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Ricci MF, Mazzeti AL, Barbosa JL, Machado FS, Bahia MT, Arantes RME, Souza SR. Profile of interstitial cells of Cajal in a murine model of chagasic megacolon. AN ACAD BRAS CIENC 2024; 96:e20231337. [PMID: 38922281 DOI: 10.1590/0001-3765202420231337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/27/2024] [Indexed: 06/27/2024] Open
Abstract
Disorders of gastrointestinal motility are the major physiologic problem in chagasic megacolon. The contraction mechanism is complex and controlled by different cell types such as enteric neurons, smooth muscle, telocytes, and an important pacemaker of the intestine, the interstitial cells of Cajal (ICCs). The role of ICCs in the progression of acute and chronic Chagas disease remains unclear. In the present work, we investigate the aspects of ICCs in a long-term model of Chagas disease that mimics the pathological aspects of human megacolon. Different subsets of ICCs isolated from Auerbach's myenteric plexuses and muscle layers of control and Trypanosoma cruzi infected animals were determined by analysis of CD117, CD44, and CD34 expression by flow cytometer. Compared with the respective controls, the results showed a reduced frequency of mature ICCs in the acute phase and three months after infection. These results demonstrate for the first time the phenotypic distribution of ICCs associated with functional dysfunction in a murine model of chagasic megacolon. This murine model proved valuable for studying the profile of ICCs as an integrative system in the gut and as a platform for understanding the mechanism of chagasic megacolon development.
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Affiliation(s)
- Mayra Fernanda Ricci
- Universidade Federal de Minas Gerais, Departamento de Patologia, Av. Presidente Antônio Carlos, 6627, Pampulha, 31270-901 Belo Horizonte, MG, Brazil
| | - Ana L Mazzeti
- Universidade do Estado de Minas Gerais, Departamento de Ciências Biomédicas e da Saúde, Av. Juca Stockler, 1130, 37900-106 Passos, MG, Brazil
| | - Joana L Barbosa
- Universidade Federal de Minas Gerais, Departamento de Bioquímica e Imunologia, Av. Presidente Antônio Carlos, 6627, Pampulha, 31270-901 Belo Horizonte, MG, Brazil
| | - Fabiana S Machado
- Universidade Federal de Minas Gerais, Departamento de Bioquímica e Imunologia, Av. Presidente Antônio Carlos, 6627, Pampulha, 31270-901 Belo Horizonte, MG, Brazil
| | - Maria Terezinha Bahia
- Universidade Federal de Ouro Preto, Departamento de Biologia e Ciências Exatas, Campus Morro do Cruzeiro, s/n, Bauxita, 35400-000 Ouro Preto, MG, Brazil
| | - Rosa Maria E Arantes
- Universidade Federal de Minas Gerais, Departamento de Patologia, Av. Presidente Antônio Carlos, 6627, Pampulha, 31270-901 Belo Horizonte, MG, Brazil
| | - Samantha R Souza
- Universidade Federal de Ouro Preto, Departamento de Biologia e Ciências Exatas, Campus Morro do Cruzeiro, s/n, Bauxita, 35400-000 Ouro Preto, MG, Brazil
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2
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Silvestrini MMA, Alessio GD, Frias BED, Sales Júnior PA, Araújo MSS, Silvestrini CMA, Brito Alvim de Melo GE, Martins-Filho OA, Teixeira-Carvalho A, Martins HR. New insights into Trypanosoma cruzi genetic diversity, and its influence on parasite biology and clinical outcomes. Front Immunol 2024; 15:1342431. [PMID: 38655255 PMCID: PMC11035809 DOI: 10.3389/fimmu.2024.1342431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/26/2024] [Indexed: 04/26/2024] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, remains a serious public health problem worldwide. The parasite was subdivided into six distinct genetic groups, called "discrete typing units" (DTUs), from TcI to TcVI. Several studies have indicated that the heterogeneity of T. cruzi species directly affects the diversity of clinical manifestations of Chagas disease, control, diagnosis performance, and susceptibility to treatment. Thus, this review aims to describe how T. cruzi genetic diversity influences the biology of the parasite and/or clinical parameters in humans. Regarding the geographic dispersion of T. cruzi, evident differences were observed in the distribution of DTUs in distinct areas. For example, TcII is the main DTU detected in Brazilian patients from the central and southeastern regions, where there are also registers of TcVI as a secondary T. cruzi DTU. An important aspect observed in previous studies is that the genetic variability of T. cruzi can impact parasite infectivity, reproduction, and differentiation in the vectors. It has been proposed that T. cruzi DTU influences the host immune response and affects disease progression. Genetic aspects of the parasite play an important role in determining which host tissues will be infected, thus heavily influencing Chagas disease's pathogenesis. Several teams have investigated the correlation between T. cruzi DTU and the reactivation of Chagas disease. In agreement with these data, it is reasonable to suppose that the immunological condition of the patient, whether or not associated with the reactivation of the T. cruzi infection and the parasite strain, may have an important role in the pathogenesis of Chagas disease. In this context, understanding the genetics of T. cruzi and its biological and clinical implications will provide new knowledge that may contribute to additional strategies in the diagnosis and clinical outcome follow-up of patients with Chagas disease, in addition to the reactivation of immunocompromised patients infected with T. cruzi.
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Affiliation(s)
| | - Glaucia Diniz Alessio
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Estefânia Diniz Frias
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Policarpo Ademar Sales Júnior
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Márcio Sobreira Silva Araújo
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Olindo Assis Martins-Filho
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Andréa Teixeira-Carvalho
- Integrated Biomarker Research Group, René Rachou Institute, Fiocruz Minas, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Helen Rodrigues Martins
- Department of Pharmacy, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
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3
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Hasslocher-Moreno AM, Saraiva RM, da Silva TL, Xavier SS, de Sousa AS. Exploring the Historical Background and Clinical Implications of Electrocardiogram in the Context of Chagas Disease Research. Rev Soc Bras Med Trop 2023; 56:0506. [PMID: 38126377 PMCID: PMC10726969 DOI: 10.1590/0037-8682-0506-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Chagas disease (CD) remains one of the most significant endemic diseases in Latin America. Approximately 30% of individuals with CD develop the cardiac form, the main determinant of morbidity and mortality, which is characterized by typical electrocardiogram (ECG) changes caused by chronic chagasic cardiopathy (CCC). This review accentuates to how crucial it is for research teams and reference centers that treat patients with CD to standardize ECG in CCC. This was a non-systematic review of the literature. ECG is the most widely used examination in the diagnosis and evaluation of CCC, and it is also employed in epidemiological surveys, risk stratification for cardiovascular events and death, and monitoring the clinical progression of the disease. Carlos Chagas and Eurico Villela published the first work addressing CCC in 1922. Other works followed, including the study by Evandro Chagas' which was the first to perform ECG in CD, culminating in Francisco Laranja's seminal work in 1956. Since the 1980s, standardizations and ECG reading codes for CD have been established. This standardization aimed to code complex arrhythmias and characteristic ventricular conduction disorders and standardize ECG readings for clinical and epidemiological studies in CD. Nearly all existing electrocardiographic abnormalities can be found in CD, with a predominance of abnormalities in the formation and conduction of cardiac stimuli. The complex and heterogeneous substrate of CD with varied electrocardiographic manifestations poses a significant challenge when comparing studies involving patients with CCC, emphasizing the need for ECG standardization in CD.
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Affiliation(s)
- Alejandro Marcel Hasslocher-Moreno
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroRJBrasil
| | - Roberto Magalhães Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroRJBrasil
| | - Telêmaco Luiz da Silva
- Cardion - Cardiologia Preventiva e Avançada, Uberlândia, MG, Brasil.Cardion - Cardiologia Preventiva e AvançadaUberlândiaMGBrasil
| | - Sergio Salles Xavier
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroRJBrasil
| | - Andréa Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroRJBrasil
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de JaneiroFaculdade de MedicinaRio de JaneiroRJBrasil
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4
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Alhassani Z, Hennawi HA, Sevella P, Mena CS, Coppola K. Chagas disease-induced ventricular tachycardia: A case report. Glob Cardiol Sci Pract 2023; 2023:e202303. [PMID: 36890840 PMCID: PMC9988298 DOI: 10.21542/gcsp.2023.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/10/2023] [Indexed: 02/08/2023] Open
Abstract
Chagas disease is a protozoal infection caused by Trypanosoma cruzi (T. cruzi) that can affect many organ systems. Chagas cardiomyopathy tends to affect 30% of infected individuals. Cardiac manifestations include myocardial fibrosis, conduction defects, cardiomyopathy, ventricular tachycardia, and sudden cardiac death. In this report, we discuss a 51-year-old male who presented with recurrent episodes of non-sustained ventricular tachycardia refractory to medical therapy.
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Affiliation(s)
- Zaineb Alhassani
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA, USA
| | - Hussam Al Hennawi
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA, USA
| | - Prerana Sevella
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA, USA
| | | | - Kathleen Coppola
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA, USA
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5
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Pinto L, Schijman AG, Alonso-Padilla J, Lozano D, Torrico MC, Gamba P, Torrez M, Lozada V, Cartagena K, Sanchez J, Torrico F, Gascon J. Molecular detection and parasite load of Trypanosoma cruzi in digestive tract tissue of Chagas disease patients affected by megacolon. Acta Trop 2022; 235:106632. [PMID: 35932843 DOI: 10.1016/j.actatropica.2022.106632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022]
Abstract
Chagas disease, caused by the Trypanosoma cruzi parasite in the Americas affects ∼ 7 million people, 30% with cardiac tissue damage and 10-15% with digestive disorders. In this study, we have developed a protocol to detect the presence of the parasite and estimate its load in resected dysfunctional tissue segments of chronically infected patients with digestive megacolon. We have included samples from 43 individuals, 38/5 with positive/negative serology for Chagas disease and digestive syndromes.. Samples of 1.5 to 2.0 cm were taken from different points of the dysfunctional digestive tract in specialized centres in Cochabamba, Bolivia. T.cruzi cultures were performed by inoculation with NNN-LIT culture medium, and genomic material was obtained from the samples formultiplex qPCR with TaqMan probes targeting satellite nuclear DNA. Cultures failed to isolate T. cruzi but qPCR reached a sensitivity of 42.1% (16/38) with all three spots and in triplicate.. A new quantification methodology using synthetic satellite DNA as quantitation standard revealed parasite loads ranging from 2.2 × 102 to 1.0 × 106 satellite DNA copies/μl. Positive samples from the distal end showed a higher parasite load. The results of the present study strengthen and add further evidence to previous findings in an experimental mouse model of chronic T. cruzi infection, providing a valuable tool to improve scientific knowledge on the relevance of the digestive tract in parasite persistence, and underlines the need of a better understanding of host-pathogen interaction in digestive tissues, considering pathophysiology, disease immunology and response to treatment.
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Affiliation(s)
| | - Alejandro G Schijman
- Laboratory of Molecular Biology of Chagas Disease, Institute for Research in Genetic Engineering and Molecular Biology (INGEBI-CONICET), Buenos Aires, Argentina
| | - Julio Alonso-Padilla
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - University of Barcelona, 08036, Barcelona, Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII)
| | - Daniel Lozano
- CEADES Foundation, Cochabamba, Bolivia.; Faculty of Medicine, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Mary Cruz Torrico
- Faculty of Medicine, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Pietro Gamba
- Pietro Gamba Foundation Anzaldo, Cochabamba, Bolivia
| | | | - Vania Lozada
- Institute of Gastroenterology Bolivian Japanese, Cochabamba, Bolivia
| | - Karina Cartagena
- Institute of Gastroenterology Bolivian Japanese, Cochabamba, Bolivia
| | - Jareth Sanchez
- Hospital "Dr. Manuel Ascencio Villarroel", Punata, Cochabamba, Bolivia
| | - Faustino Torrico
- CEADES Foundation, Cochabamba, Bolivia.; Faculty of Medicine, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Joaquim Gascon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - University of Barcelona, 08036, Barcelona, Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII)
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6
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Rawal K, Sinha R, Abbasi BA, Chaudhary A, Nath SK, Kumari P, Preeti P, Saraf D, Singh S, Mishra K, Gupta P, Mishra A, Sharma T, Gupta S, Singh P, Sood S, Subramani P, Dubey AK, Strych U, Hotez PJ, Bottazzi ME. Identification of vaccine targets in pathogens and design of a vaccine using computational approaches. Sci Rep 2021; 11:17626. [PMID: 34475453 PMCID: PMC8413327 DOI: 10.1038/s41598-021-96863-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 08/10/2021] [Indexed: 02/07/2023] Open
Abstract
Antigen identification is an important step in the vaccine development process. Computational approaches including deep learning systems can play an important role in the identification of vaccine targets using genomic and proteomic information. Here, we present a new computational system to discover and analyse novel vaccine targets leading to the design of a multi-epitope subunit vaccine candidate. The system incorporates reverse vaccinology and immuno-informatics tools to screen genomic and proteomic datasets of several pathogens such as Trypanosoma cruzi, Plasmodium falciparum, and Vibrio cholerae to identify potential vaccine candidates (PVC). Further, as a case study, we performed a detailed analysis of the genomic and proteomic dataset of T. cruzi (CL Brenner and Y strain) to shortlist eight proteins as possible vaccine antigen candidates using properties such as secretory/surface-exposed nature, low transmembrane helix (< 2), essentiality, virulence, antigenic, and non-homology with host/gut flora proteins. Subsequently, highly antigenic and immunogenic MHC class I, MHC class II and B cell epitopes were extracted from top-ranking vaccine targets. The designed vaccine construct containing 24 epitopes, 3 adjuvants, and 4 linkers was analysed for its physicochemical properties using different tools, including docking analysis. Immunological simulation studies suggested significant levels of T-helper, T-cytotoxic cells, and IgG1 will be elicited upon administration of such a putative multi-epitope vaccine construct. The vaccine construct is predicted to be soluble, stable, non-allergenic, non-toxic, and to offer cross-protection against related Trypanosoma species and strains. Further, studies are required to validate safety and immunogenicity of the vaccine.
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Affiliation(s)
- Kamal Rawal
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India.
| | - Robin Sinha
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Bilal Ahmed Abbasi
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Amit Chaudhary
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Swarsat Kaushik Nath
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Priya Kumari
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - P Preeti
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Devansh Saraf
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Shachee Singh
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Kartik Mishra
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Pranjay Gupta
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Astha Mishra
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Trapti Sharma
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Srijanee Gupta
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Prashant Singh
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Shriya Sood
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Preeti Subramani
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Aman Kumar Dubey
- Centre for Computational Biology and Bioinformatics, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Ulrich Strych
- Texas Children's Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Peter J Hotez
- Texas Children's Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Biology, Baylor University, Waco, TX, USA
| | - Maria Elena Bottazzi
- Texas Children's Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Biology, Baylor University, Waco, TX, USA
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7
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Scarim CB, Olmo F, Ferreira EI, Chin CM, Kelly JM, Fortes Francisco A. Image-Based In Vitro Screening Reveals the Trypanostatic Activity of Hydroxymethylnitrofurazone against Trypanosoma cruzi. Int J Mol Sci 2021; 22:ijms22136930. [PMID: 34203228 PMCID: PMC8268475 DOI: 10.3390/ijms22136930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/14/2021] [Accepted: 06/23/2021] [Indexed: 12/23/2022] Open
Abstract
Hydroxymethylnitrofurazone (NFOH) is a therapeutic candidate for Chagas disease (CD). It has negligible hepatotoxicity in a murine model compared to the front-line drug benznidazole (BZN). Here, using Trypanosoma cruzi strains that express bioluminescent and/or fluorescent reporter proteins, we further investigated the in vitro and in vivo activity of NFOH to define whether the compound is trypanocidal or trypanostatic. The in vitro activity was assessed by exploiting the fluorescent reporter strain using wash-out assays and real-time microscopy. For animal experimentation, BALB/c mice were inoculated with the bioluminescent reporter strain and assessed by highly sensitive in vivo and ex vivo imaging. Cyclophosphamide treatment was used to promote parasite relapse in the chronic stage of infection. Our data show that NFOH acts by a trypanostatic mechanism, and that it is more active than BZN in vitro against the infectious trypomastigote form of Trypanosoma cruzi. We also found that it is more effective at curing experimental infections in the chronic stage, compared with the acute stage, a feature that it shares with BZN. Therefore, given its reduced toxicity, enhanced anti-trypomastigote activity, and curative properties, NFOH can be considered as a potential therapeutic option for Chagas disease, perhaps in combination with other trypanocidal agents.
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Affiliation(s)
- Cauê Benito Scarim
- School of Pharmaceutical Sciences, Sao Paulo State University (UNESP), Araraquara, Sao Paulo 14800-903, Brazil; (C.B.S.); (C.M.C.)
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (F.O.); (J.M.K.)
| | - Francisco Olmo
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (F.O.); (J.M.K.)
| | - Elizabeth Igne Ferreira
- LAPEN—Laboratory of Design and Synthesis of Chemotherapeutic Agents Potentially Active on Neglected Diseases, Department of Pharmacy, School of Pharmaceutical Sciences, University of Sao Paulo (USP), Sao Paulo 05508-9000, Brazil;
| | - Chung Man Chin
- School of Pharmaceutical Sciences, Sao Paulo State University (UNESP), Araraquara, Sao Paulo 14800-903, Brazil; (C.B.S.); (C.M.C.)
- Advanced Research Center in Medicine, School of Medicine, Union of the Colleges of the Great Lakes (UNILAGO), São José do Rio Preto, Sao Paulo 15030-070, Brazil
| | - John M. Kelly
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (F.O.); (J.M.K.)
| | - Amanda Fortes Francisco
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (F.O.); (J.M.K.)
- Correspondence: ; Tel.: +44-207-612-7864
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8
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Maldonado E, Rojas DA, Urbina F, Solari A. The Use of Antioxidants as Potential Co-Adjuvants to Treat Chronic Chagas Disease. Antioxidants (Basel) 2021; 10:antiox10071022. [PMID: 34202043 PMCID: PMC8300663 DOI: 10.3390/antiox10071022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/30/2022] Open
Abstract
Chagas disease is a neglected tropical disease caused by the flagellated protozoa Trypanosome cruzi. This illness affects to almost 8–12 million people worldwide, however, is endemic to Latin American countries. It is mainly vectorially transmitted by insects of the Triatominae family, although other transmission routes also exist. T. cruzi-infected cardiomyocytes at the chronic stage of the disease display severe mitochondrial dysfunction and high ROS production, leading to chronic myocardial inflammation and heart failure. Under cellular stress, cells usually can launch mitochondrial biogenesis in order to restore energy loss. Key players to begin mitochondrial biogenesis are the PGC-1 (PPARγ coactivator 1) family of transcriptional coactivators, which are activated in response to several stimuli, either by deacetylation or dephosphorylation, and in turn can serve as coactivators for the NRF (nuclear respiratory factor) family of transcription factors. The NRF family of transcriptional activators, namely NRF1 and NRF2, can activate gene expression of oxidative phosphorylation (OXPHOS) components, mitochondrial transcriptional factor (Tfam) and nuclear encoded mitochondrial proteins, leading to mitochondrial biogenesis. On the other hand, NRF2 can activate gene expression of antioxidant enzymes in response to antioxidants, oxidants, electrophile compounds, pharmaceutical and dietary compounds in a mechanism dependent on KEAP1 (Kelch-like ECH-associated protein 1). Since a definitive cure to treat Chagas disease has not been found yet; the use of antioxidants a co-adjuvant therapy has been proposed in an effort to improve mitochondrial functions, biogenesis, and the antioxidant defenses response. Those antioxidants could activate different pathways to begin mitochondrial biogenesis and/or cytoprotective antioxidant defenses. In this review we discuss the main mechanisms of mitochondrial biogenesis and the NRF2-KEAP1 activation pathway. We also reviewed the antioxidants used as co-adjuvant therapy to treat experimental Chagas disease and their action mechanisms and finish with the discussion of antioxidant therapy used in Chagas disease patients.
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Affiliation(s)
- Edio Maldonado
- Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago 8380000, Chile;
- Correspondence: (E.M.); (A.S.)
| | - Diego A. Rojas
- Instituto de Ciencias Biomédicas (ICB), Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 8380453, Chile;
| | - Fabiola Urbina
- Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago 8380000, Chile;
| | - Aldo Solari
- Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago 8380000, Chile;
- Correspondence: (E.M.); (A.S.)
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9
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Kamdem BP, Elizabeth FI. The Role of Nitro (NO 2-), Chloro (Cl), and Fluoro (F) Substitution in the Design of Antileishmanial and Antichagasic Compounds. Curr Drug Targets 2021; 22:379-398. [PMID: 33371845 DOI: 10.2174/1389450121666201228122239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/22/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022]
Abstract
Neglected tropical diseases (NTDs) are responsible for over 500,000 deaths annually and are characterized by multiple disabilities. Leishmaniasis and Chagas diseases are among the most severe NTDs, and are caused by the Leishmania sp and Trypanosoma cruzi, respectively. Glucantime, pentamidine, and miltefosine are commonly used to treat leishmaniasis, whereas nifurtimox, benznidazole are current treatments for Chagas disease. However, these treatments are associated with drug resistance and severe side effects. Hence, the development of synthetic products, especially those containing N02, F, or Cl, are known to improve biological activity. The present work summarizes the information on the antileishmanial and antitrypanosomal activity of nitro-, chloro-, and fluorosynthetic derivatives. Scientific publications referring to halogenated derivatives in relation to antileishmanial and antitrypanosomal activities were hand-searched in databases such as SciFinder, Wiley, Science Direct, PubMed, ACS, Springer, Scielo, and so on. According to the literature information, more than 90 compounds were predicted as lead molecules with reference to their IC50/EC50 values in in vitro studies. It is worth mentioning that only active compounds with known cytotoxic effects against mammalian cells were considered in the present study. The observed activity was attributed to the presence of nitro-, fluoro-, and chloro-groups in the compound backbone. All in all, nitro and halogenated derivatives are active antileishmanial and antitrypanosomal compounds and can serve as the baseline for the development of new drugs against leishmaniasis and Chagas disease. However, efforts in in vitro and in vivo toxicity studies of the active synthetic compounds is still needed. Pharmacokinetic studies and the mechanism of action of the promising compounds need to be explored. The use of new catalysts and chemical transformation can afford unexplored halogenated compounds with improved antileishmanial and antitrypanosomal activity.
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Affiliation(s)
- Boniface P Kamdem
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Ferreira I Elizabeth
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
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Refoyo E, Troya J, Trigo E, Guzmán-Martinez G, Valbuena-López S, Caro-Codón J, Rosillo S, Moreno-Yanguela M, Tamargo J, Arribas JR, Acquatella H, Lopez-Sendon J. Comparison of Noninvasive Cardiac Test Strategies for Newly Diagnosed Chagas Disease in a Non-Endemic Zone. Am J Trop Med Hyg 2020; 103:1480-1486. [PMID: 32700660 PMCID: PMC7543797 DOI: 10.4269/ajtmh.20-0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/20/2020] [Indexed: 11/07/2022] Open
Abstract
Chagas disease is an emerging infectious disease in Europe and other non-endemic areas, mainly owing to migration from endemic areas. We aimed at investigating the value of advanced echocardiography (ECHO) and cardiac magnetic resonance (CMR) in patients newly diagnosed with Chagas disease to compare findings with those of electrocardiogram (ECG) and conventional ECHO and thus detecting cardiac abnormalities. We included consecutive patients with newly diagnosed Chagas disease and registered cardiac test results (ECG, ECHO, and CMR). We divided ECHO parameters into three tiers: 1) left ventricular ejection fraction, regional wall motion abnormality, and left ventricular diastolic dimension (ECHO-1); 2) other common ECHO parameters (ECHO-2); and 3) global longitudinal strain (GLS) (ECHO-3). Cardiac magnetic resonance included global and segmental biventricular function, the presence of myocardial fibrosis, and edema. The study comprised 100 patients from South America. The mean age was 43.9 ± 0.9 years, and 66% were women. Mean time living in Spain was 9.7 ± 0.5 years. The ECG revealed ≥ 2 abnormal findings in 47% of patients. ECHO-1 was abnormal in 22% of patients, ECHO-2 in 52%, and GLS in 16%. Cardiac magnetic resonance was abnormal in 50% of cases, and in 3% of these, ECHO was normal. When ECG and conventional ECHO were taken together, abnormalities were detected in 83% of patients. This value increased to 86% and 92% for GLS and CMR, respectively. These findings suggest that ECG and conventional ECHO should be used routinely as standard cardiac tests for newly diagnosed cases of Chagas disease. The value of advanced ECHO techniques and CMR is low.
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Affiliation(s)
- Elena Refoyo
- Department of Cardiology, La Paz University Hospital, Autónoma University of Madrid, Madrid, Spain
- Department of Cardiology, Navarra University Clinic, Madrid, Spain
| | - Jesús Troya
- Department of Internal Medicine, Infanta Leonor University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Elena Trigo
- Tropical Medicine and Travel Health Unit, Department of Internal Medicine, La Paz University Hospital, Autónoma University of Madrid, Madrid, Spain
| | - Gabriela Guzmán-Martinez
- Department of Cardiology, La Paz University Hospital, Autónoma University of Madrid, Madrid, Spain
| | - Silvia Valbuena-López
- Department of Cardiology, La Paz University Hospital, Autónoma University of Madrid, Madrid, Spain
| | - Juan Caro-Codón
- Department of Cardiology, La Paz University Hospital, Autónoma University of Madrid, Madrid, Spain
| | - Sandra Rosillo
- Department of Cardiology, La Paz University Hospital, Autónoma University of Madrid, Madrid, Spain
| | - Mar Moreno-Yanguela
- Department of Cardiology, La Paz University Hospital, Autónoma University of Madrid, Madrid, Spain
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - José Ramón Arribas
- Tropical Medicine and Travel Health Unit, Department of Internal Medicine, La Paz University Hospital, Autónoma University of Madrid, Madrid, Spain
| | | | - José Lopez-Sendon
- Department of Cardiology, La Paz University Hospital, Autónoma University of Madrid, Madrid, Spain
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11
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Rial MS, Arrúa EC, Natale MA, Bua J, Esteva MI, Prado NG, Laucella SA, Salomon CJ, Fichera LE. Efficacy of continuous versus intermittent administration of nanoformulated benznidazole during the chronic phase of Trypanosoma cruzi Nicaragua infection in mice. J Antimicrob Chemother 2020; 75:1906-1916. [DOI: 10.1093/jac/dkaa101] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/10/2020] [Accepted: 02/20/2020] [Indexed: 12/30/2022] Open
Abstract
Abstract
Background
Benznidazole and nifurtimox are effective drugs used to treat Chagas’ disease; however, their administration in patients in the chronic phase of the disease is still limited, mainly due to their limited efficacy in the later chronic stage of the disease and to the adverse effects related to these drugs.
Objectives
To evaluate the effect of low doses of nanoformulated benznidazole using a chronic model of Trypanosoma cruzi Nicaragua infection in C57BL/6J mice.
Methods
Nanoformulations were administered in two different schemes: one daily dose for 30 days or one dose every 7 days, 13 times.
Results
Both treatment schemes showed promising outcomes, such as the elimination of parasitaemia, a reduction in the levels of T. cruzi-specific antibodies and a reduction in T. cruzi-specific IFN-γ-producing cells, as well as an improvement in electrocardiographic alterations and a reduction in inflammation and fibrosis in the heart compared with untreated T. cruzi-infected animals. These results were also compared with those from our previous work on benznidazole administration, which was shown to be effective in the same chronic model.
Conclusions
In this experimental model, intermittently administered benznidazole nanoformulations were as effective as those administered continuously; however, the total dose administered in the intermittent scheme was lower, indicating a promising therapeutic approach to Chagas’ disease.
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Affiliation(s)
- M S Rial
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - E C Arrúa
- Area Técnica Farmacéutica, Departamento de Farmacia, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - M A Natale
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud de la Nación, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - J Bua
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud de la Nación, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - M I Esteva
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - N G Prado
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - S A Laucella
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud de la Nación, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - C J Salomon
- Area Técnica Farmacéutica, Departamento de Farmacia, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - L E Fichera
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud de la Nación, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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12
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Velasco A, Morillo CA. Chagas heart disease: A contemporary review. J Nucl Cardiol 2020; 27:445-451. [PMID: 30022404 DOI: 10.1007/s12350-018-1361-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 02/06/2023]
Abstract
Chagas disease is caused by a parasite infection endemic of the Americas. Traditionally observed in rural areas of Latin America, current migration trends have turned Chagas disease into a global epidemic. Acute infection is rarely severe and once it resolves, some patients can develop cardiomyopathy as part of the chronic form many years later. Multiple factors related with both the host and the parasite determine the susceptibility and progression to cardiomyopathy. Current imaging techniques are able to identify cardiac autonomic denervation, perfusion abnormalities, and myocardial fibrosis at an early of stage before the development of symptoms. The prognosis of patients with Chagasic cardiomyopathy remains poor and life-threatening ventricular arrhythmias can occur at an early stage. Treatment of chronic Chagas cardiomyopathy is challenging with a great need for more studies in the field.
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Affiliation(s)
- Alejandro Velasco
- Cardiology Division, University of Alabama at Birmingham, 201 Boshell Diabetes Building, 1808 7th Avenue South, Birmingham, AL, 35294, USA.
| | - Carlos A Morillo
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
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13
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Carneiro ACA, Costa GP, Ferreira CS, Ramos IPR, Sarandy MM, Leite ALJ, Menezes APJ, Silva BM, Nogueira KOPC, Carvalho ACC, Gonçalves RV, Talvani A. Combination therapy with benznidazole and doxycycline shows no additive effect to monotherapy with benznidazole in mice infected with the VL-10 strain of the Trypanosoma cruzi. Int J Cardiol 2020; 299:243-248. [PMID: 31353153 DOI: 10.1016/j.ijcard.2019.07.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/20/2019] [Accepted: 07/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chagas heart disease is the most important clinical manifestation of Trypanosoma cruzi infection. Pharmacological therapies have been proposed aiming to reduce inflammatory response and cardiac damage in infected hosts. In this study, we investigated the use of doxycycline (Dox), in a sub-antimicrobial dose, in monotherapy and in combination with benznidazole (Bz) during the acute phase of infection with the VL-10 strain of T. cruzi, evaluating the therapeutic effect during the acute and chronic phases of the infection. METHODS AND RESULTS C57BL/6 mice were treated for 20 days with Dox (30 mg/kg), Bz (100 mg/kg), or both drugs in combination starting 9 days after infection. Parasitemia was measured during the acute phase and the animals were monitored for 12 months, after which echocardiography analysis was performed. Blood samples were obtained from euthanized mice for CCL2, CCL5, IL-10 analysis, and cardiac fragments were collected for histopathological evaluation. Dox treatment did not ameliorate parasitological/inflammatory parameters but reduced the cardiac collagen neoformation (CN) in 35%. In contrast, Bz administration reduced parasitemia, plasma levels of CCL2 and CCL5, and cardiac infiltration during acute infection, and reduced the level of IL-10 and CN (95%) at 12 months. Dox was unable to improve ejection fraction, while Bz treatment ameliorated the ejection fraction. No additive effect was observed in combination therapy. CONCLUSION Dox monotherapy is not effective in the acute or chronic phases of experimental cardiomyopathy induced by the VL-10 strain of T. cruzi. Furthermore, combination therapy with Dox does not potentiate the effects of Bz monotherapy.
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Affiliation(s)
- Ana Cláudia Alvarenga Carneiro
- Laboratório de Imunobiologia da Inflamação, Departamento Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil
| | - G P Costa
- Laboratório de Imunobiologia da Inflamação, Departamento Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil
| | - Cyntia Silva Ferreira
- Laboratório de Biologia e Tecnologia de Micro-organismos, Departamento Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil
| | | | - Mariáurea Matias Sarandy
- Laboratório de Patologia Experimental, Departamento de Biologia Animal, Universidade Federal de Viçosa Minas Gerais, Brazil
| | - Ana Luísa Junqueira Leite
- Laboratório de Imunobiologia da Inflamação, Departamento Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil
| | - A P J Menezes
- Laboratório de Imunobiologia da Inflamação, Departamento Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil
| | - B M Silva
- Laboratório de Biologia e Tecnologia de Micro-organismos, Departamento Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil
| | - K O P C Nogueira
- Laboratório de Biomateriais e Patologia Experimental, Departamento Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil
| | - A C C Carvalho
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - Reggiani Vilela Gonçalves
- Laboratório de Patologia Experimental, Departamento de Biologia Animal, Universidade Federal de Viçosa Minas Gerais, Brazil
| | - André Talvani
- Laboratório de Imunobiologia da Inflamação, Departamento Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil.
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14
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Bern C, Messenger LA, Whitman JD, Maguire JH. Chagas Disease in the United States: a Public Health Approach. Clin Microbiol Rev 2019; 33:e00023-19. [PMID: 31776135 PMCID: PMC6927308 DOI: 10.1128/cmr.00023-19] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Trypanosoma cruzi is the etiological agent of Chagas disease, usually transmitted by triatomine vectors. An estimated 20 to 30% of infected individuals develop potentially lethal cardiac or gastrointestinal disease. Sylvatic transmission cycles exist in the southern United States, involving 11 triatomine vector species and infected mammals such as rodents, opossums, and dogs. Nevertheless, imported chronic T. cruzi infections in migrants from Latin America vastly outnumber locally acquired human cases. Benznidazole is now FDA approved, and clinical and public health efforts are under way by researchers and health departments in a number of states. Making progress will require efforts to improve awareness among providers and patients, data on diagnostic test performance and expanded availability of confirmatory testing, and evidence-based strategies to improve access to appropriate management of Chagas disease in the United States.
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Affiliation(s)
- Caryn Bern
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Jeffrey D Whitman
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - James H Maguire
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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15
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Saavedra E, González-Chávez Z, Moreno-Sánchez R, Michels PA. Drug Target Selection for Trypanosoma cruzi Metabolism by Metabolic Control Analysis and Kinetic Modeling. Curr Med Chem 2019; 26:6652-6671. [DOI: 10.2174/0929867325666180917104242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/17/2018] [Accepted: 08/17/2018] [Indexed: 11/22/2022]
Abstract
In the search for therapeutic targets in the intermediary metabolism of trypanosomatids
the gene essentiality criterion as determined by using knock-out and knock-down genetic
strategies is commonly applied. As most of the evaluated enzymes/transporters have
turned out to be essential for parasite survival, additional criteria and approaches are clearly
required for suitable drug target prioritization. The fundamentals of Metabolic Control
Analysis (MCA; an approach in the study of control and regulation of metabolism) and kinetic
modeling of metabolic pathways (a bottom-up systems biology approach) allow quantification
of the degree of control that each enzyme exerts on the pathway flux (flux control coefficient)
and metabolic intermediate concentrations (concentration control coefficient). MCA
studies have demonstrated that metabolic pathways usually have two or three enzymes with
the highest control of flux; their inhibition has more negative effects on the pathway function
than inhibition of enzymes exerting low flux control. Therefore, the enzymes with the highest
pathway control are the most convenient targets for therapeutic intervention. In this review,
the fundamentals of MCA as well as experimental strategies to determine the flux control coefficients
and metabolic modeling are analyzed. MCA and kinetic modeling have been applied
to trypanothione metabolism in Trypanosoma cruzi and the model predictions subsequently
validated in vivo. The results showed that three out of ten enzyme reactions analyzed
in the T. cruzi anti-oxidant metabolism were the most controlling enzymes. Hence, MCA and
metabolic modeling allow a further step in target prioritization for drug development against
trypanosomatids and other parasites.
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Affiliation(s)
- Emma Saavedra
- Departamento de Bioquimica, Instituto Nacional de Cardiologia Ignacio Chavez. Mexico City, Mexico
| | - Zabdi González-Chávez
- Departamento de Bioquimica, Instituto Nacional de Cardiologia Ignacio Chavez. Mexico City, Mexico
| | - Rafael Moreno-Sánchez
- Departamento de Bioquimica, Instituto Nacional de Cardiologia Ignacio Chavez. Mexico City, Mexico
| | - Paul A.M. Michels
- Centre for Immunity, Infection and Evolution (CIIE) and Centre for Translational and Chemical Biology (CTCB), School of Biological Sciences, The University of Edinburgh, Edinburgh, Scotland
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16
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Moscatelli G, Moroni S, García Bournissen F, González N, Ballering G, Schijman A, Corral R, Bisio M, Freilij H, Altcheh J. Longitudinal follow up of serological response in children treated for Chagas disease. PLoS Negl Trop Dis 2019; 13:e0007668. [PMID: 31465522 PMCID: PMC6715178 DOI: 10.1371/journal.pntd.0007668] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/28/2019] [Indexed: 01/05/2023] Open
Abstract
Background Evaluation of therapeutic response in chronic Chagas disease is a major challenge, due to prolonged persistence of Trypanosoma cruzi-specific antibodies, lack of sensitivity of parasitological tests, and need for long-term follow-up to observe negative seroconversion of conventional serological tests (CS). The objective of this study was to evaluate F2/3-ELISA serology, a promising early biomarker of therapeutic response, and T.cruzi Polymerase chain reaction (PCR) for T. cruzi Deoxyribonucleic acid (DNA), for neonatal diagnosis and evaluation of parasitemia after treatment. Methods Prospective cohort study, with three-year clinical, serological and parasitological follow-up of pediatric Chagas disease patients treated with benznidazole. Serology was evaluated by Enzyme-Linked ImmunoSorbent Assay (ELISA), Indirect hemagglutination (IHA) and F2/3-ELISA; Parasitemia by microhematocrit (MH) and PCR. Results A cohort of 107 pediatric patients treated with benznidazole was enrolled in the study. ELISA and IHA were initially reactive in 100% of patients, F2/3-ELISA serology was reactive in 80% (86/107) and 91% (97/107) had detectable parasitemia. Seventy-six (71%) patients completed at least 36 months of serological follow up after treatment. Although a similar decreasing linear trend was observed for all serological tests, F2/3-ELISA presented earlier, age dependent, negative seroconversion compared to CS. All patients reaching undetectable CS titers had previously seroreverted by F2/3-ELISA. All patients with persistently decreasing antibody titers had negative PCRs throughout the follow up period. No new cardiological lesions were observed during the 3 years follow-up period. Conclusions The data reported here, using CS, F2/3 ELISA and PCR provide support for the efficacy of benznidazole in congenital Chagas diseases. These results provide support for scaling up of screening, diagnosis and access to benznidazole treatment. Trial registration ClinicalTrials.gov 0028/04 in the Research Council, Secretary of Health Buenos Aires city Goberment. Evaluation of therapeutic response in chronic Chagas disease is a major challenge, particularly in the early post-treatment phase, due to prolonged persistence of Trypanosoma cruzi-specific antibodies and lack of sensitivity of available parasitological tests. The main limitation in evaluating Chagas disease treatment response stems from the need for long-term follow-up to observe negative seroconversion of conventional serological tests. New biomarkers of cure are needed. We evaluated F2/3-ELISA, a promising early serological marker of therapeutic response, and T.cruzi PCR for T.cruzi DNA, for neonatal diagnosis and evaluation of parasitemia after treatment. F2/3-ELISA and PCR proved to be excellent early markers of treatment response that correlate with ELISA and IHA but can identify treatment response or failure at much earlier timepoints. This information can help design future paediatric clinical trials in Chagas disease.
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Affiliation(s)
- Guillermo Moscatelli
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
- Multidisciplinary Institute for Research of Pediatric Diseases- CONICET-GCBA, Buenos Aires, Argentina
- * E-mail:
| | - Samanta Moroni
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
- Multidisciplinary Institute for Research of Pediatric Diseases- CONICET-GCBA, Buenos Aires, Argentina
| | - Facundo García Bournissen
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
- Multidisciplinary Institute for Research of Pediatric Diseases- CONICET-GCBA, Buenos Aires, Argentina
| | - Nicolás González
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Griselda Ballering
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Alejandro Schijman
- Molecular Biology Laboratory of Chagas disease, INGEBI-CONICET, Buenos Aires, Argentina
| | - Ricardo Corral
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Margarita Bisio
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Héctor Freilij
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Jaime Altcheh
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
- Multidisciplinary Institute for Research of Pediatric Diseases- CONICET-GCBA, Buenos Aires, Argentina
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T-Cell Immunophenotyping and Cytokine Production Analysis in Patients with Chagas Disease 4 Years after Benznidazole Treatment. Infect Immun 2019; 87:IAI.00103-19. [PMID: 31085707 DOI: 10.1128/iai.00103-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/06/2019] [Indexed: 01/02/2023] Open
Abstract
The major problem with Chagas disease is evolution of the chronic indeterminate form to a progressive cardiac disease. Treatment diminishes parasitemia but not clinical progression, and the immunological features involved are unclear. Here, we studied the clinical course and the immune response in patients with chronic-phase Chagas disease at 48 months after benznidazole treatment. Progression to the cardiac form of Chagas disease or its aggravation was associated with higher in vitro antigen-specific production of interferon gamma (IFN-γ) in patients with cardiac Chagas disease than in patients with the indeterminate form. Predominance of IFN-γ production over interleukin-10 (IL-10) production in antigen-specific cultures was associated with cardiac involvement. Significantly higher numbers of antigen-specific T helper 1 cells (T-Bet+ IFN-γ+) and a significantly higher IFN-γ+/IL-10+ ratio were observed in patients with cardiac Chagas disease than in patients with the indeterminate form. Cardiac damage was associated with higher numbers of T helper cells than cytotoxic T lymphocytes producing IFN-γ. Patients with cardiac Chagas disease had predominant CD25- and CD25low T regulatory (Treg) subpopulations, whereas patients with the indeterminate form manifested a higher relative mean percentage of CD25high Treg subpopulations. These findings suggest that at 48 months after benznidazole treatment, the disease can worsen or progress to the cardiac form. The progression may be related to increased IFN-γ production (mostly from CD4+ T cells) relative to IL-10 production and increased Treg percentages. Patients with the indeterminate form of Chagas disease show a more balanced ratio of proinflammatory and anti-inflammatory cytokines.
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Lidani KCF, Andrade FA, Bavia L, Damasceno FS, Beltrame MH, Messias-Reason IJ, Sandri TL. Chagas Disease: From Discovery to a Worldwide Health Problem. Front Public Health 2019; 7:166. [PMID: 31312626 PMCID: PMC6614205 DOI: 10.3389/fpubh.2019.00166] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/05/2019] [Indexed: 12/23/2022] Open
Abstract
Carlos Chagas discovered American trypanosomiasis, also named Chagas disease (CD) in his honor, just over a century ago. He described the clinical aspects of the disease, characterized by its etiological agent (Trypanosoma cruzi) and identified its insect vector. Initially, CD occurred only in Latin America and was considered a silent and poorly visible disease. More recently, CD became a neglected worldwide disease with a high morbimortality rate and substantial social impact, emerging as a significant public health threat. In this context, it is crucial to better understand better the epidemiological scenarios of CD and its transmission dynamics, involving people infected and at risk of infection, diversity of the parasite, vector species, and T. cruzi reservoirs. Although efforts have been made by endemic and non-endemic countries to control, treat, and interrupt disease transmission, the cure or complete eradication of CD are still topics of great concern and require global attention. Considering the current scenario of CD, also affecting non-endemic places such as Canada, USA, Europe, Australia, and Japan, in this review we aim to describe the spread of CD cases worldwide since its discovery until it has become a global public health concern.
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Affiliation(s)
| | - Fabiana Antunes Andrade
- Laboratory of Molecular Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Lorena Bavia
- Laboratory of Molecular Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Flávia Silva Damasceno
- Laboratory of Biochemistry of Tryps-LaBTryps, Department of Parasitology, Institute for Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Marcia Holsbach Beltrame
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná, Curitiba, Brazil
| | - Iara J. Messias-Reason
- Laboratory of Molecular Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Thaisa Lucas Sandri
- Laboratory of Molecular Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
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19
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Schijman AG. Molecular diagnosis of Trypanosoma cruzi. Acta Trop 2018; 184:59-66. [PMID: 29476727 DOI: 10.1016/j.actatropica.2018.02.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 02/05/2018] [Accepted: 02/14/2018] [Indexed: 01/01/2023]
Abstract
Chagas disease, caused by the kinetoplastid protozoan Trypanosoma cruzi, affects millions of people, most of them neglected populations. The different phases of the disease, the transmission mode and the high genetic variability of the parasite determine that molecular detection methods display different degree of success. Molecular diagnostic tests may be employed during epidemiological surveys of transmission, for early diagnosis of congenital transmission and acute infections due to oral transmission, transfusion or transplantation routes, reactivation due to immunosuppression and monitoring of treatment response in chronically infected patients receiving trypanocidal chemotherapy. This manuscript summarizes the most widely used molecular tools to detect T. cruzi infection in different epidemiological and clinical scenarios.
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Affiliation(s)
- Alejandro G Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Hector Torres" (INGEBI-CONICET), Ciudad de Buenos Aires, Argentina.
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20
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Olivera MJ, Fory JA, Olivera AJ. Therapeutic drug monitoring of benznidazole and nifurtimox: a systematic review and quality assessment of published clinical practice guidelines. Rev Soc Bras Med Trop 2018; 50:748-755. [PMID: 29340450 DOI: 10.1590/0037-8682-0399-2016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/30/2017] [Indexed: 11/22/2022] Open
Abstract
The pharmacological management of adults with chronic-phase Chagas disease is challenging despite it being the recent focus of extensive research. One of the challenges in the current clinical practice guidelines (CPGs) landscape is the existence of non-evidence-based recommendations for the use of laboratory tests in treatment monitoring. This study aimed to systematically assess the quality and consistency of recommendations of CPGs on the pharmacological management of adults with chronic-phase Chagas disease. Systematic literature searches were conducted in MEDLINE, EMBASE, SciELO and Google to identify all published CPGs relevant to the pharmacological management of Chagas disease, between January 2010 and March 2016. Three independent reviewers assessed the quality of each CPG using the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. A total of five CPGs were included and the overall quality of the guidelines for therapeutic drug monitoring of Chagas disease was moderate-to-low. There was considerable variation in the quality of the CPGs across the AGREE II domains. The domains of scope/purpose, stakeholder involvement, and clarity of presentation were rated well, and the domains of applicability and editorial independence received poor ratings. This review showed that the methodological quality of CPGs for Chagas disease was generally inappropriate, and there was no explicit link between the best available evidence and current recommendations.
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Otta DA, de Araújo FF, de Rezende VB, Souza-Fagundes EM, Elói-Santos SM, Costa-Silva MF, Santos RA, Costa HA, Siqueira-Neto JL, Martins-Filho OA, Teixeira-Carvalho A. Identification of Anti-Trypanosoma cruzi Lead Compounds with Putative Immunomodulatory Activity. Antimicrob Agents Chemother 2018; 62:e01834-17. [PMID: 29437629 PMCID: PMC5913944 DOI: 10.1128/aac.01834-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/21/2018] [Indexed: 12/13/2022] Open
Abstract
In seeking substitutions for the current Chagas disease treatment, which has several relevant side effects, new therapeutic candidates have been extensively investigated. In this context, a balanced interaction between mediators of the host immune response seems to be a key element for therapeutic success, as a proinflammatory microenvironment modulated by interleukin-10 (IL-10) is shown to be relevant to potentiate anti-Trypanosoma cruzi drug activity. This study aimed to identify the potential immunomodulatory activities of the anti-T. cruzi K777, pyronaridine (PYR), and furazolidone (FUR) compounds in peripheral blood mononuclear cells (PBMC) from noninfected (NI) subjects and chronic Chagas disease (CD) patients. Our results showed low cytotoxicity to PBMC populations, with 50% cytotoxic concentrations (CC50) of 71.0 μM (K777), 9.0 μM (PYR), and greater than 20 μM (FUR). In addition, K777 showed no impact on the exposure index (EI) of phytohemagglutinin-stimulated leukocytes (PHA), while PYR and FUR treatments induced increased EI of monocytes and T lymphocytes at late stages of apoptosis in NI subjects. Moreover, K777 induced a more prominent proinflammatory response (tumor necrosis factor alpha-positive [TNF-α+] CD8+/CD4+, gamma interferon-positive [IFN-γ+] CD4+/CD8+ modulated by interleukin-10-positive [IL-10+] CD4+ T/CD8+ T) than did PYR (TNF-α+ CD8+, IL-10+ CD8+) and FUR (TNF-α+ CD8+, IL-10+ CD8+). Signature analysis of intracytoplasmic cytokines corroborated the proinflammatory/modulated (K777) and proinflammatory (PYR and FUR) profiles previously found. In conclusion, the lead compound K777 may induce beneficial changes in the immunological profile of patients presenting the chronic phase of Chagas disease and may contribute to a more effective therapy against the disease.
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Affiliation(s)
- Dayane Andriotti Otta
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda Fortes de Araújo
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-graduação em Sanidade e Produção Animal nos Trópicos, Medicina Veterinária, Universidade de Uberaba (UNIUBE), Uberaba, Minas Gerais, Brazil
| | - Vitor Bortolo de Rezende
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Elaine Maria Souza-Fagundes
- Departamento de Fisiologia e Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Silvana Maria Elói-Santos
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Propedêutica Complementar, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Matheus Fernandes Costa-Silva
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Raiany Araújo Santos
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Heloísa Alves Costa
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Jair Lage Siqueira-Neto
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California, USA
| | - Olindo Assis Martins-Filho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Andréa Teixeira-Carvalho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
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22
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Sales Junior PA, Molina I, Fonseca Murta SM, Sánchez-Montalvá A, Salvador F, Corrêa-Oliveira R, Carneiro CM. Experimental and Clinical Treatment of Chagas Disease: A Review. Am J Trop Med Hyg 2017; 97:1289-1303. [PMID: 29016289 PMCID: PMC5817734 DOI: 10.4269/ajtmh.16-0761] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 06/24/2017] [Indexed: 01/16/2023] Open
Abstract
Chagas disease (CD) is caused by the protozoan parasite Trypanosoma cruzi that infects a broad range of triatomines and mammalian species, including man. It afflicts 8 million people in Latin America, and its incidence is increasing in nonendemic countries owing to rising international immigration and nonvectorial transmission routes such as blood donation. Since the 1960s, the only drugs available for the clinical treatment of this infection have been benznidazole (BZ) and nifurtimox (NFX). Treatment with these trypanocidal drugs is recommended in both the acute and chronic phases of CD. These drugs have low cure rates mainly during the chronic phase, in addition both drugs present side effects that may result in the interruption of the treatment. Thus, more efficient and better-tolerated new drugs or pharmaceutical formulations containing BZ or NFX are urgently needed. Here, we review the drugs currently used for CD chemotherapy, ongoing clinical assays, and most-promising new experimental drugs. In addition, the mechanism of action of the commercially available drugs, NFX and BZ, the biodistribution of the latter, and the potential for novel formulations of BZ based on nanotechnology are discussed. Taken together, the literature emphasizes the urgent need for new therapies for acute and chronic CD.
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Affiliation(s)
| | - Israel Molina
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | | | - Adrián Sánchez-Montalvá
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Fernando Salvador
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Rodrigo Corrêa-Oliveira
- Centro de Pesquisas René Rachou, FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Cláudia Martins Carneiro
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
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23
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Rassi A, Marin JA, Rassi A. Chronic Chagas cardiomyopathy: a review of the main pathogenic mechanisms and the efficacy of aetiological treatment following the BENznidazole Evaluation for Interrupting Trypanosomiasis (BENEFIT) trial. Mem Inst Oswaldo Cruz 2017; 112:224-235. [PMID: 28225900 PMCID: PMC5319366 DOI: 10.1590/0074-02760160334] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 11/22/2016] [Indexed: 11/21/2022] Open
Abstract
Chagas cardiomyopathy is the most frequent and most severe manifestation of chronic Chagas disease, and is one of the leading causes of morbidity and death in Latin America. Although the pathogenesis of Chagas cardiomyopathy is incompletely understood, it may involve several mechanisms, including parasite-dependent myocardial damage, immune-mediated myocardial injury (induced by the parasite itself and by self-antigens), and microvascular and neurogenic disturbances. In the past three decades, a consensus has emerged that parasite persistence is crucial to the development and progression of Chagas cardiomyopathy. In this context, antiparasitic treatment in the chronic phase of Chagas disease could prevent complications related to the disease. However, according to the results of the BENEFIT trial, benznidazole seems to have no benefit for arresting disease progression in patients with chronic Chagas cardiomyopathy. In this review, we give an update on the main pathogenic mechanisms of Chagas disease, and re-examine and discuss the results of the BENEFIT trial, together with its limitations and implications.
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Affiliation(s)
- Anis Rassi
- Hospital do Coração Anis Rassi, Goiânia, GO, Brasil
| | - José Antonio Marin
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Divisão de Cardiologia, Ribeirão Preto, SP, Brasil
| | - Anis Rassi
- Hospital do Coração Anis Rassi, Goiânia, GO, Brasil
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24
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Dias JCP, Ramos Jr. AN, Gontijo ED, Luquetti A, Shikanai-Yasuda MA, Coura JR, Torres RM, Melo JRDC, Almeida EAD, Oliveira Jr. WD, Silveira AC, Rezende JMD, Pinto FS, Ferreira AW, Rassi A, Fragata Filho AA, Sousa ASD, Correia D, Jansen AM, Andrade GMQ, Britto CFDPDC, Pinto AYDN, Rassi Jr. A, Campos DE, Abad-Franch F, Santos SE, Chiari E, Hasslocher-Moreno AM, Moreira EF, Marques DSDO, Silva EL, Marin-Neto JA, Galvão LMDC, Xavier SS, Valente SADS, Carvalho NB, Cardoso AV, Silva RAE, Costa VMD, Vivaldini SM, Oliveira SM, Valente VDC, Lima MM, Alves RV. 2 nd Brazilian Consensus on Chagas Disease, 2015. Rev Soc Bras Med Trop 2016; 49Suppl 1:3-60. [DOI: 10.1590/0037-8682-0505-2016] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 11/22/2022] Open
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25
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Impact of the Use of Benznidazole Followed by Antioxidant Supplementation in the Prevalence of Ventricular Arrhythmias in Patients With Chronic Chagas Disease: Pilot Study. Am J Ther 2016; 23:e1474-e1483. [DOI: 10.1097/mjt.0000000000000137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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26
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Vannucchi V, Tomberli B, Zammarchi L, Fornaro A, Castelli G, Pieralli F, Berni A, Yacoub S, Bartoloni A, Olivotto I. Chagas disease as a cause of heart failure and ventricular arrhythmias in patients long removed from endemic areas: an emerging problem in Europe. J Cardiovasc Med (Hagerstown) 2016; 16:817-23. [PMID: 25022923 DOI: 10.2459/jcm.0000000000000045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Chagas disease is a parasitic disease caused by the protozoan Trypanosoma cruzi. In endemic areas (South and Central America), Chagas disease represents a relevant public health issue, and is the most frequent cause of cardiomyopathy. In nonendemic areas, such as Europe, Chagas disease represents an emerging problem following the establishment of sizeable communities from Brazil and Bolivia. Chagas cardiomyopathy represents the most frequent and serious complication of chronic Chagas disease, affecting about 20-30% of patients, potentially leading to heart failure, arrhythmias, thromboembolism, stroke and sudden death. Because late complications of Chagas disease may develop several years or even decades after the acute infection, it may be extremely challenging to reach the correct diagnosis in patients long removed from the countries of origin. We report two examples of Chagas cardiomyopathy in South American women permanently residing in Italy for more than 20 years, presenting with cardiac manifestations ranging from left ventricular dysfunction and heart failure to isolated ventricular arrhythmias. The present review emphasizes that Chagas disease should be considered as a potential diagnosis in patients from endemic areas presenting with 'idiopathic' cardiac manifestations, even when long removed from their country of origin, with potential implications for treatment and control of Chagas disease transmission.
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Affiliation(s)
- Vieri Vannucchi
- aReferral Center for Myocardial Diseases, Internal Medicine and Infectious Disease Unit, Careggi University Hospital, Florence bDipartimento di Medicina Sperimentale e Clinica, Sezione Medicina Critica e Medicine Specialistiche, Clinica Malattie Infettive, Università degli Studi di Firenze, Firenze cInternal and Emergency Medicine Unit, Careggi Uninersity Hospital, Florence dMedicina Interna all'Orientamento all'alta complessità aziendale 2, Università degli Studi di Firenze, Firenze, Italia eDepartment of Medicine, Imperial College, Hammersmith Campus, London, UK
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27
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Perspectives in Chagas disease treatment. Glob Heart 2016; 10:189-92. [PMID: 26407515 DOI: 10.1016/j.gheart.2015.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 07/23/2015] [Indexed: 12/17/2022] Open
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28
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Campos CF, Cangussú SD, Duz ALC, Cartelle CT, Noviello MDL, Veloso VM, Bahia MT, Almeida-Leite CM, Arantes RME. Enteric Neuronal Damage, Intramuscular Denervation and Smooth Muscle Phenotype Changes as Mechanisms of Chagasic Megacolon: Evidence from a Long-Term Murine Model of Trypanosoma cruzi Infection. PLoS One 2016; 11:e0153038. [PMID: 27045678 PMCID: PMC4821538 DOI: 10.1371/journal.pone.0153038] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/06/2016] [Indexed: 01/25/2023] Open
Abstract
We developed a novel murine model of long-term infection with Trypanosoma cruzi with the aim to elucidate the pathogenesis of megacolon and the associated adaptive and neuromuscular intestinal disorders. Our intent was to produce a chronic stage of the disease since the early treatment should avoid 100% mortality of untreated animals at acute phase. Treatment allowed animals to be kept infected and alive in order to develop the chronic phase of infection with low parasitism as in human disease. A group of Swiss mice was infected with the Y strain of T. cruzi. At the 11th day after infection, a sub-group was euthanized (acute-phase group) and another sub-group was treated with benznidazole and euthanized 15 months after infection (chronic-phase group). Whole colon samples were harvested and used for studying the histopathology of the intestinal smooth muscle and the plasticity of the enteric nerves. In the acute phase, all animals presented inflammatory lesions associated with intense and diffuse parasitism of the muscular and submucosa layers, which were enlarged when compared with the controls. The occurrence of intense degenerative inflammatory changes and increased reticular fibers suggests inflammatory-induced necrosis of muscle cells. In the chronic phase, parasitism was insignificant; however, the architecture of Aüerbach plexuses was focally affected in the inflamed areas, and a significant decrease in the number of neurons and in the density of intramuscular nerve bundles was detected. Other changes observed included increased thickness of the colon wall, diffuse muscle cell hypertrophy, and increased collagen deposition, indicating early fibrosis in the damaged areas. Mast cell count significantly increased in the muscular layers. We propose a model for studying the long-term (15 months) pathogenesis of Chagasic megacolon in mice that mimics the human disease, which persists for several years and has not been fully elucidated. We hypothesize that the long-term inflammatory process mediates neuronal damage and intramuscular and intramural denervation, leading to phenotypic changes in smooth muscle cells associated with fibrosis. These long-term structural changes may represent the basic mechanism for the formation of the Chagasic megacolon.
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Affiliation(s)
- Camila França Campos
- Departamento de Patologia Geral Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Silvia Dantas Cangussú
- Departamento de Ciências Biológicas/LAFEX, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Ana Luiza Cassin Duz
- Departamento de Patologia Geral Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Christiane Teixeira Cartelle
- Departamento de Patologia Geral Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria de Lourdes Noviello
- Departamento de Patologia Geral Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vanja Maria Veloso
- Departamento de Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Maria Terezinha Bahia
- Departamento de Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Camila Megale Almeida-Leite
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rosa Maria Esteves Arantes
- Departamento de Patologia Geral Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Gutierrez J, Katan M, Elkind MS. Collagen Vascular and Infectious Diseases. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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30
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Pinazo MJ, Posada EDJ, Izquierdo L, Tassies D, Marques AF, de Lazzari E, Aldasoro E, Muñoz J, Abras A, Tebar S, Gallego M, de Almeida IC, Reverter JC, Gascon J. Altered Hypercoagulability Factors in Patients with Chronic Chagas Disease: Potential Biomarkers of Therapeutic Response. PLoS Negl Trop Dis 2016; 10:e0004269. [PMID: 26727000 PMCID: PMC4700971 DOI: 10.1371/journal.pntd.0004269] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 11/06/2015] [Indexed: 11/19/2022] Open
Abstract
Thromboembolic events were described in patients with Chagas disease without cardiomyopathy. We aim to confirm if there is a hypercoagulable state in these patients and to determine if there is an early normalization of hemostasis factors after antiparasitic treatment. Ninety-nine individuals from Chagas disease-endemic areas were classified in two groups: G1, with T.cruzi infection (n = 56); G2, healthy individuals (n = 43). Twenty-four hemostasis factors were measured at baseline. G1 patients treated with benznidazole were followed for 36 months, recording clinical parameters and performance of conventional serology, chemiluminescent enzyme-linked immunosorbent assay (trypomastigote-derived glycosylphosphatidylinositol-anchored mucins), quantitative polymerase chain reaction, and hemostasis tests every 6-month visits. Prothrombin fragment 1+2 (F1+2) and endogenous thrombin potential (ETP) were abnormally expressed in 77% and 50% of infected patients at baseline but returned to and remained at normal levels shortly after treatment in 76% and 96% of cases, respectively. Plasmin-antiplasmin complexes (PAP) were altered before treatment in 32% of G1 patients but normalized in 94% of cases several months after treatment. None of the patients with normal F1+2 values during follow-up had a positive qRT-PCR result, but 3/24 patients (13%) with normal ETP values did. In a percentage of chronic T. cruzi infected patients treated with benznidazole, altered coagulation markers returned into normal levels. F1+2, ETP and PAP could be useful markers for assessing sustained response to benznidazole.
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Affiliation(s)
- Maria-Jesus Pinazo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | - Elizabeth de Jesus Posada
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | - Luis Izquierdo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | - Dolors Tassies
- Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alexandre-Ferreira Marques
- Border Biomedical Research Center, Department of Biological Sciences, University of Texas at El Paso, El Paso, Texas, United States of America
- Universidade Federal de Minas Gerais, Departamento de Parasitologia, Belo Horizonte, Minas Gerais, Brazil
| | - Elisa de Lazzari
- Health Biostatistics, ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | - Edelweiss Aldasoro
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | - Jose Muñoz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | - Alba Abras
- Laboratori de Parasitologia, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Silvia Tebar
- Laboratori de Parasitologia, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Gallego
- Laboratori de Parasitologia, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
- Barcelona Institute for Global Health, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Igor Correia de Almeida
- Border Biomedical Research Center, Department of Biological Sciences, University of Texas at El Paso, El Paso, Texas, United States of America
| | - Joan-Carles Reverter
- Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joaquim Gascon
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
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31
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Cerny N, Sánchez Alberti A, Bivona AE, De Marzi MC, Frank FM, Cazorla SI, Malchiodi EL. Coadministration of cruzipain and GM-CSF DNAs, a new immunotherapeutic vaccine against Trypanosoma cruzi infection. Hum Vaccin Immunother 2016; 12:438-50. [PMID: 26312947 PMCID: PMC5049742 DOI: 10.1080/21645515.2015.1078044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/03/2015] [Accepted: 07/24/2015] [Indexed: 12/11/2022] Open
Abstract
Therapeutic vaccine research and development are especially important in Chagas disease considering the characteristics of the chronic infection and the number of people in the Americas living with a parasite infection for decades. We have previously reported the efficacy of attenuated Salmonella enterica (S) carrying plasmid encoding cruzipain (SCz) to protect against Trypanosoma cruzi infection. In the present work we investigated whether Cz DNA vaccine immunotherapy could be effective in controlling an ongoing T. cruzi infection in mice. We here report the intramuscular administration of naked Cz DNA or the oral administration of Salmonella as Cz DNA delivery system as therapeutic vaccines in mice during acute or chronic infection. The coadministration of a plasmid encoding GM-CSF improved vaccine performance, indicating that the stimulation of innate immune cells is needed in the event of an ongoing infection. These therapeutic vaccines were able to address the response to a protective and sustained Th1 biased profile not only against Cz but also against a variety of parasite antigens. The combined therapeutic vaccine during the chronic phase of infection prevents tissue pathology as shown by a reduced level of enzyme activity characteristic of tissue damage and a tissue status compatible with normal tissue. The obtained results suggest that immunotherapy with Cz and GM-CSF DNAs, either alone or in combination with other drug treatments, may represent a promising alternative for Chagas disease therapy.
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Affiliation(s)
- Natacha Cerny
- Cátedra de Inmunología e Instituto de Estudios de la Inmunidad Humoral (IDEHU); CONICET-UBA; Facultad de Farmacia y Bioquímica; Universidad de Buenos Aires; Buenos Aires, Argentina
- Instituto de Microbiología y Parasitología Médica; IMPaM (UBA-CONICET) y Departamento de Microbiología; Parasitología e Inmunología; Facultad de Medicina; UBA; Buenos Aires, Argentina
- Laboratorio de Inmunología; Departamento Ciencias Básicas- INEDES; Universidad Nacional de Luján; Luján, Argentina
| | - Andrés Sánchez Alberti
- Cátedra de Inmunología e Instituto de Estudios de la Inmunidad Humoral (IDEHU); CONICET-UBA; Facultad de Farmacia y Bioquímica; Universidad de Buenos Aires; Buenos Aires, Argentina
- Instituto de Microbiología y Parasitología Médica; IMPaM (UBA-CONICET) y Departamento de Microbiología; Parasitología e Inmunología; Facultad de Medicina; UBA; Buenos Aires, Argentina
| | - Augusto E Bivona
- Cátedra de Inmunología e Instituto de Estudios de la Inmunidad Humoral (IDEHU); CONICET-UBA; Facultad de Farmacia y Bioquímica; Universidad de Buenos Aires; Buenos Aires, Argentina
- Instituto de Microbiología y Parasitología Médica; IMPaM (UBA-CONICET) y Departamento de Microbiología; Parasitología e Inmunología; Facultad de Medicina; UBA; Buenos Aires, Argentina
| | - Mauricio C De Marzi
- Cátedra de Inmunología e Instituto de Estudios de la Inmunidad Humoral (IDEHU); CONICET-UBA; Facultad de Farmacia y Bioquímica; Universidad de Buenos Aires; Buenos Aires, Argentina
- Laboratorio de Inmunología; Departamento Ciencias Básicas- INEDES; Universidad Nacional de Luján; Luján, Argentina
| | - Fernanda M Frank
- Cátedra de Inmunología e Instituto de Estudios de la Inmunidad Humoral (IDEHU); CONICET-UBA; Facultad de Farmacia y Bioquímica; Universidad de Buenos Aires; Buenos Aires, Argentina
- Instituto de Microbiología y Parasitología Médica; IMPaM (UBA-CONICET) y Departamento de Microbiología; Parasitología e Inmunología; Facultad de Medicina; UBA; Buenos Aires, Argentina
| | - Silvia I Cazorla
- Cátedra de Inmunología e Instituto de Estudios de la Inmunidad Humoral (IDEHU); CONICET-UBA; Facultad de Farmacia y Bioquímica; Universidad de Buenos Aires; Buenos Aires, Argentina
- Instituto de Microbiología y Parasitología Médica; IMPaM (UBA-CONICET) y Departamento de Microbiología; Parasitología e Inmunología; Facultad de Medicina; UBA; Buenos Aires, Argentina
| | - Emilio L Malchiodi
- Cátedra de Inmunología e Instituto de Estudios de la Inmunidad Humoral (IDEHU); CONICET-UBA; Facultad de Farmacia y Bioquímica; Universidad de Buenos Aires; Buenos Aires, Argentina
- Instituto de Microbiología y Parasitología Médica; IMPaM (UBA-CONICET) y Departamento de Microbiología; Parasitología e Inmunología; Facultad de Medicina; UBA; Buenos Aires, Argentina
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Affiliation(s)
- Roberto Kalil-Filho
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
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Sguassero Y, Cuesta CB, Roberts KN, Hicks E, Comandé D, Ciapponi A, Sosa-Estani S. Course of Chronic Trypanosoma cruzi Infection after Treatment Based on Parasitological and Serological Tests: A Systematic Review of Follow-Up Studies. PLoS One 2015; 10:e0139363. [PMID: 26436678 PMCID: PMC4593559 DOI: 10.1371/journal.pone.0139363] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/11/2015] [Indexed: 12/24/2022] Open
Abstract
Background Chagas disease is caused by the flagellate protozoan Trypanosoma cruzi (T. cruzi). It is endemic in Latin American countries outside the Caribbean. The current criterion for cure in the chronic phase of the disease is the negativization of at least two serological tests such as enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence assay (IIF) and indirect hemagglutination assay (IHA). The serological evolution of treated subjects with chronic T. cruzi infection is variable. Treatment failure is indicated by a positive parasitological and/or molecular test (persistence of parasitemia). Objectives To summarize the pattern of response to treatment of parasitological, molecular and serological tests performed during the follow-up of subjects with chronic T. cruzi infection. Methods Electronic searches in relevant databases and screening of citations of potentially eligible articles were accomplished. Organizations focusing on neglected infectious diseases were asked for help in identifying relevant studies. Included studies were randomized controlled trials (RCTs), quasi-RCTs, and cohort studies involving adults and children with chronic infection who received trypanocidal treatment (benznidazole or nifurtimox) and were followed over time. The assessment of risk of bias was performed separately for each study design. The Cochrane Collaboration’s tool and the guidelines developed by Hayden et al. were used. Two reviewers extracted all data independently. A third review author was consulted in case of discordant opinion. Additional analyses were defined in ad-hoc basis. Scatter plots for percentage of positive parasitological and molecular tests and for negative serological tests were developed by using the lowess curve technique. Heterogeneity was measured by I2. The protocol was registered in PROSPERO, an international prospective register of systematic review protocols (Registration Number CRD42012002162). Results Out of 2,136 citations screened, 54 studies (six RCTs and 48 cohort studies) were included. The smoothed curves for positive xenodiagnosis and positive polymerase chain reaction (PCR) were characterized by a sharp decrease at twelve month posttreatment. Afterwards, they reached 10–20% and 40% for xenodiagnosis and PCR, respectively. The smoothed curves for negative conventional serological tests increased up to 10% after 48 months of treatment. In the long-term, the rate of negativization was between 20% and 45%. The main sources of bias identified across cohort studies were the lack of control for confounding and attrition bias. In general, RCTs were judged as low risk of bias in all domains. The level of heterogeneity across included studies was moderate to high. Additional analysis were incomplete because of the limited availability of data. In this regard, the country of origin of study participants might affect the results of parasitological and molecular tests, while the level of risk of bias might affect serological outcomes. Subgroup analysis suggested that seronegativization occurs earlier in children compared to adults. Conclusions We acknowledge that there is a dynamic pattern of response based on parasitological, molecular and serological tests in subjects chronically infected with T. cruzi after treatment. Our findings suggest a trypanocidal effect in the long-term follow-up. Further research is needed to explore potential sources of heterogeneity and to conduct reliable subgroup analysis.
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Affiliation(s)
- Yanina Sguassero
- Centro Rosarino de Estudios Perinatales (CREP), Cochrane Centre CREP, Rosario, Santa Fe, Argentina
- Instituto Nacional de Parasitología (INP), “Dr Mario Fatala Chaben”, Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Malbrán, Buenos Aires, Argentina
| | - Cristina B. Cuesta
- Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Santa Fe, Argentina
| | - Karen N. Roberts
- Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Santa Fe, Argentina
| | - Elizabeth Hicks
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Daniel Comandé
- Instituto de Efectividad Clínica y Sanitaria (IECS), Cochrane Centre IECS, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS), Cochrane Centre IECS, Buenos Aires, Argentina
| | - Sergio Sosa-Estani
- Instituto Nacional de Parasitología (INP), “Dr Mario Fatala Chaben”, Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Malbrán, Buenos Aires, Argentina
- * E-mail:
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Morillo CA, Marin-Neto JA, Avezum A, Sosa-Estani S, Rassi A, Rosas F, Villena E, Quiroz R, Bonilla R, Britto C, Guhl F, Velazquez E, Bonilla L, Meeks B, Rao-Melacini P, Pogue J, Mattos A, Lazdins J, Rassi A, Connolly SJ, Yusuf S. Randomized Trial of Benznidazole for Chronic Chagas' Cardiomyopathy. N Engl J Med 2015; 373:1295-306. [PMID: 26323937 DOI: 10.1056/nejmoa1507574] [Citation(s) in RCA: 681] [Impact Index Per Article: 75.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The role of trypanocidal therapy in patients with established Chagas' cardiomyopathy is unproven. METHODS We conducted a prospective, multicenter, randomized study involving 2854 patients with Chagas' cardiomyopathy who received benznidazole or placebo for up to 80 days and were followed for a mean of 5.4 years. The primary outcome in the time-to-event analysis was the first event of any of the components of the composite outcome of death, resuscitated cardiac arrest, sustained ventricular tachycardia, insertion of a pacemaker or implantable cardioverter-defibrillator, cardiac transplantation, new heart failure, stroke, or other thromboembolic event. RESULTS The primary outcome occurred in 394 patients (27.5%) in the benznidazole group and in 414 (29.1%) in the placebo group (hazard ratio, 0.93; 95% confidence interval [CI], 0.81 to 1.07; P=0.31). At baseline, a polymerase-chain-reaction (PCR) assay was performed on blood samples obtained from 1896 patients; 60.5% had positive results for Trypanosoma cruzi on PCR. The rates of conversion to negative PCR results (PCR conversion) were 66.2% in the benznidazole group and 33.5% in the placebo group at the end of treatment, 55.4% and 35.3%, respectively, at 2 years, and 46.7% and 33.1%, respectively, at 5 years or more (P<0.001 for all comparisons). The effect of treatment on PCR conversion varied according to geographic region: in Brazil, the odds ratio for PCR conversion was 3.03 (95% CI, 2.12 to 4.34) at 2 years and 1.87 (95% CI, 1.33 to 2.63) at 5 or more years; in Colombia and El Salvador, the odds ratio was 1.33 (95% CI, 0.90 to 1.98) at 2 years and 0.96 (95% CI, 0.63 to 1.45) at 5 or more years; and in Argentina and Bolivia, the odds ratio was 2.63 (95% CI, 1.89 to 3.66) at 2 years and 2.79 (95% CI, 1.99 to 3.92) at 5 or more years (P<0.001 for interaction). However, the rates of PCR conversion did not correspond to effects on clinical outcome (P=0.16 for interaction). CONCLUSIONS Trypanocidal therapy with benznidazole in patients with established Chagas' cardiomyopathy significantly reduced serum parasite detection but did not significantly reduce cardiac clinical deterioration through 5 years of follow-up. (Funded by the Population Health Research Institute and others; ClinicalTrials.gov number, NCT00123916; Current Controlled Trials number, ISRCTN13967269.).
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Affiliation(s)
- Carlos A Morillo
- From the Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada (C.A.M., L.B., B.M., P.R.-M., J.P., S.J.C., S.Y.); Cardiology Division, Internal Medicine Department, Medical School of Riberao Preto (J.A.M.-N.), Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A., A.M.), Hospital do Coração Anis Rassi, Goiãnia (A. Rassi Jr., A. Rassi), and Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular e Doenças Endêmicas, Rio de Janeiro (C.B.) - all in Brazil; Instituto Nacional de Parasitología Dr. Mario Fatala Chaben-Administración Nacional de Laboratorios e Institutos de Salud, Buenos Aires (S.S.-E., E. Velazquez); Fundación Clínica Abood Shaio (F.R.) and CIMPAT-Facultad de Ciencias, Universidad de los Andes (F.G.), Bogota, and Fundación Cardiovascular de Colombia, Bucaramanga (R.Q.) - all in Colombia; Hospital Eduardo Eguia, Programa Chagas, Tupiza, Bolivia (E. Villena); Hospital Nacional Rosales, San Salvador, El Salvador (R.B.); and Independent Advisor, Neglected Tropical Diseases, Geneva (J.L.)
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Penitente AR, Leite ALJ, de Paula Costa G, Shrestha D, Horta AL, Natali AJ, Neves CA, Talvani A. Enalapril in Combination with Benznidazole Reduces Cardiac Inflammation and Creatine Kinases in Mice Chronically Infected with Trypanosoma cruzi. Am J Trop Med Hyg 2015; 93:976-82. [PMID: 26350447 DOI: 10.4269/ajtmh.15-0237] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/03/2015] [Indexed: 12/31/2022] Open
Abstract
The protozoan Trypanosoma cruzi triggers an inflammatory process in mammalian heart causing events such as fibrosis, changes in the architecture and functionality in this organ. Enalapril, an angiotensin II-converting enzyme inhibitor, is a drug prescribed to ameliorate this heart dysfunction, and appears to exert a potential role in immune system regulation. Our aim was to evaluate the chronic cardiac inflammatory parameters after therapeutic treatment with enalapril and benznidazole in C57BL/6 mice infected with the VL-10 strain of T. cruzi. After infection, animals were treated with oral doses of enalapril (25 mg/kg), benznidazole (100 mg/kg), or both during 30 days. Morphometric parameters and levels of chemokines (CCL2, CCL5), IL-10, creatine kinases (CKs), and C-reactive protein were evaluated in the heart and serum at the 120th day of infection. Enalapril alone or in combination with benznidazole did not change the number of circulating parasites, but reduced cardiac leukocyte recruitment and total collagen in the cardiac tissue. Interestingly, the combination therapy (enalapril/benznidazole) also reduced the levels of chemokines, CK and CK-MB, and C-reactive proteins in chronic phase. In conclusion, during the chronic experimental T. cruzi infection, the combination therapy using enalapril plus benznidazole potentiated their immunomodulatory effects, resulting in a low production of biomarkers of cardiac lesions.
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Affiliation(s)
- Arlete Rita Penitente
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Ana Luísa Junqueira Leite
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Guilherme de Paula Costa
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Deena Shrestha
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Aline Luciano Horta
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Antônio J Natali
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Clóvis A Neves
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Andre Talvani
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Programa de Pós-Graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Minas Gerais, Brazil; Departamento de Biologia Geral, Universidade Federal de Viçosa, Minas Gerais, Brazil; Programa de Pós-Graduação em Biologia Celular e Estrutural, Universidade Federal de Viçosa, Minas Gerais, Brazil
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Benziger CP, Ribeiro ALP, Narula J. After 100 Years, the Diagnosis, Treatment, and Control of Chagas Disease
Remains a Challenge. Glob Heart 2015; 10:137-8. [DOI: 10.1016/j.gheart.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Pérez-Molina JA, Perez AM, Norman FF, Monge-Maillo B, López-Vélez R. Old and new challenges in Chagas disease. THE LANCET. INFECTIOUS DISEASES 2015; 15:1347-56. [PMID: 26231478 DOI: 10.1016/s1473-3099(15)00243-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/02/2015] [Accepted: 02/05/2015] [Indexed: 12/17/2022]
Abstract
Chagas disease, caused by the parasite Trypanosoma cruzi, is a neglected disease, which can lead to cardiomyopathy, arrhythmias, megaviscera, and more rarely, polyneuropathy in up to 30-40% of patients around 20 to 30 years after acute infection. Although it is endemic in the Americas, global population movements mean that it can be located wherever migrants from endemic areas settle. The disease was first described 100 years ago and still challenges clinicians worldwide, since diagnostic, therapeutic, and prognostic methods remain insufficient. Furthermore, factors such as HIV co-infection, immunosuppressive drugs, transplantation, and neoplastic disease can alter the natural course of the infection. We present the case of a Bolivian woman with chronic T cruzi infection diagnosed at our clinic in Madrid, Spain, who subsequently developed non-Hodgkin lymphoma. Our report illustrates the challenges of an increasingly common infection seen in non-endemic countries, and highlights both daily management dilemmas and associated difficulties that arise.
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Affiliation(s)
- Jose A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain.
| | - Angela Martinez Perez
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
| | - Francesca F Norman
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
| | - Begoña Monge-Maillo
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
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Limited Ability of Posaconazole To Cure both Acute and Chronic Trypanosoma cruzi Infections Revealed by Highly Sensitive In Vivo Imaging. Antimicrob Agents Chemother 2015; 59:4653-61. [PMID: 26014936 PMCID: PMC4505219 DOI: 10.1128/aac.00520-15] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/18/2015] [Indexed: 11/20/2022] Open
Abstract
The antifungal drug posaconazole has shown significant activity against Trypanosoma cruzi in vitro and in experimental murine models. Despite this, in a recent clinical trial it displayed limited curative potential. Drug testing is problematic in experimental Chagas disease because of difficulties in demonstrating sterile cure, particularly during the chronic stage of infection when parasite burden is extremely low and tissue distribution is ill defined. To better assess posaconazole efficacy against acute and chronic Chagas disease, we have exploited a highly sensitive bioluminescence imaging system which generates data with greater accuracy than other methods, including PCR-based approaches. Mice inoculated with bioluminescent T. cruzi were assessed by in vivo and ex vivo imaging, with cyclophosphamide-induced immunosuppression used to enhance the detection of relapse. Posaconazole was found to be significantly inferior to benznidazole as a treatment for both acute and chronic T. cruzi infections. Whereas 20 days treatment with benznidazole was 100% successful in achieving sterile cure, posaconazole failed in almost all cases. Treatment of chronic infections with posaconazole did however significantly reduce infection-induced splenomegaly, even in the absence of parasitological cure. The imaging-based screening system also revealed that adipose tissue is a major site of recrudescence in mice treated with posaconazole in the acute, but not the chronic stage of infection. This in vivo screening model for Chagas disease is predictive, reproducible and adaptable to diverse treatment schedules. It should provide greater assurance that drugs are not advanced prematurely into clinical trial.
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Sosa-Estani S, Segura EL. Integrated control of Chagas disease for its elimination as public health problem--a review. Mem Inst Oswaldo Cruz 2015; 110:289-98. [PMID: 25993503 PMCID: PMC4489466 DOI: 10.1590/0074-02760140408] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 04/02/2015] [Indexed: 11/22/2022] Open
Abstract
Chagas disease or American trypanosomiasis is, together with geohelminths, the neglected disease that causes more loss of years of healthy life due to disability in Latin America. Chagas disease, as determined by the factors and determinants, shows that different contexts require different actions, preventing new cases or reducing the burden of disease. Control strategies must combine two general courses of action including prevention of transmission to prevent the occurrence of new cases (these measures are cost effective), as well as opportune diagnosis and treatment of infected individuals in order to prevent the clinical evolution of the disease and to allow them to recuperate their health. All actions should be implemented as fully as possible and with an integrated way, to maximise the impact. Chagas disease cannot be eradicated due because of the demonstrated existence of infected wild triatomines in permanent contact with domestic cycles and it contributes to the occurrence of at least few new cases. However, it is possible to interrupt the transmission of Trypanosoma cruzi in a large territory and to eliminate Chagas disease as a public health problem with a dramatic reduction of burden of the disease.
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Affiliation(s)
- Sergio Sosa-Estani
- Instituto Nacional de Parasitología Dr Mario Fatala Chaben, Ministerio
de Salud de la Nación, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina,
Buenos Aires, Argentina
| | - Elsa Leonor Segura
- Instituto Nacional de Parasitología Dr Mario Fatala Chaben, Ministerio
de Salud de la Nación, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina,
Buenos Aires, Argentina
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Trypanothione reductase inhibitors: Overview of the action of thioridazine in different stages of Chagas disease. Acta Trop 2015; 145:79-87. [PMID: 25733492 DOI: 10.1016/j.actatropica.2015.02.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 02/18/2015] [Accepted: 02/20/2015] [Indexed: 12/13/2022]
Abstract
Thioridazine (TDZ) is a phenothiazine that has been shown to be one of the most potent phenothiazines to inhibit trypanothione reductase irreversibly. Trypanothione reductase is an essential enzyme for the survival of Trypanosoma cruzi in the host. Here, we reviewed the use of this drug for the treatment of T. cruzi experimental infection. In our laboratory, we have studied the effect of TDZ for the treatment of mice infected with different strains of T. cruzi and treated in the acute or in the chronic phases of the experimental infection, using two different schedules: TDZ at a dose of 80 mg/kg/day, for 3 days starting 1h after infection (acute phase), or TDZ 80 mg/kg/day for 12 days starting 180 days post infection (d.p.i.) (chronic phase). In our experience, the treatment of infected mice, in the acute or in the chronic phases of the infection, with TDZ led to a large reduction in the mortality rates and in the cardiac histological and electrocardiographical abnormalities, and modified the natural evolution of the experimental infection. These analyses reinforce the importance of treatment in the chronic phase to decrease, retard or stop the evolution to chagasic myocardiopathy. Other evidence leading to the use of this drug as a potential chemotherapeutic agent for Chagas disease treatment is also revised.
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Westenbrink BD, Kingma JH. Chagas, a cardiomyopathy emerging from obscurity. Eur J Heart Fail 2015; 17:355-7. [DOI: 10.1002/ejhf.261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 02/04/2023] Open
Affiliation(s)
- B. Daan Westenbrink
- Department of Cardiology; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
| | - J. Herre Kingma
- Department of Clinical Pharmacology; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
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Sabino EC, Ribeiro AL, Lee TH, Oliveira CL, Carneiro-Proietti AB, Antunes AP, Menezes MM, Ianni BM, Salemi VM, Nastari L, Fernandes F, Sachdev V, Carrick DM, Deng X, Wright D, Gonçalez TT, Murphy EL, Custer B, Busch MP. Detection of Trypanosoma cruzi DNA in blood by PCR is associated with Chagas cardiomyopathy and disease severity. Eur J Heart Fail 2015; 17:416-23. [PMID: 25678239 DOI: 10.1002/ejhf.220] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/30/2014] [Accepted: 11/07/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The significance of detection of Trypanosoma cruzi DNA in blood of antibody-positive patients for risk of development of Chagas heart disease is not well established. The objective of this study was to compare detection of T. cruzi DNA with known clinical and laboratory markers of Chagas cardiomyopathy (CC) severity. METHODS This is a case-control study nested within a retrospective cohort developed in Brazil to understand the natural history of Chagas disease. The study enrolled 499 T. cruzi seropositive blood donors (SP-BD) and 488 frequency matched seronegative control donors (SN-BD) who had donated between 1996 and 2002, and 101 patients with clinically diagnosed CC. In 2008-2010 all enrolled subjects underwent a health questionnaire, medical examination, electrocardiograms and echocardiograms and polymerase chain reaction (PCR) analyses. A blinded panel of three cardiologists adjudicated the outcome of CC. Trypanosoma cruzi kinetoplast minicircle sequences were amplified by real-time PCR using an assay with a sensitivity of one parasite per 20 mL of blood. All testing was performed on coded samples. RESULTS Rates of PCR detection of T. cruzi DNA were significantly (P = 0.003) higher in CC patients and SP-BD diagnosed with CC (79/105 [75.2 %]) compared with SP-BD without CC (143/279 [51.3%]). The presence of parasitaemia was significantly associated with known markers of disease progression such as QRS and QT interval duration, lower left ventricular ejection fraction, higher left ventricular index mass, and elevated troponin and NTpro-BNP levels. CONCLUSION Trypanosoma cruzi PCR positivity is associated with presence and severity of cardiomyopathy, suggesting a direct role of parasite persistence in disease pathogenesis.
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Affiliation(s)
- E C Sabino
- Department of Infectious Disease and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil; Fundação Pró-Sangue Hemocentro de Sao Paulo, São Paulo, Brazil
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Pinazo MJ, Thomas MC, Bua J, Perrone A, Schijman AG, Viotti RJ, Ramsey JM, Ribeiro I, Sosa-Estani S, López MC, Gascon J. Biological markers for evaluating therapeutic efficacy in Chagas disease, a systematic review. Expert Rev Anti Infect Ther 2015; 12:479-96. [PMID: 24621252 DOI: 10.1586/14787210.2014.899150] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The most neglected aspects of Chagas disease (CD) have been patient care and treatment. Despite recent progress in the development of potentially improved drugs, there is no consensus among different research groups on the lack of therapeutic response markers to evaluate efficacy of newly proposed drugs early after treatment. A systematic review of current evidence regarding molecules which are potential biomarkers for therapeutic response has been conducted using quality assessment and target responses as primary criteria. The review provides a panorama of the cumulative evidence and specific needs for development of a battery of complementary biomarkers which together fulfill ideal or acceptable criteria to evaluate early responses to treatment for chronic CD. There are several marker candidates which together may fulfill acceptable criteria to indicate the efficacy of a trypanocidal treatment. Data from ongoing studies are considered essential to improve assessment of existing markers and to identify those for early follow-up of treated patients.
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Affiliation(s)
- Maria-Jesús Pinazo
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), 132 Rosello st 4°,08036, Barcelona, Spain
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Campi-Azevedo AC, Gomes JAS, Teixeira-Carvalho A, Silveira-Lemos D, Vitelli-Avelar DM, Sathler-Avelar R, Peruhype-Magalhães V, Béla SR, Silvestre KF, Batista MA, Schachnik NCC, Correa-Oliveira R, Eloi-Santos SM, Martins-Filho OA. Etiological treatment of Chagas disease patients with benznidazole lead to a sustained pro-inflammatory profile counterbalanced by modulatory events. Immunobiology 2015; 220:564-74. [PMID: 25648688 DOI: 10.1016/j.imbio.2014.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 11/28/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
Abstract
In the present study, we characterized the phagocytic capacity, cytokine profile along with the FCγ-R and TLR expression in leukocytes from Chagas disease patients (indeterminate-IND and cardiac-CARD) before and one-year after Bz-treatment (INDT and CARDT). A down-regulation of IL-17, IFN-γ and IL-10 synthesis by neutrophils was observed in CARDT. The Bz-treatment did not impact on the expression of phagocytosis-related surface molecules or monocyte-derived cytokine profile in INDT. Although CARDT showed unaltered monocyte-phagocytic capacity, up-regulated expression of Fcγ-RI/III and TLR-4 may be related to their ability to produce IL-10 and TGF-β. Down-regulation of lymphocyte-derived cytokine was observed in INDT whereas up-regulated cytokine profile was observed for lymphocytes in CARDT. Analysis of cytokine network revealed that IND displayed a multifaceted cytokine response characterized by strong connecting axes involving pro-inflammatory/regulatory phagocytes and lymphocytes. On the other hand, CARD presented a modest cytokine network. The Bz-treatment leads to distinct cytokine network: decreasing the links in INDT, with a pivotal role of IL-10(+) monocytes and expanding the connections in CARDT. Our findings highlighted that the Bz-treatment contributes to an overall immunomodulation in INDT and induces a broad change of immunological response in CARDT, eliciting an intricate phenotypic/functional network compatible with beneficial and protective immunological events.
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Affiliation(s)
- A C Campi-Azevedo
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - J A S Gomes
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil; Laboratório de Imunologia Celular e Molecular, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil; Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil; Programa de Pós- graduação em Medicina Tropical e Infectologia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
| | - A Teixeira-Carvalho
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - D Silveira-Lemos
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - D M Vitelli-Avelar
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - R Sathler-Avelar
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - V Peruhype-Magalhães
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - S R Béla
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - K F Silvestre
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - M A Batista
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - N C C Schachnik
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - R Correa-Oliveira
- Laboratório de Imunologia Celular e Molecular, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais - INCT-DT, Brasil
| | - S M Eloi-Santos
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - O A Martins-Filho
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
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Martínez N, Elena Marson M, Enrique Mastrantonio G, Raba J, Cerutti S. Development of a LC–MS/MS methodology for the monitoring of the antichagasic drug benznidazole in human urine. Talanta 2015; 131:656-60. [DOI: 10.1016/j.talanta.2014.08.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 08/12/2014] [Accepted: 08/14/2014] [Indexed: 10/24/2022]
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Abstract
The discovery of new therapeutic options against Trypanosoma cruzi, the causative agent of Chagas disease, stands as a fundamental need. Currently, there are only two drugs available to treat this neglected disease, which represents a major public health problem in Latin America. Both available therapies, benznidazole and nifurtimox, have significant toxic side effects and their efficacy against the life-threatening symptomatic chronic stage of the disease is variable. Thus, there is an urgent need for new, improved anti–T. cruzi drugs. With the objective to reliably accelerate the drug discovery process against Chagas disease, several advances have been made in the last few years. Availability of engineered reporter gene expressing parasites triggered the development of phenotypic in vitro assays suitable for high throughput screening (HTS) as well as the establishment of new in vivo protocols that allow faster experimental outcomes. Recently, automated high content microscopy approaches have also been used to identify new parasitic inhibitors. These in vitro and in vivo early drug discovery approaches, which hopefully will contribute to bring better anti–T. cruzi drug entities in the near future, are reviewed here.
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Abstract
American trypanosomiasis, or Chagas disease, is the result of infection by the Trypanosoma cruzi parasite. Endemic in Latin America where it is the major cause of death from cardiomyopathy, the impact of the disease is reaching global proportions through migrating populations. New drugs that are safe, efficacious, low cost, and adapted to the field are critically needed. Over the past five years, there has been increased interest in the disease and a surge in activities within various organizations. However, recent clinical trials with azoles, specifically posaconazole and the ravuconazole prodrug E1224, were disappointing, with treatment failure in Chagas patients reaching 70% to 90%, as opposed to 6% to 30% failure for benznidazole-treated patients. The lack of translation from in vitro and in vivo models to the clinic observed for the azoles raises several questions. There is a scientific requirement to review and challenge whether we are indeed using the right tools and decision-making processes to progress compounds forward for the treatment of this disease. New developments in the Chagas field, including new technologies and tools now available, will be discussed, and a redesign of the current screening strategy during the discovery process is proposed.
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Affiliation(s)
- Eric Chatelain
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
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Chemello D, Goldraich L, Alvarez J, Beck-da-Silva L, Clausell N. Critical appraisal of costly therapy modalities for heart failure in a developing country. Curr Heart Fail Rep 2014; 10:421-6. [PMID: 24072512 DOI: 10.1007/s11897-013-0159-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Contemporaneous challenges in heart failure management include strategies to rationally use health economic resources and relative donor shortage to adequately offer electric devices (cardiac resynchronization therapy [CRT] and implantable cardioverter defibrillators [ICD]), ventricular assist devices (VADs) and heart transplant, respectively. These issues are particularly important in countries with middle-income rates and limited structured heart transplant centers, such as Brazil. Use of CRT and ICDs need to follow strict guidelines, further customized to public financial health conditions. Experience with VADs in is the early days in Brazil and will require extreme caution to allocate health public resources to develop VAD programs in highly selected centers. Chagas' disease is epidemiologically important in Brazil; outcomes of patients with Chagas' on electric devices are unclear while these patients fare better post-transplant than non-Chagas' patients. Thus, heart transplant remains an attractive option regarding both favorable outcomes and resource allocation for advanced heart failure patients in Brazil.
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Affiliation(s)
- Diego Chemello
- Hospital de Clinicas de Porto Alegre, Division of Cardiology, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, Brazil, 90035-903
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Altcheh J, Moscatelli G, Mastrantonio G, Moroni S, Giglio N, Marson ME, Ballering G, Bisio M, Koren G, García-Bournissen F. Population pharmacokinetic study of benznidazole in pediatric Chagas disease suggests efficacy despite lower plasma concentrations than in adults. PLoS Negl Trop Dis 2014; 8:e2907. [PMID: 24853169 PMCID: PMC4031103 DOI: 10.1371/journal.pntd.0002907] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/16/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Chagas disease, caused by the parasite Trypanosoma cruzi, can lead to long term cardiac morbidity. Treatment of children with benznidazole is effective, but no pediatric pharmacokinetics data are available and clinical pharmacology information on the drug is scarce. PATIENTS AND METHODS Prospective population pharmacokinetic (PK) cohort study in children 2-12 years old with Chagas disease treated with oral benznidazole 5-8 mg/kg/day BID for 60 days. (clinicaltrials.gov #NCT00699387). RESULTS Forty children were enrolled in the study. Mean age was 7.3 years. A total of 117 samples were obtained from 38 patients for PK analysis. A one compartment model best fit the data. Weight-corrected clearance rate (CL/F) showed a good correlation with age, with younger patients having a significantly higher CL/F than older children and adults. Simulated median steady-state benznidazole concentrations, based on model parameters, were lower for children in our study than for adults and lowest for children under 7 years of age. Treatment was efficacious in the 37 patients who completed the treatment course, and well tolerated, with few, and mild, adverse drug reactions (ADRs). DISCUSSION Observed benznidazole plasma concentrations in children were markedly lower than those previously reported in adults (treated with comparable mg/kg doses), possibly due to a higher CL/F in smaller children. These lower blood concentrations were nevertheless associated to a high therapeutic response in our cohort. Unlike adults, children have few adverse reactions to the drug, suggesting that there may be a direct correlation between drug concentrations and incidence of ADRs. Our results suggest that studies with lower doses in adults may be warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT00699387.
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Affiliation(s)
- Jaime Altcheh
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Guillermo Moscatelli
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Guido Mastrantonio
- Área de Toxicología, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Provincia de Buenos Aires, Argentina
| | - Samanta Moroni
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Norberto Giglio
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Maria Elena Marson
- Área de Toxicología, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Provincia de Buenos Aires, Argentina
| | - Griselda Ballering
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Margarita Bisio
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Gideon Koren
- Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Facundo García-Bournissen
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
- Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Marañón C, Egui A, Fernández-Villegas A, Carrilero B, Thomas MC, Segovia M, López MC. Benznidazole treatment reduces the induction of indoleamine 2,3-dioxygenase (IDO) enzymatic activity in Chagas disease symptomatic patients. Parasite Immunol 2014; 35:180-7. [PMID: 23473453 DOI: 10.1111/pim.12030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/18/2013] [Indexed: 12/24/2022]
Abstract
The enzyme indoleamine 2,3-dioxigenase (IDO) is critical for the regulation of immune responses in pro-tolerogenic antigen-presenting cell. To address the profile of immune responses associated with Chagas disease, we measured IDO activity of peripheral blood mononuclear cells from 168 chronic patients and 13 healthy donors. We found that IDO activity was increased in patients with Chagas disease when compared with controls. Moreover, the IDO activity of patients with Chagas disease in the symptomatic chronic phase, involving cardiac or digestive alterations, was higher than that detected in asymptomatic patients and correlated with the severity of the symptoms. Furthermore, benznidazole treatment induced a long-lasting decrease in IDO activity in symptomatic patients, reaching levels comparable with those of healthy donors. These results suggest that a pro-tolerogenic state is associated with the severity of Chagas disease and that benznidazole treatment is a valuable tool for breaking the parasite-driven immune tolerance in the symptomatic chronic phase of Chagas disease.
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Affiliation(s)
- C Marañón
- Instituto de Parasitología y Biomedicina López Neyra, Consejo Superior de Investigaciones Científicas (IPBLN- CSIC), Granada, Spain.
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