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Evaluating the effects of metronidazole, metformin, and onion extract on GAPDH activity and nitric oxide production in Blastocystis sp. cultures: a biochemical and therapeutic approach

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Gehad A. Basuony, Alshaimaa Hamed, Amal M. Mahfoz, Abdel Wahab M. Mahmoud, Hala Ramadan, Magda Said Ahmed Abdeltawab

A common gut parasite may be vulnerable not only to its usual medicine, but also to a diabetes drug and onion extract. The surprise is that killing it may involve changing its energy system and its chemical surroundings.

Abstract

Background Blastocystis sp. is a highly prevalent anaerobic intestinal protozoan increasingly associated with gastrointestinal disorders. Its survival within the gut microenvironment depends on metabolic pathways such as glycolysis, where glyceraldehyde-3-phosphate dehydrogenase (GAPDH) plays a central role, alongside interactions with nitric oxide (NO) derived from host defenses and surrounding microbiota. The emergence of metronidazole resistance necessitates exploration of alternative therapeutic strategies. Objective To evaluate the in vitro effects of metronidazole, metformin, and Allium cepa (onion) extract on Blastocystis sp. growth, and GAPDH activity and NO levels within the xenic culture medium. Methods Twenty-one Blastocystis-positive stool samples were cultured in Jones’ medium under xenic conditions. Cultures were treated with graded concentrations of metronidazole, metformin, and onion extract. Parasite counts were assessed microscopically, while GAPDH activity and NO levels were quantified using gas chromatography–mass spectrometry (GC–MS)-based analysis. Results All tested agents significantly reduced Blastocystis counts compared with untreated controls (p < 0.05), with metronidazole demonstrating the greatest antiparasitic effect. Significant reductions in NO levels and GAPDH activity were observed across all treatment groups (p < 0.001). Metformin (1000 µg/mL) showed the strongest inhibition of GAPDH activity, whereas metronidazole (500 µg/mL) resulted in the lowest NO levels. Correlation analysis revealed a significant negative association between NO and GAPDH in metronidazole-treated cultures, while a positive correlation was observed with metformin. Conclusion Metronidazole, metformin, and onion extract exhibit significant anti-Blastocystis activity, accompanied by modulation of key metabolic and nitrosative pathways within the microbial milieu supporting the growth

Transcript

A common gut parasite may be vulnerable not only to its usual medicine, but also to a diabetes drug and onion extract. The surprise is that killing it may involve changing its energy system and its chemical surroundings. This gut parasite is widespread, and reports have linked it with digestive problems, although the reasons remain poorly understood.

Its pathogenic potential is closely linked to metabolic adaptability. Lacking classical mitochondria, it relies mainly on glycolysis for energy production, supported by organelles adapted to anaerobic conditions. The central idea is like cutting power to a building: interrupt the system that supplies energy, and the whole operation may weaken.

Here, that key step is carried out by GAPDH, a protein involved in energy production and in the parasite’s interactions with its surroundings. The usual antiparasitic medicine remains widely used, but growing reports of resistance and treatment failure have raised concerns about how well it works.

That concern has encouraged interest in other options. Metformin, a widely used diabetes medicine, has shown effects against microbes and on nitric-oxide pathways. Onion-derived compounds have also shown parasite-fighting and protective effects, giving researchers another possible route to test.

The study therefore tested the usual medicine, metformin, and onion extract against the parasite in laboratory cultures. The focus was not only whether the parasite remained alive, but also whether treatment changed its energy-related activity and nitric-oxide levels in the surrounding culture.

Because the cultures included other gut microbes, the results offer an early picture of how these treatments may alter the wider microbial surroundings, rather than proving a direct effect on the parasite alone. The cultures were treated with different amounts of the usual medicine, metformin, and onion extract.

The researchers then counted the parasites and measured the activity of the key energy-making protein along with nitric-oxide levels. The treatments generally reduced the number of parasites compared with untreated cultures, although one onion preparation did not produce a significant reduction.

In general, stronger drug concentrations reduced the count more effectively, with some exceptions. The usual medicine reduced the parasite count most effectively, followed by metformin and the onion preparations. The spread is widest without treatment and for the weakest onion preparation, while the medicine’s results cluster tightly near zero, revealing both consistency and variability.

All treatments lowered nitric-oxide levels compared with untreated cultures, and the lowest level appeared after the usual medicine. The energy-making activity was highest in untreated cultures, while every tested treatment reduced it. Metformin produced the lowest activity of that energy-making protein.

Taken together, all three treatments reduced the parasite and changed important energy-related and nitric-oxide pathways in the cultured samples. The treatments reduced the number of Blastocystis parasites while also altering key metabolic and nitrosative pathways, offering an early clue that their effects extend beyond parasite counts.

Together, this combined pattern offers exploratory mechanistic insight into potential treatment targets beyond simply eradicating the parasite, although it remains an early laboratory clue. There is an important limit: the cultures contained a mixture of microbes, without a matching parasite-free treated control.

That realistic mixture reflects a gut-like environment, but it also means the reduced energy activity and nitric-oxide levels cannot be assigned to the parasite alone; changes in the surrounding microbes may have contributed. This xenic framework provides a realistic representation of the intestinal environment and a basis for future research on Blastocystis-related immunopathology.

The approach may also provide a translational bridge by repurposing pharmacological and herbal agents that alter local intestinal metabolic and oxidative status. The study was designed as a preliminary exploratory investigation of potential anti-Blastocystis and metabolic drug effects within this experimental framework.

All three tested treatments reduced the parasite in laboratory cultures, while also lowering two linked chemical signals. That points toward possible new treatment clues, but it does not yet prove what will work in people.

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