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Jamil Al-Obaidi MM, Desa MNM. Understanding the mechanisms underlying the disruption of the blood-brain barrier in parasitic infections. J Neurosci Res 2024; 102. [PMID: 38284852 DOI: 10.1002/jnr.25288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/16/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
Parasites have a significant impact on the neurological, cognitive, and mental well-being of humans, with a global population of over 1 billion individuals affected. The pathogenesis of central nervous system (CNS) injury in parasitic diseases remains limited, and prevention and control of parasitic CNS infections remain significant areas of research. Parasites, encompassing both unicellular and multicellular organisms, have intricate life cycles and possess the ability to infect a diverse range of hosts, including the human population. Parasitic illnesses that impact the central and peripheral nervous systems are a significant contributor to morbidity and mortality in low- to middle-income nations. The precise pathways through which neurotropic parasites infiltrate the CNS by crossing the blood-brain barrier (BBB) and cause neurological harm remain incompletely understood. Investigating brain infections caused by parasites is closely linked to studying neuroinflammation and cerebral impairment. The exact molecular and cellular mechanisms involved in this process remain incomplete, but understanding the exact mechanisms could provide insight into their pathogenesis and potentially reveal novel therapeutic targets. This review paper explores the underlying mechanisms involved in the development of neurological disorders caused by parasites, including parasite-derived elements, host immune responses, and modifications in tight junctions (TJs) proteins.
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Affiliation(s)
- Mazen M Jamil Al-Obaidi
- University of Technology and Applied Sciences, Rustaq College of Education, Science Department (Biology Unit), Rrustaq, Sultante of Oman
| | - Mohd Nasir Mohd Desa
- Department of Biomedical Sciences, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Buque H, Vaz D, Lorenzo E, Tané S, Sidat M, Nzwalo H. Severe neurocysticercosis in a quaternary hospital from Mozambique: Case series analysis. Clin Neurol Neurosurg 2023; 233:107913. [PMID: 37544023 DOI: 10.1016/j.clineuro.2023.107913] [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: 06/13/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Neurocysticercosis (NCC) is severe and leading global cause of morbidity and mortality. The disease presents with a variety of clinical presentations from focal to diffuse neurological symptoms. Despite being an endemic country, there are no studies describing the clinico-epidemiological characteristics of NCC in Mozambique. Herein, we describe a consecutive cases series of NCC from the national reference Hospital in Maputo, capital of Mozambique. METHODS Consecutive cases of NCC diagnosed during a 3-year period (January/2020-December/2022) were retrieved from the institutional clinical files and imaging database. RESULTS Six cases of NCC were identified, with mean age of 43.1 years (range 26-66). Four were males (66.6 %). The median time from the beginning of clinical manifestations to the diagnosis was 6 months (range 3-18 months). All patients presented with severe parenchymal NCC, with seizures (n = 5, 83 %) being the most common manifestation. Other clinical manifestations were dementia (n = 1) and hydrocephalus (n = 1). The imaging showed multiple lesions at different stages, with half (n = 3) of them showing the coexistence of nodular calcified lesions at earlier stages (vesicular, colloidal and granular stages). Patients were treated with anthelminthic drugs, corticosteroids and anticonvulsants and no deaths to report. The 3rd month modified Rankin scale was ≤ 2 in 83 % of patients. CONCLUSION In our case series, patients with NCC presented very late, with severe advanced stage disease, with multiple coexistent short and long-term brain lesions. These findings can be explained eventually because of the Maputo Central Hospital being national referral center receiving commonly more severe cases. Studies aiming to clarify the diagnosis pathways/barriers and NCC awareness among medical doctors working at primary and secondary health care level is mandatory to assess the real burden of NCC and implement timely diagnosis and care of patients affected by this neglected disease.
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Affiliation(s)
- Helena Buque
- Neurological Department, Central Hospital of Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Mozambique; Faculty of Medicine and Biomedical Sciences, University of Algarve, Portugal
| | - Deise Vaz
- Neurological Department, Central Hospital of Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Mozambique; Faculty of Medicine and Biomedical Sciences, University of Algarve, Portugal
| | - Elder Lorenzo
- Neurological Department, Central Hospital of Maputo, Mozambique
| | - Suraia Tané
- Radiology Department, Central Hospital of Maputo, Mozambique
| | - Mohsin Sidat
- Faculty of Medicine, Eduardo Mondlane University, Mozambique
| | - Hipólito Nzwalo
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Portugal; Algarve Biomedical Center Research Institute, Portugal.
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Moreira CAA, Murayama LHV, Martins TDC, Oliveira VT, Generoso D, Machado VMDV, Batah SS, Fabro AT, Bazan R, Zanini MA, Sciutto E, Fleury A, Hamamoto Filho PT. Sexual dimorphism in the murine model of extraparenchymal neurocysticercosis. Parasitol Res 2023; 122:2147-2154. [PMID: 37428312 DOI: 10.1007/s00436-023-07913-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
Neurocysticercosis is a heterogeneous disease, and the patient's sex seems to play a role in this heterogeneity. Hosts' sexual dimorphism in cysticercosis has been largely explored in the murine model of intraperitoneal Taenia crassiceps cysticercosis. In this study, we investigated the sexual dimorphism of inflammatory responses in a rat model of extraparenchymal neurocysticercosis caused by T. crassiceps. T. crassiceps cysticerci were inoculated in the subarachnoid space of Wistar rats (25 females, 22 males). Ninety days later, the rats were euthanized for histologic, immunohistochemistry, and cytokines studies. Ten animals also underwent a 7-T magnetic resonance imaging (MRI). Female rats presented a higher concentration of immune cells in the arachnoid-brain interface, reactive astrogliosis in the periventricular region, in situ pro-inflammatory cytokine (interleukin [IL]-6) and anti-inflammatory cytokine (IL-10), and more intense hydrocephalus on MRI than males. Intracranial hypertension signals were not observed during the observational period. Overall, these results suggest sexual dimorphism in the intracranial inflammatory response that accompanied T. crassiceps extraparenchymal neurocysticercosis.
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Affiliation(s)
- Carlos Alexandre Aguiar Moreira
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School. UNESP - São Paulo State University, Distrito de Rubião Jr, s/n, CEP 18606-986, Botucatu, São Paulo, Brazil
| | - Luis Henrique Vallesquino Murayama
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School. UNESP - São Paulo State University, Distrito de Rubião Jr, s/n, CEP 18606-986, Botucatu, São Paulo, Brazil
| | - Tatiane de Camargo Martins
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School. UNESP - São Paulo State University, Distrito de Rubião Jr, s/n, CEP 18606-986, Botucatu, São Paulo, Brazil
| | - Vinicius Tadeu Oliveira
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School. UNESP - São Paulo State University, Distrito de Rubião Jr, s/n, CEP 18606-986, Botucatu, São Paulo, Brazil
| | - Diego Generoso
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School. UNESP - São Paulo State University, Distrito de Rubião Jr, s/n, CEP 18606-986, Botucatu, São Paulo, Brazil
| | | | | | | | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School. UNESP - São Paulo State University, Distrito de Rubião Jr, s/n, CEP 18606-986, Botucatu, São Paulo, Brazil
| | - Marco Antônio Zanini
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School. UNESP - São Paulo State University, Distrito de Rubião Jr, s/n, CEP 18606-986, Botucatu, São Paulo, Brazil
| | - Edda Sciutto
- Institute of Biomedical Investigations, UNAM - National Autonomous University of Mexico, Mexico City, Mexico
| | - Agnès Fleury
- Institute of Biomedical Investigations, UNAM - National Autonomous University of Mexico, Mexico City, Mexico
- Instituto Nacional de Neurología y Neurocirurgía, Mexico City, Mexico
| | - Pedro Tadao Hamamoto Filho
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School. UNESP - São Paulo State University, Distrito de Rubião Jr, s/n, CEP 18606-986, Botucatu, São Paulo, Brazil.
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Harrison S, Thumm L, Nash TE, Nutman TB, O'Connell EM. The Local Inflammatory Profile and Predictors of Treatment Success in Subarachnoid Neurocysticercosis. Clin Infect Dis 2021; 72:e326-e333. [PMID: 33269789 DOI: 10.1093/cid/ciaa1128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Subarachnoid neurocysticercosis (SANCC) represents the most severe and difficult to treat form of neurocysticercosis. The inflammatory response contributes significantly to the morbidity and mortality of the disease. This study sought to understand the nature and evolution of the inflammation associated with SANCC, and evaluate for predictors of time to cure. METHODS There were 16 subjects with SANCC (basilar cistern, sylvian fissure, and/or spinal involvement) during active infection who had cerebrospinal fluid (CSF) cytokine and chemokine profiling, of whom 9 had a second CSF sample at (or following) the time of cure. The relationships between clinical parameters and cytokine/chemokine results were assessed. RESULTS Compared to pools of healthy donor CSF, those with active SANCC showed a significant (P < .05) increase in chemokines and cytokines associated with Type 1 immunity (interferon [IFN] γ, interleukin [IL] 12p70, C-X-C Motif Ligand 10 CXCL-10); Type 2 immunity (IL-10, IL-13); IFNα2; and the chemokines Macrophage inflammatory protein MIP-1α/CCL3, MIP-1ß/CCL4, and Vascular Endothelial Growth Factor VEGF that appears to be locally (central nervous system [CNS]) produced. Compared to those with active disease, those with CSF taken at the time of cure showed a significant decrease in most of these chemokines and cytokines. Despite this, CSF from cured SANCC patients had levels of IL-10 (P = .039), CXCL-10 (P = .039), and IL-12p70 (P = .044) above those seen in CSF from uninfected subjects. High ratios of IL-12p70/IL-10 early in infections were associated with a shorter time to cure (r = -0.559; P = .027), and a high Taenia solium burden (by quantitative polymerase chain reaction) was associated with longer times to cure (r = 0.84; P = .003). CONCLUSIONS SANCC is associated with a marked, CNS-localized cytokine-/chemokine-driven inflammatory response that largely decreases with curative therapy, though some analytes persisted above the normal range. The relative balance between proinflammatory and regulatory cytokines may be an important determinant for a cure in SANCC.
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Affiliation(s)
- Sarah Harrison
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Lauren Thumm
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Theodore E Nash
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Elise M O'Connell
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
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Abstract
Taenia solium cysticercosis and taeniasis (TSCT), caused by the tapeworm T. solium, is a foodborne and zoonotic disease classified since 2010 by WHO as a neglected tropical isease. It causes considerable impact on health and economy and is one of the leading causes of acquired epilepsy in most endemic countries of Latin America, Sub-Saharan Africa, and Asia. There is some evidence that the prevalence of TSCT in high-income countries has recently increased, mainly due to immigration from endemic areas. In regions endemic for TSCT, human cysticercosis can manifest clinically as neurocysticercosis (NCC), resulting in epileptic seizures and severe progressive headaches, amongst other neurological signs and/or symptoms. The development of these symptoms results from a complex interplay between anatomical cyst localization, environmental factors, parasite's infective potential, host genetics, and, especially, host immune responses. Treatment of individuals with active NCC (presence of viable cerebral cysts) with anthelmintic drugs together with steroids is usually effective and, in the majority, reduces the number and/or size of cerebral lesions as well as the neurological symptoms. However, in some cases, treatment may profoundly enhance anthelmintic inflammatory responses with ensuing symptoms, which, otherwise, would have remained silent as long as the cysts are viable. This intriguing silencing process is not yet fully understood but may involve active modulation of host responses by cyst-derived immunomodulatory components released directly into the surrounding brain tissue or by the induction of regulatory networks including regulatory T cells (Treg) or regulatory B cells (Breg). These processes might be disturbed once the cysts undergo treatment-induced apoptosis and necrosis or in a coinfection setting such as HIV. Herein, we review the current literature regarding the immunology and pathogenesis of NCC with a highlight on the mobilization of immune cells during human NCC and their interaction with viable and degenerating cysticerci. Moreover, the immunological parameters associated with NCC in people living with HIV/AIDS and treatments are discussed. Eventually, we propose open questions to understand the role of the immune system and its impact in this intriguing host-parasite crosstalk.
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Association of TRAF1/C5 Locus Polymorphisms with Epilepsy and Clinical Traits in Mexican Patients with Neurocysticercosis. Infect Immun 2019; 87:IAI.00347-19. [PMID: 31570557 DOI: 10.1128/iai.00347-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/20/2019] [Indexed: 02/04/2023] Open
Abstract
Neurocysticercosis is caused by the establishment of Taenia solium cysts in the central nervous system. Murine cysticercosis by Taenia crassiceps is a useful model of cysticercosis in which the complement component 5 (C5) has been linked to infection resistance/permissiveness. This work aimed to study the possible relevance for human neurocysticercosis of single nucleotide polymorphisms (SNPs) in the C5-TRAF1 region (rs17611 C/T, rs992670 G/A, rs25681 G/A, rs10818488 A/G, and rs3761847 G/A) in a Mexican population and associated with clinical and radiological traits related to neurocysticercosis severity (cell count in the cerebrospinal fluid [CSF cellularity], parasite location and parasite load in the brain, parasite degenerating stage, and epilepsy). The AG genotype of the rs3761847 SNP showed a tendency to associate with multiple brain parasites, while the CT and GG genotypes of the rs17611 and rs3761847 SNPs, respectively, showed a tendency to associate with low CSF cellularity. The rs3761847 SNP was associated with epilepsy under a dominant model, whereas rs10818488 was associated with CSF cellularity and parasite load under dominant and recessive models, respectively. For haplotypes, C5- and the TRAF1-associated SNPs were, respectively, in strong linkage disequilibrium with each other; thus, these haplotypes were studied independently. For C5 SNPs, carrying the CAA haplotype increases the risk of showing high CSF cellularity 3-fold and the risk of having extraparenchymal parasites 4-fold, two conditions that are related to severe disease. For TRAF1 SNPs, the GA and AG haplotypes were associated with CSF cellularity, and the AG haplotype was associated with epilepsy. Overall, these findings support the clear participation of C5 and TRAF1 in the risk of developing severe neurocysticercosis in the Mexican population.
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Veloz A, Reyes-Vázquez L, Patricio-Gómez JM, Romano MC. Effect of mice Taenia crassiceps WFU cysticerci infection on the ovarian folliculogenesis, enzyme expression, and serum estradiol. Exp Parasitol 2019; 207:107778. [PMID: 31629698 DOI: 10.1016/j.exppara.2019.107778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/13/2019] [Accepted: 10/14/2019] [Indexed: 11/30/2022]
Abstract
The murine infection with Taenia crassiceps WFU (T. crassiceps WFU) cysticerci has been widely used as an experimental model to better understand human cysticercosis. Several reports have established that the host hormonal environment determines the susceptibility and severity of many parasite infections. Female mice are more susceptible to infection with T. crassiceps cysticerci suggesting that a rich estrogen environment facilitates their reproduction. Ovarian androgens and estrogens are synthesized by key enzymes as P450-aromatase and 17α-hydroxilase/17, 20 lyase (P450C17). The aim of this study was to determine the effect of chronic intraperitoneal infection of T. crassiceps WFU cysticerci on mice ovarian follicular development, ovulation, the expression of ovarian P450-aromatase and P450C17, and serum 17β-estradiol, key enzymes of the ovarian steroidogenic pathway. To perform this study ovaries and serum were obtained at two, four and six months from T. crassiceps WFU cysticerci infected mice, and compared to those of healthy animals. The ovaries were fixed and processed for histology or lysed in RIPA buffer for Western blot using specific antibodies for P450C17 and P450-aromatase. 17β-estradiol serum concentration was measured by ELISA. The results showed that the infection with T. crassiceps WFU cysticerci significantly reduced the number of primordial and primary follicles after two months of infection. Through the course of the study, the corpus luteum number began to decrease, whereas atretic follicles increased. The expression of ovarian P450C17 and P450-aromatase as well as serum E2 concentration were significantly increased in the infected group compared to control. These findings show that chronic infection with Taenia crassiceps WFU may alter the reproductive functions of the female mice host.
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Affiliation(s)
- A Veloz
- Departamento de Fisiología, Biofísica y Neurociencias, CINVESTAV del I.P.N, México CdMx, Mexico
| | - Liliana Reyes-Vázquez
- Departamento de Fisiología, Biofísica y Neurociencias, CINVESTAV del I.P.N, México CdMx, Mexico; Departamento de Toxicología, CINVESTAV del I.P.N., CdMx, Mexico
| | - J M Patricio-Gómez
- Departamento de Fisiología, Biofísica y Neurociencias, CINVESTAV del I.P.N, México CdMx, Mexico
| | - M C Romano
- Departamento de Fisiología, Biofísica y Neurociencias, CINVESTAV del I.P.N, México CdMx, Mexico.
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Vieira E, Faquini IV, Silva JL, Griz MFL, Cezar AB, Almeida NS, Azevedo-Filho HRC. Subarachnoid neurocysticercosis and an intracranial infectious aneurysm: case report. Neurosurg Focus 2019; 47:E16. [DOI: 10.3171/2019.5.focus19280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/21/2019] [Indexed: 11/06/2022]
Abstract
Infectious intracranial aneurysms (IIAs) represent 2%–6% of all intracranial aneurysms and, classically, have been associated with bacterial or fungal agents. The authors report the case of a 42-year-old woman who presented with a typical history of subarachnoid hemorrhage. Digital subtraction angiography (DSA) showed an aneurysmal dilatation on the frontal M2 segment of the left middle cerebral artery (MCA). The patient was treated surgically, and multiple cysts were found in the left carotid and sylvian cisterns, associated with a dense inflammatory exudate that involved the MCA. The cysts were removed, and a fusiform aneurysmal dilatation was identified. The lesion was not amenable to direct clipping, so the authors wrapped it. Histopathological analysis of the removed cysts revealed the typical pattern of subarachnoid neurocysticercosis. The patient received cysticidal therapy with albendazole and corticosteroids, and she recovered uneventfully. Follow-up DSA performed 6 months after surgery showed complete resolution of the aneurysm. The authors performed a review of the literature and believe that there is sufficient evidence to affirm that the subarachnoid form of neurocysticercosis may lead to the development of an IIA and that Taenia solium should be listed among the possible etiological agents of IIAs, along with bacterial and fungal agents.
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Hydrocephalus in Neurocysticercosis: Challenges for Clinical Practice and Basic Research Perspectives. World Neurosurg 2019; 126:264-271. [DOI: 10.1016/j.wneu.2019.03.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 11/19/2022]
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Toledo A, Osorio R, Matus C, Martinez Lopez Y, Ramirez Cruz N, Sciutto E, Fragoso G, Arauz A, Carrillo-Mezo R, Fleury A. Human Extraparenchymal Neurocysticercosis: The Control of Inflammation Favors the Host…but Also the Parasite. Front Immunol 2018; 9:2652. [PMID: 30505305 PMCID: PMC6250850 DOI: 10.3389/fimmu.2018.02652] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/26/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Andrea Toledo
- Unidad de Neuroinflamación, Instituto de Investigaciones Biomédicas, UNAM/ Facultad de Medicina UNAM / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Rocio Osorio
- Unidad de Neuroinflamación, Instituto de Investigaciones Biomédicas, UNAM/ Facultad de Medicina UNAM / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Carlos Matus
- Unidad de Neuroinflamación, Instituto de Investigaciones Biomédicas, UNAM/ Facultad de Medicina UNAM / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Yazmin Martinez Lopez
- Unidad de Neuroinflamación, Instituto de Investigaciones Biomédicas, UNAM/ Facultad de Medicina UNAM / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Nancy Ramirez Cruz
- Unidad de Neuroinflamación, Instituto de Investigaciones Biomédicas, UNAM/ Facultad de Medicina UNAM / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Edda Sciutto
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, UNAM, Ciudad de México, Mexico
| | - Gladis Fragoso
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, UNAM, Ciudad de México, Mexico
| | - Antonio Arauz
- Clínica de Enfermedad Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Roger Carrillo-Mezo
- Departamento de Neurorradiología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Agnès Fleury
- Unidad de Neuroinflamación, Instituto de Investigaciones Biomédicas, UNAM/ Facultad de Medicina UNAM / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico.,Clínica de Neurocisticercosis, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
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Recent Advances in the Diagnosis of Neurocysticercosis. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018. [DOI: 10.1007/s40506-018-0173-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Fleury A, Alaez C, Dessein A, Rosetti M, Saenz B, Hernández M, Bobes RJ, Ramírez-Aquino R, Sciutto E, Gorodezky C, Fragoso G. No association of IL2, IL4, IL6, TNF, and IFNG gene polymorphisms was found with Taenia solium human infection or neurocysticercosis severity in a family-based study. Hum Immunol 2018; 79:578-582. [PMID: 29684412 DOI: 10.1016/j.humimm.2018.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/19/2022]
Abstract
Neurocysticercosis (NC) is caused by the establishment of the metacestode stage of Taenia solium in the human central nervous system. A great heterogeneity in the susceptibility to the infection and to the disease has been reported. While the factors involved in this heterogeneity are not completely understood, clearly different immune-inflammatory profiles have been associated to each condition. This study evaluated the association of cytokine single nucleotide polymorphisms (SNPs) with susceptibility to infection and disease severity in NC patients. Blood samples from 92 NC cases and their parents (trios) were genotyped for SNPs in five cytokines relevant for the immune response: IL4 (-589C/T), IL6 (-174C/G), IFNG (+874T/A), TNF (-238G/A), and IL2 (-330G/T). Specific DNA fragments were amplified by the polymerase chain reaction, using the 5'-nuclease Taqman assay on a 7500 platform, allowing the detection of the polymorphism genotypes. No association between the polymorphisms evaluated neither with susceptibility to infection nor with disease severity was found, although previous studies reported variations in the levels of these cytokines among different NC clinical pictures. These results, nevertheless, add new elements to our understanding of the complex pathogenic mechanisms involved in susceptibility to infection by T. solium cysticerci and the severity of the ensuing disease.
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Affiliation(s)
- A Fleury
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; Unidad Periférica del Instituto de Investigaciones Biomédicas en el Instituto Nacional de Neurología y Neurocirugía, Mexico.
| | - C Alaez
- Dept of Immunology & Immunogenetics, Instituto de Diagnóstico y Referencia Epidemiológicos-InDRE, Secretaria de Salud, Ciudad de México, Mexico; Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica, Ciudad de México, Mexico.
| | - A Dessein
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR906, GIMP, Labex ParaFrap, Aix-Marseille Université, 13005 Marseille, France.
| | - M Rosetti
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico.
| | - B Saenz
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
| | - M Hernández
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
| | - R J Bobes
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico.
| | - R Ramírez-Aquino
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
| | - E Sciutto
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico.
| | - C Gorodezky
- Dept of Immunology & Immunogenetics, Instituto de Diagnóstico y Referencia Epidemiológicos-InDRE, Secretaria de Salud, Ciudad de México, Mexico.
| | - G Fragoso
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico.
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Souza AJ, Milhomem AC, Rezende HH, Matos-Silva H, Vinaud MC, Oliveira MA, Castro AM, Lino-Júnior RS. Taenia crassiceps antigens induce a Th2 immune response and attenuate injuries experimentally induced by neurotoxoplasmosis in BALB/c mice. Parasitol Int 2018; 67:16-22. [DOI: 10.1016/j.parint.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 01/04/2023]
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Understanding host-parasite relationship: the immune central nervous system microenvironment and its effect on brain infections. Parasitology 2017; 145:988-999. [PMID: 29231805 DOI: 10.1017/s0031182017002189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The central nervous system (CNS) has been recognized as an immunologically specialized microenvironment, where immune surveillance takes a distinctive character, and where delicate neuronal networks are sustained by anti-inflammatory factors that maintain local homeostasis. However, when a foreign agent such as a parasite establishes in the CNS, a set of immune defences is mounted and several immune molecules are released to promote an array of responses, which ultimately would control the infection and associated damage. Instead, a host-parasite relationship is established, in the context of which a close biochemical coevolution and communication at all organization levels between two complex organisms have developed. The ability of the parasite to establish in its host is associated with several evasion mechanisms to the immune response and its capacity for exploiting host-derived molecules. In this context, the CNS is deeply involved in modulating immune functions, either protective or pathogenic, and possibly in parasitic activity as well, via interactions with evolutionarily conserved molecules such as growth factors, neuropeptides and hormones. This review presents available evidence on some examples of CNS parasitic infections inducing different morbi-mortality grades in low- or middle-income countries, to illustrate how the CNS microenvironment affect pathogen establishment, growth, survival and reproduction in immunocompetent hosts. A better understanding of the influence of the CNS microenvironment on neuroinfections may provide relevant insights into the mechanisms underlying these pathologies.
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TNF-α blockade suppresses pericystic inflammation following anthelmintic treatment in porcine neurocysticercosis. PLoS Negl Trop Dis 2017; 11:e0006059. [PMID: 29190292 PMCID: PMC5708608 DOI: 10.1371/journal.pntd.0006059] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/20/2017] [Indexed: 02/06/2023] Open
Abstract
Background Neurocysticercosis (NCC) is an infection of the brain with the larval cyst of the tapeworm, Taenia solium. Cysticidal treatment induces parasite killing resulting in a post inflammatory response and seizures, which generally requires corticosteroid treatment to control inflammation. The nature of this response and how to best control it is unclear. We investigated the anti-inflammatory effects of pretreatment with etanercept (ETN), an anti-tumor necrosis factor agent, or dexamethasone (DEX), a high potency corticosteroid, on the post treatment inflammatory response in naturally infected pigs with neurocysticercosis after a single dose of the cysticidal drug praziquantel (PZQ). Methodology/Principal findings We followed the methods from a previously developed treatment model of NCC in naturally infected swine. The four study groups of infected pigs included 3 groups treated with PZQ on day 0: PZQ-treated alone (100 mg/kg PO; n = 9), pretreated with dexamethasone (DEX, 0.2 mg/kg IM administered on days -1, +1 and +3; n = 6), and pretreated with etanercept (ETN, 25 mg IM per animal on days -7 and 0; n = 6). The fourth group remained untreated (n = 3). As measured by quantitative RT-PCR, ETN pretreatment depressed transcription of a wide range of proinflammatory, regulatory and matrix protease encoding genes at 120 hr post PZQ treatment in capsules of cysts that demonstrated extravasated Evans Blue (EB) (a measure of blood brain barrier dysfunction) compared to animals not receiving ETN. Transcription was significantly depressed for the proinflammatory genes tumor necrosis factor (TNF)-α, and interferon (IFN)-γ; the inflammation regulating genes cytotoxic T-lymphocyte-associated protein (CTLA)4, interleukin (IL)-13 and transforming growth factor (TGF)-β; the tissue remodeling genes matrix metalloprotease (MMP)1 and 9, tissue inhibitors of metalloproteases (TIMP)1 and 2, and the genes regulating endothelial function vascular endothelial growth factor (VEGF)1, angiopoietin (Ang)1, Ang 2, and platelet endothelial cell adhesion molecule (PECAM)-1. In contrast, transcription was only modestly decreased in the DEX pretreated pigs compared to PZQ alone, and only for TNF-α, IL-6, IFN-γ, TGF-β and Ang1. IL-10 was not affected by either ETN or DEX pretreatments. The degree of inflammation, assessed by semi-quantitative inflammatory scores, was modestly decreased in both ETN and DEX pretreated animals compared to PZQ treated pigs whereas cyst damage scores were moderately decreased only in cysts from DEX pretreated pigs. However, the proportion of cysts with EB extravasation was not significantly changed in ETN and DEX pretreated groups. Conclusions/Significance Overall, TNF-α blockade using ETN treatment modulated expression of a large variety of genes that play a role in induction and control of inflammation and structural changes. In contrast the number of inflammatory cells was only moderately decreased suggesting weaker effects on cell migration into the inflammatory capsules surrounding cysts than on release of modulatory molecules. Taken together, these data suggest that TNF-α blockade may provide a viable strategy to manage post-treatment pericystic inflammation that follows antiparasitic therapy for neurocysticercosis. Infection of the brain with larvae of the tapeworm Taenia solium is called neurocysticercosis (NCC), a disease with varied and serious neurological symptoms. Therapy requires antiparasitic drugs and corticosteroids to prevent seizures caused by treatment due to inflammation around dying parasites. The gene expression of the proinflammatory molecule tumor necrosis factor alpha (TNF-α) is increased in NCC. We treated three groups of naturally infected pigs with an antiparasitic drug: one group was also pretreated with an anti-TNF-α inhibitor, the second one with a corticosteroid, and the third was not pretreated. All pigs were infused with Evans blue dye (EB), which leaks where the blood brain barrier is damaged by inflammation around cysts. We compared the expression of several genes involved in inflammation, healing and fibrosis and regulation of vascular function in tissues surrounding cysts. In inflamed samples showing leaked EB, the inhibition of TNF-α suppressed nearly all the genes assessed, and this suppression was significantly stronger than the moderate decrease caused by corticosteroid pretreatment on most of the genes. On microscopic examination, the inflammation observed was slightly decreased with both pretreatments in relation to the group that was not pretreated. We believe that the inflammatory route that includes TNF-α should be further explored in the search for better management of inflammation directed to degenerating cysts.
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Effect of Transforming Growth Factor-β upon Taenia solium and Taenia crassiceps Cysticerci. Sci Rep 2017; 7:12345. [PMID: 28955045 PMCID: PMC5617888 DOI: 10.1038/s41598-017-12202-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/05/2017] [Indexed: 01/14/2023] Open
Abstract
Taeniids exhibit a great adaptive plasticity, which facilitates their establishment, growth, and reproduction in a hostile inflammatory microenvironment. Transforming Growth Factor-β (TGFβ), a highly pleiotropic cytokine, plays a critical role in vertebrate morphogenesis, cell differentiation, reproduction, and immune suppression. TGFβ is secreted by host cells in sites lodging parasites. The role of TGFβ in the outcome of T. solium and T. crassiceps cysticercosis is herein explored. Homologues of the TGFβ family receptors (TsRI and TsRII) and several members of the TGFβ downstream signal transduction pathway were found in T. solium genome, and the expression of Type-I and -II TGFβ receptors was confirmed by RT-PCR. Antibodies against TGFβ family receptors recognized cysticercal proteins of the expected molecular weight as determined by Western blot, and different structures in the parasite external tegument. In vitro, TGFβ promoted the growth and reproduction of T. crassiceps cysticerci and the survival of T. solium cysticerci. High TGFβ levels were found in cerebrospinal fluid from untreated neurocysticercotic patients who eventually failed to respond to the treatment (P = 0.03) pointing to the involvement of TGFβ in parasite survival. These results indicate the relevance of TGFβ in the infection outcome by promoting cysticercus growth and treatment resistance.
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Navarrete-Perea J, Isasa M, Paulo JA, Corral-Corral R, Flores-Bautista J, Hernández-Téllez B, Bobes RJ, Fragoso G, Sciutto E, Soberón X, Gygi SP, Laclette JP. Quantitative multiplexed proteomics of Taenia solium cysts obtained from the skeletal muscle and central nervous system of pigs. PLoS Negl Trop Dis 2017; 11:e0005962. [PMID: 28945737 PMCID: PMC5634658 DOI: 10.1371/journal.pntd.0005962] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/10/2017] [Accepted: 09/13/2017] [Indexed: 01/01/2023] Open
Abstract
In human and porcine cysticercosis caused by the tapeworm Taenia solium, the larval stage (cysts) can infest several tissues including the central nervous system (CNS) and the skeletal muscles (SM). The cyst’s proteomics changes associated with the tissue localization in the host tissues have been poorly studied. Quantitative multiplexed proteomics has the power to evaluate global proteome changes in response to different conditions. Here, using a TMT-multiplexed strategy we identified and quantified over 4,200 proteins in cysts obtained from the SM and CNS of pigs, of which 891 were host proteins. To our knowledge, this is the most extensive intermixing of host and parasite proteins reported for tapeworm infections.Several antigens in cysticercosis, i.e., GP50, paramyosin and a calcium-binding protein were enriched in skeletal muscle cysts. Our results suggested the occurrence of tissue-enriched antigen that could be useful in the improvement of the immunodiagnosis for cysticercosis. Using several algorithms for epitope detection, we selected 42 highly antigenic proteins enriched for each tissue localization of the cysts. Taking into account the fold changes and the antigen/epitope contents, we selected 10 proteins and produced synthetic peptides from the best epitopes. Nine peptides were recognized by serum antibodies of cysticercotic pigs, suggesting that those peptides are antigens. Mixtures of peptides derived from SM and CNS cysts yielded better results than mixtures of peptides derived from a single tissue location, however the identification of the ‘optimal’ tissue-enriched antigens remains to be discovered. Through machine learning technologies, we determined that a reliable immunodiagnostic test for porcine cysticercosis required at least five different antigenic determinants. Human and porcine cysticercosis caused by Taenia solium is a parasite disease still endemic in developing countries. The cysts can be located in different host tissues, including different organs of the central nervous system and the skeletal muscles. The molecular mechanisms associated with the tissue localization of the cysts are not well understood. Here, we described the proteome changes of the cysts obtained from different host tissues from infected pigs using quantitative multiplex proteomics. We explored the diversity of host proteins identified in the cyst’s protein extracts and we also explored the immune-localization of several host-related proteins within the cysts, and propose their possible function. We identified several proteins and antigens enriched for a given tissue localization. Several synthetic peptides designed from these tissue-enriched antigens were tested trough ELISA. Using a combination of peptide mixtures and machine learning technologies we were able to distinguish non cysticercotic and cysticercotic pig’s sera. The tissue-enriched proteins/antigens could be useful for the development of improved immuno-diagnostic tests capable of discriminate the tissue-localization of the cysts.
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Affiliation(s)
- José Navarrete-Perea
- Dept. of Immunology, Institute for Biomedical Research, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Marta Isasa
- Dept. of Cell Biology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Joao A Paulo
- Dept. of Cell Biology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ricardo Corral-Corral
- Dept. of Biochemistry and Structural Biology, Institute of Cell Physiology, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Jeanette Flores-Bautista
- Dept. of Immunology, Institute for Biomedical Research, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Beatriz Hernández-Téllez
- Dept. of Tissue and Cell Biology, School of Medicine, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Raúl J Bobes
- Dept. of Immunology, Institute for Biomedical Research, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Gladis Fragoso
- Dept. of Immunology, Institute for Biomedical Research, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Edda Sciutto
- Dept. of Immunology, Institute for Biomedical Research, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Xavier Soberón
- Instituto Nacional de Medicina Genómica, Ciudad de México, México.,Dept. of Biocatalysis and Cellular Engineering, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Morelos, México
| | - Steven P Gygi
- Dept. of Cell Biology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Juan P Laclette
- Dept. of Immunology, Institute for Biomedical Research, Universidad Nacional Autónoma de México, Ciudad de México, México
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Fleury A, Cardenas G, Adalid-Peralta L, Fragoso G, Sciutto E. Immunopathology in Taenia solium neurocysticercosis. Parasite Immunol 2016; 38:147-57. [PMID: 26667781 DOI: 10.1111/pim.12299] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 12/08/2015] [Indexed: 12/16/2022]
Abstract
Neurocysticercosis is a clinically and radiologically heterogeneous disease, ranging from asymptomatic infection to a severe, potentially fatal clinical picture. The intensity and extension of the parasite-elicited inflammatory reaction is a key factor for such variability. The main features of the inflammatory process found in the brain and in the peripheral blood of neurocysticercosis patients will be discussed in this review, and the factors involved in its modulation will be herein presented.
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Affiliation(s)
- A Fleury
- Unidad Periférica de Neuroinflamación Instituto de Investigaciones Biomédicas/Instituto Nacional de Neurología y Neurocirugía, México City, México
| | - G Cardenas
- Unidad Periférica de Neuroinflamación Instituto de Investigaciones Biomédicas/Instituto Nacional de Neurología y Neurocirugía, México City, México
| | - L Adalid-Peralta
- Unidad Periférica de Neuroinflamación Instituto de Investigaciones Biomédicas/Instituto Nacional de Neurología y Neurocirugía, México City, México
| | - G Fragoso
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México City, México
| | - E Sciutto
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México City, México
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Gonzales I, Rivera JT, Garcia HH. Pathogenesis of Taenia solium taeniasis and cysticercosis. Parasite Immunol 2016; 38:136-46. [PMID: 26824681 DOI: 10.1111/pim.12307] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/25/2016] [Indexed: 12/22/2022]
Abstract
Taenia solium infections (taeniasis/cysticercosis) are a major scourge to most developing countries. Neurocysticercosis, the infection of the human nervous system by the cystic larvae of this parasite, has a protean array of clinical manifestations varying from entirely asymptomatic infections to aggressive, lethal courses. The diversity of clinical manifestations reflects a series of contributing factors which include the number, size and location of the invading parasites, and particularly the inflammatory response of the host. This manuscript reviews the different presentations of T. solium infections in the human host with a focus on the mechanisms or processes responsible for their clinical expression.
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Affiliation(s)
- I Gonzales
- Cysticercosis Unit, Department of Transmissible Diseases, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - J T Rivera
- Department of Microbiology and Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - H H Garcia
- Cysticercosis Unit, Department of Transmissible Diseases, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.,Department of Microbiology and Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
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Mishra PK, Li Q, Munoz LE, Mares CA, Morris EG, Teale JM, Cardona AE. Reduced Leukocyte Infiltration in Absence of Eosinophils Correlates with Decreased Tissue Damage and Disease Susceptibility in ΔdblGATA Mice during Murine Neurocysticercosis. PLoS Negl Trop Dis 2016; 10:e0004787. [PMID: 27332553 PMCID: PMC4917226 DOI: 10.1371/journal.pntd.0004787] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 05/28/2016] [Indexed: 02/01/2023] Open
Abstract
Neurocysticercosis (NCC) is one of the most common helminth parasitic diseases of the central nervous system (CNS) and the leading cause of acquired epilepsy worldwide. NCC is caused by the presence of the metacestode larvae of the tapeworm Taenia solium within brain tissues. NCC patients exhibit a long asymptomatic phase followed by a phase of symptoms including increased intra-cranial pressure and seizures. While the asymptomatic phase is attributed to the immunosuppressive capabilities of viable T. solium parasites, release of antigens by dying organisms induce strong immune responses and associated symptoms. Previous studies in T. solium-infected pigs have shown that the inflammatory response consists of various leukocyte populations including eosinophils, macrophages, and T cells among others. Because the role of eosinophils within the brain has not been investigated during NCC, we examined parasite burden, disease susceptibility and the composition of the inflammatory reaction in the brains of infected wild type (WT) and eosinophil-deficient mice (ΔdblGATA) using a murine model of NCC in which mice were infected intracranially with Mesocestoides corti, a cestode parasite related to T. solium. In WT mice, we observed a time-dependent induction of eosinophil recruitment in infected mice, contrasting with an overall reduced leukocyte infiltration in ΔdblGATA brains. Although, ΔdblGATA mice exhibited an increased parasite burden, reduced tissue damage and less disease susceptibility was observed when compared to infected WT mice. Cellular infiltrates in infected ΔdblGATA mice were comprised of more mast cells, and αβ T cells, which correlated with an abundant CD8+ T cell response and reduced CD4+ Th1 and Th2 responses. Thus, our data suggest that enhanced inflammatory response in WT mice appears detrimental and associates with increased disease susceptibility, despite the reduced parasite burden in the CNS. Overall reduced leukocyte infiltration due to absence of eosinophils correlates with attenuated tissue damage and longer survival of ΔdblGATA mice. Therefore, our study suggests that approaches to clear NCC will require strategies to tightly control the host immune response while eradicating the parasite with minimal damage to brain tissue. Eosinophils are known to mediate a protective response against several parasitic infections. This is largely accomplished by eosinophil degranulation (direct killing) and modulating effective adaptive immune responses. Consequently, eosinophils can also contribute to host pathology via a bystander effect. However, the outcome of infection varies depending upon the parasite species. In the case of neurocysticercosis (NCC), the role of eosinophils in disease progression has not been investigated despite the known eosinophilic response in patients. NCC is one of the most common parasitic diseases of the brain which is caused by the metacestode (larva) of the tapeworm Taenia solium. To determine the role of eosinophils in NCC disease outcome, we used a murine model of NCC in which wildtype (WT) or eosinophil deficient mice (ΔdblGATA) were infected intracranially with Mesocestoides corti, a cestode parasite related to T. solium. Our data show that murine NCC is characterized by a robust eosinophil response that correlates with lower parasite burden in the brain. Comparison of T cell response reveals a mixed Th1/Th2 in the WT brain, and ΔdblGATA mice showed a significant decrease in both population but in particular in the Th2 response. In addition, the strong eosinophil reaction observed in WT brains correlates with exacerbated pathology and increased morbidity. Thus, our study suggest that eosinophils act as a double-edged sword playing a role in controlling the infection but worsening the disease outcome by contributing to host pathology.
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Affiliation(s)
- Pramod K. Mishra
- Department of Biology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, United States of America
- * E-mail: (PKM); (AEC)
| | - Qun Li
- Department of Biology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Luis E. Munoz
- Department of Biology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Chris A. Mares
- Department of Biology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Elizabeth G. Morris
- Department of Biology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Judy M. Teale
- Department of Biology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Astrid E. Cardona
- Department of Biology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, United States of America
- * E-mail: (PKM); (AEC)
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Abstract
SUMMARYNeurocysticercosis (NCC) is considered a neglected parasitic infection of the human central nervous system. Its pathogenesis is due to the host immune response, stage of evolution and location of the parasite. The aim of this study was to evaluate thein situand systemic immune response through cytokines dosage (IL-4, IL-10, IL-17 and IFN-γ) as well as the local inflammatory response of the experimental NCC withTaenia crassiceps. Thein situand systemic cellular and inflammatory immune response were evaluated through the cytokines quantification at 7, 30, 60 and 90 days after inoculation and histopathological analysis. All cysticerci were found within the cerebral ventricles. There was a discrete intensity of inflammatory cells of mixed immune profile, polymorphonuclear and mononuclear cells, at the beginning of the infection and predominance of mononuclear cells at the end. The systemic immune response showed a significant increase in all the analysed cytokines and predominance of the Th2 immune profile cytokines at the end of the infection. These results indicate that the location of the cysticerci may lead to ventriculomegaly. The acute phase of the infection showed a mixed Th1/Th17 profile accompanied by high levels of IL-10 while the late phase showed a Th2 immune profile.
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A Comparative Study of Peripheral Immune Responses to Taenia solium in Individuals with Parenchymal and Subarachnoid Neurocysticercosis. PLoS Negl Trop Dis 2015; 9:e0004143. [PMID: 26506532 PMCID: PMC4624727 DOI: 10.1371/journal.pntd.0004143] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 09/15/2015] [Indexed: 11/24/2022] Open
Abstract
Background The ability of Taenia solium to modulate the immune system likely contributes to their longevity in the human host. We tested the hypothesis that the nature of the immune response is related to the location of parasite and clinical manifestations of infection. Methodology Peripheral blood mononuclear cells (PBMC) were obtained from untreated patients with neurocysticercosis (NCC), categorized as having parenchymal or subarachnoid infection by the presence of cysts exclusively within the parenchyma or in subarachnoid spaces of the brain, and from uninfected (control) individuals matched by age and gender to each patient. Using multiplex detection technology, sera from NCC patients and controls and cytokine production by PBMC after T. solium antigen (TsAg) stimulation were assayed for levels of inflammatory and regulatory cytokines. PBMC were phenotyped by flow cytometry ex vivo and following in vitro stimulation with TsAg. Principal Findings Sera from patients with parenchymal NCC demonstrated significantly higher Th1 (IFN-γ/IL-12) and Th2 (IL-4/IL-13) cytokine responses and trends towards higher levels of IL-1β/IL-8/IL-5 than those obtained from patients with subarachnoid NCC. Also higher in vitro antigen-driven TNF-β secretion was detected in PBMC supernatants from parenchymal than in subarachnoid NCC. In contrast, there was a significantly higher IL-10 response to TsAg stimulation in patients with subarachnoid NCC compared to parenchymal NCC. Although no differences in regulatory T cells (Tregs) frequencies were found ex vivo, there was a trend towards greater expansion of Tregs upon TsAg stimulation in subarachnoid than in parenchymal NCC when data were normalized for the corresponding controls. Conclusions/Significance T. solium infection of the subarachnoid space is associated with an enhanced regulatory immune response compared to infection in the parenchyma. The resulting anti-inflammatory milieu may represent a parasite strategy to maintain a permissive environment in the host or diminish inflammatory damage from the host immune response in the central nervous system. Cysticercosis is a parasitic disease caused by the larval cysts of the pork tapeworm Taenia solium following accidental ingestion of tapeworm eggs. Neurocysticercosis is a leading cause of seizures and epilepsy in developing countries. The clinical manifestations depend on many factors including the number, size, location, stage of the parasites and host age, gender and immune responses. However, the most important determinant is whether the infection is restricted to the brain parenchyma (associated with seizures disorders but generally with a good prognosis) or if it involves the subarachnoid spaces in the brain (associated with an exuberant growth of the parasite, intracranial hypertension, and often resulting in mortality). In the current study, we characterized the relationship between T. solium specific immune responses and cyst location. We show that patients with subarachnoid disease have higher suppresive immune responses than the parenchymal group, potentially representing a parasite strategy to survive. Our findings implicate immune responses to be among the mechanisms that underlie the diverse clinical manifestations in neurocysticercosis.
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Singh AK, Singh SK, Singh A, Gupta KK, Khatoon J, Prasad A, Rai RP, Gupta RK, Tripathi M, Husain N, Prasad KN. Immune response to Taenia solium cysticerci after anti-parasitic therapy. Int J Parasitol 2015; 45:749-59. [DOI: 10.1016/j.ijpara.2015.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/14/2015] [Accepted: 05/18/2015] [Indexed: 01/11/2023]
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Mahanty S, Orrego MA, Mayta H, Marzal M, Cangalaya C, Paredes A, Gonzales-Gustavson E, Arroyo G, Gonzalez AE, Guerra-Giraldez C, García HH, Nash TE. Post-treatment vascular leakage and inflammatory responses around brain cysts in porcine neurocysticercosis. PLoS Negl Trop Dis 2015; 9:e0003577. [PMID: 25774662 PMCID: PMC4361613 DOI: 10.1371/journal.pntd.0003577] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/29/2015] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Siddhartha Mahanty
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- Laboratory of Immunopathology, Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
| | - Miguel Angel Orrego
- Laboratory of Immunopathology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Holger Mayta
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Miguel Marzal
- Laboratory of Immunopathology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carla Cangalaya
- Laboratory of Immunopathology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Adriana Paredes
- Laboratory of Immunopathology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Gianfranco Arroyo
- Faculty of Veterinary Sciences, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Armando E. Gonzalez
- Faculty of Veterinary Sciences, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Cristina Guerra-Giraldez
- Laboratory of Immunopathology, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hector H. García
- Laboratory of Immunopathology, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Theodore E. Nash
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- Laboratory of Immunopathology, Universidad Peruana Cayetano Heredia, Lima, Peru
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Palafox-Fonseca H, Zúñiga G, Bobes RJ, Govezensky T, Piñero D, Texco-Martínez L, Fleury A, Proaño J, Cárdenas G, Hernández M, Sciutto E, Fragoso G. Genetic variation in the Cytb gene of human cerebral Taenia solium cysticerci recovered from clinically and radiologically heterogeneous patients with neurocysticercosis. Mem Inst Oswaldo Cruz 2015; 108:914-20. [PMID: 24271046 PMCID: PMC3970634 DOI: 10.1590/0074-0276130308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/16/2013] [Indexed: 11/22/2022] Open
Abstract
Neurocysticercosis (NC) is a clinically and radiologically heterogeneous parasitic disease caused by the establishment
of larval Taenia solium in the human central nervous system. Host and/or parasite variations may be related to this observed heterogeneity. Genetic differences between pig and human-derived T. solium cysticerci have been reported previously. In this study, 28 cysticerci were surgically removed from 12 human NC patients, the mitochondrial gene that encodes cytochrome b was amplified from the cysticerci and genetic variations that may be related to NC heterogeneity were characterised. Nine different haplotypes (Ht), which were clustered in four haplogroups (Hg), were identified. Hg 3 and 4 exhibited a tendency to associate with age and gender, respectively. However, no significant associations were found between NC heterogeneity and the different T. solium cysticerci Ht or Hg. Parasite variants obtained from patients with similar NC clinical or radiological features were genetically closer than those found in groups of patients with a different NC profile when using the Mantel test. Overall, this study establishes the presence of genetic differences in the Cytb gene of T. solium isolated from human cysticerci and suggests that parasite variation could contribute to NC heterogeneity.
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Affiliation(s)
- Héctor Palafox-Fonseca
- Universidad Nacional Autónoma de México, Instituto de Investigaciones Biomédicas, MéxicoDF, México
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Cousineau SV, Alizon S. Parasite evolution in response to sex-based host heterogeneity in resistance and tolerance. J Evol Biol 2014; 27:2753-66. [PMID: 25376168 DOI: 10.1111/jeb.12541] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 12/17/2022]
Abstract
Heterogenity between sexes in terms of both the level and the type of immune response to infection is documented in many species, but its role on parasite evolution is only beginning to be explored. We adopt an evolutionary epidemiology approach to study how the ability of a host to respond to infection through active immunity (resistance) or through minimizing deleterious effects of a given parasite load (tolerance) affects the evolution of parasite virulence. Consistently with earlier models, we find that increases in host resistance and tolerance both favour more virulent parasite strains. However, we show that qualitatively different results can be obtained if dimorphism between the sexes occurs through resistance or through tolerance depending on the contact pattern between the sexes. Finally, we find that variations in host sex ratio can amplify the consequences of heterogeneity for parasite evolution. These results are analysed in the light of several examples from the literature to illustrate the prevalence of sexually dimorphic immune responses and the potential for further study of the role of sexual dimorphism on parasite evolution. Such studies are likely to be highly relevant for improving treatment of chronic infections and control of infectious diseases, and understanding the role of sex in immune function.
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Affiliation(s)
- S V Cousineau
- Laboratoire MIVEGEC (UMR CNRS 5290, IRD 224, UM1, UM2), Montpellier Cedex 5, France
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27
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Neurocysticercosis: the effectiveness of the cysticidal treatment could be influenced by the host immunity. Med Microbiol Immunol 2014; 203:373-81. [DOI: 10.1007/s00430-014-0345-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
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28
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Mkupasi EM, Ngowi HA, Sikasunge CS, Leifsson PS, Johansen MV. Distribution and histopathological changes induced by cysts of Taenia solium in the brain of pigs from Tanzania. J Helminthol 2014:1-6. [PMID: 24905052 DOI: 10.1017/s0022149x1400042x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neurocysticercosis (NCC) caused by Taenia solium cysts is a frequent but neglected parasitic disease of the central nervous system (CNS) worldwide. The aim of this study was to describe anatomical locations of cysts in the CNS and the corresponding inflammation. A total of 17 naturally infected pigs were used to evaluate the distribution of cysts and, of these, seven were used to evaluate the corresponding inflammation further, through histopathology. Clinical signs in the pigs included dullness, sluggishness, somnolence, apathy and loss of consciousness. Cysts were distributed in all cerebral lobes, i.e. 39.7% in the frontal lobe, 20.3% in the parietal lobe, 20.0% in the occipital lobe and 19.7% in the temporal lobe, and only 0.4% in the cerebellum. No cysts were found in the spinal cord. Cysts were localized as follows: 47.9% in the dorsal subarachnoid, 46.9% in the parenchyma, 4.4% in the subarachnoid base and 0.9% in the ventricles. The results of the histopathology revealed lesions in an early inflammatory stage, i.e. stage I, in all anatomical locations except for two, which showed more of an inflammatory reaction, stage III, in one pig. It was concluded that clinical signs in pigs were neither pathognomonic nor consistent. These signs, therefore, cannot be used as a reliable indicator of porcine NCC. Furthermore, T. solium cysts were found to be in abundance in all cerebral lobes, and only a few were found in the cerebellum. Regarding the inflammatory response, no significant differences were found in the location and total number of cysts. Thus, further studies are needed to explain the determinants of cyst distribution in the CNS and assess in detail clinical signs associated with porcine NCC.
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Affiliation(s)
- E M Mkupasi
- Department of Veterinary Disease Biology,Faculty of Health and Medical Sciences, University of Copenhagen,Thorvaldsensvej 57,1871Frederiksberg C,Denmark
| | - H A Ngowi
- Department of Veterinary Medicine and Public Health,Sokoine University of Agriculture,PO Box 3021,Morogoro,Tanzania
| | - C S Sikasunge
- Department of Para-clinical Studies,School of Veterinary Medicine, University of Zambia,PO Box 32379,Lusaka,Zambia
| | - P S Leifsson
- Department of Veterinary Disease Biology,Faculty of Health and Medical Sciences, University of Copenhagen,Thorvaldsensvej 57,1871Frederiksberg C,Denmark
| | - M V Johansen
- Department of Veterinary Disease Biology,Faculty of Health and Medical Sciences, University of Copenhagen,Thorvaldsensvej 57,1871Frederiksberg C,Denmark
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29
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Distribution and histopathological changes induced by cysts ofTaenia soliumin the brain of pigs from Tanzania. J Helminthol 2014; 89:559-64. [DOI: 10.1017/s0022149x14000418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractNeurocysticercosis (NCC) caused byTaenia soliumcysts is a frequent but neglected parasitic disease of the central nervous system (CNS) worldwide. The aim of this study was to describe anatomical locations of cysts in the CNS and the corresponding inflammation. A total of 17 naturally infected pigs were used to evaluate the distribution of cysts and, of these, seven were used to evaluate the corresponding inflammation further, through histopathology. Clinical signs in the pigs included dullness, sluggishness, somnolence, apathy and loss of consciousness. Cysts were distributed in all cerebral lobes, i.e. 39.7% in the frontal lobe, 20.3% in the parietal lobe, 20.0% in the occipital lobe and 19.7% in the temporal lobe, and only 0.4% in the cerebellum. No cysts were found in the spinal cord. Cysts were localized as follows: 47.9% in the dorsal subarachnoid, 46.9% in the parenchyma, 4.4% in the subarachnoid base and 0.9% in the ventricles. The results of the histopathology revealed lesions in an early inflammatory stage, i.e. stage I, in all anatomical locations except for two, which showed more of an inflammatory reaction, stage III, in one pig. It was concluded that clinical signs in pigs were neither pathognomonic nor consistent. These signs, therefore, cannot be used as a reliable indicator of porcine NCC. Furthermore,T. soliumcysts were found to be in abundance in all cerebral lobes, and only a few were found in the cerebellum. Regarding the inflammatory response, no significant differences were found in the location and total number of cysts. Thus, further studies are needed to explain the determinants of cyst distribution in the CNS and assess in detail clinical signs associated with porcine NCC.
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Evolution, molecular epidemiology and perspectives on the research of taeniid parasites with special emphasis on Taenia solium. INFECTION GENETICS AND EVOLUTION 2014; 23:150-60. [PMID: 24560729 DOI: 10.1016/j.meegid.2014.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/09/2014] [Accepted: 02/11/2014] [Indexed: 11/20/2022]
Abstract
Human cysticercosis is known since old historical times in Greece and China; however, human infections by tapeworms have accompanied human beings for more that hundred thousand years. The disease is tightly bound to poverty and lack of hygiene, and has been eradicated in developed countries, but continues being a public health problem in developing countries of Latin-American, Sub-Saharan Africa and Asia, and is also remerging in a number of non endemic countries. It is considered a neglected disease. Here we revise a number of key scientific contributions on taeniid biology that open new avenues for more effective approaches to the control of cysticercosis. The evolution of flatworms and class Cestoda is analyzed, with special emphasis on the emergence of taeniid parasites and the colonization of the human species by tapeworms. The complex molecular host-parasite interplay in this relationship as result of co-evolution between two distantly related organisms. The relevant host and parasite's factors, in the prospect of identifying species-specific molecular markers useful in epidemiological studies carried out in endemic countries. The new possibilities arising with the characterization of the genomes for several species of tapeworms, including a deeper understanding of these organisms, as well as improved tools for diagnosis, vaccination and drug treatment. The need to revise the current control and management strategies for this tropical neglected disease.
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Singh AK, Prasad KN, Prasad A, Tripathi M, Gupta RK, Husain N. Immune responses to viable and degenerative metacestodes of Taenia solium in naturally infected swine. Int J Parasitol 2013; 43:1101-7. [DOI: 10.1016/j.ijpara.2013.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/15/2013] [Accepted: 07/16/2013] [Indexed: 11/28/2022]
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Rodriguez S, Wilkins P, Dorny P. Immunological and molecular diagnosis of cysticercosis. Pathog Glob Health 2013; 106:286-98. [PMID: 23265553 DOI: 10.1179/2047773212y.0000000048] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Cysticercosis, the infection with the larval stage of Taenia solium, is a cause of neurological symptoms including seizures, affecting the quality of life of patients and their families. Diagnosis focuses on brain imaging and serological tests are mostly used as confirmatory tools. Most cases, however, occur in poor endemic areas, where both kinds of diagnostic tools are poorly available. Development of point of care diagnostic tests is one of the most important priorities for cysticercosis researches today. The ideal point of care test would require detection of viable cysticercosis and hopefully identify cases with severe or progressive forms of neurocysticercosis, leading to referral of the patient for specialized medical attention. This manuscript describes the evolution of the serological diagnosis of cysticercosis over time, and the characteristics of the most common currently available tools, their advantages and disadvantages, and their potential use in future diagnostic tests.
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Affiliation(s)
- Silvia Rodriguez
- Infectious Diseases, Instituto Nacional de Ciencias Neurológicas, Jr. Anchash 1271, Lima 1, Peru.
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Human neurocysticercosis: immunological features involved in the host's susceptibility to become infected and to develop disease. Microbes Infect 2013; 15:524-30. [PMID: 23542217 DOI: 10.1016/j.micinf.2013.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/13/2013] [Accepted: 03/15/2013] [Indexed: 11/23/2022]
Abstract
Human neurocysticercosis (NC) is a clinically and radiologically heterogeneous disease caused by the establishment of Taenia solium larvae in the central nervous system. Herein, the immunological and endocrinological features involved in resistance to infection and severe forms of the disease are reviewed, and their clinical relevance is discussed.
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Suzuki LA, Rossi CL. Evaluation of cysticercus-specific IgG (total and subclasses) and IgE antibody responses in cerebrospinal fluid samples from patients with neurocysticercosis showing intrathecal production of specific IgG antibodies. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:106-9. [PMID: 23295367 DOI: 10.1590/s0004-282x2013005000002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/24/2012] [Indexed: 12/24/2022]
Abstract
In the present study, an enzyme-linked immunosorbent assay (ELISA) standardized with vesicular fluid of Taenia solium cysticerci was used to screen for IgG (total and subclasses) and IgE antibodies in cerebrospinal fluid (CSF) samples from patients with neurocysticercosis showing intrathecal production of specific IgG antibodies and patients with other neurological disorders. The following results were obtained: IgG-ELISA: 100% sensitivity (median of the ELISA absorbances (MEA)=1.17) and 100% specificity; IgG1-ELISA: 72.7% sensitivity (MEA=0.49) and 100% specificity; IgG2-ELISA: 81.8% sensitivity (MEA=0.46) and 100% specificity; IgG3-ELISA: 63.6% sensitivity (MEA=0.12) and 100% specificity; IgG4-ELISA: 90.9% sensitivity (MEA=0.85) and 100% specificity; IgE-ELISA 93.8% sensitivity (MEA=0.60) and 100% specificity. There were no significant differences between the sensitivities and specificities in the detection of IgG-ELISA and IgE-ELISA, although in CSF samples from patients with neurocysticercosis the MEA of the IgG-ELISA was significantly higher than that of the IgE-ELISA. The sensitivity and MEA values of the IgG4-ELISA were higher than the corresponding values for the other IgG subclasses. Future studies should address the contribution of IgG4 and IgE antibodies to the physiopathology of neurocysticercosis.
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Affiliation(s)
- Lisandra Akemi Suzuki
- Department of Clinical Pathology, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
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36
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Makepeace BL, Martin C, Turner JD, Specht S. Granulocytes in helminth infection -- who is calling the shots? Curr Med Chem 2012; 19:1567-86. [PMID: 22360486 PMCID: PMC3394172 DOI: 10.2174/092986712799828337] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 12/23/2011] [Accepted: 12/26/2011] [Indexed: 02/06/2023]
Abstract
Helminths are parasitic organisms that can be broadly described as “worms” due to their elongated body plan, but which otherwise differ in shape, development, migratory routes and the predilection site of the adults and larvae. They are divided into three major groups: trematodes (flukes), which are leaf-shaped, hermaphroditic (except for blood flukes) flatworms with oral and ventral suckers; cestodes (tapeworms), which are segmented, hermaphroditic flatworms that inhabit the intestinal lumen; and nematodes (roundworms), which are dioecious, cylindrical parasites that inhabit intestinal and peripheral tissue sites. Helminths exhibit a sublime co-evolution with the host´s immune system that has enabled them to successfully colonize almost all multicellular species present in every geographical environment, including over two billion humans. In the face of this challenge, the host immune system has evolved to strike a delicate balance between attempts to neutralize the infectious assault versus limitation of damage to host tissues. Among the most important cell types during helminthic invasion are granulocytes: eosinophils, neutrophils and basophils. Depending on the specific context, these leukocytes may have pivotal roles in host protection, immunopathology, or facilitation of helminth establishment. This review provides an overview of the function of granulocytes in helminthic infections.
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Affiliation(s)
- B L Makepeace
- Department of Infection Biology, Institute of Infection & Global Health, University of Liverpool, Liverpool L69 7ZJ, UK
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37
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Nava-Castro K, Hernández-Bello R, Muñiz-Hernández S, Camacho-Arroyo I, Morales-Montor J. Sex steroids, immune system, and parasitic infections: facts and hypotheses. Ann N Y Acad Sci 2012; 1262:16-26. [DOI: 10.1111/j.1749-6632.2012.06632.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Impact of Taenia solium neurocysticercosis upon endocrine status and its relation with immuno-inflammatory parameters. Int J Parasitol 2011; 42:171-6. [PMID: 22233829 DOI: 10.1016/j.ijpara.2011.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 11/18/2011] [Accepted: 11/21/2011] [Indexed: 11/21/2022]
Abstract
Neurocysticercosis (NC) is a parasitic disease caused by the infiltration of the larval stage of Taenia solium in the central nervous system. Clinical presentations are heterogeneous and particularly depend, on the age and gender of the host. We designed a clinical study to evaluate the hormonal changes associated with neurocysticercosis and the relationships between disease heterogeneity, endocrine and immunological status. A total of 50 patients and 22 healthy subjects were included. A precise clinical and radiological description of disease for each patient was recorded. A broad hormonal profile was assessed for each participant and, in a sub-group of patients, immunological features were also evaluated. Compared with controls, all patients had lower dehydroepiandrosterone (DHEA) concentration; male patients also had lower concentrations of 17β-estradiol and higher concentrations of luteinising hormone (LH). In the clinically severe patients, lower concentrations of progesterone and androstenedione were found in women. Higher concentrations of follicle stimulating hormone (FSH) and lower concentrations of testosterone were found in men when compared with the less clinically severe patients. Significant correlations were found between estradiol and IL-10 in male patients, and between dehydroepiandrosterone (DHEA) and IL-1β, and androstenedione and IL-17 in female patients. To our knowledge the present study constitutes the first demonstration that the presence of T. solium larvae in the central nervous system can modify the host environment by the induction of endocrine and immunological changes. These results provide a stimulating background to analyse the repercussions of these changes on the course of the disease and on patient reproductive health.
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Escobedo G, Camacho-Arroyo I, Nava-Luna P, Olivos A, Pérez-Torres A, Leon-Cabrera S, Carrero J, Morales-Montor J. Progesterone induces mucosal immunity in a rodent model of human taeniosis by Taenia solium. Int J Biol Sci 2011; 7:1443-56. [PMID: 22110394 PMCID: PMC3221950 DOI: 10.7150/ijbs.7.1443] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 10/26/2011] [Indexed: 01/28/2023] Open
Abstract
More than one quarter of human world's population is exposed to intestinal helminth parasites. The Taenia solium tapeworm carrier is the main risk factor in the transmission of both human neurocysticercosis and porcine cysticercosis. Sex steroids play an important role during T. solium infection, particularly progesterone has been proposed as a key immunomodulatory hormone involved in susceptibility to human taeniosis in woman and cysticercosis in pregnant pigs. Thus, we evaluated the effect of progesterone administration upon the experimental taeniosis in golden hamsters (Mesocricetus auratus). Intact female adult hamsters were randomly divided into 3 groups: progesterone-subcutaneously treated; olive oil-treated as the vehicle group; and untreated controls. Animals were treated every other day during 4 weeks. After 2 weeks of treatment, all hamsters were orally infected with 4 viable T. solium cysticerci. After 2 weeks post infection, progesterone-treated hamsters showed reduction in adult worm recovery by 80%, compared to both vehicle-treated and non-manipulated infected animals. In contrast to control and vehicle groups, progesterone treatment diminished tapeworm length by 75% and increased proliferation rate of leukocytes from spleen and mesenteric lymph nodes of infected hamsters by 5-fold. The latter exhibited high expression levels of IL-4, IL-6 and TNF-α at the duodenal mucosa, accompanied with polymorphonuclear leukocytes infiltration. These results support that progesterone protects hamsters from the T. solium adult tapeworm establishment by improving the intestinal mucosal immunity, suggesting a potential use of analogues of this hormone as novel inductors of the gut immune response against intestinal helminth infections and probably other bowel-related disorders.
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Affiliation(s)
- Galileo Escobedo
- 1. Unidad de Medicina Experimental, Hospital General de México, México D.F. 06726, México
| | - Ignacio Camacho-Arroyo
- 2. Facultad de Química, Departamento de Biología, Universidad Nacional Autónoma de México, México D.F. 04510, México
| | - Paul Nava-Luna
- 3. Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México D.F. 04510, México
| | - Alfonso Olivos
- 4. Departamento de Medicina Experimental, Facultad de Medicina, Hospital General de México, Universidad Nacional Autónoma de México, México D.F. 06726, México
| | - Armando Pérez-Torres
- 5. Departamento de Biología Celular y Tisular, Facultad de Medicina, Universidad Nacional Autónoma de México, México D.F. 04510, México
| | - Sonia Leon-Cabrera
- 6. Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, México D.F. 04510, México
| | - J.C. Carrero
- 3. Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México D.F. 04510, México
| | - Jorge Morales-Montor
- 3. Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México D.F. 04510, México
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Immunodiagnosis of neurocysticercosis: ways to focus on the challenge. J Biomed Biotechnol 2011; 2011:516042. [PMID: 22131808 PMCID: PMC3205906 DOI: 10.1155/2011/516042] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 01/09/2023] Open
Abstract
Neurocysticercosis (NCC) is a disease of the central nervous system that is considered a public health problem in endemic areas. The definitive diagnosis of this disease is made using a combination of tools that include imaging of the brain and immunodiagnostic tests, but the facilities for performing them are usually not available in endemic areas. The immunodiagnosis of NCC is a useful tool that can provide important information on whether a patient is infected or not, but it presents many drawbacks as not all infected patients can be detected. These tests rely on purified or semipurified antigens that are sometimes difficult to prepare. Recent efforts have focused on the production of recombinant or synthetic antigens for the immunodiagnosis of NCC and interesting studies propose the use of new elements as nanobodies for diagnostic purposes. However, an immunodiagnostic test that can be considered as "gold standard" has not been developed so far. The complex nature of cysticercotic disease and the simplicity of common immunological assumptions involved explain the low scores and reproducibility of immunotests in the diagnosis of NCC. Here, the most important efforts for developing an immunodiagnostic test of NCC are listed and discussed. A more punctilious strategy based on the design of panels of confirmed positive and negative samples, the use of blind tests, and a worldwide effort is proposed in order to develop an immunodiagnostic test that can provide comparable results. The identification of a set of specific and representative antigens of T. solium and a thorough compilation of the many forms of antibody response of humans to the many forms of T. solium disease are also stressed as necessary.
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Adalid-Peralta L, Fleury A, García-Ibarra TM, Hernández M, Parkhouse M, Crispín JC, Voltaire-Proaño J, Cárdenas G, Fragoso G, Sciutto E. Human neurocysticercosis: in vivo expansion of peripheral regulatory T cells and their recruitment in the central nervous system. J Parasitol 2011; 98:142-8. [PMID: 21955298 DOI: 10.1645/ge-2839.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Human neurocysticercosis (NC) is caused by Taenia solium larvae lodged in the central nervous system. Most cases occur with no, or mild, neurological symptoms. However, in some patients, neuroinflammation is exacerbated, leading to severe forms of the disease. Considering the critical role of regulatory T cells (Tregs) in balancing inflammation in chronic diseases, their participation in restraining the inflammatory response in NC was explored in the present study. The frequency of Tregs and their relationship with the level of the proliferative response, the level of activated lymphocytes, and the cytokines expressed were determined in severe NC patients compared with those from healthy donors. Significantly increased peripheral Tregs (CD4(+)CD25(high) and CD4(+)CD25(high)FoxP3(+), CD4(+)CD25(high)CTLA4(+), and CD4(+)CD25(high) IL10(+)) and a significant decrease in activated (CD38(+) and CD69(+)) T cells were observed in 19 NC patients versus 10 healthy subjects. Significantly increased Tregs in NC are accompanied by a depressed specific, and non-specific, lymphocyte proliferative response, and they negatively correlate with activated CD4(+)CD69(+) lymphocytes. Treg frequencies were also determined in cerebral spinal fluid for 8 of the 19 NC patients. A positive significant correlation between peripheral and local Tregs was observed. Here, we report for the first time data that support the possible contribution of local and systemic Tregs in limiting neuroinflammation in NC.
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Affiliation(s)
- Laura Adalid-Peralta
- Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur 3877, Col. La Fama, México DF, México
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Sáenz B, Fleury A, Chavarría A, Hernández M, Crispin JC, Vargas-Rojas MI, Fragoso G, Sciutto E. Neurocysticercosis: local and systemic immune-inflammatory features related to severity. Med Microbiol Immunol 2011; 201:73-80. [PMID: 21698478 DOI: 10.1007/s00430-011-0207-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Indexed: 11/27/2022]
Abstract
Neurocysticercosis (NC) is caused by the establishment of Taenia solium cysticerci in the central nervous system. Previous studies have established that neuroinflammation plays a key role in the severity of the disease. However, the relationship between peripheral and local immune response remains inconclusive. This work studies the peripheral and local immune-inflammatory features and their relationships, toward the identification of potential peripheral immunologic features related to severity. A panel of cytokines was measured in paired cerebrospinal fluid (CSF) and in the supernatant of antigen-specific stimulated peripheral blood mononuclear cells samples (SN) in a total of 31 untreated inflammatory and non-inflammatory NC patients. Increased clinical and radiologic severity was associated with an increased cerebrospinal fluid cell count. A peripheral proliferative depression that negatively correlates with CSF cellularity and TNFα and that positively correlates with SN IL5 was observed in severe NC patients. These results provide evidences to support the systemic proliferative response as a biomarker to monitor the level of neuroinflammation, of possible value in the patients' follow-up during treatment.
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Affiliation(s)
- Brenda Sáenz
- Unidad Periférica del Instituto de Investigaciones Biomédicas en el Instituto Nacional de Neurología y Neurocirugía, Universidad Nacional Autónoma de México, México DF, México
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44
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Immune response in symptomatic and asymptomatic neurocysticercosis. Med Microbiol Immunol 2011; 200:255-61. [DOI: 10.1007/s00430-011-0198-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Indexed: 10/18/2022]
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45
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Fleury A, Carrillo-Mezo R, Flisser A, Sciutto E, Corona T. Subarachnoid basal neurocysticercosis: a focus on the most severe form of the disease. Expert Rev Anti Infect Ther 2011; 9:123-33. [PMID: 21171883 DOI: 10.1586/eri.10.150] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neurocysticercosis is an endemic disease in Latin America, Asia and Africa with growing occurrence in industrialized countries due to the increase in migration from low- and middle-income to high-income countries. The most severe clinical presentation is when the parasite is located in the subarachnoid space at the base of the brain (NCSAB). Aside from its clinical presentation, the severity of this form of the disease is due to the difficulties in diagnosis and treatment. Although NCSAB frequency is lower than that reported for the parenchymal location of the parasite, its clinical relevance must be emphasized. We provide a critical review of the central epidemiological, clinical, diagnostic and therapeutic features of this particular form of the disease, which is still associated with unacceptably high rates of morbidity and mortality.
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Affiliation(s)
- Agnès Fleury
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.
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McClelland EE, Smith JM. Gender specific differences in the immune response to infection. Arch Immunol Ther Exp (Warsz) 2011; 59:203-13. [PMID: 21442309 DOI: 10.1007/s00005-011-0124-3] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 12/15/2010] [Indexed: 12/17/2022]
Abstract
There are many instances where males and females differ in the susceptibility to infections. The reason for these differences in susceptibility is multifactorial. The primary cause is thought to be due to differences induced by sex hormones and their effects on gene expression as well as the immune system, but may also be due to innate physiological differences between males and females. This review summarizes gender specific differences seen in infections caused by bacteria, fungi, parasites and viruses. Ultimately, gender specific differences appear to be dependent on the microbe causing the infection, as not every infection with a specific microbial type results in increased susceptibility of one gender over the other. This suggests that there is an interaction between gender specific immune differences and the specific immune response to individual microbes.
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Affiliation(s)
- Erin E McClelland
- Department of Basic Sciences, The Commonwealth Medical College, 501 Madison Avenue, Scranton, PA 18510, USA.
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47
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Is the Presence of Depression Independent from Signs of Disease Activity in Patients with Neurocysticercosis? J Community Health 2011; 36:693-7. [DOI: 10.1007/s10900-011-9362-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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48
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Sciutto E, Rosas G, Cruz-Revilla C, Toledo A, Cervantes J, Hernández M, Hernándezt B, Goldbaum FA, de Aluja AS, Fragoso G, Larralde C. Renewed hope for a vaccine against the intestinal adult Taenia solium. J Parasitol 2010; 93:824-31. [PMID: 17918361 DOI: 10.1645/ge-1018r1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Review of experimental and observational evidence about various cestode infections of mammalian hosts revives hope for the development of an effective vaccine against adult intestinal tapeworms, the central protagonists in their transmission dynamics. As for Taenia solium, there are abundant immunological data regarding cysticercosis in humans and pigs, but information about human taeniasis is scarce. A single publication reporting protection against T. solium taeniasis by experimental primo infection and by vaccination of an experimental foster host, the immunocompetent female hamster, kindles the hope of a vaccine against the tapeworm to be used in humans, its only natural definitive host.
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Affiliation(s)
- Edda Sciutto
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, A.P. 70228, DF México.
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Neurocysticercosis, IgG immunoglobulins, and nitric oxide. Parasitol Res 2010; 106:1287-91. [DOI: 10.1007/s00436-010-1793-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 02/05/2010] [Indexed: 10/19/2022]
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50
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Almeida SMD, Gurjão SA. Frequency of depression among patients with neurocysticercosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:76-80. [DOI: 10.1590/s0004-282x2010000100017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 09/23/2009] [Indexed: 11/22/2022]
Abstract
Neurocysticercosis (NCC) is a common central nervous system infection caused by Taenia solium metacestodes. OBJECTIVE: To investigate the occurrence of depression in patients with calcified NCC form. The study group consisted of 114 patients subdivided in four groups: NCC with epilepsy, NCC without epilepsy, epilepsy without NCC and chronic headache. METHOD: Depression was evaluated and quantified by the Hamilton Rating Scale for Depression (HRSD-21). RESULTS: Percentage of patients with depression was as follows: group 1 (83%); group 2 (88%); group 3 (92%); group 4 (100%). The majority of patients had moderate depression. CONCLUSION: Incidence of depression in all groups was higher than in the general population. It is possible that, in a general way, patients with chronic diseases would have depression with similar intensity. NCC is associated with the presence of depression.
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