[Environment and child health: from health transition to shared risk?]. / Environnement et santé de l'enfant: de la transition sanitaire au risque partagé?

Children under the age of 18 account for almost half of the world's population, with most living in developing countries. Young people are especially sensitive to acute and chronic environmental conditions and 43% of environmental diseases occur in the 12% of the world's population under age 5. The main environmental threats to the health of children in developing countries are inadequate access to clean water for drinking and hygiene, exposure to air pollution: primarily indoors and secondarily outdoors, risk of accidents and wounds, and poisoning due to toxic products. Recent data suggest that the number and diversity of environmental risk factors affecting child health is increasing as a result of increasing malnutrition, pollution, and violence and consequently that the level of health and quality of life of future generations will decrease. Due to the complexity of the interactions between environmental factors and socio-economic determinants, the epidemiological transition model is poorly suited to analyzing and predicting the concurring risks of infectious disease and chronic disease (diabetes, cancer...). This article presents a number of recommendations for training health professional, developing environmental reference centers, implementing risk assessment, coordinating decentralized activities and policy, and involving parents and children in the decisional process with emphasis on divulgating study findings and developing interfaces between the various stakeholders.

Antigenic components of partially purified antigens of Leishmania donovani infantum recognized by sera from dogs with asymptomatic or active visceral leishmaniasis.

The antigenic components of a semipurified fraction of Leishmania donovani infantum were determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blot analysis using 14 serum samples from dogs with symptomatic visceral leishmaniasis and 11 serum samples from apparently healthy dogs collected in an area endemic for canine visceral leishmaniasis (CVL). It was found that these antigens were composed of many polypeptides, among which seven components recognized by symptomatic CVL sera, had molecular weights of approximately 18, 28, 30, 33, 63, 70, and 72 kilodaltons (kD); two components of 63 and 70 kD were recognized by three of 11 healthly dog sera. These findings suggest that specific antigens induce humoral immune response in dogs with asymptomatic or active visceral leishmaniasis. Infected dogs are not readily identifiable by their symptoms. The potential interest of the immunoblot test for CVL diagnostic purposes is discussed.

Antigenic components of excretory-secretory products of adult Fasciola hepatica recognized in human infections.

The antigenic components of excretory-secretory products (ESP) of adult worms of Fasciola hepatica were revealed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blot analysis using sera from 20 patients infected with F. hepatica. Sera from 184 other parasitic infections and 20 healthy volunteers were also analyzed. It was found that the ESP were composed of more than 11 polypeptides; five components detected in fascioliasis sera had molecular weights of 12.4, 16.4, 19.4, 25, and 27 kilodaltons (kD). Only the 25- and 27-kD components were recognized by all 20 fascioliasis sera. Using the ESP as antigen, it was possible to perform an enzyme-linked immunosorbent assay with a sensitivity of 95% and a specificity of 97%. Sera from other parasitic infections had antibodies to antigenic components with apparent molecular weights of 37, 38.4, 52, 63, 73, 87, 109, and 116 kD that were also found in sera from fascioliasis patients. These findings suggested that the 25- and 27-kD antigenic components may be sensitive and specific for the diagnosis of human fascioliasis.

Canine visceral leishmaniasis: successful chemotherapy induces macrophage antileishmanial activity via the L-arginine nitric oxide pathway.

Following successful chemotherapy in canine visceral leishmaniasis, monocyte-derived macrophages can induce antileishmanial activity via a gamma interferon-dependent mechanism in the presence of autologous lymphocytes. The killing of leishmania correlated with the induction of the NO synthase pathway, because it correlated with the generation of nitrogen derivative production and was abrogated in the presence of NG-monomethyl-L-arginine, a competitive inhibitor of the NO synthase pathway. The level of L-citrulline in serum, which was produced after activation of the NO synthase pathway, was markedly enhanced in dogs receiving successful chemotherapy. Taken together, these data indicate that following successful chemotherapy of visceral leishmaniasis, leishmania parasites are killed by macrophages activated by gamma interferon-producing lymphocytes via an NO-dependent mechanism.

In vitro study of the anti-leishmanial activity of biodegradable nanoparticles.

Leishmania are obligate intracellular parasites, responsible for leishmaniasis. Leishmaniasis are transmitted via insect vector to vertebrate hosts including humans. The infection was reproduced in vitro with promastigotes which can infect murine resident peritoneal cells. Amphotericin B was incorporated into poly(D, L-lactide-co-glycolide) nanoparticles, biodegradable drug carriers, to allow specific targeting inside the cell. The interaction of the drug with infected cells was determined by exposing macrophage cultures to drug carriers. The toxic effects of polymeric drug carriers were defined prior to exposing cells to drug-loaded nanoparticles. For contact times up to 4h, cells tolerated polymer concentrations of 0.01%. The viability of parasites after treatment was determined. Infected macrophages were incubated at 26 degrees C (which allows the transformation of amastigote to promastigote) along with loaded and unloaded nanoparticles, as well as the free drug alone, and a count of the parasites in the medium was recorded. Anti-leishmanial activity was observed with drug-free nanoparticles. This activity may arise through the release of hydrogen peroxide following the activation of macrophages. The incorporation of amphotericin B did not enhance this effect. Interestingly, trehalose, a cryoprotector of the freeze-dried nanoparticles, altered parasite growth and activated macrophages.

Exploitation of parasite-derived antigen in therapeutic success against canine visceral leishmaniosis. Veterinary Group of Lupino.

In an attempt to obtain therapeutic success against canine visceral leishmaniosis, the potential of LiF2 antigen (Leishmania infantum-derived Fraction 2, 94-67 kDa), given alone or in combination with the chemotherapeutic agent N-methylglucamine antimonate, was compared with conventional chemotherapy with that drug. Absence of any parasite in direct microscopic examination of bone-marrow aspirates in treated dogs was considered a parasitological cure, i.e. therapeutic success. Results showed that the disappearance of clinical symptoms did not always indicate parasitological healing in dogs. The parasitological healing rates with chemotherapy and immunotherapy alone were 37.5% and 25% respectively, in contrast to the 100% cure rate observed with chemotherapy combined with immunotherapy. The development of a protective response in dogs, as measured by the in vitro leishmanicidal activity of monocyte-derived macrophages in the presence of autologous lymphocytes, was found to correlate well with the success of therapy. The overall findings of this study give an important insight into the immunotherapeutic strategy by which therapeutic success can be achieved in canine visceral leishmaniosis.

Exploitation of parasite derived antigen in therapeutic success of human cutaneous leishmaniasis in Brazil.

In a complete study in 25 patients with American cutaneous leishmaniasis, caused by Leishmania braziliensis complex, immunotherapeutic efficacy of parasite derived antigen (94-67 KD) has been compared to antimonial therapy. Additionally, to delineate the mechanism of therapeutic success, microscopical features of immune response in active lesions and healed or non-healed lesions following therapy were analyzed. The results showed that cure rates in immunotherapy and chemotherapy were equal (> 83%). The immunohistochemical changes in two therapeutic groups were also largely similar. The analysis of humoral and cellular immune response suggest that appropriate stimulation of T helper cells in the lesion site, in association with one or more cytokines, play a key role in the healing process.

CD23 and IgE expression during the human immune response to cutaneous leishmaniasis: possible role in monocyte activation.

Leishmania brasiliensis causes cutaneous leishmaniasis (CL) in humans. During this infection, a variety of inflammatory mediators are produced by T cells and monocytes/macrophages. In the present study, we analysed serum IgE levels and their correlation with in situ expression of the low affinity receptor for IgE (Fc epsilon RII/CD23) in patients infected with L. brasiliensis before and following therapy. These analyses were compared to in situ expression of tumour necrosis factor-alpha (TNF alpha), interleukin 3 (IL3), interferon-gamma (IFN gamma) and IL4. Disease-free individuals from the same endemic area sensitized with L. brasiliensis antigens were also included in this work. Our data indicate that during infection, serum levels of IgE and TNF alpha increased and correlated with elevated in situ expression of CD23, IL4 and TNF alpha mRNA. This expression disappeared following successful treatment, but persisted in patients resistant to anti-leishmania therapy. Patients resistant to therapy differed from other cases by a dramatic decrease in their in vivo expression of IFN gamma protein. Analysis of CD23 function in purified human monocytes indicated that this antigen mediates IgE/anti-IgE-dependent TNF alpha production. These data suggest a possible in vivo role of CD23 in acute immune responses in human CL.

[Cell-mediated immunity and protection against blood stages of Plasmodium falciparum]. / Immunité à médiation cellulaire et protection contre les stades sanguins de Plasmodium falciparum.

In recent years, cell-mediated immunity against malaria has been the subject of intensive investigation either in humans from malaria endemic areas, or experimental models. Cellular immune mechanisms have been regarded as secondary to humoral immunity but, there is increasing evidence that shows its critical role in protection against blood stage plasmodium parasites. In the context of a large humoral-cellular interaction, T helper lymphocytes and monocytes/macrophages may play a key role in the elimination of plasmodial blood stages, particularly P. falciparum. IL-2, IL-4, IL-5, IFN-gamma cytokines secreted principally by CD4+ T lymphocytes and oxygen and nitrogen radicals produced by activated macrophages, are involved in the control of plasmodial infection. The spleen also plays a very important function in the anti-malarial protection by its increased capacity for filtration/destruction of parasitized red blood cells and by induction of B and T memory lymphocytes. Successful vaccination against malaria needs a choice of plasmodial antigens or B and T immunodominants epitopes able to stimulate plasmodium-specific lymphocytes and functional modification in the spleen.

A simple method for detection of monoclonal isotypes.

A simple rapid method of enzyme labeled anti-isotype assay (ELIA) for detection of monoclonal isotype on hybridoma cells is proposed. This alternative method was first carried out on hybridoma cell lines 147C11 and 257C11 produced against Trypanosoma cruzi and male accessory secretion of Panstrongylus megistus, respectively. The monoclonal antibodies produced by these hybridoma were characterized by this method as IgM (147C11) and IgG1 (257C23) isotypes, allowing evaluation of isotype without having to wait until the concentration of antibody present in the supernatant itself rises. Results were confirmed by Ouchterlony immunodiffusion. The proposed method offers the advantages of a permanent rapid procedure for light microscopy.

Immunoblot analysis of the humoral immune response to Leishmania donovani infantum polypeptides in human visceral leishmaniasis.

Using the immunoblot technique, we have compared the reactions of Leishmania donovani infantum polypeptides with the immunoglobulin G of human sera from patients with parasitologically proven L. d. infantum infection, with suspected visceral leishmaniasis, and with other leishmaniases, protozoiases, helminthiases, and fungal or bacterial diseases. A 94-kDa component reacted with all L. d. infantum-infected sera and with 75% of sera from patients with clinical and serological but no parasitological diagnoses. No reaction was observed with sera from patients in the other disease groups or with control sera. Studies of eight different isolates, subspecies, and species of the genus Leishmania demonstrated that the 94-kDa component was expressed in all strains examined.

Enzyme immunoassays for detection of malarial antigens in human plasmas by Plasmodium falciparum monoclonal antibodies.

The screening of blood donors for the detection of dangerous disease carriers is a mandatory requirement for blood transfusion centers. Enzyme immunoassay (EIA) is a suitable method for the examination of large populations. We describe a sandwich EIA allowing the detection of soluble malarial antigens in plasma using 11 mouse monoclonal antibodies. Among the 121 combinations tested, 2 were selected for their sensitivity and specificity. Both were applied to plasmas of (a) acute patients, (b) people living in malarious areas, (c) blood donors at risk (travelers), and (d) sedentary blood donors without risk. With 1 of the 2 combinations, the percentage of positive answers was 68.4% (n = 38) for a, 62.6% (n = 206) for b, 4.5% (n = 398) for c, and 0.8% (n = 485) for d; with the other combination, the percentage of positive answers was 68.4% for a, 46.1% for b, 1.5% for c, and 0% for d. Using 2 combinations simultaneously, the positive results were 94.7% for a, 70.4% for b, 5% for c, and 0.8% for d. The 2 assays are complementary and the pair can be used for maximum Plasmodium falciparum antigen recognition in prospective donors.

Interactions between the human monocytic leukaemia THP-1 cell line and Old and New World species of Leishmania.

The human promyelocytic THP-1 cell line has been found to support the growth of Leishmania parasites. THP-1 cells, differentiated with retinoic acid, cease replication while remaining in suspension. 72 +/- 8% of THP-1 cells became infected after inoculation with promastigotes of several Old and New World Leishmania species. The resulting amastigotes (19 +/- 5 per infected cell) were easy to harvest, capable of reinfecting cultures of normal human cells and, in the case of L. major and L. infantum, caused specific lesions in BALB/c mice. This culture system should facilitate biochemical and immunological studies on amastigotes and be of use in screening anti-parasite drugs.

Immunization of dogs with a Leishmania infantum-derived vaccine.

A partially-purified extract of Leishmania infantum has been administered to healthy dogs. Post-immunization sera were found to neutralize the infectivity of L. infantum and to abate the development of L. major. Muramyl dipeptide and one of its derivates, murabutide, were the best adjuvants.

Vaccine-induced immunity against cutaneous leishmaniasis in BALB/c mice.

Partially purified antigens, derived from Leishmania infantum or L. major promastigotes and isolated under reducing conditions, were used to immunize BALB/c mice. Three subcutaneous injections of the 64- to 97-kilodalton preparation in conjunction with muramyl dipeptide conferred long-lasting immunity against L. mexicana subsp. mexicana and L. major infection; they led to the development of antibodies neutralizing the infectiousness of promastigotes, induced specific delayed-hypersensitivity reactions, and generated populations of peritoneal macrophages capable of killing amastigotes. Vaccination resulted in no harmful effects, since these antigen neither exacerbated preexisting Leishmania infection nor impeded the formation of antibodies to other antigens administered concomitantly.

Application of an in vivo culture system for rapid demonstration of anti-Leishmania activity of monoclonal antibodies.

In mice, infection with Leishmania by the subcutaneous route becomes evident after about 2 months. This delay impedes the selection of monoclonal antibodies able to interfere with the infectiousness of the parasite. Using an in vivo culture system--intraperitoneal injection of TG 180 sarcoma cells along with promastigotes or amastigotes--it was possible to define within 15 to 20 days a monoclonal antibody preventing the development of Leishmania. Pretreatment of promastigotes and amastigotes of several Leishmania species with a monoclonal antibody raised against Leishmania infantum prevented infection equally in either system. These cross-reactions may be of importance in designing new approaches of immunotherapy.

[Needle aspiration biopsy in the diagnosis of cutaneous leishmaniasis]. / Prélèvement par aspiration à l'aiguille dans le diagnostic de la leishmaniose cutanée.

The classic diagnostic procedure for cutaneous leishmaniasis is based on the examination of Giemsa-stained smears made from the fluid obtained by scraping the edges of the lesion with a lancet, or prepared with small plugs of superficial tissues. In this report, we compare the results given by this standard method with those obtained by the examination of needle aspirates. Aspirates are secured by injecting a few millimetres outside the external border of the lesion 0.3 to 0.5 ml of saline through a thin needle, rubbing the injured skin, and thereafter pulling back slowly the plunger. Amastigotes were found in all smears from needle aspirates, and in only 11 out 15 obtained by scraping. Aspirates were also more suitable for cultures of parasites.

[Culture systems for production of promastigote and amastigote forms of Leishmania. Application to serological diagnosis and therapeutic trials]. / Etude de systèmes de culture pour la production des formes promastigotes et amastigotes des Leishmanies. Application au diagnostic sérologique et aux essais thérapeutiques.

Several species of leishmania and three methods of cultivation: monophasic, biphasic and co-cultivation were used in a compared study bearing on the intensive production of leishmania. In addition by applying, a new in vivo model, comprising an injection of sarcomatous cells and promastigotes into BALB/c mice and also an extraction on a discontinuous gradient (Radioselectan 60%), it was possible to obtain highly purified isolates of amastigote forms. The use of two antigens: promastigotes and amastigotes, is to be recommended for the serological diagnosis, by indirect immunofluorescence, of kala-azar. The new in vivo model merits further consideration for research concerning new molecules active against leishmania.