Improved methods for the diagnosis of African trypanosomosis

An Unbiased Immunization Strategy Results in the Identification of Enolase as a Potential Marker for Nanobody-Based Detection of Trypanosoma evansi

Trypanosoma evansi is a widely spread parasite that causes the debilitating disease “surra” in several types of ungulates. This severely challenges livestock rearing and heavily weighs on the socio-economic development in the affected areas, which include countries on five continents. Active case finding requires a sensitive and specific diagnostic test. In this paper, we describe the application of an unbiased immunization strategy to identify potential biomarkers for Nanobody (Nb)-based detection of T. evansi infections. Alpaca immunization with soluble lysates from different T. evansi strains followed by panning against T. evansi secretome resulted in the selection of a single Nb (Nb11). By combining Nb11-mediated immuno-capturing with mass spectrometry, the T. evansi target antigen was identified as the glycolytic enzyme enolase. Four additional anti-enolase binders were subsequently generated by immunizing another alpaca with the recombinant target enzyme. Together with Nb11, these binders were evaluated for their potential use in a heterologous sandwich detection format. Three Nb pairs were identified as candidates for the further development of an antigen-based assay for Nb-mediated diagnosis of T. evansi infection.

Nanobodies As Tools to Understand, Diagnose, and Treat African Trypanosomiasis

African trypanosomes are strictly extracellular protozoan parasites that cause diseases in humans and livestock and significantly affect the economic development of sub-Saharan Africa. Due to an elaborate and efficient (vector)–parasite–host interplay, required to complete their life cycle/transmission, trypanosomes have evolved efficient immune escape mechanisms that manipulate the entire host immune response. So far, not a single field applicable vaccine exists, and chemotherapy is the only strategy available to treat the disease. Current therapies, however, exhibit high drug toxicity and an increased drug resistance is being reported. In addition, diagnosis is often hampered due to the inadequacy of current diagnostic procedures. In the context of tackling the shortcomings of current treatment and diagnostic approaches, nanobodies (Nbs, derived from the heavy chain-only antibodies of camels and llamas) might represent unmet advantages compared to conventional tools. Indeed, the combination of their small size, high stability, high affinity, and specificity for their target and tailorability represents a unique advantage, which is reflected by their broad use in basic and clinical research to date. In this article, we will review and discuss (i) diagnostic and therapeutic applications of Nbs that are being evaluated in the context of African trypanosomiasis, (ii) summarize new strategies that are being developed to optimize their potency for advancing their use, and (iii) document on unexpected properties of Nbs, such as inherent trypanolytic activities, that besides opening new therapeutic avenues, might offer new insight in hidden biological activities of conventional antibodies.

An Anti-proteome Nanobody Library Approach Yields a Specific Immunoassay for Trypanosoma congolense Diagnosis Targeting Glycosomal Aldolase

BACKGROUND

Infectious diseases pose a severe worldwide threat to human and livestock health. While early diagnosis could enable prompt preventive interventions, the majority of diseases are found in rural settings where basic laboratory facilities are scarce. Under such field conditions, point-of-care immunoassays provide an appropriate solution for rapid and reliable diagnosis. The limiting steps in the development of the assay are the identification of a suitable target antigen and the selection of appropriate high affinity capture and detection antibodies. To meet these challenges, we describe the development of a Nanobody (Nb)-based antigen detection assay generated from a Nb library directed against the soluble proteome of an infectious agent. In this study, Trypanosoma congolense was chosen as a model system.

METHODOLOGY/PRINCIPAL FINDINGS

An alpaca was vaccinated with whole-parasite soluble proteome to generate a Nb library from which the most potent T. congolense specific Nb sandwich immunoassay (Nb474H-Nb474B) was selected. First, the Nb474-homologous sandwich ELISA (Nb474-ELISA) was shown to detect experimental infections with high Positive Predictive Value (98%), Sensitivity (87%) and Specificity (94%). Second, it was demonstrated under experimental conditions that the assay serves as test-of-cure after Berenil treatment. Finally, this assay allowed target antigen identification. The latter was independently purified through immuno-capturing from (i) T. congolense soluble proteome, (ii) T. congolense secretome preparation and (iii) sera of T. congolense infected mice. Subsequent mass spectrometry analysis identified the target as T. congolense glycosomal aldolase.

CONCLUSIONS/SIGNIFICANCE

The results show that glycosomal aldolase is a candidate biomarker for active T. congolense infections. In addition, and by proof-of-principle, the data demonstrate that the Nb strategy devised here offers a unique approach to both diagnostic development and target discovery that could be widely applied to other infectious diseases.

Genetic engineering of Trypanosoma (Dutonella) vivax and in vitro differentiation under axenic conditions

Trypanosoma vivax is one of the most common parasites responsible for animal trypanosomosis, and although this disease is widespread in Africa and Latin America, very few studies have been conducted on the parasite's biology. This is in part due to the fact that no reproducible experimental methods had been developed to maintain the different evolutive forms of this trypanosome under laboratory conditions. Appropriate protocols were developed in the 1990s for the axenic maintenance of three major animal Trypanosoma species: T. b. brucei, T. congolense and T. vivax. These pioneer studies rapidly led to the successful genetic manipulation of T. b. brucei and T. congolense. Advances were made in the understanding of these parasites' biology and virulence, and new drug targets were identified. By contrast, challenging in vitro conditions have been developed for T. vivax in the past, and this per se has contributed to defer both its genetic manipulation and subsequent gene function studies. Here we report on the optimization of non-infective T. vivax epimastigote axenic cultures and on the process of parasite in vitro differentiation into metacyclic infective forms. We have also constructed the first T. vivax specific expression vector that drives constitutive expression of the luciferase reporter gene. This vector was then used to establish and optimize epimastigote transfection. We then developed highly reproducible conditions that can be used to obtain and select stably transfected mutants that continue metacyclogenesis and are infectious in immunocompetent rodents.

Trypanosoma vivax is a major parasite of domestic animals in Africa and Americas. Most studies on this parasite have focused on gathering epidemiological data in the field. Studies on its biology, metabolism and interaction with the host immune system have been hindered by a lack of suitable tools for its maintenance in vitro and its genetic engineering. The work presented herein focused on determining axenic conditions for culturing and growing insect (epimastigote) forms of T. vivax and prompting their differentiation into metacyclic forms that are infectious for the mammalian host. In addition, we describe the development of appropriate vectors for parasite transgenesis and selection in vitro and their use in analyzing genetically modified parasite lines. Finally, we report on the construction of the first T. vivax recombinant strain that stably expresses a foreign gene that maintains its infectivity in immunocompetent mice. Our work is a significant breakthrough in the field as it should lead, in the future, to the identification of parasite genes that are relevant to its biology and fate, and to work that may shed light on the intricacies of T. vivax–host interactions.

Internal quality control and external quality management of data in practice

In this chapter, the use of control charts to both continuously evaluate testing in individual laboratories as well as provide data for external monitoring is examined in detail. The data is based on the publication by D. E. Rebeski' et al., "Charting methods to monitor the operational performance of ELISA method for the detection of antibodies against trypanosomes" in Veterinary Parasitology, 2001, 96, 11-50, and is a detailed example of the investigation of the performance of four indirect ELISAs for the detection of antibodies against trypanosomes using Trypanosoma congolense and T. vivax antigen-precoated plates in 15 veterinary diagnostic laboratories in Africa and Europe. The study shows the practical use of charting methods with respect to assessing the operational performance of each ELISA. Data from standardized internal quality control (IQC) samples were used to assess ELISA performance indicators with reference to expected upper and lower control limits, as determined from studies by the kit producer (tentative values). Based on unprocessed (optical density) and normalized absorbance values (calculated as a percentage positivity of a control), dispersion of values from the expected data range were estimated though plotting the location and deviation of the values. In addition, assay precision was estimated by plotting the distribution of coefficients of variation <10% of the IQCs. Binding ratios of various controls were calculated to estimate the assay proficiency with respect to the accuracy of assessing whether the IQC samples tested positive or negative in the test proper. The graphical analysis of dispersion of absorbance values in combination with assay precision and proficiency criteria were considered satisfactory to allow the evaluation of the operational performances of the ELISAs, and provide useful decision-making criteria for plate acceptance and rejection. The establishment of standardized and transparent IQC data charting methods for the indirect ELISAs provided an increased measure of confidence to national laboratories with respect to their reports on disease occurrence. Moreover, the relative assay performances among all laboratories were examined, using summary data charts, with reference to the performance criteria described. The IQC data were also examined using modified Youden plot analysis, demonstrating that indirect ELISA methods can be successfully applied at diagnostic laboratories in the tropics for monitoring trypanosomosis control programs.

Comparative evaluation of the antibody-detection ELISA technique using microplates precoated with denatured crude antigens from Trypanosoma congolense or Trypanosoma vivax

Two FAO/IAEA indirect enzyme-linked immunosorbent assays (ELISA), which use microplates precoated with denatured crude Trypanosoma congolense or Trypanosoma vivax antigen for detecting anti-trypanosomal antibodies in bovine sera, were evaluated for their sensitivity, specificity and positive and negative predictive values, using 320 Ugandan field samples (known negative sera, n = 80; known positive sera, n = 80; cattle herds where control of tsetse and trypanosomosis was practiced, n = 80; and cattle herds where there was no such control, n = 80). Cut-off points of 30% and 25% positivity were determined for the T. congolense and T. vivax assays, respectively, using a modified ROC (receiver operating characteristic) analysis. The T. congolense assay had estimated diagnostic sensitivity and specificity of 63.7% and 57.5%, respectively, while the T. vivax assay had estimated diagnostic sensitivity and specificity of 81.3% and 81.3%, respectively. The two assays conducted in parallel had estimated diagnostic sensitivity and specificity of 82.5% and 88.7%, respectively. Using the sera from the cattle in the area with control (detected prevalence of trypanosomosis 0%), both the T. congolense and T. vivax assays had negative and positive predictive values of 100% and 0%, respectively. Using the sera from the cattle in the area without control (detected prevalence of trypanosomosis 15%), the T. congolense assay had negative and positive predictive values of 91% and 33%, respectively, and the T. vivax assay had negative and positive predictive values of 93% and 27%, respectively. The T. congolense assay was in fair agreement with the buffy coat technique (BCT) (kappa = 0.25), while the T. vivax assay was in substantial agreement with the BCT (kappa = 0.625), and both assays conducted in parallel were in substantial agreement with the BCT (kappa = 0.708). Both assays were found to be proficient and suitable for the diagnosis of bovine trypanosomosis, especially when used in parallel.

Preliminary Evaluation of Diagnostic Tests Using Horses Experimentally Infected with Trypanosoma evansi

Seven surra negative horses were intravenously inoculated with 3 x 10(6)Trypanosoma evansi parasites derived from a camel. One horse was maintained as an uninfected negative control. Three antigen and three antibody detection tests were evaluated for diagnosis of infection in horses. The microhaematocrit centrifugation test (MHCT) was the most sensitive, first detecting parasites between one and three days (x 2.4) post infection (p.i.). The antigen (ag)-ELISA detected antigen between three and ten days (x 6.6) p.i. The latex agglutination test (LAT) first gave positive results on day 3 (x 3.0) p.i. Following the treatment of horses with trypanocidal drugs, the MCHT and the mouse inoculation test (MIT) became negative. Antigen levels using LAT declined and reached pre-infection levels in five out of six horses during the period of observation (92-279 days). Antigen levels using the ag-ELISA declined as well but did not reach pre-infection levels in any of the six horses.Three antibody detection techniques, ab-ELISA, card agglutination test (CATT), and immunofluorescent antibody test (IFAT) detected antibodies in the blood of all seven infected horses but not in the uninfected control. However, the ab-ELISA did not discriminate clearly between sera from infected and uninfected horses because unacceptably high ELISA background readings were detected in 15% of the surra negative horses shipped to the UAE from the UK. The ELISA antibody increased above pre-infection levels in the six horses experimentally infected, but not in one horse. In this horse the ELISA antibody level exceeded the cut-off level only after the reoccurrence of the T. evansi infection. The IFAT detected antibodies 15.7 days p.i. in all infected horses.

Charting methods to monitor the operational performance of ELISA method for the detection of antibodies against trypanosomes

Four indirect enzyme-linked immunosorbent assays (ELISAs) for the detection of antibody against trypanosomes using antigen-precoated plates (Trypanosoma congolense and T. vivax) were used in 15 veterinary diagnostic laboratories in Africa and Europe. The study provided data allowing an evaluation of charting methods with respect to the operational performance of each ELISA. Data from standardised internal quality control (IQC) samples were plotted on charts and used as the assay performance indicators with reference to expected upper and lower control limits. Based on unprocessed (optical density) and normalised absorbance values (calculated as a percentage positivity of a control), dispersion of values from the expected data range was estimated plotting the location and deviation of the values. In addition, assay precision was estimated plotting the distribution of coefficients of variation<10% of the IQCs. Binding ratios of controls were calculated to estimate the assay proficiency with respect to the accuracy of assessing that the IQC samples tested positive or negative in the test proper. The graphical analysis of dispersion of absorbance values in combination with assay precision and proficiency criteria was considered fully satisfactory to evaluate the operational performance of the ELISAs and provided useful decision criteria for plate acceptance and rejection. The establishment of standardised and transparent IQC data charting methods for the indirect ELISAs provided an increased measure of confidence to national laboratories with respect to their reports on disease occurrence. Moreover, the relative assay performances between all laboratories were examined using summary data charts with reference to the performance criteria described. The IQC data were also examined using modified Youden plot analysis demonstrating that indirect ELISA methods can be successfully applied at diagnostic laboratories in the tropics for monitoring trypanosomosis control programmes.

Estimation of trypanosomal status by the buffy coat technique and an antibody ELISA for assessment of the impact of trypanosomosis on health and productivity of N'Dama cattle in The Gambia

The buffy coat/dark ground phase contrast technique (BCT) and an indirect antibody enzyme immunoassay (ELISA) were employed to assess the trypanosomal status of 32 N'Dama cattle, aged 19-28 months, exposed to natural challenge of Glossina morsitans submorsitans and G. palpalis gambiensis. Prior to the start of the investigation animals experienced 9-16 months of tsetse challenge in the study area. Blood and corresponding serum samples were examined monthly for a period of 8 months for patent parasitaemia by BCT and presence of Trypanosoma vivax and T. congolense antibodies by ELISA. In the ELISA, the reactivity of sera to anti-trypanosomal antibodies was expressed in percent positivity (pp). Packed cell volumes (PCV) and body weights were also recorded monthly, and daily weight gain (DWG) computed to assess the impact of trypanosomal status on health and productivity. During the study period, the overall parasitaemic trypanosome prevalence was 3% (6/199), while the serological prevalence was 54.7% (109/199). Both diagnostic tests revealed a predominance of T. vivax over T. congolense infections in N'Dama cattle. Sensitivity of the immunoassay was 83.3%. In T. vivax-parasitaemic cattle, antibodies persisted for 4-6 months after the parasite was detected by BCT. A significantly higher overall mean PCV level was observed in blood samples obtained from cattle found, in any particular month, negative by BCT and ELISA, compared with those blood samples from animals responding serologically positively for anti-trypanosome antibodies. Likewise, mean DWG was significantly higher in cattle found negative for both tests in comparison to animals presenting detectable anti-trypanosome antibodies and those detected positive by both tests. A significant negative relationship was observed between pp values and PCV levels in animals seropositive for T. vivax and/or T. congolense. Similarly, a negative relationship was observed between DWGs and pp values. PCV levels were significantly positively correlated with DWGs. It was concluded that serological screening could provide useful information complementary to that obtained by the use of BCT not only to assess more accurately the trypanosomal status of cattle populations, but also to evaluate the effects of trypanosome infection on animal health and productivity and estimate the trypanosomosis risk.

Evaluation of antigen-coating procedures of enzyme-linked immunosorbent assay method for detection of trypanosomal antibodies

Research was undertaken to improve the antigen-coating step of indirect enzyme-linked immunosorbent assay (ELISA) method through the use of polystyrene 96-well plates precoated with antigenically stabile crude trypanosomal antigens. The plates were precoated with antigens, air dried and sealed before being packed in plastic bags with silica gel desiccant packets. Such plates stored at +4 and +37 degrees C provided an assay performance, which was superior to that of plates freshly coated with antigens from a frozen stock. Antigen-precoated plates consistently proved stable after storage up to +50 degrees C for at least 1 year. The accuracy of the assay was not affected, i.e. trypanosomal antibody-positive sera were clearly discriminated from trypanosomal antibody-negative negative sera. In contrast, lyophilized trypanosomal antigens lacked stability on storage at +37 degrees C for longer than 1 month. It was concluded that the routine use of antigen precoated polystyrene plates for the enzyme immunoassay technique will contribute to improved assay robustness at an acceptable diagnostic proficiency. The modified coating procedure will also provide an improved quality assurance and standardization procedure for the assay, which is required to allow the reliable detection of trypanosomal antibodies and comparison of data from different laboratories.

Detection of Trypanosoma congolense antibodies with indirect ELISAs using antigen-precoated microtitre plates

The study reports the performance of four indirect enzyme-linked immunosorbent assays (ELISAs) for antibody (AB) detection using microtitre plates which were precoated with native or heat/detergent denatured antigens (AGs) from Trypanosoma congolense (T.c.) and T. vivax (T.v.), and stored for between 1 to 206 days at +37 degrees C. Bovine serum samples were obtained by sequential bleeding of 3-months old T.c.-infected bulls and their uninfected cohorts, as well as by a single bleeding of uninfected adult cattle. The first day of AB detection, and observations on samples after this (defined as estimated ELISA sensitivity), depended on the cut-off value in the specific ELISAs. Cut-off values from pre- and early post-infection samples of individual animals demonstrated a seroconversion in all ELISAs on average after 10-15 days post-infection (dpi). The AB detection was delayed in the T.c. native and denatured AG-based ELISAs using cut-off points from uninfected cohort cattle (16.5 dpi, 19.3 dpi) and the adult cattle population (22.1 dpi, 25.0 dpi). The T.v. AG-based ELISAs however lacked crossreactiviy to T.c. ABs. The estimated sensitivity of each T.c. AG-based ELISA was above 96% throughout, but significantly lower for the T.c. native AG-based ELISA (91.1%) when the adult cattle derived cut-off point was used (p<0.01). The sensitivity of the phase contrast buffy coat technique was similar to the T.c. AG-based ELISAs, but significantly lower when the T.c. denatured AG-based ELISA was used at the adult cattle derived cut-off point (p<0.05). The implications of the results and future research aspects on ELISAs to detect trypanosomal ABs and AGs are discussed.

Tsetse--A haven for microorganisms

Arthropods are involved in the transmission of parasitic and viral agents that cause devastating diseases in animals and plants. Effective control strategies for many of these diseases still rely on the elimination or reduction of vector insect populations. In addition to these pathogenic organisms, arthropods are rich in microbes that are symbiotic in their associations and are often necessary for the fecundity and viability of their hosts. Because the viability of the host often depends on these obligate symbionts, and because these organisms often live in close proximity to disease-causing pathogens, they have been of interest to applied biologists as a potential means to genetically manipulate populations of pest species. As knowledge on these symbiotic associations accumulates from distantly related insect taxa, conserved mechanisms for their transmission and evolutionary histories are beginning to emerge. Here, Serap Aksoy summarizes current knowledge on the functional and evolutionary biology of the multiple symbionts harbored in the medically and agriculturally important insect group, tsetse, and their potential role in the control of trypanosomiasis.