Mucosal trapping and degradation of Nippostrongylus brasiliensis occurs in the absence of STAT6.

Hookworms represent a major infectious burden globally, especially in developing countries. The murine hookworm Nippostrongylus brasiliensis is normally cleared in a manner dependent on IL-13, IL4-R and STAT6 signalling. Here we have used STAT6-deficient animals to model a non-resistant population and describe 2 novel STAT6-independent processes for the clearance of N. brasiliensis. During primary infection STAT6-/- animals are able to clear gut-dwelling N. brasiliensis by a mechanism involving the trapping and degradation of worms in the gut mucosa. Here, a previously undescribed STAT6-independent up-regulation of Relm-ß was observed which correlated with the mucosal trapping and degradation of worms. Previous studies have indicated that during secondary infection STAT6 deficient animals fail to expel adult worms and remain susceptible to re-infection and long-term colonization of the gut. We report here that an initial partially protective response occurs early upon re-infection in the absence of STAT6, and that a late-phase protective secondary response arises in the gut of STAT6-deficient mice leading to the clearance of the majority of N. brasiliensis, through their trapping and death in the mucosal layer of the lower region of the small intestine. These findings show that there are a number of redundant effector pathways which act to reduce worm burden in the gut which can be activated by mechanisms that do not work through the dominant STAT6 signalling pathway and may be useful as targets for future vaccination strategies against resistant hookworm strains.

Two human cases infected by the horsehair worm, Parachordodes sp. (Nematomorpha: Chordodidae), in Japan.

The present study was performed to describe 2 human cases infected by the horsehair worm, Parachordodes sp., in Japan. Two gordiid worms were collected in the vomit and excreta of an 80-year-old woman in November 2009 in Kyoto city, and in the mouth of 1-year-old boy in December 2009 in Nara city, Japan, respectively. Both worms were males having bifurcated posterior ends and male gonads in cross sectional specimens. They were identified as Parachordodes sp. (Nematomorpha: Chordodidae) based on the characteristic morphologies of cross sections and areoles in the cuticle. DNA analysis on 18S rRNA partial sequence arrangements was also carried out and both worms were assumed to be close to the genus Paragordionus based on tree analysis, and far from Gordius sp. which has already been reported in humans in Japan. DNA sequencing of the Parachordodes worm does not appear on the database; therefore, more information on the gene sequences of the genus Parachordodes from humans, animals, or intermediates is required.

Molecular identification of Oesophagostomum and Trichuris eggs isolated from wild Japanese macaques.

Natural habitat fragmentation and reducing habitat quality have resulted in an increased appearance of Japanese macaques, Macaca fuscata (Gray, 1870), in suburban areas in Japan. To investigate the risk of zoonotic infections, a coprological survey of helminth eggs passed by wild Japanese macaques was carried out in 2009 and 2010 in Shiga Prefecture, Japan. Microscopic examination found helminth eggs in high prevalence, and nucleotide sequencing of DNA extracted from the eggs identified Oesophagostomum cf. aculeatum and Trichuris trichiura. A fecal culture also detected infective larvae of Strongyloides fuelleborni. These zoonotic nematodes pose a potential health issue to local people in areas frequented by Japanese macaques.

Anisakis simplex sensu stricto and Anisakis pegreffii: biological characteristics and pathogenetic potential in human anisakiasis.

Anisakiasis is one of the most common fishborne helminthic diseases in Japan, which is contracted by ingesting the larvae of the nematode Anisakis spp. carried by marine fish. Anisakis simplex sensu stricto (s.s.) and A. pegreffii are the dominant species in fish caught offshore Japan. The present study aimed to identify the anisakid species infecting Japanese patients and determine whether there is any difference in the pathogenetic potential of A. simplex (s.s.) and A. pegreffii. In total, 41 and 301 Anisakis larvae were isolated from Japanese patients and chub mackerel (Scomber japonicus), respectively; these were subjected to molecular identification using polymerase chain reaction targeted at a ribosomal DNA internal transcribed spacer region. Chub mackerel larvae were further examined for survival in artificial gastric juice (pH 1.8) for 7 days and for invasiveness on 0.75% solid agar over a 24-h interval. All clinical isolates, including those of asymptomatic, acute, and chronic infections as well as those from the stomach, small intestine, colon, and stool, were identified as A. simplex (s.s.). Chub mackerel harbored A. simplex (s.s.) and A. pegreffii larvae, together with a few larvae of other anisakid species. A. simplex (s.s.) larvae from chub mackerel tolerated the artificial gastric juice better than A. pegreffii, with 50% mortality in 2.6 and 1.4 days, respectively. In addition, A. simplex (s.s.) penetrated the agar at significantly higher rates than A. pegreffii. These results show that A. simplex (s.s.) larvae have the potential to survive acidic gastric juice to some extent and penetrate the stomach, small intestine, or colon in infected humans.

Hsp12.6 expression is inducible by host immunity in adult worms of the parasitic nematode Nippostrongylus brasiliensis.

Heat shock proteins (Hsp) are a family of stress-inducible molecular chaperones that play multiple roles in a wide variety of animals. However, the roles of Hsps in parasitic nematodes remain largely unknown. To elucidate the roles of Hsps in the survival and longevity of nematodes, particularly at the 2 most critical stages in their lifecycle, the infective-L3 stage and adult stage, which is subjected to host-derived immunological pressure, we examined the temporal gene transcription patterns of Hsp12.6, Hsp20, Hsp70, and Hsp90 throughout the developmental course of the nematode Nippostrongylus brasiliensis by reverse transcriptase real-time PCR. Nb-Hsp70 and Nb-Hsp90 expression were observed throughout the nematode's lifecycle, while the expression of Nb-Hsp20 was restricted to adults. Interestingly, Nb-Hsp12.6 showed a biphasic temporal expression pattern; i.e., it was expressed in infective-L3 larvae and in adults during worm expulsion from immunocompetent rats. However, the activation of Nb-Hsp12.6 in adult worms was aborted when they infected permissive athymic-rnu/rnu rats and was only marginal when they infected mast-cell-deficient Ws/Ws rats, which exhibited a low response of rat mast cell protease (RMCP) II and resistin-like molecule (Relm)-ß expression compared to those observed in immunocompetent rats. Moreover, the activation of Nb-Hsp12.6 was reversed when adult worms were transplanted into the naive rat intestine. These features of Nb-Hsp12.6, the expression of which is not only stage-specific in infective-L3, but is also inducible by mucosal immunity in adults, have implications for the survival strategies of parasitic nematodes in deleterious environmental conditions both outside and inside the host.

Ascariasis in Japan: is pig-derived Ascaris infecting humans?

Human ascariasis is caused by infection with the common roundworm Ascaris lumbricoides, although the pig roundworm Ascaris suum has also been reported to infect humans and develop into the adult stage. To elucidate whether pig-derived Ascaris infects humans in Japan, 9 Ascaris isolates obtained from Japanese patients and a further 9 Ascaris isolates of pig origin were analyzed to determine their internal transcribed spacer-1 sequences. Six of the 9 clinical isolates showed the Ascaris genotype which predominantly infects humans in endemic countries, while the other 3 clinical isolates and 9 pig-derived isolates showed the genotype predominant in pigs worldwide. These results suggest that at least some cases of human ascariasis in Japan are a result of infection with pig-derived Ascaris.

Mitochondrial DNA divergence in populations of the tapeworm Diphyllobothrium nihonkaiense and its phylogenetic relationship with Diphyllobothrium klebanovskii.

Diphyllobothrium nihonkaiense [Y. Yamane, H. Kamo, G. Bylund, J.P. Wilkgren. Diphyllobothrium nihonkaiense sp. nov (Cestoda: Diphyllobothriidae)- revised identification of Japanese broad tapeworm. Shimane J Med Sci 1986;10:29-48.] and Diphyllobothrium klebanovskii [I.V. Muratov, P.S. Posokhov. Causative agent of human diphyllobothriasis - Diphyllobothrium klebanovskii sp. n. Parazitologiia. 1988;22:165-170.] are two major species of human diphyllobothriasis in Japan and Far East Russia, respectively, but their taxonomical relationship remains unclear. In this study, we analysed the DNA sequences of 16 clinical isolates of D. nihonkaiense from Japanese people, 3 isolates of D. klebanovskii from a bear in Kamchatka, and 4 clinical isolates of D. klebanovskii from native Udygeyci people in Russia, as well as 4 plerocercoids from Oncorhynchus spp. 18S rDNA and internal transcribed spacer 1 (ITS1) sequences from D. nihonkaiense and D. klebanovskii showed a high level of similarity, indicating synonymy of the two species. Analyses of mitochondrial DNA (mtDNA) sequence polymorphisms in the cox1 and nad3 genes of D. nihonkaiense (D. klebanovskii) revealed two deeply divergent lineages, A and B, with genetic distances (Kimura-2 parameter) of 0.018-0.022. Furthermore, the distinct monophyletic groupings of cox1 haplotypes corresponded to the distinct monophyletic groupings of nad3 haplotypes. The two lineages were neither distinguished by morphological features nor defined by the localities of the samples. These results suggest that the two morphologically cryptic lineages have diverged and coexisted over a long period of time.

Alteration of the expression profiles of acidic mucin, sialytransferase, and sulfotransferases in the intestinal epithelium of rats infected with the nematode Nippostrongylus brasiliensis.

Acidic mucins such as sialomucin and sulfomucin produced by intestinal epithelial cells have been implicated in the protection of the mucosa from pathogens. In the present study, we analyzed the alteration of acidic mucins in the jejunum of euthymic and athymic rats infected with the nematode Nippostrongylus brasiliensis using alcian blue staining and a high iron-diamine method. The numbers of sialomucin+ goblet cells increased markedly 7 and 10 days post-infection and decreased gradually thereafter in euthymic rats, while athymic rats did not show sialomucin+ goblet cell hyperplasia at least until 28 days post-infection, suggesting that sialomucin production might be regulated by thymus-derived T cells. On the other hand, the numbers of sulfomucin+ goblet cells increased markedly 28 days post-infection in both euthymic and athymic rats despite the fact that sulfomucin+ goblet cell numbers in uninfected athymic rats were significantly smaller than in euthymic rats. Real-time polymerase chain reaction studies on the gene transcription levels of O-glycan sulfotransferases Gal3ST1, Gal3ST2, Gal3ST3, and Gal3ST4 in the jejunal epithelium increased gradually toward day 28 post-infection in euthymic and athymic rats. These results suggest that the production of sulfomucin and expression of Gal3STs are inducible by nematode infection without the activation of thymus-derived T cells.

Diphyllobothriasis nihonkaiense: possibly acquired in Switzerland from imported Pacific salmon.

A 5-year-old Japanese boy passed tapeworm strobila while he was living in Switzerland. During a short visit to Japan, he was successfully treated with a single dose of praziquantel. DNA sequences of ITS1, cox1 and nd3 genes from the tapeworm were compatible with those of Diphyllobothrium nihonkaiense rather than Diphyllobothrium latum, which is prevalent in Europe. The patient consumed imported salmon in Switzerland. This case highlights the globalization of D. nihonkaiense, which was once restricted to the Far East, and reflects the worldwide demand for seafood.

Diplogonoporiasis in Japan: genetic analyses of five clinical isolates.

Infection of the whale tapeworm Diplogonoporus balaenopterae (Diphyllobothriidae) is occasionally found in humans, especially among Japanese. In the present study, we analysed the nucleotide sequences of the 18S rDNA, ITS1 and cox1 genes of the immature and mature proglottids of Diplogonoporus species recovered from five Japanese patients. The nucleotide sequences of 18S rDNA, ITS1 and cox1 showed little, if any, intraspecific divergence. Phylogenetic analyses of several diphyllobothriid species revealed a close relationship of Diplogonoporus isolates with the cetacean tapeworm Diphyllobothrium stemmacephalum. The results suggest that the genus Diphyllobothrium is paraphyletic and raise a question regarding the validity of the genus Diplogonoporus.

T cell-dependent and -independent expression of intestinal epithelial cell-related molecules in rats infected with the nematode Nippostrongylus brasiliensis.

To determine how T cells of thymic origin regulate the intestinal mucous response induced by nematode infection, mucin production and goblet cell-specific secretory peptide expression were examined in euthymic rnu/+ and athymic rnu/rnu rats infected with the nematode Nippostrongylus brasiliensis. Euthymic rats showed transient goblet cell hyperplasia and upregulation of mucin production, which returned to preinfection levels by 21 days postinfection, when nematodes had been rejected from the intestine. In athymic rats, which failed to reject nematodes, goblet cell hyperplasia and accelerated mucin production continued at least until 21 days postinfection. Gene transcription of mucin-core peptide (MUC)-2 and -3 and trefoil factor (TFF)-2 and -3 in the jejunal epithelium was upregulated parallel to the levels of goblet cell hyperplasia in both euthymic and athymic rats. On the other hand, resistin-like molecule (Relm)beta, sialyltransferase Siat4c and sulfotransferase 3ST1 showed significantly higher transcription levels in euthymic than in athymic rats at 7 and/or 10 days postinfection. These results suggest that the induction of intestinal mucin production occurs without the activation of thymus-derived T cells, while the expression of Relmbeta, Siat4c and 3ST1 in the intestinal epithelial cells seems to be regulated at least partly by thymus-dependent mechanisms.

A case of human fasciolosis: discrepancy between egg size and genotype of Fasciola sp.

In human fasciolosis, differential diagnosis of the causative flukes, Fasciola hepatica and Fasciola gigantica, is problematic. We report a rare case of human fasciolosis in which an adult worm was recovered from the bile duct of a Japanese man. Morphometric data of the worm were consistent with those of F. hepatica, whereas the size of eggs in the stool indicated infection with F. gigantica. Nucleotide sequences of ITS-1 and -2 and CO1 genes of the DNA extracted from the eggs revealed that the genotype was that of F. hepatica. These findings suggest that the size of eggs is not a suitable marker for species identification in human fasciolosis, especially in settings such as the East Asian region where different karyotypes and hybrid genotypes of F. hepatica and F. gigantica have been found.

Altered expression of goblet cell- and mucin glycosylation-related genes in the intestinal epithelium during infection with the nematode Nippostrongylus brasiliensis in rat.

Intestinal nematode infection induces marked goblet cell hyperplasia and mucus secretion, but the mechanisms of regulation of the changes still remain to be elucidated. In the present study, epithelial cells were isolated from the rat small intestine at various times after Nippostrongylus brasiliensis infection, and the levels of expression of goblet cell- and mucin glycosylation-related genes were estimated by semi-quantitative reverse transcription (RT)-PCR. Among the genes investigated, mucin core peptide (MUC) 2, sialyltransferase (Siat) 4c and trefoil factor family (TFF) 3 were upregulated as early as 2-4 days post-infection, suggesting that they are associated with an early innate protective response. Seven days post-infection and thereafter, when the nematodes reached maturity, significant upregulation of MUC3, MUC4, resistin-like molecule beta (Relmbeta) and 3O-sulfotransferase (3ST)1 was observed, while 3ST2 expression levels increased after the majority of the worms were expelled from the intestine. Similar alterations of glycosylation-related gene expression were also observed in mast-cell-deficient Ws/Ws rats, suggesting that mast cells in the epithelium are not relevant to the upregulation of these genes. The present finding that the expression level of each goblet cell- or glycosylation-related gene was altered differently during the time course of infection indicates the progression of sequential qualitative changes in the mucus layer after infection.

IL-18 with IL-2 protects against Strongyloides venezuelensis infection by activating mucosal mast cell-dependent type 2 innate immunity.

C57BL/6 (B6) and B6 background STAT6(-/-) mice pretreated with IL-18 plus IL-2 showed prominent intestinal mastocytosis and rapidly expelled implanted adult worms of the gastrointestinal nematode Strongyloides venezuelensis. In contrast, identically pretreated mast cell-deficient W/W(v) mice failed to do so. Thus, activated mucosal mast cells (MMC) are crucial for parasite expulsion. B6 mice infected with S. venezuelensis third-stage larvae (L3) completed parasite expulsion by day 12 after infection, whereas IL-18(-/-) or IL-18Ralpha(-/-) B6 mice exhibited marked impairment in parasite expulsion, suggesting a substantial contribution of IL-18-dependent MMC activation to parasite expulsion. Compared with IL-18(-/-) or IL-18Ralpha(-/-) mice, S. venezuelensis L3-infected STAT6(-/-) mice have poorly activated MMC and sustained infection; although their IL-18 production is normal. Neutralization of IL-18 and IL-2 further reduces expulsion in infected STAT6(-/-) mice. These results suggest that collaboration between IL-18-dependent and Th2 cell-dependent mastocytosis is important for prompt parasite expulsion.

Expression and role of E-cadherin and CD103beta7 (alphaEbeta7 integrin) on cultured mucosal-type mast cells.

Mucosal-type mast cells (MMC) in the respiratory and/or gut epithelium play pivotal roles in the development of allergic inflammation and nematode clearance. To determine the role of E-cadherin and alphaEbeta7 integrin in MMC localization to the epithelium, we analyzed the epithelial binding of two types of mouse bone marrow-derived mast cells: S3-BMMC, which developed in medium containing stem cell factor (SCF) plus IL-3, and S39T-BMMC, which developed with SCF, IL-3, IL-9 and TGF-beta1. The latter cells were more similar to mature MMC than the former in terms of mouse mast cell protease (mMCP)-1 expression. FACS analyses revealed that S3-BMMC expressed E-cadherin and beta7 integrin but not alphaE integrin, whereas S39T-BMMC expressed alphaEbeta7 integrin as well as E-cadherin. Mn2+ promoted adhesion of S39T-BMMC to the monolayer of E-cadherin+F9 cells. The adhesion was suppressed significantly by the combined addition of blocking antibodies against integrin alphaE and E-cadherin, whereas either blocking antibody alone failed to do so. S3-BMMC adhesion was suppressed by E-cadherin blocking antibody but not by alphaE blocking antibody. These results suggested that E-cadherin and alphaEbeta7 integrin, which are expressed on MMC-analog S39T-BMMC, play an important role in mast cell-epithelial cell interaction through homophilic as well as heterophilic binding to the epithelial E-cadherin molecule.

Quinine-resistant severe falciparum malaria effectively treated with atovaquone and proguanil hydrochloride combination therapy.

A 22-year-old Japanese man noticed pyrexia and diarrhea after travel to Guinea. Notable physical findings included hepatosplenomegaly. Treatment with oral quinine and minocycline was started after definitive diagnosis of falciparum malaria by blood smear. Initially, parasitemia and body temperature decreased but by the third night of therapy his temperature increased to 40 degrees C with a slight increase of parasite count. When quinine treatment was changed to atovaquone/proguanil, his temperature dropped immediately and complete plasmodial elimination was confirmed on microscopic examination. Subsequent recrudescence of the disease was not observed. It was concluded that the antimalarial treatment with atovaquone/proguanil might become invaluable in Japan.