Field safety and efficacy of an orally administered combination of sarolaner, moxidectin and pyrantel (Simparica Trio®) for the prevention of angiostrongylosis in dogs presented as veterinary patients.

BACKGROUND: Infection with the cardiopulmonary nematode Angiostrongylus vasorum may cause severe disease in dogs, therefore prophylactic treatments are necessary to prevent infection in dogs at risk. A clinical field study was conducted to demonstrate the efficacy and safety of an oral combination of sarolaner, moxidectin and pyrantel (Simparica Trio®) for the prevention of A. vasorum infection in dogs (prevention study). A survey study was conducted concurrently to determine the infection pressure in the same areas. METHODS: Prevention and survey studies were both conducted at the same veterinary clinics in endemic hot spots for A. vasorum in Denmark and Italy. The prevention study was a randomized, placebo controlled, double masked study where 622 client-owned dogs were treated and tested at 30 days intervals for 10 months. In the survey study 1628 dogs that were at risk of infection and/or were suspected to be infected were tested by fecal and/or serological methods, and the percent of dogs positive for A. vasorum was calculated. RESULTS: In the prevention study, there were no adverse events related to treatment with Simparica Trio®. Two placebo-treated animals became infected with A. vasorum during the 10-month study period, while none of the dogs in the combination product-treated group became infected. In the survey study, 12.2% of the study dogs were found positive to A. vasorum, indicating high exposure to the parasite during the period of the prevention study. CONCLUSIONS: Monthly oral treatment with the combination of sarolaner, moxidectin and pyrantel (Simparica Trio®) was 100% effective in the prevention of natural infection with A. vasorum in dogs in highly endemic areas. In endemic areas, A. vasorum occurrence in dogs at risk is considerable.

Efficacy of orally administered combination of moxidectin, sarolaner and pyrantel (Simparica Trio™) for the prevention of experimental Angiostrongylus vasorum infection in dogs.

BACKGROUND: Infection with Angiostrongylus vasorum may cause severe clinical disease, even death in dogs, however, due to the often non-specific clinical signs, diagnosis is not always straightforward. Regular prophylactic treatment may offer a safe means to protect dogs against infection. The efficacy of a novel oral endectocide containing moxidectin, sarolaner and pyrantel was investigated for the prevention of angiostrongylosis in dogs in three placebo-controlled, randomized, masked studies. The initial study (Study 1) determined the efficacious dosage of moxidectin in the combination product by evaluating three different dose levels, and two follow-up studies (Studies 2 and 3) confirmed the efficacy of the selected moxidectin dose. METHODS: Animals were infected orally with 200 infective third-stage larvae (L3) of A. vasorum and were treated 28 days later with the combination product or with placebo. Timing of dosing relative to infection allowed for efficacy to be evaluated against the immature adult (L5) stage. Dogs in Study 1 received treatments with oral tablets to deliver 3, 12 or 24 µg/kg moxidectin in combination with 2 mg/kg sarolaner and 5.0 mg/kg pyrantel (as pamoate salt) or placebo. In Studies 2 and 3, Simparica Trio™ tablets were administered to provide minimum dosages of 1.2 mg/kg sarolaner, 24 µg/kg moxidectin and 5.0 mg/kg pyrantel (as pamoate salt). Efficacy of the combination product was calculated as the percent reduction in adult worm counts at necropsy relative to placebo. RESULTS: In Study 1, the 3, 12 and 24 µg/kg moxidectin dosage in the combination product provided 7.2%, 54.5% and 94.7% efficacy against the immature adult stages of A. vasorum, respectively. Studies 2 and 3 confirmed that the efficacy of 24 µg/kg moxidectin combined with 1.2 mg/kg sarolaner and 5 mg/kg pyrantel in Simparica Trio™ was ≥ 92.9%. All three studies established that a single oral administration of 24 µg/kg moxidectin in the combination product provided effective prophylactic treatment for angiostrongylosis, reduced L1 production and fecal excretion and minimized the tissue damage to the lungs. CONCLUSIONS: A single oral treatment of dogs with Simparica Trio™ providing moxidectin at a minimum dose of 24 µg/kg was efficacious in the prevention of angiostrongylosis.

Survey-based pilot study into the chosen therapy and prophylaxis used by UK primary care veterinary surgeons against canine angiostrongylosis.

Canine Angiostrongylosis (CA), a gastropod-borne parasitic infection caused by the metastrongyloid nematode Angiostrongylus vasorum, is an important cause of significant morbidity to domestic dogs across the UK as well as in other European countries. This study aimed to ascertain the frequency at which particular drugs were used by primary care practitioners in the UK for therapy against and prophylaxis for CA. Primary care veterinary clinicians were surveyed using an online questionnaire and face-to-face or telephone interviews. Eighty-six veterinary surgeons responded. The majority of practices (n = 52) included lungworm in their standard anthelmintic protocols; moxidectin was the most common drug used for prophylaxis (n = 71). Fenbendazole was the most frequently selected drug, by 45% of vets, for treatment of confirmed cases of CA despite it being unlicensed for this purpose in the UK and the absence of a clear treatment protocol. The results of this pilot study provide an initial insight into the approach taken by primary care practitioners in their approach to CA. This provides an important starting point for future studies investigating the decision-making for CA amongst UK veterinary surgeons, particularly to clarify whether in a larger cohort an unlicensed drug remains the treatment of choice. The absence of a clear protocol for fenbendazole means that treatment of dogs affected by CA may be suboptimal, increasing the risk of morbidity and mortality.

Monthly administrations of milbemycin oxime plus afoxolaner chewable tablets to prevent Angiostrongylus vasorum infection in dogs.

BACKGROUND: Infection of dogs with the cardiopulmonary nematode Angiostrongylus vasorum may result in severe clinical disease therefore adequate prevention is necessary. A randomized, negative control, blinded study was conducted to evaluate the efficacy in the prevention of canine A. vasorum infection after monthly administrations of NexGard Spectra®, a novel chewable tablet formulation combining the insecticide and acaricide afoxolaner and the anthelmintic milbemycin oxime, in a multiple challenge (trickle infection) model. METHODS: Twenty beagle dogs were challenged orally with doses of approximately 32-43 third-stage larvae of A. vasorum once every other week on seven occasions (Study Days -7, 7, 21, 35, 49, 63 and 77). Ten dogs were administered NexGard Spectra® as close as possible to the minimum recommended dose of afoxolaner and milbemycin oxime, i.e. 2.5 mg/kg body weight and 0.5 mg/kg body weight, respectively, four times at monthly intervals (Study Days 0, 28, 56 and 84) while the remaining ten dogs served as untreated controls. For parasite recovery and count, dogs were euthanized humanely and necropsied six to eight days following the last treatment (Study Days 90-92). Beginning six weeks after first inoculation, faeces were collected on a bi-weekly basis and examined for first-stage larvae of A. vasorum. RESULTS: Untreated dogs harboured 39-95 adult A. vasorum (geometric mean, 66.4), while zero to 24 adult A. vasorum were recovered from the treated dogs (geometric mean, 3.4; P < 0.0001). Thus, efficacy of NexGard Spectra® administered at monthly intervals against incoming A. vasorum was 94.9 %. Compared to the untreated controls, larval excretion of the treated dogs was reduced by 99.9 % (P < 0.0001). CONCLUSION: Results of this study demonstrate that NexGard Spectra®, when administered at monthly intervals, can effectively prevent canine A. vasorum infection.

Gallus gallus domesticus: paratenic host of Angiostrongylus vasorum.

Angiostrongylus vasorum, a parasite of the cardiorespiratory system in canids, has a heteroxenous biological cycle in which the intermediate hosts are terrestrial and aquatic mollusks. Generally, canids become infected by ingesting the intermediate host or paratenic hosts, such as amphibians, that contain infective larvae (L3). However, there are no reports of birds as paratenic hosts of A. vasorum. To evaluate the susceptibility and viability of Gallus gallus domesticus as a paratenic host of A. vasorum, 17 Cobb chickens were randomly divided into two groups. The animals in group A were inoculated with third stage larvae of A. vasorum, and those in group B ate snails inoculated with A. vasorum L3. At 30 days post-infection, the chickens were killed, and the muscles and organs were placed in a pepsin-HCl solution (1% HCl (37%), 1% pepsin) for 3h in an oven at 40°C to recover the L3. In group A, 1863 L3 were recovered per chicken. In group B, 2585 L3 were recovered. A dog that ingested organs and tissues from a chicken from group A released first-stage larvae of A. vasorum in its feces 51 days after infection; the dynamics of this process were monitored for 107 days, when treatment with 25 mg fenbendazole/kg body weight was performed for 21 days. Chickens nourished with infected snails or with infective L3 may be a source of infection for dogs indicate that G. gallus is a potential paratenic host for this parasite.

Proteolytic activity of the nematophagous fungus Arthrobotrys sinensis on Angiostrongylus vasorum larvae.

BACKGROUND: The predatory nematophagous fungus Arthrobotrys sinensis (SF53) produces three proteases with nematicidal activity when grown on solid media culture. However, the proteolytic profile produced by this fungus, when grown in liquid culture medium remains unknown. FINDINGS: Thus, the objective of this work was to evaluate the production of proteases from nematophagous fungus Arthrobotrys sinensis in liquid medium and its nematicidal activity on first stage larvae of A. vasorum. Proteases were obtained in its crude form, using Whatman no.1 filter paper, followed by centrifugation for 5 min at 10 × g and 4°C. A zymogram was performed with co-polymerized casein in an acrylamide gel as substrate. An in vitro assay to evaluate the nematicidal action of the proteases of A. sinensis (SF53) produced in liquid medium on A. vasorum L1 was conducted. By the analysis of the zymogram, it was observed a single halo at the beginning of digestion of the gel, suggesting that the three proteases of SF53 are produced in an enzymatic complex of large molecular weight. Regarding nematicidal activity, within 24 hours, the proteases produced in liquid medium of A. sinensis (SF53) showed a percentage reduction of 64% on the number of L1 of A. vasorum. CONCLUSION: In the present work, it is suggested that the three proteases of SF53 are produced in an enzymatic complex and was also demonstrated that these enzymes were effective in destroying A. vasorum L1.

In vitro activity of a serine protease from Monacrosporium thaumasium fungus against first-stage larvae of Angiostrongylus vasorum.

A serine protease from the nematophagous fungus Monacrosporium thaumasium (NF34a) was purified, partially characterized and tested in vitro in control of the first larval stage of Angiostrongylus vasorum. NF34a grew in liquid culture medium, producing its crude extract that was purified by ion exchange chromatography. The fractions with high protease activity were collected in a pool, and elution of proteases was monitored by enzymatic assay and protein content. Purification steps were monitored by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). Protease activity was determined under different pH and temperature conditions, and the inhibitor effects of metal ions and phenylmethylsulfonyl fluoride (PMSF) were assessed. In an experimental test, the infection process of NF34a on first-stage larvae of A. vasorum was investigated. A purified serine protease (Mt1) was identified, with an approximate molecular mass of 40 kDa and apparent homogeneity in SDS-PAGE, having optimal activity at pH 7.0 to 8.0 and temperature of 60°C. Mg(2+) and Zn(2+) partially inhibited the activity of Mt1 while PMSF inhibited it completely. Mt1 production was observed when NF34a was grown using first-stage larvae of A. vasorum as the only source of carbon and nitrogen. These results show that the enzyme may have a possible role in the infection process of the larvae. In the in vitro test of applicability against A. vasorum L(1), we observed a reduction in the number of larvae of 23.9% (p < 0.05) in the group treated with Mt1 compared with the control group. However, even this low reduction demonstrates that the Mt1 is important in the infection process.

[Larvicidal activity of a crude enzyme extract of the fungus Duddingtonia flagrans on first-stage larvae of Angiostrongylus vasorum]. / Atividade larvicida do extrato bruto enzimático do fungo Duddingtonia flagras sobre larvas de primeiro estádio de Angiostrongylus vasorum.

INTRODUCTION: Angiostrongylus vasorum is a nematode parasite of domestic dogs and potentially of humans. METHODS: This study aimed to observe the predatory activity in vitro of a crude enzyme extract of the fungus Duddingtonia flagrans on first-stage larvae of A. vasorum in laboratory conditions on 2% water-agar. RESULTS: At the end of the experiment, the percentage reductions observed for A. vasorum L1 were 53.5% (24h) and 71.3% (48h). CONCLUSIONS: Crude enzyme extract of the fungus D. flagrans destroyed the L1 in vitro and can be used as a biological control for this nematode.

Atividade larvicida do extrato bruto enzimático do fungo Duddingtonia flagras sobre larvas de primeiro estádio de Angiostrongylus vasorum / Larvicidal activity of a crude enzyme extract of the fungus Duddingtonia flagrans on first-stage larvae of Angiostrongylus vasorum

INTRODUÇÃO: Angiostrongylus vasorum é um nematóide que parasita cães domésticos e eventualmente o homem. MÉTODOS: O objetivo deste trabalho foi observar a atividade predatória in vitro do extrato bruto enzimático do fungo Duddingtonia flagrans sobre larvas de primeiro estádio A. vasorum em condições laboratoriais no meio ágar-água 2 por cento. RESULTADOS: Ao final do experimento, os percentuais de redução das L1 de A. vasorum observados foram de: 53,5 por cento (24h) e 71,3 por cento (48h) CONCLUSÕES: O extrato bruto enzimático do fungo D. flagrans destruiu in vitro as L1, podendo ser utilizado como controle biológico desse nematóide.

INTRODUCTION: Angiostrongylus vasorum is a nematode parasite of domestic dogs and potentially of humans. METHODS: This study aimed to observe the predatory activity in vitro of a crude enzyme extract of the fungus Duddingtonia flagrans on first-stage larvae of A. vasorum in laboratory conditions on 2 percent water-agar. RESULTS: At the end of the experiment, the percentage reductions observed for A. vasorum L1 were 53.5 percent (24h) and 71.3 percent (48h). CONCLUSIONS: Crude enzyme extract of the fungus D. flagrans destroyed the L1 in vitro and can be used as a biological control for this nematode.

Outcomes in mice with abdominal angiostrongyliasis treated with enoxaparin.

Abdominal angiostrongyliasis (AA) is caused by the nematode Angiostrongylus costaricensis. Parasite-associated thrombosis of mesenteric vessels may lead to intestinal infarction, which might be prevented with anti-thrombotic agents. This study assessed the effect of enoxaparin on survival and pathological findings in Swiss mice with AA. In this experiment, 24 mice were infected with A. costaricensis (10 L3 per animal) followed by treatment with subcutaneous enoxaparin (40 mg/kg/day) or water (sham), starting from 15 days post-infection (dpi) and continued until animal death. Animals were monitored until death or sacrifice at the 50th dpi. Ten mice (42%) were dead after 36 ± 8 dpi. Of these, five (50%) were treated with enoxaparin. Animals treated with enoxaparin and sham did not differ in terms of weight loss (median, 1.3 vs. 4.2 g; P = 0.303) and macroscopical findings. Microscopically, no difference was found in regard to vascular granuloma (median grade, 2 vs. 3; P = 0.293) and presence of either vasculitis (75% vs. 100%; P = 0.217), mesenteric thrombosis (33% vs. 50%; P = 0.680), or bowel necrosis (25% vs. 50%; P = 0.400). Mice dead before the 50th dpi showed more pneumonia (90% vs. 21%; P = 0.002), bowel infarction (40% vs. 0%; P = 0.02), and purulent peritonitis (60% vs. 7%; P = 0.008) compared to survivors. Prophylactic enoxaparin in mice did not prevent tissue damage and mortality related with AA. The lower prevalence of mesenteric thrombosis and bowel infarction regardless of treatment were notorious. Frequent septic complications suggest the need of studies addressing the effect of antibiotics in AA.

Angiostrongylus vasorum (French heartworm) in a dog imported into Australia.

This report describes a case of Angiostonglyus vasorum infection, sometimes referred to as French heartworm disease, in a dog imported into Western Australia from the United Kingdom. Diagnosis was made by identification of first stage larvae on fine needle aspiration of a consolidated lung lobe. First stage larvae were also identified in the faeces by the Baermann technique. The main clinical signs in this case were coughing and tachypnoea. The dog was treated successfully with fenbendazole at 50 mg/kg once daily for 10 days.

Phenantroline, lovastatin, and mebendazole do not inhibit oviposition in the murine experimental infection with Angiostrongylus costaricensis.

Abdominal angiostrongyliasis is a zoonotic infection produced by a metastrongylid intra-arterial nematode, Angiostrongylus costaricensis. Human accidental infection may result in abdominal lesions. The presence of the eggs in the tissues plays an essential role in morbidity of abdominal angiostrongyliasis. The objective of this study is to evaluate and compare the effects of lovastatin, phenanthrolin, and mebendazole on oviposition of A. costaricensis in a murine experimental model. Each group of 12 male Swiss mice (Mus musculus) was orally infected with 10 L3 of the "Santa Rosa" strain of A. costaricensis. Two control groups were established: (1) mice were infected and not treated; (2) noninfected and nontreated animals. The experimental groups received (1) lovastatin TL), at a daily dose of 250 mg/kg for 10 consecutive days 16 days after infection; (2) phenanthroline at a daily dose of 20 mg/kg for 5 consecutive days 21 days after infection; and (3) mebendazole at a daily dose of 5 mg/kg for 5 consecutive days 21 days after infection. There was no significant inhibition of oviposition for lovastatin- and mebendazole-treated animals, whereas phenanthroline was associated with the lowest averages of larviposition per postinfection day and significant reduction of mortality.

Drug trials for treatment of human angiostrongyliasis.

Abdominal and cerebral angiostrongyliasis are two important infections produced by metastrongylid worms, the former occurring in Central and South America and the later in Asia and Pacific Islands. Drug treatment is a challenge since the worms and its evolving larvae live or migrate inside vessels and efficient killing of the parasites may produce more severe lesions. Larvicidal effect of certain drugs appears to be more easily accomplished but this outcome is not useful in abdominal angiostrongyliasis since clinical manifestations appear to result from sexual maturation of the worms. We review the drug trials in murine experimental models and conclude that most of them could not be considered good candidates for treatment of human infection, except for PF1022A, pyrantel and flubendazole.

A method to obtain axenic Angiostrongylus vasorum first-stage larvae from dog feces.

An improved method to obtain a large number of axenic larvae of Angiostrongylus vasorum from fecal samples was developed in the present study. The procedure here in reported consisted of obtaining larvae using a modified Baermann technique, followed by an additional filtration step. This isolation technique recovered almost 90% of the living larvae in a clean preparation. Isolated larvae were submitted to decontamination treatments with either sodium hypochlorite or antibiotic cocktail solutions. The axenic status, as confirmed by oral inoculation of decontaminated larvae into germ-free mice, was only achieved using larvae treated with 0.5% sodium hypochlorite solution for 10 min. The isolation and decontamination treatment did not affect larval viability. Treated larvae remained viable and infective to the invertebrate host.

Inactivation of infective larvae of Angiostrongylus costaricensis with short time incubations in 1.5% bleach solution, vinegar or saturated cooking salt solution.

Angiostrongylus costaricensis is a nematode parasite of wild rodents in the Americas. Man may become infected accidentally and, sometimes, suffers a very severe abdominal disease. Ingestion of raw vegetables has been proven to be a risk factor for the acquisition of A. costaricensis and, therefore, prophylaxis should include food disinfection. The larvicidal effect of wine vinegar, saturated cooking salt (SS) and a 1.5% bleach solution (BW) were compared with a 1-h-incubation period, at room temperature. Larval viability was tested through inoculation in Swiss mice. Only one out of 560 larvae treated with BW (97.3% of the animals were uninfected) was recovered as an adult worm, while 90/336 and 29/512 larvae treated, respectively, with SS and WV were recovered as adult worms. This larvicidal effect of BW was seen also in incubation times as short as 15 min. In conclusion, the 1.5% bleach solution may be helpful for prophylaxis of human abdominal angiostrongyliasis through disinfection of raw vegetables and unpeeled fruits.

Effects of anthelmintics on the development of eggs of Angiostrongylus costaricensis in vitro.

Effects of the anthelmintics, pyrantel and levamisole, on egg development of Angiostrongylus costaricensis were studied in vitro. After 7 days, about 80% of eggs developed to first-stage larvae in Ham's F-12 medium with 10% foetal calf serum under 5% CO2. Significant inhibition of development was caused by pyrantel (10(-9) - 10(-8) g ml(-1)) and levamisole (10(-9) - 10(-8) g ml(-1)) (Mann-Whitney U-test; ), and none of the eggs developed to first-stage larvae in higher concentrations of these anthelmintics (10(-7) g ml(-1)). Furthermore, incubation with these drugs at 10(-8) g ml(-1) for at least 3 h or at 10(-4) g ml(-1) for 1 h caused irreversible effects on egg development.

Effects of nucleic acid inhibitors on the development of Angiostrongylus costaricensis in vitro.

Nucleic acid biosynthesis of Angiostrongylus costaricensis was examined with various inhibitors; aminopterin (inhibitor of purine and pyrimidine de novo biosynthetic pathways), 8-azaguanine (specific inhibitor of purine salvage pathway) and PALA (specific inhibitor of pyrimidine de novo biosynthetic pathway) were applied in in vitro culture developing from the third stage larvae to young adult in chemically defined medium. It was suggested that A. costaricensis possessed functional purine and pyrimidine de novo biosynthetic pathways and also that they could utilize exogenous sources of purines and pyrimidines by salvage pathways for their development.

Effects of amorphous and polymorphs of PF1022A, a new antinematode drug, on Angiostrongylus costaricensis in mice.

To enhance the bioavailability of PF1022A (cyclo(D-lactyl-L-N-methylleucyl-D-3-phenyllactyl-L-N-met hylleucyl-D-lactyl-L-N-methylleucyl-D-3-phenyllactyl-L-N- methylleucyl)), a newly developed antinematode drug, we examined whether the new drug has polymorphism or not. First, four forms of PF1022A, designated as form alpha, form I, form II and form III of PF1022A, were prepared. By examining physicochemical properties of these forms by various methods including X-ray powder diffractometry and differential scanning calorimetry, it became apparent that PF1022A had one amorphous (form alpha) and three crystalline polymorphic forms, form I, form II and form III. Secondly, a dissolution study was carried out, and form alpha and form III were found to have higher solubility than form I and form II. Thirdly, anti-larval effects of the 4 forms of PF1022A on tissue-dwelling nematode, Angiostrongylus costaricensis, in mice were compared when given orally for 5 successive days at 10 or 40 mg/kg/day. Significant effects were observed in almost all parameters in host mice and worms in the groups treated with form alpha or form III, each at 40 mg/kg, but form I and form II had little effect. The present results suggest that PF1022A has polymorphism and that the form alpha and form III were more effective against tissue-dwelling nematodes than the form I and form II when given orally.