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Fang T, Mohseni A, Lonardi S, Ben Mamoun C. Properties and predicted functions of large genes and proteins of apicomplexan parasites. NAR Genom Bioinform 2024; 6:lqae032. [PMID: 38584870 PMCID: PMC10993292 DOI: 10.1093/nargab/lqae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/23/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024] Open
Abstract
Evolutionary constraints greatly favor compact genomes that efficiently encode proteins. However, several eukaryotic organisms, including apicomplexan parasites such as Toxoplasma gondii, Plasmodium falciparum and Babesia duncani, the causative agents of toxoplasmosis, malaria and babesiosis, respectively, encode very large proteins, exceeding 20 times their average protein size. Although these large proteins represent <1% of the total protein pool and are generally expressed at low levels, their persistence throughout evolution raises important questions about their functions and possible evolutionary pressures to maintain them. In this study, we examined the trends in gene and protein size, function and expression patterns within seven apicomplexan pathogens. Our analysis revealed that certain large proteins in apicomplexan parasites harbor domains potentially important for functions such as antigenic variation, erythrocyte invasion and immune evasion. However, these domains are not limited to or strictly conserved within large proteins. While some of these proteins are predicted to engage in conventional metabolic pathways within these parasites, others fulfill specialized functions for pathogen-host interactions, nutrient acquisition and overall survival.
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Affiliation(s)
- Tiffany Fang
- Department of Internal Medicine, Section of Infectious Diseases, Department of Microbial Pathogenesis and Department of Pathology, Yale School of Medicine, New Haven, CT, 06520 USA
| | - Amir Mohseni
- Department of Computer Science and Engineering, University of California, Riverside, CA, 92521 USA
| | - Stefano Lonardi
- Department of Computer Science and Engineering, University of California, Riverside, CA, 92521 USA
| | - Choukri Ben Mamoun
- Department of Internal Medicine, Section of Infectious Diseases, Department of Microbial Pathogenesis and Department of Pathology, Yale School of Medicine, New Haven, CT, 06520 USA
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Drews SJ, Kjemtrup AM, Krause PJ, Lambert G, Leiby DA, Lewin A, O'Brien SF, Renaud C, Tonnetti L, Bloch EM. Transfusion-transmitted Babesia spp.: a changing landscape of epidemiology, regulation, and risk mitigation. J Clin Microbiol 2023; 61:e0126822. [PMID: 37750699 PMCID: PMC10595070 DOI: 10.1128/jcm.01268-22] [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] [Indexed: 09/27/2023] Open
Abstract
Babesia spp. are tick-borne parasites with a global distribution and diversity of vertebrate hosts. Over the next several decades, climate change is expected to impact humans, vectors, and vertebrate hosts and change the epidemiology of Babesia. Although humans are dead-end hosts for tick-transmitted Babesia, human-to-human transmission of Babesia spp. from transfusion of red blood cells and whole blood-derived platelet concentrates has been reported. In most patients, transfusion-transmitted Babesia (TTB) results in a moderate-to-severe illness. Currently, in North America, most cases of TTB have been described in the United States. TTB cases outside North America are rare, but case numbers may change over time with increased recognition of babesiosis and as the epidemiology of Babesia is impacted by climate change. Therefore, TTB is a concern of microbiologists working in blood operator settings, as well as in clinical settings where transfusion occurs. Microbiologists play an important role in deploying blood donor screening assays in Babesia endemic regions, identifying changing risks for Babesia in non-endemic areas, investigating recipients of blood products for TTB, and drafting TTB policies and guidelines. In this review, we provide an overview of the clinical presentation and epidemiology of TTB. We identify approaches and technologies to reduce the risk of collecting blood products from Babesia-infected donors and describe how investigations of TTB are undertaken. We also describe how microbiologists in Babesia non-endemic regions can assess for changing risks of TTB and decide when to focus on laboratory-test-based approaches or pathogen reduction to reduce TTB risk.
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Affiliation(s)
- Steven J. Drews
- Microbiology, Donation Policy and Studies, Canadian Blood Services, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, Division of Diagnostic and Applied Microbiology, University of Alberta, Edmonton, Alberta, Canada
| | - Anne M. Kjemtrup
- California Department of Public Health, Vector-Borne Disease Section, Sacramento, California, USA
| | - Peter J. Krause
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, USA
| | - Grayson Lambert
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, USA
| | - David A. Leiby
- Department of Microbiology, Immunology, and Tropical Medicine, George Washington University, Washington, USA
| | - Antoine Lewin
- Epidemiology, Surveillance and Biological Risk Assessment, Medical Affairs and Innovation, Héma-Québec, Montréal, Quebec, Canada
- Département d'Obstétrique et de Gynécologie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sheila F. O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Donation Policy and Studies, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Christian Renaud
- Department of Microbiology, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Laura Tonnetti
- American Red Cross, Scientific Affairs, Holland Laboratories for the Biomedical Sciences, Rockville, Maryland, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Wang Y, Zhang S, Li X, Nian Y, Liu X, Liu J, Yin H, Guan G, Wang J. A high-resolution melting approach for the simultaneous differentiation of five human babesiosis-causing Babesia species. Parasit Vectors 2023; 16:299. [PMID: 37641091 PMCID: PMC10463647 DOI: 10.1186/s13071-023-05839-5] [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: 12/28/2022] [Accepted: 06/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Six species of apicomplexan parasites of the genus Babesia, namely B. microti, B. divergens, B. duncani, B. motasi, B. crassa-like and B. venatorum, are considered to be the primary causal agents of human babesiosis in endemic areas. These six species possess variable degrees of virulence for their primary hosts. Therefore, the accurate identification of these species is critical for the adoption of appropriate therapeutic strategies. METHODS We developed a real-time PCR-high-resolution melting (qPCR-HRM) approach targeting 18S ribosomal RNA gene of five Babesia spp. based on melting temperature (Tm) and genotype confidence percentage values. This approach was then evaluated using 429 blood samples collected from patients with a history of tick bites, 120 DNA samples mixed with plasmids and 80 laboratory-infected animal samples. RESULTS The sensitivity and specificity of the proposed qPCR-HRM method were 95% and 100%, respectively, and the detection limit was 1-100 copies of the plasmid with the cloned target gene. The detection level depended on the species of Babesia analyzed. The primers designed in this study ensured not only the high interspecific specificity of our proposed method but also a high versatility for different isolates from the same species worldwide. Additionally, the Tm obtained from the prepared plasmid standard is theoretically suitable for identifying isolates of all known sequences of the five Babesia species. CONCLUSIONS The developed detection method provides a useful tool for the epidemiological investigation of human babesiosis and pre-transfusion screening.
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Affiliation(s)
- Yanbo Wang
- State Key Laboratory for Animal Disease Control and Prevention, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Science, Lanzhou, Gansu People’s Republic of China
- The Second Hospital of Lanzhou University, Lanzhou, People’s Republic of China
| | - Shangdi Zhang
- The Second Hospital of Lanzhou University, Lanzhou, People’s Republic of China
| | - Xiaoyun Li
- State Key Laboratory for Animal Disease Control and Prevention, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Science, Lanzhou, Gansu People’s Republic of China
| | - Yueli Nian
- State Key Laboratory for Animal Disease Control and Prevention, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Science, Lanzhou, Gansu People’s Republic of China
- The Second Hospital of Lanzhou University, Lanzhou, People’s Republic of China
| | - Xinyue Liu
- The Second Hospital of Lanzhou University, Lanzhou, People’s Republic of China
| | - Junlong Liu
- State Key Laboratory for Animal Disease Control and Prevention, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Science, Lanzhou, Gansu People’s Republic of China
| | - Hong Yin
- State Key Laboratory for Animal Disease Control and Prevention, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Science, Lanzhou, Gansu People’s Republic of China
- Jiangsu Co-Innovation Center for the Prevention and Control of Important Animal Infectious Disease and Zoonoses, Yangzhou University, Yangzhou, 225009 China
| | - Guiquan Guan
- State Key Laboratory for Animal Disease Control and Prevention, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Science, Lanzhou, Gansu People’s Republic of China
| | - Jinming Wang
- State Key Laboratory for Animal Disease Control and Prevention, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Science, Lanzhou, Gansu People’s Republic of China
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Bloch EM, Siller A, Tonnetti L, Drews SJ, Spencer BR, Hedges D, Mergenthal T, Weber-Schehl M, Astl M, Patel EU, Gaber M, Schennach H. Molecular Screening of Blood Donors for Babesia in Tyrol, Austria. Transfus Med Hemother 2023; 50:330-333. [PMID: 37767285 PMCID: PMC10521223 DOI: 10.1159/000528793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/19/2022] [Indexed: 09/29/2023] Open
Abstract
Introduction Babesia is a tick-borne intraerythrocytic parasite that is globally ubiquitous, yet understudied. Several species of Babesia have been shown to be transfusion-transmissible. Babesia has been reported in blood donors, animals, and ticks in the Tyrol (Western Austria), and regional cases of human babesiosis have been described. We sought to characterize the risk of Babesia to the local blood supply. Methods Prospective molecular testing was performed on blood donors who presented to regional, mobile blood collection drives in the Tyrol, Austria (27 May to October 4, 2021). Testing was conducted using the cobas® Babesia assay (Roche Molecular Systems, Inc.), a commercial PCR assay approved for blood donor screening that is capable of detecting the 4 primary species causing human babesiosis (i.e., B. microti, B. divergens, B. duncani, and B. venatorum). A confirmatory algorithm to manage initial PCR-reactive samples was developed, as were procedures for donor and product management. Results A total of 7,972 donors were enrolled and screened; 4,311 (54.1%) were male, with a median age of 47 years (IQR = 34-55). No positive cases of Babesia were detected, corresponding with an overall prevalence of 0.00% (95% CI: 0.00%, 0.05%). Discussion The findings suggest that the prevalence of Babesia is low in Austrian blood donors residing in the Tyrol, even during months of peak tick exposure. Although one cannot conclude the absence of Babesia in this population given the limited sample size, the findings suggest that the regional risk of transfusion-transmitted babesiosis is low.
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Affiliation(s)
- Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anita Siller
- Central Institute for Blood Transfusion and Immunology, Innsbruck, Austria
| | - Laura Tonnetti
- Holland Laboratories for the Biomedical Sciences, American Red Cross, Rockville, Maryland, USA
| | - Steven J. Drews
- Microbiology, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Bryan R. Spencer
- Scientific Affairs, American Red Cross, Dedham, Massachusetts, USA
| | - Doris Hedges
- Blood donor service, Bavarian Red Cross, Wiesentheid, Germany
| | | | | | - Manfred Astl
- Central Institute for Blood Transfusion and Immunology, Innsbruck, Austria
| | - Eshan U. Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manfred Gaber
- Blood donor service Tyrol, Austrian Red Cross, Rum, Austria
| | - Harald Schennach
- Central Institute for Blood Transfusion and Immunology, Innsbruck, Austria
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Marcos LA, Wormser GP. Relapsing Babesiosis With Molecular Evidence of Resistance to Certain Antimicrobials Commonly Used to Treat Babesia microti Infections. Open Forum Infect Dis 2023; 10:ofad391. [PMID: 37539067 PMCID: PMC10394720 DOI: 10.1093/ofid/ofad391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023] Open
Abstract
Human babesiosis cases are emerging with an increased incidence and a wider geographic range worldwide. Relapsing babesiosis cases are becoming more frequently encountered in clinical practice associated with the use of immunosuppressive medications. The 2020 Infectious Diseases Society of America babesiosis guideline recommends at least 6 weeks of antimicrobial treatment for highly immunocompromised patients with Babesia microti infection. Nevertheless, cases have relapsed even after 6 weeks of treatment. Genetic mutations regarded as the potential cause of antimicrobial resistance in B microti have been identified in certain relapsing cases. A few alternative antimicrobial regimens have been used successfully to achieve cure for some of these cases, but other cases have had fatal outcomes. In this review, we discuss the molecular evidence of genetic resistance to certain antimicrobials commonly used to treat B microti infections based on an evaluation of 9 patients with relapsing infection.
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Affiliation(s)
- Luis A Marcos
- Division of Infectious Diseases, Department of Medicine, Stony Brook University, Stony Brook, New York, USA
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Gary P Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla, New York, USA
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Marcos LA, Vorkas CK, Mann I, Garry E, Lamba P, Pham SK, Spector R, Papamanoli A, Krivacsy S, Lum M, Zahra A, Hou W, Spitzer ED. Reduced Cholesterol Levels during Acute Human Babesiosis. Pathogens 2023; 12:pathogens12040613. [PMID: 37111499 PMCID: PMC10144092 DOI: 10.3390/pathogens12040613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Babesiosis, an intra-erythrocytic protozoan disease, is an emerging zoonotic parasitic disease worldwide. Cholesterol levels are correlated with severe infections, such as sepsis and COVID-19, and anecdotal reports suggest that high-density lipoprotein (HDL) cholesterol declines during acute babesiosis. Our aim was to describe the cholesterol levels in patients with acute babesiosis diagnosed in an endemic area in New York, hypothesizing that HDL levels correlate with the severity of infection. METHODS We reviewed the medical records of adult patients with babesiosis diagnosed by identification of Babesia parasites on a thin blood smear and confirmed by polymerase chain reaction from 2013 to 2018, who also had available a lipid profile drawn at the time of clinical presentation. Additional lipid profile levels were considered as "baseline" if they were drawn within 2 months before or after the infection as part of routine care. RESULTS A total of 39 patients with babesiosis had a lipid profile drawn on presentation. The patients were divided into two groups for comparison based on the treating physician's clinical decision: 33 patients who were admitted to the hospital and 8 patients who were evaluated as outpatients. A history of hypertension was more common in admitted patients (37% vs. 17%, p = 0.02). The median levels of low-density lipoprotein (LDL) and HDL were significantly reduced in admitted patients compared to non-admitted patients (46 vs. 76 mg/dL, p = 0.04; and 9 vs. 28.5 mg/dL, p = 0.03, respectively). In addition, LDL and HDL levels returned to baseline values following resolution of acute babesiosis. CONCLUSION LDL and HDL levels are significantly reduced during acute babesiosis, suggesting that cholesterol depletion may predict disease severity. Pathogen and host factors may contribute to a reduction in serum cholesterol levels during acute babesiosis.
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Affiliation(s)
- Luis A Marcos
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, NY 11794, USA
| | - Charles Kyriakos Vorkas
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, NY 11794, USA
| | - Inderjit Mann
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Evan Garry
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Pooja Lamba
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Sophia K Pham
- Stony Brook Southampton Hospital, Southampton, NY 11968, USA
| | - Rachel Spector
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Aikaterini Papamanoli
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Sara Krivacsy
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Michael Lum
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Aleena Zahra
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Wei Hou
- Division of Epidemiology and Biostatistics, Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Eric D Spitzer
- Department of Pathology, Stony Brook University, Stony Brook, NY 11794, USA
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Costa V, Mercure-Corriveau N, Gourneau J, Tobian AAR, Jones JM, Lauriello A, Lanzkron S, Crowe EP, Bloch EM. Transfusion-transmitted babesiosis in a patient with sickle cell disease undergoing chronic red cell exchange. Transfusion 2023; 63:652-655. [PMID: 36637364 PMCID: PMC10033390 DOI: 10.1111/trf.17244] [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: 11/21/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Prior to laboratory-based blood donor screening for Babesia, transfusion-transmitted babesiosis (TTB) was a leading infectious risk to the blood supply in the United States. CASE REPORT A 30-year-old man with sickle cell disease (SCD) who had been on a chronic automated red cell exchange (RCE) regimen since childhood, presented approximately 2 months after an RCE, with fever, neck pain, and photophobia. Meningitis was excluded, and he was discharged. He presented again 2 days later with persistent fever, chills, headache, fatigue, and loss of appetite. RESULTS On examination, the patient was febrile but hemodynamically stable. Intra-erythrocytic inclusions were identified on a peripheral blood smear (<0.5%). B. microti IgM and IgG titers were >1:320 (Reference <1:20) >1:1024 (Reference <1:64), respectively. B. microti was confirmed by nucleic acid testing. The patient lived in a Babesia endemic state but had no risk factors for tick-borne acquisition. Of the 65 units he received in the preceding 6 months, 58 had been screened for Babesia. One of the donors of the 7 untested units was B. microti seropositive (titer 1:128; Reference 1: 64). The donor was asymptomatic and resided in a state in which Babesia screening was not required. He reported traveling in the year before his donation. CONCLUSION Although rare, TTB is still possible despite regional screening, underscoring the need for provider vigilance and education, especially in non-endemic areas. Patients with SCD are particularly vulnerable given their high frequency of transfusion and complex needs requiring blood procurement from states where Babesia screening is not mandatory.
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Affiliation(s)
- Victoria Costa
- Department of Pathology and Laboratory Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | | | - Aaron A. R. Tobian
- Department of Pathology and Laboratory Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jennifer M. Jones
- Department of Hematology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ashley Lauriello
- Department of Hematology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sophie Lanzkron
- Department of Hematology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Elizabeth P. Crowe
- Department of Pathology and Laboratory Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Evan M. Bloch
- Department of Pathology and Laboratory Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Beri D, Singh M, Rodriguez M, Goyal N, Rasquinha G, Liu Y, An X, Yazdanbakhsh K, Lobo CA. Global Metabolomic Profiling of Host Red Blood Cells Infected with Babesia divergens Reveals Novel Antiparasitic Target Pathways. Microbiol Spectr 2023; 11:e0468822. [PMID: 36786651 PMCID: PMC10100774 DOI: 10.1128/spectrum.04688-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/27/2023] [Indexed: 02/15/2023] Open
Abstract
Babesia divergens is an apicomplexan parasite that infects human red blood cells (RBCs), initiating cycles of invasion, replication, and egress, resulting in extensive metabolic modification of the host cells. Babesia is an auxotroph for most of the nutrients required to sustain these cycles. There are currently limited studies on the biochemical pathways that support these critical processes, necessitating the high-resolution global metabolomics approach described here to uncover the metabolic interactions between parasite and host RBC. Our results reveal an extensive parasite-mediated modulation of RBC metabolite levels of all classes, including lipids, amino acids, carbohydrates, and nucleotides, with numerous metabolic species varying in proportion to the level of infection. Many of these molecules are scavenged from the host RBCs. This is in accord with the needs of a rapidly proliferating parasite with limited biosynthetic capabilities. Probing these pathways in depth, we used growth inhibition assays to quantitate parasite susceptibility to drugs targeting these pathways and stimulated emission depletion (STED) microscopy to obtain high-resolution images of drug-treated parasites to correlate changes in morphology with specific metabolic blocks in order to validate the data generated by the untargeted metabolomics platform. Thus, interruption of cholesterol scavenging from the host cell led to premature parasite egress, while chemical targeting of the hydrolysis of acyl glycerides led to the buildup of malformed parasites that could not successfully egress. This is the first report detailing the global metabolomic profile of the B. divergens-infected RBC. Besides deciphering diverse aspects of the host-parasite relationship, our results can be exploited by others to uncover further drug targets in the host-parasite biochemical network. IMPORTANCE Human babesiosis is caused by apicomplexan parasites of the Babesia genus and is associated with transfusion-transmitted illness and relapsing disease in immunosuppressed populations. Through its continuous cycles of invasion, proliferation, and egress, B. divergens radically changes the metabolic environment of the host red blood cell, allowing us opportunities to study potential chemical vulnerabilities that can be targeted by drugs. This is the first global metabolomic profiling of Babesia-infected human red blood cells, and our analysis revealed perturbation in all biomolecular classes at levels proportional to the level of infection. In particular, lipids and energy flux pathways in the host cell were altered by infection. We validated the changes in key metabolic pathways by performing inhibition assays accompanied by high-resolution microscopy. Overall, this global metabolomics analysis of Babesia-infected red blood cells has helped to uncover novel aspects of parasite biology and identified potential biochemical pathways that can be targeted for chemotherapeutic intervention.
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Affiliation(s)
- Divya Beri
- Department of Blood-Borne Parasites, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Manpreet Singh
- Department of Blood-Borne Parasites, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Marilis Rodriguez
- Department of Blood-Borne Parasites, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Naman Goyal
- Department of Blood-Borne Parasites, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | | | - Yunfeng Liu
- Department of Complement Biology, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Xiuli An
- Department of Membrane Biology, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Karina Yazdanbakhsh
- Department of Complement Biology, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Cheryl A. Lobo
- Department of Blood-Borne Parasites, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
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9
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Shen L, Wang C, Wang R, Hu X, Liao S, Liu W, Du A, Ji S, Galon EM, Li H, Xuan X, Xiao J, Liu M. Serum metabolomic profiles in BALB/c mice induced by Babesia microti infection. Front Cell Infect Microbiol 2023; 13:1179967. [PMID: 37187473 PMCID: PMC10176453 DOI: 10.3389/fcimb.2023.1179967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction The protozoan parasite Babesia microti is the primary cause of human babesiosis. This parasite invades and multiplies inside red blood cells (RBCs), and infections differ significantly based on the age and immune competency of the host. The aim of this study was to investigate the use of serum metabolic profiling to identify systemic metabolic variations between B. microti-infected mice and noninfected controls. Methods A serum metabolomics analysis of BALB/c mice that had been intraperitoneally injected with 107 B. microti-infected RBCs was performed. Serum samples from the early infected group (2 days postinfection), the acutely infected group (9 days postinfection), and the noninfected group were collected and evaluated using a liquid chromatography-mass spectrometry (LC-MS) platform. Principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), and orthogonal partial least squares discriminant analysis (OPLS-DA) identified metabolomic profiles that differentiated the B. microti-infected and noninfected groups. Results Our results confirm that the serum metabolome is significantly influenced by acute B. microti infection and show that infection results in dysregulation of metabolic pathways and perturbation of metabolites. Acutely infected mice displayed perturbations in metabolites associated with taurine and hypotaurine metabolism, histidine metabolism, and arachidonic acid metabolism. Taurocholic acid, anserine, and arachidonic acid may be potential candidates as serological biomarkers for diagnosing B. microti infection at the acute stage. These metabolites could be further examined for their role in disease complexity. Discussion Our findings demonstrate that the acute stage of B. microti infection induces abnormalities in the metabolites present in mouse serum and provide new insight into the mechanisms involved in systemic metabolic changes that occur during B. microti infection.
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Affiliation(s)
- Liang Shen
- Central Laboratory, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Chunhua Wang
- Central Laboratory, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Ruilin Wang
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, China
| | - Xue Hu
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, China
| | - Shiying Liao
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, China
| | - Wentong Liu
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, China
| | - Aoling Du
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, China
| | - Shengwei Ji
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Eloiza May Galon
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Hang Li
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Xuenan Xuan
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Juan Xiao
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, China
- *Correspondence: Mingming Liu, ; Juan Xiao,
| | - Mingming Liu
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, China
- *Correspondence: Mingming Liu, ; Juan Xiao,
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Bloch EM, Zhu X, Krause PJ, Patel EU, Grabowski MK, Goel R, Auwaerter PG, Tobian AAR. Comparing the Epidemiology and Health Burden of Lyme Disease and Babesiosis Hospitalizations in the United States. Open Forum Infect Dis 2022; 9:ofac597. [PMID: 36467296 PMCID: PMC9709699 DOI: 10.1093/ofid/ofac597] [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: 09/08/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Background Lyme disease (LD) and babesiosis are increasing in the United States. We sought to characterize and compare their epidemiology and health burden using a nationally representative sample of hospitalizations. Methods Data were extracted from the National Inpatient Sample (NIS) pertaining to LD and babesiosis for 2018 and 2019. The NIS is a comprehensive database of all-payer inpatient hospitalizations, representing a stratified systematic random sample of discharges from US hospitals. Patient demographics, clinical outcomes, and admission costs were evaluated, in addition to hospital-level variables (eg, location/teaching status and census division). Annual incidence of hospitalizations was calculated using US Census Bureau data. Results The annual incidence of hospitalizations of LD-related and babesiosis-related hospitalizations were 6.98 and 2.03 per 1 000 000 persons/year. Of the 4585 LD hospitalizations in 2018-2019, 60.9% were among male patients, 85.3% were White, and 39.0% were ≥60 years. Of the 1330 babesiosis hospitalizations in 2018-2019, 72.2% were among male patients, 78.9% were White, and 74.1% were ≥60 years; 70.0% of LD and 91.7% of babesiosis hospitalizations occurred in Middle Atlantic or New England. Lower disease severity was noted in 81.8% of LD hospitalizations compared with 49.3% of babesiosis hospitalizations, whereas those suffering from high severity were 2.3% and 6.0%, respectively. The mean hospital charges for LD and babesiosis hospitalizations were $33 440.8 and $40 689.8, respectively. Conclusions Despite overlap between the 2 diseases, LD has a broader geographic range and a greater number of hospital admissions, whereas babesiosis is more severe, incurring longer hospital stays, higher inpatient costs, and deaths.
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Affiliation(s)
- Evan M Bloch
- Correspondence: Evan M. Bloch, MBChB, MS, Associate Professor of Pathology, Associate Director, Transfusion Medicine, Department of Pathology, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Carnegie 446 D1, Baltimore, MD 21287 ()
| | - Xianming Zhu
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Peter J Krause
- Department of Epidemiology and Public Health, Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, USA
| | - Eshan U Patel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - M Kate Grabowski
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Internal Medicine, Simmons Cancer Institute at Southern Illinois University, Springfield, Illinois, USA
| | - Paul G Auwaerter
- Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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