Changes in inflammatory gene expression in brain tissue adjacent and distant to a viable cyst in a rat model for neurocysticercosis

BACKGROUND

The parasite Taenia solium causes neurocysticercosis (NCC) in humans and is a common cause of adult-onset epilepsy in the developing world. Hippocampal atrophy, which occurs far from the cyst, is an emerging new complication of NCC. Evaluation of molecular pathways in brain regions close to and distant from the cyst could offer insight into this pathology.

METHODS

Rats were inoculated intracranially with T. solium oncospheres. After 4 months, RNA was extracted from brain tissue samples in rats with NCC and uninfected controls, and cDNA was generated. Expression of 38 genes related to different molecular pathways involved in the inflammatory response and healing was assessed by RT-PCR array.

RESULTS

Inflammatory cytokines IFN-γ, TNF-α, and IL-1, together with TGF-β and ARG-1, were overexpressed in tissue close to the parasite compared to non-infected tissue. Genes for IL-1A, CSF-1, FN-1, COL-3A1, and MMP-2 were overexpressed in contralateral tissue compared to non-infected tissue.

CONCLUSIONS

The viable cysticerci in the rat model for NCC is characterized by increased expression of genes associated with a proinflammatory response and fibrosis-related proteins, which may mediate the chronic state of infection. These pathways appear to influence regions far from the cyst, which may explain the emerging association between NCC and hippocampal atrophy.

Radiological evolution of porcine neurocysticercosis after combined antiparasitic treatment with praziquantel and albendazole

BACKGROUND

The onset of anthelmintic treatment of neurocysticercosis (NCC) provokes an acute immune response of the host, which in human cases is associated with exacerbation of neurological symptoms. This inflammation can occur at the first days of therapy. So, changes in the brain cysts appearance may be detected by medical imaging. We evaluated radiological changes in the appearance of brain cysts (enhancement and size) on days two and five after the onset of antiparasitic treatment using naturally infected pigs as a model for human NCC.

METHODS AND RESULTS

Contrast T1-weighted magnetic resonance imaging with gadolinium was performed before and after antiparasitic treatment. Eight NCC-infected pigs were treated with praziquantel plus albendazole and euthanized two (n = 4) and five (n = 4) days after treatment; another group of four infected pigs served as untreated controls. For each lesion, gadolinium enhancement intensity (GEI) and cyst volume were measured at baseline and after antiparasitic treatment. Volume and GEI quantification ratios (post/pre-treatment measures) were used to appraise the effect of treatment. Cysts from untreated pigs showed little variations between their basal and post treatment measures. At days 2 and 5 there were significant increases in GEI ratio compared with the untreated group (1.32 and 1.47 vs 1.01, p = 0.021 and p = 0.021). Cyst volume ratios were significantly lower at days 2 and 5 compared with the untreated group (0.60 and 0.22 vs 0.95, p = 0.04 and p = 0.02). Cysts with lower cyst volume ratios showed more marked post-treatment inflammation, loss of vesicular fluid and cyst wall wrinkling.

CONCLUSION/SIGNIFICANCE

A significant and drastic reduction of cyst size and increased pericystic enhancement occur in the initial days after antiparasitic treatment as an effect of acute perilesional immune response. These significant changes showed that early anthelmintic efficacy (day two) can be detected using magnetic resonance imaging.

Neurocysticercosis in a Rhesus Macaque (Macaca mulatta)

An 8-y-old, intact, male rhesus macaque (Macaca mulatta) was sedated to undergo MRI in preparation for the implantation of cranial hardware. During imaging, 9 focal lesions were noted in the brain and musculature of the head. The lesions were hyperechoic with hypoechoic rims. The animal was deemed inappropriate for neuroscience research, and euthanasia was elected. Gross examination revealed multiple round, thick-walled, fluid-filled cysts (diameter, approximately 0.5 cm) in multiple tissues: one each in the left caudal lung lobe, left masseter muscle, and the dura overlying the brain and 8 throughout the gray and white matter of the brain parenchyma. Formalin-fixed sections of cyst-containing brain were stained with hematoxylin and eosin. Microscopic examination and molecular analysis of the COX1 (COI) gene recognized the causative organism as Taenia solium at 99.04% identity.

Inflammation Caused by Praziquantel Treatment Depends on the Location of the Taenia solium Cysticercus in Porcine Neurocysticercosis

Background

Neurocysticercosis (NCC), infection of the central nervous system by Taenia solium cysticerci, is a pleomorphic disease. Inflammation around cysticerci is the major cause of disease but is variably present. One factor modulating the inflammatory responses may be the location and characteristics of the brain tissue adjacent to cysticerci. We analyzed and compared the inflammatory responses to cysticerci located in the parenchyma to those in the meninges or cysticerci partially in contact with both the parenchyma and the meninges (corticomeningeal).

Methodology/Principal Findings

Histological specimens of brain cysticerci (n = 196) from 11 pigs naturally infected with Taenia solium cysticerci were used. Four pigs were sacrificed after 2 days and four after 5 days of a single dose of praziquantel; 3 pigs did not receive treatment. All pigs were intravenously injected with Evans Blue to assess disruption of the blood-brain barrier. The degree of inflammation was estimated by use of a histological score (ISC) based on the extent of the inflammation in the pericystic areas as assessed in an image composed of several photomicrographs taken at 40X amplification. Parenchymal cysticerci provoked a significantly greater level of pericystic inflammation (higher ISC) after antiparasitic treatment compared to meningeal and corticomeningeal cysticerci. ISC of meningeal cysticerci was not significantly affected by treatment. In corticomeningeal cysticerci, the increase in ISC score was correlated to the extent of the cysticercus adjacent to the brain parenchyma. Disruption of the blood-brain barrier was associated with treatment only in parenchymal tissue.

Significance

Inflammatory response to cysticerci located in the meninges was significantly decreased compared to parenchymal cysticerci. The suboptimal inflammatory response to cysticidal drugs may be the reason subarachnoid NCC is generally refractory to treatment compared to parenchymal NCC.

The cystic larvae of the pork tapeworm Taenia solium may affect the human brain causing neurocysticercosis (NCC), a very frequent cause of neurological symptoms in developing countries. The clinical expression and response to treatment of human NCC are related to the location of cysticerci inside (intraparenchymal) or outside the brain parenchyma (extraparenchymal NCC). We used a naturally infected pig model to assess the characteristics of inflammation around brain cysticerci of parenchymal, meningeal and mixed locations. There were no major differences in inflammation without treatment. After antiparasitic treatment with praziquantel, inflammation around parenchymal brain cysticerci increased in comparison to meningeal located cysticerci. Cysticerci partially surrounded by both brain parenchyma and meninges showed increased inflammation in relation to the extent of the cysticercus in the brain parenchyma. The location of cysticerci within the brain is a factor that determines the extent and degree of the immune response following anticysticidal treatment. Similar changes may occur in treated human infections. Our work could contribute to explain the differences in response to antiparasitic treatment in different forms of human neurocysticercosis.

Taenia solium: Development of an Experimental Model of Porcine Neurocysticercosis

Human neurocysticercosis (NC) is caused by the establishment of Taenia solium larvae in the central nervous system. NC is a severe disease still affecting the population in developing countries of Latin America, Asia, and Africa. While great improvements have been made on NC diagnosis, treatment, and prevention, the management of patients affected by extraparenchymal parasites remains a challenge. The development of a T. solium NC experimental model in pigs that will allow the evaluation of new therapeutic alternatives is herein presented. Activated oncospheres (either 500 or 1000) were surgically implanted in the cerebral subarachnoid space of piglets. The clinical status and the level of serum antibodies in the animals were evaluated for a 4-month period after implantation. The animals were sacrificed, cysticerci were counted during necropsy, and both the macroscopic and microscopic characteristics of cysts were described. Based on the number of established cysticerci, infection efficiency ranged from 3.6% (1000 oncospheres) to 5.4% (500 oncospheres). Most parasites were caseous or calcified (38/63, 60.3%) and were surrounded by an exacerbated inflammatory response with lymphocyte infiltration and increased inflammatory markers. The infection elicited specific antibodies but no neurological signs. This novel experimental model of NC provides a useful tool to evaluate new cysticidal and anti-inflammatory approaches and it should improve the management of severe NC patients, refractory to the current treatments.

Neurocysticercosis (NC) is caused by the implantation of the larval stage of Taenia solium in the human central nervous system. Although NC diagnosis, treatment, and prevention have clearly improved in the last 40 years, the disease still causes significant morbidity and mortality in endemic regions of Latin America, Asia, and Africa. In industrialized countries, the number of diagnosed cases has increased in recent years due to immigration. In this paper, we introduce a new experimental model of T. solium neurocysticercosis in pigs. Activated oncospheres were surgically implanted in the subarachnoid space of the cerebral convexity in piglets. Then, the animals were observed during 4 months. An increase in anti-cysticercal antibodies was detected, along with an inflammatory reaction surrounding the established parasites. This experimental model of T. solium NC will improve our knowledge on the pathogenesis of the disease; additionally, it will let us evaluate new promising treatments for inflammation and improve the effectiveness of cysticidal drugs.

Post-treatment vascular leakage and inflammatory responses around brain cysts in porcine neurocysticercosis

Cysticidal treatment of neurocysticercosis, an infection of humans and pig brains with Taenia solium, results in an early inflammatory response directed to cysts causing seizures and focal neurological manifestations. Treatment-induced pericystic inflammation and its association with blood brain barrier (BBB) dysfunction, as determined by Evans blue (EB) extravasation, was studied in infected untreated and anthelmintic-treated pigs. We compared the magnitude and extent of the pericystic inflammation, presence of EB-stained capsules, the level of damage to the parasite, expression of genes for proinflammatory and regulatory cytokines, chemokines, and tissue remodeling by quantitative PCR assays between treated and untreated infected pigs and between EB-stained (blue) and non stained (clear) cysts. Inflammatory scores were higher in pericystic tissues from EB-stained cysts compared to clear cysts from untreated pigs and also from anthelmintic-treated pigs 48 hr and 120 hr after treatment. The degree of inflammation correlated with the severity of cyst wall damage and both increased significantly at 120 hours. Expression levels of the proinflammatory genes for IL-6, IFN-γ, TNF-α were higher in EB-stained cysts compared to clear cysts and unaffected brain tissues, and were generally highest at 120 hr. Additionally, expression of some markers of immunoregulatory activity (IL-10, IL-2Rα) were decreased in EB-stained capsules. An increase in other markers for regulatory T cells (CTLA4, FoxP3) was found, as well as significant increases in expression of two metalloproteases, MMP1 and MMP2 at 48 hr and 120 hr post-treatment. We conclude that the increase in severity of the inflammation caused by treatment is accompanied by both a proinflammatory and a complex regulatory response, largely limited to pericystic tissues with compromised vascular integrity. Because treatment induced inflammation occurs in porcine NCC similar to that in human cases, this model can be used to investigate mechanisms involved in host damaging inflammatory responses and agents or modalities that may control damaging post treatment inflammation.

Neurocysticercosis is caused by infection of the brain with the larval (cyst) stage of the tape worm Taenia solium in humans and pigs. Antiparasitic drug treatment is compromised by worsening of neurological symptoms during therapy due to reactive inflammation triggered by the dying parasite. The immune mechanisms that cause this inflammation are poorly understood. In this study, we investigated the nature of inflammation after treatment in pigs naturally infected with T. solium cysts. Evans blue dye injected into infected pigs marks areas in the brain where the normally impermeable capillaries have become more permeable, allowing damaging cells and molecules to leak out into the brain. By microscopy and measurement of gene expression for inflammation-inducing immune mediators, we show that inflammation in the brain tissues around cysts is more severe with increased vessel leakage. Furthermore, the levels of these mediators increased after antiparasitic drug treatment. A significant implication of these findings is that it may be possible to inhibit the inflammation around parasites using drugs or biologics that inhibit these inflammatory pathways and, thereby, reduce local brain damage during treatment. These observations may also be applicable to other inflammatory conditions that affect the brain.

Metabolite pattern ofCysticercus cellulosaemetacestode from different predilection sites of swine using proton magnetic resonance spectroscopy

Cysticercosis due to Taenia solium is one of the most common public health problems in various regions of the world. We have performed prolon magnetic resonance spectroscopy (1H MRS) experiments of the fluid aspirated from cysticerci excised from skeletal muscle (n = 16) and brain (n = 9) of infected swine to compare the metabolite pattern of cysticerci in different predilection sites. Perchloric acid extract of cysticercus cysts excised from skeletal muscles (n = 16) was also prepared to ascertain water-soluble, low molecular weight metabolites using 1H MRS. Absolute quantification and statistical analysis of different metabolites was done to look for any significant differences in different locations of cysts. The metabolite pattern of cysticerci was found to be similar in the various predilection sites. Metabolites observed were leucine, valine, alanine, lysine, glycine, lipid contents, lactate, glutamate, acetate, succinate, creatine, choline, and glucose. Concentration of creatine in cysticercus fluid of cysts removed from the muscle was found to be significantly higher (p = 0.001) than the cysts located in the brain. We conclude that the metabolite pattern in the cysticerci is not influenced by the surrounding tissue location; however concentration of certain metabolites may depend upon the tissue location.

The immune response in Taenia solium neurocysticercosis in pigs is associated with astrogliosis, axonal degeneration and altered blood-brain barrier permeability

Immunohistochemistry was used to examine the immuno-pathological changes and the extent of neuronal damage caused by either viable or dead Taenia solium cysticerci during porcine neurocysticercosis. Thirty pig brains with cerebral cysticercosis and 5 brains from T. solium free pigs were used in this study. Results revealed extensive astrogliosis, neuronal and mostly axonal damage in both early (grade I) and late (grades III and V) lesions as evidenced by an increased expression of glial fibrillary acidic protein (GFAP) and neurofilament protein (NFP). In many late lesions, astrocyte end-feet formed glial scars that surrounded the dead parasite. Rapid angiogenesis resulted in blood vessels lacking astrocyte end-feet suggesting loss of blood-brain barrier (BBB) hence allowing an influx of peripheral blood immune cells such as eosinophils, macrophages, CD3+ T cells, B lymphocytes and plasma cells into lesions. This study showed that porcine NCC was associated with severe nervous tissue damage, the host response of which is a collaborative effort between the local and peripheral immune responses comparable to that observed in human NCC. Results further implied that porcine NCC could be a useful model for understanding the course of NCC in human as well as provide useful information for therapeutic and/or immune strategies.

A survey of Taenia multiceps coenurosis in Sardinian sheep

A survey was carried out to assess the occurrence of Coenurus cerebralis infection in Sardinian sheep. A prevalence of 0.35% was observed when 566 regularly slaughtered sheep were examined. However, in 120 sheep with suspected symptoms of coenurosis examined from November 2001 to October 2002, a total of 299 cerebral coenurosis lesions were observed with an incidence of 1% per year. Lesions were classified as migratory, cystic and secondary. Most migratory lesions were found in sheep aged 3-6 months. Cavitary lesions containing cysts in different developing stages were found with high incidence per year in sheep aged 7-12 months. Secondary lesions due to the development of Coenurus were most frequent in sheep aged 19-36 months. Most sheep were found infected in spring and in early summer, between March and June. Most lesions were located in the cortex. The mean number of protoscolices per cyst was 149 (range 10-370).

Two rare clinical manifestations of coenurosis in sheep

Two rare clinical manifestations of coenurosis in sheep are reported. (i) A case of partial seizure disorder in a ram of 11 months old. During seizure episodes the animal lay down in lateral recumbency displaying initially a stuporous condition and subsequently began to revolve its head from the base of the cervix. At the necropsy of the case, Coenurus cerebralis cyst (young bladder worm) was found dorsally inside the brainstem, in the site of the tectum mesencephaly. (ii) The second-reported manifestation was a bacterial meningoengephalitis that was witnessed in two lambs of 6-7 weeks old. The lambs displayed lateral recumbency with seizure activity. At necropsy, meningoencephalitis with congestion and abscesses were observed in both of them. Interestingly, C. cerebralis cysts were also found in both brains. Streptococcus dysgalactiae was isolated from the abscesses. Possibly, S. dysgalactiae translocation of the blood-brain barrier was facilitated by the migration of the immature stages of C. cerebralis to and through the brain.

Clinical signs for identification of neurocysticercosis in swine naturally infected with Taenia solium

Taenia solium infection is a zoonotic disease and swine is the natural intermediate host. Till date no literatures have described clinical signs in swine indicative of brain involvement by cysticerci. In the present study we describe such clinical signs of porcine neurocysticercosis (NCC). These signs were excessive salivation, excessive blinking and tearing, and subconjunctival nodule. A total of 30 swine (18 with 2 or all 3 clinical signs and 12 without any sign) underwent magnetic resonance imaging (MRI). All 18 swine with above signs had NCC on MRI along with variable involvement of other organs that were subsequently confirmed by ex vivo MRI, necropsy and histopathology, while none of the 12 animals without any sign had NCC. As development of a porcine NCC model has proved difficult, we propose that naturally infected swine can be identified on the basis of these clinical signs and thus used as a model for further research on NCC.

Prediction of viability of porcine neurocysticercosis with proton magnetic resonance spectroscopy: correlation with histopathology

Neurocysticercosis (NCC) is the most frequent parasitic disease of central nervous system. In our earlier study, we had observed creatine [(creatine + phosphocreatine); (tCr)] on ex vivo proton MR spectroscopy (1H MRS) in some of the cysticercus cyst fluid samples obtained from swine's brain parenchyma. In current study, swine brains of freshly slaughtered animals naturally infected with NCC were subjected to ex vivo magnetic resonance (MR) imaging on a 1.5Tesla MR system. Cysticercus cysts (n = 12) were removed from these brains and were labeled depending upon presence or absence of edema around cysts as observed on imaging. Cysticercus cyst fluid (100 microl) was subjected to different 1H MRS experiments and results were compared with histopathological examinations to look for any relationship between tCr and parameters like quantification of musculature, and cellular infiltration in wall of the parasite. Histopathology of cyst wall was categorized into two groups based on cellular characteristics and the amount of musculature. Grade I cysts (n = 5) with no or minimal inflammation and large amount of musculature showed tCr on 1H MRS. However, grade II cysts (n = 7) with profuse inflammation and less amount of musculature in the cyst wall lacked tCr. Higher amount of musculature in grade I cysts was associated with higher concentration of tCr in the cyst fluid (r2 = 0.93, P = 0.007). Creatine appears to be a marker of innocuous and viable NCC.

Correlative MR imaging and histopathology in porcine neurocysticercosis

PURPOSE

To examine whether all the histopathologically seen features of cysticercus cysts excised from brain of swine naturally infected with neurocysticercosis during its evolution are actually visible on magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Five swine naturally infected with cerebral cysticercosis were subjected to fast spin-echo (SE) T2, SE T1, fluid attenuated inversion recovery imaging, T1-weighted magnetization transfer (MT), and postcontrast T1-weighted MT sequences on MRI. These animals were sacrificed after imaging and ex vivo imaging of the intact excised brain using the same imaging protocol was also performed. Grossing of these brains was done similar to the ex vivo imaging planes. Numeral density and external appearance of each cyst and scolex were evaluated on each pulse sequence. Amount of pericystic edema, if present, was also assessed. On histopathology, cellular characteristics, inflammatory response, and the extent of edema, if present, in the brain parenchyma around the cysts were graded. Cysts were categorized into viable, early, and late degenerated on histopathology. The MRI features of each cyst were correlated with their histopathologic findings.

RESULTS

Out of 31 cysts, eight were found to be viable, 13 early degenerated, and 10 late degenerated on histopathology. T2-weighted imaging demonstrated all the cysts while T1-weighted imaging showed 97% of the cysts. Scolex was seen in 90.3% and 93.5% of the cysts on T2- and T1-weighted images, respectively. Minimal edema (grade I) and inflammation in degenerating cysts present on histopathology was not visible on MRI. All but one of eight degenerated cysts, which showed enhancement on postcontrast MRI, had edema on imaging as well as on histopathology.

CONCLUSION

T2-weighted MRI demonstrated all the cysts that were visible on histopathology. Non-enhancement of some of the degenerated cysts along with absence of edema on MRI is likely to underestimate the staging of neurocysticercosis evolution, and these early degenerating cysts may be misdiagnosed as in viable stage.

Vaccination for the prevention of cysticercosis

Several species of taeniid cestode parasites cause cysticercosis in their intermediate hosts. The most important species is Taenia solium, which infects pigs as the natural animal intermediate host but also may infect humans as intermediate hosts, leading to the disease known as neurocysticercosis. T. solium has been identified as a potentially eradicable disease and increasing attention is being placed on efforts to control transmission of the parasite. One option to assist with control of the disease is to prevent infection occurring in pigs by vaccination, thereby breaking the parasite's life-cycle and removing the source of infection for humans. Several approaches are being examined towards development of vaccines against T. solium, one of which is the application of recombinant oncosphere antigens. Two different oncosphere antigens, designated TSOL18 and TSOL45, have been evaluated, each of which has been shown to induce complete or near complete protection against experimental challenge infection in four separate vaccine trials in pigs. Investigations have begun towards characterising various aspects of this vaccine before undertaking controlled field trials. The TSOL18/TSOL45 vaccine has the potential to make a substantial contribution to the control and, potentially, the eradication of human neurocysticercosis.

Cerebral cysticercosis in a cat

The metacestode of Taenia solium, Cysticercus cellulosae, was recovered from the brain of a cat showing central nervous clinical signs ante mortem. This is the first record of cerebral cysticercosis in a cat in South Africa.

Human and porcine Taenia solium infection in rural north India

72 members of a pig farming community and 50 slaughtered pigs in Uttar Pradesh, India, were examined between November 2000 and June 2001 for Taenia solium infection. 27 of the human subjects (38%) had intestinal taeniasis and 7 (9.7%) had reported seizures. All 3 of the latter who were examined had neurocysticercosis. 13 of the pigs (26%) had cysticercosis. Such high prevalences indicate the need for detailed assessment of the disease burden in this community.

Granuloma formation and parasite disintegration in porcine cysticercosis: comparison with human neurocysticercosis

Taenia solium cysticerci infect human beings and pigs, causing cysticercosis. In this study the pig was used as a model to characterize the immune response against cysticerci, given the difficulties in analysing the developing immune response in infected human brains. Metacestodes in different stages of viability or degeneration were isolated from the brain, heart and skeletal muscle of naturally infected swine, and the adjacent tissue was examined histologically. The immune response elicited by the cysticerci was classified into four separate stages. In stage I the parasites were surrounded by a thin layer of collagen type I, and by stage II there was a sparse inflammatory infiltrate. In stage III, granuloma formation was evident, and by stage IV the parasite was surrounded by an eosinophil-rich infiltrate and its vesicular membrane had begun to degenerate. The final stage, IV, was detected mainly in the heart but not in the brain. The granulomatous reaction in swine resembled that described previously in human patients, but differed in the abundance of eosinophils, the relative paucity of plasma cells, and the discrete deposition of collagen. These differences were probably due to the fact that in pigs the immune response can be examined earlier than in human patients, in whom sampling is inevitably made at a more chronic stage.

Cerebral cysticercosis in a woodchuck (Marmota monax)

A juvenile woodchuck (Marmota monax) with vestibular signs was found in Woodbridge, Ontario (Canada) and later euthanized. At necropsy there was marked distortion of the right side of the skull, where a large, fluctuant, subcutaneous mass extended under the zygomatic arch and caudally from the right eye towards the right ear. The mass was multiloculated and contained a large number of tapeworm cysticerci, each about 1 to 2 mm in diameter. The third and lateral ventricles of the brain were dilated and contained large numbers of similar cysticerci. Based on the exogenous budding of cysts and the morphology of the scolex in each cyst, they were identified as cysticerci of Taenia crassiceps. This is the first report of cerebral cysticercosis in a woodchuck.

Surgical treatment of coenurosis (gid) in sheep

During the past six years 623 cases of coenurosis (gid) in sheep have been treated surgically. Cysts were removed successfully from 573 of them (92 per cent) and 517 (83 per cent) were able to return to their flocks, although 36 showed no clinical improvement In 37 cases, the cyst could not be localised, and postmortem examinations showed that in nine cases the cyst was in the brainstem, and in 28 cases it was in the cerebellum. Fifty-six cases deteriorated gradually after surgery and in these cases more than one cyst was found postmortem. Thirteen cases died during surgery.