Extraintestinal amebiasis in infancy: report of three patients and epidemiologic investigations of their families.

Three infants (aged 6 weeks, 7 weeks, and 10 months) had severe Entamoeba histolytica infections characterized by colitis, hepatic abscesses, and peritonitis. The two younger children died after fulminant illnesses while the third recovered. Diagnosis was delayed in all three children by a low index of suspicion and negative stool examinations for parasites. Epidemiologic investigations of the infants' families revealed a high prevalence of amebic infections and elevated antibody titers to E histolytica; however, most family members were asymptomatic. The original source of the infections could not be identified but person-to-person spread within the families was implicated.

Characterization of the heat-shock response of Trichomonas vaginalis.

The heat-shock response induced in Trichomonas vaginalis by exposure to various incubation temperatures was traced by metabolic labeling and monitored by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and fluorography. Increasing the incubation temperature from 37 degrees C to 43 degrees C depressed normal protein production and enhanced synthesis of heat-shock proteins (hsp). Smaller increases in incubation temperature resulted in little change in protein synthesis, whereas larger temperature increases inhibited protein synthesis. The hsp produced by T. vaginalis included molecules with approximate molecular masses of 85, 78, 66, 61, 35-31, 20-15, and 12 kD. Trichomonas vaginalis switched to hsp synthesis gradually. Full conversion to hsp production occurred within 60-90 min after the initiation of the 43 degrees C stress. The period of synthesis was different for individual hsp, suggesting independent regulation of hsp production. Four strains of freshly reinitiated and culture-adapted (extended in vitro culture) T. vaginalis synthesized the 85-, 78-, and 66-kD hsp, but varied in the synthesis of the 61-, 35-, 34-, 32-, and 31-kD molecules. Culture adaptation affected the heat-shock response of two of the four strains tested.

Oxidative stress and Trichomonas vaginalis: the effect of hydrogen peroxide in vitro.

The oxidative stress response induced in Trichomonas vaginalis by exposure to various concentrations of hydrogen peroxide (H2O2) was traced by metabolic labeling and monitored by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and fluorography of trichloroacetic acid-precipitated proteins. Concentrations of H2O2 > 450 microM decreased incorporation of radiolabel into protein and altered protein synthesis resulted in a banding pattern similar to the heat shock protein profile. The proteins produced by oxidative stress included molecules with average molecular masses of 145-165, 92-84, 66, 43-46, and 35-36 kD. Oxidative stress induced changes in T. vaginalis protein synthesis slowly. Full conversion to oxidative stress response occurred within 150-180 min after stress initiation. The oxidative stress responses of three strains freshly initiated from stabilates were compared with the responses of the same strains cultured in vitro for extended periods (culture adapted). Both freshly initiated and culture adapted T. vaginalis of the three strains synthesized the 92-84- and 66-kD heat shock proteins but differed in the synthesis of the 74-75-, 43-, and 35-36-kD molecules. Culture adaptation did not modify the oxidative stress response of the three strains tested.

Characterization of a secreted cytoactive factor from Trichomonas vaginalis.

Trichomonas vaginalis, grown in Dulbecco's modified Eagle's medium with or without serum, produced a factor (TVF) which altered the morphology of certain mammalian cells in vitro. TVF had a Mr of approximately 250 kDa by gel filtration, approximately 50 kDa by SDS-PAGE, and was heat (56 degrees C, 30 min) and pH (greater than 6 or less than 8) labile. Co-incubation of TVF with adherent target cells caused a marked rounding and clumping of BHK-21 or CHO-K1 cells, but had no effect on RK-13 or WEHI-3 cells. These morphologic changes were concentration, time, and energy dependent. Reversibility was attained by exogenous serum addition (greater than 10%) or TVF washout. Target cell perturbations were not accompanied by significant changes in growth (as measured by nuclei counts, DNA content, or 3H-thymidine incorporation), in cell leakage (as assessed by lactate dehydrogenase release), or in cell viability (by trypan blue dye exclusion). TVF-induced effects were independent of cyclic AMP and cyclic GMP levels in BHK cells exposed for 5 min-24 hr.

Use of intravaginal microbicides to prevent acquisition of Trichomonas vaginalis infection in Lactobacillus-pretreated, estrogenized young mice.

D2A21, a novel peptide antibiotic has in vitro activity against a wide spectrum of sexually transmitted diseases (STD). In this study we tested the hypothesis that intravaginal D2A21 would interfere with acquisition of Trichomonas vaginalis infection in a modified mouse model. T. vaginalis infections of estrogenized young mice pretreated with Lactobacillus vaginalis or Lactobacillus rhamnosus were more frequent and persistent than those in mice pre-treated with Lactobacillus gasseri or Lactobacillus acidophilus. One hundred percent T. vaginalis infection was achieved for 2-4 days post-challenge when intravaginal L. rhamnosus pre-treatments were given to estrogenized mice 48 hr prior to a single T. vaginalis challenge. Estrogenized mice pre-treated with L. rhamnosus were pre-medicated with intravaginal placebo gel, 0.5% or 2% D2A21 gel, or 500 microg/mL metronidazole gel prior to T. vaginalis challenge. Both 2% D2A21 and metronidazole gels were significantly more efficacious (10% or none infected) than placebo gel (53% infected) in preventing vaginal T. vaginalis infections in mice.

Molecular typing of Trichomonas vaginalis isolates by HSP70 restriction fragment length polymorphism.

Subtyping isolates of Trichomonas vaginalis is an essential tool for understanding the epidemiology of this common sexually-transmitted disease. Restriction fragment length polymorphism (RFLP) analysis employing a probe from the heat-inducible cytoplasmic HSP70 gene family hybridized with EcoR I-digested genomic DNA was used in the molecular typing of Trichomonas isolates. Analysis of five American Type Culture Collection (ATCC) reference strains and 31 Jackson, Mississippi, isolates from six male and 21 female patients, revealed 10 distinct RFLP pattern subtypes of Trichomonas. The subtypes were temporally stable and cosmopolitan. The RFLP profiles seen in Maryland, Ohio, Massachusetts, and New York ATCC strains were identical to those of some Mississippi isolates, even though the samples were isolated 10-35 years apart. There was no correlation between metronidazole resistance and RFLP subtype with resistant isolates from eight patients distributed among six different subtypes.

Inhibition of Entamoeba histolytica cytotoxin by alpha 1 antiprotease and alpha 2 macroglobulin.

We previously reported partial purification of a proteinaceous substance with cytotoxic and enterotoxic activity isolated from the soluble fraction of sonicated axenically cultivated Entamoeba histolytica trophozoites. Demonstration of cytotoxic activity of the preparation (amebal toxin) was dependent on removal of serum from the tissue culture assay system. The objective of the present study was to identify the factor(s) in non-immune sera responsible for producing in vitro inhibition of amebal toxin cytotoxicity on HeLa cells. Gel filtration of non-immune sera from adult humans or bovines demonstrated that two portions of the eluate had significant inhibitory against the toxin. A high molecular weight inhibitory fraction was identified as predominantly alpha-2 macroglobulin and a low molecular weight inhibitory fraction was identified as predominantly alpha-1 antiprotease. Preparative isoelectric focusing of human serum isolated inhibitory fractions containing these same alpha globulins. Alpha-2 macroglobulin was purified and alpha-1 antiprotease was partially purified from human serum by other methods and shown to have high inhibitory activity against the amebal cytotoxin. Substances that were inhibitory to the cytotoxic activity of the amebal toxin also mediated reattachment of toxin treated HeLa cells. We conclude that the characteristics of the serum inhibitors, especially their ability to reverse the cytotoxic effects of amebal toxin on HeLa cells, suggests that the amebal toxin has protease activity.

Trichomonas vaginalis: preliminary characterization of a sperm motility inhibiting factor.

This study determined the effects of Trichomonas vaginalis trophozoites, subcellular fractions, and medium from axenic T. vaginalis cultures on human sperm motility and viability. Spent medium (pH 7.0) caused complete cessation of sperm motility after 15 minutes incubation. Trophozoite soluble fraction or formalin-killed trophozoites caused a 50 percent reduction in sperm motility, compared to 25 percent reduction caused by the trophozoite particulate fraction or the sterile medium and three percent by saline (control). Spent medium from T. vaginalis cultures reaching stationary growth phase produced the greatest reduction in sperm motility, suggesting that potency was related to time in culture and trophozoites per ml. The T. vaginalis spermicidal activity was heat-stable, trypsin-sensitive, and had a molecular weight of 12-15,000 by gel filtration. This proteinaceous substance was present in and secreted by T. vaginalis trophozoites during normal growth in axenic culture. Since this T. vaginalis byproduct rapidly killed sperm in vitro, its effects in humans may contribute to infertility in infected couples.

Sequential histopathology of cavitary liver abscess. Formation induced by axenically grown Entamoeba histolytica.

Multiple hamster liver passage of Entamoeba histolytica trophozoites with intervening recovery into axenic culture caused increased virulence as measured by increase in the size of the lesion produced. Lesions produced by amebae that had not been liver-passaged did not persist; however, multiply liver-passaged substrains produced large, fluid-filled abscesses one month to six weeks after inoculation. Six days after inoculation, lesions consisted of multiple granulomas, lymphocytes, and E histolytica trophozoites. Large, fluid-filled abscesses produced by liver-passaged substrains lacked the granulomatous appearance of the earlier lesions. The abscesses had a fibrous wall, with E histolytica trophozoites at the inner aspect. To our knowledge, the evolution of early granulomatous lesions into a cavitary abscess with features closely resembling those of human amebic abscess has not been reported previously in the experimental disease in the hamster.

Scanning electron microscopy of the cecal mucosa in Eimeria-tenella-infected and uninfected chickens.

Four major types of surface conformation were observed in the ceca of uninoculated control chickens. Spatulate villi were found in the cecal neck region, low ridges in the region where the neck expands, protruding collarlike structures in the mid cecal pouch, and flattened collars in the distal portion. In ceca infected with Eimeria tenella, there was some erosion and sloughing of the mucosal cells. These lesions were slight in the neck region, more severe in the dilated portion, most severe in the midregion, and moderate in the distal area. Oocysts were observed in the mucosal tissue of the cecal pouch.

Immunocytochemical localization of mouse alpha 2-macroglobulinlike antigenic determinants on Schistosoma mansoni adults.

Antiserum prepared in rhesus monkeys against purified mouse alpha 2-macroglobulin (alpha2M) was labeled with peroxidase and incubated with both living and formalin-fixed S. mansoni adults (perfused from mice or rhesus monkeys) in order to test for the presence of mouse alpha2M antigenic determinants on their surfaces. Following standard cytochemical processing with the appropriate controls, adult worms of both murine and primate origin were found to have mouse alpha2M-like determinants on their surfaces. Earlier observations by other methods on the presence, approximate distribution, and quantitative difference of alpha2M antigenic determinants on adult worms of mouse or rhesus origin were confirmed.

Trichomonas vaginalis: characterization of its glutamate dehydrogenase.

An NADP-linked glutamate dehydrogenase (EC 1.4.1.4) was found in the soluble fraction of Trichomonas vaginalis. Its molecular weight was about 230,000 (gel filtration). The enzyme, partially purified by diafiltration and hydroxyapatite column chromatography, was heat stable (1 hr at 57 C). It catalyzed both the amination of alpha-ketoglutarate (mean Km 0.6 mM) and the deamination of glutamate (mean Km 1.2 mM) The optimum pH of the amination reaction was 6.7, and that of the deamination reaction was 8. Glutamate was a competitive inhibitor of the amination reaction (mean Ki 5.6 mM) and alpha-ketoglutarate a partially competitive inhibitor of the deamination reaction (mean Ki 0.45 mM). Both guanosine and inosine diphosphates (1 mM) increased the Km alpha-ketoglutarate fivefold (mean Ki's 0.3 and 0.4 mM, respectively). Guanosine diphosphate reduced the Km glutamate 40%. Adenosine di- and triphosphate (1 mM) were ineffective. Because the amination reaction displayed substrate inhibition, guanosine and inosine diphosphates were potent natural inhibitors, and ammonia released by deamination reactions would tend to raise pH (amination operative at acid pH), we hypothesize that the deamination reaction may predominate in the living organism.

Microscopic observations on the filopodia of Entamoeba histolytica.

Living Entamoeba histolytica trophozoites were examined by phase-contrast microscopy. Intact critical point dried trophozoites were examined by transmission electron microscopy at an accelerating voltage of 1000 kV (HVEM) and by scanning electron microscopy (SEM). Half and quarter micrometer thick sections of epoxy-embedded trophozoites were examined by HVEM. Many of the trophozoites of 2 strains examined had surface filopodia, 1 to over 100 micrometers in length. The cytoplasm of filopodia was continuous with the cytoplasm and bounded by surface plasmalemma bearing a glycocalyx. Structures called "surface-active lysosomes with trigger," "dendritic plasmalemmal extensions," and "extra-amebic vesicles" by previous investigators probably represent portions of filopodia demonstrated in the present study. Filopodia appear to be of frequent normal occurrence in E. histolytica and may function in: (a) endocytosis or pinocytosis; (b) exocytosis; (c) attachment to substratum; (d) penetration of tissue; (e) release of cytotoxic substances; or (f) contact cytolysis of host cells.

Three aspecific ATPases in Trichomonas vaginalis.

1. Three aspecific ATPases were found in the sedimentible fractions of Trichomonas vaginalis. 2. One, with a pH optimum of 5.5, was equally activated by Ca2+ or Mg2+, moderately stable, preferred nucleotide diphosphates as substrates, and was inhibited by vanadate, oligomycin, nitrate and Na+. 3. A second, with a pH optimum of 7.5, was activated by Mg2+, preferred guanosine diphosphate as substrate, and was the least stable and most subject to inhibitors (vanadate, oligomycin, NEM, NBD-Cl, azide and Cl-). 4. The third, pH optimum 8.0, was activated by Ca2+, was latent and the most stable, reacted equally well with nucleotide tri- or diphosphates, and was the least susceptible to inhibitors (vanadate and NEM). 5. All exhibited proton-translocating ability.

Entamoeba histolytica: purification of cathepsin B.

A cytotoxic cysteine proteinase with a molecular weight of 16,000 was isolated from axenically grown trophozoites of Entamoeba histolytica. The enzyme was purified from frozen-thawed strain HM-1 by ion-exchange chromatography on DEAE-cellulose, organomercurial agarose affinity chromatography, and size-exclusion chromatography. The purified enzyme had proteinase activity that could be demonstrated on azocasein (pH 5), hemoglobin (pH 5), or carbobenzoxy-L-arginyl--L-arginyl-7-amino-4-trifluoromethylcoumarin++ + (Z-arg-arg-AFC), a substrate specific for cathepsin B. Enzyme activity was stable to high pH, but not to 40 C for 1 hr or 56 C for 0.5 hr. As typical of cysteine proteinases, inhibition of activity on Z-arg-arg-AFC by p-chloromercuribenzoate or mercury was reversed by free sulfhydryl groups. Both the proteinase and cytotoxic activities of the purified amoebal cathepsin B were inhibited by leupeptin and serum and activated by free sulfhydryl groups, supporting the hypothesis that both activities are characteristics of amoebal cathepsin B. Virulent strains of E. histolytica (HM-1 and Rahman) had significantly more cathepsin B activity per milligram protein than less virulent strains (HK-9, Laredo, and Huff). The correlation between higher levels of cathepsin B activity in strains with greater virulence could indicate a role for amoebal cathepsin B in the pathogenesis of amoebiasis.

Attachment of bacteria to intestinal epithelial cells in diarrhea caused by Escherichia coli strain RDEC-1 in the rabbit: stages and role of capsule.

RDEC-1 is a strain of Escherichia coli that, in rabbits, attaches to intestinal mucosal epithelial cells bereft of microvillar borders and causes diarrhea by an unknown mechanism. The stages of attachment of RDEC-1 bacteria to mucosal epithelial cells were examined using high-voltage electron microscopy of thick (0.5-micrometers) sections of ileum and cecum of rabbits with diarrhea. The tissues were stained with ruthenium red or antisera to strain RDEC-1 OK antigens. Micrographs, including stereopairs, demonstrated several stages of bacterial attachment. Bacteria were attached to the glycocalyxes of epithelial cell microvilli and to pedestal-like extrusions of the surfaces of epithelial cells lacking microvilli. Structures consistent with bacterial pili were rarely visualized. Attachment to microvilli appeared to be a result of the interaction of polysaccharides of the microvillar glycocalyx and the K antigen of the bacterial capsule.

Proteinase activities of Entamoeba histolytica cytotoxin.

The proteinase activity of the low molecular weight cytotoxin of Entamoeba histolytica was correlated with its cytotoxicity. Gel-filtered amebal toxin (mol wt 10-30,000) proteinase activities could be assayed on azocasein at pH 6 or on hemoglobin at pH 4.5. Proteinase activity was inhibited by serum fractions, thiol reagents, heavy metals, leupeptin, and antipain. The cytotoxic activity of gel-filtered amebal toxin was inhibited by serum fractions, leupeptin, and antipain. Increased proteinase and cytotoxic activity was produced by treatment with cysteine. These data support the action of a thiol proteinase in the production of cytopathic effects by gel-filtered amebal toxin in vitro. The cytotoxic and proteinase activities were further purified using a combination of column chromatography and preparative isoelectric focusing. Two low molecular weight cytotoxins with proteinase activity on both substrates were isolated. The major cytotoxin had an isoelectric point of 4.5 and a molecular weight of 22,000; the other cytotoxin had a basic isoelectric point. These substances may be cathepsin B-like proteinase and elastase or cathepsin G-like proteinases of E. histolytica. The major proteinase activity in the high molecular weight fraction was not cytotoxic. The isoelectric points of the high molecular weight proteinase activities corresponded to that of mammalian cathepsin D. The major cell rounding cytotoxic activity of E. histolytica extracts in vitro is probably due to the activity of a thiol-containing cathepsin B-like proteinase.