Evaluation of antischistosomal activity in animal models

1. ParasitologistsUnitedJournalDecember2014Volume7•Number2

2. Antischistosomal activity of Mirazid in experimental
schistosomiasis mansoni: exploring the controversy
Mohammad A. Al-Kazzaz, Mona H. El-Sayad, Sahar A. Abu-Helw
Department of Parasitology, Medical Research
Institute, Alexandria University, Alexandria,
Egypt
Correspondence to Mohammad A. Al-kazzaz,
MSc, 27 Street, 15 Al-Awayed, Alexandria,
Egypt Tel: + +20 100 119 5791;
e-mail: mohammadaziz73@gmail.com
Received 14 December 2015
Accepted 22 March 2016
Parasitologists United Journal
2016, 9:31–36
Background
Mirazid (MZD) was licensed in Egypt for treatment of schistosomiasis in the year
2002; the drug gained much attention experimentally and clinically, with conflicting
views on its efficacy.
Objective
The study aimed to evaluate MZD anti-schistosomal activity in an animal model at a
selected dose.
Materials and methods
Swiss albino mice (n=36) were infected with Schistosoma mansoni and divided into
two equal groups of 18 mice each: group 1 was the nontreated infected control
group given only the vehicle; gourp 2 was infected and treated with MZD at a dose of
500 mg/kg for 5 days per os 7 weeks postinfection. Efficacy of the drug was
assessed parasitologically with fecal egg counts evaluated every other day until
the animal was euthanized at 1, 2, and 4 weeks post-treatment (WPT); worm
burden, tissue egg count and oogram pattern were studied at 1, 2, and 4 WPT.
Results
MZD reduced fecal egg counts in infected mice (69.6%) and reduced total worm
load (71.9%) and tissue egg counts in the intestine and the liver (66 and 77.4%,
respectively) at 4 WPT. The drug changed oogram pattern with progress of
treatment.
Conclusion
MZD has moderate antischistosomal activity in animal models.
Keywords:
mice, mirazid, oogram pattern, Schistosoma mansoni, tissue egg count, worm burden
Parasitologists United Journal 9:31–36
© 2016 Egyptian Parasitologists United Society
1687-7942
Introduction
Mirazid (MZD) is a natural pharmaceutical
preparation introduced into the Egyptian market by
Pharco Pharmaceuticals (Alexandria, Egypt) in the
form of soft gelatin capsules since 2002. Each
capsule contains 300 mg of the purified oleoresin
extract of Commiphora molmol (Myrrh) [1]. The
Egyptian drug authority in the Egyptian Ministry of
Health registered this product for treatment of
schistosomiasis (Reg. No. 21655/2002) [2]. The
antischistosomal properties of MZD were
investigated, and reviewed both experimentally and
clinically with controversy regarding its efficacy [3].
In humans, the efficacy of MZD as an anti-
schistosomal drug was evaluated clinically with
positive results [4–9]. All in all, they enrolled 365
schistosomiasis patients (adults and children) and
treated them with MZD at a dose of 10–11.5 mg/kg
for 3–6 days. The cure rate, evaluated parasitologically
(disappearance of fecal eggs) by Kato–Katz and rectal
snip techniques at 2–3 months after treatment, was
80.7–100%. The drug proved to have nonsignificant
side effects. The drug was tested by other researchers,
with disappointing results. It showed little or no
beneficial activity as reported by Barakat et al. [10],
Botros et al. [11], and Osman et al. [12], who
altogether enrolled 206 patients (adults or children)
treated with MZD at a dose of 300–600 mg daily for
3–6 days. The drug showed a cure rate that ranged from
3.7 to 15.6 % at 3–8 WPT.
Such controversy prompted us to study the efficacy of
MZD experimentally as there are many parasitological
parameters other than fecal egg counts.
Materials and methods
Experimental study
The study was conducted at the Department of
Parasitology, Medical Research Institute (MRI),
Alexandria University, Alexandria, Egypt, during the
period from 21 July 2013 to 14 October 2014.
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Original article 31
© 2016 Parasitologists United Journal | Published by Wolters Kluwer - Medknow DOI: 10.4103/1687-7942.192993

3. Materials
The study included 36, 8-week-old female Swiss albino
mice of the CD-1 strain weighing 20±2 g, obtained from
the animal house of the MRI, Alexandria University,
Alexandria, Egypt. Laboratory-bred Biomphalaria
alexandrina snails infected with miracidiae of the
Egyptian (CD) strain of Schistosoma mansoni were
obtained from the Schistosome Biologic Supply Center,
TheodoreBilharzResearchInstitute,Cairo,Egypt.MZD
capsules were obtained as free medical samples from
Pharco Pharmaceuticals, Batch No: 296. Each capsule
(300 mg) was emptied in a flask containing 3 ml of 4%
CremophorELusedasthevehiclefordrugadministration.
Methods
Cercarial shedding
Infected B. alexandrina snails were washed with
dechlorinated water and kept in an aerated aquarium
(using an electric pump) in a dark place (by covering the
glass bath with a black plastic bag) [13]. Before use, snails
were rinsed gently with a small volume of water to remove
feces and other debris, then resuspended in water (1 ml/
snail) and left uncovered in a glass test tube under white
fluorescent light for a period of 30–60 min to release
cercariae (Fig. 1;1). After shaking gently to ensure
homogenous distribution of cercariae, 1 ml of cercarial
suspension was pipetted and placed on glass slides; a
drop of iodine was added to each slide to kill and stain
the cercariae (Fig. 1;2). With the aid of a stereobinocular
microscope, the number of cercariae was counted in each
slide. Generally, three counts were made in 3 ml cercarial
suspensionandtheaveragenumberper1 mlwascalculated.
Experimental infection
Mice were infected using the paddling technique
according to Smithers and Terry [14]. Each mouse
was exposed separately to about 100 S. mansoni
cercariae (Fig. 1;3). Infected mice were then
segregated in separate stainless steel wire mesh
cages, and received a standard well-balanced diet
and water. The mice were housed in a room
under controlled environmental temperature. Stool
examination was performed 50 days after cercarial
infection to determine the presence of S. mansoni eggs.
Drug administration
MZD was administered at a dose of 500 mg/kg for
5 days per os, 7 WPI. Each mouse required 0.1 ml
solution to reach a dose of 500 mg/kg. The dose was
selected as specified by Botros et al. [1] and
Massoud et al. [15] and is four-fold the therapeutic
dose in mice (125 mg/kg) based on Food and Drug
Administration guidelines by converting the human
dose to those for experimental animals.
Evaluation of drug efficacy was based on the following
parasitological parameters: (a) fecal eggs were counted
every other day starting 2 days post-treatment (PT) and
continued until the mice were sacrificed at 1, 2, and 4
weeks post-treatment (WPT) according to Sewify [16];
(b) for recovery of adult worms, the perfusion technique
was carried out according to Smithers and Terry [14].
The collected worms were counted to estimate the total
worm count and differentiation into male and female
worms; (c) tissue egg counts in the liver and intestine
were calculated according to Cheever [17]. Tissues were
frozen until examination; (d) the oogram pattern
(percentage of egg developmental stages) was studied
according to the method of Pellegrino et al. [18].
Figure 1
Steps of mice infections: (1) cercarial shedding; (2) cercarial count;
(3) cercarial inoculation.
32 Parasitologists United Journal 2016, Vol. 9 No. 1

4. Statistical analysis
The data were coded, collected, tabulated, and analyzed
using the independent two-sample t-test with Minitab
statistical software, version 14 (Minitab Inc.,
Pennsylvania State College, Pennsylvania, USA).
Descriptive statistics were expressed as arithmetic
mean ± SD as measures of central tendency and
dispersion, respectively. The level of significance
(P<0.05) was considered statistically significant. The
change% in each parasitological parameter was
calculated according to the following equation.
Ethical considerations
The study protocol was reviewed and approved by the
EthicsCommitteeoftheMRI,UniversityofAlexandria.
Results
MZD resulted in a nonsignificant reduction in the
number of S. mansoni eggs in the stool of the treated
group (4.5%) 1 WPT followed by significant reduction of
39.5 and 69.6% at 2 and 4 WPT, respectively, compared
with the nontreated infected group (Fig. 2 and Table 1).
MZD significantly reduced the total worm burden by 34,
50, and 72% at 1, 2, and 4 WPT, respectively (Table 1).
The number of male and female worms decreased, males
being more affected than females at 1 and 2 WPT with
significant reduction of 37.9 and 56.7% compared with
25.3 and 36.8%, respectively. At 4 WPT, there was
significant reduction of both male (75.1%) and female
worms (60%) (Table 1).
MZD produced significant reduction in the tissue egg
counts in the intestine (29.1–66%) throughout the
follow-up weeks. Reduction in the hepatic tissue egg
load was nonsignificant at 1 WPT (22.1%), and became
significant in the second and fourth week (42.7 and
Figure 2
Egg counts in the stool of MZD-treated Schistosoma mansoni-
infected mice compared with nontreated infected mice. MZD, mirazid.
Table 1 Effect of mirazid on fecal egg counts, total worm burden, and worm sex in Schistosoma mansoni-infected treated mice
compared with nontreated infected mice according to WPT
Group WPT Fecal egg counts Total worms Total males Total females
Group 1: nontreated 1 566.00±55.05 19.60±4.51 12.9±0.55 6.70±1.00
2 765.00±70.83 28.25±5.19 18.50±1.50 9.75±1.50
4 720.00±62.11 28.50±3.54 18.50±0.70 10.00±0.71
Group 2: mirazid treated 1 540.00±42.74(4.5) 13.00±2.71a
(34) 8.00±1.53a
(37.9) 5.00±0.58a
(25.3)
2 462.50±39.09a
(39.6) 14.16±2.63a
(50) 8.00±1.00a
(56.7) 6.16±0.58a
(36.8)
4 218.75±12.97a
(69.6) 8.00±3.79a
(72) 4.60±1.53a
(75.1) 3.40±1.15a
(66)
Values were expressed as mean ± SD; numbers in parentheses indicate the percentage of reduction compared with the infected
nontreated group. WPT, weeks post-treatment. a
Statistically significant at P<0.05.
Change in treated ð%Þ ¼
mean values in nontreated ðcÞ À mea n values in treated ðtÞ
mean values in nontreated ðcÞ
× 100
Table 2 Effect of mirazid on the mean tissue egg counts and the oogram pattern in Schistosoma mansoni-infected mice at 1, 2,
and 4 WPT compared with nontreated mice
Group WPT Tissue egg counts Oogram pattern
Intestine Liver Immature Mature Dead
Group 1: nontreated 1 10.3±1.13 4.56±2.84 59.60±2.28 32.60±1.99 7.80±0.59
2 14.6±1.23 6.29±3.59 61.50±3.00 27.00±0.16 11.50±0.38
4 16.5±2.76 7.82±5.80 62.50±0.71 24.50±0.12 12.00±0.41
Group 2: mirazid treated 1 7.30±1.3a
(29.1) 3.55±1.28(22.1) 55.50±4.42 19.37±2.16a
24.83±2.62a
2 7.46±0.5a
(48.9) 3.60±0.22a
(42.7) 23.25±0.99a
39.75±1.71a
37.00±2.55a
4 5.62±0.57a
(66) 1.76±0.20a
(77.4) 10.77±0.52a
52.00±3.00a
37.33±2.52a
Tissue egg count (EPG)×103
(%R). EPG, eggs per gram; WPT, weeks post-treatment. a
Statistically significant at P<0.05.
Antischistosomal activity of mirazid Al Kazzaz et al. 33

5. 77.4%) (Table 2). In the treated group the percentage of
deadeggsat1,2,and4WPTandthemeanpercentageof
mature eggs at2 and 4 WPT were significantly increased
comparedwiththevaluesinnontreatedinfectedmice.At
4 WPT, more than 50% of the eggs were mature, which
denotes interruption in egg laying as the number of
immature eggs decreased with increase in the number
of mature and dead eggs.
Discussion
MZD was tested in in vitro studies by Hassan et al.
[19], Sharaf [20], and Bakr et al. [21] in which
they exposed S. mansoni worms to various
concentrations of MZD from 100 to 400 μg/ml.
The drug elicited maximal somatic muscle
contraction at the highest concentration and a
strong lethal effect occurred after 24 h exposure.
Karamustafa et al. [22] verified the lethal effects of
MZD on adult worms and larvae of S. mansoni
(IC50=7.18–32.69 μg/ml).
In our in vivo study, MZD was tested experimentally
in S. mansoni-infected mice at a selected dose of
500 mg/kg for 5 days, producing a significant
gradual decrease in the total number of worms up to
72% by the fourth WPT but did not abolish the
infection. Using the same dose for 5 days, Massoud
et al. [15] had reported a 98% reduction in total worm
load 45 days post-infection, whereas Botros et al. [1]
found that the drug showed only 9% total worm
reduction. Bakr et al. [21] also used the same dose
of 500 mg/kg but for 3 days and obtained 82.5%
reduction in the total worm load at 1 month PT.
Hamed and Hetta [23] reported that a dose of
600 mg/kg for 3 days led to 81.1% worm reduction
27 days PT. Shorter periods of effective response to
MZD treatment were reported by Badria et al. [24]
who used the drug at a dose of 500 mg/kg twice a day
for 3 days and recorded 75% worm burden reduction
after 5 days PT. Lotfy et al. [25] also used a dose of
600 mg/kg for 5 days with significant worm load
reduction (69.3%) at 4 WPT. El-Gamal et al. [26]
studied the effect of a single dose administered 6 weeks
after infection and the drug eradicated 58.6% of total
worms at 2 WPT. However, contradictory results
reported [1,27–33] showed low worm burden
reduction rates, not more than 10%, in S. mansoni,
S. haematobium, and S. japonicum-infected mice or
hamsters treated with oral doses of MZD that
varied from 250 to 500 mg/kg for 2–5 days. Such
controversial results are expected because of
variations in drug dosage and/or number of days of
administration.
In the present work, the number of male and female
worms decreased, males being more affected than
females at 1 and 2 WPT with significant reduction
of 37.9 and 56.7% compared with 25.3 and 36.8%,
respectively. At 4 WPT, there was significant
reduction in the number of both male and female
worms (66%). These results apparently conform with
those of Bakr et al. [21] for male worms (75.1%) but
not for female worms (83.8%) from MZD-treated
mice 4 WPT with 500 mg/kg for 3 days; but Botros
et al. [1] found nonsignificant reduction in male and
female worms at 2 WPT (12.4 and 24.5%),
respectively.
Relative to the decrease in the number of worms the
drug resulted in nonsignificant reduction in the
number of S. mansoni eggs in the stool (4.5%) at 1
WPT, but it caused significant reduction (39.6 and
69.6%) at 2 and 4 WPT compared with the non-
treated infected group. Another experimental report
[34] recorded 6.6% followed by 44% reduction in fecal
egg counts at 2 and 4 WPT, respectively, using
500 mg/kg MZD for 5 days. In contrast, using a
higher dose of 600 mg/kg for 6 days, 97% reduction
in fecal egg counts was induced after 4 weeks of MZD
therapy [25].
MZD resulted in significant reduction in tissue egg
counts in the intestines (48.9–66%) throughout the 4
WPT follow-up in our study. Nonsignificant
reduction in the hepatic tissue egg load was
observed at 1 WPT (22.1%) but the drug was able
to significantly reduce the egg count in the second and
fourth WPT (42.7 and 77.4%, respectively). Higher
tissue egg count reduction of 98.2 and 97% in the
intestinal and hepatic tissue egg counts, respectively,
was recorded at 5 WPT [15]. In contrast, another
research [21] recorded a lower percentage reduction of
41% and 28.9% in hepatic and intestinal tissue egg
counts at 4 WPT and with a similar MZD dose of
500 mg/kg, but for 3 days. Other studies [1,27] found
nonsignificant change in both intestinal and hepatic
tissue egg loads at 2 WPT with a dose of MZD 300 or
500 mg/kg for 3 or 5 days, and examined 7 WPI.
Regarding the oogram pattern, MZD resulted in
significant increase in the percentage of dead eggs
at 1, 2, and 4 WPT and in the mean percentage of
mature eggs at 2 and 4 WPT compared with the
nontreated infected mice. At 4 WPT, more than 50%
of the eggs were mature. As the female worm starts
oviposition 30 days after infection and the laid
immature eggs take about 6 days to mature, a
reduction in the number of immature eggs and/or
increase in mature or dead eggs indicate that the
34 Parasitologists United Journal 2016, Vol. 9 No. 1

6. chemical examined interfered with oviposition.
Massoud et al. [15] attributed the changes in the
oogram pattern produced by MZD to an early
interruption of egg laying in the intestinal wall or
the blocking of oviposition development. Also, Badria
et al. [24] reported that MZD caused separation of
male and female-coupled worms and shifting of
female worms from their normal habitat to the liver
resulting in progressive reduction of immature eggs
deposited in the wall of the small intestine with an
increase in mature eggs (93%), but they did not report
on dead eggs. These results do not coincide with those
of other studies [1,27,28], which found an absence of
oogram alterations after MZD treatment of mice or
hamsters.
Conclusion
MZD showed moderate (72%) antischistosomal
activity in the animal model at the assigned dose
after treatment.
Acknowledgements
Many thanks to Dr Rashad Abdulghani, Department
of Parasitology, Faculty of Medicine and Health
Sciences, Sana’a University, Sana’a, Yemen, for his
support in the practical part of this work.
Author Contribution
MA Al Kazzaz suggested the idea of this work,
searched the literature, statistically analyzed the data,
and prepared the manuscript; MH El-Sayad supervised
the study and designed the experiments and shared in
the revision of the manuscript; SA Abu Helw shared in
the supervision of the study, data analysis, and revision
of the manuscript.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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