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Takayanagui OM, Haes TMD. Update on the diagnosis and management of neurocysticercosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:296-306. [PMID: 35976305 PMCID: PMC9491409 DOI: 10.1590/0004-282x-anp-2022-s115] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 05/14/2023]
Abstract
ABSTRACT Background: Neurocysticercosis (NCC) is a serious public health problem in several developing countries, including those in Latin America, Asia, and Africa. NCC is considered to be the main cause of late-onset epilepsy in endemic areas. Objective: This review summarizes recent advances in diagnosis and therapy of NCC. Methods: Relevant articles and books were reviewed and used as a source of information for this review. Results: The diagnosis of NCC is based upon neuroimaging studies (MRI and computed tomography) and laboratory analysis of the cerebrospinal fluid (CSF). Praziquantel and albendazole are considered parasiticidal drugs against NCC, but there is an intense debate over the value and safety of these drugs. Conclusion: Given the relative scarcity of clinical trials, more comparative interventional studies, especially randomized controlled trials in long-term clinical evolution, are required in order to clarify the controversy over the validity of parasitic therapy in patients with NCC.
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Carpio A, Fleury A, Kelvin EA, Romo ML, Abraham R, Tellez-Zenteno J. New guidelines for the diagnosis and treatment of neurocysticercosis: a difficult proposal for patients in endemic countries. Expert Rev Neurother 2018; 18:743-747. [PMID: 30185077 DOI: 10.1080/14737175.2018.1518133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Recent guidelines for the diagnosis and treatment for neurocysticercosis (NC) from the Infectious Disease Society of America/American Society of Tropical Medicine and Hygiene were developed to be used in the United States and Canada, where only a small fraction of NC cases occur. Areas covered: The paper discusses the strengths and weakness of the proposed guidelines. Expert commentary: Although these new guidelines bring much needed attention to a neglected parasitic disease, some of the recommendations made are based on insufficient and/or inadequate evidence. The authors only recommend one specific immunological assay for use in the diagnosis of NC, when evidence clearly supports other options. The authors strongly recommend dual-anthelminthic for patients with multiple active parenchymal cysts on the basis of one clinical trial that was stopped early. The authors recommend surgical removal of cysts in the fourth ventricle and long-term treatment for subarachnoid NC despite their own admission that there is little evidence to support these recommendations. We propose that clinicians should approach some of the recommendations in the new guidelines with caution and call for the establishment of gold-standard guidelines that can be used and adapted for the diagnosis and treatment of patients with NC worldwide.
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Affiliation(s)
- Arturo Carpio
- a Facultad de Ciencias Médicas , Universidad de Cuenca, Ecuador , New York , USA.,b G.H. Sergievsky Center , Columbia University , New York , USA
| | - Agnés Fleury
- c Instituto de Investigaciones Biomédicas , Universidad Nacional Autónoma , México DF , México.,d Secretaría de Salud , Instituto Nacional de Neurología y Neurocirugía , México DF , México
| | - Elizabeth A Kelvin
- e Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health Policy, and the CUNY Institute for Implementation Science in Population Health , City University of New York , New York , USA
| | - Matthew L Romo
- e Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health Policy, and the CUNY Institute for Implementation Science in Population Health , City University of New York , New York , USA
| | - Ronaldo Abraham
- f Departamento de Medicina , Universidade de Taubaté , São Paulo , Brazil
| | - Jose Tellez-Zenteno
- g Division of Neurology Royal University Hospital , University of Saskatchewan , Saskatoon , Canada
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Carpio A, Fleury A, Romo ML, Abraham R. Neurocysticercosis: the good, the bad, and the missing. Expert Rev Neurother 2018. [DOI: 10.1080/14737175.2018.1451328] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Arturo Carpio
- Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca, Ecuador
- G.H. Sergievsky Center, Columbia University, New York, NY, USA
| | - Agnès Fleury
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma, Ciudad de México, México
- Secretaría de Salud, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - Matthew L. Romo
- Department of Epidemiology & Biostatistics and Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Ronaldo Abraham
- Departamento de Medicina, Universidade de Taubaté, São Paulo, Brazil
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Silva HM, Vinaud MC, Lino RDS. Experimental neurocysticercosis: absence of IL-4 induces lower encephalitis. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:96-102. [PMID: 28226078 DOI: 10.1590/0004-282x20160194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/31/2016] [Indexed: 11/22/2022]
Abstract
Methods BALB/c (WT) and BALB/c (IL-4-KO) mice were inoculated intracranially with Taenia crassiceps cysticerci and euthanized at 7, 30, 60 and 90 days later, the encephala removed and histopathologically analyzed. Results The absence of IL-4 induced greater parasitism. In the initial phase of the infection, IL-4-KO showed a lower intensity in the inflammatory infiltration of polimorphonuclear cells in the host-parasite interface and intra-parenquimatous edema. The IL-4-KO animals, in the late phase of the infection, showed lower intensity of ventriculomegaly, encephalitis, and meningitis, and greater survival of the parasites in comparison with the WT animals. Conclusion The absence of IL-4 induced lower inflammatory infiltration, ventriculomegaly and perivasculitis in experimental NCC.
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Affiliation(s)
- Hidelberto Matos Silva
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia GO, Brasil.,Centro Universitário UNIRG, Faculdade de Medicina, Gurupi TO, Brasil
| | - Marina Clare Vinaud
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia GO, Brasil
| | - Ruy de Souza Lino
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia GO, Brasil
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Machado-Porto GCL, Lucato LT, Porto FHDG, de Souza EC, Nitrini R. Reversible dementia due to neurocysticercosis: Improvement of the racemose type with antihistamines. Dement Neuropsychol 2015; 9:85-90. [PMID: 29213947 PMCID: PMC5618997 DOI: 10.1590/s1980-57642015dn91000014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Infection of the human central nervous system (CNS) by the larvae of
Taenia solium, termed neurocysticercosis (NCC), is endemic
in most developing countries, where it is a major cause of acquired seizures and
other neurological morbidity, including neuropsychiatric symptoms. However,
despite its frequent manifestation, some findings, such as cognitive impairment
and dementia, remain poorly understood. Less commonly, NCC may affect the
ventricular system and subarachnoid spaces and this form is known as
extraparenchymal neurocysticercosis. A particular presentation of the
subarachnoid form is called racemose cysticercosis, which has a progressive
pattern, frequently leads to hydrocephalus and can be life-threatening. Here we
review a case of the racemose variety of cysticercosis, complicated by
hydrocephalus and reversible dementia, with remission of symptoms after
derivation and that remained stable with use of dexchlorpheniramine. We discuss
the challenges in diagnosis, imaging findings, treatment and follow-up of this
disease.
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Affiliation(s)
- Gislaine Cristina Lopes Machado-Porto
- MD, PhD student, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil. Department of Radiology, A.C.Camargo Cancer Center, São Paulo SP, Brazil
| | - Leandro Tavares Lucato
- MD, PhD, Neuroradiologist, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil. Centro de Diagnóstico Brasil, São Paulo SP, Brazil
| | - Fábio Henrique de Gobbi Porto
- MD, PhD student, Behavioral and Cognitive Neurology Unit, Department of Neurology Cognitive Disorders Reference Center (CEREDIC), HC/FMUSP, São Paulo, Brazil
| | - Evandro Cesar de Souza
- MD, PhD, Medical Assistant, Head of Neurological Radiosurgery Group, HC/FMUSP, São Paulo SP, Brazil
| | - Ricardo Nitrini
- MD, PhD, Full Professor, Behavioral and Cognitive Neurology Unit, Department of Neurology Cognitive Disorders Reference Center (CEREDIC), HC/FMUSP, São Paulo SP, Brazil
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Sahu PS, Parija S, Kumar D, Jayachandran S, Narayan S. Comparative profile of circulating antigenic peptides in CSF, serum & urine from patients with neurocysticercosis diagnosed by immunoblotting. Parasite Immunol 2014; 36:509-21. [PMID: 24965663 DOI: 10.1111/pim.12124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 06/16/2014] [Indexed: 11/28/2022]
Abstract
Traditionally serum and/or CSF specimens have been used for detection of either specific antibodies or antigens as a supportive diagnosis of NCC. However, in recent days, much interest has been shown employing noninvasive specimens such as urine. In our study, we identified and compared a profile of circulating antigenic peptides of parasite origin in three different body fluids (CSF, serum and urine) obtained from confirmed NCC cases and control subjects. The circulating antigenic peptides were resolved by SDS-PAGE and subjected to immunoblotting. For confirmation of their origin as parasite somatic or excretory secretory (ES) material, immunoreactivity was tested employing affinity purified polyclonal Taenia solium metacestode anti-somatic or ES antibodies, respectively. Only lower molecular weight antigenic peptides were found circulating in urine in contrast to serum and CSF specimens. Few somatic peptides were identified to be 100% specific for NCC (19·5 kDa in all three specimens; 131, 70 kDa in CSF and serum only; 128 kDa in CSF only). Similarly, the specific ES peptides detected were 32 kDa (in all three specimens), 16·5 kDa (in serum and CSF only), and 15 kDa (urine only). A test format detecting either one or more of these specific peptides would enhance the sensitivity in diagnosis of NCC.
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Affiliation(s)
- P S Sahu
- Division of Pathology, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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Machado LDR, Livramento JA, Vianna LS. Cerebrospinal fluid analysis in infectious diseases of the nervous system: when to ask, what to ask, what to expect. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:693-8. [DOI: 10.1590/0004-282x20130153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cerebrospinal fluid (CSF) analysis very frequently makes the difference to the diagnosis, not only in relation to infections but also in other diseases of the nervous system such as inflammatory, demyelinating, neoplastic and degenerative diseases. The authors review some practical and important features of CSF analysis in infectious diseases of the nervous system, with regard to acute bacterial meningitis, herpetic meningoencephalitis, neurotuberculosis, neurocryptococcosis, neurocysticercosis and neurosyphilis.
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Gazarian K, Rowlay M, Gazarian T, Vazquez Buchelli JE, Hernández Gonzáles M. Mimotope peptides selected from phage display combinatorial library by serum antibodies of pigs experimentally infected with Taenia solium as leads to developing diagnostic antigens for human neurocysticercosis. Peptides 2012; 38:381-8. [PMID: 23022592 DOI: 10.1016/j.peptides.2012.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 09/19/2012] [Accepted: 09/19/2012] [Indexed: 01/19/2023]
Abstract
Neurocysticercosis is caused by penetration of the tapeworm Taenia solium larvae into the central nervous system resulting in a diverse range of neurologic complications including epilepsy in endemic areas that globalization spreads worldwide. Sensitive and specific immunodiagnosis is needed for the early detection and elimination of the parasite, but the lack of standardized, readily obtainable antigens is a challenge. Here, we used the phage display for resolving the problem. The rationale of the strategy rests on the concept that the screening of combinatorial libraries with polyclonal serum to pathogens reveals families of peptides mimicking the pathogen most immunodominant epitopes indispensable for the successful diagnosis. The screening of a 7mer library with serum IgG of four pigs experimentally infected with parasite followed by computer aided segregation of the selected sequences resulted in the discovery of four clusters of homologous sequences of which one presented a family of ten mimotopes selected by three infected pig serum IgGs; the common motif sequence LSPF carried by the family was considered to be the core of an immunodominant epitope of the parasite critical for the binding with the antibody that selected the mimotopes. The immunoassay testing permitted to select a mimotope whose synthetic peptide free of the phage with the amino acid sequence Leu-Ser-Fen-Pro-Ser-Val-Val that distinguished well a panel of 21 cerebrospinal fluids of neurocysticercosis patients from the fluids of individuals with neurological complications of other etiology. This peptide is proposed as a lead for developing a novel molecularly defined diagnostic antigen(s) for the neurocysticercosis.
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Affiliation(s)
- Karlen Gazarian
- Department of Medicinal Genomics and Environmental Toxicology, Institute of Biomedical Research of the Mexican National Autonomous University, Mexico City, University Campus, CP 04510, Mexico.
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Machado LDR. The diagnosis of neurocysticercosis: a closed question? ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:1-2. [PMID: 20339642 DOI: 10.1590/s0004-282x2010000100001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abraham R, Livramento JA, Leite CDC, Pardini AX, Vaz AJ, Machado LDR. Neurocysticercosis: relationship between Taenia antigen levels in CSF and MRI. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:7-11. [PMID: 20339644 DOI: 10.1590/s0004-282x2010000100003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Accepted: 10/18/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the relationship between Taenia antigen (TA) detection in cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) findings in patients with definite diagnosis of neurocysticercosis (NC). METHOD Sixty-three patients with definite diagnosis of NC were submitted to a MRI of the brain, and to a CSF examination, with a meticulous search for TA by ELISA. RESULTS TA detection was positive in 36 patients (57.1%). A total of 836 lesions were analyzed, greatly within the cerebral parenchyma (98.7 of the lesions). Intact or non-degenerating cysts were the most common evolutive phase observed (50.4% of all lesions), 22.1% were degenerating cysts and 19.5% calcified cysts. We observed a significant relationship between TA levels detected and the total number of lesions and the number of non-degenerating cysts, but not with calcified lesions. CONCLUSION According to our results, we propose at least four important types of contribution: (1) TA detection may allow etiologic diagnosis in transitional phases of NC, with non-characteristic images; (2) in final stages of evolution of cysticercoids in the CNS, lesions may not appear on CT or MRI, and TA detection may contribute to a definite etiologic diagnosis; (3) TA detection may permit diagnosis of NC in some patients with previous negative tests for antibody detection in CSF; (4) TA detection may represent an accurate marker of disease activity in the epileptic form of NC.
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Affiliation(s)
- Ronaldo Abraham
- Medicine Department, University of Taubaté, Taubaté, SP, Brazil.
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Sciutto E, Chavarria A, Fragoso G, Fleury A, Larralde C. The immune response in Taenia solium cysticercosis: protection and injury. Parasite Immunol 2008; 29:621-36. [PMID: 18042169 DOI: 10.1111/j.1365-3024.2007.00967.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This article reviews current knowledge on the innate and acquired immune responses in human Taenia solium neurocysticercosis, highlighting the conditions that appear to be favourable for the survival or destruction of the parasite and for the benefit or injury to its host.
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Affiliation(s)
- E Sciutto
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, UNAM, México DF, Mexico.
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Benedeti MR, Falavigna DLM, Falavigna-Guilherme AL, Araújo SMD. [Epidemiological and clinical profile of neurocysticercosis patients assisted by the Hospital Universitário Regional de Maringá, Paraná, Brazil]. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 65:124-9. [PMID: 17420841 DOI: 10.1590/s0004-282x2007000100025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Accepted: 10/21/2006] [Indexed: 11/22/2022]
Abstract
The aim of this study was to drawn an epidemiological and clinical profile of the neurocysticercosis (NCC) patients assisted by Hospital Universitário Regional de Maringá. A transversal, retrospective and descriptive study based on 6,100 records of the Neurology, Neuropediatry, Neurosurgery and Psychiatry clinics was done from January/1998 to December/2004. Of these, 48 were selected with diagnosis of NCC. The prevalence was greater in female (p<0.001), 31-60 years (43.7%), and urban zone (93.8%). The number of NCC cases overcame those notified to the Epidemic Surveillance in 1998, 1999, 2001, 2002 and 2004. The epilepsy due to NCC (CI=1.77;16.07; p=0.0024) was generalized and of late onset in 91.7% patients, being associated to headache in 37.5% ones. There was need of hospitalization in 22.9% of the patients (medium time of 3.91+/-3.35 days). It was concluded that the epidemiological and clinical profile observed is peculiar, displaying some common points with other Brazilian studies.
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Affiliation(s)
- Márcia Regina Benedeti
- Centro de Estudos Superiores de Maringá, Universidade Estadual de Maringá, 87020-900 Maringá, PR, Brazil
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Iudici Neto F, Pianetti-Filho G, Araújo RN, Nascimento E. Immunodiagnosis of human neurocysticercosis by using semi-purified scolex antigens from Taenia solium cysticerci. Rev Soc Bras Med Trop 2007; 40:163-9. [PMID: 17568882 DOI: 10.1590/s0037-86822007000200004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Accepted: 02/08/2007] [Indexed: 11/22/2022] Open
Abstract
Crude antigen and semi-purified proteins from scolices of Taenia solium cysticerci were evaluated for the immunodiagnosis of human neurocysticercosis neurocysticercosis. Semi-purified proteins obtained by electrophoresis on polyacrylamide gel and by electroelution were tested by means of the immunoenzymatic reaction against sera from normal individuals and from patients with neurocysticercosis or other parasitic diseases. The 100 kDa protein provided 100% sensitivity and specificity in the immunodiagnosis. When 95 or 26 kDa proteins were used, 95 and 100% sensitivity and specificity were obtained, respectively. The assays involving crude antigen and sera from normal individuals or from patients with neurocysticercosis, diluted to 1:256, gave excellent agreement with those in which 100, 95 or 26 kDa proteins were tested against the same serum samples diluted to 1:64. (Kappa: 0.95 to 1.00). Crude scolex antigen may be useful for serological screening, while 100, 95 or 26 kDa protein can be used in confirmatory tests on neurocysticercosis-positive cases.
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Affiliation(s)
- Francesco Iudici Neto
- Divisão de Epidemiologia e Controle de Doenças, Instituto Octávio Magalhães, Fundação Ezequiel Dias, Belo Horizonte, MG
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Dificultades diagnósticas y terapéuticas en la neurocisticercosis: Presentacion de 6 casos y revisión de la literatura. Neurocirugia (Astur) 2007. [DOI: 10.1016/s1130-1473(07)70294-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Baig S, Damian RT, Morales-Montor J, Olecki P, Talhouk J, Hashmey R, White AC. Characterization of excretory/secretory endopeptidase and metallo-aminopeptidases from Taenia crassiceps metacestodes. J Parasitol 2006; 91:983-7. [PMID: 16419737 DOI: 10.1645/ge-200r1.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Cysticercosis is caused by Taenia spp. metacestodes, which must survive in the host tissues to complete their life cycle. Their survival depends on their control of host immune responses. Because many parasites use proteases to modulate host responses, we examined culture media from Taenia crassiceps metacestodes for protease activity using peptide substrates. We identified prominent aminopeptidase activity at neutral pH, which was inhibited by chelating agents and partially inhibited by the aminopeptidase inhibitor, bestatin. Endopeptidase substrates were optimally cleaved at slightly acidic pH and endopeptidase activity was inhibited by cysteine protease inhibitors. Gel filtration FPLC and subsequent visualization by silver staining revealed a metallo-aminopeptidase of molecular weight 21 kDa and cysteine proteases of Mr 70 and 64 kDA. Recombinant IL-2 was digested when incubated with parasite culture supernatants, but not with control media. IL-2 degradation was completely inhibited by 1,10 phenanthroline and partially inhibited by bestatin, suggesting that a metallo-aminopeptidase was responsible. Incubation of human IgG with culture supernatants resulted in complete degradation of IgG, which was blocked by cysteine protease inhibitors. These observations demonstrate that Taenia spp. metacestodes secrete a number of proteolytic enzymes, which may target molecules from the host immune system and assist in evasion of the host immune response.
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Affiliation(s)
- Salman Baig
- Department of Cellular Biology, University of Georgia, Biological Sciences Building, Athens, USA
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