Relationships between chemotherapy and immunity in schistosomiasis

New approaches for understanding mechanisms of drug resistance in schistosomes

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

Chemotherapeutic effects on larval stages of Schistosoma mansoni during infection and re-infection of mice

The sensitivity of the larval stages of Schistosoma mansoni to chemotherapy with praziquantel and oxamniquine was tested in mice during primary and secondary infections and after different intervals from cercarial exposure. Worm recovery by perfusion of the porto-mesenteric system, followed by counting and a morphometric study of the parasite, allowed the conclusion that the relative resistance of the larval stages of S. mansoni to schistosomicide drugs, demonstrated in primary infections, also persists when the host is already infected. This indicates that a therapeutic failure may result when an infected host is treated some time after being re-infected, because of the presence of migrating, drug-resistant, immature forms of the parasite.

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

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

Hepatic schistosomiasis

Schistosomiasis is a major, worldwide cause of morbidity and mortality. Disease from the organism Schistosoma mansoni results from egg deposition in the liver, intestines, and other organs and is associated with an intense, granulomatous response from the human host. Clinical manifestations range from mild to severe intestinal forms, and hepatosplenic schistosomiasis, which is associated with hepatic fibrosis, portal hypertension, esophageal varices, and splenomegaly. This article presents information about the epidemiology, immunopathogenesis and clinical aspects of the disease, the relationship between hepatic schistosomiasis and viral infections, diagnosis, therapy, and control strategies for schistosomiasis.

Interventions for treating schistosomiasis mansoni

BACKGROUND

Schistosomiasis is a parasite that is carried by freshwater snails. The intestinal form infects the intestine, liver and spleen and can be fatal.

OBJECTIVES

The objective of this review was to assess the effects of oxamniquine or praziquantel for treating Schistosomiasis mansoni

SEARCH STRATEGY

We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Lilacs and reference lists of articles. The Revista da Sociedade Brasileira de Medicina Tropical and Brazilian Tropical Medicine Congress abstracts were handsearched

SELECTION CRITERIA

Randomised and quasi-randomised trials comparing oxamniquine and/or praziquantel to placebo for the treatment of Schistosomiasis mansoni.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data.

MAIN RESULTS

Thirteen trials met the inclusion criteria. Praziquantel and oxamniquine were effective in curing Schistosoma mansoni infection when compared to placebo. In Africa, praziquantel 40 mg/Kg is more effective than oxamniquine 15 mg/Kg in individuals older than 14 years (OR 3.54, 95%CI 1.70, 7.38), but no difference was found when compared with oxamniquine 30 mg/Kg (OR 0.29, 95%CI 0.08, 1.01). In Brazil, praziquantel was equally effective when compared with oxamniquine in individuals older than 14 years (OR 1.70, 95%CI 0.83, 3.49). Both drugs appear safe. There was no difference in reinfection rate between zinc supplementation and placebo (OR 0.82, 95%CI 0.47, 1.41).

REVIEWER'S CONCLUSIONS

IPraziquantel and oxamniquine both appear to be effective for the treatment of Schistosomiasis mansoni, although lower doses of oxamniquine (less than 30 milligrams per kilogram) may not be as effective.

Schistosome glysoconjugates

Schistosomes are trematodes known as blood flukes that cause schistosomiasis in people and animals. The male and female worms reside mainly in intestinal veins where they lay eggs that result in a wide-ranging pathology in infected individuals. A growing body of evidence indicates that carbohydrates on glycoproteins, glycolipids and glycosaminoglycans synthesized by the parasite are targets of humoral immunity and may play a role in modulating host immune responses. Carbohydrate antigens may provide protective immunity against infection. In addition, recent evidence indicates that glycoconjugates and carbohydrate-binding proteins from the parasites and their hosts participate in egg adhesion and granuloma formation involved in disease pathology. This review will highlight our current knowledge of the glycoconjugates synthesized by the parasites and their immunological and biological properties. There is increasing anticipation in the field that information about the glycobiology of these parasites may lead to carbohydrate-based vaccines and diagnostics for the disease and perhaps new therapies for treating infected individuals.

Oral vaccination of mice with recombinant Schistosoma japonicum proteins induces specific anti-parasite antibodies and damage to adult worms after a challenge infection

Mucosal immunisation by the oral route represents a cheap and simple method for delivering protective antigens to a host against gastrointestinal and respiratory pathogens. In the case of schistosome (bloodfluke) worms, 2 life-cycle stages may be exposed to the host's mucosa; the larval schistosomulum is exposed to the respiratory mucosa and, depending on the species, the egg may come into contact with the intestinal or urinogenital mucosa. Both IgA and some Isotypes of IgG have been implicated in protective immunity against schistosomiasis in humans and in experimental animal models. We have used a novel approach to determine whether schistosome-specific antibodies and protective immunity could be generated in mice by oral administration of bacterial lysates containing recombinant Schistosoma japonicum proteins. The mice produced specific antibodies to paramyosin and GST26, 2 important vaccine candidates for schistosomiasis, but there was no significant reduction in worm burdens in groups of mice immunised with either protein. Significantly, however, transmission electron microscopy revealed damage to the teguments of adult female and male S. japonicum worms obtained from mice vaccinated with recombinant paramyosin; there was also extensive damage to the tegument of male worms recovered from mice vaccinated with recombinant GST26. Our observations that oral vaccination with bacterial lysates containing recombinant proteins induced particular classes and subclasses of circulating antibodies with resultant damage to the surface of adult worms may have important implications for the future development of oral vaccines against a systemic infection such as schistosomiasis.

Urinary excretion of the collagen cross-link pyridinoline increases during liver fibrogenesis

BACKGROUND/AIMS

Pyridinoline, a specific cross-link of mature collagen, increases in liver during fibrogenesis and its hepatic level is related to the degree of reversibility of the fibrotic process. Since pyridinoline is excreted in urine, we have investigated the relationship between its urinary level and liver fibrogenesis in a model of mild and reversible liver fibrosis, murine schistosomiasis.

METHODS

Pyridinoline was measured by HPLC in urine and in liver of Schistosoma mansoni-infected mice during the acute and the chronic phases of the infection. Collagen deposition was measured colorimetrically. Both the isolated granulomas and the surrounding liver parenchyma were analyzed.

RESULTS

In infected mice, pyridinoline increased mainly in the isolated granulomas, corresponding to the fibrotic lesions, and slightly in the surrounding parenchyma. The urinary excretion of pyridinoline increased during liver fibrogenesis and was correlated to the duration of infection (r=0.81) and to the collagen content of granulomas (r=0.81). The treatment of infected mice by praziquantel, an antiparasitic drug, did not lead to significant changes in liver collagen cross-linking by pyridinoline either in granulomas or in parenchyma. The major effect of the drug was targeted at the collagen content of parenchyma, which decreased by 50%, 18 weeks after treatment. The urinary level of pyridinoline of treated mice was negatively correlated to the length of the treatment follow-up (r=-0.76).

CONCLUSIONS

The measurement of the urinary excretion of pyridinoline could be helpful to monitor the remodeling of liver extracellular matrix occurring in fibrogenesis and the effect of chemotherapy.

Immunostimulation as adjuvant for the chemotherapy of experimental schistosomiasis

Immunosuppressed animals respond poorly to schistosomal chemotherapy and a proper response can be restored by the administration of immune serum. Present study attempts to search whether immunological stimulation would increase drug effectiveness. Swiss mice infected with 50 S. mansoni cercariae were later treated with complete Freund's adjuvant. Treatment with oxamniquine was made with 100 mg/kg.b.w., 25 mg/kg.b.w. and 50 mg/kg.b.w., the last two doses representing a fourth and a half of the recommended curative dose. Appropriate controls for the drug, the adjuvant and the infection were also studied. The serum-level of anti-S. mansoni antibodies (ELISA) and recovery of worms by perfusion of the portal vein system were the evaluated parameters. Statistical analysis of the results failed to reveal significant differences in worm recovery between adjuvant-stimulated animals treated with oxamniquine and any of the treated controls receiving the same amount of the drug. Although total lack of immunity interferes with curative treatment the usual immune response seems to be sufficient to allow for curative drug action in schistosomiasis and thus apparently does not need to be artificially stimulated.