Transporters in African trypanosomes: role in drug action and resistance

Sleeping sickness is an increasing problem in many parts of sub-Saharan Africa. The problems are compounded by the lack of new medication, and the increasing resistance against traditional drugs such as melarsoprol, berenil and isometamidium. Over the last few years, much progress has been made in understanding how drug action, and the development of resistance, is related to the mechanisms by which the parasite ingests the drugs. In some cases novel transporters have been identified. In other cases, transporters do not appear to be involved in drug uptake, and selectivity must lie with other parasite features, such as a specific target or activation of the drug. Lessons learned from studying the uptake of drugs currently in use may assist the design of a much needed new generation of trypanocides.     

Drug resistance in Trypanosoma brucei spp., the causative agents of sleeping sickness in man and nagana in cattle

Drug resistance in pathogenic trypanosomes threatens successful control of fatal sleeping sickness in man and hinders economic livestock production in sub-Saharan Africa. We report on the occurrence and development of drug resistance, and discuss the genetic basis of such resistance in Trypanosoma brucei. Understanding these mechanisms at the molecular level will enable improved management of existing drugs and provide valuable clues to the development of new trypanocides.     

Chemosensitization of Trypanosoma congolense strains resistant to isometamidium chloride by tetracyclines and enrofloxacin

Background

Because of the development of resistance in trypanosomes to trypanocidal drugs, the livelihood of millions of livestock keepers in sub-Saharan Africa is threatened now more than ever. The existing compounds have become virtually useless and pharmaceutical companies are not keen on investing in the development of new trypanocides. We may have found a breakthrough in the treatment of resistant trypanosomal infections, through the combination of the trypanocide isometamidium chloride (ISM) with two affordable veterinary antibiotics.

Methodology/Principal Findings

In a first experiment, groups of mice were inoculated with Trypanosoma congolense strains resistant to ISM and either left untreated or treated with (i) tetracycline, (ii) ISM or (iii) the combination of the antibiotic and the trypanocide. Survival analysis showed that there was a significant effect of treatment and resistance to treatment on the survival time. The groups treated with ISM (with or without antibiotic) survived significantly longer than the groups that were not treated with ISM (P<0.01). The group treated with the combination trypanocide/antibiotic survived significantly longer than the group treated with ISM (P<0.01). In a second experiment, groups of cattle were inoculated with the same resistant trypanosome strain and treated with (i) ISM, (ii) ISM associated with oxytetracycline or (iii) ISM associated with enrofloxacine. All animals treated with ISM became parasitaemic. In the groups treated with ISM-oxytetracycline and ISM-enrofloxacine, 50% of the animals were cured. Animals from the groups treated with a combination trypanocide/antibiotic presented a significantly longer prepatent period than animals treated with ISM (p<0.001). The impact of the disease on the haematocrit was low in all ISM treated groups. Yet, it was lower in the groups treated with the combination trypanocide/antibiotic (p<0.01).

Conclusions/Significance

After optimization of the administration protocol, this new therapeutic combination could constitute a promising treatment for livestock infected with drug resistant T. congolense.     

The current status of drug resistance in malaria

Drug resistant malaria is a major health problem; it poses a threat to the lives of millions of people and renders it less possible for the worldwide eradication programme to attain its goal in the foreseeable future. At present Plasmodium falciparum is resistant to varying degrees to all antimalarial drugs available e.g. chloroquine, sulfadoxine and pyrimethamine, quinine and even to the new compound, mefloquine.Chloroquine-resistant P. falciparum originated in Thailand some 25 years ago has spread in all directions to Southeast Asia, Western Pacific, to central and southeast India, East Africa and West Africa. In South America, it started in Colombia and now affects the whole of Central and South America with the exception of Argentina, Paraguay and Peru which practically have no falciparum malaria.The mechanism of drug resistance in malaria parasites is believed to be due to gene mutation selected under drug pressure. It may be one-step as in pyrimethamine or multi-step as in chloroquine. Resistant mutation occurs both in schizogony and sporogony. The parasites lose their S strains through hybridization or overgrowth, shifting in character progressively towards high grade resistance.Policies that may help to minimise further development of resistance to existing compounds and to safeguard any new drugs that may be developed in the future include (1) limit the distribution of antimalarials; (2) select priority groups for prophylaxis; (3) use the gametocidal drug primaquine to restrict transmission of resistant strains; (4) establish an effective drug monitoring system; (5) only deploy drugs for control as part of an integrated campaign; (6) control use of new antimalarial; (7) encourage the use of tested effective drug regimens for treatment and (8) encourage research on antimalarials.     

Resistance to clinical drugs in African trypanosomes

Drug resistance in African trypanosomes continues to confound clinicians and to stymy development o f equatorial Africa, taking its toll in lives and economic development. Drugs in current, widespread use have been employed continuously for over 60 years in some instances. The recent studies of Fairlamb and colleagues have outlined a defective purine-transport system in drug-resistant trypanosomes, which appears to explain resistance to several established tryponocides and suggests a guide for the development of new drugs. The recently developed agent dl-alpha-di fluoromethylornithine (DFMO) is effective against West African, but not East African, disease and its activity may be the result of the unregulated synthesis of S-odenosylmethionine in tryponosomes. In this report, Cyrus Bacchi outlines recent developments in the elucidation of mechanisms of resistance to established drugs and naturally occurring resistance to DFMO.     

Comparative proteomics to evaluate multi drug resistance in Escherichia coli

Drug resistance in food-borne bacterial pathogens is an almost inevitable consequence of the use of antimicrobial drugs, used either therapeutically or to avoid infections in food-producing animals. In the past decades, the spread and inappropriate use of antibiotics have caused a considerable increase of antibiotics to which bacteria have developed resistance and, moreover, bacteria are becoming resistant to more than one antibiotic simultaneously. Understanding mechanisms at the molecular level is extremely important to control multi-resistant strains and to develop new therapeutic strategies. In the present study, comparative proteomics was applied to characterize membrane and cytosolic proteome in order to investigate the regulation of protein expression in multi-resistance E. coli isolated from young never vaccinated water buffalo. Results highlighted differentially expressed proteins under multi drug resistance conditions giving new insights about mechanisms involved in resistance, as quorum sensing mechanisms, and suggesting possible novel bacterial targets to develop alternative antibiotic drugs.     

Reproductive disorders caused by animal trypanosomiases: a review

Pathogenic animal trypanosomes are causative agents of the most common livestock diseases which have an important economic impact on many African countries. These diseases usually cause debilitating symptoms manifested by anemia and cachexia which may result in death. Recent studies show that they cause awide range of reproductive disorders in animals, including degeneration of the hypothalamus, pituitary glands and gonads with consequent disruptions in the secretions and plasma concentrations of the hormones necessary for normal reproductive processes in both sexes. Reproductive disorders caused in male animals include delayed puberty, loss of libido, severe degenerative changes of the genitalia manifested by the production of very poor quality semen or the cessation of semen production. In female animals trypanosomiases cause severe genital lesions, temporary or permanent anestrus, and abnormal estrous cycles. Additionally, trypanosomal-induced death during pregnancy, abnormal pregnancy, dystocia, abortion, premature birth, low birth weight, stillbirth, transplacental fetal infection, neonatal death and other pathogenic effects on fetuses and offspring have been reported. Early treatment with trypanocides may prevent some of the trypanosomal-induced reproductive disorders and the resolution of mild genital lesions. Trypanosomal-induced reproductive disorders in animals are of significant economic importance, especially in sub-Saharan Africa, where tsetse transmitted trypanosomiases are endemic.     

Farmer perceptions and willingness to pay for novel livestock pest control technologies: A case of tsetse repellent collar in Kwale County in Kenya

Tsetse-transmitted Animal African Trypanosomosis (AAT) is one of the most important constraints to livestock development in Africa. Use of trypanocides has been the most widespread approach for the management of AAT, despite the associated drug resistance and health concerns associated with drug metabolites in animal products. Alternative control measures that target tsetse fly vectors of AAT, though effective, have been hard to sustain in part because these are public goods applied area-wide. The International Centre of Insect Physiology and Ecology (icipe) and partners have developed and implemented a novel tsetse repellent collar (TRC) applied on animals to limit contact of tsetse flies and livestock, thereby reducing AAT transmission. The TRC has now advanced to commercialization. A household-level survey involving 632 cattle keeping households, was conducted in Shimba Hills region of Kwale County, where field trials of the TRC have been previously conducted to assess farmers’ knowledge, perception, and practices towards the management of tsetse flies, their willingness to pay (WTP) for the TRC, and factors affecting the WTP. Almost all the respondents (90%) reported that tsetse flies were the leading cattle infesting pests in the area. About 22% of these correctly identified at least four AAT clinical signs, and even though many (68%) used trypanocidal drugs to manage the disease, 50% did not perceive the drug as being effective in AAT management (50%). Few respondents (8%) were aware of the harmful effects of trypanocidal drugs. About 89% of the respondents were aware of icipe TRC, and 30% of them were using the field trial collars during the survey. Sixty-three (63%) of them were willing to pay for the TRC at the same cost they spend treating an animal for AAT. On average farmers were willing to pay KES 3,352 per animal per year. Male educated household heads are likely to pay more for the TRC. Moreover, perceived high AAT prevalence and severity further increases the WTP. Wider dissemination and commercialization of the herd-level tsetse control approach (TRC) should be encouraged to impede AAT transmission and thus enhance food security and farm incomes among the affected rural communities. Besides the uptake of TRC can be enhanced through training, especially among women farmers.     

Combined antimalarial therapy using artemisinin

The existing armamentarium of drugs for the treatment and prevention of malaria is limited primarily by resistance (and cross-resistance between closely related drugs). However, most of these drugs still have a place and their life-span could be prolonged if better deployed and used, and also by rationally combining them based on pharmacodynamic and pharmacokinetic properties. Newer compounds are also being developed. The nature of malaria disease and its prevalence in the developing world call for innovative approaches to develop new affordable drugs and to safeguard the available ones. According to WHO, the concept of combination therapy is based on the synergistic or additive potential of two or more drugs, to improve therapeutic efficacy and also delay the development of resistance to the individual components of the combination. Combination therapy (CT) with antimalarial drugs is the simultaneous use of two or more blood schizontocidal drugs with independent modes of action and different biochemical targets in the parasite. In the context of this definition, multiple-drug therapies that include a nonantimalarial drug to enhance the antimalarial effect of a blood schizontocidal drug are not considered combination therapy. Similarly, certain antimalarial drugs that fit the criteria of synergistic fixed-dose combinations are operationally considered as single products in that neither of the individual components would be given alone for anti-malarial therapy. An example is sulfadoxine-pyrimethamine. Artemisinin-based combination therapies have been shown to improve treatment efficacy and also contain drug resistance in South-East Asia. However, major challenges exist in the deployment and use of antimalarial drug combination therapies, particularly in Africa. These include: 1) the choice of drug combinations best suited for the different epidemiological situations; 2) the cost of combination therapy; 3) the timing of the introduction of combination therapy; 4) the operational obstacles to implementation, especially compliance. As a response to increasing levels of antimalarial resistance, the World Health Organization (WHO) recommends that all countries experiencing resistance to conventional monotherapies, such as chloroquine, amodiaquine or sulfadoxine/pyrimethamine, should use combination therapies, preferably those containing artemisinin derivatives (ACTs--artemisinin-based combination therapies) for malaria caused by Plasmodium falciparum. There is a promising role of such compounds in replacing or complementing current options. Since 1979, several different formulations of artemisinin and its derivatives have been produced and studied in China in several thousand patients for either P. falciparum or P. vivax malaria. To date, there is no evidence of drug resistance to these compounds. The use of artemisinin, artemether, arteether and artesunate for either uncomplicated or severe malaria is now spreading through almost all malarious areas of the world, although some of they have no patent protection, their development (with few exceptions) has not followed yet full international standards. Both artesunate, artemether and arteether are rapidly and extensively converted to their common bioactive metabolite, dihydroarte-misinin. WHO currently recommends the following therapeutic options: 1) artemether/lumefantrine; 2) artesunate plus amodiaquine; 3) artesunate plus sulfadoxine/pyrimethamine (in areas where SP efficacy remains high); 4) artesunate plus mefloquine (in areas with low to moderate transmission); and 5) amodiaquine plus sulfadoxine/pyrimethamine, in areas where efficacy of both amodiaquine and sulfadoxine/pyrimethamine remains high (mainly limited to countries in West Africa). This non artemisinin-based combination therapy is reserved as an interim option for countries, which, for whatever reason, are unable immediately to move to ACTs.     

Connections between rodenticides and drugs: a review of natural compounds with ecological,biocidal and medical applications

Natural products have inspired over 60% of today’s drugs and biocides, including rodenticides, with examples such as warfarin, fluoroacetate and cholecalciferol. Fluoroacetate is a toxic component of poisonous plants found in Australia, Africa, South America and India and is thought to deter herbivores. Together with other rodenticides it has medical applications. In relation to its use for the control of unwanted introduced animals in New Zealand, research has focused on mode of action, sub-lethal effects, welfare, reducing its risk to non-target species, and fate in the environment following use in baits. Less attention has been placed on its role in nature. In this paper the natural occurrence of bioactives that have stimulated the development of rodenticides are reviewed and links between biocidal and medical applications are explored.     

Reversal of chloroquine resistance in falciparum malaria

Control of falciparum malaria infections has been increasingly hampered by the emergence of parasites resistant to chloroquine, pyrimethomine and other standard anti-malarials. Chloroquine-resistant strains of Plasmodium falciparum, for example, which originally appeared in South-East Asia and South America are now found in East Asia and sub-Saharan Africa(1). Attempts to combat this alarming development have to date taken two main forms: (1) the judicious use of existing ontimalarials, preferably in combinations, in an attempt to delay the emergence of resistance; and (2) on aggressive research effort aimed at identifying a new generation of antimalarial drugs. But what i f it became possible to administer an antimalarial drug together with a second drug capable of overcoming resistance to the first? A recent report from Samuel Martin and co-workers at The Walter Reed Army Institute of Research in Washington DC raises just such an intriguing possibility.     

Engineering More Stable,Selectable Marker-Free Autoluminescent Mycobacteria by One Step

In our previous study, we demonstrated that the use of the autoluminescent Mycobacterium tuberculosis as a reporter strain had the potential to drastically reduce the time, effort, animals and costs consumed in evaluation of the activities of drugs and vaccines in live mice. However, the strains were relatively unstable and lost reporter with time without selection. The kanamycin selection marker used wasn’t the best choice as it provides resistance to amino glycosides which are an important class of second line drugs used in tuberculosis treatment. In addition, the marker could limit utility of the strains for screening of new potential drugs or evaluating drug combinations for tuberculosis treatment. Limited selection marker genes for mycobacterial genetic manipulation is a major drawback for such a marker-containing strain in many research fields. Therefore, selectable marker-free, more stable autoluminescent mycobacteria are highly needed. After trying several strategies, we created such mycobacterial strains successfully by using an integrative vector and removing both the resistance maker and integrase genes by Xer site-specific recombination in one step. The corresponding plasmid vectors developed in this study could be very convenient in constructing other selectable marker-free, more stable reporter mycobacteria with diverse applications.     

Genetics and trypanotolerance

Genetic resistance to disease and its use in domestic livestock usually ranks last, if at all, amongst preferred disease control measures - usually preceded by measures such as chemotherapy, vector control and vaccination. Thus, interest in genetic resistance is often a reflection of dissatisfaction with other control strategies, and the current emphasis on trypanotolerant cattle in Africa is just such a case. Eighty years of tsetse fly eradication programmes have had little impact on tsetse distribution, although recent research with odour baited targets impregnated with insecticide brings hope for the future. The search for a vaccine has proved more arduous than anticipated and the number of drugs available for therapy and prophylaxis is limited. In the search for alternative solutions to the problem of African trypanosomiasis, attention has recently focused on genetic resistance - a subject normally covered by immunologists or veterinarians(3-7). In this article, Rosemary Dolan discusses the concept from the geneticist's viewpoint.     

Comparative epidemiology and control of trypanosomes

Tsetse-transmitted trypanosomiasis in man and domestic livestock is a major constraint to livestock and socio-economic development in Africa. Analysis of the limited number of databases on matching animal health and productivity available for cattle in tsetse-infested areas of Africa has provided new information about the value of current methods of controlling the disease. It was established that the trypanotolerant breeds of cattle, namely N'Dama and West African Shorthorn, were much more productive than originally believed, despite their small stature, and, as a result, could be considered for livestock development programmes in tsetse-infested regions. Moreover, in areas of low tsetse challenge, it was shown that the strategic use of therapeutic trypanocidal drugs allowed the maintenance of high levels of productivity in dairy cattle and demonstrated genotype and acquired differences in treatment requirements. On the other hand, the use of a prophylactic drug regime allowed beef cattle to be reared to an economically acceptable level of productivity in an area where tsetse challenge was high that animals rapidly succumbed if left untreated. These results show that the current methods available for the control of animal African trypanosomiasis can be effective if properly applied.     

Heterogeneities in anti-schistosome humoral responses following chemotherapy

Schistosomiasis is a major public health problem in Africa, the Middle East, Asia and South America. The main control strategy is to treat infected people with anthelmintic drugs, principally the safe and relatively cheap drug praziquantel. Several treatment re-infection studies in humans have shown that praziquantel can have long-term effects beyond a transient reduction of infection intensity. These long-term effects include the altering of schistosome-specific immune responses in humans, which is associated with resistance to re-infection. Differences have been observed in treatment-induced immunological changes between individuals and between populations. This article discusses the contributions of host- and parasite-related heterogeneities to post-treatment humoral responses in humans infected with Schistosoma mansoni and Schistosoma haematobium and considers the practical implications of such heterogeneity for schistosome immuno-epidemiology studies.     

Anopheles gambiae genome: perspectives for malaria control

Malaria, a disease that infects 300 million people throughout the world and kills more than a million people, mostly children in sub-Saharan Africa, involves three organisms. The human host where the disease is seen, the protozoan Plasmodium parasite and the mosquito. The parasite is transmitted to humans only by the mosquito vector, which in sub-Saharan regions is generally Anopheles gambiae. Malaria along with AIDS and tuberculosis are killing large numbers of people and crippling the economies of the affected African countries. Though an enormous effort has been made during the past twenty years to develop vaccines to block malaria in humans, the incidence of the disease is increasing in Africa. The reasons for this development include a breakdown in mosquito control related to increased insecticide resistance, as well as increased parasite resistance to antimalarial drugs. It is clear that new methods of Anopheles mosquito control are needed to ameliorate the medical and economic situation in sub-Saharan Africa. As a step toward new malaria control methods, the international Plasmodium falciparum and Anopheles gambiae consortia have carried out the full genome sequencing of the most deadly malaria parasite and the most efficient vector. These, combined with the human genome sequence, provide the genomic infrastructure for a better understanding of the complex interactions within the malaria triad. This essay discusses possible strategies as to how the Anopheles genome can contribute to malaria control.     

Veterinary anthelmintics: old and new

Between 1960 and 1980, extraordinary success was achieved in anthelmintic development for animals. In these 20 years, drugs with diverse structure, novel activity and enviable safety were produced for a global livestock industry leading to the productivity gains needed to support a human population that grew by 1.5 billion during the same period. The following 20 years have been spent refining existing molecules with niche activity (parasite and host specificity), improving delivery systems and worrying about the inexorable spread of drug resistance. The challenge for the next 20 years will be to use the technologies available to design and produce new drugs and biological controls. Then, to use the lessons of the past to ensure that the new drugs enjoy a longer useful lifespan and contribute to an animal health industry (livestock and companion) which enriches the lives of a global population. Old and new veterinary anthelmintics comprise a very large field, which could not be comprehensively reviewed in a short article. The present mini-review focuses on major chemical discoveries, formulation developments, administration strategies and new products.     

Analysis in Escherichia coli of Plasmodium falciparum dihydropteroate synthase (DHPS) alleles implicated in resistance to sulfadoxine

Mutations in Plasmodium falciparum dihydropteroate synthase have been linked to resistance to the antimalarial drug, sulfadoxine, which competes with the dihydropteroate synthase substrate, p-aminobenzoate. In an effort to evaluate the role of these mutations in a simple model system, we have expressed six relevant alleles of the P. falciparum dihydropteroate synthase gene in Escherichia coli. When each construct was produced in a dihydropteroate synthase disrupted E. coli strain that required thymidine, the thymidine requirement was lost, indicating heterologous complementation had occurred. In the presence of sulfadoxine, the growth of the strain with the wild-type dihydropteroate synthase allele was inhibited while those containing each of the five mutant alleles grew, indicating that these mutations can confer sulfadoxine resistance in E. coli. When tested against twelve additional 'sulfa' drugs a variety of responses were obtained. All strains were resistant to sulfadiazine, but the wild-type allele conferred sensitivity to all other sulfa drugs. Three alleles conferred resistance to dapsone, a drug that is to be targetted for a new regime of malaria treatment in Africa. All mutant alleles remained sensitive to sulfachloropyridazine and sulfacetamide. These results suggest new drugs that could be tried for effective malaria treatment.