Drug-Resistance ofTrypanosoma Congolenseand other Trypanosomes to Quinapyramine, Phenanthridines, Berenil and other Compounds in Mice

Drug resistance in animal trypanosomiases: Epidemiology, mechanisms and control strategies

Animal trypanosomiasis (AT) is a complex of veterinary diseases known under various names such as nagana, surra, dourine and mal de caderas, depending on the country, the infecting trypanosome species and the host. AT is caused by parasites of the genus Trypanosoma, and the main species infecting domesticated animals are T. brucei brucei, T. b. rhodesiense, T. congolense, T. simiae, T. vivax, T. evansi and T. equiperdum. AT transmission, again depending on species, is through tsetse flies or common Stomoxys and tabanid flies or through copulation. Therefore, the geographical spread of all forms of AT together is not restricted to the habitat of a single vector like the tsetse fly and currently includes almost all of Africa, and most of South America and Asia. The disease is a threat to millions of companion and farm animals in these regions, creating a financial burden in the billions of dollars to developing economies as well as serious impacts on livestock rearing and food production. Despite the scale of these impacts, control of AT is neglected and under-resourced, with diagnosis and treatments being woefully inadequate and not improving for decades. As a result, neither the incidence of the disease, nor the effectiveness of treatment is documented in most endemic countries, although it is clear that there are serious issues of resistance to the few old drugs that are available. In this review we particularly look at the drugs, their application to the various forms of AT, and their mechanisms of action and resistance. We also discuss the spread of veterinary trypanocide resistance and its drivers, and highlight current and future strategies to combat it.

Diminazene resistance in Trypanosoma congolense is not caused by reduced transport capacity but associated with reduced mitochondrial membrane potential

Trypanosoma congolense is a principal agent causing livestock trypanosomiasis in Africa, costing developing economies billions of dollars and undermining food security. Only the diamidine diminazene and the phenanthridine isometamidium are regularly used, and resistance is widespread but poorly understood. We induced stable diminazene resistance in T. congolense strain IL3000 in vitro. There was no cross-resistance with the phenanthridine drugs, melaminophenyl arsenicals, oxaborole trypanocides, or with diamidine trypanocides, except the close analogs DB829 and DB75. Fluorescence microscopy showed that accumulation of DB75 was inhibited by folate. Uptake of [³ H]-diminazene was slow with low affinity and partly but reciprocally inhibited by folate and by competing diamidines. Expression of T. congolense folate transporters in diminazene-resistant Trypanosoma brucei brucei significantly sensitized the cells to diminazene and DB829, but not to oxaborole AN7973. However, [³ H]-diminazene transport studies, whole-genome sequencing, and RNA-seq found no major changes in diminazene uptake, folate transporter sequence, or expression. Instead, all resistant clones displayed a moderate reduction in the mitochondrial membrane potential Ψm. We conclude that diminazene uptake in T. congolense proceed via multiple low affinity mechanisms including folate transporters; while resistance is associated with a reduction in Ψm it is unclear whether this is the primary cause of the resistance.

Whole-organism high-throughput screening against Trypanosoma brucei brucei

INTRODUCTION

Human African trypanosomiasis (HAT) occurs as a result of infection with the protozoan parasites Trypanosoma brucei gambiense and T.b. rhodesiense and is nearly always fatal without treatment. However, current therapeutic options are severely limited and there is a desperate need for new compounds to treat the disease. Whole-cell high-throughput screening (HTS) is a technique frequently used to identify compounds with trypanocidal activity.

AREAS COVERED

The authors examine the development of whole-organism HTS assays for T.b. brucei. The authors describe the successes achieved through HTS and discuss the advantages and disadvantages of whole-organism HTS.

EXPERT OPINION

Despite hundreds of trypanocidal molecules being identified by whole-organism HTS, very few have progressed into preclinical development. The failure of molecules identified by HTS to progress along the drug development pathway is due to a multitude of factors including undrug-like molecules and molecules having poor pharmacodynamics/kinetic properties. Future studies should focus on screening libraries that contain drug-like molecules that possess some of the properties required in the final compound.

Standardised tests in mice and cattle for the detection of drug resistance in tsetse-transmitted trypanosomes of African domestic cattle

Resistance to the drugs used to control African animal trypanosomosis is increasingly recognised as a constraint to livestock production in sub-Saharan Africa. The most commonly used tests for detection of trypanocidal drug resistance are tests using mice or ruminants, but these suffer from lack of standardisation and hence it may be difficult to compare the results of different investigators. Tests in mice are less expensive than tests in ruminants, but while tests in mice they may be useful as a general guide to resistance in a geographic area they should not be extrapolated to cattle on an individual trypanosome level. Moreover, the commonly used protocols are too laborious for their application to large number of trypanosome isolates on an area-wide basis. This paper presents guidelines for standardised testing of trypanocidal drugs in vivo, and introduces a simplified single-dose test for use in mice, which is convenient for use in areas with limited laboratory facilities. The single-dose test is appropriate for characterisation of geographic areas in terms of trypanocidal drug resistance using large numbers of trypanosome isolates, for making comparisons between areas, and for monitoring changes in trypanocidal drug resistance over time. Multiple-dose tests may be used to determine the degree of resistance of individual stabilates to be determined precisely in mice are also described, but for logistical reasons these will rarely be conducted on more than a few stabilates, and testing of a larger number of stabilates in the single-dose test will generally provide more useful information. Finally, we describe tests in cattle that may be used to determine the efficacy of recommended curative doses of trypanocidal drugs for the treatment of infection with individual trypanosome isolates, including Trypanosoma vivax, which is rarely infective for mice.

The in vitro effects of isometamidium chloride (Samorin) on the piscine hemoflagellate Cryptobia salmositica (Kinetoplastida, Bodonina)

Isometamidium chloride (Samorin) is therapeutic in rainbow trout (Oncorhynchus mykiss) during preclinical and chronic cryptobiosis. However, the toxic mechanism of isometamidium on Cryptobia salmositica has not been elucidated. The objective of the present study was to examine the in vitro effects of isometamidium on C. salmositica. Under in vitro conditions, isometamidium chloride reduced the infectivity of C. salmositica suspended in whole fish blood. It accumulated rapidly in the kinetoplast (within 1 min) and caused disruption and decantenation of kinetoplast DNA. The in vitro cryptobiacidal activity of isometamidium was reduced when parasites were incubated in medium containing serum supplement, suggesting that isometamidium also binds to plasma proteins. Isometamidium altered glycoprotein receptors (epitopes) for antibodies on the surface of C. salmositica and thus protected some of the parasites from lysis by complement-fixing antibodies. In vitro oxygen consumption and carbon dioxide production decreased in drug-exposed C. salmositica, with increased products of glycolysis, i.e., lactate and pyruvate, after exposure to isometamidium. This suggests that some C. salmositica switched from aerobic respiration to glycolysis when the mitochondrion was damaged by isometamidium.

Drug resistance in Sudanese Trypanosoma evansi

The drug sensitivities of 16 Trypanosoma evansi isolates from Sudan were examined using two different in vitro assays and rodent models. IC50 values (concentration which inhibited incorporation of 3H-hypoxanthine by 50%) obtained in a 40 h assay indicate that most of the isolates were resistant to suramin, a drug which has not been used in Sudan since 1975. Sensitivities for suramin in a 10-day-in vitro assay varied within a 124-fold range. The in vitro results were confirmed by infection/treatment experiments in mice. Sensitivities in vitro for quinapyramine varied within a 166-fold range. In mice, the least sensitive isolates were not cured with dosages up to 10 mg/kg quinapyramine. Based on in vitro results, all isolates appeared to be susceptible to isometamidium.

Resistance to diminazine aceturate by Trypanosoma congolense from cattle in the Zambezi Valley of Zimbabwe

The susceptibility of 14 stocks of Trypanosoma congolense, recently isolated from cattle, to therapeutic doses of diminazene aceturate and to isometamidium chloride was assessed in laboratory mice. Eight isolates were readily susceptible to the normal therapeutic dose of diminazene, two were resistant to the drug at 14 mg kg-1, and four were totally resistant at 28 mg kg-1. All the isolates were susceptible to isometamidium chloride at 0.5 mg kg-1. These observations highlight the need for regular evaluation of drugs used in the control of trypanosomosis.

Frequency of diminazene-resistant trypanosomes in populations of Trypanosoma congolense arising in infected animals following treatment with diminazene aceturate

The frequency of trypanosomes resistant to diminazene aceturate at a dose of 25 mg/kg of body weight was investigated for populations of Trypanosoma congolense IL 3274 which reappeared in infected mice after intraperitoneal treatment with diminazene aceturate at the same dosage. At inoculum sizes of 10(2), 10(3), 10(4), 10(5), and 10(6) trypanosomes per mouse, the relapse populations were used to initiate infections in five groups of 100 mice each by the intravenous route. Immediately after infection, 50 mice in each group were treated intraperitoneally with diminazene aceturate at the aforementioned dosage; the other 50 mice functioned as untreated controls. Thereafter, all animals were monitored for 100 days for the presence of trypanosomes. In each group, trypanosomes were detected in 50 of 50 control mice, indicating 100% infectivity for all five inoculum sizes. In contrast, in the groups of 50 mice infected with 10(2), 10(3), 10(4), 10(5) and 10(6) trypanosomes and treated with diminazene aceturate, trypanosomes were detected in 4, 11, 13, 28, and 39 of 50 mice, respectively. By logistic regression, a good fit was found between the number of mice identified as parasitemic and the inoculum sizes. Maximum likelihood estimates for the proportions of trypanosomes resistant to diminazene aceturate at 25 mg/kg of body weight for the inoculum of 10(2), 10(3), 10(4), 10(5), and 10(6) organisms were 8.335 x 10(-4), 2.485 x 10(-4), 3.02 x 10(-5), 8.3 x 10(-6), and 1.6 x 10(-6), respectively. These finding indicate that the majority of the relapse trypanosomes were susceptible the the drug dosage used for selecting the population and that, surprisingly, the calculated proportion of organisms which survived drug exposure varied inversely with the inoculum size. Further experiments with mice indicated that the inverse relationship did not result from alterations in the pharmacokinetics of the drug with different inoculum sizes. The data therefore suggest that parasite inoculum size and drug dosage are important factors in estimating the apparent frequency of diminazene-resistant trypanosomes in populations of T. congolense occurring in vivo.

In vitro assays to determine drug sensitivities of African trypanosomes: a review

In vitro test methods have been developed both for determining the sensitivity of isolates of pathogenic African trypanosomes and for evaluating new compounds for antitrypanosomal activity. The principles of the assays and their main advantages or drawbacks are presented and discussed. In vitro assays which do not require trypanosomes pre-adapted to culture conditions are the Drug Incubation Infectivity Test (DIIT) and the [3H]Hypoxanthine Incorporation Assay. Chemosensitivity tests which do require continuous growth of trypanosomes in vitro include photometric, fluorescence, growth inhibition, long-term viability and metacyclic incubation assays. Evidence is presented to use metacyclic or bloodstream forms in such assays but to avoid procyclic trypanosomes. The drug sensitivity of a homogeneous trypanosome population can be quantified by using photometric, fluorescence or growth inhibition assays lasting 1-3 days. Small numbers of resistant organisms hidden in a sensitive population can be detected employing long-term viability assays (7-10 days). Final selection of the assay to be employed will depend on the parameter to be investigated, and the equipment available.

Pharmacology of diminazene: a review

Chemotherapy for trypanosomiasis in domestic livestock depends on only a few compounds, of which several are chemically closely related. Of these compounds, the most widely used therapeutic agent in cattle, sheep and goats is diminazene aceturate. Diminazene was first described in 1955. Subsequently, a substantial body of data has been generated on various pharmacological aspects of the compound. In this review, we consider the current status of knowledge concerning the therapeutic spectrum of diminazene, resistance to diminazene in trypanosomes, and combination therapeutic regimens in which diminazene has been administered together with other compounds. Analytical techniques for diminazene, the pharmacokinetics of diminazene, data concerning diminazene's toxicity, and the different molecular mechanisms by which diminazene may exhibit trypanocidal action are also considered.

Derivation and characterization of a quinapyramine-resistant clone of Trypanosoma congolense

Over a period of 208 days a quinapyramine-resistant population was derived in vivo from a quinapyramine-susceptible clone of Trypanosoma congolense: IL 1180. While the dose of quinapyramine sulfate required to cure 50% of mice infected with the parental clone was 0.23 mg/kg of body weight, the 50% curative dose for the resistant derivative, IL 1180/Stabilate 12, was greater than 9.6 mg/kg. This approximately 40-fold increase in resistance to quinapyramine was shown to be associated with an 8-fold increase in resistance to isometamidium, a 28-fold increase in resistance to homidium, and a 5.5-fold increase in resistance to diminazene. Cross-resistance to homidium and diminazene was also demonstrated in goats. Two clones derived from the drug-resistant derivative underwent cyclical development in Glossina morsitans centralis, producing mature infection rates of 39.6 and 23.9%. Thus, induction of resistance to quinapyramine in T. congolense IL 1180 was associated with cross-resistance to isometamidium, homidium, and diminazene and did not compromise the population's ability to undergo full cyclical development in tsetse flies.

The effect of diminazene aceturate and isometamidium chloride on cultured procyclic forms of susceptible and drug-resistant Trypanosoma congolense

Cultures of insect forms of Trypanosoma congolense stocks and clones with different susceptibilities to trypanocidal drugs in vivo were initiated from bloodstream trypomastigotes harvested from mammalian hosts and maintained axenically in vitro at 27 degrees C. Growth inhibition of procyclic forms of susceptible and drug-resistant T. congolense occurred after incubation for 48 h with 0.1 ng isometamidium chloride ml or 500 ng diminazene aceturate/ml. Procyclic forms were propagated in vitro in the presence of 10 or 100 ng diminazene aceturate/ml for 20 days without or with only minor loss of growth. In the presence of 0.1 or 1 ng isometamidium chloride/ml the trypanocidal effect was detectable after 6-8 days and the cultures died after 10-12 days. Concentrations of 1 or 10 ng isometamidium chloride/ml had an irreversible effect when the trypanosomes were exposed to the drug for 24 h. Both drugs used in this study thus showed antitrypanosomal activity on T. congolense procyclic forms but it was not possible to distinguish between drug-resistant and susceptible stocks or clones employing the criteria of growth inhibition or death of trypanosomes in culture.

Variation in resistance to isometamidium chloride and diminazene aceturate by clones derived from a stock of Trypanosoma congolense

Nine clones were derived from a drug-resistant Trypanosoma congolense stock (IL 2856) and characterized in mice for their sensitivity to isometamidium chloride and diminazene aceturate. All clones were derived from the stock without drug selection and expressed high levels of resistance to isometamidium chloride (50% curative dose [CD50] values ranging from 1.5 to 5.1 mg/kg) and intermediate to high levels of resistance to diminazene aceturate (CD50 values ranging from 5.1 to 21.0 mg/kg). By contrast, the isometamidium chloride and diminazene aceturate CD50 values for a drug-sensitive clone, T. congolense IL 1180, were 0.018 mg/kg and 2.3 mg/kg, respectively. For both drugs, there appeared to be significantly different levels in expression of drug resistance amongst the 9 clones derived from IL 2856. Isoenzyme analysis of 7 enzymes showed that all 9 clones expressed the same electrophoretic variants. Thus, all 9 clones were identical for these phenotypic markers. The clone which expressed the highest level of resistance to isometamidium in mice (IL 3270) was transmitted to Boran cattle via the bite of infected Glossina morsitans centralis. IL 3270 produced an infection rate in tsetse of 5.0%. The resulting infections in cattle were shown to be resistant to intramuscular treatment with 2.0 mg/kg isometamidium chloride and 14.0 mg/kg diminazene aceturate. This contrasts with doses of 0.25 mg/kg isometamidium chloride or 3.5 mg/kg diminazene aceturate which are deemed sufficient to cure fully sensitive infections. Finally, 9 clones (subclones) were derived from IL 3270 and characterized in mice for their sensitivity to isometamidium chloride.(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of resistance to isometamidium and diminazene in Trypanosoma congolense in Boran cattle infected by Glossina morsitans centralis

Investigations were conducted on the sensitivity to isometamidium chloride (Samorin) and diminazene aceturate (Berenil) of derivatives of three of the Trypanosoma congolense stocks isolated between 1978 and 1983 from Zebu cattle in the Bobo-Dioulasso region of Burkina Faso. Boran cattle were used in the drug-sensitivity tests and were infected using Glossina morsitans centralis. The results showed that T. congolense stock IL 2466 isolated in 1978 was sensitive to the standard therapeutic dose of isometamidium chloride (0.25 mg kg-1) and of diminazene aceturate (a.i. 3.5 mg kg-1). However, T. congolense stock IL 2468 isolated in 1982 was resistant to both the prophylactic (0.5 and 1.0 mg kg-1) as well as the therapeutic doses of isometamidium chloride (up to 1.0 mg kg-1) although the sensitivity to the therapeutic dose of diminazene aceturate (3.5 mg kg-1) was not affected. The T. congolense stock IL 2856 isolated in 1983 was highly resistant to the therapeutic action of diminazene aceturate (up to 10.5 mg kg-1), as well as to the prophylactic (up to 1.0 mg kg-1) and therapeutic action of isometamidium chloride (up to 2.0 mg kg-1). The infection rates of the drug-resistant stocks of T. congolense in G.m. centralis, when goats were used as reservoir hosts, were as high (range, 22.3-56.3%) as of the drug sensitive stock (49.5%). The resistance trait in the two stocks remained stable after their cyclical development in the tsetse vectors. The rate of transmission of the drug-resistant stocks to mice by the infected tsetse was also high (mean 81.3%).

A drug incubation infectivity test (DIIT) for assessing resistance in trypanosomes

Blood stream forms of drug-resistant and sensitive Trypanosoma brucei brucei, Trypanosoma brucei evansi and Trypanosoma vivax were incubated in a liquid medium for 24 h at 37 degrees C in the presence of various concentrations of diminazene aceturate (Berenil) or isometamidium chloride (Samorin), and assayed for infectivity in mice. Whereas the infectivity to mice of all Samorin-sensitive trypanosomes was decreased after incubation with 1 ng Samorin ml-1, the Samorin-resistant stocks remained infective for mice. Two of the Samorin-resistant stocks remained infective after incubation with Samorin concentrations of up to 50 ng ml-1. The infectivity of Berenil-resistant trypanosome stocks were also retained after incubation with drug concentrations (0.5 or 1.0 micrograms ml-1) which otherwise inhibited the infectivity of Berenil-sensitive trypanosome stocks. In addition, differences in infectivity were observed when Berenil-resistant and sensitive trypanosome stocks were incubated in medium supplemented with serum from goats previously treated with Berenil. Thus, drug-resistant and sensitive trypanosomes can be clearly distinguished using the drug incubation infectivity test.

Trypanosoma congolense: drug resistance during cyclical transmissions in tsetse flies and syringe passages in mice

A drug-resistant Trypanosoma congolense strain with predetermined curative doses (CD50 and CD90) of samorin at 13.9 +/- 1.02 and 20.3 +/- 1.13 mg/kg body weight, respectively, was cyclically transmitted through tsetse flies and by syringe passages in mice in the absence of drug pressure. The changing levels of drug sensitivity were determined after every 3rd cyclic and 5th syringe passage intervals. It was noted that when the strain was maintained in tsetse flies through 12 cyclical transmissions, the CD50 and CD90 dropped slightly from 13.9 to 11.9 +/- 1.06 and from 20.3 to 18.0 +/- 1.08 mg/kg body weight, respectively. This decrease in the level of resistance was not significant (P greater than 0.05). However, when the trypanosomes were maintained by syringe passages in mice, there was a significant reduction (P less than 0.05) in the degree of resistance (CD50 from 13.9 to 11.4 +/- 1.07 and CD90 from 20.3 to 16.7 +/- 1.16 mg/kg), by the 15th syringe passage.

Gas chromatography chemical ionization mass spectrometric analysis of diminazene in plasma

A quantitative and sensitive method was developed for the determination of diminazene in plasma. The assay involves the reduction of diminazene to 4-aminobenzamidine and 4-hydrazinobenzamidine. The latter is further reduced to give an additional mole of 4-aminobenzamidine which is extracted, acetylated and condensed with hexafluoroacetylacetone to form a volatile derivative that is subsequently analyzed by gas chromatography chemical ionization mass spectrometry. 4-Aminobenzylamidine was synthesized and used as an internal standard. The method is reproducible and its sensitivity limit using 1 ml of plasma is 0.1 microgram diminazene ml-1. This sensitivity limit is sufficient to detect plasma levels in cattle following therapeutic doses of the drug.

The cyclical transmission of strains of Trypanosoma congolense and T. vivax resistant to normal therapeutic doses of trypanocidal drugs

Two strains of T. congolense and two strains ofT. vivax,resistant to normal therapeutic doses of trypanocidal drugs, were transmitted byG. morsitansandG. tachinoidesthrough series of cattle in the absence of drugs to assess the transmissibility of the trypanosomes by tsetse flies and the stability of drug resistance in the organisms during cyclical development.

The characteristics of both strains ofT. vivaxand one strain ofT. congolensewere typical of the species, but the infectivity of the second strain ofT. congolensefor laboratory animals was abnormally low.

The transmissibility of the trypanosomes was assessed on the bases of the infection rates in tsetse flies used to transmit the strains and the periods required for the development of the trypanosomes in the flies and bovine hosts. The transmissibilities of both strains ofT. vivaxand the first strain ofT. congolensewere normal by comparison with data obtained by cyclically transmitting non-resistant trypanosomes of the same species, but the period required for the development of the second strain ofT. congolensein tsetse flies was abnormally long.

There was no loss of drug resistance in any of the strains examined in the experiments. A strain ofT. congolenseretained resistance to diminazene aceturate at a dose rate of 7-0 mg/kg, homidium chloride at 2-0 mg/kg, quinapyramine sulphate at 4-4 mg/kg and isometamidium chloride at 0-5 mg/kg during a series of eight transmissions by tsetse flies in a period of 376 days.