3’Nucleotidase/nuclease is required for Leishmania infantum clinical isolate susceptibility to miltefosine

Summary Background Miltefosine treatment failure in visceral leishmaniasis in Brazil has been associated with deletion of the miltefosine susceptibility locus (MSL) in Leishmania infantum. The MSL comprises four genes, 3′ -nucleotidase/nucleases (NUC1 and NUC2); helicase-like protein (HLP); and 3,2-trans-enoyl-CoA isomerase (TEI). Methods In this study CRISPR-Cas9 was used to either epitope tag or delete NUC1, NUC2, HLP and TEI, to investigate their role in miltefosine resistance mechanisms. Additionally, miltefosine transporter genes and miltefosine-mediated reactive oxygen species homeostasis were assessed in 26 L. infantum clinical isolates. A comparative lipidomic analysis was also performed to investigate the molecular basis of miltefosine resistance. Findings Deletion of both NUC1, NUC2 from the MSL was associated with a significant decrease in miltefosine susceptibility, which was restored after re-expression. Metabolomic analysis of parasites lacking the MSL or NUC1 and NUC2 identified an increase in the parasite lipid content, including ergosterol; these lipids may contribute to miltefosine resistance by binding the drug in the membrane. Parasites lacking the MSL are more resistant to lipid metabolism perturbation caused by miltefosine and NUC1 and NUC2 are involved in this pathway. Additionally, L. infantum parasites lacking the MSL isolated from patients who relapsed after miltefosine treatment were found to modulate nitric oxide accumulation in host macrophages. Interpretation Altogether, these data indicate that multifactorial mechanisms are involved in natural resistance to miltefosine in L. infantum and that the absence of the 3’nucleotidase/nuclease genes NUC1 and NUC2 contributes to the phenotype.publishersversionpublishe

Natural Resistance of Leishmania infantum to Miltefosine Contributes to the Low Efficacy in the Treatment of Visceral Leishmaniasis in Brazil

In India visceral leishmaniasis (VL) caused by Leishmania donovani has been successfully treated with miltefosine with a cure rate of > 90%. To assess the efficacy and safety of oral miltefosine in L. infantum-causing Brazilian VL patients, a phase II, open-label, dose-escalation study of oral miltefosine was conducted in children (ages 2-12) and adolescent-adults (ages 13-60). Definitive cure was assessed at a 6 month follow-up visit. The cure rate was only 42% (6 out of 14 patients) with the recommended 28 days of therapy and 68% (19 out of 28 patients) with an extended treatment of 42 days. The in vitro miltefosine susceptibility profile of intracellular amastigote stages of the pre-treatment isolates, from cured and relapsed patients, showed a positive correlation with clinical outcome. The IC50 mean (SEM) of eventual cures was 5.1 (0.4) µM whereas that of eventual failures was 12.8 (1.9) µM (P = 0.0002). An IC50 below or above 8.0 µM predicts cure or failure, respectively with 82% sensitivity and 100% specificity. The finding of L. infantum amastigotes resistant to miltefosine in isolates from patients who eventually failed treatment, strongly suggests natural resistance to this drug, as miltefosine had never been used in Brazil before this trial was carried out

SOCS2 Is Critical for the Balancing of Immune Response and Oxidate Stress Protecting Against Acetaminophen-Induced Acute Liver Injury

Acetaminophen (APAP) is usually safe when administrated in therapeutic doses; however, APAP overdose can lead to severe liver injury. APAP can cause direct hepatocyte damage, and stimulates an inflammatory response leading to oxidative stress. Supressor of Cytokine Signaling (SOCS) 2 modulates cytokine and growth factor signaling, and plays a role in the regulation of hepatic cellular processes. Our study evaluated the role of SOCS2 in APAP liver injury. The administration of a toxic dose (600 mg/kg) of APAP caused significant liver necrosis in WT mice. In SOCS2−/− mice, there was significantly more necrosis, neutrophil recruitment, and expression of the neutrophil-active chemokine CXCL-1. Expression of proinflammatory cytokines, such as TNF-α and IL-6, was elevated, while expression of anti-inflammatory cytokines, IL-10 and TGF-β, was diminished. In vitro, SOCS2−/− hepatocytes expressed more p-NF-kB and produced more ROS than WT hepatocytes when exposed to APAP. SOCS2−/− hepatocytes were more sensitive to cell death in the presence of IL-6 and hydrogen peroxide. The administration of catalase in vitro and in vivo resulted in a pronounced reduction of cells/mice death and necrosis in the SOCS2−/− group. We have demonstrated that SOCS2 has a protective role in the liver by controlling pro-oxidative and inflammatory mechanisms induced by APAP

Correlação entre sensibilidade in vitro de isolados clínicos de Leishmania chagasi à miltefosina e resposta ao tratamento

A miltefosina tem sido utilizada com sucesso para o tratamento de LV na Índia, com um índice de cura de 94%. Entretanto, um ensaio clínico realizado pela primeira vez no Brasil demonstrou que cerca de 50% dos pacientes com LV apresentou falha após o tratamento. Uma hipótese para justificar a ocorrência de falha terapêutica em pacientes tratados no Brasil seria a ocorrência de sensibilidade variada à miltefosina entre os isolados de L. chagasi. A variação na sensibilidade à miltefosina tem sido relacionada a diferenças na capacidade de internalização da droga como resultado direto de um defeito na maquinaria de translocação presente na membrana celular da Leishmania, composta por pelo menos duas proteínas, LdMT, e sua subunidade β, LdRos3. Sendo assim, os objetivos desse estudo foram avaliar se há correlação entre a sensibilidade in vitro à miltefosina de isolados de L. chagasi com a resposta ao tratamento, e correlacionar a suscetibilidade à miltefosina com a expressão de proteínas relacionadas à sua maquinaria de translocação. Utilizando ensaios de infecção de macrófagos, os resultados obtidos mostraram que todos os isolados de pacientes curados após o tratamento foram sensíveis in vitro à miltefosina (CI50 2,6 - 7,94 μM), enquanto 10 dos 12 isolados de pacientes que apresentaram falha ao tratamento mostraram-se resistentes (CI50 > 15 μM). Os dois isolados que mostraram-se sensíveis antes do tratamento tornaram-se resistentes, mostrando a aquisição de resistência durante o tratamento. Esses dados sugerem que a falha de tratamento observada em pacientes portadores de LV no Brasil está relacionada a resistência do parasita à droga. Por outro lado, a análise da expressão gênica de proteínas responsáveis pela captação da miltefosina não mostrou diferença entre os isolados sensíveis e resistentes. Diante destes resultados acreditamos que o monitoramento da sensibilidade de isolados clínicos de Leishmania à miltefosina seja de grande relevância para predizer falha de tratamento. Além disso, considerando que testes in vitro de infecção de macrófagos são laboriosos e demorados, a busca de marcadores de resistência utilizando metodologias mais simples e rápidas é importante para facilitar esse monitoramentoThe miltefosine has been used successfully for treatment of VL in India, with a cure rate of 94%. However, a clinical trial demonstrated that, in Brazil, about 50% of patients with VL failed after treatment. One hypothesis to explain the occurrence of therapeutic failure in patients treated in Brazil would be the occurrence of variable sensitivity to miltefosine among L. chagasi isolate. The variation in the sensitivity to miltefosine has been related to differences in the ability to internalize the drug as a direct result of a defect in the translocation machinery present in the cell membrane of Leishmania, comprising at least two proteins, LdMT and its β subunit, LdRos3. Therefore, the objectives of this study were to evaluate the correlation of in vitro sensitivity to miltefosine in L. chagasi isolates with the response to treatment, and correlate miltefosine susceptibility with the expression of proteins related to their translocation machinery. Using macrophage infection assays, our results showed that all strains obtained from patients cured after treatment were susceptible to miltefosine in vitro (IC50 2.6 - 7.94 mM), whereas 10 of 12 samples of patients who presented treatment failure were resistant (IC50> 15 mM). Those two isolates that were sensitive pre-treatment have become resistant, indicating the acquisition of resistance during the treatment. Therefore, these data suggest that the treatment failure observed in patients with VL in Brazil is related to parasite drug resistance. On the other hand, the analysis of gene expression of proteins responsible for miltefosine uptake showed no difference between sensitive and resistant isolates. Considering these results, we believe that monitoring the sensitivity of clinical isolates of Leishmania to miltefosine is highly relevant for predicting treatment failure. Moreover, since in vitro infection of macrophages used to evaluate the parasite sensitivity to the drug is laborious and time consuming, the search for drug resistance markers using simple and rapid methods is important to facilitate this monitoring.Coordenação de Aperfeiçoamento de Pessoal de Nível Superio

In vitro activity of amphotericin B cochleates against Leishmania chagasi

Cochleate delivery vehicles are a novel lipid-based system with potential for delivery of amphotericin B (AmB). In this study, the efficacy of cochleates was evaluated by examining the in vitro activity of AmB cochleates (CAMB) against Leishmania chagasi in a macrophage model of infection. We demonstrate that CAMB is nontoxic to macrophages at concentrations as high as 2.5 μg/mL, whereas the conventional formulation, AmB deoxycholate, showed high toxicity at this concentration. The in vitro activity of CAMB against L. chagasi was found to be similar to that of the reference drug AmB deoxycholate, with ED50s of 0.017 μg/mL and 0.021 μg/mL, respectively. Considering that L. chagasi affects organs amenable to cochleate-mediated delivery of AmB, we hypothesize that CAMB will be an effective lipid system for the treatment of visceral leishmaniasis

Altered cardiomyocyte function and trypanosoma cruzi persistence in chagas disease

Chagas disease, caused by the triatominae Trypanosoma cruzi, is one of the leading causes of heart malfunctioning in Latin America. The cardiac phenotype is observed in 20-30% of infected people 10-40 years after their primary infection. The cardiac complications during Chagas disease range from cardiac arrhythmias to heart failure, with important involvement of the right ventricle. Interestingly, no studies have evaluated the electrical properties of right ventricle myocytes during Chagas disease and correlated them to parasite persistence. Taking advantage of a murine model of Chagas disease, we studied the histological and electrical properties of right ventricle in acute (30 days postinfection [dpi]) and chronic phases (90 dpi) of infected mice with the Colombian strain of T. cruzi and their correlation to parasite persistence. We observed an increase in collagen deposition and inflammatory infiltrate at both 30 and 90 dpi. Furthermore, using reverse transcriptase polymerase chain reaction, we detected parasites at 90 dpi in right and left ventricles. In addition, we observed action potential prolongation and reduced transient outward K+ current and L-type Ca2+ current at 30 and 90 dpi. Taking together, our results demonstrate that T. cruzi infection leads to important modifications in electrical properties associated with inflammatory infiltrate and parasite persistence in mice right ventricle, suggesting a causal role between inflammation, parasite persistence, and altered cardiomyocyte function in Chagas disease. Thus, arrhythmias observed in Chagas disease may be partially related to altered electrical function in right ventricle.CNPq [404353/2012-6]FAPESP [2014/09861-1]Universidade Federal de Minas Gerais, Inst Ciencias Biol, Dept Bioquim & Imunol, Belo Horizonte, Minas Gerais, BrazilCentro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Lab Parasitol Celular & Mol, Belo Horizonte, Minas Gerais, BrazilEscola Paulista de Medicina, Universidade Federal de São Paulo, Departamento de Biofisica, São Paulo, BrazilUniversidade Federal de Minas Gerais, Inst Ciencias Biol, Dept Patol Geral, Belo Horizonte, Minas Gerais, BrazilDepartamento de Biofisica, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu 862, Vila Clementino, São Paulo, São Paulo, Brazil, CEP 04023062CNPq: 404353/2012-6FAPESP: 2014/09861-1Web of Scienc

IL-33 signalling in liver immune cells enhances drug-induced liver injury and inflammation

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IL-33 signalling in liver immune cells enhances drug-induced liver injury and inflammation

OBJECTIVE AND DESIGN: The aim of this study was to investigate the contribution of IL-33/ST2 axis in the onset and progression of acute liver injury using a mice model of drug-induced liver injury (DILI). MATERIAL AND TREATMENTS: DILI was induced by overdose administration of acetaminophen (APAP) by oral gavage in wild-type BALB/c, ST2-deficient mice and in different bone marrow chimeras. Neutrophils were depleted by anti-Ly6G and macrophages with clodronate liposomes (CLL). METHODS: Blood and liver were collected for biochemical, immunologic and genetic analyses. Mice were imaged by confocal intravital microscopy and liver non-parenchymal cells and hepatocytes were isolated for flow cytometry, genetic and immunofluorescence studies. RESULTS: Acetaminophen overdose caused a massive necrosis and accumulation of immune cells within the liver, concomitantly with IL-33 and chemokine release. Liver non-parenchymal cells were the major sensors for IL-33, and amongst them, neutrophils were the major players in amplification of the inflammatory response triggered by IL-33/ST2 signalling pathway. CONCLUSION: Blockage of IL-33/ST2 axis reduces APAP-mediated organ injury by dampening liver chemokine release and activation of resident and infiltrating liver non-parenchymal cells.status: publishe

Combination of Mass Cytometry and Imaging Analysis Reveals Origin, Location, and Functional Repopulation of Liver Myeloid Cells in Mice

BACKGROUND & AIMS: Resident macrophages are derived from yolk sac precursors and seed the liver during embryogenesis. Native cells may be replaced by bone marrow precursors during extensive injuries, irradiation, and infections. We investigated the liver populations of myeloid immune cells and their location, as well as the dynamics of phagocyte repopulation after full depletion. The effects on liver function due to the substitution of original phagocytes by bone marrow-derived surrogates were also examined. METHODS: We collected and analyzed liver tissues from C57BL/6 (control), LysM-EGFP, B6 ACTb-EGFP, CCR2-/-, CD11c-EYFP, CD11c-EYFP-DTR, germ-free mice, CX3CR1gfp/gfp, CX3CR1gpf/wt, and CX3CR1-DTR-EYFP. Liver nonparenchymal cells were immunophenotyped using mass cytometry and gene expression analyses. Kupffer and dendritic cells were depleted from mice by administration of clodronate, and their location and phenotype were examined using intravital microscopy and time-of-flight mass cytometry. Mice were given acetaminophen gavage or intravenous injections of fluorescently labeled Escherichia coli, blood samples were collected and analyzed, and liver function was evaluated. We assessed cytokine profiles of liver tissues using a multiplexed array. RESULTS: Using mass cytometry and gene expression analyses, we identified 2 populations of hepatic macrophages and 2 populations of monocytes. We also identified 4 populations of dendritic cells and 1 population of basophils. After selective depletion of liver phagocytes, intravascular myeloid precursors began to differentiate into macrophages and dendritic cells; dendritic cells migrated out of sinusoids, after a delay, via the chemokine CX3CL1. The cell distribution returned to normal in 2 weeks, but the repopulated livers were unable to fully respond to drug-induced injury or clear bacteria for at least 1 month. This defect was associated with increased levels of inflammatory cytokines, and dexamethasone accelerated the repopulation of liver phagocytes. CONCLUSIONS: In studies of hepatic phagocyte depletion in mice, we found that myeloid precursors can differentiate into liver macrophages and dendritic cells, which each localize to distinct tissue compartments. During replenishment, macrophages acquire the ability to respond appropriately to hepatic injury and to remove bacteria from the blood stream.status: publishe