), and it increased to 91% (95% CI: 88%-92%) when the dosages were elevated to 60/80/100 mg/kg divided two or more doses. Multiple doses of artemether or artesunate over 1- or 2-week intervals resulted in protection rates of 65% to 97% for preventing schistosomiasis, and increased doses and shorter medication intervals improved their efficacies. Praziquantel and artemisinin derivatives (artemether or artesunate) in combination resulted in a higher protection rate of 84% (95% CI: 64%-91%) than praziquantel monotherapy for treatment. praziquantel and artesunate in combination had a great protection rate of 96% (95% CI: 78%-99%) for preventing schistosomes infection.

Conclusions

According to the results, praziquantel remains effective in schistosomiasis treatment, and multiple doses would improve its efficacy; meanwhile, praziquantel is also a good drug for preventing acute schistosomiasis morbidity. It's better to use multiple doses of artemether or artesunate with 1- or 2-week intervals for prevention against schistosome infection. Praziquantel and artemether or artesunate in combination perform better in treatment than praziquantel monotherapy, and they are especially suitable for treating the patients with repeated exposure to infected water.

The USAID/Government of Egypt's Schistosomiasis Research Project (SRP)

Schistosomiasis is the major public health problem in rural Egypt, with almost six million Egyptians infected as at mid-1996. In 1983, the prevalence of schistosomiasis in rural Egypt was greater than 50%, but a ten-year campaign of diagnosis and treatment has reduced the prevalence and intensity of infection. Parallel to this campaign, the government of the USA has funded a research project to examine all aspects of schistosomiasis with a view to improving the control strategy. As outlined here by Taha El Khoby, Nabil Galal and Alan Fenwick, after almost ten years, the project's achievements include: assisting WHO in its attempts to develop a vaccine against schistosomiasis, developing a suspension formulation of praziquantel suitable for young children, and establishing a unit to monitor reports of resistance to praziquantel. In addition, a large epidemiological study has established the extent of the problem in Egypt. Slow-release formulation of niclosamide, health education material for use on TV, dipstick diagnostic tests, and evaluation of ultrasound as a diagnostic tool have also been achieved. As the project closes, Egypt is left with an effective strategy for the control of schistosomiasis and several back-up tools for use in the event of development of resistance to praziquantel. The Ministry of Health and Population has the basis of a Geographical Information System (GIS) unit and the country has a trained and equipped scientific community capable of biomedical research, and almost 100 scientific papers published on their work.

Artemether shows promising female schistosomicidal and ovicidal effects on the Egyptian strain of Schistosoma mansoni after maturity of infection

Artemether is an artemisinin derivative that is used as an antimalarial drug, especially in situations where chloroquine resistance is suspected. This compound has proved to be a good prophylactic agent against schistosomiasis japonica in China. In the present study, the therapeutic efficacies of different artemether-dosing protocols were evaluated in experimentally infected mice harbouring adult Schistosoma mansoni (Egyptian strain). Mice were treated on day 46 onwards with three dosing protocols (400 mg/kg/day for 2 days; 200 mg/kg/day for 4 days; 100 mg/kg/day for 6 days) after being infected. A number of parasitological and histopathological criteria were employed in the assessment of drug efficacies compared to infected untreated control 2 weeks post-treatment. The results of the present study suggest that artemether is efficacious against the Egyptian strain of S. mansoni with total worm reductions ranging from 40.7% to 59.7% and female worm reductions ranging from 69.3% to >90%. In addition, artemether induced significant reductions, ranging from 75.2% to 82.6%, in the liver tissue egg loads as well as significant reductions, ranging from 68.8% to 78.9% in the intestinal wall egg loads. It also induced significant alterations in the oogram pattern in the intestinal mucosa of infected mice with cessation of oviposition and increased rates of dead eggs. Antipathologic activities were also evident in the amelioration of granulomas in the liver with increased ratios of healed to active ones. In conclusion, artemether could be a promising agent in the control of schistosomiasis mansoni due to its schistosomicidal effects on female worms and to its ovicidal power as well as its potentiality in the improvement of hepatic lesions.

In vitro schistosomicidal effects of some phloroglucinol derivatives from Dryopteris species against Schistosoma mansoni adult worms

The rhizomes of Dryopteris species have popularly been used as vermifuge in flatworm infections. The aim of this work was to evaluate the in vitro schistosomicidal activity of some phloroglucinol compounds, obtained from the rhizomes of Dryopteris species, against Schistosoma mansoni adult worms. All worm pairs were dead after 24 h of incubation with aspidin 25 to 100 microM (1), flavaspidic acid 50 and 100 microM (2), methylene-bis-aspidinol 100 microM (3), and desaspidin 25 to 100 microM (4). Worms incubated with 1 (25 to 100 microM) and 2 (50 to 100 microM) showed decrease motor activity with tegumental alterations, while 3 (100 microM) and 4 (10 to 100 microM) showed decrease motor activity without tegumental alterations. Desaspidinol (5) and filicinic acid (6), at the tested concentrations (10 to 100 microM), did not show activity against adult worms of S. mansoni. Praziquantel (10 microM), used as positive control, caused death of the parasites and tegumental alterations without separation of worms. In the groups treated with 100 microM of compounds 1-4, the viability of the adult worms was similar to the positive control group, in which the worms were dead. Also, both the egg productions and the development of eggs produced by the adult worms were inhibited by the incubation with compounds 1-4 (10 and 100 microM) in comparison with the negative control (RPMI 1640 medium). It is suggested that the in vitro schistosomicidal effects of phloroglucinols derivatives 1, 2, 3, and 4 may be related to the inhibition of oxidative phosphorylation pathway in S. mansoni. The present results confirmed the traditional indications of rhizomes from Dryopteris species, which possess phloroglucinol compounds, in the treatment of tapeworm infections.

Host-parasite relations and implications for control

This paper considers the various measures available to control several of the neglected tropical diseases (NTDs). To develop the optimum methods for controlling the parasites that cause these NTDs, knowledge of the life cycles of both the parasites and their vectors are essential. Each NTD requires its own strategy for control based on detailed knowledge of the life cycle, and vector control, chemotherapy, better water supplies and better hygiene are all components that may be appropriate. For some diseases, improved drugs are urgently required, for some the tools are available for elimination, while uniquely guinea worm could be eradicated without any chemotherapeutic drug being used. Several NTDs lend themselves to mass drug administration (MDA) in which human populations are annually offered safe, effective and usually donated drugs with a view to morbidity control and/or elimination. The drugs could and should be used to improve the quality of millions of lives, prevent suffering, stigma, disfigurement and early death. The role of pharmaceutical companies who have donated their drugs for the treatment of millions of disadvantaged people in the developing world is acknowledged. One result of such drug pressure however is that evolutionary change may result, and it is incumbent on scientists during monitoring and evaluation of control programmes to ensure that such changes are recognised. One other unfortunate development is that a paucity of newly trained vector-borne disease experts may constrain future control efforts.

Current chemotherapy arsenal for schistosomiasis mansoni: alternatives and challenges

Schistosomiasis still represents a major health problem in many tropical and subtropical countries despite continuing control efforts. Due to the unavailability of a vaccine that is practically applicable to humans, the use of chemotherapy is the mainstay of schistosomiasis-associated morbidity control. This paper attempts to review the antischistosomal drugs currently used in the treatment of intestinal schistosomiasis caused by Schistosoma mansoni. Their antischistosomal properties, advantages, and disadvantages as well as issues regarding the evidence for drug resistance and combination studies are reviewed in a simple manner. The recent trends towards the identification of specific chemotherapeutic targets for the treatment of schistosomes are also discussed briefly.

A schistosomiasis model with mating structure and time delay

A system of homogeneous equations with a time delay is used to model the population dynamics of schistosomes. The model includes the parasite's mating structure, multiple resistant schistosome strains, and biological complexity associated with the parasite's life cycle. Invasion criteria of resistant strains and coexistence threshold conditions are derived. These results are used to explore the impact of drug treatment on resistant strain survival. Numerical simulations indicate that the dynamical behaviors of the current model are not qualitatively different from those derived from an earlier model that ignores the impact of time delays associated with the multiple stages in parasite's life cycle. However, quantitatively the time delays make it more likely for drug-resistant strains to invade in a parasite population.

Implementation of Human Schistosomiasis Control: Challenges and Prospects

Schistosomiasis is a major disease of public health importance in humans occurring in over 70 countries of the tropics and sub-tropics. In this chapter, the history of the control of schistosomiasis is briefly discussed and current methods of control of schistosomiasis are reviewed; including mollusciciding, biological control of the intermediate snail hosts, the development of drugs to kill the adult worms, provision of clean water and health education, with a focus on the African situation. Since an effective vaccine against schistosomiasis is lacking, the emphasis today is placed on the drug praziquantel (PZQ). The marked reduction in the cost of PZQ together with the support of the Bill and Melinda Gates Foundation has enabled the drug to be used more widely in sub-Saharan Africa. Nevertheless, with the possibility of resistance to praziquantel emerging, the potential role of other drugs, such as artemether, in the control of schistosomiasis is examined. The World Health Organization (WHO) anticipates that at least 75% of all schoolchildren at risk of morbidity from schistosomiasis will be treated by 2010, with the aim of reversing morbidity. The importance of recent international initiatives such as the Schistosomiasis Control Initiative (SCI) working in Mali, Niger, Burkina Faso, Zambia, Tanzania and Uganda is recognised. There are benefits to integrating the control of schistosomiasis with other disease control programmes, such as gastrointestinal helminths and/or lymphatic filariasis (LF), since this markedly reduces the cost of delivery of the treatment. Countries that are situated on the perimeter of the distribution of schistosomiasis have either achieved or have made progress towards the elimination of the disease. For control programmes to be successful in areas such as sub-Saharan Africa, it is absolutely essential that these programmes are sustainable. Thus, it will be vital for Ministries of Health and Education to budget for the control of diseases of poverty in addition to school health, and to utilise funds from a range of sources, such as, government funds, pooled donor contributions, or bilateral and international agencies.

Proteome analysis of rhoptry-enriched fractions isolated from Plasmodium merozoites

The rhoptries of Plasmodium species participate in merozoite invasion and modification of the host erythrocyte. However, only a few rhoptry proteins have been identified using conventional gene identification protocols. To investigate the protein organization of this organelle and to identify new rhoptry proteins, merozoite rhoptries from three different Plasmodium rodent species were enriched by sucrose density gradient fractionation, and subjected to proteome analysis using multidimensional protein identification technology (MudPIT); 148 proteins were identified. To distinguish abundant cellular contaminants from bona fide organellar proteins, a differential analysis comparing the proteins in the rhoptry-enriched fractions to proteins identified from whole cell lysates of P. berghei mixed asexual blood stages was undertaken. In addition, the proteins detected were analyzed for the presence of transmembrane domains, secretory signal peptide, cell adhesion motifs, and/or rhoptry-specific tyrosine-sorting motifs. Combining the differential analysis and bioinformatic approaches, a set of 36 proteins was defined as being potentially located to the Plasmodium rhoptries. Among these potential rhoptry proteins were homologues of known rhoptry proteins, proteases, and enzymes involved in lipid metabolism. Molecular characterization and understanding of the supramolecular organization of these novel potential rhoptry proteins may assist in the identification of new intervention targets for the asexual blood stages of malaria.

Schistosoma japonicum: localization of calpain in the penetration glands and secretions of cercariae

A monoclonal antibody was generated against the large subunit of Schistosoma japonicum calpain to study the localization and possible function of the molecule in vivo. Mice were immunized with recombinant S. japonicum calpain and polyclonal antisera and a monoclonal antibody specific to schistosome calpain was obtained. In immunohistochemistry, a monoclonal antibody against S. japonicum calpain, KG-2E11, bound weakly to calpain expressed at the surface of adult worm tegument, however, it bound strongly to the cercarial secretions ("footprints") of S. japonicum, emitted from the penetration glands. The present study indicates that calpain is multifunctional as it is expressed at various locations in different developmental stages. Calpain-based vaccines could thus possibly induce protective immunity against cercariae and the following early developing stages.

Excretion of fluorescent substrates of mammalian multidrug resistance-associated protein (MRP) in the Schistosoma mansoni excretory system

The protonephridium of platyhelminths including Schistosoma mansoni plays a pivotal role in their survival by excretion of metabolic wastes as well as xenobiotics, and can be revealed in the living adult parasite by certain fluorescent compounds which are concentrated in excretory tubules and collecting ducts. To determine the presence of the multidrug resistance-associated protein (MRP) as a possible transporter in protonephridial epithelium, adult schistosomes were exposed to a fluorescent Ca2+ indicator, fluo-3 acetyloxymethyl ester, which is a potential substrate of mammalian MRP. Specific fluorescence related to fluo-3/Ca2+ chelate delineated the whole length of the protonephridial system. Simultaneously, a fluorescent substance was accumulated in the posterior part of collecting ducts and the excretory bladder. Similarly, when other fluorogenic substrates for mammalian MRP such as monoclorobimane, fluorescein diacetate, and 5(6)-carboxyfluorescein diacetate were applied to adult schistosomes, these fluorescent markers were observed in the excretory tubules through to the excretory bladder. The excretory system of mechanically-transformed schistosomula was not labelled with any of these 4 fluorescent markers. These findings suggest that the protonephridial epithelium of adult schistosomes, but not schistosomula, might express the homologue of the mammalian MRP transporting organic anionic conjugates with glutathione, glucuronate or sulphate as well as unconjugated amphiphilic organic anions.

Efficacy and side effects of praziquantel treatment in a highly endemicSchistosoma mansoni focus at Lake Albert, Uganda

The aim of the study was to assess the efficacy and side effects following single and repeated (6 weeks apart) praziquantel treatment (40 mg/kg) in a Schistosoma mansoni-endemic focus with long-standing transmission at Lake Albert in Uganda between December 1996 and January 1997. The results were based on 482 individuals, randomly representing all age and both gender groups. The cure rate following the first and second treatments was 41.9% and 69.1%, respectively. The cure rate was higher in adults than in children, irrespective of intensity of infection. In addition, the cure rate declined markedly with increasing intensity of infection. The reduction in intensity of infection was marked, being 97.7% and 99.6% after the first and second treatments, respectively. A pre- and post-treatment symptom questionnaire revealed a broad range of side effects, including abdominal pain and diarrhoea. However, no serious or long-lasting complications affecting compliance were observed. The marked reductions in faecal egg excretion and the acceptable level of side effects point to a single praziquantel treatment (40mg/kg) as the strategy of choice in such a highly endemic S. mansoni focus.

Lack of C3 affects Th2 response development and the sequelae of chemotherapy in schistosomiasis

The role of the third component of complement (C3) during schistosome infection was investigated using mice deficient in C3. While no effect was observed 8 wk after infection on worm development or liver pathology, Ag-specific Th2-associated cytokine production (IL-13, IL-5, IL-6, and IL-10) was significantly reduced, and IFN-gamma production was enhanced in the absence of C3. IgG1 and IgE, but not IgG2a or IgM, Ab responses were also significantly impaired in infected C3(-/-) mice, suggesting that C3 may play a role in IL-4-mediated Th2 response enhancement during schistosome infection. Furthermore, C3-deficient mice could not effectively clear adult worms after praziquantel (PZQ) treatment and suffered increased morbidity due to the overproduction of proinflammatory mediators following drug administration. However, the ischemic liver damage that normally accompanies PZQ administration in infected wild-type mice was substantially reduced in treated C3-deficient mice, probably due to the absence of dead or dying worms in the livers of these animals. Together these results indicate that C3 enhances Th2 responses during schistosome infection, potentiates PZQ-mediated parasite clearance, and reduces chemotherapy-induced proinflammatory mediator production.

Resistance of Schistosoma mansoni to praziquantel: is there a problem?

Evidence for resistance to praziquantel (PZQ) in Schistosoma mansoni has been sought in parasites taken from treated, but uncured human patients, and in a laboratory isolate of S. mansoni subjected to successive passages under drug pressure. Patients from villages in Egypt and Senegal have yielded isolates that can tolerate higher dosages of PZQ than other ostensible control isolates when passaged and subjected to drug treatment in mice. In vitro tests on these and the laboratory-selected isolate support the conclusion that a degree of resistance to PZQ can occur in S. mansoni, but the levels of drug resistance found so far are low. Preliminary studies have begun on these isolates to identify genetic, physiological and morphological characteristics associated with PZQ resistance and some of these may find use as markers for monitoring whether or not resistance is developing in endemic areas where the drug is used. More intensive application of PZQ can be expected in future, particularly in other parts of Africa, and vigilance will be needed to ensure that it continues to be useful as a drug for treatment of schistosomiasis. Further work is needed to elucidate the mode of action of PZQ and there is already a need for alternative drugs to treat PZQ-resistant schistosomiasis, such as already exists in northern Senegal.

Interpreting low praziquantel cure rates of Schistosoma mansoni infections in Senegal

Praziquantel is currently the drug of choice for the treatment of schistosomiasis. Selective treatment of Schistosoma mansoni infections in various endemic countries usually present cure rates of >70% when using the standard dose of 40 mg kg(-1) body weight of praziquantel. However, unusually low cure rates (18-38%) have been reported from Senegal, raising fears for emergence of resistance (or tolerance) to praziquantel. One major problem is the precise quantitative interpretation of cure rates, which allows an unequivocal distinction between drug failure and normal drug performance. This article reviews studies on praziquantel treatment of population by standardizing the data through an innovative meta-analysis and provides empirical evidence concerning the extent to which the reported low cure rates from Senegal are atypical.

Effect of combined treatment with praziquantel and artemether on Schistosoma japonicum and Schistosoma mansoni in experimentally infected animals

Praziquantel and artemether are safe and efficacious antischistosomal drugs that act against different developmental stages of the parasite: praziquantel against adult worms and artemether against schistosomula. A combined treatment has been suggested as a strategy for transmission control. Recent laboratory experiments with rabbits with a mixed infection of Schistosoma japonicum parasites of different ages confirmed the effectiveness of a combination therapy. In the present work, we assessed the effect of a combined treatment on adult worms of S. japonicum and found significantly higher worm reduction rates than with a single dose of praziquantel. In a next step, we extended the study of the combined treatment to Schistosoma mansoni. A combined treatment with 75 mg/kg praziquantel and 150 mg/kg artemether was administered to hamsters infected with juvenile and adult S. mansoni. The two drugs, administered simultaneously or spaced by 6 h, 1, 3 or 7 days, resulted in significantly higher worm reduction rates than a single treatment with praziquantel. A combination therapy with increased doses of 100 mg/kg praziquantel and 300 mg/kg artemether showed very high worm reduction rates of 90% and above, however, some hamsters died in five different combined treatment experiments, suggesting that these drug concentrations were too high. We conclude that a combined treatment with praziquantel and artemether at the lower doses is safe and more effective than praziquantel alone, which forms a foundation for designing respective clinical trials in humans.

The biochemical basis of anthelmintic action and resistance

The most commonly used modern anthelmintics include the benzimidazoles, the nicotinic agonists. praziquantel, triclabendazole and the macrocyclic lactones. These drugs interfere with target sites that are either unique to the parasite or differ in their structural features from those of the homologous counterpart present in the vertebrate host. The benzimidazoles exert their effect by binding selectively and with high affinity to the beta-subunit of helminth microtubule protein. The target site of the nicotinic agonists (e.g. levamisole, tetrahydropyrimidines) is a pharmacologically distinct nicotinic acetylcholine receptor channel in nematodes. The macrocyclic lactones (e.g. ivermectin, moxidectin) act as agonists of a family of invertebrate-specific inhibitory chloride channels that are activated by glutamic acid. The primary mode of action of other important anthelmintics (e.g. praziquantel, triclabendazole) is unknown. Anthelmintic resistance is wide-spread and a serious threat to effective control of helminth infections, especially in the veterinary area. The biochemical and genetic mechanisms underlying anthelmintic resistance are not well understood, but appear to be complex and vary among different helminth species and even isolates. The major mechanisms helminths use to acquire drug resistance appear to be through receptor loss or decrease of the target site affinity for the drug. Knowledge on the mechanisms of drug action and resistance may be exploitable for the development of new drugs and may provide information on ways to overcome parasite resistance, respectively.

Vaccine efficacy of recombinant cathepsin D aspartic protease from Schistosoma japonicum

Mice were vaccinated with recombinant Schistosoma japonicum cathepsin D aspartic protease, expressed in both insect cells and bacteria, in order to evaluate the vaccine efficacy of the schistosome protease. Mean total worm burdens were significantly reduced in vaccinated mice by 21-38%, and significant reductions in female worm burdens were also recorded (22-40%). Vaccination did not reduce fecundity; rather, we recorded increased egg output per female worm in vaccinated animals, suggesting a crowding effect. Vaccinated mice developed high levels of antibodies (predominantly IgG1, IgG2a and IgG2b isotypes), but there was no correlation between antibody levels and protective efficacy. Immune sera from vaccinated mice did not inhibit the in vitro degradation of human haemoglobin by the recombinant protease, and passive transfer of serum or antibodies from vaccinated animals, before and after parasite challenge, did not significantly reduce worm or egg burdens in recipient animals. These results suggest that antibodies may not play a key role in the protective effect elicited, and that protection may be due to a combination of humoral and cell-mediated responses

A direct competitive enzyme-linked immunosorbent assay (ELISA) for determination of praziquantel concentration in serum

A simple and reproducible enzyme-linked immunosorbent assay (ELISA) for the determination of the concentration of praziquantel in the serum was developed. Since praziquantel has no functional group to conjugate with carrier protein, praziquantel was first converted to a compound with an amino group similar to praziquantel. This compound was then conjugated to bovine serum albumin for use as an immunogen, and to horseradish peroxidase, as enzyme-labeled praziquantel, respectively. The conjugate of praziquantel-bovine serum albumin conjugate was used to raise anti-praziquantel antiserum in mice. The direct competitive ELISA was conducted by simultaneously incubating praziquantel and horseradish peroxidase-labeled praziquantel conjugate with anti-praziquantel antiserum over a second antibody and the enzyme activity of the remaining horseradish peroxidase-labeled praziquantel conjugate was measured. The intra- and inter-assay coefficient of variation was < 10% in the range of 1.0 to 30 ng ml(-1), and the limit of the detection was 0.3 ng ml(-1). The cross reactivities of anti-praziquantel antibody with compounds related to praziquantel were negligible. Using this ELISA, serum levels of praziquantel were easily determined in male Wistar rats up to 8 h following a single intraperitoneal injection at 2 mg kg(-1) of body weight.

Efficacy of praziquantel against Schistosoma mansoni with particular consideration for intensity of infection

Chemotherapy with praziquantel is the cornerstone of schistosomiasis control. In view of recent concern about tolerance or resistance to praziquantel, monitoring its efficacy in different epidemiological settings is required. We report a study among 253 schoolchildren in an area highly endemic for Schistosoma mansoni in western Côte d'Ivoire. After examining four consecutive stool specimens from each child, the first praziquantel treatment at 60 mg/kg divided into two doses was administered. Four weeks later, stool specimens were again screened over 4 consecutive days and revealed a cure rate of 71.6% and an egg reduction rate of 79.9%. There was a significant association between cure rate and intensity of infection prior to treatment with highest cure rates observed in light infections (P < 0.01). Praziquantel, at a single dose of 40 mg/kg, was again administered 35 days after the first treatment. The overall cure and egg reduction rates increased considerably. The association between cure rate and intensity of infection prior to the second treatment was significant but less pronounced. Twenty-two children remained S. mansoni positive after the two chemotherapy campaigns, and interestingly, many of these were only identified after repeated stool examinations. We argue that pre-patent infections may account for some of these 'treatment failures'. However, further studies in other endemic settings are needed, with parasitological diagnoses having a high sensitivity.

Effect of artemether against Schistosoma haematobium in experimentally infected hamsters

The drug, artemether, has been shown to be active against the juvenile stages of Schistosoma japonicum and Schistosoma mansoni in experimentally infected animals, while it is less effective on adult worms. These findings have been confirmed in randomised controlled trials in humans. Consequently, it could be expected that artemether is also active against Schistosoma haematobium. We present here the first results from experiments assessing the effect of artemether on S. haematobium. Hamsters with a single infection received intra-gastrically an initial dose of 300 mg/kg artemether on day 14, 21 or 28, followed by further doses at varying treatment regimens. In all the treatment groups, the total and female worm reduction rates were highly significant, and ranged from 78 to 100% in hamsters harbouring juvenile schistosomes. Hamsters infected three times with S. haematobium, on days 0, 4 and 9, and repeatedly treated with artemether at the same dose as above, showed highly significant total and female worm reduction rates of between 94 and 99%. Artemether was also active against 77-day-old adult S. haematobium, since its administration on two consecutive days resulted in highly significant total and female worm reduction rates of 76-89%. Our findings confirm that artemether is also active against S. haematobium, especially the schistosomules. These results provide a basis for clinical trials in humans, for further assessment of the potential of artemether for schistosomiasis control.

Drug resistance in human helminths: current situation and lessons from livestock

In this review the available reports on drug resistance in human helminths, particularly hookworms and schistosomes, are critically analyzed. The experiences with helminths of livestock are then reviewed, in particular the factors contributing to the development of anthelmintic resistance, the mechanisms and genetics of resistance to various anthelmintic classes, and the methods available for detection. These experiences appear to be worryingly similar and relevant to the potential development of drug resistance in human helminths. Recommendations to reduce its risks are suggested.

Drug resistance in human helminths: current situation and lessons from livestock

In this review the available reports on drug resistance in human helminths, particularly hookworms and schistosomes, are critically analyzed. The experiences with helminths of livestock are then reviewed, in particular the factors contributing to the development of anthelmintic resistance, the mechanisms and genetics of resistance to various anthelmintic classes, and the methods available for detection. These experiences appear to be worryingly similar and relevant to the potential development of drug resistance in human helminths. Recommendations to reduce its risks are suggested.

Randomly amplified polymorphic DNA (RAPD) polymerase chain reaction assay for identification of Schistosoma mansoni strains sensitive or tolerant to anti-schistosomal drugs

The genetic differences between Schistosoma mansoni strains from different geographic areas that were reportedly resistant or sensitive to anti-schistosomal drugs were studied with randomly amplified polymorphic DNA (RAPD) and simple sequence repeat (SSR) polymerase chain reaction (PCR) assays. Of the 20 RAPD primers we chose, 19 showed the capacity to produce a medium to high level of amplification and 6 revealed difference PCR bands between drug-resistant and drug-sensitive strains. One particular primer, 5'-CAGCGACAAG-3', showed 2 major difference bands between praziquantel (PZQ)-resistant and PZQ-sensitive strains from the endemic area of Egypt. These results demonstrate that defined sequence primers could be applied as a useful tool for differentiating drug-resistant and -sensitive schistosome parasites in the field.

Pharmacology of anthelmintic resistance

Anthelmintic resistance has grown from a curiosity to an important economic problem in several animal industries and is now set to threaten the control of human parasites. The pharmacology of anthelmintics and anthelmintic resistance has been studied most extensively in the nematode parasites of sheep. Here, Nick Sangster and Jenny Gill discuss this veterinary experience, summarizing the progress made in understanding anthelmintic resistance and highlighting the tools available for research.

Glutathione S-transferases of 28kDa as major vaccine candidates against schistosomiasis

For the development of vaccine strategies to generate efficient protection against chronic infections such as parasitic diseases, and more precisely schistosomiasis, controlling pathology could be more relevant than controlling the infection itself. Such strategies, motivated by the need for a cost-effective complement to existing control measures, should focus on parasite molecules involved in fecundity, because in metazoan parasite infections pathology is usually linked to the output of viable eggs. In numerous animal models, vaccination with glutathione S-transferases of 28kDa has been shown to generate an immune response strongly limiting the worm fecundity, in addition to the reduction of the parasite burden. Recent data on acquired immunity directed to 28GST in infected human populations, and new development to draw adapted vaccine formulations, are presented.

Snail Control Strategies for Reduction of Schistosomiasis Transmission

As intermediate hosts, molluscs play a major role in the transmission of schistosomes; they are the sites of an intense multiplication of parasites. Thus, snail control strategies are considered a priority for the reduction of schistosomiasis transmission. Here, Vinca Lardans and Colette Dissous review the efficacy of environmental management and the use of molluscicides and biological agents to control snail populations. They then describe the development of diagnostic tests, based on the detection of parasite antigens or specific parasite DNA sequences in snail tissues, to detect the early infection of snails. Finally, they discuss progress in studying the molecular basis of susceptibility and resistance phenotypes, and the possible application of the genetic manipulation of molluscs.