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Antimicrobial Agents and Chemotherapy, January 2006, p. 162-170, Vol. 50, No. 1
0066-4804/06/$08.00+0 doi:10.1128/AAC.50.1.162-170.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
Institute of Parasitology, University of Bern, Länggass-Strasse 122, CH-3012 Bern, Switzerland,1 The Romark Institute for Medical Research, Tampa, Florida 336072
Received 21 September 2005/ Returned for modification 12 October 2005/ Accepted 18 October 2005
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Originally developed as a veterinary antihelminthic (24), 2-acetolyloxy-N-(5-nitro 2-thiazolyl) benzamide (NTZ), also known as Alinia, has been shown to exhibit a wide spectrum of in vivo activity against a broad spectrum of intestinal parasites, such as Giardia lamblia, Entamoeba histolytica, Trichomonas vaginalis (1, 5), the apicomplexan Cryptosporidium parvum (11), and enteric bacteria infecting animals and humans (13, 33). NTZ has been postulated to exhibit a mode of action based upon reduction of its nitro group by nitroreductases, including pyruvate ferredoxin oxidoreductase. Thus, in this model, the nitro group would play a crucial role similar to the one postulated for MTZ. Experimental evidence for this mode of action, however, is lacking. In contrast to MTZ, NTZ has been shown to be nonmutagenic (27). In vivo, NTZ is rapidly deacetylated to tizoxanide (TIZ) (4), a compound with equal effectiveness (1, 33). In the liver, TIZ is then transformed to tizoxanide glucuronide, an inactive form, and excreted via bile or urine (4).
In this study, we have used two culture systems to investigate the efficacy and mechanisms of action of NTZ, other thiazolides (11), and MTZ against Giardia trophozoites.
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TABLE 1. Overview of compounds used in this study
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The effects of drugs were assayed by adding increasing concentrations of various thiazolides or MTZ to trophozoite subcultures. Proliferation was monitored by counting attached trophozoites during the growth phase (reverse microscope, 200x magnification) and by counting trophozoites after the final harvest at day 5 postincubation. For this final harvest, medium and unattached trophozoites were removed and replaced with ice-cold phosphate-buffered saline (PBS) in order to count only attached trophozoites. Fifty percent inhibitory concentration (IC50) values were obtained by extrapolating trophozoite numbers from the DMSO control.
Coculture of Giardia trophozoites and Caco2 intestinal cells. Caco2 cells (ATTC HTB-37) were kindly provided by Daniel Lottaz, Institute of Biochemistry and Molecular Biology, University of Bern, and were cultured in Dulbeccos modified Eagles medium containing 10% fetal calf serum, 50 U/ml of penicillin, and 50 µg/ml of streptomycin (Caco2 growth medium) at 37°C and 5% CO2. For coculture experiments, confluent lawns of Caco2 cells were trypsinized, resuspended in Caco2 growth medium, and added to the wells of a 24-well plate at a volume of 1 ml containing 2.5 x 106 cells/well. After formation of a confluent lawn (48 h postinfection), medium was exchanged for fresh medium. Axenically grown Giardia lamblia trophozoites were harvested by immersing the culture tubes for 15 min in ice, which was followed by transfer of the parasites to 15-ml Falcon tubes and centrifugation (13 min at 1,300 x g and 4°C). Parasites were then resuspended in Caco2 growth medium, and 0.1-ml portions of this suspension containing increasing numbers of trophozoites (from 5 x 103 up to 106) were added per well. The compounds to be tested were dissolved in DMSO and were added at the desired concentrations. For each experiment, control incubations were performed with DMSO alone. At different time points following the initiation of drug treatment, the medium was removed, and cultures were carefully washed with PBS (prewarmed at 37°C) and, finally, processed for DNA purification. For scanning electron microscopy (SEM), cells were grown in 24-well tissue culture plates on glass slides coated with poly-L-lysine (100 µg/ml).
Processing of DNA samples and LightCycler-based quantitative PCR. DNA purification was performed using a DNeasy kit (QIAGEN, Basel, Switzerland) according to the standard protocol suitable for tissue samples. DNA was eluted in 2 x 50 µl of AE buffer (elution buffer from the kit) and subsequently boiled for 5 min. For quantitative real-time PCR, forward cwp primer 2 (H7CWF2; 5'-GGC GAT ATT CCC GAG TGC ATG TG -3') and reverse cwp primer 2 (NH7CWR2; 5'-GTG AGG CAG TAC TCT CCG CAG T -3') were used (32). The primers were specific for cwp genes in strain GS/M-83-H7 but had the same amplification efficacy in strain WB clone C6. Detection of DNA amplification products and quantification of parasite numbers through fluorescence resonance energy transfer on a LightCycler instrument (Roche Diagnostics, Basel, Switzerland) were done as previously described (32) by assessing mean values (plus standard deviations) from triplicate determinations. As external standards, samples containing DNA equivalents from 100 trophozoites, 10 trophozoites, and 1 trophozoite were included. Reproducibility of the test system was demonstrated by proving an overall low variation within three independent runs of the standard reactions.
Scanning and transmission electron microscopy. For SEM or transmission electron microscopy (TEM), confluent lawns of trophozoites were treated with NTZ or MTZ (50 µM) or with DMSO as a solvent control. Parasites were harvested as described above and resuspended in 1 ml ice-cold PBS, transferred to 1.5 ml Eppendorf tubes, and centrifuged (5,000 x g, 5 min, 4°C). Pellets were resuspended in 100 mM cacodylate (pH 7.3) containing 2.5% glutaraldehyde and fixed overnight at 4°C. Pellets were then washed three times in 100 mM cacodylate buffer and postfixed in 100 mM cacodylate containing 1% OsO4 for 2 h. Pellets were then washed three times in distilled water and contrasted in saturated uranyl acetate for 30 min (for TEM) or directly dehydrated in an ethanol series (50%, 70%, 90%, 3 x 100%). For SEM of trophozoites in coculture with Caco2 cells, fixation, postfixation, and dehydration were performed with coated slides directly inside 24-well plates.
Samples for TEM were embedded in Epon 820 resin (16). The resin was polymerized at 65°C over a period of 48 h. Ultrathin sections were cut on a Reichert and Jung ultramicrotome and loaded onto 300-mesh copper grids (Plano GmbH, Marburg, Germany). Staining with uranyl acetate and lead citrate was performed as described previously (16). Finally, grids were viewed on a Phillips CM12 transmission electron microscope operating at 80 kV.
Samples for SEM were resuspended in 500 µl of hexamethyldisilazane, centrifuged (5,000 x g, 5 min, room temperature), resuspended in 20 µl of hexamethyldisilazane, and spotted onto glass coverslips pretreated with hexamethyldisilazane. Coverslips were air dried, sputter coated with gold, and inspected on a JEOL 840 scanning electron microscope operating at 25 kV.
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NTZ derivatives containing a bromo instead of a nitro group (Table 1) were all inactive against Giardia trophozoites (IC50s of >50 µM), with the exception of RM4820, which showed a moderate inhibitory activity (IC50 of 18.8 µM) that was lower than the ones for RM4802 and RM4805. The efficacy of MTZ was lower than those of NTZ and TIZ but still higher than that of any other drug tested in this study.
In order to visualize the morphological alterations of G. lamblia trophozoites induced by NTZ and compare them with those induced by MTZ, confluent axenic trophozoite cultures were treated with 50 µM NTZ or MTZ or with DMSO as a control. Observations with the light microscope showed that after 3 h of treatment with NTZ, approximately 50% of trophozoites were immobile; at 5 h of treatment, over 95% of trophozoites were immobile and formed large multicellular aggregates; and at 24 h of NTZ treatment, no motile trophozoites were found (data not shown). They all exhibited aberrant vacuolar cytoplasmic structures. Inspection by TEM (Fig. 1) largely confirmed these findings and showed that at 1 h of NTZ treatment, a considerable number of trophozoites already exhibited relatively small, aberrant cytoplasmic inclusions within their cytoplasm (Fig. 1A and B). At 3 h of treatment, larger vacuoles containing membranous inclusions or membrane stacks could be observed in a large number of parasites (Fig. 1C), and at 24 h of treatment, these parasites were seriously damaged, as exhibited either by a dissociation of their cytoplasmic organization (Fig. 1D) or, in many instances, by large vacuoles containing membrane residues (Fig. 1E). Besides this, however, the cytoskeletal elements of trophozoites, such as filaments associated with the ventral disk or the flagella and basal bodies, were not notably altered. In control preparations incubated in DMSO alone, no obvious changes in parasite ultrastructure could be detected (Fig. 1F).
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FIG. 1. Transmission electron microscopy of G. lamblia trophozoites treated with NTZ (50 µM) and fixed and processed at 1 h (A and B), 3 h (C), and 24 h (D and E) of treatment. Controls (F) were treated with the corresponding amount of DMSO. vd, ventral disk; nu, nucleus; f, flagellum. Bars: 0.5 µm (A and C), 2 µm (B), 1 µm (D, E, and F).
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FIG. 2. Scanning electron microscopy of G. lamblia trophozoites at different time points of NTZ or MTZ treatment. (A) Trophozoites treated with DMSO. (B to E) Trophozoites treated with 50 µM NTZ. (F to H) Trophozoites treated with 50 µM MTZ. vd, ventral disk; ds, dorsal shield. Arrows indicate distinct zones of lesions.
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FIG. 3. Scanning electron microscopy of G. lamblia trophozoites in coculture with Caco2 cells. Note the presence of small filopodiumlike surface membrane protrusions (arrows).
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FIG. 4. Trophozoite numbers in coculture with Caco2 cells. Trophozoites were inoculated to the cells in various densities in the presence of 30 µM NTZ or DMSO. Cells were harvested 24 h after infection, and trophozoites were quantified using real-time PCR. Mean values and standard errors correspond to quadruplicates.
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FIG. 5. Trophozoite numbers in coculture with Caco2 cells. Trophozoites (trophos; 105) were inoculated to the cells in the presence of 15 µM (white bars) or 30 µM (black bars) of various thiazolides, MTZ, or DMSO (control [C]). Cells were harvested at various time points, and trophozoites were quantified using real-time PCR. Mean values and standard errors correspond to quadruplicates. TIG, tizoxanide glucuronide.
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Interestingly, methylation of a bromothiazolide at position 3 on the benzene (RM4820) completely abolished the efficacy against N. caninum (10). Our studies with Giardia also indicate that the nitro group is not the only determinant of antigiardial activity. Methylation or methoxylation on position 3 of the benzene moiety had a negative impact on the efficacy compared to that of the unmodified compounds (for example, compare RM4802 to NTZ, RM4805 to TIZ, or RM4803 to RM4820). Moreover, methylation of the benzene ring at position 5, as in RM4807, had an even more pronounced negative impact, rendering the compound completely inactive. These changes in activity may reflect transport of the drug or other reactions within the cell and may not be directly related to the mechanism of action. The 5-methyl group of RM4807 may impede the reduction of the nitro group without being involved in the mechanism itself. RM4808, with a nitro group on an additional benzene ring attached with a sulfone to the thiazole moiety, was also completely inactive. Whether these changes in antiparasitic efficacy upon modification of the benzene ring are related to changes in the rate of drug uptake or whether different targets could be affected by different domains of the molecule remains to be investigated. Additional studies employing a range of other thiazolide derivatives are in progress.
In order to investigate how NTZ affects G. lamblia trophozoites under axenic culture conditions, SEM and TEM studies were performed comparatively with MTZ-treated parasites. Trophozoites treated with NTZ showed distinct alterations on the ventral disk surface membrane, which were already evident after 1 h of NTZ treatment and actually, during the following 24 h, remained the main cellular effect seen by SEM on the surface of NTZ-treated Giardia trophozoites. At present, we do not know what is causing these ventral disk surface membrane alterations. Intracellularly, distinct alterations, including the formation of cytoplasmic vacuoles and structural disintegration of the cytoplasmic compartments, were observed by TEM, showing that the parasite is seriously impaired both metabolically and structurally as early as after 1 to 5 h of NTZ treatment. We therefore conclude that the damage imposed on the ventral disk membrane is a specific mechanism leading to parasite death. If the ventral disk is responsible not only for attachment (14, 19, 21) but also for the absorption of nutrients, corresponding membrane damage will inevitably be followed by nutrient starvation of the trophozoites, resulting in a negative energy balance (18), detachment, and, finally, cell death.
Interestingly, light microscopic inspection and SEM demonstrated that trophozoites treated with MTZ show a different pattern of alterations. Parasites exhibited a tendency to swell, as described earlier (26), and in contrast to NTZ-treated parasites, trophozoites did not exhibit these alterations on the ventral disk membrane, but significant lesions were visible on the dorsal surface, most notably at 24 h of MTZ treatment. Similar alterations have been described previously on trophozoites treated with saturated fatty acids (23). Studies on the ultrastructural effects of these drugs towards cysts have revealed that NTZ and MTZ exhibit different effects, and they also differentially affect cyst viability (3). This clearly demonstrates significant differences in the mechanisms by which MTZ and NTZ kill G. lamblia trophozoites. Preliminary studies with MTZ- and NTZ-resistant strains show clear differences in the facilities to generate MTZ-resistant strains and NTZ-resistant strains (data not shown), a finding which is in agreement with findings with Helicobacter pylori (15, 22) and Cryptosporidium (11).
Effects of thiazolides on Giardia trophozoites in coculture with Caco2 cells. While the previous studies were undertaken under axenic culture conditions, a culture system in which G. lamblia trophozoites are maintained by attaching to Caco2 cells was established. Trophozoites were shown to adhere to Caco2 cells in a saturable manner, which argues for a limited number of binding sites on the Caco2 cell surface. In addition, we found that trophozoites can survive attached to Caco2 cells in Caco2 growth medium for a period of up to 48 h; during this time span, however, parasites do not proliferate.
Nevertheless, in contrast to those cell lines used for attachment assays in previous studies (6, 21), Caco2 cells are immortal and thus can be grown easily in a highly reproducible manner. For our studies with thiazolides and MTZ, a 24-h incubation period was the most useful. The differences in IC50 values observed in axenic cultures, were, however, obliterated in the coculture system, as only those compounds with low IC50 values in axenic culturethose containing nitro groupsshowed significant inhibition of trophozoite attachment at a concentration of 30 µM. This is a drug concentration that kills all trophozoites in axenic cultures. One explanation for this observation could be that the thiazolides are inactivated by the Caco2 cells (e.g., by glycosylation) and/or stored in intracellular compartments; thus, the trophozoites would encounter at the cell surface thiazolide concentrations lower than in those in the medium. It is also possible that the presence of an additional intestinal component, provided by Caco2 cells as an adhesion matrix, interferes in the direct action of these drugs. Clearly, further investigations are needed to demonstrate the identities of the factors involved.
A model for the mode of action of thiazolides. The differences in the effects of NTZ and MTZ outlined above suggest differences in the modes of action of both compounds. The nitro group of MTZ is commonly admitted to be reduced to a toxic radical by nitroreductases that are present in microaerophilic microorganisms, including bacteria and protists, but not in host cells (17, 25). For NTZ and related compounds, evidence for an in vivo reduction is lacking. Although the nitro group is a prerequisite for thiazolides with low inhibitory constants in Giardia, it is not sufficient, since the efficacy of RM4805 is impaired and RM4807 is inactive. An alternative explanation would be that modification of the benzene ring, such as the 5-methyl group of RM4807, may impede the reduction of the nitro group. RM4820, an NTZ derivative with a bromo instead of a nitro group, shows a moderate inhibition of trophozoite growth in axenic culture. Moreover, in Neospora, an intracellular apicomplexan parasite, RM4820 exhibits a proliferation inhibitory effect comparable to that of NTZ (10). The same was observed for Cryptosporidium parvum (unpublished results). The fact that a modification of the salicylic acid moiety (by, e.g., methylation) reduces the activity or even renders the compounds ineffective suggests a more complex model for the mode of action of thiazolides. In this model, both the thiazole moiety with or without nitro group and the salicylic acid moiety of the molecule determine host specificity and efficacy. Besides the unique mode of action through the nitro group by formation of radicals and nitrosative stress (18, 26, 27), thiazolides could interact with specific signaling proteins via their salicylic acid moiety. Salicylic acid has been identified as a signal molecule in different kingdoms, with functions as widespread as the triggering of defense reactions in plants (for an example, see reference 9) and inhibiting cyclooxygenase in humans (31). Therefore, it is possible that also in Giardia and related protists, thiazolides interfere in intracellular signaling pathways through their salicylic acid moiety. For instance, the correct targeting of proteins destined to reach the extracellular space (20) could be affected, and this could lead to the observed proteolytic degradation of crucial components of the ventral disk membrane and ultimately to cell death.
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TABLE 1 Continued
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This study was financially supported by Romark Research Laboratories.
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