In vitro susceptibilities of the microsporidia Encephalitozoon cuniculi, Encephalitozoon hellem, and Encephalitozoon intestinalis to albendazole and its sulfoxide and sulfone metabolites

Silver nanoparticles are effective in controlling microsporidia

Many approaches and technologies have been developed as treatments for microsporidian, infections but effective, broad-spectrum, and sustainable therapeutic approaches have not been found. Silver nanoparticles (AgNPs) have antimicrobial activity and are widely used against many different pathogens. AgNPs provide an opportunity to develop formulations that will control microsporidia. In this study, we synthesized AgNPs via a chemical reduction method and evaluated their formation, morphology, and stability using transmission electron microscopy (TEM) and ultraviolet spectroscopy analysis. We verified that AgNPs could disrupt the spore cell membrane and spore germination of microsporidia Nosema bombycis. This resulted in the release of microsporidia nucleic acids, proteins, and respiratory chain enzymes. The anti-microsporidia activity of AgNPs was studied by measuring the silkworm larvae survival rate and spore genome replication after microsporidia infection. AgNPs have anti-microsporidian activity and could be effective components of formulations for treating or preventing microsporidia infection.

Evidence-Based Advances in Rabbit Medicine

Rabbit medicine has been continuously evolving over time with increasing popularity and demand. Tremendous advances have been made in rabbit medicine over the past 5 years, including the use of imaging tools for otitis and dental disease management, the development of laboratory testing for encephalitozoonosis, or determination of prognosis in rabbits. Recent pharmacokinetic studies have been published, providing additional information on commonly used antibiotics and motility-enhancer drugs, as well as benzimidazole toxicosis. This article presents a review of evidence-based advances for liver lobe torsions, thymoma, and dental disease in rabbits and controversial and new future promising areas in rabbit medicine.

Analysis of the beta-tubulin gene and morphological changes of the microsporidium Anncaliia algerae both suggest albendazole sensitivity

The Microsporidium, Anncaliia algerae, an obligate intracellular parasite, has been identified as an opportunistic human pathogen, but treatment has not been evaluated for infections with this organism. Albendazole, an antitubulin polymerization drug used against parasitic worm infections, has been the medication of choice used to treat some microsporidial infections affecting humans, with varying results ranging from clearing infection (Encephalitozoon) to resistance (Enterocytozoon). This study illustrates the effect of albendazole treatment on A. algerae infection in Rabbit Kidney (RK13) cells and Human Fetal Lung (HFL-1) fibroblasts. Albendazole appears to have an attenuating effect on A. algerae infection and albendazole's IC50 in RK13 cells is 0.1 μg/ml. Long-term treatment inhibits up to 98% of spore production, but interrupting treatment reestablishes the infection without new exposure to the parasite as supported by microscopic observations. The parasite's beta-tubulin gene was purified, cloned, and sequenced. Five of the six specific amino acids, associated with benzimidazole sensitivity, are conserved in A. algerae. These findings suggest that A. algerae is sensitive to albendazole; however, the organism is not completely cleared from cultures.

A cell-based screen reveals that the albendazole metabolite, albendazole sulfone, targets Wolbachia

Wolbachia endosymbionts carried by filarial nematodes give rise to the neglected diseases African river blindness and lymphatic filariasis afflicting millions worldwide. Here we identify new Wolbachia-disrupting compounds by conducting high-throughput cell-based chemical screens using a Wolbachia-infected, fluorescently labeled Drosophila cell line. This screen yielded several Wolbachia-disrupting compounds including three that resembled Albendazole, a widely used anthelmintic drug that targets nematode microtubules. Follow-up studies demonstrate that a common Albendazole metabolite, Albendazole sulfone, reduces intracellular Wolbachia titer both in Drosophila melanogaster and Brugia malayi, the nematode responsible for lymphatic filariasis. Significantly, Albendazole sulfone does not disrupt Drosophila microtubule organization, suggesting that this compound reduces titer through direct targeting of Wolbachia. Accordingly, both DNA staining and FtsZ immunofluorescence demonstrates that Albendazole sulfone treatment induces Wolbachia elongation, a phenotype indicative of binary fission defects. This suggests that the efficacy of Albendazole in treating filarial nematode-based diseases is attributable to dual targeting of nematode microtubules and their Wolbachia endosymbionts.

Effect of four antimicrobials against an Encephalitozoon sp. (Microsporidia) in a grasshopper host

Encephalitozoon spp. are the primary microsporidial pathogens of humans and domesticated animals. In this experiment, we test the efficacy of 4 commercial antimicrobials against an Encephalitozoon sp. infecting a grasshopper (Romalea microptera) host. Oral treatment with fumagillin or thiabendazole significantly reduced pathogen spore counts (93% and 88% respectively), whereas spore counts of grasshoppers fed quinine produced a non-significant 53% reduction in spores, and those fed streptomycin a non-significant 29% increase in spores, compared to the control. We observed a moderate dose-response effect for thiabendazole, whereby spore count decreased as drug consumption increased. No thiabendazole-treated animals died, whereas 27% of streptomycin-treated animals died, suggesting that thiabendazole was not toxic at the doses administered. The deaths among streptomycin-treated animals may have been caused by drug toxicity, parasite burden, or both. Although fumagillin and thiabendazole significantly reduced spore counts, in no individual was the pathogen totally eliminated. Our data confirm that microsporidia are difficult to control and that fumagillin and thiabendazole are partially effective antimicrobials against this group. Our study suggests that quinine and related alkaloids should be further examined for antimicrosporidial activity, and streptomycin should be examined as a possible enhancer of microsporidiosis.

Analysis of the beta-tubulin genes from Enterocytozoon bieneusi isolates from a human and rhesus macaque

Enterocytozoon bieneusi is the most common and clinically significant microsporidium associated with chronic diarrhea and wasting in immunocompromised humans. Albendazole, which is effective against several helminths, protozoa, and microsporidia, is relatively ineffective against infections due to E. bieneusi. A likely explanation for the observed clinical resistance to albendazole was discovered from sequence analysis of the E. bieneusibeta-tubulin from isolates from an infected human and a naturally infected rhesus macaque. The beta-tubulin of E. bieneusi has a substitution at Glu(198), which is one of six amino acids reported to be associated with benzimidazole sensitivity.

Characterisation of benzimidazole binding with recombinant tubulin from Giardia duodenalis, Encephalitozoon intestinalis, and Cryptosporidium parvum

The binding kinetics of several benzimidazole compounds were determined with recombinant tubulin from benzimidazole-sensitive and -insensitive organisms. This study utilised the naturally occurring high efficacy of the benzimidazoles for the parasitic protozoa Giardia duodenalis and Encephalitozoon intestinalis, and low efficacy with Cryptosporidium parvum. Direct kinetic analysis of the benzimidazole-beta-tubulin interaction was performed using a fluorescence-based quenching method to determine the apparent association (k(on)) and dissociation (k(off)) rate constants from which the affinity constant (K(a)) was calculated. The binding kinetics were determined with recombinant alpha- and beta-tubulin from the parasitic protozoa with several benzimidazole R(2)-carbamate analogues. The affinity constant for the binding of several benzimidazoles with beta-tubulin from benzimidazole-sensitive protozoa was found to be significantly greater than binding to beta-tubulin from benzimidazole-insensitive protozoa. Additionally, the high affinity of several benzimidazole derivatives (albendazole, fenbendazole, mebendazole) for monomeric beta-tubulin and heterodimeric alphabeta-tubulin from benzimidazole-sensitive protozoa was also clearly demonstrated. The affinity constants determined with beta-tubulin from G. duodenalis and E. intestinalis also supported the observed in vitro efficacy of these compounds. The binding characteristics of the benzimidazoles with the highest in vitro efficacy (albendazole, fenbendazole, mebendazole) was reflected in their high association and slow dissociation rates with the beta-tubulin monomer or dimer from benzimidazole-sensitive protozoa compared with insensitive ones. Benzimidazole-bound alphabeta-tubulin heterodimers also had a significantly lower rate of microtubule assembly compared with benzimidazole-free alphabeta-heterodimers. The incorporation of benzimidazole-bound alphabeta-heterodimers into assembling microtubules was shown to arrest polymerisation in vitro although the addition of benzimidazole compounds to assembled microtubules did not result in depolymerisation. These findings indicate that a benzimidazole-beta-tubulin cap may be formed at the growing end of the microtubule and this cap prevents elongation of the microtubule.

Quantitation of microsporidia in cultured cells by flow cytometry

BACKGROUND

Microsporidia are obligate intracellular protozoan parasites that emerged as major opportunistic pathogens in humans since the onset of the AIDS pandemic. In the present study, we investigated whether FCM is a useful method for the quantitation of intracellular microsporidian spores in cultured cells.

METHODS

Microsporidia (Encephalitozoon cuniculi) were grown in cell cultures and various cell-lines were coincubated with microsporidian spores at different multiplicities of infection, as well as for different periods of time. After permeabilization of the cells, intracellular spores were stained with a polyclonal anti-E. cuniculi serum and a FITC-labeled secondary antibody. Stained cells were analyzed on a flow cytometer and results were compared with those of fluorescence microscopy.

RESULTS

Noninfected cells showed a lower fluorescence, while the relative fluorescence observed for infected cells was significantly higher. The cell population with the more intense fluorescence, representing cells with internalized microsporidian spores, increased with the multiplicity of infection as well as over time. Results of FCM and fluorescence microscopy were in excellent agreement for all experiments.

CONCLUSIONS

We have developed a flow cytometric assay to detect and quantify cells with intracellular microsporidian spores. This method is easy to use, highly reproducible, and should be useful for future research.

Albendazole therapy for Microsporidium diarrhea in immunocompetent Costa Rican children

BACKGROUND

Microsporidia comprise a large group of obligate intracellular parasites. Although several species have emerged as opportunistic agents in immunocompromised patients, cases have also been reported in immunocompetent patients.

METHODS

During 21 months, we conducted a randomized, open label study in 200 children hospitalized with Microsporidium subacute diarrhea. Patients had prolonged, nonbloody, nonmucoid diarrhea, with > or =10 bowel movements/day for >10 days. Patients had negative rotavirus tests, bacterial stool cultures and sugar reductive tests in feces. Stool examinations to rule out Giardia intestinalis and intestinal nematodes were performed. Microsporidium was identified by light microscopy in stool specimens stained with Giemsa and Weber techniques. One hundred patients received oral albendazole (15 mg/kg/day twice a day for 7 days) and 100 patients received only supportive therapy.

RESULTS

Both groups were comparable regarding gender, age, clinical evolution and weight. Median (range) age was 24 (6-36) months. All children had abdominal pain, nausea, vomiting and anorexia. The primary endpoint, defined as clinical improvement within 48 h of initial therapy, occurred in 95 and 30% of the albendazole-treated and untreated patients, respectively (P < 0.05). There was a significant decrease in stool frequency, reduction of clinical findings and decrease in Microsporidium parasites in stool specimens of children treated with albendazole compared with the untreated group. Median (range) duration of diarrhea was 5 (3-7) days in albendazole-treated patients versus 10 (8-15) days in untreated patients (P < 0.05).

CONCLUSION

Albendazole therapy was effective in improving the clinical manifestations and decreasing the duration of the illness of children with diarrhea caused by Microsporidium.

Phacoemulsification for the management of Encephalitozoon cuniculi-induced phacoclastic uveitis in a rabbit

Phacoemulsification was performed on a New Zealand White rabbit with slowly progressive unilateral phacoclastic uveitis and cataract formation. The irrigating solution with lenticular contents were centrifuged and examined cytologically using Weber's chromotrope-based stain. Microsporidial spores were observed and positively identified as Encephalitozoon cuniculi via polymerase chain reaction. More than 1 year following surgical therapy, the rabbit is visual and comfortable without medications.

Antigenic diversity of Encephalitozoon hellem demonstrated by subspecies-specific monoclonal antibodies

Encephalitozoon hellem is a unicellular, obligate intracellular microsporidian species detected and isolated in HIV-infected patients presenting with keratoconjunctivitis, sinusitis, tracheobronchitis, nephritis, cystitis, and disseminated infection. A total of 24 monoclonal antibodies were produced against E. hellem and characterized. The monoclonal antibodies were of the immunoglobulin (Ig) G and Ig M subclasses, and, when incorporated into indirect immunofluorescence and immunoblotting assays, reacted against 13 isolates of E. hellem originating from three geographic regions. These monoclonal antibodies did not react with one strain each of either Encephalitozoon intestinalis or Encephalitozoon cuniculi, demonstrating their specificity. Two monoclonal antibodies reacted with all karyotype B-E. hellem isolates but did not react with karyotype A-isolates from North America and the Netherlands, thus demonstrating antigenic diversity among E. hellem isolates. These results add to the increasing evidence for diversity among E. hellem, which therefore may be reclassified into subspecies.

Placental transfer of albendazole sulphoxide enantiomers in sheep

Albendazole sulphoxide (ABZSO) is an anthelmintic drug used in veterinary practice. Its molecule has a chiral centre in the sulphur atom and racemic formulations are always used. The kinetics of the ABZSO enantiomers in the last third of pregnancy in ewes, and the placental transfer to the fetus, were studied after a single-dose oral administration (7.5 mg/kg) of a racemic formulation. In mothers, the area under the plasma concentration-time curve (AUC) and C(max) values of (+)-ABZSO (42.4+/-10.5 microg/mL and 1.9+/-0.4 microg/mL, respectively) were higher than those of (-)-ABZSO (15.3+/-5.1 microg/mL and 1.0+/-0.3 microg/mL). The MRT values were 17.0+/-1.6 h for (+)-ABZSO and 13.1+/-1.8 h for (-)-ABZSO. Similar kinetic parameters were obtained in the fetus for both enantiomers, but the fetal concentrations were lower compared with values for the dam. The AUC ratio between (-)-ABZSO/(+)-ABZSO in the dam was 0.36 and in the fetuses 0.64, indicating a higher impairment for the (+)-enantiomer in its placental transfer to the fetus.

Mammalian microsporidiosis

The phylum Microspora contains a diverse group of single-celled, obligate intracellular protozoa sharing a unique organelle, the polar filament, and parasitizing a wide variety of invertebrate and vertebrate animals, including insects, fish, birds, and mammals. Encephalitozoon cuniculi is the classic microsporidial parasite of mammals, and encephalitozoonosis in rabbits and rodents has been and continues to be recognized as a confounding variable in animal-based biomedical research. Although contemporary research colonies are screened for infection with this parasite, E. cuniculi remains a cause of morbidity and mortality in pet and conventionally raised rabbits. In addition, E. cuniculi is a potential pathogen of immature domestic dogs and farm-raised foxes. The recent discovery and identification of Encephalitozoon intestinalis, Encephalitozoon hellem, and Enterocytozoon bieneusi, in addition to E. cuniculi, as opportunistic pathogens of humans have renewed interest in the Microspora. Veterinary pathologists, trained in the comparative anatomy of multiple animal species and infectious disease processes, are in a unique position to contribute to the diagnosis and knowledge of the pathogenesis of these parasitic diseases. This review article covers the life cycle, ultrastructure, and biology of mammalian microsporaidia and the clinical disease and lesions seen in laboratory and domestic animals, particularly as they relate to Encephalitozoon species. Human microsporidial disease and animal models of human infection are also addressed. Often thought of as rabbit pathogens of historical importance, E. cuniculi and the related mammalian microsporidia are emerging as significant opportunistic pathogens of immunocompromised individuals.

A preliminary investigation of alternatives to fumagillin for the treatment of Loma salmonae infection in rainbow trout

The effects of the following six treatments against Loma salmonae, a microsporidian gill pathogen, were examined in rainbow trout: fumagillin (high dose), pyrimethamine + sulphaquinoxaline, albendazole, amprolium, fumagillin (low dose), and metronidazole. The fish were infected by mouth and the treatments were administered at intervals for a period of several weeks. The results were assessed on the basis of (1) delay in the formation of xenomas, and (2) the number of xenomas per gill arch. The first five treatments, in descending order of efficacy, delayed the formation of xenomas (P<0.01), but metronidazole had no such effect. Fumagillin (high or low dose) and albendazole both reduced the number of xenomas present 10 weeks after infection (P<0.01), but the other three treatments did not do so. From these results, both fumagillin and albendazole appeared to be of potential value in controlling L. salmonae infection in trout.

Lack of in vitro antimicrosporidian activity of thalidomide

Thalidomide was evaluated for its in vitro activity against Encephalitozoon species by using the MRC-5 cell system. A cytotoxic effect was observed for concentrations of 10(1) microg/ml (P < 10(5)) and 5 microg/ml (P < 10(5)). Thalidomide did not significantly inhibit the growth of any of the microsporidia under study. These data suggest that thalidomide is not an etiologic treatment in microsporidial enteritis.