Stable expression of Escherichia coli beta-glucuronidase A (GusA) in Giardia lamblia: application to high-throughput drug susceptibility testing

OBJECTIVES: In order to create a suitable model for high-throughput drug screening, a Giardia lamblia WB C6 strain expressing Escherichia coli glucuronidase A (GusA) was created and tested with respect to susceptibility to the anti-giardial drugs nitazoxanide and metronidazole. METHODS: GusA, a well-established reporter gene in other systems, was cloned into the vector pPacVInteg allowing stable expression in G. lamblia under control of the promoter from the glutamate dehydrogenase (gdh) gene. The resulting transgenic strain was compared with the wild-type strain in a vitality assay, characterized with respect to susceptibility to nitazoxanide, metronidazole and -- as assessed in a 96-well plate format -- to a panel of 15 other compounds to be tested for anti-giardial activity. RESULTS: GusA was stably expressed in G. lamblia. Using a simple glucuronidase assay protocol, drug efficacy tests yielded results similar to those from cell counting. CONCLUSIONS: G. lamblia WB C6 GusA is a suitable tool for high-throughput anti-giardial drug screening.

Metabolism of nitro drugs metronidazole and nitazoxanide in Giardia lamblia: characterization of a novel nitroreductase (GlNR2).

OBJECTIVES The protozoan parasite Giardia lamblia causes giardiasis, a persistent diarrhoea. Nitro drugs such as the nitroimidazole metronidazole and the nitrothiazolide nitazoxanide are used for the treatment of giardiasis. Nitroreductases may play a role in activating these drugs. G. lamblia contains two nitroreductases, GlNR1 and GlNR2. The aim of this work was to elucidate the role of GlNR2. METHODS Expression of GlNR2 was analysed by reverse transcription PCR. Recombinant GlNR2 was overexpressed in G. lamblia and drug susceptibility was analysed. Recombinant GlNR2 was subjected to functional assays. Escherichia coli expressing full-length or truncated GlNR1 and GlNR2 were grown in the presence of nitro compounds. Using E. coli reporter strains for nitric oxide and DNA damage responses, we analysed whether GlNR1 and GlNR2 elicited the respective responses in the presence, or absence, of the drugs. RESULTS G. lamblia trophozoites overexpressing GlNR2 were less susceptible to both nitro drugs as compared with control trophozoites. GlNR2 was a functional nitroreductase when expressed in E. coli. E. coli expressing GlNR1 was more susceptible to metronidazole under aerobic and semi-aerobic and to nitazoxanide under semi-aerobic growth conditions. E. coli expressing GlNR2 was not susceptible to either drug. In reporter strains, GlNR1, but not GlNR2, elicited nitric oxide and DNA repair responses, even in the absence of nitro drugs. CONCLUSIONS These findings suggest that GlNR2 is an active nitroreductase with a mode of action different from that of GlNR1. Thus, susceptibility to nitro drugs may depend not only on activation, but also on inactivation of the drugs by specific nitroreductases.

Comparative characterisation of two nitroreductases from Giardia lamblia as potential activators of nitro compounds

Giardia lamblia is a protozoan parasite that causes giardiasis, a diarrhoeal disease affecting humans and various animal species. Nitro drugs such as the nitroimidazole metronidazole and the nitrothiazolide nitazoxanide are used for treatment of giardiasis. Nitroreductases such as GlNR1 and GlNR2 may play a role in activation or inactivation of these drugs. The aim of this work is to characterise these two enzymes using functional assays. For respective analyses recombinant analogues from GlNR1 and GlNR2 were produced in Escherichia coli. E. coli expressing GlNR1 and GlNR2 alone or together were grown in the presence of nitro compounds. Furthermore, pull-down assays were performed using HA-tagged GlNR1 and GlNR2 as baits. As expected, E. coli expressing GlNR1 were more susceptible to metronidazole under aerobic and semi-aerobic and to nitazoxanide under semi-aerobic growth conditions whereas E. coli expressing GlNR2 were susceptible to neither drug. Interestingly, expression of both nitroreductases gave the same results as expression of GlNR2 alone. In functional assays, both nitroreductases had their strongest activities on the quinone menadione (vitamin K3) and FAD, but reduction of nitro compounds including the nitro drugs metronidazole and nitazoxanidewas clearly detected. Full reduction of 7-nitrocoumarin to 7-aminocoumarin was preferentially achieved with GlNR2. Pull-down assays revealed that GlNR1 and GlNR2 interacted in vivo forming a multienzyme complex. These findings suggest that both nitroreductases are multifunctional. Their main biological role may reside in the reduction of vitamin K analogues and FAD. Activation by GlNR1 or inactivation by GlNR2 of nitro drugs may be the consequence of a secondary enzymatic activity either yielding (GlNR1) or eliminating (GlNR2) toxic intermediates after reduction of these compounds. © 2015 The Authors. Published by Elsevier Ltd on behalf of Australian Society for Parasitology. This is an open access article under the CC BY-NC-ND license

Effects of breastfeeding and naturally acquired immunity on infection with {\it Giardia lamblia}: A study in a cohort of Mexican infants

Giardia lamblia is one of the most common causes of gastrointestinal tract infection among young children worldwide. Yet host protection against this parasite and the effect of infection with Giardia on infant growth are poorly understood. It was hypothesized that among young children, protection against infection with Giardia is afforded by breastfeeding and previous infection with the parasite and further, that infection with Giardia decreases growth velocity. From 4/88 to 4/90, 197 infants in a poor area of Mexico City were followed from 0 to 18 months of age, with stool specimens, symptoms and feeding status data collected weekly. A total of 6,031 stool specimens were tested for Giardia antigen by enzyme-linked immunosorbent assay. There were 1.0 Giardia infections per child-year; 25% were symptomatic and 54% lasted more than 1 month; 94 infants had 1, and 33 had 2 or more infections. Breastfeeding status was coded and analyzed for each child-week of follow up. 91% of study infants were breastfed from birth, 57% at 6 months and 38% at 12 months of age. Rate ratios for non-breastfeeding adjusted for confounding factors were calculated from stratified analyses and the Cox proportional hazards model. Not breastfeeding was a significant risk factor for first infection with Giardia vs. any breastfeeding (adjusted RR = 1.8; 1.1, 2.8) at all ages; a dose response was demonstrated by degree of breastfeeding. The adjusted rate ratio for non-breastfeeding vs. partial breastfeeding was 1.6 (1.03, 2.6) and for non-breastfeeding vs. complete breastfeeding was 4.7 (1.4, 15.9). Among Giardia infected infants, breastfeeding did not protect against diarrheal symptoms or shorten the duration of carriage. First and repeat infections with Giardia did not differ in duration or the percent symptomatic. The analysis of growth and Giardia infection was inconclusive but suggested that a history of Giardia infection might be associated with decreased weight velocity, while an immediate chronic infection might be associated with increased weight velocity. In summary, these data indicate that breastfeeding protects infants against infection with Giardia; provide no evidence of protection against repeat infections resulting from a prior infection and suggest but do not establish that a history of Giardia infection might be associated with decreased growth in young children. ^

A STUDY OF ILLNESS AND RESERVOIRS ASSOCIATED WITH GIARDIA LAMBLIA IN RURAL EGYPT

A longitudinal investigation of the health effects and reservoirs of Giardia lamblia was undertaken in forty households located in a rural Nile Delta region of Egypt. Stool specimens obtained once weekly for six months from two to four year old children were cyst or trophozoite-positive in 42 percent of the 724 examined. The mean duration of excretion in all but one Giardia-negative child was seven and one-half weeks with a range of one to 17 weeks. Clinical symptoms of illness were frequently observed within a month before or after Giardia excretion in stool of children, but a statistical inference of association was not demonstrated.^ Seventeen percent of 697 specimens obtained from their mothers was Giardia-positive for a mean duration of four weeks and a range of one to 18 weeks. Mothers were observed to excrete Giardia in stool less frequently during pregnancy than during lactation.^ Nine hundred sixty-two specimens were collected from 13 species of household livestock. Giardia was detected in a total of 22 specimens from cows, goats, sheep and one duck. Giardia cysts were detected in three of 899 samples of household drinking water.^ An ELISA technique of Giardia detection in human and animal stool was field tested under variable environmental conditions. The overall sensitivity of the assay of human specimens was 74 percent and specificity was 97 percent. These values for assay of animal specimens were 82 percent and 98 percent, respectively.^ Surface antigen studies reported from the NIH Laboratory of Parasitic Diseases show that antigens of three Egyptian human isolates are different from each other and from most other isolates against which they were tested.^ The ubiquity of human and animal fecal contamination combined with estimates of ill days per child per year in this setting are substantial arguments for the introduction of a suggested mass parasite control program to intervene in the cyclical transmission of agents of enteric disease. ^

Secondary absence of mitochondria in Giardia lamblia and Trichomonas vaginalis revealed by valyl-tRNA synthetase phylogeny

Nuclear-coded valyl-tRNA synthetase (ValRS) of eukaryotes is regarded of mitochondrial origin. Complete ValRS sequences obtained by us from two amitochondriate protists, the diplomonad, Giardia lamblia and the parabasalid, Trichomonas vaginalis were of the eukaryotic type, strongly suggesting an identical history of ValRS in all eukaryotes studied so far. The findings indicate that diplomonads are secondarily amitochondriate and give further evidence for such conclusion reached recently concerning parabasalids. Together with similar findings on other amitochondriate groups (microsporidia and entamoebids), this work provides critical support for the emerging notion that no representatives of the premitochondrial stage of eukaryotic phylogenesis exist among the species living today.

A dual-specificity aminoacyl-tRNA synthetase in the deep-rooted eukaryote Giardia lamblia

Cysteinyl-tRNA (Cys-tRNA) is essential for protein synthesis. In most organisms the enzyme responsible for the formation of Cys-tRNA is cysteinyl-tRNA synthetase (CysRS). The only known exceptions are the euryarchaea Methanococcus jannaschii and Methanobacterium thermoautotrophicum, which do not encode a CysRS. Deviating from the accepted concept of one aminoacyl-tRNA synthetase per amino acid, these organisms employ prolyl-tRNA synthetase as the enzyme that carries out Cys-tRNA formation. To date this dual-specificity prolyl-cysteinyl-tRNA synthetase (ProCysRS) is only known to exist in archaea. Analysis of the preliminary genomic sequence of the primitive eukaryote Giardia lamblia indicated the presence of an archaeal prolyl-tRNA synthetase (ProRS). Its proS gene was cloned and the gene product overexpressed in Escherichia coli. By using G. lamblia, M. jannaschii, or E. coli tRNA as substrate, this ProRS was able to form Cys-tRNA and Pro-tRNA in vitro. Cys-AMP formation, but not Pro-AMP synthesis, was tRNA-dependent. The in vitro data were confirmed in vivo, as the cloned G. lamblia proS gene was able to complement a temperature-sensitive E. coli cysS strain. Inhibition studies of CysRS activity with proline analogs (thiaproline and 5′-O-[N-(l-prolyl)-sulfamoyl]adenosine) in a Giardia S-100 extract predicted that the organism also contains a canonical CysRS. This prediction was confirmed by cloning and analysis of the corresponding cysS gene. Like a number of archaea, Giardia contains two enzymes, ProCysRS and CysRS, for Cys-tRNA formation. In contrast, the purified Saccharomyces cerevisiae and E. coli ProRS enzymes were unable to form Cys-tRNA under these conditions. Thus, the dual specificity is restricted to the archaeal genre of ProRS. G. lamblia's archaeal-type prolyl- and alanyl-tRNA synthetases refine our understanding of the evolution and interaction of archaeal and eukaryal translation systems.

Cholesterol starvation induces differentiation of the intestinal parasite Giardia lamblia.

Giardia lamblia, like most human intestinal parasitic protozoa, sustains fundamental morphological and biochemical changes to survive outside the small intestine of its mammalian host by differentiating into an infective cyst. However, the stimulus that triggers this differentiation remains totally undefined. In this work, we demonstrate the induction of cyst formation in vitro when trophozoites are starved for cholesterol. Expression of cyst wall proteins was detected within encystation-specific secretory vesicles 90 min after the cells were placed in lipoprotein-deficient TYI-S-33 medium. Four cloned lines derived from two independent Giardia isolates were tested, and all formed cysts similarly. Addition of cholesterol, low density or very low density lipoproteins to the lipoprotein-deficient culture medium, inhibited the expression of cyst wall proteins, the generation of encystation-specific vesicles, and cyst wall biogenesis. In contrast, high density lipoproteins, phospholipids, bile salts, or fatty acids had little or no effect. These results indicate that cholesterol starvation is necessary and sufficient for the stimulation of Giardia encystation in vitro and, likely, in the intestine of mammalian hosts.

Transient transfection and expression of firefly luciferase in Giardia lamblia.

We have developed a gene transfer system for the protozoan parasite Giardia lamblia. This organism is responsible for many cases of diarrhea worldwide and is considered to be one of the most primitive eukaryotes. Expression of a heterologous gene was detected in this parasite after electroporation with appropriate DNA constructs. We constructed a series of transfection plasmids using flanking sequences of the Giardia glutamate dehydrogenase (GDH) gene to drive expression of the firefly luciferase reporter gene. The optimal construct consisted of a GDH/luciferase fusion gene in which the first 18 codons of the GDH gene immediately preceded the luciferase gene; this fusion gene was flanked by the upstream and downstream sequences of the GDH gene. Electroporation of this construct into Giardia yielded luciferase activity that was 3000- to 50,000-fold above background. Removal of either the 5' or 3' GDH flanking sequences from this construct resulted in significantly reduced luciferase activity, and removal of both flanking sequences reduced luciferase activity to background levels. Luciferase activity was proportional to the amount of DNA electroporated and was maximal at 6 hr after electroporation.

Avaliação de diversos métodos de detecção de cistos de Giardia spp. e Oocistos de Cryptosporidium parvum presentes no resíduo gerado após o tratamento de água de abastecimento com turbidez elevada

Este trabalho teve como objetivo avaliar diversos métodos de detecção e recuperação de cistos de Giardia spp. e de oocistos de Cryptosporidium parvum em resíduos gerados no tratamento de águas de abastecimento com turbidez elevada tendo como padrão o Método 1623.1 da USEPA (2012 ). Para tanto, ensaios utilizando aparelho Jarteste (coagulação, floculação, decantação e filtração ) foram realizados utilizando o coagulante cloreto de polialumínio - PAC. Em todos os métodos avaliados foi utilizada a técnica de purificação por separação imunomagnética - IMS. A adaptação do método floculação em carbonato de cálcio FCCa elaborado por Vesey et al. (1993) e adaptado por Feng et al. (2011), repercutiu nos melhores resultados para a amostra de resíduo sedimentado, com recuperações de 68 ± 17 % para oocisto de C. parvum e de 42 ± 7 % para cisto de Giardia spp. Entretanto, as recuperações para a amostra de água de lavagem dos filtros - ALF foram inferiores à 1 %, não sendo possível determinar um método adequado. A presença dos patógenos indica que o reuso da ALF em ETA convencionais ou o descarte em mananciais sem um tratamento prévio, pode representar problemas de contaminação. A adaptação dos métodos de Boni de Oliveira (2012) e Keegan et al. (2008), também repercutiram em porcentagens de recuperação expressivas para a amostra de resíduo sedimentado, sendo de: 41 ± 35 % para oocisto de C. parvum e 11 ± 70 % para cisto de Giardia spp., e 38 ± 26 % para oocisto de C. parvum e 26 ± 13 % para cisto de Giardia spp., respectivamente. A análise estatística não resultou em diferença significativa entre estes dois métodos, entretanto, as elevadas recuperações indicam que estes métodos podem ser melhor avaliados em pesquisas futuras.

Ocorrência e caracterização de Giardia e Cryptosporidium em águas captadas para abastecimento público no município de Cajamar-SP e avaliação do risco

Introdução: O risco à saúde humana ocasionado pela contaminação biológica de águas captadas para abastecimento público é realçado pela ocorrência de surtos de doenças associadas aos protozoários Giardia e Cryptosporidium, que possuem baixas doses infecciosas e alta capacidade de sobrevivência no ambiente, além de serem capazes de resistir ao processo tradicional de desinfecção da água (cloração). Partindo-se da hipótese de que há um risco elevado de infecção por estes protozoários pela ingestão de água tratada por métodos convencionais e que fazem uso de mananciais superficiais impactados por contaminação biológica, resultando num possível incremento da incidência de diarréias, este estudo se propôs a verificar a ocorrência destes protozoários em águas captadas para abastecimento público no município de Cajamar-SP, caracterizar sua patogenicidade e avaliar o risco associado ao seu consumo através da água tratada. Métodos: Foram coletadas 48 amostras do ribeirão dos Cristais no ponto de captação da estação de tratamento de água, semanalmente, durante 12 meses (de 16/05/2013 a 21/05/2014). A detecção e a análise da concentração dos protozoários foram realizadas de acordo com Método 1623.1 da United States Environmental Protection Agency e a extração e caracterização dos espécies/genótipos de Giardia e Cryptosporidium foi realizada através metodologias moleculares e seqüenciamento. O risco de infecção pela ingestão de cistos de Giardia e oocistos de Cryptosporidium presentes na água tratada foi calculado usando a ferramenta da Avaliação Quantitativa do Risco Microbiológico, a partir dos dados de concentração dos patógenos obtidos pelo Método 1623.1, eficiência de remoção dos (oo)cistos durante o processo convencional de tratamento da água, modelo dose-resposta e taxa de ingestão diária de água para indivíduos menores de 5 anos e maiores de 21 anos. Resultados: Cistos de Giardia foram detectados em 83,3% das amostras (40/48), com concentrações variando desde o limite de detecção (<0,1) até 8,6 cistos/L. Oocistos de Cryptosporidium foram etectados em 37,5% das amostras (18/48), com concentrações variando desde o limite de detecção (<0,1) até 2 oocistos/L. As espécies/genótipos encontrados (Giardia intestinalis A e B e Cryptosporidium parvum e hominis) são característicos de contaminação antrópica e são frequentemente identificados em estudos epidemiológicos como responsáveis por surtos. A estimativa do risco anual de infecção por Giardia foi de 3,3x10-3 (IC95% 4,6x10-3) para crianças e de 11,5x10-3 (IC95% 13,3x10-3) para adultos, enquanto o risco por Cryptosporidium foi de 1,1x10-3 (IC95% 1,7x10-3) para crianças e de 3,9x10-3 (IC95% 5,0x10-3) para adultos. O incremento da incidência de diarréias foi observado no cenário de estudo após um acidente que resultou em transbordamento de esgotos não tratados no manancial, coincidindo com o aumento na detecção de (oo)cistos. Conclusão: Os resultados evidenciaram que a vulnerabilidade do ribeirão dos Cristais a contaminações biológicas pode culminar em um risco elevado de infecção e adoecimento por Giardia e Cryptosporidium através da ingestão de água tratada. Portanto, o caso é preocupante, tanto do ponto de vista do tratamento e abastecimento de água potável, quanto da degradação e contaminação do manancial, evidenciando a necessidade de se estabelecer medidas de intervenção direcionadas a promover a qualidade da água e garantir sua segurança

ESTUDIO DE MOLÉCULAS INVOLUCRADAS EN LA REGULACIÓN DE LA HOMEOSTASIS VACUOLAR Y LA ENDOCITOSIS DE ANTIPARASITARIOS NATURALES EN GIARDIA LAMBLIA

La endocitosis y el tráfico de proteínas lisosomales son eventos esenciales en los parásitos patógenos ya que están directamente vinculados a procesos específicos vitales tales como la invasión de células hospedadoras, la nutrición y la diferenciación celular a estadios resistentes. En el parásito unicelular G. lamblia, las moléculas que participan en estos procesos fueron analizadas por nuestro grupo e incluyen la acción de las proteínas adaptadoras AP-1 y AP-2 y del coatómero clatrina, con implicancia incierta de otras proteínas adaptadoras. Recientemente, hemos identificado a la proteína GlENTHp (Giardia lamblia ENTH protein) que contiene un dominio de ENTH presente en las proteínas adaptadoras monoméricas epsina o epsinaR (proteína relacionada a epsina), que participan en la endocitosis y el tráfico de proteínas desde el aparato de Golgi a los endosomas, respectivamente, en otros tipos celulares. Hemos encontrado que GlENTHp se une clatrina y ubiquitina y, notablemente, también interactúa con la subunidad alfa de la AP-2 (que participan en la endocitosis) y la subunidad gamma de la AP-1 (implicada en el tráfico de Golgi-a-lisosoma). Encontramos también que GlENTHp estaría asociada a membrana a través de su unión a fosfoinosítidos vinculados al anclaje a la membrana plasmática y membrana de Golgi en células de mamífero. La reducción de la expresión de GlENTHp o la sobreexpresión de una mutante de GlENTHp no funcional mostró una acumulación inusual de material electrodenso en las vacuolas lisosomales periféricas o PVs, estando gravemente afectado el crecimiento de los trofozoítos. Un hallazgo similar se observó en trofozoítos salvajes tratados con lactoferrina, un metabolito antimicrobiano natural y una de las barreras de defensa del hospedador más importantes contra G. lamblia. El mismo efecto, se vió luego de la exposición de trofozoítos a LY294002, un inhibidor de las enzimas PI3 quinasas capaces de fosforilar fosfatidilinositol a fosfoinosítidos. Estos estudios acerca de la función molecular de drogas antiparasitarias y el análisis de su relación con la maquinaria endocítica nos permitirían inferir la utilidad clínica de esta droga natural en particular pero también nos permitirán establecer nuevas bases en la investigación de un enfoque de administración de drogas específicas a través de receptores de alta afinidad en general. Por lo tanto, en este proyecto nos proponemos continuar con el estudio del tráfico de proteínas mediado por clatrina implicado en el mantenimiento de la homeostasis de las PVs y su implicancia en la incorporación de giardicidas naturales. Nuevos hallazgos posiblemente nos darán una visión diferente de la función de las PVs y pueden brindar información sobre vías de intervención terapéutica alternativas contra Giardia y otros parásitos relacionados.

Identification of differentially expressed genes in a Giardia lamblia WB C6 clone resistant to nitazoxanide and metronidazole.

OBJECTIVES The characterization of differential gene expression in Giardia lamblia WB C6 strain C4 resistant to metronidazole and nitazoxanide using microarray technology and quantitative real-time PCR. METHODS In a previous study, we created and characterized the G. lamblia WB C6 clone C4 resistant to nitazoxanide and metronidazole. In this study, using a microarray-based approach, we have identified open-reading frames (ORFs) that were differentially expressed in C4 when compared with its wild-type WB C6. Using quantitative real-time PCR, we have validated the expression patterns of some of those ORFs, focusing on chaperones such as heat-shock proteins in wild-type and C4 trophozoites. In order to induce an antigenic shift, trophozoites of both strains were subjected to a cycle of en- and excystation. Expression of selected genes and resistance to nitazoxanide and metronidazole were investigated after this cycle. RESULTS Forty of a total of 9115 ORFs were found to be up-regulated and 46 to be down-regulated in C4 when compared with wild-type. After a cycle of en- and excystation, resistance of C4 to nitazoxanide and metronidazole was lost. Resistance formation and en-/excystation were correlated with changes in expression of ORFs encoding for major surface antigens such as the variant surface protein TSA417 or AS7 ('antigenic shift'). Moreover, expression patterns of the cytosolic heat-shock protein HSP70 B2, HSP40, and of the previously identified nitazoxanide-binding proteins nitroreductase and protein disulphide isomerase PDI4 were correlated with resistance and loss of resistance after en-/excystation. C4 trophozoites had a higher thermotolerance level than wild-type trophozoites. After en-/excystation, this tolerance was lost. CONCLUSIONS These results suggest that resistance formation in Giardia to nitazoxanide and metronidazole is correlated with altered expression of genes involved in stress response such as heat-shock proteins.

Recent insights into the mucosal reactions associated with Giardia lamblia infections.

Giardia lamblia is an intestinal protozoan parasite infecting humans and various other mammalian hosts. The most important clinical signs of giardiasis are diarrhoea and malabsorption. Giardia lamblia is able to undergo continuous antigenic variation of its major surface antigen, named VSP (variant surface protein). While intestinal antibodies, and more specifically anti-VSP IgA antibodies, were proven to be involved in modulating antigenic variation of the parasite the participation of the local antibody response in control of the parasite infection is still controversial. Conversely, previous studies based on experimental infections in mice showed that cellular immune mechanisms are essential for elimination of the parasite from its intestinal habitat. Furthermore, recent data indicated that inflammatory mast cells have a potential to directly, or indirectly, interfere in duodenal growth of G. lamblia trophozoites. However, this finding was challenged by other reports, which did not find a correlation between intestinal inflammation and resistance to infection. Since intestinal infiltration of inflammatory cells and/or CD8+T-cells were demonstrated to coincide with villus-shortening and crypt hyperplasia immunological reactions were considered to be a potential factor of pathogenesis in giardiasis. The contribution of physiological factors to pathogenesis was essentially assessed in vitro by co-cultivation of G. lamblia trophozoites with epithelial cell lines. By using this in vitro model, molecular (through surface lectins) and mechanical (through ventral disk) adhesion of trophozoites to the epithelium was shown to be crucial for increased epithelial permeability. This phenomenon as well as other Giardia-induced intestinal abnormalities such as loss of intestinal brush border surface area, villus flattening, inhibition of disaccharidase activities, and eventually also overgrowth of the enteric bacterial flora seem to be involved in the pathophysiology of giardiasis. However, it remains to be elucidated whether at least part of these pathological effects are causatively linked to the clinical manifestation of the disease.