Kinetics of nitric oxide production during infection and reinfection of mice with Plasmodium chabaudi

Hepatobiliary changes, antibody response, and alteration of liver enzymes in hamsters re-infected with Opisthorchis viverrini

We investigated pathological changes, antibody response, and liver enzymes in hamsters re-infected with Opisthorchis viverrini. Group 1 received a single dose of 50 metacercariae; Groups 2 and 3 were first dosed with of 30 metacercariae and re-infected with 20 more once or twice at three month intervals. Inflammation and liver cell necrosis were observed on 3D (day 3) for Group 3 and 7D for Group 2 in comparison with 21D for Group 1. Pathological changes included peri-ductal fibrosis, bile duct dilation, and small bile duct formation. Increased O. viverrini-specific IgG levels ranked in the order Group 3>Group 2>Group 1. Liver enzyme activity was related to inflammatory cell infiltration. Re-infection induced faster inflammation and more severe pathological changes in association with parasite-specific antibody during chronic inflammation. This study emphasizes that there is an important relationship between the gradual decreases of inflammation with a concomitant increase in fibrosis after re-infection.

A unifying view of ageing and disease: the double-agent theory

The quest for therapies based on molecular genetics (pharmacogenomics, DNA microarrays, etc.) drives pharmaceutical research into individual diseases of old age, but has failed to deliver an unequivocal clinical breakthrough. Attempts to treat most age-related diseases using antioxidant supplements have been equally disappointing, despite the clear benefits of a healthy diet. The double-agent theory is a new, unifying synthesis that draws on flaws in three leading theories of ageing. It argues that there is a tradeoff between oxidative stress as a critical redox signal that marshals genetic defences against physiological stress (such as infection) and oxidative stress as a cause of ageing and age-related disease. The stress response and ageing are linked by redox-sensitive transcription factors, such as NFkappaB. Ageing is a function of rising intracellular oxidative stress, rather than chronological time, but this relationship is obscured because free-radical leakage from mitochondria also tends to rise with age. Mitochondrial leakage produces a genetic response which mirrors that following infection, but because mitochondrial leakage is continuous the shift in gene expression is persistent, leading to the chronic inflammation characteristic of old age. Age-related diseases are thus the price we pay for redox control of stress-gene expression. Because the selective pressure favouring the stress response in youth is stronger than that penalising degenerative diseases after reproductive decline, we may be homeostatically refractory to antioxidant supplements that 'swamp' the redox switch. Furthermore, because genetic selection takes place predominantly in the reductive homeostatic environment of youth, alleles associated with age-related diseases are not inherently damaging (they do not inevitably express a negative effect over time), but are simply less effective in the oxidising conditions of old age. Gene therapies for age-related diseases are unlikely to succeed unless oxidative stress can be controlled physiologically, thereby altering the activity and function of potentially hundreds of genes.

Malarial nephropathy

Malaria is widely prevalent in the tropics. Clinically significant renal and renal-related disorders commonly occur in infection with Plasmodium falciparum and P. malariae. Falciparum malaria causes fluid and electrolyte disorders, transient and mild glomerulonephritis, and acute renal failure (ARF). It appears that ARF is mediated by a complex interaction of mechanical, immunologic, cytokine, humoral, acute phase response, nonspecific factors, and hemodynamic factors. Parasitized erythrocytes play a central role in all aforementioned pathogenic factors of ARF. Antimalarial drugs are still the cornerstone of treatment of falciparum infection. Because of the hypercatabolic state of falciparum malaria-induced ARF, hemodialysis as well as peritoneal dialysis should be immediately performed when there is a rapid increase of creatinine concentration. P. malariae, in contradistinction, can cause chronic glomerulopathy that may relentlessly progress to end-stage renal disease. Antimalarial drugs, corticosteroids, and immunosuppressive agents are not effective.

Nitric oxide metabolites in naturally occurring canine babesiosis

Babesiosis, caused by the virulent haemoprotozoan parasite Babesia canis rossi, is an important disease of dogs in South Africa. The nitric oxide metabolites, nitrate and nitrite (collectively termed reactive nitrogen intermediates or RNIs) were measured in admission sera from dogs in a babesiosis-endemic area. Five groups were prospectively studied: mild uncomplicated (n=9), severe uncomplicated (severe anaemia) (n=10) and complicated babesiosis (n=11); and two groups of healthy aparasitaemic dogs: endemic controls from the study area (n=10) and experimental dogs kept in tick-free conditions (n=10). Four measures of RNI production were studied: (i) serum RNI; (ii) serum RNI/creatinine ratio; (iii) fractional clearance of RNI (FC(RNI)); (iv) fractional excretion of RNI (FE(RNI)). Marked elevations of serum RNI occurred in only two dogs, both in the severe uncomplicated group. The highest concentration (log value 5.29 micromol/l) was in a dog that died, but concentrations in the other four dogs that died were unremarkable (0, 0.34, 1.66 and 2.64 micromol/l). Age, appetite and free serum haemoglobin were significant covariates for measures of RNI production. There were no significant differences among the babesiosis groups for serum RNI. Adjustment for creatinine had minor effects on the results. All babesiosis groups had significantly higher serum RNI and RNI/creatinine than the tick-free control group, but did not differ from the endemic controls except for the severe uncomplicated group, which had higher RNI/creatinine. The complicated group had significantly lower FC(RNI) and FE(RNI) than all other groups, except for the tick-free control group, which had similar FE(RNI). The results indicate that, in an endemic area, measures of RNI production are unlikely to be useful indicators of severity or outcome in canine babesiosis.

A model of development of acquired immunity to malaria in humans living under endemic conditions

Malaria remains a significant global health problem. Most morbidity and mortality in an endemic setting is in children less than 5 years old, and increasing resistance to infection and disease with age is thought to reflect a slow, gradual acquisition of protective immunity. It is not clear if the semi-immune status of adults, in which parasites are present at below clinical threshold, is the result of cumulative exposure to Plasmodium falciparum or reflects an underlying difference between adult and infant immunity. Immuno-epidemiological studies of people living in malaria-endemic areas have not produced consistent examples of surrogate markers of protection. This gulf in our understanding of immunity to malaria may be addressed by novel application of an established murine model of immune regulation of blood stage infection. This exploits two examples of loss of immunity, selective immunosuppression in pregnancy, and waning of maternally transferred protection in neonates, to distinguish the immunological determinants involved in the radical transition between susceptible and resistant immune status. It is suggested that application of this unique model should significantly advance knowledge of how acquired immunity to malaria develops and is highly relevant to the pathogenesis of malaria in human pregnancy and the design of antimalarial vaccines for use in children.

Schistosoma mansoni infection cancels the susceptibility to Plasmodium chabaudi through induction of type 1 immune responses in A/J mice

Susceptibility to Plasmodium chabaudi depends on the relative dominance of T(h)1/T(h)2 responses in host mice. A T(h)2-dominant response during the early phase of infection in susceptible A/J mice causes a fatal disease course due to severe malaria. Schistosoma mansoni is a potent inducer of a T(h)2-dominant response not only to the parasite antigens, but also to other antigens concurrently existing in the host animals. In spite of S. mansoni infection, these A/J mice escape death from malaria and showed accompanied enhanced production of IFN-gamma to malaria antigens. Treatment with anti-IFN-gamma mAb in S. mansoni-infected A/J mice abolished the resistance to malaria, indicating that IFN-gamma was responsible for the resistance to P. chabaudi in S. mansoni-infected A/J mice. Results in this study show that under certain circumstances, S. mansoni infection can promote type 1 immune responses in A/J mice that normally develop T(h)2 responses.

The role of nitric oxide in the innate resistance to microfilariae of Litomosoides sigmodontis in mice

Nitric oxide (NO) has been shown to be an important effector mechanism in the defence against various pathogens, including filariae. The production of NO, as well as H2O2, is induced by the Th1 cytokine IFN-gamma. Therefore, the microfilariae (mf) of filarial nematodes, which are known to elicit the release of IFN-gamma, may be a target of NO release. In this study, we found that mf of the filarial species Litomosoides sigmodontis were resistant to the attack of H2O2, but vulnerable to NO exposure in vitro by a chemical NO donor, as well as activated macrophages. Adult worms were considerably less affected by exposure to NO. In-vivo production of NO following injection of mf, in this and previous studies, suggested a central role in the defence to filariae. However, neither pharmaceutical inhibition of nitric oxide synthesis, nor genetic knockout of the gene for inducible nitric oxide synthase (iNOS), abrogated resistance to circulating mf in mice. Interestingly, however, iNOS-KO mice showed higher interleukin (IL)-2 responses and lower IL-10 production, compared to their wild-type counterparts. In conclusion, despite its effectiveness in vitro and the observed production of NO by ex vivo cells following infection, nitric oxide seems not to be an important factor in elimination of mf of L. sigmodontis in vivo. However, it may have a regulatory role in the immune response.

The sequestration hypothesis: an explanation for the sensitivity of malaria parasites to nitric oxide-mediated immune effector function in vivo

While the effect of reactive nitrogen intermediates (RNI) against macrophage-dwelling protozoa, such as Leishmania and Toxoplasma has become established, the possible antiparasitic function of nitric oxide (NO) and RNI against the intracellular blood stages of malaria and babesia has, until recently, been less well accepted. This was, at least in part, due to the long-standing notion that haemoglobin (Hb) universally scavenges NO and thus that erythrocytes act as a permanent sink for this molecule. It is now known that NO can be released as well as scavenged by Hb, and that the less oxygenated the blood the lower the affinity of Hb for NO. As a consequence, NO is preferentially released by venous erythrocytes. Based on the increased sensitivity of Plasmodium falciparum -infected erythrocytes to RNI in venous blood that was recently demonstrated, it is proposed that the noted greater susceptibility of mature intra-erythrocytic forms of malaria, late-stage schizonts, is coincidental with their peripheral blood withdrawal by sequestration to deep-tissue capillaries. This environment is non NO-scavenging in nature and one which would bring schizonts and macrophages into intimate proximity, providing diffusion distances sufficiently short for RNI to be effective. Given its short half-life, this hypothesis explains the potential for NO to be toxic for malaria parasites in vivo, and suggests that sequestration, a mechanism adopted by the parasite to supposedly avoid immune surveillance, may in fact have a partially counteractive effect.

Increased production of acute-phase proteins corresponds to the peak parasitaemia of primary malaria infection

Recent studies have implicated non-specific mediators associated with CD4+ T cells of the T helper 1 subset in resistance to experimental malarias. As part of continuing studies into the multifactorial role of nitric oxide and other contributors to the innate immune response in control of acute-phase malaria infection, the production of the acute-phase proteins, caeruloplasmin and serum amyloid P, following infection of naive mice with blood stages of the rodent malaria parasite Plasmodium chabaudi was investigated. Levels of both acute-phase proteins in the serum of infected mice were significantly elevated on days 7-12 post-infection compared both to other times of infection, and to background levels detected in uninfected control mice. These times corresponded to the ascending and peak primary parasitaemia, when production of interferon-gamma, tumour necrosis factor-alpha and nitric oxide is known to be raised. Although it is not apparent whether the production of caeruloplasmin and serum amyloid P has a causal effect in reducing parasitaemia or is simply a by-product of innate immunity, the detection of increased levels of circulating acute-phase proteins may act as a useful surrogate marker of high level parasitaemia, and therefore, of blood-borne malaria pathology.

Potentiation by febrifugine of host defense in mice against Plasmodium berghei NK65

The effect of febrifugine, the main alkaloidal constituent of an antimalarial crude drug, Dichroa febrifuga Lour., on protective immunity in mice infected with erythrocytic stage Plasmodium berghei NK65 was investigated. Febrifugine was administered orally, at a dose of 1 mg/kg/day, to mice before and/or after they were infected intraperitoneally with 2 x 10(6) parasitized red blood cells. Then, mortality and the levels of parasitemia and plasma NO3- [a degradation product of nitric oxide (NO)] were monitored. Febrifugine significantly reduced the mortality and the level of parasitemia. The plasma NO3- concentration began to rise within 2 days after treatment with febrifugine and declined to normal in 2 days when the mice were treated orally with febrifugine once a day for 3 consecutive days before parasite infection. This antimalarial activity of febrifugine was reduced by both N(G)-monomethyl-L-arginine and aminoguanidine. These results indicate that the increased production of NO by febrifugine plays an important role in host defense against malaria infection in mice.

A role for cytokines in potentiation of malaria vaccines through immunological modulation of blood stage infection

Malaria is the world's major parasitic disease, for which effective control measures are urgently needed. One of the difficulties hindering successful vaccine design against Plasmodium is an incomplete knowledge of antigens eliciting protective immunity, the precise types of immune response for which to aim, and how these can be induced. A greater appreciation of the mechanisms of protective immunity, on the one hand, and of immunopathology, on the other, should provide critical clues to how manipulation of the immune system may best be achieved. We are studying the regulation of the balance between T helper 1 (Th1) and T helper 2 (Th2) CD4+ T lymphocytes in immunity to asexual blood stages of malaria responsible for the pathogenicity of the disease. Protective immunity to the experimental murine malarias Plasmodium chabaudi and Plasmodium yoelii involves both Th1 and Th2 cells, which provide protection by different mechanisms at different times of infection characterised by higher and lower parasite densities, respectively. This model therefore facilitates a clearer understanding of the Th1/Th2 equilibrium that appears central to immunoregulation of all host/pathogen relationships. It also permits a detailed dissection in vivo of the mechanisms of antimalarial immunity. Here, we discuss the present state of malaria vaccine development and our current research to understand the factors involved in the modulation of vaccine-potentiated immunity.

A dichotomous role for nitric oxide in protection against blood stage malaria infection

Nitric oxide (NO) is cytotoxic and cytostatic to blood stage malaria parasites in vitro, but the precise mechanism(s) by which it mediates an effect in vivo is not known. In particular, whether or not control of acute parasitemia depends on the presence of NO is unclear. We have shown previously that blocking NO synthesis at the time of its induction may cause an increase in peak primary parasitemia during infection of mice with Plasmodium chabaudi, suggesting that NO may be parasiticidal in vivo. However, as recent data indicate that NO suppresses Th1 cell proliferation in vitro by downregulating IL-2 production, we have investigated whether this immunoregulatory function of NO affects its capacity for anti-malarial activity. Treatment of P. chabaudi-infected mice with the iNOS inhibitor aminoguanidine hemisulfate (AG) starting just prior to the peak of primary parasitemia caused a significant elevation and extension of the acute infection and led to a partial but significant abrogation of the suppression of spleen cell proliferation to both mitogen and specific antigen observed when NO synthesis was not blocked. In the absence of NO, levels of IL-2, but not of IFN-gamma, TNF-alpha, or of any Th2-regulated cytokines examined, increased significantly. However, when AG treatment was brought forward to the early ascending phase of primary parasitemia, significantly increased levels of IFN-gamma and TNF-alpha, as well as of IL-2, were observed over those for infected control mice similarly treated with phosphate-buffered saline. Moreover, despite the absence of NO, parasitemias of AG-treated mice were not significantly elevated. The effect of AG therefore appeared to be dependent upon the timing of its administration in vivo. We propose that during malaria infections, there is a dynamic balance between the regulatory and anti-parasitic roles of NO. While the immunosuppressive function of NO leads to a downregulation in vivo of production of IL-2, and indirectly of IFN-gamma and TNF-alpha, this perceived weakening of the host cell-mediated immune response is in part masked by the protective anti-malarial effects of NO itself.

Babesia bovis immunity. In vitro and in vivo evidence for IL-10 regulation of IFN-gamma and iNOS

IL-10 has been shown to have profound immunoregulatory attributes and in the bovine appears to downregulate both Th1- and Th2-like responses. Using RT-PCR, we demonstrate IL-10 in vitro down-regulation of mRNA expression of iNOS, the cytokines involved in nitric oxide signal transduction initiation (IFN-gamma and TNF-alpha), and other mononuclear phagocyte associate cytokines. In addition, using RT-PCR with peripheral blood leukocytes and spleen leukocytes, the Griess reaction, and a killing assay, we provide evidence for the importance of iNOS in a successful immune response to B. bovis infection and for high and persistent IL-10 mRNA expression when the immune response is unsuccessful. We also provide evidence that antibody developed early after an initial infection appears to lack protective attributes (neutralizing and opsonic). Together, the data suggests that IL-10 and IFN-gamma are critical molecules involved in the response to this intraerythrocytic protozoan infection.

Immunoregulation of malarial infection: balancing the vices and virtues

Malaria continues to extract an incalculable cost on human morbidity and mortality throughout tropical and subtropical regions of the world, and effective control measures are urgently needed. Despite considerable efforts in recent years to develop subunit vaccines targeted at various stages of the Plasmodium life-cycle, the commercial availability of a vaccine is still a distant prospect. One of the underlying difficulties hindering successful vaccine design is our incomplete knowledge of the precise type(s) of immune response to aim for, and then how to achieve it. A greater appreciation of the mechanisms of protective immunity, on the one hand, and of immunopathology, on the other, should provide critical clues on how manipulation of the immune system may best be achieved. Ten years have passed since the identification of the Th1/Th2 paradigm for distinguishing CD4+ T cells according to cytokine secretion patterns which determine their function. This review summarises our progress towards understanding the broad spectrum of immune responsiveness to the blood stages of the malaria parasite during experimental infections in mice and highlights the way in which examination of rodent malarias provides a powerful tool to dissect the interaction of Th1 and Th2 cells during an immune response to an infectious disease agent. It is proposed that the pliability of rodent systems for investigating immunoregulation provides valuable insight into the balance between protection and pathology in human malaria and throws light on the factors involved in the modulation of vaccine-potentiated immunity.

Inhibition of IL-2 production by nitric oxide: a novel self-regulatory mechanism for Th1 cell proliferation

Cloned Th1 cells, but not Th2 cells, specific for malaria antigen, produce nitric oxide (NO) when activated with specific antigen or Con A. Furthermore, NO inhibits proliferation of, and production of IL-2 and IFN-gamma by, Th1 but not Th2 cells. Here, it is demonstrated that the inhibition of Th1 cell proliferation by the NO donor S-nitroso-N-acetyl penicillamine (SNAP) can be reversed by the addition of rIL-2 but not of rIFN-gamma, suggesting that the inhibition of Th1 cells by NO may be preventing the production of IL-2. Dose-response studies showed that Th1 cells produce optimal levels of IL-2 and a proliferative response, and no detectable NO, when stimulated with relatively low concentrations of antigen or mitogen in vitro. As the antigen/mitogen increased, however, high levels of NO were produced, accompanied by a concomitant reduction in IL-2 secretion and T cell proliferation. The proliferation of, and IL-2-IFN-gamma production by, naive CD4+ T cells from normal spleens activated with Con A in vitro can be similarly inhibited by SNAP. These results suggest that NO may serve as a self-regulatory molecule preventing the over-expansion of Th1 cells. Unrestricted Th1 cell activity has been implicated in a range of immunopathologies and autoimmune diseases. The proposed mechanism for down-regulation of Th1 cell function may also account for the suppression of lymphocyte proliferation observed in malaria infections.