In vitro and ex vivo protoscolicidal effects of hydroalcoholic extracts of Eucalyptus microtheca on protoscoleces of Echinococcus granulosus sensu stricto: A light and scanning electron microscopy (SEM) study

Cystic echinococcosis (CE) is a globally important cyclo-zoonotic disease in terms of health, medicine, and economy (McManus et al., 2003). Different genotypes of CE are spread all over the world (Vuitton et al., 2020; Manterola et al., 2022). The causative agent of CE is E. granulosus sensu lato which infects a wide range of herbivores and humans (McManus et al., 2003). Humans and other intermediate hosts such as sheep, cattle, goats, camels, and pigs are infected by ingesting shed eggs in dog feces (Romig et al., 2017). There is no effective human vaccine available against CE, and treatment is limited to surgery, PAIR (Puncture, Aspiration, Injection, and Re-aspiration), and chemotherapy with benzimidazoles and praziquantel (WHO 1996). Surgery carries a high mortality risk, morbidity, or recurrence (Anadol et al., 2001). Also, anaphylaxis and secondary echinococcosis are the main risks of the PAIR procedure due to spillage of the cyst contents (Anadol et al., 2001). Albendazole therapy alone in treating primary CE patients is partially unsuccessful, also is not adequate in preventing recurrent cysts in surgery or PAIR (Kapan et al., 2006). Chemical protoscolicidal agents such as silver nitrate, cetrimide, and ethanol present serious side effects such as sclerosing cholangitis and hepatic necrosis (Tale et al., 2019). Then, since there is no ideal protoscolicidal agent that is effective and safe, it is essential to find new protoscolicidal agents with more efficacy, less toxicity, and less exposure time (WHO 1996; Barzin et al., 2019). The protoscolicidal agents are prescribed especially in the PAIR technique (Kismet et al., 2006). Also, an ex vivo assay was used to simulate PAIR conditions and predict the in vivo effects of protoscolicidal agents (Lamonaca et al., 2009). Furthermore, new studies have shown the high protoscolicidal potency of Eucalyptus species (Faizei et al., 2015; Faizi et al., 2018). However, no study has been done on the protoscolicidal effect of E. microtheca, so far. The present study aimed to evaluate the protoscolicidal effects of hydroalcoholic extracts of E. microtheca, which were prepared by percolation (EMP) and soxhlet extraction methods (EMS) in comparison with cetrimide both in vitro and ex vivo methods.

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