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Khurana S, Singh S, Mewara A. Diagnostic Techniques for Soil-Transmitted Helminths - Recent Advances. Res Rep Trop Med 2021; 12:181-196. [PMID: 34377048 PMCID: PMC8349539 DOI: 10.2147/rrtm.s278140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/01/2021] [Indexed: 12/26/2022] Open
Abstract
Soil-transmitted helminth (STH) infections (hookworms, Trichuris, Ascaris) and Strongyloides spp. are associated with a substantial global burden and high morbidity. Sensitive and specific methods for diagnosis of these infections are essential for mapping the burden in communities, accurate assessment of infection levels, to guide interventions and monitoring the success of STH control programs. Despite considerable progress to control STH over several decades, we are still far from identifying a fully adequate diagnostic test. Conventional microscopy-based methods such as direct Kato–Katz smear or mounts after stool centrifugation/flotation-based concentration techniques have been the mainstay of diagnosis, especially in resource-poor countries where these infections abound. However, recently, these are being adapted to closed, easy to perform, digital formats, thereby improving the sensitivity as well as applicability in a remote, resource-limited setting. The use of image analysis systems to identify and quantify helminth eggs, with potential adaptation to smartphones, is also promising. Antibody detection tests have a limited role mostly in the case of Strongyloides hyperinfection. Coproantigen detection tests have been developed and used in veterinary practice for detection of STH, but these have not been evaluated for use in humans. More sensitive molecular diagnostics, including assays developed with new bioinformatic tools and techniques such as polymerase chain reaction (PCR), quantitative PCR (qPCR) and loop-mediated amplification assay, can help in the clear and precise assessment of STH burden during elimination phase and are of immense value for diagnosis in areas with low endemicity and in travelers to endemic regions. Moreover, the molecular techniques will help detect new species that may emerge. Sample preservation and efficient DNA extraction are critical and significantly affect the efficiency of molecular diagnostic tests. In addition to the diagnosis of clinical or asymptomatic infection in humans, detection of STH eggs in environmental samples is imperative to boost STH control efforts. Overall the diagnostic performance, cost-effectiveness, ease of performance, rapidity and in-field applicability of any test should be considered when choosing from the various diagnostic assays in areas with different endemicity, in addition to striving towards the development of novel technologies and optimization of existing methods.
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Affiliation(s)
- Sumeeta Khurana
- Department of Medical Parasitology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shreya Singh
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhishek Mewara
- Department of Medical Parasitology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Lagatie O, Verheyen A, Van Asten S, Odiere MR, Djuardi Y, Levecke B, Vlaminck J, Mekonnen Z, Dana D, T'Kindt R, Sandra K, van Outersterp R, Oomens J, Lin R, Dillen L, Vreeken R, Cuyckens F, Stuyver LJ. 2-Methyl-pentanoyl-carnitine (2-MPC): a urine biomarker for patent Ascaris lumbricoides infection. Sci Rep 2020; 10:15780. [PMID: 32978457 PMCID: PMC7519643 DOI: 10.1038/s41598-020-72804-y] [Citation(s) in RCA: 11] [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: 04/06/2020] [Accepted: 09/04/2020] [Indexed: 01/12/2023] Open
Abstract
Infections with intestinal worms, such as Ascaris lumbricoides, affect hundreds of millions of people in all tropical and subtropical regions of the world. Through large-scale deworming programs, World Health Organization aims to reduce moderate-to-heavy intensity infections below 1%. Current diagnosis and monitoring of these control programs are solely based on the detection of worm eggs in stool. Here we describe how metabolome analysis was used to identify the A. lumbricoides-specific urine biomarker 2-methyl pentanoyl carnitine (2-MPC). This biomarker was found to be 85.7% accurate in determining infection and 90.5% accurate in determining a moderate-to-heavy infection. Our results also demonstrate that there is a correlation between 2-MPC levels in urine and A. lumbricoides DNA detected in stool. Furthermore, the levels of 2-MPC in urine were shown to rapidly and strongly decrease upon administration of a standard treatment (single oral dose of 400 mg albendazole). In an Ascaris suum infection model in pigs, it was found that, although 2-MPC levels were much lower compared to humans, there was a significant association between urinary 2-MPC levels and both worm counts (p = 0.023) and the number of eggs per gram (epg) counts (p < 0.001). This report demonstrates that urinary 2-MPC can be considered an A. lumbricoides-specific biomarker that can be used to monitor infection intensity.
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Affiliation(s)
- Ole Lagatie
- Janssen Global Public Health, Janssen R&D, Turnhoutseweg 30, 2340, Beerse, Belgium.
| | - Ann Verheyen
- Janssen Global Public Health, Janssen R&D, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - Stijn Van Asten
- Discovery Sciences, Janssen R&D, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - Maurice R Odiere
- Centre for Global Health Research, Kenya Medical Research Institute, P. O. Box 1578, Kisumu, 40100, Kenya
| | - Yenny Djuardi
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Daniel Dana
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Ruben T'Kindt
- Research Institute for Chromatography, President Kennedypark 26, 8500, Kortrijk, Belgium
| | - Koen Sandra
- Research Institute for Chromatography, President Kennedypark 26, 8500, Kortrijk, Belgium
| | - Rianne van Outersterp
- FELIX Laboratory, Faculty of Science, Radboud University, Toernooiveld 7, 6525 ED, Nijmegen, The Netherlands
| | - Jos Oomens
- FELIX Laboratory, Faculty of Science, Radboud University, Toernooiveld 7, 6525 ED, Nijmegen, The Netherlands
| | - Ronghui Lin
- Janssen R&D, Welsh & McKean Road, Spring House, PA, 19477-0776, USA
| | - Lieve Dillen
- Discovery Sciences, Janssen R&D, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - Rob Vreeken
- Discovery Sciences, Janssen R&D, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - Filip Cuyckens
- Discovery Sciences, Janssen R&D, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - Lieven J Stuyver
- Janssen Global Public Health, Janssen R&D, Turnhoutseweg 30, 2340, Beerse, Belgium
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An update on non-invasive urine diagnostics for human-infecting parasitic helminths: what more could be done and how? Parasitology 2019; 147:873-888. [PMID: 31831084 PMCID: PMC7284843 DOI: 10.1017/s0031182019001732] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Reliable diagnosis of human helminth infection(s) is essential for ongoing disease surveillance and disease elimination. Current WHO-recommended diagnostic assays are unreliable in low-endemic near-elimination settings and typically involve the invasive, onerous and potentially hazardous sampling of bodily fluids such as stool and blood, as well as tissue via biopsy. In contrast, diagnosis by use of non-invasive urine sampling is generally painless, more convenient and low risk. It negates the need for specialist staff, can usually be obtained immediately upon request and is better accepted by patients. In some instances, urine-based diagnostic assays have also been shown to provide a more reliable diagnosis of infection when compared to traditional methods that require alternative and more invasive bodily samples, particularly in low-endemicity settings. Given these relative benefits, we identify and review current research literature to evaluate whether non-invasive urine sampling is currently exploited to its full potential in the development of diagnostic tools for human helminthiases. Though further development, assessment and validation are needed before their routine use in control programmes, low-cost, rapid and reliable assays capable of detecting transrenal helminth-derived antigens and cell-free DNA show excellent promise for future use at the point-of-care in high-, medium- and even low-endemicity elimination settings.
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Wangchuk P, Kouremenos K, Eichenberger RM, Pearson M, Susianto A, Wishart DS, McConville MJ, Loukas A. Metabolomic profiling of the excretory-secretory products of hookworm and whipworm. Metabolomics 2019; 15:101. [PMID: 31254203 DOI: 10.1007/s11306-019-1561-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/20/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Soil-transmitted helminths infect billions of people, livestock and companion animals worldwide, and chronic infections with these nematodes represent a major health burden in many developing countries. On the other hand, complete elimination of parasitic helminths and other infectious pathogens has been implicated with rising rates of autoimmune and allergic disorders in developed countries. Given the enormous health impact of these parasites, it is surprising how little is known about the non-protein small metabolites of the excretory-secretory products (ESP), including their composition and pharmacological properties. OBJECTIVES We sought proof-of-concept that Nippostrongylus brasiliensis and Trichuris muris, rodent models of two of the most important human soil-transmitted helminths, secrete small metabolites and that some of these metabolites may have specific pharmacological functions. METHODS N. brasiliensis and T. muris ESP were collected from adult worms and filtered using a 10 kDa cut-off membrane to produce excretory-secretory metabolites (ESM). The ESM were analysed using targeted gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry for polar and non-polar small metabolites. RESULTS ESM from both N. brasiliensis and T. muris contained small molecules. A total of 54 small molecules (38 polar metabolites and 16 fatty acids) were identified, 36 known polar metabolites from N. brasiliensis and 35 from T. muris. A literature review of the identified compounds revealed that 17 of them have various demonstrated pharmacological activities. CONCLUSION N. brasiliensis and T. muris secrete polar and non-polar small molecules with as many as 17 metabolites known to exhibit various pharmacological activities.
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Affiliation(s)
- Phurpa Wangchuk
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Building E4, McGregor Rd, Smithfield, Cairns, QLD, 4878, Australia.
| | - Konstantinos Kouremenos
- Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, 30 Flemington Road, Parkville, VIC, 3010, Australia
| | - Ramon M Eichenberger
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Building E4, McGregor Rd, Smithfield, Cairns, QLD, 4878, Australia
- Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 266a, 8057, Zurich, Switzerland
| | - Mark Pearson
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Building E4, McGregor Rd, Smithfield, Cairns, QLD, 4878, Australia
| | - Atik Susianto
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Building E4, McGregor Rd, Smithfield, Cairns, QLD, 4878, Australia
| | - David S Wishart
- Department of Biological Science, University of Alberta, Edmonton, AB, Canada
| | - Malcolm J McConville
- Department of Biochemistry and Molecular Biology, University of Melbourne, 30 Flemington Road, Parkville, VIC, 3010, Australia
| | - Alex Loukas
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Building E4, McGregor Rd, Smithfield, Cairns, QLD, 4878, Australia.
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