Liver cystic echinococcosis: pre-clinical assessment of a novel, single step percutaneous treatment procedure (intracystic albendazole sulfoxide injection)

 描述(申请人提供)：囊型包虫病是一种人畜共患疾病，由犬带绦虫幼虫期细粒棘球绦虫引起，在饲养家畜的地区包括欧亚大陆、英国、澳大利亚、南美洲和北非和东非都是地方性疾病，在流行地区被认为是一个严重和昂贵的公共卫生问题。肝脏CE是最常见的临床表现，约占人类CE病例的70%。在过去的40年里，肝脏CE的治疗程序发生了变化。目前，使用四种治疗方式：(1)阿苯达唑(ABZ)内科治疗，(2)对(穿刺法、抽吸法、注射原头节杀菌剂；再抽吸法)，(3)手术切除 和(4)观察和等待不活跃的、临床上无症状的囊性病变。在大多数流行的国家，手术是治疗肝囊肿的主要方法。PATE在治疗肝脏CE方面取得了进展，只要有超声引导，就可以在资源有限的中心进行。然而，Pair有一些技术缺陷，包括需要排除膀胱胆瘘的存在，而且不是完全有效的。一种更简单、更安全、更有效的治疗方法将对流行区的患者大有裨益。目前的提案将评估一种新的治疗方法，即一步将阿苯达唑亚砜(ABZ-SF)--阿苯达唑的活性代谢物--注射到囊内。与PATE相比，这种方法耗费的资源和时间更少，不应因膀胱胆瘘的存在而受到阻碍，而且也应该比口服ABZ治疗更安全，因为它避免了与长期口服ABZ治疗相关的全身毒性。第一个项目是一项试验性的安慰剂对照实验/干预动物安全性研究，比较两种不同剂量的ABZ-SF，以确定较高的安全剂量，并提供关于抗寄生虫药物注射效果的初步信息。第二项研究是一项盲目、安慰剂对照的随机试验，测试研究1中确定的ABZ-SF的最高安全剂量。最后，在第三项研究中，也是一项盲目、对照的随机试验，我们将确定 获得治疗成功所需的最低囊腔内ABZ-SF浓度。这项提议最终可以为人类肝脏CE提供一种新的治疗方法，并将导致R34应用于未来的人体试验。

 DESCRIPTION (provided by applicant): Cystic echinococcosis (CE), a zoonotic disease caused by the larval stage of the dog tapeworm Echinococcus granulosus, is endemic to areas where livestock are raised including Eurasia, UK, Australia, South America and North and East Africa, and considered a serious and costly public health problem in endemic regions. Liver CE is the most common clinical presentation, representing around 70% of human CE cases. Treatment procedures for liver CE have evolved over the past four decades. Currently, four treatment modalities are used: (1) medical treatment with albendazole (ABZ), (2) PAIR (Puncture, Aspiration, Injection of protoscolicidal agent; Reaspiration), (3) surgery to remove the cyst and (4) watch and wait for inactive, clinically silent cysts. In most endemic countries, surgery is the main treatment approach for liver cysts. PAIR has gained ground in the treatment of liver CE and can be performed in centers with limited resources as much as ultrasound guiding is available. PAIR however has some technical drawbacks that include the need to rule out the presence of a cysto-biliary fistula, and is not completely efficacious. A simpler, safer an more effective treatment approach would be of great benefit for patients in endemic regions. The current proposal will evaluate a new treatment approach that consists on a single step injection of albendazole sulfoxide (ABZ-SF), the active metabolite of ABZ, into the cyst. This procedure is less resource and time demanding than PAIR, should not be hampered by the presence of cysto-biliary fistula, and should also be safer than oral ABZ therapy since it avoids the systemic toxicity associated with a prolonged therapy with oral ABZ. The first project is a pilot placebo controlled experimental / interventional animal safety study comparing two different doses of ABZ-SF to determine the higher safe doses as well as to provide preliminary information about efficacy of the antiparasitic drug injection. The second study is a blind, placebo controlled randomized trial testing the highest safe dose of ABZ-SF identified in study 1. Finally, in a third study, which is also a blind, controlled randomized trial, we will determine the minimal needed concentration of intracystic ABZ-SF to achieve treatment success. This proposal can eventually provide a new therapeutic approach for human liver CE, and should result in an R34 application for a future human trial.