Reaching the World Health Organization elimination targets for schistosomiasis: the importance of a One Health perspective

Exploring the genome-wide transcriptomic responses of Bulinus truncatus to Schistosoma haematobium infection: An important host-parasite system involved in the transmission of human urogenital schistosomiasis

Freshwater snails of the genus Bulinus are critical hosts for Schistosoma haematobium, the causative agent of urogenital schistosomiasis. Among the 37 recognized Bulinus species, B. truncatus is a key vector. Using RNA sequencing (RNAseq), we investigated the genome-wide transcriptional responses of B. truncatus to S. haematobium infection. Our findings suggest that snails employ a complex defense strategy against the parasites by up-regulating genes involved in immune response, stress reaction, structural integrity, metabolism, and detoxification. In response, schistosome parasites appear to manipulate the snail's defense system, as evidenced by the suppression of immune-related genes such as ficolin, peptidoglycan recognition protein, and C-type lectin domain-containing protein genes. The down-regulation of biomphalysin 9, compared to its function in Biomphalaria glabrata, indicates divergent immune strategies among snail hosts. Additionally, we compared transcriptome profiles between embryos and juveniles, providing insights into developmental processes. This study offers valuable genomic data for Bulinus snails, illuminating the molecular interactions between bulinids and schistosomes, and advancing our understanding of their developmental biology.

Structure-Based Discovery of Phytocompounds from Azadirachta indica as Potential Inhibitors of Thioredoxin Glutathione Reductase in Schistosoma mansoni

Schistosomiasis, a parasitic disease caused by Schistosoma species such as S. haematobium, S. mansoni, and S. japonicum, poses a significant global health burden. The thioredoxin glutathione reductase (TGR) enzyme, crucial for maintaining the parasite's redox balance and preventing oxidative stress, has been identified as a promising target for anti-schistosomal drug development. This study aims to identify potential TGR inhibitors from Azadirachta indica phytochemicals using molecular modeling approaches. We screened 60 compounds derived from A. indica bark and leaves through molecular docking to assess their binding affinity, followed by the evaluation of binding-free energies for the most promising candidates. Drug-likeness and pharmacokinetic properties were assessed, and molecular dynamics simulations were conducted to explore the conformational stability of the protein-ligand complexes. Our findings revealed that several A. indica compounds exhibited significantly lower docking scores (up to -9.669 kcal/mol) compared to the standard drug praziquantel (-4.349 kcal/mol). Notably, Isorhamnetin, Isomargolonone, Nimbaflavone, Quercetin, and Nimbionol demonstrated strong interactions with TGR, although Isorhamnetin showed potential mutagenicity. Further binding free energy calculations and molecular dynamics simulations confirmed the stability of Isomargolonone, Nimbionol, and Quercetin as potential TGR inhibitors. In conclusion, these findings suggest that Isomargolonone, Nimbionol, and Quercetin warrant further experimental validation as promising candidates for anti-schistosomal therapy.

Ecosystem links: Anthropogenic activities, environmental variables, and macrophytes structure snail preferences in man-made waterbodies

Freshwater snails act as obligate intermediate hosts for trematode parasites that cause trematodiases threatening public and veterinary health, and biodiversity conservation. While interest in snail control for trematodiases has re-emerged, their ecology remains poorly understood. We examined the relationship between ecosystem indicators - such as environmental variables, macroinvertebrates, macrophytes, and land use - and their correlation with snail abundance, diversity, and infection prevalence in 19 man-made ponds in eastern Zimbabwe. In total, 926 freshwater snails from 10 species were collected, with 547 individuals belonging to five schistosome-competent species: Bulinus tropicus, Bulinus truncatus, Bulinus globosus, Bulinus forskalii, and Biomphalaria pfeifferi. The remaining 379 snails comprised Radix natalensis, Gyraulus sp., and the exotic invasive species Melanoides tuberculata, Pseudosuccinea columella, and Physella acuta. Six cercarial types - mammalian schistosomes, avian schistosomes, longifurcate pharyngeates, echinostomes, amphistomes, and xiphidiocercariae - were isolated from 104 out of 926 snails (11.2 %). PCR revealed a significantly higher infection rate, with 70.2 % of snails testing positive for trematodes. Snail taxon diversity and infection rate significantly varied across land use types, with the lowest values observed in the commercial tobacco farm section, highlighting the potential adverse effects of agriculture on biodiversity. Ponds with extensive Lagarosiphon major (oxygen weed) coverage appeared to facilitate the presence and abundance of P. acuta and P. columella. Schistosome-competent snails such as B. truncatus and B. tropicus seemed to favor shallow water depths and more eutrophic sites characterized by high levels of nitrates, phytoplankton biomass, turbidity, and phycocyanin. These ponds were predominantly associated with the emergent macrophyte Cladium mariscus, revealing a potential association with important intermediate snail hosts. In conclusion, our study emphasizes the complex interplay among environmental factors, macrophyte composition, land use, and the abundance, diversity, and infection prevalence of freshwater snails, offering insights into potential strategies for targeted snail control and disease management in man-made waterbodies.

Impact of species hybridization on the clinical management of schistosomiasis: A prospective study

BACKGROUND

Species hybridization represents a real concern in terms of parasite transmission, epidemiology and morbidity of schistosomiasis. It is greatly important to better understand the impact of species hybridization for the clinical management.

METHODS

A prospective observational study was carried out in sub-Saharan migrants who were diagnosed with confirmed genitourinary schistosomiasis. A tailored protocol was applied, including Schistosoma serology, a specific urine LAMP tests for schistosomiasis and an ultrasound examination before treatment with praziquantel. A scheduled follow-up was performed at 3, 6 and 12 months to monitor treatment response, comparing patients carriers of Schistosoma hybrids with carriers of only genetically pure forms.

RESULTS

A total of 31 male patients from West Africa were included in the study with a mean age of 26.5 years. Twelve (38.7 %) of the patients were carriers of Schistosoma hybrids. As compared with patients infected with S. haematobium alone, hybrid carriers had lower haemoglobin levels (13.8 g/dL [SD 1.8] vs 14.8 g/dL [SD 1.4], p = 0.04), a greater frequency of hematuria (100 % vs 52.6 %, p = 0.005), a higher ultrasound score (2.64, SD 2.20 vs 0.89, SD 0.99; p = 0.02). However, the presence of hybrids did not result in differences in clinical and analytical responses after treatment.

CONCLUSIONS

The presence of Schistosoma hybrids seems to cause increased morbidity in infected individuals. However, it does not appear to result in differences in diagnostic tests or in clinical and analytical responses after treatment.

Changing seroprevalence of schistosomiasis japonica in China from 1982 to 2020: A systematic review and spatial analysis

BACKGROUND

Schistosomiasis is a global public health issue. In China, while the seroprevalence of Schistosomiasis japonica has currently reduced to a relatively low level, risk of infection still exists in certain areas. However, there has been a lack of comprehensive research on the long-term trends of national seroprevalence, changes across age groups, and characteristics in spatial distribution, which is crucial for effectively targeting interventions and achieving the goal of eliminating schistosomiasis by 2030. Our study aimed to address this gap by analyzing the long-term trends of Schistosomiasis japonica seroprevalence in China from 1982 to 2020 based on the data from diverse sources spanning a period of 39 years.

METHODOLOGY

Seroprevalence data were collected from literature databases and national schistosomiasis surveillance system. Meta-analysis was conducted to estimate the seroprevalence. Joinpoint model was used to identify changing trend and inflection point. Inverse distance weighted interpolation was used to determine the spatial distribution of seroprevalence.

PRINCIPAL FINDINGS

The seroprevalence decreased from 34.8% in 1982 to 2.4% in 2020 in China. Before 2006, the seroprevalence was higher in the middle age group, and a pattern of increasing with age was observed afterwards. The areas with high seroprevalence existed in Dongting Lake, Poyang Lake, Jianghan Plain, the Anhui branch of the Yangtze River and some localized mountainous regions in Sichuan and Yunnan provinces.

CONCLUSIONS/SIGNIFICANCE

There was a significant decline in the seroprevalence of Schistosomiasis japonica from 1982 to 2020 in China. Nevertheless, schistosomiasis has not been eradicated; thus, implementing precise and personalized monitoring measures is crucial for the elimination of schistosomiasis, especially in endemic areas and with a particular focus on the elderly.

Genomic data reveal a north-south split and introgression history of blood fluke (Schistosoma haematobium) populations from across Africa

The human parasitic fluke, Schistosoma haematobium hybridizes with the livestock parasite S. bovis in the laboratory, but the extent of hybridization in nature is unclear. We analyzed 34.6 million single nucleotide variants in 162 samples from 18 African countries, revealing a sharp genetic discontinuity between northern and southern S. haematobium. We found no evidence for recent hybridization. Instead the data reveal admixture events that occurred 257-879 generations ago in northern S. haematobium populations. Fifteen introgressed S. bovis genes are approaching fixation in northern S. haematobium with four genes potentially driving adaptation. We identified 19 regions that were resistant to introgression; these were enriched on the sex chromosomes. These results (i) demonstrate strong barriers to gene flow between these species, (ii) indicate that hybridization may be less common than currently envisaged, but (iii) reveal profound genomic consequences of interspecific hybridization between schistosomes of medical and veterinary importance.

Aligning antimicrobial resistance surveillance with schistosomiasis research: an interlinked One Health approach

One Health surveillance involves the analysis of human, animal and environmental samples, recognising their interconnectedness in health systems. Such considerations are crucial to investigate the transmission of many pathogens, including drug-resistant bacteria and parasites. The highest rates of antimicrobial resistance (AMR)-associated deaths are observed in sub-Saharan Africa, where concurrently the waterborne parasitic disease schistosomiasis can be highly endemic in both humans and animals. Although there is growing acknowledgment of significant interactions between bacteria and parasites, knowledge of relationships between schistosomes, microbes and AMR remains inadequate. In addition, newly emergent research has revealed the previously underappreciated roles of animals and the environment in both AMR and schistosomiasis transmission. We consider shared environmental drivers and colonisation linkage in this narrative review, with a focus on extended-spectrum beta-lactamase-mediated resistance among bacteria from the Enterobacteriaceae family, which is exceedingly prevalent and responsible for a high burden of AMR-associated deaths. Then we examine novel findings from Malawi, where the landscapes of AMR and schistosomiasis are rapidly evolving, and make comparisons to other geographic areas with similar co-infection epidemiology. We identify several knowledge gaps that could be addressed in future research, including the need to characterise the impact of intestinal schistosomiasis and freshwater contact on intestinal AMR colonisation, before proposing a rationale for connecting AMR surveillance and schistosomiasis research within a One Health framework.

Climate change could fuel urinary schistosomiasis transmission in Africa and Europe

The freshwater snail Bulinus truncatus is an important intermediate host for trematode parasites causing urogenital schistosomiasis, a tropical disease affecting over 150 million people. Despite its medical importance, uncertainty remains about its global distribution and the potential impacts of climate change on its future spread. Here, we investigate the distribution of B. truncatus, combining the outputs of correlative and mechanistic modelling methods to fully capitalize on both experimental and occurrence data of the species and to create a more reliable distribution forecast than ever constructed. We constructed ensemble correlative species distribution models using 273 occurrence points collected from different sources and a combination of climatic and (bio)physical environmental variables. Additionally, a mechanistic thermal suitability model was constructed, parameterized by recent life-history data obtained through extensive lab-based snail-temperature experiments and supplemented with an extensive literature review. Our findings reveal that the current suitable habitat for B. truncatus encompasses the Sahel region, the Middle East, and the Mediterranean segment of Africa, stretching from Southern Europe to Mozambique. Regions identified as suitable by both methods generally coincide with areas exhibiting high urogenital schistosomiasis prevalence. Model projections into the future suggest an overall net increase in suitable area of up to 17%. New suitable habitat is in Southern Europe, the Middle East, and large parts of Central Africa, while suitable habitat will be lost in the Sahel region. The change in snail habitat suitability may substantially increase the risk of urogenital schistosomiasis transmission in parts of Africa and Southern Europe while reducing it in the Sahel region.

Metalloenzyme Inhibitors against Zoonotic Infections: Focus on Leishmania and Schistosoma

The term "zoonosis" denotes diseases transmissible among vertebrate animals and humans. These diseases constitute a significant public health challenge, comprising 61% of human pathogens and causing an estimated 2.7 million deaths annually. Zoonoses not only affect human health but also impact animal welfare and economic stability, particularly in low- and middle-income nations. Leishmaniasis and schistosomiasis are two important neglected tropical diseases with a high prevalence in tropical and subtropical areas, imposing significant burdens on affected regions. Schistosomiasis, particularly rampant in sub-Saharan Africa, lacks alternative treatments to praziquantel, prompting concerns regarding parasite resistance. Similarly, leishmaniasis poses challenges with unsatisfactory treatments, urging the development of novel therapeutic strategies. Effective prevention demands a One Health approach, integrating diverse disciplines to enhance diagnostics and develop safer drugs. Metalloenzymes, involved in parasite biology and critical in different biological pathways, emerged in the last few years as useful drug targets for the treatment of human diseases. Herein we have reviewed recent reports on the discovery of inhibitors of metalloenzymes associated with zoonotic diseases like histone deacetylases (HDACs), carbonic anhydrase (CA), arginase, and heme-dependent enzymes.

In vitro Evaluation of the Antileishmanial and Antischistosomal Activities of p-Coumaric Acid Prenylated Derivatives

We have evaluated eight p-coumaric acid prenylated derivatives in vitro for their antileishmanial activity against Leishmania amazonensis promastigotes and their antischistosomal activity against Schistosoma mansoni adult worms. Compound 7 ((E)-3,4-diprenyl-4-isoprenyloxycinnamic alcohol) was the most active against L. amazonensis (IC50=45.92 μM) and S. mansoni (IC50=64.25 μM). Data indicated that the number of prenyl groups, the presence of hydroxyl at C9, and a single bond between C7 and C8 are important structural features for the antileishmanial activity of p-coumaric acid prenylated derivatives.

Exploring the Role of Community Involvement in Reducing the Burden of Schistosomiasis and Other Neglected Tropical Diseases in Malawi: Where are We in the Fight Against Neglected Tropical Diseases?

Schistosomiasis has been endemic in Malawi since 1947. Despite the longevity of endemicity of the disease, it still maintains a high burden in Malawi. This could be attributed to insufficient coverage of preventive and therapeutic mass drug administration (MDA) which mainly targets school-aged children, leaving out adults who also bear a high burden of the disease. Additionally, despite well documented impact of community involvement in boosting up the effectiveness of health programmes, there is minimal community involvement in schistosomiasis control and prevention programmes. Therefore, this perspective seeks to discuss the historical background of schistosomiasis in Malawi, gaps in community engagement and participation and suggest ways of enhancing the role of the community in prevention and control programmes. Amongst other challenges, the control programmes are centralised, leading to minimal input at the district and community level as well as low awareness of schistosomiasis control and prevention methods at the community level. It is of utmost significance therefore to provide comprehensive schistosomiasis health education to the communities and devise a thorough outline of the specific roles and responsibilities of all stakeholders including community members in the fight against schistosomiasis and other neglected tropical diseases.

A machine learning approach for modeling the occurrence of the major intermediate hosts for schistosomiasis in East Africa

Schistosomiasis, a prevalent water-borne disease second only to malaria, significantly impacts impoverished rural communities, primarily in Sub-Saharan Africa where over 90% of the severely affected population resides. The disease, majorly caused by Schistosoma mansoni and S. haematobium parasites, relies on freshwater snails, specifically Biomphalaria and Bulinus species, as crucial intermediate host (IH) snails. Targeted snail control is advisable, however, there is still limited knowledge about the community structure of the two genera especially in East Africa. Utilizing a machine learning approach, we employed random forest to identify key features influencing the distribution of both IH snails in this region. Our results reveal geography and climate as primary factors for Biomphalaria, while Bulinus occurrence is additionally influenced by soil clay content and nitrogen concentration. Favorable climate conditions indicate a high prevalence of IHs in East Africa, while the intricate connection with geography might signify either dispersal limitations or environmental filtering. Predicted probabilities demonstrate non-linear patterns, with Bulinus being more likely to occur than Biomphalaria in the region. This study provides foundational framework insights for targeted schistosomiasis prevention and control strategies in the region, assisting health workers and policymakers in their efforts.

Molecular and functional characterization of Schistosoma japonicum annexin A13

Schistosomiasis is a neglected tropical disease that affects humans and animals in tropical and subtropical regions worldwide. Schistosome eggs are responsible for the pathogenesis and transmission of schistosomiasis, thus reducing egg production is vital for prevention and control of schistosomiasis. However, the mechanisms underlying schistosome reproduction remain unclear. Annexin proteins (ANXs) are involved in the physiological and pathological functions of schistosomes, but the specific regulatory mechanisms and roles of ANX A13 in the development of Schistosoma japonicum and host-parasite interactions remain poorly understood. Therefore, in this study, the expression profiles of SjANX A13 at different life cycle stages of S. japonicum were assessed using quantitative PCR. In addition, the expression profiles of the homolog in S. mansoni were analyzed in reference to public datasets. The results of RNA interference showed that knockdown of SjANX A13 significantly affected the development and egg production of female worms in vivo. The results of an immune protection assay showed that recombinant SjANX A13 increased production of immunoglobulin G-specific antibodies. Finally, co-culture of S. japonicum exosomes with LX-2 cells using a transwell system demonstrated that SjANX A13 is involved in host-parasite interactions via exosomes. Collectively, these results will help to clarify the roles of SjANX A13 in the development of S. japonicum and host-parasite interactions as a potential vaccine candidate.

Introduction to the special issue: challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs

Twenty neglected tropical diseases (NTDs) are currently prioritised by the World Health Organization for eradication, elimination as a public health problem, elimination of transmission or control by 2030. This issue celebrates progress made since the 2012 London Declaration on NTDs and discusses challenges currently faced to achieve these goals. It comprises 14 contributions spanning NTDs tackled by intensified disease management to those addressed by preventive chemotherapy. Although COVID-19 negatively affected NTD programmes, it also served to spur new multisectoral approaches to strengthen school-based health systems. The issue highlights the needs to improve impact survey design, evaluate new diagnostics, understand the consequences of heterogeneous prevalence and human movement, the potential impact of alternative treatment strategies and the importance of zoonotic transmission. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.