Toxoplasmosis: A history of clinical observations

TKL family kinases in human apicomplexan pathogens

Apicomplexan parasites are the primary causative agents of many human diseases, including malaria, toxoplasmosis, and cryptosporidiosis. These opportunistic pathogens undergo complex life cycles with multiple developmental stages, wherein many key steps are regulated by phosphorylation mechanisms. The genomes of apicomplexan pathogens contain protein kinases from different groups including tyrosine kinase-like (TKL) family proteins. Although information on the role of TKL kinases in apicomplexans is quite limited, recent studies have revealed the important role of this family of proteins in apicomplexan biology. TKL kinases in these protozoan pathogens show unique organization with many novel domains thus making them attractive candidates for drug development. In this mini review, we summarize the current understanding of the role of TKL kinases in human apicomplexan pathogens' (Toxoplasma gondii, Plasmodium falciparum and Cryptosporidium parvum) biology and pathogenesis.

Detection of Toxoplasma gondii infection in buffaloes (Bubalus bubalis) and cattle (Bos taurus) at the Tabriz abattoir, Iran

BACKGROUND

Toxoplasma gondii is a widely prevalent zoonotic protozoan parasite in humans and warm-blooded animals worldwide. Infection of humans by this parasite can result in severe clinical symptoms, particularly in individuals with congenital toxoplasmosis or immunocompromised patients. Contamination mainly occurs through foodborne routes, especially the consumption of raw or undercooked meat from animals.

OBJECTIVES

The aim of this study was to use PCR to detect T. gondii in tissues and organs of buffaloes and cattle slaughtered at Tabriz slaughterhouse, in Iran.

METHODS

Fifty grams of heart, thigh, diaphragm and tongue from 50 buffaloes and 100 cattle slaughtered at the Tabriz industrial slaughterhouse were selected for sampling using a combination of convenience sampling. The samples were tested using a previously published PCR method.

RESULTS

Out of the 150 animal samples, T. gondii was detected in 10 (6.7%, 95%CI: 3.2-11.9), including one buffalo (2%, 95%CI: 0.1-10.6) and nine cattle (9%, 95%CI: 4.2-16.4). There was no statistically significant difference in the rate of T. gondii infection among cattle based on age and sex (p > 0.05).

CONCLUSIONS

The results indicated a potential risk of T. gondii transmission to humans through the consumption of infected meat. Therefore, appropriate and effective preventive measures should be taken to limit the transmission of this parasite to humans, and the consumption of raw and undercooked meat should be discouraged.

MicroRNA mmu-miR-511-5p: A promising Diagnostic Biomarker in Experimental Toxoplasmosis Using Different Strains and Infective Doses in Mice with Different Immune States Before and After Treatment

PURPOSE

Searching for a novel early diagnostic biomarker for toxoplasmosis, real-time-PCR was currently used to measure the serum mmu-miR-511-5p level in male Swiss-albino mice infected with either; ME49 or RH Toxoplasma gondii (T. gondii) strains.

METHODS

Three mice groups were used; (GI) constituted the non-infected control group, while (GII) and (GIII) were experimentally infected with ME49 or RH strains, respectively. GII mice were orally infected using 10 or 20 ME49 cysts (ME-10 and ME-20), both were subdivided into; non-treated (ME-10-NT and ME-20-NT) and were further subdivided into; immunocompetent (ME-10-IC and ME-20-IC) [euthanized 3-days, 1, 2, 6 or 8-weeks post-infection (PI)], and immunosuppressed using two Endoxan® injections (ME-10-IS and ME-20-IS) [euthanized 6- or 8-weeks PI], and spiramycin-treated (ME-10-SP and ME-20-SP) that received daily spiramycin, for one-week before euthanasia. GIII mice individually received 2500 intraperitoneal RH strain tachyzoites, then, were subdivided into; non-treated (RH-NT) [euthanized 3 or 5-days PI], and spiramycin-treated (RH-SP) that were euthanized 5 or 10-days PI (refer to the graphical abstract).

RESULTS

Revealed significant upregulation of mmu-miR-511-5p in GII, one-week PI, with gradually increased expression, reaching its maximum 8-weeks PI, especially in ME-20-NT group that received the higher infective dose. Immunosuppression increased the upregulation. Contrarily, treatment caused significant downregulation. GIII recorded significant upregulation 3-days PI, yet, treatment significantly decreased this expression.

CONCLUSION

Serum mmu-miR-511-5p is a sensitive biomarker for early diagnosis of ME49 and RH infection (as early as one-week and 3-days, respectively), and its expression varies according to T. gondii infective dose, duration of infection, spiramycin-treatment and host immune status.

Molecular regulation of NLRP3 inflammasome activation during parasitic infection

Parasitic diseases are a serious global health concern, causing many common and severe infections, including Chagas disease, leishmaniasis, and schistosomiasis. The NLRP3 inflammasome belongs to the NLR (nucleotide-binding domain leucine-rich-repeat-containing proteins) family, which are cytosolic proteins playing key roles in the detection of pathogens. NLRP3 inflammasomes are activated in immune responses to Plasmodium, Leishmania, Toxoplasma gondii, Entamoeba histolytica, Trypanosoma cruzi, and other parasites. The role of NLRP3 is not fully understood, but it is a crucial component of the innate immune response to parasitic infections and its functions as a sensor triggering the inflammatory response to the invasive parasites. However, while this response can limit the parasites' growth, it can also result in potentially catastrophic host pathology. This makes it essential to understand how NLRP3 interacts with parasites to initiate the inflammatory response. Plasmodium hemozoin, Leishmania glycoconjugate lipophosphoglycan (LPG) and E. histolytica Gal/GalNAc lectin can stimulate NLRP3 activation, while the dense granule protein 9 (GRA9) of T. gondii has been shown to suppress it. Several other parasitic products also have diverse effects on NLRP3 activation. Understanding the mechanism of NLRP3 interaction with these products will help to develop advanced therapeutic approaches to treat parasitic diseases. This review summarizes current knowledge of the NLRP3 inflammasome's action on the immune response to parasitic infections and aims to determine the mechanisms through which parasitic molecules either activate or inhibit its action.

Far-East Asian Toxoplasma isolates share ancestry with North and South/Central American recombinant lineages

Toxoplasma gondii is a global protozoan pathogen. Clonal lineages predominate in Europe, North America, Africa, and China, whereas highly recombinant parasites are endemic in South/Central America. Far East Asian T. gondii isolates are not included in current global population genetic structure analyses at WGS resolution. Here we report a genome-wide population study that compared eight Japanese and two Chinese isolates against representative worldwide T. gondii genomes using POPSICLE, a novel population structure analyzing software. Also included were 7 genomes resurrected from non-viable isolates by target enrichment sequencing. Visualization of the genome structure by POPSICLE shows a mixture of Chinese haplogroup (HG) 13 haploblocks introgressed within the genomes of Japanese HG2 and North American HG12. Furthermore, two ancestral lineages were identified in the Japanese strains; one lineage shares a common ancestor with HG11 found in both Japanese strains and North American HG12. The other ancestral lineage, found in T. gondii isolates from a small island in Japan, is admixed with genetically diversified South/Central American strains. Taken together, this study suggests multiple ancestral links between Far East Asian and American T. gondii strains and provides insight into the transmission history of this cosmopolitan organism.

Association between Toxoplasma gondii exposure and abdominal pain: An age- and gender-matched case-control seroprevalence study

Abdominal pain has been rarely reported in individuals infected with Toxoplasma gondii (T. gondii). The aim of this study was to determine the association between T. gondii infection and abdominal pain. Two hundred and ninety-nine patients with abdominal pain (cases) and 299 age- and gender-matched people without abdominal pain (controls) were tested for anti-T. gondii IgG and IgM antibodies. Twenty-four (8.0%) of the 299 cases and 12 (4.0%) of the 299 controls were positive for anti-T. gondii IgG antibodies (OR: 2.08; 95% CI: 1.02-4.25; P = 0.03). The seroprevalence of T. gondii infection was significantly higher in women with frequent abdominal pain than in women without this clinical feature (OR: 2.30; 95% CI: 1.06-4.96; P = 0.02). Twelve (4.0%) of the 299 cases and 7 (2.3%) of the 299 controls had high (>150 IU mL-1) anti-T. gondii IgG antibody levels (OR: 1.74; 95% CI: 0.67-4.49; P = 0.24). Seven (29.2%) of the 24 cases with anti-T. gondii IgG antibodies and 3 (25.0%) of the 12 controls with anti-T. gondii IgG antibodies were positive to anti-T. gondii IgM antibodies (OR: 1.23; 95% CI: 0.25-5.97; P = 1.00). Results suggest an association between T. gondii infection and frequent abdominal pain. Further research to confirm this association should be conducted.

Seroprevalence and risk factors of Toxoplasma gondii infection in goats from South Punjab Province, Pakistan

Layyah District in South Punjab Province of Pakistan offers the most intensive caprine economy in the country; its Indus riverine and desert environment makes the area peculiar and worthy of specific investigations. This study aimed to investigate the prevalence of anti-Toxoplasma gondii (T. gondii) IgG-antibody in goats in serum samples and the potential risk factors. The prevalence of T. gondii infection was estimated using a two-stage sample design. All caprine farms in the study area were stratified by size, and from these 110 were randomly selected. Twelve goats (>1-year-old) were selected from each farm and a total of 1320 serum samples were collected and tested by ELISA. A questionnaire on the conditions and management practices of each farm was administered to 110 farmers. Four hundred and sixteen out of 1320 sera samples (31.5%) were found positive and 89% of the flock had at least one seropositive goat. The proportion of seropositive goats tested within each flock ranged from 8.3% to 83.3%. with several factors contributing to this heterogeneity. Goat age played a significant role in the presence of cats. Significant interactions were related to goat farms having floor of dirt and kitten presence. Moreover, age class, abortion history and water source supply were modulated by owner education levels. This is the first study to determine the prevalence of anti-T. gondii antibodies in goats sera in Layyah district and the largest carried out so far in Pakistan. The remarkable presence of T. gondii among goats in areas where goat farming plays a significant economic role may pose a production threat to the small-stock industry, as well as to public health and food safety. Therefore, investigations to identify high-risk goat populations are highly recommended in order to facilitate the implementation of local control strategies.

Phosphoproteomic analysis reveals changes in A-Raf-related protein phosphorylation in response to Toxoplasma gondii infection in porcine macrophages

BACKGROUND

Toxoplasma gondii is an obligate intracellular protozoan parasite that causes severe threats to humans and livestock. Macrophages are the cell type preferentially infected by T. gondii in vivo. Protein phosphorylation is an important posttranslational modification involved in diverse cellular functions. A rapidly accelerated fibrosarcoma kinase (A-Raf) is a member of the Raf family of serine/threonine protein kinases that is necessary for MAPK activation. Our previous research found that knockout of A-Raf could reduce T. gondii-induced apoptosis in porcine alveolar macrophages (3D4/21 cells). However, limited information is available on protein phosphorylation variations and the role of A-Raf in macrophages infected with T. gondii.

METHODS

We used immobilized metal affinity chromatography (IMAC) in combination with liquid chromatography tandem mass spectrometry (LC-MS/MS) to profile changes in phosphorylation in T. gondii-infected 3D4/21 and 3D4/21-ΔAraf cells.

RESULTS

A total of 1647 differentially expressed phosphorylated proteins (DEPPs) with 3876 differentially phosphorylated sites (DPSs) were identified in T. gondii-infected 3D4/21 cells (p3T group) when compared with uninfected 3D4/21 cells (pho3 group), and 959 DEPPs with 1540 DPSs were identified in the p3T group compared with infected 3D4/21-ΔAraf cells (p3KT group). Venn analysis revealed 552 DPSs corresponding to 406 DEPPs with the same phosphorylated sites when comparing p3T/pho3 versus p3T/p3KT, which were identified as DPSs and DEPPs that were directly or indirectly related to A-Raf.

CONCLUSIONS

Our results revealed distinct responses of macrophages to T. gondii infection and the potential roles of A-Raf in fighting infection via phosphorylation of crucial proteins.

Deciphering the epidemiological dynamics: Toxoplasma gondii seroprevalence in mainland China's food animals, 2010-2023

Background

Toxoplasma gondii (T. gondii) is a significant protozoan pathogen among food animals. Despite the threat to public health by T. gondii infections, there's limited understanding of its seroprevalence and trends in food animals across mainland China. This study aimed to estimate the seroprevalence of T. gondii infections among swine, sheep, goats, chickens, and cattle in mainland China from 2010 to 2023.

Methods

We searched cross-sectional studies published between 2010 and 2023 that reported the prevalence of T. gondii in food animals from databases including PubMed, Embase, Web of Science, China Biology Medicine Disc (CBM), China National Knowledge Infrastructure (CNKI), Wanfang data, and the China Science and Technology Journal Database (CQVIP). We performed subgroup analyses to explore the impact of different factors on the seroprevalence of T. gondii. Pooled estimates of T. gondii seroprevalence were calculated with a random-effects model.

Results

An analysis of 184 studies involving 211985 animals revealed a T. gondii overall seroprevalence of 15.3% (95% CI: 13.1-17.8). Although the seroprevalence of food animals across mainland China was relatively stable from 2010 to 2023, notable variations were observed across different animal types and regions (P < 0.01), along with changes in geographical distribution. Sample type, detection method, animal age, and history of abortion were identified as key risk factors for T. gondii seroprevalence.

Conclusion

The study conducted a meta-analysis on the seroprevalence of T. gondii in mainland China's Food Animals from 2010 to 2023, and identified key risk factors. These findings advance our understanding of T. gondii infection dynamics, offering critical insights for developing control strategies and guiding public health policies.

Protective efficacy of recombinant Toxoplasma gondii dense granule protein 15 against toxoplasmosis in C57BL/6 mice

Toxoplasma gondii is a pervasive protozoan parasite that is responsible for significant zoonoses. A wide array of vaccines using different effector molecules of T. gondii have been studied worldwide to control toxoplasmosis. None of the existing vaccines are sufficiently effective to confer protective immunity. Among the different Toxoplasma-derived effector molecules, T. gondii dense granule protein 15 from the type II strain (GRA15 (II)) was recently characterized as an immunomodulatory molecule that induced host immunity via NF-κB. Therefore, we assessed the immunostimulatory and protective efficacy of recombinant GRA15 (II) (rGRA15) against T. gondii infection in a C57BL/6 mouse model. We observed that rGRA15 treatment increased the production of IL-12p40 from mouse peritoneal macrophages in vitro. Immunization of mice with rGRA15 induced the production of anti-TgGRA15-specific IgG, IgG1 and IgG2c antibodies. The rGRA15-sensitized spleen cells from mice inoculated with the same antigen strongly promoted spleen cell proliferation and IFN-γ production. Immunization with rGRA15 significantly enhanced the survival rate of mice and dramatically decreased parasite burden in mice challenged with the Pru (type II) strain. These results suggested that rGRA15 triggered humoral and cellular immune responses to control infection. However, all of the immunized mice died when challenged with the GRA15-deficient Pru strain or the RH (type I) strain. These results suggest that GRA15 (II)-dependent immunity plays a crucial role in protection against challenge infection with the type II strain of T. gondii. This study is the first report to show GRA15 (II) as a recombinant vaccine antigen against Toxoplasma infection.

The α subunit of AMP-activated protein kinase is critical for the metabolic success and tachyzoite proliferation of Toxoplasma gondii

Toxoplasma gondii is a zoonotic parasite infecting humans and nearly all warm-blooded animals. Successful parasitism in diverse hosts at various developmental stages requires the parasites to fine tune their metabolism according to environmental cues and the parasite's needs. By manipulating the β and γ subunits, we have previously shown that AMP-activated protein kinase (AMPK) has critical roles in regulating the metabolic and developmental programmes. However, the biological functions of the α catalytic subunit have not been established. T. gondii encodes a canonical AMPKα, as well as a KIN kinase whose kinase domain has high sequence similarities to those of classic AMPKα proteins. Here, we found that TgKIN is dispensable for tachyzoite growth, whereas TgAMPKα is essential. Depletion of TgAMPKα expression resulted in decreased ATP levels and reduced metabolic flux in glycolysis and the tricarboxylic acid cycle, confirming that TgAMPK is involved in metabolic regulation and energy homeostasis in the parasite. Sequential truncations at the C-terminus found an α-helix that is key for the function of TgAMPKα. The amino acid sequences of this α-helix are not conserved among various AMPKα proteins, likely because it is involved in interactions with TgAMPKβ, which only have limited sequence similarities to AMPKβ in other eukaryotes. The essential role of the less conserved C-terminus of TgAMPKα provides opportunities for parasite specific drug designs targeting TgAMPKα.

Molecular prevalence of Toxoplasma gondii and Trypanosoma evansi in recently calved female cattle from Phayao, Thailand

Background and Aim

Toxoplasma gondii and Trypanosoma evansi, the zoonotic protozoa responsible for toxoplasmosis and trypanosomiasis, are significant threats to the productivity and financial stability of livestock farming. T. gondii can be transmitted horizontally through ingestion of fecal oocysts and T. evansi through arthropod vectors. In addition, both species can be transmitted from mother to fetus through the placenta. This study aimed to assess the molecular prevalence of T. gondii and T. evansi transplacental-transmitted protozoans and to identify the epidemiological risk factors in recently calved female cattle across Phayao, Thailand.

Materials and Methods

We collected 106 bovine placentas from beef and dairy cow full-term pregnancies in Phayao, Thailand. T. gondii and T. evansi DNA were detected using targeted B1 gene and expression site-associated gene (ESAG) species-specific polymerase chain reaction (PCR), respectively.

Results

Forty-three placentas were positive for T. gondii B1 PCR, whereas only one was positive for T. evansi ESAG PCR, resulting in an overall prevalence of transplacental-transmitted protozoan infection of 41.5% (44/106). The prevalence of T. gondii and T. evansi was 40.6% (43/106) and 0.9% (1/106), respectively. No significant correlation was found between T. gondii infection and various risk factors, including locality, age, and cattle type.

Conclusion

The prevalence of transplacental-transmitted protozoan T. gondii infection was high among female cattle in Phayao, Thailand, whereas the prevalence of T. evansi infection was notably lower. Although the conventional modes of transmission differ between these two parasites, the transplacental transmission of T. evansi and especially T. gondii may play a crucial role in the persistence of these protozoan species in this area.

Toxoplasma gondii seroprevalence in the Iranian blood donors: A systematic review and meta-analysis

Background

The present systematic review and meta-analysis was done to assess the rate of Toxoplasma gondii (T. gondii) exposure among Iranian healthy blood donors.

Methods

We searched four English (PubMed, Scopus, Web of Science, and Science Direct) and two Persian databases (Magiran and SID) as well as Google Scholar as a specialized article search engine using specific keywords for relevant papers from the inception up to November 30, 2023.

Results

In total, 19 studies enrolling 8226 apparently healthy blood donors were examined regarding T. gondii-specific IgG and/or IgM antibodies, among which 2666 [32.9% (95% CI: 25.3%-41.6%)], 168 [1.4% (95% CI: 0.9%-2.1%)], and 83 [1.7% (95% CI: 1.3%-2.1%)] subjects were seropositive regarding IgG, IgM, and both IgG/IgM antibodies, respectively. Five risk factors were significantly associated with T. gondii seroprevalence, including gender (OR = 1.98; 95% CI: 1.52-2.58; P < 0.001), contact with cat (OR = 2.41; 95% CI: 1.70-3.41; P < 0.001), contact with soil (OR = 2.83; 95% CI: 1.07-7.45; P = 0.035), consuming raw/undercooked meat (OR = 1.95; 95% CI: 1.03-3.70; P = 0.039), and raw/unwashed vegetables (OR = 1.70; 95% CI: 1.25-2.31; P = 0.001).

Conclusion

A moderate rate of T. gondii exposure was found in the Iranian blood donors, with the association of several risk factors, including gender, contact with cat, contact with soil, consumption of unwashed vegetables and/or undercooked meat. Still, more studies are recommended regarding T. gondii exposure among blood donors in Iran.

Revealing the Prevalence of Toxoplasma in Sierra Morena's Wild Boar: An ELISA-Based Study Using Meat Juice

This research work focused on the prevalence of Toxoplasma gondii in wild boar from the Sierra Morena region. We conducted an ELISA analysis using meat juice samples. A total of 892 samples from six hunting seasons (2013-2019) were collected from the provinces that constitute the Sierra Morena Mountain range. These samples were analyzed using the Pigtype® ELISA kit, specifically developed for detecting T. gondii in meat juice. The overall prevalence of T. gondii in Sierra Morena was 23.2%. The highest prevalences were observed in Córdoba (31.6%) and Jaén (25.9%). These provinces exhibit the highest density of wild boar as well as the greatest presence of the Iberian lynx (Lynx pardinus). Further in-depth studies are necessary, but it appears that the presence of wild felids and scavenger behavior may be associated with this observation.

Regulation of calcium entry by cyclic GMP signaling in Toxoplasma gondii

Ca2+ signaling impacts almost every aspect of cellular life. Ca2+ signals are generated through the opening of ion channels that permit the flow of Ca2+ down an electrochemical gradient. Cytosolic Ca2+ fluctuations can be generated through Ca2+ entry from the extracellular milieu or release from intracellular stores. In Toxoplasma gondii, Ca2+ ions play critical roles in several essential functions for the parasite, like invasion of host cells, motility, and egress. Plasma membrane Ca2+ entry in T. gondii was previously shown to be activated by cytosolic calcium and inhibited by the voltage-operated Ca2+ channel blocker nifedipine. However, Ca2+ entry in T. gondii did not show the classical characteristics of store regulation. In this work, we characterized the mechanism by which cytosolic Ca2+ regulates plasma membrane Ca2+ entry in extracellular T. gondii tachyzoites loaded with the Ca2+ indicator Fura-2. We compared the inhibition by nifedipine with the effect of the broad spectrum TRP channel inhibitor, anthranilic acid or ACA, and we find that both inhibitors act on different Ca2+ entry activities. We demonstrate, using pharmacological and genetic tools, that an intracellular signaling pathway engaging cyclic GMP, protein kinase G, Ca2+, and the phosphatidyl inositol phospholipase C affects Ca2+ entry and we present a model for crosstalk between cyclic GMP and cytosolic Ca2+ for the activation of T. gondii's lytic cycle traits.

Surgical management of retinal detachment and macular holes secondary to ocular toxoplasmosis: a systematic review and meta-analysis

BACKGROUND

Toxoplasma gondii causes ocular toxoplasmosis (OT), involving inflammation, scarring, and retinal complications. The OT complications were retinal detachment (RD), and retinal breakage (RB). Surgical interventions like scleral buckling (SB) and vitrectomy are common. Limited understanding exists of the safety and efficacy of surgical management of RD/RB secondary to OT. Another complication is toxoplasmosis-related macular holes (tMH), with sparse evidence on surgical outcomes. This meta-analysis aims to clarify clinical characteristics, and surgical results, and enhance understanding of RD, RB, and MH secondary to OT.

METHODS

PubMed, Cochrane, Embase and Web of Science database were queried for retrospective studies, case series and case reports that provided information on RD, RB and MH associated with OT and reported the outcomes of: (1) Retinal reattachment of RD/RB and tMH closure; (2) Best-corrected visual acuity (BCVA) improvement; and (3) Complications. Heterogeneity was examined with I2 statistics. A random-effects model was used for outcomes with high heterogeneity. Statistical analysis was performed using the software R (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria).

RESULTS

Fourteen final studies, comprising a total of 96 patients were analyzed, 81 with RD or RB and 15 with tMH. Overall, surgical management was associated with several advantages: a high rate of retinal reattachment of RD/RB of 97% (95% Confidence Interval [CI] 92-100%; I2 = 0%), retinal reattachment of just RD of 96% (95% CI 89-100%; I2 = 30%) and tMH closure 97% (95% CI 87-100; I2 = 12%). There were significant differences in BCVA after surgeries in studies of RD/RB (MD 0.60; 95% CI 0.35-0.65; I2 = 20%) and MH (MD 0.67; 95% CI 0.50-0.84; I2 = 0%). The overall complication rate associated with surgical procedures in RD/RB secondary to OT was confirmed to be 25%.

CONCLUSIONS

The systematic review and meta-analysis showed that the treatment approaches currently in use are effective, with a remarkable rate of retinal reattachment of RD/RB, tMH closure, and substantial improvements in visual acuity. More randomized, long-term studies on disease and surgical factors can provide valuable insights into their impact on anatomical and visual outcomes.

Seroprevalence and risk factors for Toxoplasma gondii infection among pregnant women at Debre Markos Referral Hospital, northwest Ethiopia

BACKGROUND

To assess the seroprevalence and risk factors of Toxoplasma gondii infection in pregnant women at the Debre Markos Referral Hospital, northwest Ethiopia.

METHODS

A facility-based cross-sectional study was undertaken among pregnant women from March 2020 to May 2021. Sociodemographic and clinical data were collected from randomly selected participants. Five millilitres of blood was collected and an enzyme-linked immunosorbent assay kit was used to test for T. gondii immunoglobulin G (IgG) antibodies. A logistic regression model was computed to identify the risk factors. The adjusted odds ratio (aOR) was estimated along with the 95% confidence interval (CI). A statistically significant association was defined as p<0.05.

RESULTS

T. gondii IgG antibody positivity was found in 38.8% (n=132) of 340 pregnant women. Contact with cats (AOR 2.5 [95% CI 1.5 to 4.2]), eating raw/undercooked meat (AOR 5.7 [95% CI 3.2 to 10.3]), consuming unwashed vegetables (AOR 4.1 [95% CI 2.1 to 8.0]), a history of abortion (AOR 1.9 [95% CI 1.1 to 3.3]) and drinking water sources (AOR 2.5 [95% CI 1.2 to 5.2]) demonstrated a statistically significant association with T. gondii infection.

CONCLUSIONS

Toxoplasmosis was found to be fairly common in pregnant mothers. Proper cat excreta disposal, not eating raw/undercooked meat, maintaining hand cleanliness and following environmental sanitation protocols could be important to decrease T. gondii infection.

Evaluation of In Vitro Cytotoxic and Apoptotic Effects of Miltefosine on the Toxoplasma gondii RH Strain

Background

We aimed to investigate the cytotoxic and apoptotic effects of miltefosine on Toxoplasma gondii RH strain by various techniques.

Methods

The study was conducted at the Department of Parasitology and Mycology, Urmia University of Medical Sciences, Iran in 2020. Four groups of five BALB/c mice were selected. The cytotoxicity test was conducted by adding miltefosine to T. gondii tachyzoites; control tachyzoites received PBS and MTT assay was done on each suspension. For evaluating the Th1-type immune responses, the serum levels of IFN-γ and nitric oxide (NO) were assessed in mice after injecting tachyzoites and miltefosine, respectively. The flow cytometry technique was performed on T. gondii tachyzoites challenged with IC50 and IC90 doses of miltefosine and unchallenged cells. DNA fragments in T. gondii tachyzoites were detected by Terminal dUTPnick-end labeling (TUNEL) method.

Results

Overall, 256, 64, 32, and 16 μg concentrations of miltefosine, respectively could kill more than 50% of viable T. gondii tachyzoites. The infected mice group, treated with miltefosine, significantly produced more IFN-γ relative to other groups (P< 0.001). Moreover, a significant difference was found in inducible NO synthase between the experimental and control groups (P<0.05). The flow cytometry results demonstrated a concentration-dependent apoptosis rate in tachyzoites incubated with miltefosine, though the necrosis rate was non-significant. DNA fragmentation analysis indicated oligonucleotides (18-200 bp) in tachyzoites treated with 11μg of miltefosine for 24, 48 and 72 h. However, this pattern was not observed in untreated control microorganisms.

Conclusion

Miltefosine could be a favorable candidate for use as a new treatment for toxoplasmosis.

Toltrazuril alkalizer-modifying solid dispersions against Toxoplasma gondii: A pharmacotechnical strategy to improve the efficacy of the drug

Toxoplasma gondii is a zoonotic protozoan that can parasitize nucleated cells of all warm-blooded animals, and seriously harm human and livestock. Toltrazuril (TOL) has insecticidal activity against parasites of the phylum Apicomplexan at multiple development stages, but the clinical application is limited by its poor water solubility. To improve the dissolution of TOL, nine ternary solid dispersions (SD) were prepared with PEG6000 as the carrier and various alkalizers as the pH modifier. Compared with the binary SD, all ternary SDs had improved TOL dissolution although dissolution rates differed. The complete dissolution was achieved for the Ca(OH)2-SD, associated with a gradual release of the alkalizer and adequate pH regulation of the microenvironment. DSC, PXRD and FTIR analyses indicated that TOL in the Ca(OH)2-SD was present in an amorphous form and had a strong hydrogen bond with Ca(OH)2. Within the drug concentration of 100 μg/mL, Ca(OH)2-SD was proved to have no damage to host cells by in vitro cytotoxicity analysis, and its anti-T. gondii efficacy was significantly higher than that of TOL and binary SD. The in vivo efficacy of Ca(OH)2-SD against T. gondii in mice further confirmed that Ca(OH)2-SD could be used as a new strategy to prevent T. gondii from killing mice and treat toxoplasmosis. In conclusion, Ca(OH)2-SD is expected to eventually turn into a clinical candidate for toxoplasmosis treatment in the future.

Gut commensal bacteria exacerbate toxoplasmosis associated with TgSheepCHn5 (ToxoDB#2) and TgRedpandaCHn1 (ToxoDB#20) through Th1 immune response

Oral infection of mice with several strains of Toxoplasma gondii results in intestinal pathological lesions, which contributes to the invasion of this parasite. However, the exact mechanism is unclear, and only a few strains have been explored. Here, T. gondii TgSheepCHn5 and TgRedpandaCHn1 strains from sheep and red panda were evaluated. The TgSheepCHn5 and TgRedpandaCHn1 strains induced intestinal lesions, loss of Paneth cells, and gut commensal bacteria dysbiosis in Swiss Webster mice. The lesions and loss of Paneth cells were dependent on IFN-γ and gut commensal bacteria during T. gondii infection. Deleting IFN-γ or gut commensal bacteria suppressed the Th1 immune response, alleviated the lesions and parasite loading, and upregulated the number of Paneth cells. Loss of IFN-γ production accelerated mice death, whereas the deletion of gut commensal bacteria enhanced the survival time of the host. The Th1 cell immune responses have positive and negative effects on toxoplasmosis, resistance to T. gondii infection, and acceleration intestine lesions. Adjustment of Th1 cell responses and gut commensal bacteria may be effective treatments for toxoplasmosis.

An ex vivo model of Toxoplasma recrudescence reveals developmental plasticity of the bradyzoite stage

IMPORTANCE

The classical depiction of the Toxoplasma lifecycle is bradyzoite excystation conversion to tachyzoites, cell lysis, and immune control, followed by the reestablishment of bradyzoites and cysts. In contrast, we show that tachyzoite growth slows independent of the host immune response at a predictable time point following excystation. Furthermore, we demonstrate a host cell-dependent pathway of continuous amplification of the cyst-forming bradyzoite population. The developmental plasticity of the excysted bradyzoites further underlines the critical role the cyst plays in the flexibility of the lifecycle of this ubiquitous parasite. This revised model of Toxoplasma recrudescence uncovers previously unknown complexity in the clinically important bradyzoite stage of the parasite, which opens the door to further study these novel developmental features of the Toxoplasma intermediate life cycle.

Toxoplasma gondii infection regulates apoptosis of host cells via miR-185/ARAF axis

BACKGROUND

Toxoplasmosis is a zoonosis with a worldwide presence that is caused by the intracellular parasite Toxoplasma gondii. Active regulation of apoptosis is an important immune mechanism by which host cells resist the growth of T. gondii or avoid excessive pathological damage induced by this parasite. Previous studies found that upregulated expression of microRNA-185 (miR-185) during T. gondii infection has a potential role in regulating the expression of the ARAF gene, which is reported to be associated with cell proliferation and apoptosis.

METHODS

The expression levels of miR-185 and the ARAF gene were evaluated by qPCR and Western blot, respectively, in mice tissues, porcine kidney epithelial cells (PK-15) and porcine alveolar macrophages (3D4/21) following infection with the T. gondii ToxoDB#9 and RH strains. The dual luciferase reporter assay was then used to verify the relationship between miR-185 and ARAF targets in PK-15 cells. PK-15 and 3D4/21 cell lines with stable knockout of the ARAF gene were established by CRISPR, and then the apoptosis rates of the cells following T. gondii infection were detected using cell flow cytometry assays. Simultaneously, the activities of cleaved caspase-3, as a key apoptosis executive protein, were detected by Western blot to evaluate the apoptosis levels of cells.

RESULTS

Infection with both the T. gondii ToxoDB#9 and RH strains induced an increased expression of miR-185 and a decreased expression of ARAF in mice tissues, PK-15 and 3D4/21 cells. MiR-185 mimic transfections showed a significantly negative correlation in expression levels between miR-185 and the ARAF gene. The dual luciferase reporter assay confirmed that ARAF was a target of miR-185. Functional investigation revealed that T. gondii infection induced the apoptosis of PK-15 and 3D4/21 cells, which could be inhibited by ARAF knockout or overexpression of miR-185. The expression levels of cleaved caspase-3 protein were significantly lower in cells with ARAF knockout than in normal cells, which were consistent with the results of the cell flow cytometry assays.

CONCLUSIONS

Toxoplasma gondii infection could lead to the upregulation of miR-185 and the downregulation of ARAF, which was not related to the strain of T. gondii and the host cells. Toxoplasma gondii infection could regulate the apoptosis of host cells via the miR-185/ARAF axis, which represents an additional strategy used by T. gondii to counteract host-cell apoptosis in order to maintain survival and reproduce in the host cells.

Seroprevalence of Anti-Toxoplasma gondii Antibodies among Patients with Cancer at Hiwa Cancer Hospital in Sulaimani City, Kurdistan Region, Iraq

Background

Toxoplasma gondii is an opportunistic protozoan parasite that causes a life-threatening disease - toxoplasmosis - in immunocompromised individuals, including patients with cancer. This prospective cross-sectional study set out to determine the prevalence of toxoplasmosis in patients with cancer compared with that of healthy individuals.

Methods

A prospective cross-sectional study was conducted in Sulaimani City of Iraq from November 2019 to May 2020. Anti-T. gondii IgG and IgM antibodies were measured in the blood samples of 113 patients with cancer (80 with solid organ tumors and 33 with haematological malignancies) entered to Hiwa Cancer Hospital and 82 healthy controls, who were referred to the Directorate of Blood Transfusion for blood donation, using chemiluminescence microparticle immunoassay (CMIA).

Results

The prevalence of anti-T. gondii IgG was 39.8% in the patient group and 24.4% in the control group, which amounted to a significant difference (P = 0.024). Only one case of anti-T. gondii IgM positivity was observed in the patient group, and no IgM seropositivity was reported in the control group. Moreover, the seroprevalence of anti-T. gondii IgG was non-significantly higher (P = 0.102) in the patients with haematological malignancies (51.5%) than in those with solid organ tumors (35%). Occupation was the only risk factor which had a significant association with T gondii infection (odds ratio [OR]: 1.3, 95% confidence interval [CI]: 0.6746163 - 2.4282788, P = 0.029).

Conclusion

The prevalence of T. gondii infection is higher in patients with cancer than in healthy individuals. Therefore, T. gondii screening in patients with cancer is recommended.

Clinical and Serological Characteristics of Ocular Toxoplasmosis in the Democratic Republic of Congo

PURPOSE

To describe demographic data, clinical features, and serological profiles in a cohort of Congolese patients with ocular toxoplasmosis (OT).

METHOD

Cross-sectional study, carried out between March 2020 and July 2021 in two ophthalmic clinics in Kinshasa.

RESULTS

The study comprised 95 participants with OT. Fifty-three patients were male (55.8%). The mean age at presentation was 35.6 ± 14.1 years (range 8-69 years); 71 had active OT (74.7%), among them, 33 had primary OT (46.5%), and 38 had recurrences (53.5%). At presentation, 51 patients (53.7%) had visual impairment (VA < 6/18). Retinochoroidal lesions were located in the central retina in 60 patients (63.1%). Patients with primary OT tend to have higher IgG levels than those with recurrent OT (P = .01).

CONCLUSION

We report the largest cohort of patients with OT in sub-Saharan Africa. In our setting, most patients had recurrent OT with multiple, extensive, and central retinochoroidal lesions.

Congenital Toxoplasmosis Diagnosis: Current Approaches and New Insights

PURPOSE

The aim of this study is to describe and discuss current disadvantages in congenital toxoplasmosis (CT) diagnosis, and what can be improved or changed through new perspectives and technological advances.

METHODS

We used Pubmed, Cochrane, and EBSCO databases to research publications from 10 years to date describing current diagnostic methods for CT. The keywords used for this Mini-Review were Toxoplasma gondii, congenital toxoplasmosis, diagnosis, and prospects using Boolean operators such as AND, OR, identifying scientific publications highlighting the importance of implementing new diagnostic methods.

RESULTS

Current diagnosis methods have several disadvantages, i.e., time-consuming, low sensitivity or specificity, and non-cost effective, that bring up the necessity of improving or developing new approaches. Recombinant proteins can help improve specificity by generating tests that use circulating strains in a specific geographical region, SAG1 and BAG1, as they are expressed during a particular stage of the disease (acute or chronic, respectively), for its use in serological diagnoses, such as capture ELISA and immunochromatography. Point of Care (POC) tests are methods performed at the patient care site, which leads to rapid patient treatment; despite the advantages, several improvements and perspectives are necessary to be implemented globally.

CONCLUSIONS

Although already established diagnosis methods for CT may be sufficient in some regions, there is still a persistent demand to develop tests with higher throughput, cost, and time reduction in developing countries, where prevalence is high. New approaches in CT diagnosis, such as recombinant proteins, capture ELISA, immunochromatography, and POC tests methods, can increase performance in terms of specificity and sensitivity simplifying diagnostic tests' requirements.

Gestational toxoplasmosis treatment changes the child's prognosis: A cohort study in southern Brazil

BACKGROUND

We evaluate the drug treatment for pregnant women with acute toxoplasmosis to reduce the risk of congenital infection, side effects (prenatal and postnatal treatment in children) and the hazard of discontinuing the infant's medication.

METHODS

We conducted a prospective cohort study to assess the risks of congenital toxoplasmosis among children born to acutely infected women with and without treatment. We examined the relationship between "exposed" and "infected children", "number of infant neutrophils", "prenatal" and "postnatal treatment". Factor analysis of mixed data (FAMD) was used to analyze the data. All children started treatment at the hospital.

FINDINGS

Between 2017 and 2021, 233 pregnant women were evaluated at the University Hospital of Maringá; ninety-four met criteria for acute gestational toxoplasmosis. We followed up 61 children; eleven (18%) had the infection confirmed and 50 (82%) were free of toxoplasmosis (exposed). Children born to untreated mothers have 6.5-times higher risk of being infected; the transmission rate among untreated mothers was 50% versus 8.3% among treated ones. Three decreasing values of immunoglobulin G were a security parameter for stopping the child's medication in the exposed group (50/61). Neutropenia was the leading side effect among children and the infected had a 2.7 times higher risk. There was no correlation between maternal use of pyrimethamine and children's neutropenia.

INTERPRETATION

The follow-up of women with acute T. gondii infection and their children, through a multidisciplinary team, availability of anti-T. gondii serology and pre- and post-natal treatments reduced the risk of toxoplasmosis transmission.

Immune-enhancing activity of Astragalus maximus extract for inhibiting the Toxoplasma gondii infection: experimental research

Background

This study aimed to evaluate the in-vitro anti-Toxoplasma effects and cytotoxicity effects of Astragalus maximus chloroformic extract (AMCE) on the T. gondii Rh strain.

Methods

In-vitro effects of AMCE (2-64 µg/ml) on tachyzoites were measured by MTT assay for 48 h. The effects of AMCE on infectivity rate and intracellular parasites into macrophage cells (J774-A1) were evaluated. The Griess reaction assay and quantitative real-time PCR were used to determine the nitric oxide (NO) and the mRNA expression levels of IFN-γ and iNOS in infected J774-A1 macrophage cells.

Results

The mortality rate of the parasites significantly (P<0.001) increased in a dose-dependent manner with an IC50 value of 9.85 μg/ml. The rate of infection and the mean number of intracellular tachyzoites in macrophage cells were significantly reduced (P<0.001) after exposure of the macrophage cells to AMCE. The mRNA expression levels of IFN-γ, iNOS, and NO production in macrophage cells after treatment with the AMCE were increased, especially at the concentration of ½ IC50 and IC50 (P<0.001).

Conclusion

The findings of the current in vitro investigation revealed favorable anti-Toxoplasma effects of AMCE against tachyzoites and intracellular forms of T. gondii. Despite the fact that the accurate anti-Toxoplasma mechanisms of AMCE are not clear, our results showed that triggering NO production and cellular immunity can be considered as the main mechanisms of action of AMCE for controlling and eliminating T. gondii. However, further surveys are mandatory to assess the efficacy and safety of AMCE in an animal model and its accurate mechanisms of action.

Detection of Toxoplasma gondii Infection in Small Ruminants: Old Problems, and Current Solutions

Toxoplasmosis is a parasitic zoonosis of veterinary importance, with implications for public health. Toxoplasma gondii infection causes abortion or congenital disease in small ruminants. Moreover, the consumption of infected meat, cured meat products, or unpasteurized milk and dairy products can facilitate zoonotic transmission. Serological studies conducted in various European countries have shown the high seroprevalence of specific anti-T. gondii antibodies in sheep and goats related to the presence of oocysts in the environment, as well as climatic conditions. This article presents the current status of the detection possibilities for T. gondii infection in small ruminants and their milk. Serological testing is considered the most practical method for diagnosing toxoplasmosis; therefore, many studies have shown that recombinant antigens as single proteins, mixtures of various antigens, or chimeric proteins can be successfully used as an alternative to Toxoplasma lysate antigens (TLA). Several assays based on DNA amplification have been developed as alternative diagnostic methods, which are especially useful when serodiagnosis is not possible, e.g., the detection of intrauterine T. gondii infection when the fetus is not immunocompetent. These techniques employ multicopy sequences highly conserved among different strains of T. gondii in conventional, nested, competitive, and quantitative reverse transcriptase-PCR.

Microbiota and parasite relationship

The diversity of microbiota is different in each person. Many health problems such as autoimmune diseases, diabetes, cardiovascular diseases, and depression can be caused by microbiota imbalance. Since the parasite needs a host to survive, it interacts closely with the microbiota elements. Blastocystis acts on the inflammatory state of the intestine and may cause various gastrointestinal symptoms, on the contrary, it is more important for gut health because it causes bacterial diversity and richness. Blastocystis is associated with changes in gut microbiota composition, the ultimate indicator of which is the Firmicutes/Bacteroidetes ratio. The Bifidobacterium genus was significantly reduced in IBS patients and Blastocystis, and there is a significant decrease in Faecalibacterium prausnitzii, which has anti-inflammatory properties in Blastocystis infection without IBS. Lactobacillus species reduce the presence of Giardia, and the produced bacteriocins prevent parasite adhesion. The presence of helminths has been strongly associated with the transition from Bacteroidetes to Firmicutes and Clostridia. Contrary to Ascaris, alpha diversity in the intestinal microbiota decreases in chronic Trichuris muris infection, and growth and nutrient metabolism efficiency can be suppressed. Helminth infections indirectly affect mood and behavior in children through their effects on microbiota change. The main and focus of this review is to address the relationship of parasites with microbiota elements and to review the data about what changes they cause. Microbiota studies have gained importance recently and it is thought that it will contribute to the treatment of many diseases as well as in the fight against parasitic diseases in the future.

An Antibody-Based Survey of Toxoplasma gondii and Neospora caninum Infection in Client-Owned Cats from Portugal

Toxoplasma gondii and Neospora caninum are obligate intracellular protozoan parasites infecting a wide range of hosts worldwide. However, information on the epidemiology of toxoplasmosis and neosporosis in cats from Portugal is limited. Thus, this study aims to evaluate anti-T. gondii and anti-N. caninum seroprevalence in client-owned cats from Portugal and to identify risk factors using a panel of well-characterized sera. A total of 183 domestic cats were sampled and screened for antibodies against T. gondii and N. caninum using commercial ELISA assays, and their owners answered an online questionnaire designed to obtain background information. The overall anti-T. gondii and anti-N. caninum seroprevalences were 13.1% (CI: 8.97-18.77) and 3.8% (CI: 1.87-7.68), respectively. Univariate analysis revealed that living strictly indoors was a significant protection factor (cOR: 0.053; CI: 0.005-0.627), and the presence of a chronic disease a significant risk factor (cOR: 3.106; CI: 1.062-9.082) to T. gondii seroprevalence. When performing multivariate analysis, only chronic disease (aOR: 57.527; CI: 1.7-1976.7) and seropositivity to N. caninum (aOR: 7.929; CI:0.8-82.9) were found to be a significant risk factor to anti-T. gondii antibodies. To the best of our knowledge, this is the first report of N. caninum seropositivity in cats from Portugal.

An HIV-positive woman with massive brain lesion due to toxoplasmosis: A case report

Key Clinical Message

Toxoplasmosis-related huge brain lesions may require decompressive craniectomy and lesion excision to avoid brain damage. In this situation, injectable cotrimoxazole is a better choice for treatment.

Abstract

Toxoplasma gondii is a worldly distributed obligate intracellular protozoa. Toxoplasmosis is a prevalent opportunistic infection in HIV-infected people, but it was rarely recorded prior to the identification of HIV infection. Here, we report a toxoplasmosis brain lesion in an Iranian HIV-positive patient. A 45-year-old woman with a complaint of malaise was referred to the Valiasr Hospital in Arak city. In her past clinical history, the patient had a history of anemia, deep vein thrombosis (DVT), and positive HIV. The patient was informed of the diagnosis of massive brain toxoplasmosis as a definite diagnosis. The patient was then taken to the operating room for a left decompressive craniectomy, during which the ensuing brain lesion was excised. After a few days, she was discharged from the hospital in good condition and without any complications.

PP2Acα-B'/PR61 Holoenzyme of Toxoplasma gondii Is Required for the Amylopectin Metabolism and Proliferation of Tachyzoites

Here, we report that the inhibition of the PP2A subfamily by okadaic acid results in an accumulation of polysaccharides in the acute infection stage (tachyzoites) of Toxoplasma gondii, which is a protozoan of global zoonotic importance and a model for the apicomplexan parasites. The loss of the catalytic subunit α of PP2A (ΔPP2Acα) in RHΔku80 leads to the polysaccharide accumulation phenotype in the base of tachyzoites as well as residual bodies and significantly compromises the intracellular growth in vitro and the virulence in vivo. A metabolomic analysis revealed that the accumulated polysaccharides in ΔPP2Acα are derived from interrupted glucose metabolism, which affects the production of ATP and energy homeostasis in the T. gondii knockout. The assembly of the PP2Acα holoenzyme complex involved in the amylopectin metabolism in tachyzoites is possibly not regulated by LCMT1 or PME1, and this finding contributes to the identification of the regulatory B subunit (B'/PR61). The loss of B'/PR61 results in the accumulation of polysaccharide granules in the tachyzoites as well as reduced plaque formation ability, exactly the same as ΔPP2Acα. Taken together, we have identified a PP2Acα-B'/PR61 holoenzyme complex that plays a crucial role in the carbohydrate metabolism and viability in T. gondii, and its deficiency in function remarkably suppresses the growth and virulence of this important zoonotic parasite both in vitro and in vivo. Hence, rendering the PP2Acα-B'/PR61 holoenzyme functionless should be a promising strategy for the intervention of Toxoplasma acute infection and toxoplasmosis. IMPORTANCE Toxoplasma gondii switches back and forth between acute and chronic infections, mainly in response to host immunologic status, which is characterized by flexible but specific energy metabolism. Polysaccharide granules are accumulated in the acute infection stage of T. gondii that have been exposed to a chemical inhibitor of the PP2A subfamily. The genetic depletion of the catalytic subunit α of PP2A leads to this phenotype and significantly affects the cell metabolism, energy production, and viability. Further, a regulatory B subunit PR61 is necessary for the PP2A holoenzyme to function in glucose metabolism and in the intracellular growth of T. gondii tachyzoites. A deficiency of this PP2A holoenzyme complex (PP2Acα-B'/PR61) in T. gondii knockouts results in the abnormal accumulation of polysaccharides and the disruption of energy metabolism, suppressing their growth and virulence. These findings provide novel insights into cell metabolism and identify a potential target for an intervention against a T. gondii acute infection.

Apicomplexan parasites are attenuated by low-energy electron irradiation in an automated microfluidic system and protect against infection with Toxoplasma gondii

Radiation-attenuated intracellular parasites are promising immunization strategies. The irradiated parasites are able to invade host cells but fail to fully replicate, which allows for the generation of an efficient immune response. Available radiation technologies such as gamma rays require complex shielding constructions and are difficult to be integrated into pharmaceutical production processes. In this study, we evaluated for the first time low-energy electron irradiation (LEEI) as a method to generate replication-deficient Toxoplasma gondii and Cryptosporidium parvum. Similar to other radiation technologies, LEEI mainly damages nucleic acids; however, it is applicable in standard laboratories. By using a novel, continuous, and microfluidic-based LEEI process, tachyzoites of T. gondii and oocysts of C. parvum were irradiated and subsequently analyzed in vitro. The LEEI-treated parasites invaded host cells but were arrested in intracellular replication. Antibody-based analysis of surface proteins revealed no significant structural damage due to LEEI. Similarly, excystation rates of sporozoites from irradiated C. parvum oocysts were similar to those from untreated controls. Upon immunization of mice, LEEI-attenuated T. gondii tachyzoites induced high levels of antibodies and protected the animals from acute infection. These results suggest that LEEI is a useful technology for the generation of attenuated Apicomplexan parasites and has potential for the development of anti-parasitic vaccines.

Propulsive cell entry diverts pathogens from immune degradation by remodeling the phagocytic synapse

Phagocytosis is a critical immune function for infection control and tissue homeostasis. This process is typically described as non-moving pathogens being internalized and degraded in phagolysosomes. For pathogens that evade immune degradation, the prevailing view is that virulence factors that biochemically disrupt the biogenesis of phagoslysosomes are required. In contrast, here we report that physical forces exerted by pathogens during cell entry divert them away from the canonical phagolysosomal degradation pathway, and this altered intracellular fate is determined at the time of phagocytic synapse formation. We used the eukaryotic parasite Toxoplasma gondii as a model because live Toxoplasma uses gliding motility to actively invade into host cells. To differentiate the effect of physical forces from that of virulence factors in phagocytosis, we developed a strategy that used magnetic forces to induce propulsive entry of inactivated Toxoplasma into macrophage cells. Experiments and computer simulations collectively reveal that large propulsive forces suppress productive activation of receptors by hindering their spatial segregation from phosphatases at the phagocytic synapse. Consequently, the inactivated parasites, instead of being degraded in phagolysosomes, are engulfed into vacuoles that fail to mature into degradative units, following an intracellular pathway strikingly similar to that of the live motile parasite. Using opsonized beads, we further confirmed that this mechanism is general, not specific to the parasite used. These results reveal previously unknown aspects of immune evasion by demonstrating how physical forces exerted during active cell entry, independent of virulence factors, can help pathogens circumvent phagolysosomal degradation.

Novel therapeutic opportunities for Toxoplasma gondii, Trichomonas vaginalis and Giardia intestinalis infections

INTRODUCTION

Toxoplasma gondii, Trichomonas vaginalis and Giardia intestinalis are the causative agents of Toxoplasmosis, Trichomoniasis and Giardiasis, three important infections threatening human health and affecting millions of people worldwide. Although drugs and treatment are available to fight these protozoan parasites, side-effects and increasing drug resistance, require continuous efforts for the development of novel effective drugs.

AREAS COVERED

The patents search was carried out in September/October 2022 with four official scientific databases (Espacenet, Scifinder, Reaxys, Google Patents). Treatments for Toxoplasmosis, Trichomoniasis and Giardiasis (2015-2022) have been grouped according to their chemotypes. In particular, novel chemical entities have been reported and investigated for their structure-activity relationship, when accessible. On the other hand, drug repurposing, extensively exploited to obtain novel anti-protozoal treatment, has been in-depth described. Finally, natural metabolites and extracts have also been reported.

EXPERT OPINION

T. gondii, T. vaginalis and G. intestinalis are protozoan infections usually controlled by immune system in immunocompetent patients; however, they could represent a threatening health for immunocompromised people. The needs of novel effective drugs, endowed with new mechanisms of actions arises from the increasing drug resistance affecting antibiotic as well as antiprotozoal therapies. In this review different therapeutic approaches to treat protozoan infections have been reported.

Toxoplasma gondii HOOK-FTS-HIP Complex is Critical for Secretory Organelle Discharge during Motility, Invasion, and Egress

Members of the Apicomplexa phylum possess specialized secretory organelles that discharge, apically and in a timely regulated manner, key factors implicated in parasite motility, host cell invasion, egress and subversion of host cellular functions. The mechanisms regulating trafficking and apical docking of these secretory organelles are only partially elucidated. Here, we characterized two conserved endosomal trafficking regulators known to promote vesicle transport and/or fusion, HOOK and Fused Toes (FTS), in the context of organelle discharge in Toxoplasma gondii. TgHOOK and TgFTS form a complex with a coccidian-specific partner, named HOOK interacting partner (HIP). TgHOOK displays an apically enriched vesicular pattern and concentrates at the parasite apical tip where it colocalizes with TgFTS and TgHIP. Functional investigations revealed that TgHOOK is dispensable but fitness conferring. The protein regulates the apical positioning and secretion of micronemes and contributes to egress, motility, host cell attachment, and invasion. Conditional depletion of TgFTS or TgHIP impacted on the same processes but led to more severe phenotypes. This study provides evidence of endosomal trafficking regulators involved in the apical exocytosis of micronemes and possibly as a consequence or directly on the discharge of the rhoptries. IMPORTANCE Toxoplasma gondii affects between 30 and 80% of the human population, poses a life-threatening risk to immunocompromised individuals, and is a cause of abortion and birth defects following congenital transmission. T. gondii belongs to the phylum of Apicomplexa characterized by a set of unique apical secretory organelles called the micronemes and rhoptries. Upon host cell recognition, this obligatory intracellular parasite secretes specific effectors contained in micronemes and rhoptries to promote parasite invasion of host cells and subsequent persistence. Here, we identified novel T. gondii endosomal trafficking regulators and demonstrated that they regulate microneme organelle apical positioning and exocytosis, thereby strongly contributing to host cell invasion and parasite virulence.

Toxoplasma gondii profilin induces NLRP3 activation and IL-1β production/secretion in THP-1 cells

Toxoplasma gondii is a highly prevalent protozoan that infects a broad spectrum of warm-blooded animals. Profilin is a critical protein that plays a role in the movement and invasion of T. gondii. In the current study, we assessed how profilin stimulates inflammasomes and how it induces transcription and secretion of IL-1β. For this purpose, we assessed the level of TLR 2, 4, 5, and 9 expressions in a THP-1 cell line treated with profilin from T. gondii (TgP). In addition, we analyzed the expression levels of various inflammasomes, as well as IL-1β, and IL-18 in THP-1 cells treated with the NLRP3 inhibitor MCC950. TgP significantly increased the expression of TLR5 but the expression of TLR2, 4, and 9 was not significantly increased. In addition, TgP did not significantly increase the level of inflammasomes after 5 h. Treatment with MCC950 significantly reduced NLRP3 and IL-1β on both transcription and protein levels. Although the transcription level of NLRP3 was reduced 5 h after treatment with TgP, western blot analysis showed an increase in NLRP3. The western blot and ELISA analysis also showed that TgP increased both pro- and mature IL-1β. In summary, our study showed that NLRP3 most probably plays a pivotal role in the expression and production levels of IL-1β during the interaction between TgP and macrophages.

Advances in Protozoan Epigenetic Targets and Their Inhibitors for the Development of New Potential Drugs

Protozoan parasite diseases cause significant mortality and morbidity worldwide. Factors such as climate change, extreme poverty, migration, and a lack of life opportunities lead to the propagation of diseases classified as tropical or non-endemic. Although there are several drugs to combat parasitic diseases, strains resistant to routinely used drugs have been reported. In addition, many first-line drugs have adverse effects ranging from mild to severe, including potential carcinogenic effects. Therefore, new lead compounds are needed to combat these parasites. Although little has been studied regarding the epigenetic mechanisms in lower eukaryotes, it is believed that epigenetics plays an essential role in vital aspects of the organism, from controlling the life cycle to the expression of genes involved in pathogenicity. Therefore, using epigenetic targets to combat these parasites is foreseen as an area with great potential for development. This review summarizes the main known epigenetic mechanisms and their potential as therapeutics for a group of medically important protozoal parasites. Different epigenetic mechanisms are discussed, highlighting those that can be used for drug repositioning, such as histone post-translational modifications (HPTMs). Exclusive parasite targets are also emphasized, including the base J and DNA 6 mA. These two categories have the greatest potential for developing drugs to treat or eradicate these diseases.

Molecular Detection of Toxoplasma gondii in Blood Samples of Domestic Livestock in the Republic of Korea

Toxoplasma gondii, a major zoonotic pathogen distributed worldwide, causes severe infections in humans, animals, and birds. However, limited information is available regarding T. gondii infection in livestock in the Republic of Korea (ROK). Herein, we determined the prevalence of T. gondii infection in livestock in the ROK and identified animal species that can potentially transmit T. gondii to humans. B1 gene-targeting nested polymerase chain reaction detected T. gondii DNA in 3.3% (2/61), 2.9% (3/105), 14.1% (11/78), and 15.4% (14/91) of dairy cattle, beef cattle, Boer goats, and Korean native goats, respectively. The prevalence of T. gondii was significantly higher (p = 0.002) in goats than in cattle. The risk of contracting T. gondii infection was significantly higher by 6.18-fold in Korean native goats (95% confidence interval [CI]: 1.72–22.27%, p = 0.005) and by 5.58-fold in Boer goats (95% CI: 1.50–20.76%, p = 0.010) than in beef cattle. Our T. gondii DNA sequences exhibited 97.1–100% homology with those obtained from various hosts in other countries. To the best of our knowledge, this is the first study to report T. gondii infection using the blood samples of domestic ruminants in the ROK. The results revealed that the prevalence of T. gondii infection is higher in goats than in cattle as determined by molecular detection. Thus, these findings suggest that T. gondii can be transmitted from ruminants to humans via meat consumption.

CRISPR Screens Identify Toxoplasma Genes That Determine Parasite Fitness in Interferon Gamma-Stimulated Human Cells

Toxoplasma virulence depends on its ability to evade or survive the toxoplasmacidal mechanisms induced by interferon gamma (IFNγ). While many Toxoplasma genes involved in the evasion of the murine IFNγ response have been identified, genes required to survive the human IFNγ response are largely unknown. In this study, we used a genome-wide loss-of-function screen to identify Toxoplasma genes important for parasite fitness in IFNγ-stimulated primary human fibroblasts. We generated gene knockouts for the top six hits from the screen and confirmed their importance for parasite growth in IFNγ-stimulated human fibroblasts. Of these six genes, three have homology to GRA32, localize to dense granules, and coimmunoprecipitate with each other and GRA32, suggesting they might form a complex. Deletion of individual members of this complex leads to early parasite egress in IFNγ-stimulated cells. Thus, prevention of early egress is an important Toxoplasma fitness determinant in IFNγ-stimulated human cells. IMPORTANCE Toxoplasma infection causes serious complications in immunocompromised individuals and in the developing fetus. During infection, certain immune cells release a protein called interferon gamma that activates cells to destroy the parasite or inhibit its growth. While most Toxoplasma parasites are cleared by this immune response, some can survive by blocking or evading the IFNγ-induced restrictive environment. Many Toxoplasma genes that determine parasite survival in IFNγ-activated murine cells are known but parasite genes conferring fitness in IFNγ-activated human cells are largely unknown. Using a Toxoplasma adapted genome-wide loss-of-function screen, we identified many Toxoplasma genes that determine parasite fitness in IFNγ-activated human cells. The gene products of four top hits play a role in preventing early parasite egress in IFNγ-stimulated human cells. Understanding how IFNγ-stimulated human cells inhibit Toxoplasma growth and how Toxoplasma counteracts this, could lead to the development of novel therapeutics.

TgTKL4 Is a Novel Kinase That Plays an Important Role in Toxoplasma Morphology and Fitness

Protein kinases of the protozoan parasite Toxoplasma gondii have been shown to play key roles in regulating parasite motility, invasion, replication, egress and survival within the host. The tyrosine kinase-like (TKL) kinase family of proteins are a set of poorly studied kinases that our recent studies have indicated play a critical role in Toxoplasma biology. In this study, we focused on TgTKL4, another member of the TKL family that is predicted to confer parasite fitness. Endogenous tagging of TgTKL4 identified it as a temporally oscillating kinase with dynamic localization in the parasite. Gene disruption experiments suggested that TgTKL4 is important for Toxoplasma propagation in vitro, and loss of this kinase resulted in replication and invasion defects. During parasite division, TgTKL4 expression was limited to the synthesis and mitosis-cytokinesis phases and, interestingly, loss of TgTKL4 led to defects in Toxoplasma morphology. Further analysis of the parasite cytoskeleton indicated that the subpellicular microtubules are shorter and more widely spaced in parasites lacking TgTKL4. Although loss of TgTKL4 caused only moderate changes in the gene expression profile, TgTKL4 null mutants exhibited significant changes in their global phospho-proteome, including in proteins that constitute the parasite cytoskeleton. Additionally, mice inoculated intraperitoneally with TgTKL4 knockout parasites showed increased survival rates, suggesting that TgTKL4 plays an important role in acute toxoplasmosis. Together, these findings suggest that TgTKL4 mediates a signaling pathway that regulates parasite morphology and is an important factor required for parasite fitness in vitro and in vivo. IMPORTANCE Toxoplasma gondii is a protozoan parasite that can cause life-threatening disease in mammals; hence, identifying key factors required for parasite growth and pathogenesis is important to develop novel therapeutics. In this study, we identified and characterized another member of the newly described TKL family, TgTKL4, a cell cycle-regulated kinase. By disrupting TgTKL4, we determined that this kinase is required for normal parasite growth in vitro and that loss of this kinase results in parasites with reduced competence in replication and invasion processes. Specifically, Toxoplasma parasites lacking TgTKL4 had defects in cytoskeletal arrangement, resulting in parasites with abnormal morphology. Phospho-proteome studies provided further clues that decreased phosphorylation of proteins that constitute the Toxoplasma cytoskeleton could be responsible for altered morphology in TgTKL4-deficient parasites. Additionally, loss of TgTKL4 resulted in attenuation of virulence in the animal model, suggesting that TgTKL4 is an important virulence factor. Hence, this study provides a novel insight into the importance of a TgTKL4 as a fitness-determining factor for Toxoplasma propagation in vitro and pathogenesis in vivo.

A large-scale study on the seroprevalence of Toxoplasma gondii infection in humans in Iran

It is estimated that nearly one-third of the world's human population is infected with Toxoplasma gondii (Nicolle et Manceaux, 1908). Human infection is commonly asymptomatic, multifaceted, and can manifest in severe pathological forms in congenital toxoplasmosis and immunocompromised individuals. This study attempted to recognise the seroprevalence of T. gondii infection in Iranian residents referred to medical laboratories for toxoplasmosis tests throughout the country. This retrospective cross-sectional study was conducted from 2015 to 2019 on individuals referred to diagnostic laboratories in 26 provinces, and these laboratories sent their samples to the referral centres. Accordingly, data associated with serodiagnosis of toxoplasmosis, age, sex, anti-T. gondii IgG, and IgM status in Iranian residents were collected from two referral diagnostic laboratories. All individuals were evaluated using the antibody immunocapture-chemiluminescence assay (CLIA) method with the Immulite^®2000s XPi system. In this study, the first large-scale assay of T. gondii infection in Iran, an overall seroprevalence of 30.4% was among 35,047 patients examined. The highest IgM seropositivity rate was in the 10-20 years old patients. In addition, this study showed a very different prevalence of T. gondii across the country, highest in the humid areas, such as the Caspian Sea basin in the North, and the North West with seroprevalence of 48.6%.

Molecular evidence of toxoplasmosis in people living with HIV in Pakistan

BACKGROUND

Toxoplasma gondii is a zoonotically important parasite infecting almost all vertebrates. The parasite can easily infect humans through the fecal-oral route, particularly immunocompromised individuals, and children. Due to lack of epidemiological data regarding the occurrence of Toxoplasma gondii in people living with HIV in Pakistan, the present study was designed to estimate the prevalence of Toxoplasma gondii in people living with HIV.

METHODS

Briefly, 384 blood samples were randomly collected from people living with HIV registered under Punjab AIDS Control Program. DNA of all samples was extracted and the 18S rRNA gene of T. gondii was amplified through polymerase chain reaction (PCR) by using genus-specific primers. The amplicons were spread on 1.5% agar rose gel and visualized under gel documentation system. Then the amplicons were purified from the gel and subjected to sequence and phylogenetic analysis.

RESULTS

Overall prevalence of T. gondii was observed as 23.96%. The prevalence of T. gondii was significantly (p <0.05) higher in females and in middle age group (26-40 years). Similarly, the prevalence was significantly (p <0.05) higher in people with poor socioeconomic status, symptomatic patients, drugs users and people using unfiltered water for drinking. Furthermore, bodyweight (46-70 kg) and dry seasons also significantly (p <0.05) affected the prevalence of T. gondii.

CONCLUSIONS

Our findings illustrated a high infection rate of toxoplasmosis in people living with HIV which could be a significant cause of mortality. More studies need to be conducted for other opportunistic infections caused by parasites and other pathogens.

A High-Throughput Amenable Dual Luciferase System for Measuring Toxoplasma gondii Bradyzoite Viability after Drug Treatment

It is estimated that more than 2 billion people are chronically infected with the intracellular protozoan parasite Toxoplasma gondii (T. gondii). Despite this, there is currently no vaccine to prevent infection in humans, and there is no recognized curative treatment to clear tissue cysts. A major hurdle for identifying effective drug candidates against chronic-stage cysts has been the low throughput of existing in vitro assays for testing the survival of bradyzoites. We have developed a luciferase-based platform for specifically determining bradyzoite survival within in vitro cysts in a 96-well plate format. We engineered a cystogenic type II T. gondii PruΔku80Δhxgpr strain for stage-specific expression of firefly luciferase in the cytosol of bradyzoites and nanoluciferase for secretion into the lumen of the cyst (DuaLuc strain). Using this DuaLuc strain, we found that the ratio of firefly luciferase to nanoluciferase decreased upon treatment with atovaquone or LHVS, two compounds that are known to compromise bradyzoite viability. The 96-well format allowed us to test several additional compounds and generate dose-response curves for calculation of EC50 values indicating relative effectiveness of a compound. Accordingly, this DuaLuc system should be suitable for screening libraries of diverse compounds and defining the potency of hits or other compounds with a putative antibradyzoite activity.

High infection rates of Toxoplasma gondii in cattle, sheep and pigs from Israel

Toxoplasma gondii is an obligate intracellular parasite belonging to the phylum Apicomplexa, which causes the zoonotic disease toxoplasmosis. T. gondii infects almost all warm blood animals. Generally, infected animals are asymptomatic and remain infected for life. Infection of humans occurs by consumption of infected undercooked meat or contaminated vegetables, fruit and water. The aim of this study was to evaluate the prevalence and seroprevalence of T. gondii in livestock in Israel. For the serological screening we investigated the presence of antibodies against T. gondii in sera using the indirect fluorescent antibody test (IFAT). Molecular screening was preformed using conventional PCR and nested PCR for the detection of T. gondii DNA in tissue samples. Serum samples of 249 cattle and 138 sheep were collected from farms. This serological survey showed high seroprevalence with seropositivity of 29 % in cattle and 33 % in sheep. In addition, 526 paired sera and tissue samples from cattle, sheep and pigs were obtained in slaughterhouses. The serological prevalence of T. gondii in healthy animals intended for human consumption was 29.4 % in cattle, 26.1 % in sheep and 8.1 % in pigs. The molecular detection of T. gondii in the tissue samples was 7.5 % in cattle, 7.3 % in sheep and 6.3 % in pigs. Considering the combined positive results from both serological and molecular assays, exposure to or infection with the parasite was present in 26.2 % of the samples (33.8 % in cattle, 30.3 % in sheep, 12.5 % in pigs). The prevalence of T. gondii in pigs was significantly lower compared to that of cattle and sheep (P < 0.001). All PCR positive samples from animals and 12 human positive samples were genotyped using a restriction fragment length polymorphism (PCR-RFLP) method. The results showed the existence of atypical genotypes in the majority of the samples and no correlation between animals and human samples could be determined from this study. Widespread exposure to T. gondii in Israel with the presence of parasite DNA in meat from cattle, sheep and pigs meant for human consumption was found.

Beneficial Effect of Toxoplasma gondii Infection on the Prognosis of Breast Cancer Was Modified by Cytokines

Background

Animal experiments have shown the anticancer activity of Toxoplasma gondii (T. gondii), but its effect on the prognosis of cancer patients is unclear. Thus, the present study aimed to investigate the prognostic role of anti-T. gondii IgG in breast cancer patients and the modification effect of cytokines.

Methods

A total of 1121 breast cancer patients were recruited between 2008 and 2018 and followed up until December 31, 2021. Anti-T. gondii IgG and cytokines were measured using an enzyme-linked immunosorbent assay (ELISA) kit and a multiplex assay platform. Endpoints were overall survival (OS) and progression-free survival (PFS). Survival and multiplicative interaction analyses were performed using multivariate Cox regression models.

Results

According to the cutoff value of optical density (OD=0.111), 900 (80.29%) and 221 (19.71%) patients were divided into two groups: low or high anti-T. gondii IgG. Compared to patients with a low anti-T. gondii IgG level, the adjusted hazard ratios (HRs) of OS and PFS for patients with high anti-T. gondii IgG levels were 0.60 (95% confidence interval (CI): 0.37-0.99) and 0.67 (0.46-0.98), respectively. These associations were profound among patients with a high cytokine score (HR=0.29, 95% CI: 0.10-0.82 for OS; HR=0.30, 95% CI: 0.13-0.69 for PFS), accompanied by a significant interaction between the level of anti-T. gondii IgG and the cytokine score (P _interaction=0.019 for PFS); interleukin-17 (IL-17) and interleukin-9 (IL-9) were the main contributors to the interaction.

Conclusion

Anti-T. gondii IgG was found to be beneficial to breast cancer survival, especially in women with systematic inflammation and high IL-17 or IL-9 levels, suggesting the potential of T. gondii as a prognostic marker and a novel immunotherapy approach for cancer patients.

Association of Chronic Toxoplasma gondii Infection with Pro-Inflamatory Cytokine Interleukin (IL)-12 Responses in Type-2 Diabetes Mellitus Patients of Bangladesh

Toxoplasma gondii is an intracellular protozoan parasite that causes toxoplasmosis in around one-third of the world population, particularly in pregnant women and immunocompromised individuals. Diabetes mellitus (DM) is one of the most severe global health challenges in the 21st century, and especially, type-2 diabetes mellitus (T2DM) accounts for 90% of the diabetes cases diagnosed globally. In Bangladesh, the rate of T2DM is rising gradually with the improvement in living standards. The aim of this study is to find out the correlation between latent toxoplasmosis and T2DM, emphasizing the pro-inflammatory cytokine immunity. For this, 100 (N = 100) patients with T2DM and 100 (N = 100) healthy controls were enrolled to determine the seroprevalence of toxoplasmosis using enzyme-linked immunosorbent assay (ELISA). In addition, ELISA was also performed to determine the level of pro-inflammatory cytokine, interleukin (IL)-12, to understand its role in the development of toxoplasmosis. In our study, 39.39% of the T2DM patients were positive with anti-T. gondii Immunoglobulin G by ELISA, whereas the rate of seropositivity in healthy controls was 39.73%. We did not find significant association between T. gondii infection and T2DM, but our data confirmed a high prevalence of chronic toxoplasmosis in Bangladeshi population. From hematology tests, it was found that the T2DM patients had significantly lower levels of total white blood cells (P = 0.0015), circulating eosinophils (P = 0.0026), and neutrophils (P = 0.0128) than the healthy controls. On the other hand, the levels of lymphocytes (P = 0.0204) and monocytes (P = 0.0067) were significantly higher in patients. Furthermore, T. gondii infected T2DM patients had significantly higher levels of IL-12 than the healthy controls (P = 0.026), suggesting a link between parasitic infection and IL-12 secretion. Further studies are to be performed to find out the exact cause of high prevalence of chronic T. gondii infection in Bangladeshi population.

Identification and multilocus genotyping of Toxoplasma gondii isolates from congenital infection in north of Iran

Congenital toxoplasmosis can cause severe consequences in the fetus, such as spontaneous abortion which is affected by parasite strain. Also, recent studies revealed the high genetic diversity of Toxoplasma gondii. This study aims to investigate the serological status of T. gondii in pregnant women, multilocus genotyping in aborted fetuses' tissue, and archived formalin-fixed paraffin-embedded placenta. This study was performed on 100 pregnant women with spontaneous abortion and their aborted fetuses, and 250 of the archived placentae in Iran. The blood and tissue were examined for seroprevalence and genotype determination of T. gondii using ELISA and multilocus nested-PCR-RFLP, respectively. Anti-T. gondii IgG and IgM were detected in 68 samples (68%) and 1 (1%) out of 100 serums. Toxoplasma DNA was identified in 1 (1%) aborted fetuses' tissue and 32 (12.8%) placenta samples. Overall, ten positive DNA samples were successfully genotyped, and five genotypes were recognized (ToxoDB#1, #2, #10, #27, and #48). The obtained results indicated congenital toxoplasmosis is a severe risk in this region. As type I is highly pathogen and can lead to severe complications, the prevention of the infection should be considered in seronegative pregnant women.