Schistosomiasis is a parasitic infection caused by worms of the genus Schistosoma. It is a neglected tropical disease, affecting mainly populations living in poverty without adequate sanitation.... Show moreSchistosomiasis is a parasitic infection caused by worms of the genus Schistosoma. It is a neglected tropical disease, affecting mainly populations living in poverty without adequate sanitation. Treatment relies on one drug mainly, praziquantel, and its efficacy is dependent on the diagnostic tool used.Due to the parasite’s intravascular localisation, it is difficult to directly quantify them in infected humans. Thus, methods of detection like worm-derived circulating cathodic antigen (CCA) in urine or circulating anodic antigen (CAA) in urine and serum, have gained more attention. This thesis aims to explore and shed light on how to interpret schistosome-related circulating antigens CCA and CAA. We have addressed the interpretation of schistosome related assays in endemic and non-endemic regions, supported by data obtained from an animal study. Different diagnostic value can be attributed to different assays within different contexts. The results highlight the importance of a better understanding of antigen excretion patterns by different species to support optimalisation of antigen-based diagnostics of schistosomiasis. Show less
Availability of accurate tests to diagnose schistosomiasis, a neglected tropical disease caused by parasitic worms, is crucial for successful reduction of the burden of disease and eventually... Show moreAvailability of accurate tests to diagnose schistosomiasis, a neglected tropical disease caused by parasitic worms, is crucial for successful reduction of the burden of disease and eventually moving towards elimination. This thesis provides further evidence on the suitability of CAA detection for diagnosing Schistosoma infections and monitoring treatment efficacy by evaluating the UCP-LF CAA test in the context of various endemic and non-endemic settings. The UCP-LF CAA test is a lateral flow (LF) test for sensitive quantitative detection – using luminescent up-converting reporter particles (UCP) – of circulating anodic antigen (CAA). This antigen is regurgitated by live schistosome worms into the human circulation. The presence of CAA in blood or urine thus reflects an active Schistosoma infection. CAA-levels decrease rapidly after treatment of infected patients with anti-schistosomal drugs. In non-endemic settings (i.e. the absence of reinfection), CAA-levels became undetectable after treatment, indicating clearance of infection. This is in contrast to endemic settings of continuous exposure and ongoing transmission. Here, CAA-levels significantly decreased post-treatment but often remained detectable. Although alternative procedures such as antibody and DNA detection methods remain crucial for certain context-specific purposes, this thesis shows that CAA is the most favorable diagnostic marker currently available for diagnosis of active Schistosoma infections. Show less
Controlled human infection (CHI) models are an important research tool. Healthy volunteers are experimentally infected with a pathogen. In malaria research the model has been used for decades. Here... Show moreControlled human infection (CHI) models are an important research tool. Healthy volunteers are experimentally infected with a pathogen. In malaria research the model has been used for decades. Here, the model was used to test new Plasmodium falciparum strains, NF135.C10 an NF166.C8, and compare these with the commonly used strain NF54. In addition, a genetically modified malaria vaccine, PfSPZ-GA1, was tested. Unfortunately only few volunteers were protected against malaria.For schistosomiasis, a controlled human schistosomiasis infection (CoHSI) model was developed and hereafter a dose finding study with single-sex male only cercariae was performed. This study showed that in 80% of volunteers 20 cercariae were effective to induce an infection. Although the use of 30 cercariae resulted in 100% infection rate two out of three volunteers developed Katayama syndrome. These side effects were less after infection with 20 cercariae.At last suggestions were made to further improve the CHI model by the use of historical controls. Although this study design can only be used in CHI’s with well-know outcomes these study will be safer by reducing the cumulative risks as less volunteers can be used for these trials. Show less
Schistosomiasis is an acute and chronic disease caused by blood dwelling parasitic trematodes of the genus Schistosoma, and it is classified as the second most socioeconomically devastating... Show moreSchistosomiasis is an acute and chronic disease caused by blood dwelling parasitic trematodes of the genus Schistosoma, and it is classified as the second most socioeconomically devastating parasitic disease, second only to malaria. Currently the wormload is determined by the Kato-Katz method, which is not always reliable. In order to prepare diagnostic tools able to capture specific anti-carbohydrate antibodies or develop conjugate vaccines targeting these carbohydrate structures, sufficient amounts of well-defined fragments are needed. This thesis describes the synthesis of several glycans of these glycans present on the S. mansoni parasite, focusing mainly on the Circulating Anodic Antigen (CAA) and glycans bearing the unique α-(1-2)-L-Fucose-α-(1-2)-L-Fucose motifs. These glycans have been attached to gold nanoparticles and these particles were screened against several monoclonal antibodies and sera of individuals suffering from schistosomiasis. Show less
During a schistosome infection, the host generates a plethora of antibodies against schistosome glycans. This thesis looks into the anti-schistosome-glycan antibody dynamics in different hosts with... Show moreDuring a schistosome infection, the host generates a plethora of antibodies against schistosome glycans. This thesis looks into the anti-schistosome-glycan antibody dynamics in different hosts with the aim of identifying targets that are relevant in the context of infection and protection. Show less
The work presented in this thesis aimed at increasing our understanding of the effect of helminths on Plasmodium spp. immune response in co-infected individuals living in endemic countries. It... Show moreThe work presented in this thesis aimed at increasing our understanding of the effect of helminths on Plasmodium spp. immune response in co-infected individuals living in endemic countries. It presents data from studies conducted in rural and semi urban areas of Lambaréné (Gabon) where the burden of malaria and helminths is particularly important. Although scarce previous studies have indicated an effect of helminths on malaria outcomes and immune response to Plasmodium spp. parasite in co-infected subjects. However it is still debated how consistent is this effect across study sites and teams and what its immunological basis is. Show less
Low birth weight including preterm birth and intrauterine growth retardation, remains important in sub-Saharan Africa and particularly highly prevalent in Gabon. Among the risk factors of... Show more Low birth weight including preterm birth and intrauterine growth retardation, remains important in sub-Saharan Africa and particularly highly prevalent in Gabon. Among the risk factors of low birth weight in sub-Saharan Africa are very young maternal age, first pregnancy, poor gestational nutrition and small stature of the mother. In Gabon, besides malaria, the other two major parasitic infections namely urogenital schistosomiasis and the filarial infection Loa loa, are common in pregnant women. Maternal schistosomiasis like malaria showed to be associated with higher proportions of low birth weight babies. Mefloquine as an alternative preventive treatment, despite showing no difference with sulphadoxine – pyrimethamine in preventing low birth weight, was however more effective in preventing malaria infection and anaemia. Mefloquine administered for the prevention of malaria was effective against concomitant urogenital schistosomiasis, suggesting that mefloquine could seriously be considered as a combined intervention for both malaria and schistosomiasis during pregnancy, and an alternative to praziquantel. Maternal infection with L. loa was associated with expansion in the neonatal cord blood of functionally activate Tregs that kept Th1 and Th17 immune responses in check, providing some insights on the impact of in utero exposure on the offspring’s development and health. Show less
In the last few decades, childhood allergy has alarmingly increased to epidemic levels in industrialized countries. Conversely, chronic helminth infections, which are highly prevalent in developing... Show moreIn the last few decades, childhood allergy has alarmingly increased to epidemic levels in industrialized countries. Conversely, chronic helminth infections, which are highly prevalent in developing countries, are negatively associated with allergic disorders. The work in this thesis revealed that, using B-cell IL-10-deficient mice, Schistosoma mansoni-mediated protection against experimental ovalbumin-induced allergic airway inflammation (AAI) was specifically dependent on splenic IL-10-producing CD1dhi regulatory B (Breg) cells. Furthermore, we demonstrated that another B cell subset, located in the lungs, provided protection against AAI, by showing a reduced capacity to initiate Th2 cytokine responses. Markedly, we found a similarly elevated population of IL-10-producing CD1dhi B cells in peripheral blood of Schistosoma haematobium-infected Gabonese children compared to uninfected children. We observed that schistosome-induced Breg cells reduced effector T-cell cytokines and induced more Treg cells. What is interesting in this aspect, is that we found that the Breg cell compartment of patients with allergic asthma is impairment in number and activity. Therefore, the identification of the mechanisms that underlying Breg cell induction by helminths, and the identification the helminth-derived molecules involved, may open novel avenues for the treatment of allergic disease disorders by driving potent Breg cells Show less
In Africa, polyparasitism is the rule rather than the exception. The aim of this thesis was to get a detailed insight into the micro-geographical distribution and patterns of S. mansoni and S.... Show moreIn Africa, polyparasitism is the rule rather than the exception. The aim of this thesis was to get a detailed insight into the micro-geographical distribution and patterns of S. mansoni and S. haematobium co-infections, and how this affects host morbidity. A community-wide study was carried out in a co-endemic focus in the north of Senegal, combining epidemiological, ecological, immunological, and geographical analyses. This multidisciplinary approach led to several new insights. Spatial analyses showed significant clustering of Schistosoma infection and morbidity even on a micro scale; S. mansoni and S. haematobium hotspots were found in different sections of one community. Another major finding was that the presence of S. mansoni in co-infections might protect against S. haematobium-specific urinary tract morbidity. Furthermore, it was observed that S. haematobium antigens induced stronger cytokine responses than those of S. mansoni, indicating that the first species may be more immunogenic. The results of this thesis provide new leads for further research on disease etiology and underlying mechanisms in Schistosoma co-infections. Such knowledge is key to rationalizing and optimizing current schistosomiasis control strategies in co-endemic areas and to developing successful elimination strategies in the future. Show less
The application of dedicated mass spectrometry (MS) and nuclear magnetic resonance (NMR) technologies for biomarker discovery and diagnostic purposes has increased substantially in the last decade.... Show moreThe application of dedicated mass spectrometry (MS) and nuclear magnetic resonance (NMR) technologies for biomarker discovery and diagnostic purposes has increased substantially in the last decade. In the studies presented in this thesis, we have used these technologies to identify parasite or host-derived products (biomarkers) related to infection and morbidity associated with schistosomiasis and to better understand the host-parasite interaction. The application of our peptidomics and metabonomics studies on schistosomiasis have provided some novel, valuable information but they are obviously only the first step. In addition to the potential biomarkers identified with the global biomarker discovery approaches, we showed in this thesis that a more targeted approach, looking at glycosylation, also resulted in novel information on S. mansoni infection. We have identified and characterized a set of human Apolipoprotein C-III peptides aberrantly glycosylated at the O-glycosylation site (Thr74), in urine of S. mansoni- infected individuals. The presented study is the first in which MS and NMR were used for the analysis of a cohort of human S. mansoni-infected individuals. This has resulted in the identification of a number of novel markers. Nevertheless, further studies are needed to evaluate the overall applicability of these putative biomarkers Show less
Verschillende biologische systemen, zoals het 50S ribosomale Hsp15 complex, een schistosomiasis diagnostisch antigen bindend antilichaam fragment (Fab 54-5C10-A), het zuurstof producerende enzym... Show moreVerschillende biologische systemen, zoals het 50S ribosomale Hsp15 complex, een schistosomiasis diagnostisch antigen bindend antilichaam fragment (Fab 54-5C10-A), het zuurstof producerende enzym chloriet dismutase (Cld) en het belangrijke regulatoreiwit van microtubule dynamiek (EB1) zijn onderzocht met geavanceerde biochemische technieken. De structurele informatie verkregen met electronenmicroscopie (EM), kleine hoek verstrooiing van R_ntgenstraling (SAXS) en R_ntgendiffractie aan individuele eiwitkristallen werd aangevuld met informatie uit andere biofysische en biochemische methoden, zoals kolom chromatografie, gel elektroforese, oppervlakte plasmon resonantie (SPR), massa spectrometrie (MS) en electron paramagnetische resonantie (EPR). Hoewel de in dit proefschrift beschreven biologische systemen uiteenlopen wat betreft chemische samenstelling, oorsprong en biologische functie, is er juist ook gekeken naar een gemeenschappelijk kenmerk: ge_nduceerde conformatieveranderingen binnen het eiwit, eiwit-RNA of eiwitcarbohydraat complex. Show less
Schistosomiasis, also known as bilharzia, is a disease that still occurs in many parts of Africa, the Middle East and Southern America, mainly Brasil and the Caribbean. Schistosomiasis is, after... Show moreSchistosomiasis, also known as bilharzia, is a disease that still occurs in many parts of Africa, the Middle East and Southern America, mainly Brasil and the Caribbean. Schistosomiasis is, after malaria, the second most common parasitic infection. Currently 200 million people are infected with the worms that cause the disease. Schistosoma mansoni is the most common schistosome species that infects humans. The schistosome produces many different sugar structures (glycans) that are not made by humans. Central to this thesis are sugar structures with a __double fucose__. Such fucosylated glycans are mainly produced by the eggs, which play a major role in the disease schistosomiasis. The human immune defence system responds to these parasite glycans in several ways. High antibody responses have been measured against sugar structures with a __double fucose__ moiety and different types of immune cells interact with these glycan structures. Despite these immunological responses the human host is not able to clear the parasitic infection. Glycans are thought to play a role in the mechanisms that S. mansoni has developed to survive in the hostile environment of the human blood. In this thesis the structures of several glycans containing the __double fucose__ moiety have been characterised using different mass spectrometric techniques. Show less
Schistosomiasis (bilharzia) is one of the major parasitic infections in tropical areas. It is caused by blood-dwelling flukes, residing in the mesenteric and pelvic veins of the human host. Over... Show moreSchistosomiasis (bilharzia) is one of the major parasitic infections in tropical areas. It is caused by blood-dwelling flukes, residing in the mesenteric and pelvic veins of the human host. Over 200 million individuals are estimated to be infected with these worms, while at least 700 million people are at risk. The conventional method to diagnose this disease is by the demonstration of parasite eggs in faecal or urine specimens. However, this technique has several disadvantages, a.o. infections with low worm burden can be easily missed, and due to a high day-to-day fluctuation in egg counts, repeated examinations are needed to estimate the intensity of infection. Alternatively, schistosomiasis can be diagnosed by the detection of host antibodies directed against schistosome antigens. This technique has shown to be highly sensitive and specific, but is not able to differentiate between active and past infection, or to give information about intensity of infection Show less
