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Jacquel L, Hoellinger B, Marzolf G, Stab A, Guffroy A. [Atypical alveolar echinococcosis with systemic involvement in a patient treated with dupilumab]. Rev Med Interne 2024:S0248-8663(24)00095-X. [PMID: 38760184 DOI: 10.1016/j.revmed.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Alveolar echinococcosis is an endemic parasitic disease prevalent in certain cold regions of the Northern Hemisphere, including Eastern France, Switzerland, Germany, Canada, and the United States. Widely underdiagnosed, it is associated with infection by Echinococcus multilocularis, a small tapeworm belonging to the cestode class, capable of causing multi-systemic involvement, particularly in elderly or immunocompromised patients. CASE REPORT We present the case of an 82-year-old patient, immunocompromised due to prolonged corticosteroid therapy and treatment with dupilumab. She was referred to our department for a diagnostic assessment of atypical hepatic and pulmonary lesions, initially suspected of tuberculosis or an IgG4-related disease. The hypothesis of alveolar echinococcosis caused by E. multilocularis was eventually considered based on a set of arguments, further confirmed by molecular diagnosis. We discuss the role of dupilumab in the systemic evolution and atypical presentation of the disease, through the induction of a specific immunosuppression. CONCLUSION Alveolar echinococcosis should be systematically considered in case of systemic disease with prominent hepatic and pulmonary involvement, especially in immunocompromised patients.
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Affiliation(s)
- L Jacquel
- Service de médecine interne et d'immunologie clinique, Centre national de référence pour les maladies auto-immunes et systémiques (CNR RESO), Centre de compétences pour les déficits immunitaires primitifs, hôpitaux universitaires de Strasbourg, Strasbourg, France.
| | - B Hoellinger
- Service des maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - G Marzolf
- Clinique dermatologique, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - A Stab
- Service de médecine interne et d'immunologie clinique, Centre national de référence pour les maladies auto-immunes et systémiques (CNR RESO), Centre de compétences pour les déficits immunitaires primitifs, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - A Guffroy
- Service de médecine interne et d'immunologie clinique, Centre national de référence pour les maladies auto-immunes et systémiques (CNR RESO), Centre de compétences pour les déficits immunitaires primitifs, hôpitaux universitaires de Strasbourg, Strasbourg, France
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An X, Xiang W, Liu X, Li S, Xu Z, He P, Ge RL, Tang F, Cheng Z, Liu C, Liu G. A Bioengineered Nanovesicle Vaccine Boosts T-B cell Interaction for Immunotherapy of Echinococcus multilocularis. Angew Chem Int Ed Engl 2024; 63:e202319489. [PMID: 38308123 DOI: 10.1002/anie.202319489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/22/2024] [Accepted: 02/01/2024] [Indexed: 02/04/2024]
Abstract
Alveolar echinococcosis (AE) is a zoonotic parasitic disease, resulting from being infected with the metacestode larvae of the tapeworm Echinococcus multilocularis (E. multilocularis). Novel prophylactic and therapeutic interventions are urgently needed since the current chemotherapy displays limited efficiency in AE treatment. Bioengineered nano cellular membrane vesicles are widely used for displaying the native conformational epitope peptides because of their unique structure and biocompatibility. In this study, four T-cells and four B-cells dominant epitope peptides of E. multilocularis with high immunogenicity were engineered into the Vero cell surface to construct a membrane vesicle nanovaccine for the treatment of AE. The results showed that the nanovesicle vaccine can efficiently activate dendritic cells, induce specific T/B cells to form a mutually activated circuit, and inhibit E. multilocularis infection. This study presents for the first time a nanovaccine strategy that can completely eliminate the burden of E. multilocularis.
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Affiliation(s)
- Xiaoyu An
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, 4221 Xianganan Road, Xiang 'an District, Xiamen, Fujian, China
- State Key Laboratory of Stress Biology and Fujian Provincial Key Laboratory of Innovative Drug Target Research, School of Pharmaceutical Sciences, Xiamen University, 4221 Xianganan Road, Xiang 'an District, Xiamen, Fujian, China
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, 4221 Xianganan Road, Xiang 'an District, Xiamen, Fujian, China
- Shenzhen Research Institute of Xiamen University, Xiamen University, R4-A600, Virtual University Park, 19 Gaoxin South Fourth Road, Nanshan District, Shenzhen
| | - Wei Xiang
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, 4221 Xianganan Road, Xiang 'an District, Xiamen, Fujian, China
| | - Xue Liu
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, 4221 Xianganan Road, Xiang 'an District, Xiamen, Fujian, China
| | - Shuo Li
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, 4221 Xianganan Road, Xiang 'an District, Xiamen, Fujian, China
- State Key Laboratory of Stress Biology and Fujian Provincial Key Laboratory of Innovative Drug Target Research, School of Pharmaceutical Sciences, Xiamen University, 4221 Xianganan Road, Xiang 'an District, Xiamen, Fujian, China
| | - Zhijian Xu
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, 4221 Xianganan Road, Xiang 'an District, Xiamen, Fujian, China
| | - Pan He
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, 4221 Xianganan Road, Xiang 'an District, Xiamen, Fujian, China
| | - Ri-Li Ge
- Research Center for High Altitude Medicine, Qinghai Provincial Research Key Laboratory for Hydatid, Qinghai University, 16 Kunlun Road, Xining, Qinghai, China
| | - Feng Tang
- Research Center for High Altitude Medicine, Qinghai Provincial Research Key Laboratory for Hydatid, Qinghai University, 16 Kunlun Road, Xining, Qinghai, China
| | - Zhe Cheng
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, 4221 Xianganan Road, Xiang 'an District, Xiamen, Fujian, China
| | - Chao Liu
- State Key Laboratory of Stress Biology and Fujian Provincial Key Laboratory of Innovative Drug Target Research, School of Pharmaceutical Sciences, Xiamen University, 4221 Xianganan Road, Xiang 'an District, Xiamen, Fujian, China
- Shenzhen Research Institute of Xiamen University, Xiamen University, R4-A600, Virtual University Park, 19 Gaoxin South Fourth Road, Nanshan District, Shenzhen
| | - Gang Liu
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, 4221 Xianganan Road, Xiang 'an District, Xiamen, Fujian, China
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, 4221 Xianganan Road, Xiang 'an District, Xiamen, Fujian, China
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Shafiei R, Mohajerzadeh MS, Masomi HFA, Tavakoli M, Turki H, Firouzeh N. Discordance Therapeutic Protocol of Cystic Echinococcosis With WHO Guideline: A Descriptive Study Based on Liver Ultra-Sonographic Data in North Khorasan Province, Northeastern of Iran. J Ultrasound Med 2024. [PMID: 38497687 DOI: 10.1002/jum.16452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Cystic echinococcosis (CE), a helminth-associated zoonosis caused by Echinococcus granulosus, poses a significant public health problem, particularly in pastoral-rearing regions. The lack of uniform guidelines led to variations in CE management. Based on ultrasound data, the World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) classification system categorizes cysts into active, transitional, and inactive groups. This study assesses whether the therapeutic approach from liver human operation cases in North Khorasan province aligns with the WHO-IWGE reference based on ultrasound data. METHODS The research is based on ultrasound data from liver CE human operation cases collected between 2018 and 2022. This retrospective study investigates the therapeutic protocol for (CE) in North Khorasan Province, Iran, comparing it with the WHO-IWGE guidelines. We collect data from previously registered patients' medical information from our studied area's main CE surgical hospital. Moreover, as the first hospitalized survey in Iran, this study reveals insights into patient demographics, cyst stage prevalence, and treatment modalities. RESULTS Notably, more than half of the patients were treated for CE1 stage cysts, and CE4 cases, which generally do not require surgery, underwent open surgery. The results suggest a need for adherence to the "watch-and-wait" approach in specific cases. All patients underwent successful surgeries, but we do not have access to follow-up data from patients after discharge. CONCLUSIONS This descriptive study contributes to understanding the implementation of WHO guidelines in a regional context, shedding light on the challenges and variations in CE management. It seems, retraining courses for surgeons are required to update their knowledge of standard CE diagnostic and treatment methods.
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Affiliation(s)
- Reza Shafiei
- Vector-Borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mina Sadat Mohajerzadeh
- Department of Radiology and Medical Physics, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | | | - Maryam Tavakoli
- Department of Radiology and Medical Physics, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Habibollah Turki
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Nima Firouzeh
- Vector-Borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Stefaniak M, Derda M, Zmora P, Nowak SP. Risk Factors and the Character of Clinical Course of the Echinococcus multilocularis Infection in Patients in Poland. Pathogens 2023; 12:pathogens12020199. [PMID: 36839470 PMCID: PMC9962699 DOI: 10.3390/pathogens12020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Alveolar echinococcosis (AE) is a chronic zoonotic disease caused by the larval form of Echinococcus multilocularis. In humans, it may become a serious chronic infection of the liver which resembles a slow malignant process leading to death when untreated. The aim of the study was an assessment of the risk factors of the E. multilocularis infections and the description of AE clinical course in the group of 36 patients with confirmed AE, hospitalized at the Department and Clinic of Tropical and Parasitic Diseases, Poznan University of Medical Sciences between 2013 and 2022. Among the study participants, most patients cultivated land, bred livestock, worked in the forest, or were employed in animal shelters. The E. multilocularis infection was diagnosed based on imaging and immunoassay techniques within 6 months in the majority of patients hospitalized in the Department. All patients hospitalized in the Department initiated anti-parasitic therapy at the moment of the diagnosis. Pharmacological treatment combined with surgery was applied in most of the study participants, who were presented with more advanced stages of infection. We conclude the following: 1. For humans in the risk group, regular abdominal imaging examinations and the detection of specific antibodies against E. multilocularis are recommended. 2. Regular screening tests in the hyperendemic areas of AE would increase the early detection of the disease and to improve the clinical prognosis in this extremely life-threatening parasitic disease.
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Affiliation(s)
- Magdalena Stefaniak
- Department of Biology and Medical Parasitology, Institute of Biostructural Basics of Medical Sciences, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Monika Derda
- Department of Biology and Medical Parasitology, Institute of Biostructural Basics of Medical Sciences, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Pawel Zmora
- Department of Molecular Virology, Institute of Bioorganic Chemistry Polish Academy of Sciences, 61-704 Poznan, Poland
| | - Szymon Pawel Nowak
- Department and Clinic of Tropical and Parasitic Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland
- Correspondence: ; Tel.: +48-61-869-13-63
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Tian W, Ji W, Li J, Liu W, Wen Z, Wu J. Feasibility analysis and study of an intrahepatic portal vein infection hepatic alveolar echinococcosis C57 mouse model. Front Vet Sci 2022; 9:994652. [PMID: 36590810 PMCID: PMC9799256 DOI: 10.3389/fvets.2022.994652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/25/2022] [Indexed: 12/16/2022] Open
Abstract
Objective The aim of the study was to establish and study an intrahepatic portal vein infection hepatic alveolar echinococcosis (HAE) C57 mouse model and provide a theoretical basis for clinical research on HAE. Methods C57 mice were used to establish the HAE mouse model. The location, size, morphology, appearance, and pathological changes in liver lesions in different groups of mice were characterized using ultrasound, magnetic resonance imaging (MRI), and haematoxylin and eosin staining. Results The mortality rate of the C57 mice was 20%, and the success rate of infection was 75%. The abdominal ultrasound images and MRIs clearly indicated the location, size, shape, and appearance of the liver lesions and the relationship between the lesions and the adjacent organs. The size, morphology, and signal of the livers in the control group were normal. The pathological results of the experimental group indicated a hepatic vesicular acinar cyst, while those of the control group exhibited normal livers. Conclusion The intrahepatic portal vein infection HAE mouse model was successfully established.
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Affiliation(s)
- Weili Tian
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Wenchao Ji
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Jun Li
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Wenya Liu
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China,*Correspondence: Wenya Liu
| | - Zhi Wen
- The Affiliated Tumour Hospital of Xinjiang Medical University, Ürümqi, China
| | - Juan Wu
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
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Chen L, Cheng Z, Xian S, Zhan B, Xu Z, Yan Y, Chen J, Wang Y, Zhao L. Immunization with EmCRT-Induced Protective Immunity against Echinococcus multilocularis Infection in BALB/c Mice. Trop Med Infect Dis 2022; 7:279. [PMID: 36288020 DOI: 10.3390/tropicalmed7100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Alveolar echinococcosis (AE) is a severe parasitic zoonosis caused by the larval stage of Echinococcus multilocularis. The identification of the antigens eliciting acquired immunity during infection is important for vaccine development against Echinococcus infection. Here, we identified that E. multilocularis calreticulin (EmCRT), a ubiquitous protein with a Ca2+-binding ability, could be recognized by the sera of mice infected with E. multilocularis. The native EmCRT was expressed on the surface of E. multilocularis larvae as well as in the secreted products of metacestode vesicles and protoscoleces (PSCs). The coding DNA for EmCRT was cloned from the mRNA of the E. multilocularis metacestode vesicles and a recombinant EmCRT protein (rEmCRT) was expressed in E. coli. Mice immunized with soluble rEmCRT formulated with Freund’s adjuvant (FA) produced a 43.16% larval vesicle weight reduction against the challenge of E. multilocularis PSCs compared to those that received the PBS control associated with a high titer of IgG, IgG1 and IgG2a antibody responses as well as high levels of Th1 cytokines (IFN-γ and IL-2) and Th2 cytokines (IL-4, IL-5 and IL-10), produced by splenocytes. Our results suggest that EmCRT is an immunodominant protein secreted by E. multilocularis larvae and a vaccine candidate that induces partial protective immunity in vaccinated mice against Echinococcus infection.
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Zhang T, Zhang Y, Yang Z, Jiang Y, Sun L, Huang D, Tian M, Shen Y, Deng J, Hou J, Ma Y. Echinococcus multilocularis protoscoleces enhance glycolysis to promote M2 Macrophages through PI3K/Akt/mTOR Signaling Pathway. Pathog Glob Health 2022; 117:409-416. [PMID: 35876088 PMCID: PMC10177676 DOI: 10.1080/20477724.2022.2104055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Alveolar Echinococcosis (AE) is a zoonotic parasitic disease caused by Echinococcus multilocularis, but its pathogenesis remains unclear. The primary objective of this study is to explore whether Echinococcus multilocularis protoscoleces (PSCs) regulate macrophage polarization and glucose metabolism by PI3K/Akt/mTOR signaling pathway. We found that large numbers of CD68+ macrophages gathered in close liver issue from the lesion in AE patients. PSCs preferentially differentiated into M2 macrophages and the expressions of HK1, PFKL, PKM2, PI3K, Akt, p-Akt, mTOR and p-mTOR increased. The above results show that Echinococcus multilocularis protoscoleces enhance glycolysis to promote M2 macrophages through PI3K/Akt/mTOR signaling pathway.
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Affiliation(s)
- Tao Zhang
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai province, China.,Key Laboratory of Application of High Altitude Medicine in Qinghai, Qinghai University, Xining, Qinghai province, China.,Department of Rehabilitation Medicine, Qinghai University Affiliated Hospital, Xining, Qinghai province, China
| | - Yaogang Zhang
- Central Laboratory of Qinghai University Affiliated Hospital, Qinghai University Affiliated Hospital, Xining, Qinghai province, China.,Qinghai Province Research Key Laboratory of Echinococcosis, Qinghai University Affiliated Hospital, Xining, Qinghai province, China
| | - Zihan Yang
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai province, China.,Key Laboratory of Application of High Altitude Medicine in Qinghai, Qinghai University, Xining, Qinghai province, China.,Department of Neurology, Qinghai University Affiliated Hospital, Xining, Qinghai province, China
| | - Yuan Jiang
- Central Laboratory of Qinghai University Affiliated Hospital, Qinghai University Affiliated Hospital, Xining, Qinghai province, China
| | - Li Sun
- Central Laboratory of Qinghai University Affiliated Hospital, Qinghai University Affiliated Hospital, Xining, Qinghai province, China
| | - Dengliang Huang
- Central Laboratory of Qinghai University Affiliated Hospital, Qinghai University Affiliated Hospital, Xining, Qinghai province, China
| | - Meiyuan Tian
- Central Laboratory of Qinghai University Affiliated Hospital, Qinghai University Affiliated Hospital, Xining, Qinghai province, China
| | - Yinhong Shen
- Department of Pediatrics, Qinghai University Affiliated Hospital, Xining, Qinghai province, China
| | - Jun Deng
- Department of Pediatrics, Qinghai University Affiliated Hospital, Xining, Qinghai province, China
| | - Jing Hou
- Central Laboratory of Qinghai University Affiliated Hospital, Qinghai University Affiliated Hospital, Xining, Qinghai province, China
| | - Yanyan Ma
- Central Laboratory of Qinghai University Affiliated Hospital, Qinghai University Affiliated Hospital, Xining, Qinghai province, China.,Qinghai Province Research Key Laboratory of Echinococcosis, Qinghai University Affiliated Hospital, Xining, Qinghai province, China.,Department of Pediatrics, Qinghai University Affiliated Hospital, Xining, Qinghai province, China
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Xiong X, Li J, Gao D, Sheng Z, Zheng H, Liu W. Cell-Membrane Biomimetic Indocyanine Green Liposomes for Phototheranostics of Echinococcosis. Biosensors (Basel) 2022; 12:bios12050311. [PMID: 35624612 PMCID: PMC9138668 DOI: 10.3390/bios12050311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 05/05/2023]
Abstract
Echinococcosis is an important zoonotic infectious disease that seriously affects human health. Conventional diagnosis of echinococcosis relies on the application of large-scale imaging equipment, which is difficult to promote in remote areas. Meanwhile, surgery and chemotherapy for echinococcosis can cause serious trauma and side effects. Thus, the development of simple and effective treatment strategies is of great significance for the diagnosis and treatment of echinococcosis. Herein, we designed a phototheranostic system utilizing neutrophil-membrane-camouflaged indocyanine green liposomes (Lipo-ICG) for active targeting the near-infrared fluorescence diagnosis and photothermal therapy of echinococcosis. The biomimetic Lipo-ICG exhibits a remarkable photo-to-heat converting performance and desirable active-targeting features by the inflammatory chemotaxis of the neutrophil membrane. In-vitro and in-vivo studies reveal that biomimetic Lipo-ICG with high biocompatibility can achieve in-vivo near-infrared fluorescence imaging and phototherapy of echinococcosis in mouse models. Our research is the first to apply bionanomaterials to the phototherapy of echinococcosis, which provides a new standard for the convenient and noninvasive detection and treatment of zoonotic diseases.
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Affiliation(s)
- Xinxin Xiong
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China; (X.X.); (J.L.)
| | - Jun Li
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China; (X.X.); (J.L.)
| | - Duyang Gao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China; (D.G.); (Z.S.); (H.Z.)
| | - Zonghai Sheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China; (D.G.); (Z.S.); (H.Z.)
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China; (D.G.); (Z.S.); (H.Z.)
| | - Wenya Liu
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China; (X.X.); (J.L.)
- Correspondence:
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Eberhardt N, Peters L, Kapp-Schwoerer S, Beer M, Beer AJ, Grüner B, Thaiss WM. 18F-FDG-PET/MR in Alveolar Echinococcosis: Multiparametric Imaging in a Real-World Setting. Pathogens 2022; 11. [PMID: 35335672 DOI: 10.3390/pathogens11030348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023] Open
Abstract
Recent improvements in alveolar echinococcosis (AE) therapy can provide long-term disease control, and even allow structured treatment interruption in selected cases. Imaging has a pivotal role in monitoring disease activity, with 18-fluoro-deoxyglucose positron emission and computed tomography (18F-FDG-PET/CT) in particular having proven beneficial for assessing disease activity. Repetitive regular examinations to monitor therapy response, however, can lead to substantial radiation burden. Therefore, by combining metabolic information and excellent tissue contrast in magnetic resonance imaging (MRI), PET/MR appears ideally suited for this task. Here, we retrospectively analyzed 51 AE patients that underwent 18F-FDG-PET/MR. Patients had a ‘confirmed/probable’ diagnosis in 22/29 cases according to the WHO classification. FDG uptake, diffusion restriction, and MRI morphology were evaluated. We found significant differences in FDG uptake between responders to benzimidazole therapy and progressive manifestations (SUVavg 2.7 ± 1.3 vs. 5.4 ± 2.2, p < 0.001) as well as between Kodama Types 1 and 3 (F = 9.9, p < 0.003). No significant differences were detected for ADC values or MRI morphology concerning response and no correlations were present between FDG uptake and ADC values. The mean radiation dose was 5.9−6.5 mSv. We conclude that the combination of metabolic information and MRI morphology at a low radiation dose proposes PET/MR as a suitable imaging modality for AE assessment. Longitudinal studies are needed to define the role of this imaging modality.
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Hotz JF, Peters L, Kapp-Schwörer S, Theis F, Eberhardt N, Essig A, Grüner B, Hagemann JB. Evaluation of Serological Markers in Alveolar Echinococcosis Emphasizing the Correlation of PET-CTI Tracer Uptake with RecEm18 and Echinococcus-Specific IgG. Pathogens 2022; 11:pathogens11020239. [PMID: 35215182 PMCID: PMC8880252 DOI: 10.3390/pathogens11020239] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 02/05/2023] Open
Abstract
Human alveolar echinococcosis (AE), which is caused by the cestode Echinococcus (E.) multilocularis, is an epidemiologically relevant issue in modern medicine and still poses a diagnostic and therapeutic challenge. Since diagnosis mainly relies on imaging procedures and serological testing, we retrospectively and comparatively analyzed the performance of an Echinococcus IgG screening ELISA, whole serum IgE, and two specific confirmatory ELISA platforms using the defined E. multilocularis antigens Em2-Em18 (Em2+) and recombinant Em18 (recEm18). With special emphasis on the clinical usefulness of recEm18, we correlated the laboratory results with clinical characteristics and imaging findings in a large and well-characterized cohort of N = 124 AE patients, who were followed over several years after either surgical plus subsequent pharmacological treatment or pharmacotherapy alone. All patients had routinely received PET-CTI every two years. Our data reveal strong correlations for both Echinococcus IgG and recEm18 with tracer uptake in PET-CTI and parasitic lesion size and number, suggesting additional clinical usefulness of recEm18 for certain constellations only, while IgG and Em2+ still appear reasonable and sensitive screening methods for initial diagnosis of AE. With this study, we aim to contribute to further optimizing medical care of AE patients. For instance, it might be reasonable to consider the replacement of some PET-CTI follow-ups by imaging procedures with less radiation exposure or serological means alone. Further studies that clarify the correlation of serological markers with ultrasound criteria might be particularly useful, and further retrospective as well as prospective investigations are justified in this context.
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Affiliation(s)
- Julian Frederic Hotz
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, A-1090 Vienna, Austria
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
- Correspondence: (J.F.H.); (B.G.); (J.B.H.)
| | - Lynn Peters
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
| | - Silke Kapp-Schwörer
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
| | - Frauke Theis
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
| | - Nina Eberhardt
- Department of Nuclear Medicine, Ulm University Hospital, D-89081 Ulm, Germany;
| | - Andreas Essig
- Institute of Medical Microbiology and Hygiene, Ulm University Hospital, D-89081 Ulm, Germany;
| | - Beate Grüner
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
- Correspondence: (J.F.H.); (B.G.); (J.B.H.)
| | - Jürgen Benjamin Hagemann
- Institute of Medical Microbiology and Hygiene, Ulm University Hospital, D-89081 Ulm, Germany;
- Correspondence: (J.F.H.); (B.G.); (J.B.H.)
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Schuhbaur J, Schweizer M, Philipp J, Schmidberger J, Schlingeloff P, Kratzer W. Long-term follow-up of liver alveolar echinococcosis using echinococcosis multilocularis ultrasound classification. World J Gastroenterol 2021; 27:6939-6950. [PMID: 34790016 PMCID: PMC8567478 DOI: 10.3748/wjg.v27.i40.6939] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/01/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND When Echinococcus multilocularis infects humans as a false intermediate host, alveolar echinococcosis (AE) usually manifests primarily intrahepatically and is initially asymptomatic. If the disease remains undiagnosed and untreated, progressive growth occurs, reminiscent of malignant tumours. The only curative therapy is complete resection, which is limited to localised stages, and palliative drug therapy is used otherwise. Consequently, early diagnosis and reliable detection of AE lesions are important. For this reason, abdominal ultrasonography, as the most common primary imaging for AE, relies on classification systems.
AIM To investigate how hepatic AE lesion sonomorphology changes over time in the Echinococcosis Multilocularis Ulm Classification (EMUC)-ultrasound (US) classification.
METHODS Based on data from Germany’s national echinococcosis database, we evaluated clinical and US imaging data for 59 patients according to the AE case definition in our preliminary retrospective longitudinal study. There had to be at least two liver sonographies ≥ 6 mo apart, ≥ 1 hepatic AE lesion, and complete documentation in all US examinations. The minimum interval between two separately evaluated US examinations was 4 wk. The AE reference lesion was the largest hepatic AE lesion at the time of the first US examination. To classify the sonomorphologic pattern, we used EMUC-US. In addition to classifying the findings of the original US examiner, all reference lesions at each examination time point were assigned EMUC-US patterns in a blinded fashion by two investigators experienced in US diagnosis. Statistical analysis was performed using SAS version 9.4 (SAS Institute Inc., Cary, NC, United Stated). P values < 0.05 were considered statistically significant.
RESULTS The preliminary study included 59 patients, 38 (64.5%) women and 21 (35.6%) men. The mean age at initial diagnosis was 59.9 ± 16.9 years. At the time of initial ultrasonography, a hailstorm pattern was present in 42.4% (25/59) of cases, a hemangioma-like pattern in 16.9% (10/59), a pseudocystic pattern in 15.3% (9/59), and a metastasis-like pattern in 25.4% (15/59). For the hailstorm pattern, the average lesion size was 67.4 ± 26.3 mm. The average lesion size was 113.7 ± 40.8 mm with the pseudocystic pattern and 83.5 ± 27.3 mm with the hemangioma-like pattern. An average lesion size of 21.7 ± 11.0 mm was determined for the metastasis-like pattern. Although the sonomorphologic pattern remained unchanged in 84.7% (50/59) of AE reference lesions, 15.3% (9/59) showed a change over time. A change in pattern was seen exclusively for AE lesions initially classified as hemangioma-like or pseudocystic. A total of 70% (7/10) of AE lesions initially classified as hemangioma-like showed a relevant change in pattern over time, and 85.7% (6/7) of these were secondarily classified as having a hailstorm pattern, with the remainder (1/7; 14.3%) classified as having a pseudocystic pattern. A total of 22.2% (2/9) of AE lesions initially classified as pseudocystic showed a relevant change in pattern over time and were classified as having a hailstorm pattern. For AE lesions initially classified as having a hailstorm or metastatic pattern, no pattern change was evident. All patients with pattern change were on continuous drug therapy with albendazole.
CONCLUSION The sonomorphology of hepatic AE lesions may change over time. The hemangioma-like and pseudocystic patterns are affected.
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Affiliation(s)
- Jasmin Schuhbaur
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
| | - Melissa Schweizer
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
| | - Jana Philipp
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
| | - Julian Schmidberger
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
| | | | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
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