Two decades of antifilarial drug discovery: a review

Filariasis is one of the oldest, most debilitating, disabling, and disfiguring neglected tropical diseases with various clinical manifestations and a low rate of mortality, but has a high morbidity rate, which results in social stigma.

In vitro screening for anthelmintic and antitumour activity of ethnomedicinal plants from Thailand

AIM OF STUDY

This study screened for anthelmintic and/or antitumour bioactive compounds from Thai indigenous plants and evaluated effectiveness against three different worm species and two cancer cell lines.

MATERIALS AND METHODS

Methylene chloride and methanol extracts of 32 plant species were screened for in vitro anthelmintic activity against three species of worms, the nematode Caenorhabditis elegans, the digeneans Paramphistomum epiclitum and Schistosoma mansoni (cercariae). Cytotoxicity of the extracts was evaluated against two cancer cell lines: human amelanotic melanoma (C32) and human cervical carcinoma (HeLa) by the SRB assay. Anthelmintic and anticancer activities were evaluated by the inhibiting concentration at 50% death (IC(50)) and the selectivity index (SI) relative to human fibroblasts.

RESULTS AND CONCLUSIONS

None of the extracts were active against Paramphistomum epiclitum. Plumbagin, a pure compound from Plumbago indica, had the strongest activity against Caenorhabditis elegans. The methylene chloride extract of Piper chaba fruits had the strongest activity against schistosome cercariae. Strong cytotoxicity was shown by the methylene chloride extract of Michelia champaca bark and the methanol extract of Curcuma longa rhizome against C32 and HeLa, respectively. These extracts had higher SI (>100) than positive controls in relation to either the worms or the cell lines. The methanol extract of Bouea burmanica had a slightly lower activity towards C32 cells than did Michelia champaca but had a much higher SI (>27,000).

ETHNOPHARMACOLOGICAL RELEVANCE

The plant species screened in this research was recorded by several indigenous medicinal practitioners as antiparasitic, anticancer and/or related activities to the human major organ system.

A cohort study on anti-filarial IgG4 and its assessment in good and uncertain MDA-compliant subjects in brugian filariasis endemic areas in southern Thailand

The prevalence of Brugia malayi was surveyed in three highly endemic provinces in southern Thailand as part of an ongoing evaluation of the effectiveness of two rounds of mass drug administration (MDA). Prior to MDA IV, and thereafter every 6 months up to 18 months, including MDA V at 12 months, nocturnal blood sampling was assayed for microfilaria (mf) and IgG4 antibodies in 200 subjects from Nakorn Srithammarat and Surathani provinces. From an additional 300 subjects from Narathiwatt province, daytime blood was also examined for IgG4 antibodies for 1 year. Subjects who tested positive, with reciprocal IgG4 titres above 100, were dichotomized in the 'good compliant' or 'uncertain compliant' groups. Stool samples were examined for intestinal parasites from all 500 subjects simultaneously. Only two subjects (1%) tested positive for mf, while 98 subjects (19.6% of 500) tested positive for IgG4. In general, the good drug-compliant subjects were less likely to exhibit the IgG4 response than subjects in the uncertain compliant group. Only six subjects (1.2%) exhibited lymphoedema while 68 subjects (13.6%) had a total of 105 parasitic infections, with female instances of protozoan infections exceeding male instances of helminth infections. It was concluded that the two MDA rounds were highly successful in not only in reducing mf to negligible levels but also in lowering antifilarial IgG4 titres in the good compliant subjects. The IgG4 assay is a sensitive and cost-effective surveillance tool for the early detection of brugian infections that is not contingent on nocturnal blood collections.

Eliminating lymphatic filariasis: a view from the field

Among infections closely associated with poverty, lymphatic filariasis (LF) is a study in contrasts. It is both a consequence of and a contributor to poverty. Although rarely fatal, it is recognized as a leading global cause of lifelong disability as well as significant personal, social, and economic burdens coincident with disease. Infection is often considerably more prevalent in communities than the number of cases of overt pathology for which LF is best known (lymphedema, elephantiasis, and hydrocele). With an estimated 120 million to 130 million affected persons in 83 countries and 1.25 billion persons living in areas at risk, in some countries LF may be expanding its range, whereas in others, with economic development, it has disappeared with little if any targeted intervention. The transmission cycle is relatively inefficient, yet an association with pockets of deepest poverty remains tenacious. Thanks to scientific advances in diagnostic tools, and particularly in control strategies focused on large-scale drug donation and mass drug distribution programs, scientists and policy makers now consider LF eliminable. Together with new approaches for morbidity control, a hopeful tone surrounds a disease problem that as recently as two decades ago could easily have been categorized as among the most neglected of neglected diseases. Continued progress toward global LF elimination will require solutions to potential obstacles in the most challenging--that is, the poorest--endemic settings. This chapter reviews progress toward LF elimination and some of the remaining challenges from a perspective in Haiti, the only least developed country of the Americas.

Loiasis: African eye worm

The filarial parasite Loa loa is transmitted by Chrysops fly bites. Loiasis is endemic in rainforest areas of West and Central Africa, and sporadic cases have also been diagnosed in travellers and migrants. Whilst many infected persons are asymptomatic, microfilariae may be detected in the blood or adult worms may be seen under the skin or the sclera of the eye. Mass treatment programmes for onchocerciasis have raised concern about the risk of severe adverse effects when ivermectin is distributed in areas co-endemic for onchocerciasis and loiasis.