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Background Anthelminthic treatment options against schistosomiasis are limited. The current treatment relies almost exclusively on a single drug, praziquantel (PZQ). As a consequence, the development of resistance to PZQ and limited activity of PZQ against earlier development stages are respectively a risk and a limitation to achieving the goals of the new WHO roadmap towards elimination. For the discovery of new chemical starting points, the in vitro drug screening on Schistosoma mansoni (S. mansoni) against newly transformed schistosomula (NTS) is still the most predominant approach. The use of only NTS in the initial screening limits sensitivity to potential new compounds which are predominantly active in later developmental stages. Using our recently described highly standardized, straightforward and reliable culture method that generates high rates of juvenile worms, we aimed to repurpose a subset of the National Center for Advancing Translational Sciences (NCATS) Pharmaceutical Collection (340 compounds) to identify new hits with an in vitro worm culture assay. Methodology/Principal findings Cercariae were mechanically transformed into skin-stage (SkS) schistosomula and continuously cultured for 3–6 weeks to the liver stage (LiS). A commercial source of serum was identified, and decrease of NTS/well along with optimal drug testing conditions was established to test compounds on early and late LiS worms. The library was screened in 96-well format assays using praziquantel (PZQ) as a positive control. Primary screening allowed a 5.9% hit rate and generated two confirmed hits on adult worms; a prophylactic antianginal agent and an antihistaminic drug. Conclusion With this standardized and reliable in vitro assay, important S. mansoni developmental stages up to LiS worms can be generated and cultured over an extended period. When exposed to a subset of the NCATS Pharmaceutical Collection, 3 compounds yielded a defined anti-schistosomal phenotype on juvenile worms. Translation of activity on perfused adult S. mansoni worms was achieved only for perhexiline (a prophylactic antianginal agent) and astemizole (an antihistaminic drug)., Author summary Schistosomiasis continues to be a major public health problem, mainly in developing countries. Although there have been some advances in finding new drugs, praziquantel is still the drug of choice. Certainly, one of the most important advances in the search for new treatments was the ability to in vitro transform cercariae and to grow schistosomula in culture. To reduce animal use in future drug discovery efforts (3Rs), we optimized a previously established reliable and robust in vitro cell-free culture system for the generation of liver-stage worms that we applied to the screening of a compound library stemming from the National Center for Advancing Translational Sciences (NCATS) Pharmaceutical Collection.

Taenia solium cysticercosis and taeniasis (TSCT), caused by the tapeworm T. solium, is a foodborne and zoonotic disease classified since 2010 by WHO as a neglected tropical isease. It causes considerable impact on health and economy and is one of the leading causes of acquired epilepsy in most endemic countries of Latin America, Sub-Saharan Africa, and Asia. There is some evidence that the prevalence of TSCT in high-income countries has recently increased, mainly due to immigration from endemic areas. In regions endemic for TSCT, human cysticercosis can manifest clinically as neurocysticercosis (NCC), resulting in epileptic seizures and severe progressive headaches, amongst other neurological signs and/or symptoms. The development of these symptoms results from a complex interplay between anatomical cyst localization, environmental factors, parasite's infective potential, host genetics, and, especially, host immune responses. Treatment of individuals with active NCC (presence of viable cerebral cysts) with anthelmintic drugs together with steroids is usually effective and, in the majority, reduces the number and/or size of cerebral lesions as well as the neurological symptoms. However, in some cases, treatment may profoundly enhance anthelmintic inflammatory responses with ensuing symptoms, which, otherwise, would have remained silent as long as the cysts are viable. This intriguing silencing process is not yet fully understood but may involve active modulation of host responses by cyst-derived immunomodulatory components released directly into the surrounding brain tissue or by the induction of regulatory networks including regulatory T cells (Treg) or regulatory B cells (Breg). These processes might be disturbed once the cysts undergo treatment-induced apoptosis and necrosis or in a coinfection setting such as HIV. Herein, we review the current literature regarding the immunology and pathogenesis of NCC with a highlight on the mobilization of immune cells during human NCC and their interaction with viable and degenerating cysticerci. Moreover, the immunological parameters associated with NCC in people living with HIV/AIDS and treatments are discussed. Eventually, we propose open questions to understand the role of the immune system and its impact in this intriguing host-parasite crosstalk.

Manual blood smear analysis remains the gold standard to diagnose hematological disorders and infections of blood parasites. However, the analysis and interpretation of peripheral blood smears requires expert users, is time consuming, depends on inter-observer variation, and is not compatible with a high-throughput workflow for clinical routine diagnostics (Dunning & Safo, Biotech. Histochem. 2011, 86, 69–75; Pierre, Clin. Lab. Med., 2002, 22, 279–297). Instead, automated hematology analyzers only flag atypical results which provides no clear classification of diseases and require extensive sample preparation. Label-free image analysis of untouched blood cells would reduce pre-analytical efforts and potentially allows characterization of samples with higher information content compared to both smear analysis and conventional automated flow cytometry, as the blood cell morphology is preserved. Furthermore, preclinical research work is in need for non-invasive analysis of e.g. cancer cells or infected cells to support the discovery of new drugs. We suggest to apply high-throughput and label-free workflows based on digital holographic microscopy for standardizable image analysis relevant for pre- and clinical diagnosis. In the case of parasitic infections, the label-free detection and analysis of malaria parasites has been addressed by various studies (Anand et al., IEEE Photonics J., 2012, 4, 1456-1464; Seo et al., Appl. Phys. Lett., 2014, 104, 1-4; Park et al, PloS One, 2016, 11, 1-19; Ugele et al., Lab Chip, 2018, 18, 1704-1712). The detection of neglected tropical diseases affecting livestock and humans, such as Chagas disease and Leishmaniosis, has not been addressed so far by the community. Our platform technology is based on a customized differential holographic microscopy setup, which has been previously described (Ugele et al., Lab Chip, 2018, 18, 1704-1712; Ugele et al., Adv. Sci., 2018, 5, 1800761). Reference data sets of clinical leukemic samples, cancer cell cultures in solution, and in vitro cultures of various parasites were collected to understand the translational potential for this methodology. Hydrodynamic and viscoelastic focusing in a microfluidics channel was used for high-throughput imaging and enrichment/depletion of cell populations without the need for any autofocusing procedures. Morphological parameters describing the inner consistency were calculated from segmented phase images of the cells/parasites and combined with machine learning algorithms for improved analysis by the discovery of label-free biomarkers. In this way, improved subtyping of acute and chronic leukemias, myeloproliferative neoplasms, and further hematological disorders was achieved. Second, a detection of Trypanosoma and Leishmania parasites could be shown and in vitro cultures of Schistosomia mansoni were classified according to different viability stages. Third, the capability of anti-cancer drug candidate screening was demonstrated by monitoring the mesenchymal-epithelial transition of pancreas cancer cell cultures. We envision, that our platform technology has the potential as a cost-efficient method for automated diagnosis of various hematological disorders, parasitic infections, drug screening and monitoring of therapy efficacy. With further integration effort we also believe that the technology can be applied in resource limited settings.

Background The arsenal in anthelminthic treatment against schistosomiasis is limited and relies almost exclusively on a single drug, praziquantel (PZQ). Thus, resistance to PZQ could constitute a major threat. Even though PZQ is potent in killing adult worms, its activity against earlier stages is limited. Current in vitro drug screening strategies depend on newly transformed schistosomula (NTS) for initial hit identification, thereby limiting sensitivity to new compounds predominantly active in later developmental stages. Therefore, the aim of this study was to establish a highly standardized, straightforward and reliable culture method to generate and maintain advanced larval stages in vitro. We present here how this method can be a valuable tool to test drug efficacy at each intermediate larval stage, reducing the reliance on animal use (3Rs). Methodology/Principal findings Cercariae were mechanically transformed into skin-stage (SkS) schistosomula and successfully cultured for up to four weeks with no loss in viability in a commercially available medium. Under these serum- and cell-free conditions, development halted at the lung-stage (LuS). However, the addition of human serum (HSe) propelled further development into liver stage (LiS) worms within eight weeks. Skin and lung stages, as well as LiS, were submitted to 96-well drug screening assays using known anti-schistosomal compounds such as PZQ, oxamniquine (OXM), mefloquine (MFQ) and artemether (ART). Our findings showed stage-dependent differences in larval susceptibility to these compounds. Conclusion With this robust and highly standardized in vitro assay, important developmental stages of S. mansoni up to LiS worms can be generated and maintained over prolonged periods of time. The phenotype of LiS worms, when exposed to reference drugs, was comparable to most previously published works for ex vivo harvested adult worms. Therefore, this in vitro assay can help reduce reliance on animal experiments in search for new anti-schistosomal drugs., Author summary Schistosomiasis remains a major health threat, predominantly in developing countries. Even though there has been some progress in search of new drugs, praziquantel remains the only available drug. Probably the most important advance in the search for new drugs was in vitro transformation of cercariae and their subsequent culture. However, hit identification in compound screenings is exclusively tested in skin stage parasites and is only confirmed for more mature worms in a subsequent step. This is in part due to the lack of an easy culture system for advance-stage parasites. We present here a reliable and highly standardized way to generate LiS worms in vitro in a cell-free culture system. The inclusion of in vitro drug tests on advanced-stage parasites in initial hit identification will help to identify compounds that might otherwise be overlooked. Furthermore, the ability to continuously observe the parasite’s development in vitro will provide an important platform for a better understanding of its maturation in the human host. Taken together, this opens up new avenues to investigate the influence of specific cell types or host proteins on the development of Schistosoma mansoni and provides an additional tool to reduce animal use in future drug discovery efforts (3Rs).