Collagen immunotyping of the hepatic fibrosis in human alveolar echinococcosis

An extremely dense fibrosis is responsible for the main complications of alveolar echinococcosis (AE), a severe parasitic disease due to the development in the liver of a larval form of the cestode Echinococcus multilocularis. Immunotyping of collagens present in fibrous, granulomatous, and normal areas of the liver was performed in nine patients with AE. Immunofluorescent labelling of collagen types showed that dense fibrosis was entirely composed of thick bundles of type I and type III collagens, surrounding old parasitic vesicles with an autofluorescent laminated layer. In granulomatous areas, collagens were labelled as clusters consisting mainly of type III procollagen and collagen. Concentric bundles of type III collagen surrounded active parasitic vesicles. An enhancement of the normal labelling in portal spaces of the intact liver was present in all the patients. These results suggest that irreversible acellular keloid scar-like fibrosis observed in AE is the ultimate result of cytotoxic and fibrogenetic events related to the immune response of the host which are taking place initially in the granulomatous area surrounding the young parasite larvae.     

Soluble IL-2-receptor and CD8 in the serum and the periparasitic granuloma of patients with alveolar echinococcosis.

Cellular immunity plays a key role in the defence against the larva of the cestode Echinococcus multilocularis. This larva is responsible for alveolar echinococcosis (AE) of the liver, a rare parasitic disease which occurs in endemic areas including European alpine countries, Alaska, the USSR, Western China and Northern Japan. We have shown a marked decrease of the CD8+ T-cell population in the blood and we have described an infiltrate composed mainly of activated CD8+ T-cells in the liver lesions of most patients with AE. In this study, we assessed the serum level of soluble IL-2-receptor (sIL-2R) and CD8 (sCD8) in 37 patients (23 men, 14 women, mean age 59.5 yrs) with a histologically proven AE. The results, obtained using sandwich ELISA, were compared to those of healthy controls and correlated to parameters evaluating the severity of the disease. The mean serum levels of sIL-2R were significantly higher in AE patients than in controls. There was a significant correlation between sIL-2R levels and both the volume of parasitic lesions and a calculated index of severity of the disease. The mean serum levels of sCD8 did not differ significantly from the values obtained in controls. These results indicate that the infiltration of the liver by CD8+ T-lymphocytes is not associated with an increased release of sCD8 into the serum. The circulating levels of sIL-2R appear to reflect the extent as well as the severity of the disease. Immunostaining of the cells of the periparasitic granuloma suggests that the cell origin of the sIL-2R could be macrophages rather than T-lymphocytes.     

Circulating and basophil-fixed specific IgE in human alveolar echinococcosis

Biological parameters of immediate type hypersensitivity were assessed in 19 patients with alveolar echinococcosis. Serum total IgE concentrations were higher than normal values in 12 patients, and parasite-specific IgE were present in 9 patients. A significant relationship was observed between these two parameters. Evolution of specific IgE during a 1-year period appeared to correlate with surgical removal of parasitic material; it did not correlate with the clinical evolution in patients treated with mebendazole. Specific basophil fixed-IgE were demonstrated using both a basophil degranulation test and a histamine release test in the 19 patients under study, including serologically negative and circulating specific IgE-negative patients.     

Optimal risk management of human alveolar echinococcosis with vermifuge

In this study, we develop a bioeconomic model of human alveolar echinococcosis (HAE) and formulate the optimal strategies for managing the infection risks in humans by applying optimal control theory. The model has the following novel features: (i) the complex transmission cycle of HAE has been tractably incorporated into the framework of optimal control problems and (ii) the volume of vermifuge spreading to manage the risk is considered a control variable. With this model, we first obtain the stability conditions for the transmission dynamics under the condition of constant control. Second, we explicitly introduce a control variable of vermifuge spreading into the analysis by considering the associated control costs. In this optimal control problem, we have successfully derived a set of conditions for a bang-bang control and singular control, which are mainly characterized by the prevalence of infection in voles and foxes and the remaining time of control. The analytical results are demonstrated by numerical analysis and we discuss the effects of the parameter values on the optimal strategy and the transmission cycle. We find that when the prevalence of infection in foxes is low and the prevalence of infection in voles is sufficiently high, the optimal strategy is to expend no effort in vermifuge spreading.     

Prevalence of human alveolar echinococcosis in Hokkaido as evaluated by western blotting

The Western blotting (WB) method was used to evaluate the prevalence of human alveolar echinococcosis in Hokkaido, Japan. One hundred and sixteen WB-positive serum specimens were found in 1987 and 1988, and were grouped into two serologically different types from their WB-immunostaining patterns: "complete type", that showed multiple bands with various molecular weights ranging from 29 to 205 kilodaltons (kDa), and "incomplete type", that revealed a few bands with low molecular weights of 30-35 kDa and/or with molecular weights higher than 90 kDa. Therefore, we found that the WB method is applicable for the sero-epidemiological studies of human alveolar echinococcosis in Hokkaido.     

Recurrent hepatic alveolar echinococcosis: report of the first case in Korea with unproven infection route

Human alveolar echinococcosis (AE), a hepatic disorder that resembles liver cancer, is a highly aggressive and lethal zoonotic infection caused by the larval stage of the fox tapeworm, Echinococcus multilocularis. E. multilocularis is widely distributed in the northern hemisphere; the disease-endemic area stretches from north America through Europe to central and east Asia, including northern parts of Japan, but it has not been reported in Korea. Herein, we represent a first case of AE in Korea. A 41-year-old woman was found to have a large liver mass on routine medical examination. The excised mass showed multinodular, necrotic, and spongiform appearance with small irregular pseudocystic spaces. Microscopically, the mass was composed of chronic granulomatous inflammation with extensive coagulation necrosis and parasite-like structure, which was revealed as parasitic vesicles and laminated layer delineated by periodic acid-Schiff (PAS) stain. Clinical and histologic features were consistent with AE. After 8 years, a new liver mass and multiple metastatic pulmonary nodules were found and the recurred mass showed similar histologic features to the initial mass. She had never visited endemic areas of AE, and thus the exact infection route is unclear.     

Immunodiagnosis of alveolar echinococcosis using urine samples

Alveolar echinococcosis (AE) is one of the most lethal zoonotic parasitic infections. The diagnosis is based on the combination of the abdominal imaging including CT, MRI and PET, and serology. To develop a new diagnostic tool for AE with urine as samples, mouse-Echinococcus multilocularis (Em) model and then human cases were studied. The antibody levels of urine and serum samples from the infected mice and AE cases were well correlated with each other. The sensitivity and specificity of the method with urine were 91% and 98%, respectively, when IgG4 to crude Em was examined. Comparing with serum samples, the collection of urine is easier and safer and the urine diagnostic tool makes surveys of this silent disease easier.     

Localization of human mononuclear cell interleukin 1

The detection and localization of interleukin (IL) 1 in human monocytes was carried out by flow cytometry using monoclonal antibodies to IL-1 alpha and IL-1 beta proteins. IL-1 alpha was detected on the surface of monocytes and the surface expression increased following lipopolysaccharide activation. No demonstrable IL-1 beta protein could be observed on the cell surface by antibody staining, while both IL-1 alpha and IL-1 beta could be visualized intracellularly by the appropriate monoclonal antibodies following acetone permeabilization of the monocytes. Further experiments with cell associated IL-1 revealed that most of the biological activity of human monocytes could be inhibited by affinity purified polyclonal antibodies to IL-1 alpha protein, whereas no inhibitory activity was observed with IL-1 beta specific antibodies. These data support the hypothesis that a differential localization of IL-1 alpha and IL-1 beta exists within human blood-derived monocytes.     

Cell-mediated immune response in human hepatic echinococcosis. Analysis of antigen-induced lymphoproliferation and NK activity

In vitro cellular immune responsiveness was studied in 25 patients undergoing surgery for hepatic hydatid disease and in 22 matched healthy controls. Proliferation of peripheral blood mononuclear cells (PBMC) induced by phytohaemagglutinin (PHA) was not statistically different in the two groups, while proliferation induced by antigenic preparations obtained from the human commensal microorganism Candida albicans was depressed in patients as compared to healthy subjects. Confirming previous data, antigen specific proliferative response to hydatid cyst fluids was greatly enhanced in patients as compared to controls (P less than 0.01). On the other hand, natural killer (NK) activity was significantly reduced (P less than 0.005). Both impairment of NK activity and lymphoproliferation induced by commensal microorganisms suggest that patients following the parasitic infection present a condition of relevant hyporesponsiveness in cell-mediated defence.     

肝包虫病外科治疗的现状

肝包虫痛是畜牧地区常见的一种人兽共患病,是危害牧区人民健康,使牧区人民"因病致贫,因病返贫"的重要原因.目前,肝包虫病的治疗仍以外科治疗为首选,但是手术方式繁多,预后情况各异,各地区、各医院掌握技术参差不齐,到目前还没有一套完整的个体化综合性治疗方案.本综述在概括肝包虫病外科治疗方式的基础上觉得应该提出一套适应各阶层治疗水平的个体化综合治疗方案.     

The human cytotrophoblastic cell, a mononuclear chameleon

The human placenta represents an abundant; easily accessible and unlimited study material (at birth a human placenta provides about 500 g of trophoblast). Cytotrophoblastic cells (CTB) are one constituent of the human placenta and represent epithelial cells with fascinating properties: They are able to fuse to form syncytia, can behave like immotile polarized epithelial cells, can phenocopy stromal fibroblasts or endothelial cells or undergo a mesenchymal-like transformation that converts them into non proliferative and highly invasive cells. Like a chameleon, CTB are thus able to adapt to their immediate environment by phenocopying their neighbor cells. This review describes the different routes that CTB follow during their differentiation pathways, the regulation of these at the molecular level, it gives also an overview of the pathologies associated with faulty pathways and describes the usual phenotypic markers used to identify the different CTB subsets. This review is intended to stimulate investigators not acquainted with the field of placental biology to use CTB as a model to study important biological functions in vitro, such as cell fusion, cell invasion and cell transformation.     

Epidemiology of alveolar echinococcosis in southern Cantal, Auvergne region, France

Alveolar echinococcosis (AE) is a helminth zoonosis which is encountered only in the northern hemisphere. In central France, the Auvergne region represents the most western and southern extension of this helminthiasis. In 1999, a human case of AE was diagnosed in the southern part of the Cantal department, where AE was supposed absent, and an epidemiological survey was subsequently carried out. The transmission of the zoonosis in the sylvatic and peridomestic definitive hosts was studied, as well as that in the rodent and human intermediate hosts. Eleven red foxes (Vulpes vulpes) were shot, and 50 fox faecal deposits were collected. Twelve farm dogs had their faeces taken by rectal touch, and four were checked after arecoline purgation. Optical detection of Echinococcus multilocularis worms was achieved on fox intestines after scraping, and also on dog stools after arecoline therapy. Coproantigen ELISA assay was performed for the 11 scraping products, for the 50 fox faeces, and for the 12 dog faecal samples. No adult AE agent was observed by microscopy, and the ELISA assay yielded positive results in one of 11 fox intestines, one of 50 fox faeces, and 2 of 12 dog faecal samples. Twenty-five small mammals were trapped, of which 19 were Arvicola terrestris water voles. One rodent liver exhibited a hepatic lesion consistent with AE. An epidemiological questionnaire was completed in 85 human volunteers, who were also serologically tested for AE. Only one (the case's husband) exhibited a Western-blotting pattern indicative of a low-grade AE infection. The results of this preliminary study suggested a slow AE extension to the south of Cantal department from the northern focus.     

Stimulation of mononuclear cell binding to human endothelial cell monolayers by thrombin

The common occurrence of fibrin deposits in chronic inflammatory lesions suggests a possible role for thrombin in the mobilization of mononuclear cell infiltrates. For this reason, the effect of thrombin on the binding of mononuclear cells to endothelial cells (EC) was investigated. Incubation of confluent monolayers of human umbilical vein endothelial cells with thrombin markedly enhanced EC adhesiveness for both T lymphocytes and U937 cells (a monocyte-like cell line) in a time- and dose-dependent fashion. This effect was EC specific: 1) treatment of the T cells or the U937 cells with thrombin did not stimulate their adherence to EC, and 2) treatment of human foreskin fibroblasts with thrombin did not stimulate their inherently low adhesiveness for T cells. Fixation of EC monolayers with paraformaldehyde after pre-incubation with thrombin did not affect the increased adhesiveness for T cells. mAb against the LFA-1 antigen (mAb 60.3 (anti-CD18) or mAb TS1/22 (anti-CD11a), which inhibit the binding of T cells to unstimulated EC, failed to block the increased adhesion induced by thrombin, indicating that the increased binding induced by thrombin is similar to that induced by IL-1 and TNF, which showed similar resistance. These results suggest that thrombin may have a role in the extravascular emigration of mononuclear cells from post-capillary venules by virtue of its ability to stimulate the adhesiveness of EC for both lymphocytes and monocytes.     

Landscape composition and spatial prediction of alveolar echinococcosis in southern Ningxia, China

Background

Alveolar echinococcosis (AE) presents a serious public health challenge within China. Mass screening ultrasound surveys can detect pre-symptomatic AE, but targeting areas identified from hospital records is inefficient regarding AE. Prediction of undetected or emerging hotspots would increase detection rates. Voles and lemmings of the subfamily Arvicolinae are important intermediate hosts in sylvatic transmission systems. Their populations reach high densities in productive grasslands where food and cover are abundant. Habitat availability is thought to affect arvicoline population dynamic patterns and definitive host–intermediate host interactions. Arvicoline habitat correlates with AE prevalence in Western Europe and southern Gansu Province, China.

Methods and Findings

Xiji County, Ningxia Hui Autonomous Region, borders southern Gansu. The aims of this study were to map AE prevalence across Xiji and test arvicoline habitat as a predictor. Land cover was mapped using remotely sensed (Landsat) imagery. Infection status of 3,205 individuals screened in 2002–2003 was related, using generalised additive mixed models, to covariates: gender; farming; ethnicity; dog ownership; water source; and areal cover of mountain pasture and lowland pasture. A Markov random field modelled additional spatial variation and uncertainty. Mountain pasture and lowland pasture were associated with below and above average AE prevalence, respectively.

Conclusions

Low values of the normalised difference vegetation index indicated sub-optimality of lowland pasture for grassland arvicolines. Unlike other known endemic areas, grassland arvicolines probably did not provide the principal reservoir for Echinococcus multilocularis in Xiji. This result is consistent with recent small mammal surveys reporting low arvicoline densities and high densities of hamsters, pikas and jerboas, all suitable intermediate hosts for E. multilocularis, in reforested lowland pasture. The risk of re-emergence is discussed. We recommend extending monitoring to: southern Haiyuan County, where predicted prevalence was high; southern Xiji County, where prediction uncertainty was high; and monitoring small mammal community dynamics and the infection status of dogs.