Macro and microfilaricidal activities of extracts of Annona senegalensis and Milletia comosa against Onchocerca ochengi and Loa loa.

Despite the efforts employed for the control of onchocerciasis, the latter has remained a significant public health problem, due mainly to the lack of safe and effective adult worm drugs and/or microfilaricides that do not kill Loa loa microfilariae (mf). Serious adverse events have been encountered after administering ivermectin to some onchocerciasis patients coinfected with Loa loa. There is therefore, an urgent need for a macro and/or microfilaricidal drug which kills Onchocerca but not L. loa microfilariae. A total of 12 crude extracts from Milletia comosa and Annona senegalensis were prepared and screened in vitro against the bovine species of Onchocerca, O. ochengi, and L. loa mf from humans. Mf and male worm viabilities were determined by motility scoring using microscopy at 120 h of incubation with drug, while adult female worm viability and cytotoxicity were determined biochemically by MTT/formazan colorimetry after 120 h of incubation with drug. Out of the 12 extracts, all 6 from M. comosa and 4 from A. senegalensis were active against male, female and mf of O. ochengi. The hexane extract from M. comosa leaves (MCL hex) was the most active with IC50 values of 1.38, 0.86 and 17.74 µg/mL for O. ochengi adult males, adult female and the mf, respectively. About 58% of the extracts were more active against O. ochengi than L. loa mf. These results demonstrate that these extracts contain active principles that kill Onchocerca parasite and to a lesser extent L. loa, and suggest that they can be fractionated for isolation of lead molecules for the safe treatment of onchocerciasis.

In vitro anti-Onchocerca ochengi activities of extracts and chromatographic fractions of Craterispermum laurinum and Morinda lucida.

BACKGROUND: Onchocerciasis caused by Onchocerca volvulus is the world's second leading infectious cause of blindness. There is currently no cure for the disease. Ivermectin, the current drug of choice is only microfilaricidal and suboptimal response to it is increasingly being reported. Thus, in contributing to the search for a cure, crude extracts and chromatographic fractions of Craterispermum laurinum and Morinda lucida were screened in vitro, against the bovine and most popular model of the parasite, Onchocerca ochengi. METHODS: Extracted parasites were cultured in RPMI-1640 based media for 05 days in the presence of control drugs, test drugs or drug diluents only. Microfilarial motility was scored using microscopy while adult worm viability was determined biochemically by MTT/formazan colorimetry. Cytotoxicity and acute toxicity of active fractions were tested on monkey kidney epithelial cells (LLCMK2) and in Balb/c mice, respectively. RESULTS: Out of the 18 extracts screened, the methanolic extracts of the leaves of both plants recorded the highest activities against both the microfilariae (IC100 of 125 µg/ml for both extracts) and adult worms (IC100 of 250 µg/ml and 500 µg/ml for M. lucida and C. laurinum respectively). The most active chromatographic fraction was obtained from M. lucida and had an IC50 of 7.8 µg/ml and 15.63 µg/ml on microfilariae and adult worms respectively, while the most active fraction from C. laurinum had an IC50 of 15.63 µg/ml and 46.8 µg/ml, respectively on microfilariae and adult worms. The 50% cytotoxic concentration (CC50s) on LLCMK2 cells ranged from 15.625 µg/ml to 125 µg/ml for the active fractions. No acute toxicity was recorded for the extracts from both plants. Phytochemical analysis of the most active fractions revealed the presence of sterols, alkaloids, triterpenes, saponins and flavonoids. CONCLUSIONS: This study validates the use of these plants by traditional health practitioners in managing the disease, and also suggests a new source for isolation of potential lead compounds against Onchocerca volvulus.

Ethanolic extract of Azadirachta indica (A. Juss.) causing apoptosis by ROS upregulation in Dirofilaria immitis microfilaria.

Dirofilaria immitis is the causative agent of cardiopulmonary dirofilariasis in the Canine family. The aim of the study was to evaluate the efficacy of the ethanolic extract of Azadirachta indica leaves (EEA) against the microfilaria (mf) of D. immitis in vitro. EEA was evaluated for different compound classes through HPTLC. Relative motility, mortality and morphological alterations were observed in the mf after exposure to EEA. The effect of EEA on redox status in the treated mf was evaluated by some key enzymatic and non-enzymatic parameters. An enhanced reactive oxygen species (ROS) level in the treated mf along with altered redox status was evident. DNA fragmentation and terminal-deoxynucleotidyl-transferase dUTP nick end labeling (TUNEL) confirmed apoptosis. In addition, western blotting revealed down-regulation of anti-apoptotic protein and up-regulation of pro-apoptotic proteins. Taken together, the microfilaricidal activity of EEA can be attributed to its capacity to inflict oxidative stress culminating in apoptosis.

Glycyrrhetinic acid and its analogs: a new class of antifilarial agents.

Although a number of chemicals have been isolated from Glycyrrhiza glabra, only a few have been evaluated for their biological significance. As part of our drug discovery program for antifilarial agents from Indian medicinal plants, the roots of G. glabra were chemically investigated, which resulted in the isolation and characterization of an antifilarial agent, glycyrrhetinic acid (GA, 1a) effective against microfilariae (mf) in vitro (LC100: 12.5 µM; IC50: 1.20 µM), but was inactive against adult worms. Further, GA (1a) was converted into six analogs (2a-7a) and their antifilarial potential was evaluated by studying in vitro motility and MTT reduction assays employing mf and adult worms of Brugia malayi. The results showed that out of six GA analogs, the benzyl amide analog (6a) killed adults and mf at 25 and 50 µM concentration, respectively, and inhibited 49% MTT reduction potential of the adult parasites. The IC50 values were found to be 8.8 and 2.2 µM for adults and mf, respectively. The SI of the compound was >60. On the other hand the octylamide analog (7a) required much higher concentration to adversely affect the parasites. Finally, both active amide analogs (6a and 7a) were in vivo evaluated using B. malayi-jird model, which showed that analog 6a possesses promising macrofilaricidal activity at 100mg/kg, s.c. ×5 days and around 40% of the treated animals showed calcified masses of worm fragments in peritoneal cavity of the animals. To the best of our knowledge this is the first ever report on the antifilarial potential of GA analogs. Further work on optimization of the antifilarial lead is under progress.

Extracts of Euphorbia hirta Linn. (Euphorbiaceae) and Rauvolfia vomitoria Afzel (Apocynaceae) demonstrate activities against Onchocerca volvulus microfilariae in vitro.

BACKGROUND: Onchocerciasis transmitted by Onchocerca volvulus is the second major cause of blindness in the world and it impacts negatively on the socio-economic development of the communities affected. Currently, ivermectin, a microfilaricidal drug is the only drug recommended for treating this disease. There have been speculations, of late, concerning O. volvulus resistance to ivermectin. Owing to this, it has become imperative to search for new drugs. World-wide, ethnomedicines including extracts of Euphorbia hirta and Rauvolfia vomitoria are used for treating various diseases, both infectious and non-infectious. METHOD: In this study extracts of the two plants were evaluated in vitro in order to determine their effect against O. volvulus microfilariae. The toxicity of the E. hirta extracts on monkey kidney cell (LLCMK2) lines was also determined. RESULTS: The investigations showed that extracts of both plants immobilised microfilariae at different levels in vitro and, therefore, possess antifilarial properties. It was found that all the E. hirta extracts with the exception of the hexane extracts were more effective than those of R. vomitoria. Among the extracts of E. hirta the ethyl acetate fraction was most effective, and comparable to that of dimethanesulphonate salt but higher than that of Melarsoprol (Mel B). However, the crude ethanolic extract of E. hirta was found to be the least toxic to the LLCMK2 compared to the fractionated forms. CONCLUSIONS: Extracts from both plants possess antifilarial properties; however, the crude extract of E. hirta was found to be least toxic to LLCMK2.

Towards elimination of lymphatic filariasis: social mobilization issues and challenges in mass drug administration with anti-filarial drugs in Tamil Nadu, South India.

India is a signatory to World Health Assembly resolution for elimination of lymphatic filariasis (LF) and National Health Policy has set the goal of LF elimination by 2015. Annual mass drug administration (MDA) is ongoing in endemic districts since 1996-97. Compliance rate is a crucial factor in achieving elimination and was assessed in three districts of Tamil Nadu for 10th and 11th treatment rounds (TRs). An in-depth study assessed the impact of social mobilization by drug distributors (DDs) in two areas from each of the three districts. Overall coverage and compliance for assessed TRs were 76.3 and 67.7% which is below the optimum level to achieve LF elimination. Modifiable determinants continue to be the reason for non-consumption even in the 11th TR and 20.8% were systematic non-compliers. In 76.4% of the cases, DDs failed to adhere to three mandatory visits as per the guidelines. Number of visits by DDs in relation to low and high MDA coverage areas showed a significant relationship (P ≤ 0.000). MDA is limited to drug distribution alone and efforts by DDs in preparing the community were inadequate. Probable means to meet the challenges in preparation of the community is discussed.

Ivermectin-related adverse clinical events in patients treated for Mansonella ozzardi infections.

We report the occurrence of serious reactions after treatment with oral ivermectin in two patients with Mansonella ozzardi infections. Both had systemic and respiratory symptoms and recovered without sequelae. Follow-up revealed clearance of microfilaremia in both cases, with relapse in one of them. These reactions are well described in the treatment of other filarial infections, but have not yet been reported in the treatment of M. ozzardi. We are now reporting the first such known reactions with this helminthiasis.

In vitro activities of plant extracts on human Loa loa isolates and cytotoxicity for eukaryotic cells.

Loa loa, a filarial worm, can cause fatal encephalitis in humans. In an attempt to find alternatives to the standard treatments (ivermectin and diethylcarbamazine citrate), we tested 12 methanolic extracts of nine traditional plant remedies. The extracts (100-0.09 microg/ml) were incubated with 20 Loa loa microfilariae isolated from patients at 37 degrees C with 5% CO(2) in modified Eagle's medium supplemented with 10% fetal serum and antibiotics. Activity was evaluated 120 h later by counting live microfilariae under a microscope. Cytotoxicity for eukaryotic cells was estimated by measuring 3-[4,5-dimethylthiazol-2-yl]-2-5 diphenyl tetrazolium bromide transformation to formazan at 450 nM in a spectrophotometer. The plants tested were Lophira alata, Greenwayodendron suaveolens, Uapaca togoensis, Zanthoxylum heitzii, Peperomia pellucida, Piptadeniastrum africanum, Petersianthus macrocarpus, Vernonia conferta, and Vernonia hymenolepis. Chemical screening showed that most of the extracts contained reducing sugars, tannin or polyphenols, sterols or triterpenes, saponosides, and alkaloids. None contained carotinoids and few contained flavonoids. The 50% lethal concentration ranged from 0.22 to 70.28 microg/ml, while the 50% inhibitory concentration for eukaryotic cells (IC(50)) ranged from 8.52 to 119.52 microg/ml. Extracts of P. macrocarpus (selectivity index = 72.16), P. africanum (13.69), Z. heitzii (12.11), and L. alata (9.26) were highly selective for L. loa.

In vitro effect of four herbal plants on the motility of Brugia malayi microfilariae.

BACKGROUND & OBJECTIVE: Disease burden due to lymphatic filariasis is disproportionately high despite mass drug administration with conventional drugs. Usage of herbal drugs in traditional medicine is quite well known but largely empirical. Hence the present study was designed to screen the in vitro antifilarial effect of four herbal plants on Brugia malayi. METHODS: Motility of microfilariae of B. malayi after incubation for 48 h with aqueous/methanol extracts of Vitex negundo L. (roots), Butea monosperma L. (roots and leaves), Ricinus communis L. (leaves), and Aegle marmelos Corr. (leaves) was explored in the concentration range of 20 to 100 ng/ml for possible antifilarial effect by comparing with suitable solvent control. RESULTS: Butea monosperma leaves and roots, Vitex negundo root and Aegle marmelo leaves showed significant inhibition of motility of microfilariae as compared to controls whereas inhibitory activity demonstrated by Ricinus communis L. leaves was not significant. Antifilarial effects imparted by all these extracts were found to be a function of their relative concentrations. Inhibitory concentrations (IC(50)) for the plant extracts with significant antifilarial activity against Brugia malayi microfilariae in in vitro system have been derived to be 82, 83 and 70 ng/ml for Vitex negundo L., Butea monosperma L. and Aegle marmelos Corr. respectively. INTERPRETATION & CONCLUSION: The present study recorded significant antifilarial effect of all plant extracts studied except for Ricinus communis L. leaves and contributes to the development of database for novel drug candidates for human lymphatic filariasis.

Anti-microfilarial activity of methanolic extract of Vitex negundo and Aegle marmelos and their phytochemical analysis.

In the present study, methanolic extracts of roots of Vitex negundo L. and extracts of leaves of Vitex negundo L., Ricinus communis L. and Aegle marmelos Corr. were explored for possible antifilarial effect against Brugia malayi microfilariae. It was observed that among the herbal extracts, root extract of Vitex negundo L. and leaves extract of Aegle marmelos Corr. at 100 ng/ml concentration showed complete loss of motility of microfilariae after 48 hr of incubation. Thin layer chromatography of the extracts revealed the presence of alkaloids, saponin and flavonoids in the roots of Vitex negundo L. and coumarin in the leaves of Aegle marmelos Corr.

Potential antifilarial activity of fruit extracts of Ficus racemosa Linn. against Setaria cervi in vitro.

Effect of alcoholic and aqueous extracts of the fruits of F. racemosa Linn., on the spontaneous movements of both the whole worm and nerve muscle preparation of Setaria cervi and on the survival of microfilariae in vitro was studied. Alcoholic as well as aqueous extracts caused inhibition of spontaneous motility of whole worm and nerve muscle preparation of Setaria cervi characterized by increase in amplitude and tone of contractions. Initial stimulatory effect was not observed with aqueous extract on whole worm preparation, while effect of alcoholic extract on whole worm and nerve muscle preparation was characterized by an increase in amplitude and tone of contractions followed by paralysis. The concentrations required to inhibit the movement of the whole worm and nerve muscle preparation for alcoholic extract of fruits of F. racemosa were 250 and 50 microg/ml, respectively, whereas aqueous extract caused inhibition of the whole worm and nerve muscle preparation at 350 and 150 microg/ml, respectively, suggesting a cuticular barrier. Both alcoholic and aqueous extracts caused death of microfilariae in vitro. LC50 and LC90 were 21 and 35 ng/ml, respectively for alcoholic, which were 27 and 42 ng/ml for aqueous extracts.

Effects of Bay 44-4400, a new cyclodepsipeptide, on developing stages of filariae (Acanthocheilonema viteae, Brugia malayi, Litomosoides sigmodontis) in the rodent Mastomys coucha.

Bay 44-4400 was used as a spot on formulation and administered in single doses of 25 and 100 mg/kg to Acanthocheilonema viteae, Brugia malayi, and Litomosoides sigmodontis infected Mastomys coucha on various dates during prepatency, aiming to affect third stage larvae, fourth stage larvae or preadult worms. Microfilaraemia levels were controlled in comparison to untreated controls until necropsies were performed 100 days p.i. (A. viteae, L. sigmodontis) and 150 days p.i. (B. malayi) to determine the numbers of surviving worms and the condition of intrauterine developing stages. A significant proportion (86-100%) of larval and preadult stages of A. viteae were killed by Bay 44-4400 at a dose of 100 mg/kg. A dose of 25 mg/kg had only insignificant effects on the developing parasites, however, it strongly reduced microfilaraemia levels caused by surviving worms in the early phase of patency. Larval and preadult B. malayi and L. sigmodontis were not killed by Bay 44-4400 to a significant degree. Microfilaraemia developing by surviving parasites was generally and significantly reduced throughout the observation period when treatment was performed to affect the preadult parasites. In the other cases variable results were obtained. Intrauterine early embryonic stages were found to be pathologically altered in worms which had been treated at a preadult stage.

In vitro antifilarial activity of extracts of the medicinal plant Cardiospermum halicacabum against Brugia pahangi.

The in vitro effects of ethanol and aqueous extracts of the medicinal plant Cardiospermum halicacabum on adult worms and microfilariae of Brugia pahangi were investigated. With or without the plant extracts in culture medium, the motility of adult worms, microfilariae and microfilarial release from female worms were monitored daily. After 7 days of culture, viability or tissue damage of adult worms was assessed using the MTT assay. At > 500 microg ml-1, the aqueous extract significantly reduced motility of adult females after 24 h of exposure and adult males after 3 days. The aqueous extract, at > 500 microg ml-1, also significantly reduced microfilarial release from female worms, starting on day 2. The reduction in the motility of adult worms and the pattern of microfilarial release from female worms were concentration and time dependent. The MTT assay results revealed that adult worms cultured in the presence of aqueous extracts at > 500 microg ml-1 were damaged. However, the aqueous extract did not affect the motility of microfilariae with the exception of those in higher concentration extracts. Higher concentrations of ethanol extracts (2 mg ml-1) inhibited both the motility of adult worms and the release of microfilariae from females. Little effect of ethanol extracts was detected by the MTT assay, as only slight damage was caused to worms exposed only to the highest concentration (2 mg ml-1). However, ethanol extract at 500 microg ml-1 rapidly reduced the motility of microfilariae on day 2. The present study revealed that an aqueous extract of C. halicacabum has mild but definite direct macrofilaricidal action on B. pahangi.

Tolerance and efficacy of single high-dose ivermectin for the treatment of loiasis.

A study was carried out in southeastern Gabon to evaluate the tolerance and efficacy of single high doses of ivermectin in 31 Loa loa-infected subjects with low-to-moderate parasitemia (7-7,700 microfilaria/ml). The first group of 16 subjects received 300 micrograms/kg of ivermectin and, seven days later, a second group of 15 received 400 micrograms/kg. Complete clinical and biological monitoring was carried out during the first 10 days post-treatment and again after one and three months. All subjects continued with their usual activities during the study. The clinical tolerance of treatment was very good, and except in one case, only mild adverse reactions were observed, with pruritus being the most common symptom. There were no significant changes in blood or urine function test results or in hematologic results, except for a pronounced eosinophil reaction. The 400 micrograms/kg dose of ivermectin equaled or surpassed in tolerance that of 300 micrograms/kg dose. After treatment, L. loa microfilaremia decreased rapidly to less than 9% of the pretreatment value by day 10. This decrease was enhanced with the 400 micrograms/kg dose, although differences between the two groups diminished slightly with time. At 100 days post-treatment, the microfilaremia was still at less than 10% of the initial values in the two groups, which may indicate an effect of ivermectin on the adult worms.

Chemical composition of Litomosoides carinii microfilarial sheaths.

Litomosoides carinii microfilariae were exsheathed by freezing and thawing, and the sheaths were separated by filtration. Samples of pure sheaths thus obtained were hydrolyzed, methanolyzed or oxidized with nitric acid under pressure at 300 degrees C, respectively, and were analyzed for amino acids, sugars, fatty acids or for metal ions and phosphorus. Almost 75% of the sheath dry weight could thus be accounted for. Amino acids (55 weight %) were the major constituents, and amongst these glutamine and proline (approximately 11% each). The detection of 2% cysteine/cystine indicated the possible presence of disulfide crosslinks. Besides amino acids, approximately 8% of sugars--roughly equimolar amounts of (N-acetyl)galactosamine and uronic acids--1.5% of monovalent cations (Na+ and K+) and 9.5% of phosphate were detected. No appreciable amounts of fatty acids, neutral sugars, neuraminic acid, or (N-acetyl)glucosamine (i.e. no chitin) were found.

In vitro and in vivo evaluation of macrofilaricidal activity of GABA and 1,3-dipalmitoyl-2-(4-aminobutyryl)glycerol HCl: a diglyceride prodrug.

A new therapeutic target has been identified from the filaria Molinema dessetae: the gabaergic system. gamma-aminobutyric acid (GABA) itself showed antifilarial effect in vitro and a macrofilaricidal action in vivo at high dose by intraperitoneal route (10(-2) M). Nevertheless, no action was observed by oral route. The study we report here consists to obtain an antifilarial effect by oral route using a diglyceride prodrug. Such a strategy is based on the triglycerides metabolism. A diglyceride prodrug of gamma-aminobutyric acid has been synthesized and its filaricidal activity compared with that of GABA, in vitro on adults of Molinema dessetae and in vivo on Molinema dessetae infected Proechimys oris. In vitro, GABA at 2.5 x 10(-3) M induced a temporary paralysis and the ester drug at the same concentration was fully active on adults. In vivo, no significant activity was observed by oral administration of a daily dose of GABA (10(-2) M). A five day course of GABA at 10(-2) M via the intraperitoneal route induced a significant reduction of male and female worms. We did not find any activity of the prodrug in vivo, either by the oral route (10(-2) M) or after an intraperitoneal administration (10(-3) M). The interest of GABA and GABA derivatives as potential filaricidal drugs was discussed.

Effect of ivermectin on the vertical distribution of Onchocerca volvulus microfilariae in the skin.

A new technique for assessing vital and degenerative microfilariae (mf) in different skin layers of onchocerciasis patients is described. Vertical sections at least 5 mm deep were collected from the surgical nodulectomy wounds before and 2, 4 and 28 days after treatment with ivermectin and fixed in ethanol. Skin biopsies were punched horizontally with trephines and digested enzymatically with collagenase. In untreated biopsies 80% of the mf were located in the uppermost layer of 1 mm and only 1.2% were degenerated. After treatment with ivermectin the total number of mf was significantly reduced, and the distribution of living and remnant mf in the different skin layers had changed. The proportion of degenerated mf had increased markedly, but did not exceed 6% of the total pre-treatment mf level, i.e., the vast majority of the mf had actually disappeared from the skin. It is suggested that ivermectin reduces microfilarial motility slightly, and that mf are then attacked by adhering immunocompetent cells of the host and cleared by the lymphatic drainage.

Novel Onchocerca volvulus filaricides from Carapa procera, Polyalthia suaveolens and Pachypodanthium staudtii.

Suitable drugs for the elimination of adult Onchocerca volvulus are still needed since ivermectin, the new microfilaricide, appears to be ineffective against this parasite stage. Herein we report on the identification of filaricides in three medicinal plants. The compounds carapolide A, mexicanolide-methylangolensate mixture from Carapa procera and oliverine from Polyalthia suaveolens or Pachypodanthium staudtii when tested at 10-100 micrograms.ml-1 were found to exhibit considerable microfilaricidal activity after 24 hours of incubation. Oliverine was found to be filaricidal when tested against adult female worms at 100 micrograms.ml-1. Preliminary toxicity studies in mice showed carapolide A and the mexicanolide-methylangolensate mixture to be relatively non-toxic, whereas, oliverine had a minimal lethal dose of 8 mg.Kg-1 of body weight. Based on the above results further pharmacologic studies are recommended to determine, the potential application of the active compounds on the treatment of onchocerciasis.

Towards a filariasis-free community: evaluation of filariasis control over an eleven year period in Flores, Indonesia.

A population of 202 residents in an area endemic for Brugia timori lymphatic filariasis was treated in a diethylcarbamazine control programme commencing in 1977. All individuals were treated twice with diethylcarbamazine on a mass basis with additional selected treatment for cases with manifestations of infection. Clinical features of lymphatic filariasis were recorded annually until 1982, and the population re-assessed in 1988, six years after the completion of chemotherapy. Microfilarial counts were made on each occasion, and circulating filarial antigen levels measured for 1982 and 1988. The results showed a dramatic and sustained reduction in the rate of elephantiasis and adenolymphangitic disease, and of circulating antigenaemia, and the prevalence of microfilaraemia was reduced to zero by the end of the study.

The skin-dwelling microfilariae of Monanema martini in Lemniscomys striatus as potential drug screening model for onchocerciasis: midazolam effect in vitro.

The murid model of Monanema martini in Lemniscomys striatus was used to evaluate its potential as drug screening model in onchocerciasis. It had been described that the histopathology and the reaction to diethylcarbamazine treatment of this model closely resemble human onchocerciasis. To study further similarities the in vitro effect of midazolam was examined. Skin-dwelling microfilariae (mf) of M. martini were taken by skin snips and placed in either plain phosphat buffered saline or midazolam. Concentrations of 50 micrograms/ml midazolam significantly reduced motility within 15 min. The percentage of fully motile mf dropped to 9.2 and 1.4 after 15 and 30 min, respectively. In contrast to this finding fully motile mf were obtained after intraperitoneal injection of 60 mg/kg BW; but the technique used did not allow to evaluate the in vivo effect of midazolam. The similarities with the human disease and the finding that midazolam paralyses mf of M. martini like mf of O. volvulus in vitro indicate the potential of the model for simulating human onchocerciasis.