AGELESS HEALTH and AGELESS BEAUTY...
with HIRUDOTHERAPY

Picture


How the application of Medicinal Leeches works in the COSMETIC TREATMENTS.
The non-invasive HIRUDOTHERAPY, a healing method   which is over 2500 years old, again, became an approach toward natural healing and natural beauty without any side-effects, without any drugs and chemicals involved. The methods of slowing the skin aging with leeches' application have been known since ancient times. Japanese Geishas, famous for their beauty, with a smooth alabaster skin tone, were treated with face and body masks --sophisticated most organic HIRUDO-MASK were applied for extraordinary results!
In the XIX Century France using leeches for a healthy looking skin and blushing cheeks was
 "a must" routine for women!  For an immediate blood flow into cheeks leeches were placed  behind the ears, the area that the post-leeching marks were unnoticeable and hidden under the hair.
The MIRACLE OF MEDICINAL LEECHES' SALIVARY GLANDS
In nowadays hirudotherapy is not only a venue in holistic healing of all our body systems.
Through the body detoxification, blood purification and oxygenation, hirudotherapy hasREJUVENATING effect on the entire body, as well. Medicinal leeches' salivary glands  containLipids along with Hirudin, Proteins, Serotonin, Hyaluronidase, Collagenase, Elastase which are active essential ingredients in the SKINCARE (reconstruction of the cell membranes, skin cells and tissue). Lipids represent about 20% of the total weight of the salivary glands. Together with lipids are NATURAL steroid hormones such as cortisol,dehydroepiandrosterone (androstenolone), testosterone, progesterone and estradiol. The  other largest group of compounds in the salivary glands is formed byphosphatidic acids and free fatty acids
  (important source of energy).
 [Source: From the reading on hirudotherapy research studies, group papers, documents on medicinal leeches in Russia, O. Kamenev, A.Baranovski, U. Krashenyuk, Baskova and others]. 

Hirudotherapy brings healthy look and glow on a face, improves skin elasticity, stops hair loss, significantly reduces cellulite, dissolves scar tissue & visibly diminished scars, eliminates spider veins, improves blood circulation - no more "cold hands and feet"!
  There is also a “secret application” for non-invasive face lift.
For a daily skin care, hair care, etc., we recommend using ALA AQUA VITA® (try: cold hirudo-tonic splashed over the face in the morning!) New website is coming soon! 

IMAGINE -- LIFTING of the eyelids done without of surgery! No more bold spots on the scalp;No acne; No embarrassing skin condition known as a rosacea; No laser or surgery for varicose veins! You can improve a micro-circulation natural way: LEECH-WAY! After hirudotherapy treatment the healthy body shows better attitude -- the feeling of well-being has been influenced by ENDORPHINSThere are plenty of these enzymes in leech's salivary glands which are spread throughout the body during and after the leeches' application!   

Altogether, HIRUDOTHERAPY TREATMENTS and Cosmetic Sessions will take you on a LIFE-JOURNEY toward HOMEOSTSIS- with AGELESS HEALTH and AGELESS BEAUTY!
 -- Evidence based, Scientifically proven research, click and READ more!


Membantu Sembuh Alami - Alternatif & Penyembuhan Holistik, bukan Pengobatan  Medis. "

"... Obat Leech saliva glands sekresi (SGS) menentukan efek humoral hirudotherapy (lintah obat melukai kulit pasien mengikuti injeksi SGS). 
spesifisitas tinggi biologis protein aktif dalam SGS, seperti hirudin, faktor Xa inhibitor, triptase inhibitor, dll, menentukan keberhasilan pengobatan yang dilakukan oleh lintah obat. " Girudo-Med Bio-Factory, Lyubetsy, Rusia. 2007



Memang benar apa yang dikatakan Benjamin Franklin,
                         
 "Satu ons pencegahan bernilai satu pon pengobatan."

Hirudotherapy sebagai Penghargaan Terapi Alam dalam Kehidupan Wanita ...

Gambar

Hirudotherapy, non-invasif, non-bedah, ADALAH JAWABANNYA UNTUK: endometriosis,
kista, menstruasi tidak teratur, menopause, infertilitas, selulitis, penurunan berat badan, disfungsi sistem kekebalan tubuh, radang, fibromyalgia, varises, spider veins, jerawat, rosacea,
sistem limfatik kenajisan, sinus, migrain, vertigo, depresi, wasir, herpes, alami restorasi kulit, alopecia, rambut rontok, eksim, psoriasis, dan lebih banyak masalah ...
Seringkali, apa yang mereka dengar jawaban di kantor dokter --- " PENYEBAB TIDAK DIKETAHUI " ...

Hirudotherapy adalah salah satu modalitas utama dalam terapi alami kontemporer
tanpa APAPUN EFEK SAMPING dan TANPA OBAT terlibat.
ini bio menyembuhkan belum pernah terjadi sebelumnya dengan lintah obat terbuka
sebuah PINTU BARU untuk wanita segala usia !

 Tubuh akan mendapatkan keuntungan tidak hanya dari detoksifikasi
dan pemurnian darah tetapi juga dari peremajaan dilakukan untuk seluruh tubuh.
Zat bioaktif yang sedang diproduksi dalam lintah obat ini
saliva glands sekresi (SGS) yang disuntikkan ke dalam tubuh selama lintah
lampiran yang berlangsung sekitar 30 sampai 45 menit. Namun, PROSES internal yang
terus selama berhari-hari, berminggu-minggu bahkan berbulan-bulan setelah & aplikasi Hirudo medicinalis.
Dibutuhkan Anda pada jurney menuju Homeostasis .....
Maskapai anti-penuaan protein dan substanses, inhibitor seperti Hialuronidase yang meningkatkan viskositas interstisial, atau eglins,
bdelins dan lain-lain (baca di bawah "Hirudosubstances"), membuat perbaikan yang signifikan dalam elastisitas kulit,
 membawa tampilan sehat pada wajah dengan alami "pipi kemerahan" dan meningkatkan tingkat energi.
The Fenomena Hirudotherapy memerlukan melihat lebih dekat untuk menarik perhatian wanita!
      

LEECH THERAPY AROUND THE WORLD

"Helping Nature Heal - Holistic Healing, not Medical Treatment."



Benefits and Effects


Non-Invasive, No Side-Effects! Basically no pain involved! 

Leech saliva contains several bioactive substances, including anti-coagulants, blood-thinner, vaso-dilators, anesthetics, antibiotics (i.e. chloromycetyna), Hyaluronidase, Destabilase, Bdellines,  Eglines, Histamine-like substances, Lipolytic enzymes, Cholesterol esterase, Lipase, Triglyceridase  and many more.

Leech therapy works in such a wide range of applications, (it is still not fully understood) and is based on a combination of multiple effects. -


Hirudotherapy is a complex therapy and is a complementary therapy to the osteopathic medicine - 
   THE CAUSE THERAPY. 

   HIRUDOTHERAPY- through the body detoxification and blood purification, fights specific illnesses and at the same time it makes your immune system  stronger and rejuvenates your body. 

Positive effects:

general reflexogenic, hypotensive, bloodletting, decongestion, antiatherosclerosis, and many more!  

Hirudin, a potent anticoagulant in leech saliva, inhibits the conversion of fibrinogen to fibrin, preventing blood from clotting; hirudin is proved to be ten times more effective then heparin.


"...  Medicinal Leech salivary glands secretion (SGS) determines the humoral effect of hirudotherapy (medicinal leeches wounding the patient's skin followed the SGS injection) . High specificity of biological active proteins in SGS, such as hirudin, factor Xa inhibitor, triptase inhibitor, etc., determines the success of treatment done by medicinal leeches. 


Girudo-Med Bio-Factory, Lyubetsy, Russia.


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The Return of the Leech 

"A medical marvel rises from both the swamp and the pages of history.

"...One leech-made molecule, the powerful anticoagulant hirudinwon FDA approval in 1998. Medical researchers are now testing hirudin’s usefulness against angina and heart attacks, and other chemicals from leech saliva are under study."
by Mitchel Leslie, a freelance writer living in Albuquerque




Hirudo Medicinalis ARE FDA approved & classified under medical device since 2004.

"Helping Nature Heal - Holistic Healing, not Medical Treatment."

RUSSIA HIRUDOTHERAPY

Hirudotherapy (leeches) have recently become very popular.Its main advantage - it has a lasting effect of theapplication and no complications, no negative side effects on the body.In medicine, a leech was used in the fourteenth century BC. In the late 80-ies of the twentieth century, almost everypharmacy can be found standing at the counter with a jar of leeches. Leech - is the highest annelid jaw unit, whichfeeds on the blood and in the nature of the attacks on newts, frogs, and wandered into a pond animals.Most of us at the mention of the treatment of leeches frown. To feel the respect for this "animal", let us know moreof him. Outset that it will focus on the medicinal leech, and not on the pond. Of the 400 species of leech inmedicine is applied only two of its subspecies (chemist - Hirudina officinalis and healing - Hirudina medicinalis).Medical leech is grown on special farms and biological completely before applying the "sterile". Use it as a syringe,only once - after the procedure it mortifying. For our health is a miracle of nature gives his life! Teeth have noleeches. Bite leeches do not bite, and puncture. Her mouth a lot of needles, but fear them not worth it. Leechpuncture the skin surface, and immediately relieve herself and disinfecting the site of the bite. It is the medicinalleech saliva has healing properties. It's kind of a cocktail, which contains about 100 useful man enzymes. And thebody of this tiny animal like a biochemical laboratory, a natural pharmacy.
From each bite of a leech can get triple benefit
The reflex effects in the area of the bite - living acupuncture. Leech always automatically selects the placewhere suck. This is a biologically active point corresponds to an affected organ man. The doctor sent her only a little.Leech injects enzymes necessary for man in treatment of diseases, improve immunity, improve metabolism.Leech sucking blood. A small leech sucks from 3 to 5 cubic centimeters of blood. This is 3-5 times moreweight of her body, so the leech is appreciably increased in size. Thus, there is unloading bloodstream, theblood is updated, and increase the body's defenses.

The list of diseases for which treatments shown leeches
Gynecological diseases: fibroid, fibroids, breast, inflammation of the uterine appendages, vulvovaginitis, cervicalerosion, endometriosis, parameters.Urologic diseases: prostatitis, impotence, prostate adenoma, cystitis, urethritis.Cardiovascular disease: coronary heart disease, heart failure, angina, postinfarction conditions, varicose veins,hypertension, ischemia, disruption of the microcirculation.BUsable mouth: periodontal disease, stomatitis, inflammation of mucous.Diseases of the digestive system: gastritis, colitis, cholecystitis, pancreatitis, obesity, cellulite.Diseases of the nervous system:

neuritis, meningitis, brain concussion, stroke,sciatica, radiculitis, polyneuritis, chronic fatigue syndrome.

Kidney diseases: kidney failure, gall-stone disease.
Diseases of the eye: glaucoma, fatigue, reduced vision.Diseases of the musculoskeletal system: arthrosis, arthritis, osteochondrosis, osteoporosis, trauma.

Side effects in treatment of leeches:
disorders of blood coagulation system, pregnancy, persistent reduction of blood pressure.Leech is a living pharmaceutical factory, it injects into the blood through their saliva, a whole range of biologicallyactive substances, and the human body to effectively use them for self-regulation.Hirudotherapy approved by the Russian Ministry of Health and a pharmaceutical regulation of FS-42-702-97. ThisGosstandart drug with a list of indicators and monitoring methods.Today, leeches are used as a therapeutic as well as in plastic surgery and cosmetic industries.

Migrain

Lintah dan Migrain
Ada sebuah teori yang menyatakan migrain disebabkan oleh gumpalan darah kecil yang terbentuk dalam jantung, yang kemudian perjalanan ke otak dan ini mengganggu bekuan darah aliran darah ke otak sehingga menyebabkan gejala-gejala khas dari migrain seperti satu- sisi kepala-sakit, fotofobia, dan mual.Seperti yang Anda mungkin sudah tahu, ada zat yang ditemukan di lintah yang disebut Hirudin. Zat ini adalah antikoagulan, menyebabkan darah menjadi lebih encer, sehingga memungkinkan untuk aliran lebih mudah dan lebih cepat. Hirudin dapat melarutkan bekuan yang kecil yang telah dibentuk dengan mengubah fibrinogen fibrin.

Ini juga diketahui bahwa lintah dapat meningkatkan sirkulasi dalam tubuh, bahkan pada kepala, karena yang mengisap darah hanya cukup untuk mendapatkan aliran darah yang mengalir. Lintah juga dapat menyebabkan vasodilatasi, yang berarti kapal melebar, sehingga menurunkan tekanan pada dinding pembuluh-pembuluh darah, meningkatkan aliran darah.
Sirkulasi darah yang baik sangat penting! Di daerah yang menyakitkan, itu mutlak diperlukan, terutama di tempat-tempat seperti otak dan menggunakan lintah bukan obat untuk migrain lebih sehat. Untuk satu hal, obat dapat memiliki efek samping yang serius seperti lintah yang, jika ditangani dengan benar, relatif aman dan tidak memiliki efek samping yang berkepanjangan.

Obat, penghilang rasa sakit terutama kuat seperti narkotika, dapat kecanduan, jadi mereka tidak dianjurkan jika memungkinkan.Sering menggunakan obat tertentu juga dapat menyebabkan ketergantungan dan peningkatan dalam toleransi, yang berarti waktu berikutnya Anda sakit, Anda mungkin memerlukan dosis yang lebih tinggi dan saat Anda mungkin menyadari, dosis lebih tinggi obat dapat menjadi racun bagi tubuh Anda.

Zat lain dalam air liur lintah yang dikenal untuk membantu menghidupkan kembali migrain adalah anestesi alami yang dilepaskan setelah melampirkan sendiri dan dapat sangat meringankan ketidaknyamanan. Jika Anda lebih suka memiliki lintah di kepala Anda daripada sakit kepala, maka terapi lintah mungkin adalah hal untuk Anda.



Lintah adalah makhluk indah, meski memiliki reputasi mereka yang sedikit - oke, terlalu menjijikkan banyak orang, mereka masih membuktikan menjadi makhluk membantu! Invertebrata yang luar biasa ini telah menemukan cara untuk membuat kita bahagia dan pada saat yang sama menjaga diri bahagia. Ini hubungan yang saling menguntungkan, sehingga Anda benar-benar harus bertanya-tanya mengapa kebanyakan orang membenci mereka begitu banyak.

Endometriosis

Terapi Lintah dan Endometriosis


Telah ditemukan bahwa terapi lintah sangat bermanfaat bagi wanita yang menderita Endometriosis.

Penyebab nyeri pada Endometriosis adalah disebabkan oleh bekuan darah menempel pada dinding rahim serta pembengkakan daerah, racun perangkap lebih lanjut bahwa dapat sangat meningkatkan rasa sakit.

Air liur di lintah kaya dengan enzim yang dapat mencegah pengentalan darah yang menyebabkan pembekuan darah. Setelah enzim telah dibubarkan gumpalan darah dan dipulihkan aliran darah ke normal rahim, racun yang memerah pergi.
Senyawa lain yang penting dalam air liur lintah adalah anti-inflamasi enzim, yang membantu dalam pengurangan peradangan. Setelah reda peradangan, darah dapat mengalir bebas ke dalam pembuluh, yang selanjutnya melebar oleh agen vasodilator dalam air liur lintah itu.

Ada juga agen antibakteri dalam air liur lintah, yang lebih melindungi rahim dan daerah sekitarnya dari infeksi bakteri, yang juga dapat menyebabkan rasa sakit dan pembengkakan.


Terapi Lintah untuk Hepatitis

Menggunakan Terapi Lintah untuk Hepatitis

Hati adalah organ yang sangat penting, tidak hanya berfungsi untuk menyaring racun dari tubuh kita, tetapi juga menghasilkan enzim penting, bertindak sebagai tempat penyimpanan vitamin dan nutrisi dan membantu menjaga keseimbangan.

Apa Tanda dan Gejala Hepatitis?

Tanda dan gejala hepatitis bervariasi, tergantung pada penyebab peradangan hati. Beberapa orang mengalami gejala seperti flu, muntah, mual atau hilangnya nafsu makan dan diare. Kelemahan tubuh secara umum dapat dirasakan, serta nyeri otot atau nyeri pada sisi kanan tubuh di bawah tulang rusuk tersebut. Orang yang menderita hepatitis jangka panjang dapat memiliki yang berbeda menguningnya kulit dan mata; pada kenyataannya, ada banyak tanda dan gejala, tergantung pada jenis hepatitis.

Apa Penyebab Hepatitis?

Ada banyak hal yang bisa menyebabkan hepatitis, tetapi virus yang paling umum. Virus dapat ditularkan ketika ingests individu yang terkontaminasi makanan atau air, mengalami pertukaran darah atau ketika individu memiliki seks tanpa kondom dengan pasangan yang terinfeksi. Obat pecandu yang berbagi jarum dengan pecandu lain juga rentan terhadap hepatitis.

Selain virus yang dapat menyebabkan hepatitis, alkohol juga dapat mengembangkan hepatitis alkoholik, di mana hati menjadi meradang karena jumlah alkohol yang dikonsumsi berlebihan.Hepatitis alkoholik dapat menyebabkan sirosis hati yang disebabkan oleh jangka panjang konsumsi alkohol.

Ada juga sejumlah obat dan obat-obatan yang dapat merusak hati bila digunakan selama periode waktu yang panjang, misalnya beberapa obat antihipertensi, antibiotik dan obat antidepresi dapat menyebabkan beberapa peradangan hati.

Apakah Pengobatan Alternatif untuk Hepatitis?

Terapi lintah telah digunakan dalam pengobatan banyak penyakit selama ribuan tahun.
Sebuah pasokan darah yang sehat diperlukan untuk melawan infeksi dan peradangan pada hati dan enzim bermanfaat yang ditemukan dalam air liur lintah termasuk enzim anti-inflamasi yang membantu mengurangi pembengkakan serta histamin seperti enzim yang bertindak untuk vasodilate pembuluh darah, lebih meningkatkan aliran darah. Ada juga komponen antibakteri dalam air liur lintah yang membantu melawan penyakit.

Mengobati Penyakit Gusi Melalui Terapi Lintah

Gusi sehat dan Penyakit gusi

Penyakit gusi adalah salah satu masalah yang paling umum yang diderita oleh semua usia, terutama jika kebersihan gigi ketat tidak diikuti.

Faktor-faktor yang Mempengaruhi Penyakit Gusi

Salah satu faktor utama yang dapat meningkatkan perkembangan penyakit gusi adalah pertumbuhan bakteri. Sebagaimana dinyatakan di atas, kesehatan gigi yang buruk menyebabkan penumpukan plak dan karang gigi, meningkatkan pertumbuhan bakteri yang menyebabkan kerusakan gigi, bau mulut, infeksi gusi dll

Orang yang memiliki sistem kekebalan tubuh yang rendah juga berisiko lebih besar mengembangkan penyakit gusi karena tubuh rentan terhadap infeksi.

Penyakit juga dapat meningkatkan risiko mengembangkan penyakit gusi. Diabetes, misalnya dapat memperburuk kondisi yang sudah ada sebelumnya penyakit gusi karena kadar gula darah terkendali dan peningkatan viskositas darah yang beredar, yang menghambat penyembuhan, agen sehingga diperlukan (seperti nutrisi) untuk proses penyembuhan untuk benar mengambil tempat yang tidak disampaikan kepada terinfeksi dan meradang situs.

Faktor lain yang dapat menyebabkan penyakit gusi stres dan ketidakseimbangan hormon serta obat bahwa seorang individu mengambil.

Tanda dan Gejala Penyakit Gusi

Gusi Sehat

Indikator yang paling umum dari penyakit gusi adalah gingivitis atau radang gusi. Seseorang yang memiliki radang gusi biasanya akan melihat pembengkakan pada gusi, rasa tidak enak di mulut, napas buruk dan beberapa perdarahan pada gusi. Kerusakan lebih lanjut jaringan dibawa oleh produksi bakteri enzim dan racun, memperlihatkan akar gigi berlubang atau menciptakan yang baru.

Pengobatan Penyakit Gusi

Pengobatan yang paling umum untuk penyakit gusi adalah antibiotik, yang mengobati infeksi yang disebabkan oleh bakteri.Obat anti inflamasi juga diresepkan untuk mengurangi peradangan dan pembengkakan. Kursus berikutnya tindakan adalah scaling dan penghapusan plak.

Terapi Lintah untuk Penyakit Gusi

Penyakit Gusi

Lintah dikenal untuk menghasilkan enzim yang bermanfaat banyak dan telah digunakan selama bertahun-tahun untuk secara efektif mengobati penyakit gusi dan mempercepat penyembuhan. Agen antikoagulan meningkatkan aliran darah di gusi, membantu flush racun dan memungkinkan pengiriman nutrisi ke daerah yang terkena. Para agen antikoagulan juga bekerja keajaiban dalam melarutkan bekuan darah yang dapat terbentuk dalam gusi.

Komponen menguntungkan lainnya adalah agen anti-inflamasi, yang mengurangi pembengkakan dan peradangan gusi. Air liur lintah juga mengandung komponen antibakteri yang membantu dalam mengurangi pertumbuhan bakteri.





Curr Top Neurol Psychiatr Relat Discip. Vol 18, No. 3, September 2010 51
Pospelova at al.
CASE REPORT
UDC 616.133-08
HIRUDOTHERAPY IN THE TREATMENT OF BILATERAL INTERNAL CAROTID
ARTERY OCCLUSION: CASE REPORT
HIRUDOTERAPIJA U TERAPIJI BILATERALNE KAROTIDNE OKLUZIVNE BOLESTI:
PRIKAZ SLUČAJA
Maria L. Pospelova1, Oleg D. Barnaulov2
Abstract: We present a case of a 67-year-old man, who had two ischemic strokes, fi rst with a right hemiparesis
and sensory aphasia, second with signs of brain stem damage. Magnetic resonance angiography and
ultrasonography confi rmed bilateral occlusion of internal carotid arteries. Computed tomography revealed
multiple ischemic lesions of the brain. Having had contraindications for aspirin due to duodenal ulcer, the
patient was initially and aft erwards regularly treated with hirudotherapy. His general medical condition
was later stable, while neurological defi cit almost completely improved. During the eleven-year follow-up,
the patient has had only one transient ischemic attack, otherwise without any complaints. Atherosclerotic
changes have been stable, as well as the parameters of platelet function.
Key words: hirudotherapy, internal carotid artery occlusion.
Sažetak: Prikazujemo slučaj muškarca starog 67 godina sa dva ishemijska moždana udara: prvi sa desnostranom
piramidnom slabošću i senzornom afazijom, drugi sa slikom oštećenja moždanog stabla. Magnetno-
rezonantnom anigiografi jom i ultrazvukom utvrđena je obostrana okluzija unutrašnjih karotidnih
arterija. Kompjuterizovanom tomografi jom utvrđene su multiple bilateralne ishemijske lezije mozga.
Obzirom da boluje od čira na dvanaestopalačnom crevu, kao i na to da odbija hirurški tretman, pacijent
je inicijalno, kasnije i hronično u redovnim seansama, lečen hirudoterapijom. Njegovo opšte zdravstveno
stanje u daljem toku praćenja bilo je stabilno, a neurološki defi cit se gotovo u potpunosti povukao. Tokom
11 godina redovnih neuroloških kontrola, pacijent je imao jedan tranzitorni ishemični atak, bez drugih
neuroloških tegoba. Aterosklerotske promene na krvnim sudovima su sve vreme stacionarne, kao i parametri
trombocitne funkcije.
Ključne reči: Hirudoterapija, okluzija unutrašnjih karotidnih arterija
1 Unit of Neurology, Institute of the Human Brain, Russian Academy of Sciences, Saint-Petersburg, Russia.
pospelovaml@mail.ru.
2 Institute of the Human Brain, Russian Academy of Sciences, Saint-Petersburg, Russia
Correspondence to: Maria L. Pospelova, MD, PhD, Unit of Neurology, Institute of the Human Brain, Russian
Academy of Sciences, Saint-Petersburg, Russia. E-mail: pospelovaml@mail.ru.
* Received: May 26, 2010; accepted: September 9, 2010.
52 Curr Top Neurol Psychiatr Relat Discip. Vol 18, No. 3, September 2010
Pospelova at al.
INTRODUCTION
Patients with stenoses and occlusions of internal
carotid arteries (ICA) and intracranial arteries are
classifi ed as having a high risk of stroke. Population-
based studies have showed that 30% -50% of
ischemic episodes, both permanent and temporary,
are complications of atherosclerotic plaques
(1). In asymptomatic ICA stenosis of 50-99%, the
risk of cerebral ischemia is 2 - 5.2% per year and
increases in symptomatic hemodynamically signifi
cant stenosis to 8.5% per year, while symptomatic
ICA occlusions bear risk of around 11% per
year (2,3).
Th e eff ects of hirudotherapy in the treatment of
patients with stenosis or occlusion of cerebral arteries
and internal carotid arteries have not been
studied.
CASE REPORT
We present a case of a 67-year-old man who had
an ischemic stroke with right hemiparesis and
sensory aphasia. Two months aft er the initial ischemic
event he was again medically observed,
complaining of being unstable, clumsy in the right
extremities, having diffi culty in word fi nding,
with general slowness of movements, and occasional
headaches. On physical examination, he had
sensory aphasia, nystagmus to the side, left facial
palsy and hypoesthesia of the left part of the face.
Mild pyramidal palsy of the right side of the body
was evident, as well as the presence of pathological
cerebellar signs. He had had hypertension for
17 years, ischemic heart disease (acute cardiac infarction
two years before the stroke) and duodenal
ulcer.
On computed tomography, multiple bilateral ischemic
lesions of the brain were observed. Magnetic
resonance angiography and duplex scan of
cervical arteries confi rmed the occlusions of both
internal carotid arteries and a stenosis of the left
vertebral artery of more than 60%. Lipidogram
and coagulogram were normal. Th e parameters
of functional thrombocyte activity were changed
dramatically: discocytes 72%, disco-echinocytes
21.5%, total number of active thrombocytes 30%,
number of aggregated thrombocytes 26.5%, number
of small aggregates 18%, number of medium
and large aggregates 0.8. He scored 0.45 on Zung
anxiety scale (4), and 19 on Beck’s depression inventory
(BDI), indicating a mild depression (5).
Th e patient was off ered extra-intracarotid anastomosis,
which he refused. Aspirin treatment being
contraindicated, twelve sessions of hirudutherapy
were carried out. During the treatment the patient
was taking dypiridamole and antihypertensives.
Aft er hirudotherapy the patient noticed that
the headaches became less frequent and stability
when walking improved. His arterial pressure stabilized.
Th ere were no signifi cant changes in neurological
status, and the depression parameters
improved (17 points on BDI).
Th e parameters of functional platelet activity partially
normalized: number of discocytes increased
to 92% and normalized, number of disco-echinocytes
decreased to 13.5% and normalized, total
number of active thrombocytes decreased to
22.5%, number of aggregated thrombocytes decreased
to 9%, number of small aggregates normalized
at the ratio of 0.2%, number of medium
and large aggregates also returned to normal. On
the ultrasound follow- up study cerebral blood
fl ow was compensated without any signs of progression.
Further on, the patient has been under medical
observation for 10 years. Th e courses of hirudotherapy
have been carried out almost regularly in
the regimen of two times a month, with a threemonth
break in the summer. Th e patient has not
been taking any drugs apart from dypiridamole
and enalapril. For the last 9 years, he has had only
one transitory ischemic attack. Th e patient has
been neurologically stable with mild right-sided
hemiparesis and his headaches got milder.
Ultrasonographic studies of cervical arteries have
been performed annually so far, showing no progression
of atherosclerotic plaques. Platelet functional
activity normalized completely by the third
course of hirudotherapy.
Curr Top Neurol Psychiatr Relat Discip. Vol 18, No. 3, September 2010 53
Pospelova at al.
CONCLUSION
Bilateral occlusions of the cervical arteries bear rather
pessimistic prognosis concerning outcome
and repeated ischemic events. Standardized treatment
is non-specifi c and includes treatment of
the risk factors and prevention of stroke (6). We
successfully treated hypertension in our patient
with regular cardiological follow up. Due to his
contraindications we used dypiridamole and hirudotherapy
as a preventive treatment, with regular
controls of coagulation and platelet function parameters.
Th is approach proved eff ective concerning
the patient’s long-term general medical condition
and neurological state.
Despite its well known potential therapeutical effects,
hirudotherapy has not been studied in controlled
clinical trials. We proved its benefi cial effects
on platelet parameters in a small study, however
further research is required. Th e case reported
above gives practical evidence of possible positive
long-term therapeutical eff ects of hirudotherapy,
supporting our enthusiasm on this issue.
Financial Disclosure: Th e authors have nothing
to report
REFERENCES
1. Pinto A, Tuttolomondo A, Di Raimondo D,
Fernandez P, Licata G. Cerebrovascular risk factors
and clinical classifi cation of strokes. Semin Vasc Med.
2004;4(3):287-303.
2. Inzitari D, Eliasziw M, Gates P, Sharpe BL, Chan
RK, Meldrum HE, Barnett HJ. Th e causes and risk of
stroke in patients with asymptomatic internal-carotidartery
stenosis. North American Symptomatic Carotid
Endarterectomy Trial Collaborators. N Engl J Med.
2000;342(23):1693-700.
3. Zung WW. A self-rating depression scale. Arch
Gen Psychiatry. 1965;12:63-70.
4. Beck AT, Ward CH, Mendelson M, Mock J,
Erbaugh J. An inventory for measuring depression.
Arch Gen Psychiatry. 1961;4:561-571.
5. Adams HP Jr, Adams RJ, Brott T, del Zoppo GJ,
Furlan A, Goldstein LB, et al. Stroke Council of the
American Stroke Association. Guidelines for the
early management of patients with ischemic stroke:
A scientifi c statement from the Stroke Council of the
American Stroke Association. Stroke 2003; 34:1056-
1083.
Penerimaan Pasien Seperti prosedur kesehatan yang paling meningkatkan dan medis, sikap pasien terhadap penggunaan lintah tergantung pada keahlian terapist dalam menjelaskan dengan jelas proses. Ini dapat membantu untuk menyebutkan bahwa prosedur ini usia tua adalah cukup menyakitkan terutama karena daerah yang akan dirawat biasanya denervated, lintah menghasilkan anestesi nya sendiri. Dalam kebanyakan kasus pasien reseptif sangat baik. Lintah memiliki pengaruh lokal dan umum pada organisme seseorang: - Pengaruh lokal disertai dengan pendarahan pada titik gigitan, gatal dan kemerahan kulit, dan peradangan kemungkinan kelenjar getah bening. Aplikasi dan pelumasan dengan salep 'Hiruda' memberikan bantuan yang cepat dari gatal. Jika gatal berlanjut, pelumasan dengan salep harus diterapkan 2-3 kali per hari. - Reaksi umum disertai dengan peningkatan atau penurunan dalam suasana hati dan keadaan umum kesehatan. Orang biasanya menjadi lebih tenang, tidur lebih baik, dan cukup bereaksi terhadap masalah-masalah kehidupan. Dalam beberapa kasus setelah prosedur gemetar, mengantuk, lemah, dan peningkatan suhu tubuh dapat muncul. Setiap pertanyaan tidak jelas tentang perubahan kesehatan harus ditujukan langsung kepada konsultan Hirudotherapy, karena hanya penyembuh memiliki pengetahuan khusus tentang Hirudotherapy memadai dapat menilai kondisi dan menyarankan bagaimana seseorang harus berjalan sesuai dengan kondisi. Lintah hanya harus diterapkan oleh seorang konsultan Hirudotherapy atau lintah-praktisi perawat.



Leeches and their microbiota:
naturally simple symbiosis models
Joerg Graf, Yoshitomo Kikuchi and Rita V.M. Rio
Department of Molecular and Cell Biology, University of Connecticut, 91 North Eagleville Rd, Storrs, CT 06269-3125, USA
Strictly blood-feeding leeches and their limited
microbiota provide natural and powerful model systems
to examine symbiosis. Blood is devoid of essential nutrients
and it is thought that symbiotic bacteria synthesize
these for the host. In this review, three distinct leech–
microbe associations are described: (i) the mycetome,
which is the large symbiont-containing organ associated
with the esophagus; (ii) the nephridia and bladders that
form the excretory system; and (iii) the digestive tract,
where two bacterial species dominate the microbiota.
The current knowledge and features of leech biology
that promote the investigation of interspecific interactions
(host–microbe and microbe–microbe) and their
evolution are highlighted.
Model systems for bacteria–animal symbioses
Symbiosis forms a pivotal component in the existence of
many animals and plants by providing a multitude of indispensable
biological functions [1]. The complexity and intimacy
of the majority of these relationships present
difficulties in examining how symbiosis arises, identifying
the mechanisms that contribute to specificity and elucidating
the functional roles of each partner [2].Many established
model systems are either monospecific (in which the host
maintains relations with a single microbial species), artificially
reconstituted from far more complex associations, or
toomultifaceted to reveal underlyingmechanisms [3,4]. The
study of these pioneering systems has resulted in exciting
discoveries but to assess how widely applicable these findings
are, a comparative approach using a wide range of
model systems is required. The medicinal leech is a promising,
bona fide model for symbiotic associations and has a
microbial community of limited complexity to facilitate
examination of fundamental aspects of interspecific relations
(Box 1). In this review, we describe three distinct
microbe–leech associations found in different leech species:
mycetome, nephridia and bladders, and digestive-tract symbioses.
Aspects of leech biology that promote its application
as a powerful model system for the study of host–microbe
and microbe–microbe interactions will also be highlighted.
Hirudinids: taxonomy, natural history and medicinal
applications
Leeches are fascinating animals that can evoke contradictory
responses. One can observe with amazement the
leech undulating elegantly while swimming or with horror
as its whole body contracts rhythmically while pumping
the blood from an unsuspecting victim. Strictly blood-feeding
leeches are found in the orders Rhynchobdellida, species
of which feed using a tubular proboscis and have a
bacterial-symbiont-containing organ (the mycetome) associated
with the esophagus, and Arhynchobdellida, which
feed using toothed jaws and lack a mycetome [5]. Recent
molecular studies have shown that the medicinal leech,
although usually marketed as Hirudo medicinalis
(Hirudinea: Arhynchobdellida: Hirudinidae), probably
consists of a complex of at least three species: Hirudo
orientalis, the commonly sold Hirudo verbana and the
rare H. medicinalis [6–9]. Hirudinids are hermaphrodites
that deposit cocoons containing multiple eggs at the
land–water interface [5]. Juvenile leeches reportedly consume
their first blood meal from amphibians whereas
successive meals can be obtained from amphibians, fish
or mammals [5,10]. The ingested blood is quickly modified
in the crop by the discharge of water and osmolytes
through the multiple pairs of bladders that lie near the
lateral ceca of the crop (Figure 1). The erythrocytes are
stored apparently physically intact within the crop for up
to six months. The actual digestion of the blood meal and
absorption of nutrients is thought to occur in the much
smaller intestinum (located between the last pair of crop
ceca), which combines some functions of the intestine and
rectum (Figure 1).
The remarkable abilities of the medicinal leech to consume
five to six times its body weight in a single blood meal
and to release an array of potent chemicals with its saliva
has led to an unexpected resurgence of the use of leeches in
modern medicine [5]. Recently, the medicinal leech was
approved as a medical device for its bloodletting capabilities
by the Food and Drug Administration of the USA
(http://www.fda.gov/fdac/features/2004/504_leech.html).
In a manner that has yet to be reproduced by pharmaceuticals,
the direct application of H. medicinalis to areas of
acute venous congestion provides a cost-effective and reliable
treatment to ameliorate the postoperative effects
associated with reconstructive surgery [11–13]. Powerful
vasodilators and anti-inflammatory and anticoagulation
molecules have been isolated, characterized and patented
from leech saliva [14,15]. From the microbiological perspective,
an interesting observation originally made in the
1980s was the diagnosis of wound infections caused by
Aeromonas in patients receiving leech therapy [12,16]. The
use of antibiotics before bloodletting usually prevents
these infections. Earlier studies had identified Aeromonas
as the sole digestive-tract symbiont of H. medicinalis. The
Review TRENDS in Microbiology Vol.14 No.8
Corresponding author: Graf, J. (joerg.graf@uconn.edu).
www.sciencedirect.com 0966-842X/$ – see front matter 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.tim.2006.06.009
detection of one culturable symbiont led us to pursue the
feasibility of using the medicinal leech as a naturally
occurring simple model for digestive-tract associations
[17].
Symbiotic associations of leeches
Mycetome symbiosis
The most extreme and intimate examples of interspecific
relationships are intracellular symbioses. In these specialized
associations, leech symbionts are usually harbored
in the cytoplasm of mycetocytes. These are large
specialized cells that typically aggregate into a large
symbiotic organ, which, although it houses bacteria, is
called a mycetome for historical reasons [1]. Important
physiological functions occur within mycetomes, such as
the provision of essential host nutrients (e.g. vitamins
and amino acids). Obligate insect symbionts such as
Wigglesworthia spp. in tsetse flies and Buchnera spp.
in aphids are well characterized by genome sequencing
and elegant functional assays, and currently represent
366 Review TRENDS in Microbiology Vol.14 No.8
Box 1. Advantages of using the leech as a symbiosis model
(i) Inexpensive and easily bred invertebrate host.
(ii) Simple host morphology.
(iii) Limited dietary intake (blood).
(iv) Simple trinary association in the crop.
(v) In the digestive tract, the dominant Aeromonas symbiont is
culturable and amenable to genetic manipulations and reintroduction.
(vi) Aeromonas is also a pathogen, which provides an opportunity to
compare symbiosis and virulence factors in one organism.
Figure 1. Leech internal morphology depicting the structural variety of mycetomes. Drawing of the digestive tract and excretory organs based on the medicinal leech. The
inset shows schematic illustrations of mycetome morphological variations: (i) basic structure lacking mycetocytes in Hirudo verbana; (ii) large mycetocytes form a tube-like
structure in Placobdelloides spp.; (iii) a pair of pear-shaped mycetomes join the esophagus at their narrowed ends in Placobdella spp.; (iv) two pairs of large bulbous sacs
connected to the esophagus by narrow ducts comprise the mycetomes in Haementeria species. Figure redrawn, with permission, from Refs [21] and [43]. (2006)
American Society for Microbiology.
www.sciencedirect.com
model systems for intracellular symbiosis in invertebrates
[18].
In leeches, mycetomes occur in the order Rhynchobdellida
(mainly in the family Glossiphoniidae [1,5]) but not in
the order Arhynchobdellida, which includes the medicinal
leech. Three distinct mycetome morphotypes have been
described in glossiphoniid leeches [5]: large mycetocytes
that surround the esophagus lumen in Placobdelloides spp.
[Figure 1, part (ii)]; a pair of pear-shaped blind sacs in
Placobdella spp. [Figure 1, part (iii)]; and two pairs of large
bulbous sacs connected to the esophagus by narrow ducts
in Haementeria spp. [Figure 1, part (iv)].
Recent molecular phylogenetic analyses based on 16S
rRNA gene sequences have revealed that the symbionts of
Placobdelloides spp. and Haementeria spp. belong to the g-
3 subdivision of the Proteobacteria, whereas the symbionts
of Placobdella spp. belong to the Rhizobiaceae family in the
a-Proteobacteria [19–21]. The g-proteobacterial leech symbionts
cluster with the insect symbionts Buchnera spp. and
Wigglesworthia spp., although the symbionts of Placobdelloides
spp. and Haementeria spp. do not form a monophyletic
group (Figure 2) [21]. These phylogenetic
relationships suggest that the evolution of mycetome symbioses
in glossiphoniid leeches has occurred multiple
times, which is also supported by the morphological diversity
of this organ or, alternatively, suggests that the current
symbionts replaced ancestral ones.
Rickettsia symbionts
In addition to the mycetome symbionts, intracellular symbionts
that belong to the family Rickettsiaceae (a-Proteobacteria)
were discovered in three Japanese glossiphoniid
species [22,23]. The Rickettsiaceae are well-described parasitic
and/or commensalistic bacteria that can be isolated
from a wide range of animals [24]. Unlike the mycetome
symbionts, rickettsial symbionts exhibit wider tropism:they
are detected in various leech tissues such as the epidermis,
esophagus and salivary glands and exhibit a heterogeneous
distribution within host populations [22].
Intracellular symbiont transmission
Although it remains unclear whether the leech intracellular
symbionts are transovarially transmitted, multiple
observations support a transmission from parent to
offspring through the egg. In Placobdelloides spp., the
same microbial species found in adult mycetomes were
also detected in 100% of examined eggs [19]. Rickettsial
symbionts were also consistently detected in the eggs of
infected leeches [22]. Finally, Placobdella parasitica juveniles
that had never received a blood meal were shown to
harbor already large symbiont populations in their mycetomes
[20]. The inability to culture the mycetome symbionts
suggests specialization towards an intracellular
lifestyle, possibly because of their stable inheritance
through host lineages and associated genome reduction
(reviewed in Ref. [25]). The stability of these associations
supports their indispensable roles in host biology.
Nephridia and bladder symbiosis
The seminal paper by Bu¨ sing et al. [26] described the presence
of two morphologically distinct bacteria associated
within the nephridia and bladders, the excretory organs of
H. medicinalis (Figure 1). The nephridia serve to remove
waste products from the haemocoelomic fluid and recover
salts from the primary urine. The urine and nitrogenous
waste in the form of ammonia are stored in the bladder
until released [5]. 16S rRNA gene sequencing was used to
identify the symbionts residing in the nephridia and
bladders as the intracellular Ochrobactrum, an a-proteobacterium
related to Sinorhizobium (Figure 2), and
an extracellular Flavobacterium, a member of the
Bacteroidetes.*,y Furthermore, bacteria were detected
microscopically in the bladder of embryos, which strongly
supports the hypothesis of vertical transmission [27].
Although their functional roles remain uncertain, experimental
evidence suggests that the bacteria contribute to the
degradation of nitrogenous waste [26].
Digestive-tract symbiosis
The digestive-tract microbiota of hirudinid leeches is of
particular interest because of the medicinal application of
these leeches and their lack of mycetomes (unlike the
glossiphoniid leeches, in which the hallmark mycetomes
are presumed to perform an essential function for the host).
The first microbiologists who examined the hirudinid
digestive-tract microbiota in the 1950s reported the surprising
presence of a single, b-hemolytic bacterial species
that released many proteolytic enzymes [26]. Combined
with an apparent lack of host digestive enzymes in the
crop, these early investigators posed three possible functions
for the gut symbiont: (i) aiding in the digestion of
the blood meal; (ii) providing essential nutrients; and
(iii) ‘colonization resistance’, in which they function to
prevent colonization by other potentially harmful microorganisms.
More recent studies demonstrated the presence
of host-produced proteases in the intestinum, which cast
some doubt on the importance of the bacterial-produced
proteases in digestion [28]. However, the lack of direct
experimental evidence has not ruled out any of these
hypotheses (reviewed in Ref. [29]).
The symbiont was identified as Aeromonas using current
taxonomybut the species identity differed between research
groups [30–33]. Although initially reported as Aeromonas
hydrophila by several investigators, our group identified the
symbionts as Aeromonas veronii biovar sobria using biochemical
tests and 16S rRNA gene sequences [31]. It is
interesting to note that Aeromonas culicicola, which was
isolated from the midgut of female Culex quinquefasciatus
and Aedes aegyptii mosquitoes [34], has recently been
renamed A. veronii [35], suggesting a propensity of this
species to colonize the gastrointestinal tract of blood-feeding
organisms. The differing species identifications probably
reflect the dynamic and complex taxonomy of Aeromonas.
Culture-independent characterization
A limitation of the previous characterizations of digestivetract
microbiota was that the studies were purely culturebased.
It is widely recognized that 99% of microbes are
Review TRENDS in Microbiology Vol.14 No.8 367
* A. Schramm et al., abstract 505, 101st General Meeting of the American Society
for Microbiology, Orlando, USA, 2001.
y J. Graf et al., abstract 478, 100th General Meeting of the American Society for
Microbiology, Los Angeles, USA, 2000.
www.sciencedirect.com
368 Review TRENDS in Microbiology Vol.14 No.8
Figure 2. Phylogenetic tree based on the sequence of the 16S rRNA gene (neighbor-joining analysis with a Kimura’s correction; aligned 1050 bp). Bacterial phyla are shown
on the right. Leech symbionts are represented in bold and red text and their location within the host is stated in parentheses. The mycetome types in red text correspond to
those in Figure 1. Bootstrap values higher than 50% are depicted at the nodes. The scale bar represents 0.1 changes per base.
www.sciencedirect.com
presently unable to be cultivated [36,37]. Technological
developments in the culture-independent profiling of
microbial community complexity and diversity have
revealed a plethora of novel cohabiting microorganisms
that far outnumber the culturable organisms. These developments
have also greatly advanced our understanding of
the residential microbiota of digestive tracts, to which
essential roles in host biology have been attributed, such
as the provision of essential nutrients (reviewed in Ref.
[3]), development [38], energy balance [39] and the priming
of immunity [40,41]. Interesting parallels in the digestivetract
microbial composition among various host species
have been described [39,42], which raises the question of
whether their functional roles are universal or tailored to
the different hosts.
A recent culture-independent study discovered the presence
of a second symbiont in the crop that we have been
unable to cultivate in the laboratory [43]. The 16S rRNA
gene sequence indicates that it is a relative of Rikenella,
members of the Bacteroidetes that have been found in
several different digestive tracts. An exciting aspect about
the discovery of a second symbiont is the natural occurrence
of a restricted – but not monospecific – digestive-tract
microbiota, which will enable us not only to investigate
microbe–host interactions but also to investigate the interaction
between different microbial species. Relevant features
of the Aeromonas and Rikenella species that
comprise the basic two-member microbial community in
the crop are discussed here.
Aeromonadaceae
Aeromonas species are motile, Gram-negative rods that
belong to the family Aeromonadaceae [44]. A widely noted
characteristic of Aeromonas spp. is the production of a
large number of exported hydrolytic enzymes that could
aid in the breakdown of nutrients inside the digestive tract
of animals. This family currently consists of 17 facultatively
anaerobic species that occupy a spectrum of niches
ranging from free-living occupants of freshwater to opportunistic
pathogens of fish, amphibians and humans
(reviewed in Ref. [45]), and to the digestive tract symbionts
of a variety of blood feeders including mosquitoes, the
medicinal leech and the vampire bat [17,31,34,46]. Three
Aeromonas species including A. veronii are associated with
a range of maladies including wound infection, septicemia
and diarrhea in humans [45]. Therefore, A. veronii seems to
have an innate ability to infect the digestive tracts of
multiple host species where manifestations of infection
span from pathogenesis to cooperative.
Rikenellaceae
The recurring identification of 16S rRNA gene sequences
that belong to the Rikenellaceae from a wide range of
digestive tracts is suggestive of both evolutionary adaptation
and physiological contributions towards digestivetract
ecosystems (Figure 2). All of the isolates or sequences
were obtained from a variety of gastrointestinal environments
including goat rumen, termite gut, murine cecum
and the human colon [39,47,48]. Knowledge of the
Rikenella genus is further obscured because of their
fastidious growth and obligate anaerobic requirements.
A novel Rikenella species, related to Rikenella microfusus
isolated from the cecal and fecal samples of Japanese fowl
[49], has been identified as one of two dominant residents
of the medicinal leech crop [43]. An intriguing question is
whether the leech crop is sufficiently anaerobic to support
the growth of the Rikenella symbiont or if A. veronii
has to remove residual oxygen from the ingested blood
meal to prime the microenvironment for the Rikenella
symbiont.
The presence of a basic two-member microbial community
in the leech digestive crop provides an exciting and
unique opportunity to further extend knowledge of
Rikenella species, albeit indirectly. For example, differential
antibiotic regimens might be used selectively to clear
the Aeromonas or Rikenella symbiont. The reintroduction
of various concentrations of A. veronii and/or isogenic
mutants into the host can reveal whether spatial or quantitative
alterations of the Rikenella population occur by
employing techniques such as fluorescence in situ hybridization
and quantitative PCR. Host fitness assays after
differential antibiotic treatments to examine classical life
history traits such as reproductive output, growth rate and
viability could also prove valuable towards the elucidation
of microbial functional roles.
Factors that contribute to a limited microbial
complexity
Factors that contribute to the unusual simplicity of the
leech digestive symbiosis could be derived from three
sources: the ingested blood, the host and/or the symbiotic
bacteria [17,50,51]. The complement system of vertebrate
blood contains powerful antimicrobial properties [52]. Two
lines of evidence suggest that the ingested complement
system remains active for some time inside the leech
and contributes to the specificity of the microbiota.
Heat-inactivation of the blood before feeding enables
colonization by some bacterial species that were unable to
colonize when fed to the leech in fresh blood [50]. Furthermore,
the importance of the Aeromonas lipopolysaccharide
(LPS) layer in protecting against the antimicrobial properties
of the complement system has been demonstrated [53]
by observing that serum-sensitive Aeromonasmutants with
a defect in their LPS had a dramatically reduced ability to
colonize the leech [51].
Other bacteria such as Pseudomonas aeruginosa and
Staphylococcus aureus were tested for their ability to
colonize the leech digestive tract and were able to persist
inside it but had a dramatically reduced ability to grow,
independent of the activity of the complement system,
which suggests the presence of a second layer of defense
[50]. The discovery of the Aeromonas symbiont led to
speculation that this symbiont might release antimicrobial
compounds [26]. As part of a culture-independent characterization
of the leech digestive system, the microbiota of
the intestinum in which the actual digestion of the blood
occurs was also characterized. The intestinum harbored a
more diverse microbial community with an average of eight
species detected [43]. The microbial community of the
intestinum, similar to the crop, was dominated by the
Rikenella and Aeromonas symbionts. The presence of a
more diverse microbiota despite the presence of the crop
Review TRENDS in Microbiology Vol.14 No.8 369
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symbionts suggests that these two species are not responsible
for inhibiting the growth of microorganisms in the
crop unless this activity is specifically downregulated
within the intestinal environment.
Concluding remarks
Symbiosis is an important driving force of metazoan evolution.
The association of an animal with microorganisms
provides the host animal with new metabolic capabilities –
for example, enabling animals to feed exclusively on blood.
Whereas intracellular symbioses presumably require the
tightest coordination between microbe and host, extracellular
digestive-tract associations are more prevalent and
usually involve more complex microbial communities. This
complexity not only makes understanding the molecular
interactions between symbionts and host difficult but also
complicates the dissection of those interactions between
the bacterial symbionts. Although the general behavior of
bacteria belonging to one species is well understood, we are
still at the early beginnings of understanding how different
species of bacteria interact in a microbial community.
Digestive tracts are an important environment where
microbial interactions are likely to have an important role.
The digestive-tract symbiosis of the medicinal leech with
the two dominant extracellular A. veronii and Rikenellalike
symbionts provides a unique opportunity to investigate
not only microbe–host but also microbe–microbe
interactions in a naturally simple system (Box 2).
Acknowledgements
J.G. would like to thank K. Schopfer for introducing him to the leech
symbiosis. We would like to thank V. Kask for the artwork. The research
in our laboratory is supported by an NSF Career award MCB 0448052
and a grant from the Research Foundation of the University of
Connecticut to J.G. Y.K. is the recipient of a postdoctoral training
fellowship from the Japan Society for the Promotion of Science.
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370 Review TRENDS in Microbiology Vol.14 No.8
Box 2. Future directions
Mycetome symbiosis: The possibility of three distinct origins of this
symbiosis in the Rhynchobdellid leeches makes for exciting
evolutionary developmental biology (‘evo-devo’) studies. The ability
to dissect out these organs and isolate large numbers of symbionts
enables the implementation of genomic and proteomic tools to gain
an insight into their functional significance.
Nephridia and bladders symbiosis: This symbiosis has potential for
being used in comparative physiological studies with the Acidovorax-
like symbionts that are harbored within the nephridia of earthworms,
a terrestrial annelid [54,55]. It would be interesting to
observe whether the functional roles of these phylogenetically
distinct symbionts are similar.
Digestive-tract symbiosis: The combination of molecular genetic
tools for Aeromonas, fluorescence in situ hybridization for the
localization of both Aeromonas and Rikenella and the ability to
remove symbionts from juvenile hosts will provide new understanding
about molecular interactions, functional analyses and
symbiont population dynamics.
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72, 769–775


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