Olivia Valenzuela

Human Amebiasis: Breaking the Paradigm?

For over 30 years it has been established that the Entamoeba histolytica protozoan included two biologically and genetically different species, one with a pathogenic phenotype called E. histolytica and the other with a non-pathogenic phenotype called Entamoeba dispar. Both of these amoebae species can infect humans. E. histolytica has been considered as a potential pathogen that can cause serious damage to the large intestine (colitis, dysentery) and other extraintestinal organs, mainly the liver (amebic liver abscess), whereas E. dispar is a species that interacts with humans in a commensal relationship, causing no symptoms or any tissue damage. This paradigm, however, should be reconsidered or re-evaluated. In the present work, we report the detection and genotyping of E. dispar sequences of DNA obtained from patients with amebic liver abscesses, including the genotyping of an isolate obtained from a Brazilian patient with a clinical diagnosis of intestinal amebiasis that was previously characterized as an E. dispar species. The genetic diversity and phylogenetic analysis performed by our group has shown the existence of several different genotypes of E. dispar that can be associated to, or be potentiality responsible for intestinal or liver tissue damage, similar to that observed with E. histolytica.

Low number of peripheral blood B lymphocytes in patients with pulmonary tuberculosis.

The cellular immune response plays a critical role in the containment of persistent Mycobacterium tuberculosis infection; however, the immunological mechanisms that lead to its control are not completely identified. The goal of this study was to evaluate B (CD19+) and T (CD3+) peripheral blood lymphocyte profiles and T-cell subsets (CD4+ and CD8+) in patients with pulmonary tuberculosis (TB). Percentages (p = 0.02) and absolute numbers (p = 0.005) of B cells were significantly lower in patients with pulmonary TB than in healthy donors. In contrast, percentages (p = 0.12) and absolute numbers (p = 0.14) of T cells were similar in TB patients and healthy donors. No significant differences in percentages of CD4+ (p = 0.19) or CD8+ (p = 0.85) T cells between patients and healthy donors were observed. In summary, patients with pulmonary tuberculosis had a lower number of peripheral blood B lymphocytes than healthy controls.

Molecular Characterization of Cryptosporidium spp. in Children from Mexico

Cryptosporidiosis is a parasitic disease caused by Cryptosporidium spp. In immunocompetent individuals, it usually causes an acute and self-limited diarrhea; in infants, infection with Cryptosporidium spp. can cause malnutrition and growth retardation, and declined cognitive ability. In this study, we described for the first time the distribution of C. parvum and C. hominis subtypes in 12 children in Mexico by sequence characterization of the 60-kDa glycoprotein (GP60) gene of Cryptosporidium. Altogether, 7 subtypes belonging to 4 subtype families of C. hominis (Ia, Ib, Id and Ie) and 1 subtype family of C. parvum (IIa) were detected, including IaA14R3, IaA15R3, IbA10G2, IdA17, IeA11G3T3, IIaA15G2R1 and IIaA16G1R1. The frequency of the subtype families and subtypes in the samples analyzed in this study differed from what was observed in other countries.

Worldwide genealogy of Entamoeba histolytica: An overview to understand haplotype distribution and infection outcome

Although Entamoeba histolytica is one of the most prevalent intestinal parasites, how the different strains of this species are distributed all over the world and how different genotypes are associated with the infection outcome are yet to be fully understood. Recently, the use of a number of molecular markers has made the characterization of several genotypes in those regions with high incidence of amoebiasis possible. This work proposes the first genealogy of E. histolytica, with an haplotype network based on two tRNA gene-linked array of Short Tandem Repeats (STRs) reported until today, and 47 sequences from 39 new isolates of Mexican Amoebic Liver Abscesses (ALA) samples. One hundred and three sequences were obtained from D-A locus, their information about the geographic region of isolation as well as clinical diagnosis were also collected. One hundred and five sequences from N-K2 locus were also obtained as well as the region of isolation, but the information about clinical diagnosis was not available in all cases. The most abundant and widely distributed haplotype in the world is the one of E. histolytica HM1:IMSS strain. This was found in Mexico, Bangladesh, Japan, China and USA and is associated to symptomatic patients as well as asymptomatic cyst passers. Many other haplotypes were found only in a single country. Both genealogies suggest that there are no lineages within the networks that may be related to a particular geographic region or infection outcome. A concatenated analysis of the two molecular markers revealed 12 different combinations, which suggests the possibility of genetic recombination events. The present study is the first to propose a global genealogy of this species and suggests that there are still many genotypes to be discovered. The genotyping of new isolates will help to understand the great diversity and genetic structure of this parasite.

Epidemiology of amoebic liver abscess in Mexico: the case of Sonora

The division of the taxon once known as Entamoeba histolytica into two species, the pathogenic E. histolytica and the nonpathogenic E. dispar, has led to a need to re-evaluate the epidemiology of amoebic infection and disease in humans. Although all human infection with E. histolytica is now sometimes called amoebiasis, that term is restricted here to invasive intestinal or hepatic infection with the parasite. Amoebiasis, which is endemic in many tropical and subtropical areas, is thought to be associated with millions of cases of dysentery and amoebic liver abscess every year (Walsh, 1986). Even in so-called ‘endemic countries’, however, there is a considerable lack of knowledge about the epidemiology of Entamoeba infection and the invasive disease that it may cause. In his now-classical review, Elsdon-Dew (1968) reported that Mexico was a major centre of invasive amoebiasis in the Americas, with other global ‘hot-spots’ in Natal and South– east Asia. According to more recent epidemiological surveys based on modern clinical and diagnostic tools (Abd-Alla et al., 2000; Jackson et al., 2000; Blessmann et al., 2002), these observations made by Elsdon-Dew almost four decades ago — which were based mainly on the numbers of cases of amoebic liver abscess (ALA) being reported — still appear valid. Some of the earliest data on the prevalence of amoebiasis in Mexico come from the autopsy-based studies of Dr Bernardo Sepúlveda. In these investigations (Sepúlveda, 1970), 195 cases of ALA were detected during 6126 autopsies performed, between 1954 and 1967, at the Hospital General de la Ciudad de México, and another 200 such cases were observed during 3000 autopsies performed, between 1963 and 1969, at the Hospital General del Centro Médico Nacional. Although clearly biased and limited in scope, these data indicate that, 30–40 years ago, 3%–7% of Mexicans had ALA at the time of their deaths. In 1992, the Mexican Institute of Social Security (IMSS), which provides healthcare to over half of the Mexican population, recorded the treatment of 369,440 new cases of invasive intestinal amoebiasis (i.e. either amoebic colitis or dysentery) and 1922 cases of ALA (Treviño GarciaManzo et al., 1994). Fortunately, although asymptomatic intestinal infections appear less responsive, symptomatic amoebiasis generally responds extremely well to treatment with metronidazole, and the extended availability of this drug in Mexico has markedly decreased national levels of Entamoeba-attributable mortality over the last 50 years. Before 1970, for example, 9%– 13% of Mexican cases of ALA were fatal (Lee-Ramos and González-Montesinos, 1970; Alvarez and de la Rosa, 1971) but the corresponding level of fatality (as recorded by the IMSS) had fallen to just 1.2% by 1994. This decrease has been attributed not only to effective chemotherapy but also to more general improvements in the health services of Mexico, which have led to signs of an epidemiological transition, away from parasitoses and towards chronic degenerative diseases (Frenk et al., 1989, 1991). The more recent official data on the incidence of ALA in Mexico (Ximénez, 2000) show a fall from 8.5 cases/100,000 in 1995 to 3.66 cases/100,000 in 2000 (albeit with a ‘blip’, of 9.04 cases/100,000, Annals of Tropical Medicine & Parasitology, Vol. 101, No. 6, 533–538 (2007)

Prevalent HLA Class II Alleles in Mexico City Appear to Confer Resistance to the Development of Amebic Liver Abscess

Amebiasis is an endemic disease and a public health problem throughout Mexico, although the incidence rates of amebic liver abscess (ALA) vary among the geographic regions of the country. Notably, incidence rates are high in the northwestern states (especially Sonora with a rate of 12.57/100,000 inhabitants) compared with the central region (Mexico City with a rate of 0.69/100,000 inhabitants). These data may be related to host genetic factors that are partially responsible for resistance or susceptibility. Therefore, we studied the association of the HLA-DRB1 and HLA-DQB1 alleles with resistance or susceptibility to ALA in two Mexican populations, one each from Mexico City and Sonora. Ninety ALA patients were clinically diagnosed by serology and sonography. Genomic DNA was extracted from peripheral blood mononuclear cells. To establish the genetic identity of both populations, 15 short tandem repeats (STRs) were analyzed with multiplexed PCR, and the allelic frequencies of HLA were studied by PCR-SSO using LUMINEX technology. The allele frequencies obtained were compared to an ethnically matched healthy control group (146 individuals). We observed that both affected populations differed genetically from the control group. We also found interesting trends in the population from Mexico City. HLA-DQB1*02 allele frequencies were higher in ALA patients compared to the control group (0.127 vs 0.047; p= 0.01; pc= NS; OR= 2.9, 95% CI= 1.09-8.3). The less frequent alleles in ALA patients were HLA-DRB1*08 (0.118 vs 0.238 in controls; p= 0.01; pc= NS; OR= 0.42, 95% CI= 0.19-0.87) and HLA-DQB1*04 (0.109 vs 0.214; p= 0.02; pc= NS; OR= 0.40, 95% CI= 0.20-0.94). The haplotype HLA-DRB1*08/-DQB1*04 also demonstrated a protective trend against the development of this disease (0.081 vs. 0.178; p=0.02; pc=NS; OR= 0.40, 95% CI= 0.16-0.93). These trends suggest that the prevalent alleles in the population of Mexico City may be associated with protection against the development of ALA.

Effect of exogenous vitamin E on proliferation and cytokine production in peripheral blood mononuclear cells from patients with tuberculosis

Micronutrient deficiencies are frequently associated with tuberculosis (TB) worldwide. We tested the effect of exogenous vitamin E on proliferation and cytokine production of peripheral blood mononuclear cells (PBMC) from TB patients and healthy purified protein derivative (PPD)+ volunteers. Proliferation was stimulated with mycobacterial antigen (PPD) and evaluated by the incorporation of tritiated thymidine in PBMC cultured with or without 50 microm-vitamin E for 6 d. Cytokine production (IL-2 and interferon (IFN)-gamma) was determined by intracellular cytokine staining and by ELISA in the supernatant of PBMC stimulated for 24 h with phytohaemagglutinin or PPD. Our results show that culture with vitamin E increased (P < or = 0.05 ) the antigen-induced proliferation of PBMC in TB patients but not in healthy PPD+ volunteers. No significant changes in the number of cytokine-producing cells or in the production of IFN-gamma were observed with vitamin E treatment. These results indicate that vitamin E may enhance the antigen-specific in vitro response of PBMC from TB patients.

Characterization and expression of DEC205 in the cDC1 and cDC2 subsets of porcine dendritic cells from spleen, tonsil, and submaxillary and mesenteric lymph nodes

&NA; Conventional dendritic cells (cDCs) are divided into the following different subtypes: cDC1, which promotes a Th1 response, and cDC2, which stimulates a Th2 and Th17 response. These cells have not been characterized in porcine lymphoid tissues. DEC205 is a receptor that increases antigen presentation and allows DCs to cross‐present antigens. The objectives of this work were to characterize cDCs subsets in the tonsil, submaxillary and mesenteric lymph nodes and spleen lymphoid tissues and to determine their expression of DEC205 by flow cytometry. The cDC1 (MHCIIhighCADM1highCD172a−/low) and cDC2 (MHCIIhighCADM1highCD172a+) phenotypes were confirmed by the expression of characteristic cDC1 and cDC2 transcripts (FLT3, XCR1 and FCER1&agr;). Among all lymphoid tissues, the spleen had the highest frequency of total cDCs. The cDC1:cDC2 ratio showed that all lymph tissues had higher levels of cDC1 than levels of cDC2. DEC205+ cDCs were found in all analyzed tissues, albeit with different frequencies. Our research will facilitate the study on the function of these cells and the investigation of the strategies for DEC205 targeting and functional studies. HighlightsThis study describes the characterization of cDCs, cDC1 and cDC2 in porcine lymphoid tissues.Results show that the spleen had the highest frequency of cDCs.The cDC1:cDC2 ratio showed a predominant presence of cDC1 in all lymphoid tissues.DEC205 was expressed on cDC1 and cDC2 cells from all analyzed tissues.

Response of the cDC1 and cDC2 subtypes of tracheal dendritic cells to porcine reproductive and respiratory syndrome virus

Porcine reproductive and respiratory syndrome virus (PRRSV) is the most important disease affecting the swine industry worldwide. Although monocytes and macrophages, especially tissue-resident and alveolar macrophages, are the primary target of PRRSV, monocyte- and bone marrow-derived dendritic cells (DCs) are also susceptible to PRRSV infection. It has been shown that lung DCs cannot be infected with PRRSV, but the response and susceptibility of bona fide conventional DC subtypes (cDCs; cDC1 and cDC2) is unknown. In this work, evaluation of the response of tracheal cDC1 and cDC2 subsets to PRRSV revealed differential cytokine expression, whereby cDC1 subsets expressed higher levels of IFN-α and cDC2 subsets more IL-10. Toll-like receptors (TLRs) were also affected: cDC2 cells induced greater upregulation of TLR2 and TLR4, and CD163+ cells showed TLR3 upregulation. However, we could not demonstrate under our experimental conditions that cDC1 and cCD2 subsets are susceptible to PRRSV infection. Our findings show the effects of PRRSV on cDC1 and cDC2 subsets and that these cells were not infected by PRRSV.

Cryptosporidium canis in Two Mexican Toddlers.

Cryptosporidium canis is reported for the first time in 2 toddlers in Northwestern Mexico. The 2 toddlers (33 and 34 months old) were symptomatic at diagnosis, presenting diarrhea and fever, and 1 case presented chronic malnutrition. Both toddlers were HIV-negative. C. canis was identified by SspI and VspI restriction enzyme digestion of the 18S rRNA polymerase chain reaction products and confirmed by sequence analysis.