Nitric oxide debilitates the neuropathogenic schistosome Trichobilharzia regenti in mice, partly by inhibiting its vital peptidases.

BACKGROUND: Avian schistosomes, the causative agents of human cercarial dermatitis (or swimmer's itch), die in mammals but the mechanisms responsible for parasite elimination are unknown. Here we examined the role of reactive nitrogen species, nitric oxide (NO) and peroxynitrite, in the immune response of mice experimentally infected with Trichobilharzia regenti, a model species of avian schistosomes remarkable for its neuropathogenicity. METHODS: Inducible NO synthase (iNOS) was localized by immunohistochemistry in the skin and the spinal cord of mice infected by T. regenti. The impact of iNOS inhibition by aminoguanidine on parasite burden and growth was then evaluated in vivo. The vulnerability of T. regenti schistosomula to NO and peroxynitrite was assessed in vitro by viability assays and electron microscopy. Additionally, the effect of NO on the activity of T. regenti peptidases was tested using a fluorogenic substrate. RESULTS: iNOS was detected around the parasites in the epidermis 8 h post-infection and also in the spinal cord 3 days post-infection (dpi). Inhibition of iNOS resulted in slower parasite growth 3 dpi, but the opposite effect was observed 7 dpi. At the latter time point, moderately increased parasite burden was also noticed in the spinal cord. In vitro, NO did not impair the parasites, but inhibited the activity of T. regenti cathepsins B1.1 and B2, the peptidases essential for parasite migration and digestion. Peroxynitrite severely damaged the surface tegument of the parasites and decreased their viability in vitro, but rather did not participate in parasite clearance in vivo. CONCLUSIONS: Reactive nitrogen species, specifically NO, do not directly kill T. regenti in mice. NO promotes the parasite growth soon after penetration (3 dpi), but prevents it later (7 dpi) when also suspends the parasite migration in the CNS. NO-related disruption of the parasite proteolytic machinery is partly responsible for this effect.

Isoforms of Cathepsin B1 in Neurotropic Schistosomula of Trichobilharzia regenti Differ in Substrate Preferences and a Highly Expressed Catalytically Inactive Paralog Binds Cystatin.

Schistosomula (the post-infective stages) of the neurotropic schistosome Trichobilharzia regenti possess multiple isoforms of cathepsin B1 peptidase (TrCB1.1-TrCB1.6) with involvement in nutrient digestion. The comparison of substrate preferences of TrCB1.1 and TrCB1.4 showed that TrCB1.4 had a very narrow substrate specificity and after processing it was less effective toward protein substrates when compared to TrCB1.1. Self-processing of both isoforms could be facilitated by sulfated polysaccharides due to a specific binding motif in the pro-sequence. Trans-activation by heterologous enzymes was also successfully employed. Expression profiling revealed a high level of transcription of genes encoding the enzymatically inactive paralogs TrCB1.5 and TrCB1.6. The transcription level of TrCB1.6 was comparable with that of TrCB1.1 and TrCB1.2, the most abundant active isoforms. Recombinant TrCB1.6wt, a wild type paralog with a Cys29-to-Gly substitution in the active site that renders the enzyme inactive, was processed by the active TrCB1 forms and by an asparaginyl endopeptidase. Although TrCB1.6wt lacked hydrolytic activity, endopeptidase, but not dipeptidase, activity could be restored by mutating Gly29 to Cys29. The lack of exopeptidase activity may be due to other mutations, such as His110-to-Asn in the occluding loop and Asp224-to-Gly in the main body of the mature TrCB1.6, which do not occur in the active isoforms TrCB1.1 and TrCB1.4 with exopeptidase activity. The catalytically active enzymes and the inactive TrCB1.6 paralog formed complexes with chicken cystatin, thus supporting experimentally the hypothesis that inactive paralogs could potentially regulate the activity of the active forms or protect them from being inhibited by host inhibitors. The effect on cell viability and nitric oxide production by selected immune cells observed for TrCB1.1 was not confirmed for TrCB1.6. We show here that the active isoforms of TrCB1 have different affinities for peptide substrates thereby facilitating diversity in protein-derived nutrition for the parasite. The inactive paralogs are unexpectedly highly expressed and one of them retains the ability to bind cystatins, likely due to specific mutations in the occluding loop and the enzyme body. This suggests a role in sequestration of inhibitors and protection of active cysteine peptidases.

Molecular evidence for distinct modes of nutrient acquisition between visceral and neurotropic schistosomes of birds.

Trichobilharzia species are parasitic flatworms (called schistosomes or flukes) that cause important diseases in birds and humans, but very little is known about their molecular biology. Here, using a transcriptomics-bioinformatics-based approach, we explored molecular aspects pertaining to the nutritional requirements of Trichobilharzia szidati ('visceral fluke') and T. regenti ('neurotropic fluke') in their avian host. We studied the larvae of each species before they enter (cercariae) and as they migrate (schistosomules) through distinct tissues in their avian (duck) host. Cercariae of both species were enriched for pathways or molecules associated predominantly with carbohydrate metabolism, oxidative phosphorylation and translation of proteins linked to ribosome biogenesis, exosome production and/or lipid biogenesis. Schistosomules of both species were enriched for pathways or molecules associated with processes including signal transduction, cell turnover and motility, DNA replication and repair, molecular transport and/or catabolism. Comparative informatic analyses identified molecular repertoires (within, e.g., peptidases and secretory proteins) in schistosomules that can broadly degrade macromolecules in both T. szidati and T. regenti, and others that are tailored to each species to selectively acquire nutrients from particular tissues through which it migrates. Thus, this study provides molecular evidence for distinct modes of nutrient acquisition between the visceral and neurotropic flukes of birds.

Thermal preferences of bird schistosome snail hosts increase the risk of swimmer's itch.

Ambient temperature strongly affects host parasite interactions, especially when both are ectothermic. Bird schistosomes, which cercariae are known as agents of swimmer's itch and their snail hosts can be a good example of this phenomenon. The snails of these parasites play the key role, as the source of harmful larvae. Cercarial dermatitis is noted even in areas when prevalence of parasites in snail populations is very low. The main question is what adaptation in snail-fluke association can lead to a sufficient number of cercariae causing swimmer's itch in lake water? The influence of ambient temperature on snail survival and cercarial production as well as the thermal preferences of two host species naturally infected with bird schistosomes were studied. The 24-h preferences of Lymnaea stagnalis infected with Trichobilharzia szidati, and Planorbarius corneus infected with Bilharziella polonica were recorded using an oblong thermal gradient set (OTGS). Both cercariae releasing hosts of bird schistosomes preferred a significantly lower temperature than non-infected snails. Additionally, at a higher temperature, the survival of snail hosts was shortened as a result of the increase in daily cercarial expulsion. An especially interesting result concerns the release of a significantly larger total cercariae number by L. stagnalis at lower than at higher temperatures. These data indicate that preferences of infected snails to low temperature microhabitats can increase host survival and parasite success, as well as affecting the increase in the number of invasive larvae in the environment increasing the risk of swimmer's itch.

Molecular diversity of avian schistosomes in Danish freshwater snails.

Avian schistosomes are widespread parasites of snails and waterfowl and may cause cercarial dermatitis (swimmer's itch) in humans, a disease that is frequently reported in European countries. These parasites are known to occur in Denmark, but here, we applied a new approach using molecular tools to identify the parasites at species level. In order to do that, 499 pulmonate freshwater snails (Radix sp., Lymnaea stagnalis, Stagnicola sp. and Planorbarius corneus) were sampled from 12 lakes, ponds, and marshes in the greater Copenhagen area. Avian schistosome cercariae were identified by microscopy and subjected to molecular investigation by sequencing and phylogenetic analysis of the 5.8S and ITS2 ribosomal DNA for species identification. Additionally, snail hosts belonging to the genus Radix were identified by sequencing and phylogenetic analysis of partial ITS2 ribosomal DNA. Three out of 499 snails shed different species of Trichobilharzia cercariae: Trichobilharzia szidati was isolated from L. stagnalis, Trichobilharzia franki from Radix auricularia and Trichobilharzia regenti from Radix peregra. In the light of the public health risk represented by bird schistosomes, these findings are of concern and, particularly, the presence of the potentially neuro-pathogenic species, T. regenti, in Danish freshwaters calls for attention.

Cercarial dermatitis transmitted by exotic marine snail.

Cercarial dermatitis (swimmer's itch) is caused by the penetration of human skin by cercariae of schistosome parasites that develop in and are released from snail hosts. Cercarial dermatitis is frequently acquired in freshwater habitats, and less commonly in marine or estuarine waters. To investigate reports of a dermatitis outbreak in San Francisco Bay, California, we surveyed local snails for schistosome infections during 2005-2008. We found schistosomes only in Haminoea japonica, an Asian snail first reported in San Francisco Bay in 1999. Genetic markers place this schistosome within a large clade of avian schistosomes, but do not match any species for which there are genetic data. It is the second known schistosome species to cause dermatitis in western North American coastal waters; these species are transmitted by exotic snails. Introduction of exotic hosts can support unexpected emergence of an unknown parasite with serious medical or veterinary implications.

Penetration of Trichobilharzia cercariae into mammals: dangerous or negligible event?

Bird schistosomes and cases of human cercarial dermatitis occur worldwide, but the number of cases is not monitored. Experiments with two schistosomes, namely Trichobilharzia szidati and T. regenti, show that they possess potent tools to penetration bird and mammalian skin, as well as exhibit species-specific migration patterns within vertebrate bodies. Therefore, the infections may affect different organs/tissues e.g. lungs or spinal cord. In this minireview, the adaptations and pathogenic effects of bird schistosomes in experimental mammals are discussed, and some ideas/hypotheses on risks to humans from exposure to bird schistosome cercariae are expressed.

Molluscan and vertebrate immune responses to bird schistosomes.

There is a growing understanding of risks posed by human contact with the cercariae of bird schistosomes. In general, there are no fundamental biological differences between human and bird schistosomes in terms of their interactions with snail and vertebrate hosts. The penetration of host surfaces is accompanied by the release of penetration gland products and the shedding of highly antigenic surface components (miracidial ciliated plates and cercarial glycocalyx) which trigger host immune reactions. New surface structures are formed during transformation: the tegument of mother sporocysts and the tegumental double membrane of schistosomula. These surfaces apparently serve as protection against the host immune response. Certain parasite excretory-secretory products may contribute to immunosuppression or, on the other hand, stimulation of host immune reactions. Discovery of new species and their life cycles, the characterization of host-parasite interactions (including at the molecular level), the determination of parasite pathogenicity towards the host, the development of tools for differential diagnosis and the application of protective measures are all topical research streams of the future. Regularly updated information on bird schistosomes and cercarial dermatitis can be found at http://www.schistosomes.cz (web pages of Schistosome Group Prague).

[Cercarial dermatitis]. / La dermatite cercarienne.

A POTENTIAL PUBLIC HEALTH PROBLEM: Cercarial dermatitis is caused by the infestation of the skin by cercariae of nonhuman schistosomes whose commonest hosts are aquatic birds. Human contamination can occur during swimming in fresh water infested with cercariae and notably ducks. Its geographic distribution is worldwide and is increasingly described in France during the summer months. FROM A CLINICAL POINT OF VIEW: A diffuse eruption composed of prurigenous maculopapules appears within the 24 hours following exposure. Regression is spontaneous within one day to three weeks. PREVENTION IS ADVISABLE: Treatment is symptomatic in the majority of patients. The optimal prevention, for bathers, is to swim in sufficiently deep water.

The severity of mouse pathologies caused by the bird schistosome Trichobilharzia regenti in relation to host immune status.

Cercariae of the nasal bird schistosome Trichobilharzia regenti are able to penetrate into mammalian skin and migrate to the mouse central nervous system (CNS) causing tissue injury in certain cases. Our study shows that the severity of T. regenti pathologies in the CNS closely depends on the host immune status. During the primary infection of immunocompetent mice, the parasites evoked an acute inflammatory reaction in the skin and the CNS involving focal oedema and cellular infiltration of the tissue. Challenge infections resulted in the development of extensive inflammatory foci in the host skin which precluded the subsequent migration of the schistosomula to the CNS. On the other hand, during primary as well as challenge infections of immunodeficient mice (SCID), no significant immune response against the parasites was detected in any of the host organs examined; however, in contrast to immunocompetent mice, the infections were frequently manifested by severe leg paralysis.

Neurotropic behaviour of Trichobilharzia regenti in ducks and mice.

The bird nasal schistosome Trichobilharzia regenti is a new agent of cercarial dermatitis. Cercariae are able to penetrate the skin of birds and mammals including man. The parasite then attacks the central nervous system. The present study has shown that schistosomula avoid penetration of blood capillaries and enter the peripheral nerves of the legs of mice and ducks as early as 1 day post-infection (p.i.) and 1.5 days p.i., respectively. These peripheral nerves are used as a route to the spinal cord. In the specific host (duck) schistosomula were found in the spinal cord from 2 days p.i. until 15 days p.i. and in the brain from 12 days p.i. until 18 days p.i. In non-specific hosts (mice; inbred strains BALB/c, hr/hr, SCID) living schistosomula were found in the spinal cord from 2 days p.i. until 21 or 24 days p.i. (depending on the mouse strain) and in the brain of two (BALB/c, SCID) of three inbred strains from 3 days p.i. until 24 days p.i. No correlation was found between the infection dose and clinical status of the experimental hosts. A high affinity of schistosomula for the peripheral nerves was also proved in vitro, suggesting a new type of migratory behaviour in schistosomatids.

Genetic variability among cercariae of the Schistosomatidae (Trematoda: Digenea) causing swimmer's itch in Europe.

Ribosomal DNA sequences of the internal transcribed spacer 1 (ITS1) were obtained from schistosome cercariae responsible for swimmer's itch in Europe. Two types of ITS1 (1100 and 1400), which differ by the number of repeated patterns were found among cercariae shedded by Lymnaea ovata and L. auricularia (Lymnaeidae). A phylogenetic analysis of the ITS1 region showed that sequences of each type form two well-defined clades. An adult of Trichobilharzia regenti isolated from the nasal vessels of Anas platyrhynchos (Anatidae) was found to correspond to the cercaria type 1400. The sequencing of several ITS1 clones from a single cercaria of each type, as well as a specific PCR-based test suggested that both ITS1 types do not co-occur within a single individual.

Recognition of cattle skin by cercariae of Orientobilharzia turkestanica.

The cercariae of Orientobilharzia turkestanica attached to isolated cattle skin and penetrated it. The attachment was stimulated by warmth and by hydrophilic and lipophilic chemical cues of skin surface extracts. The enduring contact with the skin was also stimulated by the chemical cues, but not by warmth. Penetration of the cercariae into agar substrates was triggered by skin surface lipids, and free fatty acids were identified as the exclusively active compounds of the lipids. That the cercariae attach and remain on the skin by responding to at least two different chemical host cues is unique among the schistosomatids studied so far. It might reflect an adaptation to invade the hosts in clear water or near the water surface where chemical mud compounds will not interfere with host recognition.

Histopathology of CNS and nasal infections caused by Trichobilharzia regenti in vertebrates.

In bird infections caused by Trichobilharzia regenti, the central nervous system (CNS) represents probably the main route to the nasal cavity, where maturation of the parasite occurs. However, in an abnormal mouse host, development is incomplete and is accompanied by a strong affinity of the parasite to the CNS. In order to explain pathological changes caused by the parasite, a histological study of cross-sections from the CNS and nasal cavity was performed. In the CNS of duck and mouse, immature flukes were found. Cross-sections showed parasites located either in meninges or in matter of various parts of the spinal cord and brain. In the spinal cord, the submeningeal location led to a strong inflammatory reaction around the schistosomula and resulted in eosinophilic meningitis. In the white and gray matter of the spinal cord and in the white matter of the brain, a cellular infiltration of spongy tissue surrounded the immature parasites; and we observed dystrophic and necrotic changes of neurons, perivascular eosinophilic inflammation in the spinal cord and brain, and cell infiltration around the central canal of the spinal cord. T. regenti adults and eggs were detected in the nasal mucosa of infected ducklings; and aging of the eggs resulted in various host reactions, ranging from focal accumulation of cells to the formation of granulomas. Histopathological changes may explain symptoms described previously for prepatent and patent phases of infections caused by T. regenti, i.e., neuromotor abnormalities in birds and mammals and hemorrhages/petechiae in birds, respectively.

Trichobilharzia regenti, a pathogen of the avian and mammalian central nervous systems.

The development of nasal avian schistosomes of the genus Trichobilharzia in their final host is poorly known. Therefore, an experimental infection of ducklings (Anas platyrhynchos f. dom.) by T. regenti was performed. The infection resulted in leg paralysis and orientation/balance disorders of birds. The examination of the duck's spinal cord and brain confirmed the presence of developing parasites in pre-patent as well as patent periods. The absence of the worms in other tissues strongly supports our hypothesis that the parasite migrates through the central nervous system (CNS) to its final location in bird nasal mucosa. The injury level is probably dependent on number of parasites as well as yet unknown host factors. The affinity to the CNS seems to be high; also by exposure of experimental animals to low cercarial doses the growing worms in the CNS were found. In addition to the generally accepted view that bird schistosomes may cause cercarial dermatitis of mammals (including man), there is evidence of a partial development of T. regenti in mouse CNS; in certain cases leg paralysis was also recorded. Therefore, the pathogenesis spectrum caused by bird schistosomes in birds/mammals needs to be reconsidered.

Skin surface lipids of the domestic chicken, and neutral lipid standards as stimuli for the penetration response of Austrobilharzia variglandis cercariae.

Lipids were extracted from the skin of 2-wk-old domestic chickens using sterile cotton gauze dampened with chloroform:methanol (2:1). Preparative thin-layer chromatography separated the skin lipids into six major fractions: phospholipids, free sterols, free fatty acids, triglycerides, methyl esters, sterol esters. The penetration response of the marine avian schistosome cercaria, Austrobilharzia variglandis, to chicken skin lipid fractions, and to neutral lipid standards, was tested by coating lipids on agar in a Petri dish containing a seawater overlay. All neutral lipids tested produced significantly greater penetration responses than the chloroform control. The phospholipid skin fraction killed cercariae. Lipid from whole chicken skin produced the greatest penetration response, followed by free fatty acids and free sterol skin fractions. Of the standards tested, the whole neutral lipid standard, containing cholesterol, oleic acid, triolein, methyl oleate, and cholesteryl oleate, produced the greatest response, followed by the cholesterol standard and the oleic acid standard.