In vitro susceptibility to miltefosine of amphotericin B-resistant Leishmania (Mundinia) martiniquensis

Leishmania (Mundinia) martiniquensis is a newly described species that causes human visceral, disseminated, and mucocutaneous leishmaniases. Amphotericin B deoxycholate (AmpB) is the first-line drug for the treatment of leishmaniasis in Thailand; however, several relapse cases of leishmaniasis caused by L. martiniquensis have been documented. In this study, in vitro susceptibility to AmpB and miltefosine (MIL) of wild-type (before treatment, LSCM1) and two AmpB-resistant L. martiniquensis strains (an in vitro-induced AmpB-resistant strain, AmpBRP2i, and a relapse strain, LSCM1-6) were determined. Results reveal that the IC50 value and resistance index against both drugs of promastigotes and intracellular amastigotes of the AmpBRP2i and LSCM1-6 strains were statistically significantly higher than those of the LSCM1 strain suggesting that cross-resistance with MIL occurred in both AmpB-resistant strains. The results of this study advocate further investigation into mechanisms that involve the complex nature of AmpB/MIL resistance in L. martiniquensis and development of effective methods for the identification of the AmpB-resistant parasites to help delivery of appropriate treatments for patients and for epidemiological surveys to survey the potential spread of drug-resistant strains.

Natural infection with Leishmania (Mundinia) martiniquensis supports Culicoides peregrinus (Diptera: Ceratopogonidae) as a potential vector of leishmaniasis and characterization of a Crithidia sp. isolated from the midges

The prevalence of autochthonous leishmaniasis in Thailand is increasing but the natural vectors that are responsible for transmission remain unknown. Experimental in vivo infections in Culicoides spp. with Leishmania (Mundinia) martiniquensis and Leishmania (Mundinia) orientalis, the major causative pathogens in Thailand, have demonstrated that biting midges can act as competent vectors. Therefore, the isolation and detection of Leishmania and other trypanosomatids were performed in biting midges collected at a field site in an endemic area of leishmaniasis in Tha Ruea and a mixed farm of chickens, goats, and cattle in Khuan Phang, Nakhon Si Thammarat province, southern Thailand. Results showed that Culicoides peregrinus was the abundant species (>84%) found in both locations and only cow blood DNA was detected in engorged females. Microscopic examination revealed various forms of Leishmania promastigotes in the foregut of several C. peregrinus in the absence of bloodmeal remnants, indicating established infections. Molecular identification using ITS1 and 3'UTR HSP70 type I markers showed that the Leishmania parasites found in the midges were L. martiniquensis. The infection rate of L. martiniquensis in the collected flies was 2% in Tha Ruea and 6% in Khuan Phang, but no L. orientalis DNA or parasites were found. Additionally, organisms from two different clades of Crithidia, both possibly new species, were identified using SSU rRNA and gGAPDH genes. Choanomastigotes and promastigotes of both Crithidia spp. were observed in the hindgut of the dissected C. peregrinus. Interestingly, midges infected with both L. martiniquensis and Crithidia were found. Moreover, four strains of Crithidia from one of the clades were successfully isolated into culture. These parasites could grow at 37°C in the culture and infect BALB/c mice macrophages but no multiplication was observed, suggesting they are thermotolerant monoxenous trypanosomatids similar to Cr. thermophila. These findings provide the first evidence of natural infection of L. martiniquensis in C. peregrinus supporting it as a potential vector of L. martiniquensis.

Amphotericin B resistance correlates with increased fitness in vitro and in vivo in Leishmania (Mundinia) martiniquensis

Amphotericin B (AmpB) deoxycholate is the available first-line drug used to treat visceral leishmaniasis caused by Leishmania (Mundinia) martiniquensis, however, some cases of AmpB treatment failure have been reported in Thailand. Resistance to drugs is known to affect parasite fitness with a potential impact on parasite transmission but still little is known about the effect of resistance to drugs on L. martiniquensis. Here we aimed to gain insight into the fitness changes occurring after treatment failure or in vitro-induced resistance to AmpB. L. martiniquensis parasites isolated from a patient before (LSCM1) and after relapse (LSCM1-6) were compared for in vitro and in vivo fitness changes together with an in vitro induced AmpB-resistant parasite generated from LSCM1 parasites (AmpBRP2i). Results revealed increased metacyclogenesis of the AmpBPR2i and LSCM1-6 strains (AmpB-resistant strains) compared to the LSCM1 strain and increased fitness with respect to growth and infectivity. The LSCM1-6 and AmpBRP2i strains were present in mice for longer periods compared to the LSCM1 strain, but no clinical signs of the disease were observed. These results suggest that the AmpB-resistant parasites could be more efficiently transmitted to humans and maintained in asymptomatic hosts longer than the susceptible strain. The asymptomatic hosts therefore may represent "reservoirs" for the resistant parasites enhancing transmission. The results in this study advocate an urgent need to search and monitor for AmpB-resistant L. martiniquensis in patients with relapsing leishmaniasis and in asymptomatic patients, especially, in HIV/Leishmania coinfected patients.

Stimulation of metacyclogenesis in Leishmania (Mundinia) orientalis for mass production of metacyclic promastigotes

Leishmania (Mundinia) orientalis is a human pathogen causing leishmaniasis and studies on the properties of metacyclic promastigotes, the parasite’s infective stage, are required for a better understanding of its transmission and infection. However, information on cultivation for mass production of L. orientalis metacyclic promastigotes and factors that stimulate their metacyclogenesis is limited. Therefore, the objective of this study was to develop a suitable methodology for generating promastigote cultures containing a high proportion and number of L. orientalis metacyclic promastigotes. Various media, i.e., Schneider’s insect medium, Medium 199 and Grace’s insect medium, supplemented with various quantities of dithiothreitol, Basal Medium Eagle vitamins, pooled human urine, and fetal bovine serum, were optimized for metacyclogenesis. The results revealed that the optimum culture medium and conditions of those tested were Schneider’s insect medium supplemented with 100 μM dithiothreitol, 1% (v/v) Basal Medium Eagle vitamins, 2% (v/v) pooled human urine, and 10% (v/v) fetal bovine serum, pH 5.0 at 26°C. We also demonstrated that L. orientalis metacyclic promastigotes could be purified and enriched by negative selection using peanut lectin. Under these culture conditions, the highest yield of metacyclic promastigotes was obtained with a significantly higher percentage of parasite survival, resistance to complement-mediated lysis, and infection index in THP-1 macrophage cells compared to parasites cultured without media supplements at neutral pH. This is the first report providing a reliable method for mass production of L. orientalis metacyclic promastigotes for in vivo infections and other experimental studies of this emerging parasite in the future.

Significance of eggshell morphology as an additional tool to distinguish species of sand flies (Diptera: Psychodidae: Phlebotominae)

Morphological characteristics of eggshells are important in sand fly ootaxonomy. In this study, eggshells from Phlebotomus stantoni Newstead, Sergentomyia khawi (Raynal), and Grassomyia indica (Theodor) sand flies collected in Chiang Mai province, Thailand were examined and characterized using light microscopy (LM) and scanning electron microscopy (SEM). Then, eggshell morphology of these three species was described for the first time. Each gravid female was forced to lay eggs by decapitation and the eggs were collected for SEM analysis. Egg laying females were identified by morphological examination and molecular typing using cytochrome b (Cytb) as a molecular marker. The chorionic sculpturing of Ph. stantoni eggs combines two patterns on the same egg: unconnected parallel ridges and reticular patterns. Sergentomyia khawi and Gr. indica have similar chorionic polygonal patterns, but their exochorionic morphology and aeropylar area are different. Results indicate that eggshell morphological characteristics such as chorionic pattern, exochorionic morphology, inter-ridge/boundary area, aeropylar area (including the number of aeropyles) and basal layer, can be useful to develop morphological identification keys of eggs. These can serve as an additional tool to distinguish species of sand flies. In addition, the chorionic sculpturing of the eggs of the three species of sand flies observed by LM is useful for species identification in gravid females with spermathecae obscured by eggs.

Protein expression in female salivary glands of pyrethroid-susceptible and resistant strains of Aedes aegypti mosquitoes

BACKGROUND

A group of insecticides called pyrethroids has been used extensively worldwide and development of pyrethroid resistance within mosquito populations, especially in Aedes aegypti, has rapidly spread through populations. In this study, SDS-PAGE, 2-DE coupled with NanoLC-MS, and bioinformatics were used to analyze the female salivary gland proteins of pyrethroid-susceptible (PMD) and pyrethroid-resistant (PMD-R and UPK-R) strains of Ae. aegypti mosquitoes for the first time.

RESULTS

SDS-PAGE analysis revealed that among the three strains at least nine major proteins were detected but one protein band (20 kDa) was found only in the PMD strain. Two-dimensional gel electrophoresis analysis revealed 19 similarly expressed proteins in the salivary glands of the three strains involved in blood-feeding process, stress response, immunogenic response, and metabolic process and five additional major protein spots differentially expressed in the susceptible and resistant strains. Comparative analysis of the expression volume of each protein spot between the PMD and the PMD-R strains showed three downregulated proteins of the PMD-R mosquitoes. For UPK-R strains, six major proteins were downregulated when compared to the PMD strain. Additionally, four downregulated proteins were found in the UPK-R when compared to the PMD-R strain. These results suggest that pyrethroids might induce alteration of salivary gland proteins in resistant mosquitoes. Network analysis by STITCH database 5.0 showed that SRPN23 interacted with sodium and calcium ions, suggesting that SRPN23 might be involved in insecticide resistance.

CONCLUSIONS

Information obtained from this study will be useful for further studies on the roles of differentially expressed salivary gland proteins in resistance to insecticides and viral transmission.

Didilia sp. infecting Phlebotomus stantoni in Thailand

Nematode infection in wild caught Phlebotomine sand flies was investigated in Thailand. Light microscopy (LM) and scanning electron microscopy (SEM) were used to detect and morphologically characterize entomopathogenic nematodes that presented in the sand flies. Didilia sp. nematodes were found for the first time in the body cavity of wild caught male Phlebotomus stantoni sand flies. The Didilia sp. was identified based on the morphology of the adult nematodes, from their stylet and teeth at the anterior tip, body length, and egg shell sculpture. It was noted that every infected male sand fly had unrotated genitalia, which would not allow them to mate, thus leading to the loss of their offspring. This finding provided information that might lead to study on whether or not the Didilia sp. has the potential to control sand fly population.

Species composition and population dynamics of phlebotomine sand flies in a Leishmania infected area of Chiang Mai, Thailand

Phlebotomine sand flies are established vectors of leishmaniasis in humans. In Thailand, Leishmania martiniquensis and "Leishmania siamensis" have been described as causative agents of leishmaniasis. In this study, a survey of sand flies in the Leishmania infected area of Hang Dong district, Chiang Mai, Thailand was performed using CDC light traps for eight consecutive months, from January to August 2016. A total of 661 sand flies were collected, and of 280 female sand flies, four species of the genus Sergentomyia including Sergentomyia gemmea, S. barraudi, S. indica, and S. hivernus and one species of the genus Phlebotomus, Phlebotomus stantoni, were identified. S. gemmea and S. hivernus were found in Chiang Mai for the first time. The density of captured female sand flies was high in warm and humid periods from June to August, with temperatures of around 26°C and relative humidity about 74%. In addition, S. gemmea was the most predominant species in the area. Further studies as to whether or not these sand fly species could be a vector of Leishmaniasis in Thailand are required.

Two new HLA-B alleles, B*4422 and B*4704, identified in a study of families with autoimmunity

HLA-B typing of approximately 1 262 individuals from a study of 372 simplex families with multiple sclerosis has led to the identification of two new alleles (HLA-B*4422 and HLA-B*4704). Sequencing confirmed that both of these new alleles represent novel combinations of previously described sequence motifs, reinforcing the notion that recombination and/or gene conversion-like events play an important role in generating HLA allelic diversity. The identification of these new alleles brings the total number of HLA-B alleles to 465.

Lens refilling with injectable silicone in rabbit eyes

PURPOSE

To evaluate the technique of refilling the lens capsule with injectable silicone and assess the postoperative findings.

SETTING

Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan.

METHODS

The lens capsules in the eyes of 16 rabbits weighing 1.5 to 2.0 kg were refilled with 0.2 mL of silicone polymer (about 66% bag volume) after endocapsular phacoemulsification through an upper minicircular capsulorhexis 1.5 to 1.8 mm in diameter. The capsule opening was sealed with a silicone plug to prevent leakage of the injected silicone. Main outcome measures were surgical success rate, inflammation, endothelial cell loss, refractive change after pilocarpine 4% instillation, and capsule opacification.

RESULTS

The lens capsule could be refilled in 10 eyes. The failures were caused by capsule rupture during phacoemulsification (n = 3) and profuse leakage of the injected silicone. Silicone that leaked minimally during surgery was easily washed away. Silicone that leaked and polymerized in the anterior chamber postoperatively (n = 3) was easily removed by surgery the following day. Mean endothelial cell loss was 10.2% 1 month after surgery. Aqueous flare intensity was significantly lower on days 2 and 4 than after conventional intraocular lens implantation in a control group. The respective mean preoperative and postoperative refractions were 0.7 diopters (D) +/- 1.0 (SD) and 19.1 +/- 1.0 D and the mean change (difference between the refractions before and after topical application of pilocarpine 4%), -0.4 +/- 0.6 and 1.1 +/- 0.4 D (P < .01). Posterior capsule opacification (PCO) was noted after 3 weeks in all eyes.

CONCLUSIONS

Lens capsule refilling and capsular plug use to prevent silicone leakage was shown to be feasible and avoided complications caused by leakage. Refractive changes suggest that the procedure could yield accommodation in primates> Although neodymium: YAG laser capsulotomy did not cause herniation of the injected silicone, PCO prevention is an essential issue in lens refilling because the capsulotomy may annul the attained accommodation.

The inhibition of lens epithelial cell migration by a discontinuous capsular bend created by a band-shaped circular loop or a capsule-bending ring

BACKGROUND AND OBJECTIVE

This study investigated the inhibitory effect of a discontinuous capsular bend created by an intraocular lens (IOL) with a band-shaped loop or a capsule tension ring on migrating lens epithelial cells (LECs).

MATERIALS AND METHODS

To create a sharp bend in the capsule, the round form (shown on cross section) of the open-circular loop of a polymethylmethacrylate IOL was changed to a band-like shape, 1.0 mm wide and 0.2 mm thick. A capsule tension ring of the same shape (on cross section) with a 14-mm diameter was also made. After cataract surgery, this IOL or ring was implanted into the capsular bag in 5 rabbit eyes. The same IOL with an unmodified haptic or conventional capsule tension ring was implanted in the contralateral eye as a control. After 8 weeks, Miyake view and histopathologic examinations were performed.

RESULTS

LECs accumulated at the equatorial corner outside the haptic or ring, showing the inhibition of LEC migration. In the control eyes, LECs accumulated inside the haptic or ring, forming a Soemmering's ring cataract, thus showing markedly less inhibition of LEC migration on macroscopic and microscopic observations.

CONCLUSIONS

A discontinuous bend in the capsule significantly inhibited LEC migration in rabbit eyes. The creation of a capsular bend through the appropriate design of the IOL-haptic or capsule tension ring might significantly decrease the incidence of posterior capsule opacification for humans.

Inhibition of migrating lens epithelial cells by blocking the adhesion molecule integrin: a preliminary report

PURPOSE

To evaluate the preventive effect of blocking integrins by sustained release of RGD peptide (arginine-glycin-aspartic acid sequence) or a combination of RGD peptide and ethylenediaminotetraacetic acid (EDTA) on lens epithelial cell (LEC) migration.

SETTING

Nishi Eye Hospital, Jinshikai Medical Foundation, Osaka, Japan.

METHOD

A polylactic-glycolic acid disk containing 4% RGD or a combination of 23% EDTA and 10% RGD was implanted in the capsular bag in five rabbit eyes following standard cataract surgery. The release rate in vitro was 4.4 microg/h for RGD peptide alone and 7.8 and 7.6 microg/h for combined EDTA and RGD peptide, respectively. The contralateral eye received a disk without agents as a control.

RESULTS

After 1 month, a slight inhibition of LEC migration onto the posterior capsule was observed histopathologically in eyes receiving RGD peptide. A significant inhibition was observed in eyes with combined EDTA and RGD.

CONCLUSIONS

Application of RGD peptide and EDTA and RGD peptide may inhibit LEC migration by inhibiting the integrins expressed on the LECs. Blocking adhesion molecules expressed on LECs may reduce posterior capsule opacification.

Controlling the capsular shape in lens refilling

OBJECTIVES

To investigate control of the capsular shape by determining the ability of the lens capsule to mold injected silicone and to evaluate the relationship among the volume of silicone injected, refraction, and the amplitude of accommodation.

METHODS

After endocapsular phacoemulsification following an upper, minicircular capsulorhexis, the lens capsule of a pig eye was refilled with a silicone mixture that polymerizes in vitro in 2 hours. The minicircular capsulorhexis opening was sealed by a small silicone plug to prevent leakage. The anterior capsule curvature and refraction of the lens were measured by a Scheimpflug camera and lensometer, respectively, with and without zonular tension. Zonular tension was created using a ciliary ring sutured to the ciliary bodies and expanded.

RESULTS

The mean (+/- SD) anterior curvature of the lenses without zonular tension was 6.50 +/- 0.07 mm after 17 hours and 6.54 +/- 0.04 mm after 42 hours; with zonular tension it was 7.01 +/- 0.11 mm and 7.23 +/- 0.24 mm, respectively. The curvature became flatter when zonular tension was applied or steeper when zonular tension was abolished momentarily during measurements after 17 hours, but after 42 hours the curvature was unaffected by the application or removal of zonular pressure. The mean (+/- SD) amplitude of accommodation (the difference between refraction without zonular tension and that with it) was 3.2 +/- 0.5 diopters (D), 6.1 +/- 1.8 D, 4.8 +/- 0.8 D, and 2.8 +/- 1.3 D, when the lens was refilled with a silicone volume corresponding to 45%, 55%, 75%, and 95%, respectively, of the mean normal lens volume.

CONCLUSIONS

The lens capsule possesses some ability to mold the injected silicone during its polymerization. When the eye is atropinized, the lens capsule may conform to its nonaccommodated state. Accommodation could be obtained by various degrees of refilling. Moderate refilling yields a greater amplitude of accommodation than does more complete refilling. Using a silicone plug to seal the capsular opening facilitates lens refilling with excellent reproducibility and seems to be useful in research.

Keratan sulfate synthesis by corneal stromal cells within three-dimensional collagen gel cultures

The corneal stromal cells from 2-day-old chicks were cultured on plastic dishes or within three-dimensional collagen gel in the presence or absence of growth factor (EGF, bFGF, PDGF, TGF-beta 1, or their combinations). The cells were labeled with [35S] sulfate and [3H]-glucosamine, and the radio-labeled proteoglycans were examined. Keratan sulfate was synthesized to some extent (15.4-16.9% of total synthesis for medium fraction; 8.0% for cell layer fraction) in a primary culture even when the cells were cultured on plastic dishes, although the values were very much lower than that (42.7%) in the stromal fraction of organ culture of corneal explants. The primary culture in collagen gel showed some increase in the proportion of keratan sulfate synthesis as compared with the culture on plastic. Among growth factors, addition of EGF to the culture in gel caused a further increase in the proportion of keratan sulfate synthesis. bFGF and TGF-beta 1 increased proteoglycan synthesis as a whole to some extent, but chondroitin sulfate/dermatan sulfate synthesis was increased preferentially and, consequently, the proportion of keratan sulfate synthesis to total synthesis was decreased. PDGF also caused some decrease in the proportion. In the culture after one passage (secondary culture), the keratan sulfate synthesis decreased markedly (8.6-8.3% of total synthesis for medium fraction; 2.7% for cell layer or gel fraction) and a large chondroitin sulfate/dermatan sulfate proteoglycan appeared whether the cells were cultured on plastic or in collagen gel. But, when the medium was changed to CG medium (serum-free medium) in the middle of either primary or secondary cultures, the keratan sulfate synthesis (27.8% for medium fraction; 15.6% for gel fraction) was maintained at the level of that of the primary culture in gel. EGF and bFGF were not additive to the effect of CG medium on the keratan sulfate synthesis in the secondary culture. Instead, EGF and bFGF stimulated hyaluronic acid synthesis in the culture. The mechanism of these changes in the expression type of proteoglycan and their significance remain to be clarified.

Decreased prostaglandin E2 synthesis by lens epithelial cells cultured on heparin-surface-modified poly(methyl methacrylate)

PURPOSE

To evaluate whether heparin surface modification reduces prostaglandin E2 (PGE2) synthesis by lens epithelial cells (LECs) after intraocular lens (IOL) implantation.

SETTING

Nishi Eye Hospital, Jinshikai Medical Foundation, Osaka, Japan.

METHODS

The prostaglandin E2 (PGE2) concentration was determined in an incubation medium of human cataract LECs cultured on heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA) plates at 1, 2, 3, and 4 weeks of culture. A medium without heparin served as a control.

RESULTS

The PGE2 concentration was significantly lower in the HSM than in the control medium at 3 and 4 weeks of culture.

CONCLUSION

The results are consistent with the clinical observation of significantly decreased inflammation in eyes with HSM IOLs, indicating that such modification increases PMMA's biocompatibility with LECs.