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Coulibaly YI, Diabate AF, Sangare M, Thera SO, Dolo H, Doumbia SS, Coulibaly SY, Diarra A, Diarra L, Tanapo D, Coulibaly ME, Soumaoro L, Diallo AA, Zeguime A, Sanogo Y, Berthe A, Konipo FDN, Mackenzie C, Stephens M, Shott JP, Norman J, Klarmann-Schulz U, Hoerauf A, Majewski A, Horton J, Sullivan S, Ottesen EA, Nutman TB. Effect of Adding a Six-Week Course of Doxycycline to Intensive Hygiene-Based Care for Improving Lymphedema in a Rural Setting of Mali: A Double-Blind, Randomized Controlled 24-Month Trial. Am J Trop Med Hyg 2024; 111:22-32. [PMID: 39013374 PMCID: PMC11448486 DOI: 10.4269/ajtmh.23-0908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/09/2024] [Indexed: 07/18/2024] Open
Abstract
Lymphedema (LE) is one the most disfiguring chronic manifestations of lymphatic filariasis. Its management relies primarily on limb hygiene and local care. A previous study in Ghana demonstrating a beneficial effect of doxycycline on LE led to the current multicenter trial on the efficacy of doxycycline in filarial LE. A randomized placebo-controlled trial was initiated in two rural health districts in Mali. Patients with LE stages 1-3 were randomized to receive either doxycycline (200 mg/day) or placebo over a 6-week monitored treatment period and were then followed every 6 months for 2 years. Both groups received materials for limb hygiene that was carried out daily for the entire 2-year study. The primary endpoint was lack of progression in LE stage at 24 months. One hundred patients were enrolled in each study arm. The baseline sociodemographic characteristics of each group were largely similar. There was no significant difference at month 24 after treatment initiation in the number of subjects showing progression in LE stage between the two treatment arms (P = 0.5921). Importantly, however, the number of attacks of acute adenolymphangitis (ADLA) was reduced in both arms, but there was no significant difference between the two groups at any follow-up time point (all P >0.23). Doxycycline was well tolerated in those receiving the drug. When added to daily self-administered limb hygiene, a 6-week course of doxycycline (200 mg) was not superior to placebo in increasing the improvement associated with hygiene alone in LE volume, stage, or frequency of ADLA attacks over a 24-month period.
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Affiliation(s)
- Yaya I. Coulibaly
- International Center for Excellence in Research, Bamako, Mali
- Dermatology Hospital of Bamako, Bamako, Mali
| | | | - Moussa Sangare
- International Center for Excellence in Research, Bamako, Mali
| | - Sekou O. Thera
- International Center for Excellence in Research, Bamako, Mali
| | - Housseini Dolo
- International Center for Excellence in Research, Bamako, Mali
| | | | | | - Ayouba Diarra
- International Center for Excellence in Research, Bamako, Mali
| | - Lamine Diarra
- International Center for Excellence in Research, Bamako, Mali
| | - Diadje Tanapo
- International Center for Excellence in Research, Bamako, Mali
| | | | - Lamine Soumaoro
- International Center for Excellence in Research, Bamako, Mali
| | | | | | - Yacouba Sanogo
- International Center for Excellence in Research, Bamako, Mali
| | - Adama Berthe
- International Center for Excellence in Research, Bamako, Mali
| | | | - Charles Mackenzie
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia
- The Reaching the Last Mile Fund, The End Fund, New York, New York
| | - Mariana Stephens
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia
| | - Joseph P. Shott
- Division of Neglected Tropical Diseases, Global Health Bureau, Bethesda, Maryland
| | - Jayla Norman
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia
| | - Ute Klarmann-Schulz
- Institute for Medical Microbiology, Immunology and Parasitology, German Centre for Infection Research (DZIF), Bonn-Cologne Site, University Hospital Bonn, Bonn, Germany
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology, German Centre for Infection Research (DZIF), Bonn-Cologne Site, University Hospital Bonn, Bonn, Germany
| | - Andrew Majewski
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia
| | | | - Sarah Sullivan
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia
| | - Eric A. Ottesen
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia
| | - Thomas B. Nutman
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
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2
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Ngenya A, Klarmann-Schulz U, John W, Korir PJ, Kamugisha M, Nadal J, Moshi D, Ricchiuto A, Oriyo N, Sullivan SM, Laizer R, Horton J, Demitrius M, Feichtner A, Marandu TF, Mgaya Y, Kellings A, Kroidl I, Ogondiek J, Kuehlwein JM, Masagati L, Mackenzie C, Mosoba M, Horn S, Kagya K, Wanji S, Mandara W, Debrah LB, Ottesen EA, Debrah AY, Mwingira U, Hoerauf A, Kalinga A. Efficacy of Intensified Hygiene Measures with or without the Addition of Doxycycline in the Management of Filarial Lymphedema: A Randomized Double-Blind, Placebo-Controlled Clinical Trial in Tanzania. Am J Trop Med Hyg 2024; 111:33-51. [PMID: 39191236 PMCID: PMC11448492 DOI: 10.4269/ajtmh.24-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/29/2024] [Indexed: 08/29/2024] Open
Abstract
Lymphedema, hydrocele, and acute adenolymphangitis (ADL) are chronically disabling consequences in patients with lymphatic filariasis (LF). Provision of morbidity management and disability prevention and concurrent mass drug administration of anthelmintics are two pillars for elimination of LF. This study assessed the impact of strict hygiene protocols with or without doxycycline on the progression of filarial lymphedema. A randomized, placebo-controlled, double-blind trial was conducted in two regions in Tanzania. We enrolled 362 participants with lymphedema stages 1-3 assigned into three treatment groups of doxycycline 200 mg once daily, doxycycline 100 mg once daily, or matching placebo for 42 days in addition to hygiene measures. The participants were followed every 2 months for 2 years. Twenty-four months after treatment onset, 17.7% of participants displayed improved limb conditions, including 15/104 (14.4%) in the doxycycline 200 mg group, 16/105 (15.2%) in the doxycycline 100 mg group, and 25/107 (23.4%) in the placebo group. During the first 6 months after treatment, the number of participants experiencing an ADL attack was significantly lower in the doxycycline groups than in the placebo group. The study also found that hygiene was one of the factors associated with preventing the occurrence of acute attacks over the whole study period. Doxycycline 100 mg was a significant factor for the halt of progression (odds ratio: 0.53, P = 0.0239) when both legs if affected at baseline were considered. These findings emphasize the importance of practicing hygiene in reducing the occurrence of ADL attacks and the benefits of doxycycline with regards to acute attacks and halt of progression.
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Affiliation(s)
- Abdallah Ngenya
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Ute Klarmann-Schulz
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research, partner site Bonn-Cologne, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Winfrida John
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Patricia Jebett Korir
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research, partner site Bonn-Cologne, Bonn, Germany
| | | | - Jennifer Nadal
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Dennis Moshi
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Arcangelo Ricchiuto
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Ndekya Oriyo
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Sarah Mary Sullivan
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia
| | - Ruth Laizer
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Max Demitrius
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Anja Feichtner
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the Ludwig-Maximilians-University, Munich, Germany
- German Center for Infection Research, partner site Munich, Munich, Germany
| | - Thomas F. Marandu
- University of Dar es Salaam–Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | - Yusuph Mgaya
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Angelika Kellings
- Clinical Study Core Unit Bonn, Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the Ludwig-Maximilians-University, Munich, Germany
- German Center for Infection Research, partner site Munich, Munich, Germany
| | - John Ogondiek
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Janina M. Kuehlwein
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research, partner site Bonn-Cologne, Bonn, Germany
| | - Leonard Masagati
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Charles Mackenzie
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia
| | - Maureen Mosoba
- National Institute for Medical Research, Dar es Salaam, Tanzania
- Center for International Health, Ludwig-Maximilians-University, Munich, Germany
| | - Sacha Horn
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the Ludwig-Maximilians-University, Munich, Germany
| | - Kheri Kagya
- Regional Medical Office, Lindi Municipal Council, Lindi Region, Tanzania
| | - Samuel Wanji
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Wilfred Mandara
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Linda Batsa Debrah
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- German–West African Center for Global Health and Pandemic Prevention, partner site Kumasi, Kumasi, Ghana
| | - Eric A. Ottesen
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia
| | - Alexander Yaw Debrah
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- German–West African Center for Global Health and Pandemic Prevention, partner site Kumasi, Kumasi, Ghana
- Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Upendo Mwingira
- National Institute for Medical Research, Dar es Salaam, Tanzania
- RTI International, Washington, District of Columbia
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research, partner site Bonn-Cologne, Bonn, Germany
- German–West African Center for Global Health and Pandemic Prevention, partner site Bonn, Bonn, Germany
| | - Akili Kalinga
- National Institute for Medical Research, Dar es Salaam, Tanzania
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Debrah LB, Klarmann-Schulz U, Osei-Mensah J, Kuehlwein JM, Mubarik Y, Nadal J, Ayisi-Boateng NK, Ricchiuto A, Opoku VS, Sullivan SM, Mensah DA, Horton J, Rahamani AA, Budge PJ, Gbedema S, Korir PJ, Opoku J, Pfarr K, Kontoh DB, Kellings A, Gyasi C, Obeng MA, Gruetzmacher B, Fordjour FA, Kroidl I, Horn S, Kuutiero EK, Wauschkuhn C, Ngenya A, Mackenzie C, Wanji S, Kalinga A, Ottesen EA, Hoerauf A, Debrah AY. Adherence to Hygiene Protocols and Doxycycline Therapy in Ameliorating Lymphatic Filariasis Morbidity in an Endemic Area Post-Interruption of Disease Transmission in Ghana. Am J Trop Med Hyg 2024; 111:66-82. [PMID: 39362213 PMCID: PMC11448491 DOI: 10.4269/ajtmh.24-0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/29/2024] [Indexed: 10/05/2024] Open
Abstract
Filarial lymphedema (LE) remains a significant global problem despite the progress made toward elimination of lymphatic filariasis (LF). In Ghana, the main approach to LF is preventive chemotherapy, but this has minimal impact on individuals who have already developed LE. In 2018-2020, a 24-month randomized, double-blind, placebo-controlled trial was conducted to evaluate the efficacy of stringent hygiene measures using the Essential Package of Care with or without additional administration of doxycycline (DOX) to improve filarial leg LE. This study enrolled 356 participants with LE stages 1-3 from two districts in the Upper East Region of Ghana. In addition to regular training on appropriate care for their affected legs, participants were randomized to receive 6 weeks of either 200 mg/day DOX (n = 117), 100 mg/day DOX (n = 120), or matching placebo (n = 119). Participants were seen every 2 months, with clinical measurements done at 6, 12, 18, and 24 months to assess the status of affected legs. There was a trend toward later appearance of acute attacks after DOX, but surprisingly, DOX showed no effect on LE stage progression. In all groups, leg LE improvement was more common (DOX 200 mg: n = 23 [20%]; DOX 100 mg: n = 23 [19.5%]; placebo: n = 32 [27.4%]) than LE worsening (DOX 200 mg: n = 2 [1.7%]; DOX 100 mg: n = 3 [2.5%]; placebo: n = 2 [1.7%]). Overall, these data show a strong benefit from adherence to a strict hygiene protocol, with some added potential benefit for DOX in preventing acute attacks.
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Affiliation(s)
- Linda Batsa Debrah
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- German-West African Center for Global Health and Pandemic Prevention (G-WAC), partner site Kumasi, Ghana
| | - Ute Klarmann-Schulz
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Jubin Osei-Mensah
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- School of Veterinary Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Janina M Kuehlwein
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - Yusif Mubarik
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Jennifer Nadal
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Nana Kwame Ayisi-Boateng
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Arcangelo Ricchiuto
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Vera Serwaa Opoku
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Sarah M Sullivan
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia
| | - Derrick Adu Mensah
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | | | - Abu Abudu Rahamani
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Philip J Budge
- Washington University School of Medicine, St. Louis, Missouri
| | - Stephen Gbedema
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Patricia Jebett Korir
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - John Opoku
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Kenneth Pfarr
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - Derrick Boateng Kontoh
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Angelika Kellings
- Clinical Study Core Unit Bonn (SZB), Institute of Clinical Chemistry and Clinical Pharmacology, University Bonn, Bonn, Germany
| | - Charles Gyasi
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Michael Agyemang Obeng
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Barbara Gruetzmacher
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
| | | | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Germany
| | - Sacha Horn
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Eunice Kyaakyile Kuutiero
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Caroline Wauschkuhn
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - Abdallah Ngenya
- National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
| | - Charles Mackenzie
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia
| | - Samuel Wanji
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Akili Kalinga
- National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
| | - Eric A Ottesen
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany
- German-West African Center for Global Health and Pandemic Prevention (G-WAC), partner site Bonn, Germany
| | - Alexander Yaw Debrah
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- German-West African Center for Global Health and Pandemic Prevention (G-WAC), partner site Kumasi, Ghana
- Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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Yahathugoda TC, De Silva NL, Ruben J, Gunawardena S, Weerasooriya MV, Horton J, Budge P, Ottesen E, Sullivan SM, Stephens M, Shen J, Klarmann-Schulz U, Hoerauf A, Shott JP, Mackenzie C. LEDoxy-SL: A Placebo-Controlled, Double-Blind, Randomized, 24-Month Trial of Six Weeks of Daily Doxycycline Plus Hygiene-Based Essential Care for Reducing Progression of Filarial Lymphedema in Sri Lanka. Am J Trop Med Hyg 2024; 111:52-65. [PMID: 39043165 PMCID: PMC11448493 DOI: 10.4269/ajtmh.24-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/15/2024] [Indexed: 07/25/2024] Open
Abstract
Morbidity management of filarial lymphedema remains a challenge even during the post-lymphatic filariasis elimination era in Sri Lanka despite provision of the predominantly hygiene-based WHO Essential Package of Care. Because prior studies have suggested that 6 weeks of doxycycline may reduce progression of limb lymphedema, we conducted a randomized, placebo-controlled, superiority study to evaluate this possibility in Sri Lanka. Patients aged 14 to 65 years with lymphedema in one or both legs received either 200 mg of doxycycline daily for 6 weeks or matching placebo. The primary efficacy endpoint was improvement or lack of progression in lymphedema stage at 24 months postenrollment. Secondary endpoints included change in lymphedema stage at 12 and 24 months, frequency of acute adenolymphangitis episodes, and perceived disability measured by the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Training and supplies for limb hygiene were provided throughout the study. Two hundred participants (100 in each arm) with lymphedema of Dreyer stages 1 to 3 were enrolled. By the end of the 2-year study, 29% of the doxycycline patients and 34% of those on placebo showed improvement (i.e., a decrease in lymphedema stage), whereas 11% and 15% of the two groups showed worsening of the lymphedema. Adenolymphangitis rates were comparable in the two groups (43 doxycycline and 38 placebo recipients), although attacks lasted slightly longer in placebo patients (6.5 days versus 5.2 days). In both groups, perceived disability improved initially, with partial rebound in the second year. Only 34 adverse events affecting 24 patients (11%) occurred during the 6-week treatment period. Although doxycycline did not significantly impact lymphedema progression in this study, the results clearly indicate that clinical and personal benefits can be obtained from intensive hygiene management alone.
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Affiliation(s)
- Thishan Channa Yahathugoda
- Filariasis Research Training and Service Unit, Department of Parasitology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Nirmitha Lalindi De Silva
- Filariasis Research Training and Service Unit, Department of Parasitology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Janaka Ruben
- Filariasis Research Training and Service Unit, Department of Parasitology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Sharmini Gunawardena
- Department of Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Mirani Vasanthamala Weerasooriya
- Filariasis Research Training and Service Unit, Department of Parasitology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | | | - Philip Budge
- Washington University School of Medicine, St. Louis, Missouri
| | - Eric Ottesen
- Neglected Tropical Disease Support Center, Task Force for Global Health, Decatur. Georgia
| | - Sarah Mary Sullivan
- Neglected Tropical Disease Support Center, Task Force for Global Health, Decatur. Georgia
| | - Mariana Stephens
- Neglected Tropical Disease Support Center, Task Force for Global Health, Decatur. Georgia
| | - John Shen
- Neglected Tropical Disease Support Center, Task Force for Global Health, Decatur. Georgia
| | - Ute Klarmann-Schulz
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), German Centre for Infection Research (DZIF), Bonn-Cologne Site, University Hospital Bonn, Bonn, Germany
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), German Centre for Infection Research (DZIF), Bonn-Cologne Site, University Hospital Bonn, Bonn, Germany
| | - Joseph Patrick Shott
- Division of Neglected Tropical Diseases, U.S. Agency for International Development, Washington, District of Columbia
| | - Charles Mackenzie
- Neglected Tropical Disease Support Center, Task Force for Global Health, Decatur. Georgia
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Mackenzie CD, Kapa DR, Krishnasastry S, Douglass J, Hoerauf A, Ottesen EA. Managing Lymphedema Induced by Lymphatic Filariasis: Implementing and Improving Care at the Individual and Programmatic Levels. Am J Trop Med Hyg 2024; 111:3-21. [PMID: 39084208 PMCID: PMC11448485 DOI: 10.4269/ajtmh.23-0905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/21/2024] [Indexed: 08/02/2024] Open
Abstract
Providing and improving the care of patients suffering from lymphedema remains an essential goal for the clinical management of populations affected by lymphatic filariasis. Although the Essential Package of Care (EPC) recommended by the WHO leads to important positive benefits for many of these lymphedema patients, it is important to continue to address the challenges that remain both in quantifying these effects and in ensuring optimal care. This report, based on the authors' scientific and field experience, focuses on the impact and significance of lymphedema, its clinical presentation, current treatment approaches, and the importance of lymphedema care to the Global Program to Eliminate Lymphatic Filariasis. It emphasizes specific practical issues related to managing lymphedema, such as the importance of beginning treatment in the condition's early stages and the development of effective approaches to assess patients' progress toward improving both their clinical status and their overall quality of life. Priorities for research are also examined, particularly the need for tools to identify patients and to assess disease burden in endemic communities, the creation of EPC accessibility to as many patients as possible (i.e., targeting 100% "geographic coverage" of care), and the empowerment of patients to ensure the sustainability, and ultimately the provision of care from sectors of the national public health systems of endemic countries.
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Affiliation(s)
- Charles D. Mackenzie
- Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD), Task Force for Global Health, Atlanta, Georgia
- The END Fund, New York, New York
| | - D Ramaiah Kapa
- Consultant Lymphatic Filariasis Epidemiologist, Pondicherry, India
| | - Suma Krishnasastry
- Filariasis Research Unit, WHO Collaborating Center for LF MMDP, Government T. D. Medical College Hospital, Kerala University of Health Sciences, Alappuzha, India
| | - Jan Douglass
- Division of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital of Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Germany
| | - Eric A. Ottesen
- Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD), Task Force for Global Health, Atlanta, Georgia
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Brown S, Tadros AB, Montagna G, Bell T, Crowley F, Gallagher EJ, Dayan JH. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may reduce the risk of developing cancer-related lymphedema following axillary lymph node dissection (ALND). Front Pharmacol 2024; 15:1457363. [PMID: 39318780 PMCID: PMC11420520 DOI: 10.3389/fphar.2024.1457363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 08/22/2024] [Indexed: 09/26/2024] Open
Abstract
Purpose Patients undergoing axillary lymph node dissection (ALND) for breast cancer face a high risk of lymphedema, further increased by high body mass index (BMI) and insulin resistance. GLP-1 receptor agonists (GLP-1RAs) have the potential to reduce these risk factors, but their role in lymphedema has never been investigated. The purpose of this study was to determine if GLP-RAs can reduce the risk of lymphedema in patients undergoing ALND. Methods All patients who underwent ALND at a tertiary cancer center between 2010 and 2023 were reviewed. Patients with less than 2 years of follow-up from the time of ALND were excluded. Race, BMI, radiation, chemotherapy history, pre-existing diagnosis of diabetes, lymphedema development after ALND, and the use of GLP-1RAs were analyzed. Multivariate logistic regression analysis was performed to assess if there was a significant reduction in the risk of developing lymphedema after ALND. A sub-group analysis of non-diabetic patients was also performed. Results 3,830 patients who underwent ALND were included, 76 of which were treated with. GLP-1 RAs. The incidence of lymphedema in the GLP-1 RA cohort was 6.6% (5 patients). Compared to 28.5% (1,071 patients) in the non-GLP-1 RA cohort. On multivariate regression analysis, patients who were treated with GLP-1 RA were 86% less likely to develop lymphedema compared to the non-GLP-1 RA cohort (OR 0.14, 95% CI 0.04-0.32, p < 0.0001). A BMI of 25 kg/m 2 or greater was a statistically significant risk factor for developing lymphedema with an odds ratio of 1.34 (95% CI 1.16-1.56, p < 0.0001). Diabetes was associated with lymphedema development that closely approached statistical significance (OR 1.32, 95% CI 0.97-1.78, p = 0.06). A subgroup analysis solely on non-diabetic patients showed similar results. The odds of developing lymphedema were 84% lower for patients without diabetes treated with GLP1-RAs compared to those who did not receive GLP-1 RAs (OR 0.16, 95% CI 0.05-0.40, p < 0.0001). Conclusion GLP1-RAs appear to significantly reduce the risk of lymphedema in patientsundergoing ALND. The mechanism of action may be multifactorial and not limited to weight reduction and insulin resistance. Future prospective analysis is warranted to clarify the role of GLP-1RAs in reducing lymphedema risk.
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Affiliation(s)
- Stav Brown
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Audree B Tadros
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Giacomo Montagna
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Tajah Bell
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Fionnuala Crowley
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emily J Gallagher
- Department of Medicine, Division of Endocrinology, Diabetes and Bone Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joseph H Dayan
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- The Institute for Advanced Reconstruction, Plastic and Reconstructive Surgery, Red Bank, Paramus, NJ, United States
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7
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Risch F, Kazakov A, Specht S, Pfarr K, Fischer PU, Hoerauf A, Hübner MP. The long and winding road towards new treatments against lymphatic filariasis and onchocerciasis. Trends Parasitol 2024; 40:829-845. [PMID: 39122645 DOI: 10.1016/j.pt.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/12/2024]
Abstract
Although lymphatic filariasis and onchocerciasis have been targeted for global elimination, these helminth infections are still a major public health problem across the tropics and subtropics. Despite decades of research, treatment options remain limited and drugs that completely clear the infections, and can be used on a large scale, are still unavailable. In the present review we discuss the strengths and weaknesses of currently available treatments and new ones in development. Novel candidates (corallopyronin A, DNDi-6166, emodepside, and oxfendazole) are currently moving through (pre)clinical development, while the development of two candidates (AWZ1066S and ABBV-4083/flubentylosin) was recently halted. The preclinical R&D pipeline for filarial infections continues to be limited, and recent setbacks highlight the importance of continuous drug discovery and testing.
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Affiliation(s)
- Frederic Risch
- Institute for Medical Microbiology, Immunology, and Parasitology, University Hospital Bonn, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Alexander Kazakov
- Institute for Medical Microbiology, Immunology, and Parasitology, University Hospital Bonn, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Sabine Specht
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Kenneth Pfarr
- Institute for Medical Microbiology, Immunology, and Parasitology, University Hospital Bonn, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Peter U Fischer
- Division of Infectious Diseases, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology, and Parasitology, University Hospital Bonn, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Marc P Hübner
- Institute for Medical Microbiology, Immunology, and Parasitology, University Hospital Bonn, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany.
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8
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Hoffmann G, Lukarska M, Clare RH, Masters EK, Johnston KL, Ford L, Turner JD, Ward SA, Taylor MJ, Jensen MR, Palencia A. Targeting a microbiota Wolbachian aminoacyl-tRNA synthetase to block its pathogenic host. SCIENCE ADVANCES 2024; 10:eado1453. [PMID: 38985862 PMCID: PMC11235159 DOI: 10.1126/sciadv.ado1453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/04/2024] [Indexed: 07/12/2024]
Abstract
The interplay between humans and their microbiome is crucial for various physiological processes, including nutrient absorption, immune defense, and maintaining homeostasis. Microbiome alterations can directly contribute to diseases or heighten their likelihood. This relationship extends beyond humans; microbiota play vital roles in other organisms, including eukaryotic pathogens causing severe diseases. Notably, Wolbachia, a bacterial microbiota, is essential for parasitic worms responsible for lymphatic filariasis and onchocerciasis, devastating human illnesses. Given the lack of rapid cures for these infections and the limitations of current treatments, new drugs are imperative. Here, we disrupt Wolbachia's symbiosis with pathogens using boron-based compounds targeting an unprecedented Wolbachia enzyme, leucyl-tRNA synthetase (LeuRS), effectively inhibiting its growth. Through a compound demonstrating anti-Wolbachia efficacy in infected cells, we use biophysical experiments and x-ray crystallography to elucidate the mechanism behind Wolbachia LeuRS inhibition. We reveal that these compounds form adenosine-based adducts inhibiting protein synthesis. Overall, our study underscores the potential of disrupting key microbiota to control infections.
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Affiliation(s)
- Guillaume Hoffmann
- Institute for Advanced Biosciences (IAB), Structural Biology of Novel Drug Targets in Human Diseases, INSERM U1209, CNRS UMR 5309, Université Grenoble-Alpes, Grenoble 38000, France
| | - Maria Lukarska
- Institute for Advanced Biosciences (IAB), Structural Biology of Novel Drug Targets in Human Diseases, INSERM U1209, CNRS UMR 5309, Université Grenoble-Alpes, Grenoble 38000, France
| | - Rachel H. Clare
- Centre for Drugs and Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Ellen K.G. Masters
- Centre for Drugs and Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Kelly L. Johnston
- Centre for Drugs and Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Louise Ford
- Centre for Drugs and Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Joseph D. Turner
- Centre for Drugs and Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Steve A. Ward
- Centre for Drugs and Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Mark J. Taylor
- Centre for Drugs and Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | | | - Andrés Palencia
- Institute for Advanced Biosciences (IAB), Structural Biology of Novel Drug Targets in Human Diseases, INSERM U1209, CNRS UMR 5309, Université Grenoble-Alpes, Grenoble 38000, France
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9
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Suárez JA, Vargas-Soler JA, Manosalva-Arciniegas LI, Becerra-González S, Ramirez AL, Cáceres T, Luna N, Ramírez JD, Paniz-Mondolfi A. Wuchereria bancrofti Lymphatic Filariasis, Barrancabermeja, Colombia, 2023. Emerg Infect Dis 2024; 30:1398-1401. [PMID: 38916574 PMCID: PMC11210633 DOI: 10.3201/eid3007.231363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
We describe a recent case of lymphatic filariasis in Colombia caused by Wuchereria bancrofti nematodes. Our study combines clinical-epidemiologic findings with phylogenetic data. Resurgence of lymphatic filariasis may be linked to increasing urbanization trends and migration from previously endemic regions. Fieldwork can be a beneficial tool for screening and containing transmission.
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10
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Setegn A, Amare GA, Mihret Y. Wolbachia and Lymphatic Filarial Nematodes and Their Implications in the Pathogenesis of the Disease. J Parasitol Res 2024; 2024:3476951. [PMID: 38725798 PMCID: PMC11081757 DOI: 10.1155/2024/3476951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/12/2024] Open
Abstract
Lymphatic filariasis (LF) is an infection of three closely related filarial worms such as Wuchereria bancrofti, Brugia malayi, and Brugia timori. These worms can cause a devastating disease that involves acute and chronic lymphoedema of the extremities, which can cause elephantiasis in both sexes and hydroceles in males. These important public health nematodes were found to have a mutualistic relationship with intracellular bacteria of the genus Wolbachia, which is essential for the development and survival of the nematode. The host's inflammatory response to parasites and possibly also to the Wolbachia endosymbiont is the cause of lymphatic damage and disease pathogenesis. This review tried to describe and highlight the mutualistic associations between Wolbachia and lymphatic filarial nematodes and the role of bacteria in the pathogenesis of lymphatic filariasis. Articles for this review were searched from PubMed, Google Scholar, and other databases. Article searching was not restricted by publication year; however, only English version full-text articles were included.
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Affiliation(s)
- Abebaw Setegn
- Department of Medical Parasitology, University of Gondar, Gondar, Ethiopia
| | - Gashaw Azanaw Amare
- Department of Medical Laboratory Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Yenesew Mihret
- Department of Medical Parasitology, University of Gondar, Gondar, Ethiopia
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11
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Hamid A, Mäser P, Mahmoud AB. Drug Repurposing in the Chemotherapy of Infectious Diseases. Molecules 2024; 29:635. [PMID: 38338378 PMCID: PMC10856722 DOI: 10.3390/molecules29030635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Repurposing is a universal mechanism for innovation, from the evolution of feathers to the invention of Velcro tape. Repurposing is particularly attractive for drug development, given that it costs more than a billion dollars and takes longer than ten years to make a new drug from scratch. The COVID-19 pandemic has triggered a large number of drug repurposing activities. At the same time, it has highlighted potential pitfalls, in particular when concessions are made to the target product profile. Here, we discuss the pros and cons of drug repurposing for infectious diseases and analyze different ways of repurposing. We distinguish between opportunistic and rational approaches, i.e., just saving time and money by screening compounds that are already approved versus repurposing based on a particular target that is common to different pathogens. The latter can be further distinguished into divergent and convergent: points of attack that are divergent share common ancestry (e.g., prokaryotic targets in the apicoplast of malaria parasites), whereas those that are convergent arise from a shared lifestyle (e.g., the susceptibility of bacteria, parasites, and tumor cells to antifolates due to their high rate of DNA synthesis). We illustrate how such different scenarios can be capitalized on by using examples of drugs that have been repurposed to, from, or within the field of anti-infective chemotherapy.
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Affiliation(s)
- Amal Hamid
- Faculty of Pharmacy, University of Khartoum, Khartoum 11111, Sudan;
| | - Pascal Mäser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, 4123 Basel, Switzerland
- Faculty of Science, University of Basel, 4001 Basel, Switzerland
| | - Abdelhalim Babiker Mahmoud
- Faculty of Pharmacy, University of Khartoum, Khartoum 11111, Sudan;
- Department of Microbial Natural Products, Helmholtz Institute for Pharmaceutical Research Saarland, 66123 Saarbruecken, Germany
- Department of Microbial Drugs, Helmholtz Centre for Infection Research (HZI), 38124 Braunschweig, Germany
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12
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Brown S, Campbell AC, Kuonqui K, Sarker A, Park HJ, Shin J, Kataru RP, Coriddi M, Dayan JH, Mehrara BJ. The Future of Lymphedema: Potential Therapeutic Targets for Treatment. CURRENT BREAST CANCER REPORTS 2023; 15:1-9. [PMID: 37359311 PMCID: PMC10233555 DOI: 10.1007/s12609-023-00491-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review This review aims to summarize the current knowledge regarding the pharmacological interventions studied in both experimental and clinical trials for secondary lymphedema. Recent Findings Lymphedema is a progressive disease that results in tissue swelling, pain, and functional disability. The most common cause of secondary lymphedema in developed countries is an iatrogenic injury to the lymphatic system during cancer treatment. Despite its high incidence and severe sequelae, lymphedema is usually treated with palliative options such as compression and physical therapy. However, recent studies on the pathophysiology of lymphedema have explored pharmacological treatments in preclinical and early phase clinical trials. Summary Many potential treatment options for lymphedema have been explored throughout the past two decades including systemic agents and topical approaches to decrease the potential toxicity of systemic treatment. Treatment strategies including lymphangiogenic factors, anti-inflammatory agents, and anti-fibrotic therapies may be used independently or in conjunction with surgical approaches.
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Affiliation(s)
- Stav Brown
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Adana C. Campbell
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Kevin Kuonqui
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Ananta Sarker
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Hyeung Ju Park
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Jinyeon Shin
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Raghu P. Kataru
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Michelle Coriddi
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Joseph H. Dayan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Babak J. Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
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Abstract
Kidney disease is associated with adverse consequences in many organs beyond the kidney, including the heart, lungs, brain, and intestines. The kidney-intestinal cross talk involves intestinal epithelial damage, dysbiosis, and generation of uremic toxins. Recent studies reveal that kidney injury expands the intestinal lymphatics, increases lymphatic flow, and alters the composition of mesenteric lymph. The intestinal lymphatics, like blood vessels, are a route for transporting potentially harmful substances generated by the intestines. The lymphatic architecture and actions are uniquely suited to take up and transport large macromolecules, functions that differentiate them from blood vessels, allowing them to play a distinct role in a variety of physiological and pathological processes. Here, we focus on the mechanisms by which kidney diseases result in deleterious changes in intestinal lymphatics and consider a novel paradigm of a vicious cycle of detrimental organ cross talk. This concept involves kidney injury-induced modulation of intestinal lymphatics that promotes production and distribution of harmful factors, which in turn contributes to disease progression in distant organ systems.
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Affiliation(s)
- Jianyong Zhong
- Department of Pediatrics (J.Z., H.-C.Y., A.B.F., E.L.S., V.K.), Vanderbilt University Medical Center, Nashville, TN
- Department of Pathology, Microbiology and Immunology (J.Z., H.-C.Y., A.B.F.), Vanderbilt University Medical Center, Nashville, TN
| | - Annet Kirabo
- Department of Molecular Physiology and Biophysics (A.K.), Vanderbilt University Medical Center, Nashville, TN
- Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (A.K.)
| | - Hai-Chun Yang
- Department of Pediatrics (J.Z., H.-C.Y., A.B.F., E.L.S., V.K.), Vanderbilt University Medical Center, Nashville, TN
- Department of Pathology, Microbiology and Immunology (J.Z., H.-C.Y., A.B.F.), Vanderbilt University Medical Center, Nashville, TN
| | - Agnes B Fogo
- Department of Pediatrics (J.Z., H.-C.Y., A.B.F., E.L.S., V.K.), Vanderbilt University Medical Center, Nashville, TN
- Department of Pathology, Microbiology and Immunology (J.Z., H.-C.Y., A.B.F.), Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine (A.B.F.), Vanderbilt University Medical Center, Nashville, TN
| | - Elaine L Shelton
- Department of Pediatrics (J.Z., H.-C.Y., A.B.F., E.L.S., V.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Valentina Kon
- Department of Pediatrics (J.Z., H.-C.Y., A.B.F., E.L.S., V.K.), Vanderbilt University Medical Center, Nashville, TN
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14
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Karunakaran I, Ritter M, Pfarr K, Klarmann-Schulz U, Debrah AY, Debrah LB, Katawa G, Wanji S, Specht S, Adjobimey T, Hübner MP, Hoerauf A. Filariasis research - from basic research to drug development and novel diagnostics, over a decade of research at the Institute for Medical Microbiology, Immunology and Parasitology, Bonn, Germany. FRONTIERS IN TROPICAL DISEASES 2023; 4:1126173. [PMID: 38655130 PMCID: PMC7615856 DOI: 10.3389/fitd.2023.1126173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Filariae are vector borne parasitic nematodes, endemic in tropical and subtropical regions causing avoidable infections ranging from asymptomatic to stigmatizing and disfiguring disease. The filarial species that are the major focus of our institution's research are Onchocerca volvulus causing onchocerciasis (river blindness), Wuchereria bancrofti and Brugia spp. causing lymphatic filariasis (elephantiasis), Loa loa causing loiasis (African eye worm), and Mansonella spp causing mansonellosis. This paper aims to showcase the contribution of our institution and our collaborating partners to filarial research and covers decades of long research spanning basic research using the Litomosoides sigmodontis animal model to development of drugs and novel diagnostics. Research with the L. sigmodontis model has been extensively useful in elucidating protective immune responses against filariae as well as in identifying the mechanisms of filarial immunomodulation during metabolic, autoimmune and infectious diseases. The institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany has also been actively involved in translational research in contributing to the identification of new drug targets and pre-clinical drug research with successful and ongoing partnership with sub-Saharan Africa, mainly Ghana (the Kumasi Centre for Collaborative Research (KCCR)), Cameroon (University of Buea (UB)) and Togo (Laboratoire de Microbiologie et de Contrôle de Qualité des Denrées Alimentaires (LAMICODA)), Asia and industry partners. Further, in the direction of developing novel diagnostics that are sensitive, time, and labour saving, we have developed sensitive qPCRs as well as LAMP assays and are currently working on artificial intelligence based histology analysis for onchocerciasis. The article also highlights our ongoing research and the need for novel animal models and new drug targets.
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Affiliation(s)
- Indulekha Karunakaran
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
| | - Manuel Ritter
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
| | - Kenneth Pfarr
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Ute Klarmann-Schulz
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Alexander Yaw Debrah
- Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kumasi Center for Collaborative Research (KCCR), Kumasi, Ghana
| | - Linda Batsa Debrah
- Kumasi Center for Collaborative Research (KCCR), Kumasi, Ghana
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Gnatoulma Katawa
- Unité de Recherche en Immunologie et Immunomodulation (UR2IM)/Laboratoire de Microbiologie et de Contrôle de Qualité des Denrées Alimentaires (LAMICODA), Ecole Supérieure des Techniques Biologiques et Alimentaires, Université de Lomé, Lomé, Togo
| | - Samuel Wanji
- Parasites and Vector Research Unit (PAVRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and Environment (REFOTDE), Buea, Cameroon
| | - Sabine Specht
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Tomabu Adjobimey
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
| | - Marc P Hübner
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
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15
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Kini P, Wireko S, Osei‐Poku P, Asiedu SO, Amewu EKA, Asiedu E, Amanor E, Mensah C, Wilson MB, Larbi A, Boahen KG, Sylverken AA, Amato KR, Kwarteng A. Antibiotic resistance and mecA characterization of Staphylococcus hominis from filarial lymphedema patients in the Ahanta West District, Ghana: A cross-sectional study. Health Sci Rep 2023; 6:e1104. [PMID: 36778776 PMCID: PMC9904197 DOI: 10.1002/hsr2.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
Background and Aim Filarial infections affect over 150 million people in the tropics. One of the major forms of filarial pathologies is lymphedema; a condition where the immune response is significantly altered, resulting in changes in the normal flora. Staphylococcus hominis, a human skin commensal, can also be pathogenic in immunocompromised individuals. Therefore, there is the possibility that S. hominis could assume a different behavior in filarial lymphedema patients. To this end, we investigated the levels of antibiotic resistance and extent of mecA gene carriage in S. hominis among individuals presenting with filarial lymphedema in rural Ghana. Method We recruited 160 individuals with stages I-VII lymphedema, in a cross-sectional study in the Ahanta West District of the Western Region of Ghana. Swabs from lymphedematous limb ulcers, pus, and cutaneous surfaces were cultured using standard culture-based techniques. The culture isolates were subjected to Matrix-Assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF) mass spectrometry for bacterial identification. Antimicrobial susceptibility testing (AST) was performed using the Kirby-Bauer method. mecA genes were targeted by polymerase chain reaction for strains that were cefoxitin resistant. Results In all, 112 S. hominis were isolated. The AST results showed resistance to chloramphenicol (87.5%), tetracycline (83.3%), penicillin (79.2%), and trimethoprim/sulphamethoxazole (45.8%). Of the 112 strains of S. hominis, 51 (45.5%) were resistant to cefoxitin, and 37 (72.5%) of the cefoxitin-resistant S. hominis haboured the mecA gene. Conclusion This study indicates a heightened level of methicillin-resistant S. hominis isolated among filarial lymphedema patients. As a result, opportunistic infections of S. hominis among the already burdened filarial lymphedema patients in rural Ghana may have reduced treatment success with antibiotics.
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Affiliation(s)
- Priscilla Kini
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Solomon Wireko
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
- Department of Laboratory TechnologyKumasi Technical UniversityKumasiGhana
| | - Priscilla Osei‐Poku
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Samuel O. Asiedu
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
- Department of Theoretical and Applied Biology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Emmanuel K. A. Amewu
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ebenezer Asiedu
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ernest Amanor
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Caleb Mensah
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Mary B. Wilson
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
- Department of Biomedical EngineeringKoforidua Technical UniversityKoforiduaGhana
| | - Amma Larbi
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Kennedy G. Boahen
- Department of Clinical Microbiology, School of Medical SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Augustina A. Sylverken
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
- Department of Theoretical and Applied Biology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | | | - Alexander Kwarteng
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
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16
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Brown S, Dayan JH, Kataru RP, Mehrara BJ. The Vicious Circle of Stasis, Inflammation, and Fibrosis in Lymphedema. Plast Reconstr Surg 2023; 151:330e-341e. [PMID: 36696336 PMCID: PMC9881755 DOI: 10.1097/prs.0000000000009866] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
SUMMARY Lymphedema is a progressive disease of the lymphatic system arising from impaired lymphatic drainage, accumulation of interstitial fluid, and fibroadipose deposition. Secondary lymphedema resulting from cancer treatment is the most common form of the disease in developed countries, affecting 15% to 40% of patients with breast cancer after lymph node dissection. Despite recent advances in microsurgery, outcomes remain variable and, in some cases, inadequate. Thus, development of novel treatment strategies is an important goal. Research over the past decade suggests that lymphatic injury initiates a chronic inflammatory response that regulates the pathophysiology of lymphedema. T-cell inflammation plays a key role in this response. In this review, the authors highlight the cellular and molecular mechanisms of lymphedema and discuss promising preclinical therapies.
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Affiliation(s)
- Stav Brown
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Joseph H Dayan
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Raghu P Kataru
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Babak J Mehrara
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
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17
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Fordjour FA, Kwarteng A. The filarial and the antibiotics: Single or combination therapy using antibiotics for filariasis. Front Cell Infect Microbiol 2022; 12:1044412. [PMID: 36467729 PMCID: PMC9712956 DOI: 10.3389/fcimb.2022.1044412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/24/2022] [Indexed: 12/01/2023] Open
Abstract
Filarial infections caused by nematodes are one of the major neglected tropical diseases with public health concern. Although there is significant decrease in microfilariae (mf) prevalence following mass drug administration (IVM/DEC/ALB administration), this is transient, in that there is reported microfilaria repopulation 6-12 months after treatment. Wolbachia bacteria have been recommended as a novel target presenting antibiotic-based treatment for filarial disease. Potency of antibiotics against filarial diseases is undoubtful, however, the duration for treatment remains a hurdle yet to be overcome in filarial disease treatment.
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Affiliation(s)
- Fatima Amponsah Fordjour
- Department of Microbiology, University for Development Studies (UDS), Tamale, Ghana
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Alexander Kwarteng
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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18
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Brown S, Dayan JH, Coriddi M, McGrath L, Kataru RP, Mehrara BJ. Doxycycline for the treatment of breast cancer-related lymphedema. Front Pharmacol 2022; 13:1028926. [PMID: 36339530 PMCID: PMC9630642 DOI: 10.3389/fphar.2022.1028926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/10/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose: Secondary lymphedema is a common complication of cancer treatment for which no effective drug treatments yet exist. Level I clinical data suggests that doxycycline is effective for treating filariasis-induced lymphedema, in which it decreases tissue edema and skin abnormalities; however, this treatment has not been tested for cancer-related lymphedema. Over the past year, we used doxycycline in an off-label manner in patients with breast cancer-related secondary lymphedema. The purpose of this report was to retrospectively analyze the efficacy of this treatment. Methods: Patients who presented to our lymphedema clinic between January 2021 and January 2022 were evaluated, and barring allergies or contraindications to doxycycline treatment, were counseled on the off-label use of this treatment. Patients who wished to proceed were treated with doxycycline (200 mg given orally once daily) for 6 weeks. After IRB approval of this study, lymphedema outcomes were retrospectively reviewed. Results: Seventeen patients with a mean follow-up of 17.0 ± 13.2 weeks were identified in our retrospective review. Although doxycycline treatment had no significant effect on relative limb volume change or L-Dex scores, we found a significant improvement in patient-reported quality of life. Analysis of patient responses to the Lymphedema Life Impact Scale showed a significant improvement in the total impairment score due to improvements in the physical and psychological well-being subscales (p = 0.03, p = 0.03, p = 0.04, respectively). Conclusion: This small, retrospective study did not show significant improvements in limb volume or L-Dex scores in patients with breast cancer-related lymphedema treated with doxycycline. However, our patients reported improvements in quality-of-life measures using a validated lymphedema patient-reported outcome instrument. Our results suggest that doxycycline may be of use in patients with breast cancer-related lymphedema; however, larger and more rigorous studies are needed.
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19
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Multi-drug resistant bacteria isolates from lymphatic filariasis patients in the Ahanta West District, Ghana. BMC Microbiol 2022; 22:245. [PMID: 36221074 PMCID: PMC9552459 DOI: 10.1186/s12866-022-02624-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Antimicrobial resistance is associated with increased morbidity in secondary infections and is a global threat owning to the ubiquitous nature of resistance genes in the environment. Recent estimate put the deaths associated with bacterial antimicrobial resistance in 2019 at 4.95 million worldwide. Lymphatic filariasis (LF), a Neglected Tropical Disease (NTD), is associated with the poor living in the tropical regions of the world. LF patients are prone to developing acute dermatolymphangioadenitis (ADLA), a condition that puts them at risk of developing secondary bacterial infections due to skin peeling. ADLA particularly worsens the prognosis of patients leading to usage of antibiotics as a therapeutic intervention. This may result in inappropriate usage of antibiotics due to self-medication and non-compliance; exacerbating antimicrobial resistance in LF patients. In this perspective, we assessed the possibilities of antimicrobial resistance in LF patients. We focused on antibiotic usage, antibiotic resistance in Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa isolates and looked at genes (mecA and Extended-spectrum beta-lactamase [blaCTX-M, blaSHV and blaTEM]) coding for resistance in multi-drug resistant (MDR) bacterial isolates. Results Of the sixty (60) participants, fifty-four (n = 54, 90%) were within 31–60 years of age, twenty (n = 20, 33.33%) were unemployed and thirty-eight (n = 38, 50.67%) had wounds aged (in months) seven (7) months and above. Amoxicillin (54%) and chloramphenicol (22%) were the most frequently used antibiotics for self-medication. Staphylococcus aureus isolates (n = 26) were mostly resistant to penicillin (n = 23, 88.46%) and least resistant to erythromycin (n = 2, 7.69%). Escherichia coli isolates (n = 5) were resistant to tetracycline (n = 5, 100%) and ampicillin (n = 5, 100%) but were sensitive to meropenem (n = 5, 100%). Pseudomonas aeruginosa isolates (n = 8) were most resistant to meropenem (n = 3, 37.50%) and to a lesser ciprofloxacin (n = 2, 25%), gentamicin (n = 2, 25%) and ceftazidime (n = 2, 25%). Multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA), cephalosporin resistant Escherichia coli. and carbapenem resistant Pseudomonas aeruginosa were four (n = 4, 15.38%), two (n = 2, 40%) and two (n = 2, 25%) respectively. ESBL (blaCTX-M) and mecA genes were implicated in the resistance mechanism of Escherichia coli and MRSA, respectively. Conclusion The findings show presence of MDR isolates from LF patients presenting with chronic wounds; thus, the need to prioritize resistance of MDR bacteria into treatment strategies optimizing morbidity management protocols. This could guide antibiotic selection for treating LF patients presenting with ADLA. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-022-02624-9.
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20
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Ogino R, Yokooji T, Hayashida M, Suda S, Yamakawa S, Hayashida K. Emerging Anti-Inflammatory Pharmacotherapy and Cell-Based Therapy for Lymphedema. Int J Mol Sci 2022; 23:ijms23147614. [PMID: 35886961 PMCID: PMC9322118 DOI: 10.3390/ijms23147614] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 02/04/2023] Open
Abstract
Secondary lymphedema is a common complication of lymph node dissection or radiation therapy for cancer treatment. Conventional therapies such as compression sleeve therapy, complete decongestive physiotherapy, and surgical therapies decrease edema; however, they are not curative because they cannot modulate the pathophysiology of lymphedema. Recent advances reveal that the activation and accumulation of CD4+ T cells are key in the development of lymphedema. Based on this pathophysiology, the efficacy of pharmacotherapy (tacrolimus, anti-IL-4/IL-13 antibody, or fingolimod) and cell-based therapy for lymphedema has been demonstrated in animal models and pilot studies. In addition, mesenchymal stem/stromal cells (MSCs) have attracted attention as candidates for cell-based lymphedema therapy because they improve symptoms and decrease edema volume in the long term with no serious adverse effects in pilot studies. Furthermore, MSC transplantation promotes functional lymphatic regeneration and improves the microenvironment in animal models. In this review, we focus on inflammatory cells involved in the pathogenesis of lymphedema and discuss the efficacy and challenges of pharmacotherapy and cell-based therapies for lymphedema.
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Affiliation(s)
- Ryohei Ogino
- Department of Frontier Science for Pharmacotherapy, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; (R.O.); (T.Y.)
| | - Tomoharu Yokooji
- Department of Frontier Science for Pharmacotherapy, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; (R.O.); (T.Y.)
| | - Maiko Hayashida
- Department of Psychiatry, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo 693-8501, Japan;
| | - Shota Suda
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo 693-8501, Japan; (S.S.); (S.Y.)
| | - Sho Yamakawa
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo 693-8501, Japan; (S.S.); (S.Y.)
| | - Kenji Hayashida
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo 693-8501, Japan; (S.S.); (S.Y.)
- Correspondence: ; Tel.: +81-853-20-2210
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21
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Swart Z, Duong TA, Wingfield BD, Postma A, Slippers B. The relevance of studying insect-nematode interactions for human disease. Pathog Glob Health 2022; 116:140-145. [PMID: 34726122 PMCID: PMC9090338 DOI: 10.1080/20477724.2021.1996796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Vertebrate-parasitic nematodes cause debilitating, chronic infections in millions of people worldwide. The burden of these so-called 'neglected tropical diseases' is often carried by poorer socioeconomic communities in part because research on parasitic nematodes and their vertebrate hosts is challenging and costly. However, complex biological and pathological processes can be modeled in simpler organisms. Here, we consider how insight into the interactions between entomopathogenic nematodes (EPN), their insect hosts and bacterial symbionts may reveal novel treatment targets for parasitic nematode infections. We argue that a combination of approaches that target nematodes, as well as the interaction of pathogens with insect vectors and bacterial symbionts, offer potentially effective, but underexplored opportunities.
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Affiliation(s)
- Zorada Swart
- Department of Biochemistry Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute, University of Pretoria, South Africa
| | - Tuan A. Duong
- Department of Biochemistry Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute, University of Pretoria, South Africa
| | - Brenda D. Wingfield
- Department of Biochemistry Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute, University of Pretoria, South Africa
| | - Alisa Postma
- Department of Biochemistry Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute, University of Pretoria, South Africa
| | - Bernard Slippers
- Department of Biochemistry Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute, University of Pretoria, South Africa
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Ehrens A, Hoerauf A, Hübner MP. Current perspective of new anti-Wolbachial and direct-acting macrofilaricidal drugs as treatment strategies for human filariasis. GMS INFECTIOUS DISEASES 2022; 10:Doc02. [PMID: 35463816 PMCID: PMC9006451 DOI: 10.3205/id000079] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Filarial diseases like lymphatic filariasis and onchocerciasis belong to the Neglected Tropical Diseases and remain a public health problem in endemic countries. Lymphatic filariasis and onchocerciasis can lead to stigmatizing pathologies and present a socio-economic burden for affected people and their endemic countries. Current treatment recommendations by the WHO include mass drug administration with ivermectin for the treatment of onchocerciasis and a combination of ivermectin, albendazole and diethylcarbamazine (DEC) for the treatment of lymphatic filariasis in areas that are not co-endemic for onchocerciasis or loiasis. Limitations of these treatment strategies are due to potential severe adverse events in onchocerciasis and loiasis patients following DEC or ivermectin treatment, respectively, the lack of a macrofilaricidal efficacy of those drugs and the risk of drug resistance development. Thus, to achieve the elimination of transmission of onchocerciasis and the elimination of lymphatic filariasis as a public health problem by 2030, the WHO defined in its roadmap that new alternative treatment strategies with macrofilaricidal compounds are required. Within a collaboration of the non-profit organizations Drugs for Neglected Diseases initiative (DNDi), the Bill & Melinda Gates Foundation, and partners from academia and industry, several new promising macrofilaricidal drug candidates were identified, which will be discussed in this review.
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Affiliation(s)
- Alexandra Ehrens
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Marc P. Hübner
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
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23
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Brown S, Dayan JH, Coriddi M, Campbell A, Kuonqui K, Shin J, Park HJ, Mehrara BJ, Kataru RP. Pharmacological Treatment of Secondary Lymphedema. Front Pharmacol 2022; 13:828513. [PMID: 35145417 PMCID: PMC8822213 DOI: 10.3389/fphar.2022.828513] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/07/2022] [Indexed: 12/12/2022] Open
Abstract
Lymphedema is a chronic disease that results in swelling and decreased function due to abnormal lymphatic fluid clearance and chronic inflammation. In Western countries, lymphedema most commonly develops following an iatrogenic injury to the lymphatic system during cancer treatment. It is estimated that as many as 10 million patients suffer from lymphedema in the United States alone. Current treatments for lymphedema are palliative in nature, relying on compression garments and physical therapy to decrease interstitial fluid accumulation in the affected extremity. However, recent discoveries have increased the hopes of therapeutic interventions that may promote lymphatic regeneration and function. The purpose of this review is to summarize current experimental pharmacological strategies in the treatment of lymphedema.
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Walker J, Tanna S, Roake J, Lyons O. A systematic review of pharmacologic and cell-based therapies for treatment of lymphedema (2010-2021). J Vasc Surg Venous Lymphat Disord 2021; 10:966-975.e1. [PMID: 34587525 DOI: 10.1016/j.jvsv.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lymphedema describes the accumulation of interstitial fluid that results from lymphatic failure. Lymphedema can be of primary or secondary origin and has been estimated to affect 200 million people worldwide. Secondary lymphedema is commonly due to damage to the lymphatic vessels after surgical procedures. Treatments include compression bandaging and exercise regimens. However, at present, no pharmacologic therapy has been approved. We performed a systematic review of randomized controlled trials (RCTs) that had investigated pharmacologic and cell-based therapies for secondary lymphedema. METHODS We searched the databases MEDLINE, Embase, and ClinicalTrials.gov from January 2010 to May 2021. Only RCTs that had investigated pharmacologic and/or cell-based therapies for secondary lymphedema were eligible for inclusion. Those studies that had examined only active filarial infection were excluded. Two of us (J.W., S.T.) independently screened the studies for eligibility. RESULTS We identified eight RCTs that met the inclusion criteria. Overall, the studies were of poor quality with a high risk of bias. Ketoprofen demonstrated promising improvements in skin thickness and tissue histopathologic scores. Some evidence was found to suggest that doxycycline might be beneficial for nonfilarial secondary lymphedema, and a single, small RCT demonstrated that selenium might also confer some benefit. Neither synbiotics nor platelet-rich plasma resulted in reduced lymphedema volumes or symptom severity. Also, although bone marrow-derived stem cells resulted in improved symptom scores, no significant volume reduction was detected. Although positive results were demonstrated in trials investigating benzopyrones, previous meta-analyses have cast doubt on their efficacy. No two studies assessed the same intervention; thus, we could not perform a meta-analysis. CONCLUSIONS Although the results from some studies appeared promising, the available evidence at present is insufficient for any pharmacologic or cell-based therapy for patients with secondary lymphedema. Furthermore, large, high-quality RCTs are required before treatment recommendations will be possible.
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Affiliation(s)
- James Walker
- Academic Department of Vascular Surgery, King's College London, St Thomas' Hospital, London, UK.
| | - Sameera Tanna
- Obetetrics and Gynaecology, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Justin Roake
- Department of Surgery, University of Otago, Christchurch, New Zealand; Department of Vascular Endovascular and Transplant Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Oliver Lyons
- Academic Department of Vascular Surgery, King's College London, St Thomas' Hospital, London, UK; Department of Surgery, University of Otago, Christchurch, New Zealand; Department of Vascular Endovascular and Transplant Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
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25
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Pilot Study of Anti-Th2 Immunotherapy for the Treatment of Breast Cancer-Related Upper Extremity Lymphedema. BIOLOGY 2021; 10:biology10090934. [PMID: 34571811 PMCID: PMC8466465 DOI: 10.3390/biology10090934] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/05/2021] [Accepted: 09/14/2021] [Indexed: 01/02/2023]
Abstract
Recent studies suggest that Th2 cells play a key role in the pathology of secondary lymphedema by elaborating cytokines such as IL4 and IL13. The aim of this study was to test the efficacy of QBX258, a monoclonal IL4/IL13 neutralizing antibody, in women with breast cancer-related lymphedema (BCRL). We enrolled nine women with unilateral stage I/II BCRL and treated them once monthly with intravenous infusions of QBX258 for 4 months. We measured limb volumes, bioimpedance, and skin tonometry, and analyzed the quality of life (QOL) using a validated lymphedema questionnaire (Upper Limb Lymphedema 27, ULL-27) before treatment, immediately after treatment, and 4 months following treatment withdrawal. We also obtained 5 mm skin biopsies from the normal and lymphedematous limbs before and after treatment. Treatment was well-tolerated; however, one patient with a history of cellulitis developed cellulitis during the trial and was excluded from further analysis. We found no differences in limb volumes or bioimpedance measurements after drug treatment. However, QBX258 treatment improved skin stiffness (p < 0.001) and improved QOL measurements (Physical p < 0.05, Social p = 0.01). These improvements returned to baseline after treatment withdrawal. Histologically, treatment decreased epidermal thickness, the number of proliferating keratinocytes, type III collagen deposition, infiltration of mast cells, and the expression of Th2-inducing cytokines in the lymphedematous skin. Our limited study suggests that immunotherapy against Th2 cytokines may improve skin changes and QOL of women with BCRL. This treatment appears to be less effective for decreasing limb volumes; however, additional studies are needed.
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Deribe K, Mackenzie CD, Newport MJ, Argaw D, Molyneux DH, Davey G. Podoconiosis: key priorities for research and implementation. Trans R Soc Trop Med Hyg 2021; 114:889-895. [PMID: 33169167 PMCID: PMC7738650 DOI: 10.1093/trstmh/traa094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/31/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022] Open
Abstract
Podoconiosis is a non-infectious tropical lymphoedema causing swelling of the lower legs. Podoconiosis is associated with stigma, depression and reduced productivity, resulting in significant socio-economic impacts for affected individuals, families and communities. It is caused by barefoot exposure to soils and affects disadvantaged populations. Evidence from the past 5 y suggests that podoconiosis is amenable to public health interventions, e.g. footwear and hygiene-based morbidity management, which reduce acute clinical episodes. Although much has been learned in recent years, advances in care for these patients and worldwide control requires further reliable and relevant research. To develop a comprehensive global control strategy, the following key research priorities are important: better understanding of the global burden of podoconiosis through extended worldwide mapping, development of new point-of-care diagnostic methods and approaches to define the presence of the environmental characteristics that contribute to the development of the condition, improving treatment through an increased understanding of the pathogenesis of dermal changes over time, improved understanding of optimal ways of providing patient care at the national level, including research to optimize behavioural change strategies, determine the optimum package of care and integrate approaches to deliver robust surveillance, monitoring and evaluation of control programmes.
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Affiliation(s)
- Kebede Deribe
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton BN1 9PX, UK.,School of Public Health, College of Health Sciences, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia
| | | | - Melanie J Newport
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
| | - Daniel Argaw
- World Health Organization, Control of Neglected Tropical Diseases, Geneva 1211, Switzerland
| | | | - Gail Davey
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton BN1 9PX, UK.,School of Public Health, College of Health Sciences, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia
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27
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Ndzeshang BL, Mbiakop RT, Nchanji GT, Kien CA, Amambo GN, Abong RA, Yuyun T, Beng AA, Bonekeh J, Ritter M, Esum ME, Cho JF, Njouendou AJ, Ndifor IN, Deribe K, Fombad FF, Enyong P, Klarmann-Schulz U, Hoerauf A, Wanji S. Clinical, haematological and biochemical profiling of podoconiosis lymphoedema patients prior to their involvement in a clinical trial in the Northwest Region of Cameroon. Trans R Soc Trop Med Hyg 2021; 114:954-961. [PMID: 33258944 PMCID: PMC7738657 DOI: 10.1093/trstmh/traa146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prior to carrying out clinical trials, it is important to assess the health status of the study participants to be able to interpret subsequent changes that may be related to the effects of the treatments during the follow-up of patients. This study presents the clinical, haematological and biochemical profiles of podoconiosis patients prior to their involvement in the PodoLEDoxy clinical trial. METHODS All lower limb lymphoedema patients visiting the centre were screened and a podoconiosis diagnosis was based on clinical manifestation and detailed medical history. Patients who satisfied the eligibility criteria were enrolled in the study and their demographic data, vital signs and medical history were collected followed by biochemical and haematological examinations. RESULTS Of the 222 participants enrolled in the study, 55.4% and 41.4% had either stage 3 or 2 podoconiosis as their highest stages, respectively. On physical examination, gastritis (46%) and poor vision (2.7%) were the most prevalent health issues identified. The majority of haematological and biochemical values were within the normal range except for mean platelet volume (47.7%), plateletcrit (58.1%), platelet distribution width (66.2%), mean corpuscular volume (67.6%) and red cell distribution width-standard deviation (79.3%), where >40% of the study participants had values out of the normal. CONCLUSION The clinical, haematological and biochemical profiles of the study participants were largely within the normal range except for certain haematological parameters that might be worth investigating.
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Affiliation(s)
- Bertrand Lontum Ndzeshang
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.,Research Foundation in Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon
| | - Randy Tchachoua Mbiakop
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.,Research Foundation in Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon
| | - Gordon Takop Nchanji
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.,Research Foundation in Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon
| | - Chi Anizette Kien
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.,Research Foundation in Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon
| | - Glory Ngongeh Amambo
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.,Research Foundation in Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon
| | - Raphael Awah Abong
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.,Research Foundation in Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon
| | - Timothy Yuyun
- Regional Hospital Bamenda, P.O. Box 818, Bamenda Cameroon
| | - Amuam Andrew Beng
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.,Research Foundation in Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon
| | - John Bonekeh
- Research Foundation in Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon
| | - Manuel Ritter
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
| | - Mathias Eyong Esum
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.,Research Foundation in Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon
| | - Jerome Fru Cho
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.,Research Foundation in Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon
| | - Abdel Jelil Njouendou
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.,Research Foundation in Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon
| | | | - Kebede Deribe
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.,School of Public Health, Addis Ababa University, Ethiopia
| | - Fanny Fri Fombad
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.,Research Foundation in Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon
| | - Peter Enyong
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.,Research Foundation in Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon
| | - Ute Klarmann-Schulz
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany.,German Center for Infection Research (DZIF), partner-site Bonn-Cologne, Germany
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany.,German Center for Infection Research (DZIF), partner-site Bonn-Cologne, Germany
| | - Samuel Wanji
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.,Research Foundation in Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon
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Mackenzie CD, Mante S. Caring for patients in the global programme to eliminate lymphatic filariasis. Int Health 2021; 13:S48-S54. [PMID: 33349884 PMCID: PMC7753172 DOI: 10.1093/inthealth/ihaa080] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/12/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
Clinical lymphatic filariasis (LF) is a debilitating, disfiguring medical condition with severe psychosocial consequences for patients and their families. Addressing these patients’ medical needs is a major component of the global programme to eliminate lymphatic filariasis (GPELF). In the 20 y of providing a minimal package of care many thousands of surgical operations to correct LF hydrocoeles been performed and national programmes in >90% of LF endemic countries have received the training needed to care for their patients. The creation of educational materials detailing appropriate patient care, together with increased funding, have been key catalysts in increasing awareness of clinical LF in recent years. Nevertheless, the implementation of care for these patients has often faced challenges that have led to delays in fully implementing the patient care component of GPELF; these include locating these often stigmatised individuals, maintaining provision of the necessary consumables (e.g. soaps and creams) and maintaining programme support within already overstretched national LF teams. As the LF global programme moves to achieve success by 2030 it will be vital to continue to focus efforts on the care and rehabilitation of those suffering from lymphoedema and hydrocoeles, learning from the experiences of the past 20 y.
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Affiliation(s)
| | - Sunny Mante
- African Filariasis Morbidity Project, Korle BU, Accra, Ghana
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Krishnasastry S, Mackenzie CD. Alternative approaches to lymphoedema care in lymphatic filariasis. PLoS Negl Trop Dis 2021; 15:e0009293. [PMID: 33914741 PMCID: PMC8084153 DOI: 10.1371/journal.pntd.0009293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Suma Krishnasastry
- WHO Collaborating Centre for Lymphatic Filariasis Morbidity, Government TD Medical College, Alappuzha, Kerala, India
| | - Charles D. Mackenzie
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Atlanta, Georgia, United States of America
- * E-mail:
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Furlong-Silva J, Cross SD, Marriott AE, Pionnier N, Archer J, Steven A, Merker SS, Mack M, Hong YK, Taylor MJ, Turner JD. Tetracyclines improve experimental lymphatic filariasis pathology by disrupting interleukin-4 receptor-mediated lymphangiogenesis. J Clin Invest 2021; 131:140853. [PMID: 33434186 PMCID: PMC7919730 DOI: 10.1172/jci140853] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 01/06/2021] [Indexed: 12/21/2022] Open
Abstract
Lymphatic filariasis is the major global cause of nonhereditary lymphedema. We demonstrate that the filarial nematode Brugia malayi induced lymphatic remodeling and impaired lymphatic drainage following parasitism of limb lymphatics in a mouse model. Lymphatic insufficiency was associated with elevated circulating lymphangiogenic mediators, including vascular endothelial growth factor C. Lymphatic insufficiency was dependent on type 2 adaptive immunity, the interleukin-4 receptor, and recruitment of C-C chemokine receptor-2–positive monocytes and alternatively activated macrophages with a prolymphangiogenic phenotype. Oral treatments with second-generation tetracyclines improved lymphatic function, while other classes of antibiotic had no significant effect. Second-generation tetracyclines directly targeted lymphatic endothelial cell proliferation and modified type 2 prolymphangiogenic macrophage development. Doxycycline treatment impeded monocyte recruitment, inhibited polarization of alternatively activated macrophages, and suppressed T cell adaptive immune responses following infection. Our results determine a mechanism of action for the antimorbidity effects of doxycycline in filariasis and support clinical evaluation of second-generation tetracyclines as affordable, safe therapeutics for lymphedemas of chronic inflammatory origin.
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Affiliation(s)
- Julio Furlong-Silva
- Centre for Drugs & Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Stephen D Cross
- Centre for Drugs & Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Amy E Marriott
- Centre for Drugs & Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nicolas Pionnier
- Centre for Drugs & Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - John Archer
- Centre for Drugs & Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Andrew Steven
- Centre for Drugs & Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Stefan Schulte Merker
- Institute for Cardiovascular Organogenesis and Regeneration, Faculty of Medicine, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Matthias Mack
- Universitätsklinikum Regensburg, Regensburg, Germany
| | - Young-Kwon Hong
- Department of Surgery, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mark J Taylor
- Centre for Drugs & Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Joseph D Turner
- Centre for Drugs & Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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31
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[Parasitic dermatoses from abroad]. Hautarzt 2021; 72:163-174. [PMID: 33481049 DOI: 10.1007/s00105-020-04750-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Increased migration, the omnipresent desire to travel, climate change and a globally more mobile population enhance the risk of spreading infectious, tropical pathogens across international borders. In addition to diarrhea and fever, skin diseases present one of the most common reasons for a medical consultation upon return among travelers. These diseases are often caused by parasites. Detailed data on infectious travel diseases is scarce. However, demographic, endemic and travel-related information represent the basic requirements for physicians to choose appropriate diagnostics and adequate treatment for affected patients. This article gives an overview of common parasitic travel dermatoses, their specific diagnostic workup, treatment and preventive measures.
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Lefoulon E, Foster JM, Truchon A, Carlow CKS, Slatko BE. The Wolbachia Symbiont: Here, There and Everywhere. Results Probl Cell Differ 2021; 69:423-451. [PMID: 33263882 DOI: 10.1007/978-3-030-51849-3_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Wolbachia symbionts, first observed in the 1920s, are now known to be present in about 30-70% of tested arthropod species, in about half of tested filarial nematodes (including the majority of human filarial nematodes), and some plant-parasitic nematodes. In arthropods, they are generally viewed as parasites while in nematodes they appear to be mutualists although this demarcation is not absolute. Their presence in arthropods generally leads to reproductive anomalies, while in nematodes, they are generally required for worm development and reproduction. In mosquitos, Wolbachia inhibit RNA viral infections, leading to populational reductions in human RNA virus pathogens, whereas in filarial nematodes, their requirement for worm fertility and survival has been channeled into their use as drug targets for filariasis control. While much more research on these ubiquitous symbionts is needed, they are viewed as playing significant roles in biological processes, ranging from arthropod speciation to human health.
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Affiliation(s)
- Emilie Lefoulon
- Molecular Parasitology Group, New England Biolabs, Inc., Ipswich, MA, USA
| | - Jeremy M Foster
- Molecular Parasitology Group, New England Biolabs, Inc., Ipswich, MA, USA
| | - Alex Truchon
- Molecular Parasitology Group, New England Biolabs, Inc., Ipswich, MA, USA
| | - C K S Carlow
- Molecular Parasitology Group, New England Biolabs, Inc., Ipswich, MA, USA
| | - Barton E Slatko
- Molecular Parasitology Group, New England Biolabs, Inc., Ipswich, MA, USA.
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Horton J, Klarmann-Schulz U, Stephens M, Budge PJ, Coulibaly Y, Debrah A, Debrah LB, Krishnasastry S, Mwingira U, Ngenya A, Wanji S, Weerasooriya M, Yahathugoda C, Kroidl I, Deathe D, Majewski A, Sullivan S, Mackenzie C, Nutman TB, Shott JP, Weil G, Ottesen E, Hoerauf A. The design and development of a multicentric protocol to investigate the impact of adjunctive doxycycline on the management of peripheral lymphoedema caused by lymphatic filariasis and podoconiosis. Parasit Vectors 2020; 13:155. [PMID: 32228663 PMCID: PMC7106687 DOI: 10.1186/s13071-020-04024-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/16/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND As new lymphatic filariasis infections are eliminated through mass chemotherapy, previously affected individuals are left with the sequellae, especially chronic progressive lymphoedema. Currently this is managed by careful attention to limb hygiene to prevent infection. Studies over the past 15 years have suggested that the incorporation of doxycycline treatment may arrest or even reverse progression of lymphoedema. Most of this work has been observational or based on small studies, and if this intervention is effective, studies need to be conducted on a larger scale and under diverse geographical and social conditions before it can be incorporated into treatment policy. METHODS/DESIGN The double-blind, placebo-controlled study was designed to investigate the impact of six weeks treatment with doxycycline added to standard limb hygiene on early stage filarial lymphoedema in five sites in Africa and the Indian subcontinent. One site in Cameroon is selected for studying lymphoedema in podoconiosis. Each site was individually powered with the potential to undertake a meta-analysis on completion. Evaluation methods followed those used in Ghana in 2012 with additions resulting from advances in technology. The details of the core protocol and how it was varied to take account of differing situations at each of the sites are provided. The study will enrol up to 1800 patients and will complete in mid-2021. CONCLUSIONS This paper provides details of what challenges were faced during its development and discusses the issues and how they were resolved. In particular, the reasons for inclusion of new technology and the problems encountered with the supply of drugs for the studies are described in detail. By making these details available, it is hoped that the study protocol will help others interested in improving treatment for filarial lymphoedema in the design of future studies. Trial registration India: Clintrials.gov. NCT02929121 registered 10 Oct 2016: https://clinicaltrials.gov/ct2/show/NCT02929121 Mali: Clintrials.gov. NCT02927496 registered 7 Oct 2016: https://clinicaltrials.gov/ct2/show/NCT0292749 Sri Lanka: Clintrials.gov. NCT02929134 registered 10 Oct 2016: https://clinicaltrials.gov/ct2/show/NCT02929134 Ghana: ISRCTN. 14042737 registered 10 July 2017: https://doi.org/10.1186/ISRCTN14042737 Tanzania: ISRCTN. 65756724 registered 21 July 2017: https://doi.org/10.1186/ISRCTN65756724 Cameroon: ISRCTN. 1181662 registered 25 July 2017: https://doi.org/10.1186/ISRCTN11881662.
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Affiliation(s)
- John Horton
- Tropical Projects, 24 The Paddock, Hitchin, UK
| | - Ute Klarmann-Schulz
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), German Centre for Infection Research (DZIF), Bonn-Cologne Site, University Hospital Bonn, Venusberg-Campus 1, 53105 Bonn, Germany
| | - Mariana Stephens
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, GA USA
| | | | - Yaya Coulibaly
- Filariasis Research Unit, International Center for Excellence in Research, ICER-Mali, Bamako, Mali
| | - Alex Debrah
- Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Linda Batsa Debrah
- Department of Microbiology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Suma Krishnasastry
- Filariasis Research Unit, Govt. T D Medical College, Kerala, 699005 India
| | - Upendo Mwingira
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Abdallah Ngenya
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Samuel Wanji
- Department of Microbiology and Parasitology, University of Buea, Buea, SW State Cameroon
| | - Mirani Weerasooriya
- Filariasis Research Training and Services Unit (FRTSU), Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Channa Yahathugoda
- Filariasis Research Training and Services Unit (FRTSU), Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital of the University of Munich (LMU), Munich, Germany
| | - Drew Deathe
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, GA USA
| | - Andrew Majewski
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, GA USA
| | - Sarah Sullivan
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, GA USA
| | - Charles Mackenzie
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, GA USA
| | - Thomas B. Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892 USA
| | - Joseph P. Shott
- Division of Neglected Tropical Diseases, US Agency for International Development, 1300 Pennsylvania Ave NW, Washington, DC USA
| | - Gary Weil
- Washington University School of Medicine, St. Louis, MO USA
| | - Eric Ottesen
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, GA USA
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), German Centre for Infection Research (DZIF), Bonn-Cologne Site, University Hospital Bonn, Venusberg-Campus 1, 53105 Bonn, Germany
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Wan Sulaiman WA, Kamtchum-Tatuene J, Mohamed MH, Ramachandran V, Ching SM, Sazlly Lim SM, Hashim HZ, Inche Mat LN, Hoo FK, Basri H. Anti- Wolbachia therapy for onchocerciasis & lymphatic filariasis: Current perspectives. Indian J Med Res 2020; 149:706-714. [PMID: 31496523 PMCID: PMC6755775 DOI: 10.4103/ijmr.ijmr_454_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Onchocerciasis and lymphatic filariasis (LF) are human filarial diseases belonging to the group of neglected tropical diseases, leading to permanent and long-term disability in infected individuals in the endemic countries such as Africa and India. Microfilaricidal drugs such as ivermectin and albendazole have been used as the standard therapy in filariasis, although their efficacy in eliminating the diseases is not fully established. Anti-Wolbachia therapy employs antibiotics and is a promising approach showing potent macrofilaricidal activity and also prevents embryogenesis. This has translated to clinical benefits resulting in successful eradication of microfilarial burden, thus averting the risk of adverse events from target species as well as those due to co-infection with loiasis. Doxycycline shows potential as an anti-Wolbachia treatment, leading to the death of adult parasitic worms. It is readily available, cheap and safe to use in adult non-pregnant patients. Besides doxycycline, several other potential antibiotics are also being investigated for the treatment of LF and onchocerciasis. This review aims to discuss and summarise recent developments in the use of anti-Wolbachia drugs to treat onchocerciasis and LF.
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Affiliation(s)
- Wan Aliaa Wan Sulaiman
- Department of Medicine, Faculty of Medicine & Health Sciences; Laboratory of Medical Gerontology, Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Joseph Kamtchum-Tatuene
- Liverpool Brain Infection Group, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Mohd Hazmi Mohamed
- Department of Surgery, Faculty of Medicine & Health Sciences; Laboratory of Medical Gerontology, Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Vasudevan Ramachandran
- Laboratory of Medical Gerontology, Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Sazlyna Mohd Sazlly Lim
- Department of Medicine, Faculty of Medicine & Health Sciences, Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Hasnur Zaman Hashim
- Department of Medicine, Faculty of Medicine & Health Sciences, Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Liyana Najwa Inche Mat
- Department of Medicine, Faculty of Medicine & Health Sciences; Laboratory of Medical Gerontology, Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Fan Kee Hoo
- Department of Medicine, Faculty of Medicine & Health Sciences, Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Hamidon Basri
- Department of Medicine, Faculty of Medicine & Health Sciences; Laboratory of Medical Gerontology, Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
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Murthy PK. Strategies to Control Human Lymphatic Filarial Infection: Tweaking Host’s Immune System. Curr Top Med Chem 2019; 19:1226-1240. [DOI: 10.2174/1568026619666190618110613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 05/09/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022]
Abstract
Human lymphatic filariasis (LF), a parasitic infection caused by the nematodes Wuchereria bancrofti, Brugia malayi and B. timori, and transmitted by mosquito, results in a debilitating disease commonly identified as ‘elephantiasis’. LF affects millions of people in India and several other tropical and sub-tropical countries imposing a huge economic burden on governments due to disability associated loss of man-hours and for disease management. Efforts to control the infection by WHO’s mass drug administration (MDA) strategy using three antifilarials diethylcarbamazine, albendazole and ivermectin are only partly successful and therefore, there is an immediate need for alternative strategies. Some of the alternative strategies being explored in laboratories are: enhancing the immune competence of host by immunomodulation, combining immunomodulation with antifilarials, identifying immunoprophylactic parasite molecules (vaccine candidates) and identifying parasite molecules that can be potential drug targets. This review focuses on the advances made in this direction.
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Affiliation(s)
- Puvvada Kalpana Murthy
- Department of Zoology, University of Lucknow, University Road, Lucknow 226 007, Uttar Pradesh, India
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Karim MJ, Haq R, Mableson HE, Sultan Mahmood ASM, Rahman M, Chowdhury SM, Rahman AKMF, Hafiz I, Betts H, Mackenzie C, Taylor MJ, Kelly-Hope LA. Developing the first national database and map of lymphatic filariasis clinical cases in Bangladesh: Another step closer to the elimination goals. PLoS Negl Trop Dis 2019; 13:e0007542. [PMID: 31306409 PMCID: PMC6658114 DOI: 10.1371/journal.pntd.0007542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/25/2019] [Accepted: 06/11/2019] [Indexed: 11/18/2022] Open
Abstract
Background The Bangladesh Lymphatic Filariasis (LF) Elimination Programme has made significant progress in interrupting transmission through mass drug administration (MDA) and has now focussed its efforts on scaling up managing morbidity and preventing disability (MMDP) activities to deliver the minimum package of care to people affected by LF clinical conditions. This paper highlights the Bangladesh LF Programme’s success in conducting a large-scale cross-sectional survey to determine the number of people affected by lymphoedema and hydrocoele, which enabled clinical risk maps to be developed for targeted interventions across the 34 endemic districts (19 high endemic; 15 low endemic). Methodology/Principal findings In the 19 high endemic districts, 8,145 community clinic staff were trained to identify and report patients in their catchment area. In the 15 low endemic districts, a team of 10 trained field assistants conducted active case finding with cases reported via a SMS mHealth tool. Disease burden and prevalence maps were developed, with morbidity hotspots identified at sub-district level based on a combination of the highest prevalence rates per 100,000 and case-density rates per square kilometre (km2). The relationship between morbidity and baseline microfilaria (mf) prevalence was also examined. In total 43,678 cases were identified in the 19 high endemic districts; 30,616 limb lymphoedema (70.1%; female 55.3%), 12,824 hydrocoele (29.4%), and 238 breast/female genital swelling (0.5%). Rangpur Division reported the highest cases numbers and prevalence of lymphoedema (26,781 cases, 195 per 100,000) and hydrocoele (11661 cases, 169.6 per 100,000), with lymphoedema predominately affecting females (n = 21,652). Rangpur and Lalmonirhat Districts reported the highest case numbers (n = 11,199), and prevalence (569 per 100,000) respectively, with five overlapping lymphoedema and hydrocoele sub-district hotspots. In the 15 low endemic districts, 732 cases were identified; 661 lymphoedema (90.2%; female 39.6%), 56 hydrocoele (7.8%), and 15 both conditions (2.0%). Spearman’s correlation analysis found morbidity and mf prevalence significantly positively correlated (r = 0.904; p<0.01). Conclusions/Significance The Bangladesh LF Programme has developed one of the largest, most comprehensive country databases on LF clinical conditions in the world. It provides an essential database for health workers to identify local morbidity hotspots, deliver the minimum package of care, and address the dossier elimination requirements. The Global Programme to Eliminate Lymphatic Filariasis (GPELF) requires lymphatic filariasis (LF) endemic countries, such as Bangladesh, to estimate the number of lymphoedema and hydrocoele cases in order to deliver the minimum package of care required to control morbidity and reduce patient suffering. This paper highlights the Bangladesh LF Elimination Programme’s progress in training more than 8000 community health workers to identify more than 44,000 cases across 34 endemic districts where approximately 70 million people are at risk. The morbidity data collected enabled the creation of a national database and a series of risk maps of lymphoedema and hydrocoele to be developed, which highlighted the significant burden in northern Rangpur Division, especially of lymphoedema among female patients. The Bangladesh LF Elimination Programme’s efforts to identify LF cases across all endemic districts represents one of the most comprehensive national databases on LF clinical cases in the world. It provides an informative database for health workers to use in the delivery of the minimum package of care and a template for other countries to adopt and develop national strategies to manage morbidity and prevent disability as recommended by GPELF.
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Affiliation(s)
- Mohammad J. Karim
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
- * E-mail: (MJK); (LAK)
| | - Rouseli Haq
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Hayley E. Mableson
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - A. S. M. Sultan Mahmood
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Mujibur Rahman
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | | | | | - Israt Hafiz
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Hannah Betts
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Charles Mackenzie
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mark J. Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail: (MJK); (LAK)
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Dietrich CF, Chaubal N, Hoerauf A, Kling K, Piontek MS, Steffgen L, Mand S, Dong Y. Review of Dancing Parasites in Lymphatic Filariasis. Ultrasound Int Open 2019; 5:E65-E74. [PMID: 31312785 PMCID: PMC6629997 DOI: 10.1055/a-0918-3678] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/04/2019] [Accepted: 05/01/2019] [Indexed: 02/07/2023] Open
Abstract
Lymphatic filariasis is an infection transmitted by blood-sucking mosquitoes with filarial nematodes of the species Wuchereria bancrofti, Brugia malayi und B. timori . It is prevalent in tropical countries throughout the world, with more than 60 million people infected and more than 1 billion living in areas with the risk of transmission. Worm larvae with a length of less than 1 mm are transmitted by mosquitoes, develop in human lymphatic tissue to adult worms with a length of 7-10 cm, live in the human body for up to 10 years and produce millions of microfilariae, which can be transmitted further by mosquitoes. The adult worms can be easily observed by ultrasonography because of their size and fast movements (the so-called "filarial dance sign"), which can be differentiated from other movements (e. g., blood in venous vessels) by their characteristic movement profile in pulsed-wave Doppler mode. Therapeutic options include (combinations of) ivermectin, albendazole, diethylcarbamazine and doxycycline. The latter depletes endosymbiotic Wolbachia bacteria from the worms and thus sterilizes and later kills the adult worms (macrofilaricidal or adulticidal effect).
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Affiliation(s)
| | - Nitin Chaubal
- Thane Ultrasound Centre, Thane Ultrasound Centre, Thane, India
| | - Achim Hoerauf
- Institut für Med. Mikrobiologie, Immunologie und Parasitologie (IMMIP), Universität Bonn, Bonn, Germany
| | - Kerstin Kling
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Markus Schindler Piontek
- Caritas Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Medical Clinic 2, Bad Mergentheim, Germany
| | - Ludwig Steffgen
- Trainings-Zentrum Ultraschall-Diagnostik LS GmbH, Ultrasound, Mainleus, Germany
| | - Sabine Mand
- Institut für Med. Mikrobiologie, Immunologie und Parasitologie (IMMIP), Universität Bonn, Bonn, Germany
| | - Yi Dong
- Zhongshan Hospital, Ultrasound, Shanghai, China
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Kwarteng A, Arthur YD, Yamba JK, Sylverken AA, Kini P, Ahuno ST, Owusu-Dabo E. Influence of seasonal variation on reported filarial attacks among people living with lymphedema in Ghana. BMC Infect Dis 2019; 19:442. [PMID: 31109288 PMCID: PMC6528377 DOI: 10.1186/s12879-019-4084-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/13/2019] [Indexed: 01/14/2023] Open
Abstract
Background Lymphatic Filariasis (LF) is a vector-borne neglected tropical disease caused by the filarial nematode parasites that can lead to the disfiguring swelling of the limbs (lymphedema or elephantiasis for late stage) and/or genitalia (hydrocele) in men. Growing evidence suggests that not only are filarial lymphedema patients confronted with huge societal stigma and discrimination, but also experience acute filarial attacks accompanied by swelling of the affected part(s), fever, wounds and peeling of the skin of affected limbs(s). However, the extent to which seasonal variation influence filarial attacks among people with lymphedema was highly speculated without empirical evidence and was thus investigated. Methods In light of this, a cross-sectional study where 142 (70.4% females and 29.6% males) lymphedema patients were recruited from 8 established Wuchereria bancrofti endemic communities in the Ahanta West District, Ghana was carried out to investigate the prevalence and seasonal variation (rainy/wet and dry seasons) of acute filarial attacks. Chi-square test was used to test for association between frequency of attacks and seasonality. The STROBE guidelines for reporting cross-sectional studies was adopted. Results The average lymphedema leg stage was 2.37 and 2.33 for left and right legs, respectively, while mossy lesions, sores and ulcers were observed among 33.1% of patients with late stage disease (elephantiasis). It was found that 97 (68.3%) of the study participants experience filarial attacks during the wet season and 36 (25.4%) reported the incidence of filarial attacks during both seasons (wet and dry) while 9 (6.3%) of the study participants did not experience any attack at all. Conclusions Findings from the present study show compelling evidence that the frequency and the prevalence of filarial attacks is significantly increased during wet seasons compared to the dry season. Electronic supplementary material The online version of this article (10.1186/s12879-019-4084-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Kwarteng
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, PMB, KNUST, Kumasi, Ghana. .,Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana.
| | - Yarhands Dissou Arthur
- Department of Interdisciplinary Studies, University of Education Winneba, Kumasi Campus, Kumasi, Ghana
| | - John Kanyiri Yamba
- College of Agriculture Education, University of Education Winneba, Asante Mampong, Mampong, Ghana
| | - Augustina A Sylverken
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana.,Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana
| | - Priscilla Kini
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana
| | - Samuel Terkper Ahuno
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, PMB, KNUST, Kumasi, Ghana.,Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana.,Department of Global and International Health, School of Public Health, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana
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Nochot H, Loimek S, Priyavoravong P, Wongkamchai S, Sarasombath PT. Therapeutic efficacy of doxycycline in domestic cats naturally infected with Brugia malayi in field condition. Exp Parasitol 2019; 200:73-78. [PMID: 30953626 DOI: 10.1016/j.exppara.2019.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/11/2019] [Accepted: 03/26/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of oral doxycycline treatment for Brugia malayi as measured by microfilarial and filarial DNA clearance in naturally infected domestic cats. METHODS This study included 8 domestic cats that lived with families that resided in Tak Bai District of Narathiwat Province, which is located in Southern Thailand. The study area is a known B. malayi endemic area. All study cats received doxycycline treatment doses by their respective owners according to a previously described protocol. Briefly, doxycycline (VibraVet@) was given orally once a day during weeks 1-4, 10-11, and 16-17. Blood collections were performed at baseline before treatment, and then every month for 12 months after the initial dose of doxycycline to assess microfilaraemia by Giemsa stain, and filarial DNA detection by high-resolution melt (HRM) real-time polymerase chain reaction (PCR). RESULTS One month after the start of doxycycline treatment, five of eight cats were negative for microfilaraemia, and 4 of those were negative for filarial DNA. All cats receiving doxycycline treatment were negative for microfilaria by Giemsa stain, and for filarial DNA by HRM real-time PCR within 8 months after receiving the initial dose of doxycycline treatment. CONCLUSION Administration of oral doxycycline to domestic cats naturally infected with B. malayi in disease endemic areas can significantly reduce microfilaraemia at 1 month and filarial DNA was undetectable by 8 months after the initial dose of doxycycline treatment. No recurrence of microfilaraemia or filarial DNA was observed in study cats at 1 year after the start of doxycycline. Included cats appeared to tolerate doxycycline (VibraVet@) well, with no adverse drug reactions reported by any study cat owner.
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Affiliation(s)
- Hathai Nochot
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Sumat Loimek
- Office of Disease Prevention and Control Region 12 Songkhla, Department of Disease Control, Ministry of Public Health, Songkhla, Thailand.
| | | | - Sirichit Wongkamchai
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Abstract
Expanding treatment options alongside ensuring high coverage of mass drug administration can accelerate progress in elimination of lymphatic filariasis, say Sabine Specht and colleagues
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Affiliation(s)
- Sabine Specht
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - T K Suma
- Filariasis Research Unit, Government T D Medical College, Alappuzha, Kerala, India
| | - Belen Pedrique
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany
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Gedge LM, Bettis AA, Bradley MH, Hollingsworth TD, Turner HC. Economic evaluations of lymphatic filariasis interventions: a systematic review and research needs. Parasit Vectors 2018; 11:75. [PMID: 29391042 PMCID: PMC5793442 DOI: 10.1186/s13071-018-2616-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/02/2018] [Indexed: 01/13/2023] Open
Abstract
In 2000, the World Health Organization established the Global Programme to Eliminate Lymphatic Filariasis (GPELF), with the goal of eliminating the disease as a public health problem by 2020. Since the start of the programme, a cumulative total of 6.2 billion treatments have been delivered to affected populations - with more than 556 million people treated in 2015 alone. In this paper, we perform a rigorous systematic review of the economic evaluations of lymphatic filariasis interventions have been conducted. We demonstrate that the standard interventions to control lymphatic filariasis are consistently found to be highly cost-effective. This finding has important implications for advocacy groups and potential funders. However, there are several important inconsistencies and research gaps that need to be addressed as we move forward towards the 2020 elimination goals. One of the most important identified research gaps was a lack of evaluation of new interventions specifically targeting areas co-endemic with onchocerciasis and Loa loa - which could become a major barrier to achieving elimination.
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Affiliation(s)
- Lukyn M. Gedge
- School of Public Health, Faculty of Medicine, St Marys Campus, Imperial College London, Norfolk Place, London, W2 1PG UK
| | - Alison A. Bettis
- London Centre for Neglected Tropical Disease Research, London, UK
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Marys Campus, Imperial College London, Norfolk Place, London, W2 1PG UK
| | | | - T. Déirdre Hollingsworth
- Mathematics Institute, University of Warwick, Coventry, CV4 7AL UK
- School of Life Sciences, University of Warwick, Coventry, CV4 7AL UK
- Big Data Institute, University of Oxford, Oxford, OX3 7LF UK
| | - Hugo C. Turner
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Targeting Human Onchocerciasis: Recent Advances Beyond Ivermectin. ANNUAL REPORTS IN MEDICINAL CHEMISTRY 2018. [DOI: 10.1016/bs.armc.2018.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Single nucleotide polymorphisms in the angiogenic and lymphangiogenic pathways are associated with lymphedema caused by Wuchereria bancrofti. Hum Genomics 2017; 11:26. [PMID: 29122006 PMCID: PMC5679374 DOI: 10.1186/s40246-017-0121-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 10/20/2017] [Indexed: 01/02/2023] Open
Abstract
Background Lymphedema (LE) is a chronic clinical manifestation of filarial nematode infections characterized by lymphatic dysfunction and subsequent accumulation of protein-rich fluid in the interstitial space—lymphatic filariasis. A number of studies have identified single nucleotide polymorphisms (SNPs) associated with primary and secondary LE. To assess SNPs associated with LE caused by lymphatic filariasis, a cross-sectional study of unrelated Ghanaian volunteers was designed to genotype SNPs in 285 LE patients as cases and 682 infected patients without pathology as controls. One hundred thirty-one SNPs in 64 genes were genotyped. The genes were selected based on their roles in inflammatory processes, angiogenesis/lymphangiogenesis, and cell differentiation during tumorigenesis. Results Genetic associations with nominal significance were identified for five SNPs in three genes: vascular endothelial growth factor receptor-3 (VEGFR-3) rs75614493, two SNPs in matrix metalloprotease-2 (MMP-2) rs1030868 and rs2241145, and two SNPs in carcinoembryonic antigen-related cell adhesion molecule-1 (CEACAM-1) rs8110904 and rs8111171. Pathway analysis revealed an interplay of genes in the angiogenic/lymphangiogenic pathways. Plasma levels of both MMP-2 and CEACAM-1 were significantly higher in LE cases compared to controls. Functional characterization of the associated SNPs identified genotype GG of CEACAM-1 as the variant influencing the expression of plasma concentration, a novel finding observed in this study. Conclusion The SNP associations found in the MMP-2, CEACAM-1, and VEGFR-3 genes indicate that angiogenic/lymphangiogenic pathways are important in LE clinical development. Electronic supplementary material The online version of this article (10.1186/s40246-017-0121-7) contains supplementary material, which is available to authorized users.
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Kar SK, Dwibedi B, Das BK, Agrawala BK, Ramachandran CP, Horton J. Lymphatic pathology in asymptomatic and symptomatic children with Wuchereria bancrofti infection in children from Odisha, India and its reversal with DEC and albendazole treatment. PLoS Negl Trop Dis 2017; 11:e0005631. [PMID: 29059186 PMCID: PMC5667936 DOI: 10.1371/journal.pntd.0005631] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 11/02/2017] [Accepted: 05/10/2017] [Indexed: 11/22/2022] Open
Abstract
Background Once interruption of transmission of lymphatic filariasis is achieved, morbidity prevention and management becomes more important. A study in Brugia malayi filariasis from India has shown sub-clinical lymphatic pathology with potential reversibility. We studied a Wuchereria bancrofti infected population, the major contributor to LF globally. Methods Children aged 5–18 years from Odisha, India were screened for W. bancrofti infection and disease. 102 infected children, 50 with filarial disease and 52 without symptoms were investigated by lymphoscintigraphy and then randomized to receive a supervised single oral dose of DEC and albendazole which was repeated either annually or semi-annually. The lymphatic pathology was evaluated six monthly for two years. Findings Baseline lymphoscintigraphy showed abnormality in lower limb lymphatics in 80% of symptomatic (40/50) and 63·5% (33/52) of asymptomatic children. Progressive improvement in baseline pathology was seen in 70·8, 87·3, 98·6, and 98·6% of cases at 6, 12, 18, and 24 months follow up, while in 4·2, 22·5, 47·9 and 64·8%, pathology reverted to normal. This was independent of age (p = 0·27), symptomatic status (p = 0·57) and semi-annual/bi-annual dosing (p = 0·46). Six of eleven cases showed clinical reduction in lymphedema of legs. Interpretation A significant proportion of a young W. bancrofti infected population exhibited lymphatic pathology which was reversible with annual dosage of DEC and albendazole. This provides evidence for morbidity prevention & treatment of early lymphedema. It can also be used as a tool to improve community compliance during mass drug administration. Trial registration ClinicalTrials.gov No CTRI/2013/10/004121 Infection with lymphatic filarial parasites usually occurs early in childhood in endemic areas, but clinical signs appear much later. Reversal of lymphatic pathology has been shown with the much less common Brugia malayi infection using DEC and albendazole and there is scarce evidence whether the same occurs with bancroftian filariasis using the above drugs. We designed this study to look for prevalence of lymphatic pathology in children with and without clinical signs of infection and to observe the effect on the pre-treatment pathology using DEC and albendazole given once or twice a year. We have shown, using lymphoscintigraphy, that lymphatic vessel changes occur very early in infection, and treatment can reverse these changes, even when clinical symptoms are already apparent. This has important implications for lymphedema prevention, case management and for advocacy in the Lymphatic Filariasis Elimination Program. It also strengthens the previous evidence of benefit of treatment on early lymphedema management.
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Affiliation(s)
- Shantanu K. Kar
- Director of Medical Research, IMS & Sum Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
- Regional Medical Research Centre, Chandrasekhapur, Bhubaneswar, Odisha, India
| | - Bhagirathi Dwibedi
- Regional Medical Research Centre, Chandrasekhapur, Bhubaneswar, Odisha, India
| | - Birendra K. Das
- Utkal Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | | | - John Horton
- Tropical Projects, Hitchin, United Kingdom
- * E-mail:
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Albendazole and antibiotics synergize to deliver short-course anti- Wolbachia curative treatments in preclinical models of filariasis. Proc Natl Acad Sci U S A 2017; 114:E9712-E9721. [PMID: 29078351 PMCID: PMC5692564 DOI: 10.1073/pnas.1710845114] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Filarial nematode infections, caused by Wuchereria bancrofti, Brugia malayi (elephantiasis), and Onchocerca volvulus (river blindness) infect 150 million of the world’s poorest populations and cause profound disability. Standard treatments require repetitive, long-term, mass drug administrations and have failed to interrupted transmission in certain sub-Saharan African regions. A drug cure using doxycycline, which targets the essential filarial endosymbiont Wolbachia, is clinically effective but programmatically challenging to implement due to long treatment durations and contraindications. Here we provide proof-of-concept of a radical improvement of targeting Wolbachia via identification of drug synergy between the anthelmintic albendazole and antibiotics. This synergy enables the shortening of treatment duration of macrofilaricidal anti-Wolbachia based treatments from 4 wk to 7 d with registered drugs ready for clinical testing. Elimination of filariasis requires a macrofilaricide treatment that can be delivered within a 7-day period. Here we have identified a synergy between the anthelmintic albendazole (ABZ) and drugs depleting the filarial endosymbiont Wolbachia, a proven macrofilaricide target, which reduces treatment from several weeks to 7 days in preclinical models. ABZ had negligible effects on Wolbachia but synergized with minocycline or rifampicin (RIF) to deplete symbionts, block embryogenesis, and stop microfilariae production. Greater than 99% Wolbachia depletion following 7-day combination of RIF+ABZ also led to accelerated macrofilaricidal activity. Thus, we provide preclinical proof-of-concept of treatment shortening using antibiotic+ABZ combinations to deliver anti-Wolbachia sterilizing and macrofilaricidal effects. Our data are of immediate public health importance as RIF+ABZ are registered drugs and thus immediately implementable to deliver a 1-wk macrofilaricide. They also suggest that novel, more potent anti-Wolbachia drugs under development may be capable of delivering further treatment shortening, to days rather than weeks, if combined with benzimidazoles.
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Yahathugoda C, Weiler MJ, Rao R, De Silva L, Dixon JB, Weerasooriya MV, Weil GJ, Budge PJ. Use of a Novel Portable Three-Dimensional Imaging System to Measure Limb Volume and Circumference in Patients with Filarial Lymphedema. Am J Trop Med Hyg 2017; 97:1836-1842. [PMID: 29141750 DOI: 10.4269/ajtmh.17-0504] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The World Health Organization's Global Program to Eliminate Lymphatic Filariasis (LF) has reduced LF transmission worldwide, but millions remain affected by filarial lymphedema. Tools for clinically monitoring lymphedema in developing nations are limited. We tested a novel, portable, infrared three-dimensional imaging system (3DIS) against water displacement (WD) and tape measurement of limb circumference (TMLC) among patients with filarial leg lymphedema in Galle, Sri Lanka. Outcomes were accuracy and reproducibility of imaging system measurements. In parallel, we also tested the reproducibility of skin thickness ultrasound (STU) measurements. We examined 52 patients (104 limbs) with lymphedema of stages 0-6 (N = 28, 19, 20, 21, 2, 4, and 10, respectively). 3DIS measurements correlated nearly perfectly with WD (r2 = 0.9945) and TMLC values (r2 > 0.9801). The median time required to acquire imaging system measurements for both legs was 2.1 minutes, compared with 17, 7, and 29 minutes, respectively, for WD, TMLC, and STU. Median interexaminer coefficients of variation (CVs) for volume measurements were 1.1% (interquartile range [IQR] 0.5-2.1%) for WD and 1.7% (IQR 1.2-2.4%) for the 3DIS. CVs for circumference measurements were 1.4% (IQR 0.8-2.4%) by TMLC and 1.3% (0.8-1.9%) by 3DIS. Median interexaminer CV for STU was 13.7% (IQR 8.5-21.3%). The portable imaging system noninvasively provided accurate and reproducible limb volume and circumference measurements in approximately 2 minutes per patient. This portable technology has the potential to greatly improve assessment and monitoring of lymphedema in the clinic and in the field.
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Affiliation(s)
- Channa Yahathugoda
- Filariasis Research Training and Service Unit, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | | | - Ramakrishna Rao
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Lalindi De Silva
- Filariasis Research Training and Service Unit, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - J Brandon Dixon
- George W. Woodruff School of Mechanical Engineering, Parker H. Petit Institute of Biotechnology and Bioscience, Georgia Institute of Technology, Atlanta, Georgia
| | - Mirani V Weerasooriya
- Filariasis Research Training and Service Unit, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Gary J Weil
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Philip J Budge
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Li K, Xu H, Liu NF, Sadigh P, Evans V, Zhang YX. Far-infrared ray for treating chronic lower extremity lymphedema with dermatolymphangioadenitis: a postoperative complication of gynecological tumor resection. Arch Gynecol Obstet 2017; 295:1441-1450. [DOI: 10.1007/s00404-017-4371-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/18/2017] [Indexed: 01/06/2023]
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Stanton MC, Yamauchi M, Mkwanda SZ, Ndhlovu P, Matipula DE, Mackenzie C, Kelly-Hope LA. Measuring the physical and economic impact of filarial lymphoedema in Chikwawa district, Malawi: a case-control study. Infect Dis Poverty 2017; 6:28. [PMID: 28366168 PMCID: PMC5376674 DOI: 10.1186/s40249-017-0241-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 01/11/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is one of the primary causes of lymphoedema in sub-Saharan Africa, and has a significant impact on the quality of life (QoL) of those affected. In this paper we assess the relative impact of lymphoedema on mobility and income in Chikwawa district, Malawi. METHODS A random sample of 31 people with lymphoedema and 31 matched controls completed a QoL questionnaire from which both an overall and a mobility-specific score were calculated. Two mobility tests were undertaken, namely the 10 m walking test [10MWT] and timed up and go [TUG] test, and a subset of 10 cases-control pairs wore GPS data loggers for 3 weeks to measure their mobility in a more natural setting. Retrospective economic data was collected from all 31 case-control pairs, and each participant undertaking the GPS activity recorded daily earnings and health expenditure throughout the observation period. RESULTS Cases had a significantly poorer overall QoL (cases = 32.2, controls = 6.0, P < 0.01) and mobility-specific (cases = 43.1, controls = 7.4, P < 0.01) scores in comparison to controls. Cases were also significantly slower (P < 0.01) at completing the timed mobility tests, e.g. mean 10MWT speed of 0.83 m/s in comparison to 1.10 m/s for controls. An inconsistent relationship was observed between mobility-specific QoL scores and the timed test results for cases (10MWT correlation = -0.06, 95% CI = (-0.41, 0.30)), indicating that their perceived disability differed from their measured disability, whereas the results were consistent for controls (10MWT correlation = -0.61, 95% CI = (-0.79, -0.34)). GPS summaries indicated that cases generally walk shorter distances at slower speeds than control, covering a smaller geographical area (median area by kernel smoothing: cases = 1.25 km2, controls = 2.10 km2, P = 0.16). Cases reported earning less than half that earned by controls per week (cases = $0.70, controls = $1.86, P = 0.064), with a smaller proportion of their earnings (16% vs 22%, P = 0.461) being spent on healthcare. CONCLUSIONS Those affected by lymphoedema are at a clear disadvantage to their unaffected peers, experiencing a lower QoL as confirmed by both subjective and objective mobility measures, and lower income. This study also indicates that objective measures of mobility may be a useful supplement to self-assessed QoL questionnaires when assessing the future impact of lymphoedema management interventions.
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Affiliation(s)
- Michelle C Stanton
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Masato Yamauchi
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Paul Ndhlovu
- Chikwawa District Health Office, Chikwawa, Malawi
| | | | - Charles Mackenzie
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, USA
| | - Louise A Kelly-Hope
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
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Kwarteng A, Ahuno ST. Immunity in Filarial Infections: Lessons from Animal Models and Human Studies. Scand J Immunol 2017; 85:251-257. [DOI: 10.1111/sji.12533] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/27/2017] [Indexed: 02/03/2023]
Affiliation(s)
- A. Kwarteng
- Department of Biochemistry and Biotechnology; Kwame Nkrumah University of Science Technology, PMB; Kumasi Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR); KNUST, PMB; Kumasi Ghana
| | - S. T. Ahuno
- Department of Biochemistry and Biotechnology; Kwame Nkrumah University of Science Technology, PMB; Kumasi Ghana
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