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Cerrudo CS, Cavallero S, Rodríguez Fermepín M, González GE, Donato M, Kouyoumdzian NM, Gelpi RJ, Hertig CM, Choi MR, Fernández BE. Cardiac Natriuretic Peptide Profiles in Chronic Hypertension by Single or Sequentially Combined Renovascular and DOCA-Salt Treatments. Front Physiol 2021; 12:651246. [PMID: 34113261 PMCID: PMC8185994 DOI: 10.3389/fphys.2021.651246] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/14/2021] [Indexed: 01/19/2023] Open
Abstract
The involvement of natriuretic peptides was studied during the hypertrophic remodeling transition mediated by sequential exposure to chronic hemodynamic overload. We induced hypertension in rats by pressure (renovascular) or volume overload (DOCA-salt) during 6 and 12 weeks of treatment. We also studied the consecutive combination of both models in inverse sequences: RV 6 weeks/DS 6 weeks and DS 6 weeks/RV 6 weeks. All treated groups developed hypertension. Cardiac hypertrophy and left ventricular ANP gene expression were more pronounced in single DS than in single RV groups. BNP gene expression was positively correlated with left ventricular hypertrophy only in RV groups, while ANP gene expression was positively correlated with left ventricular hypertrophy only in DS groups. Combined models exhibited intermediate values between those of single groups at 6 and 12 weeks. The latter stimulus associated to the second applied overload is less effective than the former to trigger cardiac hypertrophy and to increase ANP and BNP gene expression. In addition, we suggest a correlation of ANP synthesis with volume overload and of BNP synthesis with pressure overload-induced hypertrophy after a prolonged treatment. Volume and pressure overload may be two mechanisms, among others, involved in the differential regulation of ANP and BNP gene expression in hypertrophied left ventricles. Plasma ANP levels reflect a response to plasma volume increase and volume overload, while circulating BNP levels seem to be regulated by cardiac BNP synthesis and ventricular hypertrophy.
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Affiliation(s)
- Carolina S. Cerrudo
- Facultad de Farmacia y Bioquímica, Cátedras de Fisiopatología y Anatomía e Histología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Susana Cavallero
- Facultad de Farmacia y Bioquímica, Cátedras de Fisiopatología y Anatomía e Histología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Martín Rodríguez Fermepín
- Facultad de Farmacia y Bioquímica, Cátedras de Fisiopatología y Anatomía e Histología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Germán E. González
- Facultad de Medicina, CONICET, Instituto de Fisiopatología Cardiovascular, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Martín Donato
- Facultad de Medicina, CONICET, Instituto de Fisiopatología Cardiovascular, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Nicolás M. Kouyoumdzian
- Instituto Alberto C. Taquini de Investigaciones en Medicina Traslacional (IATIMET), Universidad de Buenos Aires, CONICET, Buenos Aires, Argentina
| | - Ricardo J. Gelpi
- Facultad de Medicina, CONICET, Instituto de Fisiopatología Cardiovascular, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Cecilia M. Hertig
- Instituto de Ingeniería Genética y Biología Molecular (INGEBI), CONICET, Buenos Aires, Argentina
| | - Marcelo R. Choi
- Facultad de Farmacia y Bioquímica, Cátedras de Fisiopatología y Anatomía e Histología, Universidad de Buenos Aires, Buenos Aires, Argentina
- Instituto Alberto C. Taquini de Investigaciones en Medicina Traslacional (IATIMET), Universidad de Buenos Aires, CONICET, Buenos Aires, Argentina
- Instituto Universitario de Ciencias de la Salud, Fundación H. A. Barceló, Buenos Aires, Argentina
| | - Belisario E. Fernández
- Facultad de Farmacia y Bioquímica, Cátedras de Fisiopatología y Anatomía e Histología, Universidad de Buenos Aires, Buenos Aires, Argentina
- Instituto Universitario de Ciencias de la Salud, Fundación H. A. Barceló, Buenos Aires, Argentina
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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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Inflammatory and cardiac biomarkers are differentially expressed in clinical stages of Chagas disease. Int J Cardiol 2015; 199:451-9. [PMID: 26277551 DOI: 10.1016/j.ijcard.2015.07.040] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 05/29/2015] [Accepted: 07/07/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Chagas disease has a long clinically silent period following Trypanosoma cruzi infection and before development of overt clinical pathology; detectable biomarkers of infection and pathogenesis are urgently needed. We tested 22 biomarkers known to be associated with cardiomyopathy to evaluate if a biomarker signature could successfully classify T. cruzi seropositive subjects into clinical Chagas disease stage groups. METHODS This cross-sectional retrospective case-control study enrolled T. cruzi seropositive blood donors (BD) who were further characterized as having chronic Chagas cardiomyopathy (CC-BD) or not (nonCC-BD) and seronegative (SN) control donors; we also included clinically diagnosed Chagas cardiomyopathy patients (CC-P). All subjects underwent a health history questionnaire, medical examination, electro- and echocardiograms (ECG and Echo) and phlebotomy. Biomarkers were measured on blinded samples by luminex bead array and Ortho VITROS. RESULTS A clear biomarker pattern was observed only in more severe cardiac disease; this pattern included significantly elevated levels of inflammatory cytokines IFN-γ, IL-6, IL-10 and TNF-α and soluble cardiovascular disease biomarkers CK-MB, troponin, myoglobin, VCAM and NTproBNP while there were lower levels of MPO, PAI-1, and MCP-1. The markers determined to be the most predictive of disease by ROC curve analysis were NTproBNP and T. cruzi PCR status. CONCLUSIONS Although many biomarkers demonstrated increased or decreased concentrations among the clinical forms of Chagas disease, NTproBNP and T. cruzi PCR were the only tests that would independently be of clinical value for disease staging, in concert with ECG, Echo and clinical assessments.
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Pinazo MJ, Thomas MC, Bustamante J, Almeida ICD, Lopez MC, Gascon J. Biomarkers of therapeutic responses in chronic Chagas disease: state of the art and future perspectives. Mem Inst Oswaldo Cruz 2015; 110:422-32. [PMID: 25946151 PMCID: PMC4489480 DOI: 10.1590/0074-02760140435] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/25/2015] [Indexed: 01/10/2023] Open
Abstract
The definition of a biomarker provided by the World Health Organization is any
substance, structure, or process that can be measured in the body, or its products
and influence, or predict the incidence or outcome of disease. Currently, the lack of
prognosis and progression markers for chronic Chagas disease has posed limitations
for testing new drugs to treat this neglected disease. Several molecules and
techniques to detect biomarkers in Trypanosoma cruzi-infected
patients have been proposed to assess whether specific treatment with benznidazole or
nifurtimox is effective. Isolated proteins or protein groups from different
T. cruzi stages and parasite-derived glycoproteins and synthetic
neoglycoconjugates have been demonstrated to be useful for this purpose, as have
nucleic acid amplification techniques. The amplification of T. cruzi
DNA using the real-time polymerase chain reaction method is the leading test
for assessing responses to treatment in a short period of time. Biochemical
biomarkers have been tested early after specific treatment. Cytokines and surface
markers represent promising molecules for the characterisation of host cellular
responses, but need to be further assessed.
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Affiliation(s)
- Maria-Jesus Pinazo
- Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Barcelona, Spain
| | - Maria-Carmen Thomas
- Institute of Parasitology and Biomedicine López Neyra, National Research Council Institute, Granada, Spain
| | - Juan Bustamante
- Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Barcelona, Spain
| | - Igor Correia de Almeida
- Department of Biological Sciences, Border Biomedical Research Center, University of Texas at El Paso, El Paso, TX, USA
| | - Manuel-Carlos Lopez
- Institute of Parasitology and Biomedicine López Neyra, National Research Council Institute, Granada, Spain
| | - Joaquim Gascon
- Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Barcelona, Spain
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Pinazo MJ, Thomas MC, Bua J, Perrone A, Schijman AG, Viotti RJ, Ramsey JM, Ribeiro I, Sosa-Estani S, López MC, Gascon J. Biological markers for evaluating therapeutic efficacy in Chagas disease, a systematic review. Expert Rev Anti Infect Ther 2015; 12:479-96. [PMID: 24621252 DOI: 10.1586/14787210.2014.899150] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The most neglected aspects of Chagas disease (CD) have been patient care and treatment. Despite recent progress in the development of potentially improved drugs, there is no consensus among different research groups on the lack of therapeutic response markers to evaluate efficacy of newly proposed drugs early after treatment. A systematic review of current evidence regarding molecules which are potential biomarkers for therapeutic response has been conducted using quality assessment and target responses as primary criteria. The review provides a panorama of the cumulative evidence and specific needs for development of a battery of complementary biomarkers which together fulfill ideal or acceptable criteria to evaluate early responses to treatment for chronic CD. There are several marker candidates which together may fulfill acceptable criteria to indicate the efficacy of a trypanocidal treatment. Data from ongoing studies are considered essential to improve assessment of existing markers and to identify those for early follow-up of treated patients.
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Affiliation(s)
- Maria-Jesús Pinazo
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), 132 Rosello st 4°,08036, Barcelona, Spain
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Requena-Méndez A, López MC, Angheben A, Izquierdo L, Ribeiro I, Pinazo MJ, Gascon J, Muñoz J. Evaluating Chagas disease progression and cure through blood-derived biomarkers: a systematic review. Expert Rev Anti Infect Ther 2014; 11:957-76. [DOI: 10.1586/14787210.2013.824718] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Cavallero S, González GE, Seropian IM, Cerrudo CS, Matorra F, Morales C, Hertig CM, Puyó AM, Fernández BE, Gelpi RJ. Ventricular function and natriuretic peptides in sequentially combined models of hypertension. Am J Physiol Heart Circ Physiol 2010; 298:H1290-9. [PMID: 20139323 DOI: 10.1152/ajpheart.00911.2009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hemodynamic parameters and natriuretic peptide levels were evaluated in cardiac hypertrophy produced by sequentially applied renovascular (RV) and deoxycorticosterone acetate-salt (DS) models of hypertension. We studied hypertensive rats by RV or DS treatment at 2 and 4 wk, as well as by the combination of 2 wk of each treatment in an inverse sequence: RV 2 wk/DS 2 wk (RV2/DS2) and DS 2 wk/RV 2 wk (DS2/RV2). The in vivo cardiac function, interstitial fibrosis, and synthesis and secretion of types A (ANP) and B (BNP) natriuretic peptides were monitored in hypertensive models compared with their corresponding sham (Sh2, Sh4). There were no differences in relaxation parameters among RV or DS groups and combined treatments. Left ventricular +dP/dt(max) increased only in RV4 (P < 0.01 vs. Sh4), and this increase was abolished in RV2/DS2. Interstitial collagen concentration increased after 4 wk in both RV4 and RV2/DS2 groups. Although there were no changes in collagen concentration in either DS2 or DS4 groups, clipping after 2 wk of DS (DS2/RV2) remarkably stimulated interstitial fibrosis (P < 0.01 vs. DS2). Plasma BNP increased in RV treatment at 4 wk (P < 0.001 vs. Sh4), but not in DS. Interestingly, RV applied after the 2 wk of DS treatment induced a marked increase in BNP levels (P < 0.001 vs. Sh4). In this regard, plasma BNP appears to be a reliable indicator of pressure overload. Our results suggest that the second stimulus of mechanical overload in combined models of hypertension determines the evolution of hypertrophy and synthesis and secretion of ANP and BNP.
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Affiliation(s)
- Susana Cavallero
- Department of Pathophysiology, Institute of Pathophysiology and Clinical Biochemistry, University of Buenos Aires, Argentina.
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Abstract
BACKGROUND Chagas disease is a major cause of morbidity and mortality in Latin America. Knowledge of the predictors of prognosis can help clinical decision making by identifying patients' level of risk. METHODS AND RESULTS We reviewed the published literature on prognostic factors in patients with Chagas disease by performing a PubMed search for articles published in any language between 1985 and February 2006 and hand searches of the reference lists of retrieved articles. Studies were selected if they included patients in the chronic phase of Chagas disease, analyzed a clearly defined outcome (all-cause mortality, sudden cardiac deaths, and/or cardiovascular deaths), and used multivariable regression models of prognosis. From 606 potentially relevant studies, 12 met the inclusion criteria: 8 clinic-based studies including 3928 patients and 4 hospital-based studies including 349 patients. Impaired left ventricular function by echocardiogram or cineventriculogram was found to be the most common and consistent independent predictor of death. New York Heart Association functional class III/IV and cardiomegaly on the chest radiography also were independently associated with higher mortality. More recently, strong evidence was found that nonsustained ventricular tachycardia on 24-hour Holter monitoring indicated an adverse prognosis. The typical ECG abnormalities showed limited additional prognostic value. Other often-mentioned risk factors, advanced age and male sex, showed inconsistent results. A formal meta-analysis was not feasible because of the heterogeneity of published studies and the lack of minimal standards in reporting results. CONCLUSIONS A systematic review of published studies indicates that impaired left ventricular function, New York Heart Association class III/IV, cardiomegaly, and nonsustained ventricular tachycardia indicate a poor prognosis in patients with chronic Chagas disease.
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Affiliation(s)
- Anis Rassi
- Division of Cardiology, Anis Rassi Hospital, Avenida José Alves 453, Setor Oeste, Goiânia, Brazil.
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Punukollu G, Gowda RM, Khan IA, Navarro VS, Vasavada BC. Clinical aspects of the Chagas' heart disease. Int J Cardiol 2007; 115:279-83. [PMID: 16769134 DOI: 10.1016/j.ijcard.2006.03.004] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 11/29/2005] [Accepted: 03/11/2006] [Indexed: 11/30/2022]
Abstract
Chagas' heart disease, caused by protozoan Trypanosoma cruzi, is a common cause of cardiomyopathy in the Americas. Transmission of T. cruzi occurs through Reduviids, the kissing bugs. Less common ways of transmission are blood transfusion, congenital transmission, organ transplantation, laboratory accident, breastfeeding, and oral contamination. Infestation results in cardiac dysautonomia, myocardial apoptosis, and myocardial fibrosis. In acute phase, death is mostly caused by myocarditis and in chronic phase, it is mostly by irreversible cardiomyopathy. A majority of the patients with Chagas' disease remain in the latent phase of disease for 10 to 30 years or even for life. Specific anti-Chagas' therapy with trypanocide drugs is useful in acute phase but the management of chronic Chagas' heart disease is mostly empirical. The mortality during the acute phase of cardiac Chagas is around 5%. Five-year mortality of chronic Chagas' disease with cardiac dysfunction is above 50%. The clinical aspects of the Chagas' heart disease are concisely reviewed.
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