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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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da Silveira-Lemos D, Alessio GD, Batista MA, de Azevedo PO, Reis-Cunha JL, Mendes TADO, Lourdes RDA, de Lana M, Fujiwara RT, Filho OAM, Bartholomeu DC. Phenotypic, functional and serological aspects of genotypic-specific immune response of experimental T. cruzi infection. Acta Trop 2021; 222:106021. [PMID: 34161815 DOI: 10.1016/j.actatropica.2021.106021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 12/13/2022]
Abstract
The complexity and multifactorial characteristics of Chagas disease pathogenesis hampers the establishment of appropriate experimental/epidemiological sets, and therefore, still represents one of the most challenging fields for novel insights and discovery. In this context, we used a set of attributes including phenotypic, functional and serological markers of immune response as candidates to decode the genotype-specific immune response of experimental T. cruzi infection. In this investigation, we have characterized in C57BL/6 J mice, the early (parasitemia peak) and late (post-parasitemia peak) aspects of the immune response elicited by T. cruzi strains representative of TcI, TcII or TcVI. The results demonstrated earlier parasitemia peak for TcII/Y strain followed by TcVI/CL-Brener and TcI/Colombiana strains. A panoramic overview of phenotypic and functional features of the TCD4+, TCD8+ and B-cells from splenocytes demonstrated that mice infected with TcI/Colombiana strain exhibited at early stages of infection low levels of most cytokine+ cells with a slight increase at late stages of infection. Conversely, mice infected with TcII/Y strain presented an early massive increase of cytokine+ cells, which decreases at late stages. The TcVI/CL-Brener strain showed an intermediate profile at early stages of infection with a slight increase later on at post-peak of parasitemia. The panoramic analysis of immunological connectivity demonstrated that early after infection, the TcI/Colombiana strain trigger immunological network characterized by a small number of connectivity, selectively amongst cytokines that further shade towards the late stages of infection. In contrast, the TcII/Y strain elicited in more imbricate networks early after infection, comprising a robust number of interactions between pro-inflammatory mediators, regulatory cytokines and activation markers that also decrease at late infection. On the other hand, the infection with TcVI/CL-Brener strain demonstrated an intermediate profile with connectivity axes more stable at early and late stages of infection. The analysis of IgG2a reactivity to AMA, TRYPO and EPI antigens revealed that at early stages of infection, the genotype-specific reactivity to AMA, TRYPO and EPI to distinguish was higher for TcI/Colombiana as compared to TcII/Y and TcVI/CL while, at late stages of infection, higher reactivity to AMA was observed in mice infected with TcVI/CL and TcII/Y strains. The novel systems biology approaches and the use of a flow cytometry platform demonstrated that distinct T. cruzi genotypes influenced in the phenotypic and functional features of the host immune response and the genotype-specific serological reactivity during early and late stages of experimental T. cruzi infection.
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Affiliation(s)
- Denise da Silveira-Lemos
- Laboratório de Imunologia e Genômica de Parasitos - Departamento de Parasitologia, Instituto de Ciências Biológicas/ICB, Universidade Federal de Minas Gerais, Minas Gerais, Brasil; Grupo Integrado de Pesquisas em Biomarcadores - Instituto René Rachou/Fiocruz-MINAS, Minas Gerais, Brasil.
| | - Glaucia Diniz Alessio
- Grupo Integrado de Pesquisas em Biomarcadores - Instituto René Rachou/Fiocruz-MINAS, Minas Gerais, Brasil; Campus Centro-Oeste Dona Lindu, Universidade Federal de São João Del-Rei, Divinópolis, Minas Gerais, Brasil.
| | - Maurício Azevedo Batista
- Laboratório de Imunologia e Genômica de Parasitos - Departamento de Parasitologia, Instituto de Ciências Biológicas/ICB, Universidade Federal de Minas Gerais, Minas Gerais, Brasil
| | - Patrick Orestes de Azevedo
- Grupo Integrado de Pesquisas em Biomarcadores - Instituto René Rachou/Fiocruz-MINAS, Minas Gerais, Brasil
| | - João Luís Reis-Cunha
- Laboratório de Imunologia e Genômica de Parasitos - Departamento de Parasitologia, Instituto de Ciências Biológicas/ICB, Universidade Federal de Minas Gerais, Minas Gerais, Brasil
| | - Tiago Antônio de Oliveira Mendes
- Laboratório de Imunologia e Genômica de Parasitos - Departamento de Parasitologia, Instituto de Ciências Biológicas/ICB, Universidade Federal de Minas Gerais, Minas Gerais, Brasil
| | - Rodrigo de Almeida Lourdes
- Laboratório de Imunologia e Genômica de Parasitos - Departamento de Parasitologia, Instituto de Ciências Biológicas/ICB, Universidade Federal de Minas Gerais, Minas Gerais, Brasil
| | - Marta de Lana
- Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto, Minas Gerais, Brasil
| | - Ricardo Toshio Fujiwara
- Laboratório de Imunologia e Genômica de Parasitos - Departamento de Parasitologia, Instituto de Ciências Biológicas/ICB, Universidade Federal de Minas Gerais, Minas Gerais, Brasil
| | - Olindo Assis Martins Filho
- Grupo Integrado de Pesquisas em Biomarcadores - Instituto René Rachou/Fiocruz-MINAS, Minas Gerais, Brasil
| | - Daniella Castanheira Bartholomeu
- Laboratório de Imunologia e Genômica de Parasitos - Departamento de Parasitologia, Instituto de Ciências Biológicas/ICB, Universidade Federal de Minas Gerais, Minas Gerais, Brasil
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Human Chagas-Flow ATE-IgG1 for advanced universal and Trypanosoma cruzi Discrete Typing Units-specific serodiagnosis of Chagas disease. Sci Rep 2020; 10:13296. [PMID: 32764546 PMCID: PMC7414038 DOI: 10.1038/s41598-020-69921-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/21/2020] [Indexed: 12/23/2022] Open
Abstract
The molecular and serological methods available for Discrete Typing Units (DTU)-specific diagnosis of Trypanosoma cruzi in chronic Chagas disease present limitations. The study evaluated the performance of Human Chagas-Flow ATE-IgG1 for universal and DTU-specific diagnosis of Chagas disease. A total of 102 sera from Chagas disease patients (CH) chronically infected with TcI, TcVI or TcII DTUs were tested for IgG1 reactivity to amastigote/(A), trypomastigote/(T) and epimastigote/(E) antigens along the titration curve (1:250-1:32,000). The results demonstrated that "AI 250/40%", "EVI 250/30%", "AII 250/40%", "TII 250/40%" and "EII 250/30%" have outstanding accuracy (100%) to segregate CH from non-infected controls. The attributes "TI 4,000/50%", "EI 2,000/50%", "AVI 8,000/60%" and "TVI 4,000/50%" were selected for DTU-specific serotyping of Chagas disease. The isolated use of "EI 2,000/50%" provided the highest co-positivity for TcI patients (91%). The combined decision tree algorithms using the pre-defined sets of attributes showed outstanding full accuracy (92% and 97%) to discriminate "TcI vs TcVI vs TcII" and "TcI vs TcII" prototypes, respectively. The elevated performance of Human Chagas-Flow ATE-IgG1 qualifies its use for universal and TcI/TcVI/TcII-specific diagnosis of Chagas disease. These findings further support the application of this method in epidemiological surveys, post-therapeutic monitoring and clinical outcome follow-ups for Chagas disease.
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4
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Zao CL, Yang YC, Tomanek L, Cooke A, Berger R, Chien LC, Madigan R. PCR monitoring of parasitemia during drug treatment for canine Chagas disease. J Vet Diagn Invest 2019; 31:742-746. [PMID: 31378166 DOI: 10.1177/1040638719868508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To date, there is no clear standard to monitor drug treatment for canine Chagas disease. We used 2 real-time PCR (rtPCR) assays targeting Trypanosoma cruzi kinetoplast DNA (kDNA) and nuclear satellite DNA (nDNA) to detect T. cruzi in canine whole blood. Samples were collected randomly from 131 untreated dogs with unknown T. cruzi infection status in Texas. The kDNA-based rtPCR was slightly more sensitive (diagnostic sensitivity of kDNA = 49% vs. nDNA = 44%; p = 0.5732) but slightly less specific (diagnostic specificity of kDNA = 96% vs. nDNA = 97%; p > 0.9999) than the nDNA-based rtPCR. However, the differences in sensitivity and specificity between the nDNA- and kDNA-based rtPCR assays were not statistically significant. Using the nDNA- and kDNA-based qualitative rtPCR assays to monitor parasitemia from 137 itraconazole- and amiodarone-treated cases with nDNA- and kDNA-based PCR-positive baselines showed that the PCR positive rate decreased to 0% in 30 d. Using kDNA-based quantitative rtPCR to monitor normalized T. cruzi DNA copies in 4 representative dogs demonstrated that drug treatment could reduce parasite loads within 7-30 d. The kDNA-based qualitative rtPCR may be used for routine parasitemia screening of drug-treated Chagas-positive dogs, whereas nDNA-based qualitative rtPCR may be used for confirmation.
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Affiliation(s)
- Chih-Ling Zao
- VRL-San Antonio, San Antonio, TX (Zao, Yang, Tomanek, Cooke, Berger).,Epidemiology and Biostatistics, Department of Environmental and Occupational Health, University of Nevada, Las Vegas, NV (Chien).,Animal Hospital of Smithson Valley, Spring Branch, TX (Madigan)
| | - Ya-Chin Yang
- VRL-San Antonio, San Antonio, TX (Zao, Yang, Tomanek, Cooke, Berger).,Epidemiology and Biostatistics, Department of Environmental and Occupational Health, University of Nevada, Las Vegas, NV (Chien).,Animal Hospital of Smithson Valley, Spring Branch, TX (Madigan)
| | - Lisa Tomanek
- VRL-San Antonio, San Antonio, TX (Zao, Yang, Tomanek, Cooke, Berger).,Epidemiology and Biostatistics, Department of Environmental and Occupational Health, University of Nevada, Las Vegas, NV (Chien).,Animal Hospital of Smithson Valley, Spring Branch, TX (Madigan)
| | - Anthony Cooke
- VRL-San Antonio, San Antonio, TX (Zao, Yang, Tomanek, Cooke, Berger).,Epidemiology and Biostatistics, Department of Environmental and Occupational Health, University of Nevada, Las Vegas, NV (Chien).,Animal Hospital of Smithson Valley, Spring Branch, TX (Madigan)
| | - Ron Berger
- VRL-San Antonio, San Antonio, TX (Zao, Yang, Tomanek, Cooke, Berger).,Epidemiology and Biostatistics, Department of Environmental and Occupational Health, University of Nevada, Las Vegas, NV (Chien).,Animal Hospital of Smithson Valley, Spring Branch, TX (Madigan)
| | - Lung-Chang Chien
- VRL-San Antonio, San Antonio, TX (Zao, Yang, Tomanek, Cooke, Berger).,Epidemiology and Biostatistics, Department of Environmental and Occupational Health, University of Nevada, Las Vegas, NV (Chien).,Animal Hospital of Smithson Valley, Spring Branch, TX (Madigan)
| | - Roy Madigan
- VRL-San Antonio, San Antonio, TX (Zao, Yang, Tomanek, Cooke, Berger).,Epidemiology and Biostatistics, Department of Environmental and Occupational Health, University of Nevada, Las Vegas, NV (Chien).,Animal Hospital of Smithson Valley, Spring Branch, TX (Madigan)
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Nunes MCP, Beaton A, Acquatella H, Bern C, Bolger AF, Echeverría LE, Dutra WO, Gascon J, Morillo CA, Oliveira-Filho J, Ribeiro ALP, Marin-Neto JA. Chagas Cardiomyopathy: An Update of Current Clinical Knowledge and Management: A Scientific Statement From the American Heart Association. Circulation 2018; 138:e169-e209. [DOI: 10.1161/cir.0000000000000599] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background:
Chagas disease, resulting from the protozoan
Trypanosoma cruzi
, is an important cause of heart failure, stroke, arrhythmia, and sudden death. Traditionally regarded as a tropical disease found only in Central America and South America, Chagas disease now affects at least 300 000 residents of the United States and is growing in prevalence in other traditionally nonendemic areas. Healthcare providers and health systems outside of Latin America need to be equipped to recognize, diagnose, and treat Chagas disease and to prevent further disease transmission.
Methods and Results:
The American Heart Association and the Inter-American Society of Cardiology commissioned this statement to increase global awareness among providers who may encounter patients with Chagas disease outside of traditionally endemic environments. In this document, we summarize the most updated information on diagnosis, screening, and treatment of
T cruzi
infection, focusing primarily on its cardiovascular aspects. This document also provides quick reference tables, highlighting salient considerations for a patient with suspected or confirmed Chagas disease.
Conclusions:
This statement provides a broad summary of current knowledge and practice in the diagnosis and management of Chagas cardiomyopathy. It is our intent that this document will serve to increase the recognition of Chagas cardiomyopathy in low-prevalence areas and to improve care for patients with Chagas heart disease around the world.
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Alessio GD, de Araújo FF, Sales Júnior PA, Gomes MDS, do Amaral LR, Pascoal Xavier MA, Teixeira-Carvalho A, de Lana M, Martins-Filho OA. Accomplishing the genotype-specific serodiagnosis of single and dual Trypanosoma cruzi infections by flow cytometry Chagas-Flow ATE-IgG2a. PLoS Negl Trop Dis 2018; 12:e0006140. [PMID: 29462135 PMCID: PMC5843347 DOI: 10.1371/journal.pntd.0006140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 03/08/2018] [Accepted: 11/28/2017] [Indexed: 01/04/2023] Open
Abstract
The methods currently available for genotype-specific diagnosis of T. cruzi infection still present relevant limitations, especially to identify mixed infection. In the present investigation, we have evaluated the performance of Chagas-Flow ATE-IgG2a test for early and late differential diagnosis of single and dual genotype-specific T. cruzi infections. Serum samples from Swiss mice at early and late stages of T. cruzi infection were assayed in parallel batches for genotype-specific diagnosis of single (TcI, TcVI or TcII) and dual (TcI+TcVI, TcVI+TcII or TcII+TcI) infections. The intrinsic reactivity to TcI, TcVI and TcII target antigens, including amastigote (AI/AVI/AII), trypomastigote-(TI/TVI/TII) and epimastigote (EI/EVI/EII), at specific reverse of serum dilutions (500 to 64,000), was employed to provide reliable decision-trees for "early" vs "late", "single vs "dual" and "genotype-specific" serology. The results demonstrated that selective set of attributes "EII 500/EI 2,000/AII 500" were able to provide high-quality accuracy (81%) to segregate early and late stages of T. cruzi infection. The sets "TI 2,000/AI 1,000/EII 1,000" and "TI 8,000/AII 32,000" presented expressive scores to discriminate single from dual T. cruzi infections at early (85%) and late stages (84%), respectively. Moreover, the attributes "TI 4,000/TVI 500/TII 1,000", "TI 16,000/EI 2,000/EII 2,000/AI 500/TVI 500" showed good performance for genotype-specific diagnosis at early stage of single (72%) and dual (80%) T. cruzi infections, respectively. In addition, the attributes "TI 4,000/AII 1,000/EVI 1,000", "TI 64,000/AVI 500/AI 2,000/AII 1,000/EII 4,000" showed moderate performance for genotype-specific diagnosis at late stage of single (69%) and dual (76%) T. cruzi infections, respectively. The sets of decision-trees were assembled to construct a sequential algorithm with expressive accuracy (81%) for serological diagnosis of T. cruzi infection. These findings engender new perspectives for the application of Chagas-Flow ATE-IgG2a method for genotype-specific diagnosis in humans, with relevant contributions for epidemiological surveys as well as clinical and post-therapeutic monitoring of Chagas disease.
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Affiliation(s)
- Glaucia Diniz Alessio
- Laboratório de Doença de Chagas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Instituto de Ciências Exatas e Biológicas (ICEB), Universidade Federal de Ouro Preto (UFOP), Ouro Preto, MG, Brazil
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou (FIOCRUZ-Minas), Belo Horizonte, MG, Brazil
| | - Fernanda Fortes de Araújo
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou (FIOCRUZ-Minas), Belo Horizonte, MG, Brazil
- Programa de Pós-graduação em Sanidade e Produção Animal nos Trópicos, Universidade de Uberaba, Uberaba, Brazil
| | - Policarpo Ademar Sales Júnior
- Grupo de Genômica Funcional e Proteômica de Leishmania spp e Trypanosoma cruzi, Instituto René Rachou (FIOCRUZ-Minas), Belo Horizonte, MG, Brazil
| | - Matheus de Souza Gomes
- Laboratório de Bioinformática e Análises Moleculares, Universidade Federal de Uberlândia, INGEB/FACOM, Campus Patos de Minas, Patos de Minas, MG, Brazil
| | - Laurence Rodrigues do Amaral
- Laboratório de Bioinformática e Análises Moleculares, Universidade Federal de Uberlândia, INGEB/FACOM, Campus Patos de Minas, Patos de Minas, MG, Brazil
| | - Marcelo Antônio Pascoal Xavier
- Grupo de Pesquisas Clínicas e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou (FIOCRUZ-Minas), Belo Horizonte, MG, Brazil
| | - Andréa Teixeira-Carvalho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou (FIOCRUZ-Minas), Belo Horizonte, MG, Brazil
| | - Marta de Lana
- Laboratório de Doença de Chagas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Instituto de Ciências Exatas e Biológicas (ICEB), Universidade Federal de Ouro Preto (UFOP), Ouro Preto, MG, Brazil
| | - Olindo Assis Martins-Filho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou (FIOCRUZ-Minas), Belo Horizonte, MG, Brazil
- * E-mail:
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Performance of TcI/TcVI/TcII Chagas-Flow ATE-IgG2a for universal and genotype-specific serodiagnosis of Trypanosoma cruzi infection. PLoS Negl Trop Dis 2017; 11:e0005444. [PMID: 28333926 PMCID: PMC5380352 DOI: 10.1371/journal.pntd.0005444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/04/2017] [Accepted: 03/01/2017] [Indexed: 11/19/2022] Open
Abstract
Distinct Trypanosoma cruzi genotypes have been considered relevant for patient management and therapeutic response of Chagas disease. However, typing strategies for genotype-specific serodiagnosis of Chagas disease are still unavailable and requires standardization for practical application. In this study, an innovative TcI/TcVI/TcII Chagas Flow ATE-IgG2a technique was developed with applicability for universal and genotype-specific diagnosis of T. cruzi infection. For this purpose, the reactivity of serum samples (percentage of positive fluorescent parasites-PPFP) obtained from mice chronically infected with TcI/Colombiana, TcVI/CL or TcII/Y strain as well as non-infected controls were determined using amastigote-AMA, trypomastigote-TRYPO and epimastigote-EPI in parallel batches of TcI, TcVI and TcII target antigens. Data demonstrated that “α-TcII-TRYPO/1:500, cut-off/PPFP = 20%” presented an excellent performance for universal diagnosis of T. cruzi infection (AUC = 1.0, Se and Sp = 100%). The combined set of attributes “α-TcI-TRYPO/1:4,000, cut-off/PPFP = 50%”, “α-TcII-AMA/1:1,000, cut-off/PPFP = 40%” and “α-TcVI-EPI/1:1,000, cut-off/PPFP = 45%” showed good performance to segregate infections with TcI/Colombiana, TcVI/CL or TcII/Y strain. Overall, hosts infected with TcI/Colombiana and TcII/Y strains displayed opposite patterns of reactivity with “α-TcI TRYPO” and “α-TcII AMA”. Hosts infected with TcVI/CL strain showed a typical interweaved distribution pattern. The method presented a good performance for genotype-specific diagnosis, with global accuracy of 69% when the population/prototype scenario include TcI, TcVI and TcII infections and 94% when comprise only TcI and TcII infections. This study also proposes a receiver operating reactivity panel, providing a feasible tool to classify serum samples from hosts infected with distinct T. cruzi genotypes, supporting the potential of this method for universal and genotype-specific diagnosis of T. cruzi infection. Chagas disease remains a significant public health issue infecting 6–7 million people worldwide. The factors influencing the clinical heterogeneity of Chagas disease have not been elucidated, although it has been suggested that different clinical outcome may be associated with the genetic diversity of T. cruzi isolates. Moreover, differences in therapeutic response of distinct T. cruzi genotypes have been also reported. Typing strategies for genotype-specific diagnosis of Chagas disease to identify the T. cruzi discrete typing units (DTU) have already been developed, including biochemical and molecular methods, however the techniques have limitations. The majority of these methods can not directly be performed in biological and clinical samples. In addition, it has been proposed that parasite isolates from blood may not necessarily represent the full set of strains current in the individual as some strains can be confined to tissues. The improvement of genotype-specific serology to identify the T. cruzi DTU(s) present in a given host may provide a useful tool for clinical studies. In the present investigation, we developed an innovative TcI/TcVI/TcII Chagas Flow ATE-IgG2a technique with applicability for universal and genotype-specific diagnosis of T. cruzi infection that may contribute to add future insights for genotype-specific diagnosis of Chagas disease.
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8
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Oliveira MTD, Branquinho RT, Alessio GD, Mello CGC, Nogueira-de-Paiva NC, Carneiro CM, Toledo MJDO, Reis AB, Martins-Filho OAM, Lana MD. TcI, TcII and TcVI Trypanosoma cruzi samples from Chagas disease patients with distinct clinical forms and critical analysis of in vitro and in vivo behavior, response to treatment and infection evolution in murine model. Acta Trop 2017; 167:108-120. [PMID: 27908747 DOI: 10.1016/j.actatropica.2016.11.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/11/2016] [Accepted: 11/24/2016] [Indexed: 01/10/2023]
Abstract
The clonal evolution of Trypanosoma cruzi sustains scientifically the hypothesis of association between parasite's genetic, biological behavior and possibly the clinical aspects of Chagas disease in patients from whom they were isolated. This study intended to characterize a range of biological properties of TcI, TcII and TcVI T. cruzi samples in order to verify the existence of these associations. Several biological features were evaluated, including in vitro epimastigote-growth, "Vero"cells infectivity and growth, along with in vivo studies of parasitemia, polymorphism of trypomastigotes, cardiac inflammation, fibrosis and response to treatment by nifurtimox during the acute and chronic murine infection. The global results showed that the in vitro essays (acellular and cellular cultures) TcII parasites showed higher values for all parameters (growth and infectivity) than TcVI, followed by TcI. In vivo TcII parasites were more virulent and originated from patients with severe disease. Two TcII isolates from patients with severe pathology were virulent in mice, while the isolate from a patient with the indeterminate form of the disease caused mild infection. The only TcVI sample, which displayed low values in all parameters evaluated, was also originated of an indeterminate case of Chagas disease. Response to nifurtimox was not associated to parasite genetic and biology, as well as to clinical aspects of human disease. Although few number of T. cruzi samples have been analyzed, a discreet correlation between parasite genetics, biological behavior in vitro and in vivo (murine model) and the clinical form of human disease from whom the samples were isolated was verified.
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Affiliation(s)
- Maykon Tavares de Oliveira
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil
| | - Renata Tupinambá Branquinho
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (CIPHARMA), Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil
| | - Gláucia Diniz Alessio
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil
| | - Carlos Geraldo Campos Mello
- Programa de Pós-Graduação em Ciências Farmacêuticas (CIPHARMA), Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil
| | - Nívia Carolina Nogueira-de-Paiva
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil
| | - Cláudia Martins Carneiro
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (CIPHARMA), Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil; Departamento de Análises Clínicas, Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil
| | - Max Jean de Ornelas Toledo
- Departamento de Ciências Básicas da Saúde-Parasitologia, Universidade Estadual de Maringá, CEP: 87020-900, Maringá, Paraná, PR, Brazil
| | - Alexandre Barbosa Reis
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (CIPHARMA), Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil; Departamento de Análises Clínicas, Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil
| | | | - Marta de Lana
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (CIPHARMA), Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil; Departamento de Análises Clínicas, Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil.
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Balouz V, Agüero F, Buscaglia CA. Chagas Disease Diagnostic Applications: Present Knowledge and Future Steps. ADVANCES IN PARASITOLOGY 2016; 97:1-45. [PMID: 28325368 PMCID: PMC5363286 DOI: 10.1016/bs.apar.2016.10.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chagas disease, caused by the protozoan Trypanosoma cruzi, is a lifelong and debilitating illness of major significance throughout Latin America and an emergent threat to global public health. Being a neglected disease, the vast majority of Chagasic patients have limited access to proper diagnosis and treatment, and there is only a marginal investment into R&D for drug and vaccine development. In this context, identification of novel biomarkers able to transcend the current limits of diagnostic methods surfaces as a main priority in Chagas disease applied research. The expectation is that these novel biomarkers will provide reliable, reproducible and accurate results irrespective of the genetic background, infecting parasite strain, stage of disease, and clinical-associated features of Chagasic populations. In addition, they should be able to address other still unmet diagnostic needs, including early detection of congenital T. cruzi transmission, rapid assessment of treatment efficiency or failure, indication/prediction of disease progression and direct parasite typification in clinical samples. The lack of access of poor and neglected populations to essential diagnostics also stresses the necessity of developing new methods operational in point-of-care settings. In summary, emergent diagnostic tests integrating these novel and tailored tools should provide a significant impact on the effectiveness of current intervention schemes and on the clinical management of Chagasic patients. In this chapter, we discuss the present knowledge and possible future steps in Chagas disease diagnostic applications, as well as the opportunity provided by recent advances in high-throughput methods for biomarker discovery.
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Affiliation(s)
- Virginia Balouz
- Instituto de Investigaciones Biotecnológicas - Instituto Tecnológico de Chascomús (IIB-INTECH), Universidad Nacional de San Martín (UNSAM) - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), San Martín, B 1650 HMP, Buenos Aires, Argentina
| | - Fernán Agüero
- Instituto de Investigaciones Biotecnológicas - Instituto Tecnológico de Chascomús (IIB-INTECH), Universidad Nacional de San Martín (UNSAM) - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), San Martín, B 1650 HMP, Buenos Aires, Argentina
| | - Carlos A. Buscaglia
- Instituto de Investigaciones Biotecnológicas - Instituto Tecnológico de Chascomús (IIB-INTECH), Universidad Nacional de San Martín (UNSAM) - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), San Martín, B 1650 HMP, Buenos Aires, Argentina
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10
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Molecular Approaches for Diagnosis of Chagas' Disease and Genotyping of Trypanosoma cruzi. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Revisiting the Posttherapeutic Cure Criterion in Chagas Disease: Time for New Methods, More Questions, Doubts, and Polemics or Time to Change Old Concepts? BIOMED RESEARCH INTERNATIONAL 2015; 2015:652985. [PMID: 26583124 PMCID: PMC4637035 DOI: 10.1155/2015/652985] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/10/2015] [Indexed: 01/17/2023]
Abstract
One of the most relevant issues beyond the effectiveness of etiological treatment of Chagas disease is the lack of consensual/feasible tools to identify and certify the definitive parasitological cure. Several methods of distinct natures (parasitological, serological, and molecular) have been continuously proposed and novel perspectives are currently under investigation. Although the simultaneous use of distinct tests may offer better contributions and advances, it also leads to controversies of interpretation, with lack of mutual consent of cure criterion amongst researchers and physicians. In fact, when distinct host compartments (blood/tissues) are evaluated and explored, novel questions may arise due to the nature and sensitivity limit of each test. This short analytical review intends to present a chronological and critical overview and discuss the state-of-the-art distinct devices available for posttherapeutic cure assessment in Chagas disease, their contributions, meanings, and interpretation, aiming to point out the major gaps and propose novel insight for future perspectives of posttherapeutic management of Chagas disease patients.
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12
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Porrás AI, Yadon ZE, Altcheh J, Britto C, Chaves GC, Flevaud L, Martins-Filho OA, Ribeiro I, Schijman AG, Shikanai-Yasuda MA, Sosa-Estani S, Stobbaerts E, Zicker F. Target Product Profile (TPP) for Chagas Disease Point-of-Care Diagnosis and Assessment of Response to Treatment. PLoS Negl Trop Dis 2015; 9:e0003697. [PMID: 26042730 PMCID: PMC4456144 DOI: 10.1371/journal.pntd.0003697] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Analía I. Porrás
- Pan American Health Organization, Regional Office of the World Health Organization, Washington, D.C., United States of America
- * E-mail:
| | - Zaida E. Yadon
- Pan American Health Organization, Regional Office of the World Health Organization, Washington, D.C., United States of America
| | - Jaime Altcheh
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Constança Britto
- Laboratório de Biologia Molecular e Doenças Endêmicas, Oswaldo Cruz Institute, Laboratory of Molecular Biology and Endemic Diseases, FIOCRUZ, Rio de Janeiro, Brazil
| | - Gabriela C. Chaves
- Sergio Arouca National School of Public Health, FIOCRUZ, Rio de Janeiro, Brazil
| | - Laurence Flevaud
- Médecins Sans Frontières—Médecins Sans Frontières Operational Center Barcelona-Athens (OCBA), Barcelona, Spain
| | - Olindo Assis Martins-Filho
- René Rachou Research Center, Laboratory of Biomarkers of Diagnostic and Monitoring, Oswaldo Cruz Institute, Minas Gerais, Brazil
| | - Isabela Ribeiro
- Latin America Regional Office, Drugs for Neglected Diseases initiative, Rio de Janeiro, Brazil
| | - 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), Buenos Aires, Argentina
| | | | - Sergio Sosa-Estani
- Instituto Nacional de Parasitología, Dr. Mario Fatala Chaben ANLIS, Ministerio de Salud, Buenos Aires, Argentina
| | - Eric Stobbaerts
- Latin America Regional Office, Drugs for Neglected Diseases initiative, Rio de Janeiro, Brazil
| | - Fabio Zicker
- Center for Technological Development in Health, Oswaldo Cruz Foundation, (FIOCRUZ), Rio de Janeiro, Brazil
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Pinazo MJ, Thomas MC, Bustamante J, Almeida ICD, Lopez MC, Gascon J. Biomarkers of therapeutic responses in chronic Chagas disease: state of the art and future perspectives. Mem Inst Oswaldo Cruz 2015; 110:422-32. [PMID: 25946151 PMCID: PMC4489480 DOI: 10.1590/0074-02760140435] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/25/2015] [Indexed: 01/10/2023] Open
Abstract
The definition of a biomarker provided by the World Health Organization is any
substance, structure, or process that can be measured in the body, or its products
and influence, or predict the incidence or outcome of disease. Currently, the lack of
prognosis and progression markers for chronic Chagas disease has posed limitations
for testing new drugs to treat this neglected disease. Several molecules and
techniques to detect biomarkers in Trypanosoma cruzi-infected
patients have been proposed to assess whether specific treatment with benznidazole or
nifurtimox is effective. Isolated proteins or protein groups from different
T. cruzi stages and parasite-derived glycoproteins and synthetic
neoglycoconjugates have been demonstrated to be useful for this purpose, as have
nucleic acid amplification techniques. The amplification of T. cruzi
DNA using the real-time polymerase chain reaction method is the leading test
for assessing responses to treatment in a short period of time. Biochemical
biomarkers have been tested early after specific treatment. Cytokines and surface
markers represent promising molecules for the characterisation of host cellular
responses, but need to be further assessed.
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Affiliation(s)
- Maria-Jesus Pinazo
- Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Barcelona, Spain
| | - Maria-Carmen Thomas
- Institute of Parasitology and Biomedicine López Neyra, National Research Council Institute, Granada, Spain
| | - Juan Bustamante
- Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Barcelona, Spain
| | - Igor Correia de Almeida
- Department of Biological Sciences, Border Biomedical Research Center, University of Texas at El Paso, El Paso, TX, USA
| | - Manuel-Carlos Lopez
- Institute of Parasitology and Biomedicine López Neyra, National Research Council Institute, Granada, Spain
| | - Joaquim Gascon
- Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Barcelona, Spain
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