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Human T-lymphocyte proliferation, lymphokine production, and amebicidal activity elicited by the galactose-inhibitable adherence protein of Entamoeba histolytica.

We studied human T-lymphocyte responses to the purified Entamoeba histolytica galactose-inhibitable adherence protein. Individuals having serum anti-adherence protein antibodies possess peripheral blood lymphocytes which demonstrate antigen-specific responses to the purified adherence protein (10 micrograms/ml) and whole soluble amebic antigen (100 micrograms/ml). This was determined by incorporation of [3H]thymidine (53,080 and 73,114 dpm, respectively) and by increased production of interleukin-2 and gamma interferon (42.0 and 67.5 U/ml, respectively) (P less than 0.05 for each in comparison with values for control lymphocyte responses). Lymphocytes from antiamebic antibody-positive subjects develop in vitro amebicidal activity only when incubated for 5 days with the purified adherence protein (P = 0.02). In conclusion, the E. histolytica galactose-inhibitable adherence protein elicits an in vitro amebicidal cell-mediated immune response, further supporting the potential for the use of this protein in a subunit amebiasis vaccine.

Animals

Macrophage cytotoxicity against Entamoeba histolytica trophozoites is mediated by nitric oxide from L-arginine.

The killing of Entamoeba histolytica trophozoites by phagocytes involves oxidative and nonoxidative mediators. In this study, we determine whether L-arginine-derived nitric oxide (NO) is involved in the killing of E. histolytica trophozoites by activated murine macrophages in vitro. Elicited peritoneal and bone marrow-derived macrophages activated with IFN-gamma alone or with IFN-gamma and LPS killed 62 to 73% of amebae, concomitant with increased levels of nitrate (NO2). Depletion of L-arginine by addition of arginase to culture medium abrogated macrophage amebicidal activity. NG-monomethyl L-arginine, an L-arginine analog, competitively inhibited NO2 release and amebicidal activity in a dose-dependent fashion, without affecting H2O2 production; however, the addition of excess L-arginine competitively restored macrophage amebicidal effects. In culture, sodium nitrite and sodium nitroprusside were cytotoxic to E. histolytica and this was reversed by the addition of myoglobin. Exogenously added FeSO4 prevented macrophage cytotoxicity. Addition of superoxide dismutase, a scavenger of O2-, partially inhibited amebicidal activity, without influencing NO2 production. Untreated and LPS-exposed macrophages produced high levels of H2O2 independent from NO2 production and amebicidal effects. However, the addition of catalase, a scavenger of H2O2, inhibited both amebicidal activity and NO2 production by activated macrophages. Our results demonstrate that NO is the major cytotoxic molecule released by activated macrophages for the in vitro cytotoxicity of E. histolytica and that O2- and H2O2 may be cofactors for the NO effector molecule.

Animals

Uncomplicated amebic liver abscess: prospective evaluation of percutaneous therapeutic aspiration.

The performance of therapeutic aspiration in the treatment of amebic liver abscess, advocated and practiced in many centers, is controversial. Previously, this practice has been evaluated in retrospective analyses. To test the potential benefit of therapeutic aspiration, the authors undertook a prospective randomized trial in 57 patients admitted for suspected amebic liver abscess during a 15-month period. Sixteen patients were excluded from the trial. The remaining 41 patients were randomly included in one of two study groups to receive amebicidal therapy alone or amebicidal therapy coupled with image-guided percutaneous therapeutic aspiration. All patients in the trial recovered. No statistically significant benefit was demonstrated in the aspiration group for the two objective parameters evaluated: length of hospitalization and duration of time to becoming afebrile. Subjective improvement in symptoms after aspiration was greater in the aspiration group at a marginally statistically significant level. These data do not support the adjunctive performance of percutaneous therapeutic aspiration in the treatment of uncomplicated amebic liver abscess. Amebicidals alone were equally efficacious in treating the group studied.

Humans

Chemotherapeutically active anthraquinones. I. Aminoanthraquinones.

Basically substituted 2,6-diacetaminoanthraquinones proved to have an interesting in vivo effect against Entameba histolytica, but this effect was markedly exceeded by that of the series of the 2,6-diamidinoanthraquinones. A number of compounds of this series revealed a significantly stronger extraintestinal effect in the golden hamster than the standard amebicides metronidazole and tinidazole, but they were not superior to these compounds in their trichomonacidal effect, which was in general only a moderate one. In both substance classes, the amebicidal effect was confined to 2,6-disubstitution. Variations of the anthraquinone system resulted in a loss of activity. The structure-activity relationships are discussed.

Amebicides

Effects of magainins on ameba and cyst stages of Acanthamoeba polyphaga.

Amebic keratitis produced by Acanthamoeba spp. is an increasingly important ocular infection in extended-use contact lens wearers. Problems associated with the infection are compounded by the lack of effective and well-tolerated chemotherapeutic agents. The magainins, a group of naturally occurring and synthetic membrane-active peptide compounds, have been shown to be active in vitro against a clinical isolate of Acanthamoeba polyphaga. Two magainins tested extensively had minimal inhibitory and minimal amebicidal values of 20 and 25 micrograms/ml for magainin MSI-103 and 25 and 40 micrograms/ml for magainin MSI-94, respectively. Both amebastatic and amebicidal activities are enhanced by combining the magainins with silver nitrate (200 micrograms/ml) and/or other marginally effective antimicrobial agents. These combinations have activity against both trophic and cystic stages in the Acanthamoeba life cycle and have promise as antimicrobial agents in the treatment of amebic keratitis.

Acanthamoeba

The prognostic factors of severe amebic liver abscess: a retrospective study of 125 cases.

One hundred twenty-five cases of amebic liver abscess were diagnosed at Chang Gung Memorial Hospital in Taiwan from January 1981 to December 1989. An analysis of possible prognostic factors for severe amebic liver abscess was done retrospectively. The majority of the patients came from the southern part of Taiwan. Severe amebic liver abscess was defined as the rupture of an abscess that was resistant to 72 hr of medical treatment, or complicated by secondary bacterial infection. The results showed significant differences between patients with severe liver abscess and those with more moderate forms of amebic liver abscess in indices such as jaundice, hemoglobin and serum bilirubin levels, and dyspnea, as well as in pulmonary changes (right diaphragm elevation, right pleural effusion) seen on chest radiographs. Those patients with diabetes mellitus also had greater evidence of severe liver abscess. Moderate cases that were treated with amebicides showed excellent responses (no mortality). Severe cases required, in addition to amebicide therapy, either percutaneous or surgical drainage of pus, especially in those patients with ruptured abscesses. Those patients with abscesses that ruptured into the thoracic cavity were treated by either thoracostomy or needle aspiration, and all were cured. Three patients died of abscess rupture into the abdominal cavity, associated with secondary bacterial infection. The overall mortality rate was 2.4%. These symptoms and signs of severe liver abscess are indicators of the need for intensive treatment such as aspiration or surgical drainage.

Adult

Synthesis of some quinoline derivatives of potential antiamebic activity.

New compounds derived from cinchoninic acid esters and amides were prepared. The esters are those derived from p-hydroxy-N-methyldichloroacetanilide (diloxanide) whereas the amides are from piperazine whose hydrogen is substituted by a dichloroacetyl group. The dichloroacetamido group is responsible for the amebicidal activity in several related compounds.

Amebicides

Clinical trial methodology in intestinal parasitic diseases.

The high prevalence of intestinal parasitic infections as an index of underdevelopment, especially in tropical countries, is related to poverty, poor housing, lack of sanitation, malnutrition, and ignorance. The effects are lowered work capacity, physical and mental retardation, leading to recurrences and exacerbations of the parasitism and malnutrition. The most prevalent parasites, methods of detection by specific tests in patients in clinical trials involving antiparasitic drugs are dealt with. How and by whom investigations of new drugs should be undertaken, the need for a basic knowledge of parasitology and techniques of the discipline, of biostatistics, and use of such controls as randomized allotment to treatment groups, placebo administration, and double-blind assessments are emphasized. The justification for undertaking an evaluation of an antiparasitic drug is predicated on the demonstration of safety in exhaustive in vitro and animal studies and of the drug's potential superiority as to efficacy and lower incidence of unwanted side effects, as compared with existing agents. Tolerance and dose-range studies should be conducted in male adult hospitalized patients under close supervision. The evaluation of amebicides in clinical trials, as well as of anthelmintics, is considered in terms of differentiation and reproductive habits of specific causative agents and tests for detecting their elimination to determine improvement under drug therapy. The problem of reinfection, particuarly of nonhospitalized patients under the adverse conditions of life, is stressed.

Amebiasis

Experimental muscular amebiasis in hamsters as a biological model.

Trophozoites of Entamoeba histolytica maintained in vitro in Pavlova's medium were inoculated by deep intramuscular injection into the proximal left hindleg of hamsters. Thioglycollate medium was utilized as a successful vehicle to induce the infection. The invasion of the muscular tissue by the vegetative forms caused the formation of abscesses with great destruction of muscular fibers. The lesions were limited to the muscular tissue of the femoral area. The number of trophozoites, the medium of thioglycollate as a vehicle, the volume of the inoculum and the trauma caused by the needle were important elements in the evolution of the muscular amebic abscesses. A limited trial of the amebicidal activity of metronidazole utilizing the amebic intramuscular infection was also performed.

Abscess

Amebic liver abscess: 1966-1976.

A 10-year retrospective analysis of 15 patients with amebic liver abscess is reviewed and represents a continuation of the previous 2-decade experience at our institution (37 patients). Records were studied to determine the population affected, presenting symptoms, physical and laboratory findings, type and response to therapy. Most patients were rural males of lower socioeconomic status in the third to fifth decade of life. They presened as a febrile illness with abdominal pain for an average of 2 1/2 months duration. Significanct physical abnormalities were tender hepatomegaly (93%), right-sided pulmonary changes (40%), and fever (66%). All patients had abnormal liver scan, positive amebic serology, and hypoalbuminemia. All patients promptly responded to amebicidal therapy except one whose therapy was delayed. Clinical suspicion, liver scanning, serologic testing, and response to therapy are the keys to diagnosis.

Adult

Macrophage colony-stimulating factor enhances the respiratory burst of human monocytes in response to Entamoeba histolytica.

Mononuclear phagocytes (MP) are probably the most capable effector cells of the body in the defense against virulent strains of E. histolytica. Killing of E. histolytica by MP appears to involve both oxidative and non-oxidative mechanisms. Thus, in this study we have investigated whether trophozoites of an axenic virulent strain E. histolytica HM1:IMSS (EH) were capable of eliciting an oxidative response in pure populations of freshly isolated human monocytes. Using a luminol-enhanced chemiluminescence assay we demonstrate that these cells produce a strong respiratory burst when challenged with live amebas over a wide range of MP:EH ratios. Furthermore, pre-incubation of monocytes with recombinant Macrophage Colony Stimulating Factor (M-CSF) could further increase the oxidative metabolism of MP in response to E. histolytica. Our results indicate that, in contrast to what occurs with polymorphonuclear leukocytes, the interaction of E. histolytica with MP leads to the production of reactive oxygen intermediates by this cells. The enhancement of this potent microbicidal mechanism by inflammatory cytokines may further increase the amebicidal capacity of human mononuclear phagocytes.

Adult