Serological Monitoring of Progression of Alveolar Echinococcosis with Multiorgan Involvement by Use of Recombinant Em18

Ishikawa, Yuji; Sako, Yasuhito; Itoh, Sonoyo; Ohtake, Takaaki; Kohgo, Yutaka; Matsuno, Takeo; Ohsaki, Yoshinobu; Miyokawa, Naoyuki; Nakao, Minoru; Nakaya, Kazuhiro; Itō, Akira

doi:10.1128/jcm.01111-09

Cited by 29 publications

(21 citation statements)

References 31 publications

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“…This observation indicates that Em18 can be highly useful for assessing the parasite activities in human AE patients following interventional measures. Similar results have recently been published in which rEm18 serology was shown to be reliable for monitoring the progression of AE (11,31). A much greater proportion (28.9%) of CE cases were observed to exhibit specific antibody against rEm18 than those (3% to 13%) described in previous studies (16,18,30,37), in which positive patients were found to have complicated or multiple cysts.…”

Section: Discussionsupporting

confidence: 87%

Specific IgG Responses to Recombinant Antigen B and Em18 in Cystic and Alveolar Echinococcosis in China

Itō

Chen

et al. 2010

Clin Vaccine Immunol

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An understanding of the correlation of the specific antibody responses and the disease phase is essential in evaluating diagnostic values of immunological tests in human echinococcosis. In this study, 422 echinococcosis patients diagnosed by ultrasonography, including 246 with cystic echinococcosis (CE), 173 with alveolar echinococcosis (AE), and 3 with dual infection, were tested for specific IgG in sera against recombinant AgB (rAgB) and recombinant Em18 (rEm18) in an enzyme-linked immunosorbent assay. As a result, rAgB-specific antibody was detected in 77.6% of CE and 86.1% of AE patients, while rEm18-specific antibody was present in 28.9% of CE and 87.3% of AE patients. Additionally, all three patients with dual infection exhibited specific antibodies responding to rAgB and rEm18. Further analysis revealed that rAgB-specific antibody was elevated in a significantly greater proportion (87.3%) of CE patients with cysts at active or transitional stages (CE1, CE2, or CE3), compared to 54.8% of other patients with cysts at an early or an inactive stage (CL or CE4 or CE5). Furthermore, rAgB-specific antibody was detected in 95.6% of CE2 cases, which was statistically greater than that (73.7%) in CE1 patients. Although rEm18-specific antibody was elevated in 28.9% of CE patients, the positive reaction was much weaker in CE than in AE cases. Serum levels and concentrations of rEm18-specific antibody were further indicated to be strongly disease phase correlated in AE patients, with positive rates of 97.4% in cases with alveolar lesions containing central necrosis and 66.7% in patients with early alveolar lesions that measured <5 cm.Humans acquire the infection of echinococcosis by accidental ingestion of eggs excreted with feces of carnivores harboring the adult worms of Echinococcus spp. The eggs hatch in the small intestine of humans, releasing the oncosphere, which migrates via the portal system into various organs and then develops into the metacestode stage. The larval parasite can establish itself in any part of the human body but most frequently does so in the liver (32). Diagnosis of human echinococcosis is primarily based on the pathognomonic features in images obtained using imaging techniques including ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). Of these techniques, B-ultrasound is much more widely applied, as CT and MRI are too expensive and largely inaccessible in most areas where echinococcosis is endemic. Criteria for classification of cystic echinococcosis (CE) and alveolar echinococcosis (AE) have been proposed based on stage-specific ultrasound images (20,36). Briefly, on the basis of conformational features of cysts, CE lesions are differentiated into six types: CL, CE1, CE2, CE3, CE4, and CE5. The CL type refers to a cystic lesion of a parasite origin and without a clear rim, indicating the parasite is at a very early stage of development. The CE1 type describes a unilocular simple cyst with uniform anechoic content and, importantly, with a visible wall, while...

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Section: Discussionsupporting

confidence: 87%

Specific IgG Responses to Recombinant Antigen B and Em18 in Cystic and Alveolar Echinococcosis in China

Itō

Chen

et al. 2010

Clin Vaccine Immunol

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“…In cases with curative resections, continuous and dramatic decreases in antibody levels after resection of an alveolar hydatid cyst were observed. These results are consistent with those of previous studies using Em18 and other native E. multilocularis metacestode antigens (1,7,9,12,16,17,18). In cases with unresectable and stable diseases, the kinetics of antibody levels varied in individual patients.…”

Section: Resultssupporting

confidence: 92%

“…In a case with a calcified lesion (patient 1), a slow decrease in antibody levels was observed, and the last serum sample became negative by the ELISA but was ICT positive. Because antibody levels in patients are very closely related to the progression of AE (1,7,9,12,16,17,18), the efficacy of chemotherapy using benzimidazole against parasites might influence the variability of antibody responses.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, serologic analysis is considered to be useful for monitoring disease activity (4,8,10). Studies by an enzymelinked immunosorbent assay (ELISA) with recombinant E. multilocularis 18-kDa antigen (rEm18) (14) and serum samples from patients in different clinical stages of AE according to the World Health Organization (WHO)-PNM (P, parasitic mass in the liver; N, involvement of neighboring organs; M, metastasis) system (11) have revealed that specific immunoglobulin G (IgG) antibody levels in a patient's serum shows a close relationship between the clinical status and the individual treatment (7,9,17,18). However, the ELISA is time-consuming and requires special materials and equipment, which renders this test unsuitable for direct clinical applications.…”

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Immunochromatographic Test with Recombinant Em18 Antigen for the Follow-Up Study of Alveolar Echinococcosis

Sako¹,

Tappe²,

Fukuda³

et al. 2011

Clin. Vaccine Immunol.

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The performance of a rapid and simple immunochromatographic test (ICT) with recombinant Em18 (rEm18) antigen for serological follow-up of Echinococcus multilocularis infection was evaluated by comparison with that of an enzyme-linked immunosorbent assay (ELISA) with rEm18, using serum samples from patients who underwent surgery and/or received antiparasitic chemotherapy. The degree of Em18-band intensity on the ICT correlated highly with the absorbance value obtained by the ELISA. The kinetics of antibody levels obtained by the ICT paralleled those of the ELISA. These data suggest that the ICT has high potential as an easy-to-handle, fast, and reliable follow-up tool to monitor the status of alveolar echinococcosis in different stages.

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“…11 , 12 Case 4 showed very strong antibody responses to RecEm18, the highly specific diagnostic antigen for detection of active AE by both IB and ICT. [10][11][12][13][14][15] This finding indicates that this woman still had active lesions, because serology becomes negative within 1 year of successful radical resection. 12 , 13 A pre-surgical serum sample from case 5 also showed very strong antibody responses to RecEm18 in IB and ICT, suggesting that AE could have been easily confirmed if serology was introduced for diagnosis before surgery.…”

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confidence: 81%

Histopathological, Serological, and Molecular Confirmation of Indigenous Alveolar Echinococcosis Cases in Mongolia

Itō

Agvaandaram²,

Bat-Ochir³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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Alveolar echinococcosis cases diagnosed histopathologically in 2002, 2006, 2007, and 2009 in Ulaanbaatar, Mongolia were reconfirmed by evaluating the cytochrome c oxidase subunit I gene of mitochondrial DNA. The most recent three cases using paraffin-embedded and ethanol-fixed specimens revealed that one was of the “Asian” haplotype, whereas two others were of the “Inner Mongolian” type. All patients were born in the western provinces of Mongolia, they never resided outside of Mongolia, and they were given a preliminary diagnosis of malignant hepatic tumor or abscess. The most recent two cases were also confirmed serologically to be active alveolar echinococcosis.

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Serological Monitoring of Progression of Alveolar Echinococcosis with Multiorgan Involvement by Use of Recombinant Em18

Cited by 29 publications

References 31 publications

Specific IgG Responses to Recombinant Antigen B and Em18 in Cystic and Alveolar Echinococcosis in China

Specific IgG Responses to Recombinant Antigen B and Em18 in Cystic and Alveolar Echinococcosis in China

Immunochromatographic Test with Recombinant Em18 Antigen for the Follow-Up Study of Alveolar Echinococcosis

Histopathological, Serological, and Molecular Confirmation of Indigenous Alveolar Echinococcosis Cases in Mongolia

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