Efficacious and safe dose of praziquantel for the successful treatment of feline reservoir hosts with opisthorchiasis

Clonorchiasis and opisthorchiasis: epidemiology, transmission, clinical features, morbidity, diagnosis, treatment, and control

Clonorchis sinensis, Opisthorchis viverrini, and Opisthorchis felineus are important liver flukes that cause a considerable public health burden in eastern Asia, southeastern Asia, and eastern Europe, respectively. The life cycles are complex, involving humans, animal reservoirs, and two kinds of intermediate hosts. An interplay of biological, cultural, ecological, economic, and social factors drives transmission. Chronic infections are associated with liver and biliary complications, most importantly cholangiocarcinoma. With regard to diagnosis, stool microscopy is widely used in epidemiologic surveys and for individual diagnosis. Immunologic techniques are employed for screening purposes, and molecular techniques facilitate species differentiation in reference laboratories. The mainstay of control is preventive chemotherapy with praziquantel, usually combined with behavioral change through information, education and communication, and environmental control. Tribendimidine, a drug registered in the People's Republic of China for soil-transmitted helminth infections, shows potential against both C. sinensis and O. viverrini and, hence, warrants further clinical development. Novel control approaches include fish vaccine and biological control. Considerable advances have been made using multi-omics which may trigger the development of new interventions. Pressing research needs include mapping the current distribution, disentangling the transmission, accurately estimating the disease burden, and developing new diagnostic and treatment tools, which would aid to optimize control and elimination measures.

Roaming behavior of the owned domestic cats (Felis catus) with possible roles in the transmission of Opisthorchis viverrini in the endemic area in Khon Kaen, Thailand

In the endemic area of the liver fluke (Opisthorchis viverrini) infection, effective control of opisthorchiasis using One Health approaches requires transmission interruption in all hosts in the parasite life cycle. Owned domestic cats (Felis catus) are considered an important species among mammalian reservoirs. Similar to humans, household cats become infected by eating raw, contaminated fish and spread the O. viverrini eggs to the environment by defecation. In rural areas, cat owners usually feed their cats with human food or food waste, especially fish dishes. There is a high risk for cats to become infected and deposit eggs in the peri-household environment. The lack of research on domestic cats led us to study their roaming behavior, roaming range, habitat preference and risk of disease transmission. GPS loggers were harnessed to 28 domestic cats in 7 villages around Lawa Lake, the endemic area of human opisthorchiasis. All cats were examined for the O. viverrini infection status using modified formalin-ether concentration technique (MFECT) before application of the GPS device used to observe and record their roaming distance and range area. Then, composition analysis for habitat selection was performed using the location data. Additionally, cat owners were interviewed using participatory epidemiologic methods for their perceptions and knowledge about the reservoir hosts of this trematode. Our study suggested that the prevalence of O. viverrini in cats in this area has not declined appreciably in comparison with our previous study four years ago, although the treatment and control has been applied intensively in humans. The longest distance that individual cats roamed ranged from 51 to 363 meters (mean±SD = 154.48±90.71). The cats traveled tracks around their home. There was no significant difference in the average distance that cats ranged between O. viverrini infected group (154.13±72.80 meters) and the non-infected group (154.67±101.39 meters) was found. Compositional analysis suggested that the domestic cats preferred urban habitats where food and safety were probably more available. It appears that the main transmission route for infection of cats was contaminated fish fed to cats or fish that remained in their houses. Therefore, owners should refrain from feeding their cats potentially contaminated foods, food scraps and raw fish remains and prevent their cats from accessing them. Moreover, the participatory epidemiology results suggest that awareness of villagers is not enough for the effective and sustainable control of the disease.

Curcumin and Its Supramolecular Complex with Disodium Glycyrrhizinate as Potential Drugs for the Liver Fluke Infection Caused by Opisthorchis felineus

Opisthorchiosis is a parasitic liver disease found in mammals that is widespread throughout the world and causes systemic inflammation. Praziquantel remains the drug of choice for the treatment of opisthorchiosis, despite its many adverse effects. An anthelmintic effect is attributed to the main curcuminoid of Curcuma longa L. roots-curcumin (Cur)-along with many other therapeutic properties. To overcome the poor solubility of curcumin in water, a micellar complex of curcumin with the disodium salt of glycyrrhizic acid (Cur:Na₂GA, molar ratio 1:1) was prepared via solid-phase mechanical processing. In vitro experiments revealed a noticeable immobilizing effect of curcumin and of Cur:Na₂GA on mature and juvenile Opisthorchis felineus individuals. In vivo experiments showed that curcumin (50 mg/kg) had an anthelmintic effect after 30 days of administration to O. felineus-infected hamsters, but the effect was weaker than that of a single administration of praziquantel (400 mg/kg). Cur:Na₂GA (50 mg/kg, 30 days), which contains less free curcumin, did not exert this action. The complex, just as free curcumin or better, activated the expression of bile acid synthesis genes (Cyp7A1, Fxr, and Rxra), which was suppressed by O. felineus infection and by praziquantel. Curcumin reduced the rate of inflammatory infiltration, whereas Cur:Na₂GA reduced periductal fibrosis. Immunohistochemically, a decrease in liver inflammation markers was found, which is determined by calculating the numbers of tumor-necrosis-factor-positive cells during the curcumin treatment and of kynurenine-3-monooxygenase-positive cells during the Cur:Na₂GA treatment. A biochemical blood test revealed a normalizing effect of Cur:Na₂GA (comparable to that of curcumin) on lipid metabolism. We believe that the further development and investigation of therapeutics based on curcuminoids in relation Opisthorchis felineus and other trematode infections will be useful for clinical practice and veterinary medicine.

Opisthorchis felineus genes differentially expressed under praziquantel shed light on the nature of tegument disruption and indicate the adaptive role of cGMP-dependent protein kinase

Opisthorchis felineus is a trematode flatworm that parasitises mammals, including humans, and is mainly spread throughout Eastern Europe and Western Siberia. The main drug used in treatment of opisthorchiasis and other trematode and cestode infestations is praziquantel (PZQ). We provide a possible explanation of PZQ-mediated tegument disruption. The idea is that the nature of tegument disruption is related to failure of surface renovation due to insufficiency of microtubule transport of vesicles. This insufficiency arises from microtubule destabilisation, which in the medium term leads to the decrease in tubulins alpha, beta and dynein mRNA amounts and deficiency of the corresponding proteins. We also found the upregulation of cGMP-dependent protein kinase gene, and we concluded that its protein product helped to overcome the effect of praziquantel and might be a promising target for combined anthelmintic therapy with PZQ. We concluded that function of saposin-like protein 2 (SAP2) is unlikely associated with membrane fusion, and SAP2 is probably able to bind some type of hydrophobic compounds including praziquantel.

TroCCAP recommendations for the diagnosis, prevention and treatment of parasitic infections in dogs and cats in the tropics

The Tropical Council for Companion Animal Parasites Ltd. (TroCCAP) is a not-for-profit organisation whose mission is to independently inform, guide and make best-practice recommendations for the diagnosis, treatment and control of companion animal parasites in the tropics and sub-tropics, with the aim of protecting animal and human health. In line with this primary mission, TroCCAP recently developed guidelines for the diagnosis, treatment and control of feline and canine parasites in the tropics. The development of these guidelines required unique and complex considerations to be addressed, often inapplicable to developed nations. Much of the tropics encompass middle-to-low income countries in which poor standards of environmental hygiene and large populations of stray dogs and cats coexist. In these regions, a range of parasites pose a high risk to companion animals, which ultimately may place their owners at risk of acquiring parasitic zoonoses. These considerations led to the development of unique recommendations with regard, for example, to deworming and endoparasite testing intervals for the control of both global and 'region-specific' parasites in the tropics. Moreover, the 'off-' or 'extra'-label use of drugs for the treatment and control of parasitic infections is common practice in many tropical countries and many generic products lack manufacturers' information on efficacy, safety, and quality control. Recommendations and advice concerning the use of such drugs and protocols are also addressed in these guidelines. The formation of these guidelines is an important first step towards improving the education of veterinarians specifically regarding best-practice for the diagnosis, treatment and control of canine and feline parasites in the tropics.

Effectiveness of Repeated Administration of Praziquantel with Disodium Glycyrrhizinate and Two Enantiomers of Praziquantel on Opisthorchis felineus (Rivolta, 1884)

BACKGROUND

Nowadays, it is still important to develop effective anti-opisthorchiasis agents. In this work, we tested a complex of praziquantel (PZQ) with a plant origin compound-disodium glycyrrhizinate-in the ratio 1:10 PZQ:Na₂GA, containing 11-fold less of the active ingredient. Our aim was to study various ways to treat trematode Opisthorchis felineus with this complex in vitro. Additionally, an in vitro comparison of the anthelmintic action was made among racemic-PZQ, (R)-PZQ, and (S)-PZQ on juvenile and adult maritae of O. felineus.

METHODS

Worms extracted from the hamsters were subjected to various regimens of administration of the complex: once a day for 3 days or three times within 1 day. Moreover, mature maritae and juvenile worms of O. felineus were subjected to the comparison the anthelmintic effectiveness of racemic-PZQ, (R)-PZQ, and (S)-PZQ.

RESULTS

The O. felineus maritae that received PZQ:Na₂GA (1:10) thrice within 1 day were most strongly affected by the drug. Their motility substantially decreased already on the second day after the last dose, and the percentage of live worms by the end of the experimental period was the lowest. These results indicate a cumulative anthelmintic effect of this substance under the regimen "three times within 1 day." For the first time, we report that among the three substances (racemic-PZQ and two enantiomers), (R)-PZQ has the highest anthelmintic activity, toward both juvenile and sexually mature maritae of O. felineus.

CONCLUSION

These findings suggest that the development of a supramolecular complex of (R)-PZQ with disodium glycyrrhizinate and administration of this complex three times within 1 day are promising approaches.

Chromatographic Quantification of Ivermectin and Pranziquantel in the Tablets Using Stability Indicating RP-HPLC Method

Background: A new stability indicating RP-HPLC based assay method was developed to quantify ivermectin and praziquantel simultaneously and applied effectively to tablets. Methods: The simultaneous assay of ivermectin and praziquantel by RP-HPLC was done using an YMC C18 (250 mm × 4.6 mm, 5 µm) column with a mobile phase mixture of 0.1M disodium hydrogen phosphate (pH 4.5) and acetonitrile (55:45, v/v) using a isocratic flow rate of 1.0 ml/min and measured at 242 nm using photodiode array detector. All parameters were validated following the ICH guiding principles. The method was applied to quantify ivermectin and praziquantel simultaneously in tablets. Results: The retention values of ivermectin and praziquantel were 3.465 min and 4.468 min, respectively. The method’s linearity was found to be 1-3 µg/ml (ivermectin) and 25-75 µg/ml (praziquantel). The limit of detection was 0.010 µg/ml (ivermectin) and 0.046 µg/ml (praziquantel); limit of quantification was 0.033 µg/ml (ivermectin) and 0.155 µg/ml (praziquantel). The percent relative standard deviation of ivermectin and praziquantel was ˂1.0%. The percent assay was 99.51% and 99.20% for ivermectin and praziquantel, respectively. In tablets, the percent recovery of ivermectin and praziquantel was 99.60% and 99.38% with a percent relative standard deviation value of 0.353% and 0.106%, respectively. Stability indicating capability of the method was demonstrated through the stress degradation studies. Conclusion: The developed method was proved to be selective, precise and accurate for the quality control of ivermectin and praziquantel in tablets.

Reservoir Animals and Their Roles in Transmission of Opisthorchis viverrini

Although any fish-eating mammals could be potential definitive hosts of Opisthorchis viverrini, only a few, especially cats and dogs, are actually known reservoir hosts for this parasite. Both animals usually get infected via consuming raw or undercooked contaminated fish, fish dishes or food remains from households. The infected animals sustain parasite egg spread via open environment defecation. Cats are the most important reservoir with higher prevalence rates of O. viverrini infection than dogs in endemic areas. Usually Opisthorchis-infected animals do not exhibit apparent clinical symptoms or specific abnormalities in laboratory examinations. Pathological findings in these animal reservoirs are basically similar to those seen in humans and experimental animals, namely periductal inflammation, biliary hyperplasia and periductal fibrosis. However, O. viverrini-associated cholangiocarcinoma has not yet been reported in the reservoir animals at present. Praziquantel is a treatment of choice not only for humans but also for animal reservoirs. Integrated control of opisthorchiasis in animal reservoirs is based on holistic approaches such as EcoHealth/One Health concepts. In fact integrated control of opisthorchiasis in humans in ecosystem has also proved successful, for example, the Lawa model for opisthorchiasis control in the endemic area of Khon Kaen, Thailand. Other feral and wild animals in endemic areas might also be potential reservoirs, and this requires more investigation. In addition, genetic diversity and evolution of the flukes might also influence zoonotic capability.