Albendazole increases the inflammatory response and the amount of Em2-positive small particles of Echinococcus multilocularis (spems) in human hepatic alveolar echinococcosis lesions.

Franz J Ricken,Peter Moller,Julian Schmidberger,Peter Kern,Peter Deplazes,Tanja Kaltenbach,Juliane Nell,Thomas F E Barth,Doris Henne-Bruns,Andreas Hillenbrand,Beate Grüner,Wolfgang Kratzer

doi:10.1371/journal.pntd.0005636

Franz J Ricken, Peter Moller + Show 10 more

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https://doi.org/10.1371/journal.pntd.0005636

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Abstract

BackgroundAlveolar echinococcosis (AE) is caused by the metacestode stage of Echinococcus multilocularis. The inflammatory response to this infection is influenced by the interaction of the parasite with the host. We aimed to analyze human liver lesions infected with Echinococcus multilocularis and the changes of the cellular infiltrates during albendazole (ABZ) treatment.Methodology/Principal findingsWe analyzed liver tissue samples from 8 untreated patients, 5 patients treated with two daily doses of 400 mg ABZ for up to two months and 7 patients treated for more than two months with the same ABZ therapy. A broad panel of monoclonal antibodies was used to characterize the lesion by immunohistochemistry. A change in the cellular infiltrate was observed between the different chemotherapy times. During the initial phases of treatment an increase in CD15+ granulocytes and CD68+ histocytes as well as in small particles of Echinococcus multilocularis (spems) was observed in the tissue surrounding the metacestode. Furthermore, we observed an increase in CD4+ T cells, CD20+ B cells and CD38+ plasma cells during a longer duration of treatment.Conclusions/SignificanceABZ treatment of AE leads to morphological changes characterized by an initial, predominantly acute, inflammatory response which is gradually replaced by a response of the adaptive immune system.

Highlights

Human alveolar echinococcosis (AE), caused by the tapeworm Echinococcus multilocularis, is considered one of the most pathogenic zoonosis in humans with endemic areas in the Northern hemisphere and in Western China [1,2]
Alveolar echinococcosis (AE) is a life-threatening disease in humans caused by the larval stages of E. multilocularis
It has been shown that the infection in humans is associated with a modulated immune response

Summary

Introduction

Human alveolar echinococcosis (AE), caused by the tapeworm Echinococcus multilocularis, is considered one of the most pathogenic zoonosis in humans with endemic areas in the Northern hemisphere and in Western China [1,2]. The adult worms live in the intestine of canids, such as the red fox (Vulpes vulpes). Eggs are released into the environment through the feces of canids. In humans who accidentally ingest the eggs, the multi-vesicular metacestode shows a tumor-like growth pattern predominantly in the liver. Lifelong treatment is necessary if the patient has non-resectable lesions. Alveolar echinococcosis (AE) is caused by the metacestode stage of Echinococcus multilocularis. We aimed to analyze human liver lesions infected with Echinococcus multilocularis and the changes of the cellular infiltrates during albendazole (ABZ) treatment

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