Induction of resistance to Schistosoma mansoni in mice by chemotherapy: migration of schistosomula in primary and challenge infections

Drug-induced exposure of Schistosoma mansoni antigens SmCD59a and SmKK7

Background

Schistosomiasis is a serious health problem especially in developing countries and affects more than 243 million people. Only few anthelmintic drugs are available up to now. A major obstacle for drug treatment is the different developmental stages and the varying host compartments during worm development. Anthelmintic drugs have been tested mainly on adult schistosomes or freshly transformed cercariae. Knowledge concerning the larval stages is lacking.

Methodology/Principal Findings

In this study, we used in vitro-grown schistosomula (aged between 2 to 14 days) to investigate drug effects of the three anthelmintics praziquantel, artemether, and oxamniquine. Further, we analyzed the antibody accessibility of two exemplary schistosome antigens SmCD59a and SmKK7, before and after drug treatment. Our results demonstrated that praziquantel applied at a concentration of 1 μM inhibited development of all life stages. Application of 10 μM praziquantel led to dramatic morphological changes of all schistosomula. Artemether at 1 and 10 μM had differential effects depending on whether it was applied to 2-day as compared to 7- and 14-day schistosomula. While 2-day schistosomula were not killed but inhibited from further development, severe morphological damage was seen in 7- and 14-day schistosomula. Oxamniquine (1 and 10 μM) led to severe morphological impairment in all life stages. Analyzing the accessibility of the antigens SmCD59a and SmKK7 before drug treatment showed no antibody binding on living intact schistosomula. However, when schistosomula were treated with anthelmintics, both antigens became exposed on the larvae. Oxamniquine turned out to be most effective in promoting antibody binding to all schistosomula stages.

Conclusion

This study has revealed marked differences in anthelmintic drug effects against larvae. Drug treatment increases surface antigen presentation and renders larvae accessible to antibody attack.

Schistosomiasis is one of the major parasitic diseases in developing countries and still causes 200,000 deaths per year. Mass drug administration programs with praziquantel, the drug of choice against schistosomiasis, are currently undertaken in Sub-Saharan Africa. Praziquantel, although efficient against adult worms, fails to cure early infection. The complex developmental stages of schistosomes and migration through varying host compartments with different local drug concentration are a challenge for drug treatment. After infecting their mammalian host, schistosomula traverse through skin and the vasculature of lung, liver and intestines. During their migration, they develop from larvae to paired adults in approximately 4 to 5 weeks. So far, drug effects have been analyzed on adult worms or freshly transformed schistosomula only. Information about the effects on the larval stages is lacking. We were able to transfer the larval development of the first three weeks into the culture dish. This tool can be used for the analysis of drug effects against schistosomula and for investigation of the accessibility, expression and localization of antigens. Rendering the parasite’s larvae vulnerable to the host’s immune system by increasing antigen presentation is an important aspect of drug activity. We demonstrate on in vitro-cultured Schistosoma mansoni larvae, that SmCD59a and SmKK7, as examples for hidden antigens, become accessible to antibodies following drug treatment.

Experimentally promising antischistosomal drugs: a review of some drug candidates not reaching the clinical use

Schistosomiasis is a chronic parasitic disease affecting about 207 million people in the world. It still represents a major health problem in many tropical and sub-tropical countries as well as for travelers from developed countries. Control of the disease depends mainly on chemotherapy, with praziquantel becoming the exclusive drug. Extensive use of praziquantel with concerns about the possibility of drug resistance development, unavailability of an applicable vaccine, and the absence of a reasonable alternative to praziquantel all represent a real challenge. One of the suggested solutions is to exploit the advantages of compounds that proved efficacious at the experimental level with a good safety profile. These may undergo further investigations for the sake of developing their antischistosomal properties or to incorporate them in combination therapies. Chemotherapy literature is redundant with a huge number of compounds screened for their schistosomicidal properties. However, only a few of these may act as drug leads that could be promising in the development of a therapeutic reserve for schistosomiasis. The present paper reviews previous studies carried out on some of these compounds.

Schistosoma mansoni: evaluation of the activity of oxamniquine on schistosomules, at 24 hours after infection

Mice transcutaneously infected with about 400 cercariae were submitted to treatment with oxamniquine (400 mg/kg), 24 hours after infection. The recovery of schistosomules, at 4, 24, 48 and 72 hours and 35 days after treatment, showed the activity of the drug on the parasites, thus practically preventing their migration from the skin to the lungs. Worm recovery performed in the lungs (96 hours after treatment) showed recovery means of 0.6 worms/mouse in the treated group and 53.8 in the control group (untreated). The perfusion of the portal system carried out at 35 days after treatment clearly showed the elimination of all the parasites in the treated group, whereas a recovery mean of 144.7 worms/mouse was detected in the control group (untreated). These findings confirm the efficacy of oxamniquine at the skin phase of infection, and also show similarity with the immunization method that uses irradiated cercariae. The practical application of these findings in the medical clinic is discussed too.

Autoradiographic quantification of the efficacy of niridazole in mice infected with 75Se-labelled cercariae of Schistosoma mansoni

The effects of the anti-schistosomal drug, niridazole, on the migration of Schistosoma mansoni larvae, biosynthetically radioisotope-labelled with 75[Se]-selenomethionine, was evaluated by autoradiography of compressed tissues of mice treated daily from Days 6 to 10 post-infection with 200 mg kg-1 niridazole. The results were compared with the migration of schistosomula in untreated controls. The distribution of schistosomula was altered in niridazole-treated mice, where there was a delayed migration from the lungs relative to the controls and significantly fewer schistosomula in total appeared to reach the liver. The total percentage of schistosomula detected as autoradiographic foci was significantly lower in treated mice than in the untreated controls. Niridazole-treated mice were free of any foci 10 days after the last treatment and no adult worms were recovered on perfusion of the hepatic portal system relative to control mice from which 5.8% of the infective cercariae were recovered as adult worms at Day 42 post-infection.

Schistosoma mansoni: acquired immunity in mice after the use of oxamniquine at the evolutive skin and pulmonary phases

Mice infected with 350 cercariae of Schistosoma mansoni (LE strain) were treated with oxamniquine, at the dose of 400 mg/kg, 24, 48, 72, and 96 h after infection. Forty days after the treatment, the animals were submitted to a challenge infection with 80 cercariae, through the abdominal and ear skins. The number of immature worms in the animal groups treated 24 and 96 h after the first infection was found to be lower than that in the control group, thus showing that the death of schistosomes by chemotherapy, at the skin and pulmonary phases, causes an acquired resistance state.

Induction of immunity against Schistosoma mansoni by drug (Ro11-3128)-terminated infections: analysis of surface antigen recognition

As with 20 krad-irradiated infections in mice, the present study shows that the immunity induced by Ro11-3128 termination of unattenuated infections at the skin stage is species specific, not operating against S. japonicum. Treatment with the drug Ro15-5458, also effective at the skin stage, however, resulted in significantly lower levels of resistance than Ro11-3128. Sera from mice immunized by infection plus Ro11-3128 treatment on days 1 or 2 (Ro11S) coprecipitated essentially the same pattern of 125I-labelled surface antigens as the 20 krad vaccine serum (VMS), viz. Mr 38,000, 32,000, 23,000 and 15,000. However, recognition by Ro11S was markedly stronger. Sera from the infected and Ro15-5458-treated mice (Ro15S) failed to recognize the Mr 23,000 antigen and produced a weaker response than Ro11S or VMS against the Mr 38,000 or 32,000 antigens but a comparable response to VMS against the Mr 15,000 antigen. Ro11S and VMS also recognized the Mr 16,000 surface antigen seen by Western blotting but its recognition by Ro15S was weaker. Compared with sera from animals treated at the skin stage, sera from animals treated at the lung stage (day + 6) showed weaker recognition of the Mr 32,000 and 15,000 antigens and no recognition of the Mr 23,000 antigen. In contrast, sera from mice treated at 15 days recognized both the Mr 32,000 and 23,000 antigens but not the Mr 15,000 antigen. Mice treated at these times show progressively less immunity than at the skin stage. Infected but untreated animals only showed significant recognition of the Mr 32,000 antigen. Thus compared with infections treated with Ro11-3128 on days 1 or 2, treatment at later times or with the drug Ro15-5458 resulted in selective and differential absence or diminution of response against either the Mr 38,000, 32,000, 23,000, 16,000 or 15,000 antigens. In vitro, Ro11-3128, in contrast to Ro15-5458, caused multiple vesicle formation at the surface of skin stage schistosomula but this was progressively less pronounced with lung and liver stage worms. The vesicles were shown to express surface membrane antigens but were apparently not derived from the existing outer leaflet of the surface membrane. It is suggested that this altered antigen expression might explain the optimum immunity induced.

Schistosoma mansoni: an ultrastructural examination of skin migration in the hamster cheek pouch

The hamster cheek pouch has been used to investigate the skin migration of schistosomula at the ultrastructural level. Parasites have been observed up to 72 h post-infection. Despite rapidly reaching the epidermal basement membrane schistosomula remain in an epidermal location for at least 40 h post-infection, by which time the acetabular glands and their ducts have been lost and the transformation from cercaria to schistosomulum completed. Entry into the dermis and exit from the skin via the blood vessels is therefore by mechanical means or by lytic secretions emanating from a source other than the acetabular glands. The head gland which persists in the dermal schistosomula is a probable source of such secretions. The observations suggest that the apical area and musculature of the head capsule are important in gaining access to the lumen of blood vessels.

Resistance following drug attenuation (Ro 11-3128 or oxamniquine) of early Schistosoma mansoni infections in mice

A single dose of Ro 11-3128 was found to be 98-100% effective against Schistosoma mansoni infections at intervals of 3 h to 15 days following infection, and apparently killed the schistosomula stages soon after administration, thus allowing an assessment of the immunizing potential of progressive larval stages. Following infection with 500 unirradiated cercariae, optimum resistance was manifest by groups drug-treated at 48-96 h (60-75%). Significantly lower levels of resistance occurred with early (3 h) or later (6-15 day) treatments. Superimposition of an infection treated at 15 days on a prior infection which had been treated at 2 days did not reduce the level of resistance caused by the latter, indicating that the infection plus delayed treatment had not induced suppression. Thus the peak resistance manifest during the 48-96 h period may reflect optimum expression of protective antigens. Comparison of irradiated (20 krad.) with unirradiated infections showed that, when drug-terminated 24, 48 or 96 h post-infection, irradiated cercariae induced significantly less resistance than unirradiated cercariae, perhaps indicating a delayed appearance of protective antigens following radiation treatment.