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Babu SK, Sahoo DR, Mohanta PP, Naik PK. Exploring the antifilarial potential of an important medicinal plant Typhonium trilobatum (L. Schoot): Isolation, characterization, and structural elucidation of bioactive compounds against Brugia malayi. JOURNAL OF ETHNOPHARMACOLOGY 2024; 326:117858. [PMID: 38346526 DOI: 10.1016/j.jep.2024.117858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/26/2024]
Abstract
ETHNOPHARMACOLOGY RELEVANCE The plant Typhonium trilobatum has been utilized in traditional medicine for the treatment of many ailments, including parasitic infections. Recent examinations indicate that the bioactive substances from this plant may have antiparasitic activities against Brugia malayi, which have not been determined. PURPOSE The parasitic nematodes Brugia malayi, Brugia timori, and Wuchereria bancrofti causing lymphatic filariasis, remain a significant challenge to global public health. Given the ongoing nature of this enduring menace, the current research endeavours to examine the efficacy of an important medicinal plant, Typhonium trilobatum. METHODS Different extracts of the T. trilobatum tubers were evaluated for their antiparasitic activity. The most prominent extract was subjected to Gas Chromatography Mass Spectrometry (GC-MS) and High Performance Liquid Chromatography (HPLC) followed by Column Chromatography for isolating bioactive molecules. The major compounds were isolated and characterized based on different spectroscopic techniques (FTIR, NMR and HRMS). Further, the antiparasitic activity of the isolated compounds was evaluated against B. malayi and compared with clinically used antifilarial drugs like Diethylcarbamazine and Ivermectin. RESULTS The methanolic extract of the tuber exhibited significant antiparasitic activity compared to the other extracts. The bioactive molecules isolated from the crude extract were identified as Linoleic acid and Palmitic acid. Antiparasitic activity of both the compounds has been performed against B. malayi and compared with clinically used antifilarial drugs, Ivermectin and DEC. The IC50 value of Linoleic acid was found to be 6.09 ± 0.78 μg/ml after 24 h and 4.27 ± 0.63 μg/ml after 48 h, whereas for Palmitic acid the value was 12.35 ± 1.09 μg/ml after 24 h and 8.79 ± 0.94 μg/ml after 48 h. The IC50 values of both the molecules were found to be similar to the standard drug Ivermectin (IC50 value of 11.88 ± 1.07 μg/ml in 24 h and 2.74 ± 0.43 μg/ml in 48 h), and much better compared to the DEC (IC50 values of 194.2 ± 2.28 μg/ml in 24 h and 101.8 ± 2.06 μg/ml in 48 h). Furthermore, it has been observed that both the crude extracts and the isolated compounds do not exhibit any detrimental effects on the J774.A.1 macrophage cell line. CONCLUSION The isolation and characterization of bioactive compounds present in the methanolic tuber extract of Typhonium trilobatum were explored. Moreover, the antimicrofilarial activity of the crude extracts and its two major compounds were determined using Brugia malayi microfilarial parasites without any significant side effects.
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Affiliation(s)
- Swaraj Kumar Babu
- Centre of Excellence in Natural Products and Therapeutics, Department of Biotechnology and Bioinformatics, Sambalpur University, Jyoti Vihar, Sambalpur, Odisha, India.
| | - Dibya Ranjan Sahoo
- Centre of Excellence in Natural Products and Therapeutics, Department of Biotechnology and Bioinformatics, Sambalpur University, Jyoti Vihar, Sambalpur, Odisha, India.
| | - Prajna Parimita Mohanta
- Centre of Excellence in Natural Products and Therapeutics, Department of Biotechnology and Bioinformatics, Sambalpur University, Jyoti Vihar, Sambalpur, Odisha, India.
| | - Pradeep Kumar Naik
- Centre of Excellence in Natural Products and Therapeutics, Department of Biotechnology and Bioinformatics, Sambalpur University, Jyoti Vihar, Sambalpur, Odisha, India.
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Debrah LB, Gyasi C, Ahiadorme M, Rahamani AA, Opoku VS, Obeng P, Osei-Mensah J, Obeng MA, Mensah DA, Debrah AY. Association of haemato-biochemical indices and blood composite ratios with microfilaridermia in Onchocerciasis patients. BMC Infect Dis 2024; 24:384. [PMID: 38589790 PMCID: PMC11003075 DOI: 10.1186/s12879-024-09278-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/01/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Onchocerciasis causes chronic systemic inflammation. Several studies have used markers such as haemato-biochemical indices to predict the occurrence of systemic inflammation. This study assessed the variability and predictability of haemato-biochemical indices and blood composite ratios (BCRs) in microfilariae positive (MF+) and microfilariae negative (MF-) subgroups of onchocercomata participants. METHODS One hundred and five (105) MF + and 34 MF- participants were retrospectively recruited into the study. Screening for the presence of O. volvulus microfilariae was done from skin snips taken from the left and right iliac crests of participants using established and approved protocols. Haematological and biochemical indices were measured using standard laboratory automated analyzers. Blood composite ratios (BCRs) were calculated as ratios of the absolute parameters involved. RESULTS A significantly increased total WBC, absolute eosinophil, eosinophil percent and absolute basophil were observed in the MF + participants compared to MF- participants. Reduced gamma-glutamyl transferase (GGT) with increased estimated glomerular filtration rate (eGFR) was significantly associated with MF + participants compared to MF- participants. BCRs were significantly higher for eosinophil-to-neutrophil ratio (ENR), eosinophil-to-monocyte ratio (EMR), eosinophil-to-basophil ratio (EBR) and eosinophil-to-lymphocyte ratio (ELR) in MF + participants compared to MF- participants. After multivariate adjustment, onchocercomata participants with increased eosinophil counts (aOR = 13.86, 95% CI [2.07-92.90], p = 0.007), ENR x10 (aOR = 1.42, 95% CI [1.05-1.93], p = 0.025), EMR (aOR = 2.64, 95% CI [1.25-5.60], p = 0.011), EBR (aOR = 1.07, 95% CI [1.01-1.10], p = 0.020) and ELR x10 (aOR = 1.69, 95% CI [1.14-2.51], p = 0.009) were more likely to have microfilaridermia. CONCLUSIONS Elevated eosinophil counts with higher ENR, EMR, EBR and ELR levels are significantly associated with microfilaridermia in onchocercomata participants. Combining BCRs with eosinophil count significantly led to an improvement in the conventional model for predicting microfilaridermia.
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Affiliation(s)
- Linda Batsa Debrah
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Gyasi
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Monica Ahiadorme
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abu Abudu Rahamani
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Vera Serwaa Opoku
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Prince Obeng
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jubin Osei-Mensah
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Pathobiology, School of Veterinary Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Agyemang Obeng
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Derrick Adu Mensah
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Alexander Yaw Debrah
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Antonio JA, Rollason V, Musumeci S, Finckh A, Lazarou I, Laffitte E, Nendaz M, Serratrice J, Coen M. Mazzotti reaction: Ivermectin-associated polyarthritis after delayed scabies treatment. Case report and review of the literature. Therapie 2021; 77:612-616. [PMID: 34732299 DOI: 10.1016/j.therap.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/20/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Jessica Amado Antonio
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Stefano Musumeci
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Axel Finckh
- Division of Rheumatology, Department of Medicine, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Ilias Lazarou
- Division of Rheumatology, Department of Medicine, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Emmanuel Laffitte
- Division of Dermatology, Department of Medicine, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Mathieu Nendaz
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospital, 1205 Geneva, Switzerland; Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Jacques Serratrice
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Matteo Coen
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospital, 1205 Geneva, Switzerland; Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland.
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Zero Eosinophil Count as a Predictor of Clozapine-Associated Late-Onset Agranulocytosis: A Case Report. J Clin Psychopharmacol 2018; 38:531-532. [PMID: 30113930 DOI: 10.1097/jcp.0000000000000935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Ivermectin susceptibility and sporontocidal effect in Greater Mekong Subregion Anopheles. Malar J 2017; 16:280. [PMID: 28687086 PMCID: PMC5501099 DOI: 10.1186/s12936-017-1923-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/28/2017] [Indexed: 12/26/2022] Open
Abstract
Background Novel vector control methods that can directly target outdoor malaria transmission are urgently needed in the Greater Mekong Subregion (GMS) to accelerate malaria elimination and artemisinin resistance containment efforts. Ivermectin mass drug administration (MDA) to humans has been shown to effectively kill wild Anopheles and suppress malaria transmission in West Africa. Preliminary laboratory investigations were performed to determine ivermectin susceptibility and sporontocidal effect in GMS Anopheles malaria vectors coupled with pharmacokinetic models of ivermectin at escalating doses. Methods A population-based pharmacokinetic model of ivermectin was developed using pre-existing data from a clinical trial conducted in Thai volunteers at the 200 µg/kg dose. To assess ivermectin susceptibility, various concentrations of ivermectin compound were mixed in human blood meals and blood-fed to Anopheles dirus, Anopheles minimus, Anopheles sawadwongporni, and Anopheles campestris. Mosquito survival was monitored daily for 7 days and a non-linear mixed effects model with probit analyses was used to calculate concentrations of ivermectin that killed 50% (LC50) of mosquitoes for each species. Blood samples were collected from Plasmodium vivax positive patients and offered to mosquitoes with or without ivermectin at the ivermectin LC25 or LC5 for An. dirus and An. minimus. Results The GMS Anopheles displayed a range of susceptibility to ivermectin with species listed from most to least susceptible being An. minimus (LC50 = 16.3 ng/ml) > An. campestris (LC50 = 26.4 ng/ml) = An. sawadwongporni (LC50 = 26.9 ng/ml) > An. dirus (LC50 = 55.6 ng/ml). Mosquito survivorship results, the pharmacokinetic model, and extensive safety data indicated that ivermectin 400 µg/kg is the ideal minimal dose for MDA in the GMS for malaria parasite transmission control. Ivermectin compound was sporontocidal to P. vivax in both An. dirus and An. minimus at the LC25 and LC5 concentrations. Conclusions Ivermectin is lethal to dominant GMS Anopheles malaria vectors and inhibits sporogony of P. vivax at safe human relevant concentrations. The data suggest that ivermectin MDA has potential in the GMS as a vector and transmission blocking control tool to aid malaria elimination efforts. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1923-8) contains supplementary material, which is available to authorized users.
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Wanji S, Eyong EEJ, Tendongfor N, Ngwa CJ, Esuka EN, Kengne-Ouafo AJ, Datchoua-Poutcheu FR, Enyong P, Agnew D, Eversole RR, Hopkins A, Mackenzie CD. Ivermectin treatment of Loa loa hyper-microfilaraemic baboons (Papio anubis): Assessment of microfilarial load reduction, haematological and biochemical parameters and histopathological changes following treatment. PLoS Negl Trop Dis 2017; 11:e0005576. [PMID: 28686693 PMCID: PMC5533442 DOI: 10.1371/journal.pntd.0005576] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 07/28/2017] [Accepted: 04/17/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Individuals with high intensity of Loa loa are at risk of developing serious adverse events (SAEs) post treatment with ivermectin. These SAEs have remained unclear and a programmatic impediment to the advancement of community directed treatment with ivermectin. The pathogenesis of these SAEs following ivermectin has never been investigated experimentally. The Loa/baboon (Papio anubis) model can be used to investigate the pathogenesis of Loa-associated encephalopathy following ivermectin treatment in humans. METHODS 12 baboons with microfilarial loads > 8,000mf/mL of blood were randomised into four groups: Group 1 (control group receiving no drug), Group 2 receiving ivermectin (IVM) alone, Group 3 receiving ivermectin plus aspirin (IVM + ASA), and Group 4 receiving ivermectin plus prednisone (IVM + PSE). Blood samples collected before treatment and at Day 5, 7 or 10 post treatment, were analysed for parasitological, hematological and biochemical parameters using standard techniques. Clinical monitoring of animals for side effects took place every 6 hours post treatment until autopsy. At autopsy free fluids and a large number of standard organs were collected, examined and tissues fixed in 10% buffered formalin and processed for standard haematoxylin-eosin staining and specific immunocytochemical staining. RESULTS Mf counts dropped significantly (p<0.05) in all animals following ivermectin treatment with reductions as high as (89.9%) recorded; while no significant drop was observed in the control animals. Apart from haemoglobin (Hb) levels which recorded a significant (p = 0.028) drop post treatment, all other haematological and biochemical parameters did not show any significant changes (p>0.05). All animals became withdrawn 48 hours after IVM administration. All treated animals recorded clinical manifestations including rashes, itching, diarrhoea, conjunctival haemorrhages, lymph node enlargement, pinkish ears, swollen face and restlessness; one animal died 5 hours after IVM administration. Macroscopic changes in post-mortem tissues observed comprised haemorrhages in the brain, lungs, heart, which seen in all groups given ivermectin but not in the untreated animals. Microscopically, the major cellular changes seen, which were present in all the ivermectin treated animals included microfilariae in varying degrees of degeneration in small vessels. These were frequently associated with fibrin deposition, endothelial changes including damage to the integrity of the blood vessel and the presence of extravascular erythrocytes (haemorrhages). There was an increased presence of eosinophils and other chronic inflammatory types in certain tissues and organs, often in large numbers and associated with microfilarial destruction. Highly vascularized organs like the brain, heart, lungs and kidneys were observed to have more microfilariae in tissue sections. The number of mf seen in the brain and kidneys of animals administered IVM alone tripled that of control animals. Co-administration of IVM + PSE caused a greater increase in mf in the brain and kidneys while the reverse was noticed with the co-administration of IVM + ASA. CONCLUSIONS The treatment of Loa hyper-microfilaraemic individuals with ivermectin produces a clinical spectrum that parallels that seen in Loa hyper-microfilaraemic humans treated with ivermectin. The utilization of this experimental model can contribute to the improved management of the adverse responses in humans.
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Affiliation(s)
- Samuel Wanji
- Parasites and Vectors Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, South West Region, Cameroon
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
| | - Ebanga-Echi J. Eyong
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
- Department of Biological Sciences, Faculty of Science, The University of Bamenda, Bambili, North West Region, Cameroon
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, Buea, South West Region, Cameroon
| | - Nicholas Tendongfor
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
| | - Che J. Ngwa
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
| | - Elive N. Esuka
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
| | - Arnaud J. Kengne-Ouafo
- Parasites and Vectors Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, South West Region, Cameroon
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
| | - Fabrice R. Datchoua-Poutcheu
- Parasites and Vectors Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, South West Region, Cameroon
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
| | - Peter Enyong
- Parasites and Vectors Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, South West Region, Cameroon
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
| | - Dalen Agnew
- Department of Pathobiology & Diagnostic Investigation, Michigan State University, East Lansing, MI, United States of America
| | - Rob R. Eversole
- Department of Biological Sciences, Western Michigan University, Kalamazoo, Michigan, United States of America
| | - Adrian Hopkins
- Mectizan Donation Programme, 325 Swanton Way, Decatur, Atlanta, Georgia, United States of America
| | - Charles D. Mackenzie
- Filarial Programmes Support Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Herrick JA, Legrand F, Gounoue R, Nchinda G, Montavon C, Bopda J, Tchana SM, Ondigui BE, Nguluwe K, Fay MP, Makiya M, Metenou S, Nutman TB, Kamgno J, Klion AD. Posttreatment Reactions After Single-Dose Diethylcarbamazine or Ivermectin in Subjects With Loa loa Infection. Clin Infect Dis 2017; 64:1017-1025. [PMID: 28329346 DOI: 10.1093/cid/cix016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/15/2017] [Indexed: 12/17/2022] Open
Abstract
Background Severe adverse reactions have been observed in individuals with Loa loa infection treated with either diethylcarbamazine (DEC), the drug of choice for loiasis, or ivermectin (IVM), which is used in mass drug administration programs for control of onchocerciasis and lymphatic filariasis in Africa. In this study, posttreatment clinical and immunologic reactions were compared following single-dose therapy with DEC or IVM to assess whether these reactions have the same underlying pathophysiology. Methods Twelve patients with loiasis and microfilarial counts <2000 mf/mL were randomized to receive single-dose DEC (8 mg/kg) or IVM (200 µg/kg). Clinical and laboratory assessments were performed at 4, 8, 24, 48, and 72 hours and 5, 7, 9, and 14 days posttreatment. Results Posttreatment adverse events were similar following DEC or IVM, but peaked earlier in subjects who received DEC, consistent with a trend toward more rapid and complete microfilarial clearance in the DEC group. After a transient rise (post-IVM) or fall (post-DEC) in the first 24 hours posttreatment, the eosinophil count rose significantly in both groups, peaking at day 5 in the DEC group and day 9 in the IVM group. Serum interleukin 5 levels and eosinophil activation, as assessed by surface expression of CD69 and serum levels of eosinophil granule proteins, were increased posttreatment in both groups. Conclusions Despite differences in eosinophil and lymphocyte counts during the first 24 hours posttreatment, the overall pattern of hematologic and immunologic changes suggest that posttreatment reactions following DEC and IVM share a common pathophysiology. Clinical Trials Registration NCT01593722.
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Affiliation(s)
- Jesica A Herrick
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Fanny Legrand
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Godwin Nchinda
- Laboratory of Immunology, Chantal Biya International Reference Centre for Research on Prevention and Management of HIV/AIDS, Yaoundé, Cameroon
| | - Céline Montavon
- Institut de recherche pour le développement, Montpellier, France
| | - Jean Bopda
- Center for Research on Filariasis and Other Tropical Diseases, Yaoundé, Cameroon
| | | | | | | | - Michael P Fay
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Michelle Makiya
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Simon Metenou
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Joseph Kamgno
- Center for Research on Filariasis and Other Tropical Diseases, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
| | - Amy D Klion
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Mai CS, Hamm DM, Banla M, Agossou A, Schulz-Key H, Heuschkel C, Soboslay PT. Onchocerca volvulus-specific antibody and cytokine responses in onchocerciasis patients after 16 years of repeated ivermectin therapy. Clin Exp Immunol 2007; 147:504-12. [PMID: 17302900 PMCID: PMC1810490 DOI: 10.1111/j.1365-2249.2006.03312.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The recommended control option against onchocerciasis is repeated ivermectin treatment, which will need to be implemented for decades, and it remains unknown how repeated ivermectin therapy might affect immunity against Onchocerca volvulus in the long term. O. volvulus-specific antibody reactivity and cellular cytokine production were investigated in onchocerciasis patients receiving ivermectin (150 microg/kg) annually for 16 years. In treated patients, the T helper type 2 (Th2) cytokine interleukin (IL)-5 and T regulatory IL-10 in response to O. volvulus antigen (OvAg) and bacteria-derived Streptolysin O (SL-O) diminished to levels found in infection-free endemic controls; also, cellular release of Th1-type interferon (IFN)-gamma at 16 years post initial ivermectin treatment (p.i.t.) approached control levels. In ivermectin-treated onchocerciasis patients, IL-5 production in responses to the mitogen phytohaemagglutinin (PHA) decreased, but IL-10 in response PHA increased, and neither attained the cytokine production levels of endemic controls. At 16 years p.i.t., O. volvulus-specific IgG1 and IgG4 subclass reactivity still persisted at higher levels in onchocerciasis patients than in O. volvulus exposed but microfilariae-free endemic controls. In addition, cytokine responses remained depressed in onchocerciasis patients infected concurrently with Mansonella perstans and Necator americanus or Entamoeba histolytica/dispar. Thus, long-term ivermectin therapy of onchocerciasis may not suffice to re-establish fully a balanced Th1 and Th2 immune responsiveness in O. volvulus microfilariae-negative individuals. Such deficient reconstitution of immune competence may be due to an as yet continuing and uncontrolled reinfection with O. volvulus, but parasite co-infections can also bias and may prevent the development of such immunity.
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Affiliation(s)
- C S Mai
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
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Udall DN. Recent updates on onchocerciasis: diagnosis and treatment. Clin Infect Dis 2006; 44:53-60. [PMID: 17143815 DOI: 10.1086/509325] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Accepted: 07/31/2006] [Indexed: 11/03/2022] Open
Abstract
Recent progress in onchocerciasis research has led to improved understanding of the immunopathology of Onchocerca volvulus, as well as improvements in diagnosis and treatment of this morbid disease. This article reviews the recent literature, highlighting breakthroughs in sensitive means of antigen testing and an unusual new approach to therapy that targets an endosymbiotic bacterium required for filarial worm fecundity.
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Affiliation(s)
- Don N Udall
- University of California-San Diego, Dermatology Clinical Trials Unit, La Jolla, CA 92037-1300, USA.
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Olson BG, Domachowske JB. Mazzotti reaction after presumptive treatment for schistosomiasis and strongyloidiasis in a Liberian refugee. Pediatr Infect Dis J 2006; 25:466-8. [PMID: 16645520 DOI: 10.1097/01.inf.0000217415.68892.0c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a case of the Mazzotti reaction in a 13-year-old Liberian refugee after presumptive treatment of schistosomiasis and strongyloidiasis with ivermectin, praziquantel and albendazole. The patient was hospitalized with fever, urticaria, abdominal pain and angioedema. Twelve hours after treatment with intravenous methylprednisolone he had complete resolution of his symptoms.
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Affiliation(s)
- Bradley G Olson
- State University of New York, Upstate Medical University, Syracuse 13210, USA.
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Reimert CM, Fitzsimmons CM, Joseph S, Mwatha JK, Jones FM, Kimani G, Hoffmann KF, Booth M, Kabatereine NB, Dunne DW, Vennervald BJ. Eosinophil activity in Schistosoma mansoni infections in vivo and in vitro in relation to plasma cytokine profile pre- and posttreatment with praziquantel. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2006; 13:584-93. [PMID: 16682480 PMCID: PMC1459652 DOI: 10.1128/cvi.13.5.584-593.2006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 01/10/2006] [Accepted: 02/28/2006] [Indexed: 11/20/2022]
Abstract
Eosinophil activity in vivo and in vitro was studied in relation to infection intensities and plasma cytokine profiles of 51 Schistosoma mansoni-infected Ugandan fishermen before treatment and 24 h and 3 weeks posttreatment. Blood eosinophil numbers significantly declined 24 h posttreatment, but significant eosinophilia had developed by 3 weeks posttreatment. Cellular eosinophil cationic protein (ECP) content increased significantly during the transient eosinopenia but was significantly reduced 3 weeks later. No similar reduction in cellular eosinophil protein X (EPX) content was seen. Before treatment, S. mansoni infection intensity was positively correlated with 24-h boosts in plasma interleukin-5 (IL-5) and IL-6 levels, which were in turn negatively correlated with the posttreatment fall in eosinophil numbers. Significant correlations were observed between pretreatment infection intensities and plasma IL-10 and eotaxin levels. Treatment induced significant fluctuations in plasma IL-5, IL-6, IL-10, tumor necrosis factor alpha (TNF-alpha), and eotaxin levels. Optimal relative release of ECP and EPX in vitro was detected in S. mansoni soluble egg antigen-stimulated cultures during transient eosinopenia. Our data suggest that blood eosinophils are activated during S. mansoni infection and that treatment induces a burst in released antigens, causing increased production of IL-5, IL-6, IL-10, and eotaxin; a drop in TNF-alpha levels; and a transient sequestration of eosinophils, which leaves fewer degranulated eosinophils in the circulation 24 h posttreatment, followed by the development of eosinophilia 3 weeks later. During these events, it appears that preferential release of ECP occurs in vivo. Moreover, it is possible that infection intensity-dependent levels of plasma IL-10 may be involved in the prevention of treatment-induced anaphylactic reactions.
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Affiliation(s)
- Claus M Reimert
- DBL, Institute for Health Research and Development, Jaegersborg Alle 1 D, 2720 Charlottenlund, Denmark.
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12
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Fux CA, Chappuis B, Holzer B, Aebi C, Bordmann G, Marti H, Hatz C. Mansonella perstans causing symptomatic hypereosinophilia in a missionary family. Travel Med Infect Dis 2005; 4:275-80. [PMID: 16905458 DOI: 10.1016/j.tmaid.2005.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Accepted: 07/28/2005] [Indexed: 11/19/2022]
Abstract
Mansonella perstans is rarely pathogenic. The rare reports of symptomatic cases, however, include severe complications. Three cases of symptomatic hypereosinophilia with multi-organ involvement are described in a missionary family returning from tropical Africa. Pathogenicity may be related to the induction of hypereosinophilia rather than direct host-parasite interactions.
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Affiliation(s)
- Christoph A Fux
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3010 Bern, Switzerland
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13
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Kamgno J, Gardon J, Gardon-Wendel N, Duke BOL, Boussinesq M. Adverse systemic reactions to treatment of onchocerciasis with ivermectin at normal and high doses given annually or three-monthly. Trans R Soc Trop Med Hyg 2004; 98:496-504. [PMID: 15186939 DOI: 10.1016/j.trstmh.2003.10.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2003] [Revised: 10/28/2003] [Accepted: 10/29/2003] [Indexed: 10/26/2022] Open
Abstract
In Cameroon, a 3-year randomized, double-blind controlled trial was conducted to determine if ivermectin, given at 3-monthly intervals and/or at high doses (800 microg/kg), had a greater effect on adult Onchocerca volvulus than standard annual doses of 150 microg/kg. Adverse reactions were recorded and analysed in a logistic regression model with random effects to assess the influence of the dose and rhythm of treatment on their occurrence. After the first dose, 3-monthly treatment was associated with a clearly reduced risk of reactions, especially oedematous swellings, pruritus and back-pain. Oedematous swellings and subjective ocular troubles were found to be associated with high doses of ivermectin. These results reinforce former parasitological conclusions that it would be desirable to evaluate the feasibility and effects on transmission of large-scale 3-monthly treatments with standard doses of ivermectin for onchocerciasis control. Owing to the unexpected ocular reactions, the use of high doses to counteract any future resistance of O. volvulus to ivermectin should be considered with caution.
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Affiliation(s)
- Joseph Kamgno
- Laboratoire mixte IRD-CPC d'Epidémiologie et de Santé publique, Centre Pasteur du Cameroun, B.P. 1274, Yaoundé, Cameroon.
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14
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Boussinesq M, Gardon J, Gardon-Wendel N, Chippaux JP. Clinical picture, epidemiology and outcome of Loa-associated serious adverse events related to mass ivermectin treatment of onchocerciasis in Cameroon. FILARIA JOURNAL 2003; 2 Suppl 1:S4. [PMID: 14975061 PMCID: PMC2147657 DOI: 10.1186/1475-2883-2-s1-s4] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In August 2002, 65 cases of Loa-associated neurological Serious Adverse Events were reported after ivermectin treatment. The first signs, occurring within the 12-24 hours following treatment, included fatigue, generalized arthralgia, and sometimes agitation, mutism, and incontinence. Disorders of consciousness, including coma, generally appeared between 24 and 72 hours, and showed a rapid variation with time. The most frequent objective neurological signs were extrapyramidal. The patients presented with haemorrhages of the conjunctiva and of the retina. Biological examinations showed a massive Loa microfilaruria, the passage of Loa microfilariae into the cerebrospinal fluid, haematuria, and an increase in the C-reactive protein, all of which have been correlated with the high intensity of the initial Loa microfilaraemia. Eosinophil counts decreased dramatically within the first 24 hours, and then rose again rapidly. Electroencephalograms suggested the existence of a diffuse pathological process within the first weeks; the abnormalities disappearing after 3-6 months. Death may occur when patients are not properly managed, i.e. in the absence of good nursing. However, some patients who recovered showed sequelae such as aphasia, episodic amnesia, or extrapyramidal signs. The main risk factor for these encephalopathies is the intensity of the initial Loa microfilaraemia. The disorders of consciousness may occur when there are >50,000 Loa microfilariae per ml. The possible roles of co-factors, such as Loa strains, genetic predisposition of individuals, co-infestations with other parasites, or alcohol consumption, seem to be minor but they should be considered. The mechanisms of the post-ivermectin Loa-related encephalopathies should be investigated to improve the management of patients developing the condition.
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Affiliation(s)
- Michel Boussinesq
- Institut de Recherche pour le Développement (IRD), DSS, 213 rue La Fayette, 75480 Paris Cedex 10, France
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15
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Awadzi K. Clinical picture and outcome of Serious Adverse Events in the treatment of Onchocerciasis. FILARIA JOURNAL 2003; 2 Suppl 1:S6. [PMID: 14975063 PMCID: PMC2147654 DOI: 10.1186/1475-2883-2-s1-s6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Ivermectin (Mectizan®) is the only drug currently recommended for the treatment and control of onchocerciasis. Serious adverse events rarely occur during treatment, except in subjects heavily infected with Loa Loa. This review of drug-related serious adverse events in the treatment of onchocerciasis therefore revisited the pre-Mectizan® reference drugs, DEC and suramin, and other candidate drugs studied extensively for the treatment of human onchocerciasis. The benzimidazole carbamate derivatives and the antibiotic doxycycline were excluded, since no serious adverse events have been reported regarding their use. Using recommended definitions, serious adverse events reported or observed after the use of each drug were summarised, the level of attribution determined, and the results tabulated. Prominence was given to treatment-related deaths. The clinical picture of severe symptomatic postural hypotension is described and used to illustrate the difference between the severity and the seriousness of an adverse event. The epidemiology, management and outcome of serious adverse events are presented. The role of future research is discussed.
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Affiliation(s)
- Kwablah Awadzi
- Onchocerciasis Chemotherapy Research Centre (OCRC) Hohoe Hospital, Hohoe, Ghana.
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16
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Guzzo CA, Furtek CI, Porras AG, Chen C, Tipping R, Clineschmidt CM, Sciberras DG, Hsieh JY, Lasseter KC. Safety, Tolerability, and Pharmacokinetics of Escalating High Doses of Ivermectin in Healthy Adult Subjects. J Clin Pharmacol 2002. [DOI: 10.1177/009127002237994] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Cynthia A. Guzzo
- Merck Research Laboratories, Blue Bell and West Point, Pennsylvania, and Terlings Park, United Kingdom
| | - Christine I. Furtek
- Merck Research Laboratories, Blue Bell and West Point, Pennsylvania, and Terlings Park, United Kingdom
| | - Arturo G. Porras
- Merck Research Laboratories, Blue Bell and West Point, Pennsylvania, and Terlings Park, United Kingdom
| | - Cong Chen
- Merck Research Laboratories, Blue Bell and West Point, Pennsylvania, and Terlings Park, United Kingdom
| | - Robert Tipping
- Merck Research Laboratories, Blue Bell and West Point, Pennsylvania, and Terlings Park, United Kingdom
| | - Coleen M. Clineschmidt
- Merck Research Laboratories, Blue Bell and West Point, Pennsylvania, and Terlings Park, United Kingdom
| | - David G. Sciberras
- Merck Research Laboratories, Blue Bell and West Point, Pennsylvania, and Terlings Park, United Kingdom
| | - John Y‐K. Hsieh
- Merck Research Laboratories, Blue Bell and West Point, Pennsylvania, and Terlings Park, United Kingdom
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Cooper PJ, Chico M, Sandoval C, Espinel I, Guevara A, Levine MM, Griffin GE, Nutman TB. Human infection with Ascaris lumbricoides is associated with suppression of the interleukin-2 response to recombinant cholera toxin B subunit following vaccination with the live oral cholera vaccine CVD 103-HgR. Infect Immun 2001; 69:1574-80. [PMID: 11179329 PMCID: PMC98058 DOI: 10.1128/iai.69.3.1574-1580.2001] [Citation(s) in RCA: 183] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2000] [Accepted: 12/08/2000] [Indexed: 11/20/2022] Open
Abstract
To investigate the potential immunomodulatory effects of concurrent ascariasis on the cytokine response to a live oral vaccine, we measured cytokine responses to cholera toxin B subunit (CT-B) following vaccination with the live oral cholera vaccine CVD 103-HgR in Ascaris lumbricoides-infected subjects randomized in a double-blind study to receive two doses of either albendazole or placebo prior to vaccination and in a group of healthy U.S. controls. Postvaccination cytokine responses to CT-B were characterized by transient increases in the production of interleukin-2 (IL-2; P = 0.02) and gamma interferon (IFN-gamma; P = 0.001) in the three study groups combined; however, postvaccination increases in IFN-gamma were significant only in the albendazole-treated A. lumbricoides infection group (P = 0.008). Postvaccination levels of IL-2 were significantly greater in the albendazole-treated group compared with the placebo group (P = 0.03). No changes in levels of Th1 and Th2 cytokines in response to control ascaris antigens were observed over the same period. These findings indicate that vaccination with CVD 103-HgR is associated with a Th1 cytokine response (IL-2 and IFN-gamma) to CT-B, that infection with A. lumbricoides diminishes the magnitude of this response, and that albendazole treatment prior to vaccination was able to partially reverse the deficit in IL-2. The potential modulation of the immune response to oral vaccines by geohelminth parasites has important implications for the design of vaccination campaigns in geohelminth-endemic areas.
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Affiliation(s)
- P J Cooper
- Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
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18
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Mackenzie CD. Human onchocerciasis: the essential partnership between research and disease control efforts. Curr Opin Infect Dis 2000; 13:457-464. [PMID: 11964814 DOI: 10.1097/00001432-200010000-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Twenty years ago onchocerciasis was a disease generally ignored by the medical world, except by those who actually worked with the affected people in Africa and Latin America. Now, largely as a result of the success of mass vector control and drug treatment programs, this is a disease management model for developing countries. The recent literature on onchocerciasis has, not surprisingly, mainly focused on various aspects of control. Investigation into the more basic questions is needed to ensure continued effective disease control. The present mass drug control program is based on a single pharmaceutical, ivermectin (Mectizan), which acts almost exclusively on the microfilarial stage of the infection. Efforts are being made to identify other useful drugs; however, no major candidates have yet appeared. The identification of potential biochemical targets for anti-filarial compounds through a better understanding of the biochemistry of these worms is being pursued. The Onchocerca volvulus endosymbiont Wolbachia may provide a target for therapeutic intervention. An improved understanding of the genomics of O. volvulus has made possible the identification of strain differences in the parasites, and an appreciation of the relevance of these strain differences to the clinical disease, onchocerciasis. There is a need for a better understanding of the clinical disease, and the various pathogenic mechanisms that underly the different syndromes. It is particularly important to understand the pathological basis and mechanisms underlying the adverse responses that can occur with chemotherapy. Present control programs now need to be carefully monitored for effectiveness using new assessment tools, such as antigen assays and the identification of organisms in pools of vectors. Current efforts to control onchocerciasis must be coordinated with new chemotherapy-based control programs for other worm diseases that are emerging. The results of laboratory studies are increasingly being applied to improve the effectiveness of field-based control programs and their assessment. Such research is essential for progress towards the goals of controlling and eliminating onchocerciasis.
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Cooper PJ, Beck LA, Espinel I, Deyampert NM, Hartnell A, Jose PJ, Paredes W, Guderian RH, Nutman TB. Eotaxin and RANTES expression by the dermal endothelium is associated with eosinophil infiltration after ivermectin treatment of onchocerciasis. Clin Immunol 2000; 95:51-61. [PMID: 10794432 DOI: 10.1006/clim.1999.4829] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The roles of eotaxin, RANTES, and MCP-3 expression in eosinophil recruitment to the site of parasite killing that occurs following ivermectin treatment of onchocerciasis were assessed in the skin of 13 Onchocerca volvulus-infected subjects and two noninfected controls before and after ivermectin treatment. Adverse reactions in infected subjects were associated with the appearance of eosinophils in the dermis as part of a perivascular inflammatory infiltrate. Although no expression of RANTES and eotaxin was seen in dermal vascular endothelial cells in biopsies taken before treatment (nor at any time in the skin of uninfected controls), endothelial expression of both eotaxin and RANTES was noted by 24 h following treatment. While RANTES expression was transient, eotaxin expression increased in parallel with increasing eosinophil recruitment up to 60 h posttreatment. These observations indicate that endothelial expression of eotaxin and RANTES may have an important role in eosinophil recruitment into the skin during helminth-killing reactions.
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Affiliation(s)
- P J Cooper
- Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, Maryland 20892-0425, USA
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