Mechanisms and Treatment of Chronic, Latent Human Strongyloidiasis

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PROJECT SUMMARY The intestinal parasitic nematode Strongyloides stercoralis infects approximately 100 million people worldwide and an estimated 100,000 in impoverished communities in the USA. In its uncomplicated form, human strongyloidiasis results in chronic enteritis, diarrhea and failure to thrive in children, a syndrome common to other soil-transmitted nematode infections. Unlike other parasitic nematodes, S. stercoralis is capable of autoinfection, and therefore self-replication in individual hosts. Autoinfection may occur at a low, well-regulated level and give rise to chronic, latent infections that can apparently last for the life of the host. In patients subjected to immunosuppressive chemotherapy or infected by HTLV-1, these exceedingly chronic infections may progress to states in which autoinfection is dysregulated, resulting in potentially fatal disseminated hyperinfection. Use of steroidal immunosuppressants is frequently associated with episodes of hyperinfective strongyloidiasis, and can stimulate autoinfection by S. stercoralis in animal models. In its exploratory phase, this project will examine the mechanism by which steroids regulate autoinfection by S. stercoralis. We will test three non-mutually exclusive hypotheses of how this regulation occurs. The first two hypotheses are related and hold that medicinal steroids or their host metabolites, respectively, act directly on the parasite via its Ss-DAF-12 nuclear hormone receptor to stimulate and maintain autoinfection. These two hypotheses will be tested under Aim 1 of the R21 phase of the project by ascertaining whether common medicinal steroids such as prednisolone or its common metabolites can activate Ss-DAF-12 signaling in a cell based reporter assay. In vivo experiments will ascertain whether pre-treatment of larval S. stercoralis with medicinal steroids can potentiate autoinfection when these parasites are inoculated into a host. The third hypothesis of steroid regulation of autoinfection is that this occurs in an indirect manner with respect to the parasite by suppressing the host's immune system and thereby rendering it more permissive for this process. We will test this hypothesis under Aim 2 of the R21 phase by ablating immune effector cell populations that remain in the congenitally immune-deficient NSG mouse and ascertaining whether autoinfection occurs independent of steroid treatment. Attainment of milestones comprising evidence of direct steroid effects on S. stercoralis will support progression of the project to a translational R33 phase where, under Aim-3, compounds arising as hits from an existing system for high-throughput screening of small-molecule libraries for agonists and antagonists of Ss-DAF-12 will be prioritized for in vivo testing. Under Aim 4 in the R33 phase, hits will be tested for efficacy in preventing autoinfection in a gerbil model simulating drug-induced autoinfection, and, if results from the R21 phase allow, in an NSG mouse model of spontaneous autoinfection stimulated by underlying immune deficiency. Milestones indicating success in the R33 phase will be three lead compounds that clear hyperchronic S. stercoralis infection.