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Langenberg MCC, Hoogerwerf MA, Koopman JPR, Janse JJ, Kos-van Oosterhoud J, Feijt C, Jochems SP, de Dood CJ, van Schuijlenburg R, Ozir-Fazalalikhan A, Manurung MD, Sartono E, van der Beek MT, Winkel BMF, Verbeek-Menken PH, Stam KA, van Leeuwen FWB, Meij P, van Diepen A, van Lieshout L, van Dam GJ, Corstjens PLAM, Hokke CH, Yazdanbakhsh M, Visser LG, Roestenberg M. A controlled human Schistosoma mansoni infection model to advance novel drugs, vaccines and diagnostics. Nat Med 2020; 26:326-32. [PMID: 32066978 DOI: 10.1038/s41591-020-0759-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/09/2020] [Indexed: 11/08/2022]
Abstract
Schistosomiasis treatment relies on the use of a single drug, praziquantel, which is insufficient to control transmission in highly endemic areas1. Novel medicines and vaccines are urgently needed2,3. An experimental human model for schistosomiasis could accelerate the development of these products. We performed a dose-escalating clinical safety trial in 17 volunteers with male Schistosoma mansoni cercariae, which do not produce eggs (clinicaltrials.gov NCT02755324), at the Leiden University Medical Center, the Netherlands. The primary endpoints were adverse events and infectivity. We found a dose-related increase in adverse events related to acute schistosomiasis syndrome, which occurred in 9 of 17 volunteers. Overall, 5 volunteers (all 3 of the high dose group and 2 of 11 of the medium dose group) reported severe adverse events. Worm-derived circulating anodic antigen, the biomarker of the primary infection endpoint, peaked in 82% of volunteers at 3-10 weeks following exposure. All volunteers showed IgM and IgG1 seroconversion and worm-specific cytokine production by CD4+ T cells. All volunteers were cured with praziquantel provided at 12 weeks after exposure. Infection with 20 Schistosoma mansoni cercariae led to severe adverse events in 18% of volunteers and high infection rates. This infection model paves the way for fast-track product development for treatment and prevention of schistosomiasis.
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Trumble BC, Stieglitz J, Blackwell AD, Allayee H, Beheim B, Finch CE, Gurven M, Kaplan H. Apolipoprotein E4 is associated with improved cognitive function in Amazonian forager-horticulturalists with a high parasite burden. FASEB J 2016; 31:1508-1515. [PMID: 28031319 DOI: 10.1096/fj.201601084r] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/12/2016] [Indexed: 12/20/2022]
Abstract
The apolipoprotein E4 (E4) allele is present worldwide, despite its associations with higher risk of cardiovascular morbidity, accelerated cognitive decline during aging, and Alzheimer's disease (AD). The E4 allele is especially prevalent in some tropical regions with a high parasite burden. Equatorial populations also face a potential dual burden of high E4 prevalence combined with parasitic infections that can also reduce cognitive performance. We examined the interactions of E4, parasite burden, and cognitive performance in a traditional, nonindustrialized population of Amazonian forager-horticulturalists (N = 372) to test whether E4 protects against cognitive decline in environments with a heavy pathogen burden. Contrary to observations in industrial populations, older adult E4 carriers with high parasite burdens either maintained or showed slight improvements in cognitive performance, whereas non-E4 carriers with a high parasite burden showed reduced cognitive performance. Being an E4 carrier is the strongest risk factor to date of AD and cognitive decline in industrial populations; it is associated with greater cognitive performance in individuals facing a high parasite and pathogen load, suggesting advantages to the E4 allele under certain environmental conditions. The current mismatch between postindustrial hygienic lifestyles and active parasite-rich environs may be critical for understanding genetic risk for cognitive aging.-Trumble, B. C., Stieglitz, J., Blackwell, A. D., Allayee, H., Beheim, B., Finch, C. E., Gurven, M., Kaplan, H. Apolipoprotein E4 is associated with improved cognitive function in Amazonian forager-horticulturalists with a high parasite burden.
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Affiliation(s)
- Benjamin C Trumble
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA; .,Center for Evolution and Medicine, Arizona State University, Tempe, Arizona, USA
| | - Jonathan Stieglitz
- Institute for Advanced Study in Toulouse, Toulouse, France.,Department of Anthropology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Aaron D Blackwell
- Department of Anthropology, University of California, Santa Barbara, Santa Barbara, California, USA
| | - Hooman Allayee
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA.,Institute for Genetic Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Bret Beheim
- Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Caleb E Finch
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA.,Dornsife College, University of Southern California, Los Angeles, California, USA
| | - Michael Gurven
- Department of Anthropology, University of California, Santa Barbara, Santa Barbara, California, USA
| | - Hillard Kaplan
- Department of Anthropology, University of New Mexico, Albuquerque, New Mexico, USA
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Cavellani CL, Corrêa RR, Ferraz ML, Rocha LP, Faleiros AC, Lino Junior Rde S, Dos Reis MA, Teixeira Vde P. Influence of gender on cardiac and encephalic inflammation in the elderly with cysticercosis: a case control study. J Trop Med 2012; 2012:540858. [PMID: 23056059 DOI: 10.1155/2012/540858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 07/24/2012] [Accepted: 08/15/2012] [Indexed: 11/18/2022] Open
Abstract
Background. The present study explores the influence of the host's age and gender upon the inflammatory infiltrate. We aimed to quantify the inflammatory infiltrate caused by cysticercosis, which is related to aging, in the heart and in the encephalon. Methods. 75 autopsy protocols with cysticercosis diagnosis from department of pathology at a university hospital from 1970 to 2008 were reviewed. Two groups were formed: elderly with cysticercosis and nonelderly with cysticercosis. We used KS-300 (Kontron-Zeiss) software for morphometric analysis of the inflammation. Results. The elderly had an average of 3.1 ± 2.5 cysticerci, whereas the non-elderly had 2.7 ± 3.8 parasites. The non-elderly group with cysticercosis had significantly more inflammation, both cardiac and encephalic, than the elderly group. The elderly females with cysticercosis had more cardiac and encephalic inflammation. Conclusions. In this study, we showed that the non-elderly had significantly more cardiac and encephalic inflammation than the elderly, and that such inflammatory infiltrate decreases with age and depends upon the evolutionary stage of the cysticercus. Furthermore, there are differences concerning gender in the intensity of the inflammatory response due to cysticerci in the heart and brain parenchyma during senescence. Even during this period, women continue to have a more intense response to the parasitosis.
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Pavlin BI, Kozarsky P, Cetron MS. Acute pulmonary schistosomiasis in travelers: case report and review of the literature. Travel Med Infect Dis 2012; 10:209-19. [PMID: 22981182 DOI: 10.1016/j.tmaid.2012.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 06/14/2012] [Accepted: 06/20/2012] [Indexed: 11/21/2022]
Abstract
We report the case of an American traveler who developed acute pulmonary schistosomiasis after swimming in a lake in Madagascar, and we review the literature on acute pulmonary schistosomiasis. Schistosomiasis is one of the world's most prevalent parasitic diseases, with three species (Schistosoma mansoni, Schistosoma haematobium and Schistosoma japonicum) causing the greatest burden of disease. Pulmonary manifestations may develop in infected travelers from non-endemic areas after their first exposure. The pathophysiology of acute pulmonary disease is not well-understood, but is related to immune response, particularly via inflammatory cytokines. Diagnosis of schistosomiasis may be either through identification of characteristic ova in urine or stool or through serology. Anti-inflammatory drugs can provide symptomatic relief; praziquantel, the mainstay of chronic schistosomiasis treatment, is likely not effective against acute disease; the only reliable prevention remains avoidance of contaminated freshwater in endemic areas, as there is no vaccine. Travelers who have been exposed to potentially contaminated freshwater in endemic areas should seek testing and, if infected, treatment, in order to avoid severe manifestations of acute schistosomiasis and prevent complications of chronic disease. Clinicians are reminded to elicit a detailed travel and exposure history from their patients.
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Ferreira CR, de Campos FPF, Ramos JG, Martines JADS, Kim EIM, Smeili LAA. Schistosomiasis: a case of severe infection with fatal outcome. Autops Case Rep 2012; 2:7-17. [PMID: 31528556 PMCID: PMC6735636 DOI: 10.4322/acr.2012.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 02/28/2012] [Indexed: 11/23/2022] Open
Abstract
Schistosomiasis is one of the most common parasitic diseases, still considered of public health significance. Acute schistosomiasis is of difficult diagnosis and therefore has been overlooked, misdiagnosed, underestimated and underreported in endemic areas. The delay between the exposure to contaminated water and the initial symptoms may explain this challenging diagnosis. Acute schistosomiasis is frequently reported in non-immune individuals while reinfection cases occurring in endemic areas is scarcely documented. The later usually shows a benign course but fatal cases do exist. The authors report a case of a young female patient, in the late puerperium, with a three-month history of weight loss, intermittent fever, cough, thoracic and abdominal pain and increased abdominal girth. Physical examination showed a tachycardia, tachypnea and hypotension. Laboratory tests showed a mild anemia, eosinophilia, and a slightly elevation of liver enzymes. Thorax and abdominal multidetector computed tomography evidenced a diffuse and bilateral pulmonary micronodules and peritoneal and intestinal wall thickening. The patient progressed rapidly to hepatic insufficiency, and death after respiratory insufficiency. An autopsy was performed and the findings were compatible with acute Schistosomiasis in a patient previously exposed to Schistosoma mansoni.
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Affiliation(s)
- Cristiane Rúbia Ferreira
- Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - João Gabriel Ramos
- Department of Internal Medicine Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brasil
| | | | - Elizabeth Im Myung Kim
- Department of Internal Medicine - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
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