Chronic Schistosoma Mansoni Infection Research Articles

Cysteinyl leukotriene receptor-1 as a potential target for host-directed therapy during chronic schistosomiasis in murine model.

Schistosomiasis remains the most devastating neglected tropical disease, affecting over 240 million people world-wide. The disease is caused by the eggs laid by mature female worms that are trapped in host's tissues, resulting in chronic Th2 driven fibrogranulmatous pathology. Although the disease can be treated with a relatively inexpensive drug, praziquantel (PZQ), re-infections remain a major problem in endemic areas. There is a need for new therapeutic drugs and alternative drug treatments for schistosomiasis. The current study hypothesized that cysteinyl leukotrienes (cysLTs) could mediate fibroproliferative pathology during schistosomiasis. Cysteinyl leukotrienes (cysLTs) are potent lipid mediators that are known to be key players in inflammatory diseases, such as asthma and allergic rhinitis. The present study aimed to investigate the role of cysLTR1 during experimental acute and chronic schistosomiasis using cysLTR1-/- mice, as well as the use of cysLTR1 inhibitor (Montelukast) to assess immune responses during chronic Schistosoma mansoni infection. Mice deficient of cysLTR1 and littermate control mice were infected with either high or low dose of Schistosoma mansoni to achieve chronic or acute schistosomiasis, respectively. Hepatic granulomatous inflammation, hepatic fibrosis and IL-4 production in the liver was significantly reduced in mice lacking cysLTR1 during chronic schistosomiasis, while reduced liver pathology was observed during acute schistosomiasis. Pharmacological blockade of cysLTR1 using montelukast in combination with PZQ reduced hepatic inflammation and parasite egg burden in chronically infected mice. Combination therapy led to the expansion of Tregs in chronically infected mice. We show that the disruption of cysLTR1 is dispensable for host survival during schistosomiasis, suggesting an important role cysLTR1 may play during early immunity against schistosomiasis. Our findings revealed that the combination of montelukast and PZQ could be a potential prophylactic treatment for chronic schistosomiasis by reducing fibrogranulomatous pathology in mice. In conclusion, the present study demonstrated that cysLTR1 is a potential target for host-directed therapy to ameliorate fibrogranulomatous pathology in the liver during chronic and acute schistosomiasis in mice.

Different panel of toll-like receptors expression during chronic Schistosoma mansoni infection in experimental animals

BackgroundMany studies have reported the immunomodulatory effect of helminths to avoid the lethal immunopathology. During schistosomiasis, the immune response is orchestrated by toll-like receptors (TLRs). Modulating TLRs can alter the function of antigen presentation cells with the shift of the host's Th1 response to a dominant regulatory Th2 response. The objective of our study was to clarify which TLRs are related to the immune response of chronic Schistosoma infection. MethodsThe study animals were divided into two groups; group I: uninfected mice; control group and group II: Schistosoma mansoni infected mice. mRNA expression of TLR2, 3, 4, 7, and 9 in different organs (liver, large intestine, and spleen) were assessed on day 90 post-infection. ResultsTLR gene expression has changed depending on the tissue studied as the mRNA level of TLR2, TLR7, and TLR9 were significantly upregulated in all examined organs while TLR3 expression showed only significant upregulation in the liver of infected mice. On the other hand, TLR4 expression was significantly upregulated in the liver while significantly downregulated in the large intestine. ConclusionThis study provides a better understanding of TLRs profile in different organs against S. mansoni parasites during the chronic phase of infection.

Schistosoma mansoni infection induces plasmablast and plasma cell death in the bone marrow and accelerates the decline of host vaccine responses.

Schistosomiasis is a potentially lethal parasitic disease that profoundly impacts systemic immune function in chronically infected hosts through mechanisms that remain unknown. Given the immunoregulatory dysregulation experienced in infected individuals, this study examined the impact of chronic schistosomiasis on the sustainability of vaccine-induced immunity in both children living in endemic areas and experimental infections in mice. Data show that chronic Schistosoma mansoni infection impaired the persistence of vaccine specific antibody responses in poliovirus-vaccinated humans and mice. Mechanistically, schistosomiasis primarily fostered plasmablast and plasma cell death in the bone marrow and removal of parasites following praziquantel treatment reversed the observed cell death and partially restored vaccine-induced memory responses associated with increased serum anti-polio antibody responses. Our findings strongly suggest a previously unrecognized mechanism to explain how chronic schistosomiasis interferes with an otherwise effective vaccine regimen and further advocates for therapeutic intervention strategies that reduce schistosomiasis burden in endemic areas prior to vaccination.

Abstract P138: Schistosoma Mansoni- Induced Shedding Of Extracellular Vesicles From Lung Microvascular Endothelial Cells

Introduction: Schistosomiasis-associated Pulmonary Arterial Hypertension (Sch-PAH) is a life-threatening complication of chronic Schistosoma mansoni infection. Sch-PAH is marked by obliteration and remodeling of the pulmonary vasculature in response to S. mansoni eggs. Remodeled and occluded vessels increase vascular resistance and can lead to heart failure and death. Currently, there are no target therapies for the treatment of Sch-PAH. Hypothesis: S. mansoni egg-derived antigens alter pulmonary endothelial cell (EC) Caveolin-1 (Cav-1) expression and phosphorylation contributing to the loading and shedding of extracellular vesicles (EVs), which in turn stimulates abnormal EC survival leading to Sch-PAH. Methods/Results: Immunohistology and western blot analysis of lungs from S. mansoni -infected mice revealed a significant decrease in Cav-1 expression in the egg-dependent granuloma area when compared to uninfected control animals, indicating that local S. mansoni -associated molecules and inflammatory mediators contribute to Cav-1 depletion. Previously we showed that upon vascular injury, Cav-1 deficiency leads to the survival of an abnormal EC phenotype through an unclear mechanism. Analysis of survival-associated genes in isolated lung ECs from Flk1 +/GFP ; Cav1 -/- mice, revealed a high expression of the anti-apoptotic BIRC2 and BIRC5 (known as c-IAP2 and surviving, respectively) when compared to control ECs. Interesting, in vitro exposure to the major S. mansoni egg antigen, Sm-p40 (1 μg/mL), induced time-dependent phosphorylation of Cav-1 Tyr14 in human lung microvascular ECs (HMVEC-L; 228.2 +/- 38.28% of control; p<0.05; n=4), which culminated in c-IAP2 expression. Furthermore, Sm-p40 treatment of HMVEC-L increased ERK1/2 phosphorylation, which in presence of pro-inflammatory mediators IL-6, TNF-a, and ATP, significantly increased the shedding of EVs implicating P-ERK1/2 in the mechanism of shedding of Cav-1-EVs. Conclusions: This work is uncovering the biological role and potential translational relevance of pathogen-induced EC-Cav-1 depletion via shedding of EVs during Sch-PAH.

Patients with severe schistosomiasis mansoni in Ituri Province, Democratic Republic of the Congo

BackgroundSevere hepatosplenic complications arise in patients with chronic Schistosoma mansoni infection after heavy exposure to disease agents in endemic areas. These complications are rarely reported and, hence, underestimated.Case presentationWe report on eight patients with severe morbidity associated with S. mansoni infection in Ituri Province, northeastern Democratic Republic of Congo (DRC). The patients were identified during a community-based survey in 2017; one patient was seen at the district hospital. After taking the patients’ history, a clinical examination and an abdominal ultrasonographical examination were performed. S. mansoni infection was diagnosed in fecal (Kato-Katz technique) and urine (point-of-case circulating cathodic antigen test) samples. These eight patients with severe intestinal and hepatosplenic complications were identified from four villages with high S. mansoni infection prevalence and related morbidity. The patients’ ages ranged from 19 to 57 years; four patients were women. Three patients reported hematemesis. Two patients were severely anemic. All patients reported non-specific abdominal symptoms, such as diarrhea (six patients), abdominal pain (seven patients), and blood in the stool (five patients), as well as weight loss (two patients). Abdominal ultrasonography revealed ascites in four patients. All patients had portal hypertension with hepatomegaly (seven patients) or splenomegaly (five patients). Of the six patients with a discernable liver parenchyma pattern, five displayed pattern F and three patient displayed pattern E. Liver parenchyma was not visible for two patients with severe ascites. An S. mansoni infection was confirmed in six patients, with infection intensity ranging from light to heavy. All S. mansoni positive patients were treated with praziquantel (40 mg/kg body weight) and referred to the district hospital for follow-up. One patient with severe ascites died two weeks after we saw her. Due to security and accessibility reasons, the villages could not be visited again and the patients were lost to follow-up.ConclusionsOur observations of patients with severe schistosomiasis document the severe degree of endemicity of S. mansoni in the province and suggest an urgent need for adequate schistosomiasis control measures that target vulnerable population groups and address severe complications.

SYNERGY BETWEEN BETA-1, 3-GLUCAN AND PRAZIQUANTEL IN THE TREATMENT OF EXPERIMENTAL CHRONIC SCHISTOSOMIASIS MANSONI

Praziquantel can develop resistance and cannot counteract schistosomiasis pathology. β-glucanwas used as an immunomodulator for innate and acquired immunity. This study evaluated theeffects of β-glucan either alone or with PZQ on chronic Schistosoma mansoni infection. Micewere divided into five groups: uninfected control, infected untreated, PZQ treated, β-glucantreated and combined treatment groups. Treatment started at the end of 8th week P.I. Parasitological,histopathological, immunohistochemical (α-SMA) studies and biochemical assays (Myeloperoxidaseactivity, NO, TNF-α, INF-γ, IL-13 & hydroxyproline) in liver tissues were done.Combination of β-glucan and PZQ therapy resulted in significant decrease in adults count, hepaticegg loads, granuloma number and diameter as well as significant improvement of hepaticpathology and reduction of hepatic fibrosis.

Brazilian red propolis exhibits antiparasitic properties in vitro and reduces worm burden and egg production in an mouse model harboring either early or chronic Schistosoma mansoni infection

Ethnopharmacological relevancePropolis has been used in folk medicine for thousands of years and, in the past few decades, it has attracted renewed interest. Although propolis has been traditionally used in many communities worldwide against parasitic diseases, its effect against Schistosoma mansoni infection remains unclear. Aim of the studyTo demonstrate the effects of Brazilian red propolis on Schistosoma mansoni ex vivo and in an animal model of schistosomiasis. Materials and methodsIn vitro, we monitored phenotypic and tegumental changes as well as the effects of the crude extract of propolis on pairing and egg production. In a mouse infected with either immature (early infection) or adult (chronic infection) worms, propolis was administered by oral gavage and we studied the influence of this natural product on worm burden and egg production. ResultsPropolis 25 μg/mL reduced motility and caused 100% mortality of adult parasites ex vivo. Further analysis revealed a pronounced reduction in oviposition after exposure to propolis at sub-lethal concentrations. In addition, scanning electron microscopy showed morphological alterations in the tegument of schistosomes. In the animal model, propolis markedly reduced worm burden and egg production in both early and chronic S. mansoni infection when compared to untreated control animals. ConclusionsThe efficacy of Brazilian red propolis in both in vitro and in vivo studies suggests its potential anthelmintic properties against S. mansoni infection.

A cross-sectional study of periportal fibrosis and Schistosoma mansoni infection among school-aged children in a hard-to-reach area of Madagascar.

A cross-sectional survey was performed to estimate the prevalence of periportal fibrosis in children based on ultrasound examination in the Marolambo district of the Atsinanana region of Madagascar. This is a remote area known to have a high prevalence of intestinal schistosomiasis. School-aged children (5-14y) were selected from six villages for parasitological and sonographic examination. Circulating cathodic antigen (CCA) tests and Kato Katz (KK) stool microscopy were performed. Video-clips of liver views were recorded with a SonoSite iViz and interpreted in the UK by comparison with standardised images (WHO protocol). The prevalence of schistosomiasis according to CCA testing was 97.8% (269/275) and 73.8% (203/275) by KK. Sonographic evidence of periportal fibrosis was observed in 11.3% (31/275). The youngest children with fibrosis were aged 6 y. Fibrosis was more common in older children (p=0.03) but was not associated with either infection intensity category (p=0.07) or gender (p=0.67). Findings of periportal fibrosis among children in these hard-to-reach villages suggests chronic Schistosoma mansoni infection from a very young age. This may reflect other similarly remote schistosomiasis-endemic areas and reinforces the need to investigate morbidity in neglected communities to understand the true extent of disease burden in endemic countries.

An investigation into the role of chronic Schistosoma mansoni infection on Human Papillomavirus (HPV) vaccine induced protective responses.

BackgroundSchistosoma mansoni is one of the most common helminth infections affecting a large population of people in sub-Saharan Africa. This helminth infection is known to cause immunomodulation which has affected the efficacy of a number of vaccines. This study examined whether a chronic schistosoma infection has an effect on the immunogenicity of HPV vaccine which is currently administered to girls and women aged 9 to 24. Little is known about the immune responses of the HPV vaccine in individuals with chronic schistosomiasis.MethodsThis study was carried out at the Institute of Primate Research (IPR) and involved an Olive baboon model. The experimental animals were randomly placed into three groups (n = 3–4); Two groups were infected with S. mansoni cercaria, and allowed to reach chronic stage (week 12 onwards), at week 13 and 14 post-infection, one group was treated with 80mg/kg of praziquantel (PZQ). Sixty four weeks post schistosoma infection, all groups received 2 doses of the Cervarix HPV vaccine a month apart. Specific immune responses to the HPV and parasite specific antigens were evaluated.ResultsAnimals with chronic S. mansoni infection elicited significantly reduced levels of HPV specific IgG antibodies 8 weeks after vaccination compared the PZQ treated and uninfected groups. There was no significant difference in cellular proliferation nor IL-4 and IFN-γ production in all groups.ConclusionChronic S. mansoni infection results in reduction of protective HPV specific IgG antibodies in a Nonhuman Primate model, suggesting a compromised effect of the vaccine. Treatment of schistosomiasis infection with PZQ prior to HPV vaccination, however, reversed this effect supporting anti-helminthic treatment before vaccination.

Host Defense Versus Immunosuppression: Unisexual Infection With Male or Female Schistosoma mansoni Differentially Impacts the Immune Response Against Invading Cercariae.

Infection with the intravascular diecious trematode Schistosoma spp. remains a serious tropical disease and public health problem in the developing world, affecting over 258 million people worldwide. During chronic Schistosoma mansoni infection, complex immune responses to tissue-entrapped parasite eggs provoke granulomatous inflammation which leads to serious damage of the liver and intestine. The suppression of protective host immune mechanisms by helminths promotes parasite survival and benefits the host by reducing tissue damage. However, immune-suppressive cytokines may reduce vaccine-induced immune responses. By combining a single-sex infection system with a murine air pouch model, we were able to demonstrate that male and female schistosomes play opposing roles in modulating the host’s immune response. Female schistosomes suppress early innate immune responses to invading cercariae in the skin and upregulate anergy-associated genes. In contrast, male schistosomes trigger strong innate immune reactions which lead to a reduction in worm and egg burden in the liver. Our data suggest that the female worm is a neglected player in the dampening of the host’s immune defense system and is therefore a promising target for new immune modulatory therapies.

Impact of treatment with a Protein Tyrosine Kinase Inhibitor (Genistein) on acute and chronic experimental Schistosoma mansoni infection

Schistosomiasis mansoni is considered one of the most common fibrotic diseases resulting from inflammation and deposition of fibrous tissue around parasitic eggs trapped in the liver, causing morbidity and mortality. Chemotherapy against schistosomiasis is largely dependent on Praziquantel (PZQ). Yet, the huge administration of it in endemic areas and its incompetence towards the immature stages have raised serious alarms against the development of drug resistance. Few drugs are directed to reverse schistosomal liver fibrosis, particularly at the chronic and advanced stages of the disease.Recently, protein tyrosine kinase (PTK) inhibitors have been identified as potent anti-schistosomal and anti-fibrotic drugs against schistosomes, that may suppress and reverse Schistosoma mansoni (S. mansoni) induced liver fibrosis.The present study was designed to assess the anti-schistosomal and antifibrotic activity of Genistein, a PTK inhibitor, in comparison to PZQ, on both acute and chronic S. mansoni-infected mice using different parasitological, histopathological and immunohistochemical studies.Genistein showed a significant reduction (P < .05) in total worm burden, tissue egg load, mean hepatic granulomas diameter and numbers, percentage of collagen and expression of transforming growth factor-beta 1 (TGF-β 1) in the examined hepatocytes with elevation in percentage of degenerated ova, in comparison to the control groups, in both acute and chronic stages of infection. The best results were obtained when Genistein was combined with PZQ.Therefore, it was concluded that Genistein showed a promising anti-schistosomal and anti-fibrotic properties which could make it one of the new potential targets in chemotherapy against schistosomiasis.

Bone marrow-derived cells migrate to the liver and contribute to the generation of different cell types in chronic Schistosoma mansoni infection

The main pathogenic event caused by Schistosoma mansoni infection is characterized by a granulomatous inflammatory reaction around parasite eggs and fibrosis in the liver. We have previously shown that transplantation of bone marrow cells (BMC) promotes a reduction in liver fibrosis in chronically S. mansoni-infected mice. Here we investigated the presence and phenotype of bone marrow-derived cells in livers of S. mansoni-infected mice. During the chronic phase of infection, C57BL/6 mice had an increased number of circulating mesenchymal stem cells and endothelial progenitor cells in the peripheral blood when compared to uninfected controls. In order to investigate the fate of BMC in the liver, we generated bone marrow chimeric mice by transplanting BMC from transgenic green fluorescent protein (GFP) mice into lethally irradiated wild-type C57BL/6 mice. S. mansoni-infected chimeric mice did not demonstrate increased mortality and developed similar liver histopathological features, when compared to wild-type S. mansoni-infected mice. GFP+ bone marrow-derived cells were found in the liver parenchyma, particularly in periportal regions. CD45+GFP+ cells were found in the granulomas. Flow cytometry analysis of digested liver tissue characterized GFP+ cells as lymphocytes, myeloid cells and stem cells. GFP+ cells were also found in areas of collagen deposition, although rare GFP+ cells expressed the myofibroblast cell marker α-SMA. Additionally GFP+ endothelial cells (co-stained with von Willebrand factor) were frequently observed, while BMC-derived hepatocytes (GFP+ albumin+ cells) were sparsely found in the liver of chimeric mice chronically infected with S. mansoni. In conclusion, BMC are recruited to the liver during chronic experimental infection with S. mansoni and contribute to the generation of different cell types involved, not only in disease pathogenesis, but possibly in liver regeneration and repair.

Identification of specific proteins in colorectal cancer patients with Schistosoma mansoni infection as a possible biomarker for the treatment of this infection

ObjectiveTo identify the associated proteins or antigens in serum of colorectal cancer patients with and without the chronic Schistosoma mansoni (S. mansoni) infection in Sudan. MethodsThe study included 93 patients with colorectal cancer and/or S. mansoni infection. A clinical database of colorectal cancer patients was documented by pathologist and information of S. mansoni infection was collected through stool analysis. Blood samples were collected from the identified patients. Geographical distribution of patients and etiological factors of colorectal cancer and S. mansoni infection were also discussed in this study. The proteins extracted from serum samples of patients using Tri Reagent were electrophoretically separated on sodium dodecyl sulfate polyacrylamide gel electrophoresis. Specific protein band was then subjected to matrix laser desorption ionisation-time assistance-of-flight mass spectrometry analysis. ResultsStool analysis documented that 40 patients were colorectal cancer patients infected with S. mansoni, 26 patients were diagnosed with colorectal cancer only, and 27 patients were infected with S. mansoni only. Approximately 27% of participating patients with colorectal cancer and S. mansoni infection in this study came from Gezira State. A specific protein band was identified from the serum samples of colorectal cancer patients with S. mansoni infection on the separated protein by sodium dodecyl sulfate polyacrylamide gel electrophoresis. The specific protein band was then analyzed by matrix laser desorption ionisation-time assistance-of-flight mass spectrometry and identified as a clusterin protein. ConclusionsThe study showed that the colorectal cancer patients infected with S. mansoni expressed clusterin protein, indicating that clusterin protein may be a potential biomarker to aid in the treatment of colorectal cancer patients infected with S. mansoni in the future.

Disposition of Mefloquine and Enpiroline Is Highly Influenced by a Chronic Schistosoma mansoni Infection

Chronic Schistosoma mansoni infections lead to severe tissue destruction of the gut wall and liver and can influence drug disposition. This study aimed to investigate the impact of a chronic S. mansoni infection on the pharmacokinetic (PK) parameters of two promising antischistosomal lead candidates (mefloquine and enpiroline) in mice. Studies were conducted in two different mouse cohorts (S. mansoni-infected and uninfected mice) for both drugs. Plasma samples were collected at various time points after oral treatment (200 mg/kg of body weight) with study drugs. A high-performance liquid chromatography (HPLC) method was validated to analyze enpiroline and mefloquine in plasma. Livers and intestines were collected from infected animals to determine the onset of action, hepatic shift, and worm burden reduction. Following mefloquine administration, hepatic shifting and significant worm burden reductions (79.2%) were observed after 72 h. At 1 week posttreatment with enpiroline, the majority of worms had migrated to the liver and significant worm burden reductions were observed (93.1%). The HPLC method was selective, accurate (87.8 to 111.4%), and precise (<10%) for the analysis of both drugs in plasma samples. The PK profiles revealed increased values for half-life (t1/2) and area under the concentration-time curve (AUC) for both drugs in infected animals compared to the t1/2 and AUC values in uninfected animals. Considerable changes were observed for mefloquine, with a 5-fold increase of t1/2 (182.7 h versus 33.6 h) and 2-fold increase of AUC (1,116,517.8 ng · h/ml versus 522,409.1 ng · h/ml). S. mansoni infections in mice influence the PK profiles of enpiroline and mefloquine, leading to delayed clearance. Our data confirm that drug disposition should be carefully studied in schistosomiasis patients.

Proteomic changes at 8 weeks after infection are associated with chronic liver pathology in experimental schistosomiasis.

Chronic Schistosoma mansoni infection can present as a moderate or severe disease, termed intestinal or hepatosplenic schistosomiasis, respectively. Similarly, either moderate splenomegaly or hypersplenomegaly syndrome develops in CBA/J mice by 20weeks of infection and is similar to intestinal or hepatosplenic schistosomiasis respectively. Using this mouse model and two-dimensional differential in gel electrophoresis, the liver proteomic signatures of uninfected mice and mice infected for 6, 8, 12, or 20weeks were compared, and significant protein spots identified using mass spectrometry. We found the greatest number of changes at 12weeks suggesting that this period represents the peak time of change. Pathway analysis identified specific proteins and pathways that correlated to the pathological changes indicative of severe disease, and these pathways were involved as early as 8weeks after infection. These findings provide insight into the development of severe liver pathology in schistosomiasis and may aid in developing biomarkers for hepatosplenic schistosomiasis.

Peripheral atrophy/central hypertrophy complex in chronic hepatic Schistosoma mansoni infection with histological correlation

Objective Peripheral atrophy/central hypertrophy (PACH) complex has been described in various chronic liver diseases but never in chronic hepatic Schistosoma mansoni infection. This study describes the imaging and anatomic features of PACH complex in four patients using high resolution cross-sectional imaging with 3D reconstructions and pathologic correlation. Materials and methods Two radiologists assessed imaging studies from four patients with proven chronic hepatic S. mansoni infections for presence of PACH complex, hepatic surface lobulations, capsular thickening, periportal fibrosis, hepatic calcification, gallbladder wall enhancement and thickening, and splenomegaly. 3D volume rendering and curved planar and oblique reformation in the planes of the hepatic veins were performed to better evaluate the 3D position of the hepatic veins relative to the liver parenchyma and capsule. Results All four patients had PACH complex and hepatic surface lobulations. 3D volume rendered images demonstrated severe peripheral atrophy with migration of hepatic veins on the capsular surface of the liver. Multiplanar reconstruction demonstrated coexisting hypertrophy about the central portal veins and atrophy of the peripheral liver parenchyma with thinned or no parenchyma between the hepatic veins and the liver capsule. All patients also had capsular thickening, splenomegaly, and no calcifications. While all patients had enhancement of the gallbladder wall in the arterial phase without thickening, three patients had dilated veins on the surface of the gallbladder wall. Three patients also had periportal fibrosis. Conclusion This study is the first to report PACH complex in chronic hepatic S. mansoni infection. Atrophy results in crowding of smaller hepatic veins in the periphery of the liver. Finally, hepatic capsular thickening on imaging is a further sign of this infection.

Immunohistochemical expression of oestrogen and progesterone receptors during experimental acute and chronic murine Schistosomiasis mansoni

The responsibility of Schistosoma mansoni in female infertility is still controversial. This study was conducted to evaluate the effect of acute and chronic schistosomiasis mansoni infection on the endometrium using immunohistochemical analysis of uterine hormone receptor expression. Twenty-four nonpregnant swiss albino mice were divided into three groups: control, noninfected; acute; and chronic Schistosoma mansoni infection. Histological sections of uterine specimens were examined by light microscope with an image analyzing system to detect structural histological, estrogen receptor (ER) and progesterone receptor (PR) expression in the endometrium. No secretory phase was detected in the endometrium in acute and chronic Schistosoma infection. Hormone receptor expression (ER and PR) showed statistically significant differences among the groups (p< 0.05), with significant low ER hormone expression in chronic infection, compared to control proliferative, control secretory and acute infection cases, and statistically significant high PR expression in both acute and chronic infection cases compared to the control secretory cases (p< 0.05). Schistosomiasis mansoni seems to have an important impact on the hormone expression of affected women. Further studies to explore the mechanism of such changes are recommended.

Massa tumoral secundária a infecção por Schistosoma mansoni simulando neoplasia de pulmão: relato de caso

Patients with chronic Schistosoma mansoni infection may feature a range of pulmonary symptoms and radiological findings. Eggs, and rarely adult worms, may passively enter the pulmonary circulation, usually via the portal system, where they may cause pulmonary inflammation, fibrosis, hypertension and cor pulmonale. A 25-year-old patient who lived in a schistosomiasis endemic area with a pulmonary mass suggestive of malignancy underwent exploratory thoracotomy. The mass was adherent, with no resection possibility. The lung-biopsy specimen evaluation showed several granulomas with Schistosoma mansoni eggs and hyperplasic connective tissue with no sign of malignancy. The patient had respiratory failure and hypotension immediately post-surgery. Specific treatment (praziquantel) and prednisone were given. The patient had pneumonia and septic shock. The patient was given antibiotics, vasopressors, mechanical ventilation and hemodialysis with no improvement, and subsequently died 28 days after the surgery.

CD4+ and CD8+ Distribution Profile in Individuals Infected by Schistosoma mansoni

Patients with chronic Schistosoma mansoni infection show lower anti-soluble egg antigen (SEA) proliferation responses and higher responses to soluble worm antigen preparation (SWAP). To compare the activation status and proliferation response of peripheral blood mononuclear cells (PBMC) of infected (XTO) and egg-negative individuals (NI) living in the same endemic area. XTO (n = 51) and NI individuals from the same geographical area (n = 37) and healthy blood donors (n = 22) were evaluated before and after stimulation with SEA and SWAP. The expression of activation markers (CD4(+) HLADR(+), CD8(high+)HLA-DR(+) and CD8(+) CD28(+)) and proliferation assay was assessed by flow cytometry. PBMC from infected patients showed lower frequency of CD4(+) but no change in CD8(+) T cells when compared with the healthy donor group. The ratio CD4(+)/CD8(+) was 1.3, 0.6 and 0.5 in healthy donors, infected and non-infected individuals, respectively. The HLA-DR(+) expression on CD8(+) was higher in PBMC from infected and non-infected individuals than from healthy donors, but similar in both total lymphocytes and CD4(+) populations. No intergroup proliferation response differences were observed in CD4(+) and CD8(+) PBMC unstimulated and stimulated with SEA and SWAP. The SEA but not SWAP-stimulated cells showed a decrease in the expression of phosphorylated extracellular signal-regulated kinase (ERK1/2). XTO and NI individuals living in the same area presented a smaller per cent of CD4(+) and a higher per cent of CD8(+) cells. The activation by either CD8(high+)HLA-DR(+) or CD8(high+)HLA-DR(+)/CD8(+) was enhanced and decreased in XTO and NI by CD8(+) CD28(+) and CD8(+) CD28(+)/CD8(+) when compared with healthy donor. ERK phosphorylation was attenuated in XTO and NI individuals when stimulated with SEA but not SWAP.

Relative imbalance between T regulatory cells and activated T cells in mice with differential morbidity in chronicSchistosoma mansoniinfections

Chronic (20-week) Schistosoma mansoni infections of CBA/J male mice present as two distinct forms of morbidity. Most mice develop moderate splenomegaly syndrome (MSS) resembling the intestinal form of chronic human schistosomiasis mansoni, while approximately 20% of mice develop hypersplenomegaly syndrome (HSS), more consistent with the severe hepatosplenic form of chronic human schistosomiasis mansoni. Here, we report the relative proportions of natural T regulatory cells (Treg) and activated CD4(+) T cells (Tact) for both splenic and granulomatous cell populations of MSS and HSS mice. Proportions of both Treg and Tact are greater in HSS than MSS mice. However, the ratios of Treg to Tact in both splenic and granulomatous cell populations from MSS mice are significantly higher than those of HSS mice. For both HSS and MSS mice, in vitro proliferation of their CD3(+) splenic cells induced by soluble egg antigens is inversely correlated with the ratio of Treg to Tact. Also, spleen or granuloma cells from MSS mice produced higher mean levels of IFN-gamma than those from HSS mice. Differential IFN-gamma productive capacities dictated by Treg : Tact ratios may contribute to the development of differential morbidities in this model of chronic experimental schistosomiasis mansoni.