Melarsoprol Sensitivity Profile of Trypanosoma brucei gambiense Isolates from Cured and Relapsed Sleeping Sickness Patients from the Democratic Republic of the Congo

Abstract

Sleeping sickness caused by Trypanosoma brucei (T.b.) gambiense constitutes a serious health problem in sub-Sahara Africa. In some foci, alarmingly high relapse rates were observed in patients treated with melarsoprol, which used to be the first line treatment for patients in the neurological disease stage. Particularly problematic was the situation in Mbuji-Mayi, East Kasai Province in the Democratic Republic of the Congo with a 57% relapse rate compared to a 5% relapse rate in Masi-Manimba, Bandundu Province. The present study aimed at investigating the mechanisms underlying the high relapse rate in Mbuji-Mayi using an extended collection of recently isolated T.b. gambiense strains from Mbuji-Mayi and from Masi-Manimba. Forty five T.b. gambiense strains were used. Forty one were isolated from patients that were cured or relapsed after melarsoprol treatment in Mbuji-Mayi. In vivo drug sensitivity tests provide evidence of reduced melarsoprol sensitivity in these strains. This reduced melarsoprol sensitivity was not attributable to mutations in TbAT1. However, in all these strains, irrespective of the patient treatment outcome, the two aquaglyceroporin (AQP) 2 and 3 genes are replaced by chimeric AQP2/3 genes that may be associated with resistance to pentamidine and melarsoprol. The 4 T.b. gambiense strains isolated in Masi-Manimba contain both wild-type AQP2 and a different chimeric AQP2/3. These findings suggest that the reduced in vivo melarsoprol sensitivity of the Mbuji-Mayi strains and the high relapse rates in that sleeping sickness focus are caused by mutations in the AQP2/AQP3 locus and not by mutations in TbAT1. We conclude that mutations in the TbAQP2/3 locus of the local T.b. gambiense strains may explain the high melarsoprol relapse rates in the Mbuji-Mayi focus but other factors must also be involved in the treatment outcome of individual patients. Sleeping sickness, or human African trypanosomosis, constitutes a serious health problem in sub-Sahara Africa. Treatment is a key factor in the control of this disease, not only to save the lives of the individual patients but also to stop transmission. As for other infectious diseases, drug resistance forms a constant threat for sleeping sickness control. Understanding the mechanisms underlying drug resistance is of uppermost importance for evidence-based adaptation of treatment protocols as well as for the development of new drugs. In this study we investigated the phenotype and genotype of more than 40 recently isolated strains of Trypanosoma brucei gambiense, the parasite that causes sleeping sickness in West and Central Africa. By comparing the parasites from cured and from relapsing patients in two separated sleeping sickness foci, we can explain the difference in treatment failure rates between these two sleeping sickness foci in D.R. Congo. We also provide evidence that treatment outcome in the individual patient is not exclusively defined by the drug resistance genotype of the infecting parasite but that other factors must be involved.