Short Report: Immunodiagnosis of Human Fascioliasis Using Recombinant Fasciola Hepatica Cathepsin L1 Cysteine Proteinase
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Am. J. Trop. Med. Hyg., 60(5), 1999, pp. 749±751 Copyright q 1999 by The American Society of Tropical Medicine and Hygiene SHORT REPORT: IMMUNODIAGNOSIS OF HUMAN FASCIOLIASIS USING RECOMBINANT FASCIOLA HEPATICA CATHEPSIN L1 CYSTEINE PROTEINASE SANDRA M. O'NEILL, MICHAEL PARKINSON, ANDREW J. DOWD, WILMA STRAUSS, RENE ANGLES, AND JOHN P. DALTON School of Biological Sciences, Dublin City University, Dublin, Ireland; Unidad de Parasitologia, Instituto Nacional de Laboratorios de Salud, Secretaria Nacional de Salud, La Paz, Bolivia Abstract. Our laboratory recently developed a diagnostic test (ELISA) for human fascioliasis based on the detec- tion of serum IgG4 antibodies reactive with Fasciola hepatica cathepsin L1 (CL1). In the present study, we have used recombinant CL1, generated by functional expression of the cDNA in Saccharomyces cerevisiae, in this im- munodiagnostic test and compared its performance with native CL1. Sera obtained from 64 individuals living in Cutusuma village in the northern Altiplano of Bolivia, a region with a high prevalence of human fascioliasis, were analyzed by the IgG4-ELISA. A highly statistically signi®cant correlation (r2 5 0.751, P , 0.001) was demonstrated between the absorbances obtained using the recombinant and native proteins. These assays showed that 38 (59%) of the individuals tested were seropositive for fascioliasis, whereas only 26 of them were coprologically positive for F. hepatica eggs. All seronegative patients were also coprologically negative. Serum from individuals infected with schistosomiasis mansoni, cysticercosis, hydatidosis, and Chagas disease did not contain antibodies reactive with the recombinant or native CL1. Therefore, recombinant CL1 shows excellent potential for the development of the ®rst standardized assay for the sensitive and speci®c diagnosis of human fascioliasis. Finally, our data supports earlier reports on the high prevalence of human fascioliasis in the Bolivian Altiplano, which collectively suggest that the disease has been endemic there for more than a decade. Fascioliasis is caused by liver ¯ukes of the genus Fasci- 6 SD age of 15.23 6 12.46 years. Coprologic analysis for ola. Although the disease is predominantly one of domestic F. hepatica eggs was performed on fecal samples obtained animals such as sheep and cattle, it is now emerging as an from all individuals using the sedimentation method of Rich- important chronic disease of humans.1±3 Recent estimates ie.11 Serum samples obtained from patients infected with suggest that as many as 2.4 million people are infected with schistosomiasis mansoni (20), cysticercosis (15), hydatidosis the parasite worldwide and 2.4 million are at risk.3,4 The (15) and Chagas disease (15) were obtained from the Insti- disease is particularly prevalent among the Aymaran people tuto Nacional de Laboratorios de Salud (INLASA) serum of the northern Altiplano region of Bolivia, with incidences library and used to test for cross-reactivity in the test. Con- of up to 60% being reported.5±8 Our laboratory recently de- trol serum samples were provided by eight volunteers at veloped a simple ELISA for the detection of serum IgG4 Dublin City University. The study was approved by the Hu- antibodies reactive with F. hepatica cathepsin L1 (CL1) pro- man Ethics Committee of INLASA and the Department of teinase.7 The use of puri®ed CL1 antigen in this ELISA pro- Health of Bolivia. vided a more speci®c immunodiagnosis of human fascioli- The ELISAs were carried out as previously described by asis than tests that use parasite somatic or excretory/secre- O'Neill and others.7 Brie¯y, 100 ml of native or recombinant tory (ES) antigen. CL1 antigen (5 mg/ml) was incubated overnight at 378Cin We have also recently reported the expression of func- wells of microtiter plates (Nuclon, Kamstrup, Roskilde, Den- tionally active recombinant F. hepatica CL1 in the yeast mark). The wells were blocked with a solution of 2% bovine Saccharomyces cerevisiae.9 In the present study, we exam- serum albumin/0.1% Tween 20 in phosphate-buffered saline ined the potential of this recombinant protein as a diagnostic for 30 min at 378C and human sera (1:125 dilution) was then reagent for human fascioliasis in the IgG4-ELISA and com- added into triplicate wells. Bound human antibodies were pared the performance of the antigen with native CL1 anti- detected using biotin-conjugated anti-human IgG4 (1:2,000 gen. Recombinant CL1 was puri®ed from yeast culture me- dilution), avidin-conjugated alkaline phosphatase, and the dium by gel ®ltration chromatography on Sephacryl S200 substrate 2,2-azino-bis (3-ethylbenzthiazoline-6-su¯onic HR,9 and native CL1 was puri®ed from ES products by a acid) (all from the Sigma Chemical Co., Poole, Dorset, Unit- combination of gel ®ltration chromatography on Sephacryl ed Kingdom). Plates were read after 15 min on a Titerteck S200 HR and ion exchange chromatography on QAE-Se- (Helsinki, Finland) multiscan ELISA plate reader at an ab- phadex.10 The concentration of each antigen preparation was sorbance of 405 nm. measured using a bicinchoninic acid protein assay kit (Pierce The absorbance readings obtained from the ELISAs using and Warner, Chester, United Kingdom). recombinant and native CL1 were plotted as scattergrams The nature of the study was explained to each individual, (Figure 1). Hierarchical agglomerative cluster analysis re- and prior to volunteering to provide blood and feces, each vealed that the scatter of points divided into two clusters, person signed a document of consent that also carried their one compact cluster of low absorbance readings and a dif- name and personal details. Blood samples were obtained in fuse cluster of high absorbance readings (Figure 1). Cut-off 1986 from 64 native Aymara living in the village of Cutu- points between the clusters were set at 3.09 standard devi- suma (approximately 50 km north of La Paz, Bolivia). The ations from the mean of the low absorbance cluster and were serum was separated and stored at 2208C. The age of the 0.117 and 0.121 for the recombinant and native proteins, volunteers ranged between seven and 76 years, with a mean respectively. Using the cut-off points, 38 individuals (59%) 749 750 O'NEILL AND OTHERS TABLE 1 Summary of the serologic and coprologic data obtained from 64 individuals in the village of Cutusuma, Bolivia (1986)* Group Recombinant CL1 Native CL1 Egg1 Seropositive 26 26 Egg1 Seronegative 0 0 Egg2 Seropositive 12 12 Egg2 Seronegative 26 26 Total 64 64 * CL1 5 cathespin L1. cercosis, hydatidosis, and Chagas disease were negative by IgG4-ELISAs that used either recombinant or native CL1. Although schistosomes also express cathepsin L proteinas- es,12 we have shown that antibodies prepared against F. he- FIGURE 1. Scattergram of the data obtained with the IgG4- patica cathepsin L proteinases do not cross-react with these ELISA using recombinant cathespsin L1 (CL1) and native CL1 an- (Brady C, Dalton JP, unpublished data). tigens. Hierarchical agglomerative cluster analysis using the com- Human fascioliasis is becoming increasingly recognized bined data obtained for both proteins separated the population into as a serious public health problem, particularly in regions of low absorbance (seronegative) and high absorbance (seropositive) subpopulations. The vertical and horizontal dashed lines indicate the Bolivia and Peru. Regional climatic factors coupled with the calculated cut-off points for each antigen. The closed circles repre- rural lifestyle and dietary habits of the indigenous population sent individuals who were coprologically positive and the open cir- contribute to transmission of the disease year round.6,8,13 cles represent those who were coprologically negative. The diagonal Clinical manifestations of human fascioliasis include fever, line represents the regression of seropositive individuals for recom- binant CL1 against native CL1. right hypochondrial pain, anorexia, weight loss, persistent diarrhea, and vomiting. However, many individuals are asymptomatic or present vague symptoms rendering clinical were seropositive and 26 were seronegative by the IgG4- diagnosis problematic.1 Accordingly, the development of a ELISA using both the recombinant and native CL1 (Figure simple, sensitive, and cost-effective diagnostic assay is im- 1 and Table 1). Chi-square analysis on whether individuals perative. While coprologic analysis may ful®ll some of these were seronegative or seropositive showed a highly signi®- requirements, it is clear that it provides a de®nitive parasi- cant relationship between the two proteins. Regression and tologic diagnosis only when eggs are found in the patient's correlation analysis of the data for the seropositive individ- feces, and that early infections cannot be detected using this uals showed that there was a highly linear relationship be- method. tween the two antigens (r2 5 0.751, P , 0.001) (Figure 1). Cathepsin L1 was considered a potential candidate for se- All patients who were coprologically positive (26) were rologic diagnosis of fascioliasis because it was secreted by also seropositive in the IgG4-ELISA using the recombinant all stages of the parasite that develop in the mammalian host or native proteins. Chi-square analysis showed that it was and was highly immunogenic in infected animals (antibodies highly unlikely (P , 0.001) that the coprologic and serolog- can be detected within two weeks after infection).10 O'Neill ically positive individuals would group together by chance and others7 demonstrated that this de®ned antigen discrimi- and thus reinforced the designation of the high absorbance nated between seropositive and seronegative individuals for cluster as the infected subpopulation. However, 12 copro- fascioliasis markedly better than crude antigens such as logically negative patients were identi®ed as seropositive. whole worm extracts of total ES products. Both the present These individuals may harbor early (prepatent) infections, study and that of O'Neill and others7 have shown that all since the appearance of eggs in the feces only follows the patients who were coprologically positive for F.