Platelets mediate the action of diethylcarbamazine on microfilariae

More than 400 million people in the world are infected by filarial parasites leading to a wide range of pathologies. Although introduced in 1947, the mainstay of the therapy and control of the filariases is diethylcarbamazine (N,N-diethyl-4-methyl-1-piperazine carboxamide; DEC), the mode of action of which still remains unknown despite widespread use and intensive laboratory investigations. The marked contrast between an extremely rapid action in vivo and the absence of any significant activity on microfilariae in vitro is unique among chemotherapeutic agents. DEC has been thought to modify the surface layer of the microfilariae and expose them to immunological cell-mediated lysis. This report provides the first evidence that the effect of DEC is mediated by blood platelets with the additional triggering of a filarial excretory antigen (FEA). The killing mechanism is antibody-independent and involves the participation of free radicals.