Persistence of the Nocturnal Thyrotropin Surge and Preservation of the Sleep-Related Variations of TSH in African Trypanosomiasis

The aim of this work was to study the nycthemeral and sleep-related variations of thyrotropin (TSH) in sleeping sickness (Human African trypanosomiasis). Six untreated patients were studied during 24 hours using 10 min blood sampling and polygraphic sleep recordings. These patients were compared to 5 healthy African subjects. The patients were selected during a medical investigation in Congo. Sleeping sickness was diagnosed clinically and confirmed by the detection of Trypanosoma brucei gambiense in the blood, the cerebrospinal fluid, or in a lymph node puncture, and by a serologic immunofluorescence test. Blood was withdrawn continuously via a catheter and sampled into 10 min aliquots in an adjoining room. TSH was measured by a commercial IRMA kit. Sleep was recorded by continuous polysomnography and scored visually. The integrity of the sleep-wake cycle varied greatly among patients, ranging from major disruption with insomnia to almost undisturbed nocturnal sleep. Mean TSH levels were slightly higher in the patients than in the controls, although the difference was not significant. The nocturnal surge was preserved in all but one patient and its amplitude was not different between patients and controls. There were more TSH pulses in the patients, maybe due to fragmented sleep with many awakenings. The relationships between sleep structure and TSH variations were preserved, with decreasing TSH levels during slow-wave sleep and increasing levels after awakenings. We conclude that contrarily to other biological rhythms, the nycthemeral pattern of TSH is preserved in the sleeping sickness patients. The TSH nocturnal surge persisted, unlike in other nonthyroidal illnesses. The relationhsips between TSH variations and sleep structure are also preserved, demonstrating the robustness of this association.     

人类非洲锥虫病的治疗研究进展

人类非洲锥虫病是一种被忽视的热带寄生虫病,威胁着撒哈拉以南非洲人民的生命健康。目前临床使用的治疗药物有四种,这些药物副作用多,用药困难并产生了一定的耐药性,因此有必要开发安全有效且利于服用的药物。目前有三类候选药物相继进入临床实验阶段,在不久的将来可能会进入临床应用。另外,还有许多正在研究的治疗药物,包括天然产物、磷酸二酯酶抑制剂、蛋白酶抑制剂、拓扑异构酶抑制剂、亮氨酰t RNA合成酶抑制剂、微管蛋白抑制剂以及一些靶点尚不明确却有很好的锥虫抑制活性的化合物。其中,壳二孢呋喃酮选择性较好,喹啉-3-羧酸类衍生物毒性低,5-硝基-2-呋喃酰胺类化合物对硝呋莫司耐受的锥虫仍有活性。这些研究无疑都为新型抗锥虫药物的出现提供了可能,相信在不久的将来越来越多的药物会在临床使用。     

Discovery of Infection Associated Metabolic Markers in Human African Trypanosomiasis

Human African trypanosomiasis (HAT) remains a major neglected tropical disease in Sub-Saharan Africa. As clinical symptoms are usually non-specific, new diagnostic and prognostic markers are urgently needed to enhance the number of identified cases and optimise treatment. This is particularly important for disease caused by Trypanosoma brucei rhodesiense, where indirect immunodiagnostic approaches have to date been unsuccessful. We have conducted global metabolic profiling of plasma from T.b.rhodesiense HAT patients and endemic controls, using ¹H nuclear magnetic resonance (NMR) spectroscopy and ultra-performance liquid chromatography, coupled with mass spectrometry (UPLC-MS) and identified differences in the lipid, amino acid and metabolite profiles. Altogether 16 significantly disease discriminatory metabolite markers were found using NMR, and a further 37 lipid markers via UPLC-MS. These included significantly higher levels of phenylalanine, formate, creatinine, N-acetylated glycoprotein and triglycerides in patients relative to controls. HAT patients also displayed lower concentrations of histidine, sphingomyelins, lysophosphatidylcholines, and several polyunsaturated phosphatidylcholines. While the disease metabolite profile was partially consistent with previous data published in experimental rodent infection, we also found unique lipid and amino acid profile markers highlighting subtle but important differences between the host response to trypanosome infections between animal models and natural human infections. Our results demonstrate the potential of metabolic profiling in the identification of novel diagnostic biomarkers and the elucidation of pathogenetic mechanisms in this disease.     

Monitoring the Progress towards the Elimination of Gambiense Human African Trypanosomiasis

BackgroundOver the last few years, momentum has gathered around the feasibility and opportunity of eliminating gambiense human African trypanosomiasis (g-HAT). Under the leadership of the World Health Organization (WHO), a large coalition of stakeholders is now committed to achieving this goal. A roadmap has been laid out, and indicators and milestones have been defined to monitor the progress of the elimination of g-HAT as a public health problem by 2020. Subsequently, a more ambitious objective was set for 2030: to stop disease transmission. This paper provides a situational update to 2012 for a number of indicators of elimination: number of cases annually reported, geographic distribution of the disease and areas and populations at different levels of risk.ResultsComparing the 5-year periods 2003-2007 and 2008-2012, the area at high or very high risk of g-HAT shrank by 60%, while the area at moderate risk decreased by 22%. These are the areas where g-HAT is still to be considered a public health problem (i.e. > 1 HAT reported case per 10,000 people per annum). This contraction of at-risk areas corresponds to a reduction of 57% for the population at high or very high risk (from 4.1 to 1.8 million), and 20% for moderate risk (from 14.0 to 11.3 million).DiscussionImproved data completeness and accuracy of the Atlas of HAT enhanced our capacity to monitor the progress towards the elimination of g-HAT. The trends in the selected indicators suggest that, in recent years, progress has been steady and in line with the elimination goal laid out in the WHO roadmap on neglected tropical diseases.     

Preclinical Assessment of the Treatment of Second-Stage African Trypanosomiasis with Cordycepin and Deoxycoformycin

Background

There is an urgent need to substitute the highly toxic compounds still in use for treatment of the encephalitic stage of human African trypanosomiasis (HAT). We here assessed the treatment with the doublet cordycepin and the deaminase inhibitor deoxycoformycin for this stage of infection with Trypanosoma brucei (T.b.).

Methodology/Principal Findings

Cordycepin was selected as the most efficient drug from a direct parasite viability screening of a compound library of nucleoside analogues. The minimal number of doses and concentrations of the drugs effective for treatment of T.b. brucei infections in mice were determined. Oral, intraperitoneal or subcutaneous administrations of the compounds were successful for treatment. The doublet was effective for treatment of late stage experimental infections with human pathogenic T.b. rhodesiense and T.b. gambiense isolates. Late stage infection treatment diminished the levels of inflammatory cytokines in brains of infected mice. Incubation with cordycepin resulted in programmed cell death followed by secondary necrosis of the parasites. T.b. brucei strains developed resistance to cordycepin after culture with increasing concentrations of the compound. However, cordycepin-resistant parasites showed diminished virulence and were not cross-resistant to other drugs used for treatment of HAT, i.e. pentamidine, suramin and melarsoprol. Although resistant parasites were mutated in the gene coding for P2 nucleoside adenosine transporter, P2 knockout trypanosomes showed no altered resistance to cordycepin, indicating that absence of the P2 transporter is not sufficient to render the trypanosomes resistant to the drug.

Conclusions/Significance

Altogether, our data strongly support testing of treatment with a combination of cordycepin and deoxycoformycin as an alternative for treatment of second-stage and/or melarsoprol-resistant HAT.     

Thyrotropin (TSH) regulates triiodothyronine (T3) production in the unicellular Tetrahymena

The aim of the experiments was to study the regulation of triiodothyronine (T3) production in the unicellular Tetrahymena. Untreated and troph-hormone treated specimen were prepared and in different timepoints T3 content was measured and compared by immunocytochemical flow cytometry. 0.1 or 0.001 IU TSH in tryptone-yeast medium stimulated T3 synthesis at 10, 20, 30 min, but does not stimulate after 1 h. The overlapping gonadotropic hormone (GTH) also did it, however only at 10 min. In Losina salt solution (physiological for Tetrahymena) the effect was weaker, however outer amino acid source was not absolutely needed for the production of the hormone. The results show that the TSH regulation of thyroid hormone synthesis (storage, secretion) and troph-hormone overlap can be deduced to a unicellular level. This may allow the hypothesis that the endocrine mechanisms proved at a low level of phylogeny are preserved for the higher ranked organisms.     

Syndromic Algorithms for Detection of Gambiense Human African Trypanosomiasis in South Sudan

Background

Active screening by mobile teams is considered the best method for detecting human African trypanosomiasis (HAT) caused by Trypanosoma brucei gambiense but the current funding context in many post-conflict countries limits this approach. As an alternative, non-specialist health care workers (HCWs) in peripheral health facilities could be trained to identify potential cases who need testing based on their symptoms. We explored the predictive value of syndromic referral algorithms to identify symptomatic cases of HAT among a treatment-seeking population in Nimule, South Sudan.

Methodology/Principal Findings

Symptom data from 462 patients (27 cases) presenting for a HAT test via passive screening over a 7 month period were collected to construct and evaluate over 14,000 four item syndromic algorithms considered simple enough to be used by peripheral HCWs. For comparison, algorithms developed in other settings were also tested on our data, and a panel of expert HAT clinicians were asked to make referral decisions based on the symptom dataset. The best performing algorithms consisted of three core symptoms (sleep problems, neurological problems and weight loss), with or without a history of oedema, cervical adenopathy or proximity to livestock. They had a sensitivity of 88.9–92.6%, a negative predictive value of up to 98.8% and a positive predictive value in this context of 8.4–8.7%. In terms of sensitivity, these out-performed more complex algorithms identified in other studies, as well as the expert panel. The best-performing algorithm is predicted to identify about 9/10 treatment-seeking HAT cases, though only 1/10 patients referred would test positive.

Conclusions/Significance

In the absence of regular active screening, improving referrals of HAT patients through other means is essential. Systematic use of syndromic algorithms by peripheral HCWs has the potential to increase case detection and would increase their participation in HAT programmes. The algorithms proposed here, though promising, should be validated elsewhere.     

Nocturnal behavior in a group of female African elephants

The nocturnal behavior of a stable group of female, African elephants (Loxodonta africana africana) was studied to: (1) examine their behavior as a function of hour of night; (2) qualitatively compare the elephants' activity budgets to those reported in a previous study; and (3) document the presence of aggressive and stereotypic behaviors that might necessitate a change in their management. The elephants were systematically observed at least five times per week for 10 weeks between 17:00 and 08:00. Instantaneous focal samples of behavior, location, and proximity were taken every minute on a rotating basis, and all observed occurrences of social behavior were recorded. The hour of night affected elephant activity: significant relationships were found between hour of night and percent of time they spent feeding, lying, and standing. The overall activity budgets of the elephants were similar to the activity budgets reported in a previous study, although differences were evident in lying, stereotypic, and social behaviors. These differences might be a function of age. Affiliative behaviors accounted for 57% of the elephants' social behaviors, and agonistic behaviors among the elephants occurred infrequently and caused no injuries. Additionally, the elephants used all areas to which they had access. These findings provide compelling evidence that unrestricted social access during the night is the appropriate management strategy for these elephants. The results from the present study also highlight the importance of replicating existing studies and using multiple behavioral measures to make decisions regarding the welfare and management of stable groups of captive elephants. Zoo Biol 25:173–186, 2006. © 2006 Wiley‐Liss, Inc.     

Evaluation of the Diagnostic Accuracy of Prototype Rapid Tests for Human African Trypanosomiasis

BackgroundDiagnosis of human African trypanosomiasis (HAT) remains a challenge both for active screening, which is critical in control of the disease, and in the point-of-care scenario where early and accurate diagnosis is essential. Recently, the first field deployment of a lateral flow rapid diagnostic test (RDT) for HAT, “SD BIOLINE HAT” has taken place. In this study, we evaluated the performance of “SD BIOLINE HAT” and two new prototype RDTs.Conclusions/SignificanceBoth “SD BIOLINE HAT” and the prototype devices performed comparably well to one another and also to the published performance range of the card agglutination test for trypanosomiasis in sensitivity and specificity. The performance of individual antigens enabled us to predict that an all-recombinant antigen RDT can be developed with an accuracy equivalent to “ SD BIOLINE HAT.” Such an RDT would have advantages in simplified manufacture, lower unit cost and assured reproducibility.     

Quantifying epidemiological drivers of gambiense human African Trypanosomiasis across the Democratic Republic of Congo

Gambiense human African trypanosomiasis (gHAT) is a virulent disease declining in burden but still endemic in West and Central Africa. Although it is targeted for elimination of transmission by 2030, there remain numerous questions about the drivers of infection and how these vary geographically.In this study we focus on the Democratic Republic of Congo (DRC), which accounted for 84% of the global case burden in 2016, to explore changes in transmission across the country and elucidate factors which may have contributed to the persistence of disease or success of interventions in different regions. We present a Bayesian fitting methodology, applied to 168 endemic health zones (∼100,000 population size), which allows for calibration of a mechanistic gHAT model to case data (from the World Health Organization HAT Atlas) in an adaptive and automated framework.It was found that the model needed to capture improvements in passive detection to match observed trends in the data within former Bandundu and Bas Congo provinces indicating these regions have substantially reduced time to detection. Health zones in these provinces generally had longer burn-in periods during fitting due to additional model parameters.Posterior probability distributions were found for a range of fitted parameters in each health zone; these included the basic reproduction number estimates for pre-1998 (R₀) which was inferred to be between 1 and 1.14, in line with previous gHAT estimates, with higher median values typically in health zones with more case reporting in the 2000s.Previously, it was not clear whether a fall in active case finding in the period contributed to the declining case numbers. The modelling here accounts for variable screening and suggests that underlying transmission has also reduced greatly—on average 96% in former Equateur, 93% in former Bas Congo and 89% in former Bandundu—Equateur and Bandundu having had the highest case burdens in 2000. This analysis also sets out a framework to enable future predictions for the country.     

Nocturnal behavior in a group of unchained female African elephants

The chaining of elephants at night is a common management strategy in zoos, yet the costs and benefits of such a strategy are relatively unknown. A study of three unchained female African elephants was undertaken to document their nocturnal behavior. The subjects were observed between the hours of 1800 and 0800 for 10 weeks in the summer of 1992 (total of 172 hr) and 14 weeks in the summer of 1994 (total of 153 hr). Scan data were collected every 5 min to gather information on activity budgets, social proximity, and space utilization. All‐occurrence data were collected on social and non‐social behaviors. In each year of the study, the subjects spent equivalent amounts of time eating, lying, standing, and walking. Additionally, subjects spent half of their time within one body length of another animal and utilized all three available enclosures. Social and non‐social behaviors were frequent, and these data plus the activity profiles reveal the animals generally were most active between the hours of 1800 and 2400 and 0600 and 0700. The findings suggest that the use of no restraints is currently an effective strategy for this elephant group. The high activity levels observed during many of the early evening hours suggest that zoos could permit increased activity and social interactions by extending the hours when the elephants are unchained. Zoo Biol 18:101–109, 1999. © 1999 Wiley‐Liss, Inc.     

夜间低温胁迫对番茄叶片活性氧代谢及AsA-GSH循环的影响

以番茄品种‘辽园多丽’为试材,利用人工气候室模拟设施生产中的夜间低温胁迫环境,研究9℃和6℃夜低温对番茄叶片活性氧代谢和AsA-GSH循环的影响。结果显示:9℃和6℃夜间低温胁迫3～9d可诱导番茄叶片中超氧阴离子(O2.-)产生速率、过氧化氢(H2O2)和丙二醛(MDA)含量上升;抑制过氧化物酶(POD)、过氧化氢酶(CAT)的活性,增加超氧化物歧化酶(SOD)和AsA-GSH循环中抗坏血酸过氧化物酶(APX)、脱氢抗坏血酸还原酶(DHAR)、谷胱甘肽还原酶(GR)的活性,并提高还原型抗坏血酸(AsA)、还原型谷胱甘肽(GSH)、氧化型谷胱甘肽(GSSG)的含量。研究表明,在夜间低温胁迫过程中,增加的番茄叶片中SOD活性和AsA-GSH循环清除活性氧的能力并未与氧还原的速率一致,从而导致番茄叶片中活性氧的累积,使细胞膜系统受到一定破坏,在6℃处理的植物中尤为明显。     

Human African Trypanosomiasis Diagnosis in First-Line Health Services of Endemic Countries,a Systematic Review

While the incidence of Human African Trypanosomiasis (HAT) is decreasing, the control approach is shifting from active population screening by mobile teams to passive case detection in primary care centers. We conducted a systematic review of the literature between 1970 and 2011 to assess which diagnostic tools are most suitable for use in first-line health facilities in endemic countries. Our search retrieved 16 different screening and confirmation tests for HAT. The thermostable format of the Card Agglutination Test for Trypanosomiasis (CATT test) was the most appropriate screening test. Lateral flow antibody detection tests could become alternative screening tests in the near future. Confirmation of HAT diagnosis still depends on visualizing the parasite in direct microscopy. All other currently available confirmation tests are either technically too demanding and/or lack sensitivity and thus rather inappropriate for use at health center level. Novel applications of molecular tests may have potential for use at district hospital level.     

Improvements on Restricted Insecticide Application Protocol for Control of Human and Animal African Trypanosomiasis in Eastern Uganda

Background

African trypanosomes constrain livestock and human health in Sub-Saharan Africa, and aggravate poverty and hunger of these otherwise largely livestock-keeping communities. To solve this, there is need to develop and use effective and cheap tsetse control methods. To this end, we aimed at determining the smallest proportion of a cattle herd that needs to be sprayed on the legs, bellies and ears (RAP) for effective Human and Animal African Trypanosomiasis (HAT/AAT) control.

Methodology/Principal finding

Cattle in 20 villages were ear-tagged and injected with two doses of diminazene diaceturate (DA) forty days apart, and randomly allocated to one of five treatment regimens namely; no treatment, 25%, 50%, 75% monthly RAP and every 3 month Albendazole drench. Cattle trypanosome re-infection rate was determined by molecular techniques. ArcMap V10.3 was used to map apparent tsetse density (FTD) from trap catches. The effect of graded RAP on incidence risk ratios and trypanosome prevalence was determined using Poisson and logistic random effect models in R and STATA V12.1 respectively. Incidence was estimated at 9.8/100 years in RAP regimens, significantly lower compared to 25.7/100 years in the non-RAP regimens (incidence rate ratio: 0.37; 95% CI: 0.22–0.65; P<0.001). Likewise, trypanosome prevalence after one year of follow up was significantly lower in RAP animals than in non-RAP animals (4% vs 15%, OR: 0.20, 95% CI: 0.08–0.44; P<0.001). Contrary to our expectation, level of protection did not increase with increasing proportion of animals treated.

Conclusions/significance

Reduction in RAP coverage did not significantly affect efficacy of treatment. This is envisaged to improve RAP adaptability to low income livestock keepers but needs further evaluation in different tsetse challenge, HAT/AAT transmission rates and management systems before adopting it for routine tsetse control programs.     

Variations in enamel thickness and structure in East African hominids

Tooth fragments are an appreciable but neglected proportion of fossil hominid specimens. The present study on 47 naturally fractured enamel surfaces of premolar and molar teeth of Plio-Pleistocene East African hominids measured enamel thickness, slope of incremental lines (striae of Retzius), and the morphology of Hunter Schreger bands (HSBs). Specimens allocated to three categories--"robust" australopithecines (EAFROB), "early Homo" (EAFHOM), and "unknown"--were photographed in ethanol with polarised light. Enamel thickness was measured on the occlusal (OT), cuspal (CT), and lateral (LT) aspects. The angle of intersection of striae of Retzius (D) with the enamel-dentine junction (EDJ) was recorded, together with the degree of curvature and width of Hunter-Schreger bands (HSB). Absolute measurements of enamel thickness were scaled by using two allometry correction factors. Absolute thicknesses of all enamel measurements were significantly greater in the EAFROB (OT 3.1 mm; CT 3.3 mm; LT 2.4 mm) compared with EAFHOM (OT 1.4 mm; CT 1.6 mm; LT 1.6 mm) categories. Correction for size reduces the mean difference between the two taxa, but CT and OT thickness remain significantly different (P less than 0.05). HSBs in EAFROB were relatively straight and narrower (means = 52.8 micron) than in EAFHOM, which are more curved and wider (means = 62.0 micron), suggesting greater enamel prism decussation in early Homo. The slope of striae was less in EAFROB permanent molars (means = 23 degrees) compared with EAFHOM (means = 31 degrees), indicating faster rates of coverage during crown formation in "robust" australopithecines. We conclude that the study of fractured enamel surfaces can contribute to our understanding of the systematic relationships and patterns of enamel growth of early hominids.     

Discovery of new S-adenosylmethionine decarboxylase inhibitors for the treatment of Human African Trypanosomiasis (HAT)

Modification of the structure of trypanosomal AdoMetDC inhibitor 1 (MDL73811) resulted in the identification of a new inhibitor 7a, which features a methyl substituent at the 8-position. Compound 7a exhibits improved potencies against both the trypanosomal AdoMetDC enzyme and parasites, and better blood brain barrier penetration than 1.     

Incorporating Scale Dependence in Disease Burden Estimates: The Case of Human African Trypanosomiasis in Uganda

Background

The WHO has established the disability-adjusted life year (DALY) as a metric for measuring the burden of human disease and injury globally. However, most DALY estimates have been calculated as national totals. We mapped spatial variation in the burden of human African trypanosomiasis (HAT) in Uganda for the years 2000–2009. This represents the first geographically delimited estimation of HAT disease burden at the sub-country scale.

Methodology/Principal Findings

Disability-adjusted life-year (DALY) totals for HAT were estimated based on modelled age and mortality distributions, mapped using Geographic Information Systems (GIS) software, and summarised by parish and district. While the national total burden of HAT is low relative to other conditions, high-impact districts in Uganda had DALY rates comparable to the national burden rates for major infectious diseases. The calculated average national DALY rate for 2000–2009 was 486.3 DALYs/100 000 persons/year, whereas three districts afflicted by rhodesiense HAT in southeastern Uganda had burden rates above 5000 DALYs/100 000 persons/year, comparable to national GBD 2004 average burden rates for malaria and HIV/AIDS.

Conclusions/Significance

These results provide updated and improved estimates of HAT burden across Uganda, taking into account sensitivity to under-reporting. Our results highlight the critical importance of spatial scale in disease burden analyses. National aggregations of disease burden have resulted in an implied bias against highly focal diseases for which geographically targeted interventions may be feasible and cost-effective. This has significant implications for the use of DALY estimates to prioritize disease interventions and inform cost-benefit analyses.