Plant-derived compounds for the treatment of schistosomiasis: Improving efficacy via nano-drug delivery.

Schistosomiasis is a neglected infectious tropical disease that is second in occurrence only to hookworm infection in sub-Saharan Africa. Presently, chemotherapy is the main method of control and treatment of this disease due to the absence of a vaccine. However, Praziquantel, which is the only chemotherapeutic option, lacks efficacy against the early developmental stages of schistosomes. A number of plant-derived compounds, including alkaloids, terpenes and phenolics, have displayed in vitro and in vivo efficacy against Schistosoma species. This review explores how the application of nanotechnology can improve the efficacy of these plant-derived schistosomicidal compounds through the use of nano-enabled drug delivery systems to improve bioavailability.

Lactate dehydrogenase and malate dehydrogenase: Potential antiparasitic targets for drug development studies.

Parasitic diseases remain a major public health concern for humans, claiming millions of lives annually. Although different treatments are required for these diseases, drug usage is limited due to the development of resistance and toxicity, which necessitate alternative therapies. It has been shown in the literature that parasitic lactate dehydrogenases (LDH) and malate dehydrogenases (MDH) have unique pharmacological selective and specificity properties compared to other isoforms, thus highlighting them as viable therapeutic targets involved in aerobic and anaerobic glycolytic pathways. LDH and MDH are important therapeutic targets for invasive parasites because they play a critical role in the progression and development of parasitic diseases. Any strategy to impede these enzymes would be fatal to the parasites, paving the way to develop and discover novel antiparasitic agents. This review aims to highlight the importance of parasitic LDH and MDH as therapeutic drug targets in selected obligate apicoplast parasites. To the best of our knowledge, this review presents the first comprehensive review of LDH and MDH as potential antiparasitic targets for drug development studies.

A multi-dimensional, time-lapse, high content screening platform applied to schistosomiasis drug discovery.

Approximately 10% of the world's population is at risk of schistosomiasis, a disease of poverty caused by the Schistosoma parasite. To facilitate drug discovery for this complex flatworm, we developed an automated high-content screen to quantify the multidimensional responses of Schistosoma mansoni post-infective larvae (somules) to chemical insult. We describe an integrated platform to process worms at scale, collect time-lapsed, bright-field images, segment highly variable and touching worms, and then store, visualize, and query dynamic phenotypes. To demonstrate the methodology, we treated somules with seven drugs that generated diverse responses and evaluated 45 static and kinetic response descriptors relative to concentration and time. For compound screening, we used the Mahalanobis distance to compare multidimensional phenotypic effects induced by 1323 approved drugs. Overall, we characterize both known anti-schistosomals and identify new bioactives. Apart from facilitating drug discovery, the multidimensional quantification provided by this platform will allow mapping of chemistry to phenotype.

Molluscicidal effectiveness of Luo-Wei, a novel plant-derived molluscicide, against Oncomelania hupensis, Biomphalaria alexandrina and Bulinus truncatus.

BACKGROUND: Control of snail intermediate hosts has been proved to be a fast and efficient approach for interrupting the transmission of schistosomiasis. Some plant extracts have shown obvious molluscicidal activity, and a new compound Luo-Wei, also named tea-seed distilled saponin (TDS), was developed based on the saponins extracted from Camellia oleifera seeds. We aimed to test the molluscicidal activity of 4% TDS against the intermediate host snails in China and Egypt, and evaluate its environmental safety to non-target organisms. METHODS: In the laboratory, Oncomelania hupensis, Biomphalaria alexandrina and Bulinus truncatus were exposed to 4% TDS, and the median lethal concentration (LC50) was estimated at 24, 48 and 72 h. In the field, snail mortalities were assessed 1, 2, 3 and 7 d post-immersion with 2.5 g/m3 4% TDS and 1, 3, 7 and 15 d post-spraying with 5 g/m2 4% TDS. In addition, the acute toxicity of 4% TDS to Japanese quail (Coturnix japonica), zebrafish (Brachydanio rerio) and freshwater shrimp (Macrobrachium nipponense) was assessed by estimations of LC50 or median lethal dose (LD50). RESULTS: In the laboratory, the LC50 values of 4% TDS for O. hupensis were 0.701, 0.371 and 0.33 mg/L at 24, 48 and 72 h, respectively, and 4% TDS showed a 1.975 mg/L [corrected] 24 h LC50 against B. alexandrina, and a 1.396 mg/L 24 h LC50 against B. truncatus. Across all study regions, the pooled mortalities of O. hupensis were 72, 86, 94 and 98% at 1, 2, 3 and 7 d, following field immersion of 4% TDS at a dose of 2.5 g/m3, and were 69, 77, 85 and 88% at 1, 3, 7 and 15 d, following field spraying at 5 g/m2, respectively. 4% TDS had moderate toxicity to Japanese quail (7 d LD50 > 60 mg/kg) and to shrimp (96 h LC50 = 6.28 mg/L; 95% CI: 3.53-11.2 mg/L), whereas its toxicity to zebrafish was high (96 h LC50 = 0.15 mg/L; 95% CI: 0.14-0.17 mg/L). CONCLUSIONS: 4% TDS is active against O. hupensis, B. alexandrina and B. truncatus under laboratory and field conditions, and it may be a candidate molluscicide of plant origin.

Phenotypic screening of nonsteroidal anti-inflammatory drugs identified mefenamic acid as a drug for the treatment of schistosomiasis.

BACKGROUND: Treatment and control of schistosomiasis, one of the most insidious and serious parasitic diseases, depend almost entirely on a single drug, praziquantel. Since the funding for drug development for poverty-associated diseases is very limited, drug repurposing is a promising strategy. In this study, 73 nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used in medical and veterinary fields were evaluated for their anti-schistosomal properties. METHODS: The efficacy of NSAIDs was first tested against adult Schistosoma mansoni ex vivo using phenotypic screening strategy, effective drugs were further tested in a murine model of schistosomiasis. The disease parameters measured were worm and egg burden, hepato- and splenomegaly. FINDINGS: From 73 NSAIDs, five (mefenamic acid, tolfenamic acid, meclofenamic acid, celecoxib, and diclofenac) were identified to effectively kill schistosomes. These results were further supported by scanning electron microscopy analysis. In addition, the octanol-water partition coefficient, both for neutral and ionized species, revealed to be a critical property for the ex vivo activity profile. Compounds were then tested in vivo using both patent and a prepatent S. mansoni infection in a mouse model. The most effective NSAID was mefenamic acid, which highly reduced worm burden, egg production, and hepato- and splenomegaly. INTERPRETATION: The treatment regimen used in this study is within the range for which mefenamic acid has been used in clinical practice, thus, it is demonstrated the capacity of mefenamic acid to act as a potent anti-schistosomal agent suitable for clinical repurposing in the treatment of schistosomiasis.

Results of a national school-based deworming programme on soil-transmitted helminths infections and schistosomiasis in Kenya: 2012-2017.

BACKGROUND: Soil-transmitted helminth (STH) and schistosome infections are among the most prevalent neglected tropical diseases (NTDs) in the world. School-aged children are particularly vulnerable to these chronic infections that can impair growth, nutritional status and cognitive ability. Mass drug administration (MDA) delivered either once or twice annually is a safe and effective approach recommended by the World Health Organization (WHO) to reduce worm burden. In 2012, Kenya began a national school-based deworming programme (NSBDP) aimed at reducing infection and associated morbidity. The change in prevalence and intensity of these infections was monitored over five years (2012-2017). Here, we present the changes in STH and schistosome infections between baseline and endline assessments, as well as explore the yearly patterns of infection reductions. METHODS: We used series of pre- and post-MDA intervention, repeat cross-sectional surveys in a representative, stratified, two-stage sample of schools in 16 counties of Kenya. The programme consisted of two tiers of monitoring; a national baseline, midterm and endline surveys consisting of 200 schools, and pre- and post-MDA surveys conducted yearly consisting of 60 schools. Stool and urine samples were collected from randomly selected school children and examined for STH and schistosome infections using Kato-Katz and urine filtration techniques respectively. RESULTS: Overall, 32.3%, 16.4% and 13.5% of the children were infected with any STH species during baseline, midterm and endline assessment, respectively, with a relative reduction of 58.2% over the five-year period. The overall prevalence of S. mansoni was 2.1%, 1.5% and 1.7% and of S. haematobium was 14.8%, 6.8% and 2.4%, respectively, for baseline, midterm and endline surveys. We observed inter-region and inter-county heterogeneity variation in the infection levels. CONCLUSIONS: The analysis provided robust assessment of the programme and outlined the current prevalence, mean intensity and re-infection pattern of these infections. Our findings will allow the Government of Kenya to make informed decisions on the strategy to control and eliminate these NTDs. Our results suggest that complimentary interventions may have to be introduced to sustain the chemotherapeutic gains of MDA and accelerate attainment of elimination of these NTDs as a public health problem in Kenya.

Structure-Based Study of Natural Products with Anti-Schistosoma Activity.

BACKGROUND: Schistosomiasis is a parasitic protozoal disease caused by flatworms of the genus Schistosoma. Although the disease threatens millions of lives, it is still at the top list of neglected tropical diseases and praziquantel, the only common schistosocidal drug in use, has records of decreasing efficiency and cases of resistance. Also, reports revealed that people in the rural areas, who are most affected, rely mostly on traditional herbal medicines because of limited access to modern healthcare. The use of computers in drug development has become a routine practice because they are cost and time effective. OBJECTIVE: We used computational techniques to discover potent Schistosoma inhibitors of natural product origin. METHODS: Computer-based techniques were employed to discover anti-schistosoma lead/hit from plant metabolites isolated from African medicinal plants which have shown activity or are responsible for activity against Schistosomes. The plant metabolites were evaluated for 'drug-likeness' and docked toward four selected validated Schistosoma drug targets; Glutathione S-transferase, Thioredoxin glutathione reductase, Histone deacetylase and Schistosoma masoni arginase, with PDB codes: 1M9A, 2X99, 4BZ8 and 4Q3T respectively. RESULTS: A total of 27 bioactive compounds with anti-Schistosoma history were retrieved from literature. The phytochemicals with Lipinski violation of ≤ 2 were found to exhibit comparable binding affinities toward the studied targets as the co-crystallized inhibitors. Predicted binding modes of the compounds toward respective target showed key intermolecular interactions involved in the ligandtarget relationship. Moreover, one of the compounds emerged as the most interesting candidate by both being drug-like and inhibiting the activities of the studied enzyme targets at micro-molar range. CONCLUSION: Our study identified schistosocidal leads with high bioavailability profile and the exploration of binding modes could lay the foundation for synthetic modification of the plant metabolites for the development of novel anti-schistosoma drug(s) with new mechanism of action.

[Current status of schistosomiasis in Santchou health area, (Santchou Health District, Cameroon western region)]. / Situation actuelle de la schistosomiase dans l'aire de santé de Santchou, (District de santé de Santchou, Région de l'Ouest-Cameroun).

INTRODUCTION: Schistosomiasis, the second endemic parasitic infection in the world, is a parasitosis caused by trematodes from the genus Schistosoma. Our study aims to assess the prevalence of different species of schistosomes (Schistosoma mansoni, haematobium and intercalatum) among schoolchildren and to identify risk factors, clinical signs of schistosomiasis, and schistosomiasis intermediate host snails in stagnant water. METHODS: We conducted a cross sectional study over a three months period. The study consisted of sociodemographic and clinical data recording, collection of stool samples and urine, molluscan research and treatment of positive students for other helminths. Laboratory tests were performed at the Medical Research Institute and the study of Medicinal Plants in Yaounde where stool samples and urine were examined using KATO KATZ and centrifugation technique respectively, and shellfish species were determined by a malacologist. RESULTS: A total of 400 students aged between 8-16 years, 223 (55.7%) girls and 177 (44.3%) boys attending 4 elementary school were enrolled in the study. The social survey revealed that 154 students out of 400 (or 38.5%) were in contact with the river water at least once a week, 58% from around noon. All students had at least one symptom of schistosomiasis although nonspecific and dominated by abdominal pain in 72% of cases (n = 288 of 400). Biologically, no schistosomiasis eggs were detected. Cercaria releasing rate was negative in the 100 watery species found. CONCLUSION: The Santchou health area is not an active outbreak of schistosomiasis, but remains a risk area because of rice cultivation and stagnant water. The intensification of health education campaigns among the general population would delay the onset of this infection in the locality.

[Removal of weremit from the abdomen. Interpretation and efficacy of an ancient Egyptian prescription by the newest scientific results]. / A weremit kiuzése a hasból. Óegyiptomi recept hatásosságának értelmezése az újabb kutatási eredmények alapján.

Significant percentage of today's knowledge of ancient Egyptian medicine has been acquired from papyri left behind from various periods of Egyptian history. The longest and the most comprehensive is the Ebers papyrus, kept at the University Museum of Leipzig, which was written more than one thousand years before Hippocrates (c. 460-377 BC). One of the riddles among the prescriptions of the Ebers papyrus Eb20 has been used in order to remove the so called "wemyt" weremit from the abdomen with the help of a drink, which consists of "jnnk", Conyza dioscoridis in milk or sweet beer. The authors assume that the disease could be an infection of Schistosoma haematobium and/or Schistosoma mansoni. Nowadays the tea of Conyza dioscoridis is widely used as an important part of traditional medicine against rheumatism, intestinal distention and cramps, as well as an antiperspirant, and with external use for wound healing. The authors' intent is to interpret the efficacy of the above-mentioned ancient prescription with the help of modern medical and pharmaceutical knowledge.

Studies on the molluscicidal activity of Agave angustifolia and Pittosporum tobira on schistosomiasis transmitting snails.

In the search for new molluscicidal plants for controlling the snail vectors of schistosomiasis, laboratory evaluation was made to assess the molluscicidal activity of Agave angustifolia and Pittosporum tobira plants against Biomphalaria alexandrina snails. Results indicated that both plants have promising molluscicidal activity as the LC90 of the dry powder of both plants was 120 ppm. Both plants showed marked cercaricidal and miracidicidal potencies against S. mansoni larvae. The LC90 of both plants (120 ppm) killed most B. alexandrina eggs within 24 h of exposure. The sub-lethal concentrations of both plants markedly suppressed the survival rate of B. alexandrina snails and the mortality increased with increasing the concentrations and the exposure period up to 10 successive weeks. The accumulative toxic effect of these concentrations was continuous during the recovery period. Also, the reproductive rates of exposed snails were greatly affected even through the recovery period. This depression in reproductive ability of snails was accompanied by histological damage in the hermaphrodite glands of exposed snails. Meanwhile, the growth of snails was estimated weekly and it showed great inhibition in exposed snails comparing with the control ones.

The roles of water, sanitation and hygiene in reducing schistosomiasis: a review.

Schistosomiasis is a disease caused by infection with blood flukes of the genus Schistosoma. Transmission of, and exposure to, the parasite result from faecal or urinary contamination of freshwater containing intermediate host snails, and dermal contact with the same water. The World Health Assembly resolution 65.21 from May 2012 urges member states to eliminate schistosomiasis through preventive chemotherapy (i.e. periodic large-scale administration of the antischistosomal drug praziquantel to school-aged children and other high-risk groups), provision of water, sanitation and hygiene (WASH) and snail control. However, control measures focus almost exclusively on preventive chemotherapy, while only few studies made an attempt to determine the impact of upgraded access to safe water, adequate sanitation and good hygiene on schistosome transmission. We recently completed a systematic review and meta-analysis pertaining to WASH and schistosomiasis and found that people with safe water and adequate sanitation have significantly lower odds of a Schistosoma infection. Importantly though, the transmission of schistosomiasis is deeply entrenched in social-ecological systems, and hence is governed by setting-specific cultural and environmental factors that determine human behaviour and snail populations. Here, we provide a comprehensive review of the literature, which explores the transmission routes of schistosomes, particularly focussing on how these might be disrupted with WASH-related technologies and human behaviour. Additionally, future research directions in this area are highlighted.

A new schistosomicidal and antioxidative phenylpropanoid from Astragalus englerianus.

A new phenylpropanoid, (E)-2,3,4-trimethoxy-5-(1-propenyl)phenol (1), along with five known aromatic compounds (2-6), was isolated from the methanol extract of roots of Astragalus englerianus. Their structures were elucidated based on the analyses of extensive spectroscopic data and comparison of their physicochemical properties. Compounds 1 and 2 were evaluated schistosomicidal activities, and all the isolated compounds were tested for their antioxidant activities in vitro. Compound 1 showed significant schistosomicidal activity with worm mortality rates of 66.7% and 83.3% within 12 and 24 h in a drug-containing (1.16 mM) RPMI 1640 medium, respectively. Also, compound 1 exhibited excellent antioxidant activity (2,2-diphenyl-1-(2,4,6-trinitrophenyl)hydrazyl free radical-scavenging capability) with an IC50 value of 81.3 ± 1.3 µM.

Schistosomicidal and antioxidant flavonoids from Astragalus englerianus.

Astragalus englerianus is a close relative of the traditional Chinese medicine plant Radix Astragali (Huang-qi) and is mainly distributed in Yunnan. It has been traditionally used as a substitute of "Huang-qi" for reducing fatigue and enhancing immunity by local folks. A phytochemical study of the methanol extract of the roots led to the isolation of three new flavonoids including one aurone (1) and two chalcones (2 and 3), as well as two known flavonoids (4 and 5). Their structures were elucidated based on the analyses of extensive spectroscopic data and comparison of their physicochemical properties. This is the first report on the occurrence of ß-hydroxydihydrochalcone, 2',5'-dioxygenchalcones, and 2',5'-dioxygenaurone in the genus Astragalus. All the isolated compounds were tested in vitro for their schistosomicidal and antioxidant activities. Compounds 2 and 4 showed schistosomicidal activities with worm mortality rates of 100 % within 12 h in a drug-containing (0.70 and 0.77 mM, respectively) RPMI 1640 medium. Compounds 1 and 2 exhibited antioxidant activities in 2,2-diphenyl-1-(2,4,6-trinitrophenyl)hydrazyl free radical scavenging assays, with IC50 values of 35.9 ± 1.1 and 12.2 ± 1.1 µM, respectively.

[Clinical efficiency of tanshinone IIA-sulfonate in treatment of liver fibrosis of advanced schistosomiasis].

OBJECTIVE: To evaluate the clinical efficiency of tanshinone IIA-sulfonate (STS) in the treatment of liver fibrosis of advanced schistosomiasis. METHODS: A total of 73 advanced schistosomiasis patients were selected into a treatment group and 55 cases of advanced schistosomiasis were selected into a control group, and dipstick dye immunoassay assay (DDIA) for schistosomiasis and HBsAg of all the patients were negative. The patients in the treatment group received STS for 14 days, and all the patients in both groups received the conventional liver-protecting treatment for 14 days. All the patients in both groups received the measurements of portal vein, 4 indicators of liver fibrosis (P III P, C IV, HA, LN), and 3 indicators of serum enzyme activities (ALT, AST, gamma-GT). RESULTS: After the treatments, the inside diameters of the portal vein and the degrees of the positive results of indicators of serum enzyme activities of all the patients of both groups decreased, but there were no statistically significant differences compared with those before the treatment. In the treatment group, the degrees of the positive results of indicators of liver fibrosis decreased somewhat, but there were no statistically significant differences compared with those before the treatment except C IV. In the control group, the degrees of the positive results of indicators of liver fibrosis fluctuated. In the treatment group, the indicator of liver fibrosis, CIV improved and the 2 indicators of liver fibrosis, PIIIP and HA improved significantly, but the indicators of serum enzyme activities did not improve. CONCLUSION: STS is effective in the treatment of liver fibrosis of advanced schistosomiasis.

Whole organism high-content screening by label-free, image-based Bayesian classification for parasitic diseases.

Sole reliance on one drug, Praziquantel, for treatment and control of schistosomiasis raises concerns about development of widespread resistance, prompting renewed interest in the discovery of new anthelmintics. To discover new leads we designed an automated label-free, high content-based, high throughput screen (HTS) to assess drug-induced effects on in vitro cultured larvae (schistosomula) using bright-field imaging. Automatic image analysis and Bayesian prediction models define morphological damage, hit/non-hit prediction and larval phenotype characterization. Motility was also assessed from time-lapse images. In screening a 10,041 compound library the HTS correctly detected 99.8% of the hits scored visually. A proportion of these larval hits were also active in an adult worm ex-vivo screen and are the subject of ongoing studies. The method allows, for the first time, screening of large compound collections against schistosomes and the methods are adaptable to other whole organism and cell-based screening by morphology and motility phenotyping.

[Preventive effect of plant cercaricide Fangyouling for schistosome infection].

OBJECTIVE: To evaluate the preventive effect of Fangyouling (a plant cercaricide) for schistosome infection in the field. METHODS: Villagers contacting schistosome infested water in 3 administrative villages in Hubei Province were randomly selected, and the villagers rubbing Fangyouling before they contacted with the infested water were divided into Group I (159 cases) and those not rubbing Fangyouling before they contacted with the infested water were divided into Group II (172 persons). All the villagers were investigated by questionnaire, and their infections of schistosome were tested by sera and fecal examinations. RESULTS: There were no differences of constituent ratios of gender, age, occupation, time and type of infested water contact between the two groups (all P values > 0.05). The positive rates of sera and fecal examinations were 3.14% and 1.87%, respectively in Group I , and the positive rates of sera and fecal examinations were 9.30% and 6.40%, respectively in Group II, and there were significant differences between both the results of sera and fecal examinations of Group I and Group II (both P values < 0.05). In Group I , there were 110 people who completely embrocated Fangyouling, and their positive rates of sera and fecal examinations were 0.91% and 0, respectively. There are 42 people who incompletely embrocated Fangyouling, and their positive rates of sera and fecal examinations were 8.16% and 6.12%, respectively, and there were significant differences (both P values < 0.05). CONCLUSIONS: The preventive effect of schistosome infection of Fangyouling is significant. Incomplete embrocating may be one of the possible reasons for people still being infected with schistosome after rubbing the protective agent.

In vitro evaluation of the schistosomicidal potential of Eremanthus erythropappus (DC) McLeisch (Asteraceae) extracts.

Eremanthus erythropappus (DC) McLeisch, a plant popularly known as Candeia (Asteraceae), has high therapeutic potential. In this study, the in vitro schistosomicidal potentials of the ethanolic, dichloromethane and hexane extract of branches were evaluated. Couples of worms obtained from the infected mice were cultured in RPMI supplemented with foetal bovine serum and antibiotics. Four pairs of adult worms were exposed to increasing concentrations of each extract and examined by light microscope. The extracts at 100 and 200 µg mL(-1) had schistosomicidal activity, as demonstrated by the analysis of several aspects such as tegument darkening, absence of motility, incapacity of adhesion in culture plate and absence of egg in culture medium. At 50 and 75 µg mL(-1), the dichloromethane and hexane extracts were highly effective. The results suggest that these extracts could be useful in the development of new schistosomicidal drugs.

Comparison of microscopy and Alamar blue reduction in a larval based assay for schistosome drug screening.

BACKGROUND: In view of the current widespread use of and reliance on a single schistosomicide, praziquantel, there is a pressing need to discover and develop alternative drugs for schistosomiasis. One approach to this is to develop High Throughput in vitro whole organism screens (HTS) to identify hits amongst large compound libraries. METHODOLOGY/PRINCIPAL FINDINGS: We have been carrying out low throughput (24-well plate) in vitro testing based on microscopic evaluation of killing of ex-vivo adult S. mansoni worms using selected compound collections mainly provided through the WHO-TDR Helminth Drug Initiative. To increase throughput, we introduced a similar but higher throughput 96-well primary in vitro assay using the schistosomula stage which can be readily produced in vitro in large quantities. In addition to morphological readout of viability we have investigated using fluorometric determination of the reduction of Alamar blue (AB), a redox indicator of enzyme activity widely used in whole organism screening. A panel of 7 known schistosome active compounds including praziquantel, produced diverse effects on larval morphology within 3 days of culture although only two induced marked larval death within 7 days. The AB assay was very effective in detecting these lethal compounds but proved more inconsistent in detecting compounds which damaged but did not kill. The utility of the AB assay in detecting compounds which cause severe morbidity and/or death of schistosomula was confirmed in testing a panel of compounds previously selected in library screening as having activity against the adult worms. Furthermore, in prospective library screening, the AB assay was able to detect all compounds which induced killing and also the majority of compounds designated as hits based on morphological changes. CONCLUSION: We conclude that an HTS combining AB readout and image-based analysis would provide an efficient and stringent primary assay for schistosome drug discovery.

Soil transmitted helminth infections and schistosomiasis in school age children in sub-Saharan Africa: efficacy of chemotherapeutic intervention since World Health Assembly Resolution 2001.

Soil transmitted helminth infections (STH) and schistosomiasis constitute major public health challenges among school-age children in sub-Saharan Africa. This review assessed the efficacy of chemotherapeutic intervention in line with the World Health Assembly (WHA) resolution since the passage in 2001. Using the Medline Entrez-Pubmed search, relevant publications were identified via combinations of key words such as helminth infection, school children, chemotherapy, Africa. Albendazole, mebendazole, and praziquantel were the antihelminthic drugs most commonly evaluated. Cure rates >80% and egg reduction rates >90% were recorded in most cases of schistosomiasis using praziquantel. Albendazole was very effective against A. lumbricoides and hookworm infections with majority of the studies recording cure rates >75%, but the efficacy of the drug was poor against T. trichiura. To ensure the realization of the WHA resolution, there is need for regular treatment of school children, development of alternative antihelminthic drugs and vaccines, environmental control measures and health education.

Development and validation of a quantitative, high-throughput, fluorescent-based bioassay to detect schistosoma viability.

BACKGROUND: Schistosomiasis, caused by infection with the blood fluke Schistosoma, is responsible for greater than 200,000 human deaths per annum. Objective high-throughput screens for detecting novel anti-schistosomal targets will drive 'genome to drug' lead translational science at an unprecedented rate. Current methods for detecting schistosome viability rely on qualitative microscopic criteria, which require an understanding of parasite morphology, and most importantly, must be subjectively interpreted. These limitations, in the current state of the art, have significantly impeded progress into whole schistosome screening for next generation chemotherapies. METHODOLOGY/PRINCIPAL FINDINGS: We present here a microtiter plate-based method for reproducibly detecting schistosomula viability that takes advantage of the differential uptake of fluorophores (propidium iodide and fluorescein diacetate) by living organisms. We validate this high-throughput system in detecting schistosomula viability using auranofin (a known inhibitor of thioredoxin glutathione reductase), praziquantel and a range of small compounds with previously-described (gambogic acid, sodium salinomycin, ethinyl estradiol, fluoxetidine hydrochloride, miconazole nitrate, chlorpromazine hydrochloride, amphotericin b, niclosamide) or suggested (bepridil, ciclopirox, rescinnamine, flucytosine, vinblastine and carbidopa) anti-schistosomal activities. This developed method is sensitive (200 schistosomula/well can be assayed), relevant to industrial (384-well microtiter plate compatibility) and academic (96-well microtiter plate compatibility) settings, translatable to functional genomics screens and drug assays, does not require a priori knowledge of schistosome biology and is quantitative. CONCLUSIONS/SIGNIFICANCE: The wide-scale application of this fluorescence-based bioassay will greatly accelerate the objective identification of novel therapeutic lead targets/compounds to combat schistosomiasis. Adapting this bioassay for use with other parasitic worm species further offers an opportunity for great strides to be made against additional neglected tropical diseases of biomedical and veterinary importance.