Discovery of Benzopyrrolizidines as Promising Antigiardiasic Agents

Current treatments for giardiasis include drugs with undesirable side effects, which increase the levels of therapeutic desertion and promote drug resistance in the parasites. Herein, we describe the antigiardiasic evaluation on Giardia lamblia trophozoites of a structurally diverse collection of 74 molecules. Among these scaffolds, we discovered a benzopyrrolizidine derivative with higher antigiardiasic activity (IC₅₀ = 11 µM) and lower cytotoxicity in human cell cultures (IC₅₀ = 130 µM) than those displayed by the current gold-standard drugs (metronidazole and tinidazole). Furthermore, this compound produced morphologic modifications of trophozoites, with occasional loss of one of the nuclei, among other changes not observed with standard giardicidal drugs, suggesting that it might act through a novel mechanism of action.

Toxocara: Seroprevalence in Mexico

In Mexico, toxocariasis, like some other parasitosis in humans, is not a disease of conventional surveillance or immediate notification. Seroprevalence studies are scarce, six dealing with paediatric populations and eight dealing with adults; the reports were only from four states in Mexico. There were 1596 children, and the seroprevalence was 13.8%. In the case of adults, there were 1827 subjects, and seroprevalence was 4.7%. There is a significant positive association between seroprevalence and the paediatric population P<0.0001 (OR, 3.285; 95% CI, 2.541-4.279). It is advisable to perform competitive ELISAs and add another diagnostic test, such as Western blot or the detection of circulating antigens to reduce diagnostic uncertainty. This neglected parasitosis can be confused with retinoblastoma. Therefore, there is a risk of ocular enucleation. It is necessary to sensitise the authorities of the Ministry of Health and decision-makers, to provide economic support for epidemiological surveillance of this zoonotic parasite.

Piqueria trinervia as a source of metabolites against Giardia intestinalis

CONTEXT

Piqueria trinervia Cav. (Asteraceae) is a plant species with a long history in traditional medicine to cure diarrhoea and other digestive disorders.

OBJECTIVE

The study investigates the antigiardial activity of piquerol, trinervinol, red oil and two fractions (F1 and F2) from P. trinervia.

MATERIALS AND METHODS

P. trinervia was collected in the Ajusco in Mexico City. Aerial parts were ground and mixed with water to obtain the extract, which was treated with dichloromethane to isolate piquerol and trinervinol (P & T). Remnants were the red oil, fractions 1 and 2 (RO, F1 & F2). Trophozoites of Giardia intestinalis were treated with P, T, RO, F1 and F2 at different concentrations (0.78-200 μg/mL) for 48 h. Antigiardial activity was measured using the methylene blue reduction, and the cytotoxicity assayed on human fibroblasts and Vero cells by reduction of tetrazolium salts.

RESULTS

Trinervinol and piquerol showed antigiardial activity with an IC₅₀ = 2.03 and 2.42 μg/mL, and IC₉₀ = 13.03 and 8.74 μg/mL, respectively. The concentrations of trinervinol (CC₅₀ = 590 μg/mL) and piquerol (CC₅₀ = 501 μg/mL) were not cytotoxic to human fibroblasts.

CONCLUSIONS

Compounds from P. trinervia showed antigiardial activity; to enhance this activity, piquerol and trinervinol can be chemically modified.

Toxocara canis: Analysis of the kinetics of antigen release and antibody production in an in vivo model for the detection of past or present infection

Worldwide, Toxocara canis is an important zoonotic nematode of public health concern. This soil-transmitted helminth causes visceral larva and ocular larva migrans in paratenic hosts. The detection of T. canis larva migrans is complicated because current immunological tests detect only IgG antibodies, which can cross-react with antigens from other parasites and cannot distinguish between the past and present infection. Analysis of antigen release and antibody production could help improve the detection of larva migrans. Here, we report the kinetics of antigen release, IgM and IgG production in an in vivo model for the detection of past or present infection. We used four groups of seven mice: two groups infected orally with 50 or 100 embryonated eggs, and the other two infected intraperitoneally with 50 or 100 live larvae. We obtained blood samples at 0, 3, 7, and 14days and, then, every two weeks until day 140. Sandwich ELISA and indirect ELISA were performed for antigen capture and the detection of immunoglobulins, respectively. Mice inoculated with larvae developed an immune response faster than those inoculated with eggs. In all groups, antigen capture was positive starting at 3days until 140days post-inoculation (dpi). Detection of immunoglobulins was at 14 or 28dpi in mice inoculated with larvae or eggs, respectively. Negative IgM values were detected at days 98 and 112. The samples remained positive for IgG until the last day of the experiment. Data suggest that in mice inoculated with T canis eggs, some larvae did not hatch, others died or never reached the bloodstream. Based on our model, we propose that there is early infection when only antigens are present, and active larva migrans when antigen and immunoglobulins are detected, implying an immune response of the host against the antigen. Our study offers a view into the parasite-host relationship and enables us to infer if there are live larvae. Additionally, these findings provide a foundation for the diagnosis and differentiation of recent infection and active larva migrans.

Giardia duodenalis genotypes among schoolchildren and their families and pets in urban and rural areas of Sinaloa, Mexico

INTRODUCTION

Giardiasis is a human health concern worldwide, especially among schoolchildren. Giardia duodenalis genotypes A and B are infective to humans, but their zoonotic potential remains controversial. In Mexico, the most prevalent genotype is A, but B was also detected in southeastern Mexico. In Sinaloa state, northwestern Mexico, giardiasis is highly prevalent, but Giardia genotypes have been poorly studied.

METHODOLOGY

This study aimed to investigate the distribution and clinical-epidemiological correlation of G. duodenalis genotypes in schoolchildren and their families and pets in urban and rural areas of Sinaloa state, Mexico.

RESULTS

Among 395 schoolchildren (274 urban, 121 rural), 76 (49 urban, 27 rural) were infected with G. duodenalis. In total, 22 families (15 urban, 7 rural) of infected schoolchildren, consisting of 60 family members (41 urban, 19 rural) and 21 pet dogs (15 urban, 6 rural) were examined; 10 family members (5 urban, 5 rural) and 5 pet dogs (3 urban, 2 rural) of 10 families (6 urban, 4 rural) were infected. After PCR-RFLP analyses of vsp417 and gdh genes, genotype prevalence among infected urban schoolchildren was 79.5% AI, 12.8% AII, and 7.7% mixed AI+B. However, only AI genotype was found in family members and pets. In the rural area, only the AI genotype was detected. Genotypes were not correlated with clinical manifestations.

CONCLUSIONS

This paper shows the presence of B genotype in northwestern Mexico for the first time. Detection of AI genotype in dogs suggested the possible role of dogs as the reservoir for human giardiasis in Sinaloa, Mexico.

The invasive potential of Giardia intestinalis in an in vivo model

Giardiasis is a neglected parasitic disease that affects primarily children, in whom it delays physical and mental development. The pathophysiology of giardiasis in not well understood, and most reports have identified Giardia intestinalis trophozoites only in the lumen and on the brush border of the small intestine. We identified Giardia trophozoites within the epithelium of the small intestine of a lactose intolerance patient. The Giardia trophozoites were obtained and cultured in vitro. In addition, we demonstrated Giardia trophozoite invasion in an animal model. Giardia trophozoites invaded the intestinal mucosa and submucosa of infected gerbils. The invasive trophozoites were observed at 21, 30 and 60 days age, and the average numbers of invaded sites were 17 ± 5, 15 ± 4, and 9 ± 3, respectively. We found trophozoites between epithelial cells, at the base of empty goblet cells, in lacteal vessels and within the submucosa. The morphological integrity of the invasive trophozoites was demonstrated via electron microscopy. The analysis of the gerbils infected with the trophozoites of the WB reference strain did not show intraepithelial trophozoites. These results demonstrate another Giardia pathogenic mechanism, opening the door to numerous future studies.

Successful capture of Toxocara canis larva antigens from human serum samples

Background

Toxocara canis is a nematode that parasitizes dogs, while humans are paratenic hosts. When humans are infected the migrating larvae damage the liver, lungs and even the nervous system. Larva migrans diagnosis is based on immunological techniques; however, the commercial immunodiagnostic kits detect anti-T. canis antibodies which may cross-react with other parasites, mainly nematodes with extra-intestinal migration. Moreover, antibodies do not necessarily reflect an active infection; so detection and quantification of circulating antigens may provide appropriate and timely information for treatment, which prevents irreversible damage. Here we report the standardization of a monoclonal antibody based antigen capture ELISA to diagnose human toxocariasis without cross-reaction.

Methods

We developed anti-T. canis polyclonal antibodies in rabbits and a monoclonal antibody in mouse which did not cross-react with 15 antigens from several parasites. The sandwich ELISA standardization was performed using sera from mice experimentally infected. We tested the method using 29 positive and 58 negative human sera previously typified with a commercial kit, which detects antibodies.

Results

Only 5.0 μg/mL and 10 μg/mL polyclonal antibodies and monoclonal antibody, respectively, were needed in the sandwich ELISA standardization, detecting since 440 pg/mL larva antigens. Nine out of 29 antibody-positive sera were also positive for antigens and no false positive were found. Taking the antibody kit as the reference standard, the sensibility and specificity of the antigen test were 31% and 100%, respectively.

Conclusions

With these tools we established a detection threshold as low as 440 pg/mL antigen. Monoclonal antibody is specific, and did not cross-react with antigens from other parasites. Detection of circulating antigens helps provide appropriate and timely treatment and prevents irreversible damage.

Intraepithelial giardia intestinalis: a case report and literature review

The giardiasis is a neglected parasitic disease. The WHO has estimated more than 280 million of human infections each year; however, intraepithelial giardiasis is a rare entity, there are only 5 reports showing invasive giardiasis. A pediatric female patient with chronic abdominal pain, diarrhea, or pasty stools, without fever, was seen in the Gastroenterology and Nutrition Service. The stool studies were negative for pathogens and lactose hydrogen breath test was positive. The presumptive clinical diagnosis was giardiasis and the patient was empirically treated with nitazoxanide. But, the patient persisted with abdominal pain and pasty stools. Endoscopy was indicated to search for Helicobacter and Giardia. Guardian and patient gave written informed consent. Hematological profile was normal. The endoscopy was performed under general anesthesia and the biopsies and duodenal aspirate were obtained. The microscopic analyses of duodenal fluid showed Giardia trophozoites. Electron microscopic analysis was negative for Helicobacter pylori, but Giardia trophozoites with a typical crescent shape within the tissue were found. The patient was treated with tinidazole, subsequent tests showed that lactose absorption was normal, stool examinations were negative for Giardia and abdominal pain had stopped. This case suggest that intraepithelial giardiasis could be a common entity but unseen because the giardiasis diagnosis is usually made on fecal samples. Future studies are necessary to determine the role of intraepithelial trophozoites in giardiasis pathogenic mechanisms.

[Microsporidia in pediatric patients with leukemia or limphoma]

INTRODUCTION

Microsporidia are intracellular micro-organisms, characterized by mature spores with chitin walls and by one extrusive polar tube through which they pour their sporoplasm to the host cells. In immunocompromised patients, Enterocytozoon bieneusi and Encephalitozoon intestinalis produce diarrhea and systemic dissemination. In Mexico there is not information about microsporidia in children with cancer.

OBJECTIVE

The aim of this pilot study was to investigate the presence of microsporidia species in pediatric patients with leukemia or lymphoma.

MATERIAL AND METHODS

We obtained fecal samples from thirteen patients. The samples were processed to detect microsporidia by both modified Ziehl-Neelsen and clacofluor white stains, DNA was isolated to amplify rRNA specific sequences, to identify E. bieneusi, E. intestinalis, E. cuniculi and E. hellem by DNA polymerase chain reaction (PCR). Other parasites and pathogenic bacteria were also tested.

RESULTS

Based on morphologic traits 7/13 samples were found positives to microsporidia and 6/10 by PCR. Was identified E. bieneusi in three patients with leukemia and one with lymphoma, another two children with leukemia were infected with E. intestinalis. Almost all children were high-risk patients and in phase of re-induction, consolidation or with many chemotherapy treatments. All the patients with microspiridia did not present diarrhea at the moment of the sampling; however, in two children with diarrhea it was found Cyclospora cayetanensis. Also we obtained feces from five patients' mothers and microsporidia spores were identified by stain in all of them and by PCR it was diagnosed the species in three of them.

CONCLUSION

It was demonstrated that the feces of patients with leukemia or lymphoma had microsporidia, therefore is necessary to know the prevalence of these microorganisms and to analyze their impact in evolution of cancer patients.

Goblet cells: are they an unspecific barrier against Giardia intestinalis or a gate?

Giardiosis is one of the major intestinal parasitic diseases of human beings as well as wild and domesticated animals. Several protective mechanisms against infection have been described. However, specific information about relationship between giardiosis and the increased proliferation of goblet cells (GC) in patients infected with Giardia intestinalis (Syn. G. duodenalis, G. lamblia) is scarce. In this work, we compare and quantify the number of GC, and have inferred their metabolic state in the small intestine of dogs parasitized with Giardia intestinalis compared to dogs without parasites. Small intestine segments were processed using routine methods for histology and electron microscopy; areas and cells were screened with an Axiovision Ver. 4.0 system. Data were analyzed by ANOVA and comparison of averages. Parasitized dogs showed higher GC numbers than nonparasitized ones. Averages were: 20+/-0.81 GC/25 microm(2) with independent mucin granules and 11+/-1.53 GC/25 microm(2) that were expelling mucus, compared to 11+/-0.94 GC/25 microm(2) and 1+/-0.27 GC/25 microm(2), respectively, in nonparasitized dogs (Tukey, p<0.001). The increases in GC number seem to be an unspecific defensive mechanism against Giardia trophozoites. However, we found some evidence supporting that GC hyperplasia could be a prejudicial to epithelial barrier that gives rise to gates allowing for Giardia-tissue invasion.

A simple and inexpensive in vitro method for retrieving fertilized Toxocara canis eggs

The erratic migration of nematode larvae is potentially deleterious for humans, especially those produced by Toxocara roundworms. Diagnosis of human toxocariosis: visceral larva migrans depends on antibody detection against excretions-secretions (E/S) from Toxocara larvae by enzyme-linked immunosorbent assay. In the present work, we wish to propose a simple and cheap culture procedure for keeping T. canis female worms alive. We removed living worms from the small intestine of euthanized puppies at the Canine Control Centre "Culhuacan" in the Southern part of Mexico City. To ascertain the utility of the method, we compared the population size of fertilized eggs from both female worms kept in culture (FCM) and those obtained using uterus excision method (UEM). Operationally, a fertilized egg develops a larva after 1 month. Our results show that the culture method was superior at a ratio of 3:1 over UEM. FCM had advantages over UEM, such as (1) low probability of contamination with foreign antigens, (2) greater safety for infective egg manipulation, and (3) gave rise to a higher percentage of fertile eggs.

Oregano (Lippia spp.) kills Giardia intestinalis trophozoites in vitro: antigiardiasic activity and ultrastructural damage

In the world, giardiosis is still a very important parasitic disease; only in Asia, Africa and America, there are more than 200 million of infected people in a year. The usual treatments are drugs that produce undesirable secondary effects, perhaps favouring the resistant strain selection. One alternative is to research compounds from plants used as antidiarrhoeic or antiparasitic in the traditional medicine. In a previous work, we found that Lippia beriandieri (Oregano) revealed to be more potent than tinidazole, a common antigiardiasic drug. In this current work, we tested the cell viability by re-culture and reduction of MTT-tetrazolium salts to MTT-formazan, and we showed the effect of oregano ethanolic extracts against Giardia intestinalis (synonyms: Giardia duodenalis, Giardia lamblia) trophozoites at concentrations ranging form 58 to 588 microg. We demonstrated the ultrastructural injury produced by oregano extracts in this parasite. Trophozoites lost their size and shape and showed damage in nucleus structure, perhaps by breaking the pattern of nucleoskeleton proteins.

Giardia intestinalis and other zoonotic parasites: Prevalence in adult dogs from the southern part of Mexico City

The protozoan Giardia intestinalis is a mammalian-infecting parasite. It produces diarrhoea and malabsorption in its hosts. There is growing evidence that dogs could be reservoirs and play an important role in transmission. In Mexico, there are few data on the frequency of G. intestinalis. Therefore, we studied the small intestine of stray dogs, euthanazed at the "Culhuacan" Control Canine Centre, towards the end of 1997 and during the summer of 1998. We microscopically analysed intestinal contents and mucus samples taken every 3cm. During the cold season (winter), parasites were not found in 38/100 dogs, in contrast to 8/100 through the warm season. We found that 42/100 in winter and 51/100 in summer harboured G. intestinalis. To our knowledge, these G. intestinalis frequencies are the highest found in adult dogs worldwide. The results showed a rise in Ancylostoma spp. from 23/100 to 67/100 during the cold and warm seasons. Toxocara canis frequencies varied between 12/100 and 18/100, respectively. The data suggest that the probability of infection is higher during the hottest months compared to the coldest months of the year. Both puppies and adult dogs are highly infected. Dogs are reservoirs for zoonotic parasites; for this reason, it is imperative for humans to avoid fecal contamination in streets, public gardens and parks.

[In vitro measurement of nitazoxanide sensitivity of 4 Giardia duodenalis isolates obtained from different hosts]

BACKGROUND

In Mexico giardiosis is the most prevalent parasitic disease in children. Treatment with antiparasitics derived from: nitroimidazoles, benzimidazoles and nitrofuranes have been used; but, some of them have undesirable side effects. Recently nitazoxanide (Ntz) was introduced in Mexico; however, there are few studies on Giardia duodenalis susceptibility to Ntz.

OBJECTIVE

To determine G. duodenalis sensitivity to Ntz and compare it to tinidazole (Tnz).

MATERIAL AND METHODS

Assays were performed in four G. duodenalis isolates: INP231087MM, INP210897-AXA1 obtained from humans infections, INP170693HG8, INP300693-CP5 from a cat and a dog, respectively. Half million trophozoites were exposed to different Ntz or Tnz concentrations in TYI-S-33, for 24 hours at 37 degrees C. Trophozoite viability was tested by the colorimetric method of MTT-tetrazolium salts reduction to MTT-formazan. To analyze ultrastructural damage, control and experimental samples were processed by standard electron microscopy methods. Experiments were carried out, in a double blind in triplicate and repeated four times. Results were analyzed by variance analysis.

RESULTS

Susceptibility at 100% were in a Ntz concentration ranging from 1 microgram to 7 micrograms and in a Tnz concentration ranging from 1 microgram to 4 micrograms. There were significant differences when sensitivities to Ntz were compared between them (P < 0.001). The ultrastructural analysis showed changes in trophozoite volume, loss of characteristic shape and swelling.

CONCLUSIONS

This is the first report of G. duodenalis susceptibility to Ntz performed in isolates from different hosts. G. duodenalis isolates were more susceptible to Tnz than Ntz.

[Cyclospora in 2 Mexican children]

We report two patients, one symptomatic and another asymptomatic, infected with Cyclospora an enteropathogen recently described. The symptoms were: abdominal pain, hiporexia, vomit, bruxism, watery diarrhea 3 or 4 times in a day but self-limiting after 24 to 72 hours. In both children there were unsporulated oocysts with a diameter of 8.44 +/- 0.146 microns detected in feces concentrated by Faust's technique; the confirmation was achieved with a Ziehl-Neelsen stain and the observation of sporulated oocysts (two sporocysts per oocyst). In Mexico, Cyclospora is perhaps overlooked or it is mistaken with oocysts of Cryptosporidium.

[In vitro effect against Giardia of 14 plant extracts]

OBJECTIVE

To investigate antigiardiasic activity in plants used in Mexico as antidiarrheics and/or antiparasitics.

MATERIALS AND METHODS

Fourteen species were evaluated. The antigiardiasic activity was measured in vitro in a blinded fashion using trophozoites of Giardia duodenalis incubated with plant extracts. The viability of trophozoites was ascertained using MTT (3-[4,5-dimethylthiazol-2-il]-2, 5-diphenyl tetrazolium bromide) which is reduced to MTT-formazan by the activity of live trophozoites. The reduced MTT was extracted with an acidified alcohol (2-propanol with HCI 0.04 M) and measured in a spectrophotometer at 570 nm. Negative (trophozoites without extract) and positive controls (incubated with tinadazol) were included.

RESULTS

The scientific and trivial names of the plants are given (trivials in Spanish marked by an asterisk). They had the following trophozoite mortality (mean +/- SD in percent): Justicia spicigera (muicle*) = 91 +/- 0.5; Lipia beriandieri (oregano) = 90 +/- 0.6; Psidium guajava (guava) = 87 +/- 1.0; positive control of tinidazol = 79 +/- 1.9; Punica granutus (granado*) = 78 +/- 1.3; Magnifera indica (mango) = 77 +/- 1.0; Plantago major (lante*) = 76 +/- 1.2; Cupressus semperbirens (cipres) = 73 +/- 1.2; Castella tormentosa (chaparro amargoso*) = 70 +/- 0.7; Hematoxilon campechanum (palo de Campeche*) = 67 +/- 1.2. Without or with a low mean activity were Prosopis juliflora (mesquite*) and Rizophora mangle (mangle*) with 0%, Oriza sativa (rice) with 5%, Capsicum annum (pimiento*) with 21% and Persea americana (avocado) with 23%. There were no associations of the antigiardiasic effect with concentration or osmolality of the extracts.

CONCLUSIONS

A clear in vitro antigiardiasic effects was seen in nine species. Three of them were superior to tinidazol which is a drug of common use in the treatment of giardiasis.

[Giardia duodenalis: analysis of malic enzyme expression with isoelectric focusing]

We wish to propose a data base of the isoelectric point (pl) for Giardia duodenalis isozymes [corrected]. As a contribution to this end we characterized by electrophoresis the isozymes of the malic enzyme (ME) of ten G. duodenalis isolates from Mexican children. Isoelectric focusing was performed in a vertical system using a one mm slab gel of 5.5% acrylamide prepared with 6.5% carrier ampholytes, pH 3-10, and 10% glycerol. Each test sample (10 micrograms) and a series of protein markers of known pl were applied in duplicate, and a minimum of six samples for each isolate were prefocused at 1.5 W, 200 V for 0.25 hour and focused at 2100 volt-hour, 3 W, 800 V. With the regression equation for protein markers Y = 1.886 + 5.709(X) (standard error for X = 0.001 and Y = 0.136), we calculated the pls for each isozyme of the malic enzyme detected in the G. duodenalis isolates. The pl of the isozymes were between 5.70-7.63 and the clone INP-100588-CMG1 was different from the parental isolates in three isozymes: pl 7.34, 7.16 and 6.99. The determination of isoelectric points of the isozymes of other enzymes of Giardia duodenalis should be a useful tool for the detection of their genetic variability by numeric comparison.