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Loebel M, Grabowski P, Heidecke H, Bauer S, Hanitsch LG, Wittke K, Meisel C, Reinke P, Volk HD, Fluge Ø, Mella O, Scheibenbogen C. Antibodies to β adrenergic and muscarinic cholinergic receptors in patients with Chronic Fatigue Syndrome. Brain Behav Immun 2016; 52:32-39. [PMID: 26399744 DOI: 10.1016/j.bbi.2015.09.013] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/18/2015] [Accepted: 09/19/2015] [Indexed: 10/23/2022] Open
Abstract
Infection-triggered disease onset, chronic immune activation and autonomic dysregulation in CFS point to an autoimmune disease directed against neurotransmitter receptors. Autoantibodies against G-protein coupled receptors were shown to play a pathogenic role in several autoimmune diseases. Here, serum samples from a patient cohort from Berlin (n=268) and from Bergen with pre- and post-treatment samples from 25 patients treated within the KTS-2 rituximab trial were analysed for IgG against human α and β adrenergic, muscarinic (M) 1-5 acetylcholine, dopamine, serotonin, angiotensin, and endothelin receptors by ELISA and compared to a healthy control cohort (n=108). Antibodies against β2, M3 and M4 receptors were significantly elevated in CFS patients compared to controls. In contrast, levels of antibodies against α adrenergic, dopamine, serotonin, angiotensin, and endothelin receptors were not different between patients and controls. A high correlation was found between levels of autoantibodies and elevated IgG1-3 subclasses, but not with IgG4. Further patients with high β2 antibodies had significantly more frequently activated HLA-DR+ T cells and more frequently thyreoperoxidase and anti-nuclear antibodies. In patients receiving rituximab maintenance treatment achieving prolonged B-cell depletion, elevated β2 and M4 receptor autoantibodies significantly declined in clinical responder, but not in non-responder. We provide evidence that 29.5% of patients with CFS had elevated antibodies against one or more M acetylcholine and β adrenergic receptors which are potential biomarkers for response to B-cell depleting therapy. The association of autoantibodies with immune markers suggests that they activate B and T cells expressing β adrenergic and M acetylcholine receptors. Dysregulation of acetylcholine and adrenergic signalling could also explain various clinical symptoms of CFS.
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Affiliation(s)
- Madlen Loebel
- Institute for Medical Immunology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany.
| | - Patricia Grabowski
- Institute for Medical Immunology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
| | | | - Sandra Bauer
- Institute for Medical Immunology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
| | - Leif G Hanitsch
- Institute for Medical Immunology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
| | - Kirsten Wittke
- Institute for Medical Immunology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
| | - Christian Meisel
- Institute for Medical Immunology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany; Labor Berlin GmbH, Immunology Department, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
| | - Petra Reinke
- Department of Nephrology, Charité University Medicine Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine Berlin, Germany
| | - Hans-Dieter Volk
- Institute for Medical Immunology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine Berlin, Germany
| | - Øystein Fluge
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Olav Mella
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Carmen Scheibenbogen
- Institute for Medical Immunology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine Berlin, Germany
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Neves BCD, Bacilio ML, Berrueta L, Salmen S, Peterson DL, Donis JH, Nuñez TJ, Davila DF. Muscarinic antibodies and heart rate responses to dynamic exercise and to the Valsalva maneuver in chronic chagasic patients. Rev Inst Med Trop Sao Paulo 2013; 55:31-7. [PMID: 23328723 DOI: 10.1590/s0036-46652013000100006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 08/14/2012] [Indexed: 11/22/2022] Open
Abstract
We have studied the cardiac chronotropic responses to the Valsalva maneuver and to dynamic exercise of twenty chronic chagasic patients with normal left ventricular function and no segmental wall abnormalities by two-dimensional echocardiogram. The absolute increase in heart rate of the patients (Δ = 21.5 ± 10 bpm, M±SD) during the maneuver was significantly diminished when compared to controls (Δ = 31.30 ± 70, M±SD, p = 0.03). The minimum heart rate (58.24 ± 8.90 vs. 62.80 ± 10, p = 0.68) and the absolute decrease in heart rate at the end of the maneuver (Δ = 38.30 ± 13 vs. Δ = 31.47 ± 17, p = 0.10) were not different from controls. The initial heart rate acceleration during dynamic exercise (Δ = 12 ± 7.55 vs. Δ = 19 ± 7.27, M±SD, p = 0.01) was also diminished, but the heart rate recovery during the first ten seconds was more prominent in the sero-positive patients (Median: 14, Interquartile range: (9.75-17.50 vs. 5(0-8.75, p = 0.001). The serum levels of muscarinic cardiac auto-antibodies were significantly higher in the chagasic patients (Median: 34.58, Interquartile Range: 17-46.5, Optical Density) than in controls (Median: 0, Interquartile Range: 0-22.25, p = 0.001) and correlated significantly and directly (r = 0.68, p = 0.002) with early heart rate recovery during dynamic exercise. The results of this investigation indirectly suggest that, the cardiac muscarinic auto-antibodies may have positive agonist effects on parasympathetic heart rate control of chagasic patients.
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Affiliation(s)
- Barbara C das Neves
- Instituto de Investigaciones Cardiovasculares, Universidad de Los Andes, Mérida, Venezuela
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Dávila DF, Donis JH, Arata de Bellabarba G, Villarroel V, Sanchez F, Berrueta L, Salmen S, Das Neves B. Cardiac autonomic control mechanisms in the pathogenesis of chagas' heart disease. Interdiscip Perspect Infect Dis 2012; 2012:980739. [PMID: 23091486 PMCID: PMC3467757 DOI: 10.1155/2012/980739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 08/27/2012] [Indexed: 11/17/2022] Open
Abstract
Primary abnormalities of the autonomic nervous system had been postulated as the pathogenic mechanisms of myocardial damage, in patients with Chagas disease. However, recent investigations indicate that these abnormalities are secondary and amenable to treatment with beta-adrenergic blockers. Moreover, muscarinic cardiac autoantibodies appear to enhance parasympathetic activity on the sinus node. Therefore, the purpose of this paper is to analyze how knowledge on Chagas' disease evolved from being initially considered as a primary cardioneuromyopathy to the current status of a congestive cardiomyopathy of parasitic origin.
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Affiliation(s)
- Diego F. Dávila
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Jose H. Donis
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Gabriela Arata de Bellabarba
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Vanesa Villarroel
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Francisco Sanchez
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Lisbeth Berrueta
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Siham Salmen
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
| | - Barbara Das Neves
- Instituto de Investigaciones Cardiovasculares, Departamento de Fisiopatología, Instituto de Inmunologìa Clinica, Facultad de Medicina, Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida 5101, Venezuela
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Teixeira ARL, Hecht MM, Guimaro MC, Sousa AO, Nitz N. Pathogenesis of chagas' disease: parasite persistence and autoimmunity. Clin Microbiol Rev 2011; 24:592-630. [PMID: 21734249 PMCID: PMC3131057 DOI: 10.1128/cmr.00063-10] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Acute Trypanosoma cruzi infections can be asymptomatic, but chronically infected individuals can die of Chagas' disease. The transfer of the parasite mitochondrial kinetoplast DNA (kDNA) minicircle to the genome of chagasic patients can explain the pathogenesis of the disease; in cases of Chagas' disease with evident cardiomyopathy, the kDNA minicircles integrate mainly into retrotransposons at several chromosomes, but the minicircles are also detected in coding regions of genes that regulate cell growth, differentiation, and immune responses. An accurate evaluation of the role played by the genotype alterations in the autoimmune rejection of self-tissues in Chagas' disease is achieved with the cross-kingdom chicken model system, which is refractory to T. cruzi infections. The inoculation of T. cruzi into embryonated eggs prior to incubation generates parasite-free chicks, which retain the kDNA minicircle sequence mainly in the macrochromosome coding genes. Crossbreeding transfers the kDNA mutations to the chicken progeny. The kDNA-mutated chickens develop severe cardiomyopathy in adult life and die of heart failure. The phenotyping of the lesions revealed that cytotoxic CD45, CD8(+) γδ, and CD8α(+) T lymphocytes carry out the rejection of the chicken heart. These results suggest that the inflammatory cardiomyopathy of Chagas' disease is a genetically driven autoimmune disease.
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Affiliation(s)
- Antonio R L Teixeira
- Chagas Disease Multidisciplinary Research Laboratory, University of Brasilia, Federal District, Brazil.
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Ribeiro ALP, Cassini P, Peixoto SV, Lima-Costa MF. Vagal impairment in elderly Chagas disease patients: a population-based study (the Bambuí study). Int J Cardiol 2009; 147:359-65. [PMID: 19875184 DOI: 10.1016/j.ijcard.2009.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 07/11/2009] [Accepted: 10/11/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chagas disease (ChD) will become predominantly a disease of the elderly, as a consequence of the effectiveness of control measures in many Latin American countries. The effects of the disease in old age have received little attention. We investigated the effects of ageing in the association between cardiac vagal impairment, a typical feature of ChD, and chronic Trypanosoma cruzi infection. METHODS The study sample of this cross-sectional study consists of 1014 subjects ≥ 60 years old (mean age = 68.3; SD = 6.9) residing in Bambuí City (Southeast Brazil). ECG was recorded and one-breath sinus arrhythmia test was performed. Maximal expiratory over the minimal inspiratory (E:I) ratio and heart rate variability (HRV) measurements were calculated. Ordinal logistic regression was used to assess the relation between vagal indexes and chronic T. cruzi infection. RESULTS The prevalence of T. cruzi infection was 32.0% and of major ECG abnormalities, 43.4%. Among individuals aged 60-69 years, T. cruzi infection was significantly and independently associated with reduced SDNN (OR 0.38; 95% CI 0.27-0.53), RMSSD (OR 0.48; 0.34-0.67) and EI: ratio (OR 0.45; 95% CI 0.33-0.63). Among individuals aged >70 years, no significant odds ratios were found in either the unadjusted or the adjusted analysis. The presence of major ECG abnormalities did not affect the association between vagal indexes and T. cruzi infection. CONCLUSIONS Disease-specific vagal cardiac dysfunction was observed in ChD individuals below 70. However, further ageing interferes significantly with vagal heart modulation, attenuating the difference of HRV indexes between ChD and non-ChD subjects.
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Affiliation(s)
- Antonio Luiz P Ribeiro
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Benchimol-Barbosa PR. Comments on the letter by Ribeiro et al.: impairment of parasympathetic-mediated autonomic modulation of the heart in Chagas' cardiomyopathy: parasympathetic modulation vs. tonus. Int J Cardiol 2008; 135:126-7. [PMID: 18486245 DOI: 10.1016/j.ijcard.2008.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 01/12/2008] [Indexed: 11/17/2022]
Abstract
Chagas' disease is complex immune-mediated disease originated after Trypanosome cruzi transmission, and a major cause of heart failure in Latin American continent. Auto-antibodies directed to type 2 muscarinic parasympathetic (M2) receptors seem to play key roles on the pathogenesis of heart disease, in particular in the impairment of the cardiac autonomic modulation. When talking about M2 agonistic effects, one should first argue about the differences between the terms 'modulation' and 'tonus' before describing possible autonomic influences on the heart.
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Chagas disease: Impaired vagal modulation has been demonstrated, enhanced parasympathetic activity remains to be proved. Int J Cardiol 2008. [DOI: 10.1016/j.ijcard.2007.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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