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      Angiostrongylus cantonensis cathepsin B-like protease (Ac-cathB-1) is involved in host gut penetration Translated title: La protéase ressemblant à la cathepsine B (Ac-cathB-1) d’Angiostrongylus cantonensis est impliquée dans la pénétration de l’intestin de l’hôte

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          Abstract

          Although the global spread of the emerging zoonosis, human angiostrongyliasis, has attracted increasing attention, understanding of specific gene function has been impeded by the inaccessibility of genetic manipulation of the pathogen nematode causing this disease, Angiostrongylus cantonensis. Many parasitic proteases play key roles in host-parasite interactions, but those of A. cantonensis are always expressed as the inactive form in prokaryotic expression systems, thereby impeding functional studies. Hence, a lentiviral system that drives secreted expression of target genes fused to a Myc-His tag was used to obtain recombinant Ac-cathB-1 with biological activity. Although this class of proteases was always reported to function in nutrition and immune evasion in parasitic nematodes, recombinant Ac-cathB-1 was capable of hydrolysis of fibronectin and laminin as well as the extracellular matrix of IEC-6 monolayer, so that the intercellular space of the IEC-6 monolayer increased 5.15 times as compared to the control, while the shape of the adherent cells partly rounded up. This suggests a probable role for this protease in intestinal epithelial penetration. The inhibition of Ac-cathB-1 enzymatic activity with antiserum partly suppressed larval penetration ability in the isolated intestine. Thus, an effective system for heterologous expression of parasite proteases is presented for studying gene function in A. cantonensis; and Ac-cathB-1 was related to larval penetration ability in the host small intestine.

          Translated abstract

          Bien que la propagation mondiale de l’angiostrongylose humaine, une zoonose émergente, attire une attention croissante, la compréhension de la fonction de gènes spécifiques a été entravée par l’inaccessibilité de la manipulation génétique du nématode pathogène de cette maladie, Angiostrongylus cantonensis. Beaucoup de protéases parasitaires jouent des rôles clés dans l’interaction hôte-parasite, mais celles d’A. cantonensis sont toujours exprimées sous forme inactive dans les systèmes procaryotes d’expression, empêchant ainsi des études fonctionnelles. Par conséquent, un système lentiviral qui permet l’expression sécrétée de gènes cibles fusionnés à un marqueur Myc-His a été utilisé pour obtenir de l’Ac-cathB-1 recombinante ayant une activité biologique. Bien que cette classe de protéases ait toujours été rapportée comme impliquée dans l’alimentation et l’évasion immunitaire chez les nématodes parasites, l’Ac-cathB-1 recombinante était capable d’hydrolyser la fibronectine et la laminine, ainsi que la matrice extracellulaire de monocouches IEC-6, de sorte que les espaces intercellulaires des monocouches IEC-6 étaient augmentés de 5.15 fois par rapport au contrôle, tandis que la forme des cellules adhérentes devenait partiellement arrondie. Ceci suggère un rôle de cette protéase dans la pénétration de l’épithélium intestinal. L’inhibition de l’activité enzymatique d’Ac-cathB-1 par un antisérum a supprimé en partie la capacité de pénétration des larves dans l’intestin isolé. Ainsi, un système efficace pour l’expression hétérologue de protéases de parasites est présenté pour l’étude de la fonction des gènes chez A. cantonensis, et Ac-cathB-1 a été liée à la capacité de pénétration de l’intestin grêle de l’hôte par des larves.

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          CRISPR-Cas9-Mediated Single-Gene and Gene Family Disruption in Trypanosoma cruzi

          INTRODUCTION The protozoan parasite Trypanosoma cruzi is the causative agent of Chagas disease, the highest-impact infectious disease of the Americas, with 10 to 20 million humans and innumerable animals affected. The study of T. cruzi and Chagas disease is particularly challenging, in part due to the complexity and unique characteristics of its genome and the relative paucity of tools for manipulation of these characteristics and thus determine their importance for parasite persistence and pathogenicity. In addition to the substantial number of genes lacking homologues in other eukaryotes, the T. cruzi genome also contains an unprecedented number of gene families, in some cases families with thousands of members (1 – 3). Among the largest of these gene families are those encoding trans-sialdase-like proteins, mucins, and mucin-associated proteins that are expressed on the parasite surface and thus directly interact with insect and animal hosts—including interactions as immunological targets. Although methods to express exogenous genes or overexpress endogenous genes and to delete genes in T. cruzi have proven useful, these methods are laborious and time-consuming. For example, current gene knockout (KO) strategies utilize spontaneous homologous recombination of a DNA cassette containing a drug selection marker generally flanked by ~500 bp of coding sequence (CDS) or untranslated regions (UTRs) of the target gene. In addition to the fact that homologous recombination in T. cruzi has a very low efficiency, this approach is limited to a single-allele KO per drug selection marker (4), and the drug selection process is slow, requiring at least 1 month per allele. Collectively, the success rate for generating null mutants in T. cruzi is low, and the limited number of drug-selectable markers restricts the number of manipulations that can be attempted in a single organism. These constraints, in combination with the absence of a functional RNA interference (RNAi) system in T. cruzi, make virtually unapproachable the manipulation of multigene families and the determination of how gene family sizes are generated, maintained, and contribute to parasite success in T. cruzi. A system with RNA-guided nucleases utilizing clustered, regularly interspaced, short palindromic repeats, the CRISPR-associated (CRISPR-Cas) nuclease system, has enabled rapid, targeted modification of a wide range of genomes (5). The system has proven especially useful because of its relative ease and high efficiency, as well as the ability to achieve multiple modifications in a single organism/cell (6). The specificity and targeted genome editing by CRISPR-Cas9 is achieved by a guide RNA that directs the Cas9 protein to genome locations by RNA-DNA hybridization, introducing a double-stranded break (DSB). In most species, the repair of the DSBs occurs by a nonhomologous end-joining (NHEJ) pathway, creating insertions or deletions (indels) or, if in the presence of an appropriate DNA template, by homologous recombination. Here we report the use of the CRISPR-Cas9 system in T. cruzi to knock out target genes and to enhance gene insertion by homologous recombination. Gene disruption is highly efficient, with up to 70% of the population exhibiting a mutant phenotype, and rapid, with decreased protein levels evident as early as 2 days after transfection. Because of these qualities, observation of the impact of disruption of essential genes was possible, with an efficiency rivaling that of RNAi. In the absence of a template, repair of the Cas9-induced DSBs in T. cruzi occurs exclusively by microhomology-mediated end joining (MMEJ) with various-sized deletions, depending on the locations of the homologous regions. The latter finding confirms the apparent absence of NHEJ and the dominance of MMEJ repair mechanisms in kinetoplastids (7, 8). Finally, we provide proof of concept that the CRISPR-Cas9 system can be multiplexed to knock out multiple genes in a large (>50-member) gene family, with no apparent off-target mutations. These results establish a powerful new tool for genome manipulation in T. cruzi and open the door to greater understanding of the roles of essential genes and large gene families in the biology of this human pathogen and its interactions with its animal hosts. RESULTS High-frequency Cas9-sgRNA-mediated gene disruption in T. cruzi. To determine the ability of single guide RNA (sgRNA) of Cas9 to disrupt genes in T. cruzi, we first stably expressed both enhanced green fluorescent protein (eGFP) and Cas9 in T. cruzi by using separate pTrex backbone plasmids (9) under G418 and blasticidin drug selection, respectively (Fig. 1A). Transfection of epimastigotes of T. cruzi with sgRNA, which was previously shown to mediate eGFP disruption in human cell lines (10), resulted in rapid and highly efficient reduction in GFP expression. Each of the three sgRNAs induced loss of GFP in ~50 to 60% of parasites as early as day 2 after transfection (Fig. 1B), No reduction in eGFP expression was observed in epimastigotes transfected with 80-bp human 18S rRNA as a control. GFP-targeted sgRNAs were also very efficient at disrupting gene expression when electroporated into trypomastigotes of T. cruzi, with Vero cells infected with recently transfected trypomastigotes showing a mixture of GFP-positive and GFP-negative parasites 5 days after transfection/infection (Fig. 1D). FIG 1  Cas9-mediated eGFP disruption in T. cruzi epimastigotes and trypomastigotes. (A) Design of constructs for stable expression of eGFP and nucleus-localized Cas9 in T. cruzi. (B) Flow cytometric analysis results for T. cruzi eGFP- and Cas9-expressing epimastigotes transfected with eGFP sgRNA. Disruption of eGFP was evident as early as 2 days posttransfection (dpt), and progressive loss of the GFP signal was observed over time. (C) ELISA analysis results for Cas9 expression in GFP-positive (eGFP-intact parasites [sequence confirmed]) and GFP-negative (Cas9-induced KO) parasites sorted following eGFP disruption. Expression levels of Cas9 were normalized to α-tubulin expression in corresponding samples. (D) eGFP- and Cas9-expressing T. cruzi trypomastigotes transfected with eGFP sgRNA or control RNA and then used to infect Vero cells and imaged 5 days later. Comparison of 4′,6-diamidino-2-phenylindole (DAPI)-stained nuclei and kinetoplasts with GFP fluorescence demonstrated a mixture of GFP-expressing and nonexpressing parasites in the eGFP-targeting sgRNA-transfected group and uniform GFP expression in parasites transfected with control RNA. Although the Cas9-mediated mutation of GFP was highly efficient, 40% or more of the population of parasites transfected with sgRNA showed no change in GFP expression levels. Simultaneous (see Fig. S1 in the supplemental material) or serial (see Fig. S2 in the supplemental material) transfection with multiple GFP-directed guides only modestly increased the frequency of eGFP mutations above that from a single guide. Additionally, increasing the concentration of sgRNA to >10 µg/107 parasites failed to impact the frequency of eGFP mutants (see Fig. S3 in the supplemental material). To determine if this “resistance” to Cas9-mediated mutation might be linked to Cas9 protein levels, we used fluorescence-activated cell sorting to analyze the GFP-positive and GFP-negative parasites following transfection with the eGFP sgRNA, and we measured Cas9 levels in an enzyme-linked immunosorbent assay (ELISA). On average, the GFP-positive parasites had significantly lower levels of Cas9 protein than parasites in which GFP was disrupted by sgRNA transfection (Fig. 1C), suggesting that the less-than-100% efficiency of gene disruption in this system is due to low and variable levels of Cas9 expression. sgRNA-guided Cas9 mutation of endogenous genes. In order to validate the use of CRISPR-Cas9 to mutate endogenous genes, we designed sgRNA targeting a number of T. cruzi genes by using a custom sgRNA design tool that selects sgRNA based in part on the absence of predicted off-targets (available at http://grna.ctegd.uga.edu). Transfection of T. cruzi epimastigotes or trypomastigotes with sgRNA targeting the multicopy α-tubulin genes resulted in parasites with misshapen and enlarged cell bodies and multiple flagella (Fig. 2A and B). Similar defects in cytokinesis and cell shape were previously reported following RNAi-mediated knockdown of α-tubulin in Trypanosoma brucei (11). FIG 2  Disruption of endogenous T. cruzi genes by Cas9-mediated mutation. (A) 4′,6-Diamidino-2-phenylindole-stained Cas9-expressing T. cruzi trypomastigotes were transfected with α-tubulin-targeting sgRNA, used to infect Vero cells, and imaged 4 days later. Note the enlarged intracellular amastigote with multiple nuclei (arrow). (B) Swollen and multiflagellated Cas9-expressing T. cruzi epimastigote transfected with α-tubulin-targeting sgRNA. (C) HAL activity determined by the rate of urocanic acid formation (measured as the optical density at 277 nm) in epimastigote lysates 4 days posttransfection of HAL gene-targeting sgRNA or control (Ctrl) RNA. (Left) HAL activity of the transfected population; (right) HAL activity of individual clonal lines. Epimastigotes transfected with the HAL sgRNA exhibited a 60% decrease in HAL activity at day 4 posttransfection compared to parasites transfected with the control 18s RNA. Three of the four clones tested exhibited no HAL activity. (D) BODIPY-labeled fatty acid analogue uptake by epimastigotes at days 8 and 15 posttransfection with FATP (fatty acid transporter) gene-targeting sgRNA or control RNA. sgRNA-guided Cas9 targeting of FATP resulted in a 37% decrease in the fatty acid uptake rate at day 8, but at 2 weeks posttransfection, near-normal FA uptake was observed, suggesting the loss of the FATP mutant population and survival of only the nonmutated WT population. To better estimate the efficiency of endogenous gene knockout using sgRNA-guided Cas9, we performed transfection of sgRNA targeting single-locus genes encoding histidine ammonia lyase (HAL), an enzyme in the histidine metabolism pathway whose enzymatic activity can be easily quantified, and the putative fatty acid transporter (FATP) gene, whose protein actively can be monitored by uptake of BODIPY-labeled fatty acids. Epimastigotes transfected with the HAL sgRNA exhibited a 60% decrease in HAL activity at day 4 posttransfection compared to parasites transfected with the control 18s RNA (Fig. 2C). The epimastigotes were cloned by limiting dilution and assayed for HAL activity. Of the four clones tested, three exhibited no HAL activity, suggesting KO of both HAL alleles, and one (B6) demonstrated HAL activity similar to epimastigotes transfected with control 18s RNA. sgRNA-guided Cas9 targeting of FATP resulted in a 37% decrease in the fatty acid uptake rate (Fig. 2D). Our previous attempts to generate null mutants in FATP by conventional knockout strategies failed (4), indicating that the null mutation of FATP in T. cruzi is probably lethal. Indeed, examination of FA import activity in FATP-sgRNA parasites at 2 weeks posttransfection showed a near-normal FA uptake rate, suggesting the loss of the FATP mutant population and survival of only the nonmutated wild-type (WT) population. Thus, the high efficiency of the CRISPR-Cas9 system in T. cruzi allows for the study of loss of function over time due to the disruption of essential genes. MMEJ-mediated repair of CRISPR-Cas9-induced DSBs in T. cruzi. Double-stranded DNA breaks induced by guided nucleases such as Cas9 are generally repaired in one of two ways: by error-prone NHEJ, resulting in indels of various sizes, or by homology-directed repair, which allows precise editing, from point mutations to large indels, depending on the available template. Sequencing of the eGFP gene from eGFP-negative clones produced by eGFP sequence-guided Cas9 DSBs showed a consistent 33-bp deletion at the sgRNA targeting site (Fig. 3). Although the deletion junctions occurred at slightly different positions, they all fell between a pair of homologous sequences of 10 bp flanking the cut site (Fig. 3, red highlight). This pattern is consistent with MMEJ pathway repair of DSBs in T. cruzi. Sequencing of the GFP gene from clones of the eGFP sgRNA-transfected population that remained GFP positive (Fig. 3) showed an intact GFP sequence, again consistent with insufficient Cas9-mediated DSBs in some parasites (data not shown). FIG 3  Sequencing of the eGFP gene in GFP-disrupted clones sorted from parasite populations transfected with eGFP-targeting sgRNA 3 (top) and sgRNA 1 (bottom). Underlined is the sgRNA targeting sequence, the PAM is boxed (on the reverse strand), red marks show microhomology sequences flanking the sgRNA targeting sequence, and double-stranded cut sites are indicated with blue arrows. The sequence of negative clone 1 in the sgRNA-1 set (bottom) shows a single-base deletion in this region, likely due to a spontaneous mutation in GFP. All other sequences showed a 33-bp deletion; although deletion junctions occurred at slightly different positions, they all fell between a pair of homologous sequences of 10 bp flanking the cut site, as predicted by repair via an MMEJ pathway. Cas9-facilitated homologous recombination. Template-mediated repair of sgRNA-guided Cas9 cuts has been used to facilitate homology-directed repair (HDR) (12 – 16). In the presence of template DNA with sufficient homologous flanking sequences, homologous recombination can be induced in T. cruzi and has been extensively used for deletion of specific genes (4). However, this process appears to have very low efficiency and requires ~30 days of drug selection to obtain stable recombinants. To determine if sgRNA-guided Cas9 cuts could be used to achieve higher rates of homologous recombination in T. cruzi, we conducted a fluorescence marker swap assay. T. cruzi epimastigotes harboring an eGFP expression cassette were cotransfected with both a sgRNA targeting eGFP and a tdTomato expression cassette with 5′ and 3′ homology to the eGFP insert (Fig. 4A). As expected from the high rate of mutation observed with eGFP and other endogenous genes, the sgRNA transfection resulted in a predominant loss of eGFP fluorescence (Fig. 4B). However, the sgRNA targeting eGFP at the position from bp 100 and 152, respectively, yielded a 0.11% and 0.069% rate of fluorescence marker swap. In stark contrast, in the absence of the eGFP-targeted sgRNA (but in the presence of the tdTomato template), homologous recombination was below the level of detection by this assay. FIG 4  Homologous recombination-mediated replacement of the eGFP gene with a tdTomato gene facilitated by Cas9-induced DSBs in eGFP. (A) Schematic diagram of the fluorescence marker swap assay design. T. cruzi epimastigotes harboring an eGFP expression cassette were cotransfected with both a sgRNA targeting eGFP at position bp 100 or 152  and a tdTomato expression cassette with 5′ and 3′ homologies to the eGFP insert. (B) Flow cytometric analysis of tdTomato-eGFP fluorescence marker swap performed in Cas9-expressing epimastigotes 5 days after transfection with the indicated eGFP-targeting sgRNAs. Numbers indicate percentages of cells in each quadrant. The sgRNA targeting eGFP at position bp 100 and 152 , respectively, yielded a 0.11% and 0.069% rate of fluorescence marker swap, indicated by the loss of GFP and gain of tdTomato. In the absence of the eGFP-targeted sgRNA (but in the presence of the tdTomato template), homologous recombination was below the level of detection by this assay. Cas9 nickase (Cas9n), a mutant form of Cas9 which cuts only a single strand of the double-stranded DNA, has been successfully used in other organisms to favor gene repair by HDR over the production of mutations commonly produced by NHEJ repair of DSBs (17). However, transfection of neither a single nor double sgRNA (at eGFP positions 313 and 339) into Cas9 nickase-expressing epimastigotes of T. cruzi produced detectable replacement of eGFP with the supplied tdTomato template (see Fig. S4 and S5 in the supplemental material). Mutation of a multigene family in T. cruzi. In addition to the time required to knock out multiple alleles in T. cruzi using conventional homologous recombination with drug-selectable markers (4), the genetic manipulation of T. cruzi is also challenging because of the high proportion of genes within moderate to large families (1). The success with the apparent disruption of multiple α-tubulin genes (T. cruzi is thought to have 10 to 18 loci for α-tubulin) prompted us to test if RNA-guided Cas9 could disrupt larger gene families in T. cruzi. For this purpose, we selected the β-galactofuranosyl glycosyltransferase (β-GalGT) family of 65 annotated genes (see Table S3 in the supplemental material). Members of this gene family share an average of 93.1% nucleotide sequence homology, making it possible to target the whole gene family with as few as 3 sgRNAs (Fig. 5A). We conducted sequential transfections of the 3 guides, assessing surface β-galactosyl residues after each transfection by using a fluorescently labeled peanut agglutinin (PNA) lectin specific for Gal-β(1,3)-GalNAc. Flow cytometric analysis demonstrated progressive reduction in surface β-galactosyl residues with each delivery of an additional sgRNA (Fig. 5B). FIG 5  Knockdown of β-GalGT activity by Cas9-mediated gene family mutation. (A) sgRNA targeting strategies for the β-GalGTgene family. DNA alignment at sgRNA targeting regions are shown: highlighted in yellow are sgRNA targeting sequences. sgRNAs 1, 2, and 3 target 43, 49, and 56 out of 65 genes in the gene family, and each gene is targeted by at least one sgRNA. Complete gene identifiers, genome locations, and annotations are presented in Table S3 in the supplemental material. (B) Flow cytometric histograms of PNA-stained T. cruzi epimastigotes transfected sequentially with one, two, or three sgRNAs targeting the β-GalGT gene family (top) or treated with β-galactosidase (bottom). PNA binds specifically to β-galactosyl residues and indicates a progressive reduction in surface β-galactosyl residues with each additional sgRNA transfection. Biochemical removal of surface β-galactosyl residues using galactosidase was used as a control for the PNA staining. (C) Genome sequencing reads support novel junctions in the 3 target regions (from top): target site 1, target site 2, and target site 3. Boxed is the PAM (on the reverse strand), red shows microhomology sequences flanking the sgRNA targeting sequence, and the double-stranded cut sites are indicated with blue arrows. To further assess the genome-wide efficiency of β-GalGT mutation and to determine potential off-target mutations induced by Cas9 armed with multiple sgRNAs, we conducted whole-genome sequencing of the uncloned parasite population that had received 3 sgRNAs and compared these results to those with Cas9-expressing cells not receiving sgRNAs. For guide sites 1, 2, and 3, novel junctions indicative of gene deletions were detected in 35, 64, and 27 reads, respectively (Fig. 5C). These reads accounted for 31%, 30%, and 23% of the total reads that mapped to corresponding target regions, indicating that, collectively, 63% of the β-GalGT genes have a deletion in at least one target site. This calculation matches closely to the observed loss of surface galactose residues of approximately 58% determined by lectin staining (Fig. 5B). As with previous single-copy gene targeting by Cas9-sgRNA in T. cruzi, the mutations induced were all deletions (of 101, 14, and 162 bp for sites 1, 2, and 3, respectively) and were all associated with regions of microhomology, again supporting MMEJ as the mechanism of repair of DSBs in T. cruzi (Fig. 5C). Potential off-target regions were identified in the genome as sequences that matched to sgRNA targeting sequence with less than 6 mismatches but excluding any mismatches in the protospacer adjacent motif (PAM), since this motif is required for Cas9 DSBs (18). By this criterion, all 3 guides have a total of 2 potential off-target sites in the T. cruzi genome, and with 100× and 80× coverage in these regions, no mutations in these sites were observed. As deep sequencing read mappers tend to have low tolerance for indels, we used custom perl scripts to search unmapped reads for indels in the 2 possible off-target sites, and again we found no indels supported by >2 similar reads. Thus, we concluded that the multiple genes can be simultaneously mutated in the T. cruzi genome without production of detectable off-target mutations. Impact of Cas9 expression on T. cruzi growth. We previously observed that T. cruzi lines expressing selected exogenous proteins occasionally have altered growth kinetics. Examination of T. cruzi epimastigotes with stable Cas9 expression indicated a substantial increase in doubling time (Fig. 6A). To attempt to rescue WT growth in these Cas9-expressing lines, we designed an sgRNA targeting Cas9 and used these guides to disrupt the Cas9 gene, rapidly returning these lines to wild-type growth (Fig. 6A). Further evidence of the disruption of the Cas9 gene by Cas9-sgRNA-guided Cas9 protein was obtained by the failure of eGFP-sgRNA to alter eGFP expression in the lines transfected with the Cas9 sgRNA (Fig. 6B). Endogenous T. cruzi genes and the Cas9 gene can also be simultaneously disrupted. Cotransfection of HAL-sgRNA and Cas9-sgRNA resulted in clones devoid of HAL activity and with defective Cas9 (Fig. 6C). Thus, Cas9 can mediate disruption of its own coding gene, making it possible to perform genome modifications in T. cruzi lines expressing Cas9 and simultaneously “killing” Cas9 expression. FIG 6  Cas9 expression negatively impacts growth of T. cruzi epimastiogtes but could mediate disruption of its own coding sequence. (A) Growth curve of eGFP-labeled epimastigotes that do not express Cas9 (wt), expresses Cas9, or have had Cas9 knocked out by transfecting Cas9-targeting sgRNA. Parasites with stable Cas9 expression had a significantly greater doubling time compared to WT or Cas9-disrupted parasites. (B) Cas9 activity was abolished by 83% and 95% on day 5 and day 10 posttransfection (dpt), respectively, with Cas9-targeting sgRNA, as determined in an eGFP disruption assay, demonstrating that Cas9 could mediate disruption of its own coding sequence. (C) HAL activity determined by rate of urocanic acid formation (measured as the optical density at 277 nm [OD277]) in lysates of clonal epimastigote lines from parasites cotransfected with Cas9 gene-targeting sgRNA, HAL gene-targeting sgRNA, or control (Ctrl) RNA. Sequencing of the Cas9 gene in clone C10, which lacked HAL activity, confirmed the disruption of Cas9, thus demonstrating knockout of both the Cas9 gene and HAL gene in parallel. DISCUSSION Understanding the complexities of host-pathogen interactions is greatly facilitated by the ability to manipulate host and pathogen genomes—by gene disruption or by insertion of genes with new or enhanced functions. While manipulation of the T. cruzi genome has been possible for some time, the processes to achieve modifications are not rapid, easy, or routine. We previously reported on a multisite Gateway approach for the more facile production of constructs for gene disruption in T. cruzi (4). However, because of the low rate of homologous recombination and the relatively high resistance of T. cruzi to antibiotic selection, production of null mutants of single-copy genes using this approach requires a minimum of several months and the use of multiple antibiotic resistance genes. The limited number of available resistance genes makes knockout of more than 1 or 2 genes unmanageable by this approach. The latter limitation is a particular problem in T. cruzi, which has over 100 gene families with 4 or more members and several families that contain hundreds of genes. And, unlike its closest genetic relatives, the African trypanosomes, T. cruzi lacks the machinery for inhibitory RNAs (19, 20), making suppression of gene function by RNAi infeasible. The CRISPR-Cas system has rapidly transformed the speed and ease of gene manipulation for multiple species (5). By adapting CRISPR-Cas9 for use in T. cruzi, we were able to quickly and efficiently disrupt endogenous single-copy and multicopy genes, as well as exogenous genes. Because of the high rate of gene mutation when using CRISPR-Cas9 in T. cruzi—routinely 60 to 70% double-/multiallelic mutations—the impact of gene disruption can be observed within days when appropriate assays are available (e.g., fluorescence for GFP, enzyme activity for HAL, and fatty acid uptake for FATP) instead of months, as in the case of conventional knockouts. For genes lacking assays that can be applied to a parasite population, the principal limiting factor with CRISPR-Cas-mediated mutation is the time required to generate sufficient numbers of parasites from clones in order to confirm the mutations/phenotypes. The high efficiency of CRISPR-Cas-induced mutations in T. cruzi also means that null mutants in essential genes can be generated and monitored over time as protein activity is lost. Our previous studies suggested that genes involved in fatty acid uptake and β-oxidation (4) are essential in T. cruzi. We found further support for that conclusion here with the observation that targeting FATP for mutation results in a population of parasites with decreased FA uptake soon after transfection and a return to normal FA uptake by 2 weeks posttransfection, presumably due to the death of the null mutants in the population. We also found that CRISPR-Cas9 could greatly facilitate HR between a supplied template and specific locations in the genome. By introducing a DSB via RNA-guided Cas9, we were able to replace a genomic eGFP sequence with a larger tdTomato sequence at a frequency several orders of magnitude greater than in the absence of the DSB. This increased frequency makes feasible a number of additional approaches to manipulation of T. cruzi, including the tagging of genes in their endogenous loci and rapid isolation of gene replacement mutants by flow sorting based on a knock-in of a fluorescent protein. Although in the presence of an appropriate template, HR is observed at a detectable frequency following the introduction of RNA-guided DSBs, mutations resulting from error-prone end joining appear to be the preferred mechanism of repairing these DSBs in T. cruzi. For multiple analyzed mutations, we found strong evidence for MMEJ as the mechanism of repair of DSBs in T. cruzi. MMEJ has been considered a “backup” pathway for DSB repair in most species but appears to be the primary mechanism in trypanosomes, in which NHEJ is absent (8). MMEJ generally uses 5- to 20-bp regions of microhomology to repair DSBs, in the process leaving deletions between the microhomology regions (21). As such, the deletion size should be predictable, once the specific rules for MMEJ are defined (e.g., the relative contribution of microhomology length and distance from the cut site to the repair), and these data can be employed to more efficiently design sgRNAs (22). There is also increasing appreciation for the role of MMEJ in DSB repair in species where NHEJ dominates (23) and emerging information on the putative components of the MMEJ repair machinery (23, 24). Because NHEJ is naturally absent in T. cruzi and other kinetoplastids, these organisms should be especially useful for the further dissection of MMEJ mechanisms. Additionally, knowledge of the components uniquely involved in MMEJ could provide insights into how to minimize this error-prone repair pathway and potentially enhance HR, further optimizing in situ genome editing in T. cruzi. The potential for off-target sequence disruption is always a concern when using genome editing tools, including CRISPR-Cas (25). However, because of the compactness and low complexity of the T. cruzi genome, and with the aid of the sgRNA finder program we developed for T. cruzi, we were able to select highly gene-specific sgRNAs with low sequence identity ( 20), large (>50), and very large (>500) gene families, and among these are ones encoding the thousands of mucins, mucin-associated proteins, and trans-sialdase-like proteins that form a large part of the interface between the parasite and mammalian hosts. Modest expansion of gene families in some organisms has been linked to the potential to succeed in variable environments (29). However, the size of the trans-sialidase gene family, its variability in composition among different parasite isolates, and its targeting by the host immune responses all argue that the family may have expanded from the few copies identified in other kinetoplastids to its current size in T. cruzi in part as an immune evasion mechanism. Testing of this hypothesis has not previously been possible, due to the lack of functional RNAi or another knockdown/knockout system capable of regulating the expression of hundreds of genes. The demonstration here of the ability to knock down a gene family of 65 members may pave the way for studying these much larger gene families of T. cruzi. CRISPR-Cas has revolutionized genome editing in multiple species, and we have shown here the similar promise for use in the kinetoplastid parasite T. cruzi. As already noted, the exclusive dependence on MMEJ for DSB repair and the enormous multiplexing capabilities are observations unique to the CRISPR-Cas system for T. cruzi at the current time. Cas9 expression in T. cruzi does come at the price of decreased growth potential, a consequence also noted in Saccharomyces cerevisiae when Cas9 was highly expressed (30), presumably due to Cas9’s ability to bind to DNA at PAMs without sgRNA. But this effect was reversible upon mutation of the Cas9 gene (using the CRISPR-Cas system itself), providing the potential to simultaneously mutate endogenous T. cruzi genes and Cas9 by using a mixture of sgRNAs. Hopefully, this study is only the beginning of the exploitation of the CRISPR-Cas system in kinetoplastids. MATERIALS AND METHODS Growth, transfection, and cloning of T. cruzi. Epimastigotes of the CL strain of T. cruzi were cultured at 26°C in supplemented liver digested-neutralized tryptose (LDNT) medium as described previously (4). Unless otherwise indicated, 5 × 106 early-log-phase epimastigotes or recently egressed trypomastigotes were resuspended in 100 µl room temperature human T cell Nucleofector solution (Amaxa AG, Cologne, Germany) and 20 µg sgRNA in a total volume of 15 µl and electroporated using the program U-33 in an Amaxa Nucleofector device. For sequential transfections, parasites were allowed 5 days of recovery time between transfections. For tests of homologous recombination, an additional 10 µg of template DNA was added. The electroporated parasites were cultured in 25-cm2 cell culture flasks (Corning Inc., Lowell, MA) with 10 ml LDNT medium. To generate T. cruzi lines stably expressing eGFP and Cas9, 10 µg linearized pTrex-n-eGFP-Neo plasmid was transfected into epimastigotes by using the protocol described above. A total of 250 mg/ml G418 was added at 24 h posttransfection, and the drug concentration was maintained for 4 weeks (at which point parasites transfected with no DNA were no longer viable), eGFP-positive parasites were then sorted by using a MoFlow cell sorter (Dako-Cytomation, Denmark). Sorted eGFP-positive parasites were transfected with pTrex-b-NLS-hSpCas9, 25 µg/ml blasticidin was added 24 h posttransfection, and the drug concentration was maintained for 4 weeks. The doubling time of epimastigotes was calculated by fitting an exponential curve to density data from days 1 to 14 of culture by using least squares fitting on the Doubling Time website. Plasmid construction. The T. cruzi pTrex-n-eGFP and pTrex-b-NLS-hSpCas9 plasmids were constructed by subcloning the coding sequence of hSpCas9 from pX330 (26) or eGFP (GenBank accession number JQ693016.1; bp 633 to 1352), respectively, into multiple cloning sites of the pTrex plasmid (9) containing a neomycin phosphotransferase gene (pTrex-n) or blasticidin-S deaminase gene (pTrex-b). sgRNA preparation. sgRNA targeting sequences were designed using a custom sgRNA design tool (available at https://grna.ctegd.uga.edu) that (i) identifies all potential 20-bp sequences containing an NGG PAM site within the query sequence, (ii) predicts all potential off-target sites for each sgRNA, including those with 5 or fewer mismatches to the sgRNA, (iii) indicates the microhomology pairs flanking the sequences targeted by the identified sgRNA, and (iv) predicts targeting efficiency by using a position-specific nucleotide composition scoring matrix (31). A list of ranked sgRNA targeting sequences is returned based on minimal off-targets and minimal flanking distance of microhomology pairs and maximum length of microhomology sequence. For guide design, sgRNAs that are severely self-complementary, potentially preventing hybridization with target DNA, are eliminated by RNA secondary structure predictions obtained at the website http://rna.tbi.univie.ac.at/cgi-bin/RNAfold.cgi . sgRNAs were in vitro transcribed by using the MEGAshortscript T7 kit (Ambion, Life Technologies) according to the manufacturer’s instructions. DNA templates for sgRNA in vitro transcription were generated by using PCR to amplify sgRNA scaffold sequence from plasmid pX330 using 5′ primers containing T7 promoter sequence and the above-described designed 20-bp target sequence (see Tables S1 and S2 in the supplemental material). An 80-bp fragment of human 18S rRNA transcribed from pTRI-RNA 18S control template supplied with the MEGAshortscript kit (Life Technologies) was used as control RNA. Flow cytometry and fluorescence microscopy. Flow cytometric analysis was performed using a CyAn flow cytometer (Beckman Coulter), and data were collected by using the Summit v4.3 software (Beckman Coulter). For single-cell cloning, drug-selected lines were deposited into a 96-well plate at a density of 1 cell/well by using a MoFlow cell sorter (Dako-Cytomation, Denmark) and cultured in 200 µl LDNT supplemented with G418 or blasticidin. Each population from an individual well was considered an individual clone. Fluorescence microscopy was performed to determine the presence of GFP in intracellular and amastigote-stage T. cruzi posttransfection with sgRNA targeting eGFP, using a modification of the protocol described previously (32). Images were acquired with an Applied Precision Delta Vision microscope, and images were deconvolved and adjusted for contrast using the Softworx software (Applied Precision). ELISA analysis. To determine the relative abundance of Cas9 protein in epimastigotes, serial dilutions of whole-cell lysates (cells lysed by 4 freeze-thaw cycles) were assayed with anti-FLAG M2 monoclonal antibody (1:1,000) and anti-α-tubulin monoclonal antibody (1:500) as a loading standard. Histidine ammonia lyase assay. Epimastigote-stage parasites (1 × 106) were disrupted by freeze-thawing, and the lysate was incubated in 100 mM Tris-HCl (pH 9.0) and 50 mM MgCl2 buffer for 30 min at 25°C before 100 mM histidine was added. HAL activity was determined based on the rate of urocanic acid formation, which was measured based on absorbance at 277 nm after addition of histidine (33). BODIPY-labeled fatty acid uptake assay. The uptake of fatty acids by T. cruzi epimastigotes was measured using the QBT fatty acid uptake assay kit (Molecular Devices). Briefly, 1 × 107 T. cruzi epimastigotes were pelleted from LDNT medium, resuspended in 10 µl phosphate-buffered saline (PBS; pH 7.0), and then 200 µl of reconstituted QBT loading solution was added and the parasites were immediately analyzed by using a CyAn flow cytometer (Beckman Coulter). Flow cytometry data were collected continuously for 200 s. To calculate the rate of fatty acid uptake rate with Summit 4.3 (Beckman Coulter), the continuous data were first converted into discrete data by binning fluorescence intensity data into 4-s intervals and determining the mean fluorescence intensity (MFI) for each bin. Then, MFIs were plotted against the center point time stamp of each bin, and the slope of the trend line was used to calculate the uptake rate. Galactosidase treatment and PNA staining. T. cruzi epimastigotes (1 × 107) were washed twice in PBS and then incubated at 37°C for 1.5 h with 10 U of β-galactosidase (grade VIII from Escherichia coli; Sigma-Aldrich) in PBS (pH 7.3) containing 50 mM Tris-HCl, 10 mM 2-mercaptoethanol, and 10 mM MgCl2. To assess surface galactose residues, parasites were incubated with 10 µg/ml PNA-Alexa Fluor 647 conjugate (Life Technologies) in PBS at 37°C for 10 min and analyzed by using a CyAn flow cytometer (Beckman Coulter). Whole-genome sequencing. Genomic DNA was isolated from T. cruzi epimastigotes as previously described (34). The DNA samples were enzymatically sheared to a 150-bp mean fragment size by using the Ion Shear DNA fragmentation kit (Life Technologies) and ligated to bar-coded adapters by using the Ion Xpress Plus fragment library kit (Life Technologies) per the manufacturer’s instructions. Adapter-ligated DNA was size selected using the Pippen prep apparatus (Sage Biosciences) and quantified by using BioAnalyzer (Agilent) and an ion library quantitation kit (Life Technologies), and the libraries were pooled equally and used to template ion sphere particles by using the Ion PI template OT2 200 kit v2 (Life Technologies), per the manufacturer’s instructions. Templated beads were then loaded onto a P1 ion proton sequencing chip and sequenced on the Ion Proton system (Life Technologies). Sequencing reads were mapped to the T. cruzi strain CL Brener reference genome (TritrypDB version 5) by using Tmap 4.2 (Life Technologies) with nondefault parameters: a score match of 4 and a pen mismatch of 5. To assess mutations at potential off-target sites, a custom perl script was written to identify novel junctions supported by unmapped reads, briefly, all unmapped reads were first analyzed via BLAST to a reference genome using the BLASTn-short program in the suite BLAST 2/2/29+ with nondefault parameters of reward of 2, penalty of 3, and E value of 0.001. Reads that had greater than 95% overall sequence coverage (coverage gap less than 10 bp) and a best hit for each alignment segment coming from 2 or more different locations in the genome were considered reads that supported a novel junction. SUPPLEMENTAL MATERIAL Figure S1 Simultaneous transfection of two eGFP-targeting sgRNAs resulted in a modest increase of the eGFP disruption rate compared to transfection of a single eGFP-targeting sgRNA. Equal amounts of total sgRNA were used for each transfection mixture. Download Figure S1, TIF file, 0.4 MB. Figure S2 Sequential transfection of the same sgRNA resulted in a marginal increase in the frequency of eGFP disruption. Download Figure S2, TIF file, 0.4 MB. Figure S3 Impact of the quantity of transfected sgRNA on eGFP disruption rate. The bulk of eGFP disruption rate was achieved with 10 µg of sgRNA, with only marginal increases of eGFP disruption achieved by doubling or quadrupling the sgRNA concentration. Download Figure S3, TIF file, 0.4 MB. Figure S4 Flow cytometric analysis of tdTomato-eGFP fluorescence marker swap performed in Cas9-nickase-expressing epimastigotes. eGFP was targeted by a single sgRNA at bp 100 or 152. Numbers indicate percentages of cells in each quadrant. All groups were cotransfected with the tdTomato expression cassette template. Download Figure S4, TIF file, 0.6 MB. Figure S5 Flow cytometric analysis of tdTomato-eGFP fluorescence marker swap performed in Cas9-nickase-expressing epimastigotes. eGFP was targeted in a “double-nick” fashion by using a pair of closely positioned sgRNA on opposite strands, likely resulting in a double-stranded break due to the closely positioned nicks on both strands. Numbers indicate percentages of cells in each quadrant. Download Figure S5, TIF file, 0.5 MB. Table S1 List of primers used in this study. Table S1, DOCX file, 0.02 MB. Table S2 List of sgRNA targeting sequences used in this study. Table S2, DOCX file, 0.02 MB. Table S3 List of annotated β-GalGT genes targeted in this study. Table S3, DOCX file, 0.01 MB.
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            The silencing of cysteine proteases in Fasciola hepatica newly excysted juveniles using RNA interference reduces gut penetration.

            Probing protein function in parasitic flatworms is hampered by the difficulties associated with the development of transgenic approaches. Although RNA interference (RNAi) in schistosomes shows much promise, it has not been reported in other trematodes. Here, we show the successful silencing of the cysteine proteases cathepsin B and L in the infective stage of Fasciola hepatica newly excysted juveniles (NEJs). Silencing resulted in marked reductions in target transcript levels and significant diminution in the encoded proteins in the gut. RNAi of either enzyme in NEJs induced transient, abnormal locomotory phenotypes, and significantly reduced penetration of the rat intestinal wall.
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              Invasive Snails and an Emerging Infectious Disease: Results from the First National Survey on Angiostrongylus cantonensis in China

              Introduction Eosinophilic meningitis, a potentially fatal disease caused by Angiostrongylus cantonensis, is considered an emerging infectious disease in mainland China [1],[2]. The first human case of angiostrongyliasis in mainland China was reported in 1978, and a few more cases were diagnosed until the mid-1990s. Subsequently, several outbreaks have been recorded [1]. The first major angiostrongyliasis outbreak, involving 65 patients, was documented from Wenzhou in Zhejiang province in 1997 [3]. The biggest outbreak in China thus far could be attributed to a freshwater snail, i.e., Pomacea canaliculata, and took place in the capital Beijing in 2006 [4]. Of the 160 infected individuals involved in this outbreak, 100 were hospitalized [5]. This outbreak also demonstrated that angiostrongyliasis had moved beyond its traditional endemic areas located in the southeastern coastal regions of China. The parasite was first described by Chen based on worm specimens collected from pulmonary arteries of rats in Guangzhou (Canton) [6] and Dougherty proposed the name A. cantonensis in 1946 [7]. Adult A. cantonensis live in the pulmonary arteries of its definitive hosts, i.e., rodents, especially rats, which pass infective first-stage larvae (L1) in their feces. The life cycle also involves mollusks, harboring larval stages. In humans, larvae fail to mature, and hence humans and their excreta play no role in the transmission and direct dissemination of the parasite. Humans become infected by ingesting third-stage larvae (L3) in raw or undercooked intermediate host mollusks (e.g., snails and slugs) or paratenic hosts (e.g., freshwater prawns, crabs, frogs and fish) [8]–[10]. Lettuce and vegetable juice have also been identified as sources of infection when contaminated with intermediate or paratenic hosts [11],[12]. Due to the low host specificity of A. cantonensis it is difficult to control this parasite [1]. Two snail species, i.e., Achatina fulica and P. canaliculata, are believed to be closely associated with angiostrongyliasis in China. These snails were imported into mainland China in 1931 [13],[14] and 1981 [1],[15], respectively, and have rapidly extended their geographic ranges. Indeed, these two snails are now listed as invasive species by the Chinese government. In response to the recent angiostrongyliasis outbreak in Beijing that had received considerable national and international attention and mass-media coverage, the Ministry of Health (MoH) of China launched the first national survey on A. cantonensis. Here, we report the design and key findings of this survey. Moreover, predictions are made for the spatial distribution of A. cantonensis and its intermediate hosts. Finally, recommendations are offered for the prevention of angiostrongyliasis. Methods Ethics Statement The project entitled “The first national survey on Angiostrongylus cantonensis in China” has been approved by the institutional ethics committee of the National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention in Shanghai (ref. no. 2006030101). Animal experiments were carried out in adherence to institutional guidelines for animal husbandry. Design of the national survey on A. cantonensis The first national survey pertaining to A. cantonensis and its definitive and intermediate hosts in mainland China was implemented in two phases over a 1-year period, i.e., between September and November 2006, and between March and October 2007. Considering that the distribution of A. cantonensis is affected by several environmental and ecological factors, the potential distribution of the parasite was first determined. Temperature was selected as the main factor to predict the potential distribution of the parasite and two invasive snail species in China. Since revealing the distribution of both the parasite and two snail species implicated in its transmission was the main aim of this survey, the widest potential distribution of P. canaliculata, which has previously been regarded as the most important intermediate host, delineated the survey region. The potential range of P. canaliculata in China was predicted using a degree-day model based on temperature data obtained from 149 observing stations across China [16]. A grid with a spatial resolution of 40×40 km was laid over the predicted area, and approximately 5% of the grid cells were randomly selected for sample collection. In each survey grid cell, one village was randomly selected for subsequent field work. The geographic coordinates of the survey villages were recorded using a hand-held global positioning system (GPS) device (GPSmap 70; Kansas, USA). Field survey of A. cantonensis and its hosts Rats are the definitive hosts of A. cantonensis. Some insectivores also serve as suitable definitive hosts [17],[18]. Therefore, rats (e.g., Rattus norvegicus) and insectivores (Soricidae, e.g., Suncus murinus) were trapped in fields and in residents' houses. All captured animals were euthanized and dissected to determine the presence of adult A. cantonensis in their hearts and lung arteries. Freshwater snails (e.g., P. canaliculata and Bellamya aeruginosa), terrestrial snails (e.g., A. fulica) and certain terrestrial slugs were collected from the surroundings of the study villages, and from restaurants and markets in the capital town of the counties, and snail farms across the study area, and examined for the presence of A. cantonensis larvae. Up to 100 specimens of each species were collected at each study site. The intermediate hosts were artificially digested using routine procedures (incubation in a solution containing 0.2% pepsin and 0.7% hydrochloric acid at 37°C for 2 h) [19]. Additionally, for the examination of P. canaliculata, a recently developed method relying on specific lung tissue features of this species was employed [19],[20]. In brief, the lungs were separated from the snail body and opened. The nodules containing A. cantonensis larvae were then directly observed under a microscope. Paratenic hosts were also collected from markets and restaurants, and examined for L3 using an artificial digestion method. A. cantonensis larvae were identified based on distinct morphological criteria described elsewhere [21]. For quality control purpose, larvae identified as A. cantonensis from approximately 10% of the foci where A. cantonensis was found to be endemic were intragastrically injected into Sprague-Dawley (SD) rats. The animals were then maintained in the laboratory to confirm the identity of adult worms. Analysis An area was considered A. cantonensis endemic if the parasite was detected in any kind of animals captured in the field. The geographic locations of these sampling sites were linked to an existing geographic information system (GIS), using the software ArcGIS version 9.1 (ESRI, USA). Subsequently, ordinary kriging, a statistical technique for spatial prediction [22], was performed, and thus a smoothed risk map of the A. cantonensis infection prevalence in P. canaliculata was produced. Results A. cantonensis hosts and their infection status The first national survey pertaining to A. cantonensis in China was implemented in 164 counties belonging to 19 provinces. A detailed list of the surveyed locations is available from the corresponding author upon request. Various mollusks were collected, belonging to one of the three following groups: (i) freshwater snails, (ii) terrestrial snails, and (iii) terrestrial slugs. All collected specimens were deposited in the “Preservation Center for Parasite Specimens in China” (http://www.psic.cn), and further details are available from this center upon request. Overall, 11,709 P. canaliculata were screened, 6.8% of which harbored L3 of A. cantonensis. The prevalence among the other freshwater snails (a total of 7,287 specimens were examined) was only 0.05%. Of 3,549 A. fulica examined, 13.4% were infected. The infection prevalence among the 1,421 other terrestrial snail specimens was only 0.3%. Finally, 5,370 terrestrial slugs were dissected, revealing an infection prevalence of 6.5%. Hence, the endemicity of A. cantonensis in mainland China is primarily attributable to P. canaliculata, A. fulica and terrestrial slugs (Figure 1). 10.1371/journal.pntd.0000368.g001 Figure 1 Number and infection status of potential intermediate hosts of Angiostrongylus cantonensis examined during the first national survey in mainland China, 2006/2007. Of the 711 potential host animals trapped during the field surveys, 32 were found to be infected with A. cantonensis (31 R. norvegicus and one R. flavipectus; overall prevalence: 4.2%). None of the 46 insectivores (Suncus murinus) were infected. The 652 paratenic hosts collected during the survey included frogs, shrimps, crabs, toads and fish. No A. cantonensis was found in any of these animals. The prediction map of the A. cantonensis prevalence in P. canaliculata in China, using an ordinary kriging approach with a spherical model, highlighted two potential clusters with prevalences of 19–28% in Guangxi province and 28–40% in Fujian province, respectively (Figure 2). 10.1371/journal.pntd.0000368.g002 Figure 2 Predicted Angiostrongylus cantonensis prevalence within Pomacea canaliculata in mainland China, 2006/2007. The map is based on the currently available data regarding the prevalence of A. cantonensis within P. canaliculata, smoothed by ordinary kriging. The predicted prevalences were then stratified into 10 categories by the smart quantiles technique. Geographic distribution of A. cantonensis and its main hosts Figure 3 shows the current distribution of A. cantonensis at county level in China. The parasite was identified in 59 of the 164 surveyed counties (36.0%). Most of the A. cantonensis-endemic areas were defined by infections in P. canaliculata and/or A. fulica snails. Only in three counties infected rats were found, but the presence of the parasite in intermediate hosts could not be ascertained. Seven provinces in southeastern China (i.e., Hainan, Guangdong, Guangxi, Fujian, Jiangxi, Hunan, and Zhejiang) were identified as A. cantonensis endemic. 10.1371/journal.pntd.0000368.g003 Figure 3 Occurrence of Angiostrongylus cantonensis according to hosts in mainland China, 2006/2007. Each point represents a county where the national survey was implemented. All field sites are located within a region delimited by northern latitude 18°13′–34°50′ and eastern longitude 97°50′–122°07′. The results pertaining to two invasive snail species, i.e., Pomacea canaliculata and Achatina fulica, are highlighted, and the infection status of other animals was omitted whenever infected snails were found in the same places. P. canaliculata was introduced in Zhongshan city, Guangdong province in 1981 [15]. As shown in Figure 4, P. canaliculata is now well established in southern China in a band spanning northeast-southwest. A separate endemic area is located in the Sichuan basin. The snail now colonizes almost the entire Pearl River valley, the Southern River system and the Southeast River system. The snail has also been observed in mountainous areas at high elevations in Yunnan province. Moreover, P. canaliculata snails have crossed from the Pearl River valley into the Yangtze River valley, and already inhabit the southeast section of the latter. 10.1371/journal.pntd.0000368.g004 Figure 4 Distribution of Pomacea canaliculata in mainland China, 2006/2007. All field sites are located in a region delimited by the northern latitude 18°13′–34°50′ and eastern longitude 97°50′–122°07′. Also shown are the terrain and the waterways along with the point of introduction of P. canaliculata (Zhongshan city; red star). The elevation is depicted with green indicating the lowest elevation and red indicating the highest elevations. Figure 5 shows that A. fulica has a more focal distribution than P. canaliculata, although the former species had been introduced into China half a century earlier than the latter. At present, A. fulica is known to occur in the provinces of Guangdong, Hainan, and Guangxi, in the southern areas of Yunnan and Fujian provinces, and in one county of Guizhou province. Unlike P. canaliculata, A. fulica occurs only south of 25° N latitude, and does not appear to be associated with major river networks. 10.1371/journal.pntd.0000368.g005 Figure 5 Distribution of Achatina fulica in mainland China, 2006/2007. All field sites are located in a region delimited by the northern latitude 18°13′–34°50′ and eastern longitude 97°50′–122°07′. The terrain and the waterways along with the point of introduction of the terrestrial A. fulica (Xiamen; red star) are also presented in this map. The elevation is depicted with green indicating the lowest elevation and red indicating the highest elevations. Intermediate host snails on markets and in restaurants P. canaliculata snails were found on markets and/or in restaurants in 21 counties, whereas A. fulica snails were detected in three counties only. Infected P. canaliculata and A. fulica were found in nine and two counties, respectively. Additionally, two native freshwater snail species, i.e., B. aeruginosa and Cipangopaludina chinensis, were commonly found to be on sale in many markets and restaurants. C. chinensis is one of the key intermediate hosts of A. cantonensis in Taiwan and, in the current survey, infected specimens were detected in one restaurant in Fujian province. To our knowledge, this is the first report of A. cantonensis-infected C. chinensis from mainland China. On two markets in Guangdong and Guangxi provinces, infected B. aeruginosa snails were detected. Commercial snail farming Only two commercial snail farms for P. canaliculata (located in Jiangsu and Jiangxi provinces) and one for A. fulica (in Zhejiang province) were identified during this survey. None of the snails collected in these farms was infected with A. cantonensis. Discussion Eosinophilic meningitis caused by A. cantonensis is endemic in Southeast Asia, Australia, the Pacific Islands and the Caribbean. To date, more than 2,800 human cases have been reported [23]. It had been suggested that the parasite was dispersed from East Asia to other regions in two important hosts, i.e., rats (definitive host) and A. fulica (intermediate host) especially during World War II [24]. Today, the parasite is still expanding its range and the associated disease is emerging in some regions, particularly China [1], [25]–[28]. The results of the first national survey on the distribution of A. cantonensis and its hosts in China reported here indicate that there is a need for strengthening food safety inspections and food-borne disease surveillance. Long-distance trade, biological invasion and animal migration are contributing to the emergence of new diseases and the re-emergence of diseases that have previously been controlled [29]–[32]. Angiostrongyliasis in mainland China is an example of such an emerging food-borne disease. Its spread can be linked to the introduction, farming and consumption of certain snail species. Extrapolating from recent observations, the incidence of angiostrongyliasis is likely to further increase in China, although the 2006 outbreak in Beijing triggered considerable attention and a change in attitudes toward this parasitic infection not only in the medical and research community, but also the general public. The results of the national survey can be summarized as follows. First, the A. cantonensis-endemic area is very wide, covering seven southern provinces. However, not a single snail or rat infected with A. cantonensis was found in Yunnan province. This observation comes as a surprise, since the parasite was first documented in Yunnan some 20 years ago [33], and several outbreaks have occurred subsequently [34],[35], most recently in Dali (early 2008). Hence, Yunnan must clearly be considered a potentially endemic province. Second, several freshwater and terrestrial snail species were found on local markets and in restaurants, and A. cantonensis-infected P. canaliculata and A. fulica clearly destined for human consumption were recorded. This observation suggests that the transmission of A. cantonensis to humans is ongoing, and that the health education and awareness raising campaigns initiated after the 2006 outbreak in Beijing – targeting consumers, health personnel and officials alike – must be improved since they appeared to have failed yet to stop the sale and consumption of infected snails. It follows that the impact of the previous health education campaigns through mass media to change human behavior has probably been overestimated, because angiostrongyliasis outbreaks continued in Guangdong province in 2007 [36] and Yunnan province in early-2008, involving six and 41 patients, respectively. Third, culturally-routed dietary habits of certain ethnic groups increase the risk of A. cantonensis infection. For example, the consumption of raw or undercooked freshwater snails is held responsible for the early-2008 angiostrongyliasis outbreak in Dali. As a direct consequence of the booming inland tourism in China, the interest in minority dishes is growing, and ethnic dining has become popular among tourists and wealthy urban residents alike. Travelers to endemic regions with a tradition of preparing snails for human consumption should be better informed about the risks associated with certain dishes, and food inspection and hygiene regulations need to be enforced. Fourth, among the different factors facilitating the spread and transmission of A. cantonensis in China, the two invasive mollusk species P. canaliculata and A. fulica, play a central role. A range of mollusks can serve as intermediate hosts of A. cantonensis and were examined during the national survey. The prevalence of A. cantonensis infection among P. canaliculata, A. fulica and terrestrial slugs was found to govern the endemicity of this parasite in China. However, terrestrial slugs had rarely been found to be associated with human angiostrongyliasis; the only exception being their occasional use in local traditional medicine [37]–[39]. Thus, P. canaliculata and A. fulica are probably responsible for most angiostrongyliasis cases in China. Both snails not only expand their range, but also frequently go on the table for human consumption. Interestingly, P. canaliculata and A. fulica have facilitated the spread of the endemic area of A. cantonensis rather than the introduction of a new pathogen. Man-made ecological transformations and climate change are important drivers of the spread of exotic species and their establishment in new areas [29],[40],[41]. The emergence of several infectious diseases has already been attributed to the invasion of efficient vectors or hosts involved in their life cycle [42]. These two invasive snail species impact on the endemicity and transmission of A. cantonensis in at least two ways. First, the invasion of these snails facilitates the establishment of the life cycle of the parasite and thus increases the chances for an exposure of native mollusks to A. cantonensis in existing endemic areas. Previous experiments indeed documented a superior susceptibility of these snails to A. cantonensis compared to native snails [43]. Second, these invasive snails accelerate the spread of A. cantonensis since they rapidly expand their range, resulting in the local establishment of the snail and – sometimes – the parasite life cycle in previously non-endemic areas. A. fulica was recorded for the first time in mainland China in 1931 [14]. It has been suggested that eggs of A. fulica were accidentally imported from Singapore with shipments of plants, and that an initial snail population became established in Xiamen (Amoy) [13]. These terrestrial snails are nocturnal and become active under high-humidity conditions [44]. The snails feed on plants and deposit their eggs in the soil nearby. This behavior facilitates their dispersal through long-distance transportation of pot plants [13]. Since their unintentional introduction, A. fulica spreads across southern China, probably facilitated by the rapid expansion of long-distance trade and an increasing demand for farmed plants going hand-in-hand with China's ongoing economic development. It has even been speculated that A. fulica invaded China more than once. For example, the snail populations in Yunnan province might derive from trade with Indochina (Mekong basin) rather than eastern China [45]. The public health significance of A. fulica in mainland China was only noted when a parasitologically-confirmed case of angiostrongyliasis found in 1984 could be linked to this snail [46]. However, the consumption of A. fulica snails is generally less popular than that of P. canaliculata in mainland China. The freshwater snail P. canaliculata was deliberately introduced into China for human consumption. The invasion process can be stratified into three stages, i.e., (i) introduction, (ii) establishment, and (iii) spread [47]. It was first imported into Zhongshan city in Guangdong province approximately 30 years ago [1]. Subsequently, the snail was farmed in most southern provinces with commercial aims [15]. However, within a few years, the snail also became established outside due to abandoning of farms and deliberate release [15]. Currently, the snails have reached 30° N latitude and had been found as high as 1,960 m above sea level in Yunnan province. It is conceivable that the dense river networks in eastern and southern China contributed to the dispersal of this snail. The isolated snail population in the Sichuan basin has expanded freely in this area for about 20 years. The easternmost natural colonies were observed in Zhoushan in Zhejiang province, suggesting a line from Zhoushan to the Sichuan basin south of which climate conditions are suitable for the snails to thrive. This line might move further northward as a consequence of global warming [48]. The public health significance of P. canaliculata was emphasized by the first major angiostrongyliasis outbreak in Wenzhou in 1997 [3]. The results of the national survey presented here suggest a close relationship between the endemicity of A. cantonensis and the area where P. canaliculata breed two or even three generations per year [16], suggesting that A. cantonensis largely depends on this freshwater snail for its expansion in China. Although P. canaliculata in the whole endemic area of A. cantonensis were found to be infected, point prevalences of infection are heterogeneous: two heavily endemic areas could be identified in the provinces of Fujian and Guangxi, respectively. The snail is indeed responsible for many sporadic cases recorded throughout Fujian province. However, it remains to be investigated why no angiostrongyliasis cases have been observed thus far in Guangxi province. Although both A. fulica and P. canaliculata appear to have contributed to the emergence of angiostrongyliasis in China, several characteristics of P. canaliculata suggest that this species is mainly responsible for the spread of A. cantonensis. This claim is supported as follows. First, the aquatic P. canaliculata probably spread along waterways, accelerated through flooding events. This might partly explain why P. canaliculata more rapidly expanded its range than A. fulica, which appears to largely depend on human-facilitated transport. Second, the area colonized by P. canaliculata also expands far beyond that of A. fulica despite a considerably longer presence of the latter in China. Third, the consumption of P. canaliculata is more popular than that of A. fulica. During the national survey, for example, P. canaliculata was on sale in 21 counties, while A. fulica was only noted in three counties. The national survey shed light on different important aspects regarding the distribution of A. cantonensis and its hosts in China. The results indicate a need for more pointed attention to this emerging threat through awareness-raising campaigns among the medical community, the establishment of a hospital-based sentinel surveillance system, improved community-based health education and strengthening of food safety inspection. A number of pressing research questions could also be identified. For example, the model for predicting the prevalence of A. cantonensis within P. canaliculata identified two high-prevalence clusters. However, the accuracy of this prediction has not been assessed since no ground truthing of the predictions has been made thus far. The small-scale distribution, the range of hosts and the host-parasite compatibility should also be investigated to deepen our understanding of the transmission dynamics. In conclusion, the first national survey revealed the distribution of A. cantonensis and two invasive snail species, i.e., P. canaliculata and A. fulica, and the pivotal role of these invasive snails for the transmission of this parasite. The results of the survey also suggest that people are at risk of angiostrongyliasis through consumption of raw or undercooked snails infected with A. cantonensis that are found in many markets and restaurants. Continued health education, rigorous food inspection, and hospital-based surveillance are needed to prevent recurrent angiostrongyliasis outbreaks in China.
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                Author and article information

                Journal
                Parasite
                Parasite
                parasite
                Parasite
                EDP Sciences
                1252-607X
                1776-1042
                2015
                18 December 2015
                : 22
                : ( publisher-idID: parasite/2015/01 )
                Affiliations
                [1 ] School of Life Sciences, Xiamen University Fujian 361102 P.R. China
                [2 ] State Key Laboratory of Cellular Stress Biology, Xiamen University Fujian 361102 P.R. China
                [3 ] Medical College, Xiamen University Fujian 361102 P.R. China
                Author notes
                [* ]Corresponding author: dmluo@ 123456xmu.edu.cn
                Article
                parasite150074 10.1051/parasite/2015037
                10.1051/parasite/2015037
                4684300
                26682577
                © Y. Long et al., published by EDP Sciences, 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 5, Tables: 0, Equations: 0, References: 39, Pages: 11
                Funding
                Funded by: the National Nature Science Foundation of China
                Award ID: 81171595
                Categories
                Research Article

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