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Parreira de Aquino G, Mendes Gomes MA, Köpke Salinas R, Laranjeira-Silva MF. Lipid and fatty acid metabolism in trypanosomatids. MICROBIAL CELL 2021; 8:262-275. [PMID: 34782859 PMCID: PMC8561143 DOI: 10.15698/mic2021.11.764] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 12/18/2022]
Abstract
Trypanosomiases and leishmaniases are neglected tropical diseases that have been spreading to previously non-affected areas in recent years. Identification of new chemotherapeutics is needed as there are no vaccines and the currently available treatment options are highly toxic and often ineffective. The causative agents for these diseases are the protozoan parasites of the Trypanosomatidae family, and they alternate between invertebrate and vertebrate hosts during their life cycles. Hence, these parasites must be able to adapt to different environments and compete with their hosts for several essential compounds, such as amino acids, vitamins, ions, carbohydrates, and lipids. Among these nutrients, lipids and fatty acids (FAs) are essential for parasite survival. Trypanosomatids require massive amounts of FAs, and they can either synthesize FAs de novo or scavenge them from the host. Moreover, FAs are the major energy source during specific life cycle stages of T. brucei, T. cruzi, and Leishmania. Therefore, considering the distinctive features of FAs metabolism in trypanosomatids, these pathways could be exploited for the development of novel antiparasitic drugs. In this review, we highlight specific aspects of lipid and FA metabolism in the protozoan parasites T. brucei, T. cruzi, and Leishmania spp., as well as the pathways that have been explored for the development of new chemotherapies.
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Affiliation(s)
| | | | - Roberto Köpke Salinas
- Department of Biochemistry, Institute of Chemistry, University of São Paulo, São Paulo, Brazil
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Loria AD, Dattilo V, Santoro D, Guccione J, De Luca A, Ciaramella P, Pirozzi M, Iaccino E. Expression of Serum Exosomal miRNA 122 and Lipoprotein Levels in Dogs Naturally Infected by Leishmania infantum: A Preliminary Study. Animals (Basel) 2020; 10:ani10010100. [PMID: 31936232 PMCID: PMC7023135 DOI: 10.3390/ani10010100] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 12/21/2022] Open
Abstract
Simple Summary The immunopathogenesis of leishmaniasis is not completely understood. Exosomes are extracellular vesicles produced by most eukaryotic cells, containing various molecular constituents with biological effects (e.g., proteins, peptides, RNA). They play an important role in cell-to-cell signaling. Recently, exosomal microRNA were demonstrated to be able to regulate gene expression and protein production in mammalian cells, serving as potential biomarkers of disease. The microRNA miR-122 is a biomarker of hepatic damage widely studied in mice in the course of Leishmania infection. Leishmania organisms can interfere with miR-122 production leading to a dysfunction in cholesterol metabolism ensuring its proliferation in the infected host. In this study, we suggest that such a phenomenon may also occur in dogs affected by Leishmania infection. Abstract Current knowledge on the role of exosomal microRNA (miRNA) in canine leishmaniasis (CL), with particular regards to the interaction between miR-122 and lipid alterations, is limited. The aim of this study was to isolate/characterize exosomes in canine serum and evaluate the expression of miR-122 in ten healthy and ten leishmaniotic dogs. Serum exosomes were isolated using a polymer-based kit, ExoQuick® and characterized by flow cytometry and transmission electron microscopy, whereas miR-122-5p expression was evaluated by quantitative reverse-transcriptase polymerase chain reaction. A significant decreased expression of exosomal miR-122-5p, decreased serum levels of high-density lipoproteins, and increased serum levels of low-density lipoproteins were seen in leishmaniotic dogs when compared with healthy dogs. These results suggest that hepatic dysfunctions induced by the parasite interfere with lipoprotein status. The decreased expression of exosomal miR122 represents an additional effect of Leishmania infection in dogs as in people.
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Affiliation(s)
- Antonio Di Loria
- Department of Veterinary Medicine and Animal Productions, University Federico II, 80130 Napoli, Italy; (J.G.); (P.C.)
- Correspondence: (A.D.L.); (D.S.)
| | - Vincenzo Dattilo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Domenico Santoro
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
- Correspondence: (A.D.L.); (D.S.)
| | - Jacopo Guccione
- Department of Veterinary Medicine and Animal Productions, University Federico II, 80130 Napoli, Italy; (J.G.); (P.C.)
| | - Adriana De Luca
- Department of Veterinary Medicine and Animal Productions, University Federico II, 80130 Napoli, Italy; (J.G.); (P.C.)
| | - Paolo Ciaramella
- Department of Veterinary Medicine and Animal Productions, University Federico II, 80130 Napoli, Italy; (J.G.); (P.C.)
| | - Marinella Pirozzi
- Institute of Protein Biochemistry, National Research Council, 88100 Napoli, Italy;
| | - Enrico Iaccino
- Department of Experimental and Clinical Medicine Magna Graecia University, 88100 Catanzaro, Italy;
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Trypanosoma cruzi epimastigotes are able to store and mobilize high amounts of cholesterol in reservosome lipid inclusions. PLoS One 2011; 6:e22359. [PMID: 21818313 PMCID: PMC3144899 DOI: 10.1371/journal.pone.0022359] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 06/26/2011] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Reservosomes are lysosome-related organelles found in Trypanosoma cruzi epimastigotes. They represent the last step in epimastigote endocytic route, accumulating a set of proteins and enzymes related to protein digestion and lipid metabolism. The reservosome matrix contains planar membranes, vesicles and lipid inclusions. Some of the latter may assume rectangular or sword-shaped crystalloid forms surrounded by a phospholipid monolayer, resembling the cholesterol crystals in foam cells. METHODOLOGY/PRINCIPAL FINDINGS Using Nile Red fluorimetry and fluorescence microscopy, as well as electron microscopy, we have established a direct correlation between serum concentration in culture medium and the presence of crystalloid lipid inclusions. Starting from a reservosome purified fraction, we have developed a fractionation protocol to isolate lipid inclusions. Gas-chromatography mass-spectrometry (GC-MS) analysis revealed that lipid inclusions are composed mainly by cholesterol and cholesterol esters. Moreover, when the parasites with crystalloid lipid-loaded reservosomes were maintained in serum free medium for 48 hours the inclusions disappeared almost completely, including the sword shaped ones. CONCLUSIONS/SIGNIFICANCE Taken together, our results suggest that epimastigote forms of T. cruzi store high amounts of neutral lipids from extracellular medium, mostly cholesterol or cholesterol esters inside reservosomes. Interestingly, the parasites are able to disassemble the reservosome cholesterol crystalloid inclusions when submitted to serum starvation.
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Vigueira PA, Paul KS. Requirement for acetyl-CoA carboxylase in Trypanosoma brucei is dependent upon the growth environment. Mol Microbiol 2011; 80:117-32. [PMID: 21306439 DOI: 10.1111/j.1365-2958.2011.07563.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Trypanosoma brucei, the causative agent of human African trypanosomiasis, possesses two fatty acid synthesis pathways: a major de novo synthesis pathway in the ER and a mitochondrial pathway. The 2-carbon donor for both pathways is malonyl-CoA, which is synthesized from acetyl-CoA by Acetyl-CoA carboxylase (ACC). Here, we show that T. brucei ACC shares the same enzyme architecture and moderate ∼ 30% identity with yeast and human ACCs. ACC is cytoplasmic and appears to be distributed throughout the cell in numerous puncta distinct from glycosomes and other organelles. ACC is active in both bloodstream and procyclic forms. Reduction of ACC activity by RNA interference (RNAi) resulted in a stage-specific phenotype. In procyclic forms, ACC RNAi resulted in 50-75% reduction in fatty acid elongation and a 64% reduction in growth in low-lipid media. In bloodstream forms, ACC RNAi resulted in a minor 15% decrease in fatty acid elongation and no growth defect in culture, even in low-lipid media. However, ACC RNAi did attenuate virulence in a mouse model of infection. Thus the requirement for ACC in T. brucei is dependent upon the growth environment in two different life cycle stages.
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Affiliation(s)
- Patrick A Vigueira
- Department of Biological Sciences, Clemson University, Clemson, SC 29634, USA
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Sehgal A, Bettiol S, Pypaert M, Wenk MR, Kaasch A, Blader IJ, Joiner KA, Coppens I. Peculiarities of host cholesterol transport to the unique intracellular vacuole containing Toxoplasma. Traffic 2006; 6:1125-41. [PMID: 16262724 DOI: 10.1111/j.1600-0854.2005.00348.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The intracellular protozoan Toxoplasma gondii is auxotrophic for low-density lipoprotein (LDL)-derived cholesterol (C). We previously showed that T. gondii scavenges this essential lipid from host endolysosomal compartments and that C delivery to the parasitophorous vacuole (PV) does not require transit through host Golgi or endoplasmic reticulum. In this study, we explore the itinerary of C from the host endolysosomes to the PV. Labeled C incorporated into LDL is rapidly detected in intravacuolar parasites and partially esterified by the parasites. In contrast to diverse mammalian organelles, the post-endolysosomal transfer of C to the PV does not involve the host plasma membrane as an intermediate. Nevertheless, the PV membrane is accessible to extracellular sterol acceptors, suggesting C trafficking from intracellular parasites to host plasma membrane. C movement to the PV requires temperatures permissive for vesicular transport, metabolic energy and functional microtubules. Host caveolae vesicles and the sterol carrier protein-2 do not participate in this process. Proteolytic treatment of purified PV or free parasites abolishes C acquisition by the parasites. Altogether, these results support a vesicular transport system from host endolysosomes to the PV, and a requirement for PV membrane and parasite plasma membrane proteins in C delivery to T. gondii.
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Affiliation(s)
- Alfica Sehgal
- Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
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Hung CH, Qiao X, Lee PT, Lee MGS. Clathrin-dependent targeting of receptors to the flagellar pocket of procyclic-form Trypanosoma brucei. EUKARYOTIC CELL 2005; 3:1004-14. [PMID: 15302833 PMCID: PMC500874 DOI: 10.1128/ec.3.4.1004-1014.2004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In trypanosomatids, endocytosis and exocytosis occur exclusively at the flagellar pocket, which represents about 0.43% of the pellicle membrane and is a deep invagination of the plasma membrane where the flagellum extends from the cell. Receptor molecules are selectively retained at the flagellar pocket. We studied the function of clathrin heavy chain (TbCLH) in the trafficking of the flagellar pocket receptors in Trypanosoma brucei by using the double-stranded RNA interference approach. It appears that TbCLH is essential for the survival of both the procyclic form and the bloodstream form of T. brucei, even though structures resembling large coated endocytic vesicles are absent in procyclic-form trypanosomes. Down-regulation of TbCLH by RNA interference (RNAi) for 24 h rapidly and drastically reduced the uptake of macromolecules via receptor-mediated endocytosis in procyclic-form trypanosomes. This result suggested the importance of TbCLH in receptor-mediated endocytosis of the procyclic-form trypanosome, in which the formation of large coated endocytic vesicles may not be required. Surprisingly, induction of TbCLH RNAi in the procyclic T. brucei for a period of 48 h prohibited the export of the flagellar pocket-associated transmembrane receptor CRAM from the endoplasmic reticulum to the flagellar pocket, while trafficking of the glycosylphosphatidylinositol-anchored procyclin coat was not significantly affected. After 72 h of induction of TbCLH RNAi, procyclics exhibited morphological changes to an apolar round shape without a distinct structure of the flagellar pocket and flagellum. Although trypanosomes, like other eukaryotes, use similar organelles and machinery for protein sorting and transport, our studies reveal a novel role for clathrin in the secretory pathway of trypanosomes. We speculate that the clathrin-dependent trafficking of proteins to the flagellar pocket may be essential for the biogenesis and maintenance of the flagellar pocket in trypanosomes.
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Affiliation(s)
- Chien-Hui Hung
- Department of Pathology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA
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McConville MJ, Mullin KA, Ilgoutz SC, Teasdale RD. Secretory pathway of trypanosomatid parasites. Microbiol Mol Biol Rev 2002; 66:122-54; table of contents. [PMID: 11875130 PMCID: PMC120783 DOI: 10.1128/mmbr.66.1.122-154.2002] [Citation(s) in RCA: 175] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The Trypanosomatidae comprise a large group of parasitic protozoa, some of which cause important diseases in humans. These include Trypanosoma brucei (the causative agent of African sleeping sickness and nagana in cattle), Trypanosoma cruzi (the causative agent of Chagas' disease in Central and South America), and Leishmania spp. (the causative agent of visceral and [muco]cutaneous leishmaniasis throughout the tropics and subtropics). The cell surfaces of these parasites are covered in complex protein- or carbohydrate-rich coats that are required for parasite survival and infectivity in their respective insect vectors and mammalian hosts. These molecules are assembled in the secretory pathway. Recent advances in the genetic manipulation of these parasites as well as progress with the parasite genome projects has greatly advanced our understanding of processes that underlie secretory transport in trypanosomatids. This article provides an overview of the organization of the trypanosomatid secretory pathway and connections that exist with endocytic organelles and multiple lytic and storage vacuoles. A number of the molecular components that are required for vesicular transport have been identified, as have some of the sorting signals that direct proteins to the cell surface or organelles in the endosome-vacuole system. Finally, the subcellular organization of the major glycosylation pathways in these parasites is reviewed. Studies on these highly divergent eukaryotes provide important insights into the molecular processes underlying secretory transport that arose very early in eukaryotic evolution. They also reveal unusual or novel aspects of secretory transport and protein glycosylation that may be exploited in developing new antiparasite drugs.
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Affiliation(s)
- Malcolm J McConville
- Department of Biochemistry and Molecular Biology, University of Melbourne, Parkville, Victoria 3010, Australia.
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Drain J, Bishop JR, Hajduk SL. Haptoglobin-related Protein Mediates Trypanosome Lytic Factor Binding to Trypanosomes. J Biol Chem 2001; 276:30254-60. [PMID: 11352898 DOI: 10.1074/jbc.m010198200] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Trypanosome lytic factor (TLF-1) is an unusual high density lipoprotein (HDL) found in human serum that is toxic to Trypanosoma brucei brucei and may be critical in preventing human infections by this parasite. TLF-1 is composed of four major apolipoproteins: apolipoprotein AI, apolipoprotein AII, paraoxonase, and the primate-specific haptoglobin-related protein (Hpr). Hpr is greater than 90% homologous to haptoglobin (Hp), an abundant acute phase serum protein. Killing of trypanosomes by TLF-1 requires cell surface binding, endocytosis, and subsequent lysosomal targeting. Low temperature binding studies reveal two receptors for TLF-1: one that is high affinity/low capacity (K(d) approximately 12 nm, 350 receptors per cell) and another that binds with low affinity/high capacity (K(d) approximately 1 microm, 60,000 receptors per cell). The low affinity binding is competed by nonlytic human HDL and is likely to be apolipoprotein AI-mediated. Purified human Hpr and human Hp bind to trypanosomes, are internalized, and are targeted to the lysosome. Furthermore, Hpr shows competition for TLF-1 binding, and a monoclonal antibody against Hpr prevents both TLF-1 uptake and trypanosome killing. Based on these results, we propose that Hpr mediates the high affinity binding of TLF-1 to T. b. brucei through a haptoglobin-like receptor.
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Affiliation(s)
- J Drain
- Department of Biochemistry and Molecular Genetics, School of Medicine, University of Alabama at Birmingham, 35294, USA
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Ridgley EL, Ruben L. Phospholipase from Trypanosoma brucei releases arachidonic acid by sequential sn-1, sn-2 deacylation of phospholipids. Mol Biochem Parasitol 2001; 114:29-40. [PMID: 11356511 DOI: 10.1016/s0166-6851(01)00234-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previously, we showed that arachidonic acid (AA) stimulates Ca2+ currents in pathogenic Trypanosoma brucei (Eintracht J, Maathai R, Mellors A, Ruben L. Calcium entry in Trypanosoma brucei is regulated by phospholipase A2 and arachidonic acid. Biochem. J 1998;336:659-666). Here we examine the mechanism used by T. brucei to release AA from the sn-2 position of diacyl glycero-phospholipids. We report that T. brucei accomplishes this feat in the apparent absence of phospholipase A2 (PLA2). Instead, deacylation is initiated at the sn-1 position, followed by acyl migration and hydrolysis with LysoPLA. Neither whole cell homogenates nor enriched protein fractions could release AA from substrates whose sn-1 position contained a non-hydrolyzable alkyl ether linkage. These same fractions however, released AA from ester linked phospholipids, and TLC analysis of the reaction products supported the sequential deacylation process. The release of sn-2 AA from 1-palmitoyl-2-[1-14C]arachidonyl-sn-glycero-3-PC was linear up to 90 min at an average rate of 50 nmol x min(-1) x mg(-1). sn-2 AA was processed more efficiently than sn-2 palmitate. The reaction was also greatest for: LysoPC>diacyl-PC (sn-1 labeled)>diacyl-PC (sn-2 labeled). Product formation was sensitive to polar head group, and PI was processed at less than 10% the rate of PC or PE. The enzymatic deacylation was inhibited by the serine specific reagent, methyl arachidonyl fluorophosphonate (MAFP) and the cysteine reagent N-ethylmaleimide (NEM). Both NEM and MAFP inhibited LysoPLA activity under conditions where there was little effect on PLA1 activity. Overall, we conclude that T. brucei can release AA from diacyl glycero-phospholipids by a sequential deacylation process. Two independent active sites appear to be involved. Interestingly, a high percentage of inner leaflet phospholipids are protected from degradation since they occur in the non-hydrolyzable 1-alkyl ether form.
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Affiliation(s)
- E L Ridgley
- Department of Biological Sciences, Southern Methodist University, Dallas, TX 75275, USA
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Porto-Carreiro I, Attias M, Miranda K, De Souza W, Cunha-e-Silva N. Trypanosoma cruzi epimastigote endocytic pathway: cargo enters the cytostome and passes through an early endosomal network before storage in reservosomes. Eur J Cell Biol 2000; 79:858-69. [PMID: 11139150 DOI: 10.1078/0171-9335-00112] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
It has been known for many years that trypanosomatids require exogenous essential growth factors in order to divide. Two surface domains are involved in starting nutrient endocytosis: the flagellar pocket and the cytostome. Although the flagellar pocket plays a fundamental role in the endocytic process occurring in several trypanosomatids, we have shown the cytostome as the main structure involved in this process in epimastigote forms of T. cruzi. After one minute of endocytosis, cargo is still found at the cytostome entry as well as along the cytopharynx. After two, five and fifteen minutes of endocytosis, cargo was seen inside vesicles and tubules, prior to fusing with reservosomes. Three-dimensional reconstruction of these tubules and vesicles showed they are interconnected, forming an intricate and branched network, distributed from the perinuclear region to the posterior end of the cell. Whole unfixed parasites that had taken up gold-protein conjugates for fifteen minutes were washed and dried on electron microscope grids. Observation with an energy-filtering transmission electron microscope revealed long gold-filled tubules at the posterior end of the cell. Parasites treated with ammonium chloride had their intracellular traffic slowed down, which allowed us to observe many events of vesicle fusion. The acidic nature of this network was evidenced using acridine orange. Based on pH and protein uptake kinetics we propose that the vesicular-tubular network is the early endosome of Trypanosoma cruzi epimastigotes.
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Affiliation(s)
- I Porto-Carreiro
- Laboratório de Ultraestrutura Celular Hertha Meyer, Instituto de Biofísica Carlos Chagas Filho, UFRJ, Rio de Janeiro, Brasil
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Liu J, Qiao X, Du D, Lee MG. Receptor-mediated endocytosis in the procyclic form of Trypanosoma brucei. J Biol Chem 2000; 275:12032-40. [PMID: 10766835 DOI: 10.1074/jbc.275.16.12032] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In Trypanosomatids, endocytosis and exocytosis occur exclusively at the flagellar pocket, a deep invagination of the plasma membrane where the flagellum extends from the cell. Both bloodstream and procyclic trypanosomes are capable of internalizing macromolecules. However, structures resembling coated vesicles were only identified in bloodstream form and not in procyclic form trypanosomes. Due to the apparent absence of coated vesicles in procyclics, the significance of receptor-mediated endocytosis in procyclic trypanosomes has been considered of minimal importance. We show that the flagellar pocket associated cysteine-rich acidic transmembrane protein (CRAM) may function as an high density lipoprotein receptor in the procyclic form trypanosome. Using anti-CRAM IgG we have characterized the process of CRAM-mediated endocytosis in procyclic form trypanosomes. The wild type procyclic trypanosome binds and internalizes anti-CRAM IgG but not the non-immune IgG in a saturable and time-dependent manner; the binding and uptake of (125)I-labeled anti-CRAM IgG are inhibited by excess unlabeled anti-CRAM IgG. Uptake and degradation of anti-CRAM IgG do not occur at 4 degrees C. At 28 degrees C, the internalized anti-CRAM IgG were efficiently degraded through a process that is inhibited by incubation at 4 degrees C and sensitive to the presence of chloroquine. The uptake and degradation of anti-CRAM IgG does not occur in the CRAM null mutant cell line. These results suggested that the uptake of anti-CRAM IgG in the wild type procyclics occurs via receptor-mediated endocytosis of the CRAM protein. Deletion of the cytoplasmic extension of CRAM drastically reduced the degradation but not the binding of anti-CRAM IgG. This result indicated that potential internalization signals may be present in the cytoplasmic extension of CRAM. This is the first time that the importance of receptor-mediated endocytosis in procyclic form trypanosomes has been demonstrated.
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Affiliation(s)
- J Liu
- Department of Pathology, New York University School of Medicine, New York, New York 10016, USA
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