Nitazoxanide (NTZ), a drug currently being tested in human clinical trials for efficacy against chronic cryptosporidiosis, was assessed in cell culture and in two animal models. The inhibitory activity of NTZ was compared with that of paromomycin (PRM), a drug that is partially effective against Cryptosporidium parvum. A concentration of 10 μg of NTZ/ml (32 μM) consistently reduced parasite growth in cell culture by more than 90% with little evidence of drug-associated cytotoxicity, in contrast to an 80% reduction produced by PRM at 2,000 μg/ml (3.2 mM). In contrast to its efficacy in vitro, NTZ at either 100 or 200 mg/kg of body weight/day for 10 days was ineffective at reducing the parasite burden in C. parvum-infected, anti-gamma-interferon-conditioned SCID mice. Combined treatment with NTZ and PRM was no more effective than treatment with PRM alone. Finally, NTZ was partially effective at reducing the parasite burden in a gnotobiotic piglet diarrhea model when given orally for 11 days at 250 mg/kg/day but not at 125 mg/kg/day. However, the higher dose of NTZ induced a drug-related diarrhea in piglets that might have influenced its therapeutic efficacy. As we have previously reported, PRM was effective at markedly reducing the parasite burden in piglets at a dosage of 500 mg/kg/day. Our results indicate that of all of the models tested, the piglet diarrhea model most closely mimics the partial response to NTZ treatment reported to occur in patients with chronic cryptosporidiosis.

Salivary gland lysates of the sand fly Lutzomyia longipalpis markedly enhance the course of infection with Leishmania major in mice. Here we examine various parameters of this phenomenon. The exacerbative effect of L. longipalpis salivary gland lysates occurred in five different mouse strains; however, the character of the effect varied from one strain to another. Consistent exacerbation of infection was achieved with as little as 1/10 of a gland. The exacerbative effect applied to more than one Leishmania species and to more than one species of sand fly, since salivary gland lysates of L. longipalpis enhanced infection with L. mexicana amazonensis and salivary gland lysates of Phiebotomus papatasi enhanced infection with L. major. A synthetic rat calcitonin gene-related peptide was also found to exacerbate infection with L. major but was found to be approximately 100-fold less potent than saliva in mediating this effect. In addition, lesions induced at skin sites at which L. longipalpis had probed for a blood meal exhibited an exacerbated course of infection similar to that seen when parasites were injected with sand fly salivary gland lysates.

Cryptosporidiosis is a serious disease in malnourished children and in people with malignancies or AIDS. Current rodent models for evaluating drug therapy against cryptosporidiosis have many limitations, including the need for a high inoculum, the absence of symptoms resembling those seen in humans, and the need to maintain exogenous immunosuppression. We have developed a gamma interferon knockout (GKO) mouse model with which to evaluate therapies againstC. parvum and have used paromomycin for evaluation of this model. The GKO model offers considerable improvements over other systems, since it requires no additional immunosuppression and adult mice can be infected with as few as 10 oocysts (compared with 107 for SCID mice). Infected mice develop profound gastrointestinal dysfunction due to extensive infection and severe mucosal damage involving the entire small intestine. Clinical symptoms, which include depression, anorexia, weight loss, and wasting, result in death within 2 to 4 weeks. The time of death depends on the oocyst challenge dose. Paromomycin modulated parasitological and clinical parameters in highly predictable and significant ways, including prevention of death. In addition, examination of the extensively infected gut provided an important insight into the dynamics between a specific drug treatment, its impact on the extent and the site of parasite distribution, and clinical outcome. These uniform symptoms of weight loss, wasting, and death are powerful new parameters which bring this model closer to the actual disease seen in humans and other susceptible mammalian species.

Cryptosporidium parvum infects intestinal epithelial cells and does not invade deeper layers of the intestinal mucosa. Nonetheless, an inflammatory cell infiltrate that consists of neutrophils and mononuclear cells is often present in the lamina propria, which underlies the epithelium. This study investigated the host epithelial cell response to C. parvum by assessing in vitro and in vivo the expression and production of proinflammatory cytokines by intestinal epithelial cells after infection. The human colon epithelial cell lines HCT-8 and Caco-2 and human intestinal xenografts in SCID mice were infected with C. parvum. The expression and secretion of the C-X-C chemokines interleukin-8 (IL-8) and GRO␣ were determined by reverse transcription-PCR analysis and enzyme-linked immunosorbent assay. Our results demonstrate that upregulated expression and secretion of IL-8 and GRO␣ after C. parvum infection of intestinal epithelial cells first occurred 16 to 24 h after infection and increased over the ensuing 1 to 2 days. The kinetics of C-X-C chemokine production by C. parvum-infected epithelial cells contrast markedly with the rapid but transient expression of C-X-C chemokines by epithelial cells infected with invasive enteric bacteria. C-X-C chemokine secretion in C. parvum-infected epithelial cells occurred predominantly from the basolateral surface in polarized monolayers of Caco-2 cells grown in Transwell cultures, whereas cell lysis occurred at the apical surface. The basolateral secretion of IL-8 and GRO␣ from C. parvum-infected epithelial cells suggests that C-X-C chemokines produced by those cells contribute to the mucosal inflammatory cell infiltrate in the underlying intestinal mucosa. Cryptosporidium parvum is a common cause of diarrhea in humans and animals (5). Infection most commonly involves the small intestine and is usually self-limited, and the diarrhea which accompanies infection is transient in immunocompetent hosts (6). However, in immunocompromised individuals (e.g., patients with AIDS), diarrhea persists and frequently the infection and pathological changes are more widespread, possibly involving the biliary tract, pancreas, stomach, esophagus, and respiratory tract as well as the small intestine (3, 12, 19, 35). In the intestine, C. parvum resides in epithelial cells (31). The life cycle of C. parvum in the intestinal mucosa includes several stages (14). When oocysts are ingested, sporozoites excyst and rapidly infect host epithelial cells. C. parvum establishes itself intracellularly but extracytoplasmically in a parasitophorous vacuole beneath the apical membrane of the epithelial cell. After asexual multiplications in epithelial cells over the ensuing 16 to 48 h, type I and II merozoites are released and infect new epithelial cells. Type II merozoites differentiate into microgamonts and macrogamonts and initiate sexual reproduction between 3 and 5 days postinfection (p.i.). After macrogametes are fertilized by microgametes, they develop into oocysts, which sporulate in situ.

Previous work from our laboratory demonstrated that the infectivity of the protozoan parasite Leishmania major was enhanced in mice if the infecting inoculum contained salivary gland lysates from the sand fly vector Lutzomyia longipalpis. The present study was designed to address the hypothesis that sand fly salivary gland material may function by inhibiting the host immune response. Results indicated that sand fly saliva inhibited the ability of macrophages to present leishmanial antigens to parasite-specific T cells.