Anti-Opisthorchis felineus effects of artemisinin derivatives: An in vitro study

BACKGROUND

The drug of choice for the treatment of opisthorchiasis caused by trematodes Opisthorchis viverrini and O. felineus is praziquantel (PZQ), but there is a constant search for new anthelmintics, including those of plant origin. Positive results on the use of artemisinin derivatives against O. viverrini opisthorchiasis have been shown previously, but the effect of these compounds on O. felineus has not been studied. Therefore, here, a comparative analysis of anthelmintic properties of artemisinin derivatives (artesunate [AS], artemether [AM], and dihydroartemisinin [DHA]) was carried out in vitro in relation to PZQ. Experiments were performed on newly excysted metacercariae (NEMs) and adult flukes of O. felineus.

RESULTS

Dose- and time-dependent effects of artemisinin derivatives and of PZQ were assessed in terms of motility and mortality of both NEMs and adult flukes. The most pronounced anthelmintic action was exerted by DHA, whose half-maximal inhibitory concentrations (IC50) of 1.9 (NEMs) and 2.02 µg/mL (adult flukes) were lower than those of PZQ (0.56 and 0.25 µg/mL, respectively). In contrast to PZQ, the effects of DHA and AS were similar when we compared the two developmental stages of O. felineus (NEMs and adult flukes). In addition, AM, AS, and especially DHA at doses of 100 µg/mL disrupted tegument integrity in adult flukes, which was not observed with PZQ.

CONCLUSIONS

Artemisinin derivatives (AS, AM, and DHA) have good anthelmintic efficacy against the trematode O. felineus, and the action of these substances is comparable to (and sometimes better than) the effects of PZQ.

Characterization and in vitro functional analysis of thioredoxin glutathione reductase from the liver fluke Opisthorchis viverrini

The carcinogenic liver fluke Opisthorchis viverrini causes several hepatobiliary diseases including a bile duct cancer-cholangiocarcinoma (CCA), which is a major public health problem in many countries in the Greater Mekong Sub-region. Praziquantel is the main drug against this parasite, however, reduced drug efficacy has been observed in some endemic areas. Therefore, alternative drugs are needed to prepare for praziquantel resistance in the future. The selenoprotein thioredoxin glutathione reductase (TGR) enzyme, which plays a crucial role in cellular redox balance of parasitic flatworms, has been shown as a potential drug target against these parasites. Hence, this study aimed to investigate the TGR of O. viverrini and assess its potential as a drug target. An open reading frame (ORF) that encodes O. viverrini TGR (Ov-TGR) was cloned from an O. viverrini cDNA library and the nucleotide were sequenced. The 1,812 nucleotides of the Ov-TGR full ORF encoded a polypeptide of 603 amino acid residues with a predicted molecular mass of 66 kDa. The putative amino acid sequence shared 55-96.8% similarities with TGRs from other helminths and mammals. Phylogenetic analysis revealed a close relationship of Ov-TGR with that of other trematodes. The ORF of Ov-TGR was inserted into pABC2 plasmid and transformed into Escherichia coli strain C321.ΔA to facilitate selenocysteine incorporation. The recombinant Ov-TGR (rOv-TGR-SEC) was expressed as a soluble protein and detected as a dimer form in the non-reducing sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Its thioredoxin reductase (TrxR) and glutathione reductase (GR) activities were detected using DTNB, Trx and GSSG substrates with the Michaelis constant (Km) of 292.6 ± 52.3 µM, 8.09 ± 1.91 µM and 13.74 ± 1.2 µM, respectively. The TGR enzyme activities were effectively inhibited by a well-known inhibitor, auranofin in a dose-dependent manner. Moreover, auranofin expressed a lethal toxic effect on both newly excysted juveniles (NEJs) and adult worms of O. viverrini in vitro. Taken together, these results indicated that Ov-TGR is crucial for O. viverrini survival and maybe a potential target for the development of novel agents against opisthorschiasis.

Current and Novel Therapies Against Helminthic Infections: The Potential of Antioxidants Combined with Drugs

Infections caused by Schistosoma haematobium and Opisthorchisviverrini are classified as Group 1 biological carcinogen and it has been postulated that parasites produce oxysterol and estrogen-like metabolites that might be considered as initiators of infection-associated carcinogenesis. Chemotherapy for these helminthic infections relies on a single drug, praziquantel, (PZQ) that mainly targets the parasite. Additionally, PZQ has some major drawbacks as inefficacy against juvenile form and alone it is not capable to counteract pathologies associated to infections or prevent carcinogenesis. There is an urgent need to develop novel therapeutic approaches that not only target the parasite but also improve the pathologies associated to infection, and ultimately, counteract or/and prevent the carcinogenesis processes. Repurposing the drug in combination of compounds with different modes of action is a promising strategy to find novel therapeutics approaches against these helminthic infections and its pathologies. Here, we emphasized that using antioxidants either alone or combined with anthelmintic drugs could ameliorate tissue damage, infection-associated complications, moreover, could prevent the development of cancer associated to infections. Hence, antioxidants represent a potential adjuvant approach during treatment to reduce morbidity and mortality. Despite the success of some strategies, there is a long way to go to implement novel therapies for schistosomiasis.

Inhibition of the Formation In Vitro of Putatively Carcinogenic Metabolites Derived from S. haematobium and O. viverrini by Combination of Drugs with Antioxidants

Infections caused by Schistosoma haematobium and Opisthorchis viverrini are classified as carcinogenic. Although carcinogenesis might be a multifactorial process, it has been postulated that these helminth produce/excrete oxysterols and estrogen-like metabolites that might act as initiators of their infection-associated carcinogenesis. Current treatment and control of these infections rely on a single drug, praziquantel, that mainly targets the parasites and not the pathologies related to the infection including cancer. Thus, there is a need to search for novel therapeutic alternatives that might include combinations of drugs and drug repurposing. Based on these concepts, we propose a novel therapeutic strategy that combines drugs with molecule antioxidants. We evaluate the efficacy of a novel therapeutic strategy to prevent the formation of putative carcinogenic metabolites precursors and DNA adducts. Firstly, we used a methodology previously established to synthesize metabolites precursors and DNA adducts in the presence of CYP450. Then, we evaluated the inhibition of their formation induced by drugs and antioxidants alone or in combination. Drugs and resveratrol alone did not show a significant inhibitory effect while N-acetylcysteine inhibited the formation of most metabolite precursors and DNA adducts. Moreover, the combinations of classical drugs with antioxidants were more effective rather than compounds alone. This strategy might be a valuable tool to prevent the initiation of helminth infection-associated carcinogenesis.

Efficacy and safety of tribendimidine against Opisthorchis viverrini: two randomised, parallel-group, single-blind, dose-ranging, phase 2 trials

BACKGROUND

Treatment of the liver fluke infection Opisthorchis viverrini relies exclusively on praziquantel. Tribendimidine could be an alternative treatment option. We aimed to assess the efficacy and safety of ascending single, oral doses of tribendimidine in patients with O viverrini infection.

METHODS

We did two randomised, parallel-group, single-blind, dose-ranging, phase 2 trials in children (aged 8-14 years) and adults and adolescents (≥15 years) in three O viverrini endemic villages in Champasack province, southern Laos. Patients with O viverrini infection were randomly assigned, via a computer-generated central block-randomisation procedure, with block sizes of three (study 1) and four, eight, and 12 (study 2), to receive oral tribendimidine at doses of 200 mg, 400 mg, or 600 mg in a 1:1:1 ratio (adults and adolescents in study 1); 25 mg, 50 mg, 100 mg, or 200 mg (four 50 mg tablets) in a 1:1:1:1 ratio (adults and adolescents in study 2); or 100 mg, 200 mg, or 400 mg in a 1:1:1 ratio (children in study 1). One non-randomised group of children received tribendimidine 50 mg (study 2). Participants, investigators, and laboratory technicians doing the diagnostic assessments were masked to group assignment, but the investigator administering treatment could have recognised the treatment group based on the number of tablets. The primary objective was to estimate the dose-response relation in terms of cure rate and egg reduction rate. We did available-case analysis of all patients with primary endpoint data. We predicted dose-response associations with Emax models. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN96948551.

FINDINGS

Between Oct 25, 2012, and Nov 5, 2013, 318 adolescents and adults were randomly assigned to seven tribendimidine dose groups: 200 mg (n=51), 400 mg (n=49), or 600 mg (n=47) in study 1, and 25 mg (n=39), 50 mg (n=47), 100 mg (n=44), or 200 mg (four 50 mg tablets; n=41) in study 2. 128 children were randomly assigned to receive tribendimidine 100 mg (n=44), 200 mg (n=40), or 400 mg (n=44) in study 1; 39 children were enrolled and received tribendimidine 50 mg in study 2. In adolescents and adults, the number of patients cured increased with increasing tribendimidine doses up to 100 mg: ten of 39 patients (25·6%, 95% CI 13·0-42·1) were cured in the 25 mg group, 20 of 47 patients (42·6%, 28·3-57·8) were cured in the 50 mg group, and 34 of 44 patients (77·3%, 62·2-88·5) were cured in the 100 mg group; geometric mean egg reduction rates were 86·9% (95% CI 74·8-93·4), 95·9% (92·7-97·7), and 99·1% (98·2-99·7), respectively. The 200 mg dose resulted in cure in 40 of 47 (83·0%, 69·2-92·5) adolescents and adults given the 200 mg tablet and 25 of 41 (61·0%, 95% CI 44·5-75·8) of those given four 50 mg tablets; the 400 mg dose resulted in cure in 43 of 47 patients (91·5%, 79·6-97·6) and the 600 mg dose resulted in cure in 36 of 45 patients (80·0%, 65·4-90·4). Corresponding egg reduction rates were 99·8% (95% CI 99·7-100·0) with one 200 mg tablet, 97·9% (95·9-99·2) with four 50 mg tablets, 99·9% (99·8-100·0) with 400 mg, and 99·8% (99·6-99·9) with 600 mg. The Emax model predicted an egg reduction rate of 99·0% (95% CI 95·7-99·8) at 111 mg in adolescents and adults. 50 mg tribendimidine had moderate efficacy in children, with cure recorded in 16 of 39 patients (41·0%, 95% CI 25·6-57·9). The 100 mg dose resulted in cure in 40 of 44 children (98·9%, 95% CI 78·3-97·5) and an egg reduction rate of 99·7% (95% CI 99·0-100·0), with no increased efficacy at higher doses. The Emax model predicted an egg reduction rate of 99·0% (95% CI 92·2-99·9) at 215 mg. Few adverse events were reported and were mostly mild, with few moderate and no serious events. The most common adverse events 3 h after treatment in adolescents and adults were vertigo (n=35 [11%]), headache (n=9 [3%]), nausea (n=6 [2%]), and fatigue (n=4 [1%]), and in children were headache (n=3 [2%]), vertigo (n=2 [1%]), and fatigue (n=2 [1%]).

INTERPRETATION

Tribendimidine has excellent efficacy and tolerability at doses of 100 mg and above. Our study included mainly adults and children with low-intensity O viverrini infection; future studies should assess the efficacy of tribendimidine in patients with infections of moderate and high intensity.

FUNDING

Department for International Development, Medical Research Council, Wellcome Trust Joint Global Health Trials Scheme.

[The problem of opisthorchiasis in Ukraine and current approaches to its treatment]

The opisthorchiasis epidemiological situation in Ukraine and the Sumy Region that has the largest natural focus of invasion has been analyzed. Its morbidity rate is 21.6 per 100,000 population, which is more than 20 times greater than that in Ukraine. The clinical course of the disease in the endemic focus, the attribute of which is the high percentage of its latent form, has been examined. Praziquantel is the most effective drug for the etiotropic therapy of opisthorchiasis.

[Experience of using reamberin for detoxification therapy at the stage of deworming in children with chronic opisthorchiasis]

The study presents data on the reversible aggregation of erythrocytes in 50 children with chronic opisthorchiasis and 45 children with inflammatory diseases of the upper digestive tract without opisthorchiasis (chronic gastroduodenitis, duodenal ulcers), all patients aged from 7 to 17 years. The results of using reamberin for detoxification therapy at the stage of deworming in children with chronic opisthorchiasis are assessed.

Efficacy of praziquantel against Schistosoma mekongi and Opisthorchis viverrini: a randomized, single-blinded dose-comparison trial

Background

Schistosomiasis and opisthorchiasis are of public health importance in Southeast Asia. Praziquantel (PZQ) is the drug of choice for morbidity control but few dose comparisons have been made.

Methodology

Ninety-three schoolchildren were enrolled in an area of Lao PDR where Schistosoma mekongi and Opisthorchis viverrini coexist for a PZQ dose-comparison trial. Prevalence and intensity of infections were determined by a rigorous diagnostic effort (3 stool specimens, each examined with triplicate Kato-Katz) before and 28–30 days after treatment. Ninety children with full baseline data were randomized to receive PZQ: the 40 mg/kg standard single dose (n = 45) or a 75 mg/kg total dose (50 mg/kg+25 mg/kg, 4 hours apart; n = 45). Adverse events were assessed at 3 and 24 hours posttreatment.

Principal Findings

Baseline infection prevalence of S. mekongi and O. viverrini were 87.8% and 98.9%, respectively. S. mekongi cure rates were 75.0% (95% confidence interval (CI): 56.6–88.5%) and 80.8% (95% CI: 60.6–93.4%) for 40 mg/kg and 75 mg/kg PZQ, respectively (P = 0.60). O. viverrini cure rates were significantly different at 71.4% (95% CI: 53.4–84.4%) and 96.6% (95% CI: not defined), respectively (P = 0.009). Egg reduction rates (ERRs) against O. viverrini were very high for both doses (>99%), but slightly lower for S. mekongi at 40 mg/kg (96.4% vs. 98.1%) and not influenced by increasing diagnostic effort. O. viverrini cure rates would have been overestimated and no statistical difference between doses found if efficacy was based on a minimum sampling effort (single Kato-Katz before and after treatment). Adverse events were common (96%), mainly mild with no significant differences between the two treatment groups.

Conclusions/Significance

Cure rate from the 75 mg/kg PZQ dose was more efficacious than 40 mg/kg against O. viverrini but not against S. mekongi infections, while ERRs were similar for both doses.

Trial Registration

Controlled-Trials.com ISRCTN57714676

Parasitic worm infections are of public health importance in Southeast Asia. Particularly, the blood-dwelling Schistosoma mekongi worm, which is acquired by skin contact with the infectious cercariae in freshwater, can lead to liver enlargement. An infection with Opisthorchis viverrini is obtained by consumption of undercooked freshwater fish, and this infection increases the risk of developing cholangiocarcinoma. A single oral dose of 40 mg/kg praziquantel is recommended for mass treatment of schistosomiasis and opisthorchiasis, while at the individual level, a total dose of 75 mg/kg divided into three doses, is currently common practice to treat O. viverrini infection. Diagnosis is based on stool examination under a microscope for detection of worm eggs, but is limited by the low sensitivity of the widely used Kato-Katz technique. In this study, we showed that a 75 mg/kg total dose of praziquantel (50 mg/kg+25 mg/kg given 4 hours apart) cleared significantly more O. viverrini infections than a single 40 mg/kg dose, but no difference was observed for S. mekongi. Solicited adverse event profiles were mainly mild and similar in both groups. Repeated stool examination before and after treatment was essential for an accurate assessment of drug efficacy in terms of cure rate, but showed no effect on assessing egg reduction rates.

Opisthorchiidosis--a review

The discovery history of opisthorchiid flukes dates back more than 200 years. The life cycle of these liver flukes includes prosobranch snails as the first and a big variety of freshwater fish as the second intermediate hosts. Opisthorchis felineus, O. viverrini and Clonorchis sinensis are species of major medical importance, while sporadic cases of human infection with other representatives of this family are also documented in the literature. There are estimations that 17 million people are infected and more than 350 million people are at risk, mainly in Asian countries. Although opisthorchiid flukes live in the bile ducts of the liver and in the gall bladder, they can affect surrounding liver tissue and even other organs. They are also known to induce the production of autoantibodies as well as allergic reactions. However, the main medical significance is their role in the formation of malignant tumors. Since the clinical symptoms are not specific, a diagnosis must be confirmed by parasitological examination or the detection of antibodies. Apart from coproscopical methods, there are more recent and highly specific assays available, like the detection of coproantigen or the detection of DNA. Praziquantel is the drug of choice for the treatment of opisthorchiidosis. In order to prevent infection, consumption of raw flesh of freshwater fish must be avoided.

The Digenea parasite Opisthorchis felineus: a target for the discovery and development of novel drugs

Opisthorchosis is a helminthiasis affecting mainly the hepatobiliary system and pancreas; its most dramatic complication is malignization of the organs infected by the parasites. The causative agents of opisthorchosis are two species of liver flukes, the trematodes belonging to the family Opisthorchiidae--Opisthorchis felineus and O. viverrini. The Chinese liver fluke, Clonorchis sinensis, also member of the family Opisthorchiidae, causes clonorchosis, a disease very close in symptomatology. According to different estimations, up to 40 million people are currently infected with these liver flukes and up to 600-750 million people in Eurasian countries constitute the risk group. These parasites colonize ever-increasing new areas in Eurasia where this disease has never been previously reported. Opisthorchiases are gradually transforming from a local problem of individual geographic regions to a widespead problem; in particular, O. viverrini is now referred to as "an underestimated parasite." As we see it, O. felineus has all the reasons to share this status. First and foremost, the observed expansion is likely to be connected with the ever-increasing intensity of traffic flows and migration of the infection carriers between cities, regions, and countries. This review briefs the characteristics of O. felineus and the other liver flukes persisting in various countries of Eurasia, clinical manifestations of opisthorchosis, the drugs for chemotherapy of trematodiasis, and the strategy for discovery of new antihelminthic drugs.

[Nondrug treatment for opisthorchiasis]

In vitro experimental studies of the antiopisthorchiasis properties of currently available non-drug treatment are ofgreat practical value. The studies demonstrated that the herbal drug ecorsol and the background resonance radiation of the Opisthorchis spectrum exerted an anti-helminthic effect that was evaluated by the marital death and amounted to 83.6 to 96.4%. The experimental studies provided evidence that the background radiation, by using the electromagnetic spectrum of Opisthorchis, had a sufficient helminthocidal effect on mature Opisthorchis felineus in the in vitro experiment, which allows these means to be recommended for the non-drug treatment of chronic opisthorchiasis.

Evaluation of the in vivo activity of tribendimidine against Schistosoma mansoni, Fasciola hepatica, Clonorchis sinensis, and Opisthorchis viverrini

We examined the in vivo activity of tribendimidine against selected trematodes. A single 150-mg/kg dose of tribendimidine achieved a 99.1% reduction of Clonorchis sinensis in rats. A 400-mg/kg dose of tribendimidine reduced Opisthorchis viverrini in hamsters by 95.7%. High doses of tribendimidine showed no activity against Schistosoma mansoni and Fasciola hepatica.

Effect of artesunate and artemether against Clonorchis sinensis and Opisthorchis viverrini in rodent models

Food-borne trematodiasis is an emerging public health problem and there is a need to develop novel treatment options. We examined the in vivo efficacy of single oral doses of artesunate and artemether administered to rodents experimentally infected with either Clonorchis sinensis or Opisthorchis viverrini. Rats infected with adult C. sinensis were administered artesunate or artemether at doses of 75, 150 or 300 mg/kg. Hamsters infected with adult O. viverrini were administered artesunate or artemether at doses of 200, 400 or 600 mg/kg. Treatment efficacy was assessed according to reductions in worm burden compared with infected but untreated control animals. Worm burden reductions of 98.6-100% were found in C. sinensis-infected rats after a single dose of artesunate and artemether at 150 mg/kg. Administration of artesunate and artemether at a dose of 400mg/kg to O. viverrini-infected hamsters resulted in worm burden reductions of 77.6% and 65.5%, respectively. However, both drugs showed toxic effects when administered to O. viverrini-infected hamsters at a dose > or =400mg/kg. Our study demonstrates that artesunate and artemether possess excellent clonorchicidal activities in vivo. These findings provide a foundation for subsequent clinical trials. More laboratory investigations are warranted to investigate further the opisthorchicidal properties of the artemisinins.

iNOS-dependent DNA damage via NF-kappaB expression in hamsters infected with Opisthorchis viverrini and its suppression by the antihelminthic drug praziquantel

Inflammation-mediated DNA damage triggered by Opisthorchis viverrini (OV) infection is a major risk factor of cholangiocarcinoma (CCA). We have recently reported that nitrative and oxidative DNA damage participates in CCA development caused by repeated infection with OV [Pinlaor et al., Carcinogenesis 2004; 25:1535-42]. Therefore, to clarify the preventive effect of the antihelminthic drug praziquantel against cholangiocarcinogenesis, we assessed the effect of this drug on nitrative and oxidative DNA damage, including the formation of 8-nitroguanine and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG), and the expression of inducible nitric oxide synthase (iNOS) by immunohistochemistry in OV-infected hamsters. We also examined the expression of nuclear factor-kappaB (NF-kappaB), which functions as a tumor promoter in inflammation-associated cancer. Our results showed that although 1-week treatment with praziquantel did not kill parasites completely in hamsters on days 14 and 30, this drug dramatically reduced inflammatory cell infiltration. Double immunofluorescence staining showed that drug treatment almost completely diminished OV-induced 8-nitroguanine and 8-oxodG formation in bile duct epithelial cells. Quantitative analysis using an electrochemical detector coupled to HPLC revealed that 8-oxodG level in the liver of OV-infected hamsters was significantly decreased by drug treatment (p<0.05). Western blotting and immunohistochemistry revealed that the expression of NF-kappaB and iNOS in bile duct epithelium was reduced by drug treatment. The amount of nitrate plus nitrite in the liver and plasma was significantly decreased after drug treatment. It is concluded that praziquantel can exhibit a preventive effect against OV-induced cholangiocarcinoma by inhibiting iNOS-dependent DNA damage through not only elimination of parasites but also a potential antiinflammatory effect.

Prevalence of Opisthorchis viverrini infection among villagers harboring Opisthorchis-like eggs

The precise occurrence of Opisthochis viverrini infection in humans, who were positive for Opisthorchis-like eggs in a stool examination, was determined using the potassium permanganate staining method. In the 68 specimens examined, there were more individual O. viverrini eggs (38.24%) than singular Haplorchis taichui eggs (29.41%). One-fourth of the total specimens contained a mixed infection of O. viverrini and H. taichi eggs. The median ratio of O. viverrini: H. taichui eggs in mixed infection cases was 2.29 (min = 1, max = 17.5). It is suggested that chemotherapy with praziquentel treatment should be given to patients who are positive for O. viverrini-like eggs.

[Adaptability of Opisthorchis felineus metacercariae as a result of altered phagocytic activity of polymorphonuclear neutrophils]

The higher absorptivity of neutrophils during their alpha-tocopherol stimulation has been found to promote lower adaptability in the metacercariae of Opisthorchis felineus, a reverse picture was observed when cyclophosphanum was used. The antihelminthic effect of biltricide is probably to be unassociated with the changed functional activity of polymorphonuclear leukocytes, but to be determined by its direct action on helminths. This phenomenon was studied on golden hamsters inoculated with Opisthorchis felineus. On day 2 after inoculation, the following drugs were given for a fortnight: biltricide in a single dose of 60 mg/kg weight; biltricide used in a daily fractionated dose of 60 mg/kg; cyclophosphanum (6 mg/kg, every second day); alpha-tocopherol in a daily dose of 30 mg every day.

[The disinfection of fish in the family Cyprinidae of Opisthorchis felineus Riv. metacercariae by the combined use of acetic acid and table salt]

The studies were aimed at optimizing the procedure for disinfection of carps from the larvae of a pathogen of opisthorchiasis. The effects of different concentrations of acetic acid solutions on the viability of encysted O. felineus metacercariae isolated from ide (Leuciscus idus L.) tissue, as well as on that of larvae located in the fish muscles were examined by consequently using the solutions of acetic acid and salt. Acetic acid solutions (3 and 6%) are minimally effective in suppressing the viability of encysted O. felineus metacercariae isolated from fish tissues, 6% acetic solution being approximately 6 times higher. Acetic acid pretreatment of fish led to the higher salt penetration rate into the muscles of fish when it was salted thereafter and accelerated the death of O. felineus metacercariae. To correct the way of salting the fish invaded by Opisthorchis metacercariae, 4-hour fish presoaking in 6% acetic acid solution is most promising, which promotes the acceleration of the death of metacercariae and exerts no noticeable effect on the marketable state and taste of fish.

[The results of an experimental study of an anti-Opisthorchis preparation made from plant raw material]

Agents and biologically active fractions derived from medical plants grown in Siberia were tested in vitro and in vivo. The extract from the aspen bark displayed the highest antiopisthorchiatic activity. This agent given at a concentration of 10(-3) caused 100% death of Opisthorchis 72 hours later. In golden hamster experiments, the efficiency of the aspen bark extract was 73.48-83.0%. Butanolic and ethylacetatic extracts were found to have the greatest antiopisthorchiatic activity. The results of chemical and chromatographic studies indicated that active fractions contained salicine and its derivatives. The aspen bark extract produces no substantial toxic effect on laboratory animals and belongs to the class "Low-toxic substances".

Opisthorchis viverrini: effect of praziquantel on the adult tegument

Ultrastructural changes of the tegument of adult liver flukes, Opisthorchis viverrini, after in vitro incubation in Minimal Essential Medium containing 0, 0.1, 1.0 and 10.0 micrograms/ml of anthelminthic praziquantel for 5, 15, 30, 45 and 60 minutes were investigated by scanning (SEM) and transmission (TEM) electron microscopy. SEM observations showed that the surface damage was composed of blebbing due to the swelling of microvilli, followed later by the disruption of these structures to form lesions that caused the erosion and desquamation of the surface. Sensory papillae, by contrast, appeared relatively unaffected. The surface changes could be observed at all doses but the extent of damage increased with increasing duration of incubation and concentration of the drug. The ventral as well as the dorsal surfaces exhibited similar change, whereas the anterior part tended to be damaged less than the posterior part. Under TEM observations, the earliest sign of changes was the depolymerization of the microtrabecular network in scattered foci, which resulted in the formation of non-membrane-bound vacuoles under microvilli. The basal infoldings also became dilated, and some turned into membrane-bound vacuoles in the basal zone. Subsequently, microvilli became enlarged, and eventually formed blebs that later rupture to form lesion spots as observed in the SEM. Finally, the microtrabecular network in all regions broke down, creating vacuoles of various sizes throughout the tegument, leading to its total disintegration and detachment. The sequence of morphological changes was generally similar at all doses; however, the changes occurred faster at the higher doses and the longer incubation times. In addition, at the longer durations myofilaments in most muscle cells also became depolymerized, while microtubules were unchanged by the drug. Therefore, it is possible that praziquantel, through its induction of Ca2+ influx, causes depolymerization of the microtrabecular network that leads to the vacuolization, swelling, blebbing, and eventually the disruption and detachment of the tegument, and the breakdown of myofilaments in the muscle cells.

Opisthorchis viverrini: the effects of colchicine and cytochalasin B on the adult tegument

The roles of the tegumental cytoskeleton were tested by treating adult flukes with colchicine and cytochalasin B. Following a short incubation period (10-20 minutes), colchicine disrupted microtubules in the tegumental cells' processes which, in turn, affected the transport of dense granules from the cells' soma to the tegument; as a result some of these granules were fused together to form membrane-bound vacuoles. In addition, at many spots microtrabeculae were also depolymerized, which resulted in the formation of non-membrane-bound vacuoles and the distension of microvilli to form blebs, some of which were disrupted. After prolonged incubation (120 minutes), general breakdown of the tegumental cytoskeleton occurred, and parts of it were sloughed off. In cytochalasin B treatment, the responses were similar to those of colchicine but with less severity. After a short incubation period (10-20 minutes), the microtrabeculae were depolymerized which led to the formation of non-membrane-bound vacuoles in the apical and middle zones of the tegument. Later, the tegumental microvilli were distended to form blebs but no evidence of tegumental sloughing occurred even in prolonged incubation. From these observations, it was concluded that microtubules played a role in the translocation of granules from the tegumental cells to the tegument which modulated the synthesis of membrane and glycocalyx, while microtrabeculae were involved in the maintenance of the structure and integrity of the tegument.

Opisthorchiasis control in northeast Thailand: proposal for a new approach

Opisthorchiasis, i.e. infection with the liver fluke Opisthorchis viverrini is an important health problem in Thailand and adjacent Laos, and its control is therefore of high priority. Pilot projects have shown that after praziquantel treatment high re-infection rates occurred within a short period of time. To reduce re-infections it is proposed to couple the time of treatment to the seasonal transmission dynamics and thus treat the population in March when risk of infection for the snail and fish intermediate and the human definitive hosts is lowest. Adjustment would save costs and time.

Repeated exposure to Opisthorchis viverrini and treatment with the antihelminthic Praziquantel lacks carcinogenic potential

The effects of repeated Praziquantel administration, subsequent to infection and reinfection with Opisthorchis viverrini (OV), on lesion development in the Syrian hamster liver were investigated. Five applications of the antihelminthic drug were made (300 mg/kg body wt, i.g.), each time approximately 5 weeks after dosing with 60-80 OV metacercariae at weeks 0, 8, 16, 24 and 32. The animals were then maintained until week 40 when they were killed; histopathological investigation revealed no significant development of either hepatocellular of cholangiocellular preneoplastic/neoplastic lesions. The results indicate that repeated exposure to Praziquantel at levels sufficient for successful removal of parasite infestation does not itself carry carcinogenic risk.

Treatment of Opisthorchiasis viverrini in hamsters with albendazole

Efficacy of many drugs against Opisthorchis viverrini in man were shown by the percentages of egg reduction and the absence of egg in faeces. In some cases, however, the eggs reappeared after a period of time. The pathological changes of the bile duct could cause partial or even complete obstruction of the bile passages, thus resulting in the occurrence of natural egg reduction. Albendazole, a broad spectrum anthelmintic was used to treat opisthorchiasis viverrini in hamsters. At dosage of 100 mg per kg body weight twice daily for three consecutive days, the drug yielded an average of 81.5% of worm reduction at four months after medication. In this study complete cure was not obtained.

Evaluation of selected anthelmintic compounds for activity against Opisthorchis viverrini

In vitro and in vivo experiments were employed in the screening of potential anthelmintic agents against Opisthorchis viverrini infection in hamsters. A few selected groups of compounds tested included those that are commercially available as well as those that are still being tested by various pharmaceutical firms. The compounds tested in the present study were praziquantel, amoscanate, albendazole, flubendazole, metrifonate, metronidazole and benzodiazepine derivatives. Results from both in vitro and in vivo experiments showed that at the dosages employed, praziquantel was the only one that gave complete cure, as judged from faecal egg examination and worm recovery at the time of sacrifice. It was therapeutically effective against different developmental stages of O. viverrini including the metacercariae. Moreover, the drug was also effective as a chemoprophylactic agent when given 6 to 12 hr prior to being exposed to infective metacercariae. Other compounds tested were considerably less active although some might have permanently damaged the fluke reproductive capacity, while others were able to suppress egg-laying capacity only temporarily. Together, results suggests that the ineffectiveness of most agents tested in this study is not related to their inability to attain concentrations high enough to kill or damage the flukes in the biliary system but is most likely due the inherent lack of capacity to kill the flukes.

Alterations of the surface tegument of Opisthorchis viverrini exposed to praziquantel in vitro and in vivo

The in vitro and in vivo effects of praziquantel on the ultrastructural surface of Opisthorchis viverrini were investigated using scanning electronmicroscopy. For the in vitro study, adult flukes were collected from experimentally infected hamsters, and were incubated for various time intervals at 37 degrees C in Earle's basal medium containing praziquantel at final concentrations of 0.01-100 micrograms/ml. For the in vivo study, flukes were collected from the biliary system of experimentally infected hamsters that had been treated 4 hours previously with 350 mg of praziquantel per kg body weight (mg/kg). Flukes were also obtained from the feces of a patient with opisthorchiasis who had been given praziquantel once at a dose of 40 mg/kg 4-6 hours previously and from the bile of a patient at the time of operation 24 hours after praziquantel treatment. Scanning electronmicroscopic analyses of the surface teguments of flukes exposed to praziquantel either in vitro or in vivo showed similar changes. Tegumental bubbles of different sizes appeared on the surface; they later ruptured and resulted in the formation of crater-like lesions. These lesions might be so extensive as to result in the peeling of the entire areas. On occasions, "micronodules" appeared later in these areas and those at the periphery of the lesions; these micronodules may represent an attempt by the worm to regenerate new tegument. The possibility that these ultrastructural changes may represent a generalized response of the tegumental surface to an obnoxious agent was discussed.

Stimulation of Ca2+ uptake in the human liver fluke Opisthorchis viverrini by praziquantel

45Ca2+ uptake by the human liver fluke Opisthorchis viverrini is enhanced by praziquantel. The drug-induced 45Ca2+ uptake was dependent on the presence of Ca2+ and was attenuated in the presence of 10 mM Mg2+. La3+ and vanadate at concentration of 1 mM partially reduced the amount of 45Ca2+ uptake into the liver fluke in response to praziquantel treatment. The stimulating effect of praziquantel was eliminated in the presence of 10 microM verapamil. These findings suggest that praziquantel increases the permeability of the liver fluke tegument to Ca2+ probably by interfering with the mechanism that regulates Ca2+ binding or transport across the tegumental membrane.