Beruflich Dokumente
Kultur Dokumente
Review
Modes of Action of Anthelmintic Drugs
R.J. MARTIN
Depa,/men/ o/ l',e,li,i,al Vete,'i,m,y .Sciences. R. CDOS.V.S., Su,n,,,e,hall. University' of Edinbu,gh, Edinburgh Etq9 I QH, UK
SUMMARY
Modes of action of anthelmintic drugs are described. Some anthelmintic drugs act rapidly and selectively
on neuronmscular transmission of nematodes. Levamisole, pyrantel and morantel are agonists at nicotinic
acetylcholine receptors of nematode muscle and cause spastic paralysis. Dichlorvos and haloxon are
organophosphorus cholinesterase antagonists. Piperazine is a GABA (T-amino-bu~ric acid) agonist at
receptors on nematode muscles and causes flaccid paralysis. The avermectins increase the opening of
glutanmte-gated chh)ride (GltlC1) channels and produce paralysis of phmTngeal pumping. Praziquantel
has a selective efl'ect on the tegument of trematodes and increases permeability of calcium. Other
anthehnintics have a biochemical mode of action. The benzimidazole drugs bind selectively to ~-tubulin
of nematodes, cestodes and fluke, and inhibit nficrotubule formation. The salicylanilides: rafoxanide,
oxych)zanide, brotianide and closantel and the substituted phenol, nitroxynil, are proton ionophores.
Clorsuhm is a selective antagonist of fluke phosphoglycerate kinase and mutase. Diethylcarbamazine
blocks host, and possibly parasite, enzymes involved in arachidonic acid metabolism, and enhances the
innate, nonspecific immune system.
Kx-~WOnl)S: Mode of action; anthehnintics; levamisole; dichlorvos; piperazine; avermectins; praziquantel;
benzimidazoles; salicylanilides; clorsulon; diethylcarbamazine.
INTRODUCTION
Parasitic nematodes affect animals and man causing considerable suffering and poor growth.
Effective anthehnintic drugs, used to treat and
control these infestations, must have selective
toxic effects on these parasites. Unfortunately
with the increased use of these compounds,
anthelmintic resistance has appeared and
increased in fl-equency (Prichard, 1994). If resistance to a particular anthehnintic has occurred, it
is likely that another anthelmintic with the same
mode of action will also be ineffective although
other anthehnintics with another mode of action,
may still be effective. Clearly then, it is important
to have an understanding of the mode of action of
anthehnintics in order to inform the selection of
effective therapeutic agents. This rexqew describes
modes of action of anthelmintic drugs (Table I).
1(190-0233/t)7/04(1011-24/S 12.00/0
NICOTINIC AGONISTS
12
Table I.
Summary table o f the m o d e s o f action o f anthelmintic drugs
Iqxam/de,~
Icvanlisole
Illllanlisolt'
pVlatltel
ii1( ii+~lll tcl
I)cphcnhlili
lht'llillni
,1 ,w,me
(".
Nilverm
Slyqllill
Stl(ingid
P;u'alct'l
( :anlll)ar
nlcthvridinc
Acetylcholinesterase inhibitors
11;llOXOll
Mulitwttrma
dichhwvos
GABA agonist
pipura/hic
End.rid.
GiuCI potentiators
ivt'l+lllt'Clill
al)alllcclill
d~WalllCClill
[V(IIIR'C
l)t~('tOlll;tX
( :v(It'ctill
inoxidcciin
niill)cinvcin l)
praziqu,in tel
l)l~mcit
thial)cnda]<dc
Thibcnz.lc
Equibcn, N~vil)cn
koditac
Valb,lzcn
Rvc<d)cn
Callli)t,lld~iztilt +
~lxil)cndaz<dc
all)cndazolc
albcndazoic sulphoxidc
I{'nl)cndazoic
tlxl{.lldazoh.
lllt'l)('llda/ilit'
Ihd)cndazole
I~'bantcl
nclol)ilnin
lhioj)hanaic
triclabcnda/olc
Proton ionophores
chls<tntcl
i-alilyanidt+
oxvch izi.illidc
I)r(>tianidc
nill~,xvnil
niclopholan
]lt'xachlorophcnt.
Pilll[I('lll"
Svstamcx
Tchniu
Fhil)vn~l
~alVVtTIII
I Icpadcx
\V< wlnal:tc, Ncmal,tx
Fasincx
Flukivcr
Flukanidc. Ranidu
Zanil
In Fhlkombin and Vermadcx
Trodax, l)ov<.'n ix
BilevolL Dist<don
(:oopaphcnc, l)ismdin
dil)rllmosalan
nich;samidc
dialnphent'lhidc
( '.ol-il)an
C](II'SII](III
In h'omec Super
dicthvlcarl)amazine
(:aricide,Filaricide
micropip-
e t t e s fl'mn Ascaris s u u m b o d y m u s c l e s h a v e s h o w n
t h a t b a t h a p p l i c a t i o n o f t e t r a m i s o l e , t h e D/l.
racemic mixture of levamisole, produces ntem-
Butamisole
CH
13
N/H
CHa
S
Pyrantel
Morantel
Oxantel
CHal
CIita
CI~:,
%)
CHa
Thenium
CH:I
Methyridine
0 - - CH 2 - - CH,2 - -
N+
--
CH._,
I
CHa
Bephenium
C>
Fig. 1.
CH a
O --
CH 2 --
CH 2 --
'
N +
--
CH2
CHa
/CH
2 - CH 2 - O - - CH 2
C?
C h m n i c a l structures of nicotinic a n t h c h n i n t i c s .
brahe del)olarization, an increase in spike fl'eqnency and contraction (Aceves el al., 1970).
Pvrantel and its analogues also produce depolarization, increased spike actMtv and contl-action
when applied to Ascaris muscle (Aubr)' el al., 1970)
suggesting that these compounds have a common
mode of action.
The two-microelectrode currelat-clamp and vohage-clamp teclmiques have been used to exalnine
m t t s c l e n l e m b r a n e conductance changes in Ascaris
produced by acetylcholine, levamisole, pyrantel
and morantel (Martin, 1982a; Harrow & Gration,
1985). These anthehnintics have I)een shown to
increase the meml)rane conductance and depolarize the membrane by opening non-selective cation
ion-channels that are permeable to both Na + and
K+. Simultaneous application of acetylcholine and
pyrantel showed that both agonists acted on the
same nicotinic receptors, and the relative potency
of the anthehnintics in bath application exper-
14
(c)~
(a)
t ~ ~
Dorsalnelve cord
Syncylium
eao
~'ry
Arm
Syncytium
s cord
J
200 I.tm
1 mm
(b)
Posterior
Anterior
DE3
.%
-YY Y V Y
Dorsal
nerve
Y Y
cor
Left ./
commissure
J. ~ k v
v
YY
YY
.t ,k 2~ ,k
.,
YY
YY
YY
o w
Y Y Y Y Y
7
Y
g
g
Ventral
nerve
cord
Fig. 2. Diagrams o f tile n e u r o n m s c u l a r o r g a n i z a t i o n of n e m a t o d e somatic muscle. (a) Diagram o f a s(mmlic muscle cell
showing: the c o n t r a c t i l e spindle region; tile b a l l o o n - s h a p e d bag that c o n t a i n s tile n u c l e u s a n d glycogen granules; tile a r m
which is a process o f tile muscle a n d r e a c h e s to o n e o f tile n e r v e c o r d s w h e r e i, divides into t]ngers Ihal I()lnl all
electrically-coupled c o m p l e x with the fingers o f a d j a c e n t muscle cells a n d collectiveh' is k n o w n as the svncvtitml. T h e
muscle cell possesses synaptic nicotinic acetylcholine receptors, a n d synaptic GABA r e c e p t o r s at tile svncvtial region a n d
extrasynaptic acetylcholine a n d G,MIA r e c e p t o r s over tile surface o f the muscle. (b) Diagram o f the dorsal a n d ventral
n e r v e cord showing the cell r e p r e s e n t e d in a s e g m e n t . All tile cell b o d i e s o f tile m o t o r n e t t r o n e s are c o n t a i n e d in tile
ventral n e r v e cord. Each s e g m e n t has t h r e e r i g h t - h a n d c o m m i s s u r e s a n d o n e left-hand c o m m i s s u r e . Each c o m m i s s u r e is
m a d e up o f o n e or two a x o n s or d e n d r i t e s o f tile m o t o r n e u r o n e s that pass r o u n d the body to c o n n e c t tile ventral a n d
dorsal n e r v e cord. W i t h i n each s e g m e n t t h e r e are 11 m o t o r nero-ones that are divided into seven a n a t o m i c a l types (DEI,
DE2, DE3: dorsal excitato~3.' m o t o r n e u r o n e s . DI: dorsal i n h i b i t o r y m o t o r n e u r o n e s . VI: ventral i n h i b i t o r y m o t o r n e u r o n e .
VI & V2: ventral excitatocv n t o t o r n e u r o n e s . T h e r e m a i n i n g a x o n s in the ventral nelwe cord are i n t e r s e g m e n t a l n e u r o n e s .
Tile excitatory m o t o r n e u r o n e s are c h o l i n e r g i c a n d tile i n h i b i t o r y m o t o r n e u r o n e s are GABAergic. (c) Diagrmn of a cross
section o f the body just caudal to the p h a u , ngeal muscle. It shows the relative locations of tile n e r v e cords, lateral lines, gut
a n d muscle cells.
tration of the anthelmintic. This property of producing open channel block has been established
using
single-channel
recording
techniques
(Robertson & Martin, 1993).
15
Table II
Voltage sensitivity o f dissociation constants o f o p e n channel block by the nicotinic anthelmintics
Membrane
-50 mV
-75 mV
Voltage-sensitivlty of h]~
I33 l.evamisole
2KI, l5,rantel
Kl~ Morantel
KR Oxantel
123 I.tXJ
46 IJM
37 IJ.Xl
20 I.t~l
e-fold eve D' 40 mV
12 p.xt
1 ~,xl
18.5 I.tM
7.5 law
e-fbld every 22 mV
e-fold ever), 29 mV
e-fold every 20 mV
/~ is the dissociation constant: the lower the concentration of this constant the more potent it is. At the concentration
of the KB the channel is blocked for 50% of its open time so tile response would be reduced by a half.
16
10
%
5
1 pA L
0
10
15
20 ms
(b~
1PA3~ms
............
~~
............................................ i
......
C
0
(c) Pyrantel
C
15O
10%
C
00
10
15
20 ms
Fig. 3. Patch-clamp records of silagle-channel currents activated by levamisole. The patch-clamp technique allows the
activit3' of single ion-channels in the membrane of the cell to be recorded as the channel opens and closes. Small ( l x l 0 -v-'
A) current pulses are recorded with this technique. The currents are rectangular in shape; C is the closed state and O is
the open state. (a) Histogram of open-times and records of levamisole-activated single-channel currents. Cell-attached
patches. Openings downward. Patch potential -75 mV; 10 laM levamisole in the patch pipette. Mean open time: 1.34 ms.
(b) A flickering burst demonstrating channel block produced by 30 last levamisole at -75 mV, cell-attached patch. The
comb effect of the channel current is characteristic of a drug moving into and blocking the ion-channel. (c) Histogram of
open-times and records of pyrantel-activated single-channel currents. Cell-attached patch; openings downward; patchpotential -75 mV; 0.1 I.tM micromolar pyrantel in the patch-pipette. Mean open-time: 1.09 ms. The pyrantel channel open
times are on average slightly shorter than those of levamisole.
17
Dichlo,wos
o
H
CH30\ li
I
C]
/p--o--c~-c /
CH30
C1
Haloxon
0
C1CH2CH2 0 /
CH3
Fig. 4.
(:heroical s t r u c t u r e o f d i c h l o r v o s a n d h a l o x o n .
ORGANOPHOSPORUS
INHIBITORS
CHOLINESTERASE
Dichlmvos, haloxon
Compounds like dichlorvos and haloxon are
selective organophosphorus anti-cholinesterases
(Fig. 4), and have an anthehnintic action, as well
as all insecticidal, action. Dichlorvos and haloxon
can control insect parasites, as well as hehninth
parasites. The mode of action of these compounds
is to block tile action of the parasite enzyme, acetylcholinesterase, leading to the excessive build up
of tile neurotransmitter, acetylcholine. This mode
of action also predisposes towards toxicity in the
host
animal
where
acetylcholinesterase
enzymes are also present. Because more selective
combined
anthehnintic+insecticidal
agents
(avermectins and milbemycin) are available, the
organophosphorus compounds are now used less
frequently.
The existence of cholinesterase, the enzyme
that breaks down acetylcholine, was first described
in Ascmis by Bueding (1952). The distribution of
cholinesterase was described by Lee (1962) who
used histochemical techniques. In the head
region of Ascmis, most of the enzyme activity is
associated with the contractile spindle region of
the muscle and is in the extracellular matrix. Lee
(1962) also described cholinesterase activity on
the muscle arms near their endings on the nerve
cords but not on the bag region of the muscle.
In C. elegans, three classes of acetylcholinesterase are recognized: class A, class B, and class C,
,
/ \
COOH
GABA
,A,
\ NH;?
Piperazine
2 pA
100ms
GABA AGONIST
genes:
owl,
Although acetylcholinesterase
is responsible for
the breakdown
of acehllcholine
and involvecl in
motor action in nematodes, it is also secretecl into
the external environment
in large quantities bv 4.
.s717077 and other parasitic
nematodes. The fun&on
of llle secretecl aceh~lcholinesterase
ma), be to
reduce the effects of host acetylcholine
in the
intestine, perhaps clecreasing niucosal glanclulai
secretion by the host. The original hypothesis of a
biochemical hold-fast effect (recluced acetylcholine in the host intestine blocking peristalsis of the
gut) has now been rqjectecl. The identification
of
the function of secreted cholinesterase
hy parasitic nematodes, ancl the abilitv to antagonize this
enz\me, mav lead to the increased use of anticholinesterases in the future to facilitate renio\xl
of gut nematodes.
uw2
a ~OCH'~
H3C
0...1~ ~
CHa
.-CHa
IlL o_._A
h-o j.
Abamectin
OCH.~
HO_
2-.
"~
~" " ~
0 ~
hl
OCHa
OH
"
CH
:'
CH,
Doramectin
l! o._.'o
]__I ~
OH
H I - . . ~ CH:,
OH
Milbemyein D
H3C"
"]1
OH
Moxidectin
c_Y
0
CHaR
HO.~ ~ . , .CHa
CHa
~CHa
Fig. 6.
19
~CHa
CHa
T h e avermectins (Fig. 6) are a g r o u p o f broadspectruna, macrocyclic, lactone antibiotic anthelmintics used to control n e m a t o d e parasites in
man and animals (Campbell & Benz, 1984), and
assumed to have the same m o d e o f action in both
(Shoop et al., 1995). T h e y are used to control
onchocerciasis (river blindness) in h u m a n s and
gastrointestinal, cardiac and respirato~-y n e m a t o d e
parasites o f domestic animals. T h e m o d e o f action
o f the avermectins is to selectively paralyse the
parasite by increasing muscle CI- permeability, but
the identity o f the channel targeted by the avermectins has been controversial, see Arena (1994)
for a r e c e n t review. Cloning o f a GluCl-otl and a
GIu('I-~3 subunit fi'om the model soil n e m a t o d e C
elegans, and co-expression o f the subunits in Xenopus oocytes, has led to the identification o f an
avermectin-sensitive GIuC1 ion-channel (Cully et
al., 1994). T h e effects o f avermectins, at low concentrations, are to potentiate the effect o f glutamate, and at h i g h e r concentrations, the avermectins o p e n the glutanmte-gated c h a n n e l directly.
T h e selective therapeutic effects o f the avennectins could be explained by an action o n a Glu CI-
FI LI/,q.~.fiIIBL. Z~t)le, C
20
Terminal i
bulb
:
Isthmus
Carpus
Metacarpus
---
Procarpus
:::::::::::::::::::::::
i::ii!iiiiiiii::i
i
i! i
~ p m o
::.::::.: p m 3
::
pm4
pm3
:.::::.: ~
E ~
Fig. 7. Diagram of the phalyngeal muscle of (J. eh'gan,~ showing tile location ~f the GIuC1 receptors ~m the pro4 muscle
ceils that are innervated by the m3 motor neurones. Also illustrated is the division o1 the p h a l ) n g e a l muscle into Ihe
regions: lerminal bulb: isthmus: carpus (sul)divided into metacarpus and procarpus). T h e o l h e l l l l ( l l ( } l " I l e l l l ' ( } l l e s
(Ill l, m2,
m4 ~" mS) that innervate the muscle cells (pro3, proS, pro6, pro7) are shown. The i n t e r n e u r o n e s 15 thai inhibits m3, as well as
m4, is shown. Adapted t i o m Avery (I ~).t)~:~).
Head
Pharynx
Nerve cord
Intestine
Effect of glutamate
Fig. 9 shows effects of the application of milbemycin D and glutamate oll Ascaris phal3,ngeal
muscle input conductance and membrane potential: glutamate [Fig. 9(b)] produces a transient
small hyperpolarization of 1 mV associated with
an increase in membrane conductance. The effect
of glutamate but not GABA [Fig. 9(c)] in pharyngeal AscaTis preparations is to produce a reversible
increase in input conductance associated with a
small change in membrane potential and to
r" -7iillI[llililliitlllll
Effect of milbemycin D
. . . .
---
. . . . .
llll "
- -
5 mV _ _
30s
890 nM Milbemycin
(b)
.....
:,,,ii',iiii,,.,?d.Tifflntitl'tl[lillllllllillilil
llllllIHltli!
llTiii,Nl!lI,E!ll!
l ! ilt 5mVl__
I,[!iIL!!I
tttlillhlll,Ll,li&L,ll[tl[,tlktdlt[
tilhliltttt
30 s
300 ~IMGABA
Ascam.
21
T h e effect o f ivermectin a n d m i l b e m y c i n D, on
the C. elegans avermectin-sensitive g l u t a m a t e
r e c e p t o r e x p r e s s e d in Xenopus oocytes is to prod u c e a p o t e n t i a t i o n o f g l u t a m a t e effects a n d to
p r o d u c e a slow irreversible increase in c o n d u c tance o f the m e m b r a n e (Cully et al., 1994). T h e
effects o f m i l b e m y c i n D on the i n p u t c o n d u c t a n c e
o f the Ascaris p h a r y n g e a l p r e p a r a t i o n is to prod u c e a small c h a n g e in m e m b r a n e c o n d u c t a n c e
a n d to p o t e n t i a t e the effect o f low c o n c e n t r a t i o n s
o f g l u t a m a t e [Figs. (9a), 10(a), (b), (c) a n d (d)].
T h e location o f the GIuC1 r e c e p t o r or the avermectin b i n d i n g 0t-subunit in the n e m a t o d e
r e m a i n s to be e x p l o r e d fully. R e c e n t m o l e c u l a r
biological e x p e r i m e n t s with C. elegans on an ivermectin-resistant strain (avr-15) suggest that it is a
GluCl-0t2 subunit that is p r e s e n t in the p h a r y n g e a l
muscle of C. elegans n o t the GluCl-otl (review:
Cully el al., 1996). T h e location a n d function o f
the original GluCl-cd subunit r e m a i n s to be determined. However, the p r e s e n c e o f m o r e than o n e
GluCl-ot subunit indicates the p r e s e n c e o f m o r e
than o n e site of action for the avermectins. It
implies that the a p p e a r a n c e of resistance to avermectins requires m u t a t i o n o f m o r e than o n e
gene.
In addition to effects on the p h a r y n g e a l muscle,
ivermectin also has an effect on somatic muscle
a n d o p e n s non-GABA activated channels, a n d in
addition,
inhibits
GABA-activated
channels
( H o l d e n - D y e & Walker, 1990). T h u s again it
a p p e a r s that the a v e r m e c t i n s may have m o r e than
o n e site o f action in parasitic n e m a t o d e s .
INCREASED
CALCIUM
PERMEABILITY
Praziquantel
Fig. 11 shows the c h e m i c a l su-ucture o f praziquantel. Praziquantel has a selective toxic effect
on schistosome parasites, w h e r e its m o d e o f action
has b e e n studied m o r e extensively (Andrews et al.,
1983; H a r n e t t , 1988) t h a n in cestodes. Many
actions o f p r a z i q u a n t e l may be e x p l a i n e d by an
increased Ca `'+ p e r m e a b i l i t y o f parasite muscle
a n d / o r t e g u m e n t a l m e m b r a n e s . Fig. 12 is a diag r a m o f the schistosome t e g u m e n t a n d u n d e r l y i n g
muscle that illustrates the k n o w n sites w h e r e Ca `'+
crosses into a n d b e t w e e n intracellular c o m p a r t ments, a n d t h e r e f o r e , the possible sites for praziquantel action.
'22
12f
(a)
/
100 ~-
60-
4O
2O
0.1
0.2
0.3
(b)
0.4
0.5
Milbemycin (prq)
(c)
0.6
I
0.7
0.8
0.9
(d)
5 mV
30 JaMGlut.
30 p.xl Glut.
in 30 nM Milb.
30 p.~ Glut.
in 300 nM Milb.
1 rain
Fig. 10. (;luta,mlte potentiation effects ()f milbcmvcin D. (a) ( | ) Pl()l of peak A(; produced by. 30 p_~lghmm)aw againsl
milbemvcin co,lcentnuioq: (O) plot ()f resting input conductance ()f the phalynx agains! mill)cmvcin c().ccn,alion.
Resuhs fiom the experiment illustrated in (b), (c) & (d).(b) ('ontrol 30 ~.txlglutamate vcsp()nsc, peak A(;, is small. 16 ~.tS.
(c) In the pvescace of 30 .xt milbemvcin (D) the" peak A(; produced by 30 ~Xl gltmtmatc i.cvcased t() 27 l.tS. (d) 300 nxl
milbemvcin D increased the peak A(; to 86 laS. I . this pavticttlar prel)aration the gltmlmatt" resp().se was a small
depolarizing potential, indicating that the (:l-reversal p()te.tial was slightly depolarized relative, to the' m c m b r a . c
potential.
.N
Fig. 11.
Double
Host (Blood)
membrane
Ca 2+ 5
I
'
ua
1 ,-, I
'V.,
"Na
23
"
.
_ " .
2+
,
C a 2+
-
"
"
.
"~
z,
Ca2+
"
"
- 2+
Ida
. .
- Ca2+
4
V
'
Fig. 12. Diagram of 1he s t r u c t u r e of the body wall of Schi.~losoma ma,soni showing the possible sites of action of
p r a z i q u a n t e l a n d meclaanisms of Ca'-" t r a n s p o r t into a n d o u t o t the t e g u m e n t . 1: Vohage-activated Ca +-'+ c h a n n e l . 2:
II'Jll'~lct'lhll~tl" i]lessell~el activated Ca +-'" chanllel. 3: E x t r a c e l h d a r r e c e p t o r o p e r a t e d Ca ~" c h a n n e l . 4: Non-selective cation
c h a n n e l also allowing t+ntz-v of Ca'-". 5 : N a ' / C a e+ e x c h a n g e r . 6: Ca `'+ ATPase pt, m p i n g out ( ' J * . 7: I n t r a t e g t m l e n t a l Ca e+
buffers. 8: IP:~ releasable store from the sarcol)lasmic rcticuhtm. 9: Ca*-'" i n d u c e d Ca'-" release c h a n n e l (CICR c h a n n e l ) . I0:
(;~(-'" ATPase pttmp: savcoplasmic e n d o p l a s m i c r e t i c t d u m Ca'-'- (SERCA). 11: Electrical j t m c t i o n b e t w e e n mttscle cell a n d
tegumetlt. 12: Electrical j u n c t i o n s b e t w e e n tnuscle cells. If praziqttantel acts like caffeine it would act o n site 9. 13: A
p r o t o n I)tttnp may set tq) a pH g r a d i e n t actress the t e g u m e n t a n d be r e q u i r e d for q o r m a l titnction. A p r o t o n i o n o p h o r e
wc+uld ttl)Set tiffs g r a d i e n t a n d lead to the d e m i s e c~t+the organism.
blocked by Mg '-'+, or La :~+ but not I)y Ni '-'+ Co e+ 01the calcium-channel blocker D-600 (Fetterer et al.,
1980; Wolde-Mussie et al., 1982). The application
of a high K+ solution to depolarize the schistosome preparation results in a rapid depolarization, but the application of praziquantel resultsin
a slower onset depolarization. From these observations, it may be concluded that praziquantel somehow results in an increase in Ca `-'+ permeability
across parasite m e m b r a n e s via channels that are
not activated by depolarization. These channels
must be pharmacologically different fi'om those of
the host animal or the praziquantel would affect
the host animal.
Experiments on a snail smooth muscle preparation (Gardner & Brezden, 1984) have illustrated that caffeine mimics the effect of praziquantel in producing contraction, and that prior
treatment of the muscle preparation with caffeine
24
fl-tulmlin binding
Mebendazole (Borgers et al., 1975; Van den
Bossche & De Nollin, 1973) and flubendazole
(Van den Bossche & De Nollin, 1973) induce the
loss of cytoplasmic microtubules of the tegumental and intestinal cells of cestodes and nematodes, and this is followed by loss of transport of
Formation of microtubules
The formation of mio'otubnles is a dynamic
process (Fig. 14.) Formation involves the polynmrization of tubulin at one end (the positive pole)
and the depolymerization at tile other end (the
negative pole). The microtubules that tbrm are
made up of 13 tubulin molecule rings (6 0f
tubulin+7 13-tubulin alternating with 7 0t-tubulin+6
[3-tubulin rings). Seventy-five to 85% of the mass
of microtubules is composed of the tubtdin proteins but in addition, microtubule-associated proteins (MAPs) are present stabilizing the structure.
A number of factors favour polymerization including GTP, Mg'-', and an increase in temperature (to
37C). A decrease in temperature (to 4C), the
presence of Ca `-'+or cahnodulin will favour depoly-
25
BENZIMIDAZOLES
"I
PRODRUG
NHCO2CH3
N~C
NHCO2CH3
iL
NHCOCH2OCH3
Thiabendazole:
R = H--
Cambendazole:
R = (CHa)2CHOCONH--
BENZIMIDAZOLE CARBAMATES
R
TRICLABENDAZOLE
CI
CI
'
'
.N.
[
NHCO2CH a
i
N
I
CH 3
"~
"
SCH 3
H
H
R =
(/,, - -
~'~
S--
@
@
@,
O
Oxfendazole: R =
S---
El
Mebendazole: R =
Flubendazole: R =
C m
0
S m
Fig. 13. Chemical structure of benzinfid~oles, benzimidazole carbamates, prodrug febantel and the antifluke drug
triclabendazole.
m e r i z a t i o n . Interestingly, c~- a n d [3-tubulin will
pol),merize into a n u m b e r o f s h a p e s (rings a n d
sheets) in a d d i t i o n to m i c r o t u b u l e s w h e n in vitro
p r e p a r a t i o n s are m a d e . T h e t b r m a t i o n o f microt u b u l e s m a y be i n h i b i t e d by substances that b i n d
to the l e a d i n g e d g e (the positive pole) o f p o l y m e r ization. This p r o c e s s o f i n h i b i t i o n is k n o w n as
' c a p p i n g ' , a n d c o l c h i c i n e , vinblastine, vincristine,
26
IH TI300im
200
i i
400
Hinge
Q) a-tubulin
+ ~-tubulin~
~ ( ~
~ D ~ :
13 membered
spiral made of
alternating ~and [3-tubulin
Vesicle
transport along
Negative pole.
Microtubule
breakdown
increased by fall in
temperature and Ca ++.
Positive pole.
Microtubule
formation
increased
by GTP, Mg+,
temperature
inhibited by
benzimidazoles.
Fig. 14. Diagram of the 50 kDa ~-tubulin protein. It consists of three domains that are separated by protease action. In
the middle in a 'hinge' allowing the molecule to fold. The location of the amino acids 100, 200, 300 and 400 are shown.
Below this is a diagram representing the formation of microtubules by 0t- and ~-tubulin that polymerizes by forming a 13
membered hollow spiral. Each turn of the spiral allows the 0t- and ~-tubulin to pack ahernately along the length of the
microtubule. Polymerization takes place at the positive pole where temperature and GTP Mg '' and other factors favour
microtubule formation. The formation of microtubules is inhibited by binding of benzimidazoles to ~-tubulin to produce
'Capping' and inhibition of further microtubule formation. Breakdown occurs at the negative pole. The physiological
function of the microtubules include intracellular transport via special proteins, kinesins or dynesins (here represented by
the match-stick man).
P R O T O N I O N O P H O R E S : SALICYLANILIDES
AND SUBSTITUTED PHENOLS.
27
series o f protein c o m p l e x e s on the inner mitochondrial m m n b r a n e . This process leads to protons being p u m p e d out o f the m i t o c h o n d r i a
matrix p r o d u c i n g a p r o t o n motive force that is
due to the pH gradient and t r a n s m e m b r a n e electric potential. ATP is synthesized when the protons flow back into the m i t o c h o n d r i a l matrix
t h r o u g h an enzyme complex. This process of oxidative phosphoD, lation takes place in the host animal (StD, er, 1995), as well as in the parasitic helminths (Van den Bossche, 1972; McKellar &
Kinabo, 1991).
Lipid soluble substances that can car D' protons
may shuttle across the inner m e m b r a n e o f the
m i t o c h o n d r i a , and remove the p r o t o n gradient
and u n c o u p l e oxidative phosphorylation so that
the oxidation o f NADH and FADH is no longer
linked to the p r o d u c t i o n of ATP and may carry, on
without its production. Fig. 15 shows the position
o f the p r o t o n that is able to dissociate froni a variety of c o m p o u n d s . 2,4-Dilfitrophenol, carbonyl-pt r i f l u o r o - m e t h o x y p h e n y l h y d r a z o n e , (Stryer, 1995)
and laexachloroplaene, nitroxynil, oxvclozanide
(Corbett & Goose, 1971; Edwards el al., 1981b) are
all lipophilic c o m p o u n d s that are capable o f
carr}.'ing p r o t o n s across m e m b r a n e s , and therefore, may act to u n c o u p l e oxidative pbosphoD,1ation preventing the p r o d u c t i o n of the p r o t o n
gradient
across
the
inner
mitochondrial
membrane.
T h e nleclaallism of action of the p r o t o n ionophores has been assnmed to be to selectively
u n c o u p l e oxidative pbosphoD'lation in parasite
m i t o c h o n d r i a . Pax and B e n n e t t (1989) have
e x p e r i m e n t a l evidence that the i n n e r m e m b r a n e
o f the parasite may not be the site o f action of the
p r o t o n iollophores. T h e v observed that application of closantel to Schistosoma mansoni and Fasciola hepatica p r o d u c e s a fall in t e g u m e n t a l pH
(6.8-6.5) when m e a s u r e d with an intracellular
electrode, and that this c h a n g e in pH o c c u r r e d
after 10 rain and before an), c h a n g e in the production o f ATP bv the parasite. T h e intra-tegumental [',all in p H was associated with a reduction
in motility o f the parasite and could explain the
anti-parasitic action o f closantel. It was c o n c l u d e d
by Pax and B e n n e t t (1989) that closantel was a
m e m b r a n e active molecule and that it may affect a
n u m b e r o f biochemical and physiological processes. T h e s e processes are presumably sensitive to
changes in intra-tegumental pH. T h u s the site o f
action o f the p r o t o n i o n o p h o r e s may include the
t e g u m e n t r a t h e r than just the m i t o c h o n d r i a .
28
C1
OH
CI
CI
OH
C1
CI
Rafoxanide
I
OH
C1
~ C O ! ~
I
OH
C1
Closantel
I
OH
C1
CON__//
OH
\/x_._?__</
\~---Cl
CI
Brotianide
C1
OH
Br
OCOCH
3
CI
CS o< r
CI
Nitroxynil
DIAMPHENETHIDE
O2N
29
Diamphenethide
. / - - ,,'
CH3CONH --
/ . . . .
'i:,
/, 4 /
OCHzCHzOCH2CHeO
'
NHCOCH 3
/
.. /
Clorsulon
C1
CI2 = C
~\
NH2
SONH 2
H2NO2S
Diethylcarbamazine
CHaN
C9H5
NCON
....,
C2Hs
Fig. 17.
I N H I B I T I O N OF P H O S P H O G L Y C E R A T E
KINASE A N D MUTASE
Clorsulon
31)
E1
-- I + E
/
\
E-ATP
\
3PG-E-ATP
,/
"
3PG-E
Fig. 18. Diagram o f the competitive a n t a g o n i s m o f 19hlsl)hoglyctwate kiqase (El o f l,'asciola hepatica by clorsulon (1).
DiphosphoiT1 glycerale: DiPG. 3-Plmsphol3l glyceratc: 3PC;.
DIETHYLCARBAMAZINE
The cllelnical structure of diethylcarbamazine a
piperazine derivative is shown in Fig. 17. Elect,-ophysiological experiments following bath application to A. suum of high concentrations of
diethvlcarbamazine have shown that it does not
mimic the action of piperazine (Martin, 1985).
Effects of diethylcarbamazine
A major indication for diethylcarbamazine at
low doses is as an anti-filarial drug; it is a good
microfilaricide (including microfilariae of the dog
hearnvorm, Dirofilana immilis) but has limited
macrofilaricidal effects. The limited action of
diethylcarbamazine against some aduh hehninths
(e.g. cattle lung3vorm, Dicl~,ocauhts) requires
nearly 10 times the dose of the prophylactic antifilarial dose, and may therebre, invoh,e another
mode of action. This review covers the mode of
action of low closes of diethylcarbamazine; little is
known of the mode of action of high doses of
diethylcarbamazine.
Most studies suggest that diethylcarbamazine
has no direct action on filarial parasites (Johnson
el al., 1991). It appears to have no action at
reasonable concentrations in vilro. In marked contrast to in vitro experiments, it is known that in
vivo diethylcarbamazine is effective within 4 rain
following intravenous injection (Hawking &
Laurie, 1949). The specific immune response
M()DES
OF
:M71"ION
OF
ANTHEI.MINTIC
DRL'(;S
31
MEMBRANE
PHOSPHOLIPIDS
SE
r ........................
i DIETHYLCARBAMAZINE i
"--r
1 PLA 2 . . . . . 1~-GLUCOCORTICOIDS
..................
1
i. . . . . . . . . . . . . . . . . . . . . . . . . . .
ARACHIDONIC
ACID
......................
5-LIPOXYGENASE / J
~_,
.-"-"
-1
, DIETHYLCARBAMAZINE
1_ _
andNSAIDS
CYCLO-OXYGENASE
5-HPTE
5-HETE
/
LTA I SYNTHASE /
""""'~
PGGo and
PG-H+ '~.~"".
\ ~
~ PGE2
.\ macrophages; microfilaria
\\
LTA4
12 and 15
HPTE/HETE
platelets; neutrophils;
eosinopils.
LTC 4 SYNTHASE
LTC.I
eosinophil;
mast cell
PGD~
mast-cells
'\
PGI.,: PROSTACYCLIN
\ vascular endothelium and
\.. microfilaria
LTB4
neutrol~hils;
macropnages
TXA2: THROMBOXAN
platelets
LTD4
eosinophil;
mast cell
I
LTE 4
eosinophil;
mast cell
Fig. 19. Diagram of the pr(~duction of the leukotrienes and prostaglandins via lipoxygenase or cyclo-oxygenase fi-om
ar,tchidonic acid thal is produced from membrane phospholipids as a result ol phospholipase A=, acidity. The inhibitory
silc.s of action of gluccwo,ticoids, non-steroidal anti-inllammatola' drugs (NSAIDs) and diethvlcarbamazine are shown.
l)iethvlcmbamazine is shown inhil)iting the action of LTA, svnthase thal converts 5-hydr,>peroxyeicosatetraenoic acids (5HPE'I:E) and 5-1avdroxveicosatet,aenoic acids (5-HETE) to the let,kotrienes I.TAa and I+TA~ to LTC; in mast cells and
eosinophils. Dietl~vlcarbamazine is also shown inhibiting the cych>-oxygenase enzyme that converts a,achidonic acid to the
prostaglm]dins P(~G._, and P(;H._,. The subsequent production of P(;D_,. PGE=,, PGI=, & TY~-k,_,is also inhibited in the blood
vessels and ,nicrol]lari;~.
ACKNOWLEDGEMENTS
I a m p l e a s e d to a c k n o w l e d g e the financial s u p p o r t
o f the W e l l c o m e T r u s t w h o have s u p p o r t e d m y
w o r k o n the e l e c t r o p h y s i o l o g y o f t h e p i p e r a z i n e ,
32
Asca,is.
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