7. Experimental trypanosomiasis

(a) Diagnostics

[See also 27: no. 12707.]

(b) Pathology and immunology

[See also 27: no. 12834.]

Serum biochemical changes in goats challenged with either Trypanosoma congolense or Trypanosoma brucei and uninfected controls were investigated. Experimental goats received a primary trypanosome challenge on day 0, treated with diminazene aceturate on day 49 and received a secondary trypanosome challenge on day 77 of the 136-day experiment. Infection was associated with development of anaemia, hypoproteinaemia, hypoalbuminaemia, hypocholesteraemia, low density and high density hypolipidaemia. In both the primary and secondary challenges, however, serum free fatty acid concentrations were significantly higher than those of the controls. These changes suggest that the growing numbers of trypanosomes post-infection in goats require some lipids and proteins to support their growth, while the higher free fatty acid concentration observed may directly contribute to the development of anaemia as free fatty acids are known to be potentially cytotoxic and haemolytic in vitro.

Human African trypanosomiasis, also known as sleeping sickness, affects the CNS at the late stage of the disease. Untreated the disease is invariably fatal, and melarsoprol, the only available and effective treatment for CNS disease, is associated in up to 10 percent of cases with a severe post-treatment reactive encephalopathy (PTRE), which can itself cause death. We used a reproducible mouse model of the PTRE to investigate the pathogenesis and treatment of this condition. Mice infected with Trypanosoma brucei brucei and treated subcuratively with diminazene aceturate develop a severe meningoencephalitis that closely resembles PTRE. We previously reported that substance P plays an important role in PTRE. We investigated the effect of disrupting the gene encoding for the NK1 receptor in mice on the clinical and neuroinflammatory response in this model. After induction of PTRE, NK1^-/- mice showed a significant reduction in clinical impairment compared with NK1^+/+ mice, but the severity of the neuroinflammatory response was significantly greater in NK1^-/- mice. To explore the mechanisms of this dissociated phenotype, we treated infected NK1^-/- mice with antagonists to NK2 and NK3 receptors, either singly or in combination. While none of these antagonist treatments altered the clinical score, combined treatment with the NK2 and NK3 antagonists significantly reduced the neuroinflammatory grading score in the NK1^-/- mice. Thus, the clinical and neuroinflammatory responses to parasite invasion can be mediated by different pathways, and, importantly, the neuroinflammatory response is altered by alternative tachykinin receptor usage. These findings could be exploited to develop novel anti-inflammatory therapies in human African trypanosomiasis by modulating the NK1 receptor as well as the parasite.

The heat shock protein (HSP) 70.1 gene lies on mouse chromosome 17 among the candidates for Tir1, the major quantitative trait locus associated with response to Trypanosoma congolense infection. To evaluate whether the HSP70.1 gene is involved in the response, we compared the susceptibility of HSP70.1-deficient C57BL/6 J, resistant wild-type C57BL/6 J and susceptible A/J mice. No differences were observed between HSP70.1-deficient and wild-type C57BL/6 J mice in survival time, levels of parasitaemia and anemia, suggesting that there is no involvement of the HSP70.1 gene in control of T. congolense infection. The course of infection was markedly different between A/J and C57BL/6 J mice. A/J mice showed a bi-phasic survival pattern, which seemed to be associated with two waves of high parasitaemia, but developed only moderate anaemia. C57BL/6 J mice controlled parasitaemia well but developed severe anaemia in the late stage of infection.

The release of sialic acid (SA) into the serum by BalbC mice infected with Trypanosoma congolense was investigated. A progressive increase in the level of serum sialic acid corresponding to anaemia and parasitaemia was observed. At maximum parasitaemia, the level of total sialic acid from the red blood cells dropped by about 45 percent. A steady rise in the level of serum sialidase activity and a low packed cell volume with an increase in parasitaemia were observed. The possible role of a secreted bloodstream Trypanosoma congolense serum sialidase and the development of anaemia in the pathogenesis of trypanosomiasis are discussed.

The interaction between the blood protozoan parasite, Trypanosoma brucei and the gastrointestinal nematode parasite, Strongyloides ratti was studied in outbred white albino rats. Rats were grouped and given either single infection with T. brucei or S. ratti or concurrently infected with both parasites. Blood parasitaemia and packed cell volume, faecal egg/larva output, adult worm burden and survivability were monitored in order to assess the interactive effects of the infections. All trypanosome-infected rats became parasitaemic within one week of infection but surprisingly parasitaemia was higher in the single than concurrently infected group of rats. In addition all animals with single T. brucei infection had died by 14 days after the infection, whereas animals with concurrent infection were still alive by day 28 after the infection when the experiment was terminated. Concurrent infection resulted in significant increase in daily S. ratti egg/larval output in faeces (P < 0.01), but lesser numbers of adult worms were recovered from the intestine of sacrificed rats on day 8 post-infection. Taken together these results suggest that T. brucei and S. ratti interact in a manner that ameliorates their pathogenic effects resulting in a decrease in the level of parasitaemia and intestinal worm burden and in increased life span of the infected rats. These results differ from the classical immunosuppressive attributes of T. brucei and the results are discussed in the context of the possible immune responses that might have contributed to this outcome and the potential significance of the findings in alternative control method of trypanosomosis.

Infection of humans with Trypanosoma brucei causes sleeping sickness, which is invariably fatal if left untreated. The course of infection is characterized, among others, by multiple organ damage including cardiovascular dysfunctions such as hypotension and breakdown of the blood-brain barrier. The latter eventually leads to the parasite invasion into central nervous system and ultimately to the death of the patient. Nitric oxide (NO) synthesised from L-arginine via endothelial NO-synthase (eNOS) is involved in the control of vascular tone and permeability. The present study explores the effect of T. brucei infection on the endothelium-dependent in vitro vasomotor response of isolated mouse aortas. Aorta rings were suspended in organ chambers for isometric tension recording. The endothelium-dependent NO-mediated relaxation in response to acetylcholine (10^-9 to 10^-5 M) was markedly enhanced in the infected mice compared to controls (P < 0.05), whereas the endothelium-independent vasodilation to an exogenous NO-donor, sodium nitroprusside, was comparable in both groups. Norepinephrine-stimulated contraction was also comparable in the absence or presence of the NO-synthase inhibitor N^w-Nitro-L-arginine methyl ester (L-NAME; 10^-4M) in both groups. The enhanced endothelium-dependent relaxation in the infected mice correlated well with a 3.5-fold increase in eNOS protein level in these aortas as compared to those of control mice (P = 0.05). Thus, T. brucei infection enhances eNOS protein expression in the endothelium, causing a pronounced vasodilation. Overproduction of NO in trypanosomiasis may be involved in the observed generalised hypotension and in an increased vascular permeability that facilitates T. brucei invasion into surrounding tissues and its penetration into the central nervous system in later phases of infection.

(c) Chemotherapeutics

[See also 27: nos. 12663, 12822.]

The antitrypanosomal activity of 101 crude ethanol extracts derived from 88 medicinal plants from Côte d’Ivoire was determined in vitro using Trypanosoma brucei rhodesiense. Of those extracts 8 showed good activity (IC₅₀ values less than or equal to 8 mg/ml), 37 revealed a weak activity (IC₅₀ values between 25 and 8.1 mg/ml) and 56 did not show any activity at all (IC₅₀ values greater than or equal to 25 mg/ml). The extracts of Enantia polycarpa (Annonaceae) and Trichilia emetica (Meliaceae) were the most promising ones. Their IC₅₀ values were 0.5 and 0.04 mg/ml, respectively, and the selectivity index 616 and 209, respectively. This is the first report of in vitro antitrypanosomal activity of these two plants. Their high activities render them candidates for the isolation of compounds which could develop into new lead structures for drug development programs against African trypanosomiasis. Seven of the tested extracts exhibited an antiplasmodial activity against Kl strain of Plasmodium falciparum with IC₅₀ values below 4 mg/ml. The highest activity was found for Enantia polycarpa stem bark with an IC₅₀ value of 0.126 mg/ml.

Diamidines, and pentamidine in particular, have a long history as valuable chemotherapeutic agents against infectious disease. Their selectivity is due mostly to selective accumulation by the pathogen, rather than the host cell; and acquired resistance is frequently the result of changes in transmembrane transport of the drug. Here, recent progress in elucidating the mechanisms of diamidine transport in three important protozoan pathogens, Trypanosoma brucei, Leishmania and Plasmodium falciparum, is reviewed, and the implications for drug resistance are discussed.

Methanolic and aqueous extracts derived from 43 plant species, selected either from ethnobotanical or chemotaxonomical data, were screened for their antiprotozoal activity against Leishmania donovani and Trypanosoma brucei brucei. The cytotoxic activity against KB cells was also determined. Eight extracts had IC₅₀ values of less than 10 mg/ml against Leishmania donovani. The most active was Triclisia patens with an IC₅₀ value of 1.5 mg/ml against Leishmania donovani. Annona purpurea and Alstonia macrophylla had IC₅₀ values below 10 mg/ml against Trypanosoma brucei brucei. Annona purpurea was the most cytotoxic against KB cells.

The genomic sequences of parasitic diseases are rapidly becoming available and, recently, the full sequence of Plasmodium falciparum has been published. Much has been promised from this genomic revolution including the identification of new drug targets and novel chemotherapeutic treatments for the control of parasitic diseases. The challenge to use this information efficiently will require functional genomics tools such as bioinformatics, microarrays, proteomics and chemical genomics to identify potential drug targets, and to allow the development of optimized lead compounds. The information generated from these tools will provide a crucial link from genomic analysis to drug discovery.

In human African trypanosomiasis (HAT), the parasites invade the central nervous system (CNS), leading to the development of meningo-encephalitis and an irreversible demyelinating process, which kills the patient unless specific treatment is undertaken. Among the experimental trypanocides, the nitroimidazole derivative megazol alone at optimal doses does not cure late-stage disease tested in mouse models; however the combination of suramin and megazol is able to cure infected mice without CNS involvement. We recently developed an experimental model of HAT with a sharp decrease in both the food intake and the body weight which may constitute an effective index of the early meningo-encephalitic phase. Using this model, we tested this hypothesis by the exclusive effectiveness of a megazol and suramin combination treatment to eliminate CNS trypanosomes. Sprague-Dawley rats were infected with Trypanosoma brucei brucei AnTat 1.1E. Food intake and body weight were measured daily from the day of infection to death. Haematocrite was measured twice a week. Treatment consisted of 20 mg suramin per kg body weight administered intraperitoneally (i.p.) alone, or three daily doses (80 mg/kg) of megazol given per os, or suramin (20 mg/kg, i.p.) followed 24 h later by three daily doses (80 mg/kg) of megazol given per os. Treatment was followed by an increase in daily body weight and food intake similar to those of the control animals, two weeks after treatment. The anaemia that developed after infection is also cleared as shown by the haematocrite measurements. The rats treated with megazol alone died about 29 days after treatment and those treated with suramin after about 26 days. Seven months later, no signs of relapse were seen in 10 of 12 rats treated with the therapeutic combination, indicating that this chemotherapy regimen was curative. The results support our previous finding, i.e. the decrease in body weight may constitute a diagnosis index of the early meningo-encephalitic phase.

Nine biochemically distinct cationic antimicrobial peptides were tested in vitro for their effects on bloodstream forms and procyclic (insect) forms of African trypanosomes, the protozoan parasites that cause African sleeping sickness in humans and trypanosomiasis in domestic animals. At low concentrations, one peptide completely inhibited growth of bloodstream forms, one inhibited procyclic forms, and five inhibited both trypanosome life cycle stages. The peptides were also tested on Sodalis glossinidius, a bacterial symbiont of tsetse flies. Sodalis glossinidius was highly resistant to seven of the nine peptides, including both that specifically inhibited either bloodstream or procyclic forms and three of the five that inhibited both trypanosome life cycle stages. The results indicate that several of these peptides may be ideal candidates for therapy of trypanosome infected mammals or for transgenic expression in S. glossinidius as a strategy for inhibiting trypanosome survival, development, and maturation in tsetse and interference with transmission of African sleeping sickness.

Infestation with parasitic helminths is a common problem in human populations of third world countries and is ubiquitous in livestock and other domestic animals. The cell-membrane efflux pump, P-glycoprotein (Pgp), appears to contribute to anthelmintic resistance. Pgp has been identified from both phyla of parasitic helminths, Platyhelmintha and Nematoda, and alterations in expression levels and allele frequencies of Pgp in anthelmintic-resistant populations have been observed in nematodes. Localisation of Pgp has been studied in the free-living nematode Caenorhabditis elegans and in the sheep parasite Haemonchus contortus using specific monoclonal antibodies or lectins. Reversing agents used in human studies, such as the calcium-channel blocker verapamil (VPL), appear to have similar effects in helminths as they do in human cancer cells: the efficacy of drug treatment is increased in drug-resistant parasites when reversing agents are co-administered with the anthelmintic. The functional role of the Pgp glycosylation was also studied using a lectin specific for the a-mannosyl residues and showed that resistance can be associated with a decreased affinity of the lectin for Pgp sites and that up to 50 percent reversion in the resistance to benzimidazoles (BZ) can be obtained using this lectin. Furthermore, the current knowledge on the role of Pgp in molecular mechanisms of drug resistance in the parasitic protozoan genus Trypanosoma is discussed. In some Trypanosoma species it was shown that drug resistance was associated with reduced uptake and in other ones with increased efflux. Several trypanosome Pgp-coding sequences have been described. In contrast to earlier data, most recent observations, based on experimentally over-expressed Pgp in Trypanosoma brucei, indicate a possible involvement in the mechanism of drug resistance in this parasite.

Trypanosomatids are the causative agents of African sleeping sickness, Chagas’ disease, and the different manifestations of leishmaniasis. New drugs against these parasitic protozoa are urgently needed since the current drugs are unsatisfactory, in particular due to serious adverse side effects. In trypanosomes and leishmanias, the nearly ubiquitous glutathione/glutathione reductase system is replaced by trypanothione and trypanothione reductase. The essential role of trypanothione reductase in the parasite thiol metabolism and its absence from the mammalian host render the enzyme a highly attractive target molecule for a structure-based drug development against trypanosomatids. This article provides an overview on the known classes of trypanothione reductase inhibitors and their in vitro activity against parasitic protozoa. The (dis)advantages of the different types of compounds as potential drug candidates as well as modern computer-based approaches to the identification of new leads are discussed.

We studied the biological activity of three newly synthesized metal complexes of triazole-pyrimidine derivatives that were previously observed to inhibit in vitro growth of epimastigotes of Trypanosoma cruzi and procyclic forms of T. brucei brucei. We analyzed the possible inhibitory effect of these compounds on the synthesis of DNA, RNA and protein, and on the ultrastructure and excretion of metabolites by these parasites. RNA synthesis was inhibited by all three complexes assayed. These complexes also led to anomalies of the main organelles (e.g. nucleus, kinetoplast and mitochondria). In addition, these complexes may be capable of altering the excretion of metabolites by the parasites.

Little progress has been made in the treatment of African trypanosomiasis over the past decades. L-carnitine has a major role in the glycolysis-based energy supply of blood trypanosomes for it stimulates constant ATP production. To investigate whether administration of the isomer D-carnitine could exert a competitive inhibition on the metabolic pathway of the L-form, possibly resulting in parasite replication inhibition, several formulations of this compound were tested on Trypanosoma lewisi and T. brucei rhodesiense in rodent models. High oral dosages of D-carnitine inner salt and proprionyl-D-carnitine were not toxic to animals and induced about 50 percent parasite growth inhibition in reversible, i.e. competitive, fashion. A putative mechanism could be an interference in pyruvate kinase activity and hence ATP production. Considering both lack of toxicity and inhibitory activity, D-carnitine may have a role to play in the treatment of African trypanosomiasis in association with available trypanocidal drugs.

Antimicrobial peptides are components of the innate immune systems of a wide variety of eukaryotic organisms and are being developed as antibiotics in the fight against bacterial and fungal infections. We explored the potential activities of antimicrobial peptides against the African trypanosome Trypanosoma brucei, a vector-borne protozoan parasite that is responsible for significant morbidity and mortality in both humans and animals. Three classes of mammalian antimicrobial peptides were tested: a-defensins, b-defensins, and cathelicidins. Although members of all three classes of antimicrobial peptides showed activity, those derived from the cathelicidin class were most effective, killing both insect and bloodstream forms of the parasite. The mechanism of action of the cathelicidins against T. brucei involves disruption of surface membrane integrity. Administration of cathelicidin antimicrobial peptides to mice with late-stage T. brucei infection acutely decreased parasitemia and prolonged survival. These results highlight the potential use of antimicrobial peptides for the treatment of African trypanosomiasis.

The major lysosomal cysteine proteinase of African trypanosomes is a candidate target for novel chemotherapy of sleeping sickness. This cathepsin L-like enzyme is termed rhodesain and brucipain in Trypanosoma brucei rhodesiense and Trypanosoma brucei brucei, respectively. Three potent and selective dipeptidyl cathepsin L inhibitors have been investigated for their trypanocidal activities in vitro using culture-adapted bloodstream forms of T. b. brucei. Compared with general cysteine proteinase inhibitors used previously by ourselves and others, the present inhibitors had improved selectivity indices and, importantly, anti-trypanosomal activities comparable with those of commercial anti-sleeping sickness drugs. Using purified recombinant rhodesain, potent k_inact/K_i values of up to 2.3×10⁶ M^-1 s^-1 were recorded with the inhibitors. Also, all inhibitors blocked proteinolysis in the lysosome consistent with the inhibition of rhodesain/brucipain. In conclusion, the data support the potential of cathepsin L inhibitors for rational anti-trypanosomal drug development.

During an ethnopharmacological survey of antiparasitic medicinal plants used in Ivory Coast, seventeen plants were identified and collected. Polar, non-polar and alkaloidic extracts of various parts of these species were evaluated in vitro in an antiparasitic drug screening. Antimalarial, leishmanicidal, trypanocidal, antihelminthiasis and antiscabies activities were determined. Among the selected plants, Anogeissus leiocarpus and Terminalia glaucescens were strongly active against Plasmodium falciparum. Lawsonia inermis, selectively prescribed against trypanosomiasis shows interesting trypanocidal activities as did another fifteen plants. Anthelmintic activities were found for ten active species and two species (Uvaria afzelii and Monodora myristica) were active against mites.

Trypanosomes cause African sleeping sickness, affecting millions of humans and animals. We tested trypanosome microtubule-associate protein (MAP p15) as a vaccine in mice, and show that p15 (native or recombinant) generated up to 100 percent protection from an otherwise lethal challenge of a heterologous strain of Trypanosoma brucei. We also tested the adenovirus as a vaccine delivery system and show that both adenoviral vector containing p15 gene or control adenovirus containing lacZ gene generated a protective response and exhibited strong CD8+ T-cell proliferation. These results suggest that the p15 protein itself is an effective vaccine and that the adenovirus may be used to mount a non-specific cellular immune response.

The discovery and optimization of antiparasitic compounds has profited by information-based methods newly emerged in the modern drug development process. The generation of computer models enables the cost-efficient and fast computational screening of virtual compound libraries for biologically active molecules. Two sources of information are available: structure-based drug design utilizes information about the disease target. We describe two different computational approaches, realized as the fast, flexible docking program FlexX and as the de novo design program LUDI. Ligand-based drug design, on the other hand, requires the structures and experimental data from biologically active compounds. Parasitic targets and antiparasitic compounds studied by various information-based methods include trypanosomal trypanothione reductase, antiprotozoal bisphosphonates, and trypanosomal glycosomal glyceraldehyde-3-phosphate dehydrogenase.