Host Determinants of Reinfection with Schistosomes in Humans: A Systematic Review and Meta-analysis

Background

Schistosomiasis is still a major public health burden in the tropics and subtropics. Although there is an effective chemotherapy (Praziquantel) for this disease, reinfection occurs rapidly after mass drug administration (MDA). Because the entire population do not get reinfected at the same rate, it is possible that host factors may play a dominant role in determining resistance or susceptibility to reinfection with schistosomes. Here, we systematically reviewed and meta-analyzed studies that reported associations between reinfection with the principal human-infecting species (S. mansoni, S. japonicum and S. haematobium) and host socio-demographic, epidemiological, immunological and genetic factors.

Methodology/Principal Findings

PubMed, Scopus, Google Scholar, Cochrane Review Library and African Journals Online public databases were searched in October 2013 to retrieve studies assessing association of host factors with reinfection with schistosomes. Meta-analysis was performed to generate pooled odds ratios and standardized mean differences as overall effect estimates for dichotomous and continuous variables, respectively. Quality assessment of included studies, heterogeneity between studies and publication bias were also assessed. Out of the initial 2739 records, 109 studies were included in the analyses, of which only 32 studies with 37 data sets were eligible for quantitative data synthesis. Among several host factors identified, strong positive association was found with age and pre-treatment intensity, and only slightly for gender. These factors are major determinants of exposure and disease transmission. Significant positive association was found with anti-SWA IgG4 level, and a negative overall effect for association with IgE levels. This reconfirmed the concept that IgE/IgG4 balance is a major determinant of protective immunity against schistosomiasis. Other identified determinants were reported by a small number of studies to enable interpretation.

Conclusions

Our data contribute to the understanding of host-parasite interaction as it affects reinfection, and is a potential tool to guide planning and tailoring of community interventions to target high-risk groups.     

Suppressing Glucose Transporter Gene Expression in Schistosomes Impairs Parasite Feeding and Decreases Survival in the Mammalian Host

Adult schistosomes live in the host''s bloodstream where they import nutrients such as glucose across their body surface (the tegument). The parasite tegument is an unusual structure since it is enclosed not by the typical one but by two closely apposed lipid bilayers. Within the tegument two glucose importing proteins have been identified; these are schistosome glucose transporter (SGTP) 1 and 4. SGTP4 is present in the host interactive, apical tegumental membranes, while SGTP1 is found in the tegumental basal membrane (as well as in internal tissues). The SGTPs act by facilitated diffusion. To examine the importance of these proteins for the parasites, RNAi was employed to knock down expression of both SGTP genes in the schistosomula and adult worm life stages. Both qRT-PCR and western blotting analysis confirmed successful gene suppression. It was found that SGTP1 or SGTP4-suppressed parasites exhibit an impaired ability to import glucose compared to control worms. In addition, parasites with both SGTP1 and SGTP4 simultaneously suppressed showed a further reduction in capacity to import glucose compared to parasites with a single suppressed SGTP gene. Despite this debility, all suppressed parasites exhibited no phenotypic distinction compared to controls when cultured in rich medium. Following prolonged incubation in glucose-depleted medium however, significantly fewer SGTP-suppressed parasites survived. Finally, SGTP-suppressed parasites showed decreased viability in vivo following infection of experimental animals. These findings provide direct evidence for the importance of SGTP1 and SGTP4 for schistosomes in importing exogenous glucose and show that these proteins are important for normal parasite development in the mammalian host.     

Cryptococcal Interactions with the Host Immune System

Opportunistic pathogens have become of increasing medical importance over the last decade due to the AIDS pandemic. Not only is cryptococcosis the fourth-most-common fatal infectious disease in sub-Saharan Africa, but also Cryptococcus is an emerging pathogen of immunocompetent individuals. The interaction between Cryptococcus and the host''s immune system is a major determinant for the outcome of disease. Despite initial infection in early childhood with Cryptococcus neoformans and frequent exposure to C. neoformans within the environment, immunocompetent individuals are generally able to contain the fungus or maintain the yeast in a latent state. However, immune deficiencies lead to disseminating infections that are uniformly fatal without rapid clinical intervention. This review will discuss the innate and adaptive immune responses to Cryptococcus and cryptococcal strategies to evade the host''s defense mechanisms. It will also address the importance of these strategies in pathogenesis and the potential of immunotherapy in cryptococcosis treatment.The basidiomycetous yeast genus Cryptococcus includes the two medically important pathogens C. neoformans and C. gattii. These two species are further divided into C. neoformans serotypes A (C. neoformans var. grubii), D (C. neoformans var. neoformans), and A/D and C. gattii serotypes B and C (formerly C. neoformans var. gattii) based on differential antibody recognition of the polysaccharide capsule (135). The two pathogenic species show different geographical distributions. C. neoformans is globally distributed and has been isolated from various natural sources, with particularly high concentrations occurring in avian guano, rotting vegetables, and soil. In contrast, C. gattii is geographically restricted to tropical and subtropical regions, with the notable exception of British Columbia. In tropical and subtropical regions, it has been found to be associated with the eucalyptus species Eucalyptus camaldulensis, Eucalyptus tereticornis, Eucalyptus rudis, and Eucalyptus gomphocephala (64, 172). C. neoformans causes mainly opportunistic infections in immunocompromised patients with underlying conditions, such as HIV, leukemia, and other cancers, or in those taking corticosteroid medication (135). Serotype A is responsible for the majority of cryptococcosis cases in immunocompromised hosts (135). In contrast, C. gattii affects mainly immunocompetent individuals. The recent and spreading cryptococcosis outbreak in healthy individuals in British Columbia has highlighted the potential of C. gattii to act as an emerging pathogen (84, 85, 121). In addition, other non-C. neoformans/non-C. gattii species, such as Cryptococcus laurentii and Cryptococcus albidus, have recently started to emerge as potential human pathogens (83).Cryptococcal infection can be asymptomatic, chronic, or acute. Typically, an initial pulmonary infection can spread systemically, with a particular predilection for the central nervous system. Pulmonary infections are in most cases asymptomatic. However, they can involve coughing, pleuritic chest pain, fever, dyspnoea, weight loss, and malaise. Pneumonia and acute respiratory distress syndrome have been reported mainly for immunocompromised patients (17, 141). Cryptococcosis of the central nervous system is life threatening and presents as meningitis or meningoencephalitis, with symptoms such as headache, increased intracranial pressure, fever, lethargy, coma, personality changes, and memory loss. Less common are secondary infections of the skin, lungs, prostate, and eye (135). A recent publication estimated 957,900 cases of cryptococcal meningitis resulting in 624,700 deaths globally each year (150). It is the leading cause of death in HIV-infected individuals, with an incidence of 30% and a mortality of 30 to 60%. The mortality rate in transplant patients is even higher (20 to 100%) (Centers for Disease Control and Prevention) (135).The dramatic course of Cryptococcus infections in immunocompromised individuals shows the importance of an intact immune response to the pathogen. This review will consider both the host''s innate and adaptive immune responses to C. neoformans and C. gattii together with the pathogens'' strategy to undermine these defense mechanisms and how current knowledge might be applied to improve anticryptococcal therapy.     

RNA干扰介导原核细胞适应性免疫

RNA干扰广泛存在于真核细胞中, 其作用机制已得到比较清楚阐明.虽然在原核细胞中已发现微小RNA(miRNA)参与的基因沉默调节细菌基因表达, 但尚未发现小干扰RNA (siRNA)参与的基因沉默机制.近年在原核细胞基因组中发现一类新的成簇的规律间隔的短回文重复序列 (clustered regularly interspaced short palindromic repeat, CRISPR)和与其相关的基因.生物信息学分析和预测表明两者构成的CRISPR相关系统介导原核细胞RNA干扰, 进而发挥免疫防御功能.这一假说新近得到了实验证实, 与此同时首次揭示了原核细胞的适应性免疫机制.这种防御机制不同于真核细胞适应性免疫机制, 除具特异性外, 还具有遗传性.     

Comparative Proteomics Identifies Host Immune System Proteins Affected by Infection with Mycobacterium bovis

Mycobacteria of the Mycobacterium tuberculosis complex (MTBC) greatly impact human and animal health worldwide. The mycobacterial life cycle is complex, and the mechanisms resulting in pathogen infection and survival in host cells are not fully understood. Eurasian wild boar (Sus scrofa) are natural reservoir hosts for MTBC and a model for mycobacterial infection and tuberculosis (TB). In the wild boar TB model, mycobacterial infection affects the expression of innate and adaptive immune response genes in mandibular lymph nodes and oropharyngeal tonsils, and biomarkers have been proposed as correlates with resistance to natural infection. However, the mechanisms used by mycobacteria to manipulate host immune response are not fully characterized. Our hypothesis is that the immune system proteins under-represented in infected animals, when compared to uninfected controls, are used by mycobacteria to guarantee pathogen infection and transmission. To address this hypothesis, a comparative proteomics approach was used to compare host response between uninfected (TB-) and M. bovis-infected young (TB+) and adult animals with different infection status [TB lesions localized in the head (TB+) or affecting multiple organs (TB++)]. The results identified host immune system proteins that play an important role in host response to mycobacteria. Calcium binding protein A9, Heme peroxidase, Lactotransferrin, Cathelicidin and Peptidoglycan-recognition protein were under-represented in TB+ animals when compared to uninfected TB- controls, but protein levels were higher as infection progressed in TB++ animals when compared to TB- and/or TB+ adult wild boar. MHCI was the only protein over-represented in TB+ adult wild boar when compared to uninfected TB- controls. The results reported here suggest that M. bovis manipulates host immune response by reducing the production of immune system proteins. However, as infection progresses, wild boar immune response recovers to limit pathogen multiplication and promote survival, facilitating pathogen transmission.     

Host Location by Ichneumonid Parasitoids is Associated with Nest Dimensions of the Host Bee Species

Parasitoid fitness depends on the ability of females to locate a host. In some species of Ichneumonoidea, female parasitoids detect potential hosts through vibratory cues emanating from them or through vibrational sounding produced by antennal tapping on the substrate. In this study, we (1) describe host location behaviors in Grotea gayi Spinola (Hymenoptera: Ichneumonidae) and Labena sp. on nests of Manuelia postica Spinola (Hymenoptera: Apidae), (2) compare nest dimensions between parasitized and unparasitized nests, (3) correlate the length of M. postica nests with the number of immature individuals developing, and (4) establish the relative proportion of parasitized nests along the breeding period of M. postica. Based on our results, we propose that these parasitoids use vibrational sounding as a host location mechanism and that they are able to assess host nest dimensions and choose those which may provide them with a higher fitness. Finally, we discuss an ancestral host?Cparasitoid relationship between Manuelia and ichneumonid species.     

Virulence Frequencies Influenced by Host Resistance in the Host-Pathogen System Wheat-Powdery Mildew

The virulence spectrum for different regions in Germany in 1986 shows that only virulences for resistance genes Pm1, 4a, 7, 8 and Ml-i are common in Northern Germany; in the Southern part only Pm3b and 9 (+Pm1+ 2) remain effective; the combination Pm2 + 6 is effective within the whole country. The selection pressure of resistance genes on virulences is complex, but was relatively stable under different environmental conditions in 1985 and 1986.     

Host Range and Interference Studies of Three Classes of Pig Endogenous Retrovirus

Recent interest in the use of porcine organs, tissues, and cells for xenotransplantation to humans has highlighted the need to characterize the properties of pig endogenous retroviruses (PERVs). Analysis of a variety of pig cells allowed us to isolate and identify three classes of infectious type C endogenous retrovirus (PERV-A, PERV-B, and PERV-C) which have distinct env genes but have highly homologous sequences in the rest of the genome. To study the properties of these env genes, expression plasmids for the three env genes were constructed and used to generate retrovirus vectors bearing corresponding Env proteins. Host range analyses by the vector transduction assay showed that PERV-A and PERV-B Envs have wider host ranges, including several human cell lines, compared with PERV-C Env, which infected only two pig cell lines and one human cell line. All PERVs could infect pig cells, indicating that the PERVs have a potential to replicate in pig transplants in immunosuppressed patients. Receptors for PERV-A and PERV-B were present on cells of some other species, including mink, rat, mouse, and dog, suggesting that such species may provide useful model systems to study infection and pathogenicity of PERV. In contrast, no vector transduction was observed on nonhuman primate cell lines, casting doubt on the utility of nonhuman primates as models for PERV zoonosis. Interference studies showed that the three PERV strains use receptors distinct from each other and from a number of other type C mammalian retroviruses.Pig-to-human xenotransplantation has the potential to alleviate the shortage of allogeneic organs for transplantation (1, 25). In addition, it may also allow the development of novel therapies by providing unlimited supplies of cells and tissues (9, 11, 13, 18). Recently, substantial progress has been made in overcoming immunological barriers to cross-species transplantation (25, 27). At the same time, however, serious concerns that zoonotic infections might occur as a result of xenotransplantation have been expressed (1, 6, 30). Our report that an established pig cell line produces a porcine endogenous retrovirus (PERV) that can infect human cells fueled these concerns (23). Subsequently, the isolation of human tropic PERV from stimulated miniswine peripheral blood lymphocytes (38) has shown that normal pig cells can also produce potentially hazardous virus. PERVs may be difficult to eliminate from donor animals because multiple copies of PERV genomes are present in normal pig genomes (2, 16, 23). PERV infection may have serious impact on the health of not only transplant recipients but also the human population at large, if spread of an undetected infectious agent into the community were to take place (3, 31). To assess the risk posed by the PERVs for pig-to-human transplantation, a greater understanding of the properties of the PERVs is required.Sequence analyses indicate that the infectious PERVs are closely related to one another in their gag and pol genes, with maximum amino acid divergence of around 5% (2, 16a, 23). The PERVs are members of the mammalian type C retrovirus genus showing closest homology to the gibbon ape leukemia virus (GALV) pol gene, with about 70% amino acid identity, and 60 to 70% identity to murine leukemia viruses (MLV). However, three distinct env genes have now been identified in PERV clones. Two of these env genes, PERV-A and PERV-B, were cloned from human 293 cells infected with PK15 virus (16). The third distinct class of PERV env gene, here designated PERV-C, was reported as a part of a full-length PERV genome isolated from miniature swine lymphocytes (PERV-MSL) and from a swine lymphoma (PERV-Tsukuba-1) (2, 32). The three types show marked differences in the VRA, VRB, and PRO regions of SU surface glycoprotein (2, 16). Differences in these regions determine the host range specificity of the different classes of MLV (4, 5). These observations suggest that the PERVs belong to three distinct classes with different host range specificities. To test this idea, the functions of the three types of PERV env gene were examined and correlated to production, infection, and replication of PERVs in cell culture. Recombinant retrovirus vectors bearing PERV Env proteins were developed and their host ranges, cell tropism, and interference with each other as well as with other type C retroviruses were examined. The results of these experiments are the subject of this report.     

Strain-Specific Interactions of Listeria monocytogenes with the Autophagy System in Host Cells

Listeria monocytogenes is an intracellular bacterial pathogen that can replicate in the cytosol of host cells. These bacteria undergo actin-based motility in the cytosol via expression of ActA, which recruits host actin-regulatory proteins to the bacterial surface. L. monocytogenes is thought to evade killing by autophagy using ActA-dependent mechanisms. ActA-independent mechanisms of autophagy evasion have also been proposed, but remain poorly understood. Here we examined autophagy of non-motile (ΔactA) mutants of L. monocytogenes strains 10403S and EGD-e, two commonly studied strains of this pathogen. The ΔactA mutants displayed accumulation of ubiquitinated proteins and p62/SQSTM1 on their surface. However, only strain EGD-e ΔactA displayed colocalization with the autophagy marker LC3 at 8 hours post infection. A bacteriostatic agent (chloramphenicol) was required for LC3 recruitment to 10403S ΔactA, suggesting that these bacteria produce a factor for autophagy evasion. Internalin K was proposed to block autophagy of L. monocytogenes in the cytosol of host cells. However, deletion of inlK in either the wild-type or ΔactA background of strain 10403S had no impact on autophagy evasion by bacteria, indicating it does not play an essential role in evading autophagy. Replication of ΔactA mutants of strain EGD-e and 10403S was comparable to their parent wild-type strain in macrophages. Thus, ΔactA mutants of L. monocytogenes can block killing by autophagy at a step downstream of protein ubiquitination and, in the case of strain EGD-e, downstream of LC3 recruitment to bacteria. Our findings highlight the strain-specific differences in the mechanisms that L. monocytogenes uses to evade killing by autophagy in host cells.     

Haemostatic variables associated with diabetes and its complications.

To study the possible role of an "increased thrombotic tendency" in the vascular complications of diabetes several tests of haemostatic function were carried out on 91 men and 63 women with diabetes aged 35-54 years and the results compared with findings in 686 men and 393 women of the same age in the Northwick Park Heart Study. Mean values for factors VII and X, fibrinogen, and platelet adhesiveness were higher in the diabetics, but mean fibrinolytic activity and whole blood platelet counts were lower. Antithrombin III values were also higher in the diabetics, which may have constituted a protective response to other changes favouring the onset of vascular disease. Diabetics with retinopathy had higher factor VII and antithrombin III values, and those with proteinuria had higher values for factor VII, fibrinogen, and platelet adhesiveness than those without these complications. These findings suggest a potentially important association between a thrombogenic tendency and vascular disease in diabetes. Nevertheless, prospective data are needed to clarify whether the haemostatic abnormalities precede the onset of clinically manifest vascular complications or are a consequence of them.     

Interference by azide in the estimation of carbohydrates with anthrone

The anthrone reaction for the determination of carbohydrates, hexoses, pentoses, and polysaccharides is a general method which is very widely used. In this method a bacteriostatic agent, usually sodium azide, benzoic acid, or other bacteriostatic agents are added to the solution. These compounds, especially azide, appear to interfere with the development of the specific colour, introducing a serious error in the determination. A detailed study of the effect of azide and other interfering agents on a number of various carbohydrates have been made with some suggestions as to how errors may be avoided.     

Schistosomes: the road from host-parasite interactions to vaccines in clinical trials

Insights over recent years into the interactions between helminths, including schistosomes, and the immune system have generated new concepts in immunology and significant advances in vaccine strategies. Here, we report recent advances that substantially increase our understanding of the nature of the host innate and adaptive responses to schistosomes and on strategies elaborated by the parasite to manipulate such responses. We also describe the long road that has allowed us to move from the identification of an anti-schistosome vaccine candidate, a 28kDa glutathione-S-transferase, to its recent evaluation in human clinical trials.     

Specific Nucleic AcId Ligation for the detection of Schistosomes: SNAILS

Schistosomiasis, also known as bilharzia or snail fever, is a debilitating neglected tropical disease (NTD), caused by parasitic trematode flatworms of the genus Schistosoma, that has an annual mortality rate of 280,000 people in sub-Saharan Africa alone. Schistosomiasis is transmitted via contact with water bodies that are home to the intermediate host snail which shed the infective cercariae into the water. Schistosome lifecycles are complex, and while not all schistosome species cause human disease, endemic regions also typically feature animal-infecting schistosomes that can have broader economic and/or food security implications. Therefore, the development of species-specific Schistosoma detection technologies may help to inform evidence-based local environmental, food security and health systems policy making. Crucially, schistosomiasis disproportionally affects low- and middle-income (LMIC) countries and for that reason, environmental screening of water bodies for schistosomes may aid with the targeting of water, sanitation, and hygiene (WASH) interventions and preventive chemotherapy to regions at highest risk of schistosomiasis transmission, and to monitor the effectiveness of such interventions at reducing the risk over time. To this end, we developed a DNA-based biosensor termed Specific Nucleic AcId Ligation for the detection of Schistosomes or ‘SNAILS’. Here we show that ‘SNAILS’ enables species-specific detection from genomic DNA (gDNA) samples that were collected from the field in endemic areas.     

Interaction of CSFV E2 Protein with Swine Host Factors as Detected by Yeast Two-Hybrid System

E2 is one of the envelope glycoproteins of pestiviruses, including classical swine fever virus (CSFV) and bovine viral diarrhea virus (BVDV). E2 is involved in several critical functions, including virus entry into target cells, induction of a protective immune response and virulence in swine. However, there is no information regarding any host binding partners for the E2 proteins. Here, we utilized the yeast two-hybrid system and identified fifty-seven host proteins as positive binding partners which bound E2 from both CSFV and BVDV with the exception of two proteins that were found to be positive for binding only to CSFV E2. Alanine scanning of CSFV E2 demonstrated that the binding sites for these cellular proteins on E2 are likely non-linear binding sites. The possible roles of the identified host proteins are discussed as the results presented here will be important for future studies to elucidate mechanisms of host protein-virus interactions during pestivirus infection. However, due to the limitations of the yeast two hybrid system, the proteins identified is not exhaustive and each interaction identified needs to be confirmed by independent experimental approaches in the context of virus-infected cells before any definitive conclusion can be drawn on relevance for the virus life cycle.     

Schistosomes: unanswered questions on the basic biology of the host-parasite relationship

As is the case in many parasite infections, research into schistosomiasis has not yet yielded a vaccine and, although chemotherapy with praziquantel is very effective, the mechanism of action of this drug is unknown. John Kusel and colleagues here suggest that an understanding of basic biological phenomena, such as the role of Ca(2+) in skin penetration and the function of the adult excretory system, might lead to important breakthroughs. Other crucial questions are also addressed, with the hope of stimulating debate. They invite suggestions and correspondence from others working in related fields.