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Avalos-Borges EE, Acevedo-Arcique CM, Segura-Correa JC, Jiménez-Coello M, Garg NJ, Ortega-Pacheco A. Echocardiographic Documentation of Dilated Cardiomyopathy Development in Dogs Naturally Infected with Trypanosoma cruzi. Animals (Basel) 2024; 14:1884. [PMID: 38997996 PMCID: PMC11240442 DOI: 10.3390/ani14131884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/16/2024] [Accepted: 06/22/2024] [Indexed: 07/14/2024] Open
Abstract
We aimed to characterize the echocardiographic alterations in dogs from an endemic region that were naturally infected with T. cruzi. Dogs (n = 130) seropositive for antibodies against T. cruzi and/or with acute parasitemia were enrolled in the study. Indicators of changes in the structure and systolic and diastolic functions of the left ventricle (LV) and blood flow patterns were evaluated by echocardiography. The frequency and extent of alterations in these indicators were associated with the severity of the disease. Briefly, 15 (11.54%) dogs were diagnosed with dilated cardiomyopathy (DCM), and 115 (88.46%) dogs were diagnosed as being without DCM. Infected dogs with DCM exhibited structural features of LV dysfunction, e.g., a significant (p < 0.05) increase in the LV internal diameter at systole and diastole (LVID-s, LVID-d) and a decline in the LV posterior wall (LVPW-d) thickness at diastole. Despite an increase in stroke volume and cardiac output indicating contraction force, DCM resulted in a decreased ejection fraction, affecting systolic function. Dogs that were diagnosed as DCM-negative but were positive for T. cruzi by PCR exhibited a high frequency of an increase in the thickness of the interventricular septum in systole (IVS-s) and the LV posterior wall in diastole (LVPW-d), a decline in the LV inner diameter (LVID-d, LVID-s), and fractional shortening (FS). The thinning of the LVPW at systole was the most defining feature observed in chronically infected dogs. In summary, this is the first study reporting the echocardiographic changes occurring in dogs naturally infected with T. cruzi and developing DCM. Our data suggest that changes in LVID are a major indicator of risk of cardiac involvement, and the observation of changes in the IVS, LVPW, and FS have predictive value in determining the risk of DCM development in infected dogs.
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Affiliation(s)
- Eduardo E. Avalos-Borges
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Km 15.5 Carretera Mérida-Xmatkuil, Apdo. Postal 4-116 Itzimná, Mérida 97000, Yucatán, Mexico; (E.E.A.-B.); (J.C.S.-C.)
| | - Carlos M. Acevedo-Arcique
- Hospital Veterinario para Perros y Gatos, Universidad Autónoma de Yucatán, Av. Itzaes No. 490 x 29, C. 18 No. 271, San José Vergel, Mérida 97000, Yucatán, Mexico;
| | - Jose C. Segura-Correa
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Km 15.5 Carretera Mérida-Xmatkuil, Apdo. Postal 4-116 Itzimná, Mérida 97000, Yucatán, Mexico; (E.E.A.-B.); (J.C.S.-C.)
| | - Matilde Jiménez-Coello
- Laboratorio de Microbiologia, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Av. Itzaes No. 490 x 29, Mérida 97000, Yucatán, Mexico;
| | - Nisha J. Garg
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, TX 77555-1070, USA;
| | - Antonio Ortega-Pacheco
- Departamento de Salud Animal y Medicina Preventiva, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Km 15.5 Carretera Mérida-Xmatkuil, Apdo. Postal 4-116 Itzimná, Mérida 97000, Yucatán, Mexico; (E.E.A.-B.); (J.C.S.-C.)
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Bosch-Nicolau P, Espinosa-Pereiro J, Salvador F, Sánchez-Montalvá A, Molina I. Association Between Trypanosoma cruzi DNA in Peripheral Blood and Chronic Chagasic Cardiomyopathy: A Systematic Review. Front Cardiovasc Med 2022; 8:787214. [PMID: 35174221 PMCID: PMC8841718 DOI: 10.3389/fcvm.2021.787214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic chagasic cardiomyopathy (CCC) is the most important complication of patients with Chagas disease (CD). The role of persistent detection of DNA in peripheral blood and its association to CCC is unknown. We performed a systematic review up to July 2021, including studies that reported ratios of CCC and PCR positivity among non-treated adult patients. We identified 749 records and selected 12 for inclusion corresponding to 1,686 patients. Eight studies were performed in endemic countries and 4 in non-endemic countries. Only two studies showed an association between CCC and Trypanosoma cruzi parasitemia by means of PCR detection. Six studies reported greater positive PCR ratios among patients with CCC than in the patients with indeterminate chagas disease (ICD) with no statistical significance. A significant risk of bias has been detected among most of the studies. Therefore, while we performed a meta-analysis, wide inter-study heterogeneity impeded its interpretation.ConclusionsWith the available information, we could not establish a correlation between PCR-detectable parasitemia and CCC.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020216072, identifier: CRD42020216072.
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Affiliation(s)
- Pau Bosch-Nicolau
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Espinosa-Pereiro
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Salvador
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Israel Molina
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- *Correspondence: Israel Molina
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Abstract
Inflammatory activation occurs in nearly all forms of myocardial injury. In contrast, inflammatory cardiomyopathies refer to a diverse group of disorders in which inflammation of the heart (or myocarditis) is the proximate cause of myocardial dysfunction, causing injury that can range from a fully recoverable syndrome to one that leads to chronic remodeling and dilated cardiomyopathy. The most common cause of inflammatory cardiomyopathies in developed countries is lymphocytic myocarditis most commonly caused by a viral pathogenesis. In Latin America, cardiomyopathy caused by Chagas disease is endemic. The true incidence of myocarditis is unknown to the limited utilization and the poor sensitivity of endomyocardial biopsies (especially for patchy diseases such as lymphocytic myocarditis and sarcoidosis) using the gold-standard Dallas criteria. Emerging immunohistochemistry criteria and molecular diagnostic techniques are being developed that will improve diagnostic yield, provide additional clues into the pathophysiology, and offer an application of precision medicine to these important syndromes. Immunosuppression is recommended for patients with cardiac sarcoidosis, giant cell myocarditis, and myocarditis associated with connective tissue disorders and may be beneficial in chronic viral myocarditis once virus is cleared. Further trials of immunosuppression, antiviral, and immunomodulating therapies are needed. Together, with new molecular-based diagnostics and therapies tailored to specific pathogeneses, the outcome of patients with these disorders may improve.
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Affiliation(s)
- Barry H Trachtenberg
- From the Houston Methodist DeBakey Heart and Vascular Center (B.H.T.), TX; University of Miami Leonard Miller School of Medicine, FL (J.M.H.); and Interdisciplinary Stem Cell Institute, Miami, FL (J.M.H.)
| | - Joshua M Hare
- From the Houston Methodist DeBakey Heart and Vascular Center (B.H.T.), TX; University of Miami Leonard Miller School of Medicine, FL (J.M.H.); and Interdisciplinary Stem Cell Institute, Miami, FL (J.M.H.).
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Rassi A, Marin JA, Rassi A. Chronic Chagas cardiomyopathy: a review of the main pathogenic mechanisms and the efficacy of aetiological treatment following the BENznidazole Evaluation for Interrupting Trypanosomiasis (BENEFIT) trial. Mem Inst Oswaldo Cruz 2017; 112:224-235. [PMID: 28225900 PMCID: PMC5319366 DOI: 10.1590/0074-02760160334] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 11/22/2016] [Indexed: 11/21/2022] Open
Abstract
Chagas cardiomyopathy is the most frequent and most severe manifestation of chronic Chagas disease, and is one of the leading causes of morbidity and death in Latin America. Although the pathogenesis of Chagas cardiomyopathy is incompletely understood, it may involve several mechanisms, including parasite-dependent myocardial damage, immune-mediated myocardial injury (induced by the parasite itself and by self-antigens), and microvascular and neurogenic disturbances. In the past three decades, a consensus has emerged that parasite persistence is crucial to the development and progression of Chagas cardiomyopathy. In this context, antiparasitic treatment in the chronic phase of Chagas disease could prevent complications related to the disease. However, according to the results of the BENEFIT trial, benznidazole seems to have no benefit for arresting disease progression in patients with chronic Chagas cardiomyopathy. In this review, we give an update on the main pathogenic mechanisms of Chagas disease, and re-examine and discuss the results of the BENEFIT trial, together with its limitations and implications.
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Affiliation(s)
- Anis Rassi
- Hospital do Coração Anis Rassi, Goiânia, GO, Brasil
| | - José Antonio Marin
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Divisão de Cardiologia, Ribeirão Preto, SP, Brasil
| | - Anis Rassi
- Hospital do Coração Anis Rassi, Goiânia, GO, Brasil
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Morrot A, Villar SR, González FB, Pérez AR. Evasion and Immuno-Endocrine Regulation in Parasite Infection: Two Sides of the Same Coin in Chagas Disease? Front Microbiol 2016; 7:704. [PMID: 27242726 PMCID: PMC4876113 DOI: 10.3389/fmicb.2016.00704] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/28/2016] [Indexed: 12/16/2022] Open
Abstract
Chagas disease is a serious illness caused by the protozoan parasite Trypanosoma cruzi. Nearly 30% of chronically infected people develop cardiac, digestive, or mixed alterations, suggesting a broad range of host-parasite interactions that finally impact upon chronic disease outcome. The ability of T. cruzi to persist and cause pathology seems to depend on diverse factors like T. cruzi strains, the infective load and the route of infection, presence of virulence factors, the parasite capacity to avoid protective immune response, the strength and type of host defense mechanisms and the genetic background of the host. The host-parasite interaction is subject to a constant neuro-endocrine regulation that is thought to influence the adaptive immune system, and as the infection proceeds it can lead to a broad range of outcomes, ranging from pathogen elimination to its continued persistence in the host. In this context, T. cruzi evasion strategies and host defense mechanisms can be envisioned as two sides of the same coin, influencing parasite persistence and different outcomes observed in Chagas disease. Understanding how T. cruzi evade host's innate and adaptive immune response will provide important clues to better dissect mechanisms underlying the pathophysiology of Chagas disease.
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Affiliation(s)
- Alexandre Morrot
- Institute of Microbiology, Federal University of Rio de Janeiro Rio de Janeiro, Brazil
| | - Silvina R Villar
- Institute of Clinical and Experimental Immunology of Rosario, CONICET, National University of RosarioRosario, Argentina; Faculty of Medical Sciences, National University of RosarioRosario, Argentina
| | - Florencia B González
- Institute of Clinical and Experimental Immunology of Rosario, CONICET, National University of RosarioRosario, Argentina; Faculty of Medical Sciences, National University of RosarioRosario, Argentina
| | - Ana R Pérez
- Institute of Clinical and Experimental Immunology of Rosario, CONICET, National University of RosarioRosario, Argentina; Faculty of Medical Sciences, National University of RosarioRosario, Argentina
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Pinazo MJ, Miranda B, Rodríguez-Villar C, Altclas J, Serra MB, García-Otero EC, de Almeida EA, de la Mata García M, Gascon J, Rodríguez MG, Manito N, Camacho AM, Oppenheimer F, Puente SP, Riarte A, Coronas JS, Lletí MS, Sanz GF, Torrico F, Tendero DT, Ussetti P, Shikanai-Yasuda MA. Recommendations for management of Chagas disease in organ and hematopoietic tissue transplantation programs in nonendemic areas. Transplant Rev (Orlando) 2011; 25:91-101. [DOI: 10.1016/j.trre.2010.12.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 12/22/2022]
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Herrera RN, de Amaya EID, Aguilar RCP, Turoni CJ, Marañón R, Berman SG, Luciardi HL, Coviello A, de Bruno MP. Inflammatory and Prothrombotic Activation With Conserved Endothelial Function in Patients With Chronic, Asymptomatic Chagas Disease. Clin Appl Thromb Hemost 2010; 17:502-7. [DOI: 10.1177/1076029610375814] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Previously, our group showed a prothrombotic state in asymptomatic patients with chronic Chagas disease. The current paper studies the inflammatory status and endothelial function in these patients. Methods: In 40 patients and 40 healthy volunteers, we evaluated prothrombotic state, blood parasitemia (molecular biology: polymerized chain reaction [PCR]-amplification), tissue factor pathway inhibitor antibodies (aTFPI), interleukin 6 (IL-6), and vascular cell adhesion molecule-1 (VCAM-1). Endothelial function was determined by reactive hyperemia (pulse plethysmography). Results: In patients, prothrombin fragment 1 + 2, d-dimer, PAI-1, and fibrinogen were higher. Amplification of 121/122 primers ( Trypanosoma cruzi) was positive in 45% of the patients. Patients presented higher values of aTFPI- immunoglobulin G (IgG; P < .05), aTFPI-IgM ( P < .001), IL-6 ( P = .004), and VCAM-1 ( P = .00001). In both groups, endothelial function was preserved. Conclusions: We found that asymptomatic patients with chronic Chagas disease presented a prothrombotic/inflammatory status. The fact that endothelial function is still preserved suggests that prothrombosis and inflammation are primarily implicated in the beginning of cardiovascular damage.
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Affiliation(s)
- Ramón N. Herrera
- Haemostasis and Thrombosis Department - “Zenón J. Santillán” Hospital Health Center; Facultad de Medicina -Universidad Nacional de Tucumán, Tucumán (Argentina)
| | - Elba I. Díaz de Amaya
- Haemostasis and Thrombosis Department - “Zenón J. Santillán” Hospital Health Center; Facultad de Medicina -Universidad Nacional de Tucumán, Tucumán (Argentina)
| | - Rossana C. Pérez Aguilar
- Haemostasis and Thrombosis Department - “Zenón J. Santillán” Hospital Health Center; Facultad de Medicina -Universidad Nacional de Tucumán, Tucumán (Argentina)
| | - Claudio Joo Turoni
- Medical School - Universidad Nacional de Tucumán-Instituto Superior de Investigaciones Biológicas (INSIBIO); CONICET
| | - Rodrigo Marañón
- Medical School - Universidad Nacional de Tucumán-Instituto Superior de Investigaciones Biológicas (INSIBIO); CONICET
| | - Sofía G. Berman
- Haemostasis and Thrombosis Department - “Zenón J. Santillán” Hospital Health Center; Facultad de Medicina -Universidad Nacional de Tucumán, Tucumán (Argentina)
| | - Héctor L. Luciardi
- Haemostasis and Thrombosis Department - “Zenón J. Santillán” Hospital Health Center; Facultad de Medicina -Universidad Nacional de Tucumán, Tucumán (Argentina)
| | - Alfredo Coviello
- Medical School - Universidad Nacional de Tucumán-Instituto Superior de Investigaciones Biológicas (INSIBIO); CONICET
| | - María Peral de Bruno
- Medical School - Universidad Nacional de Tucumán-Instituto Superior de Investigaciones Biológicas (INSIBIO); CONICET
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8
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Wen JJ, Gupta S, Guan Z, Dhiman M, Condon D, Lui C, Garg NJ. Phenyl-alpha-tert-butyl-nitrone and benzonidazole treatment controlled the mitochondrial oxidative stress and evolution of cardiomyopathy in chronic chagasic Rats. J Am Coll Cardiol 2010; 55:2499-508. [PMID: 20510218 DOI: 10.1016/j.jacc.2010.02.030] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 02/09/2010] [Accepted: 02/15/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the pathological importance of oxidative stress-induced injurious processes in chagasic heart dysfunction. BACKGROUND Trypanosoma cruzi-induced inflammatory pathology and a feedback cycle of mitochondrial dysfunction and oxidative stress may contribute to Chagas disease. METHODS Sprague-Dawley rats were infected with T. cruzi and treated with phenyl-alpha-tert-butylnitrone (PBN), an antioxidant, and/or benzonidazole (BZ), an antiparasitic agent. We monitored myocardial parasite burden, oxidative adducts, mitochondrial complex activities, respiration, and adenosine triphosphate synthesis rates, and inflammatory and cardiac remodeling responses during disease development. The cardiac hemodynamics was determined for all rats. RESULTS Benzonidazole (not PBN) decreased the parasite persistence and immune adverse events (proinflammatory cytokine expression, beta-nicotinamide adenine dinucleotide phosphate oxidase and myeloperoxidase activities, and inflammatory infiltrate) in chronically infected hearts. PBN +/- BZ (not BZ alone) decreased the mitochondrial reactive oxygen species level, oxidative adducts (malonyldialdehyde, 4-hydroxynonenal, carbonyls), hypertrophic gene expression (atrial natriuretic peptide, B-type natriuretic peptide, alpha-skeletal actin), and collagen deposition and preserved the respiratory chain efficiency and energy status in chronically infected hearts. Subsequently, LV dysfunction was prevented in PBN +/- BZ-treated chagasic rats. CONCLUSIONS BZ treatment after the acute stage decreased the parasite persistence and inflammatory pathology. Yet, oxidative adducts, mitochondrial dysfunction, and remodeling responses persisted and contributed to declining cardiac function in chagasic rats. Combination treatment (PBN + BZ) was beneficial in arresting the T. cruzi-induced inflammatory and oxidative pathology and chronic heart failure in chagasic rats.
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Affiliation(s)
- Jian-Jun Wen
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas 77555-1070, USA
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9
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Aguilar-Shea A, Coleto-Lovera D, López-García E, Bernardo-Fernández T. Enfermedad de Chagas en España. Semergen 2008. [DOI: 10.1016/s1138-3593(08)75208-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Cooley G, Etheridge RD, Boehlke C, Bundy B, Weatherly DB, Minning T, Haney M, Postan M, Laucella S, Tarleton RL. High throughput selection of effective serodiagnostics for Trypanosoma cruzi infection. PLoS Negl Trop Dis 2008; 2:e316. [PMID: 18841200 PMCID: PMC2556098 DOI: 10.1371/journal.pntd.0000316] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 09/12/2008] [Indexed: 11/21/2022] Open
Abstract
Background Diagnosis of Trypanosoma cruzi infection by direct pathogen detection is complicated by the low parasite burden in subjects persistently infected with this agent of human Chagas disease. Determination of infection status by serological analysis has also been faulty, largely due to the lack of well-characterized parasite reagents for the detection of anti-parasite antibodies. Methods In this study, we screened more than 400 recombinant proteins of T. cruzi, including randomly selected and those known to be highly expressed in the parasite stages present in mammalian hosts, for the ability to detect anti-parasite antibodies in the sera of subjects with confirmed or suspected T. cruzi infection. Findings A set of 16 protein groups were identified and incorporated into a multiplex bead array format which detected 100% of >100 confirmed positive sera and also documented consistent, strong and broad responses in samples undetected or discordant using conventional serologic tests. Each serum had a distinct but highly stable reaction pattern. This diagnostic panel was also useful for monitoring drug treatment efficacy in chronic Chagas disease. Conclusions These results substantially extend the variety and quality of diagnostic targets for Chagas disease and offer a useful tool for determining treatment success or failure. The diagnosis of Trypanosoma cruzi infection (the cause of human Chagas disease) is difficult because the symptoms of the infection are often absent or non-specific, and because the parasites themselves are usually below the level of detection in the infected subjects. Therefore, diagnosis generally depends on the measurement of T. cruzi–specific antibodies produced in response to the infection. However, current methods to detect anti–T. cruzi antibodies are relatively poor. In this study, we have conducted a broad screen of >400 T. cruzi proteins to identify those proteins which are best able to detect anti–T. cruzi antibodies. Using a set of proteins selected by this screen, we were able to detect 100% of >100 confirmed positive human cases of T. cruzi infection, as well as suspect cases that were negative using existing tests. This protein panel was also able to detect apparent changes in infection status following drug treatment of individuals with chronic T. cruzi infection. The results of this study should allow for significant improvements in the detection of T. cruzi infection and better screening methods to avoid blood transfusion–related transmission of the infection, and offer a crucial tool for determining the success or failure of drug treatment and other intervention strategies to limit the impact of Chagas disease.
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Affiliation(s)
- Gretchen Cooley
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - R. Drew Etheridge
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Courtney Boehlke
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Becky Bundy
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - D. Brent Weatherly
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Todd Minning
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Matthew Haney
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Miriam Postan
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Buenos Aires, Argentina
| | - Susana Laucella
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Buenos Aires, Argentina
| | - Rick L. Tarleton
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
- * E-mail:
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11
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Garg N, Bhatia V. Current status and future prospects for a vaccine against American trypanosomiasis. Expert Rev Vaccines 2007; 4:867-80. [PMID: 16372882 DOI: 10.1586/14760584.4.6.867] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The clinically relevant pathognomonic consequences of human infection by Trypanosoma cruzi are dilation and hypertrophy of the left ventricle walls and thinning of the apex. The major complications and debilitating evolutionary outcomes of chronic infection include ventricular fibrillation, thromboembolism and congestive heart failure. American trypanosomiasis (Chagas disease) poses serious public healthcare and budgetary concerns. The currently available drugs, although effective against acute infection, are highly toxic and ineffective in arresting or attenuating clinical disease symptoms in chronic patients. The development of an efficacious prophylactic vaccine faces many challenges, and progress is slow, despite several years of effort. Studies in animal models and human patients have revealed the pathogenic mechanisms during disease progression, pathology of disease and features of protective immunity. Accordingly, several antigens, antigen-delivery vehicles and adjuvants have been tested in animal models, and some efforts have been successful in controlling infection and disease. This review will summarize the accumulated knowledge about the parasite and disease, as well as pathogenesis and protective immunity. The authors will discuss the efforts to date, and the challenges faced in achieving an efficient prophylactic vaccine against human American trypanosomiasis, and present the future perspectives.
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Affiliation(s)
- Nisha Garg
- Sealy Center for Vaccine Development, Department of Microbiology, Immunology and Pathology, University of Texas Medical Branch, Galveston TX 77555, USA.
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12
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Zacks MA, Wen JJ, Vyatkina G, Bhatia V, Garg N. An overview of chagasic cardiomyopathy: pathogenic importance of oxidative stress. AN ACAD BRAS CIENC 2005; 77:695-715. [PMID: 16341444 DOI: 10.1590/s0001-37652005000400009] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
There is growing evidence to suggest that chagasic myocardia are exposed to sustained oxidative stress-induced injuries that may contribute to disease progression. Pathogen invasion- and replication-mediated cellular injuries and immune-mediated cytotoxic reactions are the common source of reactive oxygen species (ROS) in infectious etiologies. However, our understanding of the source and role of oxidative stress in chagasic cardiomyopathy (CCM) remains incomplete. In this review, we discuss the evidence for increased oxidative stress in chagasic disease, with emphasis on mitochondrial abnormalities, electron transport chain dysfunction and its role in sustaining oxidative stress in myocardium. We discuss the literature reporting the consequences of sustained oxidative stress in CCM pathogenesis.
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Affiliation(s)
- Michele A Zacks
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA
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Maldonado C, Albano S, Vettorazzi L, Salomone O, Zlocowski JC, Abiega C, Amuchastegui M, Córdoba R, Alvarellos T. Using polymerase chain reaction in early diagnosis of re-activated Trypanosoma cruzi infection after heart transplantation. J Heart Lung Transplant 2004; 23:1345-8. [PMID: 15607662 DOI: 10.1016/j.healun.2003.09.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2003] [Revised: 09/08/2003] [Accepted: 09/10/2003] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Heart transplantation is an effective treatment for patients with end-stage Chagas' heart disease. Re-activation of Chagas' disease in transplant recipients is frequent, triggered by immunosuppression level. Therefore, highly sensitive methods for early diagnosis of Chagas' disease relapse are necessary to initiate appropriate therapy. We analyzed the use of polymerase chain reaction (PCR) in the clinical follow-up of heart transplant recipients. METHODS We prospectively evaluated 4 heart transplant recipients at the Hospital Privado, Cordoba, Argentina, who had terminal Chagas' disease. The parameters analyzed were presence of parasites in the blood (blood culture, Strout) and in endomyocardial biopsy (EMB) samples, and PCR was performed with oligonucleotides directed to a nuclear repetitive sequence of Trypanosoma cruzi. We evaluated these parameters weekly from the day of transplantation until results were negative and then during regular follow-up visits. RESULTS In 2 patients, we detected T cruzi using PCR in peripheral blood 30 days before clinical evidence of re-activation. In the 3rd case, PCR results in peripheral blood were positive from the day before transplantation, followed by positive results in EMB and sub-cutaneous chagomas biopsy specimens. Only 1 patient had positive Strout results for parasites in skin lesions, and none showed amastigotes in the biopsy specimens. After clinical diagnosis, all patients received 5 mg/kg/day benzimidazole for 6 months, with acceptable tolerance and good clinical outcome. All patients had negative peripheral blood PRC results after 30 days of treatment. One patient had intermittent positive PCR results during follow-up, with no evidence of clinical re-activation. CONCLUSION Polymerase chain reaction detection of T Cruzi in heart transplant recipients is a more sensitive and specific procedure in diagnosing Chagas' disease re-activation.
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Affiliation(s)
- Cecilia Maldonado
- Molecular Diagnosis Laboratory, Fundación para el Progreso de la Medicina, Córdoba, Argentina
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Basquiera AL, Sembaj A, Aguerri AM, Omelianiuk M, Guzmán S, Moreno Barral J, Caeiro TF, Madoery RJ, Salomone OA. Risk progression to chronic Chagas cardiomyopathy: influence of male sex and of parasitaemia detected by polymerase chain reaction. Heart 2003; 89:1186-90. [PMID: 12975414 PMCID: PMC1767891 DOI: 10.1136/heart.89.10.1186] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Polymerase chain reaction (PCR) allows detection of Trypanosoma cruzi in blood throughout the course of Chagas' disease. OBJECTIVE To determine whether T cruzi DNA detected by PCR is associated with progression to chronic Chagas cardiomyopathy. DESIGN Prospective cohort study. SETTING A tertiary care centre in Argentina. PATIENTS 56 consecutive patients with chronic T cruzi infection. METHODS Clinical examination, ECG, and Doppler echocardiography were carried out at baseline and at the end of the follow up. Detection of T cruzi DNA by PCR amplifying a nuclear sequence was undertaken in all patients at baseline. MAIN OUTCOME MEASURES Progression was defined as death from chronic cardiomyopathy or the presence of a new ECG or left ventricular echocardiographic abnormality at the end of follow up. RESULTS The 56 patients (21 male, 35 female; mean (SD) age, 56.0 (11.3) years) were followed for a mean 936.3 (244.39) days. Progression to cardiomyopathy was detected in 12 patients (21.4%). Three of these patients died after baseline evaluation. Univariate analysis showed that a positive PCR (relative risk 4.09, 95% confidence interval (CI) 1.60 to 9.85) and male sex (5.00, 95% CI 1.65 to 15.73) were associated with progression. Multivariable logistic regression indicated that both sex and PCR were independent variables affecting the outcome. CONCLUSIONS In a cohort of seropositive individuals, patients with T cruzi DNA detected by PCR and male patients were at higher risk of progression. These results highlight the importance of T cruzi in the pathophysiology of chronic cardiomyopathy.
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Affiliation(s)
- A L Basquiera
- Internal Medicine Training Programme, Department of Education, Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina.
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Alejandro Salomone O. [Chagas cardiomyopathy and thrombosis: the beginning and the end of a dangerous affair]. Rev Esp Cardiol 2003; 56:333-4. [PMID: 12689565 DOI: 10.1016/s0300-8932(03)76874-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gironès N, Fresno M. Etiology of Chagas disease myocarditis: autoimmunity, parasite persistence, or both? Trends Parasitol 2003; 19:19-22. [PMID: 12488221 DOI: 10.1016/s1471-4922(02)00006-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Núria Gironès
- Centro de Biología Molecular, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Cantoblanco, E-28049 Madrid, Spain
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Salomone OA, Caeiro TF, Madoery RJ, Amuchástegui M, Omelinauk M, Juri D, Kaski JC. High plasma immunoreactive endothelin levels in patients with Chagas' cardiomyopathy. Am J Cardiol 2001; 87:1217-20; A7. [PMID: 11356406 DOI: 10.1016/s0002-9149(01)01502-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- O A Salomone
- Hospital Privado Centro Médico de Córdoba (affiliated to Catholic University of Córdoba), Córdoba, Argentina.
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