Nicholas C. Sangster

Anthelmintic resistance: past, present and future

Anthelmintic resistance continues to increase in geographic range, in the number of species affected and the range of drugs involved. Several aspects of resistance have emerged as important issues. They include lack of genetic reversion, presence of side resistance and lack of universality. Furthermore, resistant isolates recovered from the field may have different characteristics to those selected in pen passage. Research into anthelmintic resistance has not progressed far beyond the stage of descriptive research. Some progress has been made in developing control strategies and in diagnosing resistance, especially in the development and adoption of in-vitro tests. However, these still need improvements in their ability to detect resistance to closantel and avermectin/milbemycin anthelmintics. Less progress into understanding the basis of resistance has occurred. Research priorities include improvement of diagnostic tests and the development of molecular tests, particularly for resistance to levamisole and the avermectin/milbemycins. Resistance itself, as a selectable marker for genetic transfection in parasites, is a potential tool for investigating parasite biology.

Pharmacology of Anthelmintic Resistance

Anthelmintic resistance has grown from a curiosity to an important economic problem in several animal industries and is now set to threaten the control of human parasites. The pharmacology of anthelmintics and anthelmintic resistance has been studied most extensively in the nematode parasites of sheep. Here, Nick Sangster and Jenny Gill discuss this veterinary experience, summarizing the progress made in understanding anthelmintic resistance and highlighting the tools available for research.

Managing parasiticide resistance.

Resistance to antiparasitic drugs is all too common in parasites of veterinary interest. The fact that resistance has arisen in so many different species of parasite and hosts against so many different drugs and in so many geographic areas suggests that the resistances may have common features. Such features may be useful in generating ideas for resistance management. Although describing the nature and presence of resistance remains an important objective, there is now a pressing need to develop improved methods of detection of resistance and to devise schemes for integrated parasite management (IPM). Multidisciplinary teams of researchers and extension workers are exploring new ways to deal with the problem of resistance.

Frontiers in anthelmintic pharmacology

Research in anthelmintic pharmacology faces a grim future. The parent field of veterinary parasitology has seemingly been devalued by governments, universities and the animal industry in general. Primarily due to the success of the macrocyclic lactone anthelmintics in cattle, problems caused by helminth infections are widely perceived to be unimportant. The market for anthelmintics in other host species that are plagued by resistance, such as sheep and horses, is thought to be too small to sustain a discovery program in the animal health pharmaceutical industry. These attitudes are both alarming and foolish. The recent history of resistance to antibiotics provides more than adequate warning that complacency about the continued efficacy of any class of drugs for the chemotherapy of an infectious disease is folly. Parasitology remains a dominant feature of veterinary medicine and of the animal health industry. Investment into research on the basic and clinical pharmacology of anthelmintics is essential to ensure chemotherapeutic control of these organisms into the 21st century. In this article, we propose a set of questions that should receive priority for research funding in order to bring this field into the modern era. While the specific questions are open for revision, we believe that organized support of a prioritized list of research objectives could stimulate a renaissance in research in veterinary helminthology. To accept the status quo is to surrender.

Pharmacology of anthelmintic resistance in cyathostomes: will it occur with the avermectin/milbemycins?

Anthelmintic-resistance has emerged as a problem in several animal industries. In the horse, cyathostome resistance to all available treatments except for the avermectin/milbemycins means that these drugs provide the cornerstone of control. Ivermectin has been available for several years; the related compound moxidectin is more recent. Although we do not know for sure, aspects of moxidectin such as its persistent action and its efficacy against mucosal stages of cyathostomes, may enhance the rate of development of resistance. On the other hand, selection pressure would be reduced if the persistence of moxidectin allows it to be used less frequently in the field. Reduced anthelmintic usage and surveillance of egg reappearance period are the most useful tools in managing resistance.

Disposition of oxfendazole in goats and efficacy compared with sheep

The disposition of intraruminally administered oxfendazole (OFZ) in goats was studied at 5, 10 and 20 mg kg-1. The area under the plasma concentration with time curve (AUC) increased with increasing dose but at a declining rate. AUC was lower after intra-abomasal compared with intraruminal administration. OFZ was less effective against drug resistant Trichostrongylus colubriformis in goats than in sheep but was of similar efficacy against drug resistant Haemonchus contortus in both host species. In the same experiment peak plasma levels of OFZ in goats were about half those in sheep given the same dose. Of 70 goats tested in the field, total rumen bypass occurred in 12 per cent and partial bypass in 67 per cent. Lower systemic availability due to bypass would be expected to reduce further anthelmintic efficacy in goats. From the results of these experiments a dose rate of 10 mg kg-1 is recommended for goats. When given at this rate as a divided dose at 12 hourly intervals over 24 hours, OFZ was significantly more effective than a single dose in reducing egg counts.

Tubulin and benzimidazole-resistance in Trichostrongylus colubriformis (Nematoda).

Benzimidazole treatment produced greater effects on microtubule-dependent acetylcholinesterase secretion, the presence of microtubules in intestinal cells, and colchicine binding in susceptible compared with benzimidazole-resistant Trichostrongylus colubriformis. In addition, the binding of benzimidazoles was markedly reduced in preparations from the latter strain, indicating that the mechanism of resistance to benzimidazoles in this nematode involves a reduced affinity of tubulin for benzimidazoles.

Comparative pharmacokinetic behaviour of albendazole in sheep and goats

Albendazole (ABZ) containing a trace of [14C]-ABZ was administered intraruminally at 4.75 mg kg-1 to Merino sheep and Angora goats and the pharmacokinetic behaviour of ABZ and its metabolites in plasma nd abomasal fluid compared. The systemic availability (area under the curve, AUC) for total [14C]-labelled metabolites was significantly lower in goats than in sheep. This was largely attributable to the disposition of ABZ sulphoxide (ABZ.SO) which had a significantly lower maximum concentration (Cmax) in goats (0.94 +/- 0.04 micrograms ml-1) than in sheep (1.41 +/- 0.24 micrograms ml-1). The AUC of [14C] in abomasal fluid was similar in goats and sheep, with approximately 35 and 45% of the dose passing the pylorus in the two species, respectively. ABZ, ABZ.SO and ABZ sulphone (ABZ.SO2) were present in the abomasal fluid of both species but between-species differences were only evident with ABZ.SO which had a lower Cmax in goats compared with sheep. The relative proportions of the [14C] dose excreted in urine and faeces were similar between species. It is suggested that ABZ may be sequestered to a greater extent in the liver of goats than of sheep which would result in lower concentrations of ABZ.SO in plasma and abomasal fluid. This behaviour might be compensated for by administering ABZ to goats at a proportionally higher dose rate.

Evaluation of tests for anthelmintic resistance in cyathostomes

Resistance, especially to the anthelmintic benzimidazoles (BZ), has been reported in horse cyathostomes world-wide. Diagnosis of resistance has traditionally been made by faecal egg count reduction (FECR) trials, however, this technique has limitations. Some of the shortcomings may be resolved by refining the test or by using an in vitro test. FECR tests and the larval development assay (LDA) were performed on adult horses held on 15 different horse properties across a wide geographical area of NSW, Australia. FECR were measured before and 10-14 after days treatment with oxibendazole (OBZ), morantel (MOR) or ivermectin (IVM) at recommended dose rates. Eight properties were rejected following low pre-treatment egg counts, leaving seven in the study. On these, the majority of larvae recovered from faecal cultures were cyathostomes. Using a definition of resistance as a FECR of <90%, resistance to OBZ was present on six properties and to MOR on two properties. Resistance to IVM was not detected. An alternative method of calculating FECR based on individual horse egg counts pre- and post-treatment was developed and results from the same properties compared with the results of the LDA. For example, for the BZ, correlation coefficients of values of lethal concentration to kill 50% of population (LC50) on LDA and FECR percentages were -0.536 before and -0.704 after OBZ treatment. We conclude that the LDA has the potential to be a single visit test for detection of anthelmintic resistance in horse cyathostomes but requires further investigation and standardisation.

Resistance to antiparasitic drugs: the role of molecular diagnosis

Chemotherapy is central to the control of many parasite infections of both medical and veterinary importance. However, control has been compromised by the emergence of drug resistance in several important parasite species. Such parasites cover a broad phylogenetic range and include protozoa, helminths and arthropods. In order to achieve effective parasite control in the future, the recognition and diagnosis of resistance will be crucial. This demand for early, accurate diagnosis of resistance to specific drugs in different parasite species can potentially be met by modern molecular techniques. This paper summarises the resistance status of a range of important parasites and reviews the available molecular techniques for resistance diagnosis. Opportunities for applying successes in some species to other species where resistance is less well understood are explored. The practical application of molecular techniques and the impact of the technology on improving parasite control are discussed.