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de Sousa AS, Vermeij D, Ramos AN, Luquetti AO. Chagas disease. Lancet 2024; 403:203-218. [PMID: 38071985 DOI: 10.1016/s0140-6736(23)01787-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 01/15/2024]
Abstract
Chagas disease persists as a global public health problem due to the high morbidity and mortality burden. Despite the possibility of a cure and advances in transmission control, epidemiological transformations, such as urbanisation and globalisation, and the emerging importance of oral and vertical transmission mean that Chagas disease should be considered an emerging disease, with new cases occurring worldwide. Important barriers to diagnosis, treatment, and care remain, resulting in repressed numbers of reported cases, which in turn leads to inadequate public policies. The validation of new diagnostic tools and treatment options is needed, as existing tools pose serious limitations to access to health care. Integrated models of surveillance, with community and intersectional participation, embedded in the concept of One Health, are essential for control. In addition, mitigation strategies for the main social determinants of health, including difficulties imposed by migration, are important to improve access to comprehensive health care in a globalised scenario.
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Affiliation(s)
- Andréa Silvestre de Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Debbie Vermeij
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Alberto Novaes Ramos
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Alejandro O Luquetti
- Center of Studies for Chagas Disease, Hospital das Clínicas, Federal University of Goiás, Goiânia, Brazil
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2
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Antonietti L, Mariani J, Martínez MJ, Santalla M, Vensentini N, Kyle DA, de Abreu M, Tajer C, Lacunza E, Ferrero P. Circulating microRNAs as biomarkers of Chagas cardiomyopathy. Front Cardiovasc Med 2023; 10:1250029. [PMID: 38173812 PMCID: PMC10762800 DOI: 10.3389/fcvm.2023.1250029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background Chagas cardiomyopathy (CHCM) is the most important clinical manifestation of Chagas disease. The analysis of cardiac miRNAs may contribute to predicting the progression to CHCM in Chagas indeterminate phase and/or to the differential diagnosis for cardiomyopathy. Methods We carried out a case-control study to identify circulating miRNAs associated with CHCM. We assigned 104 participants to four groups: healthy controls (HC), Chagas non-cardiomyopathy controls, CHCM cases, and ischemic cardiomyopathy controls. We performed a clinical, echocardiographic, and laboratory evaluation and profiled circulating miRNA in the serum samples. Results Differences between groups were observed in clinical variables and in the analysis of miRNAs. Compared to HC, CHCM participants had 4 over-expressed and 6 under-expressed miRNAs; miR-95-3p and miR-130b-3p were upregulated in CHCM compared with controls, Chagas non-cardiomyopathy and ischemic cardiomyopathy participants, suggesting that might be a hallmark of CHCM. Analysis of gene targets associated with cardiac injury yielded results of genes involved in arrhythmia generation, cardiomegaly, and hypertrophy. Conclusions Our data suggest that the expression of circulating miRNAs identified by deep sequencing in CHCM could be associated with different cardiac phenotypes in CHCM subjects, compared with Chagas non-CHCM, ischemic cardiomyopathy controls, and healthy controls.
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Affiliation(s)
- Laura Antonietti
- Department of Cardiology, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina
- Health Sciences Institute, Arturo Jauretche National University, Florencio Varela, Buenos Aires, Argentina
| | - Javier Mariani
- Department of Cardiology, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina
- Health Sciences Institute, Arturo Jauretche National University, Florencio Varela, Buenos Aires, Argentina
| | - María Jose Martínez
- Department of Cardiology, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina
| | - Manuela Santalla
- Cardiovascular Research Center Dr. Horacio Cingolani, Faculty of Medical Sciences, La Plata National University, La Plata, Buenos Aires, Argentina
| | - Natalia Vensentini
- Department of Cardiology, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina
| | - Diego Alfredo Kyle
- Department of Cardiology, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina
| | - Maximiliano de Abreu
- Department of Cardiology, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina
- Health Sciences Institute, Arturo Jauretche National University, Florencio Varela, Buenos Aires, Argentina
| | - Carlos Tajer
- Department of Cardiology, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina
- Health Sciences Institute, Arturo Jauretche National University, Florencio Varela, Buenos Aires, Argentina
| | - Ezequiel Lacunza
- Basic and Applied Inmunological Research, Faculty of Medical Sciences, La Plata National University, La Plata, Buenos Aires, Argentina
| | - Paola Ferrero
- Cardiovascular Research Center Dr. Horacio Cingolani, Faculty of Medical Sciences, La Plata National University, La Plata, Buenos Aires, Argentina
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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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Jimenez A, Winokur EJ. Chagas Disease Cardiomyopathy. Dimens Crit Care Nurs 2023; 42:202-210. [PMID: 37219474 DOI: 10.1097/dcc.0000000000000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Chagas disease is a prominent neglected tropical disease endemic to many countries in Latin America. Cardiomyopathy is the most serious manifestation due to the severity and complications of heart failure. As a result of expanded immigration and globalization, there is an increased number of patients with Chagas cardiomyopathy who are being admitted to hospitals in the United States. It is imperative as a critical care nurse to be educated on the nature of Chagas cardiomyopathy as it differs from the more commonly seen ischemic and nonischemic forms. This article provides an overview of the clinical course, management, and treatment options of Chagas cardiomyopathy.
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5
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Vattikonda K, Peterson CJ, Mulkey B, Allen B. A Case of Chagas Cardiomyopathy in Western Virginia: Worlds Away? Cureus 2023; 15:e42158. [PMID: 37602121 PMCID: PMC10438999 DOI: 10.7759/cureus.42158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Chagas cardiomyopathy, caused by the parasite Trypanosoma cruzi, is a significant cause of cardiac pathology worldwide. Though most frequently observed in Latin America, Chagas disease is present in the United States and should be considered in patients with heart block or other cardiac abnormalities and previous travel to or residence in endemic areas. Here we describe a new diagnosis of Chagas cardiomyopathy in a patient residing in Virginia with a previous residence in Mexico.
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Affiliation(s)
- Kiriti Vattikonda
- Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | | | - Benjamin Mulkey
- Cardiology, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Bradley Allen
- Cardiology, Virginia Tech Carilion School of Medicine, Roanoke, USA
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6
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Marin-Neto JA, Rassi A, Oliveira GMM, Correia LCL, Ramos Júnior AN, Luquetti AO, Hasslocher-Moreno AM, Sousa ASD, Paola AAVD, Sousa ACS, Ribeiro ALP, Correia Filho D, Souza DDSMD, Cunha-Neto E, Ramires FJA, Bacal F, Nunes MDCP, Martinelli Filho M, Scanavacca MI, Saraiva RM, Oliveira Júnior WAD, Lorga-Filho AM, Guimarães ADJBDA, Braga ALL, Oliveira ASD, Sarabanda AVL, Pinto AYDN, Carmo AALD, Schmidt A, Costa ARD, Ianni BM, Markman Filho B, Rochitte CE, Macêdo CT, Mady C, Chevillard C, Virgens CMBD, Castro CND, Britto CFDPDC, Pisani C, Rassi DDC, Sobral Filho DC, Almeida DRD, Bocchi EA, Mesquita ET, Mendes FDSNS, Gondim FTP, Silva GMSD, Peixoto GDL, Lima GGD, Veloso HH, Moreira HT, Lopes HB, Pinto IMF, Ferreira JMBB, Nunes JPS, Barreto-Filho JAS, Saraiva JFK, Lannes-Vieira J, Oliveira JLM, Armaganijan LV, Martins LC, Sangenis LHC, Barbosa MPT, Almeida-Santos MA, Simões MV, Yasuda MAS, Moreira MDCV, Higuchi MDL, Monteiro MRDCC, Mediano MFF, Lima MM, Oliveira MTD, Romano MMD, Araujo NNSLD, Medeiros PDTJ, Alves RV, Teixeira RA, Pedrosa RC, Aras Junior R, Torres RM, Povoa RMDS, Rassi SG, Alves SMM, Tavares SBDN, Palmeira SL, Silva Júnior TLD, Rodrigues TDR, Madrini Junior V, Brant VMDC, Dutra WO, Dias JCP. SBC Guideline on the Diagnosis and Treatment of Patients with Cardiomyopathy of Chagas Disease - 2023. Arq Bras Cardiol 2023; 120:e20230269. [PMID: 37377258 PMCID: PMC10344417 DOI: 10.36660/abc.20230269] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- José Antonio Marin-Neto
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Anis Rassi
- Hospital do Coração Anis Rassi , Goiânia , GO - Brasil
| | | | | | | | - Alejandro Ostermayer Luquetti
- Centro de Estudos da Doença de Chagas , Hospital das Clínicas da Universidade Federal de Goiás , Goiânia , GO - Brasil
| | | | - Andréa Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe , São Cristóvão , SE - Brasil
- Hospital São Lucas , Rede D`Or São Luiz , Aracaju , SE - Brasil
| | | | | | | | - Edecio Cunha-Neto
- Universidade de São Paulo , Faculdade de Medicina da Universidade, São Paulo , SP - Brasil
| | - Felix Jose Alvarez Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Maurício Ibrahim Scanavacca
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Magalhães Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Adalberto Menezes Lorga-Filho
- Instituto de Moléstias Cardiovasculares , São José do Rio Preto , SP - Brasil
- Hospital de Base de Rio Preto , São José do Rio Preto , SP - Brasil
| | | | | | - Adriana Sarmento de Oliveira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Ana Yecê das Neves Pinto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Andre Schmidt
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Andréa Rodrigues da Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Barbara Maria Ianni
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Carlos Eduardo Rochitte
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Hcor , Associação Beneficente Síria , São Paulo , SP - Brasil
| | | | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Marselha - França
| | | | | | | | - Cristiano Pisani
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Evandro Tinoco Mesquita
- Hospital Universitário Antônio Pedro da Faculdade Federal Fluminense , Niterói , RJ - Brasil
| | | | | | | | | | | | - Henrique Horta Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Henrique Turin Moreira
- Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | | | | | | | - João Paulo Silva Nunes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Fundação Zerbini, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | | | | | - Luiz Cláudio Martins
- Universidade Estadual de Campinas , Faculdade de Ciências Médicas , Campinas , SP - Brasil
| | | | | | | | - Marcos Vinicius Simões
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | | | | | - Maria de Lourdes Higuchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Mauro Felippe Felix Mediano
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
| | - Mayara Maia Lima
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | | | | | - Renato Vieira Alves
- Instituto René Rachou , Fundação Oswaldo Cruz , Belo Horizonte , MG - Brasil
| | - Ricardo Alkmim Teixeira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Coury Pedrosa
- Hospital Universitário Clementino Fraga Filho , Instituto do Coração Edson Saad - Universidade Federal do Rio de Janeiro , RJ - Brasil
| | | | | | | | | | - Silvia Marinho Martins Alves
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico Universitário da Universidade de Pernambuco (PROCAPE/UPE), Recife , PE - Brasil
| | | | - Swamy Lima Palmeira
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | - Vagner Madrini Junior
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | - João Carlos Pinto Dias
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
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7
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Saraiva RM, Mediano MFF, Quintana MS, Sperandio da Silva GM, Costa AR, Sousa AS, Sangenis LHC, Mendes FS, Veloso HH, Xavier SS, Holanda MT, Hasslocher-Moreno AM. Two-dimensional strain derived parameters provide independent predictors of progression to Chagas cardiomyopathy and mortality in patients with Chagas disease. IJC HEART & VASCULATURE 2022; 38:100955. [PMID: 35169612 PMCID: PMC8826593 DOI: 10.1016/j.ijcha.2022.100955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
Abstract
Background Patients with chronic Chagas disease (CD) cardiomyopathy have a high mortality. We evaluated if two-dimensional (2D) strain (ε) parameters provide independent predictors of progression to CD cardiomyopathy and all-cause mortality. Methods A total of 408 patients with chronic CD (58.6% women; 53 ± 11 years; clinical forms: indeterminate 34.1%, cardiac 57.6%, digestive 1.2%, cardiodigestive 7.1%) were consecutively included in this single-center prospective longitudinal study. Echocardiographic evaluation included left atrial and left ventricular (LV) function on ε analyses. Primary end-point was a composite of all-cause mortality or heart transplant. Secondary end-point was CD progression defined as the occurrence of changes typical of CD in electrocardiogram, sustained ventricular tachycardia, wall motion abnormalities, or heart failure among patients with the indeterminate form at baseline. Multivariable Cox-proportional-hazards regression analyses were performed to test if 2D ε parameters were associated with the studied end-points. P values < 0.05 were considered significant. Results The primary end-point occurred in 91 patients after a follow-up of 6.5 ± 2.7 years. CD progression occurred in 26 out of 144 patients without cardiac form at baseline (2.88 cases/100 patient-years). Peak LV circumferential (HR 1.09, 95% CI 1.01–1.18, P = .02) and radial (HR 0.97, 95% CI 0.95–0.99, P = .007) ε, and LV torsion (HR 0.51, 95% CI 0.35–0.74, P = .0004) were independent predictors of the primary end-point. Peak LV radial ε (HR 0.96, 95% CI 0.93–0.99, P = .03) was an independent predictor of CD progression. Conclusions Therefore, 2D ε derived parameters can be useful for CD progression and mortality prediction.
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Saraiva RM, Mediano MFF, Mendes FSNS, Sperandio da Silva GM, Veloso HH, Sangenis LHC, Silva PSD, Mazzoli-Rocha F, Sousa AS, Holanda MT, Hasslocher-Moreno AM. Chagas heart disease: An overview of diagnosis, manifestations, treatment, and care. World J Cardiol 2021; 13:654-675. [PMID: 35070110 PMCID: PMC8716970 DOI: 10.4330/wjc.v13.i12.654] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/11/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
Chagas heart disease (CHD) affects approximately 30% of patients chronically infected with the protozoa Trypanosoma cruzi. CHD is classified into four stages of increasing severity according to electrocardiographic, echocardiographic, and clinical criteria. CHD presents with a myriad of clinical manifestations, but its main complications are sudden cardiac death, heart failure, and stroke. Importantly, CHD has a higher incidence of sudden cardiac death and stroke than most other cardiopathies, and patients with CHD complicated by heart failure have a higher mortality than patients with heart failure caused by other etiologies. Among patients with CHD, approximately 90% of deaths can be attributed to complications of Chagas disease. Sudden cardiac death is the most common cause of death (55%–60%), followed by heart failure (25%–30%) and stroke (10%–15%). The high morbimortality and the unique characteristics of CHD demand an individualized approach according to the stage of the disease and associated complications the patient presents with. Therefore, the management of CHD is challenging, and in this review, we present the most updated available data to help clinicians and cardiologists in the care of these patients. We describe the clinical manifestations, diagnosis and classification criteria, risk stratification, and approach to the different clinical aspects of CHD using diagnostic tools and pharmacological and non-pharmacological treatments.
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Affiliation(s)
- Roberto M Saraiva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Mauro Felippe F Mediano
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Fernanda SNS Mendes
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | | | - Henrique H Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Luiz Henrique C Sangenis
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Paula Simplício da Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Flavia Mazzoli-Rocha
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Andréa S Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Marcelo T Holanda
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Alejandro M Hasslocher-Moreno
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
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9
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Hasslocher-Moreno AM, Xavier SS, Saraiva RM, de Sousa AS. Indeterminate form of Chagas disease: historical, conceptual, clinical, and prognostic aspects. Rev Soc Bras Med Trop 2021; 54:e02542021. [PMID: 34320133 PMCID: PMC8313101 DOI: 10.1590/0037-8682-0254-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/24/2021] [Indexed: 12/02/2022] Open
Abstract
Chagas disease (CD) remains a serious endemic disease in Latin America and a major public health problem. Because of globalization, the disease has spread to non-endemic areas in the northern hemisphere. In the chronic phase of the disease, most patients present with the indeterminate form (IF), characterized by positive serology for Trypanosoma cruzi, absence of clinical findings, and normal findings in electrocardiogram (ECG). IF was not recognized as a clinical entity until decades after the discovery of the disease, and only in the 1940-50s, it was categorized as a form of CD, and its conceptual definition was ratified in the 1980s. Children, adolescents, and young adults with the IF benefit from etiological treatment and tend to have less progression to heart disease in the long term than the untreated ones. IF patients have an essentially benign clinical condition, and their prognosis can be compared to that of healthy individuals with normal ECG findings. Currently, because of aging, patients with the IF have comorbidities that require attention in health services.
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Affiliation(s)
| | - Sergio Salles Xavier
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro
Chagas, Rio de Janeiro, RJ, Brasil
| | - Roberto Magalhães Saraiva
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro
Chagas, Rio de Janeiro, RJ, Brasil
| | - Andréa Silvestre de Sousa
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro
Chagas, Rio de Janeiro, RJ, Brasil
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio
de Janeiro, RJ, Brasil
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do Nascimento Couceiro K, Ortiz JV, do Nascimento Correia M, da Silva E Silva MRH, Brandão AR, da Silva PRL, Doria SS, Bestetti RB, de Sousa DRT, da Silva Junior RCA, das Graças Vale Barbosa Guerra M, Ferreira JMBB, de Oliveira Guerra JA. The Selvester QRS score as an estimative of myocardial injury in acute chagasic patients from the Brazilian Amazon. BMC Infect Dis 2021; 21:396. [PMID: 33926389 PMCID: PMC8082885 DOI: 10.1186/s12879-021-06083-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Brazilian Amazon, a new epidemiological profile of Chagas disease transmission, the oral route, has been detected and cited as being responsible for the increase in acute cases in Brazil. The clinical evaluation of acute Chagas disease (ACD) has been a challenge since it can progress to a chronic phase with cardiac alterations, and the follow-up by modern diagnostic methods is very difficult due to the socio-geographical characteristics of the Brazilian Amazon. Thus, alternatives should be sought to alleviate this problem. We conducted a study to evaluate subjects with ACD using the 12-lead ECG QRS score (Selvester score) as an estimative of myocardial injury progression before and after ACD treatment. METHODS The study included indigenous subjects from the Amazon region with ACD in clinical follow-up at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) Chagas Disease outpatient clinic in the state of Amazonas, Brazil. The control group consisted of 31 healthy volunteers with no history of heart disease and no reactive serology for Chagas disease. Baseline ECG was performed in all subjects. The Selvester scoring method was performed according to the standardized guide (< 3 points: no myocardial injury,> 3: points × 3% = % of the predicted LV infarction). RESULTS A total of 62 subjects were included, 31 as cases and 31 as controls. The mean follow-up of the case group was 17 months. The control group presented normal ECG. The case group presented 13 alterations before treatment and 11 after. Nineteen individuals presented scores > 3 points, 6 before and 13 after. In 19.36% of subjects, myocardial injury was found before treatment and in 41.94% after treatment. CONCLUSION This is the first study that uses the Selvester score (SS) to predict myocardial injury in subjects with ACD. The results of this study suggest the significant presence of myocardial injury from the beginning of treatment to the period post treatment of ACD, which demonstrates that the SS can be applied for stratification and follow-up of Chagas disease in the Amazon region.
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Affiliation(s)
- Katia do Nascimento Couceiro
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil.
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.
| | - Jessica Vanina Ortiz
- Departamento de Ciências Fisiológicas, Universidade Federal do Amazonas, Manaus, Brazil
| | | | - Mônica Regina Hosannah da Silva E Silva
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Fundação de Hematologia e Hemoterapia do Amazonas, Manaus, Brazil
| | | | - Paula Rita Leite da Silva
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Susan Smith Doria
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Débora Raysa Teixeira de Sousa
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Rubens Celso Andrade da Silva Junior
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Maria das Graças Vale Barbosa Guerra
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - João Marcos Bemfica Barbosa Ferreira
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Jorge Augusto de Oliveira Guerra
- Programa de Pós Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
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11
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Azevedo ACA, Barros MVL, Klaboe LG, Edvardsen T, Costa HS, Paixao GMM, Junior ORS, Nunes MCP, Rocha MOC. Association between myocardial mechanical dispersion and ventricular arrhythmogenicity in chagas cardiomyopathy. Int J Cardiovasc Imaging 2021; 37:2727-2734. [PMID: 33881664 DOI: 10.1007/s10554-021-02246-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/14/2021] [Indexed: 11/24/2022]
Abstract
Chagas disease is a major health concern in Latin America. Ventricular arrhythmia (VA) is a hallmark of Chagas cardiomyopathy (CCM), associated with worse prognosis. The present study aimed to verify the association between myocardial mechanical dispersion (MD) and ventricular arrhythmogenicity in CCM. In a cross-sectional study, 77 patients (55.8 ± 10.4 years) with CCM were evaluated. Global longitudinal strain (GLS) and MD were assessed by echocardiography, derived from the speckle tracking technique. Myocardial MD was measured from the onset of the Q/R wave on electrocardiogram to the peak longitudinal strain in 16 segments of the left ventricle. Frequency and complexity of ventricular extrasystoles (VES) were assessed by dynamic electrocardiography. The density and complexity of VES and the presence of non-sustained ventricular tachycardias (NSVTs) increase as MD increases. In logistic regression, MD was the only variable associated with the presence of paired VES and ventricular bigeminy. In addition, both MD and GLS were associated with the presence of NSVT (both, p < 0.01), and MD was independently associated with NSVT (OR 1.04, 95% CI 1.004-1.201, p = 0.031). In CCM, MD is associated with a higher density and complexity of VES, including NSVT.
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Affiliation(s)
- A C A Azevedo
- Department of Internal Medicine, School of Medicine of the Federal University of Minas Gerais. Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG, 30130 100, Brazil
| | - M V L Barros
- Department of Internal Medicine, School of Medicine of the Federal University of Minas Gerais. Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG, 30130 100, Brazil.,Faculdade de Saúde E Ecologia Humana, Vespasiano, Brazil
| | - L G Klaboe
- Center for Cardiological Innovation, Oslo, Norway
| | | | - H S Costa
- Department of Internal Medicine, School of Medicine of the Federal University of Minas Gerais. Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG, 30130 100, Brazil
| | - G M M Paixao
- Department of Internal Medicine, School of Medicine of the Federal University of Minas Gerais. Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG, 30130 100, Brazil
| | - O R Santos Junior
- Department of Internal Medicine, School of Medicine of the Federal University of Minas Gerais. Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG, 30130 100, Brazil
| | - M C P Nunes
- Department of Internal Medicine, School of Medicine of the Federal University of Minas Gerais. Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG, 30130 100, Brazil
| | - M O C Rocha
- Department of Internal Medicine, School of Medicine of the Federal University of Minas Gerais. Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG, 30130 100, Brazil.
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12
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Hernández M, Wicz S, Pérez Caballero E, Santamaría MH, Corral RS. Dual chemotherapy with benznidazole at suboptimal dose plus curcumin nanoparticles mitigates Trypanosoma cruzi-elicited chronic cardiomyopathy. Parasitol Int 2020; 81:102248. [PMID: 33238215 DOI: 10.1016/j.parint.2020.102248] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 01/04/2023]
Abstract
Curcumin (Cur) is a natural polyphenolic flavonoid isolated from the rhizomes of Curcuma longa. Its anti-inflammatory and cardioprotective properties are increasingly considered to have beneficial effects on the progression of cardiomyopathy associated with Chagas disease, caused by Trypanosoma cruzi. However, the Cur therapeutic limitation is its bioavailability and new Cur nanomedicine formulations are developed to overcome this obstacle. In this research, we provide evidence showing that oral therapy with a suboptimal dose of the standard parasiticidal drug benznidazole (BZ) in combination with Cur-loaded nanoparticles is capable of reducing myocardial parasite load, cardiac hypertrophy, inflammation and fibrosis in mice with long-term infection by T. cruzi. Treatment with BZ plus Cur was highly effective in downregulating myocardial expression of proinflammatory cytokines/chemokines (IL-1β, TNF-α, IL-6, CCL5), and the level/activity of matrix metalloproteinases (MMP-2, MMP-9) and inducible enzymes (cyclooxygenase, nitric oxide synthase) implicated in leukocyte recruitment and cardiac remodeling. Oral administration of a Cur-based nanoformulation displays potential as a complementary strategy to the conventional BZ chemotherapy in the treatment of chronic Chagas heart disease.
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Affiliation(s)
- Matías Hernández
- Laboratorio de Biomedicina Molecular, Facultad de Química, Bioquímica y Farmacia, Universidad Nacional de San Luis, San Luis, Argentina
| | - Susana Wicz
- Laboratorio de Biomedicina Molecular, Facultad de Química, Bioquímica y Farmacia, Universidad Nacional de San Luis, San Luis, Argentina
| | | | - Miguel H Santamaría
- Laboratorio de Biología Experimental, Centro de Estudios Metabólicos, Santander, Spain
| | - Ricardo S Corral
- Servicio de Parasitología-Chagas, Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP, GCBA-CONICET), Hospital de Niños "Dr. Ricardo Gutiérrez", Buenos Aires, Argentina.
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13
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Cianciulli TF, Albarracín GA, Napoli Llobera M, Prado NG, Saccheri MC, Hernández Vásquez YM, Méndez RJ, Beck MA, Baez KG, Balletti LR. Speckle tracking echocardiography in the indeterminate form of Chagas disease. Echocardiography 2020; 38:39-46. [PMID: 33140890 DOI: 10.1111/echo.14917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/06/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Chagas disease is one of the most common diseases in Latin-America, and cardiac involvement is a significant cause of death. Assessment of myocardial strain may detect early myocardial damage. OBJECTIVES To determine differences in longitudinal strain using speckle tracking to assess regional and global left ventricular function in patients with the indeterminate form of Chagas disease, in comparison with a control group. METHODS This is a retrospective matched case-control study, conducted in a single center. We evaluated 45 adult patients with Chagas disease, diagnosed with 2 serological methods, without evidence of cardiac involvement, who were compared with 45 healthy control subjects, who were sex- and age-matched. All patients underwent Doppler echocardiography and longitudinal strain with speckle tracking. RESULTS Median age was 59 years, and 60% were female. Echocardiographic parameters were similar in patients with Chagas and control subjects. In patients with Chagas, global strain differed significantly from that of control subjects (-17 vs -20.3, P < .001). Segmental strain showed 7 abnormal segments in patients with Chagas (P < .05). CONCLUSIONS In patients with the indeterminate form of Chagas disease, global and segmental longitudinal peak systolic strain is reduced compared with healthy subjects, thus suggesting that it could be a sensitive technique to detect early myocardial damage. These findings could provide useful information regarding the pathophysiology of cardiac involvement and understand whether they might have prognostic usefulness or help develop strategies to modify the course and prognosis of patients with Chagas disease. A longitudinal prospective study would be necessary to validate our findings.
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Affiliation(s)
- Tomás Francisco Cianciulli
- Division of Cardiology, Echocardiography Laboratory, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Ciudad Autónoma de Buenos Aires, Argentina.,Researcher of the Ministry of Health of the Government of the City of Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gerardo Ariel Albarracín
- Division of Cardiology, Echocardiography Laboratory, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariano Napoli Llobera
- Division of Cardiology, Echocardiography Laboratory, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Ciudad Autónoma de Buenos Aires, Argentina
| | - Nilda Graciela Prado
- Division of Cardiology, Echocardiography Laboratory, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Ciudad Autónoma de Buenos Aires, Argentina.,Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben", Ciudad Autónoma de Buenos Aires, Argentina
| | - María Cristina Saccheri
- Division of Cardiology, Echocardiography Laboratory, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Ricardo José Méndez
- Division of Cardiology, Echocardiography Laboratory, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Ciudad Autónoma de Buenos Aires, Argentina
| | - Martín Alejandro Beck
- Division of Cardiology, Echocardiography Laboratory, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Ciudad Autónoma de Buenos Aires, Argentina
| | - Karina Giselle Baez
- Division of Cardiology, Echocardiography Laboratory, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Ciudad Autónoma de Buenos Aires, Argentina
| | - Lorena Romina Balletti
- Division of Cardiology, Echocardiography Laboratory, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Ciudad Autónoma de Buenos Aires, Argentina
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14
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Lidani KCF, Sandri TL, Castillo-Neyra R, Andrade FA, Guimarães CM, Marques EN, Beltrame MH, Gilman RH, de Messias-Reason I. Clinical and epidemiological aspects of chronic Chagas disease from Southern Brazil. Rev Soc Bras Med Trop 2020; 53:e20200225. [PMID: 33111908 PMCID: PMC7580281 DOI: 10.1590/0037-8682-0225-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/31/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Patients with Chagas disease (CD), caused by Trypanosoma cruzi, present a higher risk of developing other chronic diseases, which may contribute to CD severity. Since CD is underreported in the southern state of Paraná, Brazil, we aimed to characterize clinical and epidemiological aspects of individuals chronically infected with T. cruzi in Southern Brazil. METHODS A community hospital-based study was performed, recording clinical/demographic characteristics of 237 patients with CD from Southern Brazil. To estimate the association between different forms of CD and sociodemographic and clinical variables, multiple logistic regression models were built using the Akaike information criterion. RESULTS Mean age was 57.5 years and 59% were females. Most patients' (60%) place of origin/birth was within Paraná and they were admitted to the CD outpatient clinic after presenting with cardiac/digestive symptoms (64%). The predominant form of CD was cardiac (53%), followed by indeterminate (36%), and digestive (11%). The main electrocardiographic changes were in the right bundle branch block (39%) and left anterior fascicular block (32%). The average number of comorbidities per patient was 3.9±2.3; systemic arterial hypertension was most common (64%), followed by dyslipidemia (34%) and diabetes (19%); overlapping comorbidities were counted separately. Male sex was associated with symptomatic cardiac CD (OR=2.92; 95%CI: 1.05-8.12; p=0.040). CONCLUSIONS This study provided greater understanding of the distribution and clinical profile of CD patients in Southern Brazil, indicating a high prevalence of comorbidities among these patients who are a vulnerable group due to advanced age and substantial risk of morbidity.
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Affiliation(s)
| | - Thaisa Lucas Sandri
- University of Tübingen, Institute of Tropical Medicine, Tübingen,
BW, Germany
| | - Ricardo Castillo-Neyra
- University of Pennsylvania, Perelman School of Medicine, Department
of Biostatistics, Epidemiology & Informatics, Philadelphia, PA, USA
| | - Fabiana Antunes Andrade
- Universidade Federal do Paraná, Departamento de Patologia Médica,
Hospital de Clínicas, Curitiba, PR, Brasil
| | - Cesar Maistro Guimarães
- Universidade Federal do Paraná, Hospital de Clínicas, Unidade de
Terapia Intensiva, Curitiba, PR, Brasil
| | - Eduardo Nunes Marques
- Universidade Federal do Paraná, Departamento de Patologia Médica,
Hospital de Clínicas, Curitiba, PR, Brasil
| | - Marcia Holsbach Beltrame
- Universidade Federal do Paraná, Departamento de Genética,
Laboratório de Genética Molecular Humana, Curitiba, PR, Brasil
| | - Robert Hugh Gilman
- Johns Hopkins Bloomberg School of Public Health, Department of
International Health, Baltimore, MD, USA
| | - Iara de Messias-Reason
- Universidade Federal do Paraná, Departamento de Patologia Médica,
Hospital de Clínicas, Curitiba, PR, Brasil
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15
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Effect of exercise training on cardiovascular autonomic and muscular function in subclinical Chagas cardiomyopathy: a randomized controlled trial. Clin Auton Res 2020; 31:239-251. [PMID: 32875456 DOI: 10.1007/s10286-020-00721-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Patients with chronic chagasic cardiomyopathy with preserved ventricular function present with autonomic imbalance. This study evaluated the effects of exercise training (ET) in restoring peripheral and cardiac autonomic control and skeletal muscle phenotype in patients with subclinical chronic chagasic cardiomyopathy. METHODS This controlled trial (NCT02295215) included 24 chronic chagasic cardiomyopathy patients who were randomized www.random.org/lists/ into two groups: those who underwent exercise training (n = 12) and those who continued their usual activities (n = 12). Eight patients completed the exercise training protocol, and 10 patients were clinically followed up for 4 months. Muscular sympathetic nerve activity was measured by microneurography and muscle blood flow (MBF) using venous occlusion plethysmography. The low-frequency component of heart rate variability in normalized units (LFnuHR) reflects sympathetic activity in the heart, and the low-frequency component of systolic blood pressure variability in normalized units reflects sympathetic activity in the vessels. The infusion of vasoactive drugs (phenylephrine and sodium nitroprusside) was used to evaluate cardiac baroreflex sensitivity, and a vastus lateralis muscle biopsy was performed to evaluate atrogin-1 and MuRF-1 gene expression. RESULTS The baroreflex sensitivity for increases (p = 0.002) and decreases (p = 0.02) in systolic blood pressure increased in the ET group. Muscle blood flow also increased only in the ET group (p = 0.004). Only the ET group had reduced resting muscular sympathetic nerve activity levels (p = 0.008) and sympathetic activity in the heart (LFnu; p = 0.004) and vessels (p = 0.04) after 4 months. Regarding skeletal muscle, after 4 months, participants in the exercise training group presented with lower atrogin-1 gene expression than participants who continued their activities as usual (p = 0.001). The reduction in muscular sympathetic nerve activity was positively associated with reduced atrogin-1 (r = 0.86; p = 0.02) and MuRF-1 gene expression (r = 0.64; p = 0.06); it was negatively associated with improved baroreflex sensitivity both for increases (r = -0.72; p = 0.020) and decreases (r = -0.82; p = 0.001) in blood pressure. CONCLUSIONS ET improved cardiac and peripheral autonomic function in patients with subclinical chagasic cardiomyopathy. ET reduced MSNA and sympathetic activity in the heart and vessels and increased cardiac parasympathetic tone and baroreflex sensitivity. Regarding peripheral muscle, after 4 months, patients who underwent exercise training had an increased cross-sectional area of type I fibers and oxidative metabolism of muscle fibers, and decreased atrogin-1 gene expression, compared to participants who continued their activities as usual. In addition, the reduction in MSNA was associated with improved cardiac baroreflex sensitivity, reduced sympathetic cardiovascular tone, and reduced atrogin-1 and MuRF-1 gene expression. TRIAL REGISTRATION ID: NCT02295215. Registered in June 2013.
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16
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Hasslocher-Moreno AM, Salles Xavier S, Magalhães Saraiva R, Conde Sangenis LH, Teixeira de Holanda M, Horta Veloso H, Rodrigues da Costa A, de Souza Nogueira Sardinha Mendes F, Alvarenga Americano do Brasil PE, Sperandio da Silva GM, Felix Mediano MF, Silvestre de Sousa A. Progression Rate from the Indeterminate Form to the Cardiac Form in Patients with Chronic Chagas Disease: Twenty-Two-Year Follow-Up in a Brazilian Urban Cohort. Trop Med Infect Dis 2020; 5:tropicalmed5020076. [PMID: 32408570 PMCID: PMC7345528 DOI: 10.3390/tropicalmed5020076] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022] Open
Abstract
Most patients with chronic Chagas disease (CD) present the indeterminate form and are at risk to develop the cardiac form. However, the actual rate of progression to the cardiac form is still unknown. Methods: In total, 550 patients with the indeterminate CD form were followed by means of annual electrocardiogram at our outpatient clinic. The studied endpoint was progression to cardiac form defined by the appearance of electrocardiographic changes typical of CD. The progression rate was calculated as the cumulative progression rate and the incidence progression rate per 100 patient years. Results: Thirty-seven patients progressed to the CD cardiac form within a mean of 73 ± 48 months of follow-up, which resulted in a 6.9% cumulative progression rate and incidence rate of 1.48 cases/100 patient years. Patients who progressed were older (mean age 47.8 ± 12.2 years), had a higher prevalence of associated heart diseases (p < 0.0001), positive xenodiagnosis (p = 0.007), and were born in the most endemic Brazilian states (p = 0.018). Previous co-morbidities remained the only variable associated with CD progression after multivariate Cox proportional hazards regression analysis (p = 0.002). Conclusion: The progression rate to chronic CD cardiac form is low and inferior to rates previously reported in other studies.
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Rodríguez-Morales O, Roldán FJ, Vargas-Barrón J, Parra-Benítez E, Medina-García MDL, Vergara-Bello E, Arce-Fonseca M. Echocardiographic Findings in Canine Model of Chagas Disease Immunized with DNA Trypanosoma cruzi Genes. Animals (Basel) 2020; 10:E648. [PMID: 32283649 PMCID: PMC7222844 DOI: 10.3390/ani10040648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023] Open
Abstract
Chagas disease (ChD) is considered an emerging disease in the USA and Europe. Trypanosoma cruzi genes encoding a trans-sialidase protein and an amastigote-specific glycoprotein were tested as vaccines in canine model. The aim for this study was determining the prophylactic effect of these genes in experimentally infected dogs by echocardiography evaluation to compare with our findings obtained by other techniques published previously. Low fractional-shortening values of non-vaccinated dogs suggested an impairment in general cardiac function. Low left ventricular ejection fraction values found in infected dogs suggested myocardial injury regardless of whether they were vaccinated. Low left ventricular diastolic/systolic diameters suggested that progressive heart damage or heart dilation could be prevented by DNA vaccination. Systolic peak time was higher in non-vaccinated groups, increasing vulnerability to malignant arrhythmias and sudden death. High left ventricular volume suggested a decrease in wall thickness that might lead to increased size of the heart cavity, except in the pBCSP plasmid-vaccinated dogs. There was an echocardiographic evidence of left ventricular dilation and reduction in systolic function in experimental chagasic dogs. Echocardiography allowed a more complete follow-up of the pathological process in the living patient than with other techniques like electrocardiography, anatomopathology, and histopathology, being the method of choice for characterizing the clinical stages of ChD.
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Affiliation(s)
- Olivia Rodríguez-Morales
- Department of Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico; (O.R.-M.); (E.P.-B.); (M.d.L.M.-G.); (E.V.-B.)
| | - Francisco-Javier Roldán
- Department of Echocardiography, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico; (F.-J.R.); (J.V.-B.)
| | - Jesús Vargas-Barrón
- Department of Echocardiography, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico; (F.-J.R.); (J.V.-B.)
| | - Enrique Parra-Benítez
- Department of Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico; (O.R.-M.); (E.P.-B.); (M.d.L.M.-G.); (E.V.-B.)
| | - María de Lourdes Medina-García
- Department of Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico; (O.R.-M.); (E.P.-B.); (M.d.L.M.-G.); (E.V.-B.)
| | - Emilia Vergara-Bello
- Department of Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico; (O.R.-M.); (E.P.-B.); (M.d.L.M.-G.); (E.V.-B.)
| | - Minerva Arce-Fonseca
- Department of Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico; (O.R.-M.); (E.P.-B.); (M.d.L.M.-G.); (E.V.-B.)
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18
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Groom ZC, Zochios V, Protopapas AD. Translating Chagasic dilating cardiomyopathy to surgical therapies: An under published global challenge. SAGE Open Med 2020; 7:2050312119895927. [PMID: 31897298 PMCID: PMC6920581 DOI: 10.1177/2050312119895927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/27/2019] [Indexed: 12/21/2022] Open
Abstract
Chagas disease is a neglected parasitic anthropozoonosis of the Americas linked to social deprivation with no hope of eradication in the future. Having been the most common non-ischemic cause of dilating cardiomyopathy in Latin America, it now spreads beyond the geographical boundaries of its vector via imported and autochthonous transmission. We review the evidence on surgery in Chagasic heart failure and offer a brief narrative on the main aspects of translational management. There is very limited literature on surgery for Chagasic heart failure, especially assist devices and transplantation. This may be attributed to the often unsurmountable economic burden of this single-system parasymphatholytic heart failure to young sufferers who commonly have very limited access to the aforementioned procedures. Chagasic heart failure offers a so far neglected translational model of parasymphatholytic non-ischemic cardiac failure.
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Affiliation(s)
- Zoe C Groom
- Costello Medical Consulting Limited, Cambridge, UK
| | - Vasileios Zochios
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, West Midlands Deanery, Birmingham, UK.,Department of Anaesthesia and Intensive Care Medicine, Glenfield Hospital, University Hospitals of Leicester National Health Service Trust, Leicester, UK
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Vergara C, Muñoz G, Martínez G, Apt W, Zulantay I. Detection of Trypanosoma cruzi by PCR in adults with chronic Chagas disease treated with nifurtimox. PLoS One 2019; 14:e0221100. [PMID: 31433828 PMCID: PMC6703690 DOI: 10.1371/journal.pone.0221100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/30/2019] [Indexed: 12/19/2022] Open
Abstract
Chagas disease, a vector-borne parasitosis caused by Trypanosoma cruzi, is endemic to Latin America and has spread to other countries due to immigration of infected persons. It is estimated that 160,000 people are infected in Chile, most of them in the chronic phase and without etiological treatment. The infection is confirmed by conventional serological methods while molecular methods have become in valuable tools to evaluate parasitemia in treated and non-treated chronic Chagas disease patients. The objective of this study was to determine, by conventional Polymerase Chain Reaction, the presence of T. cruzi kinetoplastid DNA in peripheral blood samples from 114 adult individuals with confirmed chronic Chagas disease, before and 6.6 years (average) after treatment with nifurtimox. The samples were received and preserved in guanidine-EDTA until DNA purification. Conventional PCR assays were performed in triplicate with T. cruzi kinetoplastid DNA primers 121 and 122. The amplified products were fractionated by electrophoresis in 2% agarose gels. A 330 bp product represented a positive assay. 84.2% (96 cases) and 6.1% (7 cases) of the samples taken before and after the treatment, respectively, were positive. The McNemar test showed a statistically significant difference between the groups of samples (p<0.001). Since serological negativization (the current cure criterion) delay many years after therapy and positive parasitological results represent a treatment failure, the conversion of pre-therapy positive conventional PCR is a qualitative and complementary tool that could be included in protocols of prolonged follow-up.
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Affiliation(s)
- Camilo Vergara
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Gabriela Muñoz
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Gabriela Martínez
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Werner Apt
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Inés Zulantay
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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20
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Meyers AC, Hamer SA, Matthews D, Gordon SG, Saunders AB. Risk factors and select cardiac characteristics in dogs naturally infected with Trypanosoma cruzi presenting to a teaching hospital in Texas. J Vet Intern Med 2019; 33:1695-1706. [PMID: 31119786 PMCID: PMC6639495 DOI: 10.1111/jvim.15516] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 05/03/2019] [Indexed: 12/18/2022] Open
Abstract
Background Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, causes sudden death and chronic heart disease with no currently approved treatment. Objective To report epidemiologic and select cardiac characteristics associated with T. cruzi infection in dogs presenting to a teaching hospital in Texas. Animals Three hundred seventy‐five client‐owned dogs. Methods A retrospective search of medical records identified dogs tested for T. cruzi antibodies or with histologic T. cruzi parasites. Data retrieved included signalment, location of residence, reported reason for testing, cardiac troponin I (cTnI) concentration, and ECG abnormalities. Results Trypanosoma cruzi‐infected dogs (N = 63, 16.8%) were significantly younger than negative dogs (N = 312) (mean, 5.9 ± 3.8 versus 7.4 ± 4.0 years; P = .007) with no difference by sex or breed. Ninety‐one breeds were tested; the highest percent infected were non‐sporting (10/35; 29%) and toy breed (10/42; 24%) groups. The odds of infection were 13 times greater among dogs with an infected housemate or littermate (95% confidence interval [CI], 3.94‐50.45; P < .001). Infected dogs were more likely to have ventricular arrhythmias (odds ratio [OR], 2.19; 95% CI, 1.15‐4.33, P = .02), combinations of ECG abnormalities (OR, 2.91; 95% CI, 1.37‐5.99; P = .004), and cTnI >0.129 ng/mL (ADVIA; OR, 10.71; 95% CI, 1.60‐212.21; P = .035). Conclusions and Clinical Importance Dogs infected with T. cruzi were identified in Texas in many breed groups including breeds affected by well‐described heart diseases that mimic Chagas disease suggesting a need for increased awareness, including knowledge of when to consider testing.
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Affiliation(s)
- Alyssa C Meyers
- Department of Veterinary Integrative Bioscience, Texas A&M University, College Station, Texas
| | - Sarah A Hamer
- Department of Veterinary Integrative Bioscience, Texas A&M University, College Station, Texas
| | - Derek Matthews
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
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Could angiotensin-modulating drugs be relevant for the treatment of Trypanosoma cruzi infection? A systematic review of preclinical and clinical evidence. Parasitology 2019; 146:914-927. [DOI: 10.1017/s003118201900009x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AbstractAlthough leucocytes are targets of renin-angiotensin system (RAS) effector molecules and RAS-modulating drugs exert immunomodulatory effects, their impact onTrypanosoma cruziinfection remains poorly understood. By using the framework of a systematic review, we integrated the preclinical and clinical evidence to investigate the relevance of angiotensin-inhibiting drugs onT. cruziinfections. From a comprehensive and structured search in biomedical databases, only original studies were analysed. In preclinical and clinical studies, captopril, enalapril and losartan were RAS-modulating drugs used. The mainin vitrofindings indicated that these drugs increased parasite uptake per host cells, IL-12 expression by infected dendritic cells and IFN-γby T lymphocytes, in addition to attenuating IL-10 and IL-17 production by CD8 + T cells. In animal models, reduced parasitaemia, tissue parasitism, leucocytes infiltration and mortality were often observed inT. cruzi-infected animals receiving RAS-modulating drugs. In patients with Chagas’ disease, these drugs exerted a controversial impact on cytokine and hormone levels, and a limited effect on cardiovascular function. Considering a detailed evaluation of reporting and methodological quality, the current preclinical and clinical evidence is at high risk of bias, and we hope that our critical analysis will be useful in mitigating the risk of bias in further studies.
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Mendonça AAS, Coelho CM, Veloso MP, Caldas IS, Gonçalves RV, Teixeira AL, de Miranda AS, Novaes RD. Relevance of Trypanothione Reductase Inhibitors on Trypanosoma cruzi Infection: A Systematic Review, Meta-Analysis, and In Silico Integrated Approach. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:8676578. [PMID: 30473742 PMCID: PMC6220389 DOI: 10.1155/2018/8676578] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/14/2018] [Indexed: 02/08/2023]
Abstract
Due to the rudimentary antioxidant defenses in Trypanosoma cruzi, disruptors of redox balance are promising candidates for new antitrypanosomal drugs. We developed an integrated model based on systematic review, meta-analyses, and molecular modeling to evaluate the effect of trypanothione reductase (TR) inhibitors in T. cruzi infections. Our findings indicated that the TR inhibitors analyzed were effective in reducing parasitemia and mortality due to Trypanosoma cruzi infection in animal models. The most investigated drugs (clomipramine and thioridazine) showed no beneficial effects on the occurrence of infection-related electrocardiographic abnormalities or the affinity and density of cardiac β-adrenergic receptors. The affinity between the tested ligands and the active site of TR was confirmed by molecular docking. However, the molecular affinity score was unable to explain TR inhibition and T. cruzi death in vitro or the antiparasitic potential of these drugs when tested in preclinical models of T. cruzi infection. The divergence of in silico, in vitro, and in vivo findings indicated that the anti-T. cruzi effects of the analyzed drugs were not restricted to TR inhibition. As in vivo studies on TR inhibitors are still scarce and exhibit methodological limitations, mechanistic and highly controlled studies are required to improve the quality of evidence.
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Affiliation(s)
- Andréa Aparecida Santos Mendonça
- Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, 37130-001 Minas Gerais, Brazil
- Department of Structural Biology, Federal University of Alfenas, Alfenas, 37130-001 Minas Gerais, Brazil
| | - Camila Morais Coelho
- Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, 37130-001 Minas Gerais, Brazil
| | - Marcia Paranho Veloso
- Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, 37130-001 Minas Gerais, Brazil
| | - Ivo Santana Caldas
- Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, 37130-001 Minas Gerais, Brazil
- Department of Pathology and Parasitology, Federal University of Alfenas, Alfenas, 37130-001 Minas Gerais, Brazil
| | | | - Antônio Lucio Teixeira
- Interdisciplinary Laboratory of Medical Investigation, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, 30130-100 Minas Gerais, Brazil
| | - Aline Silva de Miranda
- Interdisciplinary Laboratory of Medical Investigation, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, 30130-100 Minas Gerais, Brazil
- Institute of Biological Sciences, Department of Morphology, Federal University of Minas Gerais, Belo Horizonte, 30130-100 Minas Gerais, Brazil
| | - Rômulo Dias Novaes
- Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, 37130-001 Minas Gerais, Brazil
- Department of Structural Biology, Federal University of Alfenas, Alfenas, 37130-001 Minas Gerais, Brazil
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Fernández ML, Hernández Y, Scollo K, Esteva MI, Riarte AR, Prado NG. Chagas cardiomyopathy associated with serological cure after trypanocidal treatment during childhood. Rev Soc Bras Med Trop 2018; 51:557-559. [DOI: 10.1590/0037-8682-0364-2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 05/08/2018] [Indexed: 11/21/2022] Open
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Santana DY, Salgado RM, Fevereiro M, Silva do Nascimento R, Fonseca R, Saraiva Câmara NO, Epiphanio S, Marinho CRF, Barreto-Chaves ML, D’ Império-Lima MR, Álvarez JM. MyD88 activation in cardiomyocytes contributes to the heart immune response to acute Trypanosoma cruzi infection with no effect on local parasite control. PLoS Negl Trop Dis 2018; 12:e0006617. [PMID: 30067739 PMCID: PMC6089445 DOI: 10.1371/journal.pntd.0006617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/13/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022] Open
Abstract
Cardiomyopathy is the most serious consequence of Chagas disease, a neglected human disorder caused by Trypanosoma cruzi infection. Because T. cruzi parasites invade cardiomyocytes, we sought to investigate whether these cells recognize the parasite in vivo by receptors signaling through the MyD88 adaptor, which mediates the activation pathway of most Toll-like receptors (TLRs) and IL-1/IL-18 receptors, and influence the development of acute cardiac pathology. First, we showed that HL-1 cardiac muscle cell line expresses MyD88 gene and protein at resting state and after T. cruzi infection. To evaluate the role in vivo of MyD88 expression in cardiomyocytes, we generated Mer+MyD88flox+/+ mice in which tamoxifen treatment is expected to eliminate the MyD88 gene exclusively in cardiomyocytes. This Cre-loxP model was validated by both PCR and western blot analysis; tamoxifen treatment of Mer+MyD88flox+/+ mice resulted in decreased MyD88 gene and protein expression in the heart, but not in the spleen, while had no effect on littermates. The elimination of MyD88 in cardiomyocytes determined a lower increase in CCL5, IFNγ and TNFα gene transcription during acute infection by T. cruzi parasites of the Y strain, but it did not significantly modify heart leukocyte infiltration and parasitism. Together, our results show that cardiomyocytes can sense T. cruzi infection through MyD88-mediated molecular pathways and contribute to the local immune response to the parasite. The strong pro-inflammatory response of heart-recruited leukocytes may overshadow the effects of MyD88 deficiency in cardiomyocytes on the local leukocyte recruitment and T. cruzi control during acute infection.
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Affiliation(s)
- Danni Yohani Santana
- Department of Immunology of Biomedical Sciences Institute, University of São Paulo, São Paulo, SP, Brazil
| | - Rafael Moysés Salgado
- Department of Immunology of Biomedical Sciences Institute, University of São Paulo, São Paulo, SP, Brazil
| | - Marina Fevereiro
- Department of Anatomy of Biomedical Sciences Institute, University of São Paulo, São Paulo, SP, Brazil
| | | | - Raissa Fonseca
- Department of Immunology of Biomedical Sciences Institute, University of São Paulo, São Paulo, SP, Brazil
| | - Niels Olsen Saraiva Câmara
- Department of Immunology of Biomedical Sciences Institute, University of São Paulo, São Paulo, SP, Brazil
| | - Sabrina Epiphanio
- Department of Clinical and Toxicologic Analyses, Faculty of Pharmacy, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | - José M. Álvarez
- Department of Immunology of Biomedical Sciences Institute, University of São Paulo, São Paulo, SP, Brazil
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Leite DI, Fontes FDV, Bastos MM, Hoelz LVB, Bianco MDCAD, de Oliveira AP, da Silva PB, da Silva CF, Batista DDGJ, da Gama ANS, Peres RB, Villar JDF, Soeiro MDNC, Boechat N. New 1,2,3-triazole-based analogues of benznidazole for use against Trypanosoma cruzi infection: In vitro and in vivo evaluations. Chem Biol Drug Des 2018; 92:1670-1682. [PMID: 29745048 DOI: 10.1111/cbdd.13333] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/09/2018] [Accepted: 04/21/2018] [Indexed: 12/18/2022]
Abstract
Chagas disease has spread throughout the world mainly because of the migration of infected individuals. In Brazil, only benznidazole (Bnz) is used; however, it is toxic and not active in the chronic phase, and cases of resistance are described. This work aimed at the synthesis and the trypanocidal evaluation in vitro and in vivo of six new Bnz analogues (3-8). They were designed by exploring the bioisosteric substitution between the amide group contained in Bnz and the 1,2,3-triazole ring. All the compounds were synthesized in good yields. With the exception of compound 7, the in vitro biological evaluation shows that all Bnz analogues were active against the amastigote form, whereas only compounds 3, 4, 5, and 8 were active against trypomastigote. Compounds 4 and 5 showed the most promising activities in vitro against the form of trypomastigote, being more active than Bnz. In vivo evaluation of compounds, 3-8 showed lower potency and higher toxicity than Bnz. Although the 1,2,3-triazole ring has been described in the literature as an amide bioisostere, its substitution here has reduced the activity of the compounds and made them more toxic. Thus, further molecular optimization could provide novel therapeutic agents for Chagas' disease.
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Affiliation(s)
- Débora Inácio Leite
- Departamento de Sintese de Farmacos, Instituto de Tecnologia em Farmacos, Farmanguinhos - Fiocruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.,Programa de Pos-Graduação em Farmacologia e Quimica Medicinal do Instituto de Ciencias Biomedicas - ICB- UFRJ, Centro de Ciências da Saúde - CCS, Rio de Janeiro, Brasil
| | - Fábio de Vasconcellos Fontes
- Departamento de Sintese de Farmacos, Instituto de Tecnologia em Farmacos, Farmanguinhos - Fiocruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.,Departamento de Ciencia e Tecnologia, Praça General Tiburcio, Instituto Militar de Engenharia, Rio de Janeiro, Brasil
| | - Monica Macedo Bastos
- Departamento de Sintese de Farmacos, Instituto de Tecnologia em Farmacos, Farmanguinhos - Fiocruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.,Programa de Pos-Graduação em Farmacologia e Quimica Medicinal do Instituto de Ciencias Biomedicas - ICB- UFRJ, Centro de Ciências da Saúde - CCS, Rio de Janeiro, Brasil
| | - Lucas Villas Boas Hoelz
- Departamento de Sintese de Farmacos, Instituto de Tecnologia em Farmacos, Farmanguinhos - Fiocruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Maria da Conceição Avelino Dias Bianco
- Departamento de Sintese de Farmacos, Instituto de Tecnologia em Farmacos, Farmanguinhos - Fiocruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.,Programa de Pos-Graduação em Farmacologia e Quimica Medicinal do Instituto de Ciencias Biomedicas - ICB- UFRJ, Centro de Ciências da Saúde - CCS, Rio de Janeiro, Brasil
| | - Andressa Paula de Oliveira
- Departamento de Sintese de Farmacos, Instituto de Tecnologia em Farmacos, Farmanguinhos - Fiocruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.,Programa de Pos-Graduação em Farmacologia e Quimica Medicinal do Instituto de Ciencias Biomedicas - ICB- UFRJ, Centro de Ciências da Saúde - CCS, Rio de Janeiro, Brasil.,PROBIN - Abeu - Centro Universitario UNIABEU, Belford Roxo, Rio de Janeiro, Brasil
| | | | - Cristiane França da Silva
- Laboratorio de Biologia Celular, Instituto Oswaldo Cruz - IOC, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Denise da Gama Jean Batista
- Laboratorio de Biologia Celular, Instituto Oswaldo Cruz - IOC, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Raiza Brandão Peres
- Laboratorio de Biologia Celular, Instituto Oswaldo Cruz - IOC, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jose Daniel Figueroa Villar
- Departamento de Ciencia e Tecnologia, Praça General Tiburcio, Instituto Militar de Engenharia, Rio de Janeiro, Brasil
| | | | - Nubia Boechat
- Departamento de Sintese de Farmacos, Instituto de Tecnologia em Farmacos, Farmanguinhos - Fiocruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.,Programa de Pos-Graduação em Farmacologia e Quimica Medicinal do Instituto de Ciencias Biomedicas - ICB- UFRJ, Centro de Ciências da Saúde - CCS, Rio de Janeiro, Brasil
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Gasparim AZ, Fontes CER, Rossoni DF, Toledo MJDO. Epidemiological and clinical profile of patients with Chagas disease in the Central-North area of Paraná, Southern Brazil. Rev Soc Bras Med Trop 2018; 51:225-230. [PMID: 29768559 DOI: 10.1590/0037-8682-0173-2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/17/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Profiles of patients with Chagas disease in Paraná were studied. METHODS A descriptive, questionnaire-based study was performed. RESULTS Of 270 participants, 64% were female, 60% were aged ≥65 years, 91% were infected via vector transmission, and 44% were infected in Paraná. Indeterminate (30%), cardiac (36%), cardiodigestive (20%) and digestive (14%) forms were found. CONCLUSIONS Patients who were older than 65 years of age, retired, female, living in the urban area of Maringá, and infected by vector transmission in childhood in Paraná presented cardiac and digestive signs and did not receive etiological treatment when first diagnosed.
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Affiliation(s)
- Aretuza Zaupa Gasparim
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá, Maringá, Paraná, Brasil
| | - Carlos Edmundo Rodrigues Fontes
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá, Maringá, Paraná, Brasil.,Departamento de Medicina, Universidade Estadual de Maringá, Maringá, Paraná, Brasil
| | | | - Max Jean de Ornelas Toledo
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá, Maringá, Paraná, Brasil.,Departamento de Ciências Básicas da Saúde, Universidade Estadual de Maringá, Maringá, Paraná, Brasil
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Genetic Polymorphisms of Manganese-Dependent Superoxide Dismutase in Chagas Disease. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Almeida BCS, Carmo AALD, Barbosa MPT, Silva JLPD, Ribeiro ALP. Association between Microvolt T-Wave Alternans and Malignant Ventricular Arrhythmias in Chagas Disease. Arq Bras Cardiol 2018; 110:412-417. [PMID: 29641645 PMCID: PMC5967132 DOI: 10.5935/abc.20180056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/18/2017] [Indexed: 01/06/2023] Open
Abstract
Background Sudden cardiac death is the most frequent death mechanism in Chagas disease,
responsible for 55% to 65% of the deaths of patients with chronic Chagas
cardiomyopathy (CCC). The most often involved electrophysiological
mechanisms are ventricular tachycardia and ventricular fibrillation. The
implantable cardioverter defibrillator (ICD) has a beneficial role in
preventing sudden death due to malignant ventricular arrhythmias, and, thus
the correct identification of patients at risk is required. The association
of microvolt T-wave alternans (MTWA) with the appearance of ventricular
arrhythmias has been assessed in different heart diseases. The role of MTWA
is mostly unknown in patients with CCC. Objectives To evaluate the association between MTWA and the occurrence of malignant
ventricular arrhythmias in patients with CCC. Method This is a case-control study including patients with CCC and ICD, with
history of malignant ventricular arrhythmias (case group), and patients with
CCC and no history of those arrhythmias (control group). The MTWA test
results were classified as negative and non-negative (positive and
indeterminate). The significance level adopted was a = 0.05. Results We recruited 96 patients, 45 cases (46.8%) and 51 controls (53.1%). The MTWA
test was non-negative in 36/45 cases (80%) and 15/51 controls (29.4%)
[OR = 9.60 (95%CI: 3.41 - 27.93)]. After adjustment for known
confounding factors in a logistic regression model, the non-negative result
continued to be associated with malignant ventricular arrhythmias [OR
= 5.17 (95%CI: 1.05 - 25.51)]. Conclusion Patients with CCC and history of malignant ventricular arrhythmias more often
have a non-negative MTWA test as compared to patients with no history of
arrhythmia.
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Affiliation(s)
| | - André Assis Lopes do Carmo
- Hospital das Clínicas e Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil
| | - Marco Paulo Tomaz Barbosa
- Hospital das Clínicas e Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil
| | | | - Antonio Luiz Pinho Ribeiro
- Hospital das Clínicas e Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil
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Silva RRD, Reis MS, Pereira BDB, Nascimento EMD, Pedrosa RC. Additional value of anaerobic threshold in a general mortality prediction model in a urban patient cohort with Chagas cardiomyopathy. Rev Port Cardiol 2017; 36:927-934. [PMID: 29223851 DOI: 10.1016/j.repc.2017.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/22/2017] [Accepted: 06/29/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Anaerobic threshold (AT) is recognized as objective and direct measurement that reflects variations in metabolism of skeletal muscles during exercise. Its prognostic value in heart diseases of non-chagasic etiology is well established. However, the assessment of risk of death in Chagas heart disease is relatively well established by Rassi score. But, the added value that AT can bring to Rassi score has not been studied yet. OBJECTIVES To assess whether AT presents additional effect to Rassi score in patients with chronic Chagas' heart disease. METHODS Prospective research of dynamic cohort by review of 150 medical records of patients. Were selected for cohort 45 medical records of patients who underwent cardiopulmonary exercise testing between 1996-1997 and followed until September 2015. Data analysis to detect association between studied variables can be seen using a logistic regression model. The suitability of the models was verified using ROC curves and the coefficient of determination R2. RESULTS 8 patients (17.78%) died by September 2015, with 7 of them (87.5%) from cardiovascular causes, of which 4 (57.14%) were considered on high risk by Rassi score. With Rassi score as independent variable, and death being the outcome, we obtained an area under the curve (AUC)=0.711, with R2=0.214. Instituting AT as independent variable, we found AUC=0.706, with R2=0.078. When we define Rassi score and AT as independent variables, it was obtained AUC=0.800 and R2=0.263. CONCLUSION when AT is included in logistic regression, it increases by 5% the explanation (R2) to the death estimation.
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Affiliation(s)
- Roberto Ribeiro da Silva
- Hospital Federal de Bonsucesso, Serviço de Fisioterapia, Rio de Janeiro, RJ, Brasil; Hospital Universitário Gaffrèe e Guinle - UNIRIO, Serviço de Fisioterapia, Rio de Janeiro, RJ, Brasil.
| | - Michel Silva Reis
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Instituto do Coração Edson Saad (Ices), Rio de Janeiro, RJ, Brasil
| | - Basílio de Bragança Pereira
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Instituto do Coração Edson Saad (Ices), Rio de Janeiro, RJ, Brasil; Universidade Federal do Rio de Janeiro, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (Coppe), Rio de Janeiro, RJ, Brasil
| | - Emilia Matos do Nascimento
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Instituto do Coração Edson Saad (Ices), Rio de Janeiro, RJ, Brasil; Universidade Federal do Rio de Janeiro, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (Coppe), Rio de Janeiro, RJ, Brasil
| | - Roberto Coury Pedrosa
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Instituto do Coração Edson Saad (Ices), Rio de Janeiro, RJ, Brasil
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Silva RRD, Reis MS, Pereira BDB, Nascimento EMD, Pedrosa RC. Additional value of anaerobic threshold in a general mortality prediction model in a urban patient cohort with Chagas cardiomyopathy. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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de Paiva Bezerra R, de Miranda Alves MA, Conforto AB, Rodrigues DLG, Silva GS. Etiological Classification of Stroke in Patients with Chagas Disease Using TOAST, Causative Classification System TOAST, and ASCOD Phenotyping. J Stroke Cerebrovasc Dis 2017; 26:2864-2869. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022] Open
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Caballero EP, Santamaría MH, Corral RS. Endogenous osteopontin induces myocardial CCL5 and MMP-2 activation that contributes to inflammation and cardiac remodeling in a mouse model of chronic Chagas heart disease. Biochim Biophys Acta Mol Basis Dis 2017; 1864:11-23. [PMID: 28987763 DOI: 10.1016/j.bbadis.2017.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/21/2017] [Accepted: 10/03/2017] [Indexed: 01/22/2023]
Abstract
Cardiac dysfunction with progressive inflammation and fibrosis is a hallmark of Chagas disease caused by persistent Trypanosoma cruzi infection. Osteopontin (OPN) is a pro-inflammatory cytokine that orchestrates mechanisms controlling cell recruitment and cardiac architecture. Our main goal was to study the role of endogenous OPN as a modulator of myocardial CCL5 chemokine and MMP-2 metalloproteinase, and its pathological impact in a murine model of Chagas heart disease. Wild-type (WT) and OPN-deficient (spp1 -/-) mice were parasite-infected (Brazil strain) for 100days. Both groups developed chronic myocarditis with similar parasite burden and survival rates. However, spp1 -/- infection showed lower heart-to-body ratio (P<0.01) as well as reduced inflammatory pathology (P<0.05), CCL5 expression (P<0.05), myocyte size (P<0.05) and fibrosis (P<0.01) in cardiac tissues. Intense OPN labeling was observed in inflammatory cells recruited to infected heart (P<0.05). Plasma concentration of MMP-2 was higher (P<0.05) in infected WT than in spp1 -/- mice. Coincidently, specific immunostaining revealed increased gelatinase expression (P<0.01) and activity (P<0.05) in the inflamed hearts from T. cruzi WT mice, but not in their spp1 -/- littermates. CCL5 and MMP-2 induction occurred preferentially (P<0.01) in WT heart-invading CD8+ T cells and was mediated via phospho-JNK MAPK signaling. Heart levels of OPN, CCL5 and MMP-2 correlated (P<0.01) with collagen accumulation in the infected WT group only. Endogenous OPN emerges as a key player in the pathogenesis of chronic Chagas heart disease, through the upregulation of myocardial CCL5/MMP-2 expression and activities resulting in pro-inflammatory and pro-hypertrophic events, cardiac remodeling and interstitial fibrosis.
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Affiliation(s)
| | - Miguel H Santamaría
- Laboratorio de Biología Experimental, Centro de Estudios Metabólicos, Santander, Spain
| | - Ricardo S Corral
- Servicio de Parasitología-Chagas, Hospital de Niños "Dr. Ricardo Gutiérrez", Buenos Aires, Argentina.
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Vargas de Oliveira EC, Carneiro ZA, de Albuquerque S, Marchetti JM. Development and Evaluation of a Nanoemulsion Containing Ursolic Acid: a Promising Trypanocidal Agent : Nanoemulsion with Ursolic Acid Against T. cruzi. AAPS PharmSciTech 2017; 18:2551-2560. [PMID: 28224391 DOI: 10.1208/s12249-017-0736-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/02/2017] [Indexed: 11/30/2022] Open
Abstract
Over a hundred years after the discovery of Chagas disease, this ailment continues to affect thousands of people. For more than 40 years, only two drugs have been available to treat it. Ursolic acid is a naturally occurring terpene that has shown a good trypanocidal action. However, the hydrophobicity of this compound presents a challenge for the development of proper delivery systems. Nanostructured systems are a prominent in delivering lipophilic drugs. Thus, a nanoemulsion containing ursolic acid was developed and had its trypanocidal activity and cytotoxicity evaluated. Pseudo-ternary phase diagrams and hydrophilic-lipophilic balance (HLB) system were used in the development. The system was stable throughout 90 days of testing, as evidenced by turbidimetry analysis and measurements of the droplet size (57.3 nm) and polydispersity index (0.24). Fourier transform infrared spectroscopy and mass spectrometry evidenced drug's integrity in the formulation. An in vitro dissolution profile showed 75% of ursolic acid release after 5 min from the nanoemulsion into the alkaline dissolution medium, while only 20% could be released from a physical mixture after 2 h. Trypanocidal activity and cytotoxicity were evaluated on the CL Brener strain and LLC-MK2 (monkey kidney) fibroblast by chlorophenol red-β-D-galactoside (CPRG) method. Biological studies showed that the developed formulation was nontoxic and effective against replicant forms of the parasite. A stable and efficient nanoemulsion could be developed to improve the delivery of a promising drug to treat a threatening illness such as Chagas disease.
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Affiliation(s)
- Erika Cristina Vargas de Oliveira
- Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Avenida do Café s/n, 14040-903, Ribeirão Preto, São Paulo, Brazil.
- Department of Pharmaceutical Sciences, College of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Av. Zeferino Vaz, s/n, Bairro Monte Alegre, 14040-903, Ribeirão Preto, SP, Brazil.
| | - Zumira Aparecida Carneiro
- Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Avenida do Café s/n, 14040-903, Ribeirão Preto, São Paulo, Brazil
| | - Sérgio de Albuquerque
- Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Avenida do Café s/n, 14040-903, Ribeirão Preto, São Paulo, Brazil
| | - Juliana Maldonado Marchetti
- Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Avenida do Café s/n, 14040-903, Ribeirão Preto, São Paulo, Brazil
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Genetic Adjuvantation of a Cell-Based Therapeutic Vaccine for Amelioration of Chagasic Cardiomyopathy. Infect Immun 2017; 85:IAI.00127-17. [PMID: 28674032 DOI: 10.1128/iai.00127-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/21/2017] [Indexed: 12/19/2022] Open
Abstract
Chagas disease, caused by infection with the protozoan parasite Trypanosoma cruzi, is a leading cause of heart disease ("chagasic cardiomyopathy") in Latin America, disproportionately affecting people in resource-poor areas. The efficacy of currently approved pharmaceutical treatments is limited mainly to acute infection, and there are no effective treatments for the chronic phase of the disease. Preclinical models of Chagas disease have demonstrated that antigen-specific CD8+ gamma interferon (IFN-γ)-positive T-cell responses are essential for reducing parasite burdens, increasing survival, and decreasing cardiac pathology in both the acute and chronic phases of Chagas disease. In the present study, we developed a genetically adjuvanted, dendritic cell-based immunotherapeutic for acute Chagas disease in an attempt to delay or prevent the cardiac complications that eventually result from chronic T. cruzi infection. Dendritic cells transduced with the adjuvant, an adenoviral vector encoding a dominant negative isoform of Src homology region 2 domain-containing tyrosine phosphatase 1 (SHP-1) along with the T. cruzi Tc24 antigen and trans-sialidase antigen 1 (TSA1), induced significant numbers of antigen-specific CD8+ IFN-γ-positive cells following injection into BALB/c mice. A vaccine platform transduced with the adenoviral vector and loaded in tandem with the recombinant protein reduced parasite burdens by 76% to >99% in comparison to a variety of different controls and significantly reduced cardiac pathology in a BALB/c mouse model of live Chagas disease. Although no statistical differences in overall survival rates among cohorts were observed, the data suggest that immunotherapeutic strategies for the treatment of acute Chagas disease are feasible and that this approach may warrant further study.
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Oliveira TDSFD, Santos BND, Galdino TS, Hasslocher-Moreno AM, Bastos OMP, Sousa MAD. Trypanosoma cruzi I genotype among isolates from patients with chronic Chagas disease followed at the Evandro Chagas National Institute of Infectious Diseases (FIOCRUZ, Brazil). Rev Soc Bras Med Trop 2017; 50:35-43. [PMID: 28327800 DOI: 10.1590/0037-8682-0406-2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/02/2016] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION: Trypanosoma cruzi is the etiologic agent of Chagas disease in humans, mainly in Latin America. Trypanosome stocks were isolated by hemoculture from patients followed at Evandro Chagas National Institute of Infectious Diseases (FIOCRUZ) and studied using different approaches. METHODS: For species and genotype identification, the stocks were analyzed by parasitological techniques, polymerase chain reaction assays targeted to specific DNA sequences, isoenzyme patterns, besides sequencing of a polymorphic locus of TcSC5D gene (one stock). RESULTS: The isolates presented typical T. cruzi morphology and usually grew well in routine culture media. Metacyclic trypomastigotes were found in cultures or experimentally infected Triatoma infestans. All isolates were pure T. cruzi cultures, presenting typical 330-bp products from kinetoplast DNA minicircles, and 250 or 200-bp amplicons from the mini-exon non-transcribed spacer. Their genetic type assignment was resolved by their isoenzyme profiles. The finding of TcI in one asymptomatic patient from Paraíba was confirmed by the sequencing assay. TcVI was found in two asymptomatic individuals from Bahia and Rio Grande do Sul. TcII was identified in six patients from Pernambuco, Bahia and Minas Gerais, who presented different clinical forms: cardiac (2), digestive with megaesophagus (1), and indeterminate (3). CONCLUSIONS: The main T. cruzi genotypes found in Brazilian chronic patients were identified in this work, including TcI, which is less frequent and usually causes asymptomatic disease, unlike that in other American countries. This study emphasizes the importance of T. cruzi genotyping for possible correlations between the parasite and patient' responses to therapeutic treatment or disease clinical manifestations.
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Affiliation(s)
| | | | - Tainah Silva Galdino
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | | | - Otilio Machado Pereira Bastos
- Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - Maria Auxiliadora de Sousa
- Coleção de Tripanossomatídeos, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.,Laboratório de Toxoplasmose e Outras Protozooses, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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Lidani KCF, Bavia L, Ambrosio AR, de Messias-Reason IJ. The Complement System: A Prey of Trypanosoma cruzi. Front Microbiol 2017; 8:607. [PMID: 28473804 PMCID: PMC5397499 DOI: 10.3389/fmicb.2017.00607] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/24/2017] [Indexed: 12/27/2022] Open
Abstract
Trypanosoma cruzi is a protozoan parasite known to cause Chagas disease (CD), a neglected sickness that affects around 6-8 million people worldwide. Originally, CD was mainly found in Latin America but more recently, it has been spread to countries in North America, Asia, and Europe due the international migration from endemic areas. Thus, at present CD represents an important concern of global public health. Most of individuals that are infected by T. cruzi may remain in asymptomatic form all lifelong, but up to 40% of them will develop cardiomyopathy, digestive mega syndromes, or both. The interaction between the T. cruzi infective forms and host-related immune factors represents a key point for a better understanding of the physiopathology of CD. In this context, the complement, as one of the first line of host defense against infection was shown to play an important role in recognizing T. cruzi metacyclic trypomastigotes and in controlling parasite invasion. The complement consists of at least 35 or more plasma proteins and cell surface receptors/regulators, which can be activated by three pathways: classical (CP), lectin (LP), and alternative (AP). The CP and LP are mainly initiated by immune complexes or pathogen-associated molecular patterns (PAMPs), respectively, whereas AP is spontaneously activated by hydrolysis of C3. Once activated, several relevant complement functions are generated which include opsonization and phagocytosis of particles or microorganisms and cell lysis. An important step during T. cruzi infection is when intracellular trypomastigotes are release to bloodstream where they may be target by complement. Nevertheless, the parasite uses a sequence of events in order to escape from complement-mediated lysis. In fact, several T. cruzi molecules are known to interfere in the initiation of all three pathways and in the assembly of C3 convertase, a key step in the activation of complement. Moreover, T. cruzi promotes secretion of plasma membrane-derived vesicles from host cells, which prevent the activity of C3 convertase C4b2a and thereby may hinder complement. In this review, we aim to present an overview on the strategies used by T. cruzi in order to circumvent the activation of complement and, consequently, its biological effects.
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Affiliation(s)
| | | | | | - Iara J. de Messias-Reason
- Laboratory of Molecular Immunopathology, Clinical Hospital, Federal University of ParanáCuritiba, Brazil
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Biodegradable Polymeric Nanocapsules Prevent Cardiotoxicity of Anti-Trypanosomal Lychnopholide. Sci Rep 2017; 7:44998. [PMID: 28349937 PMCID: PMC5368638 DOI: 10.1038/srep44998] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 02/17/2017] [Indexed: 12/14/2022] Open
Abstract
Chagas disease is a neglected parasitic disease caused by the protozoan Trypanosoma cruzi. New antitrypanosomal options are desirable to prevent complications, including a high rate of cardiomyopathy. Recently, a natural substance, lychnopholide, has shown therapeutic potential, especially when encapsulated in biodegradable polymeric nanocapsules. However, little is known regarding possible adverse effects of lychnopholide. Here we show that repeated-dose intravenous administration of free lychnopholide (2.0 mg/kg/day) for 20 days caused cardiopathy and mortality in healthy C57BL/6 mice. Echocardiography revealed concentric left ventricular hypertrophy with preserved ejection fraction, diastolic dysfunction and chamber dilatation at end-stage. Single cardiomyocytes presented altered contractility and Ca2+ handling, with spontaneous Ca2+ waves in diastole. Acute in vitro lychnopholide application on cardiomyocytes from healthy mice also induced Ca2+ handling alterations with abnormal RyR2-mediated diastolic Ca2+ release. Strikingly, the encapsulation of lychnopholide prevented the cardiac alterations induced in vivo by the free form repeated doses. Nanocapsules alone had no adverse cardiac effects. Altogether, our data establish lychnopholide presented in nanocapsule form more firmly as a promising new drug candidate to cure Chagas disease with minimal cardiotoxicity. Our study also highlights the potential of nanotechnology not only to improve the efficacy of a drug but also to protect against its adverse effects.
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de Oliveira AP, Ayo CM, Mimura KKO, Oliani SM, Bernardo CR, Camargo AVS, Ronchi LS, Borim AA, de Campos Júnior E, Brandão de Mattos CC, Castiglioni L, Bestetti RB, Cavasini CE, de Mattos LC. Plasma concentrations of CCL3 and CCL4 in the cardiac and digestive clinical forms of chronic Chagas disease. Cytokine 2016; 91:51-56. [PMID: 28002786 DOI: 10.1016/j.cyto.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/13/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
Abstract
The aim of this study was to investigate the plasma levels of the CCL3 and CCL4 chemokines in patients with the cardiac and digestive clinical forms of chronic Chagas disease and in cardiac patients with and without left ventricular systolic dysfunction (LVSD). Plasma samples from 75 patients were evaluated by enzyme-linked immunosorbent assay (ELISA) to confirm infection by T. cruzi. Plasma levels of the CCL3 and CCL4 chemokines were measured using Milliplex® MAP assay (Millipore). There were no significant differences in the levels of CCL3 and CCL4 between patients with the digestive and cardiac clinical forms of Chagas disease. Moreover, no significant differences were found between patients without LVSD and those with LVSD. Higher CCL3 and CCL4 plasma levels were found in patients with LVSD compared to those with the digestive form of the disease. The CCL3 and CCL4 chemokines might not be involved in differential susceptibility to the digestive and cardiac clinical forms of chronic Chagas disease, and it seems they do not influence the development of LVSD.
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Affiliation(s)
- Amanda Priscila de Oliveira
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil
| | - Christiane Maria Ayo
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil
| | - Kallyne Kioko Oliveira Mimura
- Immunomorphology Laboratory, Biology Department, Universidade Estadual Paulista Júlio de Mesquita Filho, Rua Cristóvão Colombo, 2265, 15054-000 São José do Rio Preto, SP, Brazil
| | - Sonia Maria Oliani
- Immunomorphology Laboratory, Biology Department, Universidade Estadual Paulista Júlio de Mesquita Filho, Rua Cristóvão Colombo, 2265, 15054-000 São José do Rio Preto, SP, Brazil
| | - Cássia Rubia Bernardo
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil
| | - Ana Vitória Silveira Camargo
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil
| | - Luís Sérgio Ronchi
- Surgery Department, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil; Hospital de Base, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Aldenis Albaneze Borim
- Surgery Department, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil; Hospital de Base, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Eumildo de Campos Júnior
- Surgery Department, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil; Hospital de Base, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Cinara Cássia Brandão de Mattos
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil
| | - Lilian Castiglioni
- Department of Epidemiology and Public Health, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil
| | - Reinaldo Bulgarelli Bestetti
- Department of Cardiology and Cardiovascular Surgery, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil; Hospital de Base, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Carlos Eugênio Cavasini
- Center for the Investigation of Microorganisms, Department of Dermatological, Infectious and Parasitic Diseases, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil
| | - Luiz Carlos de Mattos
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil.
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Hernández M, Wicz S, Corral RS. Cardioprotective actions of curcumin on the pathogenic NFAT/COX-2/prostaglandin E 2 pathway induced during Trypanosoma cruzi infection. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2016; 23:1392-1400. [PMID: 27765359 DOI: 10.1016/j.phymed.2016.06.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/18/2016] [Accepted: 06/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Diverse cardiovascular signaling routes have been considered critical for Chagas cardiomyopathy caused by the protozoan parasite Trypanosoma cruzi. Along this line, T. cruzi infection and endothelin-1 (ET-1) have been shown to cooperatively activate the Ca2+/NFAT cascade in cardiomyocytes, leading to cyclooxygenase type 2 (COX-2) induction and increased release of prostanoids and prohypertrophic peptides. PURPOSE To determine whether the well-known cardioprotective and anti-inflammatory effects of curcumin (Cur) could be helpful to interfere with this key machinery for pathogenesis of Chagas myocarditis. STUDY DESIGN Cur treatment was evaluated through in vivo studies using a murine model of acute T. cruzi infection and in vitro experiments using ET-1-stimulated and parasite-infected mouse cardiomyocytes. METHODS Cur-treated and untreated infected mice were followed-up to estimate survival postinfection and heart tissues from both groups were analyzed for inflammatory infiltration by histopathology, whereas parasite load, induction of arachidonic acid pathway and natriuretic peptide expression were determined by real-time PCR. Molecular analysis of Cur myocardial targets included intracellular calcium measurement, NFAT and COX-2 induction in transfected cells, and assessment of NFAT, COX-2 and microsomal prostaglandin E synthase-1 (mPGES-1) levels by immunoblotting, prostaglandin E2 (PGE2) by ELISA, b-type natriuretic peptide (BNP) by real-time PCR, and PGE2/EP4 receptor/BNP interaction by transwell experiments. RESULTS Cur treatment of acute Chagas mice enhanced survival and proved to hinder relevant inflammatory processes in the heart, including leukocyte recruitment, activation of the eicosanoid pathway and BNP overexpression, without modifying parasite burden in the organ. Cur was capable of blocking Ca2+-dependent NFATc1 transcriptional activity, COX-2 and mPGES-1 induction, and subsequent PGE2 production in ET-1-stimulated and parasite-infected cardiomyocytes. Furthermore, the decline of cardiomyocyte-derived prostaglandin levels achieved upon Cur treatment impaired effective PGE2/EP4 receptor interaction, resulting in attenuated expression of BNP, a strong indicator of cardiac pathogenesis in Chagas disease, in both infected and uninfected cells. CONCLUSION Our current study shows a putative mechanism of action of Cur involving inhibition of the Ca2+/NFAT-dependent, pathogenic COX-2/mPGES-1/PGE2 pathway in T. cruzi-infected myocytes, underlying cardioprotection achieved in Cur-treated infected mice. With a view to the limited therapeutic possibilities available, Cur represents a promising approach for the treatment of Chagas heart disease.
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Affiliation(s)
- Matías Hernández
- Laboratorio de Biomedicina Molecular, Facultad de Química, Bioquímica y Farmacia, Universidad Nacional de San Luis, San Luis, Argentina
| | - Susana Wicz
- Laboratorio de Biomedicina Molecular, Facultad de Química, Bioquímica y Farmacia, Universidad Nacional de San Luis, San Luis, Argentina
| | - Ricardo S Corral
- Servicio de Parasitología-Chagas, Hospital de Niños "Dr. Ricardo Gutiérrez", Ciudad de Buenos Aires, Argentina.
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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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de Oliveira AP, Ayo CM, Bestetti RB, Brandão de Mattos CC, Cavasini CE, de Mattos LC. The role of CCR5 in Chagas disease - a systematic review. INFECTION GENETICS AND EVOLUTION 2016; 45:132-137. [PMID: 27539514 DOI: 10.1016/j.meegid.2016.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/01/2016] [Accepted: 08/12/2016] [Indexed: 01/08/2023]
Abstract
Chagas disease is an infection caused by the protozoan Trypanosoma cruzi. The clinical manifestations result from the chronic forms of the disease: indeterminate, cardiac, digestive or mixed. The pathogenesis of this disease is related to the genetic variability of both the parasite and the host with polymorphisms of genes involved in immune response possibly being involved in the variable clinical course. Cytokines play a key role in regulating immune response, in particular chemokines exert a crucial role in the control of leukocyte migration during the host's response to infectious processes. Furthermore, inflammatory cytokines and chemokines have been implicated in the generation of inflammatory infiltrates and tissue damage. The involvement of the CC Chemokine Receptor 5 (CCR5) in leukocyte migration to sites of inflammation has been elucidated and this receptor has been investigated in Chagas disease. Here we review the role of CCR5 in T. cruzi infection as well as its importance in the pathogenesis of the Chagas disease.
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Affiliation(s)
- Amanda P de Oliveira
- Laboratório de Imunogenética, Departamento de Biologia Molecular, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil
| | - Christiane M Ayo
- Laboratório de Imunogenética, Departamento de Biologia Molecular, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil
| | - Reinaldo B Bestetti
- Departamento de Cardiologia e Cirurgia Cardiovascular, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil
| | - Cinara C Brandão de Mattos
- Laboratório de Imunogenética, Departamento de Biologia Molecular, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil
| | - Carlos E Cavasini
- Centro de Investigação de Microrganismos, Departamento de Doenças Dermatológicas, Infecciosas e Parasitárias, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil
| | - Luiz C de Mattos
- Laboratório de Imunogenética, Departamento de Biologia Molecular, Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 São José do Rio Preto, SP, Brazil.
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Indeterminate form of Chagas disease: is left ventricular torsional mechanics a clue to subclinical myocardial abnormalities? J Echocardiogr 2016; 15:6-12. [PMID: 27450558 DOI: 10.1007/s12574-016-0305-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chagas disease (CD) is highly endemic in Latin America, and has been emerging in developed countries. Early diagnosis of left ventricular (LV) systolic dysfunction, routinely done by echocardiography, is crucial for therapy. Speckle tracking echocardiography allows determination of LV segmental rotations, twist/torsion, and this analysis may disclose an unapparent myocardial contractile deficit in initial stages of CD. Therefore, this study aimed to highlight a possible unapparent myocardial contractile deficit in CD indeterminate form (IF) by a comprehensive torsional mechanics analysis. METHODS Patients with CDIF diagnosis, initial chagasic cardiomyopathy (CCMP characterized by ECG abnormalities and LVEF > 0.55), and normal controls were prospectively enrolled, and underwent conventional echocardiogram with images acquisition for STE offline analysis. Target parameters were basal and apical rotations, and calculation of twist and torsion. RESULTS A total of 42 patients were included (CDIF, eight; CCMP, 13; and 21 controls). Chagasic patients had a mean age of 55 years, five (24 %) men, and controls, 50 years, seven (33 %) men. Torsional mechanics analyzes resulted in no significant difference in all parameters studied between groups. Twist in CDIF was 20.8° ± 6.5°; CCMP, 19.0° ± 3.5° and controls, 19.7° ± 3.7° (p = 0.67). Torsion in CDIF was 2.6° ± 0.8°; CCMP, 2.4° ± 0.6° and controls, 2.4° ± 0.5° (p = 0.63). CONCLUSIONS Patients with Chagas disease have no abnormalities in torsional mechanics during its indeterminate and initial cardiomyopathy stages.
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Martí‐Carvajal AJ, Kwong JSW. Pharmacological interventions for treating heart failure in patients with Chagas cardiomyopathy. Cochrane Database Syst Rev 2016; 7:CD009077. [PMID: 27388039 PMCID: PMC6457883 DOI: 10.1002/14651858.cd009077.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chagas disease-related cardiomyopathy is a major cause of morbidity and mortality in Latin America. Despite the substantial burden to the healthcare system, there is uncertainty regarding the efficacy and safety of pharmacological interventions for treating heart failure in people with Chagas disease. This is an update of a Cochrane review published in 2012. OBJECTIVES To assess the clinical benefits and harms of current pharmacological interventions for treating heart failure in people with Chagas cardiomyopathy. SEARCH METHODS We updated the searches in the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, Issue 1), MEDLINE (Ovid; 1946 to to February Week 1 2016), EMBASE (Ovid; 1947 to 2016 Week 07), LILACS (1982 to 15 February 2016), and Web of Science (Thomson Reuters; 1970 to 15 February 2016). We checked the reference lists of included papers. We applied no language restrictions. SELECTION CRITERIA We included randomised clinical trials (RCTs) that assessed the effects of pharmacological interventions to treat heart failure in adult patients (18 years or older) with symptomatic heart failure (New York Heart Association classes II to IV), regardless of the left ventricular ejection fraction stage (reduced or preserved), with Chagas cardiomyopathy. We did not apply limits to the length of follow-up. Primary outcomes were all-cause mortality, cardiovascular mortality at 30 days, time-to-heart decompensation, disease-free period (at 30, 60, and 90 days), and adverse events. DATA COLLECTION AND ANALYSIS Two authors independently performed study selection, 'Risk of bias' assessment and data extraction. We estimated relative risk (RR) and 95% confidence intervals (CIs) for dichotomous outcomes. We measured statistical heterogeneity using the I² statistic. We used a fixed-effect model to synthesize the findings. We contacted authors for additional data. We developed 'Summary of findings' (SoF) tables and used GRADE methodology to assess the quality of the evidence. MAIN RESULTS In this update, we identified one new trial. Therefore, this version includes three trials (108 participants). Two trials compared carvedilol against placebo and another assessed rosuvastatin versus placebo. All trials had a high risk of bias.Meta-analysis of two trials showed a lower proportion of all-cause mortality in the carvedilol groups compared with the placebo groups (RR 0.69; 95% CI 0.12 to 3.88, I² = 0%; 69 participants; very low-quality evidence). Neither of the trials reported on cardiovascular mortality, time-to-heart decompensation, or disease-free periods.One trial (30 participants) found no difference in hospital readmissions (RR 1.00; 95% CI 0.31 to 3.28; very low-quality of evidence) or reported adverse events (RR 0.92; 95% CI 0.67 to 1.27; very low-quality of evidence) between the carvedilol and placebo groups.There was very low-quality evidence from two trials of inconclusive effects on quality of life (QoL) between the carvedilol and placebo groups. One trial (30 participants) assessed QoL with the Minnesota Living With Heart Failure Questionnaire (21 items; item scores range from 0 to 5; a lower MLHFQ score is better). The MD was -14.74; 95% CI -24.75 to -4.73. The other trial (39 participants) measured QoL with the Medical Outcomes Study 36-item short-form health survey (SF-36; item scores range from 0 to 100; higher SF-36 score is better). Data were not provided.One trial (39 participants) assessed the effect of rosuvastatin versus placebo. The trial did not report on any primary outcomes or adverse events. There was very low-quality evidence of uncertain effects on QoL (no data were provided). AUTHORS' CONCLUSIONS This first update of our review found very low-quality evidence for the effects of either carvedilol or rosuvastatin, compared with placebo, for treating heart failure in people with Chagas disease. The three included trials were underpowered and had a high risk of bias. There were no conclusive data to support or reject the use of either carvedilol or rosuvastatin for treating Chagas cardiomyopathy. Unless randomised clinical trials provide evidence of a treatment effect, and the trade-off between potential benefits and harms is established, policy-makers, clinicians, and academics should be cautious when recommending or administering either carvedilol or rosuvastatin to treat heart failure in people with Chagas disease. The efficacy and safety of other pharmacological interventions for treating heart failure in people with Chagas disease remains unknown.
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Affiliation(s)
| | - Joey SW Kwong
- West China Hospital, Sichuan UniversityChinese Evidence‐Based Medicine CenterNo. 37, Guo Xue XiangChengduSichuanChina610041
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Analysis of Regional Left Ventricular Strain in Patients with Chagas Disease and Normal Left Ventricular Systolic Function. J Am Soc Echocardiogr 2016; 29:679-88. [DOI: 10.1016/j.echo.2016.03.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Indexed: 12/11/2022]
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Lima MSM, Villarraga HR, Abduch MCD, Lima MF, Cruz CBBV, Bittencourt MS, Voos MC, Sbano JCN, Mathias W, Tsutsui JM. Comprehensive left ventricular mechanics analysis by speckle tracking echocardiography in Chagas disease. Cardiovasc Ultrasound 2016; 14:20. [PMID: 27229468 PMCID: PMC4882839 DOI: 10.1186/s12947-016-0062-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/14/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chagas disease (CD) is a frequent cause of dilated cardiomyopathy (CMP) in developing countries, leading to clinical heart failure and worse prognosis. Therefore, the development and evolution of this CMP has always been a major topic in numbers of previous studies. A comprehensive echocardiographic study of left ventricular (LV) mechanics, fully assessing myocardial contraction, has never been done before. This could help characterize and improve the understanding of the evolution of this prevalent CMP. METHODS A total of 47 chagasic and 84 control patients were included in this study and allocated in groups according to LV ejection fraction. 2D-Echocardiogram was acquired for LV mechanics analysis by speckle tracking echocardiography. RESULTS Mean age of chagasic individuals was 55y and 16 (34 %) were men. Significant difference was found in global longitudinal velocity analysis, with lower values in indeterminate form. In the group with severe systolic dysfunction, a paradoxical increase in longitudinal and apical radial displacements were demonstrated. In parallel, segmental analyzes highlighted lower values of radial displacement, strain and strain rate into inferior and inferolateral walls, with increase of these values in septal and anterior walls. CONCLUSION Chagasic CMP has a vicarious pattern of contraction in the course of its evolution, defined by reduced displacement and strain into inferior and posterior walls with paradoxical increase in septal and anterior segments. Also, lower longitudinal velocities were demonstrated in CD indeterminate form, which may indicate an incipient myocardial injury.
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Affiliation(s)
- Marcio Silva Miguel Lima
- Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil.
| | | | - Maria Cristina Donadio Abduch
- Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil
| | - Marta Fernandes Lima
- Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil
| | - Cecilia Beatriz Bittencourt Viana Cruz
- Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil
| | - Marcio Sommer Bittencourt
- Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil
| | - Mariana Callil Voos
- Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil
| | - Joao Cesar Nunes Sbano
- Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil
| | - Wilson Mathias
- Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil
| | - Jeane Mike Tsutsui
- Serviço de Ecocardiografia, Instituto do Coração (InCor), University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05.403-000, Sao Paulo, SP, Brazil
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A Novel Vaccine Approach for Chagas Disease Using Rare Adenovirus Serotype 48 Vectors. Viruses 2016; 8:78. [PMID: 26978385 PMCID: PMC4810268 DOI: 10.3390/v8030078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/26/2016] [Accepted: 03/03/2016] [Indexed: 12/28/2022] Open
Abstract
Due to the increasing amount of people afflicted worldwide with Chagas disease and an increasing prevalence in the United States, there is a greater need to develop a safe and effective vaccine for this neglected disease. Adenovirus serotype 5 (Ad5) is the most common adenovirus vector used for gene therapy and vaccine approaches, but its efficacy is limited by preexisting vector immunity in humans resulting from natural infections. Therefore, we have employed rare serotype adenovirus 48 (Ad48) as an alternative choice for adenovirus/Chagas vaccine therapy. In this study, we modified Ad5 and Ad48 vectors to contain T. cruzi’s amastigote surface protein 2 (ASP-2) in the adenoviral early gene. We also modified Ad5 and Ad48 vectors to utilize the “Antigen Capsid-Incorporation” strategy by adding T. cruzi epitopes to protein IX (pIX). Mice that were immunized with the modified vectors were able to elicit T. cruzi-specific humoral and cellular responses. This study indicates that Ad48-modified vectors function comparable to or even premium to Ad5-modified vectors. This study provides novel data demonstrating that Ad48 can be used as a potential adenovirus vaccine vector against Chagas disease.
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Hollowed J, McCullough M, Sanchez D, Traina M, Hernandez S, Murillo E. Rapidly Progressing Chagas Cardiomyopathy. Am J Trop Med Hyg 2016; 94:894-6. [PMID: 26856912 DOI: 10.4269/ajtmh.15-0616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/17/2015] [Indexed: 11/07/2022] Open
Abstract
Chagas disease, caused by the parasite Trypanosoma cruzi, can cause a potentially life-threatening cardiomyopathy in approximately 10-40% of afflicted individuals. The decline in cardiac function characteristically progresses over the course of many years. We report a case of Chagas disease in which the patient experienced an atypical rapid deterioration to severe cardiomyopathy over the course of 16 months. This case argues the need for increased routine surveillance for patients with confirmed T. cruzi infection, who are determined to be at high-risk for worsening cardiomyopathy.
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Affiliation(s)
- John Hollowed
- Department of Cardiology, Olive View-University of California, Los Angeles (UCLA) Medical Center, Sylmar, California
| | - Matthew McCullough
- Department of Cardiology, Olive View-University of California, Los Angeles (UCLA) Medical Center, Sylmar, California
| | - Daniel Sanchez
- Department of Cardiology, Olive View-University of California, Los Angeles (UCLA) Medical Center, Sylmar, California
| | - Mahmoud Traina
- Department of Cardiology, Olive View-University of California, Los Angeles (UCLA) Medical Center, Sylmar, California
| | - Salvador Hernandez
- Department of Cardiology, Olive View-University of California, Los Angeles (UCLA) Medical Center, Sylmar, California
| | - Efrain Murillo
- Department of Cardiology, Olive View-University of California, Los Angeles (UCLA) Medical Center, Sylmar, California
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Teixeira TL, Machado FC, Alves da Silva A, Teixeira SC, Borges BC, Dos Santos MA, Martins FA, Brígido PC, Rodrigues AA, Notário AFO, Ferreira BA, Servato JPS, Deconte SR, Lopes DS, Ávila VMR, Araújo FDA, Tomiosso TC, Silva MJB, da Silva CV. Trypanosoma cruzi P21: a potential novel target for chagasic cardiomyopathy therapy. Sci Rep 2015; 5:16877. [PMID: 26574156 PMCID: PMC4648062 DOI: 10.1038/srep16877] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 10/21/2015] [Indexed: 11/09/2022] Open
Abstract
Chagas disease, which is caused by the parasite Trypanosoma cruzi, is an important cause of cardiomyopathy in Latin America. It is estimated that 10%–30% of all infected individuals will acquire chronic chagasic cardiomyopathy (CCC). The etiology of CCC is multifactorial and involves parasite genotype, host genetic polymorphisms, immune response, signaling pathways and autoimmune progression. Herein we verified the impact of the recombinant form of P21 (rP21), a secreted T. cruzi protein involved in host cell invasion, on progression of inflammatory process in a polyester sponge-induced inflammation model. Results indicated that rP21 can recruit immune cells induce myeloperoxidase and IL-4 production and decrease blood vessels formation compared to controls in vitro and in vivo. In conclusion, T. cruzi P21 may be a potential target for the development of P21 antagonist compounds to treat chagasic cardiomyopathy.
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Affiliation(s)
- Thaise Lara Teixeira
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil
| | - Fabrício Castro Machado
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil.,Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo, SP, Brasil
| | - Aline Alves da Silva
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil
| | - Samuel Cota Teixeira
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil
| | | | | | - Flávia Alves Martins
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil
| | | | - Adele Aud Rodrigues
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil
| | | | | | | | - Simone Ramos Deconte
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil
| | - Daiana Silva Lopes
- Instituto de Genética e Bioquímica, Universidade Federal de Uberlândia, MG, Brasil
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Novaes RD, Gonçalves RV, Caldas IS. Galectin-3 and Chagas Disease–Associated Cardiomyopathy. J Infect Dis 2015; 213:871. [DOI: 10.1093/infdis/jiv486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/06/2015] [Indexed: 11/14/2022] Open
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50
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Diagnostic Challenges of Chagas Cardiomyopathy and CMR Imaging. Glob Heart 2015; 10:181-7. [DOI: 10.1016/j.gheart.2015.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/18/2015] [Accepted: 07/09/2015] [Indexed: 11/18/2022] Open
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