Entamoeba histolytica: Membrane and Non-Membrane Protein Structure, Function, Immune Response Interaction, and Vaccine Development

Entamoeba histolytica is a protozoan parasite that is the causative agent of amoebiasis. This parasite has caused widespread infection in India, Africa, Mexico, and Central and South America, and results in 100,000 deaths yearly. An immune response is a body's mechanism for eradicating and fighting against substances it sees as harmful or foreign. E. histolytica biological membranes are considered foreign and immunogenic to the human body, thereby initiating the body's immune responses. Understanding immune response and antigen interaction are essential for vaccine development. Thus, this review aims to identify and understand the protein structure, function, and interaction of the biological membrane with the immune response, which could contribute to vaccine development. Furthermore, the current trend of vaccine development studies to combat amoebiasis is also reviewed.

Assessing the prevalence and risk factors associated with Entamoeba complex infection among the Orang Asli school children in Perak, Malaysia through molecular approach

This study performed a cross-sectional investigation on the prevalence of Entamoeba complex infection comprising Entamoeba histolytica, Entamoeba dispar, and Entamoeba moshkovskii and their associated risk factors among the Orang Asli school children in three districts in Perak, Malaysia. Stool samples collected from 544 school children aged between 7 and 12 years old were examined through the nested multiplex PCR assay. The univariate and multivariate regression analyses were then carried out to determine the risk factor associated with Entamoeba complex infection. The overall prevalence of Entamoeba complex infections (E. histolytica, E. dispar and E. moshkovskii) was 21.3% (116/544). Most positive school children were infected with E. moshkovskii (10.7%; 58/544), followed by E. dispar (9.0%; 49/544) and E. histolytica (5.0%; 27/544). Not washing their hands after using the toilet was identified as the only significant risk factor for E. histolytica. The significant risk factors associated with E. moshkovskii infection included children within the age of 10-12 years old, with high BMI, living with working and non-educated mothers, no toilet in the house, not washing their hands after using the toilet, and fever. On the other hand, drinking water from the river, well, and rain was associated with a decreased risk of E. dispar infection. In conclusion, this study showed a high prevalence of Entamoeba spp. infections among the Orang Asli school children in Perak, Malaysia. Addressing the identified risk factors coupled with a holistic approach in breaking the transmission of Entamoeba complex can help improve their quality of life.

A Review: Natural and Synthetic Compounds Targeting Entamoeba histolytica and Its Biological Membrane

Amoebiasis is the third most common parasitic cause of morbidity and mortality, particularly in countries with poor hygienic settings in central and south America, Africa, and India. This disease is caused by a protozoan parasite, namely Entamoeba histolytica, which infects approximately 50 million people worldwide, resulting in 70,000 deaths every year. Since the 1960s, E. histolytica infection has been successfully treated with metronidazole. However, there are drawbacks to metronidazole therapy: the side effects, duration of treatment, and need for additional drugs to prevent transmission. Previous interdisciplinary studies, including biophysics, bioinformatics, chemistry, and, more recently, lipidomics studies, have increased biomembranes’ publicity. The biological membranes are comprised of a mixture of membrane and cytosolic proteins. They work hand in hand mainly at the membrane part. They act as dedicated platforms for a whole range of cellular processes, such as cell proliferation, adhesion, migration, and intracellular trafficking, thus are appealing targets for drug treatment. Therefore, this review aims to observe the updated trend of the research regarding the biological membranes of E. histolytica from 2015 to 2021, which may help further research regarding the drug targeting the biological membrane.

Molecular Prevalence of Ent amoeba histolytica and Ent amoeba dispar Infection among Aboriginal Communities in the Southern Region of Perak, Malaysia

INTRODUCTION: In Malaysia, there are little up-to-date data on the prevalence of Ent amoeba spp. and most of the previous studies were carried out using the conventional insensitive method of stool microscopic examinations. MATERIALS AND METHODS: A cross-sectional study was conducted from September 2018 to Mac 2019 in the three villages of Orang Asli communities at Slim River, Perak using the molecular assay. Risk factors associated with Ent amoeba spp. infection was assessed by analysing questionnaire responses obtained from the study participants. RESULTS: From the 55 stool samples collected, molecular prevalence revealed 7.3% and 9.1% E. histolytica and E. dispar infection respectively. Infection was due to indiscriminate defecation and not washing hands after playing with soil or gardening, as well as associated with gastrointestinal symptoms. CONCLUSION: This study showed that there is still an ongoing transmission of Ent amoeba spp. among the studied population, thus warrants the implementation of specific prevention and control strategies of this infection in Malaysia.

Multi-Laboratory Evaluation of a Lateral Flow Rapid Test for Detection of Amebic Liver Abscess

Independent evaluations of XEh Rapid^®, an IgG4-based rapid dipstick test, were performed to assess its diagnostic performance to detect amebic liver abscess (ALA) using 405 samples at seven laboratories in four countries. The test showed high diagnostic specificity (97-100%) when tested with samples from healthy individuals (n = 100) and patients with other diseases (n = 151). The diagnostic sensitivity was tested with a total of 154 samples, and the results were variable. It was high in three laboratories (89-94%), and moderate (72%) and low (38%) in two other laboratories. Challenges and issues faced in the evaluation process are discussed. Nevertheless, XEh Rapid is promising to be developed into a point-of-care test in particular for resource-limited settings, and thus merits further confirmation of its diagnostic sensitivity.

In Vitro Testing of Potential Entamoeba histolytica Pyruvate Phosphate Dikinase Inhibitors

Adverse effects and resistance to metronidazole have motivated the search for new antiamoebic agents against Entamoeba histolytica. Control of amoeba growth may be achieved by inhibiting the function of the glycolytic enzyme and pyruvate phosphate dikinase (PPDK). In this study, we screened 10 compounds using an in vitro PPDK enzyme assay. These compounds were selected from a virtual screening of compounds in the National Cancer Institute database. The antiamoebic activity of the selected compounds was also evaluated by determining minimal inhibitory concentrations (MICs) and IC₅₀ values using the nitro-blue tetrazolium reduction assay. Seven of the 10 compounds showed inhibitory activities against the adenosine triphosphate (ATP)/inorganic phosphate binding site of the ATP-grasp domain. Two compounds, NSC349156 (pancratistatin) and NSC228137 (7-ethoxy-4-[4-methylphenyl] sulfonyl-3-oxido-2, 1, 3-benzoxadiazol-3-ium), exhibited inhibitory effects on the growth of E. histolytica trophozoites with MIC values of 25 and 50 μM, and IC₅₀ values of 14 and 20.7 μM, respectively.

Development and initial evaluation of a lateral flow dipstick test for antigen detection of Entamoeba histolytica in stool sample

Entamoeba histolytica infection remains a public health concern in developing countries. Early diagnosis of amoebiasis can avoid disease complications, thus this study was aimed at developing a test that can rapidly detect the parasite antigens in stool samples. Rabbits were individually immunized with recombinant pyruvate phosphate dikinase (rPPDK) and E. histolytica excretory-secretory antigens to produce polyclonal antibodies. A rapid dipstick test was produced using anti-rPPDK PAb lined on the dipstick as capture reagent and anti-EhESA PAb conjugated to colloidal gold as the detector reagent. Using E. histolytica-spiked in stool sample of a healthy individual, the detection limit of the dipstick test was found to be 1000 cells ml^-1. Meanwhile when rPPDK was spiked in the stool sample, the minimum concentration detected by the dipstick test was 0.1 μg ml^-1. The performances of the dipstick, commercial Techlab E. histolytica II enzyme-linked immunosorbent assays (ELISA) and real-time PCR were compared using 70 stool samples from patients infected with Entamoeba species (n = 45) and other intestinal pathogens (n = 25). When compared to real-time PCR, the diagnostic sensitivity of the dipstick for detection of E. histolytica was 65.4% (n = 17/26); while the diagnostic specificity when tested with stool samples containing other intestinal pathogens was 92% (23/25). In contrast, Techlab E. histolytica II ELISA detected 19.2% (5/26) of the E. histolytica-positive samples as compared to real-time PCR. The lateral flow dipstick test produced in this study enabled rapid detection of E. histolytica, thus it showed good potential to be further developed into a diagnostic tool for intestinal amoebiasis.

Production of Toxocara cati TES-120 Recombinant Antigen and Comparison with its T. canis Homolog for Serodiagnosis of Toxocariasis

Toxocariasis is a cosmopolitan zoonotic disease caused by the infective larvae of Toxocara canis and T. cati. Diagnosis in humans is usually based on clinical symptoms and serology. Immunoglobulin G (IgG)-enzyme-linked immunosorbent assay kits using T. canis excretory-secretory (TES) larval antigens are commonly used for serodiagnosis. Differences in the antigens of the two Toxocara species may influence the diagnostic sensitivity of the test. In this study, T. cati recombinant TES-120 (rTES-120) was cloned, expressed, and compared with its T. canis homolog in an IgG4-western blot. The diagnostic sensitivity and specificity of T. cati rTES-120 were 70% (33/47) and 100% (39/39), respectively. T. canis rTES-120 showed 57.4% sensitivity and 94.4% specificity. When the results of assays using rTES-120 of both species were considered, the diagnostic sensitivity was 76%. This study shows that using antigens from both Toxocara species may improve the serodiagnosis of toxocariasis.

Production of recombinant Entamoeba histolytica pyruvate phosphate dikinase and its application in a lateral flow dipstick test for amoebic liver abscess

Background

Amoebic liver abscess (ALA) is the most common clinical manifestation of extraintestinal amoebiasis especially in developing countries, causing up to 100 000 fatal cases annually. Accurate and early diagnosis is important to prevent the disease complications, however its diagnosis still poses many challenges due to the limitations of the available detection tools. Pyruvate phosphate dikinase (PPDK), an excretory-secretory protein of E. histolytica, has been reported as a potential diagnostic marker for ALA, hence it may be exploited in the development of a new test for ALA.

Methods

Recombinant PPDK (rPPDK) was expressed, purified and evaluated by Western blot. In parallel, recombinant galactose-and-N-acetyl-D-galactosamine inhibitable lectin (Gal/GalNAc lectin) was produced and tested similarly. The protein identity was confirmed by analysis using MALDI-TOF/TOF. A lateral flow dipstick (LFD) test using rPPDK was subsequently developed (rPPDK-LFD) and evaluated for serodiagnosis of ALA.

Results

rPPDK was expressed as soluble protein after 4 hours of induction with 1 mM isopropyl β-D-1-thiogalactopyranoside (IPTG) at 30°C. Purification using nickel-nitrilotriacetic acid (Ni-NTA) resin yielded 1.5 mg of rPPDK from 1 L of culture with estimated molecular mass of 98 kDa on SDS-PAGE. Western blots using sera from patients with ALA, healthy individuals and other diseases probed with anti-human IgG₄-HRP showed the highest sensitivity (93.3%) and specificity (100%); as compared to blots using IgG and IgG₁ as secondary antibodies. Moreover, rPPDK showed better specificity when compared to rGal/GalNAc lectin. In the development of the LFD test, the optimum amount of rPPDK was 0.625 μg per dipstick and the optimum working concentration of colloidal gold conjugated anti-human IgG₄ was optical density (OD) 5 (1.7 μg of anti-human IgG₄). Evaluation of rPPDK-LFD using ALA patients and controls serum samples showed 87% diagnostic sensitivity and 100% specificity.

Conclusion

The developed rPPDK-LFD showed good potential for rapid diagnosis of ALA, and merit further multicentre validation using larger number of serum samples.

Vitamin A-fortified monosodium glutamate and vitamin A status: a controlled field trial

A controlled trial of fortification of crystalline monosodium glutamate (MSG) with 810 micrograms RE vitamin A/g was undertaken in an area of endemic vitamin A deficiency in Indonesia. Powdered MSG was used to mask the yellow color of the vitamin A. Fortified MSG was marketed through ordinary channels in five villages in the program area and five nearby villages served as the control area. The product retained 84% of its potency after 4 mo and 57% after 11 mo in the marketplace. Base-line serum and breast-milk vitamin A levels were slightly higher in the control areas. Follow-up serum levels increased dramatically in program villages, 0.67 +/- 0.33 at prefortification base line to 0.92 +/- 0.33 mumol/L (p less than 0.001) at 11 mo after introduction of the fortified product. Breast-milk levels also rose, from 0.60 +/- 0.29 at base line to 0.67 +/- 0.30 mumol/L at 11 mo (p less than 0.05). Serum and breast-milk levels in control villages did not change.