1
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Burqi AMK, Satti L, Mahboob S, Anwar SOZ, Bizanjo M, Rafique M, Ghanchi NK. Successful Treatment of Confirmed Naegleria fowleri Primary Amebic Meningoencephalitis. Emerg Infect Dis 2024; 30:803-805. [PMID: 38526236 PMCID: PMC10977850 DOI: 10.3201/eid3004.230979] [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: 03/26/2024] Open
Abstract
Primary amebic meningoencephalitis caused by Naegleria fowleri is a rare but nearly always fatal parasitic infection of the brain. Globally, few survivors have been reported, and the disease has no specific treatment. We report a confirmed case in Pakistan in a 22-year-old man who survived after aggressive therapy.
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2
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Yethindra V, Ramanujam SK, Mummadi D, Kanteti KP, Vityala S, Damineni U. In silico-based vaccine design against Naegleria fowleri causing primary amebic meningoencephalitis. Indian J Pharmacol 2024; 56:148-149. [PMID: 38687320 PMCID: PMC11161009 DOI: 10.4103/ijp.ijp_482_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/24/2023] [Accepted: 03/18/2024] [Indexed: 05/02/2024] Open
Affiliation(s)
- Vityala Yethindra
- Honorary International Faculty, AJ Institute of Medical Sciences and Research Centre, Mangalore Karnataka, India
| | - Sai Kiran Ramanujam
- Department of Public Health and Biostatistics, Saint Louis University, Saint Louis, United States
| | - Dharani Mummadi
- Department of Public Health and Biostatistics, Saint Louis University, Saint Louis, United States
| | - Krishna Priya Kanteti
- Department of General Medicine, Gandhi Medical College and Hospital, Secunderabad, India
| | - Srilaxmi Vityala
- Department of Fisheries Resource Management, ICAR-Central Institute of Fisheries Education, Andheri, Mumbai, India
| | - Ujwala Damineni
- Department of General Medicine, Maheshwara Medical College and Hospital, Hyderabad, Telangana, India
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3
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Pomeroy J, Khalifa MM, Milanes JE, Palmentiero CM, Morris JC, Golden JE. Synthesis and Evaluation of Benzylamine Inhibitors of Neuropathogenic Naegleria fowleri "Brain-Eating" Amoeba. ACS Med Chem Lett 2024; 15:87-92. [PMID: 38229759 PMCID: PMC10789148 DOI: 10.1021/acsmedchemlett.3c00440] [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] [Received: 09/28/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/18/2024] Open
Abstract
Current therapy for primary amoebic meningoencephalitis (PAM), a highly lethal brain infection in humans caused by Naegleria fowleri amoeba, is restricted to repurposed drugs with limited efficacy and success. Discovery of an antiamoebic benzylamine scaffold 2 precipitated a medicinal chemistry effort to improve potency, cytotoxicity profile, and drug-like properties. Thirty-four compounds were prepared, leading to compound 28 with significant gains in potency (EC50 = 0.92 μM), solubility, and microsomal stability and a demonstrated absence of cytotoxicity in SH-SY5Y human neuroblastoma cells (CC50 > 20 μM). The compounds demonstrated excellent blood-brain barrier permeability in an in vitro assay, thereby providing a new structural scaffold that inhibits N. fowleri viability and permits the investigation of therapeutic interventions in an understudied neglected disease.
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Affiliation(s)
- Julia
M. Pomeroy
- Department
of Chemistry, University of Wisconsin-Madison, Madison, Wisconsin 53706, United
States
| | - Muhammad M. Khalifa
- School
of Pharmacy, Division of Pharmaceutical Sciences, University of Wisconsin-Madison, Madison, Wisconsin 53705, United States
| | - Jillian E. Milanes
- Eukaryotic
Pathogens Innovation Center, Department of Genetics and Biochemistry, Clemson University, Clemson, South Carolina 29634, United States
| | - Caroline M. Palmentiero
- Eukaryotic
Pathogens Innovation Center, Department of Genetics and Biochemistry, Clemson University, Clemson, South Carolina 29634, United States
| | - James C. Morris
- Eukaryotic
Pathogens Innovation Center, Department of Genetics and Biochemistry, Clemson University, Clemson, South Carolina 29634, United States
| | - Jennifer E. Golden
- Department
of Chemistry, University of Wisconsin-Madison, Madison, Wisconsin 53706, United
States
- School
of Pharmacy, Division of Pharmaceutical Sciences, University of Wisconsin-Madison, Madison, Wisconsin 53705, United States
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4
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Hall AD, Kumar JE, Golba CE, Luckett KM, Bryant WK. Primary amebic meningoencephalitis: a review of Naegleria fowleri and analysis of successfully treated cases. Parasitol Res 2024; 123:84. [PMID: 38182931 DOI: 10.1007/s00436-023-08094-w] [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: 10/28/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024]
Abstract
Primary amebic meningoencephalitis (PAM) is a necrotizing and hemorrhagic inflammation of the brain and meninges caused by Naegleria fowleri, a free-living thermophilic ameba of freshwater systems. PAM remains a neglected disease that disproportionately affects children in tropical and subtropical climates, with an estimated mortality rate of 95-98%. Due to anthropogenic climate change, the average temperature in the USA has increased by 0.72 to 1.06 °C in the last century, promoting the poleward spread of N. fowleri. PAM is often misdiagnosed as bacterial meningitis or viral encephalitis, which shortens the window for potentially life-saving treatment. Diagnosis relies on the patient's history of freshwater exposure and the physician's high index of suspicion, supported by cerebrospinal fluid studies. While no experimental trials have been conducted to assess the relative efficacy of treatment regimens, anti-amebic therapy with adjunctive neuroprotection is standard treatment in the USA. We performed a literature review and identified five patients from North America between 1962 and 2022 who survived PAM with various degrees of sequelae.
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Affiliation(s)
- Ashton D Hall
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Julia E Kumar
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Claire E Golba
- Department of Emergency Medicine, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
| | - Keith M Luckett
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Whitney K Bryant
- Department of Emergency Medicine, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA.
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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5
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Sharma V, Madia VN, Tudino V, Nguyen JV, Debnath A, Messore A, Ialongo D, Patacchini E, Palenca I, Basili Franzin S, Seguella L, Esposito G, Petrucci R, Di Matteo P, Bortolami M, Saccoliti F, Di Santo R, Scipione L, Costi R, Podust LM. Miconazole-like Scaffold is a Promising Lead for Naegleria fowleri-Specific CYP51 Inhibitors. J Med Chem 2023; 66:17059-17073. [PMID: 38085955 PMCID: PMC10758121 DOI: 10.1021/acs.jmedchem.3c01898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 12/29/2023]
Abstract
Developing drugs for brain infection by Naegleria fowleri is an unmet medical need. We used a combination of cheminformatics, target-, and phenotypic-based drug discovery methods to identify inhibitors that target an essential N. fowleri enzyme, sterol 14-demethylase (NfCYP51). A total of 124 compounds preselected in silico were tested against N. fowleri. Nine primary hits with EC50 ≤ 10 μM were phenotypically identified. Cocrystallization with NfCYP51 focused attention on one primary hit, miconazole-like compound 2a. The S-enantiomer of 2a produced a 1.74 Å cocrystal structure. A set of analogues was then synthesized and evaluated to confirm the superiority of the S-configuration over the R-configuration and the advantage of an ether linkage over an ester linkage. The two compounds, S-8b and S-9b, had an improved EC50 and KD compared to 2a. Importantly, both were readily taken up into the brain. The brain-to-plasma distribution coefficient of S-9b was 1.02 ± 0.12, suggesting further evaluation as a lead for primary amoebic meningoencephalitis.
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Affiliation(s)
- Vandna Sharma
- Skaggs
School of Pharmacy and Pharmaceutical Sciences, Center for Discovery
and Innovation in Parasitic Diseases, University
of California San Diego, La Jolla, California 92093, United States
| | - Valentina Noemi Madia
- Dipartimento
di Chimica e Tecnologie del Farmaco, Istituto Pasteur-Fondazione Cenci
Bolognetti, “Sapienza” Università
di Roma, p.le Aldo Moro 5, Rome I-00185, Italy
| | - Valeria Tudino
- Dipartimento
di Biotecnologie, Università degli
Studi di Siena, Chimica e Farmacia via Aldo Moro 2, Siena 53100, Italy
| | - Jennifer V. Nguyen
- Skaggs
School of Pharmacy and Pharmaceutical Sciences, Center for Discovery
and Innovation in Parasitic Diseases, University
of California San Diego, La Jolla, California 92093, United States
| | - Anjan Debnath
- Skaggs
School of Pharmacy and Pharmaceutical Sciences, Center for Discovery
and Innovation in Parasitic Diseases, University
of California San Diego, La Jolla, California 92093, United States
| | - Antonella Messore
- Dipartimento
di Chimica e Tecnologie del Farmaco, Istituto Pasteur-Fondazione Cenci
Bolognetti, “Sapienza” Università
di Roma, p.le Aldo Moro 5, Rome I-00185, Italy
| | - Davide Ialongo
- Dipartimento
di Chimica e Tecnologie del Farmaco, Istituto Pasteur-Fondazione Cenci
Bolognetti, “Sapienza” Università
di Roma, p.le Aldo Moro 5, Rome I-00185, Italy
| | - Elisa Patacchini
- Dipartimento
di Chimica e Tecnologie del Farmaco, Istituto Pasteur-Fondazione Cenci
Bolognetti, “Sapienza” Università
di Roma, p.le Aldo Moro 5, Rome I-00185, Italy
| | - Irene Palenca
- Department
of Physiology and Pharmacology “V. Erspamer”, “Sapienza″ Università di Roma, p.le Aldo Moro 5, Rome I-00185, Italy
| | - Silvia Basili Franzin
- Department
of Physiology and Pharmacology “V. Erspamer”, “Sapienza″ Università di Roma, p.le Aldo Moro 5, Rome I-00185, Italy
| | - Luisa Seguella
- Department
of Physiology and Pharmacology “V. Erspamer”, “Sapienza″ Università di Roma, p.le Aldo Moro 5, Rome I-00185, Italy
| | - Giuseppe Esposito
- Department
of Physiology and Pharmacology “V. Erspamer”, “Sapienza″ Università di Roma, p.le Aldo Moro 5, Rome I-00185, Italy
| | - Rita Petrucci
- Dipartimento
di Scienze di Base e Applicate per l’Ingegneria, “Sapienza” Università di Roma, Via Castro Laurenziano 7, Rome 00161, Italy
| | - Paola Di Matteo
- Dipartimento
di Scienze di Base e Applicate per l’Ingegneria, “Sapienza” Università di Roma, Via Castro Laurenziano 7, Rome 00161, Italy
| | - Martina Bortolami
- Dipartimento
di Scienze di Base e Applicate per l’Ingegneria, “Sapienza” Università di Roma, Via Castro Laurenziano 7, Rome 00161, Italy
| | - Francesco Saccoliti
- D3 PharmaChemistry, Italian
Institute of Technology, Via Morego 30, Genova 16163, Italy
| | - Roberto Di Santo
- Dipartimento
di Chimica e Tecnologie del Farmaco, Istituto Pasteur-Fondazione Cenci
Bolognetti, “Sapienza” Università
di Roma, p.le Aldo Moro 5, Rome I-00185, Italy
| | - Luigi Scipione
- Dipartimento
di Chimica e Tecnologie del Farmaco, Istituto Pasteur-Fondazione Cenci
Bolognetti, “Sapienza” Università
di Roma, p.le Aldo Moro 5, Rome I-00185, Italy
| | - Roberta Costi
- Dipartimento
di Chimica e Tecnologie del Farmaco, Istituto Pasteur-Fondazione Cenci
Bolognetti, “Sapienza” Università
di Roma, p.le Aldo Moro 5, Rome I-00185, Italy
| | - Larissa M. Podust
- Skaggs
School of Pharmacy and Pharmaceutical Sciences, Center for Discovery
and Innovation in Parasitic Diseases, University
of California San Diego, La Jolla, California 92093, United States
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6
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Kassu M, Parvatkar PT, Milanes J, Monaghan NP, Kim C, Dowgiallo M, Zhao Y, Asakawa AH, Huang L, Wagner A, Miller B, Carter K, Barrett KF, Tillery LM, Barrett LK, Phan IQ, Subramanian S, Myler PJ, Van Voorhis WC, Leahy JW, Rice CA, Kyle DE, Morris J, Manetsch R. Shotgun Kinetic Target-Guided Synthesis Approach Enables the Discovery of Small-Molecule Inhibitors against Pathogenic Free-Living Amoeba Glucokinases. ACS Infect Dis 2023; 9:2190-2201. [PMID: 37820055 PMCID: PMC10644346 DOI: 10.1021/acsinfecdis.3c00284] [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: 06/20/2023] [Indexed: 10/13/2023]
Abstract
Pathogenic free-living amoebae (pFLA) can cause life-threatening central nervous system (CNS) infections and warrant the investigation of new chemical agents to combat the rise of infection from these pathogens. Naegleria fowleri glucokinase (NfGlck), a key metabolic enzyme involved in generating glucose-6-phosphate, was previously identified as a potential target due to its limited sequence similarity with human Glck (HsGlck). Herein, we used our previously demonstrated multifragment kinetic target-guided synthesis (KTGS) screening strategy to identify inhibitors against pFLA glucokinases. Unlike the majority of previous KTGS reports, our current study implements a "shotgun" approach, where fragments were not biased by predetermined binding potentials. The study resulted in the identification of 12 inhibitors against 3 pFLA glucokinase enzymes─NfGlck, Balamuthia mandrillaris Glck (BmGlck), and Acanthamoeba castellanii Glck (AcGlck). This work demonstrates the utility of KTGS to identify small-molecule binders for biological targets where resolved X-ray crystal structures are not readily accessible.
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Affiliation(s)
- Mintesinot Kassu
- Department
of Chemistry and Chemical Biology, Northeastern
University, Boston, Massachusetts 02115, United States
| | - Prakash T. Parvatkar
- Department
of Chemistry and Chemical Biology, Northeastern
University, Boston, Massachusetts 02115, United States
| | - Jillian Milanes
- Eukaryotic
Pathogens Innovation Center, Department of Genetics and Biochemistry, Clemson University, Clemson, South Carolina 29634, United States
| | - Neil P. Monaghan
- Eukaryotic
Pathogens Innovation Center, Department of Genetics and Biochemistry, Clemson University, Clemson, South Carolina 29634, United States
| | - Chungsik Kim
- Department
of Chemistry and Chemical Biology, Northeastern
University, Boston, Massachusetts 02115, United States
| | - Matthew Dowgiallo
- Department
of Chemistry and Chemical Biology, Northeastern
University, Boston, Massachusetts 02115, United States
| | - Yingzhao Zhao
- Department
of Chemistry and Chemical Biology, Northeastern
University, Boston, Massachusetts 02115, United States
| | - Ami H. Asakawa
- Department
of Pharmaceutical Sciences, Northeastern
University, Boston, Massachusetts 02115, United States
| | - Lili Huang
- Department
of Chemistry and Chemical Biology, Northeastern
University, Boston, Massachusetts 02115, United States
| | - Alicia Wagner
- Department
of Chemistry and Chemical Biology, Northeastern
University, Boston, Massachusetts 02115, United States
| | - Brandon Miller
- Department
of Chemistry and Chemical Biology, Northeastern
University, Boston, Massachusetts 02115, United States
| | - Karissa Carter
- Department
of Chemistry and Chemical Biology, Northeastern
University, Boston, Massachusetts 02115, United States
| | - Kayleigh F. Barrett
- Center
for Emerging and Re-emerging Infectious Diseases (CERID), Division
of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98109, United States
| | - Logan M. Tillery
- Center
for Emerging and Re-emerging Infectious Diseases (CERID), Division
of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98109, United States
| | - Lynn K. Barrett
- Center
for Emerging and Re-emerging Infectious Diseases (CERID), Division
of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98109, United States
| | - Isabelle Q. Phan
- Center for Global Infectious Diseases Research, Seattle Children’s Research Center, Seattle, Washington 98109, United States
| | - Sandhya Subramanian
- Center for Global Infectious Diseases Research, Seattle Children’s Research Center, Seattle, Washington 98109, United States
| | - Peter J. Myler
- Center for Global Infectious Diseases Research, Seattle Children’s Research Center, Seattle, Washington 98109, United States
| | - Wesley C. Van Voorhis
- Center
for Emerging and Re-emerging Infectious Diseases (CERID), Division
of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98109, United States
| | - James W. Leahy
- Department of Chemistry, University
of
South Florida, Tampa, Florida 33620, United States
| | - Christopher A. Rice
- Department
of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana 47907, United States
- Purdue
Institute for Drug Discovery (PIDD), Purdue
University, West Lafayette, Indiana 47907, United States
- Purdue Institute
of Inflammation, Immunology and Infectious Disease (PI4D), Purdue University, West Lafayette, Indiana 47907, United States
- Department
of Cellular Biology, University of Georgia, Athens, Georgia 30602, United States
| | - Dennis E. Kyle
- Department
of Cellular Biology, University of Georgia, Athens, Georgia 30602, United States
| | - James Morris
- Eukaryotic
Pathogens Innovation Center, Department of Genetics and Biochemistry, Clemson University, Clemson, South Carolina 29634, United States
| | - Roman Manetsch
- Department
of Chemistry and Chemical Biology, Northeastern
University, Boston, Massachusetts 02115, United States
- Department
of Pharmaceutical Sciences, Northeastern
University, Boston, Massachusetts 02115, United States
- Center
for Drug Discovery, Northeastern University, Boston, Massachusetts 02115, United States
- Barnett
Institute of Chemical and Biological Analysis, Northeastern University, Boston, Massachusetts 02115, United States
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7
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Akbar N, Siddiqui R, El-Gamal MI, Zaraei SO, Alawfi BS, Khan NA. The anti-amoebic potential of carboxamide derivatives containing sulfonyl or sulfamoyl moieties against brain-eating Naegleria fowleri. Parasitol Res 2023; 122:2539-2548. [PMID: 37665414 DOI: 10.1007/s00436-023-07953-w] [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: 05/22/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023]
Abstract
Naegleria fowleri is a free-living thermophilic flagellate amoeba that causes a rare but life-threatening infection called primary amoebic meningoencephalitis (PAM), with a very high fatality rate. Herein, the anti-amoebic potential of carboxamide derivatives possessing sulfonyl or sulfamoyl moiety was assessed against pathogenic N. fowleri using amoebicidal, cytotoxicity and cytopathogenicity assays. The results from amoebicidal experiments showed that derivatives dramatically reduced N. fowleri viability. Selected derivatives demonstrated IC50 values at lower concentrations; 1j showed IC50 at 24.65 μM, while 1k inhibited 50% amoebae growth at 23.31 μM. Compounds with significant amoebicidal effects demonstrated limited cytotoxicity against human cerebral microvascular endothelial cells. Finally, some derivatives mitigated N. fowleri-instigated host cell death. Ultimately, this study demonstrated that 1j and 1k exhibited potent anti-amoebic activity and ought to be looked at in future studies for the development of therapeutic anti-amoebic pharmaceuticals. Further investigation is required to determine the clinical relevance of our findings.
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Affiliation(s)
- Noor Akbar
- Research Institute of Medical and Health Sciences, University of Sharjah, University City, Sharjah, 27272, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, University City, Sharjah, 27272, United Arab Emirates
| | - Ruqaiyyah Siddiqui
- College of Arts and Sciences, American University of Sharjah, University City, Sharjah, 26666, United Arab Emirates
- Microbiota Research Center, Istinye University, 34010, Istanbul, Turkey
| | - Mohammed I El-Gamal
- Research Institute of Medical and Health Sciences, University of Sharjah, University City, Sharjah, 27272, United Arab Emirates.
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, 27272, United Arab Emirates.
- Department of Medicinal Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, Egypt.
| | - Seyed-Omar Zaraei
- Research Institute of Medical and Health Sciences, University of Sharjah, University City, Sharjah, 27272, United Arab Emirates
| | - Bader S Alawfi
- Department of Medical Laboratories Technology, College of Applied Medical Sciences, Taibah University, Madinah, 42353, Saudi Arabia
| | - Naveed Ahmed Khan
- Microbiota Research Center, Istinye University, 34010, Istanbul, Turkey.
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8
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Nadeem A, Malik IA, Afridi EK, Shariq F. Naegleria fowleri outbreak in Pakistan: unveiling the crisis and path to recovery. Front Public Health 2023; 11:1266400. [PMID: 37927850 PMCID: PMC10620794 DOI: 10.3389/fpubh.2023.1266400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023] Open
Abstract
The outbreak of Naegleria fowleri in Pakistan presents a significant public health concern due to its high fatality rate and limited treatment options. This review explores the impact of the outbreak on communities and the challenges faced in combating the disease. It evaluates available treatment options and highlights the need for early diagnosis and intervention. The study proposes recommendations to improve public health preparedness, including public awareness campaigns, enhanced healthcare infrastructure, and robust water surveillance systems. Collaboration between research institutions and public health organizations is emphasized to develop effective outbreak response strategies.
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Affiliation(s)
- Abdullah Nadeem
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Inshal Arshad Malik
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | - Eesha Khan Afridi
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | - Fariha Shariq
- Department of Medicine, Karachi Medical and Dental College, Karachi, Sindh, Pakistan
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9
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Hong KW, Jeong JH, Byun JH, Hong SH, Ju JW, Bae IG. Fatal Primary Amebic Meningoencephalitis due to Naegleria fowleri: The First Imported Case in Korea. Yonsei Med J 2023; 64:641-645. [PMID: 37727924 PMCID: PMC10522881 DOI: 10.3349/ymj.2023.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 09/21/2023] Open
Abstract
Primary amebic meningoencephalitis (PAM) is a rare, but almost always fatal, central nervous system infection caused by Naegleria fowleri, which are thermophilic free-living amoeba. Here, we report the first case of PAM detected in South Korea, probably imported from Thailand. Despite antimicrobial treatment for N. fowleri infection with a combination of intravenous liposomal amphotericin B, fluconazole, azithromycin, and oral rifampin, the patient died 13 days after the onset of symptoms. Clinicians in South Korea treating severe meningoencephalitis, especially in individuals returning from tropical areas, are encouraged to include PAM in the differential diagnoses, given the accelerated global warming and increased overseas trips.
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Affiliation(s)
- Kyung-Wook Hong
- Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jong Hwan Jeong
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jung-Hyun Byun
- Department of Laboratory Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Sung-Hee Hong
- Division of Vectors and Parasitic Diseases, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Jung-Won Ju
- Division of Vectors and Parasitic Diseases, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - In-Gyu Bae
- Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.
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10
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Eger L, Pence MA. The Brief Case: A Case of Primary Amebic Meningoencephalitis (PAM) after Exposure at a Splash Pad. J Clin Microbiol 2023; 61:e0126922. [PMID: 37470480 PMCID: PMC10358179 DOI: 10.1128/jcm.01269-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Affiliation(s)
- Lynne Eger
- Department of Infectious Diseases, Cook Children’s Medical Center, Fort Worth, Texas, USA
| | - Morgan A. Pence
- Department of Pathology and Laboratory Medicine, Cook Children’s Medical Center, Fort Worth, Texas, USA
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11
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Baqer NN, Mohammed AS, A.AL-Aboody B, Ismail AM. Genetic Detection of Amoebic Meningoencephalitis Causing by Naegleria Fowleri in Iraq: A Case Report. IRANIAN JOURNAL OF PARASITOLOGY 2023; 18:408-413. [PMID: 37886244 PMCID: PMC10597877 DOI: 10.18502/ijpa.v18i3.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/09/2023] [Indexed: 10/28/2023]
Abstract
We diagnosed a case report of amoebic meningoencephalitis by Naegleria fowleri. This case represented the first recording in Iraq where it was not recording previously. This case was diagnosed after the death of an 18-year-old girl patient who lived in a rural area of Mosul in Iraq. Genetics detection of N. fowleri showed PCR product was 183bp for 18S rRNA gene. It was registered as the first recording of Iraqi isolate N. fowleri in GenBank with accession number OP380864.1. It is necessary to examine microscopically the cerebral spinal fluid (CSF) to observe the amoeba stages and exclude the bacterial causative. Rapid diagnosis may help in the treatment of amoebic meningoencephalitis. In addition, genetic identification can diagnose amoeba. Avoiding swimming or using freshwater contributes to prevent amoebic meningoencephalitis infection.
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Affiliation(s)
- Noor Nihad Baqer
- Water and Environment Directorate, Ministry of Science and Technology, Baghdad, Iraq
| | | | - Bassad A.AL-Aboody
- Department of Biology, College of Science, University of Thi-Qar, Nasiriyah, Iraq
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12
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Chen CW, Moseman EA. Pro-inflammatory cytokine responses to Naegleria fowleri infection. FRONTIERS IN TROPICAL DISEASES 2023; 3. [PMID: 37065537 PMCID: PMC10104475 DOI: 10.3389/fitd.2022.1082334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Naegleria fowleri, or the “brain-eating amoeba,” is responsible for a rare, but lethal, infection known as primary amoebic meningoencephalitis (PAM). Confirmed PAM cases have seen both a rise in numbers, as well as expansion of geographic range over the past several decades. There is no effective therapy for PAM and the clinical prognosis remains grim with a mortality rate over 95%. The role of the immune response in disease prevention and disease severity remains unclear. In this review, we explore potential roles of inflammatory immune responses to N. fowleri in disease pathogenesis with a primary focus on pro-inflammatory cytokines IL-1, IL-6, and TNFα. We also discuss modulating proinflammatory cytokines as an additional immune therapy in PAM treatment.
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13
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Leal dos Santos D, Chaúque BJM, Virginio VG, Cossa VC, Pettan-Brewer C, Schrekker HS, Rott MB. Occurrence of Naegleria fowleri and their implication for health - a look under the One Health approaches. Int J Hyg Environ Health 2022; 246:114053. [DOI: 10.1016/j.ijheh.2022.114053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
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14
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Joseph RB, Rauf A, Chettali AM, Pillai R, Vijayan A, Mv P. Primary amoebic meningoencephalitis in children- report of two cases from South India. Trop Doct 2022; 52:553-555. [PMID: 35880290 DOI: 10.1177/00494755221097046] [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: 11/15/2022]
Abstract
Primary Amoebic meningoencephalitis is a rare and fatal neuro-infection caused by free-living fresh-water amoeba Naegleria fowleri. It is a ubiquitous organism and the infection occurs usually via contact with warm water-bodies. The clinical presentation is often indistinguishable from acute bacterial meningitis and the diagnosis can be made by CSF wet smear examination if there is a high index of suspicion. The disease progresses rapidly compared to pyogenic meningitis and usually has a fatal outcome. Reports of two confirmed cases of primary amoebic meningoencephalitis in children from different centres in Kerala state of India are presented here. In spite of early diagnosis and treatment, both these patients demised. Primary amoebic meningoencephalitis should be considered in the differential diagnosis of acute meningitis, especially in patients with recent freshwater exposure. Implementation of chlorination of pools of water bodies, especially if re-opened for recreational purpose after prolonged periods of non-use, needs vigorous implementation.
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Affiliation(s)
| | - Abdul Rauf
- Department of Pediatrics, 75619Baby Memorial Hospital, Calicut, Kerala, India
| | | | - Rajappan Pillai
- Department of Pediatrics, 416649Aster Medcity, Kochi, Kerala, India
| | - Ajay Vijayan
- Department of Pediatrics, 75619Baby Memorial Hospital, Calicut, Kerala, India
| | - Poornima Mv
- Department of Microbiology, 75619Baby Memorial Hospital, Calicut, Kerala, India
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15
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Arberas-Jiménez I, Rizo-Liendo A, Nocchi N, Sifaoui I, Chao-Pellicer J, Souto ML, Suárez-Gómez B, Díaz-Marrero AR, Fernández JJ, Piñero JE, Lorenzo-Morales J. Sesquiterpene lactones as potential therapeutic agents against Naegleria fowleri. Pharmacotherapy 2022; 147:112694. [DOI: 10.1016/j.biopha.2022.112694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 02/09/2023]
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16
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Martín-Escolano R, Yiangou L, Kazana E, Robinson GK, Michaelis M, Tsaousis AD. Repurposing in vitro approaches for screening anti-parasitic drugs against the brain-eating amoeba Naegleria fowleri. Int J Parasitol Drugs Drug Resist 2021; 17:204-212. [PMID: 34875573 PMCID: PMC8652063 DOI: 10.1016/j.ijpddr.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/22/2022]
Abstract
Naegleria fowleri is both a pathogenic and a free-living microbial eukaryote, responsible for the development of primary amoebic meningoencephalitis (PAM) in humans. PAM is a rapid, severe and fatal underestimated infectious disease, which has been reported in countries with warmer climates. The major drawbacks with PAM are the lack of effective therapies and delay in diagnosis. The current frontline treatment presents a low rate of recovery (5%) and severe adverse effects. For example, many drug candidates lack efficacy, since they do not effectively cross the blood-brain-barrier. Consequently, more effective drugs are urgently needed. Herein, we report a new in vitro method suitable for medium- and high-throughput drug discovery assays, using the closely related Naegleria gruberi as a model. We have subsequently used this method to screen a library of 1175 Food and Drug Administration-approved drugs. As a result, we present three drugs (camptothecin, pyrimethamine, and terbinafine) that can be repurposed, and are anticipated to readily cross the blood-brain-barrier with activity against Naegleria species in therapeutically achievable concentrations. Successively, we integrated several in vitro assays that resulted in identifying fast-acting and high amoebicidal drugs. In conclusion, we present a new approach for the identification of anti-Naegleria drugs along with three potential drug candidates for further development for the treatment of PAM.
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Affiliation(s)
- Rubén Martín-Escolano
- Laboratory of Molecular & Evolutionary Parasitology, RAPID Group, School of Biosciences, University of Kent, Canterbury, CT2 7NJ, UK
| | - Lyto Yiangou
- Laboratory of Molecular & Evolutionary Parasitology, RAPID Group, School of Biosciences, University of Kent, Canterbury, CT2 7NJ, UK; School of Biosciences, University of Kent, Canterbury, CT2 7NJ, UK
| | - Eleanna Kazana
- Laboratory of Molecular & Evolutionary Parasitology, RAPID Group, School of Biosciences, University of Kent, Canterbury, CT2 7NJ, UK
| | - Gary K Robinson
- School of Biosciences, University of Kent, Canterbury, CT2 7NJ, UK
| | - Martin Michaelis
- School of Biosciences, University of Kent, Canterbury, CT2 7NJ, UK.
| | - Anastasios D Tsaousis
- Laboratory of Molecular & Evolutionary Parasitology, RAPID Group, School of Biosciences, University of Kent, Canterbury, CT2 7NJ, UK; School of Biosciences, University of Kent, Canterbury, CT2 7NJ, UK.
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17
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Mungroo MR, Khan NA, Maciver S, Siddiqui R. Opportunistic free-living amoebal pathogens. Pathog Glob Health 2021; 116:70-84. [PMID: 34602025 DOI: 10.1080/20477724.2021.1985892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Pathogenic free-living amoebae affecting the central nervous system are known to cause granulomatous amoebic encephalitis (GAE) or primary amoebic meningoencephalitis (PAM). Although hosts with impaired immunity are generally at a higher risk of severe disease, amoebae such as Naegleria fowleri and Balamuthia mandrillaris can instigate disease in otherwise immunocompetent individuals, whereas Acanthamoeba species mostly infect immunocompromised people. Acanthamoeba also cause a sight-threatening eye infection, mostly in contact lens wearers. Although infections due to pathogenic amoebae are considered rare, recently, these deadly amoebae were detected in water supplies in the USA. This is of particular concern, especially with global warming further exacerbating the problem. Herein, we describe the epidemiology, presentation, diagnosis, and management of free-living amoeba infections.
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Affiliation(s)
- Mohammad Ridwane Mungroo
- Department of Clinical Sciences, College of Medicine, University City, Sharjah, United Arab Emirates
| | - Naveed Ahmed Khan
- Department of Clinical Sciences, College of Medicine, University City, Sharjah, United Arab Emirates.,Research Institute of Health and Medical Sciences, University of Sharjah, Sharjah, UAE
| | - Sutherland Maciver
- Centre for Discovery Brain Sciences, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Edinburgh, UK
| | - Ruqaiyyah Siddiqui
- College of Arts and Sciences, American University of Sharjah, Sharjah, UAE
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18
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Güémez A, García E. Primary Amoebic Meningoencephalitis by Naegleria fowleri: Pathogenesis and Treatments. Biomolecules 2021; 11:biom11091320. [PMID: 34572533 PMCID: PMC8469197 DOI: 10.3390/biom11091320] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 12/29/2022] Open
Abstract
Naegleria fowleri is a free-living amoeba (FLA) that is commonly known as the "brain-eating amoeba." This parasite can invade the central nervous system (CNS), causing an acute and fulminating infection known as primary amoebic meningoencephalitis (PAM). Even though PAM is characterized by low morbidity, it has shown a mortality rate of 98%, usually causing death in less than two weeks after the initial exposure. This review summarizes the most recent information about N. fowleri, its pathogenic molecular mechanisms, and the neuropathological processes implicated. Additionally, this review includes the main therapeutic strategies described in case reports and preclinical studies, including the possible use of immunomodulatory agents to decrease neurological damage.
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19
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Herman EK, Greninger A, van der Giezen M, Ginger ML, Ramirez-Macias I, Miller HC, Morgan MJ, Tsaousis AD, Velle K, Vargová R, Záhonová K, Najle SR, MacIntyre G, Muller N, Wittwer M, Zysset-Burri DC, Eliáš M, Slamovits CH, Weirauch MT, Fritz-Laylin L, Marciano-Cabral F, Puzon GJ, Walsh T, Chiu C, Dacks JB. Genomics and transcriptomics yields a system-level view of the biology of the pathogen Naegleria fowleri. BMC Biol 2021; 19:142. [PMID: 34294116 PMCID: PMC8296547 DOI: 10.1186/s12915-021-01078-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The opportunistic pathogen Naegleria fowleri establishes infection in the human brain, killing almost invariably within 2 weeks. The amoeba performs piece-meal ingestion, or trogocytosis, of brain material causing direct tissue damage and massive inflammation. The cellular basis distinguishing N. fowleri from other Naegleria species, which are all non-pathogenic, is not known. Yet, with the geographic range of N. fowleri advancing, potentially due to climate change, understanding how this pathogen invades and kills is both important and timely. RESULTS Here, we report an -omics approach to understanding N. fowleri biology and infection at the system level. We sequenced two new strains of N. fowleri and performed a transcriptomic analysis of low- versus high-pathogenicity N. fowleri cultured in a mouse infection model. Comparative analysis provides an in-depth assessment of encoded protein complement between strains, finding high conservation. Molecular evolutionary analyses of multiple diverse cellular systems demonstrate that the N. fowleri genome encodes a similarly complete cellular repertoire to that found in free-living N. gruberi. From transcriptomics, neither stress responses nor traits conferred from lateral gene transfer are suggested as critical for pathogenicity. By contrast, cellular systems such as proteases, lysosomal machinery, and motility, together with metabolic reprogramming and novel N. fowleri proteins, are all implicated in facilitating pathogenicity within the host. Upregulation in mouse-passaged N. fowleri of genes associated with glutamate metabolism and ammonia transport suggests adaptation to available carbon sources in the central nervous system. CONCLUSIONS In-depth analysis of Naegleria genomes and transcriptomes provides a model of cellular systems involved in opportunistic pathogenicity, uncovering new angles to understanding the biology of a rare but highly fatal pathogen.
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Affiliation(s)
- Emily K Herman
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
| | - Alex Greninger
- Laboratory Medicine and Medicine / Infectious Diseases, UCSF-Abbott Viral Diagnostics and Discovery Center, UCSF Clinical Microbiology Laboratory UCSF School of Medicine, San Francisco, USA
- Department of Laboratory Medicine, University of Washington Medical Center, Montlake, USA
| | - Mark van der Giezen
- Centre for Organelle Research, Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - Michael L Ginger
- School of Applied Sciences, Department of Biological and Geographical Sciences, University of Huddersfield, Huddersfield, UK
| | - Inmaculada Ramirez-Macias
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Department of Cardiology, Hospital Clinico Universitario Virgen de la Arrixaca. Instituto Murciano de Investigación Biosanitaria. Centro de Investigación Biomedica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Haylea C Miller
- CSIRO Land and Water, Centre for Environment and Life Sciences, Private Bag No.5, Wembley, Western Australia 6913, Australia
- CSIRO, Indian Oceans Marine Research Centre, Environomics Future Science Platform, Crawley, WA, Australia
| | - Matthew J Morgan
- CSIRO Land and Water, Black Mountain Laboratories, Canberra, Australia
| | | | - Katrina Velle
- Department of Biology, University of Massachusetts, Amherst, UK
| | - Romana Vargová
- Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - Kristína Záhonová
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Faculty of Science, Charles University, BIOCEV, Prague, Czech Republic
- Institute of Parasitology, Biology Centre, Czech Academy of Sciences, České Budějovice, Czech Republic
| | - Sebastian Rodrigo Najle
- Institut de Biologia Evolutiva (UPF-CSIC), Barcelona, Spain
- Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), 08003, Barcelona, Catalonia, Spain
| | - Georgina MacIntyre
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Norbert Muller
- Institute of Parasitology, Vetsuisse Faculty Bern, University of Bern, Bern, Switzerland
| | - Mattias Wittwer
- Spiez Laboratory, Federal Office for Civil Protection, Austrasse, Spiez, Switzerland
| | - Denise C Zysset-Burri
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marek Eliáš
- Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - Claudio H Slamovits
- Department of Biochemistry and Molecular Biology, Centre for Comparative Genomics and Evolutionary Bioinformatics, Dalhousie University, Halifax, Canada
| | - Matthew T Weirauch
- Center for Autoimmune Genomics and Etiology and Divisions of Biomedical Informatics and Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | | | - Francine Marciano-Cabral
- Department of Microbiology and Immunology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Geoffrey J Puzon
- CSIRO Land and Water, Centre for Environment and Life Sciences, Private Bag No.5, Wembley, Western Australia 6913, Australia
| | - Tom Walsh
- CSIRO Land and Water, Black Mountain Laboratories, Canberra, Australia
| | - Charles Chiu
- Laboratory Medicine and Medicine / Infectious Diseases, UCSF-Abbott Viral Diagnostics and Discovery Center, UCSF Clinical Microbiology Laboratory UCSF School of Medicine, San Francisco, USA
| | - Joel B Dacks
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
- Institute of Parasitology, Biology Centre, Czech Academy of Sciences, České Budějovice, Czech Republic.
- Department of Life Sciences, The Natural History Museum, London, UK.
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20
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Gharpure R, Bliton J, Goodman A, Ali IKM, Yoder J, Cope JR. Epidemiology and Clinical Characteristics of Primary Amebic Meningoencephalitis Caused by Naegleria fowleri: A Global Review. Clin Infect Dis 2021; 73:e19-e27. [PMID: 32369575 DOI: 10.1093/cid/ciaa520] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/29/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary amebic meningoencephalitis (PAM) is a rapidly progressive and often fatal condition caused by the free-living ameba Naegleria fowleri. To estimate the global occurrence, characterize the epidemiology, and describe the clinical features of PAM, we report a series of PAM cases published in the international literature and reported to the Centers for Disease Control and Prevention (CDC). METHODS We performed a literature search of PAM case reports published through 2018. Additionally, we included cases reported through the CDC's Free-Living Ameba surveillance or diagnosed via CDC's Free-Living and Intestinal Amebas Laboratory. Cases were classified as confirmed, probable, or suspect on the basis of confirmatory testing, presentation, exposure, and disease course. RESULTS A total of 381 PAM cases were identified. Seven reported survivors were classified as confirmed. The most commonly reported exposure associated with PAM was swimming/diving, and the most common class of water source was lakes/ponds/reservoirs. Patients were predominantly male (75%), with a median age of 14 years. Confirmed and probable cases were similar in their survival, course of illness, and cerebrospinal fluid (CSF) findings. CONCLUSIONS PAM is a rare but deadly disease with worldwide occurrence. Improved clinician awareness, resulting in earlier diagnosis and treatment, may contribute to increased survival among PAM patients. The case definition of probable used in this study appears to capture cases of PAM, as evidenced by similarities in outcomes, clinical course, and CSF profile to confirmed cases. In the absence of confirmatory testing, clinicians could use this case definition to identify cases of PAM.
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Affiliation(s)
- Radhika Gharpure
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Bliton
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexandra Goodman
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ibne Karim M Ali
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan Yoder
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer R Cope
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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21
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Naegleria fowleri: Protein structures to facilitate drug discovery for the deadly, pathogenic free-living amoeba. PLoS One 2021; 16:e0241738. [PMID: 33760815 PMCID: PMC7990177 DOI: 10.1371/journal.pone.0241738] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/25/2021] [Indexed: 12/19/2022] Open
Abstract
Naegleria fowleri is a pathogenic, thermophilic, free-living amoeba which causes primary amebic meningoencephalitis (PAM). Penetrating the olfactory mucosa, the brain-eating amoeba travels along the olfactory nerves, burrowing through the cribriform plate to its destination: the brain’s frontal lobes. The amoeba thrives in warm, freshwater environments, with peak infection rates in the summer months and has a mortality rate of approximately 97%. A major contributor to the pathogen’s high mortality is the lack of sensitivity of N. fowleri to current drug therapies, even in the face of combination-drug therapy. To enable rational drug discovery and design efforts we have pursued protein production and crystallography-based structure determination efforts for likely drug targets from N. fowleri. The genes were selected if they had homology to drug targets listed in Drug Bank or were nominated by primary investigators engaged in N. fowleri research. In 2017, 178 N. fowleri protein targets were queued to the Seattle Structural Genomics Center of Infectious Disease (SSGCID) pipeline, and to date 89 soluble recombinant proteins and 19 unique target structures have been produced. Many of the new protein structures are potential drug targets and contain structural differences compared to their human homologs, which could allow for the development of pathogen-specific inhibitors. Five of the structures were analyzed in more detail, and four of five show promise that selective inhibitors of the active site could be found. The 19 solved crystal structures build a foundation for future work in combating this devastating disease by encouraging further investigation to stimulate drug discovery for this neglected pathogen.
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22
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Alli A, Ortiz JF, Morillo Cox Á, Armas M, Orellana VA. Miltefosine: A Miracle Drug for Meningoencephalitis Caused by Free-Living Amoebas. Cureus 2021; 13:e13698. [PMID: 33833918 PMCID: PMC8020194 DOI: 10.7759/cureus.13698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 11/05/2022] Open
Abstract
Meningoencephalitis caused by free-living amoebas (FLA) has a high mortality rate, and most treatments are ineffective. FLA includes Naegleria, Fowleri, Acanthamoeba, and Balamuthia mandrillaris (M). We explore the use of miltefosine in the treatment of one of these infections. The concerning mortality of the infection obligates us to look for more effective treatments for meningoencephalitis caused by FLA. During this review, we will consolidate the knowledge of using miltefosine in these three infections. We will investigate the mechanism by which the drug is effective in these infections as well. After this comprehensive review, we should assess if miltefosine improves the mortality and prognosis of the infection with the information collected. We used a Medical Subject Headings (MeSH) search on PubMed. Inclusion criteria included papers written in the English language and human subjects research for the past 25 years. Until today, there are no definitive guidelines to be followed when treating such patients. However, miltefosine has demonstrated promising results. Miltefosine decreases the usual mortality rate in the three infections; however, there are few reports due to the low frequency of these infections. Almost all cases we documented have survived. More information needs to be gathered for the use of miltefosine for these infections.
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Affiliation(s)
- Ammar Alli
- Internal Medicine, Tishreen University Faculty of Medicine, Lattakia, SYR
- Internal Medicine, Universitat de Barcelona, Barcelona, ESP
| | - Juan Fernando Ortiz
- Neurology, Universidad San Francisco de Quito, Quito, ECU
- Neurology, Larkin Community Hospital, Miami, USA
| | | | - Maria Armas
- Surgery, Pontificia Universidad Catolica del Ecuador, Quito, ECU
| | - Victor A Orellana
- Obstetrics and Gynecology, Pontifica Universidad Católica del Ecuador, Quito, ECU
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23
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Taravaud A, Fechtali-Moute Z, Loiseau PM, Pomel S. Drugs used for the treatment of cerebral and disseminated infections caused by free-living amoebae. Clin Transl Sci 2021; 14:791-805. [PMID: 33650319 PMCID: PMC8212752 DOI: 10.1111/cts.12955] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 01/29/2023] Open
Abstract
Free‐living amoebae (FLAs) are protozoa developing autonomously in diverse natural or artificial environments. The FLAs Acanthamoeba spp., Balamuthia mandrillaris, and Naegleria fowleri represent a risk for human health as they can become pathogenic and cause severe cerebral infections, named granulomatous amoebic encephalitis (GAE), Balamuthia amoebic encephalitis (BAE), and primary amoebic meningoencephalitis (PAM), respectively. Additionally, Acanthamoeba sp. can also rarely disseminate to diverse organs, such as the skin, sinuses, or bones, and cause extracerebral disseminated acanthamebiasis (EDA). No consensus treatment has been established for cerebral FLA infections or EDA. The therapy of cerebral and disseminated FLA infections often empirically associates a large diversity of drugs, all exhibiting a high toxicity. Nevertheless, these pathologies lead to a high mortality, above 90% of the cases, even in the presence of a treatment. In the present work, a total of 474 clinical cases of FLA infections gathered from the literature allowed to determine the frequency of usage, as well as the efficacy of the main drugs and drug combinations used in the treatment of these pathologies. The efficacy of drug usage was determined based on the survival rate after drug administration. The most efficient drugs, drug combinations, and their mechanism of action were discussed in regard to the present recommendations for the treatment of GAE, EDA, BAE, and PAM. At the end, this review aims to provide a useful tool for physicians in their choice to optimize the treatment of FLA infections.
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Affiliation(s)
- Alexandre Taravaud
- BioCIS, Université Paris-Sud, CNRS, Université Paris-Saclay, Châtenay-Malabry, France
| | - Zineb Fechtali-Moute
- BioCIS, Université Paris-Sud, CNRS, Université Paris-Saclay, Châtenay-Malabry, France
| | - Philippe M Loiseau
- BioCIS, Université Paris-Sud, CNRS, Université Paris-Saclay, Châtenay-Malabry, France
| | - Sébastien Pomel
- BioCIS, Université Paris-Sud, CNRS, Université Paris-Saclay, Châtenay-Malabry, France
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24
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Abstract
Naegleria fowleriis a thermophilic free-living ameba that is found in warm, fresh water and causes primary amebic meningoencephalitis (PAM) in humans with high mortality rate. Here we report a case of newborn admitted with destructive clinical features of PAM after having bath with unchlorinated well water on a summer day.
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Affiliation(s)
- Yalcin Celik
- Department of Pediatrics, Mersin University School of Medicine, Mersin 33120, Turkey
| | - Ali Ertuğ Arslankoylu
- Department of Pediatrics, Mersin University School of Medicine, Mersin 33120, Turkey
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25
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Angelici MC, Walochnik J, Calderaro A, Saxinger L, Dacks JB. Free-living amoebae and other neglected protistan pathogens: Health emergency signals? Eur J Protistol 2020; 77:125760. [PMID: 33340850 DOI: 10.1016/j.ejop.2020.125760] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/25/2020] [Accepted: 11/13/2020] [Indexed: 02/08/2023]
Abstract
Protistan parasites have an undisputed global health impact. However, outside of a few key exceptions, e.g. the agent of malaria, most of these infectious agents are neglected as important health threats. The Symposium entitled "Free-living amoebae and neglected pathogenic protozoa: health emergency signals?" held at the European Congress of Protistology in Rome, July 2019, brought together researchers addressing scientific and clinical questions about some of these fascinating organisms. Topics presented included the molecular basis of pathogenicity in Acanthamoeba; genomics of Naegleria fowleri; and epidemiology of poorly diagnosed enteric protistan species, including Giardia, Cryptosporidium, Blastocystis, Dientamoeba. The Symposium aim was to excite the audience about the opportunities and challenges of research in these underexplored organisms and to underline the public health implications of currently under-appreciated protistan infections. The major take home message is that any knowledge that we gain about these organisms will allow us to better address them, in terms of monitoring and treatment, as sources of future health emergencies.
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Affiliation(s)
| | - Julia Walochnik
- Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Adriana Calderaro
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lynora Saxinger
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Alberta, Canada
| | - Joel B Dacks
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Alberta, Canada; Institute of Parasitology, Biology Centre, Czech Academy of Sciences České Budějovice, Czech Republic.
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A Fatal Case of Primary Amoebic Meningoencephalitis from Recreational Waters. Case Rep Crit Care 2020; 2020:9235794. [PMID: 32550028 PMCID: PMC7275226 DOI: 10.1155/2020/9235794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background Naegleria Fowleri is a single-cell, thermophilic amphizoid amoeba, and a rare known causative agent for primary amoebic meningoencephalitis with >97% mortality rate. The amoeba resides in freshwater lakes and ponds but can also survive in inadequately chlorinated pools and recreational waters. The mode of infection includes activities such as diving or jumping into freshwater or submerging the head under the water. Although most commonly seen in the southern United States, it is essential to keep this clinical suspicion in mind regardless of geography, as presenting symptoms can be very similar to classic bacterial meningitis. Case Summary. We report the first-ever case in the state of New Jersey of a 29-year-old male presented after a visit to a recreational water park in Texas five days before his presentation with altered mental status. In ICU, his ICP remained refractory to multiple therapies, including antibiotics and antivirals, external ventriculostomy drain, hypertonic saline, pentobarbital-induced coma, and bilateral hemicraniectomies. The CSF analysis revealed trophozoites indicating a protozoan infection, which we diagnosed in the neurocritical unit, and the patient was then immediately started with treatment that included amphotericin B, rifampin, azithromycin, and fluconazole. This suspicion was promptly confirmed by the Center for Disease Control (CDC). Unfortunately, despite all the aggressive intervention by the multidisciplinary team, the patient did not survive. Conclusion As per the CDC, only four people out of 143 known infected individuals in the United States from 1962 to 2017 have survived. Symptoms start with a median of 5 days after exposure to contaminated water. Given the rarity of this case and its very high mortality rate, it is crucial to diagnose primary amoebic meningoencephalitis accurately as its presentation can mimic bacterial meningitis. It is vital to obtain a careful and thorough history, as it can aid in prompt diagnosis and treatment.
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Ehrenkaufer G, Li P, Stebbins EE, Kangussu-Marcolino MM, Debnath A, White CV, Moser MS, DeRisi J, Gisselberg J, Yeh E, Wang SC, Company AH, Monti L, Caffrey CR, Huston CD, Wang B, Singh U. Identification of anisomycin, prodigiosin and obatoclax as compounds with broad-spectrum anti-parasitic activity. PLoS Negl Trop Dis 2020; 14:e0008150. [PMID: 32196500 PMCID: PMC7112225 DOI: 10.1371/journal.pntd.0008150] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/01/2020] [Accepted: 02/18/2020] [Indexed: 01/20/2023] Open
Abstract
Parasitic infections are a major source of human suffering, mortality, and economic loss, but drug development for these diseases has been stymied by the significant expense involved in bringing a drug though clinical trials and to market. Identification of single compounds active against multiple parasitic pathogens could improve the economic incentives for drug development as well as simplifying treatment regimens. We recently performed a screen of repurposed compounds against the protozoan parasite Entamoeba histolytica, causative agent of amebic dysentery, and identified four compounds (anisomycin, prodigiosin, obatoclax and nithiamide) with low micromolar potency and drug-like properties. Here, we extend our investigation of these drugs. We assayed the speed of killing of E. histolytica trophozoites and found that all four have more rapid action than the current drug of choice, metronidazole. We further established a multi-institute collaboration to determine whether these compounds may have efficacy against other parasites and opportunistic pathogens. We found that anisomycin, prodigiosin and obatoclax all have broad-spectrum antiparasitic activity in vitro, including activity against schistosomes, T. brucei, and apicomplexan parasites. In several cases, the drugs were found to have significant improvements over existing drugs. For instance, both obatoclax and prodigiosin were more efficacious at inhibiting the juvenile form of Schistosoma than the current standard of care, praziquantel. Additionally, low micromolar potencies were observed against pathogenic free-living amebae (Naegleria fowleri, Balamuthia mandrillaris and Acanthamoeba castellanii), which cause CNS infection and for which there are currently no reliable treatments. These results, combined with the previous human use of three of these drugs (obatoclax, anisomycin and nithiamide), support the idea that these compounds could serve as the basis for the development of broad-spectrum anti-parasitic drugs.
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Affiliation(s)
- Gretchen Ehrenkaufer
- Division of Infectious Diseases, Department of Internal Medicine, Stanford University, Stanford, CA, United States of America
| | - Pengyang Li
- Department of Bioengineering, Stanford University, Stanford, CA, United States of America
| | - Erin E. Stebbins
- Department of Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont, United States of America
| | - Monica M. Kangussu-Marcolino
- Division of Infectious Diseases, Department of Internal Medicine, Stanford University, Stanford, CA, United States of America
| | - Anjan Debnath
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States of America
| | - Corin V. White
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, California, United States of America
| | - Matthew S. Moser
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, California, United States of America
| | - Joseph DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, California, United States of America
| | - Jolyn Gisselberg
- Department of Biochemistry, Stanford Medical School, Stanford University, Stanford, CA, United States of America
| | - Ellen Yeh
- Department of Biochemistry, Stanford Medical School, Stanford University, Stanford, CA, United States of America
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, United States of America
- Department of Pathology, Stanford University, Stanford, CA, United States of America
| | - Steven C. Wang
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States of America
| | - Ana Hervella Company
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States of America
| | - Ludovica Monti
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States of America
| | - Conor R. Caffrey
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States of America
| | - Christopher D. Huston
- Department of Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont, United States of America
| | - Bo Wang
- Department of Bioengineering, Stanford University, Stanford, CA, United States of America
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Upinder Singh
- Division of Infectious Diseases, Department of Internal Medicine, Stanford University, Stanford, CA, United States of America
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, United States of America
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Shi D, Chahal KK, Oto P, Nothias LF, Debnath A, McKerrow JH, Podust LM, Abagyan R. Identification of Four Amoebicidal Nontoxic Compounds by a Molecular Docking Screen of Naegleria fowleri Sterol Δ8-Δ7-Isomerase and Phenotypic Assays. ACS Infect Dis 2019; 5:2029-2038. [PMID: 31583882 PMCID: PMC7085920 DOI: 10.1021/acsinfecdis.9b00227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Naegleria fowleri is a free-living amoeba causing primary amoebic meningoencephalitis, a rapid-onset brain infection in humans with over 97% mortality rate. Despite some progress in the treatment of the disease, there is no single, proven, evidence-based treatment with a high probability of cure. Here we report the chemical library screening and experimental identification of four new compounds with amoebicidal effects against N. fowleri. The chemical library was screened by molecular docking against a homology model of sterol Δ8-Δ7 isomerase (NfERG2). Thirty top-ranking hits were then tested in a cell-based assay for antiproliferative/amoebicidal activities. Eight chemicals exhibited nearly 100% inhibition of N. fowleri at 50 μM, with the EC50 values ranging from 6 to 25 μM. A cell toxicity assay using human HEK-293 cells was also performed. Four of the compounds preferentially kill amoeba cells with no apparent human cell toxicities. These compounds fall into two distinct chemical scaffolds with druglike properties.
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Affiliation(s)
- Da Shi
- Skaggs School of Pharmacy and Pharmaceutical Science, University of California San Diego,9500 Gilman Drive, La Jolla, California, 92093, United States of America
| | - Kirti Kandhwal Chahal
- Skaggs School of Pharmacy and Pharmaceutical Science, University of California San Diego,9500 Gilman Drive, La Jolla, California, 92093, United States of America
- Department of Pharmaceutical Sciences, Guru Jambheshwar University of Science and Technology, Hisar-Delhi Bypass Road, Hisar, Haryana 125001, India
| | - Patricia Oto
- Skaggs School of Pharmacy and Pharmaceutical Science, University of California San Diego,9500 Gilman Drive, La Jolla, California, 92093, United States of America
| | - Louis-Felix Nothias
- Skaggs School of Pharmacy and Pharmaceutical Science, University of California San Diego,9500 Gilman Drive, La Jolla, California, 92093, United States of America
| | - Anjan Debnath
- Skaggs School of Pharmacy and Pharmaceutical Science, University of California San Diego,9500 Gilman Drive, La Jolla, California, 92093, United States of America
| | - James H. McKerrow
- Skaggs School of Pharmacy and Pharmaceutical Science, University of California San Diego,9500 Gilman Drive, La Jolla, California, 92093, United States of America
| | - Larissa M. Podust
- Skaggs School of Pharmacy and Pharmaceutical Science, University of California San Diego,9500 Gilman Drive, La Jolla, California, 92093, United States of America
| | - Ruben Abagyan
- Skaggs School of Pharmacy and Pharmaceutical Science, University of California San Diego,9500 Gilman Drive, La Jolla, California, 92093, United States of America
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29
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Kangussu-Marcolino MM, Ehrenkaufer GM, Chen E, Debnath A, Singh U. Identification of plicamycin, TG02, panobinostat, lestaurtinib, and GDC-0084 as promising compounds for the treatment of central nervous system infections caused by the free-living amebae Naegleria, Acanthamoeba and Balamuthia. Int J Parasitol Drugs Drug Resist 2019; 11:80-94. [PMID: 31707263 PMCID: PMC6849155 DOI: 10.1016/j.ijpddr.2019.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/18/2019] [Accepted: 10/17/2019] [Indexed: 01/11/2023]
Abstract
The free-living amebae Naegleria, Acanthamoeba, and Balamuthia cause rare but life-threatening infections. All three parasites can cause meningoencephalitis. Acanthamoeba can also cause chronic keratitis and both Balamuthia and Acanthamoeba can cause skin and systemic infections. There are minimal drug development pipelines for these pathogens despite a lack of available treatment regimens and high fatality rates. To identify anti-amebic drugs, we screened 159 compounds from a high-value repurposed library against trophozoites of the three amebae. Our efforts identified 38 compounds with activity against at least one ameba. Multiple drugs that bind the ATP-binding pocket of mTOR and PI3K are active, highlighting these compounds as important inhibitors of these parasites. Importantly, 24 active compounds have progressed at least to phase II clinical studies and overall 15 compounds were active against all three amebae. Based on central nervous system (CNS) penetration or exceptional potency against one amebic species, we identified sixteen priority compounds for the treatment of meningoencephalitis caused by these pathogens. The top five compounds are (i) plicamycin, active against all three free-living amebae and previously U.S. Food and Drug Administration (FDA) approved, (ii) TG02, active against all three amebae, (iii and iv) FDA-approved panobinostat and FDA orphan drug lestaurtinib, both highly potent against Naegleria, and (v) GDC-0084, a CNS penetrant mTOR inhibitor, active against at least two of the three amebae. These results set the stage for further investigation of these clinically advanced compounds for treatment of infections caused by the free-living amebae, including treatment of the highly fatal meningoencephalitis.
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Affiliation(s)
- Monica M Kangussu-Marcolino
- Division of Infectious Diseases, Department of Internal Medicine, Stanford University, Grant Building, S-143, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Gretchen M Ehrenkaufer
- Division of Infectious Diseases, Department of Internal Medicine, Stanford University, Grant Building, S-143, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Emily Chen
- uHTS Laboratory Rm 101, 11119 N Torrey Pines Rd. Calibr, A Division of the Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Anjan Debnath
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Upinder Singh
- Division of Infectious Diseases, Department of Internal Medicine, Stanford University, Grant Building, S-143, 300 Pasteur Drive, Stanford, CA, 94305, USA; Department of Microbiology and Immunology, Stanford University, Stanford, CA, 94305, USA.
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30
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Jahangeer M, Mahmood Z, Munir N, Waraich U, Tahir IM, Akram M, Ali Shah SM, Zulfqar A, Zainab R. Naegleria fowleri: Sources of infection, pathophysiology, diagnosis, and management; a review. Clin Exp Pharmacol Physiol 2019; 47:199-212. [DOI: 10.1111/1440-1681.13192] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/07/2019] [Accepted: 10/12/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Muhammad Jahangeer
- Department of Biochemistry Government College University Faisalabad Faisalabad Pakistan
| | - Zahed Mahmood
- Department of Biochemistry Government College University Faisalabad Faisalabad Pakistan
| | - Naveed Munir
- Department of Biochemistry Government College University Faisalabad Faisalabad Pakistan
- College of Allied Health Professionals Directorate of Medical Sciences Government College University Faisalabad Faisalabad Pakistan
| | | | - Imtiaz Mahmood Tahir
- College of Allied Health Professionals Directorate of Medical Sciences Government College University Faisalabad Faisalabad Pakistan
| | - Muhammad Akram
- Department of Eastern Medicine Directorate of Medical Sciences Government College University Faisalabad Faisalabad Pakistan
| | - Syed Muhammad Ali Shah
- Department of Eastern Medicine Directorate of Medical Sciences Government College University Faisalabad Faisalabad Pakistan
| | - Ayesha Zulfqar
- Department of Biochemistry Government College University Faisalabad Faisalabad Pakistan
| | - Rida Zainab
- Department of Eastern Medicine Directorate of Medical Sciences Government College University Faisalabad Faisalabad Pakistan
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31
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Vugia DJ, Richardson J, Tarro T, Vareechon C, Pannaraj PS, Traub E, Cope JR, Balter S. Notes from the Field: Fatal Naegleria fowleri Meningoencephalitis After Swimming in Hot Spring Water - California, 2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:793-794. [PMID: 31513557 PMCID: PMC6753969 DOI: 10.15585/mmwr.mm6836a3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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Rizo-Liendo A, Sifaoui I, Reyes-Batlle M, Chiboub O, Rodríguez-Expósito RL, Bethencourt-Estrella CJ, San Nicolás-Hernández D, Hendiger EB, López-Arencibia A, Rocha-Cabrera P, Piñero JE, Lorenzo-Morales J. In Vitro Activity of Statins against Naegleria fowleri. Pathogens 2019; 8:E122. [PMID: 31398829 PMCID: PMC6789626 DOI: 10.3390/pathogens8030122] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/03/2019] [Accepted: 08/05/2019] [Indexed: 01/26/2023] Open
Abstract
Naegleria fowleri causes a deadly disease called primary amoebic meningoencephalitis (PAM). Even though PAM is still considered a rare disease, the number of reported cases worldwide has been increasing each year. Among the factors to be considered for this, awareness about this disease, and also global warming, as these amoebae thrive in warm water bodies, seem to be the key factors. Until present, no fully effective drugs have been developed to treat PAM, and the current options are amphotericin B and miltefosine, which present side effects such as liver and kidney toxicity. Statins are able to inhibit the 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, which is a key enzyme for the synthesis of ergosterol of the cell membrane of these amoebae. Therefore, the in vitro activity of a group of statins was tested in this study against two types of strains of Naegleria fowleri. The obtained results showed that fluvastatin was the most effective statin tested in this study and was able to eliminate these amoebae at concentrations of 0.179 ± 0.078 to 1.682 ± 0.775 µM depending on the tested strain of N. fowleri. Therefore, fluvastatin could be a potential novel therapeutic agent against this emerging pathogen.
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Affiliation(s)
- Aitor Rizo-Liendo
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain
| | - Ines Sifaoui
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain
- Laboratoire Matériaux-Molécules et Applications, La Marsa, University of Carthage, Carthage 1054, Tunisia
| | - María Reyes-Batlle
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain
| | - Olfa Chiboub
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain
- Laboratoire Matériaux-Molécules et Applications, La Marsa, University of Carthage, Carthage 1054, Tunisia
| | - Rubén L Rodríguez-Expósito
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain
| | - Carlos J Bethencourt-Estrella
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain
| | - Desirée San Nicolás-Hernández
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain
| | - Edyta B Hendiger
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain
- Department of Medical Biology, Medical University of Warsaw, 02091 Warsaw, Poland
| | - Atteneri López-Arencibia
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain
| | - Pedro Rocha-Cabrera
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain
- Clínica Nivaria, Santa Cruz de Tenerife, Canary Islands, 38203 Tenerife, Spain
| | - José E Piñero
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain.
| | - Jacob Lorenzo-Morales
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain.
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Vareechon C, Tarro T, Polanco C, Anand V, Pannaraj PS, Dien Bard J. Eight-Year-Old Male With Primary Amebic Meningoencephalitis. Open Forum Infect Dis 2019; 6:ofz349. [PMID: 31660390 PMCID: PMC6735792 DOI: 10.1093/ofid/ofz349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/26/2019] [Indexed: 11/23/2022] Open
Abstract
Naegleria fowleri is a thermophilic free-living amoeba that is found in warm, fresh water and causes primary amebic meningoencephalitis (PAM). The following report demonstrates the rapid and destructive clinical features of PAM in an 8-year-old male who presented with severe headaches approximately 12 days after swimming in a hot spring.
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Affiliation(s)
- Chairut Vareechon
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, California
| | - Thomas Tarro
- Department of Infectious Disease, Children's Hospital Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles
| | - Claudia Polanco
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, California
| | - Vikram Anand
- Department of Infectious Disease, Children's Hospital Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles
| | - Pia S Pannaraj
- Department of Infectious Disease, Children's Hospital Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles
| | - Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles
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35
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Gompf SG, Garcia C. Lethal encounters: The evolving spectrum of amoebic meningoencephalitis. IDCases 2019; 15:e00524. [PMID: 30937287 PMCID: PMC6430007 DOI: 10.1016/j.idcr.2019.e00524] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/21/2022] Open
Abstract
The free-living amoebae are thermophilic organisms that may play an increasing role among diseases of a warming world. They are uncommon, accidental, yet high consequence pathogens, with differing pathologic syndromes. New prospects for diagnosis and life-saving treatment make early disease recognition imperative. We review the three most commonly diagnosed species that infect humans: Naegleria fowleri, Acanthamoeba species, and Balamuthia mandrillaris.
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Affiliation(s)
- Sandra G. Gompf
- James A. Haley Veterans Hospital, 13000 Bruce B. Downs Blvd., 33612, Tampa, FL, United States
- University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, United States
| | - Cristina Garcia
- James A. Haley Veterans Hospital, 13000 Bruce B. Downs Blvd., 33612, Tampa, FL, United States
- University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, United States
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36
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Zhou W, Debnath A, Jennings G, Hahn HJ, Vanderloop BH, Chaudhuri M, Nes WD, Podust LM. Enzymatic chokepoints and synergistic drug targets in the sterol biosynthesis pathway of Naegleria fowleri. PLoS Pathog 2018; 14:e1007245. [PMID: 30212566 PMCID: PMC6136796 DOI: 10.1371/journal.ppat.1007245] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/27/2018] [Indexed: 11/29/2022] Open
Abstract
Naegleria fowleri is a free-living amoeba that can also act as an opportunistic pathogen causing severe brain infection, primary amebic meningoencephalitis (PAM), in humans. The high mortality rate of PAM (exceeding 97%) is attributed to (i) delayed diagnosis, (ii) lack of safe and effective anti-N. fowleri drugs, and (iii) difficulty of delivering drugs to the brain. Our work addresses identification of new molecular targets that may link anti-Naegleria drug discovery to the existing pharmacopeia of brain-penetrant drugs. Using inhibitors with known mechanism of action as molecular probes, we mapped the sterol biosynthesis pathway of N. fowleri by GC-MS analysis of metabolites. Based on this analysis, we chemically validated two enzymes downstream to CYP51, sterol C24-methyltransferase (SMT, ERG6) and sterol Δ8-Δ7 -isomerase (ERG2), as potential therapeutic drug targets in N. fowleri. The sterol biosynthetic cascade in N. fowleri displayed a mixture of canonical features peculiar to different domains of life: lower eukaryotes, plants and vertebrates. In addition to the cycloartenol→ergosterol biosynthetic route, a route leading to de novo cholesterol biosynthesis emerged. Isotopic labeling of the de novo-synthesized sterols by feeding N. gruberi trophozoites on the U13C-glucose-containing growth medium identified an exogenous origin of cholesterol, while 7-dehydrocholesterol (7DHC) had enriched 13C-content, suggesting a dual origin of this metabolite both from de novo biosynthesis and metabolism of scavenged cholesterol. Sterol homeostasis in Naegleria may be orchestrated over the course of its life-cycle by a "switch" between ergosterol and cholesterol biosynthesis. By demonstrating the growth inhibition and synergistic effects of the sterol biosynthesis inhibitors, we validated new, potentially druggable, molecular targets in N. fowleri. The similarity of the Naegleria sterol Δ8-Δ7 -isomerase to the human non-opioid σ1 receptor, implicated in human CNS conditions such as addiction, amnesia, pain and depression, provides an incentive to assess structurally diverse small-molecule brain-penetrant drugs targeting the human receptor for anti-Naegleria activity.
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Affiliation(s)
- Wenxu Zhou
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas, United States of America
| | - Anjan Debnath
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, United States of America
| | - Gareth Jennings
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, United States of America
| | - Hye Jee Hahn
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, United States of America
| | - Boden H. Vanderloop
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas, United States of America
| | - Minu Chaudhuri
- Department of Microbiology and Immunology, Meharry Medical College, Nashville, Tennessee, United States of America
| | - W. David Nes
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas, United States of America
| | - Larissa M. Podust
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, United States of America
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Wang Q, Li J, Ji J, Yang L, Chen L, Zhou R, Yang Y, Zheng H, Yuan J, Li L, Bi Y, Gao GF, Ma J, Liu Y. A case of Naegleria fowleri related primary amoebic meningoencephalitis in China diagnosed by next-generation sequencing. BMC Infect Dis 2018; 18:349. [PMID: 30055569 PMCID: PMC6064090 DOI: 10.1186/s12879-018-3261-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 07/19/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Primary amoebic meningoencephalitis (PAM), caused by Naegleria fowleri, is a rare protozoan infectious disease in China. A fatality rate of over 95% had been reported due to extremely rapid disease progression in the USA and other countries. Rapid and precise identification of the causative agent is very important to clinicians for guiding their choices for administering countermeasures in the clinic. In this report, we applied the next-generation sequencing (NGS) method to rapidly show that N. fowleri was the causative agent of a fatal case involving a 42-year-old man with severe PAM disease, the first reported in mainland China. CASE PRESENTATION A 42-year old male in a deep coma was admitted to Shenzhen Third People's Hospital, a special medical care unit with expertise in infectious diseases. Increased intracranial pressure was detected. The cerebrospinal fluid (CSF) sample was found to be red and cloudy with increased leukocyte and protein levels. While bacterial cultures with CSF were negative, N. fowleri was determined to be the causative agent with NGS. Amphotericin B (AmB), a drug with anti-amoeba activity, was used immediately, but the treatment came too late and the patient died 2 days after the NGS confirmation. CONCLUSION In this paper, we reported a case of PAM disease for the first time in mainland China. NGS was used for rapid diagnosis and provided guidance for prescribing medications. However, the patient died due to a late admission amid advanced PAM disease. Early detection of N. fowleri is necessary in order to select effective drug treatments and control the disease progression. Despite the negative survival outcome, NGS was shown to be a promising method of rapid and precise identification of N. fowleri.
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Affiliation(s)
- Qiang Wang
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, 29 Bulan Rd, Shenzhen, 518112 China
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Institute of Microbiology, Center for Influenza Research and Early-warning (CASCIRE), Chinese Academy of Sciences, Beijing, 100101 China
| | - Jianming Li
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, 29 Bulan Rd, Shenzhen, 518112 China
| | - Jingkai Ji
- BGI-Shenzhen, Shenzhen, 518083 China
- China National GeneBank, BGI-Shenzhen, Shenzhen, 518120 China
| | - Liuqing Yang
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, 29 Bulan Rd, Shenzhen, 518112 China
| | - Li Chen
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, 29 Bulan Rd, Shenzhen, 518112 China
| | - Rongrong Zhou
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, 29 Bulan Rd, Shenzhen, 518112 China
| | - Yang Yang
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, 29 Bulan Rd, Shenzhen, 518112 China
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Institute of Microbiology, Center for Influenza Research and Early-warning (CASCIRE), Chinese Academy of Sciences, Beijing, 100101 China
| | - Haixia Zheng
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, 29 Bulan Rd, Shenzhen, 518112 China
| | - Jing Yuan
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, 29 Bulan Rd, Shenzhen, 518112 China
| | - Liqiang Li
- BGI-Shenzhen, Shenzhen, 518083 China
- China National GeneBank, BGI-Shenzhen, Shenzhen, 518120 China
| | - Yuhai Bi
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, 29 Bulan Rd, Shenzhen, 518112 China
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Institute of Microbiology, Center for Influenza Research and Early-warning (CASCIRE), Chinese Academy of Sciences, Beijing, 100101 China
| | - George F. Gao
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, 29 Bulan Rd, Shenzhen, 518112 China
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Institute of Microbiology, Center for Influenza Research and Early-warning (CASCIRE), Chinese Academy of Sciences, Beijing, 100101 China
- Office of Director-General, Chinese Center for Disease Control and Prevention, Beijing, 102206 China
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, 100049 China
| | - Jinmin Ma
- BGI-Shenzhen, Shenzhen, 518083 China
- China National GeneBank, BGI-Shenzhen, Shenzhen, 518120 China
- Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Yingxia Liu
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, 29 Bulan Rd, Shenzhen, 518112 China
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, 100049 China
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Nehete LS, Kumar A, Chavali P, A. R. P, Devi BI. Fulminant acanthamoebic meningoencephalitis in immunocompetent patients: an uncommon entity. Br J Neurosurg 2018; 36:98-101. [DOI: 10.1080/02688697.2018.1485873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Lokesh Suresh Nehete
- Department of Neurosurgery, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Anil Kumar
- Department of Neurosurgery, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Pooja Chavali
- Department of Neuropathology, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Prabhuraj A. R.
- Department of Neurosurgery, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
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Iron economy in Naegleria gruberi reflects its metabolic flexibility. Int J Parasitol 2018; 48:719-727. [PMID: 29738737 DOI: 10.1016/j.ijpara.2018.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 11/24/2022]
Abstract
Naegleria gruberi is a free-living amoeba, closely related to the human pathogen Naegleria fowleri, the causative agent of the deadly human disease primary amoebic meningoencephalitis. Herein, we investigated the effect of iron limitation on different aspects of N. gruberi metabolism. Iron metabolism is among the most conserved pathways found in all eukaryotes. It includes the delivery, storage and utilisation of iron in many cell processes. Nevertheless, most of the iron metabolism pathways of N. gruberi are still not characterised, even though iron balance within the cell is crucial. We found a single homolog of ferritin in the N. gruberi genome and showed its localisation in the mitochondrion. Using comparative mass spectrometry, we identified 229 upregulated and 184 down-regulated proteins under iron-limited conditions. The most down-regulated protein under iron-limited conditions was hemerythrin, and a similar effect on the expression of hemerythrin was found in N. fowleri. Among the other down-regulated proteins were [FeFe]-hydrogenase and its maturase HydG and several heme-containing proteins. The activities of [FeFe]-hydrogenase, as well as alcohol dehydrogenase, were also decreased by iron deficiency. Our results indicate that N. gruberi is able to rearrange its metabolism according to iron availability, prioritising mitochondrial pathways. We hypothesise that the mitochondrion is the center for iron homeostasis in N. gruberi, with mitochondrially localised ferritin as a potential key component of this process.
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40
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Bellini NK, Santos TM, da Silva MTA, Thiemann OH. The therapeutic strategies against Naegleria fowleri. Exp Parasitol 2018; 187:1-11. [DOI: 10.1016/j.exppara.2018.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 02/07/2018] [Accepted: 02/28/2018] [Indexed: 12/13/2022]
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Chomba M, Mucheleng'anga LA, Fwoloshi S, Ngulube J, Mutengo MM. A case report: primary amoebic meningoencephalitis in a young Zambian adult. BMC Infect Dis 2017; 17:532. [PMID: 28764655 PMCID: PMC5540533 DOI: 10.1186/s12879-017-2638-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/25/2017] [Indexed: 11/18/2022] Open
Abstract
Background Primary amoebic meningoencephalitis (PAM) is a fulminant disease of the brain caused by Naegleria fowleri. Although the disease is rare, the case fatality rate is very high. In this report, we describe the first case of PAM in Zambia. Case presentation The patient presented with sudden onset of seizures and fever on admission. On physical examination he was febrile, comatose and with a stiff neck. Cerebral spinal fluid (CSF) collected on admission did not reveal any organism on microscopy or culture but showed elevated white cell count. A working diagnosis of severe septicemia with acute meningoencephalitis was then made and the patient was started on IV Cephtriaxone (2 g) twice daily. Despite receiving treatment, his condition deteriorated. A second CSF sample collected on day 3 was also negative for bacteria and other organisms. However, a repeat CSF sample collected on day 8 revealed numerous motile organisms that were identified as Naegleria on microscopy and confirmed to be N. fowleri on polymerase chain reaction. The patient died on day 8 of hospital admission after having received one dose of Amphotericin B (50 mg). Features consistent with PAM were detected on autopsy. Conclusion The isolation of N. fowleri in this patient calls for increased awareness among clinical and laboratory staff on suspected PAM cases to promptly diagnose and effectively manage the disease. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2638-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mashina Chomba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Luchenga A Mucheleng'anga
- Department of Pathology and Microbiology, University Teaching Hospital and University of Zambia- School of Medicine, Lusaka, Zambia
| | - Sombo Fwoloshi
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Joseph Ngulube
- Department of Pathology and Microbiology, University Teaching Hospital and University of Zambia- School of Medicine, Lusaka, Zambia
| | - Mable M Mutengo
- Department of Pathology and Microbiology, University Teaching Hospital and University of Zambia- School of Medicine, Lusaka, Zambia.
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42
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Mailles A, Stahl JP, Bloch KC. Update and new insights in encephalitis. Clin Microbiol Infect 2017; 23:607-613. [PMID: 28501667 DOI: 10.1016/j.cmi.2017.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/30/2017] [Accepted: 05/01/2017] [Indexed: 01/17/2023]
Abstract
Infectious encephalitis is a rare but severe medical condition resulting from direct invasion of the brain by viruses, bacteria, fungi or parasites, or indirect post-infectious immune or inflammatory disorders when the infectious agent does not cross the blood-brain barrier. Infectious encephalitis cases represent an interesting and accurate sentinel to follow up on trends in infectious diseases or to detect emerging infections. Using Pubmed and Embase, we searched the most relevant publications over the last years. We present here an update on the important findings and new data recently published about infectious encephalitis.
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Affiliation(s)
- A Mailles
- Santé publique France, Saint-Maurice, France; ESCMID Study Group on infections of the Brain.
| | - J-P Stahl
- ESCMID Study Group on infections of the Brain; Joseph Fourier University, University Hospital, Grenoble, France
| | - K C Bloch
- Vanderbilt University Medical Center, Nashville, TN, USA
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43
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Stowe RC, Pehlivan D, Friederich KE, Lopez MA, DiCarlo SM, Boerwinkle VL. Primary Amebic Meningoencephalitis in Children: A Report of Two Fatal Cases and Review of the Literature. Pediatr Neurol 2017; 70:75-79. [PMID: 28389055 DOI: 10.1016/j.pediatrneurol.2017.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Primary amebic meningoencephalitis is a rare, almost uniformly fatal disease of cerebral invasion by Naegleria fowleri, occurring most commonly after swimming in warm fresh water in summer months. Treatment using the experimental medication miltefosine demonstrated improved survival and favorable neurocognitive outcome in a 2013 North American patient. There is little information about the electroencephalographic findings of such patients, and our understanding of factors predicting survival is limited. METHODS AND RESULTS We describe two children, aged four and 14 years, who both presented with seizures and altered mental status after recent fresh water swimming exposures. With evidence of pyogenic meningitis and examination of cerebrospinal fluid demonstrating motile trophozoites on wet mount, N. fowleri meningoencephalitis was diagnosed. Amebicidal antibiotic regimens with miltefosine were administered. Continuous electroencephalography monitoring demonstrated evolution from diffuse slowing to seizures, status epilepticus, and eventually global attenuation and absence of activity. Both patients ultimately died after complications of progressive increasing intracranial pressure and hemodynamic compromise. CONCLUSIONS Primary amebic meningoencephalitis is a serious, sporadic infection. We describe two fatal pediatric patients, the evolution of their electroencephalography findings, and compare their findings with the 13 reported pediatric survivors.
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Affiliation(s)
- Robert C Stowe
- Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas.
| | - Davut Pehlivan
- Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas
| | - Katie E Friederich
- Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas
| | - Michael A Lopez
- Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas
| | - Shannon M DiCarlo
- Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas
| | - Varina L Boerwinkle
- Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas
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Yu Z, Miller HC, Puzon GJ, Clowers BH. Development of Untargeted Metabolomics Methods for the Rapid Detection of Pathogenic Naegleria fowleri. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:4210-4219. [PMID: 28290675 DOI: 10.1021/acs.est.6b05969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Despite comparatively low levels of infection, primary amoebic meningoencephalitis (PAM) induced by Naegleria fowleri is extremely lethal, with mortality rates above 95%. As a thermophile, this organism is often found in moderate-to-warm climates and has the potential to colonize drinking water distribution systems (DWDSs). Current detection approaches require days to obtain results, whereas swift corrective action can maximize the benefit of public health. Presently, there is little information regarding the underlying in situ metabolism for this amoeba but the potential exists to exploit differentially expressed metabolic signatures as a rapid detection technique. This research outlines the biochemical profiles of selected pathogenic and nonpathogenic Naegleria in vitro using an untargeted metabolomics approach to identify a panel of diagnostically meaningful compounds that may enable rapid detection of viable pathogenic N. fowleri and augment results from traditional monitoring approaches.
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Affiliation(s)
- Zhihao Yu
- Department of Chemistry, Washington State University , P.O. Box 644630, Pullman, Washington 99164, United States
| | - Haylea C Miller
- CSIRO Land and Water, Centre for Environment and Life Sciences , Private Bag No. 5, Wembley, Western Australia 6913, Australia
| | - Geoffrey J Puzon
- CSIRO Land and Water, Centre for Environment and Life Sciences , Private Bag No. 5, Wembley, Western Australia 6913, Australia
| | - Brian H Clowers
- Department of Chemistry, Washington State University , P.O. Box 644630, Pullman, Washington 99164, United States
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Pugh JJ, Levy RA. Naegleria fowleri: Diagnosis, Pathophysiology of Brain Inflammation, and Antimicrobial Treatments. ACS Chem Neurosci 2016; 7:1178-9. [PMID: 27525348 DOI: 10.1021/acschemneuro.6b00232] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Primary amoebic meningoencephalitis (PAM) is a very rare disease with a high mortality rate. PAM is caused by Naegleria fowleri, an amoeba which resides in freshwater lakes and ponds and can survive in inadequately chlorinated pools ( Lopez, C.; Budge, P.; Chen, J., et al. Primary amebic meningoencephalitis: a case report and literature review . Pediatr. Emerg. Care 2012 , 28 , 272 - 276 ). In the past 50 years, there have been over 130 cases of Naegleria induced PAM in the United States with only three known survivors; one survivor was diagnosed and treated at Arkansas Children's Hospital. Successful treatment of PAM started with a rapid diagnosis, extensive antimicrobial therapy including an investigational medication miltefosine, supportive care, an intraventricular shunt, and hypothermia. These treatments address different aspects of the disease process. Increased understanding of the diagnosis and treatment of PAM is important especially for patients who present with meningitis-like findings during the summer months.
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Affiliation(s)
- J. Jeffrey Pugh
- Department of Pharmacy, and ‡Department of
Pathology, Arkansas Children’s Hospital, Little Rock, Arkansas 72202, United States
| | - Rebecca A. Levy
- Department of Pharmacy, and ‡Department of
Pathology, Arkansas Children’s Hospital, Little Rock, Arkansas 72202, United States
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Cope JR, Ali IK. Primary Amebic Meningoencephalitis: What Have We Learned in the Last 5 Years? Curr Infect Dis Rep 2016; 18:31. [PMID: 27614893 DOI: 10.1007/s11908-016-0539-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Primary amebic meningoencephalitis (PAM) is a devastating infection of the brain caused by the thermophilic free-living ameba, Naegleria fowleri. Infection can occur when water containing the ameba enters the body through the nose, usually during recreational water activities such as swimming or diving. Historically, in the USA, cases were mostly reported from the warmer southern-tier states. In the last 5 years, several notable changes have been documented in PAM epidemiology including a northward expansion of infections and new types of water exposures. The recent reports of two PAM survivors provide hope for improved outcomes with early diagnosis and aggressive treatment. Advanced molecular laboratory tools such as genome sequencing might provide more insight into the pathogenicity of N. fowleri. Clinicians treating patients with meningitis and warm freshwater exposure are encouraged to consider PAM in their differential diagnoses.
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Affiliation(s)
- Jennifer R Cope
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, 30329, USA.
| | - Ibne K Ali
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, 30329, USA
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NLRP3 Inflammasome Activation in THP-1 Target Cells Triggered by Pathogenic Naegleria fowleri. Infect Immun 2016; 84:2422-8. [PMID: 27297387 DOI: 10.1128/iai.00275-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/06/2016] [Indexed: 01/06/2023] Open
Abstract
Naegleria fowleri, known as the brain-eating amoeba, causes acute primary amoebic meningoencephalitis. During swimming and other recreational water activities, N. fowleri trophozoites penetrate the nasal mucosa and invade the olfactory bulbs, resulting in intense inflammatory reactions in the forebrain tissue. To investigate what kinds of inflammasome molecules are expressed in target cells due to N. fowleri infection, human macrophage cells (THP-1 cells) were cocultured with N. fowleri trophozoites in a noncontact system, and consequently, interleukin-1β (IL-1β) production was estimated. Caspase-1 activation and IL-1β production from THP-1 cells by Western blotting and the culture supernatant by enzyme-linked immunosorbent assay analysis were observed at 3 h after cocultivation. In addition, the increased expression of ASC and NLRP3, which make up an inflammasome complex, was also observed at 3 h after cocultivation. To confirm the caspase-1 activation and IL-1β production via the NLRP3 inflammasome in THP-1 cells triggered by N. fowleri trophozoites, THP-1 cells were pretreated with several inhibitors. The inhibition assay showed that CA-074 (a cathepsin B inhibitor), glybenclamide (an NLRP3 molecule inhibitor), and N-benzyloxycarbony-Val-Ala-Asp(O-methyl)-fluoromethylketone (Z-VAD-FMK; a caspase-1 inhibitor) reduced the levels of caspase-1 activation and IL-1β production from THP-1 cells. This study suggests that N. fowleri infection induces the NLRP3 inflammasome, which activates caspase-1 and subsequently produces IL-1β, thus resulting in inflammation.
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Martínez-Castillo M, Cárdenas-Zúñiga R, Coronado-Velázquez D, Debnath A, Serrano-Luna J, Shibayama M. Naegleria fowleri after 50 years: is it a neglected pathogen? J Med Microbiol 2016; 65:885-896. [PMID: 27381464 DOI: 10.1099/jmm.0.000303] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
It has been 50 years since the first case of primary amoebic meningoencephalitis (PAM), an acute and rapidly fatal disease of the central nervous system (CNS), was reported in Australia. It is now known that the aetiological agent of PAM is Naegleria fowleri, an amoeba that is commonly known as 'the brain-eating amoeba'. N. fowleri infects humans of different ages who are in contact with water contaminated with this micro-organism. N. fowleri is distributed worldwide and is found growing in bodies of freshwater in tropical and subtropical environments. The number of PAM cases has recently increased, and the rate of recovery from PAM has been estimated at only 5 %. Amphotericin B has been used to treat patients with PAM. However, it is important to note that there is no specific treatment for PAM. Moreover, this amoeba is considered a neglected micro-organism. Researchers have exerted great effort to design effective drugs to treat PAM and to understand the pathogenesis of PAM over the past 50 years, such as its pathology, molecular and cellular biology, diagnosis and prevention, and its biological implications, including its pathogenic genotypes, its distribution and its ecology. Given the rapid progression of PAM and its high mortality rate, it is important that investigations continue and that researchers collaborate to gain better understanding of the pathogenesis of this disease and, consequently, to improve the diagnosis and treatment of this devastating infection of the CNS.
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Affiliation(s)
- Moisés Martínez-Castillo
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies of the National Polytechnic Institute, Av. IPN 2508, Mexico City 07360, Mexico
| | - Roberto Cárdenas-Zúñiga
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies of the National Polytechnic Institute, Av. IPN 2508, Mexico City 07360, Mexico
| | - Daniel Coronado-Velázquez
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies of the National Polytechnic Institute, Av. IPN 2508, Mexico City 07360, Mexico
| | - Anjan Debnath
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Jesús Serrano-Luna
- Department of Cell Biology, Center for Research and Advanced Studies of the National Polytechnic Institute, Av. IPN 2508, Mexico City 07360, Mexico
| | - Mineko Shibayama
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies of the National Polytechnic Institute, Av. IPN 2508, Mexico City 07360, Mexico
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