Therapy with atovaquone for Cryptosporidium parvum infection in neonatal severe combined immunodeficiency mice

Recent advances in the search for new anti-coccidial drugs

Coccidia provide a rich hunting ground for drug-designers, as there are significant biochemical differences between the parasites and their hosts. Recent years have brought the discovery of the plastid and its possible metabolic machinery, characterisation of acidocalcisomes, reports on the apparent absence from some coccidia of a typical mitochondrion, and the discovery of the mannitol cycle and shikimate pathway in the parasites. Moreover, modern technologies such as genomics and proteomics are bringing new insights into the biochemistry of coccidia and highlighting possible drug targets in abundance. A major issue for would-be drug discoverers is to decide upon the targets to prioritise. This review provides an update on recent findings on how coccidia differ biochemically from vertebrates. It includes discoveries within coccidian parasites themselves but also uses findings in Plasmodium to provide an overview of biochemical features that may be characteristics of many apicomplexan parasites and so potential targets for broad-spectrum drugs.

Plasmodium falciparum: the effects of atovaquone resistance on respiration

Atovaquone is an antimalarial agent that specifically inhibits the cytochrome bc(1) complex of the cytochrome pathway. High-level atovaquone resistance is associated with a point mutation in the cytochrome b gene. A pair of isogenic clinical isolates of Plasmodium falciparum derived from before and after the acquisition of atovaquone resistance was used to determine whether the change in the cytochrome b gene resulted in changes in respiration in response to atovaquone. Since P. falciparum appears to utilize a branched respiratory system comprising both the cytochrome and an alternative respiratory pathway, the proportion of each pathway utilized by the sensitive and resistant parasites was investigated. Atovaquone inhibited total parasite oxygen consumption by up to 66% in the sensitive isolate but only up to 28% in the resistant isolate. Both the atovaquone-sensitive and the atovaquone-resistant parasites were comparably sensitive to the alternative pathway inhibitor, salicylhydroxamic acid. Atovaquone appeared to partially inhibit the rate of oxygen consumed through the alternative pathway in only the atovaquone-sensitive isolate. Cross resistance was noted between atovaquone and a new antimalarial agent WR243251. However, the level of WR243251 resistance was very modest compared to the level of atovaquone resistance. WR243251 was shown to rapidly reduce the rate of parasite oxygen consumption by almost 80% in the atovaquone-sensitive isolate and by 57% in the atovaquone-resistant isolate. Drug interaction studies suggest that atovaquone and WR243251 may inhibit growth additively or with mild synergy. Together, these results suggest that while WR243251 may inhibit respiration, its target of action probably differs from that of atovaquone.

Activity of decoquinate against Cryptosporidium parvum in cell cultures and neonatal mice

Cryptosporidium parvum is an apicomplexan parasite that is an important cause of diarrhea in neonatal calves and humans. No treatment is currently available for neonatal calves. We have recently learned from colleagues in the pharmaceutical industry that dairy practitioners are sometimes using decoquinate for the treatment of neonatal bovine cryptosporidiosis. Therefore, the present study was undertaken to determine whether the clinical observations in calves can be substantiated by laboratory investigation. Oocysts of the KSU-1 isolate of C. parvum were used to infect human ileocecal epithelial cells in vitro to measure the efficacy of treatment using an ELISA based assay. No activity was observed at 10 or 50microM decoquinate, but at 100microM an 8% inhibition of development was seen. Oocysts of the AUCp-1 isolate of C. parvum were then used to infect suckling mice. The numbers of oocysts observed in suckling mice treated with 2.5 or 5.0mg/kg decoquinate were not significantly different from untreated control suckling mice (p0.05). The results of our study suggest that decoquinate should have little efficacy for treatment of neonatal bovine cryptosporidiosis if administered once per day and that any clinical improvement observed in treated calves may be due to factors unrelated to decoquinate's effect on C. parvum.

Biochemical peculiarities and drug targets in Cryptosporidium parvum: lessons from other coccidian parasites

There is an urgent need for effective medicines for treating human and animal cryptosporidiosis. In the absence of drugs being found using an empirical route, the structure-based approach may be the better option for discovering new chemotherapeutic agents against these diseases. With this objective, what possible drug targets are there? Here, Graham Coombs speculates on the best putative targets for chemotherapeutic attack, and reviews what is known and what can be deduced about the biochemical features of Cryptosporidium parvum, the causative agent of cryptosporidiosis, emphasizing the ways in which the parasite differs biochemically from its mammalian hosts.

The gamma interferon gene knockout mouse: a highly sensitive model for evaluation of therapeutic agents against Cryptosporidium parvum

Cryptosporidiosis is a serious disease in malnourished children and in people with malignancies or AIDS. Current rodent models for evaluating drug therapy against cryptosporidiosis have many limitations, including the need for a high inoculum, the absence of symptoms resembling those seen in humans, and the need to maintain exogenous immunosuppression. We have developed a gamma interferon knockout (GKO) mouse model with which to evaluate therapies against C. parvum and have used paromomycin for evaluation of this model. The GKO model offers considerable improvements over other systems, since it requires no additional immunosuppression and adult mice can be infected with as few as 10 oocysts (compared with 10(7) for SCID mice). Infected mice develop profound gastrointestinal dysfunction due to extensive infection and severe mucosal damage involving the entire small intestine. Clinical symptoms, which include depression, anorexia, weight loss, and wasting, result in death within 2 to 4 weeks. The time of death depends on the oocyst challenge dose. Paromomycin modulated parasitological and clinical parameters in highly predictable and significant ways, including prevention of death. In addition, examination of the extensively infected gut provided an important insight into the dynamics between a specific drug treatment, its impact on the extent and the site of parasite distribution, and clinical outcome. These uniform symptoms of weight loss, wasting, and death are powerful new parameters which bring this model closer to the actual disease seen in humans and other susceptible mammalian species.

Update on the management of intestinal cryptosporidiosis in AIDS

OBJECTIVE

To update readers on the pharmacotherapeutic management of cryptosporidiosis in patients with AIDS.

DATA SOURCES

A MEDLINE search was used to identify pertinent literature. Additionally, programs and abstracts from the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy; the 1st International Conference on Macrolides, Azalides, and Streptogramins; the 93rd American Society for Microbiology Meeting; and the 6th and 7th International Conferences on AIDS were used.

DATA EXTRACTION

Available data from in vitro, animal, and human experiments were reviewed.

DATA SYNTHESIS

Intestinal cryptosporidiosis in patients with AIDS can be a life-threatening opportunistic infection. However, there can be significant variability in disease expression, including spontaneous remission. Supportive care with hydration and nutritional supplementation remains a hallmark of therapy. Unfortunately, there is no proven specific pharmacotherapy of cryptosporidiosis in patients with AIDS. Numerous agents have been analyzed for in vitro activity and efficacy in experimental animal models and actual human cases of the infection, including paromomycin, azithromycin, clarithromycin, octreotide, hyperimmune bovine colostrum, bovine transfer factor, and many others. Because limited numbers of controlled trials have been conducted with potential therapeutic agents, the majority of the information to date is preliminary in nature.

CONCLUSIONS

Despite the availability of some evolving and potentially promising treatment modalities, further controlled clinical trials are necessary to evaluate the role of pharmacotherapy for intestinal cryptosporidiosis in patients with AIDS.