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de Franca MNF, Rodrigues LS, Barreto AS, da Cruz GS, Aragão-Santos JC, da Silva AM, de Jesus AR, Palatnik-de-Sousa CB, de Almeida RP, Corrêa CB. CD4 + Th1 and Th17 responses and multifunctional CD8 T lymphocytes associated with cure or disease worsening in human visceral leishmaniasis. Front Immunol 2024; 15:1277557. [PMID: 38410517 PMCID: PMC10895669 DOI: 10.3389/fimmu.2024.1277557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/02/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction In VL, a proinflammatory phenotype is typically associated with enhanced phagocytosis and a Th1 mediated immune response resulting in infection control. In contrast, an anti-inflammatory phenotype, associated with a predominant regulatory response, typically enables intracellular multiplication of Leishmania parasites and disease progression. Methods To investigate the impact of chemotherapy on Th2 and Th17 immune responses in patients with visceral leishmaniasis (VL), we assessed all combinations of intracellular expression of IFN-γ, IL-10, IL-4 and IL-17 in the CD4+ and CD8+ T cell populations of peripheral blood mononuclear cell (PBMC) samples from patients, after antigenic stimulation with Leishmania lysate, throughout treatment and follow-up. As increases in spleen and liver sizes and decreases in hematocrit, hemogloblin, erythrocytes, monocytes, leukocytes and platelets levels are strongly related to the disease, we studied the correlations between the frequencies of T cells producing the afore mentioned cytokines, individually and in combination, and these variables, as markers of disease or cure. Results We found that the frequency of IFN-γ-producingCD4+ T cells increased until the end of chemotherapy with Glucantime® or AmBisome ®, while IL-10, IL-4 and IL-17-producing CD4+ T cells peaked on day 7 following the start of treatment. Although the frequency of CD4+IL-17+ cells decreased during treatment an increase was observed after clinical cure. The frequency of CD4+ T cells producing only IFN-γ or IL-17 correlated with blood monocytes levels. Frequencies of double-producers of IFN-γ and IL-10 or IL-4 correlated positively with eosinophils and platelets levels. Together, this suggest that IFN-γ drives the immune response towards Th1 at cure. In contrast, and associated with disease or Th2 response, the frequency of CD4+ IL-10+ cells correlated positively with spleen sizes and negatively with circulating monocyte levels, while the frequency of CD4+ producing both IL-4 and IL-10 correlated negatively with platelets levels. The frequency of CD8+ single-producers of IFN-γ increased from day 21 to 90 while that of single-producers of IL-10 peaked on day 7, of IL-4 on day 30 and of IL-17, on day 180. IFN-γ expression in CD8+ single- and double-producers of cytokines was indicative of an immune response associated with cure. In contrast, frequencies of CD8+ double-producers of IL-4 and IL-10, IL-4 and IL-17 and IL-10 and IL-17 and producers of three and four cytokines, were associated with disease and were low after the cure. Frequencies of CD8+ T cells producing IFN-γ alone or with IL-17 were positively correlated with platelets levels. In contrast, as markers of disease: 1) frequencies of single producers of IL-10 correlated negatively with leukocytes levels, 2) frequencies of double producers of IL-4 and IL-10 correlated negatively with platelet, leukocyte, lymphocyte and circulating monocyte levels, 3) frequencies of triple-producers of IFN-γ, IL-4 and IL-10 correlated negatively with platelet, leukocyte and neutrophil levels and 4) frequencies of producers of IFN-γ, IL-4, IL-10 and IL-17 simultaneously correlated positively with spleen size, and negatively with leukocyte and neutrophil levels. Discussion Our results confirmed that the clinical improvement of VL patients correlates with the decrease of an IL-4 and IL-10 CD4+Th2 response, the recovery of CD4+ Th1 and Th17 responses and the frequency of CD8+ single-producers of IFN-γ and double producers of IFN-γ and IL-17.
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Affiliation(s)
- Mariana Nobre Farias de Franca
- Laboratory of Biology and Immunology of Cancer and Leishmania, Department of Morphology, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Lorranny Santana Rodrigues
- Laboratory of Biology and Immunology of Cancer and Leishmania, Department of Morphology, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Aline Silva Barreto
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Division of Immunology and Molecular Biology Laboratory, University Hospital/Empresa Brasileira de Serviços Hospitalares (EBSERBH), Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Geydson Silveira da Cruz
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Division of Immunology and Molecular Biology Laboratory, University Hospital/Empresa Brasileira de Serviços Hospitalares (EBSERBH), Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - José Carlos Aragão-Santos
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Department of Physical Education, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Angela Maria da Silva
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Amélia Ribeiro de Jesus
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Division of Immunology and Molecular Biology Laboratory, University Hospital/Empresa Brasileira de Serviços Hospitalares (EBSERBH), Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe, Brazil
| | - Clarisa B. Palatnik-de-Sousa
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro, Immunology Investigative Institute (III), Insititutos nacionais de Ciência e Tecnologia (INCT), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Rio de Janeiro, Brazil
- Graduate Program in Vegetal Biotechnology and Bioprocesses, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roque Pacheco de Almeida
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Division of Immunology and Molecular Biology Laboratory, University Hospital/Empresa Brasileira de Serviços Hospitalares (EBSERBH), Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe, Brazil
| | - Cristiane Bani Corrêa
- Laboratory of Biology and Immunology of Cancer and Leishmania, Department of Morphology, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
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Melkie I, Yimer M, Alemu G, Tegegne B. Asymptomatic Leishmania donovani infection and associated factors among blood donors attending at Metema district Blood Bank, Northwest Ethiopia: a cross- sectional study. Arch Public Health 2023; 81:62. [PMID: 37085820 PMCID: PMC10120276 DOI: 10.1186/s13690-023-01082-7] [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: 12/12/2022] [Accepted: 04/06/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Ethiopia is one of the top 10 countries in the world where 90% visceral leishmaniasis cases are reported. Metema-Humera lowlands are the most important foci in Ethiopia. Blood transfusion in visceral leishmaniasis endemic foci in Ethiopia does not consider screening of visceral leishmaniasis during blood donation. The aim of this study is therefore, was to assess asymptomatic Leishmania donovani infection and associated factors among blood donors attending at Metema district Blood Bank, Northwest Ethiopia. METHODS A Health facility based cross-sectional study was conducted at Metema Blood Bank from February to March 2020. A total of 205 blood donors were eligible and participated in this study. Structured questionnaire were used to collect data on socio-demographic characteristics and perceived risk factors associated with asymptomatic visceral leishmaniasis among blood donors. Blood donors were screened using both rK39 and direct agglutination tests based on the manufactures' instructions. Data were analyzed using SPSS version 20.0. Chi-square test was used to assess associations of Leishmania donovani infection with predisposing factors. Associations were considered statstically significant on P-value < 0.05 at 95% confidence level. RESULTS Of the total 205 participants, 32(15.6%) were positive for asymptomatic Leishmania donovani infection at least by one of the diagnostic tests used. Eight (3.9%) and 30(14.6%) of the participants` were positive by the rK39 and direct agglutination tests, respectively. Six (2.9%) donors were tested positive by both diagnostic tests. Family history of visceral leishmaniasis (X²=11.334, P = 0.003) and having neighbors with history of visceral leishmaniasis (X²=5.923, P = 0.015) were significantly associated with asymptomatic Leishmania donovani infection among blood donors. CONCLUSIONS The prevalence of asymptomatic Leishmania donovani infection was 15.6%. Asymptomatic visceral leishmaniasis was significantly associated with donors' family and neighbors' history of infection. Therefore, laboratory screening of blood donors for visceral leishmaniasis in endemic areas will be mandatory. Moreover, this study will give base line information for future study in the country.
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Affiliation(s)
- Iyasu Melkie
- Bahir Dar city administration Blood Bank, Bahir Dar city, Ethiopia
| | - Mulat Yimer
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar city, Ethiopia.
| | - Getaneh Alemu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar city, Ethiopia
| | - Banchamlak Tegegne
- Medical Parasitology Department, Amhara Public Health Institute, Bahir Dar city, Ethiopia
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Hammarström H, Moreno J, Dotevall L, Calander AM. Leishmania infantum infection after visiting southern Spain in patients on biological treatment; an observational, longitudinal, cohort study. Travel Med Infect Dis 2023; 53:102570. [PMID: 37001789 DOI: 10.1016/j.tmaid.2023.102570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/19/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Reports of leishmaniasis in immunosuppressed patients after visiting the Mediterranean Basin are becoming increasingly common. Still, awareness of the risk of infection and its clinical manifestations may be insufficient among healthcare professionals in the travellers' home countries. METHODS This observational, longitudinal study included 47 patients from Sweden with rheumatic disease and ongoing immunomodulatory treatment, who visited a rehabilitation centre in southern Spain where leishmaniasis is endemic. Patients were evaluated for clinical signs of leishmaniasis at baseline and after three years. Patients with leishmaniasis were followed for 4-5 years. The treatment outcome was assessed by clinical evaluation and determination of the cell-mediated immunological response to Leishmania by a whole blood cytokine release assay. RESULTS Seven patients (15%) were diagnosed with leishmaniasis. The median time from exposure to the onset of symptoms was 3 [1-17] months. The median delay between the onset of symptoms and treatment start was 9 [1-12] months. All patients with leishmaniasis responded well to treatment. Only one patient had a relapse, which occurred within the first year. CONCLUSION Healthcare professionals need to be aware of the increased risk of leishmaniasis for travellers who are immunosuppressed. Knowledge of the symptoms is crucial for a timely diagnosis and early treatment.
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Affiliation(s)
- Helena Hammarström
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, and Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, CIBERINFEC, Majadahonda, 28220, Madrid, Spain
| | - Leif Dotevall
- Department of Communicable Disease Control, Region Västra Götaland, Gothenburg, Sweden
| | - Ann-Marie Calander
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Asymptomatic Leishmania infection in humans: A systematic review. J Infect Public Health 2023; 16:286-294. [PMID: 36630836 DOI: 10.1016/j.jiph.2022.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Leishmaniasis is a highly prevalent neglected tropical disease. It mainly presents as two forms: cutaneous and visceral leishmaniasis, the latter being the most severe form. However, asymptomatic cases of Leishmania infection result in an increase in the underreporting and transmission of the protozoan OBJECTIVES: In this study, articles on the incidence of asymptomatic Leishmania infection were systematically reviewed. METHODS The publications identified in the Medline/PubMed and Science Direct databases included 4568 articles. Inclusion, exclusion, and eligibility criterion analysis resulted in 83 articles being retained. These studies were mostly performed in Brazil (n = 26) and India (n = 15). RESULTS Several detection techniques have been used for diagnosis. Among the species found were L. infantum and L. donovani, which result in visceral leishmaniasis, and L. amazonensis, L. braziliensis, and L. panamensis. The incidence rates varied between the analyzed locations, largely due to sampling and the presence or absence of endemism in the regions. The largest populations analyzed were in two studies performed in India and Nepal. One of these studies evaluated 32,529 people and the incidence rate was 8.3% (n = 2702), while the other study evaluated 21,267 people and the incidence rate was 1.76% (n = 375). Only 14.28% of the studies investigated leishmaniasis in blood donors. Preexisting diseases have also been reported. CONCLUSION The findings of this systematic review present the incidence of cases of asymptomatic Leishmania infection worldwide, in addition to detailing the studies and offering information for researchers and health authorities to seek alternatives to reduce the number of leishmaniasis cases.
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Kalita E, Panda M, Rao A, Prajapati VK. Exploring the role of secretory proteins in the human infectious diseases diagnosis and therapeutics. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2023; 133:231-269. [PMID: 36707203 DOI: 10.1016/bs.apcsb.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Secretory proteins are playing important role during the host-pathogen interaction to develop the infection or protection into the cell. Pathogens developing infectious disease to human being are taken up by host macrophages or number of immune cells, play an important role in physiological, developmental and immunological function. At the same time, infectious agents are also secreting various proteins to neutralize the resistance caused by host cells and also helping the pathogens to develop the infection. Secretory proteins (secretome) are only developed at the time of host-pathogen interaction, therefore they become very important to develop the targeted and potential therapeutic strategies. Pathogen specific secretory proteins released during interaction with host cell provide opportunity to develop point of care and rapid diagnostic kits. Proteins secreted by pathogens at the time of interaction with host cell have also been found as immunogenic in nature and numbers of vaccines have been developed to control the spread of human infectious diseases. This chapter highlights the importance of secretory proteins in the development of diagnostic and therapeutic strategies to fight against human infectious diseases.
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Affiliation(s)
- Elora Kalita
- Department of Biochemistry, School of Life Sciences, Central University of Rajasthan, Ajmer, Rajasthan, India
| | - Mamta Panda
- Department of Biochemistry, School of Life Sciences, Central University of Rajasthan, Ajmer, Rajasthan, India
| | - Abhishek Rao
- Department of Biochemistry, School of Life Sciences, Central University of Rajasthan, Ajmer, Rajasthan, India
| | - Vijay Kumar Prajapati
- Department of Biochemistry, School of Life Sciences, Central University of Rajasthan, Ajmer, Rajasthan, India.
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De Pascali AM, Todeschini R, Baiocchi S, Ortalli M, Attard L, Ibarra-Meneses AV, Carrillo E, Varani S. Test combination to detect latent Leishmania infection: A prevalence study in a newly endemic area for L. infantum, northeastern Italy. PLoS Negl Trop Dis 2022; 16:e0010676. [PMID: 35969605 PMCID: PMC9410555 DOI: 10.1371/journal.pntd.0010676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/25/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Most people infected with Leishmania remain asymptomatic, which is a common element that may promote the resurgence of clinically evident leishmaniasis in individuals with impaired cell-mediated immune responses. Unfortunately, there is no universally accepted assay to identify asymptomatic infection. This cross-sectional study focuses on the employment of three methods targeting different features of the parasitic infection to be used in combination for the screening of latent leishmaniasis in a newly endemic area of northeastern Italy. Methodology/principal findings The selected methods included highly sensitive Real-Time PCR for detection of parasitic kinetoplast (k)DNA in peripheral blood, Western Blot (WB) for detection of specific IgG, and Whole Blood stimulation Assay (WBA) to evaluate the anti-leishmanial T-cell response by quantifying the production of IL-2 after stimulation of patients’ blood with Leishmania specific antigens. Among 145 individuals living in a municipality of the Bologna province, northeastern Italy, recruited and screened for Leishmania infection, 23 subjects tested positive (15.9%) to one or more tests. Positive serology was the most common marker of latent leishmaniasis (15/145, 10%), followed by the detection of specific cell-mediated response (12/145, 8%), while only few individuals (6/145, 4%) harbored parasitic DNA in the blood. Conclusions/significance Combining different tests substantially increased the yield of positivity in detecting latent Leishmania infection. The test combination that we employed in this study appears to be effective to accurately identify latent leishmaniasis in an endemic area. After infection with Leishmania infantum cutaneous or visceral leishmaniasis can develop, but in most cases the host becomes an asymptomatic carrier of the parasite. This key population of individuals with latent leishmaniasis can undergo reactivation of the infection with severe outcome in case of immunosuppression and can contribute to disease transmission. The public health impact of leishmaniasis is currently underestimated in Europe, despite Leishmania infection is endemic in the Mediterranean countries and outbreaks of human leishmaniasis have been reported in the last decades, including northeastern Italy. One of the causes contributing to this neglect is that the available diagnostic tests exhibit scarce sensitivity in identification of latent leishmaniasis. In this study, we identified latent Leishmania infection in a newly endemic area of northeastern Italy by using three different diagnostic methods; serological, molecular and immunological tests. Sixteen percent of individuals residing in the selected area were shown to be positive to at least one of the three tests, which indicates a previous contact with the parasite. This study highlights the importance of test combination to enhance the ability to identify latent Leishmania infection.
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Affiliation(s)
- Alessandra Mistral De Pascali
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Renato Todeschini
- Unit of Hygiene and Public Health, Department of Public Health, AUSL Bologna, Bologna, Italy
| | - Simone Baiocchi
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Margherita Ortalli
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luciano Attard
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ana Victoria Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda (Madrid), Spain, CIBERINFEC
- Département de pathologie et microbiologie, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
- The Research Group on Infectious Diseases in Production Animals (GREMIP), Faculty of Veterinary Medicine, Université de Montréal, Montreal, Canada
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda (Madrid), Spain, CIBERINFEC
- * E-mail: (EC); (SV)
| | - Stefania Varani
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- * E-mail: (EC); (SV)
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Guedes DL, da Silva ED, Castro MCAB, Júnior WLB, Ibarra-Meneses AV, Tsoumanis A, Adriaensen W, van Griensven J, Pereira VRA, de Medeiros ZM. Comparison of serum cytokine levels in symptomatic and asymptomatic HIV-Leishmania coinfected individuals from a Brazilian visceral leishmaniasis endemic area. PLoS Negl Trop Dis 2022; 16:e0010542. [PMID: 35714136 PMCID: PMC9246190 DOI: 10.1371/journal.pntd.0010542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 06/30/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Visceral leishmaniasis (VL) remains an important infectious disease worldwide. VL-HIV coinfected individuals can present with atypical clinical forms of VL and have a high risk of VL relapse. Some cytokines have been described as potential markers to diagnose active VL and to predict the severity of the cases. However, few studies have included VL-HIV coinfected patients. We aimed to characterize the levels of several cytokines among VL-HIV coinfected individuals living in a VL-endemic area in Northeast Brazil. Methods This was a retrospective, cross-sectional study, aiming to estimate the levels of various cytokines in symptomatic and asymptomatic VL-HIV coinfected individuals. There were 134 study participants (35 symptomatic VL-HIV, 75 asymptomatic VL-HIV, and 24 healthy controls), all ≥ 18 years-old. Serum cytokine levels (interferon-γ, tumor necrosis factor, and interleukins 2, 4, 6, 10, and 17A) were quantified using the Becton Dickinson-BD’s Cytometric Bead Array (CBA) system. Results The population mainly consisted of men (64.9%), with a median age of 35 (27–41) years. Asymptomatic individuals were younger (p = 0.013), with more years of education (p < 0.001), and were more often on antiretroviral therapy (p < 0.001) than those in the symptomatic group. Hemoglobin levels (p < 0.001), lymphocytes (p < 0.001) and CD4 count (p < 0.001) were lower in symptomatic individuals, while HIV viral loads were higher (p < 0.001). In the symptomatic VL-HIV coinfected group, we observed increased serum levels of IL-17A, IL-6, and IL-10 compared to asymptomatic patients and the healthy controls. There were no differences in the levels of all cytokines between asymptomatic VL-HIV coinfected individuals and the healthy controls. Conclusions Higher serum levels of IL-17A, IL-6, and IL-10 cytokines were observed in symptomatic coinfected individuals but not in asymptomatically infected individuals. More studies among HIV-positive persons are needed to better understand the role of serum cytokines for prognosis, to define cure and predict VL relapses in VL-HIV coinfected individuals. Visceral leishmaniasis (VL) is a parasitic disease, classified as a neglected disease by the World Health Organization. It is present in more than 60 countries in four continents, with most tropical and subtropical countries affected. Without treatment, the disease is fatal. HIV-positive persons are especially affected by VL, with a worst prognosis. One of the main complications is the frequent reactivation of the disease even after successful treatment (VL relapse). Up to now, it is not clear why and when these reactivations occur, and many researches are trying to find some biological markers to answer this. Cytokines are one of these markers that may explain the progression of the disease. In this study, we compared the level of several key cytokines in symptomatic VL-HIV coinfected patients, asymptomatic VL-HIV coinfected individuals, and healthy controls living in a VL-endemic region in Northeastern Brazil. The serum cytokine levels were higher in symptomatic patients when compared with asymptomatic and healthy controls. More studies following VL-HIV patients are necessary to understand how these cytokines and the other biomarkers vary over time and whether they can predict VL relapse, and also the progression and the prognosis of the disease.
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Affiliation(s)
- Diego Lins Guedes
- Department of Parasitology, Aggeu Magalhães Institute–Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
- Curso de medicina, Núcleo de Ciências da Vida, Centro Acadêmico do Agreste, Universidade Federal de Pernambuco, Caruaru, Pernambuco, Brazil
- * E-mail:
| | - Elis Dionísio da Silva
- Department of Immunology, Aggeu Magalhães Institute–Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
| | - Maria Carolina Accioly Brelaz Castro
- Department of Immunology, Aggeu Magalhães Institute–Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
- Parasitology Laboratory, Federal University of Pernambuco, Vitoria de Santo Antão, Pernambuco, Brazil
| | - Walter Lins Barbosa Júnior
- Department of Parasitology, Aggeu Magalhães Institute–Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
| | - Ana Victoria Ibarra-Meneses
- Département de pathologie et microbiologie. Faculté de médecine vétérinaire. Université de Montréal, Saint-Hyacinthe, QC, Canada
- The Research Group on Infectious Diseases in Production Animals (GREMIP), Faculty of Veterinary Medicine, Université de Montréal, Montreal, Canada
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Wim Adriaensen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Valéria Rêgo Alves Pereira
- Department of Immunology, Aggeu Magalhães Institute–Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
| | - Zulma Maria de Medeiros
- Department of Parasitology, Aggeu Magalhães Institute–Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
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Carrasco-Antón N, Ibarra-Meneses AV, Carrillo E, Fernández-Ruiz M, Hernández-Jiménez P, Aguado JM, Moreno J, López-Medrano F. An exploratory analysis of C-X-C motif chemokine ligand 10 as a new biomarker of asymptomatic Leishmania infantum infection in Solid-Organ Transplant Recipients. J Infect 2022; 84:573-578. [PMID: 35101535 DOI: 10.1016/j.jinf.2022.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Sensitive and less laborious assays are needed to detect asymptomatic Leishmania among solid organ transplant (SOT) recipients. Using SLA-stimulated plasma from SOT recipients living where an outbreak of Leishmania infantum occurred, we examined potential biomarkers to identify asymptomatic Leishmania infections. METHODS Concentrations of cytokines/chemokines in plasma from whole blood stimulated with specific Leishmania antigen (SLA) were compared against infection status as determined by a currently used cell proliferation assay. RESULTS Twenty-six percent (13/50) of the SOT recipients had a cell proliferation assay (CPA) indicating asymptomatic infection, and showed higher processed plasma C-X-C motif chemokine ligand 10 (CXCL10 or IP-10) concentrations than did non-infected subjects (median 2272.0 pg/ml [IQR-1570-2772] vs. 18.2 pg/ml [IQR 1-150.1]; p<0.0001). CXCL10 showed a sensitivity of 93% and a specificity of 95% compared to CPA. In addition, we demonstrated that the number of asymptomatic infections detected using CXCL10, decreased with distance from a park at the centre of the mentioned outbreak. CONCLUSION CXCL10 in plasma from SLA-stimulated blood could be a robust biomarker of asymptomatic L. infantum infection in solid organ transplant recipients.
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Affiliation(s)
- Nerea Carrasco-Antón
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain, CIBERINFEC.
| | - Ana Victoria Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, Spanish National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain, CIBERINFEC.
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, Spanish National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain, CIBERINFEC.
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain, CIBERINFEC.
| | - Pilar Hernández-Jiménez
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain, CIBERINFEC.
| | - José María Aguado
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain, CIBERINFEC.
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, Spanish National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain, CIBERINFEC.
| | - Francisco López-Medrano
- WHO Collaborating Centre for Leishmaniasis, Spanish National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain, CIBERINFEC.
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Ibarra-Meneses AV, Corbeil A, Wagner V, Onwuchekwa C, Fernandez-Prada C. Identification of asymptomatic Leishmania infections: a scoping review. Parasit Vectors 2022; 15:5. [PMID: 34983616 PMCID: PMC8727076 DOI: 10.1186/s13071-021-05129-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/11/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Asymptomatic Leishmania infection may play an important role in the transmission of the parasite in endemic areas. At present there is no consensus on the definition of asymptomatic Leishmania infection, nor is there a safe and accessible gold standard test for its identification. METHODS This paper presents a scoping review to summarize definitions of asymptomatic Leishmania infection found in the literature, as well as to detail the approach (molecular, serological, cellular, and/or parasitological tests) used by researchers to identify this asymptomatic population. A scoping review of published and gray literature related to asymptomatic Leishmania infection was conducted; retrieved citations were screened based on predefined eligibility criteria, and relevant data items were extracted from eligible articles. The analysis is descriptive and is presented using tables, figures, and thematic narrative synthesis. RESULTS We conducted a screening of 3008 articles, of which 175 were selected for the full review. Of these articles, we selected 106 that met the inclusion criteria. These articles were published between 1991 and 2021, and in the last 5 years, up to 38 articles were reported. Most of the studies were conducted in Brazil (26%), Spain (14%), India (12%), Bangladesh (10%), and Ethiopia (7%). Of the studies, 84.9% were conducted in the immunocompetent population, while 15.1% were conducted in the immunosuppressed population (HIV, immunosuppressive drugs, and organ transplantation population). We report 14 different techniques and 10 strategies employed by researchers to define asymptomatic Leishmania infection in an endemic area. CONCLUSIONS The definition of asymptomatic Leishmania infection is not unified across the literature, but often includes the following criteria: residence (or extended stay) in a Leishmania-endemic area, no reported signs/symptoms compatible with leishmaniasis, and positive on a combination of serological, molecular, cellular, and/or parasitological tests. Caution is recommended when comparing results of different studies on the subject of asymptomatic infections, as the reported prevalence cannot be confidently compared between areas due to the wide variety of tests employed by research groups. More research on the importance of asymptomatic immunosuppressed and immunocompetent Leishmania-positive populations in leishmaniasis epidemiology is required.
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Affiliation(s)
- Ana Victoria Ibarra-Meneses
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada.,The Research Group on Infectious Diseases in Production Animals (GREMIP), Faculty of Veterinary Medicine, Université de Montréal, Saint Hyacinthe, Canada
| | - Audrey Corbeil
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada.,The Research Group on Infectious Diseases in Production Animals (GREMIP), Faculty of Veterinary Medicine, Université de Montréal, Saint Hyacinthe, Canada
| | - Victoria Wagner
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada.,The Research Group on Infectious Diseases in Production Animals (GREMIP), Faculty of Veterinary Medicine, Université de Montréal, Saint Hyacinthe, Canada
| | - Chukwuemeka Onwuchekwa
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Christopher Fernandez-Prada
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada. .,The Research Group on Infectious Diseases in Production Animals (GREMIP), Faculty of Veterinary Medicine, Université de Montréal, Saint Hyacinthe, Canada.
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10
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França ADO, Soares LS, Pompilio MA, Tozetti IA, Bonin CM, Dorval MEMC. Cytokine profile in Leishmania-positive blood donors. PLoS One 2020; 15:e0238933. [PMID: 32966326 PMCID: PMC7511012 DOI: 10.1371/journal.pone.0238933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/26/2020] [Indexed: 12/03/2022] Open
Abstract
Serum levels of interleukin 2 (IL-2), interleukin 4 (IL-4), interleukin 6 (IL-6), interleukin 10 (IL-10), interleukin 17 (IL-17), interferon gamma (IFN-γ), tumor necrosis factor α (TNF-α), and interleukin 1β (IL-1β), cytokines involved in the immune response, were investigated in 75 Leishmania-positive blood donors living in endemic areas. Based on their status in 2011 and 2015, the subjects were clustered into three groups: positive for at least one diagnostic method in both years, but lacking clinical progression to disease (G1); positive on at least one method in 2011 but negative in 2015 (G2); negative on all methods in both years (G3). Donors were interviewed for sociodemographic data collection and underwent clinical evaluation and laboratory tests. Serum cytokines were quantified using a CBA Flex set (BD Biosciences). Significant differences were found for all the cytokines evaluated, with lower concentrations in consistently Leishmania-negative individuals. The exception was IFN-γ, with similar levels among all donors. No changes consistent with active disease were observed in the laboratory results for Leishmania-positive donors who underwent clinical evaluation, none of whom progressed to disease. This suggests that infection control is associated with serum IL-17 levels. Resolution of Leishmania infection in positive donors may be related to high levels of IL-17 and low levels of IL-10, highlighting the role played by IL-17 in asymptomatic Leishmania-infected individuals.
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Affiliation(s)
- Adriana de Oliveira França
- Laboratory of Clinical Parasitology, Graduate Program in Infectious and Parasitic Diseases, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
- * E-mail:
| | - Luana Silva Soares
- Laboratory of Immunology, Universidade Católica Dom Bosco, Campo Grande, MS, Brazil
| | - Mauricio Antonio Pompilio
- Hélio Mandetta School of Medicine, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Inês Aparecida Tozetti
- Laboratory of Immunobiology, Institute of Biosciences, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Camila Mareti Bonin
- Laboratory of Immunobiology, Institute of Biosciences, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
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11
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Ibarra-Meneses AV, Carrillo E, Nieto J, Sánchez C, Ortega S, Estirado A, Latasa Zamalloa P, Sanz JC, García-Comas L, Ordobás M, Moreno J. Prevalence of asymptomatic Leishmania infection and associated risk factors, after an outbreak in the south-western Madrid region, Spain, 2015. ACTA ACUST UNITED AC 2020; 24. [PMID: 31164191 PMCID: PMC6549460 DOI: 10.2807/1560-7917.es.2019.24.22.1800379] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BackgroundA large outbreak of leishmaniasis with 758 cutaneous and visceral leishmaniasis cases occurred in 2009 in Fuenlabrada, in the south-west of the Madrid region of Spain.AimWe aimed to determine the prevalence of asymptomatic Leishmania infection after this outbreak, and its associated risk factors.MethodsA cross-sectional study of 804 healthy individuals living in Fuenlabrada who had no history of leishmaniasis, was conducted between January and July 2015. Asymptomatic infections were sought by either a combination of PCR, immunofluorescent antibody titre, and direct agglutination tests, or by whole blood stimulation assay (WBA) with interleukin-2 (IL-2) quantification.ResultsUsing the first approach, prevalence of asymptomatic individuals was 1.1% (9/804), while the second returned a value of 20.7% (143/804). Older age, being male, proximity to the park where the focus of infection was identified, and living in a detached house, were all strongly associated with the prevalence of asymptomatic infection.ConclusionsThe true number of infected individuals may be underestimated if only serological methods are used. The combination of WBA with IL-2 quantification may allow to better determine the prevalence of asymptomatic Leishmania infection, which would be useful in establishing control measures and in quantifying their impact. In our study, the use of WBA with IL-2 quantification also helped establish the risk factors that influence exposure to and infection by Leishmania.
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Affiliation(s)
- Ana Victoria Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Javier Nieto
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Carmen Sánchez
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Sheila Ortega
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Alicia Estirado
- Department of Epidemiology, Consejería de Sanidad de la Comunidad de Madrid, Madrid, Spain
| | - Pello Latasa Zamalloa
- Department of Epidemiology, Consejería de Sanidad de la Comunidad de Madrid, Madrid, Spain
| | - Juan Carlos Sanz
- Regional Public Health Laboratory, Health Department of the Community of Madrid, Madrid, Spain
| | - Luis García-Comas
- Department of Epidemiology, Consejería de Sanidad de la Comunidad de Madrid, Madrid, Spain
| | - María Ordobás
- Department of Epidemiology, Consejería de Sanidad de la Comunidad de Madrid, Madrid, Spain
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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12
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Whole Blood Stimulation Assay as a Treatment Outcome Monitoring Tool for VL Patients in Ethiopia: A Pilot Evaluation. J Immunol Res 2020; 2020:8385672. [PMID: 32377538 PMCID: PMC7193677 DOI: 10.1155/2020/8385672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/04/2019] [Indexed: 11/20/2022] Open
Abstract
Visceral leishmaniasis (VL) is a lethal disease if left untreated. Current treatments produce variable rates of treatment failure and toxicity without sterile cure, rendering treatment efficacy monitoring essential. To avoid repeated invasive tissue aspirates as well as empirical treatment, there is a need for new tools that allow a less-invasive and early assessment of treatment efficacy in the field. Cross-sectional studies have suggested levels of cytokines/chemokines after whole blood stimulation as good markers of cure, but longitudinal studies are lacking. In this study, we followed 13 active VL cases in an endemic area in Ethiopia by measuring the production of IFN-γ, TNF-α, IP-10, IL-2, IL-10, MCP-1, and MIG before, during, and at the end of treatment. After 24 hours of stimulation of whole blood with soluble Leishmania antigen, we observed an early, robust, and incremental increase of IFN-γ, TNF-α, and IP-10 levels in all patients during treatment. Moreover, based on the IFN-γ levels that showed an average 13-fold increase from the time of diagnosis until the end of treatment, we could almost perfectly discriminate active from cured status. Similar concentrations and patterns were found in stimulation assays with the two main Leishmania species. The levels of IFN-γ, IP-10, or TNF-α also seemed to be inversely associated with the parasite load at baseline. Despite a 1/10 drop in concentrations, similar patterns were observed in IFN-γ and IP-10 levels when dried plasma spots were stored at 4°C for an average of 225 days. All the above evidence suggests a detectable restoration of cell-mediated immunity in VL and its association with parasite clearance. With a potential application in rural settings by means of dried plasma spots, we recommend to further explore the early diagnostic value of such assays for treatment efficacy monitoring in large cohort studies including treatment failure cases.
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Guillén MC, Alcover MM, Borruel N, Sulleiro E, Salvador F, Berenguer D, Herrera-de Guise C, Rodríguez V, Moure Z, Sánchez-Montalvà A, Molina I, Fisa R, Riera C. Leishmania infantum asymptomatic infection in inflammatory bowel disease patients under anti-TNF therapy. Heliyon 2020; 6:e03940. [PMID: 32420499 PMCID: PMC7218013 DOI: 10.1016/j.heliyon.2020.e03940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/12/2019] [Accepted: 05/04/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In recent years anti-TNF therapy has been associated with leishmaniasis in immunocompromised patients from endemic areas. Nevertheless, data on asymptomatic Leishmania infection in such patients is scarce. The aim of this study was to determine the prevalence of asymptomatic infection in inflammatory bowel disease (IBD) patients treated with TNF inhibitors living in an endemic area (Catalonia) and to follow up them to study how the infection evolved. METHODS 192 IBD patients (143 Crohn's disease; 49 ulcerative colitis) from Catalonia (Spain), an area endemic for L. infantum, were recruited. Peripheral blood samples were collected and tested for anti-Leishmania antibodies by Western blotting (WB). Leishmania kinetoplast DNA was detected in peripheral blood mononuclear cells (PBMC) by a quantitative PCR. RESULTS Serology was positive in 3.1% and Leishmania DNA was found in 8.8%, with a low parasitic load and humoral response. The prevalence was 10.9%, patients being considered infected if they tested positive by at least one of the techniques. Eight out of the 21 patients with asymptomatic leishmaniasis were monitored for 3-8 months after the first test. None of them showed an increased parasitemia or humoral response, or developed leishmaniasis during the follow-up period. CONCLUSION The prevalence of Leishmania asymptomatic infection detected in our IBD cohort is similar to that found in healthy population in close endemic areas. Due to the short monitoring period, it is not possible to reach a conclusion about the risk of Leishmania reactivation from this study.
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Affiliation(s)
- M. Carmen Guillén
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Avda Joan XXIII, 27-31, 08028, Barcelona, Spain
| | - M. Magdalena Alcover
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Avda Joan XXIII, 27-31, 08028, Barcelona, Spain
| | - Natalia Borruel
- Crohn's and Colitis Attention Unit, Vall d’Hebron University Hospital, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Elena Sulleiro
- Department of Microbiology, Vall d’Hebron University Hospital, PROSICS, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Diana Berenguer
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Avda Joan XXIII, 27-31, 08028, Barcelona, Spain
| | - Claudia Herrera-de Guise
- Crohn's and Colitis Attention Unit, Vall d’Hebron University Hospital, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Verónica Rodríguez
- Crohn's and Colitis Attention Unit, Vall d’Hebron University Hospital, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Zaira Moure
- Department of Microbiology, Vall d’Hebron University Hospital, PROSICS, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Adrián Sánchez-Montalvà
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Israel Molina
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, Ps Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Roser Fisa
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Avda Joan XXIII, 27-31, 08028, Barcelona, Spain
| | - Cristina Riera
- Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Avda Joan XXIII, 27-31, 08028, Barcelona, Spain
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14
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Molina R, Jiménez M, García-Martínez J, San Martín JV, Carrillo E, Sánchez C, Moreno J, Alves F, Alvar J. Role of asymptomatic and symptomatic humans as reservoirs of visceral leishmaniasis in a Mediterranean context. PLoS Negl Trop Dis 2020; 14:e0008253. [PMID: 32324738 PMCID: PMC7200008 DOI: 10.1371/journal.pntd.0008253] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/05/2020] [Accepted: 03/26/2020] [Indexed: 12/20/2022] Open
Abstract
Background In the Mediterranean basin, Leishmania infantum is the causative agent of visceral leishmaniasis (VL), a zoonosis in which the dog is the primary domestic reservoir, although wildlife may have a leading role in the sylvatic cycle of the disease in some areas. Infections without disease are very frequent. There is limited information regarding the role that VL patients and asymptomatic infected individuals could be playing in the transmission of L. infantum. Xenodiagnosis of leishmaniasis has been used in this descriptive study to explore the role of symptomatic and asymptomatic infected individuals as reservoirs in a recent focus of leishmaniasis in southwestern Madrid, Spain. Methodology and main findings Asymptomatic blood donors (n = 24), immunocompetent patients who were untreated (n = 12) or treated (n = 11) for visceral leishmaniasis (VL), and immunocompromised patients with VL (n = 3) were enrolled in the study. Their infectivity to Phlebotomus perniciosus was studied by indirect xenodiagnosis on peripheral blood samples. Quantitative polymerase chain reaction of blood samples from immunocompetent patients untreated for VL and immunocompromised untreated, treated and under secondary prophylaxis for VL was performed. Antibodies against Leishmania were studied by indirect fluorescent antibody and rK39-immunochromatographic tests. A lymphoproliferative assay with a soluble Leishmania antigen was used to screen for leishmaniasis infection in the healthy population. Sixty-two xenodiagnostic tests were carried out and 5,080 sand flies were dissected. Positive xenodiagnosis was recorded in four patients, with different sand fly infection rates: 1 immunosuppressed HIV / L. infantum coinfected asymptomatic patient, 1 immunosuppressed patient with multiple myeloma and symptomatic active VL, and 2 immunocompetent patients with untreated active VL. All blood donors were negative for both xenodiagnosis and conventional PCR. Conclusions / Significance There is no consensus amongst authors on the definition of an ‘asymptomatic case’ nor on the tools for screening; we, therefore, have adopted one for the sake of clarity. Immunocompetent subjects, both infected asymptomatics and those treated for VL, are limited in number and appear to have no epidemiological relevance. The impact is limited for immunocompetent patients with untreated active VL, whilst immunosuppressed individuals undergoing immunosuppressive therapy and immunosuppressed individuals HIV / L. infantum coinfected were the most infectious towards sand flies. It is noteworthy that the HIV / L. infantum coinfected patient with asymptomatic leishmaniasis was easily infectious to sand flies for a long time, despite being under continuous prophylaxis for leishmaniasis. Accordingly, screening for latent Leishmania infection in HIV-infected patients is recommended in scenarios where transmission occurs. In addition, screening for VL in HIV-infected patients who have spent time in VL-endemic areas should also be implemented in non-endemic areas. More research is needed to better understand if some asymptomatic coinfected individuals contribute to transmission as ‘super-spreaders’. Leishmaniasis is a set of diseases caused by Leishmania parasites and transmitted through the bites of infected phlebotomine sand fly females during blood ingestion. Visceral leishmaniasis (VL) is caused by Leishmania infantum in the Mediterranean region and dog is the primary domestic reservoir, although we can not ignore the role that wild reservoirs can have under certain conditions. As for the role of the human host in the transmission of the disease is not fully understood. The present work explores this important epidemiological aspect to try to clarify it. The study concludes that asymptomatic infected individuals and the immunocompetent patients treated for VL have no epidemiological impact in the transmission of L. infantum. As for the immunocompetent patients with untreated active VL its impact is limited, whilst immunosupressed patients are the most infectious towards sand flies. Thus, the screening for latent Leishmania infection in HIV-infected patients is recommended in scenarios where transmission occurs.
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Affiliation(s)
- Ricardo Molina
- Laboratory of Medical Entomology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- * E-mail: (RM); (MJ); (JA)
| | - Maribel Jiménez
- Laboratory of Medical Entomology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- * E-mail: (RM); (MJ); (JA)
| | - Jesús García-Martínez
- Clinical Laboratory Service, Blood Bank, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Juan Víctor San Martín
- Internal Medicine Service, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Carmen Sánchez
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Fabiana Alves
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Jorge Alvar
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
- * E-mail: (RM); (MJ); (JA)
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Altamura F, Rajesh R, Catta-Preta CMC, Moretti NS, Cestari I. The current drug discovery landscape for trypanosomiasis and leishmaniasis: Challenges and strategies to identify drug targets. Drug Dev Res 2020; 83:225-252. [PMID: 32249457 DOI: 10.1002/ddr.21664] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/05/2020] [Accepted: 03/13/2020] [Indexed: 12/11/2022]
Abstract
Human trypanosomiasis and leishmaniasis are vector-borne neglected tropical diseases caused by infection with the protozoan parasites Trypanosoma spp. and Leishmania spp., respectively. Once restricted to endemic areas, these diseases are now distributed worldwide due to human migration, climate change, and anthropogenic disturbance, causing significant health and economic burden globally. The current chemotherapy used to treat these diseases has limited efficacy, and drug resistance is spreading. Hence, new drugs are urgently needed. Phenotypic compound screenings have prevailed as the leading method to discover new drug candidates against these diseases. However, the publication of the complete genome sequences of multiple strains, advances in the application of CRISPR/Cas9 technology, and in vivo bioluminescence-based imaging have set the stage for advancing target-based drug discovery. This review analyses the limitations of the narrow pool of available drugs presently used for treating these diseases. It describes the current drug-based clinical trials highlighting the most promising leads. Furthermore, the review presents a focused discussion on the most important biological and pharmacological challenges that target-based drug discovery programs must overcome to advance drug candidates. Finally, it examines the advantages and limitations of modern research tools designed to identify and validate essential genes as drug targets, including genomic editing applications and in vivo imaging.
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Affiliation(s)
- Fernando Altamura
- Institute of Parasitology, McGill University, Ste Anne de Bellevue, Quebec, Canada
| | - Rishi Rajesh
- Institute of Parasitology, McGill University, Ste Anne de Bellevue, Quebec, Canada
| | | | - Nilmar S Moretti
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Igor Cestari
- Institute of Parasitology, McGill University, Ste Anne de Bellevue, Quebec, Canada
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Ibarra-Meneses AV, Moreno J, Carrillo E. New Strategies and Biomarkers for the Control of Visceral Leishmaniasis. Trends Parasitol 2019; 36:29-38. [PMID: 31718888 DOI: 10.1016/j.pt.2019.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 02/06/2023]
Abstract
Effective diagnosis and treatment of visceral leishmaniasis, together with the study of vectors and reservoirs, can lead to a better understanding of the parasite transmission dynamics and the development of more efficient control measures. Recent studies have applied new methodologies and biomarkers, and these have contributed to the early and rapid diagnosis of the disease; assessment of success of pharmacological treatments; efficient monitoring of immunosuppressed individuals; and to population screening for field trials of vaccine efficacy. This opinion article proposes an update to the diagnostic tools for visceral leishmaniasis and their rational and combined use to establish the real prevalence of infection or of exposure to Leishmania in endemic areas.
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Affiliation(s)
- Ana V Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda (Madrid), Spain
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda (Madrid), Spain.
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda (Madrid), Spain
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17
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de Araújo Santos FJ, da Silva LS, Júnior JDES, Ramos de Mesquita TG, de Souza MLG, de Andrade Júnior MC, Talhari S, Ramasawmy R. Single nucleotide polymorphisms of the genes IL-2, IL-2RB, and JAK3 in patients with cutaneous leishmaniasis caused by Leishmania (V.) guyanensis in Manaus, Amazonas, Brazil. PLoS One 2019; 14:e0220572. [PMID: 31393896 PMCID: PMC6687158 DOI: 10.1371/journal.pone.0220572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/18/2019] [Indexed: 11/18/2022] Open
Abstract
Leishmaniasis is a disease caused by intracellular protozoan parasites of the genus Leishmania. In endemic areas, only a portion of exposed subjects develops cutaneous leishmaniasis (CL), suggesting that the genetic inheritance of the host plays a vital role in both resistance and susceptibility to the disease. Interleukin-2 (IL-2) is a cytokine that plays a central role in the regulation of the immune response in infection through the axis IL-2/IL-2R (receptor) complex, triggering a series of intracellular events, among which the signaling of Janus kinase/signal transducers and activators of transcription (JAK-STAT). The present study aimed at verifying the possible relationship between single nucleotide polymorphism (s) (SNP s) in the genes IL-2, IL-2RB, and JAK3 in subjects with CL caused by Leishmania guyanensis in the city of Manaus, state of Amazonas, Brazil. 820 patients with CL and 850 healthy subjects (control group) coming from the same endemic areas as the patients were examined. The SNPs -2425G/A (rs4833248) and -330 T/G (rs2069762), located in the IL-2 gene promoter region, seem to influence the expression of the gene and the SNP +10558G/A (rs1003694) and +13295T/C (rs3212760) located in the 3rd intron of the IL-2RB gene and the 13th intron of the JAK3 gene, respectively, were studied by PCR-RFLP. Genotypes and alleles frequencies were obtained by direct counting. For the comparison between the two groups, the χ2 test with OR (odds ratio) and the 95% confidence interval (CI) were used. Similar genotypes and alleles frequencies for the different SNPs were observed in both patients with CL and healthy controls. Comparison of genotypic and allelic frequency between patients with CL and healthy subjects did not show any difference. These polymorphisms do not predict susceptibility to, or protection against the development of CL caused by L. guyanensis in the Amazonas.
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Affiliation(s)
- Felipe Jules de Araújo Santos
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Lener Santos da Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | - Tirza Gabrielle Ramos de Mesquita
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | - Moacir Couto de Andrade Júnior
- Post-Graduation Department, Nilton Lins University, Manaus, Amazonas, Brazil
- Department of Food Technology, Instituto Nacional de Pesquisas da Amazônia (INPA), Manaus, Amazonas, Brazil
| | - Sinésio Talhari
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Rajendranath Ramasawmy
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-graduação de Imunologia Básica, Universidade Federal do Amazonas, Manaus, Brazil
- Faculdade de Medicina, Nilton Lins University, Manaus, Amazonas, Brazil
- * E-mail:
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Evaluation of methods for detection of asymptomatic individuals infected with Leishmania infantum in the state of Piauí, Brazil. PLoS Negl Trop Dis 2019; 13:e0007493. [PMID: 31260440 PMCID: PMC6625727 DOI: 10.1371/journal.pntd.0007493] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/12/2019] [Accepted: 05/24/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Visceral Leishmaniasis in humans presents with fever, anemia, and splenomegaly and can be lethal if not treated. Nevertheless, the majority of Leishmania infantum-infected individuals does not manifest symptoms and remain so provided they are not immunosuppressed. In this work, the performance of different tests was evaluated to detect asymptomatic individuals who were living in Teresina, Piauí state, Brazil, an endemic area for VL. METHODOLOGY L. infantum-specific antibodies were detected by ELISA and two different rapid immunochromatographic (IC) diagnostic tests, Kalazar Detect and OnSite, and parasitic loads were detected by real time PCR [qPCR]. Additionally, we measured levels of the biomarkers monokine induced by IFN-γ (MIG) and IFN-γ-induced protein 10 (IP-10) before and after stimulation of whole blood with soluble Leishmania antigen [SLA]. PRINCIPAL FINDINGS Kalazar Detect and OnSite detected, respectively, 76% and 64% of patients presenting with active Visceral Leishmaniasis; 50% and 57% of patients remained positive in these tests, respectively, after treatment. Of the healthy participants in the study who were living in the endemic area, only 1.7% were positive with both of the IC tests. On the other hand, reactivity in ELISA tests revealed that 13% of these individuals presented asymptomatic infections; among VL patients, 84% presenting with active disease were reactive in ELISA, and after treatment, 55.5% were seropositive. L. infantum DNA was present in the blood of 37.9% of infected individuals living in the endemic area, while IP-10 and MIG biomarkers were detected in 26.7% of them. The greatest concordance of positivity occurred between ELISA and qPCR. CONCLUSION The association of different techniques can detect asymptomatic infections, however, more research is necessary to develop ideal biomarkers that are simple to use in the clinic and in field studies in areas endemic for Visceral Leishmaniasis.
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Moreno J. Assessment of Vaccine-Induced Immunity Against Canine Visceral Leishmaniasis. Front Vet Sci 2019; 6:168. [PMID: 31214607 PMCID: PMC6558161 DOI: 10.3389/fvets.2019.00168] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/16/2019] [Indexed: 12/20/2022] Open
Abstract
Canine visceral leishmaniasis is an increasingly important public health problem. Dogs infected by Leishmania infantum are the main domestic reservoir of the parasite and play a key role in its transmission to humans. Recent findings have helped in the development of novel diagnostic methods, and of control measures such as vaccines, some of which are already commercially available. However, quantitative procedures should be followed to confirm whether these vaccines elicit a cell-mediated immune response. The present work describes the need for this evaluation, and the techniques available for confirming this type of immune response.
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Affiliation(s)
- Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, Laboratory for Reference and Research in Parasitology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
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20
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Asymptomatic immune responders to Leishmania among HIV positive patients. PLoS Negl Trop Dis 2019; 13:e0007461. [PMID: 31158223 PMCID: PMC6564048 DOI: 10.1371/journal.pntd.0007461] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 06/13/2019] [Accepted: 05/13/2019] [Indexed: 12/14/2022] Open
Abstract
Concomitant infection with human immunodeficiency virus (HIV) and the Leishmania parasite is a growing public health problem, the result of the former spreading to areas where the latter is endemic. Leishmania infection is usually asymptomatic in immunocompetent individuals, but the proportion of HIV+ individuals in contact with the parasite who remain asymptomatic is not known. The aim of the present work was to examine the use of cytokine release assays in the detection of asymptomatic immune responders to Leishmania among HIV+ patients with no previous leishmaniasis or current symptomatology. Eighty two HIV+ patients (all from Fuenlabrada, Madrid, Spain, where a leishmaniasis outbreak occurred in 2009) were examined for Leishmania infantum infection using molecular and humoral response-based methods. None returned a positive molecular or serological result for the parasite. Thirteen subjects showed a positive lymphoproliferative response to soluble Leishmania antigen (SLA), although the mean CD4+ T lymphocyte counts of these patients was below the normal range. Stimulation of peripheral blood mononuclear cells (PBMC) or whole blood with SLA (the lymphoproliferative assay and whole blood assay respectively), led to the production of specific cytokines and chemokines. Thus, despite being immunocompromised, HIV+ patients can maintain a Th1-type cellular response to Leishmania. In addition, cytokine release assays would appear to be useful tools for detecting these individuals via the identification of IFN-γ in the supernatants of SLA-stimulated PBMC, and of IFN-γ, MIG and IL-2 in SLA-stimulated whole blood. These biomarkers appear to be 100% reliable for detecting asymptomatic immune responders to Leishmania among HIV+ patients. The proportion of patients with HIV+ who have at some time been infected with the Leishmania parasite, but who remain asymptomatic, is unknown. It is important to be able to identify such patients to determine the prevalence of asymptomatic leishmaniasis in the HIV+ population, and because these persons are at increased risk of developing symptomatic visceral leishmaniasis. In the present work, a population of HIV+ patients showing a cellular immune response to Leishmania infantum was identified. These subjects all showed a clear Th1-type response when their PBMC or blood were stimulated in vitro with soluble Leishmania antigen (SLA). Cytokine release assays and the detection of IFN-γ, MIG and IL-2 (specific biomarkers for immunity to Leishmania) were found to be useful for detecting this population of HIV+ patients. New studies with larger numbers of patients are needed to confirm the present results.
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21
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Bahrami F, Harandi AM, Rafati S. Biomarkers of Cutaneous Leishmaniasis. Front Cell Infect Microbiol 2018; 8:222. [PMID: 29998089 PMCID: PMC6029629 DOI: 10.3389/fcimb.2018.00222] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/11/2018] [Indexed: 12/12/2022] Open
Abstract
Cutaneous leishmaniasis (CL) is an immune-mediated skin pathology caused mainly by Leishmania (L.) major, Leishmania tropica, Leishmania braziliensis, L. mexicana, and L. amazonensis. The burden of CL in terms of morbidity and social stigmas are concentrated on certain developing countries in Asia, Africa, and South America. People with asymptomatic CL represent a large proportion of the infected individuals in the endemic areas who exhibit no lesion and can control the infection by as yet not fully understood mechanisms. Currently, there is no approved prophylactic control measure for CL. Discovery of biomarkers of CL infection and immunity can inform the development of more precise diagnostics tools as well as curative or preventive strategies to control CL. Herein, we provide a brief overview of the state-of-the-art for the biomarkers of CL with a special emphasis on the asymptomatic CL biomarkers. Among the identified CL biomarkers so far, direct biomarkers which indicate the actual presence of the infection as well as indirect biomarkers which reflect the host's reaction to the infection, such as alterations in delayed type hypersensitivity, T-cell subpopulations and cytokines, adenosine deaminase, and antibodies against the sand fly saliva proteins are discussed in detail. The future avenues such as the use of systems analysis to identify and characterize novel CL biomarkers are also discussed.
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Affiliation(s)
- Fariborz Bahrami
- Department of Immunology, Pasteur Institute of Iran, Tehran, Iran
| | - Ali M Harandi
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sima Rafati
- Department of Immunotherapy and Leishmania Vaccine Research, Pasteur Institute of Iran, Tehran, Iran
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22
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Ontoria E, Hernández-Santana YE, González-García AC, López MC, Valladares B, Carmelo E. Transcriptional Profiling of Immune-Related Genes in Leishmania infantum-Infected Mice: Identification of Potential Biomarkers of Infection and Progression of Disease. Front Cell Infect Microbiol 2018; 8:197. [PMID: 30013952 PMCID: PMC6036295 DOI: 10.3389/fcimb.2018.00197] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/28/2018] [Indexed: 12/27/2022] Open
Abstract
Leishmania spp. is a protozoan parasite that affects millions of people around the world. At present, there is no effective vaccine to prevent leishmaniases in humans. A major limitation in vaccine development is the lack of precise understanding of the particular immunological mechanisms that allow parasite survival in the host. The parasite-host cell interaction induces dramatic changes in transcriptome patterns in both organisms, therefore, a detailed analysis of gene expression in infected tissues will contribute to the evaluation of drug and vaccine candidates, the identification of potential biomarkers, and the understanding of the immunological pathways that lead to protection or progression of disease. In this large-scale analysis, differential expression of 112 immune-related genes has been analyzed using high-throughput qPCR in spleens of infected and naïve Balb/c mice at four different time points. This analysis revealed that early response against Leishmania infection is characterized by the upregulation of Th1 markers and M1-macrophage activation molecules such as Ifng, Stat1, Cxcl9, Cxcl10, Ccr5, Cxcr3, Xcl1, and Ccl3. This activation doesn't protect spleen from infection, since parasitic burden rises along time. This marked difference in gene expression between infected and control mice disappears during intermediate stages of infection, probably related to the strong anti-inflammatory and immunosuppresory signals that are activated early upon infection (Ctla4) or remain activated throughout the experiment (Il18bp). The overexpression of these Th1/M1 markers is restored later in the chronic phase (8 wpi), suggesting the generation of a classical "protective response" against leishmaniasis. Nonetheless, the parasitic burden rockets at this timepoint. This apparent contradiction can be explained by the generation of a regulatory immune response characterized by overexpression of Ifng, Tnfa, Il10, and downregulation Il4 that counteracts the Th1/M1 response. This large pool of data was also used to identify potential biomarkers of infection and parasitic burden in spleen, on the bases of two different regression models. Given the results, gene expression signature analysis appears as a useful tool to identify mechanisms involved in disease outcome and to establish a rational approach for the identification of potential biomarkers useful for monitoring disease progression, new therapies or vaccine development.
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Affiliation(s)
- Eduardo Ontoria
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, La Laguna, Spain
| | - Yasmina E. Hernández-Santana
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, La Laguna, Spain
| | - Ana C. González-García
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, La Laguna, Spain
| | - Manuel C. López
- Departamento de Biología Molecular, Instituto de Parasitología y Biomedicina “López Neyra”, Consejo Superior de Investigaciones Científicas, Granada, Spain
| | - Basilio Valladares
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, La Laguna, Spain
| | - Emma Carmelo
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, La Laguna, Spain
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Fernández L, Carrillo E, Sánchez-Sampedro L, Sánchez C, Ibarra-Meneses AV, Jimenez MA, Almeida VDA, Esteban M, Moreno J. Antigenicity of Leishmania-Activated C-Kinase Antigen (LACK) in Human Peripheral Blood Mononuclear Cells, and Protective Effect of Prime-Boost Vaccination With pCI-neo-LACK Plus Attenuated LACK-Expressing Vaccinia Viruses in Hamsters. Front Immunol 2018; 9:843. [PMID: 29740446 PMCID: PMC5924775 DOI: 10.3389/fimmu.2018.00843] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/05/2018] [Indexed: 11/17/2022] Open
Abstract
Leishmania-activated C-kinase antigen (LACK) is a highly conserved protein among Leishmania species and is considered a viable vaccine candidate for human leishmaniasis. In animal models, prime-boost vaccination with LACK-expressing plasmids plus attenuated vaccinia viruses (modified vaccinia Ankara [MVA] and mutant M65) expressing LACK, has been shown to protect against cutaneous leishmaniasis (CL). Further, LACK demonstrated to induce the production of protective cytokines in patients with active CL or cured visceral leishmaniasis, as well as in asymptomatic individuals from endemic areas. However, whether LACK is capable to trigger cytokine release by peripheral blood mononuclear cells from patients cured of CL due to Leishmania infantum (L. infantum) or induce protection in L. infantum-infected hamsters [visceral leishmaniasis (VL) model], has not yet been analyzed. The present work examines the ex vivo immunogenicity of LACK in cured VL and CL patients, and asymptomatic subjects from an L. infantum area. It also evaluates the vaccine potential of LACK against L. infantum infection in hamsters, in a protocol of priming with plasmid pCI-neo-LACK (DNA-LACK) followed by a booster with the poxvirus vectors MVA-LACK or M65-LACK. LACK-stimulated PBMC from both asymptomatic and cured subjects responded by producing IFN-γ, TNF-α, and granzyme B (Th1-type response). Further, 78% of PBMC samples that responded to soluble Leishmania antigen showed IFN-γ secretion following stimulation with LACK. In hamsters, the protocol of DNA-LACK prime/MVA-LACK or M65-LACK virus boost vaccination significantly reduced the amount of Leishmania DNA in the liver and bone marrow, with no differences recorded between the use of MVA or M65 virus vector options. In summary, the Th1-type and cytotoxic responses elicited by LACK in PBMC from human subjects infected with L. infantum, and the parasite protective effect of prime/boost vaccination in hamsters with DNA-LACK/MVA-LACK and DNA-LACK/M65-LACK, revealed the significance of LACK in activating human and hamster immune responses and support LACK to be a valuable candidate for inclusion in a vaccine against human VL.
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Affiliation(s)
- Laura Fernández
- WHO Collaborating Center for Leishmaniasis, National Center of Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Eugenia Carrillo
- WHO Collaborating Center for Leishmaniasis, National Center of Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Lucas Sánchez-Sampedro
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas (CNB-CSIC), Madrid, Spain
| | - Carmen Sánchez
- WHO Collaborating Center for Leishmaniasis, National Center of Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Victoria Ibarra-Meneses
- WHO Collaborating Center for Leishmaniasis, National Center of Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - M Angeles Jimenez
- Departamento Medicina y Cirugia Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Mariano Esteban
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas (CNB-CSIC), Madrid, Spain
| | - Javier Moreno
- WHO Collaborating Center for Leishmaniasis, National Center of Microbiology, Instituto de Salud Carlos III, Madrid, Spain
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Ibarra-Meneses AV, Cruz I, Chicharro C, Sánchez C, Biéler S, Broger T, Moreno J, Carrillo E. Evaluation of fluorimetry and direct visualization to interpret results of a loop-mediated isothermal amplification kit to detect Leishmania DNA. Parasit Vectors 2018; 11:250. [PMID: 29665825 PMCID: PMC5905109 DOI: 10.1186/s13071-018-2836-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/06/2018] [Indexed: 11/13/2022] Open
Abstract
Background Nucleic acid amplification tests (NAATs) have proven to be advantageous in the diagnosis of leishmaniases, allowing sensitive diagnosis of: (i) cutaneous leishmaniasis in long duration lesions and (ii) visceral leishmaniasis using a less-invasive sample like peripheral blood, in opposition to tissue aspiration required for parasite demonstration by microscopy. Despite their benefits, the implementation of NAATs for leishmaniasis diagnosis at the point-of-care has not been achieved yet, mostly due to the complexity and logistical issues associated with PCR-based methods. Methods In this work, we have evaluated the performance of a ready-to-use loop-mediated isothermal amplification (LAMP) kit using two real time fluorimeters to amplify leishmanial DNA obtained by silica column-based and Boil & Spin protocols. Results The different approaches used to run and interpret the LAMP reactions showed a performance equivalent to PCR and real-time PCR, using spiked and clinical samples. The time to positivity obtained with real-time fluorimetry showed an excellent correlation with both Ct values and parasite load from real-time quantitative PCR. Conclusions The results obtained open the possibility of using a highly stable, ready-to-use LAMP kit for the accurate diagnosis of leishmaniasis at the point-of-care. Furthermore, the feasibility of relating time to positivity, determined with a portable real-time fluorimeter, with the parasite burden could have a wider application in the management of leishmaniasis, such as in treatment efficacy monitoring or as a pharmacodynamics tool in clinical trials.
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Affiliation(s)
- Ana V Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Israel Cruz
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Carmen Chicharro
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Sánchez
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Sylvain Biéler
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Tobias Broger
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
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Ibarra-Meneses AV, Mondal D, Alvar J, Moreno J, Carrillo E. Cytokines and chemokines measured in dried SLA-stimulated whole blood spots for asymptomatic Leishmania infantum and Leishmania donovani infection. Sci Rep 2017; 7:17266. [PMID: 29222521 PMCID: PMC5722824 DOI: 10.1038/s41598-017-17315-z] [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: 07/27/2017] [Accepted: 11/24/2017] [Indexed: 11/09/2022] Open
Abstract
Whole blood stimulation with soluble Leishmania antigen (SLA), followed by plasma cytokine and chemokine determination, provides means of detecting subjects with asymptomatic Leishmania infection. This work examines the potential of Protein Saver 903 cards for the storage and transport of SLA-stimulated dried plasma spot samples. Blood was collected from asymptomatic and negative control subjects living in a Leishmania infantum- (Spain) and Leishmania donovani-endemic area (Bangladesh). After SLA-stimulation, three types of sample were prepared: frozen liquid plasma (-20 °C), and plasma dropped onto Protein Saver cards kept at -20 °C (DPS-FZ), and at ambient temperature (DPS-AT). The concentrations of IFN-γ, IL-2, CXCL10, CXCL9, CCL2 and CXCL8 in the thawed liquid plasma (TLP), DPS-FZ and DPS-AT samples were then determined. Strong correlations were seen between the TLP and DPS-FZ/AT samples for all the studied cytokines/chemokines in both the L. infantum and L. donovani areas. Protein Saver 903 cards would therefore appear to allow for the transport of SLA-stimulated plasma samples by courier at ambient temperature. The CXCL10 and CXCL9 detectable in these plasma spots provided robust markers for identifying asymptomatic subjects from both endemic areas. This easy procedure opens up new possibilities for field studies in resource-limited settings, which could help in Leishmania control.
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Affiliation(s)
- A V Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - D Mondal
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - J Alvar
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - J Moreno
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - E Carrillo
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.
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Ibarra-Meneses AV, Sanchez C, Alvar J, Moreno J, Carrillo E. Monocyte Chemotactic Protein 1 in Plasma from Soluble Leishmania Antigen-Stimulated Whole Blood as a Potential Biomarker of the Cellular Immune Response to Leishmania infantum. Front Immunol 2017; 8:1208. [PMID: 29033933 PMCID: PMC5626820 DOI: 10.3389/fimmu.2017.01208] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/12/2017] [Indexed: 01/15/2023] Open
Abstract
New biomarkers are needed to identify asymptomatic Leishmania infection as well as immunity following vaccination or treatment. With the aim of finding a robust biomarker to assess an effective cellular immune response, monocyte chemotactic protein 1 (MCP-1) was examined in plasma from soluble Leishmania antigen (SLA)-stimulated whole blood collected from subjects living in a Leishmania infantum-endemic area. MCP-1, expressed 110 times more strongly than IL-2, identified 87.5% of asymptomatic subjects and verified some asymptomatic subjects close to the cutoff. MCP-1 was also significantly elevated in all patients cured of visceral leishmaniasis (VL), unlike IL-2, indicating the specific memory response generated against Leishmania. These results show MCP-1 to be a robust candidate biomarker of immunity that could be used as a marker of cure and to both select and follow the population in vaccine phase I–III human clinical trials with developed rapid, easy-to-use field tools.
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Affiliation(s)
- Ana V Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Sanchez
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge Alvar
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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Carrillo E, Fernandez L, Ibarra-Meneses AV, Santos MLB, Nico D, de Luca PM, Correa CB, de Almeida RP, Moreno J, Palatnik-de-Sousa CB. F1 Domain of the Leishmania (Leishmania) donovani Nucleoside Hydrolase Promotes a Th1 Response in Leishmania (Leishmania) infantum Cured Patients and in Asymptomatic Individuals Living in an Endemic Area of Leishmaniasis. Front Immunol 2017; 8:750. [PMID: 28747911 PMCID: PMC5506215 DOI: 10.3389/fimmu.2017.00750] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/13/2017] [Indexed: 01/09/2023] Open
Abstract
The Leishmania (Leishmania) donovani nucleoside hydrolase NH36 is the main antigen of the Leishmune® vaccine and one of the promising candidates for vaccination against visceral leishmaniasis. The antigenicity of the N-terminal (F1), the central (F2), or the C-terminal recombinant domain (F3) of NH36 was evaluated using peripheral blood mononuclear cells (PBMC) from individuals infected with L. (L.) infantum from an endemic area of visceral leishmaniasis of Spain. Both NH36 and F1 domains significantly increased the PBMC proliferation stimulation index of cured patients and infected asymptomatic individuals compared to healthy controls. Moreover, F1 induced a 19% higher proliferative response than NH36 in asymptomatic exposed subjects. In addition, in patients cured from visceral leishmaniasis, proliferation in response to NH36 and F1 was accompanied by a significant increase of IFN-γ and TNF-α secretion, which was 42-43% higher, in response to F1 than to NH36. The interleukin 17 (IL-17) secretion was stronger in asymptomatic subjects, in response to F1, as well as in cured cutaneous leishmaniasis after NH36 stimulation. While no IL-10 secretion was determined by F1, a granzyme B increase was detected in supernatants from cured patients after stimulation with either NH36 or F1. These data demonstrate that F1 is the domain of NH36 that induces a recall cellular response in individuals with acquired resistance to the infection by L. (L.) infantum. In addition, F1 and NH36 discriminated the IgG3 humoral response in patients with active visceral leishmaniasis due to L. (L.) donovani (Ethiopia) and L. (L.) infantum (Spain) from that of endemic and non-endemic area controls. NH36 showed higher reactivity with sera from L. (L.) donovani-infected individuals, indicating species specificity. We conclude that the F1 domain, previously characterized as an inducer of the Th1 and Th17 responses in cured/exposed patients infected with L. (L.) infantum chagasi, may also be involved in the generation of a protective response against L. (L.) infantum and represents a potential vaccine candidate for the control of human leishmaniasis alone, or in combination with other HLA epitopes/antigens.
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Affiliation(s)
- Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiologia, Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Fernandez
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiologia, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Victoria Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiologia, Instituto de Salud Carlos III, Madrid, Spain
| | - Micheli L. B. Santos
- Departamento de Medicina, Hospital Universitário, Universidade Federal de Sergipe, Aracaju, Brazil
| | - Dirlei Nico
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula M. de Luca
- Laboratório de Imunoparasitologia, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Roque Pacheco de Almeida
- Departamento de Medicina, Hospital Universitário, Universidade Federal de Sergipe, Aracaju, Brazil
- Instituto Nacional de Ciência e Tecnologia de Investigação em Imunologia, São Paulo, Brazil
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiologia, Instituto de Salud Carlos III, Madrid, Spain
| | - Clarisa B. Palatnik-de-Sousa
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia de Investigação em Imunologia, São Paulo, Brazil
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Ibarra-Meneses AV, Ghosh P, Hossain F, Chowdhury R, Mondal D, Alvar J, Moreno J, Carrillo E. IFN-γ, IL-2, IP-10, and MIG as Biomarkers of Exposure to Leishmania spp., and of Cure in Human Visceral Leishmaniasis. Front Cell Infect Microbiol 2017; 7:200. [PMID: 28620584 PMCID: PMC5449718 DOI: 10.3389/fcimb.2017.00200] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/04/2017] [Indexed: 11/13/2022] Open
Abstract
New biomarkers are needed for monitoring the effectiveness of treatment for visceral leishmaniasis (VL). They might also improve the detection of the asymptomatic population in Leishmania-endemic areas. This paper examines the IL-2, IFN-γ, IFN-γ-induced protein 10 (IP-10), and monokine-induced-by-IFN-γ (MIG) levels in whole blood-stimulated in vitro with soluble Leishmania antigen (SLA)-taken from asymptomatic individuals and patients treated for VL living in a post-outbreak (Leishmania infantum) area in Spain, and in an endemic (Leishmania donovani) area of Bangladesh. IP-10 was found to be an accurate global marker of asymptomatic subjects with positive cellular/humoral tests, while MIG was found to be a better marker of contact with L. donovani than IL-2 but no for those with L. infantum. Determining IP-10, MIG, and IFN-γ levels proved useful in monitoring the cellular immune response following treatment for active disease caused by L. infantum.
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Affiliation(s)
- Ana V Ibarra-Meneses
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiologia, Instituto de Salud CarlosMadrid, Spain
| | - Prakash Ghosh
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease ResearchDhaka, Bangladesh
| | - Faria Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease ResearchDhaka, Bangladesh
| | - Rajashree Chowdhury
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease ResearchDhaka, Bangladesh
| | - Dinesh Mondal
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease ResearchDhaka, Bangladesh
| | - Jorge Alvar
- Drugs for Neglected Diseases InitiativeGeneva, Switzerland
| | - Javier Moreno
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiologia, Instituto de Salud CarlosMadrid, Spain
| | - Eugenia Carrillo
- WHO Collaborating Centre for Leishmaniasis, Centro Nacional de Microbiologia, Instituto de Salud CarlosMadrid, Spain
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29
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Castro A, Carrillo E, San Martín JV, Botana L, Molina L, Matía B, Fernandez L, Horrillo L, Ibarra-Meneses A, Sanchez C, Ruiz-Giardin JM, Moreno J. Lymphoproliferative response after stimulation with soluble leishmania antigen (SLA) as a predictor of visceral leishmaniasis (VL) relapse in HIV+ patients. Acta Trop 2016; 164:345-351. [PMID: 27693332 DOI: 10.1016/j.actatropica.2016.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/22/2016] [Accepted: 09/08/2016] [Indexed: 11/25/2022]
Abstract
The introduction of HAART resulted in the decrease of Leishmania/HIV co-infection cases; nevertheless, the number of relapses remains high and secondary prophylaxis is recommended. However, secondary prophylaxis is not necessary in all patients, and presents a high risk of toxicity and an elevated cost. Our aim was to study whether specific cellular response to Leishmania infantum (measured by cell proliferation response after stimulation with soluble Leishmania antigen (SLA)), could be a useful tool to attempt a secondary prophylaxis withdrawal. In June 2009 an outbreak of leishmaniasis by Leishmania infantum was declared in the southeast of Madrid, and since January 2013, we recruited 10 HIV+ patients that had been treated for visceral leishmaniasis. 6 patients had positive SLA-cell proliferation test. The mean CD4 cell counts of those patients with positive SLA were 140 cel/mm3 and 40 cel/mm3 in those with negative SLA test. 3 patients with positive SLA-cell proliferation test (CD4 count: 336, 307, 625) were not on prophylaxis, and the other 3 patients (CD4 count: 152, 189, 359) were on secondary prophylaxis that was withdrawn after the positive SLA-cell proliferation test with no posterior relapses (mean follow up 60 weeks). From the 4 patients, which had negative SLA-cell proliferation test and continued on prophylaxis, 3 had positive PCR for Leishmania at the end of the follow-up and 2 presented clinical relapses. The performance of SLA-cell proliferation test can be a useful tool that can permit us to try withdrawal of the prophylaxis in Leishmania/HIV co-infected patients with low CD4+ counts under clinical supervision, diminishing risk of toxicity and cost.
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