Detection of antibodies against glycolipids of Echinococcus multilocularis metacestodes in sera of patients with alveolar hydatid disease

Glycosphingolipids in human parasites

Glycosphingolipids (GSLs) are comprised of glycans (oligosaccharides) linked to a lipid containing a sphingosine moiety. They are major membrane components in cells of most animals, and importantly, they also occur in parasitic protozoans and worms that infect people. While the endogenous functions of the GSLs in most parasites are elusive, many of these GSLs are recognized by antibodies in infected human and animal hosts, and thus, their structures, biosynthesis, and functions are of great interest. Such knowledge of GSLs could lead to new drugs and diagnostics for treating infections, as well as novel vaccine strategies. The diversity of GSLs recently identified in such infectious organisms and aspects of their immune recognition are major topics of this review. It is not intended to be exhaustive but to highlight aspects of GSL glycans in human parasites.

Syntheses and Biological Activities of Glycoconjugates

This review describes the oligosaccharide syntheses and biological activities of glycosphingolipids, focusing especially on those found in invertebrates like millipedes, nematoda parasites, and cestoda parasites, and model compounds related to a major antigenic epitope against antibupleurum 2IIc/PG-1-IgG from antiulcer pectic polysaccharides. A novel and simple approach for the rational design of glycoclusters and glycodendrimers by coupling with a sugar unit and a cluster unit, was developed with beta-alanine derivatives used to construct the latter compounds.

Serodiagnostic potential of chemically synthesized glycosphingolipid antigens in an enzyme-linked immunosorbent assay for alveolar echinococcosis

In the serodiagnosis of alveolar echinococcosis, the detection of specific reactions against not only protein but also carbohydrate antigen is useful and both antigens supplement each other. Though recombinant protein antigens have recently advanced, the preparation of carbohydrate antigen still depends on extraction from crude antigens. In the latter case, it is not conventional to obtain carbohydrate antigen as a single component for examination and research. Therefore, chemically synthesized carbohydrate antigens were prepared for serodiagnosis by the enzyme-linked immunosorbent assay (ELISA). Four antigens with the structure of glycosphingolipids fromEchinococcus multiloculariswere examined and one antigen, Galβ1-6(Fucα1-3)Galβ1-6Galβ1-ceramide, was found to show significant serodiagnostic potential in differentiating alveolar from cystic echinococcosis.

Morphological variability withinOesophagostomum bifurcumamong different primate species from Ghana

AdultOesophagostomum bifurcum(Nematoda: Strongylida) from human and non-human primates from Ghana were compared in order to investigate the extent of morphological variability within the species. Using analysis of variance and principal component analysis, significant differences in morphological characters (such as parasite length, width, length of the oesophagus and length of spicules) were demonstrated betweenO. bifurcumworms from humans, the Mona, Patas or Green monkey and/or Olive baboons. These findings suggest thatO. bifurcumfrom different species of primate host represent distinct population variants, also supported by recent epidemiological and genetic studies ofO. bifurcumfrom such hosts.

Synthetic studies on glycosphingolipids from Protostomia phyla: total syntheses of glycosphingolipids from the parasite, Echinococcus multilocularis

Efficient and systematic syntheses of four neutral glycosphingolipids that have been isolated from the metacestodes of Echinococcus multilocularis have been achieved. A key step is the direct glycosylation of galactosyl donors using thioglycosides with benzoyl ceramide in the presence of N-iodosuccinimide (NIS)/TfOH, which gave the desired oligosaccharide derivatives. The fully protected glycosides 13, 20, 22 and 25 were deprotected to give four target glycosphingolipids (1-4).

Salvage treatment with amphotericin B in progressive human alveolar echinococcosis

Most patients with alveolar echinococcosis are diagnosed at a late stage when the disease has advanced to unresectable hepatic lesions. These patients require lifelong therapy with benzimidazoles, the only medical treatment currently available. To date, no treatment option remains for patients with benzimidazole intolerance or treatment failure. Amphotericin B was recently shown to exert antiparasitic activity in vitro. Here, we report the efficacy of amphotericin B in human alveolar echinococcosis. In three patients with extensive disease and without further treatment options, disease progression had been documented over several months. They were treated with amphotericin B intravenously at a dose of 0.5 mg/kg of body weight three times per week. Follow-up parameters were physical examination, laboratory parameters, and imaging techniques. Amphotericin B treatment effectively halted parasite growth in all three patients. The antiparasitic effect was most evident by spontaneous closure of cutaneous fistulae in two patients and by constant size of parasitic lesions during treatment, as assessed radiologically. Metabolic activity in parasitic areas was visualized by positron emission tomography and significantly decreased during treatment. However, progressive affection of the heart in one patient could not be stopped. All patients currently continue on amphotericin B and have been treated for 25, 17, and 14 months, respectively. We introduce amphotericin B as salvage treatment for alveolar echinococcosis patients with intolerance or resistance to benzimidazoles, as it effectively suppresses parasite growth. Amphotericin B is not parasitocidal; therefore long-term treatment has to be anticipated.

Effect of amphotericin B on larval growth of Echinococcus multilocularis

Alveolar echinococcosis is caused by the parasitic cestode Echinococcus multilocularis. Benzimidazoles, namely, mebendazole and albendazole, are the only drugs available for the treatment of inoperable alveolar echinococcosis. At present, no therapeutic alternative is available for patients with progressive disease under treatment or for patients who are unable to tolerate the side effects of the benzimidazoles. In addition, benzimidazoles are only parasitostatic for E. multilocularis. Thus, new therapeutic options are of paramount importance. In the present study we examined the in vitro effect of amphotericin B on E. multilocularis larvae. E. multilocularis metacestodes grown in the peritoneal cavities of Mongolian gerbils were transferred into a culture system. Vesicles budded from the tissue blocks and increased in number and size during the first 5 weeks. After 6 weeks drugs were added and deleterious effects on the vesicles were observed macroscopically and microscopically. By use of this in vitro tissue culture model we demonstrated that amphotericin B effectively inhibits the growth of E. multilocularis metacestodes. This destructive effect was significantly more rapid with amphotericin B than with the benzimidazoles. Cyclic treatment was effective in suppressing parasite growth. However, amphotericin B appears to be parasitostatic for E. multilocularis larvae, and regrowth occurs even after extended periods. In summary, amphotericin B constitutes the first promising alternative for the treatment of alveolar echinococcosis in cases of intolerance or resistance to benzimidazoles. It holds promise as an effective treatment option for otherwise fatal courses of disease.

Immunodiagnostic differentiation of alveolar and cystic echinococcosis using ELISA test with 18-kDa antigen extracted from Echinococcus protoscoleces

Immunoblotting analysis was carried out using crude extracts of Echinococccus multilocularis and E. granulosus. A total of 214 serum samples were examined for the detection of antibody responses against 18-kDa polypeptides (Eg18 and Em18). Of 44 sera from patients with alveolar echinococcosis (AE) 91% were positive against both Eg18 and Em18, compared with 10% and 13%, respectively, of 70 cystic echinococcosis (CE) samples and 13% and 17% of 29 cysticercosis samples. A relatively purified 18-kDa antigen was extracted from E. granulosus protoscoleces and an 18-kDa-ELISA test which is simple, fast and highly sensitive and specific has been established. A comparative ELISA analysis, using the purified 18-kDa antigen and pooled AE and CE serum, indicated that there are significant differences in antibody levels between AE and CE sera. The maximum ratio for the evaluation of AE to CE was 2.26. The 18-kDa-ELISA was positive for 91% (40/44) and 11% (8/70) of AE and CE sera, respectively, and there was no cross-reactivity with cysticercosis sera or healthy controls. The overall diagnostic values of 18-kDa-ELISA for AE sera were sensitivity 91%, specificity 94%, positive predictive value 83% and negative predictive value 97%. We conclude that (i) the 18-kDa antigenic component may not be species specific but (ii) levels of antibody to the 18-kDa antigen are significantly different between AE and CE sera. Therefore, the 18-kDa antigen can be a reliable serological marker for differentiation of AE from CE.

Synthetic studies on glycosphingolipids from the parasite Echinococcus multilocularis

Novel neutral glycosphingolipids isolated from the metacestodes of Echinococcus multilocularis by Persat, may be expected to be involved in host-parasite interactions. We have synthesized these glycosphingolipid analogues containing 2-branched fatty alkyl residues in place of ceramide. The glycosylation of galactosyl donors 4 and 5 with each of the acceptors 2 and 11 in the presence of N-iodosuccinimide (NIS)/TfOH, and the glycosylation of fucosyl donor 13 with acceptors 12 and 20 in the presence of dimethyl(methylthio)sulfonium triflate (DMTST) gave the desired oligosaccharide derivatives at good yield. The fully per-O-acylated 2-(trimethylsilyl)ethyl glycosides 6, 15, 21, and 26 were converted to glycosylimidates 7, 16, 22, and 27, which were condensed with 2-(tetradecyl)hexadecanol and subsequently deacylated give four target glycosphingolipid analogues.

Inhibition of human peripheral blood mononuclear cell proliferative response by glycosphingolipids from metacestodes of Echinococcus multilocularis

The effect on human peripheral blood mononuclear cells (PBMCs) of neutral glycosphingolipids extracted from metacestodes of the parasite Echinococcus multilocularis was investigated. Neutral glycosphingolipids inhibited [3H]thymidine uptake by human PBMCs upon stimulation by mitogens such as phytohemagglutinin A and pokeweed mitogen or by allogeneic Burkitt B cells. This effect was dose dependent and was related to a decrease in interleukin 2 (IL-2) synthesis, the expression of IL-2 receptors (CD25) being unmodified. Addition of exogenous recombinant IL-2 restored the cell proliferation. Partial inhibition of immunoglobulin G (IgG), IgA, and IgM synthesis was observed in the supernatant of cell culture in association with the inhibitory effect. Identification of active subfractions contained in the neutral glycosphingolipid fraction was also studied in relation to cell viability. The free ceramide fraction had an inhibitory effect, in part related to cell lysis, particularly at high concentration, while the monogalactosylceramides had a paradoxical effect: as an activator at low concentrations and as an inhibitor at high concentrations, with limited cell survival. The immunogenic neutral glycosphingolipids containing at least two carbohydrate residues, all having a structure based on Gal beta 1-->6Gal, were inhibitors of PBMC proliferation and showed good cell survival. These results suggest that parasite neutral glycosphingolipids may play an immunologically relevant role in alveolar hydatid disease.

Neutral glycolipids of Schistosoma mansoni as feasible antigens in the detection of schistosomiasis

The neutral glycolipid fraction from mouse-propagated, Schistosoma mansoni adult worms has been investigated as to its chromatographic and antigenic properties, and whether it fulfills the serodiagnostic antigen requirements of sensitivity and specificity in the detection of schistosomiasis. Serological analyses were performed by thin-layer chromatography immunostaining and ELISA. In the acute-phase form of mouse schistosomiasis, the kinetics of development of neutral glycolipid-specific antibody levels was correlated with the intensity of the initial infection and the response was dominated by IgG, as represented by the subclass IgG1. With the experimental animal helminthiases screened, glycolipid antigenicity fulfilled the fundamental traits for a serodiagnostic reagent. In the chronic-phase form of human schistosomiasis mansoni, neutral glycolipid-specific antibody levels were not correlated with the intensity of infection, as estimated from the faecal content of parasite eggs, whilst the isotypic response was dominated by IgM and IgG, the latter represented primarily by IgG1 and secondarily by IgG3. With other human helminthiases, glycolipid antigenicity was incomplete, in that, the specificity was only partially fulfilled. The reason for this incomplete specificity has been clarified, in part, by the detection of cryptic schistosomiasis infections in the cohorts of African patient sera examined.

Free ceramides of Echinococcus multilocularis metacestodes

Free ceramides were isolated and purified from the metacestodes of Echinococcus multilocularis. Two different fractions were obtained by preparative thin-layer chromatography. Their structure was determined by gas chromatography and electron impact mass spectrometry of trimethylsilylated derivatives. The ceramide with the higher thin-layer chromatographic migration rate contained exclusively erythro-sphinganine associated with saturated C16, C18 and very-long-chain fatty acids (up to C30) and unsaturated C24 fatty acid. The second ceramide contained 90.3% sphingosine and 9.7% sphinganine associated with saturated C16 and C24 and unsaturated C18 and C24 fatty acids. These findings were discussed with regard to the structure and metabolic pathway of neutral and acid glycosphingolipids found in the metacestodes.

Bovine cysticercosis: demonstration in experimentally infected calves of serum IgG antibodies reactive with neutral glycolipids of Taenia saginata and T. crassiceps metacestodes

The immunoreactivity of Taenia saginata and T. crassiceps metacestode neutral glyco(sphingo)lipids towards IgG antibodies derived from the sera of calves with experimental cysticercosis has been established. The glyco(sphingo)lipids are separable by normal-phase HPTLC (high-performance thin-layer chromatography) into groups of increasing sugar-chain length (lipid/ceramide mono-, di-, tri-, tetra- and > tetrasaccharides), with those corresponding to three and four hexoses being the main immunoreactive components (HPTLC immunostaining). In ELISA (enzyme-linked immunosorbent assay), reverse-phase HPTLC-isolated T. crassiceps metacestode glyco(sphingo)lipids equivalent to tri- and tetrahexoside allowed a discrimination between non-infected and infected calves (at least 80 metacestodes recovered). The formation of IgG antibodies was correlated with the infection, not with other non-specific inducing factors, as seen by the differential humoral response detected in experimentally infected (T. saginata) calves before and after Praziquantel treatment (HPTLC immunostaining and ELISA).

Litomosoides carinii: macrofilariae-derived glycolipids--chromatography, serology and potential in the evaluation of anthelminthic efficacy

A preliminary characterization of the glycolipids of Litomosoides carinii macrofilariae, resolved according to their chromatographic, chemical and serological properties, has been performed. Emphasis has been placed on the neutral fraction glycolipids. These are separable on thinlayer chromatography into two groups of fast and slow migrating band components, that differ in their migration, differential chemical staining and serological traits, respectively. Serological analyses have been accomplished by thin-layer chromatography immunostaining and ELISA. Only components of the slow migrating band group react with infection serum from Litomosoides carinii-infected Mastomys coucha. Cross-reactivity experiments with homologous and heterologous infection sera of various helminthiases indicate that, epitopes bound to the neutral glycolipid fraction show structural similarity within the Nematoda, but not to the Cestoda or Trematoda. The dynamic development of specific Ig-, IgG- and IgM-anti-neutral glycolipid fraction antibody levels were correlated with the different progression of L. carinii and Brugia malayi infections in the multimammate rat, Mastomys coucha. The reduction in the dynamics of IgG- and IgM-antibody levels on chemotherapeutic treatment with the filaricides flubendazole and CGP 20376 has been related to their macrofilaricide-activity.

Chromatographic and antigenic properties of Echinococcus granulosus hydatid cyst-derived glycolipids

The neutral and acidic fraction glycolipids of Echinococcus granulosus metacestode tissue compartments were isolated, defined by their chromatographic and antigenic properties, and assessed as to their efficacy as antigens in the serodiagnosis of human hepatic cystic and alveolar echinococcosis, and other helminthiases. Analyses were accomplished by thin-layer chromatography immunostaining and ELISA. The neutral glycolipid fraction's major carbohydrate epitope was the same as or very similar to that of Taenia crassiceps neutral glyco(sphingo)lipids, as represented by the 'neogala'-series core structure. The blood group-active, carbohydrate epitope P1 was expressed by a number of neutral fraction glycolipid component bands. The reverse-phase, thin-layer chromatography-isolated neutral fraction glycolipid component, designated Ag1, was efficient in the serological discrimination of cystic echinococcosis medium to high-titred sera. Ag1 did not specifically discriminate low-titred sera, i.e., other human helminthiases. The detected sialic acid residues of the acidic fraction glycolipids, on enzymatic cleavage, were identified as N-acylneuraminic acid and terminal. The acidic fraction glycolipids exhibited the paradox of only chemically minor components being antigenic towards cystic and alveolar echinococcosis infection sera. The combined acidic fraction glycolipid components Ra and Rx were capable of serological discrimination between cystic echinococcosis, alveolar echinococcosis and other helminthiases.

Isolation, initial characterization and serological studies of glycolipid antigens from Babesia bovis-infected erythrocytes

Serological analysis of Babesia bovis-derived glycolipids by ELISA and the indirect fluorescent antibody technique demonstrated the existence of their antigenic and immunogenic activities not only in B. bovis but also in B. bigemina infections. This indicates that serological cross-reactivity of B. bovis and B. bigemina relates to glycolipids. The negative ELISA reaction obtained with Anaplasma marginale antisera suggested the specificity of the reaction to the genus Babesia. Fractionation of these glycolipids by Florisil Sep-Pak column chromatography with subsequent HPTLC immunostaining and Orcinol staining suggested the presence of carbohydrate antigenic determinants in B. bovis glycolipids.