v R I 86.85 Se 3 blthr C.l G368207 3 0 6 9 2 1 0 7 8 5 9 0 4 1 University of Ghana http://ugspace.ug.edu.gh DIAGNOSTIC POTENTIAL OF EXTANT ANTI- SCHJSTOSOMA GENUS-SPECIFIC MONOCLONAL ANTIBODIES A Thesis Presented to The Board o f Graduate Studies, University o f Ghana, Legon Ghana In Part fulfilment o f the Requirements for the Degree o f Masters o f Philosophy (M. Phil) Biochemistry By SEFAH KWAME BSc. (Hons) Department o f Biochemistry, Faculty o f Science, University o f Ghana Legon, Accra, Ghana. SEPTEMBER 2001 University of Ghana http://ugspace.ug.edu.gh I hereby declare that except for the references cited from the work o f other researchers, which I have duly acknowledged, this work was as a result of my own original research and this thesis, either in whole, or in part has not been presented for another degree elsewhere. DECLARATION KWAME SEFAH (Student) A Dr. K. M Bosompem (Supervisor) Prof. F. N. Gyang (Supervisor) University of Ghana http://ugspace.ug.edu.gh DEDICATION To my wife And Children University of Ghana http://ugspace.ug.edu.gh I am greatly indebted to my supervisors Dr. K. M. Bosompem o f the Noguchi Memorial Institute for Medical Research (NMIMR) and Prof. F. N. Gyang, Department o f Biochemistry, University o f Ghana. This thesis could not have been completed without their forbearance, patients, expert guidance and constructive comments. I am also grateful to the Director o f NMIMR Prof. D. Ofori-Adjei and the entire staff o f the Institute for the assistance offered me. I am especially thankful to the head o f the Parasitology Unit, Dr. M. D. Wilson for accommodating and encouraging me throughout my stay at the Institute. The contributions o f Mr. M. A. Appawu, Dr. D. Boakye and Dr. Y. Osada (JICA expert) were tremendous. I am also exceedingly grateful to the following Mr. W. K Anyan, J. Otchere, U. S. McKakpo, D. Boamah, J. Quartey, J. R. K. Asigbee, S. K. Dadzie, S. Otoo, Mrs. I. Ayi all o f the Parasitology Unit for their encouragement likewise Mr. E Asiedu-Opare, Aggoe (Drivers) for taking me to and from the field. In addition the assistance o f the following was remarkable, Mr. H. Asmah, Odoi, and Sis. Susie o f the Electron Microscopy Unit as well as the entire staff o f the P3 laboratoiy for assisting me in the use o f some facilities, particularly the computarised Microplate plate reader. I am also very grateful to all the lecturers at the Department o f Biochemistry, University o f Ghana, for the training and the discipline that they have instilled in me. The following people have also contributed immensely in diverse ways, Mr. Solomon Yaw Darko, Mrs. Annis Darko Mr. John Dadzie Mensah, Justice Essoun-Nyarko and Banson Richard. To all my family members especially, Messers Anane Boateng, Kofi Duah, J. S. Adu-Sefah, Mrs. Mercy Adu-Sefah and Kwasi Addai for their prayers and financial support and to my wife Vivian Anowi and my children Adelaide Sefah, Kofi Sefah and Nana Amma Sefah-Antwi, I say God Bless you all for you patience. ACKNOWLEDGEMENT University of Ghana http://ugspace.ug.edu.gh I again wish to thank the people o f Galilea and Agbekotsepko for providing me with specimen for the entire project. Finally, I acknowledge the financial support o f this project by Shell Ghana Limited, which provided a student stipend. University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS DECLARATION...........................................................................................................................1 DEDICATION.............................................................................................................................n ACKNOW LEDGEM ENT.......................................................................................................HI TABLE OF CONTENTS...........................................................................................................V LIST OF TA BLES...................................................................................................................VH LIST OF FIG U R ES...............................................................................................................VID LIST OF PL A T E S........................................................................- ..........................................IX LIST OF ADDREVIATIONS.................................................................................................. X ABSTRACT...............................................................................................................................XH CHAPTER 1............................................................................................................................... - 1 INTRODUCTION AND LITERATURE R EV IEW ................................................ - ..........1 INTRODUCTION......................................................................................................................1 Objectives o f the study......................................................................................................... 4 Justification for the study......................................................................................................4 LITERATURE REVIEW......................................................................................................... 5 Schistosomiasis and Schistosomes...................................................................................... 5 The S. haematobium group .............................................................................................. 6 The S. mansoni group ....................................................................................................... 7 The S. indicum group........................................................................................................ 8 The S. japonicum group ....................................................................................................9 The life cycle o f schistosomes........................................................................................10 Schistosomiasis in Ghana...................................................................................................15 Animal schistosomiasis...................................................................................................... 17 Schistosome antigens.......................................................................................................... 20 Adult Worm Antigen (AWA)............................................................................................20 Schistosomula Surface Antigen........................................................................................ 21 Schistosome Egg Antigens (SEA)..................................................................................23 Cross- reactive Antigens................................................................................................ 24 Excretory-secretory Antigens.........................................................................................25 Enzyme-linked Immunosorbent Assay (ELISA).............................................................26 Monoclonal Antibodies (MoAbs)..................................................................................... 27 Uses o f Antibodies.......................................................................................................... 29 Purification o f Antibodies..............................................................................................29 Diagnosis o f human schistosomiasis.................................................................................31 Eggs in urine................................................................................................................... 31 Eggs in Stool................................................................................................................... 32 Biopsies............................................................................................................................ 33 Immunodiagnosis............................................................................................................ 33 Diagnosis o f animal schistosomiasis.................................................................................36 University of Ghana http://ugspace.ug.edu.gh CHAPTER 2 37 GENERAL MATERIALS AND M ETH O D S......................................................................37 Study area ............................................................................................................................ 37 Resuscitation o f Hybridoma Cells..................................................................................... 37 Cloning and Propagation o f Hybridoma Cells................................................................. 38 Cryopreservation o f Hybridoma Cells...............................................................................39 Determination o f Immunoglobulin Class and Subclass..................................................39 Purification o f Monoclonal Antiboddies..........................................................................40 Amicon Filtration............................................................................................................40 Ammonium Sulphate Precipitation................................................................................40 Gel Filtration.................................................................................................................. 40 Micro-Plate ELISA..............................................................................................................41 Cross-reactivity testing o f MoAbs using schistosome and P. falciparum antigens in microplate ELISA...............................................................................................................42 Preparation o f Horseradish Peroxidase Antibody Conjugates....................................... 42 Coating o f the Test MoAbs on PVDF and Nitrocellulose Membranes by Dot-ELISA ............................................................................................................................................... 43 Coating o f the Selected MoAbs to Micro-titre Plates.....................................................44 Dipstick ELISA procedure................................................................................................. 45 Microplate-based Sandwich ELISA..................................................................................45 Membrane-based sandwich ELISA...................................................................................46 Microscopical Diagnostic Methods...................................................................................46 Collection and Analysis o f Human Urine and Stool Specimen..................................46 Collection and Analysis o f Cattle Blood and Faecal Samples................................... 47 Fixation o f miracidia with Kamovsky reagent................................................................48 IF AT Procedure................................................................................................................... 48 CHAPTER 3 ....... 49 RESULTS................................................................................................................ 49 Prepared monoclonal antibody reagents...........................................................................49 Reactivity o f selected monoclonal antibodies as determined by micro-plate ELISA. 52 Development o f assays.......................................................................................................59 Detection o f Schistosoma antigens in human urine using the selected monoclonal antibodies.........................................................................................................................59 Prevalence o f Schistosoma infection in cattle as determined by microscopy..............66 Schistosoma infection rates in cattle as determined by IF AT and micro-plate ELISA ...............................................................................................................................................69 CHAPTER FO U R.............................................................................................................. 71 DISCUSSION AND CONCLUTION....................................................................................71 REFERENCES...........................................................................................................................78 University of Ghana http://ugspace.ug.edu.gh Table 1. Some biological characteristics o f the selected monoclonal antibodies.........................................................................................................50 Table 2. Reactivity o f the selected monoclonal antibodies........................................ 53 Table 3. Prevalence o f urinary and intestinal schistosomiasis as determined by microscopy and dipstick-ELISA using different MoAbs....................61 Table 4. Diagnosis o f schistosomiasis by microscopy and dipstick-ELISA using the selected MoAbs.............................................................................62 Table 5. S. haematobium egg count............................................................................. 63 Table 6. Binding studies o f the selected MoAbs onto different micro titre plates and membranes.................................................................................... 65 Table 7. Detection o f parasite ova in stool samples o f cattle (short horn variety) from Agbekpotsepko.................................................................................... 67 Table 8. Diagnosis o f schistosomiasis in cattle by microscopy and micro-plate ELISA using the selected MoAbs.................................................................70 LIST OF TABLES University of Ghana http://ugspace.ug.edu.gh Figure 1. Reactivity o f Sh3/34.10 with schistosome antigen and P. falciparum crude antigen extract.................................................................................... 54 Figure 2. Reactivity o f Sh3/38.2 with schistosome antigen and P. falciparum crude antigen extract.................................................................................... 55 Figure 3. Reactivity o f Sh4/14.3 with schistosome antigen and P. falciparum crude antigen extract.................................................................................... 56 Figure 4. Reactivity o f Sh5/32.30 with schistosome antigen and P. falciparum crude antigen extract.................................................................................... 57 Figure 5. Reactivity o f Sh5/34.10 with schistosome antigen and P. falciparum crude antigen extract.................................................................................... 58 LIST OF FIGURES viii University of Ghana http://ugspace.ug.edu.gh Plate 1. Immunodiffusion............................................................................................ 51 Eggs o f parasites identified in faecal specimen o f cattle Plate 2. S. bovis............................................................................................................68 LIST OF PLATES ix University of Ghana http://ugspace.ug.edu.gh ABBREVIATIONS ABTS Azino-bis(3-ethylbenzthiazoline-6-sulfbnic acid) DAB Diaminobenzidine tetrahydrochloride DMSO Diamthylsulfoxide EDTA Ethylenediaminetetraacetate ELISA En2 yme-linked immunosorbent assay FBS Foetal bovine serum FITC flourescein isothiocynate Hr Hour HRPO Horseradish peroxidase IFAT Indirect immunoflourescent antibody test Ig Immunoglobulin IgA Immunoglobulin A IgD Immunoglobulin D IgE Immunoglobulin E IgG Immunoglobulin G IgM Immunoglobulin M 1 Litre MoAb Monoclonal antibody ml Millilitre(s) min Minutes Mr Molecular weight fi) Microlititre \ig Microgramme NMIMR Noguchi Memorial Institute for Medical Research PBS Phosphate buffered saline University of Ghana http://ugspace.ug.edu.gh PH Negative logarithm base o f hydrogen ion concentration TBS Tris buffered saline Xg Times gravitational force ABTS 2,2-azo-bis-3-ethylbenzthiazoline-6-Sulphonic acid OPD O-phenylenediam ine TMB 3,3’ 5,5’-tetramethylbenzidine base pNPP p-nitro phenylphosphate IMDM Iscove’s Modified Dulbecco’s Medium University of Ghana http://ugspace.ug.edu.gh ABSTRACT The suitability o f five Schistosoma genus-specific monoclonal antibodies (MoAbs) (Sh3/34.10, Sh3/38.2, Sh4/14.3, Sh5/32.30 and Sh5/34.10) in detecting schistosome antigens in infected human and cattle was evaluated. These antibodies were employed in various diagnostic assays to diagnose human and animal schistosomiasis. Extant MoAb secreting hybridoma cells were first propagated in culture to produce the MoAbs. The culture supernatants containing secreted antibodies were analysed by immunodiffusion and the isotypes o f the immunoglobulins shown to be IgM (Sh3/34.10, Sh3/38.2, Sh5/32.30 and Sh5/34.10) and IgGl (Sh4/14.3). Gel purified fractions o f the MoAbs were utilised in developing dipstick ELISA and micro-plate ELISA in diagnosing schistosomiasis. Also, the suitability o f the indirect immunoflourescent Antibody Test (IFAT) was employed to demonstrate anti-schistosoma antibodies in the blood o f infected cattle. Three o f the antibodies (Sh3/38.2, Sh4/14.3, Sh5/32.30) showed no cross-reactivity with Plasmodium falciparum circum-sporozoite protein (CSP) and crude antigen extract of P. falciparum. However Sh3/34.10 and Sh5/34.10 reacted with the crude antigen extract o f P. falciparum at high antibody concentrations even though the reactivity was abrogated at higher antibody titres. In human schistosomiasis, the diagnostic potential o f the MoAbs in detecting schistosome antigens were assessed alongside microscopy and the standard Sh2/15.F urinary schistosomiasis dipstick ELISA developed by researchers at the NMIMR. Out o f 74 human subjects from a schistosomiasis endemic area screened for urinary schistosomiasis, 81.1% were microscopically positive for S. haematobium eggs whilst the standard dipstick assay gave prevalence estimate o f 87.3%. The sensitivity o f this assay was 100% whereas the specificity was 64.7% compared with microscopy as the gold standard test. Dipstick assays utilizing the individual Schistosoma genus-specific monoclonal antibodies estimated prevalences o f urinary schistosomiasis between 48.6 and xii University of Ghana http://ugspace.ug.edu.gh 58.1%. The sensitivities o f the assays were however lower (60.0-71.1%) compared with microscopy as the gold standard test. Nonetheless, each o f the antibodies showed a high specificity o f 100% in detecting S. haematobium urinary antigens. The Schistosoma genus-specific antibodies performed similarly when utilized in dipstick to detect S. mansoni infections. Two assays (IFAT and MoAb-based plate ELISA) were developed to diagnose animal schistosomiasis in cattle. The sensitivities o f these assays compared well with microscopy. In determining the prevalence o f S. bovis, microscopy gave a prevalence o f 53.1% compared with 50.0% determined by IFAT. Micro- plate based ELISA utilizing different Schistosoma genus-specific MoAbs estimated prevalence o f S. bovis between 46.9% and 50.0%. These assays were sensitive (ranging from 88.2-94.1%) compared with microscopy as the gold standard test and the specificity was each 100%. In view o f the limitations o f the microscopical approach the assays provided alternative diagnostic tool in detecting animal schistosomiasis in cattle. The study also demonstrated 3.1% (1/32) prevalence o f S. indicum in mixed infection with S. bovis by microscopy. Eleven other cattle parasites eggs were demonstrated by microscopy with prevalence ranging from 3.1-21.9%. There was no evidence o f cross-reactivity between the antigens o f these parasites and the Schistosoma genus-specific MoAbs utilised. This study revealed the diagnostic potentials o f the Schistosoma genus-specific MoAbs in detecting schistosome antigens in both humans and cattle. The development of Schistosoma genus-specific MoAb-based dipstick ELISA for diagnosing schistosomiasis is promising. University of Ghana http://ugspace.ug.edu.gh CHAPTER 1 INTRODUCTION AND LITERATURE REVIEW INTRODUCTION Schistosomiasis is the name given to the group o f human and animal diseases caused by blood-dwelling helminth o f the genus Schistosoma. Schistosomiasis infections are normally chronic and take many years. Despite the availability o f chemotherapy, more than 200 million people and millions o f domestic animals are infected with schistosomes in 73 countries that harbour the intermediate snail host o f the family Planorbidae (Manson- Bahr and Bell, 1991). In addition, 600 million people are at risk o f infection. The affected areas include Africa, South America, India, South-East Asia, the Far East, part o f the Middle East and the Mediterranean countries including a small focus in Portugal (Rollinson and Southgate, 1987). The World Health Organisation (W.H.O) reports that schistosomiasis is second most prevalent parasitic disease in the tropics after malaria (Atlas, 1995). Three main species o f schistosomes (Schistosoma mansoni, S. japonicum and S. haematobium) are responsible for infection in humans (Boothroyd and Komuniecki, 1995). However the contributions o f other species such as S. mekongi and S. intercalatum cannot be underestimated. A number o f species are also known to infect livestock. These include: S. matheei (commonly in cattle, sheep and goat); S. bovis (cattle); S leiperi (herbivores); S indicum (variety of domesticated animals including sheep camel goat and cattle) and S. spindale (ruminants) (Rollinson and Southgate, 1987). Schistosomiasis is primarily a rural disease whose transmission depends on a variety o f factors including; (1) contamination o f fresh water with human/animal urine or faeces containing viable Schistosoma eggs, (2) the presence o f schistosomiasis host snails and in the case o f aquatic species, water temperature, rate o f flow, acidity or alkalinity and the content o f organic matter conducive to snail growth are important factors and (3) human contact with water l University of Ghana http://ugspace.ug.edu.gh containing infective cercariae (Manson-Bahr and Bell, 1991). Infection with schistosomiasis is initiated when cercariae penetrate the skin and transform into schistosomula, which subsequently enter the vasculature and migrate via the lungs to the hepatic portal system (S. mansoni and S. japonicum ) or the urogenital venules (S. haematobium) (Boothroyd and Komuniecki, 1995). In some parts o f Africa, where S. haematobium and S. mansoni are prevalent, mixed infections are common. Manson-Bahr and Bell (1991) reported 60% mixed infections in parts o f the Nile Delta and 22% in European patients in Zimbabwe. Typically in areas endemic for Schistosomiasis, the distribution o f infection intensity is overdispersed, such that younger people (less than 18 years old) excrete more eggs and therefore are more heavily infected than older individuals (Boothroyd and Komuniecki, 1995). Following chemotherapy, re-exposure to infective cercariae leads to rapid re-infection in young people who may regain heavy infection whereas older individuals tend to be less severely affected. A definitive diagnosis of schistosomiasis may be achieved by examination o f the urine, stool, rectal or bladder biopsy for eggs through microscopy and also by serological tests. The microscopical technique, which is the most commonly used, is very specific (100%) but not sensitive enough. Moreover it is time consuming, tedious and not field applicable making its dependency limited. There is therefore the need for differential diagnosis. The Serological tests (based on the detection o f host antibodies directed against schistosome antigen) on the other hand are useful in diagnosis o f both apparent and inapparent infections. Virtually all the well-established assays including Enzyme-linked immunosorbent assay (ELISA), Indirect Immunofluorescence assay, Slide flocculation, Plasma card, Precipitin, Indirect Haemagglutination, Miracidial immobilization, Circumoval precipitin test (COPT) and Complement fixation test (CFT) (Manson- Bahr and Bell, 1991), have been applied to identification of schistosome species and the diagnosis o f schistosomiasis, however, very few have been advocated for large-scale use in 2 University of Ghana http://ugspace.ug.edu.gh diagnosis due to lack o f sensitivity. Among the most promising alternative diagnosis for urinary schistosomiasis are the Schistosoma genus- specific circulating anodic and cathodic antigen (CAA and CCA) detection assay (Kremsner el al., 1994; De Jonge et al., 1989) and the recently developed S. haematobium species-specific dipstick ELISA (Bosompem et al., 1996a). These are more sensitive and detect circulatory and or urinary antigens utilizing non-invasive membrane-based assays, which are more suited for field use in endemic areas. The CAA and CCA detection assays are yet to be adopted for use. On the other hand, the urinary schistosomiasis dipstick has been tested in some parts o f Ghana and successfully adopted for application in routine diagnosis o f the disease in the field. The specific detection o f S. mansoni is yet to be developed. The incidence o f mixed infections limits the extent o f the applicability o f the urinary Schistosoma dipstick method in diagnosis because positive test results are silent on the mixed infections o f S. haematobium with other schistosome species. There is thus the need to develop field applicable assays, which are either S. mansoni species-specific or Schistosoma genus-specific so that other schistosome infections and or mixed infections could be diagnosed. In circumstances where the urinary Schistosoma dipstick is used alongside a Schistosoma genus-specific assay in humans, intestinal schistosomiasis may be diagnosed by exclusion. It was for these reasons that the present study was conducted to determine the diagnostic potential o f existing Schistosoma genus-specific monoclonal antibodies and further utilised in the development o f membrane/micro-plate based ELISA’s for the diagnosis o f both human, and animal schistosomiasis, which has little attention. 3 University of Ghana http://ugspace.ug.edu.gh Objectives of the study (i) To produce monoclonal antibodies in vitro by propagating existing hybridoma cells and purifying the antibodies for use in diagnosis. (ii) To determine the specificity o f purified monoclonal antibodies in cross-reactivity studies using crude antigen extracts o f S. haematobium, S. mansoni, S. japonicum, and Plasmodium falciparum.. (iii) To utilize Schistosoma genus-specific monoclonal antibodies in developing membrane or micro-plate based ELISA for diagnosis o f schistosomiasis. (iv) To diagnose S. mansoni infection in humans by exclusion using the developed Schistosoma genus-specific ELISA and the existing S. haematobium species- specific dipstick method. ELISA. (v) To utilize the developed Schistosoma genus-specific monoclonal antibodies in detection o f schistosome antigens in infected animals using blood specimens. (vi) To determine the specificity and sensitivity o f the Schistosoma genus- specific monoclonal antibody-based assays by comparison with the microscopical detection o f parasite ova in urine and stool specimens. Justification for the study The determination o f the diagnostic potential o f Schistosoma genus-specific monoclonal antibodies would promote accurate diagnosis o f mixed schistosome infections in humans. Also the establishment o f field applicable Schistosoma genus-specific diagnostic assays would enable investigations into the occurrence and spread o f animal schistosomiasis in Ghana on which currently there is little, if any, information available. 4 University of Ghana http://ugspace.ug.edu.gh LITERATURE REVIEW Schistosomiasis and Schistosomes Schistosomes are trematodes belonging to the family Schitosomatidae. Members o f this family show morphological and physiological peculiarities, which set them apart from other trematodes. They are dioecious digenia. The male worm is flat and leaf-like and is folded to form a gynaeocophoric canal formed by ventrally flexed lateral outgrowths where the slender female is held (Manson-Bahr and Bell, 1991; Rollinson and Southgate, 1987). Schistosomes live in the blood stream o f warm-blooded hosts, being the only trematodes to do so. The specific location o f the parasite in the host depends on which schistosome species is involved. For instance S. haematobium localises in the vesical plexus around the urinogenital system whilst S. mansoni, S.japonicum, S. intercalatum and S. mekongi are normally found in the hepatic portal system around the gastro-intestinal tract (Sturrock, 1993). The life cycle o f schistosomes consists o f alternate generations, each with its own host. The adult worms infect vertebrates and the two larval stages miracidia and cercaria occur in susceptible snail. Miracidia hatch from the eggs and invade the snails specific to each schistosome species whilst the cercaria leave the snail to invade definitive host. A feature o f the life cycle o f schistosomes is that multiplication takes place in each o f the different hosts so that it is very difficult to break the cycle (Manson-Bahr and Bell, 1991). The family schistosomatidae is divided into three subfamilies, the Schistosomatinae, Bilharziallinae and Gigantobilharzianae (Rollinson and Southgate, 1987), consisting o f twelve genera in all. Seven out o f these genera are confined to birds and the rest to mammals. However, only the genus Schistosoma is associated with man (Rollinson and Southgate, 1987). This genus has achieved the greatest geographical distribution and diversification in terms o f numbers o f recognised parasite species and 5 University of Ghana http://ugspace.ug.edu.gh different hosts parasitised. The overall distributional range o f the different schistosome species is primarily influenced by the presence or absence o f suitable mammalian and intermediate snail host (reviewed by Sturrock 1987). Some schistosomes easily infect snail o f one geographical area but fail to infect or infect with difficulty the same snail from a different area (Manson-Bahr and Bell, 1991). The genus Schistosoma is recognized by eighteen species placed in four different groups also called species complexes by Kuntz (1955). This was based on the common relationships o f the parasite species within particular snail host genera and on zoo-geographical distribution pattern as well as the morphology o f the parasite eggs. The groups are the S. haematobium, S. mansoni, S. japonicum and S. indicum species complexes. The S. haematobium group Schistosoma haematobium was the first schistosome to be described. Bilharz identified the parasites in 1852 and in 1864 Harley reported urinary schistosomiasis in people in South Africa (Rollinson and Southgate, 1987; Sturrock, 1993). The S. haematobium group is widely distributed in Africa and the Eastern mediterranean region including Iran, Islamic Republic o f Iraq, Jordan, Lebanon, Oman, Saudi Arabia, Syria and Yemen (Sturrock, 1993). The species complex consists o f seven species. These are S. haematobium, S. intercalatum, S. metheei, S. bovis, S. carassoni, S. margrebowiei and S. leperi. Members within the group show substantial dissimilarities in the morphology of the egg as well as the definitive host specificity. There is thus evidence for geographical variation in many characters associated with the S. haematobium group o f species. For example, studies by Wright and Knowlers (1972) on laboratory hamsters showed that differences occur between geographical strains o f the parasite in many biological features such as intermediate host specificity, infectivity o f cercariae, growth rates and maturation times o f adult worms, fecundity rate and host-organ distribution o f eggs. In general the intermediate host o f S. haematobium species complexes are the Bulinus species. S. 6 University of Ghana http://ugspace.ug.edu.gh haematobium in the Afrotropical region is transmitted by snails o f the B. africanus group, whilst in the Mediterranean area and S. W. Asia it is by tetraploid members o f the B. truncat us/tropicus complex. In Arabia and Mauritius transmission is by members o f the B. forskalii group. In West Africa, however, all the three snail groups are known to act as intermediate hosts for S. haematobium (Frendson, 1979). O f particular significance is the division between S. haematobium from North Africa and the Middle East, and the parasite from the Afrotropical region. With few exceptions, neither o f the parasites can develop in the snail host o f the other. Though there are marked differences between members o f the S. haematobium group, natural hybridisation has been reported to occur. For example a Camerounian strain o f S. haematobium and S. intercalatum hybrid was reported from Loum, in a previously ‘pure’ S. haematobium area (Jordan and Webbe, 1993). Again, ample evidence has accumulated from different sources with various reports o f the occurrence o f natural hybrids o f S. haematobium and the cattle parasite S. metheei in humans (Van Wyk, 1983). The S. mansoni group Intestinal schistosomiasis in man is mainly caused by S. mansoni, the schistosome species with considerable amount o f information (Rollinson and Southgate, 1987). The early stages o f chronic infections are free o f obvious symptoms and signs but the later stages, with liver and spleen enlargement, are more easily detected by clinical examination (Jordan and Webbe, 1993). The parasite is common in Libya, Oman, Saudi Arabia, People’s Democratic Republic o f Yemen, Madagascar and over greater part o f Africa south o f the Sahara. In the Carribbean it is endermic in Puerto Rico, Saint Lucia, Antigua, Dominican Republic, Martinique and Montserrat. Several reports o f infection with S. mansoni in a wide array o f mammalian hosts have been made. The role o f animal hosts in maintaining the parasite has also been reported. For instance, Fenwick (1969) recovered 5. 7 University of Ghana http://ugspace.ug.edu.gh mansoni from all seven baboons examined in an area o f Northern Tanzania, particularly uninhibited by man. Experimental evidence has shown that S. mansoni strains from different geographical areas may display differences in their biological characteristics and in their infectivity or pathogenicity. For instance, de Lima e Costa and Katz (1982) observed that in mice, strains o f S. mansoni originating from the same locality may show statistical differences in infectivity, effect on leucocyte count, numbers o f eggs per female worm and response to treatment. Other members o f the species complex include S. edwardiense and S. hippopotami, both o f hippopotamus (Rollinson and Southgate, 1987), and S. rodhaini found in dogs, civic cat as well as a variety o f rodents. The major intermediate hosts are the group o f snails o f the genus Biomphalaria. Almost all known species are susceptible to S. mansoni. The S. indicum group Members o f this species complex are mostly o f veterinary importance. S. indicum, first reported in equines by Montgomery (1906) is known to infect a variety o f domesticated animals on the Indian subcontinent including sheep, camel, goat, cattle and buffalo. Another member S. spindale is found in the portal and mesenteric veins o f the small and large intestine o f ruminants. The parasite has been reported in many parts o f India, Sri Lanka, Indonesia, Malaysia, Thailand and Vietnam. It is also thought to be one o f the causes o f schistosomal dermatitis in man, especially in rice paddy fields where S. indicum infected buffaloes coexist with the intermediate host Indoplanobia exustus. The rodent Bandicota bengalensis has been found naturally infected with S. indicum (Rollinson and Southgate, 1987). Another member, o f the S. indicum group, Schistosoma nasale is responsible for nasal schistosomiasis, or snoring disease in cattle, sheep and goats. The adult worms are found in the veins o f the nasal mucosa. Also, S. incognitum, is reported in Thailand, Java 8 University of Ghana http://ugspace.ug.edu.gh and Sulamesi primarily in rodent species o f the genera Bandicota and Rattus, and in wild deer in Indonesia. In India, it is commonly found in pigs. In Thailand and Indonesia, Radix auricularia appears to be the intermediate host o f S. incognitum (Rollinson and Southgate, 1987). The S. japonicum group Schistosoma japonicum differs from the other schistosome species affecting man in many ways. Probably, the greatest significance is the acute stage o f its infection, a well recognised and frequently fatal condition that can be o f epidemic proportion (Jordan and Webbe, 1993). It is responsible for a grave, debilitating and chronic form o f intestinal schistosomiasis, which affects both man and domestic animals. It has a reputation o f being the most serious o f the schistosomes affecting man, generally because o f the large number o f eggs produced by the adult female worms. The disease in the Far East is endemic in parts o f China (Hunan, Hubei, Jiangxi, Anhui and Jiangsu Provinces) (Yuan Hong, 1993), Phillipine, Japan (Kufu, Katayama and Chikugo River Basin), Taiwan and Indonesia. Schistosoma japonicum occurs as a natural parasite o f a large number o f mammalian species, which play an important role in the epidemiology o f the disease. In some endemic areas in Mainland China, 31 species o f wild animals including carnivores, rodents, primates, insectivores and artiodactyls have been found with natural infections o f S. japonicum (Mao and Shao, 1982). All the strains of S. japonicum are transmitted by populations o f the amphibious polytypic snail Oncomelania hupensis which consists o f six subspecies. These are O. h. chiui and O. h. formosana in Taiwan, O. h. hupensis in Mainland China, O. h. lindoensis in Sulamesi, O. h. quadrasi in the Philippines and O.h. nosophora in Japan (Davis, 1980). Other group members include S. mekongi and S. sinensium. S. mekongi is responsible for human schistosomiasis in Khong Island in the Mekong River in Southern Laos and in many parts o f northern and central Kampuchea 9 University of Ghana http://ugspace.ug.edu.gh (Cambodia) (Voge et al., 1978). The intermediate host is Tricula aperta (Liang and Kiticoon, 1980). The life cycle o f schistosomes Though the first schistosome was described in 1851 by the German pathologist Theodor Bilharz, it was not until 1915 that the life cycle o f the schistosomes was unraveled. This revealed the connection between the diseases and the fresh water planorbid snail which act as intermediate host to the parasites (Rollinson and Southgate, 1987). The life cycle comprises o f the following stages; egg, miracidium, first and second stage sporocysts, cercaria, schistosomulum and adult worm. The first and second stage sporocysts reproduce asexually within the snail whilst the adult worms reproduce sexually in the definitive mammalian host. The eggs laid by schistosome worms in the definitive mammalian host are passed out into fresh water via the urine or stool depending on the species o f schistosome. In water, the eggs hatch into the first larval stage, the miracidium (Manson-Bahr and Bell, 1991). For instance S. haematobium eggs are mostly passed through urine (though not exclusive) whilst S. mansoni, S. japonicum, S. matheei and S. intercalatum eggs are released mostly through faeces. There is a wide range o f size and shape o f the schistosome eggs and the shape has been found to vary with the parasite species and diet o f the definitive host (Rollinson and Southgate, 1987). The eggs are non-operculate, round or oval with one spiny appendage (Manson-Bahr and Bell, 1991), found in lateral or terminal position. This character o f the eggshell is a very important distinguishing feature o f one schistosome species from another on morphological basis. Schistosome eggs secrete histolytic enzymes through micropores in the shells, which help passage through the endothelium o f the blood vessels. It is the soluble egg antigens, mostly the charbohydrate component) which is responsible for much o f the pathology (Manson-Bahr and Bell, 1991; 10 University of Ghana http://ugspace.ug.edu.gh Sturrock, 1993). The embiyo within the egg develops into the next larval stage, the miracidium. The miracidium has a complex array o f sensory receptors, which are considered to aid in locating a snail host. It is thought that miracidia are attracted to intermediate snail host by undefined complex o f water-soluble substances (miraxone) secreted by the snails. This has been confirmed by the attraction o f S. mansoni miracidia to B. glabata (Chemin, 1970) and S. haematobium miracidia to B. globosus (Shiff and Kriel, 1970). Miracidium swims actively by means o f its ciliated epidermis, which beat rhythmically to propel it to a compatible snail host. It must be emphasized that miracidia do not discriminate between species o f snails and will sometimes enter the incorrect host thereby preventing further development (Manson-Bahr and Bell, 1991). However, if a miracidium enters a compatible intermediate host, it metamorphosis into the next stage, the mother sporocyst. The penetration occurs by a mechanical action o f the apical papilla breaking the snail’s epithelium while the numerous membrane folds o f the terebratorium act as a sucker to facilitate fixation as revealed by light and electron microscopy (Kinoti, 1971; Brooker, 1972; Lo Verde, 1975). The ciliated epidermis o f the mother (primary) sporocyst is cast off and is replaced by a syncytial tegument. Within the elongated sac o f the mother sporocyst, germinal cells develop into a number o f daughter sporocysts. These leave the mother sporocyst after about 8 days and migrate to the digestive gland (liver) o f the snail host (Manson-Bahr and Bell, 1991; Sturrock, 1993). Within them further germinal cells develop asexually into numerous biforked-tailed free-swimming cercariae. The mature cercaria escapes from the daughter sporocyst, migrates through the tissue o f the snail and finally emerges to swim freely in the water by means o f its muscular, bifurcated tail. Thousands o f cercariae o f the same sex may be developed from one miracidium. Cercariae are unisexual, non-feeding, fish-like with a pear-shaped head. They depend entirely on their glycogen reserves (Wilson, 1987) and are influenced by light, gravity agitation, touch and temperature. They are therefore short lived (Manson-Bahr and Bell, 1991). It is the 11 University of Ghana http://ugspace.ug.edu.gh second free-living infective schistosome larva. Cercariae o f all human schistosomes are grossly similar, about 1mm in length. The oral head has an anterior sucker (Cousin and Dorsey, 1991) and a prominent, muscular ventral sucker or acetabulum, a mouth, oesophagus and a pair o f short caeca. It also has an excretory system o f flame cells, tubules and excretory ducts leading into an excretory bladder at the posterior end o f the body. Electron microscopy has revealed that the body is covered by a tegument bounded by a lipid bilayer, which appears trilaminate, usually covered by an amorphous glycocalyx (Sturrock, 1993). They tend to accumulate in the area o f the mantle collar o f the snail, that is, close to the head o f the snail in the region where escape to the outside is simple. The pattern o f the release o f cercariae differs somewhat between the three main human schistosomes. Normally S. mansoni cercarial shedding starts within 1 to 2 hours after stimulation. The process is more prolonged for S. haematobium, which takes 2 to 4 hours. Pesigan el al. (1958) reported that the process was even slower for S. japonicum requiring many hours o f stimulation before shedding. The life cycle is continued if a cercaria penetrates the intact skin o f man or subcutaneous tissue into the blood circulatory system (Sturrock, 1993). Three distinct phases have been described by Haas and Schmidt (1982) to be involved in penetration. These are (1) attachment; (2) creeping over surface exploring for an entry site and (3) penetration into the epidermis. Phases 1 and 2 can be stimulated by thermal and chemical stimuli whereas phase 3 is stimulated by chemical stimuli alone. Haas and Schmidt (1982) further demonstrated that only aliphatic hydrocarbon chains with both a polar and a non­ polar head group were effective stimulants. Free fatty acids produced on human skin by the action o f bacterial esterases on triglycerides are thought to be the probable natural stimulants (Rollinson and Southgate, 1987). Penetration o f the cercaria is the result o f coordinated muscular and secretory processes in the cercaria, presumably under nervous control. Following entry, the cercaria transforms into a tailless worm-like schistosomulum before entering the blood system 12 University of Ghana http://ugspace.ug.edu.gh directly (or rarely, indirectly via the lymphatics) to be carried passively via the right heart, lungs and left heart to the general systemic vessels. It then enters the splanchnic blood vessels en route to the liver and matures into adult worm (Sturrock, 1993). Most worms leave the liver when they are sexually mature and have mated. They then migrate to the veins o f the vesical plexus (S. haematobium) or the mesenteric veins (S. mansoni, S. japonicum, S. metheei and S. intercalatum) where they begin to lay eggs. The period between penetration by the cercaria and egg laying may be 30-50 days or more (Manson- Bahr and Bell, 1991). The transformation from cercariae to schistosomulum involves profound morphological and physiological changes. The cercarial glycocalyx is lost during this period and the single bilipid epithelial membrane surrounding the body is replaced by a double bilayer that appears as a heptalaminate membrane in electron micrographs. The two lipid bilayers are linked by larger protein molecules detected by freeze-fracture ultramicroscopy (McLaren, 1980). A fully transformed schistosomulum has obvious oral and ventral suckers and is elongated posteriorly compared with the cercarial body as revealed by ultrastructural studies on the transformation process by Basch and Samuelson, (1990). Cercaria as well as young schistosomulum, o f 3-4 hours are susceptible to killing by eosinophils, neutrophils and macrophages (McLaren and Ramalho-Pinto, 1979; McLaren and James, 1985). They are fully susceptible to complement (C) damage either by the alternate or by the classical pathways (Fishelson, 1989). However, during development, schistosomulum acquires resistance to complement-mediated damaged (Levi-SchafFer et al 1982; Marikovsky et al., 1986;). This conversion to C-resistance occurs both in vitro and in vivo upon incubation in artificial medium (Clegg and Smither, 1972; Fishelson, 1989; Horta et al., 1991). The parasite also adapts to the isotonic medium within the definitive host (Sturrock, 1993; Tarrab-Hazdai et al., 1997). 13 University of Ghana http://ugspace.ug.edu.gh The adult worm (male and female) has a prehensile oral sucker, which surrounds the mouth anteriorly, and a ventral sucker on the ventral surface. The worm attaches itself to the wall o f the vessel in which it lives with the ventral sucker. A most distinctive feature is the large ventral grove, the gynaecophoric canal, in which the female is retained during pairing. The external surface is characterized by an abundance o f papillae (Erasmus, 1987). Externally, the body is covered by a tegument, which may bear spines, tuberculations and/or hairs. The tegument is an acellular, syncitial layer bounded externally by a plasma membrane composed o f two bilipid membranes. In vitro studies by Sturrock (1993) indicates that the outer bilipid membrane is shed continuously and replaced by the products o f organelles in the deeper syncytium o f the tegument. This might presumably happen in vivo. The tegument is a living tissue capable o f taking up nutrients and other essential substances, especially inorganic ions (McLaren, 1980). Circular and longitudinal muscles below the tegument and other specialized muscles are coordinated by a network o f fibres to allow body contractions and other movements. The remaining organs are embedded in mesenchymatous cells (Sturrock, 1993). Waste products are excreted by the two longitudinal canals, which open posteriorly and are fed by connecting tubules. There are flame cells whose function is to fan fluid wastes into the tubules by means o f the vibratile cilia with which they are equipped (Manson-Bahr and Bell, 1991). Proteolytic enzymes secreted by cells lining the gut act on host blood ingested through the mouth, breaking down serum globulins and haemoglobin from RBC into tyrosine (Sturrock, 1993). Schistosomes feed onliquid material in the host in which the worm lives and obtain oxygen from the blood ofthe host (Manson-Bahr and Bell, 1991). The life span o f the schistosome worm has been the subject o f controversy. On the basis o f deita obtained from persons who left an endemic area and who years later were found to be still passing eggs, a claim has been made that the worm can live up to 30 years 14 University of Ghana http://ugspace.ug.edu.gh (Adel, 1990). The mean life span o f the worm, however seems to be much shorter. Warren et al, 1974 reported o f a study outcome where a group o f Yemeni immigrants moved to a non-endemic country, the mean life span of S. mansoni worm was shown to be 5-10 years. In S. haematobium infections, investigations suggest that its life span may even be shorter than that o f S. mansoni (Anderson, 1987). Schistosomiasis in Ghana Ghana is among the countries with the highest prevalence rates o f urinary schistosomiasis (Berquist, 1987). It is widespread in most parts o f country (Ashitey et al., 1974). The snails responsible for the transmission o f the urinary schistosomiasis in Ghana are the Bulinus trancatus and B. globosus (Odei, 1961; Onori et al., 1963). B. globosus is reported however to be the most important and widely distributed in the country. The construction o f the Akosombo dam on the Volta River, and the subsequent formation o f the Volta Lake altered the existing physical, biological and the socio­ economic environment o f the people. Although the lake and the head pond created a number o f developmental possibilities in fisheries, transport, agriculture, wildlife and tourism, they also created a number o f public health problems, such as the incidence of schistosomiasis. The formation o f the lake led to an explosion o f aquatic weeds to which snail vectors o f schistosomiasis attach and feed. In addition, organic materials in the lake increased as a result o f the submerged vegetations, providing source o f nutrients for the snails. This led to an increase in the population o f B. truncatus in the lake (Odei, 1973). These problems notwithstanding, there was an accompanying increase in fish population. This attracted a number o f fishermen, especially from the area o f the Volta Delta, which was highly endemic for schistosomiasis (Kalitsi, 1973). The lake, which is the world’s largest artificial lake, has approximately 90% o f the children in the neighboring villages’ infected with schistosomes. They often contaminate their environment creating continual cycle that leads to poor School performance and growth. Most Africa’s dams are known to 15 University of Ghana http://ugspace.ug.edu.gh have similar problems. For instance after the construction o f the Diama Dam on the Senegal River in Mauritania, transmission rates rose to new heights. This introduced schistosomiasis to both Senegal and Mauritania. Other Dams such as Kainji in Nigeria and Kariba in Zimbabwe have contributed to the prevalence and spread o f schistosomiasis. Today, urinary schistosomiasis has become the main problem associated with the Volta Lake. This is accompanied by the fact that the inhabitants depend completely on the lake water for their domestic use. There is no proper human waste disposal system and the inhabitants freely urinate and defeacate at the lakeshore, perpetuating the cycle of schstosomiasis transmission (Kalitsi, 1973). It is reported that villages located closer to the lake generally showed a higher schistosomiasis infection rate than those situated further away. In a survey o f school children from the village o f Mepe, it was shown that the prevalence o f schistosomiasis in children who had never visited the Volta Lake was only 10.7%, whereas those children who had visited the lakeside at least once had a prevalence o f 69.9% (Jones, 1973). The intestinal form o f schistosomiasis is also known to occur mostly in the northern and south-eastern parts o f the country (Papema, 1968). Though the intermediate snail host (Biomphilaria. Pfeifferi) is widely distributed in the entire country most of them are however uninfected (Wen, personal communication). The contributions o f other species such as S. mekongi and S. intercalatum to human infection are not known. Furthermore, it is not documented if any o f the animal schistosomes are present in Ghana. Yet some of these animal parasites such as S. bovis occasionally infect humans (Rollinson and Southgate, 1987). Schistosomiasis in Ghana is an important occupational hazard associated with fishing and fanning. However large numbers o f children and women are also infected as a result o f domestic and recreational activities. A stratified random samples o f schools of the Suhum Kraboa Coaltar District for prevalence and intensity of urinary schistosomiasis by Ashitey et al, (1974) showed overall prevalence o f 56.9% and that schools with high 16 University of Ghana http://ugspace.ug.edu.gh prevalence above 60% were close to the three main rivers, Densu, Suhum and Kua. Interestingly, out of 23892 new attendants, only 161 cases o f urinary schistosomiasis were recorded in Suhum hospital. In 1994, a prevalence o f 67.7% for urinary schistosomaisis and 68,9% for intestinal schistosomiasis in the Kasene-Nankana District in the upper east region o f Ghana was attributed to the Tono Irrigation Scheme. It was also reported by Aryeetey et al, (2000), an overall prevalence o f S. haematobium infection varying between 54.8 and 60.0% in the Southern Ghana at three defined rural areas drained by the Densu River. This indicates that urinary schistosomiasis is a major public health problem in this area. In recent times, both S. mansoni and S haematobium have been reported to spread in Ghana and overlap in hyperendermic areas where the schistosomiasis snail hosts coexist. This has resulted in mixed infections involving both S. mansoni and S. haemaobium with more complicating effects on children. In 1996, an S. mansoni prevalence o f 10.3% and a 22.5% mixed infection rates were recorded in Sogakope, a town in southeastern Ghana. In the same year a urinary Schistosomiasis prevalence o f 47.6% was recorded in Mayera, a village in the Greater Accra Region o f Ghana (Bosompem et al., 1996b). Furthermore, this disease has severel effects on economic development of the country as it impacts negatively on the vast tourist and irrigation potential of the Volta and other Lakes. Unfortunately the picture regarding animal schistosomiasis and its effect on human in Ghana is yet to be determined. Animal schistosomiasis Natural infections o f domestic and wild animals with human schistosomes have been investigated by several workers (Barbosa et al., 1953; Pesigan et al., 1958; Nelson et al., 1962; Fenwick, 1969; Mansour, 1973). Nelson, (1960) concluded that all schistosomes infecting man in Africa are zoonotic and that the disease is naturally transmitted between reserviour hosts and man. In some other parts o f the world (such as China and 17 University of Ghana http://ugspace.ug.edu.gh Philippines), where human schistosome infection and disease have been reduced, further reduction seemed difficult because o f the continual transmission from infected animals (McGarvey et al., 1998). Natural survey data in China indicated an S. japonicum prevalence o f 7% among cattle and 9.6% in water buffalo. Although infection rates o f 10­ 15% were found in pigs and in water buffalo, specific community studies in endemic Provinces showed higher prevalence rates in cattle. Studies o f the spatial distribution o f animal faeces in the lake and marsh regions, and the mountainous regions o f China suggested that cattle dung contributes substantially to potential transmission o f S. japonicum infection (McGarvey et al., 1998). An epidemiological study o f S. japonicum in domestic animals in two municipalities o f the eastern coastal plain o f Leyte, Philippines, showed that pigs had the highest rates o f prevalence. They found out that dogs had the highest mean 24-hour-egg output, and pigs had the highest proportion o f hatchable eggs. However, dogs’ served important role in maintaining the transmission o f the parasite as indicated by a high transmission potential and the close habitual contact o f the animal to humans (Fernandez et al., 1982). In Zambia, schistosomiasis is reported to be endemic with occurrence o f S. haematobium and S. mansoni in man and S. matheei, S. margrebowiei and S. leiperi in domestic and wild animals. Schistosoma haematobium and S. metheei are the most widely distributed species and their transmission overlaps in rural areas where man and domestic animals utilize the same water bodies. It is significant to note that B. globosus is the intermediate host for both species (Vercruysse et al., 1994). Similarly in a study in Senegal, Albaret et al, (1985), reported that Bulinus umbilicatus is the principal vector of S. curassoni (the dominant species in domestic ruminants and in man) and S. haematobium (existing in pure infections and in mixed infections with S. curassoni in man) Studies based on the morphological characteristics o f eggs in South Africa, Zimbabwe and Zambia have revealed incidental S. matheei infections in man. Wright, 18 University of Ghana http://ugspace.ug.edu.gh Southgate and Ross (1979) demonstrated that S. haematobium and S. matheei readily hybridize in man and that FI hybrids are both viable and fertile. Pitchford (1977) therefore suggested that in time the two species would be supplanted by a single species, which may infect man and cattle with equal ease. Jiang et al, (1997) conducted investigations in highly endemic areas o f schistosomiasis japonica in Weishan and Aryans countries. It was observed that, the number o f domestic animals was increasing annually and the proportion o f animal husbandry gains in the total agriculture income had a yearly escalating tendency and that infection rate o f inhabitants was upgrading as a result o f the development o f frequent irrigation o f domestic animals. Owing to frequent irrigation o f domestic animals, serious spread o f infection sources and high prevalence o f schistosomiasis japonica occurred. Van Wyk (1983) reported that in Southern Africa schistosomiasis is practically as widely disseminated in animals as in humans. The prevalence in animals is very high in certain areas, for instance up to 90% in parts o f the lowveld o f the Transvaal. S. matheei was the only schistosome o f importance in animals in South Africa, with exception o f S. mansoni, which had been recovered from primates and rodents and a single waterbuck (Pitchford, 1977) and S. haematobium recovered from one buffalo (Pitchford, 1977). S. matheei was discovered in 1926 by Veglia and in 1929 Le Roux (Veglia and Le Roux, 1929) reported S. matheei in sheep near Humansdorp in the eastern Cape Province and recovered S. matheei ova from cattle faeces on the same farm. It shares the intermediate snail host, Bulinus (Physopsis) sp. with the human schistosome S. haematobium. Apart from South Africa, S. matheei occurs in most neighbouring territories and as far as parts o f Tanzania, Chad and Nigeria (Pitchford, 1977). It has the ability to develop in humans as cattle schistosome ova have been demonstrated in both urinary and intestinal infections in humans in Southern Africa by numerous workers (Alves, 1949; Pitchford, 1959; Cawston, 1922; Blackie, 1932; Kisner el al., 1953; Cruz, 1971). In Ghana however, the contributions o f other schistosome species such as S. 19 University of Ghana http://ugspace.ug.edu.gh mekangi S. bovis and S. intercalation to human infection is not known. Personal communication with researchers at Animal Research Institute and Dr. Wen o f the Schistosomiasis Control Unit o f the Ministry o f Health, Ghana revealed that currently there is no documentation on animal schistosomiasis. Thus the picture regarding animal schistosomiasis and its effect on human in Ghana is yet to be determined. Consequently veterinary epidemiological studies are urgently needed to improve the understanding o f the zoonotic implications o f the disease and to create a basis for suitable control measures in domestic animals if any. Schistosome antigens Attention has been focused on the schistosome surface as a primary source o f parasite antigens for protective purposes and as a major site o f immune attack. A variety o f antigens secreted or excreted by the different life stages (adult worm, miracidia hatching fluid o f viable eggs) o f schistosomes are present in the circulation and/ or the urine o f the infected host (Hermann, 1993). These have different antigenic stimuli. Several o f the schistosome surface antigens have now been identified and a number have been cloned; many are glycoprotein, with both the peptide and carbohydrate components acting as important epitopes. Some o f these epitopes are shared between different life cycle stages, providing a molecular basis for phenomena such as concomitant immunity and generation of blocking antibodies. A variety o f other antigens o f internal origin are released as the worm feeds and metabolizes (Hermann, 1993). Adult Worm Antigen (AWA) A detailed analysis by Norden and Strand (1984) of adult worm antigens recognized by sera from patients infected with S. mansoni, S. haematobium or S. japonicum concentrated on antigens present in the glycoprotein fraction prepared by affinity chromatography using Concanavalin A. This fraction was used based on the 20 University of Ghana http://ugspace.ug.edu.gh previous work by Strand et al. (1982) showing that it is the most antigenic. Twenty to thirty polypeptides out o f about 50 from each schistosome species were found to be antigenic as revealed by immunoprecipitation with the homologous infection sera. Sera from S. haematobium precipitated all but 3 o f the antigens recognised by S. mansoni sera amongst the glycoproteins. However, a lower degree o f cross reactivity was observed using sera from patients infected with S. japonicum. Kelly et al. (1987) described similar findings by comparing antigens immunoprecipitated from cell free translation product synthesized from adult worm mRNA o f S. mansoni and S. haematobium. Approximately 40 strongly labelled polypeptide antigens were resolved following 2-dimensional polyacrylamide gel electrophoresis and immunoprecipitates obtained by using homologous human infection sera. Once again extensive cross-reaction was evident with only three S. haematobium antigenic polypeptide (Mr 45,000, 27,000 and 14,000) being recognized specifically by S. mansoni infection sera. The significance o f these studies is that they give an indication o f the antigenic complexity o f the schistosomes. O f the three major species which infect humans, it appears that S mansoni and S. haematobium may be more closely related antigenically to each other than to S. japonicum , although a relatively small proportion o f the polypeptides antigens is specific to any one species (Kelly, 1987). Schistosomula Surface Antigens A preferred parasitic stage for generation o f monoclonal antibody to schistosome antigens is the schistosomulum. During the transition from cercariae into schistosomula, the trilaminate surface membrane o f cercariae matures into a double unit bilayer that covers the schistosomula (Hockley and Mclaren, 1973). This surface membrane contains stage-specific glycoproteins, which may represent targets for the host’s immune response (Hockley and Mclaren,). Monoclonal antibody that recognise surface antigens of 21 University of Ghana http://ugspace.ug.edu.gh schistosomula have therefore been sought. By far, the majority o f studies o f schistosomulum surface antigens have concentrated on S. mansoni. The frequent technique used to identify surface antigens include radio-iodination o f live, freshly transformed schistosomula, followed by the immunoprecipitation with a variety o f antisera. Numerous polypeptides generally o f Mr 100,000 have been labelled using lactoperoxidase-catalysed iodination by Ramasay, (1979) and Snary et al. (1980). Dissous et al. (1981) also identified a set o f antigens o f Mr 32,000-40,000 by precipitation with immune rat sera. Schistosomula surface antigens o f S. haematobium have also been identified using iodogen-catalysed labelling followed by immunoprecipitation with human infection sera (Simpson et al., 1985). Major antigens o f Mr 17,000 and a complex o f Mr 24,000-30,000 have been observed. Similar techniques had been used to identify surface antigens o f S. japonicum. Most o f the schistosomulum surface antigens are glycoxylated and both carbohydrate and polypeptide moieties contribute to their antigenicity. It is reported that surface polypeptide epitopes can induce protection (Kelly, 1987). Polypeptides antigens present on the schistosomulum surface are therefore strong candidates as antigens capable o f mediating immunity. They are recognised either singly or in combination by monoclonal antibodies that passively transfer protection in experimental animals. Importantly, they also elicit an antibody response in human patients and do not appear to show significant antigenic diversity. A number o f monoclonal antibodies against the Mr 20,000 antigen have been produced (Tavares et al., 1984; Yi et al., 1986b) and although to date, none has consistently transferred immunity, in some experiments statistically significant levels o f protection have however been obtained (Kelly, 1987). Substantial evidence for the involvement o f surface antigen in immunity is provided by the observations that schistosomulum surface antigens o f S. mansoni, S. haematobium and S. japonicum show species specificity, whilst the somatic antigens show 22 University of Ghana http://ugspace.ug.edu.gh considerable cross reaction (Kelly, 1987). The first immunization studies using purified antigens were reported by Smith and Clegg (1985), who used the protective monoclonal antibody WP66.4, which recognized schistosomulum surface antigen o f Mr 200,000 and 38,000 to purify a cross-reacting antigen o f Mr 155,000 from adult worm. In addition, an antigen o f Mr 53,000 was purified from schistosomula extracts using a further MoAb which had previously been shown to bind the schistosomulum surface but which was not protective. Schistosome Egg Antigens (SEA) Many o f the eggs produced by schistosomes do not reach the external environment but are swept to the liver by the portal blood flow where they impact on the presinusoidal capillaries (Saad et al., 1994). Proteolytic enzymes are considered important mediators in the egg migration process from the site o f ovipositor to the lumen o f the gut or the bladder. The mature eggs secrete through the micropore in the eggshell, a complex mixture o f antigens that elicit both cellular and antibody-mediated immunologic response (Smither and Doenhof£ 1982; Saad et al., 1994). Soluble egg antigens contain multiple glycoproteins, polysaccharides and non- glycoconjugated proteins (Carter and Colley, 1978 and 1979). Warren (1972) reported that SEA extracted from the schistosome egg by homogenization and ultra centrifugation could trigger o f granulomatous hypersensitivity and other immune reactions typical o f intact eggs. Egg antigens may vary considerably in concentration among schistosome eggs of different geographic origin. A major egg glycoprotein was shown to be four times abundant in a Puerto Rican strain o f S. mansoni than in an Egyptian strain (Hamburger et al., 1982). Also Pelley et al. (1976) noticed intraspecies differences at the protein level by comparing protein o f SEA among S. mansoni strains from different geographical regions using high performance SDS-polyacrylamide gel capillary electrophoresis. 23 University of Ghana http://ugspace.ug.edu.gh Three egg antigens (major serologic antigens- MSA1, MSA2 and MSA3) have been purified from S. mansoni (Hamburger et al., 1976 and Pelley et al., 1976) and serological studies suggested that only MSA1 (negligible amount in immature eggs, but abundant in mature ones) was egg stage and species specific. Nibbeling et al. (1998) demonstrated that 16 monoclonal antibodies were reactive with S. haematobium SEA in addition to S. mansoni SEA. The MoAbs were tested as possible immunodiagnostic reagents in homologous sandwich ELISA format to detect circulatory SEAs in serum and urine samples o f S. mansoni or S. haematobium infected individuals. In another study, De Brito et al. (1998) reported that adult worm antigen (AWA) and SEA were localized ultrastructurally by immunoelution microscopy using two MoAbs in the glomeruli o f hamsters infected with S. mansoni cercariae or injected with S. mansoni eggs. Both SEA and AWA were present mainly in cytoplasm o f mesangial cells, matrix and glomerular basement membrane. Their findings suggested that egg antigens contribute to the pathogenesis o f experimental glomerulopathy in the hamster. Detection o f circulating SEA is very important in the sense that it may provide complementary data to those o f circulating adult worm antigens. This may enable a more sensitive level o f antigen detection in a similar way to that found in parallel testing for CAA and CCA (Van Lieshout et al., 1991). The measurement o f SEA levels may also provide a more accurate representation o f tissue egg burdens since it is the eggs that produce a great deal o f the morbidity associated with S. mansoni infection and assessment of SEA levels could become a more accurate index o f morbidity than existing diagnostic test. Finally assessment o f SEA could also be used to measure the effects o f anti-fecundity thereby providing a tool in monitoring effect o f new vaccines. Cross- reactive schistosome antigens There are some egg antigens, which cross-react with other stages o f the parasite. Von Lichtenberg et al. (1963) showed that mice immunized with eggs developed 24 University of Ghana http://ugspace.ug.edu.gh antibodies, which reacted with the cercarial surface. Ham et al. (1984) produced anti-egg monoclonal antibodies that bound to the schistosomulum surface. In another study, Yi et al (1986a) described four MoAbs, which recognized epitopes present in all stages o f the schistosome life cycle. There is enough evidence that much o f the cross-reaction between the schistosomulum surface and the egg is due to shared carbohydrate epitopes (Omer-Ali et al., 1986). The epitopes, as indicated, are not species-specific and it is thus suggested that the stimulation o f antibody recognizing such carbohydrate epitopes may be a factor in cross-specific concomitant immunity. Attallah et al. (1998) reported a polypeptide (Mr 7,000) in antigenic extracts o f the three developmental stages (egg, cercaria and adult worm) o f S. mansoni by western blotting. This antigen was isolated and purified from crude soluble worm antigen preparation by immunoaffinity chromatography using CNBr-activated sepharose-4B beads coupled with the BRL4 MoAb. Excretory-secretory Antigens Excretory-secretory group o f antigens consists o f polypeptides, glycoproteins, proteoglycans and polysaccharides (Nash and Deelder, 1985; de Jonge, 1990). They are gut-associated antigens present in the vomitus and in excretory-secretory materials o f adult schistosomes and are released into circulation o f the host by the regular regurgitation of digested blood. These antigens were described by Bergren and Weller (1967) as circulatory by virtue o f the fact that they are found constantly in the blood and other body fluids o f infected individuals. Their presence in a patient therefore indicates an active infection with viable worms (Hermann, 1993). Two proteoglycan gut-associated antigens (circulating anodic and circulating cathodic antigens, CAA, CCA) have been detected in serum, urine and breast milk o f African and South American patients with schistosomiasis mansoni (Santoro et al., 1980; Feldmeier et al., 1986b; de Jonge et al 1990) in serum and urine o f patients infected with 25 University of Ghana http://ugspace.ug.edu.gh S. haematobium or S. intercalatum (Feldmeier et al., 1986b; de Jonge et al., 1989b) and in serum o f Filipinos infected with S. japonicum (Vant Wout et al., 1992). This supports the report by Bawden and Weller (1974) that the CAA was not species-specific by demonstrating its presence in S. mansoni, S. haematobium and S. japonicum adult worm homogenates and in the sera o f mice and hamsters heavily infected with either S. mansoni or S. japonicum. CAA as described by Gold, Rosen and Weller (1969) are heat stable, dialyzable and anodic as determined by its immunoelectrophoretic mobility unlike the low molecular weight CCA, which is cathodic. Other circulatory antigens have also been identified and characterized. Crabtree and Senft (1974) described several purine salvage enzymes (adenosine phosphorylase, adenosine kinase, adenosine deaminase and purine nucleotide phosphorylase) present in schistosome vomitus (excretory-secretory gut product). These enzymes could incite histaminic skin reactions (reagenic responses) in the host. Enzyme-linked Immunosorbent Assay (ELISA) One o f the most widely used applications o f MoAbs is enzyme-linked immunosorbent assay (ELISA). ELISA is based on antibody recognition o f a particular antigenic epitope. It combines the specificity of antibodies with the sensitivity o f simple spectrophotometric enzyme assays by using antibodies or antigens coupled to an easily assayed enzyme that also possesses a high turnover number (Wilson and Walker, 1995). ELISA is replacing radioimmunoassays because o f the lack o f radio hazards. It is also extremely economical in the use o f reagents (Riott et al., 1993); large numbers o f tests can be performed in a relatively short time. Also the enzyme conjugates are more stable than radioactive isotypes (McMichael and Beverley, 1986). For screening, an indirect method is invariably used in which an appropriate enzyme is covalently coupled to anti-mouse or rat immunoglobulin antibody (McMichael and Beverley, 1986). Binding enzymes are selected which show simple kinetics and can 26 University of Ghana http://ugspace.ug.edu.gh be assayed by a simple procedure (normally spectrophotometric). The most commonly used enzymes are the alkaline phosphatase, B-D-galactosidase and horseradish peroxidase. Binding o f anti-immunoglobulin is detected by conversion o f enzyme substrate to a coloured reaction product or precipitate. The putative antiserum is reacted with specific antigen attached to a solid phase. Solid phases commonly used in ELISA include cross-linked dextran or polyacrylamide beads, filter paper (cellulose) discs (membrane-based ELISAs) and disposable polystyrene microtitre plates (plate ELISAs), which are convenient for large numbers o f samples. The appropriate antigen or antibody may be attached to the solid phase by passive adsorption or covalent coupling with cyanogen bromide. Colourless substrates that are converted to a coloured product by the enzyme are popular. For instance, p-nitrophenylphosphate (pNPP) is converted to the yellow p- nitrophenol by alkaline phosphatase. Substrates used with peroxidase include 2,2-azo-bis 3-ethylbenzthiazoline-6-sulphonic acids (ABTS), O-phenylenediamine (OPD), and 3,3’, 5,5’-tetramethylbenzidine base (TMB), diaminobenzidine tetrahydrochloride (DAB), yield green, orange, blue and brown colours respectively. In all ELISAs reference positive and negative samples must be included in each series o f tests to ensure accurate and reproducible results. ELISA can be used for the assay o f virtually any antigen, hapten or antibody. It is used predominantly in clinical biochemistry in the study o f infectious diseases including detection o f bacterial toxins. It is also used to assay antibodies in infectious diseases including Plasmodium, Schistosoma and Trypanosoma spp. Monoclonal Antibodies (MoAbs) Antibodies or immunoglobulins (Ig) are a group o f glycoproteins present in the blood serum and tissue fluids produced by B-lymphocytes. They are the soluble form o f the B cells antigen receptor. All antibodies have the same basic structure but they are 27 University of Ghana http://ugspace.ug.edu.gh diverse in the region that binds to the antigenic determinant site (epitope) o f the antigen. The epitopes may be either peptide or carbohydrate in nature or more rarely lipid. One part (Fab) binds to antigen and the other parts (Fc) interact with other elements o f the immune system. Antibodies allow the immune system to recognize specific pathogens and their products (Roitt et al., 1993). Many different antibodies (polyclonal antibodies) secreted against several antigen epitopes are found in the immune sera. As a result immune sera are non-specific to any one particular determinant and cross-react with antigens from various sources (Campbell, 1984). They are therefore not suitable for assays in which antibody specificity is crucial. Polyclonal antibodies are particularly valuable for immunoprecipitation and immunoblotting. Prior to 1975, it was possible to only produce polyclonal antibodies. Kohler and Milstein (1975) developed a procedure to produce monoclonal antibodies from hybridoma cells. These are cells formed by fusion o f B-lymphocytes (antibody producing cells) from the spleen o f an immunized animal, with a myloma cell that has the capacity for unlimited proliferation (immortal). The single fused cell possesses the property o f the immortal cell and the specific antibody production. The hybridoma can then be injected into animals to induce antibody-secreting myloma cells to produce antibodies collected in ascites (in vivo) or they can be grown in mass culture to produce specific antibodies (in vitro). Antibodies produced by monoclonal hybridomas have many outstanding advantages over the conventional antisera. Apart from their monospecificity, specific antibody is available in concentrations several orders o f magnitude greater than in the conventional sera and can be derived for almost any purpose. It is possible to introduce stable internal labels into the antibody molecule by culturing the hybridoma cells with radiolabelled amino acid, a possibility not available with the conventional sera (Rosemarine, 1986). These advantages have made certain experimental techniques much simpler and more reliable and perhaps more importantly, have allowed the development of 28 University of Ghana http://ugspace.ug.edu.gh powerful experimental approaches not possible with conventional antibodies. Uses o f Antibodies Monoclonal antibodies are in effect homogeneous immunological reagents o f defined specificity, high specific activity and selected isotype. They have been established as exceptionally powerful research agents and also with potential clinical uses. In immunochemistry, MoAbs have been utilized for determining the structure and biochemical characteristics o f molecules. They have made possible monospecific reagents o f veiy high specific activity to virtually any molecule o f interest, bringing the possibility o f using immunochemical techniques to almost every laboratory. Monoclonal antibody techniques have provided an opportunity to re-evaluate the role o f immunological methods for the diagnosis o f infectious diseases. Antibodies o f diagnostic potential have therefore been prepared in research laboratories against a battery o f viruses, bacteria fungi and parasites (Nowinski et al., 1983). In a study by Nowinski et al, (1983) the diagnostic utility o f monoclonal antibodies for gonococcal, chlamydial and herpes virus infections were described. The antibodies used demonstrated sensitivity o f 94-99% for culture confirmation and 85-90% for direct diagnosis o f specimens smeared on microscope slides. They have significant impart on the characterization o f parasite antigens in schistosomiasis (Ham et al., 1985; Capron et al., 1987). Advances toward antigen analysis using MoAbs are o f particular importance in defining relevant antigens to be selected for possible vaccine development (Simpson and Coli, 1987). Purification o f Antibodies Purification and characterization is a prerequisite to studying biological molecules. Purified antibodies are requires for a number o f techniques. MoAbs produced in culture supernatants and ascites may contain impurities that 29 University of Ghana http://ugspace.ug.edu.gh can ultimately affect the reactivity and or the sensitivity o f the antibody. Particularly, antibodies present in the form o f ascites are generally not ideal for use without some form o f purification to remove contaminants such as the oily solutions used to induce and promote ascites formation. Also the common media used for the growth o f MoAb- producing cells in vitro and supplements with fetal bovine serum (FBS) or fetal calf serum (FCS), which may account for about 10% o f the complete medium. These serum supplements (proteins) usually serve as contaminants and they interfere in some o f the assays that utilize MoAbs. Notwithstanding, unpurified antibodies can be perfectly used in cytotoxicity studies if the concentration o f the antibodies is not important. There is a wide variety o f methods to purify antibodies and the correct choice of purification will depend on a number o f factors including (1) the manner in which the antibody will be used (2) the species in which the antibody was produced (3) the class and subclass and (4) the source (ascites or tissue culture supernatant). The most commonly used method in the purification is ammonium sulphate precipitation. The concentration at which antibody is precipitated varies from species to species but most antibodies will precipitate at 50% saturation. A disadvantage o f the ammonium sulphate method is that the resulting antibody will not be pure. They will be contaminated with other high molecular weight proteins, as well as proteins that are trapped in the large flocculant’s precipitate. Therefore ammonium sulphate precipitation is not suitable for single step purification but must be combined with other methods if a pure antibody is needed. The antibody isotype is one o f the most important factors that influence the choice o f protocol for subsequent purification (Goding, 1986). For instance, IgG monoclonal antibodies are best purified by ion-exchange chromatography whilst IgM antibodies require gel filtration. 30 University of Ghana http://ugspace.ug.edu.gh Diagnosis of human schistosomiasis The control o f schistosomiasis is an urgent task, which requires unproved diagnosis and treatment as well as effective prevention (Han Xu et al., 1989). Decisions on prognosis and assessment o f morbidity, evaluation o f chemotherapy and control measures all build on the results from diagnostic tests (Hermann, 1993). It is thus important to select a diagnostic tool that corresponds to the type o f information sought by the clinician or the epidemiologist. There is therefore the need for more simple, rapid, sensitive, reproducible and cost effective diagnostic test for schistosomiasis. There are three different approaches for the diagnosis o f the disease. These are the (1) direct parasitological methods, which detect schistosome ova in urine, stool or the rectal mucosa and histological methods disclose schistosomula, adult worm or eggs in tissue biopsies, (2) indirect methods which rely on clinical, biochemical or immunological disease markers, detect pathology typically or frequently associated with schistosome infections and (3) immunological methods which measure the immune response to certain schistosome antigens or the concentration o f parasite-derived antigens in blood or urine (Hermann, 1993). Eggs in urine The intensity o f schistosome infection is measured by quantitative egg counts, which are highly variable (Deelder et al., 1989) and may depend on the immune status o f the host (Damian, 1987). Urine samples may be examined under microscope for S. haematobium eggs. This method has been widely used in individuals and community diagnosis (WHO 1983c). The method is simple, rapid, specific but not very sensitive. The sensitivity can however be increased if (1) samples are collected at noon where egg secretion is maximum, (2) examination o f the sediment from large volume o f urine (Peters and Kazura, 1987). It is generally accepted that the excretion of eggs in urine follows a circadian rhythm with a 31 University of Ghana http://ugspace.ug.edu.gh peak around noon. Since eggs are responsible for the presence of lower renal track pathology in schistosomiasis haematobium, measurement o f haematuria, proteinuria and leucocyturia also varies with the time o f the day (Doehring et al 1985a, b). Urine sediments may be obtained by centrifugation or filtration. In filtration, paper, polycarbonate, polyamide or membranes derived from other synthetic fibres may be used. The membranes differ in properties (Bradley, 1965; Peters et al., 1976; Pugh, 1978). Paper filters have to be stained in order to allow identification o f schistosome ova. On polycarbonate membranes, ova are more easily identified (Hermann, 1993). Staining with 1.0% trypanblue facilitates visualization and allows discrimination between viable and non-viable ova (Feldmeier et al., 1979). Other stains in use include 5-10% tincture of iodine or solutions o f eosin, methylene blue or ninhydrine. Centrifugation is a valuable alternative to filtration. Richards et al, (1984) emphasized that the sensitivity o f centrifugation compares favourably to that o f the usual filtration o f 10ml in low intensity infection. It is worth noting that egg detection in urine has drawbacks. It may be biased in urine o f females o f childbearing age. This is because the epithelial cells frequently in female urine tend to clog filter membranes, which may completely disguise schistosome eggs. Also when urine is contaminated with menstrual blood, lysis o f erythrocytes is required to disclose ova in sediments or on filter membranes. This may usually be achieved by addition o f 10% HC1 to urine sample (Feldmeier et al., 1979). Eggs in Stool The ideal field method for the detection o f schistosome ova in stool is still lacking (Hermann, 1993). Currently, the technique described by Kato and Miura (1954) for diagnosing hookworm/Ascaris infections, which was amended by Katz et al. (1972) and modified by several workers (Teesdale and Amin, 1976; Peters et al., 1980) has been widely accepted as a valuable compromise for fieldwork. A specified amount o f stool specimen cast by a template is treated with 50% (v/v) glycerol in water containing 3% 32 University of Ghana http://ugspace.ug.edu.gh malachite green before microscopic examination. The method is sensitive for the detection o f light infection, quick and suitable for large epidemiological studies. Biopsies Infections with all human schistosomes can be diagnosed by microscopic examination of minute biopsies of the rectal mucosa. Snips are taken from suspicious lesion or from the plica transversalis recti. The efficiency o f rectal biopsy has been shown in schistosomiasis mansoni (da Cunha, 1982), schistosomiasis intercalatum (Feldmeier et al., 1981a) the oriental schistosomes (Maunouiy et al., 1990). Even in infection with S. haematobium, eggs are frequently detected in rectal snips (Badran et al., 1955; Harries et al., 1986). The biopsies are crushed between two thick cover slips and the surface examined. Quantitative results are obtained that significantly correlate to the number per gram o f faeces. If few drops o f glycerol-malachite solution are added to the biopsy before compression, viable and non-viable eggs are easily differentiated by morphological aspects (Cancado et al., 1965). Rectal biopsies are especially meaningful in the assessment o f cure rates after chemotherapy. However, the histological sectioning is invasive and therefore limited in application. Immunodiagnosis Schistosomiasis remains a serious worldwide public health problem with a still unfulfilled need for routine cost- effective method o f diagnosis. Such methods are required not only for people in endemic areas but increasingly for tourists who may be infected during visits to such places. The routine parasitological diagnosis o f schistosomiasis though very specific, is beset with a number o f limitations making its use unreliable. These limitations include the relative insensitivity in the detection o f low intensity infectious patients; difficulty in achieving homogenous distribution o f S. haematobium ova in urine (Braun-Munzinger and Southgate, 1992) as well as the day-day and circadian variation in egg excretion. This may 33 University of Ghana http://ugspace.ug.edu.gh lead to incorrect estimates in prevalence and intensity o f infection (Gryseels, 1994). It is also laborious, not field applicable and expensive. There is therefore the need for differential diagnosis. This must be simple, rapid, sensitive, reproducible and cost-effective. The increasing demands for simple and reliable assays have been noted in field monitoring o f schistosomiasis in the endemic areas where control measures have been taken for years (Qian-Li et al., 1993). It is therefore suggested that due to the relative insensitivity o f both the parasitological and antigen detection, antibody detection method could find increasingly use in situations o f low infection intensity (Hamilton et al., 1998). Numerous schistosome serodiagnostic assays (based on the detection o f host antibodies directed against schistosome antigen) with high sensitivity and specificity have been developed (Mott and Dixon, 1982; Qian-Li et al., 1993). Detection o f specific antibodies is a valuable tool for immunoepidemiological studies, but antibody levels are, in general, not related with the intensity o f the infection nor are they indicative o f a still active infection (Deelder et al., 1994). This does not discriminate between previous exposure and current infection (Simpson and Smithers, 1985). Assays that could measure circulatory antigens secreted by live parasites and discriminate infections based on their intensity might be able to evaluate the efficacy o f chemotherapy and the effectiveness o f future vaccines (Barsoum et al., 1991). All these attributes would be highly desirable. Therefore the detection o f circulatory antigens in schistosomiasis is increasingly used as a diagnostic tool, because level o f antigens is correlated with worm burden and antigen would disappear relatively rapidly from circulation after successful chemotherapy (Deelder etal., 1994). Although circulatory antigens may be produced by several life cycle stages, including eggs, the most important diagnostic antigens are the CAA and CCA, which are associated with the syncytium lining the gut o f the adult worm (Deelder et al., 1976). The CAA level in relation to intensity o f infection has been studied in S. mansoni, S. 34 University of Ghana http://ugspace.ug.edu.gh haematobium, S. japonicum and S. intercalatum infections (Deelder et al., 1989; Deelder et al., 1990; De Jonge et al., 1988). It was reported that, in general, CAA levels correlated with the intensity o f infection as determined by egg output. When CAA or CCA is measured quantitatively, antigen concentration in serum or urine significantly correlated to the number o f eggs excreted in stool or urine (Santoro et al., 1980; Feldmeier et al., 1986b; de Jonge et al., 1989b; Von’t Wout et al., 1992). These findings confirmed the notion that the concentration o f gut-associated antigens in blood or in urine is directly linked to the number o f adult worm present in mesenteric or prevesical plexus, which in turn determines the number o f eggs passed into the intestine or the bladder respectively. Following chemotherapy however, CAA levels in serum were found to decline rapidly with a half-life o f 2.5 days (De Jonge et al., 1989). Deelder et al, 1994 reported similar findings that in S. haematobium and S. japonicum infections, CCA and/or CAA serum levels decreased soon after treatment. The introduction o f ELISA and radioimmunoassays has led to improvement in the sensitivity o f serodiagnostic techniques for schistosomiasis (Smither and Doenhoff, 1982). ELISA however is the preferred option, in that the assay is based on stable antigen- antibody complexes and does not require the use o f harmful radioactive substances. In a cross-sectional survey, Al-Sherbiny et al. (1999) used serum, urine and stool samples from patients in an area known to be endemic for S. haematobium in Egypt. Diagnosis was approached in two parallel ways; the physical examination o f urine and stool microscopic analysis and two advanced immunodiagnostic assay systems, Falcon assay screening test (FAST)-ELISA and the enzyme-linked immuno electro transfer blot (EITB). Parasitologically, the overall prevalence o f S. haematobium was 15.8%. The combination o f urine CCA and serum CAA for detecting circulatory antigens and the combination of the S. haematobium adult worm microsomal antigens (HAMA) FAST- ELISA and HAMA EITB for detecting antibodies significantly improved the sensitivity o f detecting S. haematobium circulatory antigens and antibodies. 35 University of Ghana http://ugspace.ug.edu.gh Diagnosis of animal schistosomiasis Diagnosis o f animal schistosomiasis is mainly based on the clinico-pathological symptoms o f diarrhoea, wasting and anaemia. The relatively persistent diarrhoea, often blood stained and containing mucus may help to differentiate this syndrome from faciolosis (Urquhart et al., 1988). The routine method o f diagnosis is the microscopical examination for parasite eggs in faecal samples. However the demonstration o f the characteristic eggs in the faeces or in squash preparations o f blood and mucus from the faeces is useful in the period following high infection but less useful as egg production drops in the later stages of infection. Generally when schistosomiasis is suspected, diagnosis is best confirmed by a detailed post-mortem examination which will reveal the lesion and if the mesentery is stretched, the presence o f numerous schistosomes in the veins (Urquhart et al., 1988). These methods are time consuming and there is therefore the need for alternative diagnosis such as serological diagnosis particularly in epidemiological surveys. 36 University of Ghana http://ugspace.ug.edu.gh CHAPTER 2 GENERAL MATERIALS AND METHODS Study area Two villages, Galilea and Agbekpotsepko, were chosen as study areas based upon epidemiological data on the distribution o f schistosomiasis. Galilea is a village in the Ga District o f the Greater Accra region. It is located along the Weija Dam, which serves as the main source o f domestic water for the community. The weedy bank o f the dam contains large amount o f decomposing plants and twigs and is infested with Bulinus and Biomphilaria snails. The dam constitutes a principal source o f water and transmission o f schistosomiasis. Agbekpotsepko is located in the Dangbe West District o f the Greater Accra region. The vegetation is mainly o f grass with few trees. The area is swampy and constitutes a suitable breeding site for schistosome intermediate snail host. The main occupation o f the community is farming and free range cattle rearing. The sources of water for the community are streams, which also serve the cattle. It was therefore suitable to select the area to investigate the prevalence o f animal schistosomiasis. Resuscitation of Hybridoma Cells Monoclonal antibody secreting hybridama cell lines cryopreserved in 7.5% dimethylsulfoxide (DMSO) in Iscove’s Modified Dulbecco’s Medium (IMDM) were retrieved from liquid nitrogen at -196°C. The content o f a vial was thawed rapidly in a water bath at 37°C and immediately transferred into a 15ml centrifuge tube cont