Hookworm infection caused by Ancylostoma duodenale or Necator americanus is a significant global health threat, causing chronic anemia, malnutrition, developmental delay, enteritis, and increased susceptibility to non-parasitic diseases. One of the most prevalent of the neglected tropical diseases, hookworm infection affects almost 1 billion people worldwide, particularly in developing countries. Current methods for diagnosis and treatment of hookworm infection are largely the same as they have been for the past century. However, several recent advances in the molecular characterization of hookworm virulence factors now provide researchers with an improved understanding of disease pathogenesis, potential targets for treatment and novel antigens for vaccine development. In order to better understand hookworm pathophysiology and immunology in human populations, a comprehensive, cross-sectional immunoepidemiologic survey of approximately 200 villagers in a remote area of the Peruvian Amazon was conducted. Hookworm prevalence rates were found to approach 40% by microscopic diagnosis. Additionally, molecular speciation techniques showed that both A. duodenale and N. americanus are endemic to this region. Reagents from a laboratory model of hookworm disease were then utilized to characterize human immune responses to hookworm specific antigens. By studying the immunoepidemiology of an endemic community we have found that a laboratory strain of hookworm, Anyclostoma ceylanicum, is a useful tool for describing species specific immune responses to disease. This work lays the foundation for future development of improved hookworm diagnostic techniques by molecular and immunologic methods.

Los parásitos nematodos producen diversas proteínas solubles que unen lípidos (LBPs) estructuralmente distintas a las del huésped. Las funciones que cumplen se desconocen pero se hipotetiza que estarían involucradas en las funciones típicas internas de organismos multicelulares, como la utilización y transporte de compuestos no solubles, y en externas especializadas. Algunas de estas proteínas participarían en la modificación del entorno local en el tejido del huésped, posibilitando la modulación y la evasión de la respuesta inmune. Entre las LBPs producidas por nematodos se encuentran las FAR (Fatty Acid and Retinol binding proteins), una clase novedosa de proteínas que unen ácidos grasos y retinol. Tienen un tamaño aproximado de 19 kDa y sus estructuras que parecen ser ricas en alfa-hélices aún no han sido completamente dilucidadas. La comprensión del rol que cumple esta familia de proteínas tiene gran interés fisiopatológico ya que podrían desempeñar funciones relevantes en la biología de los parásitos que las producen y dadas las diferencias estructurales que presentarían con respecto a las LBPs de sus huéspedes, servirían como potenciales blancos para el diseño de nuevas terapias antiparasitarias. Con la finalidad de contribuir a la caracterización de las proteínas FAR y avanzar de este modo en la determinación de su función biológica, se llevaron a cabo estudios biofísicos y estructurales que permitieron resolver la estructura de Na-FAR-1 en solución por espectroscopía de resonancia magnética nuclear. Determinándose que consta de once hélices que conforman una cavidad interna de gran tamaño, donde podrían ubicarse ligandos hidrofóbicos. La estequiometría de unión de los complejos formados por Na-FAR-1 estaría dada por cuatro moléculas de ácido oleico por molécula de proteína, pero se limitaría a una única molécula de ligando en el caso del retinol y de los análogos fluorescentes de ácidos grasos empleados para su estudio. A su vez se evidenció que además de los ligandos esperados como ácidos grasos y retinol, esta proteína es capaz de unir fosfolípidos y diacilglicéridos. La amplia diversidad de unión a ligandos, sumada a su localización en el intestino del nematodo, indicarían que podría participar en el direccionamiento hacia los distintos tejidos de los lípidos ingeridos.

With over a billion people infected world wide, hookworms are considered as important human pathogens, particularly in developing countries which have the highest rates of infections. Hookworms reside in the gastrointestinal tract of the host where they continuously feed on blood, leading to conditions such as chronic irondeficiency anaemia. The majority of blood-feeding parasites rely on proteins found in blood to provide many of their nutritional requirements for growth, reproduction and survival. Of the numerous proteins found in blood, haemoglobin (Hb) is one of the most abundant. In order to acquire amino acids for protein synthesis, it is thought that haematophagous parasites degrade Hb using various classes of endo- and exoproteases, in a manner similar to that which occurs in catabolism of proteins in mammalian cellular lysosomes. This study identified and characterised proteases involved in the Hb degradation process in the human hookworm, Necator americanus, in order to identify potential candidate antigens for a vaccine that interrupts blood-feeding. Red blood cells ingested by hookworms are lysed to release Hb, which is cleaved by various proteases into dipeptides or free amino acids and these are taken up through the gut membrane by amino acid transporters. Proteases expressed in the intestinal tract of hookworms are thought to play a major role in this process and would therefore make good targets for vaccine candidates aimed at interrupting blood-feeding. To identify these proteases, adult hookworms (both N. americanus and Ancylostoma caninum) were sectioned and intestinal tissue was dissected via laser microdissection microscopy. RNA extracted from the dissected tissue was used to generate gut-specific cDNA, which then was used to create plasmid libraries. Each library was subjected to shotgun sequencing, and of the 480 expressed sequence tags (ESTs) sequenced from each species, 268 and 276 contigs were assembled from the N. americanus and A. caninum libraries, respectively. Nine percent of N. americanus and 6.5% of A. caninum contigs were considered novel as no homologues were identified in any published/accessible database. The gene ontology (GO) classification system was used to categorise the contigs to predicted biological functions. Only 17% and 38% of N. americanus and A. caninum contigs, respectively, were assigned GO categories, while the rest were classified as being of unknown function. The most highly represented GO categories were molecular functions such as protein binding and catalytic activity. The most abundant transcripts encoded fatty acid binding proteins, C-type lectins and activation associated secreted proteins, indicative of the diversity of functions that occur in this complex organ. Of particular interest to this study were the contigs that encoded for cysteine and metalloproteases, expanding the list of potential N. americanus haemoglobinases. In the N. americanus cDNA library, four contigs encoding for cathepsin B cysteine proteases were identified. Three contigs from the A. caninum and one contig from the N. americanus cDNA libraries encoded for metalloproteases, including astacin-like and O-sialoglycoprotein endopeptidases, neither of which had previously been reported from adult hookworms. Apart from haemoglobinases, other mRNAs encoding potential vaccine candidate molecules were identified, including anti-clotting factors, defensins and membrane proteins. This study confirmed that the gut of hookworms encodes a diverse range of proteases, some of which are likely to be involved in Hb digestion and have the potential to be hidden (cryptic) vaccine antigens. Four cysteine proteases (Na-CP-2, -3, -4 and -5) were identified from the gut cDNA library of N. americanus. All four proteases belong to the clan CA, family C1, share homology with human cathepsin B and possess a modified occluding loop. Real-time PCR indicated that all transcripts were up-regulated in the adult stage of the hookworm parasite with high levels of mRNA expression detected in gut cDNA. All four proteases were expressed in recombinant form, but only Na-CP-3 was successfully expressed in soluble form in the yeast Pichia pastoris. Proteolytic activity for Na-CP-3 was detected on a gelatin zymogen gel, however no catalytic activity was detected against the class-specific fluorogenic peptides Z-Phe-Arg-AMC and Z-Arg-Arg-AMC. Mass spectrometry analysis of the purified protein suggested that the pro-region had not been processed in trans when the protein was secreted by yeast. Incubation of Na-CP-3 in salt buffers containing dextran sulfate resulted in autoprocessing of the pro-region as detected by Western blot and catalytic activity was detected against Z-Phe-Arg-AMC. Activated Na-CP-3 did not digest intact tetrameric human Hb. The other three cysteine proteases (Na-CP-2, -4, and -5) were expressed in insoluble form in Escherichia coli. Antibodies to all four proteins (Na- CP-2 to 5) immunolocalised to the gut region of the adult worm, supporting mRNA amplification results and strongly indicated that they might play a role in nutrient acquisition. Hb digestion in blood feeding parasites such as schistosomes and Plasmodium spp. occurs via a semi-ordered cascade of proteolysis involving numerous enzymes. In Plasmodium falciparum, at least three distinct mechanistic classes of endopeptidases have been implicated in this process, and at least two classes have been implicated in schistosomes. A similar process is thought to occur in hookworms. An aspartic protease, Na-APR-1, was expressed in P. pastoris and purified protein was shown to cleave the class-specific fluorogenic peptide 7- Methoxycoumarin-4-Acetyl-GKPILFFRLK(DNP)-D-Arg-Amide. Recombinant Na- APR-1 was able to cleave intact human Hb and completely degrade the 16 kDa monomer and 32 kDa dimer within one hour. Recombinant Na-CP-3 was not able to cleave intact Hb, but was able to further digest globin fragments that had previously been digested with Na-APR-1. A clan MA metalloprotease, Na-MEP-1, was identified in gut tissue of N. americanus and was expressed in recombinant form in Hi5 insect cells using the baculovirus expression system. Recombinant Na-MEP-1 displayed proteolytic activity when assessed by gelatin zymography, but was incapable of cleaving intact Hb. However, Na-MEP-1 did cleave globin fragments which had previously been incubated with Na-APR-1 and Na-CP-3. Hb digested with all three proteases was subjected to reverse phase HPLC and peptides were analysed using Liquid Chromatography-Mass Spectrometry (LC-MS). A total of 74 cleavage sites were identified within Hb ƒ¿ and ƒÀ chains. Na-APR-1 was responsible for cleavage of Hb at the hinge region, probably unravelling the molecule so that Na- CP-3 and Na-MEP-1 could gain access to globin peptides. All three proteases were promiscuous in their subsite specificities, but the most common P1-P1Œ residues were hydrophobic and/or bulky in nature, such as Phe, Leu and Ala. Antibodies to all three proteins (Na-APR-1, -CP-3, -MEP-1) immunolocalised to the gut region of the worm, further supporting their roles in Hb degradation. These results suggest that Hb degradation in N. americanus follows a similar pattern to that which has been described in Plasomdium falciparum. Studies conducted in this project have identified a number of potential haemoglobinases and have demonstrated that the gut region of the hookworm contains a multitude of proteases which could be targeted for production of new chemotherapies or as vaccine candidates. Results presented here also suggest that the Hb degradation process occurs in an ordered cascade, similar to those which have been reported in other haematophagous parasites. More importantly, it has been confirmed that Na-APR-1 plays a crucial role in the initiation of the Hb degradation process and therefore targeting this molecule as a vaccine candidate could provide high levels of protection against hookworm infection.

The effect of different types of sanitation facilities on soil contamination with geohelminth eggs and the associated risk factors were assessed in three informal settlements in Durban, South Africa. Adult members of 30 households in each settlement were interviewed to determine their knowledge, attitudes and perceptions on risk factors associated with geohelminth transmission. Two hundred soil samples were collected in each study settlement from areas considered potential sources of infection such as houses, pathways, sanitation facilities and washing areas. Of the total 600 soil samples collected, 190 (32%) were positive for geohelminth eggs with the eggs of Ascaris lumbricoides, Trichuris trichiura and Taenia spp. being recovered. Quarry Road West, where open defaecation was the most common (80%), sanitation coverage the lowest (11%) and lack of knowledge on geohelminth transmission high (97%), showed the highest levels of soil contamination (mean = 102.55eggs/100g). Stool samples were also collected from 135 children aged 1-16 years living in the three study areas. Children were found to be infected with A. lumbricoides and T. trichiura with prevalences of 33.4 and 6.5%, respectively and corresponding geometric mean intensities of 5.6 and 0.87eggs/g faeces. Some children (9.6%) also harboured dual infections. No hookworm or tapeworm infections were recorded. The results show a direct link between high levels of soil contamination and increased prevalence and infection rates. Indiscriminate defaecation by community members is recognised as the main contributing factor of geohelminth eggs in soil. The type and the number of toilets provided to a community greatly influence the success of a sanitation facility. In order to effectively control geohelminth transmission, health education and antihelminthic treatment need to accompany sanitation programmes in these areas. / Thesis (M.Sc.)-University of KwaZulu-Natal, Westville, 2011.