Computational Identification of Master Regulators Influencing Trypanotolerance in Cattle.

African Animal Trypanosomiasis (AAT) is transmitted by the tsetse fly which carries pathogenic trypanosomes in its saliva, thus causing debilitating infection to livestock health. As the disease advances, a multistage progression process is observed based on the progressive clinical signs displayed in the host's body. Investigation of genes expressed with regular monotonic patterns (known as Monotonically Expressed Genes (MEGs)) and of their master regulators can provide important clue for the understanding of the molecular mechanisms underlying the AAT disease. For this purpose, we analysed MEGs for three tissues (liver, spleen and lymph node) of two cattle breeds, namely trypanosusceptible Boran and trypanotolerant N'Dama. Our analysis revealed cattle breed-specific master regulators which are highly related to distinguish the genetic programs in both cattle breeds. Especially the master regulators MYC and DBP found in this study, seem to influence the immune responses strongly, thereby susceptibility and trypanotolerance of Boran and N'Dama respectively. Furthermore, our pathway analysis also bolsters the crucial roles of these master regulators. Taken together, our findings provide novel insights into breed-specific master regulators which orchestrate the regulatory cascades influencing the level of trypanotolerance in cattle breeds and thus could be promising drug targets for future therapeutic interventions.

Gambian human African trypanosomiasis in North West Uganda. Are we on course for the 2020 target?

In 1994, combined active and passive screening reported 1469 cases from the historic Gambian Human African Trypanosomiasis (gHAT) foci of West Nile, Uganda. Since 2011 systematic active screening has stopped and there has been reliance on passive screening. During 2014, passive screening alone detected just nine cases. In the same year a tsetse control intervention was expanded to cover the main gHAT foci in West Nile to curtail transmission of gHAT contributing to the elimination of gHAT as a public health problem in the area. It is known that sole reliance on passive screening is slow to detect cases and can underestimate the actual true number. We therefore undertook an active screening programme designed to test the efficacy of these interventions against gHAT transmission and clarify disease status. Screening was conducted in 28 randomly selected villages throughout the study area, aiming to sample all residents. Whole blood from 10,963 participants was analysed using CATT and 97 CATT suspects (0.9%) were evaluated with microscopy and trypanolysis. No confirmed cases were found providing evidence that the gHAT prevention programmes in West Nile have been effective. Results confirm gHAT prevalence in the study area of West Nile is below the elimination threshold (1 new case / 10,000 population), making elimination on course across this study area if status is maintained. The findings of this study can be used to guide future HAT and tsetse management in other gHAT foci, where reduced caseloads necessitate a shift from active to passive screening.

Neutrophils enhance early Trypanosoma brucei infection onset.

In this study, Trypanosoma brucei was naturally transmitted to mice through the bites of infected Glossina morsitans tsetse flies. Neutrophils were recruited rapidly to the bite site, whereas monocytes were attracted more gradually. Expression of inflammatory cytokines (il1b, il6), il10 and neutrophil chemokines (cxcl1, cxcl5) was transiently up-regulated at the site of parasite inoculation. Then, a second influx of neutrophils occurred that coincided with the previously described parasite retention and expansion in the ear dermis. Congenital and experimental neutropenia models, combined with bioluminescent imaging, indicate that neutrophils do not significantly contribute to dermal parasite control and elicit higher systemic parasitemia levels during the infection onset. Engulfment of parasites by neutrophils in the skin was rarely observed and was restricted to parasites with reduced motility/viability, whereas live parasites escaped phagocytosis. To our knowledge, this study represents the first description of a trypanosome infection promoting role of early innate immunological reactions following an infective tsetse fly bite. Our data indicate that the trypanosome is not hindered in its early development and benefits from the host innate responses with the neutrophils being important regulators of the early infection, as already demonstrated for the sand fly transmitted Leishmania parasite.

Assessing Strategies Against Gambiense Sleeping Sickness Through Mathematical Modeling.

Background: Control of gambiense sleeping sickness relies predominantly on passive and active screening of people, followed by treatment. Methods: Mathematical modeling explores the potential of 3 complementary interventions in high- and low-transmission settings. Results: Intervention strategies that included vector control are predicted to halt transmission most quickly. Targeted active screening, with better and more focused coverage, and enhanced passive surveillance, with improved access to diagnosis and treatment, are both estimated to avert many new infections but, when used alone, are unlikely to halt transmission before 2030 in high-risk settings. Conclusions: There was general model consensus in the ranking of the 3 complementary interventions studied, although with discrepancies between the quantitative predictions due to differing epidemiological assumptions within the models. While these predictions provide generic insights into improving control, the most effective strategy in any situation depends on the specific epidemiology in the region and the associated costs.

The impact of passive case detection on the transmission dynamics of gambiense Human African Trypanosomiasis.

Gambiense Human African Trypanosomiasis (HAT), or sleeping sickness, is a vector-borne disease affecting largely rural populations in Western and Central Africa. The main method for detecting and treating cases of gambiense HAT are active screening through mobile teams and passive detection through self-referral of patients to dedicated treatment centres or hospitals. Strategies based on active case finding and treatment have drastically reduced the global incidence of the disease over recent decades. However, little is known about the coverage and transmission impact of passive case detection. We used a mathematical model to analyse data from the period between active screening sessions in hundreds of villages that were monitored as part of three HAT control projects run by Médecins Sans Frontières in Southern Sudan and Uganda in the late 1990s and early 2000s. We found heterogeneity in incidence across villages, with a small minority of villages found to have much higher transmission rates and burdens than the majority. We further found that only a minority of prevalent cases in the first, haemo-lymphatic stage of the disease were detected passively (maximum likelihood estimate <30% in all three settings), whereas around 50% of patients in the second, meningo-encephalitic were detected. We estimated that passive case detection reduced transmission in affected areas by between 30 and 50%, suggesting that there is great potential value in improving rates of passive case detection. As gambiense HAT is driven towards elimination, it will be important to establish good systems of passive screening, and estimates such as the ones here will be of value in assessing the expected impact of moving from a primarily active to a more passive screening regime.

Adding tsetse control to medical activities contributes to decreasing transmission of sleeping sickness in the Mandoul focus (Chad).

BACKGROUND: Gambian sleeping sickness or HAT (human African trypanosomiasis) is a neglected tropical disease caused by Trypanosoma brucei gambiense transmitted by riverine species of tsetse. A global programme aims to eliminate the disease as a public health problem by 2020 and stop transmission by 2030. In the South of Chad, the Mandoul area is a persistent focus of Gambian sleeping sickness where around 100 HAT cases were still diagnosed and treated annually until 2013. Pre-2014, control of HAT relied solely on case detection and treatment, which lead to a gradual decrease in the number of cases of HAT due to annual screening of the population. METHODS: Because of the persistence of transmission and detection of new cases, we assessed whether the addition of vector control to case detection and treatment could further reduce transmission and consequently, reduce annual incidence of HAT in Mandoul. In particular, we investigated the impact of deploying 'tiny targets' which attract and kill tsetse. Before tsetse control commenced, a census of the human population was conducted and their settlements mapped. A pre-intervention survey of tsetse distribution and abundance was implemented in November 2013 and 2600 targets were deployed in the riverine habitats of tsetse in early 2014, 2015 and 2016. Impact on tsetse and on the incidence of sleeping sickness was assessed through nine tsetse monitoring surveys and four medical surveys of the human population in 2014 and 2015. Mathematical modelling was used to assess the relative impact of tsetse control on incidence compared to active and passive screening. FINDINGS: The census indicated that a population of 38674 inhabitants lived in the vicinity of the Mandoul focus. Within this focus in November 2013, the vector is Glossina fuscipes fuscipes and the mean catch of tsetse from traps was 0.7 flies/trap/day (range, 0-26). The catch of tsetse from 44 sentinel biconical traps declined after target deployment with only five tsetse being caught in nine surveys giving a mean catch of 0.005 tsetse/trap/day. Modelling indicates that 70.4% (95% CI: 51-95%) of the reduction in reported cases between 2013 and 2015 can be attributed to vector control with the rest due to medical intervention. Similarly tiny targets are estimated to have reduced new infections dramatically with 62.8% (95% CI: 59-66%) of the reduction due to tsetse control, and 8.5% (95% 8-9%) to enhanced passive detection. Model predictions anticipate that elimination as a public health problem could be achieved by 2018 in this focus if vector control and screening continue at the present level and, furthermore, there may have been virtually no transmission since 2015. CONCLUSION: This work shows that tiny targets reduced the numbers of tsetse in this focus in Chad, which may have interrupted transmission and the combination of tsetse control to medical detection and treatment has played a major role in reducing in HAT incidence in 2014 and 2015.

Relationship between Neutrophil-To-Lymphocyte Ratio and Electrocardiographic Ischemia Grade in STEMI / Associação entre a Relação Neutrófilos/Linfócitos e o Grau de Isquemia Eletrocardiográfica no IAMEST

Background: Neutrophil-to-lymphocyte ratio (NLR) has been found to be a good predictor of future adverse cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Changes in the QRS terminal portion have also been associated with adverse outcomes following STEMI. Objective: To investigate the relationship between ECG ischemia grade and NLR in patients presenting with STEMI, in order to determine additional conventional risk factors for early risk stratification. Methods: Patients with STEMI were investigated. The grade of ischemia was analyzed from the ECG performed on admission. White blood cells and subtypes were measured as part of the automated complete blood count (CBC) analysis. Patients were classified into two groups according to the ischemia grade presented on the admission ECG, as grade 2 ischemia (G2I) and grade 3 ischemia (G3I). Results: Patients with G3I had significantly lower mean left ventricular ejection fraction than those in G2I (44.58 ± 7.23 vs. 48.44 ± 7.61, p = 0.001). As expected, in-hospital mortality rate increased proportionally with the increase in ischemia grade (p = 0.036). There were significant differences in percentage of lymphocytes (p = 0.010) and percentage of neutrophils (p = 0.004), and therefore, NLR was significantly different between G2I and G3I patients (p < 0.001). Multivariate logistic regression analysis revealed that only NLR was the independent variable with a significant effect on ECG ischemia grade (odds ratio = 1.254, 95% confidence interval 1.120–1.403, p < 0.001). Conclusion: We found an association between G3I and elevated NLR in patients with STEMI. We believe that such an association might provide an additional prognostic value for risk stratification in patients with STEMI when combined with standardized risk scores. .

Fundamento: A relação neutrófilos/linfócitos (N/L) tem sido descrita como boa preditora de eventos cardiovasculares adversos futuros em pacientes com infarto agudo do miocárdio com elevação do segmento ST (IAMEST). Mudanças na porção terminal do complexo QRS também têm sido associadas a eventos adversos após IAMEST. Objetivo: Investigar a associação entre o grau de isquemia no ECG e a relação N/L em pacientes com IAMEST para determinar fatores de risco convencionais adicionais na estratificação precoce de risco. Métodos: Pacientes com IAMEST foram investigados. O grau de isquemia foi analisado a partir do ECG obtido à admissão. A contagem de leucócitos e seus subtipos foi realizada a partir de hemograma automatizado. De acordo com o grau de isquemia presente no ECG de admissão, os pacientes foram classificados em dois grupos, isquemia grau 2 (IG2) e isquemia grau 3 (IG3). Resultados: Pacientes com IG3 apresentaram valores médios significativamente menores de fração de ejeção do ventrículo esquerdo do que os pacientes com IG2 (44,58 ± 7,23 versus 48,44 ± 7,61; p = 0,001). Como esperado, a taxa de mortalidade intra-hospitalar aumentou proporcionalmente com o aumento no grau de isquemia (p = 0,036). Houve diferenças significativas nas porcentagens de linfócitos (p = 0,010) e de neutrófilos (p = 0,004) e, portanto, a relação N/L diferiu significativamente entre pacientes com IG2 e IG3 (p < 0,001). À análise de regressão logística multivariada, apenas a relação N/L emergiu como variável independente com efeito significativo sobre o grau de isquemia no ECG (odds ratio = 1,254; intervalo de confiança de 95% 1,120-1,403; p < 0,001). Conclusão: Nós encontramos uma associação entre IG3 e relação N/L aumentada em pacientes com IAMEST. Acreditamos que esta associação possa oferecer um valor prognóstico adicional para estratificação de risco em pacientes com IAMEST quando usado em combinação com escores de risco padronizados. .

The bacterial flora of tsetse fly midgut and its effect on trypanosome transmission.

The tsetse fly, Glossina palpalis is a vector of the trypanosome that causes sleeping sickness in humans and nagana in cattle along with associated human health problems and massive economic losses. The insect is also known to carry a number of symbionts such as Sodalis, Wigglesworthia, Wolbachia whose effects on the physiology of the insect have been studied in depth. However, effects of other bacterial flora on the physiology of the host and vector competence have received little attention. Epidemiological studies on tsetse fly populations from different geographic sites revealed the presence of a variety of bacteria in the midgut. The most common of the flora belong to the genera Entrobacter (most common), Enterococcus, and Acinetobacter. It was a little surprising to find such diversity in the tsetse midgut since the insect is monophagous consuming vertebrate blood only. Diversity of bacteria is normally associated with polyphagous insects. In contrast to the symbionts, the role of resident midgut bacterial flora on the physiology of the fly and vector competence remains to be elucidated. With regard, Sodalis glossinidius, our data showed that flies harbouring this symbiont have three times greater probability of being infected by trypanosomes than flies without the symbiont. The data delineated in these studies under score the need to carry out detailed investigations on the role of resident bacteria on the physiology of the fly and vector competence.

[Glossina feeding habits and diversity of species of trypanosomes in an active focus of human African trypanosomiasis in Gabon]. / Régime alimentaire des glossines et diversité des espèces de trypanosomes dans un foyer actif de trypanosomose humaine africaine au Gabon.

Feeding host is an important factor upon which depend the Glossina infection rate and the proportion of different species of trypanosome. Glossina feed both upon animals and humans. In order to identify species of trypanosomes present in the Komo-Mondah focus and to verify whether there is any relationship between the prevalence of sleeping sickness and the feeding habits of Glossina, we have carried out an entomological survey in this focus of Gabon. Flies were dissected and organs were analysed by PCR, while the origin of blood meals was determined by ELISA. Three species of trypanosomes were found: Trypanosoma congolense "forest type" (14/104; 13.46%), Trypanosoma vivax (11/104; 10.58%) and Trypanosoma brucei s.l. (65/104; 62.5%) with 13.46% (14/104) of mixed infections of T. brucei s.l. and T. congolense Glossina palpalis palpalis was caught in all biotopes investigated (91.85%) and was infected by all these species of trypanosomes. Glossina caliginea was not infected and Glossina fuscipes fuscipes was infected by T. brucei s.l. Tsetse flies feed more on animals than on humans in almost all villages, but there was no significant difference between the number of blood meals taken upon these two groups of vertebrates (Chi 2 = 7.43; p > 0.05). A negative correlation was found between the zoophylic/anthropophylic index and the prevalence of HAT. This result is insufficient to conclude that this index can be used as an indicator of the degree of prevalence of HAT. In contrary, the trypanosomian risk seems to be an appropriate indicator of the prevalence of HAT in an area. The identification of the reservoir hosts in this focus would be useful for a good understanding of the HAT epidemiology.

Development of a mathematical model for mechanical transmission of trypanosomes and other pathogens of cattle transmitted by tabanids.

Mechanical transmission of pathogens by biting insects is a non-specific phenomenon in which pathogens are transmitted from the blood of an infected host to another host during interrupted feeding of the insects. A large range of pathogens can be mechanically transmitted, e.g. hemoparasites, bacteria and viruses. Some pathogens are almost exclusively mechanically transmitted, while others are also cyclically transmitted. For agents transmitted both cyclically and mechanically (mixed transmission), such as certain African pathogenic trypanosomes, the relative impact of mechanical versus cyclical transmission is essentially unknown. We have developed a mathematical model of pathogen transmission by a defined insect population to evaluate the importance of mechanical transmission. Based on a series of experiments aimed at demonstrating mechanical transmission of African trypanosomes by tabanids, the main parameters of the model were either quantified (host parasitaemia, mean individual insect burden, initial prevalence of infection) or estimated (unknown parameters). This model allows us to simulate the evolution of pathogen prevalence under various predictive circumstances, including control measures and could be used to assess the risk of mechanical transmission under field conditions. If adjustments of parameters are provided, this model could be generalized to other pathogenic agents present in the blood of their hosts (Bovine Leukemia virus, Anaplasma, etc.) or other biting insects such as biting muscids (stomoxyines) and hippoboscids.

Tsetse fly saliva accelerates the onset of Trypanosoma brucei infection in a mouse model associated with a reduced host inflammatory response.

Tsetse flies (Glossina sp.) are the vectors that transmit African trypanosomes, protozoan parasites that cause human sleeping sickness and veterinary infections in the African continent. These blood-feeding dipteran insects deposit saliva at the feeding site that enables the blood-feeding process. Here we demonstrate that tsetse fly saliva also accelerates the onset of a Trypanosoma brucei infection. This effect was associated with a reduced inflammatory reaction at the site of infection initiation (reflected by a decrease of interleukin-6 [IL-6] and IL-12 mRNA) as well as lower serum concentrations of the trypanocidal cytokine tumor necrosis factor. Variant-specific surface glycoprotein-specific antibody isotypes immunoglobulin M (IgM) and IgG2a, implicated in trypanosome clearance, were not suppressed. We propose that tsetse fly saliva accelerates the onset of trypanosome infection by inhibiting local and systemic inflammatory responses involved in parasite control.

The vervet monkey (Chlorocebus aethiops) as an experimental model for Trypanosoma brucei gambiense human African trypanosomiasis: a clinical, biological and pathological study.

It has long been known that the vervet monkey, Chlorocebus (C.) aethiops, can be infected with Trypanosoma rhodesiense, but this model has not been described for T. gambiense. In this study, we report the development of such a model for human African trypanosomiasis. Twelve vervet monkeys infected with T. gambiense developed chronic disease. The duration of the disease ranged between 23 and 612 days (median 89 days) in five untreated animals. Trypanosomes were detected in the blood within the first 10 days post-infection and in the cerebrospinal fluid, with a median delay of 120 days (n = 4, range 28-348 days). Clinical changes included loss of weight, adenopathy, and in some cases eyelid oedema and lethargy. Haematological alterations included decreases in haemoglobin level and transitory decreases in platelet count. Biological modifications included increased gamma globulins and total proteins and decreased albumin. Pathological features of the infection were presence of Mott's cells, inflammatory infiltration of either mononuclear cells or lymphocytes and plasma cells in the brain parenchyma, and astrocytosis. These observations indicate that the development of the disease in vervet monkeys is similar to human T. gambiense infection. We conclude that C. aethiops is a promising experimental primate model for the study of T. gambiense trypanosomiasis.

Principles of area-wide integrated tsetse fly control using the sterile insect technique.

The tsetse fly and the disease trypanosomosis it transmits, is one of the most severe medical and veterinary problems in Africa, infecting around 50,000 people every year and preventing the development of sustainable and productive agricultural systems. The most efficient way to contain the disease is by the management of entire populations of the vector (area-wide approach) using a combination of several control methods in an integrated pest management campaign. A very powerful method for integration in these programmes as a final eradication component is the sterile insect technique (SIT). The technique relies on the rearing of the target insect in large numbers in specialised production centres, the sterilisation with ionising radiation of one of the sexes and the sustained sequential release of the sterilised insects over the target area. Contrary to conventional control methods, the sterile insect technique becomes more efficient with decreasing density of the target population. Hence, the technique fits well within the concept of integrated pest management, as its complementary use in a phased approach with other suppression techniques, results in maximum efficiency. The five main prerequisites required to use the sterile insect technique against a target insect have been achieved for tsetse flies: 1. adequate information on the ecology of the insect is available, 2. the mass-production of the target insect is economically feasible, 3. efficient suppression techniques are available to reduce the population density of the target insect, 4. sufficient sterile males are available for release and their competitiveness is optimal, 5. the gamma treated sperm is competitive with the wild sperm. This paper gives a detailed review of the five implementation phases of the sterile insect technique based area-wide integrated pest management campaign against Glossina austeni on the island of Unguja, Zanzibar. The potential future prospects and requirements of using the sterile insect technique against tsetse populations are likewise presented.

[Is vector control needed in the fight against sleeping sickness? A biomathematical approach]. / Faut-il ou non un contrôle des vecteurs dans la lutte contre la maladie du sommeil? Une approche bio-mathématique du problème.

Vector control and the detection (followed by treatment) of infected individual are the two methods currently available for the control of sleeping sickness. The basic reproduction rate of a compartmental model (Kermack and McKendrick) is used to analyze and compare the two strategies. The model shows that when there is a long first stage characteristic of an endemic situation, the detection of sick individuals is more efficient than vector control. This higher efficiency of detection decreases in a epidemic situation. In this case vector control in the form of a decrease in vector density and/or an increase in vector mortality is relatively more efficient than detection. Because it is squared in the basic reproduction rate, the probability of a tsetse blood meal on humans is an important and sensitive parameter in the study of control strategies. This sensitivity has been observed previously and empirically by field workers. When the probability of a tsetse blood meal on humans is above a certain value, vector control becomes warranted or even necessary.

Suppression of T-cell responsiveness during tsetse-transmitted trypanosomiasis in cattle.

In the present study, we demonstrate that lymph node cells from cattle infected with T. congolense through tsetse fly challenge were unable to proliferate in vitro following activation with the T-cell mitogen Concanavalin A. This was associated with a simultaneous suppression of interleukin 2 (IL-2) production and interleukin 2 receptor (IL-2R) expression. However, the capacity of the cells to secrete interferon gamma following the mitogenic activation was not affected by the infection.

Trypanosoma congolense: host responses following tsetse transmitted infection of Kilifi isolates in goats.

East African x Galla goats, when infected with Trypanosoma congolense isolates from the Kilifi area of Kenya by Glossina morsitans centralis, did not develop the characteristic chancre reaction at the bite sites, whereas bites of tsetse infected with the cloned T. congolense IL.1180 from Serengeti, Tanzania, resulted in chancres in the same goats. Histological changes could not be observed in skin biopsies collected 8 or 9 days after infection with Kilifi isolates. However, all goats became parasitemic about 10 days after challenge. It is concluded that the absence of chancre development is a characteristic feature of T. congolense parasites from Kilifi. The isoenzyme analysis of clones of two T. congolense Kilifi isolates and the T. congolense clone IL.1180 indicated that they belong to different zymodemes. Neutralizing antibodies to homologous metacyclic variable antigen types were detected in six out of seven (86%) of the sera from goats infected with a clone or stock of a T. congolense Kilifi isolate, 20 days after infection. Goats primed by tsetse transmitted infection with a stock or clone of T. congolense from Kilifi and treated with Berenil were, in three out of eight cases (37%), not immune to homologous challenge. It is suggested that the reduced immune response to metacyclic variable antigen types could be a result of the absence of cellular infiltration, i.e., chancre development in the skin at the tsetse bite site. It is concluded that the use of the chancre reaction as a marker for serodeme analysis of recently isolated stocks of T. congolense from Kilifi was not feasible.

Maternally derived immunity in young mice to infection with Trypanosoma brucei and its potentiation by Berenil chemotherapy.

Young mice which were allowed to suckle, from birth, a mother infected with Trypanosoma brucei, or a mother whose infection had been cured before parturition with Berenil chemotherapy, were themselves immune to homologous trypanosome challenge. This immunity extended until approximately 25 days of age, and was transmitted in the colostrum/milk of the mother. Mice born of infected mothers, but transferred at birth to normal foster mothers, were susceptible to trypanosome infection. Drug prophylaxis in normal newborn mice was also effective for approximately 25 days, but in mice which, in addition, received colostral antibody from the mother, combined immunochemoprophylaxis protected the offspring for 40-50 days. Since the combination of protective strategies continued to resist challenge beyond the stage when, on its own, each component's efficacy had decayed, it may be of practical value as an approach to improved disease control under certain field conditions where trypanosomiasis prevails.

Electron-microscopic localization of Trypanosoma brucei gambiense transmitted by Glossina morsitans centralis in Microtus montanus.

In Microtus montanus infected with T. b. gambiense, electron microscopic examination of lymph nodes, spleen, liver, heart, choroid plexus and brain demonstrated extravascular populations of trypanosomes distributed throughout interstitial spaces, accompanied by a moderate cellular infiltration of plasma cells. The trypanosomes exhibited numerous profiles; some were dividing, others were in different stages of lysis, or phagocytosed. Penetration of trypanosomes into hepatocytes was observed. The present investigation indicated that trypanosomes migrated to the brain parenchyma from the Virchow-Robin spaces but could not confirm whether the parasites reached the Virchow-Robin spaces by traversing the ependymal cells lining the choroid plexus or by migrating through the endothelial cells of the cerebral blood vessels.