The experiments: YN JI AK. Performed the experiments: YN. Analyzed the

The experiments: YN JI AK. Performed the experiments: YN. Analyzed the data: YN JI. Wrote the paper: YN JI AK.(PDF)Table S2 List of plasmids.(PDF)
African Trypanosomiases (AT) cause devastating diseases of livestock and humans in areas of Africa that harbor the vector, the Tsetse fly. Approximately 70 million people are currently estimated to be at risk of contracting the disease. Between 2000 and 2009, about 175,000 human cases were reported, the vast majority of which were caused by Trypanosoma brucei gambiense in West Africa [1]. Human African trypanosomiasis (HAT) new infection rates are currently relatively low, at about 10,000 cases per year [2] but maintenance of this level relies on continuous surveillance efforts [2]. The conventional profile of human African trypanosomiasis (HAT) includes an initial hemolymphatic stage (stage I), with no specific signs [3]. This progresses to a late stage (stage II) involving the central nervous system. Progress is much slower for T. b. gambiense infection than for infection by the East African form, T. b. rhodesiense. Although most patients eventually succumb to infection if untreated, a few cases have been reported in which patients become asymptomatic or even self-cure [4,5].The standard serological screening method for T. gambiense Title Loaded From File disease is the Card Agglutination Test for Trypanosomiasis (CATT), followed by a trypanoloysis test and parasitological confirmation by microscopy. The CATT and trypanolysis tests both rely on immunoglobulins that interact, respectively, with one and three variant antigens on the surface of the trypanosomes; the trypanolysis test is more specific [6]. Microscopy can be supplemented by DNA amplification methods in the unlikely event that facilities are available [2,7]. The only way to determine the disease stage is via examination of the cerebrospinal fluid (CSF) for trypanosomes or lymphocytes [2]. Although some molecular markers are showing promise, these too rely upon a CSF Title Loaded From File sample [8,9]. Ultimately, the ideal solution would be a drug, which can be used to treat both stages [10,11], but in the meantime less invasive methods to determine the disease stage would aid control efforts and might remove one barrier to patients’ willingness to seek diagnosis.miRNA in Human Sleeping SicknessCATT-seropositive individuals without parasitological confirmation are frequently encountered in T. b. gambiense endemic areas (e.g. [12,13]). Some of these individuals are also positive in the trypanolysis test, ruling out false positivity due to non-specific agglutination. Follow-up of these individuals in Guinea has shown that they can be classified into three categories: (i) those who develop HAT later were presumably in the early phase of infection); (ii) those who maintain high serological responses to the CATT (.2 years) may be asymptomatic carriers and (iii) those who later becoming negative in the CATT might have self-cured [5]. Both host and parasite variations have been implicated in this diversity in disease presentation [14,15]. Humans respond to infection with increases in various cytokines; results from mice implicate innate, macrophage-based immune responses in protection, in addition to antibody-mediated responses to the major surface antigen, the variant surface glycoprotein [15]. A recent microarray-based study of mice infected with T. b. brucei (which is closely related to T. b. rhodesiense) confirmed activation of macrophages and several cytokine responses [16].The experiments: YN JI AK. Performed the experiments: YN. Analyzed the data: YN JI. Wrote the paper: YN JI AK.(PDF)Table S2 List of plasmids.(PDF)
African Trypanosomiases (AT) cause devastating diseases of livestock and humans in areas of Africa that harbor the vector, the Tsetse fly. Approximately 70 million people are currently estimated to be at risk of contracting the disease. Between 2000 and 2009, about 175,000 human cases were reported, the vast majority of which were caused by Trypanosoma brucei gambiense in West Africa [1]. Human African trypanosomiasis (HAT) new infection rates are currently relatively low, at about 10,000 cases per year [2] but maintenance of this level relies on continuous surveillance efforts [2]. The conventional profile of human African trypanosomiasis (HAT) includes an initial hemolymphatic stage (stage I), with no specific signs [3]. This progresses to a late stage (stage II) involving the central nervous system. Progress is much slower for T. b. gambiense infection than for infection by the East African form, T. b. rhodesiense. Although most patients eventually succumb to infection if untreated, a few cases have been reported in which patients become asymptomatic or even self-cure [4,5].The standard serological screening method for T. gambiense disease is the Card Agglutination Test for Trypanosomiasis (CATT), followed by a trypanoloysis test and parasitological confirmation by microscopy. The CATT and trypanolysis tests both rely on immunoglobulins that interact, respectively, with one and three variant antigens on the surface of the trypanosomes; the trypanolysis test is more specific [6]. Microscopy can be supplemented by DNA amplification methods in the unlikely event that facilities are available [2,7]. The only way to determine the disease stage is via examination of the cerebrospinal fluid (CSF) for trypanosomes or lymphocytes [2]. Although some molecular markers are showing promise, these too rely upon a CSF sample [8,9]. Ultimately, the ideal solution would be a drug, which can be used to treat both stages [10,11], but in the meantime less invasive methods to determine the disease stage would aid control efforts and might remove one barrier to patients’ willingness to seek diagnosis.miRNA in Human Sleeping SicknessCATT-seropositive individuals without parasitological confirmation are frequently encountered in T. b. gambiense endemic areas (e.g. [12,13]). Some of these individuals are also positive in the trypanolysis test, ruling out false positivity due to non-specific agglutination. Follow-up of these individuals in Guinea has shown that they can be classified into three categories: (i) those who develop HAT later were presumably in the early phase of infection); (ii) those who maintain high serological responses to the CATT (.2 years) may be asymptomatic carriers and (iii) those who later becoming negative in the CATT might have self-cured [5]. Both host and parasite variations have been implicated in this diversity in disease presentation [14,15]. Humans respond to infection with increases in various cytokines; results from mice implicate innate, macrophage-based immune responses in protection, in addition to antibody-mediated responses to the major surface antigen, the variant surface glycoprotein [15]. A recent microarray-based study of mice infected with T. b. brucei (which is closely related to T. b. rhodesiense) confirmed activation of macrophages and several cytokine responses [16].

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