UNIFORM STROBILAR DEVELOPMENT OF ECHINOCOCCUS MULTILOCULARIS IN VITRO FROM PROTOSCOLEX TO IMMATURE STAGES

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UNIFORM STROBILAR DEVELOPMENT OF ECHINOCOCCUS MULTILOCULARIS IN VITRO FROM PROTOSCOLEX TO IMMATURE STAGES J. Parasitol., 76(2), 1990, p. 240-247? American Society of Parasitologists 1990 R. C. A. Thompson*, P. Deplazes, and J. Eckert Institute of Parasitology, University of Zurich, Winterthurerstrasse 266a, Zurich CH-8057, Switzerland ABSTRACT: The aim of this study was to obtain uniformity in strobilar development ofechinococcus multilocularis from protoscoleces in vitro. The isolate of E. multilocularis used was derived initially from a human case in France and subsequently maintained in the laboratory by intraperitoneal passage in Meriones unguiculatus. Protoscoleces used for culture were obtained using preparative procedures in which parasite tissue was disrupted gently with minimal exposure to pepsin and acidic conditions followed by immediate exposure to pancreatin in alkaline solution. Resultant cultures contained large numbers of evaginated, active, vermiform stages, which exhibited uniform strobilar development with formation of the first proglottid and segment and limited maturation of the first proglottid. All worms that exhibited proglottization subsequently segmented. Further proglottization did not occur and all worms degenerated within a few days following segmentation. The results are discussed in light of current knowledge of the relationships of somatic and germinal processes in Echinococcus. In view of these results, further studies should be encouraged to improve strobilar development of E. multilocularis in vitro. A major limitation to research on the strobilar stage of Echinococcus is the nature of the definitive host and problems associated with keeping dogs and cats in the laboratory, particularly if the infection is allowed to proceed to patency. An alternative to in vivo maintenance is the development of in vitro cultivation procedures. Considerable success has been achieved with axenic culture of the common sheep strain of Echinococcus granulosus, in which reproducible procedures for development from the protoscolex to sexual maturity have been established, although fertilization has not been achieved in vitro (Smyth and Davies, 1974; and reviewed by Howell, 1986; Arme, 1987). In contrast, attempts to obtain strobilar development of Echinococcus multilocularis in vitro have produced very different results. Webster and Cameron (1963) and Lukashenko (1964) demonstrated that cystic development from larval tissues ofe. multilocularis would occur readily in vitro but that occasionally a few protoscoleces developed in a strobilate direction. However, although 2 or 3 segments were formed, proglottization did not take place and the culture conditions under which segmentation was induced were not defined. The characteristic features of subsequent more detailed experiments are that Received 21 July 1989; revised 2 November 1989; accepted 4 November 1989. * On leave from the Division of Veterinary Biology, School of Veterinary Studies, Murdoch University, Western Australia 6150. 240 development is highly variable, and although sexually mature forms can be produced from protoscoleces, segmentation is often suppressed or incomplete (Smyth and Davies, 1975; Smyth, 1979; Smyth and Barrett, 1979; and reviewed by Howell, 1986; Arme, 1987). These results may reflect some fundamental difference between E. granulosus and E. multilocularis in the factors required to initiate and trigger the various stages of adult differentiation, unusual features of the isolate of E. multilocularis used, or differences in preparative procedures used to obtain protoscoleces of E. granulosus and E. multilocularis. From the public health viewpoint, E. multilocularis is a far more dangerous parasite than E. granulosus with human infections considered to be incurable in a high proportion of cases (Mosimann, 1980). There are thus many advantages to being able to achieve some degree of normal development with E. multilocularis in vitro. The aim of the present study was to try and obtain uniformity in strobilar development in vitro by modification of previously established preparative procedures. MATERIALS AND METHODS Source of parasite material The isolate of E. multilocularis used in this study originated in 1985 from a human patient in France and is designated by the code F4. The isolate has been subsequently maintained in the Institute of Parasitology, University of Zurich, by intraperitoneal passage (Eckert and Pohlenz, 1976) in Meriones unguiculatus.

THOMPSON ET AL.-IN VITRO DEVELOPMENT OF E. MULTILOCULARIS 241 50 ml plastic - centrifuge tube Serum-free medium - Inner plastic tube Sedimented material Filter held in place..:.-. containing host and cystic by perspex collar tissues, and protoscoleces of E. multilocularis Nylon filter :. ;.. / 200lm pore size :. \ :.. / (Scrynel NY 20 HD) ' _ Collected protoscoleces FIGURE 1. Diagram of apparatus used for filtering sedimented material containing host and cystic tissues and protoscoleces of Echinococcus multilocularis. Processing of parasite material The F4 isolate of E. multilocularis proliferates rapidly in M. unguiculatus and larval material for in vitro studies was therefore harvested at autopsy from animals 6-8 wk after infection. Larval masses were rapidly removed from the body cavity and immersed in sterile phosphate-buffered saline (PBS) at 10 C. All subsequent procedures were carried out in a laminar flow sterile air chamber. Once sufficient material was collected, it was minced finely with a scalpel blade in a stainless steel sieve with an overall diameter of 6 cm and 1-mm mesh size. PBS was poured periodically through the sieve and parasite material collected into a 500-ml conical flask. The mincing process was normally completed within 60 min and the collected sediment washed twice in PBS at 10 C before transfer to a 2-L cylinder containing PBS, in which the sediment was washed 4 times to remove host fibrous material and fatty tissue. Following washing, the collected protoscoleces were checked for viability, using the criterion of flame cell activity, and to ensure that the majority were still invaginated. Only material in which at least 90% of the protoscoleces were viable with no sign of evagination was used. Sedimented material was transferred to a 10-ml vial containing a 0.9% solution of sodium chloride acidified to ph 2 with a few drops of 1 M hydrochloric acid [S 1] for 20 min at 37 C. Sedimented material was then aspirated and transferred to a vial containing 1% pancreatin (Fluka), 10% dog bile (sterilized by filtration, 0.25-M-m pore size), 1% NaHCO3 in distilled water (ph 8) [S2], and incubated at 37 C for 30 min with vigorous shaking once every 5 min. The sediment was then placed onto a nylon filter in the apparatus shown in Figure 1, in serum-free medium (Table I), with or without 0.3% trypsin (Difco; 1:250), at 37 C for 16-18 hr. Culture conditions Echinococcus multilocularis was cultured in a diphasic culture system with a solid base prepared by coagulating newborn calf serum in an oven at 76 C for 60 min. The composition of the liquid phase was based on that developed for E. granulosus (Smyth, 1979) and is given in Table I. Approximately 600 protoscoleces were cultivated in each 30-ml plastic tissue culture flask TABLE I. Composition of liquid medium for the in vitro cultivation of Echinococcus multilocularis. Medium CMRL 1066 with glutamine (Flow Laboratories) 650 ml 30% D-glucose (Fluka) 14.5 ml 5% sodium taurocholate (Serva) in distilled water 4.2 ml 5% yeast extract (GIBCO) in Hanks' saline 90 ml Sodium bicarbonate (Fluka) 4.2 g HEPES (Fluka) 20 mm Penicillin/streptomycin (KC Biological) 0.4 mg Gentamycin sulfate (Serva) 100 mg Amphotericin (GIBCO) 2 mg Fetal calf serum (KC Biological) 250 ml (Falcon) containing a 5-ml coagulated serum base and 10 ml of culture fluid as an overlay. The culture flasks were placed in an upright position with their caps slightly loose in a Heraeus tissue culture incubator at 38 C within which a constant gas phase of 5% CO2 in air was maintained. The culture fluid was changed every 3 days and all cultures remained axenic throughout this study. Cultures were viewed in a Periplan (Leitz, Germany) inverted microscope and photographs taken with a Wild (Heerbrugg, Switzerland) MPS15 Semiphotomat and MP511 camera attachment. Worms were stained unfixed in Blachin's lactic acid carmine. Two in vitro experiments were conducted 4 mo apart using different samples of the F4 isolate and culture media. Experimental infection of dogs and subsequent in vitro development To determine whether the F4 isolate of E. multilocularis was capable of normal strobilate development in vivo, 2 6-mo-old Appenzeller dogs were each infected orally with approximately 7,500 protoscoleces according to established procedures (Thompson and Eckert, 1983). Dogs were autopsied 21 days postinfection and worms were collected and processed for morphological study and transfer to in vitro cultures as previously described (Thompson and Eckert, 1982, 1983). RESULTS Following transfer from acidic (S 1) to alkaline (S2) solution, evagination of the majority (70-80%) of protoscoleces was accomplished within 5 min and activity increased throughout the 30- min incubation period. After incubation in S2, some host and E. multilocularis cystic tissue remained. However, the subsequent 16-18-hr incubation in the filtration apparatus (Fig. 1) resulted in a preparation of protoscoleces virtually devoid of any host or cystic tissue apart from some calcareous corpuscles. The pronounced activity observed during incubation in S2 declined during filtration but increased to similar high levels after 24 hr in culture. No further evagination of protoscoleces was seen after 24 hr in cul-

/I 242 THE JOURNAL OF PARASITOLOGY, VOL. 76, NO. 2, APRIL 1990 / /l 2-3 ''rt N., 4 / I t. /'. /.. %K -11 m FIGURES 2-7. Stages of development of Echinococcus multilocularis in vitro. 2. Day 4, showing evaginated, vermiform stage (arrow) and unevaginated form on the far left. Note excretory canal. Scale bar = 200 um. 3. Day 8, showing elongated strobilating form with reduced numbers of calcareous corpuscles and posterior excretory bladder. Scale bar = 200 ium. 4. Day 8, as for 3, but devoid of calcareous corpuscles. Scale bar = 200,im. 5. Day 8, showing evidence of early proglottid formation (arrow). Scale bar = 500 ium. 6. Day 12, stained specimen showing proglottid formation and banding. Scale bar = 200,um. 7. Day 14, showing proglottid formation and segmentation (arrow). Scale bar = 500,um.

T THOMPSON ET AL.-IN VITRO DEVELOPMENT OF E. MULTILOCULARIS 243 I Ap'-'S - 1". i *4.-,,. a'. I / ''II '* I I f '1 J M " t is' ii/ I,. z J', ;. '. *' t ef - :, f',-'^f 4e.. I o X t I.., ~ r.w x. 1 ; 1.,,. i- :4 t i- v 1".-r f h 1. A tf 3 4 " ture and any still invaginated either died or became vesicular. The proportion of evaginated protoscoleces varied, but in these experiments always exceeded 70%. The age of the metacestode material used for in vitro studies is critical. In preliminary experiments, we found that protoscoleces isolated from larval tissue removed from rodents 4-5 wk after infection, although apparently fully differentiated morphologically, were inactive and invariably failed to evaginate. Over the next few days in culture, evaginated protoscoleces gradually elongated and became more vermiform and by day 4 had increased in length from approximately 0.8 mm to a maximum of 1.5 mm (Fig. 2). These changes were evident particularly in cultures containing worms incubated with trypsin during filtration. Trypsintreated worms also began to lose their calcareous corpuscles on day 4 and were virtually devoid of them by day 6. Untreated worms commenced losing their calcareous corpuscles on day 6 and had lost most of them by day 8 (Figs. 3, 4). Following this time, no difference was observed between trypsin and nontrypsin-treated worms. All worms remained active and by day 7 were up to 2 mm in length. Excretory canals were evident in the majority of strobilating worms by day 7 and the excretory bladder by day 8 (Figs. 3, 4). The first evidence of proglottid formation was seen after 8 days (Fig. 5), but in some cultures proglottization did not commence until day 16. Banding and segmentation did not occur without proglottid formation, and they were always seen 24 and 48 hr after proglottization, respectively (Figs. 6, 7). The majority of evaginated worms, which always exceeded 60%, had produced a proglottid and segment by the 20th day of culture. Subsequent maturation of the proglottid was also seen in most worms with elongation of the genital rudiment (stage 1) and unilateral extension (stage 2) (Figs. 8, 11). Such worms usually had increased their length up to 2.8 mm. This stage of development was the most advanced obtained and, once reached, worms started to degenerate posteriorly and vesiculate (Figs. 9, 10) without any further strobilar development. The 10 FIGURES 8-10. Stages of development of Echinococcus multilocularis in vitro. 8. Day 16, stained specimen showing lateral extension of genital rudiment (arrow). Scale bar = 200,um. 9. Day 18, showing posterior degeneration and vesiculation. Scale bar = 200,tm. 10. Day 24, grossly vesiculated form. Scale bar = 200 um.

244 THE JOURNAL OF PARASITOLOGY, VOL. 76, NO. 2, APRIL 1990 0 g~ Degeneration - Maturation _ 69 <^~~ stage 2 A3f--1-* Maturation I. i 9 stage 1 \fi 6 L Segment - T k ( - rogittid Excretory bladder - Excretory canals - _...F Lost calcareous ^ U n corpuscles - Losing calcareoaus R!, \^;1 corpuscles J Vermiform- Evaginated - Invaginated 0 5 25 Days FIGURE 11. Diagram summarizing the development most rapid (A) and slowest (0) development times. of Echinococcus multilocularis in vitro, showing the stages of development obtained are summarized in Figure 11. Adult E. multilocularis were recovered from the 2 dogs experimentally infected with the F4 isolate. The 21 -day-old worms were sexually mature with a dilated uterus in the terminal segment containing developing ova and vitelline cells. Worms transferred to in vitro cultures produced embryonated eggs with fully developed embryophores within 8 days, thus conforming to the results of previously published experiments (Thompson and Eckert, 1982). DISCUSSION The development of adult Echinococcus involves germinal and somatic differentiation and has been divided into the following processes: proglottization, maturation, growth, and segmentation (Thompson, 1986). Germinal differentiation comprises proglottization and the maturation of the proglottids; somatic differentiation comprises growth and the somatic delineation of each proglottid by segmentation (Freeman, 1973; Mehlhom et al., 1981). The pioneering work by J. D. Smyth and his colleagues on the development of Echinococcus in vitro has demonstrated that germinal differentiation, growth, and segmentation take place independently (Smyth, 1971; Smyth and Davies, 1975; Smyth and Bar- rett, 1979; and reviewed by Howel, 1986; Arme, 1987). Sequential studies in vivo confirmed the independence of these developmental processes (Thompson, 1977). The preparative procedures and subsequent culture conditions to which our French isolate (F4) of E. multilocularis was exposed obviously provided the correct nutrient requirements and environmental stimuli for evagination and uniform, reproducible, sequential development with the production of the first proglottid and segment in the majority of strobilating worms. However, subsequent maturation of the first proglottid was limited and further proglottization did not occur. Worms subsequently became cystic and degenerated. This was not due to a sudden deterioration in culture conditions because a cessation of strobilar development only took place after formation of the first segment so that, whereas some worms in a culture would be undergoing degeneration, other worms at a less advanced stage of development would appear normal. Identical results also were obtained on different occasions using different batches of culture media and samples of the F4 isolate. In the in vitro experiments of Smyth and colleagues with E. multilocularis, segmentation was usually suppressed, but sexual maturation often proceeded with essentially monozoic forms being produced (reviewed by

THOMPSON ET AL.-IN VITRO DEVELOPMENT OF E. MULTILOCULARIS 245 Smyth, 1979; Howell, 1986; Arme, 1987). In the present study, development was normal in that proglottization was always followed by segmentation. However, the lack of further development suggests that another environmental stimulus may be required to initiate subsequent maturation. In the absence of this stimulus, our observations suggest that segmentation can, in some way, act to inhibit subsequent development. This, therefore, indicates that somatic and germinative processes cannot be considered to operate completely independently in E. multilocularis. The reasons for the differences between our experiments and those of Smyth and his colleagues could be due to procedural and/or parasite factors. The preparative techniques used in previous studies involved prolonged treatment of E. multilocularis metacestode tissue with pepsin and frequent adjustment of the ph by the addition of HCl during digestion (Smyth, 1979). It is clear that E. multilocularis is extremely sensitive to environmental conditions, and excessive exposure to pepsin at low ph could upset the fine balance that obviously exists within this organism. In the procedures described here, we succeeded in minimizing harsh treatment in the initial stages of processing parasite tissue. Parasite material was gently disrupted manually rather than by homogenization, pepsin was not used, and exposure to acidic conditions was limited to 20 min. Following this step, we did not wash the parasite material in neutral saline as in previous studies, but instead, immediately exposed the protoscoleces to pancreatin in alkaline solution. This, perhaps, more closely reflects in vivo conditions following passage from the stomach to the small intestine, and we feel that the sudden change in ph and/or generation of CO2 enhanced the rate of evagination and stimulated activity. Such treatment may also have provided an important stimulus for strobilar development. The subsequent filtration process resulted in very clean parasite preparations. The culture conditions to which our isolate of E. multilocularis were exposed did not differ significantly from those used by Smyth and coworkers, and we do not consider that minor variations in media constituents would have accounted for the differences in results. The isolate of E. multilocularis used in this study was originally of human origin but subsequently passaged in gerbils for 3 yr. However, although of human origin, rather than from a natural intermediate host, the F4 isolate of E. multilocularis grew nor- mally in vivo, and fertilized worms produced embryonated eggs after transfer from dogs to axenic culture. The original host origin of the isolate of E. multilocularis used by Smyth is not clear although it originated from Germany (Smyth, pers. comm.). It had been passaged in laboratory rodents for more than 8 yr but this isolate was also shown to develop normally in vivo (Smyth and Davies, 1975). There is no evidence, therefore, that either of the 2 isolates possessed any defect in their ability to develop normally under natural conditions, unlike the situation with isolates of some asexually proliferating larval cestodes such as Taenia crassiceps (Freeman, 1962) that fail to strobilate in vivo after prolonged laboratory passage. It is possible that genetic differences between the 2 isolates may have contributed to the contrasting results reported here. Genetic variation is common in E. granulosus with several strains shown to differ in their developmental characteristics in vitro and in vivo (Eckert and Thompson, 1988; Thompson and Lymbery, 1988). Strain variation does not appear to be as common in E. multilocularis, although few detailed studies have been undertaken to investigate the occurrence of genetic heterogeneity in this species. However, available data support the existence of some variation within E. multilocularis (reviewed by Thompson and Lymbery, 1988) and the present results could be a reflection of such variation. In vitro studies with E. multilocularis have demonstrated the complexity of developmental processes associated with adult differentiation. The fact that they exhibit some degree of independence suggests a very complicated process of cytodifferentiation and the possible existence of several primitive cell lines as in other cestodes (Sulgostowska, 1972, 1974). However, studies with both E. multilocularis and E. granulosus suggest that only 1 primitive cell type exists (Sakamoto and Sugimura, 1970; Gustafsson, 1976). If there is only 1 such cell, it is obviously extremely sensitive to environmental conditions. Our present observations and those of other workers (Smyth and Barrett, 1979), on the sequence of development in vitro, indicate that a number of yet to be defined environmental triggers are necessary for development to proceed normally. The results of the present study also demonstrated considerable variability in the onset of proglottization. The reasons why some worms commenced proglottization on day 8,

246 THE JOURNAL OF PARASITOLOGY, VOL. 76, NO. 2, APRIL 1990 whereas others required much longer under identical culture conditions are not known, but they may reflect heterogeneity of the parasite population. Thompson (1986) suggested that it was unlikely that the factors that initiated adult differentiation in E. granulosus would differ from those in E. multilocularis. The present results suggest that such a conclusion may have been premature. The developmental biology of E. multilocularis is strikingly different from E. granulosus. Echinococcus multilocularis develops far more rapidly than E. granulosus in both definitive and intermediate hosts and, in the latter, shows a remarkable proliferative capacity and behaves like an infiltrative metastatic tumor (Vogel, 1978; Eckert et al., 1983; Mehlhorn et al., 1983; Thompson, 1986). These differences presumably result from differences in the control of gene expression, as suggested by Howell (1986). The uniformity in results obtained in the present study should encourage further work to be undertaken on the in vitro cultivation of adult E. multilocularis. In addition, there is obvious value of continued in vitro manipulations in increasing our understanding of cytodifferentiation in Echinococcus and other cestodes. Howell (1986) also suggested that in light of the contrasting in vivo and in vitro developmental features of E. multilocularis and E. granulosus, molecular biological investigations of their genomes may reveal unusual genetic control mechanisms or genomic characteristics that may provide fundamental information that explains the differing properties of the organisms. ACKNOWLEDGMENTS This work was supported by the Roche Research Foundation, Basel, Switzerland, to whom grateful thanks is made. We also express our appreciation to Alan Lymbery for his critical appraisal of this manuscript, Russ Hobbs for his expertise in producing the diagrams, and Geoff Griffiths for skillful photography. LITERATURE CITED ARME, C. 1987. Cestoda. In In vitro methods for parasite cultivation, A. E. R. Taylor and J. R. Baker (eds.). Academic Press, London, p. 282-317. ECKERT, J., AND J. POHLENZ. 1976. Zur Wirkung von Mebendazol auf Metazestoden von Mesocestoides corti und Echinococcus multilocularis. Tropen- medizin und Parasitologie 27: 247-262., AND R. C. A. THOMPSON. 1988. Echinococcus strains in Europe: A review. Tropical Medicine and Parasitology 39: 1-8.,, AND H. MEHLHORN. 1983. Proliferation and metastases formation of larval Echinococcus multilocularis. I. Animal model, macroscopical and histological findings. Zeitschrift fir Parasitenkunde 69: 737-748. FREEMAN, R. S. 1962. Studies on the biology of Taenia crassiceps (Zeder, 1800) Rudolphi, 1810 (Cestoda). 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THOMPSON ET AL.-IN VITRO DEVELOPMENT OF E MULTILOCULARIS 247? 1974. The development of organ systems in cestodes. II. Histogenesis of the reproductive system in Hymenolepis diminuta (Rudolphi, 1819) (Hymenolepididae). Acta Parasitologica Polonica 22:179-190. THOMPSON, R. C. A. 1977. Growth, segmentation and maturation of the British horse and sheep strains of Echinococcus granulosus in dogs. International Journal for Parasitology 7: 281-285. 1986. Biology and systematics of Echinococcus. In The biology of Echinococcus and hydatid disease, R. C. A. Thompson (ed.). George Allen and Unwin, London, p. 5-43., AND J. ECKERT. 1982. The production of eggs by Echinococcus multilocularis in the laboratory following in vivo and in vitro development. Zeitschrift fur Parasitenkunde 68: 227-234., AND. 1983. Observations on Echinococcus multilocularis in the definitive host. Zeitschrift fur Parasitenkunde 69: 335-345., AND A. J. LYMBERY. 1988. The nature, extent and significance of variation within the genus Echinococcus. Advances in Parasitology 27: 209-258. VOGEL, H. 1978. Wie wiichst der Alveolarechinokokkus? Tropenmedizin und Parasitologie 29: 1-11. WEBSTER, G. A., AND T. W. M. CAMERON. 1963. Some preliminary observations on the development of Echinococcus in vitro. Canadian Journal of Zoology 41: 185-194. J. Parasitol., 76(2), 1990, p. 247? American Society of Parasitologists 1990 ANNOUNCEMENT... International Symposium on Emerging Problems in Food-borne Parasitic Zoonoses An international symposium on emerging problems in food-borne parasitic zoonoses will be held in Chiang Mai, Thailand, on 14-17 November 1990. It is becoming more evident that the problem of animal product-borne diseases, such as toxoplasmosis, cysticercosis, trichinosis, capillariasis, angiostrongyliasis, gnathostomiasis, sarcosporidiosis, and trematodiases is increasing. The economic consequences of these zoonoses for agriculture, and their associated public health impact, is quite severe in some regions of Southeast Asia and elsewhere in the world. The development of animal production systems is handicapped by these problems and a better understanding of the problems is needed before effective control strategies can be developed. Therefore, there is a need to bring capable scientists with the relevant experience from various parts of the world into contact with Southeast Asian agricultural and public health scientists to provide guidance on how to deal with the problems. We welcome participation by all interested individuals and groups. For further information, contact Professor Chamlong Harinasuta, SEAMEO TROPMED Project, 420/6 Rajvithi Road, Bangkok 10400 Thailand; or Dr. John H. Cross, Department of Preventive Medicine and Biometrics, Uniformed Services of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814; telephone (202) 295-3139.