Profound Activity of the Anti-cancer Drug Bortezomib against <i>Echinococcus multilocularis</i> Metacestodes Identifies the Proteasome as a Novel Drug Target for Cestodes

<div><p>A library of 426 FDA-approved drugs was screened for in vitro activity against <i>E. multilocularis</i> metacestodes employing the phosphoglucose isomerase (PGI) assay. Initial screening at 20 µM revealed that 7 drugs induced considerable metacestode damage, and further dose-response studies revealed that bortezomib (BTZ), a proteasome inhibitor developed for the chemotherapy of myeloma, displayed high anti-metacestodal activity with an EC<sub>50</sub> of 0.6 µM. BTZ treatment of <i>E. multilocularis</i> metacestodes led to an accumulation of ubiquinated proteins and unequivocally parasite death. In-gel zymography assays using <i>E. multilocularis</i> extracts demonstrated BTZ-mediated inhibition of protease activity in a band of approximately 23 kDa, the same size at which the proteasome subunit beta 5 of <i>E. multilocularis</i> could be detected by Western blot. Balb/c mice experimentally infected with <i>E. multilocularis</i> metacestodes were used to assess BTZ treatment, starting at 6 weeks post-infection by intraperitoneal injection of BTZ. This treatment led to reduced parasite weight, but to a degree that was not statistically significant, and it induced adverse effects such as diarrhea and neurological symptoms. In conclusion, the proteasome was identified as a drug target in <i>E. multilocularis</i> metacestodes that can be efficiently inhibited by BTZ in vitro. However, translation of these findings into in vivo efficacy requires further adjustments of treatment regimens using BTZ, or possibly other proteasome inhibitors.</p></div>