Purified Trypanosoma cruzi specific glycoprotein for discriminative serological diagnosis of South American trypanosomiasis (Chagas' disease)

Development and Application of an ELISA Assay Using Excretion/Secretion Proteins from Epimastigote Forms of T. cruzi (ESEA Antigens) for the Diagnosis of Chagas Disease

An indirect enzyme-linked immunoabsorbent assay (ELISA) for Trypanosoma cruzi was developed using epimastigote secretion/excretion proteins (ESEA antigens) obtained from axenic culture supernatants. A panel of 120 serum samples from subjects with confirmed Chagas disease (n = 50), healthy controls (n = 50), and patients with other parasitic diseases (n = 20) was used to evaluate the new ESEA-based ELISA (ELISA(ESEA)). This new test had excellent sensitivity (98%) and acceptable specificity (88%). Cross-reactivity was observed largely in sera from subjects with Leishmania and Ascaris infections. Using Western blotting and epimastigotes from two distinct T. cruzi isolates, several polypeptide bands with molecular masses ranging from 50 to 220 kDa were detected in pooled chagasic sera. However, the band pattern for each isolate was different. These data suggest that an inexpensive and technically simple ELISA based on ESEA antigens is a promising new tool for the diagnosis of Chagas disease.

The use of an excreted superoxide dismutase in an ELISA and Western blotting for the diagnosis of Leishmania (Leishmania) infantum naturally infected dogs

An excreted iron superoxide dismutase of pI 3.75 and a molecular mass of approximately 25 kDa was partially purified by QAE Sephadex ion-exchange chromatography from the in vitro culture of Leishmania (Leishmania) infantum. This enzyme was detected by enzyme-linked immunosorbent assay and Western blot of anti-L. infantum antibodies in dog serum. For the determination of the sensitivity and specificity of this protein, the results using the complete-parasite antigen fraction were taken as references. For this, 39 sera were assayed in dogs from different Spanish provinces. By Western blot, at a dilution of 1:250, 82% of the sera were positive when superoxide dismutase excreted was used as the antigen, against 56.4% positivity when the complete parasite was used as the antigen. These findings support the results of a previous study, indicating that the superoxide dismutase excreted can be useful in diagnosing L. (L.) infantum.

Serological diagnosis of Trypanosoma cruzi: evaluation of three enzyme immunoassays and an indirect immunofluorescent assay

Chagas' disease is an important cause of heart failure in Latin America, but is rare in the United States. The immigration of persons from endemic countries increases the potential of encountering patients with the disease. Concerns have also been raised about the introduction of Trypanosoma cruzi, the parasite that causes the disease, into the blood supply and during organ transplantation. To compare Chagas' antibody tests that are available in the United States, we evaluated three IgG ELISAs, CeLLabs T. cruzi ELISA, Hemagen Chagas' kit and IVD Research Chagas' Serum Microwell ELISA, and MarDx indirect immunofluorescent assays. The CeLLabs and Hemagen IgG ELISAs had 100 % agreement, sensitivity and specificity. The IVD Research IgG ELISA had 94·6 % agreement, 100 % sensitivity and 93 % specificity.

Saliva ELISA: a method for the diagnosis of chronic Chagas disease in endemic areas

An indirect enzyme linked immunosorbent assay (ELISA) was applied to saliva to detect chronic infection by Trypanosoma cruzi in humans. Saliva samples from 114 Chagas' disease chronically infected individuals, characterized by three serological tests and clinical evaluation and from 100 healthy controls were tested for T. cruzi specific IgG antibodies. At dilution of 1 in 2, specific antibodies were detected in saliva samples from 103 of 114 samples from infected patients and 5 of 100 controls (sensitivity 90.4%, specificity 95%). There was no significant correlation between the antibody titre and cardiac or gastrointestinal tract disease. This assay possesses some advantages over other methods as saliva collection is non-invasive, requires no special equipment and whole saliva gave reproducible results. Although serology remains the gold standard for T. cruzi infection, these results suggest that T. cruzi specific salivary antibody detection may provide a screening diagnostic test and contribute to epidemiological studies of chronic trypanosomiasis infection in endemic areas.

Presence of IgM antibodies to Trypanosoma cruzi urinary antigen in sera from patients with acute Chagas' disease

An 80-kilodalton Trypanosoma cruzi antigen is eliminated in the urine of infected hosts during the acute stage of Chagas' disease. We show that affinity-purified urinary antigen is recognised by IgM antibodies in the sera from acute chagasic patients. Comparing our urinary antigen assay with that using a whole T. cruzi lysate antigen for IgM antibody detection, we demonstrated that ELISA with urinary antigen increases the diagnostic sensitivity and specificity of IgM serology in recent chagasic infection. Twenty-six of 30 patients with acute T. cruzi infection had serum IgM antibodies that reacted with urinary antigen by ELISA, while lysate antigen IgM was detected in 24 sera. When sera from patients suffering other parasitoses were tested, strong cross-reactions occurred in ELISA with T. cruzi lysate antigen, whereas ELISA with urinary antigen proved to better discriminate acute chagasic patients. Human antibodies to urinary antigen immunoprecipitated this T. cruzi urinary antigen and also inhibited the binding of monoclonal antibody to urinary antigen in an inhibition assay. These findings suggest that urinary antigen may be useful for the development of serodiagnostic procedures for acute T. cruzi infection.

[Review of the biologic and diagnostic aspects of Trypanosoma (Herpetosoma) rangeli]

This review has three objectives: a) To stimulate further research of this prevalent human infection b) to examine the progress of current diagnostic techniques and c) to emphasise the significance of the flagellate parasite Trypanosoma (Herpetosoma) rangeli in Chagas' Disease endemic areas of South and Central America. Both Trypanosoma rangeli and Trypanosoma cruzi overlap in many of the areas of Latin America utilising the same triatomine vectors. Also a vast range of mammalian species have been found naturally infected with T. rangeli. The biology of the parasitism of T. rangeli is revised and emphasis is given regarding its biological cycle. T. cruzi and T. rangeli share common antigens and cross react serologically. Human infection in the chronic phase may be misdiagnosed as T. cruzi infection. Conventional and modern diagnostic and identification methods are discussed. Unfortunately we do not know the real distribution of T. rangeli infections in most areas and epidemiological studies to examine concomitant dual infections deserve further investigation.

Improved specificity of Trypanosoma cruzi identification by polymerase chain reaction using an oligonucleotide derived from the amino-terminal sequence of a Tc24 protein

In the present study, the diagnostic value of Trypanosoma cruzi recombinant protein (Tc24) was examined. Although antibodies against Tc24 were detected during natural and experimental T. cruzi infections, specificity studies revealed that sera from T. rangeli-infected mice also recognized to some extent Tc24 protein. In addition, sera from Tc24-immunized mice reacted against a 21 kDa polypeptide in T. rangeli extracts. Detailed analysis of the antibody response against 20-40 peptide localized in the Tc24 amino-terminal domain suggests that this sequence is not expressed by T. rangeli 21 kDa antigen. Therefore, the PCR reaction using oligonucleotides corresponding to a 20-26 peptide clearly demonstrated the specificity of the oligoprobes for T. cruzi identification. Positive signals were also found when using blood samples from T. cruzi-infected mice. Taken together, these results suggest that the PCR-based 20-26 assay may be useful in the specific diagnosis of Chagas' disease.

Immunoparasitological studies of Trypanosoma cruzi low virulence clones from Panama: humoral immune responses and antigenic cross-reactions with Trypanosoma rangeli in experimentally infected mice

The kinetics of humoral immune responses were investigated in mice experimentally infected with five clones of Trypanosoma cruzi isolated from different sources in Panama. Sera were collected at different timepoints post-infection. ELISA and IHA tests were used to detect antibodies against T. cruzi epimastigote antigens. The levels of T. cruzi specific antibodies increased during the course of infection; at day 90 post-infection the range was between 1:5120 and 1:10240. A high correlation was evident between ELISA and IHA results. Western blots revealed that these antibodies recognized polypeptides of 81, 76 and 71 KDa during the first weeks and 81, 76, 71, 50, 40, 28 and 12 KDa after 30-50 days. Only minor differences in antigen recognition patterns were demonstrated, suggesting that the major antigens may be represented in all clones. T. rangeli antigens were also recognized by T. cruzi seropositive sera. However, an ELISA test using antigens isolated from a genomic expression library of T. cruzi revealed that a hyperimmune rabbit serum against T. rangeli was unable to recognize the repeat sequence of SAPA (Shed Acute Phase Antigen) peptides but did recognize a number of other T. cruzi synthetic peptide antigens. The importance of these findings, in the context of Chagas' disease, is discussed.

Detection of antibodies to Trypanosoma cruzi among blood donors in the southwestern and western United States. II. Evaluation of a supplemental enzyme immunoassay and radioimmunoprecipitation assay for confirmation of seroreactivity

BACKGROUND

Chagas' disease, caused by the protozoan parasite Trypanosoma cruzi, is endemic to Latin America and may be transmitted in the United States via blood donated by infected immigrants. Blood-borne pathogens such as T. cruzi require supplemental testing for confirmation of seroreactivity.

STUDY DESIGN AND METHODS

A study was undertaken to determine an optimal scheme for confirmation of seroreactivity in repeatedly reactive samples identified by the Chagas antibody enzyme immunoassay (EIA). The procedure for initial confirmation involves three purified antigens coated onto three separate polystyrene beads and uses an EIA format. If the sample is reactive with two of three or three of three antigens, it is confirmed as seroreactive. If none or one of three beads is reactive, the sample is indeterminate and subjected to a radioimmunoprecipitation assay (RIPA). The RIPA must demonstrate characteristic bands at 32, 34, and 90 kDa.

RESULTS

When tested with sera from persons with potentially cross-reactive diseases (n = 39) or against a presumed negative population from southeast Wisconsin (n = 289), the confirmatory EIA had a specificity of 100 percent. Sensitivity was 100 percent (28/28) with xenodiagnosis-positive sera and 97.6 percent (80/82) with chagasic sera from Latin America. The RIPA showed a specificity of 100 percent in EIA-nonreactive samples (n = 100) and a sensitivity of 100 percent with both xenodiagnosis-positive (28/28) and chagasic (82/82) sera.

CONCLUSION

The confirmatory EIA and the RIPA together provide a highly specific and sensitive means of confirming seroreactivity for antibodies to T. cruzi.

Comparison of chagasic and non-chagasic myocardiopathies by ELISA and immunoblotting with antigens of Trypanosoma cruzi and Trypanosoma rangeli

Trypanosoma cruzi associated myocardiopathy, or Chagas disease, continues to be a serious problem in Venezuela, for which there is neither a vaccine nor a cure. In order to learn more about the humoral immune response to trypanosomal antigens, and to try to identify dominant antigens, we used ELISA and immunoblotting to study the reactivity of sera from patients with chagasic and non-chagasic myocardiopathies, against surface and secreted proteins from T. cruzi and T. rangeli. Both species are found in the same insect vector, but only T. cruzi is thought to be pathogenic in vertebrates. The ELISA results fell into three patterns: (1) high reactivity values with both T. cruzi and T. rangeli surface and secreted proteins; (2) high values to T. cruzi but low values with T. rangeli; and (3) high values to T. rangeli and low values with T. cruzi. This finding that some chagasic sera react more strongly against T. rangeli than against T. cruzi is intriguing, and warrants further investigation. When chagasic sera were tested on Western blots of total extracts of T. cruzi and T. rangeli, the pattern of reactive bands was similar against both parasites, but no two sera showed an identical pattern. Furthermore, there was no correlation between a particular immunoblotting pattern and either the antibody titer, or the severity of the disease. Several T. cruzi and T. rangeli antigens were recognized by sera from healthy controls as well as from patients with other tropical diseases endemic in Venezuela. Overall, our results suggest that the humoral immune response to trypanosomal antigens is complex, and no single antigen may be the determining factor in the pathogenesis of chagasic myocardiopathy.

Chagas' disease and blood transfusion: a New World problem?

American trypanosomiasis (Chagas' disease) can be transmitted by blood transfusion. For almost 40 years, this transmission has been limited to Latin America, but recently, three cases have been reported in the USA and Canada. With increasing emigration to North America and Europe, Chagas' disease may be introduced to the Northern hemisphere by transfusion of blood from carriers. This review will focus on the discovery, biology and antigenic profile of Trypanosoma cruzi (the aetiological agent of Chagas' disease), including the invertebrate vectors, animal reservoirs and transmission to humans, with special reference to blood transfusion. Finally, diagnostic tests and prophylactic measures for the prevention of Chagas' disease will be discussed.

Identification and synthesis of a major conserved antigenic epitope of Trypanosoma cruzi

A gene sequence encoding an immunodominant protein with a repetitive epitope from the protozoan Trypanosoma cruzi, the causative agent of Chagas disease, was cloned and expressed. The identified 10-amino acid repeat is present within a high-molecular-weight trypomastigote antigen that appears specific to and conserved among T. cruzi isolates. More importantly, greater than 95% of T. cruzi infection sera, including both chronic and acute Chagas disease, contained elevated levels of antibody to a 15-amino acid synthetic peptide bearing the repetitive B-cell epitope. Considering the wide diversity of T. cruzi parasites, as well as the broad spectrum of clinical manifestations of Chagas disease, such a prevalent immune response among patients is significant and applicable to the control of Chagas disease through the diagnosis of T. cruzi infection.

Evaluation of recombinant trypomastigote surface antigens of Trypanosoma cruzi in screening sera from a population in rural Northeastern Brazil endemic for chagas' disease

A perfect serologic test for infection with Trypanosoma cruzi does not exist. This study uses recombinant T. cruzi surface proteins in the antibody capture enzyme linked immunoabsorption assay (ELISA); and compares this approach to the more standard immunofluorescence assay (IFA). Three recombinant antigens are studied: F1-160 corresponding to the 160 kDa flagellar associated surface protein of trypomastigotes (the motile form of T. cruzi in mammalian infections); and SA 85-1.1 and 1.2 corresponding to different members of the 85 kDa family of surface proteins expressed by trypomastigotes and amastigotes (the replicative, non-motile form of T. cruzi in mammalian infections). Each recombinant antigen is found to be highly specific (range 86-94%) but relatively insensitive (range 36-52%) when used to screen for antibodies to T. cruzi. Defining seropositivity as reactivity to any of the three recombinant antigens markedly increases the sensitivity (72%) with only a minor reduction in specificity (82%). Thus, employing recombinant T. cruzi antigens to screen for T. cruzi infection has promise, but improvements in sensitivity must be made before widespread utilization is recommended.

Characterization of major surface and excretory-secretory immunogens of Trypanosoma cruzi trypomastigotes and identification of potential protective antigen

The surface antigens of Trypanosoma cruzi trypomastigotes were identified by immunoprecipitation and were compared with metabolically labelled excretory-secretory products (ES) released by the parasites in vitro. A series of major immunogenic components in the ES antigens were revealed (160 kDa, 130 kDa and 80-110 kDa). The trypomastigote surface also bears the 130 kDa band and the 80-110 kDa complex. Competition experiments demonstrated the common antigenic structure of the ES and the surface antigens. Two-dimensional analysis of ES antigens immunoprecipitated by human Chagasic serum revealed several spots in the 80-110 kDa region with a wide range of isoelectric points (PI between 5.4 and 6.7). This reflects a charge heterogeneity of these polypeptides. The trypomastigote 85 kDa polypeptide was also identified in the ES antigens by using a monoclonal antibody against this antigen. Two-dimensional analysis of the 85 kDa proteins shed from the surface of trypomastigotes and immunoprecipitated by the monoclonal antibody 155D3 showed 2 major spots: a major part of the 85 kDa polypeptide was found at pH 6.5-6.6, whereas a substantial amount of the antigen was found at pH 5.7. An additional component with molecular weight of approximately 58 kDa and isoelectric points of 6.5 and 6.6, was also visualized. Detection of the 85 kDa polypeptide circulating in serum from patients with acute and chronic Chagas' disease was achieved using an enzyme-linked immunosorbent assay. In addition, the data obtained showed that a polyclonal antibody to the 85 kDa polypeptide could be used to passively induce a partial protection of Fischer rats against acute lethal infection. Thus, the antigens recognized by polyclonal antibody appear to play a role in the development of protective immunity against T. cruzi.

Serodiagnosis of Chagas' disease using monoclonal antibody against Trypanosoma cruzi-specific Mr 25,000 antigen

A mouse monoclonal antibody TCF87, prepared previously, was reactive with Trypanosoma cruzi-specific Mr 25,000 antigen regardless of strain. The Mr 25,000 antigen was recognized by all sera from chagasic patients living in different areas of South America, when examined by Western immunoblotting analysis. Although many antigens of T. cruzi epimastigotes were also recognized by sera from patients with leishmaniasis, the Mr 25,000 antigen of T. cruzi did not react with leishmaniasic sera. These results indicate that Mr 25,000 antigen recognized by TCF87 is valuable as a diagnostic antigen for Chagas' disease. When a competition enzyme-linked immunosorbent assay using TCF87 was carried out, all sera from Chagas' disease patients showed positive inhibition. By contrast, all patients with leishmaniasis or other parasitic diseases were scored as seronegative. The present study suggests that competition enzyme-linked immunosorbent assay using monoclonal antibody against the Mr 25,000 antigen of T. cruzi will be useful for serodiagnosis of Chagas' disease in areas where leishmaniasis is co-endemic.

Trypanosoma cruzi: characterization of in vitro and in vivo synthesized polypeptides from epimastigote forms of different strains

Intact RNAs were isolated from epimastigote forms of different Trypanosoma cruzi strains. Translation of the mRNAs using rabbit reticulocyte lysate and analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis showed protein profiles comparable to those observed by labeling cells in vivo. No major interstrain differences were observed in the patterns of the polypeptides synthesized in vitro and in vivo, indicating that metabolic proteins are similar among distinct strains. Several T. cruzi polypeptides produced in the rabbit reticulocyte lysate system were immunoprecipitated by specific antisera. The patterns of antigenic polypeptides recognized by antisera raised against epimastigotes from different strains were also very similar.

Clinical Trypanosoma rangeli infection as a complication of Chagas' disease

Laboratory studies on a group of 20 patients from the Rio Negro Valley, Colombia selected for detailed study showed that 14 gave antibody reactions on immunoassay consistent with Trypanosoma cruzi or T. rangeli infections. Four were diagnosed as having T. rangeli infection, 4 had mixed infections and 6 were infected with T. cruzi alone. Immunoprecipitation analysis showed that sera from T. cruzi-infected patients recognized a similar range of trypomastigote-derived polypeptides as sera from patients in Brazil, and all of the Colombian sera reacted with the 160 kiloDalton (kDa) polypeptide associated with active infection. Although sera from patients with T. rangeli infection alone gave a positive immunofluorescence or ELISA reaction with T. rangeli, they failed to bind to parasite polypeptides by either immunoprecipitation or Western blotting. Intriguingly, sera from patients with mixed infections consistently gave a stronger, but qualitatively similar, binding reaction in immunoprecipitation and Western blotting compared to sera from patients infected with T. cruzi alone.

Analysis of Trypanosoma cruzi antigens bound by specific antibodies and by antibodies to related trypanosomatids

Antigens of the epimastigote stage of Trypanosoma cruzi were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis under reducing conditions and examined for their ability to bind antibodies in sera from humans infected with this organism or infected with one or both of the related protozoa Leishmania braziliensis and Leishmania donovani by protein blot analysis and enzyme-linked immunosorbent assay. Most of the antigens were bound by antibodies against each one of the organisms. A group of antigens with Mrs between 31,000 and 21,000 were bound by antibodies against T. cruzi only. These antigens were isolated and used in an enzyme-linked immunosorbent assay for the differential diagnosis of Chagas' disease, with excellent results. All sera from individuals proven to be infected with T. cruzi reacted with the antigens, whereas none of the sera from individuals proven to be infected with L. braziliensis or L. donovani reacted with the antigens, even when tested at a low dilution. Biochemical characterization of the isolated antigens revealed the presence of protein and carbohydrate. The reactivity of the isolated antigens with antibodies was completely abolished by pronase and partially abolished by sodium periodate. Protein blot analysis of sera from mice immunized with the antigens revealed a major large band with an Mr between 31,000 and 21,000 and a minor band with an Mr of 45,000, suggesting sharing of epitopes between antigens of different Mrs. These sera did not agglutinate or lyse live epimastigotes. Indirect immunofluorescent antibody tests with live and dead epimastigotes revealed that antibodies in the sera only bound to Formalin-killed organisms.

Identification and analysis of epimastigote surface and metabolic proteins in Trypanosoma cruzi

Metabolic and surface membrane proteins of four epimastigote-stage Trypanosoma cruzi clones were analyzed by one and two-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis. No major inter-clonal differences were observed in the metabolic protein patterns, indicating that these proteins are highly conserved. However, marked quantitative and qualitative differences were observed in surface-labeled protein patterns following both one and two-dimensional electrophoretic analyses. Inter and intra-clonal differences in antigenic properties also were demonstrated by immunoprecipitation of the surface proteins with sera from animals immunized or infected with various T. cruzi stocks. Thus, a wide spectrum of both phenotypic and antigenic diversity exists in T. cruzi which may be relevant to problems of the diagnosis and immunotherapy of Chagas' disease.

A Mr 90 000 surface polypeptide of Trypanosoma cruzi as a candidate for a Chagas' disease diagnostic antigen

Trypanosoma cruzi (Peru strain) trypomastigotes and epimastigotes were biosynthetically labeled with [35S]methionine, and the proteins were analyzed by two dimensional polyacrylamide gel electrophoresis (2D-PAGE). 2D-PAGE analysis of the trypomastigotes showed a complex array of polypeptides with distinct clusters at Mr 88 000-92 000, isoelectric point (pI) 5.6-6.0, and Mr 72 000-76 000, pI 5.6-5.8. 2D-PAGE analysis of the epimastigotes did not show the cluster of polypeptides at Mr 90 000. When the trypomastigote lysate was reacted with sera from either mice or humans chronically infected with T. cruzi, 10-50 polypeptides were immunoprecipitated. Five of these polypeptides were recognized by all sera tested. However, of these polypeptides, only three, two of Mr 90 000 and one of Mr 150 000, can be identified by immunoreaction of [35S]methionine-labeled live parasites as surface proteins of T. cruzi trypomastigotes. 125I-iminobiotinylated surface proteins isolated from T. cruzi trypomastigotes were immunoprecipitated with the same series of sera as described above. Chagasic sera immunoprecipitated an antigen of Mr 90 000. The [35S]methionine and 125I-labeled Mr 90 000 polypeptides were not immunoprecipitated with sera from individuals infected with Leishmania donovani, Leishmania braziliensis, Leishmania tropica or Leishmania mexicana. These data indicate that a surface polypeptide of Mr 90000, pI 5.8-5.9 is a viable candidate for a Chagas' disease diagnostic antigen.

Further evaluation of lectin affinity purified glycoprotein (GP90) in the enzyme linked immunosorbent assay (ELISA) for diagnosis of Trypanosoma cruzi infection

Sera from 143 patients considered to be infected with Trypanosoma cruzi on the basis of epidemiological, clinical and standard serological evidence gave positive results in the enzyme-linked immunosorbent assay (ELISA) using a lectin affinity purified 90,000 molecular weight glycoprotein (GP90) antigen preparation. Levels of antibody did not discriminate between clinically classified groups of patients in the chronic phase of infection. The GP90 preparation was found to be heterogeneous.