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Antimicrobial Agents and Chemotherapy, November 2005, p. 4628-4634, Vol. 49, No. 11
0066-4804/05/$08.00+0 doi:10.1128/AAC.49.11.4628-4634.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.
Laboratoire de Parasitologie, and ADEN EA-3234, CHU Charles Nicolle, Rouen, France,1 Laboratoire d'Anatomopathologie, CHU Charles Nicolle, Rouen, France,2 Laboratoire d'Immunologie et Immunopathologie, UPRES EA-2128, CHU Clemenceau, Caen, France,3 Romark Laboratories, Tampa, Florida4
Received 25 May 2005/ Returned for modification 30 June 2005/ Accepted 30 August 2005
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95% against at least one parasite or against all three, respectively. In immunosuppressed Cryptosporidium parvum-infected Mongolian gerbils orally treated with either 200 or 400 mg of agent RM-6427/kg of body weight/day for 8 days, fecal microscopic oocyst shedding was abolished in 6/10 animals (P of <0.001 versus untreated controls) and mean shedding was reduced by 90.5% (P of <0.0001) and 92.0% (P of <0.0001), respectively, higher levels of inhibition than after nitazoxanide (200 mg/kg/day for 8 days) or paromomycin (100 mg/kg/day for 8 days) treatment (55.0%, P of <0.001, and 17.5%, P of >0.05, respectively). After RM-6427 therapy (200 mg/kg/day for 8 days), the reduction in the ratio of animals with intracellular parasites was nearly significant in ileum (P = 0.067) and more marked in the biliary tract (P < 0.0013) than after nitazoxanide or paromomycin treatment (0.05 < P < 0.004). RM-6428 treatment at a regimen of 400 mg/kg/day for 12 days inhibited oocyst shedding, measured using flow cytometry from day 4 (P < 0.05) to day 12 (P < 0.02) of therapy, when 2/15 animals had no shedding (P < 0.0001) and 11/15 were free of gut and/or biliary tract parasites (P < 0.01). No mucosal alteration was microscopically observed for treated or untreated infected gerbils. To our knowledge, this report is the first to suggest that the isoflavone class of agents has the potential for anticoccidial therapy. |
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On the basis of their primary sequences, several protein kinases (PK) of parasitic protozoa belong to well-characterized families known to play pivotal roles in signal transduction in other eukaryotes. Epidermal growth factor (EGF)-like peptides, a phylogenetically conserved group of mitogens, act via binding to receptor tyrosine kinases of the EGF receptor (EGFR) family, which are located at the surface of target cells (30). Ligand binding to the extracellular portion of the corresponding EGFR leads to an activation of the intracellular tyrosine kinase (TK) domain, which initiates downstream signaling pathways, of which the best characterized is the mitogen-activated protein kinase cascade (21, 24, 39).
EGF-like peptides appear to be important mediators of host-parasite interactions during protozoan infections. It has recently been shown that incubation with mammalian EGF stimulated G protein-dependent signaling mechanisms in Trypanosoma cruzi (22). It has also been suggested that the effects of mammalian EGF are mediated by parasite-determined EGFR (23). Although genes encoding conventional receptor-linked TK have not been identified yet for the genomes of Plasmodium falciparum, Leishmania major, or Trypanosoma brucei, tyrosine/histidine phosphorylation evidenced for parasitic protozoa supports protein tyrosine kinase (PTK) activity (12). Since structural differences between parasite and host PK might result in differential affinities of inhibitory molecules, PTK and more generally PK are attractive targets in the search for therapeutic agents against parasitic diseases (25).
Potential mediation of parasite-determined, not yet characterized, EGFR-like molecules may provide a clue for candidate inhibitory molecules such as flavonoid compounds. Genistein, a naturally occurring isoflavone found chiefly in soy products, exhibits micromolar potency in inhibiting EGFR protein tyrosine kinases (EGFR PTK) (1, 2, 37). The aim of the present study was to investigate the anticoccidial activities of EGFR PTK inhibitor genistein analogs as a novel approach to identify anticoccidian agents and to explore EGFR PTK-mediated regulatory mechanisms of coccidian development.
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TABLE 1. Nomenclature of substituted dihydroxyisoflavone and trihydroxydeoxybenzoin derivatives
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FIG. 1. Structures of (A) 5,7-dihydroxyisoflavone (3-phenyl-4H-benzopyran-4-one) and (B) 2,4,6-trihydroxydeoxybenzoin (2,4,6- hydroxy-1,2-diphenyl-ethan-1-one).
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Evaluation of host cell toxicity of agents. Flat-bottomed 96-well microtiter plates were seeded with BM or HCT-8 cells, and resulting monolayers were used to determine the cytotoxic effects of the test agents. Each agent dilution was examined in triplicate. Cell death due to toxicity was determined using a nitroblue tetrazolium chloride monohydrate reduction assay (CellTiter 96 AQueous nonradioactive cell proliferation assay; Promega Corp., Madison, Wis.). Decreases in the optical density at 450 nm (OD450) were expressed as percentages of the OD450 value in agent-free control cultures.
Origin of parasites. Cryptosporidium parvum oocysts (bovine genotype 2) were purified from feces obtained from calves experimentally infected with an isolate maintained by R. Mancassola and M. Naciri, Laboratoire de Pathologie Aviaire, Institut National de Recherche Agronomique, Nouzilly, France. Feces stored in a 2.5% K2Cr2O7 solution for less than 3 months were layered on a discontinuous sucrose density gradient (densities, 1.045 and 1.090), and isolated oocysts were bleached before excystation and cell culture infection. Sarcocystis neurona strain SnSO-1 merozoites originated from a Southern sea otter, and Neospora caninum merozoites of the NC-1 strain were kind gifts of David S. Lindsay and were handled as previously reported (15, 27).
Assessment of the inhibitory activities of agents on Neospora caninum and Sarcocystis neurona in vitro development. Cells were resuspended in 25-cm2 culture flasks or in 6-well culture plates containing culture medium. They were incubated for 1 to 2 days. When the monolayer was >80% confluent, each culture recipient was inoculated with Sarcocystis neurona or Neospora caninum merozoites harvested from infected BM cell cultures which were detached from the plastic growth surface by using a rubber cell scraper and passed through a 30-gauge needle attached to a syringe to rupture host cells. As previously described, this procedure resulted in cell monolayer infection, which was microscopically checked (16, 26). Parasites were harvested by centrifugation (10 min, 1,800 x g, 4 to 10°C) and resuspended in RPMI 1640 medium at room temperature. Merozoites were counted using a hemacytometer, and each culture flask or well containing confluent cell monolayers was inoculated with 2.5 x 105 to 5 x 105 parasites. Each culture was performed in triplicate, and each set of experiments was done twice. Two hours later, medium containing free merozoites was removed and replaced by agent-containing medium or agent-free medium as a control. Quantitation of merozoite production was conducted at a time sufficient for production of large numbers of merozoites in untreated cultures, i.e., 3 days for Neospora caninum and 9 days for Sarcocystis neurona (six and three schizogonic cycles, respectively). The merozoite-containing medium was removed separately from each flask and rinsed with 2 ml of Ca2+- and Mg2+-free Hanks' balanced solution to detach adhering merozoites, which were pooled with the merozoite-containing medium. After centrifugation at 1,800 x g for 10 min at 4°C, the supernatant was discarded, the pellet volume was measured, and the number of merozoites was determined by being counted using a hemacytometer. The total number of merozoites present in each well/flask was determined by multiplying the volume of the pellet by the number of merozoites and was expressed as the mean number (±1 standard deviation) from 10 counts. The activity of each test compound was expressed as follows: inhibition of merozoite production (%) = [(mean number of merozoites in treated cultures) (mean number of merozoites in untreated cultures)]/(mean number of merozoites in untreated cultures) x 100. The 50% inhibitory concentration (IC50) was defined as the concentration of agent (in µg/ml of culture) which resulted in a mean 50% inhibition of parasite development.
Assessment of the inhibitory effects of agents on Cryptosporidium parvum in vitro development. To prepare monolayers for Cryptosporidium parvum infection, HCT-8 cells (105/ml) were seeded in 16-well tissue culture chambers (LabTek chamber slides; Nunc, Rochester, N.Y.). Cells were cultured at 37°C in a humidified, 5% CO2 atmosphere to >80% confluence, as assessed before Cryptosporidium parvum infection. Purified oocysts were counted in a hemacytometer and permitted to excyst in a 1.5% taurocholic acid solution (Sigma) in BHK 21 medium for 90 min at 37°C in a humidified, 5% CO2 atmosphere. Parasite suspensions (containing excysted and nonexcysted oocysts) were sieved through a 5-µm cellulose acetate filter (Sartorius, Goettingen, Germany) to remove nonexcysted oocysts, empty shells, and debris, which were microscopically absent from final sporozoite suspensions. Fifty microliters of medium containing sporozoites at a concentration of 2.5 x 105/ml was added to each confluent-monolayer well. Slides were incubated for 2 h at 37°C, and medium containing free sporozoites was removed and replaced by 0.2 ml of agent-containing or agent-free coculture medium which consisted of RPMI 1640 containing ascorbic acid (35mg/liter), glucose (25 mM), insulin (100 IU/liter), HEPES buffer (15 mM), streptomycin (1 g/liter), penicillin (100,000 IU/liter), and FCS (5% [vol/vol]). Under these conditions, complete (asexual- and sexual-stage) Cryptosporidium parvum development was obtained as previously described (20, 28). Forty-eight hours later, treated or nontreated infected cells layered on tissue culture chambers were fixed in pure methanol for 10 min and rinsed with phosphate-buffered saline (PBS). Cryptosporidium parvum development was verified by indirect immunofluorescence in a moist chamber at 37°C. PBS-normal goat serum (3%)-Tween 20 (0.1%) buffer was added to each culture well for 3 h to inhibit nonspecific protein binding. Hyperimmune rat anti-Cryptosporidium parvum serum (final dilution in PBS-normal goat serum-Tween buffer of 1:400) was added to each well for 30 min. Wells were washed three times with PBS, and for 30 min fluorescein isothiocyanate-conjugated anti-rat immunoglobulin G and immunoglobulin M (heavy and light chain) goat antibodies (final dilution, 1:200; Jackson Immunoresearch, Westgrove, Pa.) were added. Wells were washed three times with PBS, and slides were mounted in buffered Mowiol (Calbiochem, La Jolla, Calif.). All developmental parasite stages were counted in 20 microscopic fields for each culture condition by using an epifluorescence immersion microscope (x1,250). Activities of the test compounds were expressed as follows: inhibition of Cryptosporidium parvum development (%) = [(mean number of intracellular parasitic forms in treated wells) (mean number of intracellular parasitic forms in untreated wells)]/(mean number of parasitic forms in untreated wells) x 100. The IC50 was defined as the concentration (in mg/liter of culture) of agent which resulted in a mean 50% inhibition of Cryptosporidium parvum development.
In vivo assessment of RM-6427 and RM-6428 in Cryptosporidium parvum-infected immunosuppressed gerbils. An immunosuppressed-gerbil model was used as previously described (3). Male and female Mongolian gerbils (Meriones unguiculatus) weighing 22 to 27 g at the beginning of the study were individually housed in plastic cages equipped with a grill ceiling providing rodent food granules and water ad libitum. Each cage was protected by a top sterile paper wrap to comply with level II contamination requirements. Animals were handled according to the technical and ethical regulations of the French Ministry of Agriculture. Gerbils were immunosuppressed by dexamethasone (0.8 mg/animal; Qualimed, Puteaux, France) injected every second day for 10 days before oocyst ingestion and administered until the end of the experiment, i.e., day 12 postinfection. On day 0, each gerbil was gavaged with 105 Cryptosporidium parvum oocysts, and animals were divided into five treatment groups as indicated in Table 2. Starting 4 h after oocyst ingestion, RM-6427, PRM, or NTZ suspension was administered twice daily by oral gavage, for 8 (RM-6427) or 12 (PRM and NTZ) consecutive days. Cryptosporidium parvum infection was assessed by measuring oocyst shedding in feces collected for 24 h from each animal on days 4, 8, and 12 postinfection. Feces were suspended in 10% (wt/vol) formalin solution and homogenized, and oocysts were counted by phase-contrast microscopic examination of smears prepared by mixing fecal suspensions with a carbol fuchsine solution. Oocyst numbers were expressed per microscopic field (MF) after counting 10 MFs (x400 magnification) or verifying the absence of oocysts in 30 MFs. Results were measured as the mean oocyst counts determined by two independent investigators.
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TABLE 2. In vivo efficacies of RM-6427, RM-6428, nitazoxanide, and paromomycin against Cryptosporidium parvum in immunosuppressed Mongolian gerbils
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Histological study. Histological examinations of distal ilea and biliary tracts were performed with animals which were killed on day 12 postinfection. Tissues were fixed in 10% formalin, cut, and embedded in paraffin. Four-micrometer sections were stained with hematoxylin-eosin-saffron and were considered infected if at least one cryptosporidial developmental form was microscopically observed within one mucosal epithelial cell.
Statistical analysis.
Comparisons between groups were performed using the Wilcoxon rank sums or Mann-Whitney tests for oocyst shedding or Fisher's exact test for intracellular parasites in ilea and biliary tracts. A P value of
0.05 was considered significant.
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Inhibition of in vitro coccidian development by genistein analogs.
As shown in Table 3, 20 agents induced a maximum development inhibition (MI) of more than 95% for at least one parasite. Seventeen inhibited Neospora caninum with IC50s ranging from 0.6 to 3.1 µg/ml, 13 inhibited Sarcocystis neurona with IC50s ranging from 0.7 to 2.95 µg/ml, and 11 inhibited Cryptosporidium parvum with IC50s ranging from 0.75 to 3.75 µg/ml. For five agents, i.e., RM-6403, RM-6425, RM-6427, RM-6428, and RM-6436, the MI was
95% for the three parasites.
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TABLE 3. Inhibitory activities of dihydroxyisoflavone and trihydroxydeoxybenzoin derivatives on Neospora caninum, Sarcocystis neurona, and Cryptosporidium parvum in vitro development
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Present results with different coccidia, host cells, and agents suggest common mechanisms of parasite development inhibition, although differential effects of the various analogs tested may also be consistent with different modes of action. Several lines of evidence suggest that isoflavone derivatives act directly on parasites. In the present study, the cell line type did not interfere with the efficacy of agents active against more than one coccidium, and for Cryptosporidium parvum, in vitro activities of RM-6427 and RM-6428 were confirmed in vivo. For Cryptosporidium parvum-infected HCT-8 cell cultures treated with effective agents, no early Cryptosporidium parvum developmental stage was seen, which suggests no interference with host cell signaling and/or cytoskeletal rearrangement (data not shown). For Sarcocystis neurona, it was previously shown that host cell cytoskeletal rearrangement was not crucial for intracellular development in vitro, since Sarcocystis neurona develops freely in host cell cytoplasm without a parasitophorous vacuole (14). Potential coccidial targets are microneme proteins with EGF-like domains which are sequentially released at initial contact and establish physical interaction with host cells. The microneme-associated protein NcMIC3, found in Neospora caninum tachyzoites and bradyzoites, contains a stretch of four consecutive EGF-like domains, and its secretion onto the surface resulted in their outward exposure, associated with increased capacity of Neospora caninum to adhere to host cells in vitro via interaction with host cell surface receptors (32, 33). In Toxoplasma gondii tachyzoites, microneme proteins exhibit adhesive (including EGF-like) domains which carry out important functions related to intracellular protein-protein interactions, and the adhesin TgMIC3, recently characterized as a microneme protein, carries five overlapping EGF-like domains (10, 19, 29). For Eimeria tenella, a transmembrane microneme protein (EtMIC4) carrying a large extracellular domain including EGF-like sequences has been described and several overlapping expressed sequence tags are predicted to encode a protein carrying an EGF-like motif and a stretch of tyrosine residues (36). Stretches of tyrosine residues have also been previously identified for the microneme protein GP900 of Cryptosporidium parvum (4).
Alternatively, direct effects on host cells may be involved. A common feature of proteins which include EGF-like motifs is their role in extracellular functions such as ligand-receptor adhesive interactions (8). It has been hypothesized that the EGF-EGFR axis, which belongs to one family of gastrointestinal growth peptides, was involved in initial attachment and cytoskeletal alterations associated with cellular invasion of microbial organisms, including apicomplexan sporozoites/merozoites (6). Prior incubation of mammalian cells with EGF was shown to significantly inhibit invasion by Trypanosoma cruzi, and administration of EGF at the apical surface of enterocytes significantly reduced Cryptosporidium parvum epithelial colonization independently of a direct anticoccidial effect, further suggesting a role for the EGF-EGFR axis in the infection process (6, 40). Apical EGF significantly reduced Cryptosporidium andersoni infection of human and bovine epithelial cells by inhibiting Cryptosporidium-induced apoptosis and disruption of zonula occludens 1, while not affecting oocyst viability (7).
Other observations suggest integrated anticoccidial effects and host cell modulation. In Theileria parva, signal transduction processes within both sporozoites and host cells were required for infection (34). Interaction of intracellular protozoa with host cells appears to occur by involving transducing signal mechanisms (6). A rapid onset of PK activities following sporozoite attachment was previously reported for Toxoplasma, and it was shown that the parasite induces phosphorylation of host cell molecules (17, 31). For malaria parasites, it was shown that protein phosphorylation within the merozoite also played an important role in the internalization step of invasion of host erythrocytes (41). Parasite signaling and cytoskeletal reorganization are likely to be involved in establishing infection, as reported for Theileria parva, in which signal transduction processes within both host cells and sporozoites are required for infection (18, 34). EGF-like peptides are possible mediators of cell-cell communication that occurs between eukaryotic parasites and hosts (30). For Toxoplasma gondii, it has been shown that EGFR PTK inhibitors interfere with both attachment and penetration of tachyzoites in macrophages with rapid onset of PK activities and that the parasite induces phosphorylation of host cell molecules (17, 31). In a recent study, the PK inhibitor genistein significantly inhibited in vitro Cryptosporidium parvum infection, which provides indirect evidence for parasite-induced responses in host cells with activation of phosphoinositide 3-kinase activity via TK growth factor receptors (18). Sporozoite attachment in the absence of further development was observed after pretreatment with PK inhibitors, suggesting that attachment is an event prefatory to host cell responses, and kinase activity was rapidly induced by sporozoite attachment, suggesting a role for signal transduction events in early parasite-host cell dynamics.
Present data are consistent with the extensive use of the EGF-EGFR axis by apicomplexan parasites and the potential capacity for EGFR inhibitors to alter parasite interactions with host cells and interfere with the infection process. They prompt further investigation to more fully define the molecular mechanisms of activity, especially in vivo, since most TK inhibitors have served so far as tools to set up in vitro assay systems and only a few have exhibited in vivo efficacy. Investigation of potential in vivo interferences with host kinases is especially needed. Information is also required on inhibitor absorption following oral administration and the active metabolites in relation to activity on biliary parasite sequestration, by reference to NTZ, which is known to be partially absorbed from the gastrointestinal tract and metabolized in blood to form active metabolites which have been identified in the bile (5, 35). To our knowledge, this is the first report suggesting that isoflavone analogs have the potential for further development as anticoccidial therapy.
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