A high-throughput phenotypic screen identifies clofazimine as a potential treatment for cryptosporidiosis.

Cryptosporidiosis has emerged as a leading cause of non-viral diarrhea in children under five years of age in the developing world, yet the current standard of care to treat Cryptosporidium infections, nitazoxanide, demonstrates limited and immune-dependent efficacy. Given the lack of treatments with universal efficacy, drug discovery efforts against cryptosporidiosis are necessary to find therapeutics more efficacious than the standard of care. To date, cryptosporidiosis drug discovery efforts have been limited to a few targeted mechanisms in the parasite and whole cell phenotypic screens against small, focused collections of compounds. Using a previous screen as a basis, we initiated the largest known drug discovery effort to identify novel anticryptosporidial agents. A high-content imaging assay for inhibitors of Cryptosporidium parvum proliferation within a human intestinal epithelial cell line was miniaturized and automated to enable high-throughput phenotypic screening against a large, diverse library of small molecules. A screen of 78,942 compounds identified 12 anticryptosporidial hits with sub-micromolar activity, including clofazimine, an FDA-approved drug for the treatment of leprosy, which demonstrated potent and selective in vitro activity (EC50 = 15 nM) against C. parvum. Clofazimine also displayed activity against C. hominis-the other most clinically-relevant species of Cryptosporidium. Importantly, clofazimine is known to accumulate within epithelial cells of the small intestine, the primary site of Cryptosporidium infection. In a mouse model of acute cryptosporidiosis, a once daily dosage regimen for three consecutive days or a single high dose resulted in reduction of oocyst shedding below the limit detectable by flow cytometry. Recently, a target product profile (TPP) for an anticryptosporidial compound was proposed by Huston et al. and highlights the need for a short dosing regimen (< 7 days) and formulations for children < 2 years. Clofazimine has a long history of use and has demonstrated a good safety profile for a disease that requires chronic dosing for a period of time ranging 3-36 months. These results, taken with clofazimine's status as an FDA-approved drug with over four decades of use for the treatment of leprosy, support the continued investigation of clofazimine both as a new chemical tool for understanding cryptosporidium biology and a potential new treatment of cryptosporidiosis.

Clinical and histopathological features of paucibacillary leprosy before and after multidrug therapy: a prospective study.

BACKGROUND: Leprosy often heals with residual skin lesions after completion of treatment. WHO recommends fixed duration multidrug therapy (MDT) irrespective of whether lesions clear or persist after treatment. Patients with residual lesions are often unsatisfied and may undergo repeat biopsy and re-treatment. This study was conducted to compare the clinicohistopathological features in paucibacillary leprosy before and after MDT from September 2012 to February 2014. METHODS: Sixty-one untreated cases of paucibacillary leprosy were investigated and given standard WHO paucibacillary-MDT for 6 months. Scoring of clinical activity was done; histopathological activity was graded according to granuloma fraction. Forty-four patients who completed the treatment were subjected to post-treatment biopsy. Clinical response to therapy was graded as active, resolving and inactive and histopathological changes were compared in all patients. RESULTS: Among the 44 patients, the lesions were inactive, resolving and active in 39% (17/44), 39% (17/44) and 23% (10/44) of patients respectively. Histologically, disease was inactive, resolving and active in 30% (13/44), 9% (4/44) and 61% (27/44). But histomorphological features suggesting regression: loose granulomas (59%, 26/44); lymphocyte predominance (66%, 29/44); vacuolar change in epithelioid cell cytoplasm (59%, 26/44), were statistically significant in post-treatment compared to pre-treatment. CONCLUSIONS: Although histological resolution is slower than clinical resolution, qualitative histomorphological changes in correlation with clinical inactivity can offer a fair suggestion to the clinician to terminate therapy.

STING-Dependent 2'-5' Oligoadenylate Synthetase-Like Production Is Required for Intracellular Mycobacterium leprae Survival.

Cytosolic detection of nucleic acids elicits a type I interferon (IFN) response and plays a critical role in host defense against intracellular pathogens. Herein, a global gene expression profile of Mycobacterium leprae-infected primary human Schwann cells identified the genes differentially expressed in the type I IFN pathway. Among them, the gene encoding 2'-5' oligoadenylate synthetase-like (OASL) underwent the greatest upregulation and was also shown to be upregulated in M. leprae-infected human macrophage cell lineages, primary monocytes, and skin lesion specimens from patients with a disseminated form of leprosy. OASL knock down was associated with decreased viability of M. leprae that was concomitant with upregulation of either antimicrobial peptide expression or autophagy levels. Downregulation of MCP-1/CCL2 release was also observed during OASL knock down. M. leprae-mediated OASL expression was dependent on cytosolic DNA sensing mediated by stimulator of IFN genes signaling. The addition of M. leprae DNA enhanced nonpathogenic Mycobacterium bovis bacillus Calmette-Guerin intracellular survival, downregulated antimicrobial peptide expression, and increased MCP-1/CCL2 secretion. Thus, our data uncover a promycobacterial role for OASL during M. leprae infection that directs the host immune response toward a niche that permits survival of the pathogen.

STING-Dependent 2'-5' oligoadenylate synthetase-like production is required for intracellular Mycobacterium leprae survival

Cytosolic detection of nucleic acids elicits a type I interferon (IFN) response and plays a critical role in host defense against intracellular pathogens. Herein, a global gene expression profile of Mycobacterium leprae-infected primary human Schwann cells identified the genes differentially expressed in the type I IFN pathway. Among them, the gene encoding 2'-5' oligoadenylate synthetase-like (OASL) underwent the greatest upregulation and was also shown to be upregulated in M. leprae-infected human macrophage cell lineages, primary monocytes, and skin lesion specimens from patients with a disseminated form of leprosy. OASL knock down was associated with decreased viability of M. leprae that was concomitant with upregulation of either antimicrobial peptide expression or autophagy levels. Downregulation of MCP-1/CCL2 release was also observed during OASL knock down. M. leprae-mediated OASL expression was dependent on cytosolic DNA sensing mediated by stimulator of IFN genes signaling. The addition of M. leprae DNA enhanced nonpathogenic Mycobacterium bovis bacillus Calmette-Guerin intracellular survival, downregulated antimicrobial peptide expression, and increased MCP-1/CCL2 secretion. Thus, our data uncover a promycobacterial role for OASL during M. leprae infection that directs the host immune response toward a niche that permits survival of the pathogen.

Leucine-rich repeat kinase 2 deficiency is protective in rhabdomyolysis-induced kidney injury.

Mutations in the leucine-rich repeat kinase 2 (LRRK2) gene are the most common known genetic cause of Parkinson's disease, and LRRK2 is also linked to Crohn's and Hansen's disease. LRRK2 is expressed in many organs in mammals but is particularly abundant in the kidney. We find that LRRK2 protein is predominantly localized to collecting duct cells in the rat kidney, with much lower expression in other kidney cells. While genetic knockout (KO) of LRRK2 expression is well-tolerated in mice and rats, a unique age-dependent pathology develops in the kidney. The cortex and medulla of LRRK2 KO rat kidneys become darkly pigmented in early adulthood, yet aged animals display no overt signs of kidney failure. Accompanying the dark pigment we find substantial macrophage infiltration in LRRK2 KO kidneys, suggesting the presence of chronic inflammation that may predispose to kidney disease. Unexpectedly, the dark kidneys of the LRRK2 KO rats are highly resistant to rhabdomyolysis-induced acute kidney injury compared with wild-type rats. Biochemical profiling of the LRRK2 KO kidneys using immunohistochemistry, proteomic and lipidomic analyses show a massive accumulation of hemoglobin and lipofuscin in renal tubules that account for the pigmentation. The proximal tubules demonstrate a corresponding up-regulation of the cytoprotective protein heme oxygenase-1 (HO-1) which is capable of mitigating acute kidney injury. The unusual kidney pathology of LRRK2 KO rats highlights several novel physiological roles for LRRK2 and provides indirect evidence for HO-1 expression as a protective mechanism in acute kidney injury in LRRK2 deficiency.

Envolvimento do receptor TLR-9 na resposta imune do hospedeiro durante o curso da infecção pelo Mycobacterium leprae / Involvement of the TLR9 receptor in host immune responses during infection by Mycobacterium leprae

Mycobacterium leprae, agente etiológico da hanseníase, expressa em abundância uma proteína catiônica semelhante às histonas, denominada Hlp, presente tanto no envelope como no nucleóide bacteriano. O reconhecimento do DNA bacteriano, rico em motivos CpG não metilados, pelo receptor TLR-9 representa uma importante via para a ativação da resposta imune inata, a qual pode levar à eliminação do agente infeccioso ou mediar manifestações patológicas. Foi mostrado ainda que complexos DNA-histona são mais potentes agonistas de TLR-9 que DNA sozinho. Assim, o presente trabalho teve como objetivo investigar o envolvimento do receptor TLR-9 na ativação da resposta imune do hospedeiro durante o curso da infecção pelo M. leprae.Inicialmente foi analisada a participação do TLR-9 na ativação da resposta imune inata em células epiteliais alveolares da linhagem A549 após estímulo com M. leprae. M. leprae foi capaz de induzir aumento das quimiocinas IL-8 eMCP-1 e a transcrição gênica do peptídeo antimicrobiano HbetaD-2 nas células epiteliais. O aumento da expressão de CD80 na superfície celular também foi observada após estímulo com o bacilo. O complexo CpG-Hlp micobacteriano solúvel também induziu aumento na produção de IL-8 nas células A549. Foi observado que o aumento de IL-8 induzido pelo M. leprae ocorre de forma dependente da translocação nuclear do NF-capaB e que o antagonista sintético deTLR-9 afetou a secreção de IL-8 induzida pelo M. leprae. A adição de CpG aoM. smegmatis selvagem, mas não mutante para o gene hlp, aumentou a produção de IL-8 pelas células epiteliais. Em conjunto, esses dados sugerem que as células epiteliais respiratórias podem reconhecer M. leprae via TLR-9 e,assim, participar da resposta imune inata no sítio inicial da infecção. Uma vez que o aparecimento do eritema nodoso hansênico (ENH) está associado a liberação massiva de antígenos micobacterianos, foi investigado o envolvimento do TLR-9 na patogênese do ENH...

Mycobacterium leprae, etiological agent of leprosy, expresses in abundance acationic protein similar to histones, called histone-like protein (Hlp), present inthe envelope as well as in bacterial nucleoid.The recognition of bacterial DNArich in unmethylated CpG motifs by TLR-9 is an important pathway for activationof the innate immune response, which can lead to the elimination of theinfectious agent or mediate pathological manifestations. Moreover, studiesshowed that DNA-histone complexes are more potent agonists of TLR-9 thanDNA alone. This study aimed to investigate the involvement of TLR-9 in theactivation of the host immune response during the course of M. leprae infection.Initially, we analyzed the participation of TLR-9 activation on the innate immuneresponse in A549 alveolar epithelial cells after stimulation with M. leprae. It wasshown that M. leprae was able to induce the chemokines IL-8 and MCP-1, andgene transcription of antimicrobial peptide HbetaD-2 in epithelial cells. Theincrease of CD80 expression on the cell surface was also observed afterstimulation with bacillus. Soluble mycobacterial CpG-Hlp complex also inducedan increase in IL-8 in A549 cells. It was observed that the increase of IL-8,induced by M. leprae, occurs dependently nuclear translocation of NF-capaB andsynthetic TLR-9 antagonist affected IL-8 secretion induced by M. leprae. Theaddition of CpG to wild type M. smegmatis, but not to the mutant gene hlp,increased IL-8 production by epithelial cells. As a whole, these results suggestthat respiratory epithelial cells can recognize M. leprae via TLR-9 and thusparticipate in the innate immune response in the initial infection site. Since theappearance of erythema nodosum leprosum (ENL) is associated with themassive release of mycobacterial antigens, it was investigated the involvementof TLR-9 in the pathogenesis of ENL...

Interaction of Mycobacterium leprae with human airway epithelial cells: adherence, entry, survival, and identification of potential adhesins by surface proteome analysis.

This study examined the in vitro interaction between Mycobacterium leprae, the causative agent of leprosy, and human alveolar and nasal epithelial cells, demonstrating that M. leprae can enter both cell types and that both are capable of sustaining bacterial survival. Moreover, delivery of M. leprae to the nasal septum of mice resulted in macrophage and epithelial cell infection in the lung tissue, sustaining the idea that the airways constitute an important M. leprae entry route into the human body. Since critical aspects in understanding the mechanisms of infection are the identification and characterization of the adhesins involved in pathogen-host cell interaction, the nude mouse-derived M. leprae cell surface-exposed proteome was studied to uncover potentially relevant adhesin candidates. A total of 279 cell surface-exposed proteins were identified based on selective biotinylation, streptavidin-affinity purification, and shotgun mass spectrometry; 11 of those proteins have been previously described as potential adhesins. In vitro assays with the recombinant forms of the histone-like protein (Hlp) and the heparin-binding hemagglutinin (HBHA), considered to be major mycobacterial adhesins, confirmed their capacity to promote bacterial attachment to epithelial cells. Taking our data together, they suggest that the airway epithelium may act as a reservoir and/or portal of entry for M. leprae in humans. Moreover, our report sheds light on the potentially critical adhesins involved in M. leprae-epithelial cell interaction that may be useful in designing more effective tools for leprosy control.

Heparin-binding hemagglutinin (HBHA) of Mycobacterium leprae is expressed during infection and enhances bacterial adherence to epithelial cells.

A heparin-binding hemagglutinin (HBHA) expressed on the surface of Mycobacterium tuberculosis is an antigenic protein that has been implicated in bacterial adherence to epithelial cells and systemic dissemination. In this study, the potential role of the Mycobacterium leprae HBHA (ML-HBHA) homologue in leprosy was investigated. Initially, the in vivo expression of HBHA and its association with the M. leprae cell envelope was confirmed by immunoblotting and proteomic analysis. Mycobacterium leprae recombinant HBHA (rML-HBHA) bound to a heparin-Sepharose column, and its capacity to act as an adhesin was demonstrated in experiments showing that the exogenous addition of the protein to latex beads or to M. leprae cells promotes a dramatic increase in association with epithelial cells. Finally, serum anti-HBHA immunoglobulin G levels were investigated in individuals infected with M. leprae. Altogether, our data indicate that HBHA is recognized during the course of bacterial infection in humans and may play a role in leprosy pathogenesis.

Genome and transcriptome scale portrait of sigma factors in Mycobacterium avium subsp. paratuberculosis.

Mycobacterium avium subsp. paratuberculosis (MAP) is the etiological agent of Johne's disease (JD), a chronic gastroenteritis of ruminants and other animals, including primates. Many evidences suggested association of MAP to Crohn's disease, a chronic granulomatous gastrointestinal disease of humans with strong similarities with JD. The present study attempts to evaluate global gene regulation in MAP, which has not been addressed previously, despite the availability of MAP genome sequence. For this purpose, we investigated: (i) the presence of sigma factors and their relationship to sigma factors of other mycobacteria (M. avium subsp.avium, M. tuberculosis, M. bovis, M. leprae and M. smegmatis), and (ii) their expression during different growth conditions and in vitro infection of intestinal epithelial Caco2 cells. MAP genome contains 19 putative sigma factor, but only 12 belong to gene families common to other mycobacteria. Gene expression was evaluated with Real-Time PCR during growth in 7H9 medium and mycobactin J, in 7H9 medium plus mycobactin J and lisozyme, and during infection of Caco2 cells: very different expression patterns were observed and, on the whole, only 7 sigma factors were found to be expressed. sigJ was upregulated during the infection of Caco2 cells. Even if only few sigma factors were expressed in the three conditions tested, the overall high numbers of MAP sigma factors suggests a noteworthy flexibility of this pathogen. Thus, this first report on expression of MAP sigma factors opens the way to an extensive characterization of global gene regulation, as a key to understand strategies of survival and mechanisms of infections used by this organism.

Recombinant Mycobacterium leprae protein associated with entry into mammalian cells of respiratory and skin components.

BACKGROUND: The transmission of Mycobacterium leprae, the causative pathogen of leprosy, has been postulated to occur mainly through upper respiratory route rather than skin-to-skin contact via minor injuries. The M. leprae genome contains mce1A gene, which encodes a putative mammalian cell entry protein. However, to date, there have been no functional analyses of the M. leprae mce1A gene product. OBJECTIVE: The aim of this study was to elucidate a possible relationship between this transmission mechanism and the mce1A gene product. METHODS: We analyzed the cell uptake activity in vitro of polystyrene latex beads coated with a purified recombinant (r-) protein expressed by a 849-bp locus within the mce1A gene. RESULTS: The r-protein promoted uptake of the beads into human nasal epithelial cells derived from nasal polyps, human bronchial epithelial cell line, normal human dermal fibroblasts, normal human microvascular endothelial cells and normal human keratinocytes cultured at 0.01 mM extracellular calcium concentration [Ca]; no uptake occurred with keratinocytes cultured at 1.2mM [Ca]. CONCLUSION: These results suggest that the mce1A gene product can mediate M. leprae entry into respiratory epithelial cells as their natural target cells, which may be the main mode of transmission. Endothelial cells, on the other hand, may serve as the reservoir of the bacilli for long-term infection. The M. leprae Mce1A protein has potential important implications for mode of transmission and pathogenesis of leprosy.

Interaction of Mycobacterium avium complex with human respiratory epithelial cells.

Adherence of Mycobacterium avium complex (MAC) to human respiratory epithelial cells (HEp-2) induced 2 distinct modes of internalization. In the first, MAC induced ruffling of HEp-2 cell membrane and formation of surface projections securing the bacilli on the surface, and concurrent membrane depressions, beneath the sites of attachment of bacilli, resulted in internalization of the organisms. The second mode involved formation of membrane folds wrapping around the bacilli, followed by internalization. Two MAC proteins of approximately 31 kD and approximately 25 kD, respectively, were identified that mediated these interactions specific for HEp-2 cells. The N-terminal amino acid sequence of the 31-kD MAC protein displayed homology with the 21-kD hypothetical protein of Mycobacterium tuberculosis, and the 25-kD MAC protein showed homology with Mn-superoxide dismutase of MAC and Mycobacterium leprae. These 2 HEp-2 cell-specific MAC proteins may be involved in the interaction of MAC with epithelial cells.

The UspA1 protein and a second type of UspA2 protein mediate adherence of Moraxella catarrhalis to human epithelial cells in vitro.

The UspA1 and UspA2 proteins of Moraxella catarrhalis are structurally related, are exposed on the bacterial cell surface, and migrate as very high-molecular-weight complexes in sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Previous analysis of uspA1 and uspA2 mutants of M. catarrhalis strain 035E indicated that UspA1 was involved in adherence of this organism to Chang conjunctival epithelial cells in vitro and that expression of UspA2 was essential for resistance of this strain to killing by normal human serum (C. Aebi, E. R. Lafontaine, L. D. Cope, J. L. Latimer, S. R. Lumbley, G. H. McCracken, Jr., and E. J. Hansen, Infect. Immun. 66:3113-3119, 1998). In the present study, isogenic uspA1, uspA2, and uspA1 uspA2 mutations were constructed in three additional M. catarrhalis strains: 012E, TTA37, and 046E. The uspA1 mutant of strain 012E had a decreased ability to attach to Chang cells. However, inactivation of the uspA1 gene in both strain TTA37 and strain 046E did not cause a significant decrease in attachment ability. Inactivation of the uspA2 gene of strain TTA37 did result in a loss of attachment ability. Nucleotide sequence analysis revealed that the predicted protein encoded by the uspA2 genes of both strains TTA37 and 046E had a N-terminal half that resembled the N-terminal half of UspA1 proteins, whereas the C-terminal half of this protein was nearly identical to those of previously characterized UspA2 proteins. The gene encoding this "hybrid" protein was designated uspA2H. PCR-based analysis revealed that approximately 20% of M. catarrhalis strains apparently possess a uspA2H gene instead of a uspA2 gene. The M. catarrhalis uspA1, uspA2, and uspA2H genes were cloned and expressed in Haemophilus influenzae cells, which were used to prove that both the UspA1 and UspA2H proteins can function as adhesins in vitro.

Roles of soluble fibronectin and beta 1 integrin receptors in the binding of Mycobacterium leprae to nasal epithelial cells.

The mechanisms by which Mycobacterium leprae invades the human host are presently unknown. We investigated the ability of M. leprae to bind to human RPMI 2650 cells, a human nasal septal epithelial cell line, using both microscopic observation and an ELISA technique. The results demonstrated that M. leprae adheres to nasal cells after binding to soluble fibronectin. Furthermore, it was observed that M. leprae could bind to the beta 1 chain of the integrins in the absence of serum or mucus. These results demonstrated that M. leprae uses fibronectin and fibronectin receptors on the surface of epithelial cells to bind and possibly invade the nasal epithelial cells.

Phagocytosis of Mycobacterium leprae and M. avium by armadillo lung fibroblasts and kidney epithelial cells.

In vitro cell cultures of lung fibroblasts and kidney epithelial cells were established from a freshly killed armadillo and were inoculated with Mycobacterium leprae. Lung fibroblasts were also inoculated with M. avium. Phagocytosis was allowed for 6 h at an input of about 50 bacilli/cell, and the ultrastructure was then studied at 24 and 48 hours, and 4, 7 and 10 days. Following observations were made: 1. Armadillo cells could be maintained for nearly 3 months. 2. Both lung fibroblasts and kidney epithelial cells phagocytized M. leprae at a high rate. 3. Lung fibroblasts also phagocytized M. avium but with a rate much slower than M. leprae. 4. Both in M. leprae and M. avium, an electron-translucent halo surrounded the ingested bacteria within hours of phagocytosis, and this halo appeared to lessen the diffusion of lysosomal enzymes towards the bacterium. 5. M. leprae was often phagocytized in clumps of 3 to 5 bacilli, which separated inside the cell resulting into small individual phagosomes with a single bacterium. 6. In our experimental conditions, there was no evidence of multiplication for both M. leprae and M. avium. 7. The phagocytized bacilli slowly degraded with longer incubation periods, however, the undigested cell bodies remained inside the phagosomes.

Tuberculoid leprosy and tuberculosis skin: a comparative histopathological study.

Since it has been found hard to differentiate histopathologically tuberculoid leprosy from tuberculosis of the skin, a study of 20 biopsies from each of those conditions was undertaken to identify if possible some of their characteristic features. In tuberculoid leprosy along with tuberculoid granulomata there is always selective involvement and destruction of nerves, lack of fibrosis, absence of caseous necrosis and often epidermal atrophy. In cutaneous tuberculosis, on the other hand, in addition to tuberculous granuloma, there is often a proliferation reaction of the epidermis, areas of ulceration, absence of nerve destruction, marked increase in the reticulin, significant fibrosis and occasionally caseous necrosis.

Immunoglobulin deposits in lepromatous leprosy skin. Presence of deposits in apparently uninvolved skin and occurrence of serum antiepithelial antibodies.

Immunoglobulin deposits were detected in ten of 13 biopsy specimens from apparently uninvolved skin of patients with lepromatous leprosy. There were deposits of IgM at the dermoepidermal junction in the skin of five patients, and deposits of IgM along the dermal collagen and elastic fibers in the skin of the other five. The deposits were eluted with acid buffers and high molarity salt solution. Circulating IgG antibodies to intercellular substance of epithelial cells, similar to those present in pemphigus vulgaris, were found in 25% of patients with lepromatous leprosy who were studied. These antibodies appeared to be different from the skin-bound immunoglobulin deposits.