Decreased risk of cholangiocarcinogenesis following repeated cycles of Opisthorchis viverrini infection-praziquantel treatment: Magnetic Resonance Imaging (MRI) and histopathological study in a hamster model

Sectional Anatomy with Micro-Computed Tomography and Magnetic Resonance Imaging Correlation of the Middle and Caudal Abdominal Regions in the Syrian Hamster (Mesocricetus auratus)

The abdomen is a key region in small animal veterinary practice, with the middle and caudal sections housing various organ systems that are susceptible to dysfunction, necessitating medical intervention or surgery. Sectional imaging techniques like CT and MRI are commonly used in small mammals, but no studies have focused on rodent abdomen. This study aimed to correlate micro-CT and MRI images of the middle and caudal abdominal regions with corresponding anatomical sections in Syrian hamsters (SHs), which are popular pets and experimental models. Ten healthy male SHs were used, and anatomical structures from frozen sections were compared with corresponding MCT and MRI images. Clinically relevant structures identified in anatomical sections were discernible on MCT and MRI scans. The key findings include the presence of glandular and non-glandular stomachs, the stomach and cecum primarily located on the left side, the absence of ampulla coli, sacculus rotundus, and cecal appendix, and sacculation of the colon, as well as the jejunum, mainly on the right side. The vesicular, coagulating, and prostate glands were also present, and the right kidney did not extend to the last thoracic vertebra. The results were similar to abdominal anatomical and radiologic studies in rats, mice, and guinea pigs, regardless of the rat's and mice's sacculated cecum and the guinea pig's glandular stomach. However, significant differences were observed compared to the rabbit abdomen's sectional anatomy and CT findings. This study highlights the diagnostic value of MCT and MRI in SHs and provides a valuable reference for interpreting cross-sectional abdominal images in SHs.

Goblet cell metaplasia and mucin alterations in biliary epithelial cells during Opisthorchis viverrini infection in rodent models: Insights into host susceptibility and defense mechanisms

Background and Aim

Chronic Opisthorchis viverrini (OV) infection induces significant biliary changes and is a major risk factor for cholangiocarcinoma. However, the role of goblet cell metaplasia (GCM) and mucin dynamics in host defense and parasite persistence remains poorly understood. This study aims to characterize biliary histological changes, particularly mucin types, and compare responses between susceptible (hamsters) and non-susceptible (mice) hosts during early to chronic OV infection.

Materials and Methods

Thirty-five male golden Syrian hamsters and 35 male BALB/c mice were divided into infected and control groups. Infected animals received 50 OV metacercariae through gastric intubation and were sacrificed on days 1, 2, 7, 14, 28, and 56 post-infection. Histological, histochemical (Alcian Blue, periodic Acid-Schiff, and high iron diamine), and immunohistochemical (Bromodeoxyuridine [BrdU]) analyses were performed to assess mucin production, GCM, and bile duct proliferation.

Results

Mice demonstrated an early, robust biliary response with pronounced hyperplasia and GCM characterized by acid mucin overproduction during the acute phase (days 1-28). Conversely, hamsters exhibited delayed biliary proliferation and GCM, with predominant sulfated mucins appearing during the chronic phase (days 28-56). BrdU immunoreactivity indicated earlier and stronger bile duct epithelial proliferation in mice, correlating with worm clearance by day 28. In hamsters, mucosal changes supported worm survival, as evidenced by continued parasite presence and egg production. Statistical analyses confirmed significant differences in mucin types and hyperplasia between species across infection stages.

Conclusion

Distinct mucosal responses in hamsters and mice reflect their susceptibility to OV infection. Acid mucins in mice facilitate worm expulsion, while sulfated mucins in hamsters appear to promote parasite persistence. These findings highlight the dual roles of mucins in host defense and parasite survival, providing insight into mechanisms underlying susceptibility and resistance in OV infections.

Evaluation of sectional anatomic, micro-computed tomographic, and magnetic resonance imaging features of the thorax in Syrian hamsters (Mesocricetus auratus)

Clinically, the rodent thorax is important because of the variety of problems that may affect the heart, lungs, and other thoracic structures. Syrian hamsters are the most common pet and experimental hamster species. Sectional imaging of small mammals is widely increasing in use for clinical and research settings; however, no reports on the thoracic sectional imaging anatomy in this species have been made. Therefore, this study aimed at evaluating micro-computed tomography (MCT), magnetic resonance image (MRI), and gross sections of the Syrian hamster thorax. Eight healthy adult male and female Syrian hamsters were examined. Anesthetized hamsters were evaluated by MCT and 3 Tesla MRI. After imaging, the frozen slab sections were photographed, and identified anatomic structures were matched with structures on corresponding MCT and/or MRI images. Clinically relevant anatomic features of the Syrian hamster thorax that were identified on transverse and sagittal anatomic sections could be discerned on the corresponding MCT and MRI scans. The three matched images were exhibited the following features: (1) the narrow thoracic cavity and small lung space, (2) the heart positioning ventral and medial to lung, (3) heart ventricles locating towards the left side, and (4) parallel cardiac position relative to the sternum. The obtained results were similar to those have only been reported in rabbits, regardless of heart orientation and lung lobe covering the heart. The results of this study support the use of MCT and MRI as diagnostic tools in Syrian hamsters and provide reference values for the clinically relevant anatomic structures of thorax.

Inflammatory responses to Opisthorchis viverrini infection in animal models: A comparison between susceptible and nonsusceptible hosts in different anatomical locations

Background

Inflammation caused by Opisthorchis viverrini infection increases the risk of cholangitis, cholecystitis, and leads to bile duct cancer (cholangiocarcinoma or CCA). However, only certain infected individuals are susceptible to CCA, suggesting the involvement of host factors in cancer development. In addition, there are reports indicating differences in the locations of CCA.

Aim

This study aims to investigate cellular inflammatory responses in the common bile duct (CB), intrahepatic bile duct (IHB), and gallbladder (GB) in susceptible and non-susceptible hosts following O. viverrini infection.

Methods

Thirty Syrian golden hamsters (a susceptible host) and 30 BALB/c mice (a non-susceptible host) infected with O. viverrini were studied at six time points (five animals per group). Histopathological evaluations were conducted on samples from the IHB, CB, and GB. Inflammatory cell infiltration was quantitatively assessed and compared between groups and time points. Statistical analysis was performed using one-way ANOVA, with a significance level of p < 0.05.

Results

Inflammation was significantly more pronounced in the IHB compared to the other two biliary locations. In comparison between susceptible and non-susceptible hosts, the intensity of inflammation was higher in the OV+H group than in the OV+M group (p < 0.05).

Conclusion

This study highlights the association between host response to inflammation, tissue location, and host susceptibility, with the IHB showing particular susceptibility to inflammation and pathological changes. These findings contribute to our understanding of the increased risk of CCA in susceptible hosts.

Unraveling the relationship among inflammatory responses, oxidative damage, and host susceptibility to Opisthorchis viverrini infection: A comparative analysis in animal models

Background and Aim

Opisthorchis viverrini infection-induced inflammation contributes to cholangiocarcinoma (CCA) development in humans and animals. Inflammation generates free radicals, such as reactive oxygen species and reactive nitrogen species (RNS), which damage the host's DNA. However, only 5% of O. viverrini-infected individuals develop malignancy, suggesting that variations in the inflammatory response of individuals to the parasite may influence susceptibility. Due to limitations in studying human susceptibility, we used an animal model to investigate the profiles of inflammatory reactions, oxidative burst, and irreversible DNA damage. This study aimed to explore the potential role of inflammation and RNS in causing DNA damage that may predispose susceptible hosts and non-susceptible animal models to cancer development in O. viverrini infection.

Materials and Methods

This experimental study was conducted on 30 Syrian golden hamsters (OV-H) and 30 BALB/c mice (OV-M) infected with O. viverrini, representing susceptible and non-susceptible models, respectively. Five animals per group were examined at six predetermined time points during the experiment. Biliary tract samples were systematically investigated using histopathological evaluation for inflammatory cell infiltration and immunohistochemical staining for RNS production and markers of DNA damage, including nitrotyrosine and 8-hydroxy-2'-deoxyguanosine. These features were quantified and compared among the experimental groups. Mann-Whitney U-test was used for statistical analysis, with p < 0.05 considered statistically significant.

Results

The comparison revealed that the OV-M group exhibited significantly earlier and higher rates of inflammatory cell infiltration during the acute phase, whereas the OV-H group exhibited chronic and more severe inflammation (p < 0.020). Intracellular RNS production and DNA damage were closely associated with the inflammatory response.

Conclusion

This study demonstrates differential responses in susceptible and non-susceptible models of O. viverrini infection regarding disease onset and duration, as well as intracellular RNS production and DNA damage caused by inflammation. Persistent inflammation generated oxidatively damaged DNA, which is a distinct pathological characteristic of susceptible hosts and may be critical for CCA development.

Reduction of carcinogens in fermented fish (pla-ra and pla-som) by heating

Background and Aim

The risk factors for cholangiocarcinoma (CCA) are opisthorchiasis and the intake of a combination of nitroso compounds through the consumption of traditionally fermented fish, which is very popular in areas where liver flukes are endemic. The incidence of CCA remains high because this cultural habit of rural people has been altered. Therefore, decreasing nitrate and nitrite concentrations in fermented fish are an alternative approach to reducing the risk of CCA. Thus, this study aimed to reduce nitrate and nitrite concentrations in fermented foods by heating and investigated its effect on CCA development in a hamster model.

Materials and Methods

We used Association of Official Analytical Chemists method 973.31 to measure the nitrate and nitrite concentrations in both fermented fish (pla-ra [PR]) and pickled fish (pla-som [PS]) before and after boiling for 5 and 30 min, respectively. The same samples were fed to Opisthorchis viverrini (OV)-infected or -uninfected hamsters for 3 months. Thereafter, the hamsters' liver and blood were collected for analysis.

Results

The levels of nitrates and nitrites in PS and PR significantly decreased following boiling for 5 and 30 min. The OV-PR and OV-PS groups showed dramatically increased numbers of inflammatory cells, fibrosis surrounding the bile duct, and focal fibrotic areas. However, after boiling the fermented dishes for 5 and 30 min, the extent of inflammatory cell infiltration and intensity of fibrosis in these groups were decreased.

Conclusion

Our findings suggest that boiling reduces nitrate and nitrite toxicity in fermented dishes, as evidenced by reduced hepatic inflammation. However, regardless of heating, kidney tissues are adversely affected when fermented meals are consumed daily.

Current status of human liver fluke infections in the Greater Mekong Subregion

The Greater Mekong Subregion (GMS) is a trans-national region of the Mekong River basin in Southeast Asia comprising Cambodia, the People's Republic of China (specifically Yunnan Province and Guangxi Zhuang Autonomous Region), Lao People's Democratic Republic (Lao PDR), Myanmar, Thailand, and Vietnam home to more than 340 million people or almost 4.5% of the global population. Human liver fluke infections caused by Opisthorchis viverrini and Clonorchis sinensis have been major public health problems in this region for decades. Opisthorchiasis caused by O. viverrini is prevalent in Thailand, Lao PDR, Cambodia and central-southern Vietnam with more than 12 million people infected. Clonorchiasis caused by C. sinensis is endemic in northern Vietnam and Guangxi with estimated 3.5 -5 million infected. The infections can cause several liver and biliary diseases such as cholangitis, periductal fibrosis, gallstones, and cholangiocarcinoma (CCA), a fatal bile duct cancer. Key determinants of the geographical distribution differences of the two liver fluke species are snail species and geographic barriers. Main risk behaviour of the infections is the culture of eating raw fish "the raw attitude" of people in the GMS, especially the Tai/Dai/Thai/Laos ethnic groups, the major population in the GMS. Over the past 20 years, there is a big change in prevalence of the infections. Opisthorchiasis has long been endemic, particularly in northern and northeastern Thailand and Lao PDR with over 8-10 million cases estimated. However, after several rounds of national campaign against opisthorchiasis using integrated control approach in Thailand over the past three decades, the prevalence of O. viverrini infection has reduced from over 15% in 1996 to 2.2% in 2019. High prevalence of O. viverrini infection continues in Lao PDR and central Vietnam. Emerging high prevalence, up to a maximum of 47.5%, has been noted in Cambodia during the past 10 years possibly due to more studies being conducted rather than increasing prevalence. O. viverrini infection has now also been reported in Lower Myanmar in recent years. Clonorchiasis has been known in northern Vietnam and southern China for a long time. Several surveys have reported infections in Guangxi in the last 10 years, and until now liver fluke infected cases have not been reported in Yunnan. Overall, nowadays, there is a shift in high risk areas for GMS liver fluke infection from northeastern Thailand to Lao PDR, Cambodia, Vietnam, Myanmar, and Guangxi P.R. China. Urgent systematic disease mapping and integrated liver fluke control using One Health approaches should be implemented nationwide in GMS countries.

Effects of Three-time Administration of a Supramolecular Complex of Praziquantel with Disodium Glycyrrhizinate on Trematode Opisthorchis felineus in Hamsters

BACKGROUND

Praziquantel (PZQ) is the most commonly used anthelmintic drug for treating trematodiases. It was shown here that PZQ in complex with disodium glycyrrhizinate (PZQ-Na₂GA, in the 1:10 ratio) has higher bioavailability than PZQ alone. Our aim was to determine the effects of three-time administration of PZQ-Na₂GA in an experimental opisthorchiasis felinea model.

METHODS

The PZQ-Na₂GA complex (1:10) at a 400 mg/kg dose (meaning 36.4 mg/kg PZQ) was administered to Opisthorchis felineus-infected hamsters three times under a "9:00 am-6:00 pm-9:00 am" regimen (PZQ-Na₂GA × 3). Effects of treatment were assessed as a reduction of helminth load in the hamsters and as changes in physiological, hematological, and blood biochemical parameters. The helminths extracted from the liver of the hamsters that received PZQ-Na₂GA thrice were assayed for sensitivity to PZQ in vitro.

RESULTS

PZQ-Na₂GA × 3 reduced the number of O. felineus helminths in the liver by 87%, which is 30% better than a previously reported effect of one-time administration of the complex. Meanwhile, relative weights of the liver and thymus diminished, and some hematological parameters improved. The helminths extracted from the hamsters 1 month after the PZQ-Na₂GA × 3 treatment showed elevated sensitivity to PZQ, as determined in vitro.

CONCLUSION

Compared with previously published data on the effectiveness of various drugs in experimental opisthorchiasis felinea, PZQ-Na₂GA × 3 exerts the most potent anthelmintic effect. In addition, PZQ-Na₂GA × 3 improves physiological status of O. felineus-infected hamsters and sensitizes the surviving parasites to subsequent PZQ treatment.

Towards Evidence-based Control of Opisthorchis viverrini

Transmission of the carcinogenic liver fluke Opisthorchis viverrini is ongoing across Southeast Asia. Endemic countries within the region are in different stages of achieving control. However, evidence on which interventions are the most effective for reducing parasite transmission, and the resulting liver cancer, is currently lacking. Quantitative modelling can be used to evaluate different control measures against O. viverrini and assist the design of clinical trials. In this article we evaluate the epidemiological parameters that underpin models of O. viverrini and the data necessary for their estimation, with the aim of developing evidence-based strategies for parasite control at a national or regional level.

Behavior-related risk factors for opisthorchiasis-associated cholangiocarcinoma among rural people living along the mekong river in five greater mekong subregion countries

Opisthorchiasis-associated cholangiocarcinoma (OV-CCA) is a major public health problem in Greater Mekong Subregion (GMS) Countries, the poorest region in Asia. People in this region have similar traditions or respect the same religion. There is no difference in lifestyle and food culture. Excluding Thailand, publications on risk factors for OV-CCA from the GMS Countries are few, especially data on behavioral risk factors for OV-CCA. Therefore, this study aimed to assess the behavior-related risk factors and to compare the risk of OV-CCA among rural people living along the Mekong River in five GMS countries. It was a cross-sectional analytic study during June and October 2017. All participants with informed consent completed the questionnaires. Descriptive statistics were used to describe the prevalence of risk factors. Odds ratio with 95% confidence intervals were used to compare the risk of OV-CCA. It was found that there were more drinkers than non-drinkers in all areas, except in Vietnam. The highest history of liver fluke infection was found in Cambodia. Praziquantel use and consumption of raw freshwater fish dishes were mostly found in Lao PDR. The highest consumption of nitrosamine-contaminated foodstuffs was found in Ubon Ratchathani, Thailand. The spatial comparison of OV-CCA risk showed that Lao PDR and Ubon Ratchathani were two risk areas when compared to Tachileik, Myanmar (a reference area). This study provided the behavior-related risk factors for OV-CCA among people in five GMS Countries which would be a major jigsaw puzzle leading to proactive surveillance for OV-CCA prevention in the future.

The antioxidants resveratrol and N-acetylcysteine enhance anthelmintic activity of praziquantel and artesunate against Schistosoma mansoni

BACKGROUND

Treatment of schistosomiasis has relied on the anthelmintic drug praziquantel (PZQ) for more than a generation. Despite its celebrated performance for treatment and control of schistosomiasis and other platyhelminth infections, praziquantel has some shortcomings and the inability of this drug to counteract disease sequelae prompts the need for novel therapeutic strategies.

METHODS

Using a host-parasite model involving Biomphalaria glabrata and Schistosoma mansoni we established mechanical transformation of S. mansoni cercariae into newly transformed schistosomula (NTS) and characterized optimal culture conditions. Thereafter, we investigated the antischistosomal activity and ability of the antioxidants N-acetylcysteine (NAC) and resveratrol (RESV) to augment the performance of praziquantel and/or artesunate (AS) against larval stages of the parasite. Drug effects were evaluated by using an automated microscopical system to study live and fixed parasites and by transmission electron microscopy (TEM).

RESULTS

Transformation rates of cercariae to schistosomula reached ~ 70% when the manipulation process was optimized. Several culture media were tested, with M199 supplemented with HEPES found to be suitable for S. mansoni NTS. Among the antioxidants studied, RESV alone or combined with anthelminthic drugs achieved better results rather N-acetylcysteine (NAC). TEM observations demonstrated that the combination of AS + RESV induced severe, extensive alterations to the tegument and subtegument of NTS when compared to the constituent compounds alone. Two anthelmintic-antioxidant combinations, praziquantel-resveratrol [combination index (CI) = 0.74] and artesunate-resveratrol (CI = 0.34) displayed moderate and strong synergy, respectively.

CONCLUSIONS

The use of viability markers including staining with propidium iodide increased the accuracy of drug screening assays against S. mansoni NTS. The synergies observed might be the consequence of increased action by RESV on targets of AS and PZQ and/or they may act through concomitantly on discrete targets to enhance overall antischistosomal action. Combinations of active agents, preferably with discrete modes of action including activity against developmental stages and/or the potential to ameliorate infection-associated pathology, might be pursued in order to identify novel therapeutic interventions.

Liver Fluke-Associated Biliary Tract Cancer

Cholangiocarcinoma (CCA) is an aggressive cancer arising from epithelial cells of the bile duct. Most patients with CCA have an unresectable tumor at the time of diagnosis. In Western countries, the risk of CCA increases in patients with primary sclerosing cholangitis, whereas liver fluke infection appears to be the major risk factor for CCA in Asian countries. A diagnosis of liver fluke infection often relies on stool samples, including microscopic examination, polymerase chain reaction-based assays, and fluke antigen detection. Tests of serum, saliva and urine samples are also potentially diagnostic. The presence of liver fluke along with exogenous carcinogens magnifies the risk of CCA in people living in endemic areas. The “liver fluke-cholangiocarcinoma” carcinogenesis pathways consist of mechanical damage to the bile duct epithelium, immunopathologic and cellular reactions to the liver fluke’s antigens and excretory/secretory products, liver fluke-induced changes in the biliary tract microbiome and the effects of repeated treatment for liver fluke. A vaccine and novel biomarkers are needed for the primary and secondary prevention of CCA in endemic areas. Importantly, climate change exerts an effect on vector-borne parasitic diseases, and awareness of liver fluke should be enhanced in potentially migrated habitat areas.

Reservoir Animals and Their Roles in Transmission of Opisthorchis viverrini

Although any fish-eating mammals could be potential definitive hosts of Opisthorchis viverrini, only a few, especially cats and dogs, are actually known reservoir hosts for this parasite. Both animals usually get infected via consuming raw or undercooked contaminated fish, fish dishes or food remains from households. The infected animals sustain parasite egg spread via open environment defecation. Cats are the most important reservoir with higher prevalence rates of O. viverrini infection than dogs in endemic areas. Usually Opisthorchis-infected animals do not exhibit apparent clinical symptoms or specific abnormalities in laboratory examinations. Pathological findings in these animal reservoirs are basically similar to those seen in humans and experimental animals, namely periductal inflammation, biliary hyperplasia and periductal fibrosis. However, O. viverrini-associated cholangiocarcinoma has not yet been reported in the reservoir animals at present. Praziquantel is a treatment of choice not only for humans but also for animal reservoirs. Integrated control of opisthorchiasis in animal reservoirs is based on holistic approaches such as EcoHealth/One Health concepts. In fact integrated control of opisthorchiasis in humans in ecosystem has also proved successful, for example, the Lawa model for opisthorchiasis control in the endemic area of Khon Kaen, Thailand. Other feral and wild animals in endemic areas might also be potential reservoirs, and this requires more investigation. In addition, genetic diversity and evolution of the flukes might also influence zoonotic capability.