1
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Barbosa JMC, Pedra-Rezende Y, Mata-Santos HA, Vilar-Pereira G, Melo TGD, Ramos IP, Gibaldi D, Moreira OC, Nunes DF, Batista MM, Lannes-Vieira J, Daliry A, Salomão K. Preclinical evaluation of combined therapy with amiodarone and low-dose benznidazole in a mouse model of chronic Trypanosoma cruzi infection. Biomed Pharmacother 2024; 175:116742. [PMID: 38754265 DOI: 10.1016/j.biopha.2024.116742] [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: 03/08/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
Chagasic chronic cardiomyopathy (CCC) is the primary clinical manifestation of Chagas disease (CD), caused by Trypanosoma cruzi. Current therapeutic options for CD are limited to benznidazole (Bz) and nifurtimox. Amiodarone (AMD) has emerged as most effective drug for treating the arrhythmic form of CCC. To address the effects of Bz and AMD we used a preclinical model of CCC. Female C57BL/6 mice were infected with T. cruzi and subjected to oral treatment for 30 consecutive days, either as monotherapy or in combination. AMD in monotherapy decreased the prolonged QTc interval, the incidence of atrioventricular conduction disorders and cardiac hypertrophy. However, AMD monotherapy did not impact parasitemia, parasite load, TNF concentration and production of reactive oxygen species (ROS) in cardiac tissue. Alike Bz therapy, the combination of Bz and AMD (Bz/AMD), improved cardiac electric abnormalities detected T. cruzi-infected mice such as decrease in heart rates, enlargement of PR and QTc intervals and increased incidence of atrioventricular block and sinus arrhythmia. Further, Bz/AMD therapy ameliorated the ventricular function and reduced parasite burden in the cardiac tissue and parasitemia to a degree comparable to Bz monotherapy. Importantly, Bz/AMD treatment efficiently reduced TNF concentration in the cardiac tissue and plasma and had beneficial effects on immunological abnormalities. Moreover, in the cardiac tissue Bz/AMD therapy reduced fibronectin and collagen deposition, mitochondrial damage and production of ROS, and improved sarcomeric and gap junction integrity. Our study underlines the potential of the Bz/AMD therapy, as we have shown that combination increased efficacy in the treatment of CCC.
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Affiliation(s)
- Juliana Magalhães Chaves Barbosa
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil; Laboratório de Fisiopatologia Clínica e Experimental, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Yasmin Pedra-Rezende
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil; Laboratório de Biologia das Interações, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Hílton Antônio Mata-Santos
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Laboratório de Análise e Desenvolvimento de Inibidores Enzimáticos e Laboratório Multiusuário de Análises por RMN, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Glaucia Vilar-Pereira
- Laboratório de Biologia das Interações, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Tatiana Galvão de Melo
- Laboratório de Ultraestrutura Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Isalira Peroba Ramos
- Centro Nacional de Biologia Estrutural e Bioimagem, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniel Gibaldi
- Laboratório de Biologia das Interações, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Otacilio C Moreira
- Laboratório de Virologia e Parasitologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Daniela Ferreira Nunes
- Laboratório de Virologia e Parasitologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcos Meuser Batista
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Joseli Lannes-Vieira
- Laboratório de Biologia das Interações, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Anissa Daliry
- Laboratório de Fisiopatologia Clínica e Experimental, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Kelly Salomão
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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2
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Torres DJL, Dos Santos Oliveira KK, da Silva Barros M, Moreira LR, de Freitas Firmino L, da Piedade Costa Reis de Albuquerque M, da Glória Aureliano Melo Cavalcante M, Martins SM, de Oliveira Junior WA, da Silva Rabello MC, de Lorena VMB. TNF blockers alone and associated with Benznidazole impact in vitro cytokine dynamics in chronic Chagas disease. Parasite Immunol 2024; 46:e13024. [PMID: 38385576 DOI: 10.1111/pim.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/23/2024]
Abstract
Studies involving the immune response in Chagas disease suggest an imbalance in the immune response of symptomatic patients, with an inflammatory profile dominating in Chagas heart disease, mainly by tumour necrosis factor (TNF). TNF is considered a key cytokine in immunopathology in chronic carriers in several processes during the immune response. Our work aimed to evaluate regulatory (interleukin [IL]-4 and IL-10) and inflammatory (TNF, interferon-gamma [IFN-γ], IL-2 and IL-6) cytokines in peripheral blood mononuclear cells culture supernatants. of affected patients with undetermined clinical forms-IND (n = 13) mild heart form-CARD1 (n = 13) and severe cardiac form-CARD2 (n = 16), treated in vitro with two TNF blockers, Adalimumab (ADA) and Etanercept (ETA) alone or in association with Benznidazole (BZ). The results indicate that ADA was more competent in blocking TNF (compared to ETA) in all groups but with much lower levels in the CARD2 group. ETA statistically decreased TNF levels only in the CARD2 group. IFN-γ increased in the CARD2 group after treatment with ETA relative to ADA. IL-4 had its levels decreased when treated by both drugs. IL-2 was detected in cells from CARD2 carriers compared to the NEG group after treatment with both drugs. The association with BZ decreased levels of IL-2/TNF and increased IL-4. These data reinforce the participation of TNF in severe Chagas heart disease and bring perspectives on using these blockers in the immunological treatment of Chagas disease since the use of BZ is extremely limited in these patients.
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Affiliation(s)
- Diego José Lira Torres
- Universidade Federal de Pernambuco-UFPE, Recife, Pernambuco, Brazil
- Instituto Aggeu Magalhães-IAM/Fiocruz, Recife, Pernambuco, Brazil
| | - Kamila Kássia Dos Santos Oliveira
- Universidade Federal de Pernambuco-UFPE, Recife, Pernambuco, Brazil
- Instituto Aggeu Magalhães-IAM/Fiocruz, Recife, Pernambuco, Brazil
| | - Michelle da Silva Barros
- Universidade Federal de Pernambuco-UFPE, Recife, Pernambuco, Brazil
- Instituto Aggeu Magalhães-IAM/Fiocruz, Recife, Pernambuco, Brazil
| | - Leyllane Rafael Moreira
- Universidade Federal de Pernambuco-UFPE, Recife, Pernambuco, Brazil
- Instituto Aggeu Magalhães-IAM/Fiocruz, Recife, Pernambuco, Brazil
| | - Luciane de Freitas Firmino
- Universidade Federal de Pernambuco-UFPE, Recife, Pernambuco, Brazil
- Instituto Aggeu Magalhães-IAM/Fiocruz, Recife, Pernambuco, Brazil
| | | | | | - Sílvia Marinho Martins
- Ambulatório De Doença De Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico De Pernambuco, Recife, Pernambuco, Brazil
| | - Wilson Alves de Oliveira Junior
- Ambulatório De Doença De Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico De Pernambuco, Recife, Pernambuco, Brazil
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3
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Liu Z, Ulrich vonBargen R, Kendricks AL, Wheeler K, Leão AC, Sankaranarayanan K, Dean DA, Kane SS, Hossain E, Pollet J, Bottazzi ME, Hotez PJ, Jones KM, McCall LI. Localized cardiac small molecule trajectories and persistent chemical sequelae in experimental Chagas disease. Nat Commun 2023; 14:6769. [PMID: 37880260 PMCID: PMC10600178 DOI: 10.1038/s41467-023-42247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023] Open
Abstract
Post-infectious conditions present major health burdens but remain poorly understood. In Chagas disease (CD), caused by Trypanosoma cruzi parasites, antiparasitic agents that successfully clear T. cruzi do not always improve clinical outcomes. In this study, we reveal differential small molecule trajectories between cardiac regions during chronic T. cruzi infection, matching with characteristic CD apical aneurysm sites. Incomplete, region-specific, cardiac small molecule restoration is observed in animals treated with the antiparasitic benznidazole. In contrast, superior restoration of the cardiac small molecule profile is observed for a combination treatment of reduced-dose benznidazole plus an immunotherapy, even with less parasite burden reduction. Overall, these results reveal molecular mechanisms of CD treatment based on simultaneous effects on the pathogen and on host small molecule responses, and expand our understanding of clinical treatment failure in CD. This link between infection and subsequent persistent small molecule perturbation broadens our understanding of infectious disease sequelae.
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Affiliation(s)
- Zongyuan Liu
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, USA
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA
| | - Rebecca Ulrich vonBargen
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA
- Department of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
| | | | - Kate Wheeler
- Department of Biology, University of Oklahoma, Norman, OK, USA
| | - Ana Carolina Leão
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Krithivasan Sankaranarayanan
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA
- Department of Microbiology and Plant Biology, University of Oklahoma, Norman, OK, USA
| | - Danya A Dean
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, USA
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA
| | - Shelley S Kane
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, USA
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA
| | - Ekram Hossain
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, USA
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA
| | - Jeroen Pollet
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Maria Elena Bottazzi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Peter J Hotez
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Kathryn M Jones
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
| | - Laura-Isobel McCall
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, USA.
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA.
- Department of Microbiology and Plant Biology, University of Oklahoma, Norman, OK, USA.
- Department of Chemistry and Biochemistry, San Diego State University, San Diego, CA, USA.
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4
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Rial MS, Reigada C, Prado N, Bua J, Esteva M, Pereira CA, Fichera LE. Effectiveness of the repurposed drug isotretinoin in an experimental murine model of Chagas disease. Acta Trop 2023; 242:106920. [PMID: 37028584 DOI: 10.1016/j.actatropica.2023.106920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/21/2023] [Accepted: 04/04/2023] [Indexed: 04/09/2023]
Abstract
Benznidazole and nifurtimox are the drugs currently used for the treatment of Chagas disease, however its side effects may affect patient adherence. In the search for new alternative therapies, we previously identified isotretinoin (ISO), an FDA-approved drug widely used for the treatment of severe acne through a drug repurposing strategy. ISO shows a strong activity against Trypanosoma cruzi parasites in the nanomolar range, and its mechanism of action is through the inhibition of T. cruzi polyamine and amino acid transporters from the Amino Acid/Auxin Permeases (AAAP) family. In this work, a murine model of chronic Chagas disease (C57BL/6 J mice), intraperitoneally infected with T. cruzi Nicaragua isolate (DTU TcI), were treated with different oral administrations of ISO: daily doses of 5 mg/kg/day for 30 days and weekly doses of 10 mg/kg during 13 weeks. The efficacy of the treatments was evaluated by monitoring blood parasitemia by qPCR, anti-T. cruzi antibodies by ELISA, and cardiac abnormalities by electrocardiography. No parasites were detected in blood after any of the ISO treatments. The electrocardiographic study of the untreated chronic mice showed a significant decrease in heart rate, while in the treated mice this negative chronotropic effect was not observed. Atrioventricular nodal conduction time in untreated mice was significantly longer than in treated animals. Mice treated even with ISO 10 mg/kg dose every 7 days, showed a significant reduction in anti-T. cruzi IgG levels. In conclusion, the intermittent administration of ISO 10 mg/kg would improve myocardial compromise during the chronic stage.
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Affiliation(s)
- Marcela S Rial
- Instituto Nacional de Parasitología Dr. M Fatala Chaben/ANLIS-Malbrán, Buenos Aires, Argentina
| | - Chantal Reigada
- Facultad de Medicina, Instituto de Investigaciones Médicas A. Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina; Instituto de Investigaciones Médicas (IDIM), Laboratorio de Parasitología Molecular, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Nilda Prado
- Instituto Nacional de Parasitología Dr. M Fatala Chaben/ANLIS-Malbrán, Buenos Aires, Argentina
| | - Jacqueline Bua
- Instituto Nacional de Parasitología Dr. M Fatala Chaben/ANLIS-Malbrán, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Mónica Esteva
- Instituto Nacional de Parasitología Dr. M Fatala Chaben/ANLIS-Malbrán, Buenos Aires, Argentina
| | - Claudio A Pereira
- Facultad de Medicina, Instituto de Investigaciones Médicas A. Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina; Instituto de Investigaciones Médicas (IDIM), Laboratorio de Parasitología Molecular, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Laura E Fichera
- Instituto Nacional de Parasitología Dr. M Fatala Chaben/ANLIS-Malbrán, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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5
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Bustamante JM, White BE, Wilkerson GK, Hodo CL, Auckland LD, Wang W, McCain S, Hamer SA, Saunders AB, Tarleton RL. Frequency Variation and Dose Modification of Benznidazole Administration for the Treatment of Trypanosoma cruzi Infection in Mice, Dogs, and Nonhuman Primates. Antimicrob Agents Chemother 2023; 67:e0013223. [PMID: 37039666 PMCID: PMC10190575 DOI: 10.1128/aac.00132-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/22/2023] [Indexed: 04/12/2023] Open
Abstract
Trypanosoma cruzi naturally infects a broad range of mammalian species and frequently results in the pathology that has been most extensively characterized in human Chagas disease. Currently employed treatment regimens fail to achieve parasitological cure of T. cruzi infection in the majority of cases. In this study, we have extended our previous investigations of more effective, higher dose, intermittent administration protocols using the FDA-approved drug benznidazole (BNZ), in experimentally infected mice and in naturally infected dogs and nonhuman primates (NHP). Collectively, these studies demonstrate that twice-weekly administration of BNZ for more than 4 months at doses that are ~2.5-fold that of previously used daily dosing protocols, provided the best chance to obtain parasitological cure. Dosing less frequently or for shorter time periods was less dependable in all species. Prior treatment using an ineffective dosing regimen in NHPs did not prevent the attainment of parasitological cure with an intensified BNZ dosing protocol. Furthermore, parasites isolated after a failed BNZ treatment showed nearly identical susceptibility to BNZ as those obtained prior to treatment, confirming the low risk of induction of drug resistance with BNZ and the ability to adjust the treatment protocol when an initial regimen fails. These results provide guidance for the use of BNZ as an effective treatment for T. cruzi infection and encourage its wider use, minimally in high value dogs and at-risk NHP, but also potentially in humans, until better options are available.
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Affiliation(s)
- Juan M. Bustamante
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
| | - Brooke E. White
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
| | - Gregory K. Wilkerson
- MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, Bastrop, Texas, USA
| | - Carolyn L. Hodo
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine and Biomedical Research, Texas A&M University, College Station, Texas, USA
| | - Lisa D. Auckland
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine and Biomedical Research, Texas A&M University, College Station, Texas, USA
| | - Wei Wang
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
| | | | - Sarah A. Hamer
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine and Biomedical Research, Texas A&M University, College Station, Texas, USA
| | - Ashley B. Saunders
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Rick L. Tarleton
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
- Department of Cellular Biology, University of Georgia, Athens, Georgia, USA
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6
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Tarleton RL. Effective drug discovery in Chagas disease. Trends Parasitol 2023; 39:423-431. [PMID: 37024318 DOI: 10.1016/j.pt.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 04/07/2023]
Abstract
The Chagas field has gone >50 years without tangible progress toward new therapies. My colleagues and I have recently reported on a benzoxaborole compound that achieves consistent parasitological cure in experimentally infected mice and in naturally infected non-human primates (NHPs). While these results do not assure success in human clinical trials, they significantly de-risk this process and form a strong justification for such trials. Highly effective drug discovery depends on a solid understanding of host and parasite biology and excellent knowledge in designing and validating chemical entities. This opinion piece seeks to provide perspectives on the process that led to the discovery of AN15368, with the hope that this will facilitate the discovery of additional clinical candidates for Chagas disease.
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Affiliation(s)
- Rick L Tarleton
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA 30602, USA.
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7
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Bustamante JM, White BE, Wilkerson GK, Hodo CL, Auckland LD, Wang W, McCain S, Hamer SA, Saunders AB, Tarleton RL. Frequency variation and dose modification of benznidazole administration for the treatment of Trypanosoma cruzi infection in mice, dogs and non-human primates. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.01.526739. [PMID: 36778432 PMCID: PMC9915573 DOI: 10.1101/2023.02.01.526739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Trypanosoma cruzi naturally infects a broad range of mammalian species and frequently results in the pathology that has been most extensively characterized in human Chagas disease. Currently employed treatment regimens fail to achieve parasitological cure of T. cruzi infection in the majority of cases. In this study, we have extended our previous investigations of more effective, higher dose, intermittent administration protocols using the FDA-approved drug benznidazole (BNZ), in experimentally infected mice and in naturally infected dogs and non-human primates (NHP). Collectively these studies demonstrate that twice-weekly administration of BNZ for more than 4 months at doses that are ∼2.5-fold that of previously used daily dosing protocols, provided the best chance to obtain parasitological cure. Dosing less frequently or for shorter time periods was less dependable in all species. Prior treatment using an ineffective dosing regimen in NHPs did not prevent the attainment of parasitological cure with an intensified BNZ dosing protocol. Furthermore, parasites isolated after a failed BNZ treatment showed nearly identical susceptibility to BNZ as those obtained prior to treatment, confirming the low risk of induction of drug resistance with BNZ and the ability to adjust the treatment protocol when an initial regimen fails. These results provide guidance for the use of BNZ as an effective treatment for T. cruzi infection and encourage its wider use, minimally in high value dogs and at-risk NHP, but also potentially in humans, until better options are available.
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Affiliation(s)
- Juan M Bustamante
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
| | - Brooke E White
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
| | - Gregory K Wilkerson
- MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, Bastrop, Texas, USA
| | - Carolyn L Hodo
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine and Biomedical Research, Texas A&M University, College Station, Texas, USA
| | - Lisa D Auckland
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine and Biomedical Research, Texas A&M University, College Station, Texas, USA
| | - Wei Wang
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
| | | | - Sarah A Hamer
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine and Biomedical Research, Texas A&M University, College Station, Texas, USA
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Rick L Tarleton
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
- Department of Cellular Biology, University of Georgia, Athens, Georgia, USA
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8
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Bustamante JM, Padilla AM, White B, Auckland LD, Busselman RE, Collins S, Malcolm EL, Wilson BF, Saunders AB, Hamer SA, Tarleton RL. Prophylactic low-dose, bi-weekly benznidazole treatment fails to prevent Trypanosoma cruzi infection in dogs under intense transmission pressure. PLoS Negl Trop Dis 2022; 16:e0010688. [PMID: 36315597 PMCID: PMC9648846 DOI: 10.1371/journal.pntd.0010688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/10/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
Trypanosoma cruzi naturally infects a wide variety of wild and domesticated mammals, in addition to humans. Depending on the infection dose and other factors, the acute infection can be life-threatening, and in all cases, the risk of chagasic heart disease is high in persistently infected hosts. Domestic, working, and semi-feral dogs in the Americas are at significant risk of T. cruzi infection and in certain settings in the southern United States, the risk of new infections can exceed 30% per year, even with the use of vector control protocols. In this study, we explored whether intermittent low-dose treatment with the trypanocidal compound benznidazole (BNZ) during the transmission season, could alter the number of new infections in dogs in an area of known, intense transmission pressure. Preliminary studies in mice suggested that twice-weekly administration of BNZ could prevent or truncate infections when parasites were delivered at the mid-point between BNZ doses. Pre-transmission season screening of 126 dogs identified 53 dogs (42.1%) as T. cruzi infection positive, based upon blood PCR and Luminex-based serology. Serial monitoring of the 67 uninfected dogs during the high transmission season (May to October) revealed 15 (22.4%) new infections, 6 in the untreated control group and 9 in the group receiving BNZ prophylaxis, indicating no impact of this prophylaxis regimen on the incidence of new infections. Although these studies suggest that rigorously timed and more potent dosing regimen may be needed to achieve an immediate benefit of prophylaxis, additional studies would be needed to determine if drug prophylaxis reduced disease severity despite this failure to prevent new infections.
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Affiliation(s)
- Juan M. Bustamante
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Angel M. Padilla
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Brooke White
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Lisa D. Auckland
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Rachel E. Busselman
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Stephanie Collins
- Chaparral Veterinary Center, Jourdanton, Texas, United States of America
| | - Elizabeth L. Malcolm
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, United States of America
| | - Briana F. Wilson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, United States of America
| | - Ashley B. Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, United States of America
| | - Sarah A. Hamer
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Rick L. Tarleton
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
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9
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Caputo MB, Elias J, Cesar G, Alvarez MG, Laucella SA, Albareda MC. Role of the Complement System in the Modulation of T-Cell Responses in Chronic Chagas Disease. Front Cell Infect Microbiol 2022; 12:910854. [PMID: 35846776 PMCID: PMC9282465 DOI: 10.3389/fcimb.2022.910854] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/26/2022] [Indexed: 01/19/2023] Open
Abstract
Chagas disease, caused by the intracellular pathogen Trypanosoma cruzi, is the parasitic disease with the greatest impact in Latin America and the most common cause of infectious myocarditis in the world. The immune system plays a central role in the control of T. cruzi infection but at the same time needs to be controlled to prevent the development of pathology in the host. It has been shown that persistent infection with T. cruzi induces exhaustion of parasite-specific T cell responses in subjects with chronic Chagas disease. The continuous inflammatory reaction due to parasite persistence in the heart also leads to necrosis and fibrosis. The complement system is a key element of the innate immune system, but recent findings have also shown that the interaction between its components and immune cell receptors might modulate several functions of the adaptive immune system. Moreover, the findings that most of immune cells can produce complement proteins and express their receptors have led to the notion that the complement system also has non canonical functions in the T cell. During human infection by T. cruzi, complement activation might play a dual role in the acute and chronic phases of Chagas disease; it is initially crucial in controlling parasitemia and might later contributes to the development of symptomatic forms of Chagas disease due to its role in T-cell regulation. Herein, we will discuss the putative role of effector complement molecules on T-cell immune exhaustion during chronic human T. cruzi infection.
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Affiliation(s)
- María Belén Caputo
- Investigation Department, Instituto Nacional de Parasitología Dr. Fatala Chaben, Buenos Aires, Argentina
| | - Josefina Elias
- Investigation Department, Instituto Nacional de Parasitología Dr. Fatala Chaben, Buenos Aires, Argentina
| | - Gonzalo Cesar
- Investigation Department, Instituto Nacional de Parasitología Dr. Fatala Chaben, Buenos Aires, Argentina
| | - María Gabriela Alvarez
- Chagas Section, Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Susana Adriana Laucella
- Investigation Department, Instituto Nacional de Parasitología Dr. Fatala Chaben, Buenos Aires, Argentina
- Chagas Section, Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - María Cecilia Albareda
- Investigation Department, Instituto Nacional de Parasitología Dr. Fatala Chaben, Buenos Aires, Argentina
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10
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Jones KM, Poveda C, Versteeg L, Bottazzi ME, Hotez PJ. Preclinical advances and the immunophysiology of a new therapeutic chagas disease vaccine. Expert Rev Vaccines 2022; 21:1185-1203. [PMID: 35735065 DOI: 10.1080/14760584.2022.2093721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic infection with the protozoal parasite Trypanosoma cruzi leads to a progressive cardiac disease, known as chronic Chagasic cardiomyopathy (CCC). A new therapeutic Chagas disease vaccine is in development to augment existing antiparasitic chemotherapy drugs. AREAS COVERED We report on our current understanding of the underlying immunologic and physiologic mechanisms that lead to CCC, including parasite immune escape mechanisms that allow persistence and the subsequent inflammatory and fibrotic processes that lead to clinical disease. We report on vaccine design and the observed immunotherapeutic effects including induction of a balanced TH1/TH2/TH17 immune response that leads to reduced parasite burdens and tissue pathology. Further, we report vaccine-linked chemotherapy, a dose sparing strategy to further reduce parasite burdens and tissue pathology. EXPERT OPINION Our vaccine-linked chemotherapeutic approach is a multimodal treatment strategy, addressing both the parasite persistence and the underlying deleterious host inflammatory and fibrotic responses that lead to cardiac dysfunction. In targeting treatment towards patients with chronic indeterminate or early determinate Chagas disease, this vaccine-linked chemotherapeutic approach will be highly economical and will reduce the global disease burden and deaths due to CCC.
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Affiliation(s)
- Kathryn M Jones
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Cristina Poveda
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Leroy Versteeg
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America.,Cell Biology and Immunology Group, Wageningen University & Research, De Elst 1, 6708 WD Wageningen, The Netherlands
| | - Maria Elena Bottazzi
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Biology, Baylor University, Waco, Texas, United States of America
| | - Peter J Hotez
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Biology, Baylor University, Waco, Texas, United States of America.,James A. Baker III Institute for Public Policy, Rice University, Houston, Texas, United States of America.,Hagler Institute for Advanced Study at Texas A&M University, College Station, Texas, United States of America
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11
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Assessment of a combined treatment with a therapeutic vaccine and benznidazole for the Trypanosoma cruzi chronic infection. Acta Trop 2022; 229:106334. [PMID: 35101415 DOI: 10.1016/j.actatropica.2022.106334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/07/2023]
Abstract
The difficulties encountered in achieving treatments for chronic Chagas disease have promoted the investigation of new therapeutic strategies. In this study, we used two murine models of Trypanosoma cruzi chronic infection to determine the usefulness of applying a therapeutic vaccine alone or followed by benznidazole (Bz) chemotherapy. A vaccine formulation based on an N-terminal fragment of Trans-sialidase (TS) and Immunostimulant Particle Adjuvant (ISPA) - TSNt-ISPA was obtained. Firstly, the immunogenicity and protective capacity of TSNt-ISPA was demonstrated as a prophylactic formulation in an acute model of infection. Later, the formulation was assessed as a therapeutic vaccine alone or combined with (Bz) using two models of chronic infection. BALB/c mice chronically infected with Sylvio X10/4 or Tulahuen cl2 T. cruzi strains were not treated as control or treated only with the therapeutic vaccine TSNt-ISPA, with a combined treatment TSNt-ISPA+Bz (Bz applied after the vaccine), or only with Bz. The vaccination schedule consisted of TSNt-ISPA administration at days110, 120, and 130 post-infection (pi) and Bz administration was performed daily from day 140 to 170 pi. At day 273 pi, electrocardiographic (ECG) parameters, heart parasite load, myocarditis, and heart fibrosis were assessed. In both models, therapeutic administration of TSNt-ISPA reduced ECG alterations and the cardiac tissue damage observed in the chronic phase. Moreover, vaccine treatment significantly decreased heart parasite load in both Sylvio X10/4 and Tulahuen cl2 infected mice. The combined treatment, but not Bz or vaccine administration alone, allowed to restore ECG parameters in Tulahuen cl2 infected mice. The results indicate the usefulness of the therapeutic TSNt-ISPA formulation in BALB/c mice chronically infected with Sylvio X10/4 or Tulahuen cl2 strain. For the mice infected with T. cruzi Tulahuen cl2 strain, the combined treatment with the vaccine and Bz had a more positive effect on the course of heart disease than the individual treatments with the vaccine or Bz alone.
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12
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Lascano F, García Bournissen F, Altcheh J. Review of pharmacological options for the treatment of Chagas disease. Br J Clin Pharmacol 2022; 88:383-402. [PMID: 33314266 DOI: 10.1111/bcp.14700] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/09/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022] Open
Abstract
Chagas disease (CD) is a worldwide problem, with over 8 million people infected in both rural and urban areas. CD was first described over a century ago, but only two drugs are currently available for CD treatment: benznidazole (BZN) and nifurtimox (NF). Treating CD-infected patients, especially children and women of reproductive age, is vital in order to prevent long-term sequelae, such as heart and gastrointestinal dysfunction, but this aim is still far from being accomplished. Currently, the strongest data to support benefit-risk considerations come from trials in children. Treatment response biomarkers need further development as serology is being questioned as the best method to assess treatment response. This article is a narrative review on the pharmacology of drugs for CD, particularly BZN and NF. Data on drug biopharmaceutical characteristics, safety and efficacy of both drugs are summarized from a clinical perspective. Current data on alternative compounds under evaluation for CD treatment, and new possible treatment response biomarkers are also discussed. Early diagnosis and treatment of CD, especially in paediatric patients, is vital for an effective and safe use of the available drugs (i.e. BZN and NF). New biomarkers for CD are urgently needed for the diagnosis and evaluation of treatment efficacy, and to guide efforts from academia and pharmaceutical companies to accelerate the process of new drug development.
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Affiliation(s)
- Fernanda Lascano
- Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Gobierno de la Ciudad de la Nación Argentina, Buenos Aires, Argentina.,Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Facundo García Bournissen
- Division of Pediatric Clinical Pharmacology, Department of Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Jaime Altcheh
- Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Gobierno de la Ciudad de la Nación Argentina, Buenos Aires, Argentina.,Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
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13
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Farani PSG, Begum K, Vilar-Pereira G, Pereira IR, Almeida IC, Roy S, Lannes-Vieira J, Moreira OC. Treatment With Suboptimal Dose of Benznidazole Mitigates Immune Response Molecular Pathways in Mice With Chronic Chagas Cardiomyopathy. Front Cell Infect Microbiol 2021; 11:692655. [PMID: 34381739 PMCID: PMC8351877 DOI: 10.3389/fcimb.2021.692655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/25/2021] [Indexed: 12/21/2022] Open
Abstract
Chronic Chagas cardiomyopathy (CCC) is the most frequent and severe form of Chagas disease, a neglected tropical illness caused by the protozoan Trypanosoma cruzi, and the main cause of morbimortality from cardiovascular problems in endemic areas. Although efforts have been made to understand the signaling pathways and molecular mechanisms underlying CCC, the immunological signaling pathways regulated by the etiological treatment with benznidazole (Bz) has not been reported. In experimental CCC, Bz combined with the hemorheological and immunoregulatory agent pentoxifylline (PTX) has beneficial effects on CCC. To explore the molecular mechanisms of Bz or Bz+PTX therapeutic strategies, C57BL/6 mice chronically infected with the T. cruzi Colombian strain (discrete typing unit TcI) and showing electrocardiographic abnormalities were submitted to suboptimal dose of Bz or Bz+PTX from 120 to 150 days postinfection. Electrocardiographic alterations, such as prolonged corrected QT interval and heart parasite load, were beneficially impacted by Bz and Bz+PTX. RT-qPCR TaqMan array was used to evaluate the expression of 92 genes related to the immune response in RNA extracted from heart tissues. In comparison with non-infected mice, 30 genes were upregulated, and 31 were downregulated in infected mice. Particularly, infection upregulated the cytokines IFN-γ, IL-12b, and IL-2 (126-, 44-, and 18-fold change, respectively) and the T-cell chemoattractants CCL3 and CCL5 (23- and 16-fold change, respectively). Bz therapy restored the expression of genes related to inflammatory response, cellular development, growth, and proliferation, and tissue development pathways, most probably linked to the cardiac remodeling processes inherent to CCC, thus mitigating the Th1-driven response found in vehicle-treated infected mice. The combined Bz+PTX therapy revealed pathways related to the modulation of cell death and survival, and organismal survival, supporting that this strategy may mitigate the progression of CCC. Altogether, our results contribute to the better understanding of the molecular mechanisms of the immune response in the heart tissue in chronic Chagas disease and reinforce that parasite persistence and dysregulated immune response underpin CCC severity. Therefore, Bz and Bz+PTX chemotherapies emerge as tools to interfere in these pathways aiming to improve CCC prognosis.
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Affiliation(s)
- Priscila Silva Grijó Farani
- Real Time PCR Platform RPT09A, Laboratory of Molecular Biology and Endemic Diseases, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,Laboratory of Biology of the Interactions, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Khodeza Begum
- Department of Biological Sciences, Border Biomedical Research Center, University of Texas at El Paso, El Paso, TX, United States
| | - Glaucia Vilar-Pereira
- Laboratory of Biology of the Interactions, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Isabela Resende Pereira
- Laboratory of Biology of the Interactions, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Igor C Almeida
- Department of Biological Sciences, Border Biomedical Research Center, University of Texas at El Paso, El Paso, TX, United States
| | - Sourav Roy
- Department of Biological Sciences, Border Biomedical Research Center, University of Texas at El Paso, El Paso, TX, United States
| | - Joseli Lannes-Vieira
- Laboratory of Biology of the Interactions, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Otacilio Cruz Moreira
- Real Time PCR Platform RPT09A, Laboratory of Molecular Biology and Endemic Diseases, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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14
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Natale MA, Minning T, Albareda MC, Castro Eiro MD, Álvarez MG, Lococo B, Cesar G, Bertocchi G, Elias MJ, Caputo MB, Tarleton RL, Laucella SA. Immune exhaustion in chronic Chagas disease: Pro-inflammatory and immunomodulatory action of IL-27 in vitro. PLoS Negl Trop Dis 2021; 15:e0009473. [PMID: 34061845 PMCID: PMC8195349 DOI: 10.1371/journal.pntd.0009473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/11/2021] [Accepted: 05/13/2021] [Indexed: 01/07/2023] Open
Abstract
In chronic Chagas disease, Trypanosoma cruzi-specific T-cell function decreases over time, and alterations in the homeostatic IL-7/IL-7R axis are evident, consistent with a process of immune exhaustion. IL-27 is an important immunoregulatory cytokine that shares T-cell signaling with IL-7 and other cytokines of the IL-12 family and might be involved in the transcriptional regulation of T-cell function. Here, we evaluated the expression and function of IL-27R in antigen-experienced T cells from subjects with chronic Chagas disease and assessed whether in vitro treatment with IL-27 and IL-7 might improve T. cruzi-specific polyfunctional T-cell responses. In vitro exposure of PBMCs to T. cruzi induced a downregulation of IL-27R in CD4+ T cells and an upregulation in CD8+ T cells in subjects without heart disease, while IL-27R expression remained unaltered in subjects with more severe clinical stages. The modulation of IL-27R was associated with functional signaling through STAT3 and STAT5 and induction of the downstream genes TBX21, EOMES and CXCL9 in response to IL-27. In vitro treatment of PBMCs with IL-27 and IL-7 improved monofunctional and polyfunctional Th1 responses, accompanied by the induction of IL-10 and Bcl-2 expression in subjects without heart disease but did not improve those in subjects with cardiomyopathy. Our findings support the process of desensitization of the IL-27/IL-27R pathway along with disease severity and that the pro-inflammatory and immunomodulatory mechanisms of IL-27 might be interconnected.
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Affiliation(s)
- María Ailén Natale
- Instituto Nacional de Parasitología Dr. Mario Fatala Chaben, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Todd Minning
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, United States of America
| | - María Cecilia Albareda
- Instituto Nacional de Parasitología Dr. Mario Fatala Chaben, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Melisa Daiana Castro Eiro
- Instituto Nacional de Parasitología Dr. Mario Fatala Chaben, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | - Bruno Lococo
- Hospital Interzonal General de Agudos “Eva Perón”, San Martín, Argentina
| | - Gonzalo Cesar
- Instituto Nacional de Parasitología Dr. Mario Fatala Chaben, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Graciela Bertocchi
- Hospital Interzonal General de Agudos “Eva Perón”, San Martín, Argentina
| | - María Josefina Elias
- Instituto Nacional de Parasitología Dr. Mario Fatala Chaben, Buenos Aires, Argentina
| | - María Belén Caputo
- Instituto Nacional de Parasitología Dr. Mario Fatala Chaben, Buenos Aires, Argentina
| | - Rick Lee Tarleton
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, United States of America
| | - Susana Adriana Laucella
- Instituto Nacional de Parasitología Dr. Mario Fatala Chaben, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Hospital Interzonal General de Agudos “Eva Perón”, San Martín, Argentina
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15
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Castro Eiro MD, Natale MA, Alvarez MG, Shen H, Viotti R, Lococo B, Bua J, Nuñez M, Bertocchi GL, Albareda MC, Cesar G, Tarleton RL, Laucella SA. Reduced Trypanosoma cruzi-specific humoral response and enhanced T cell immunity after treatment interruption with benznidazole in chronic Chagas disease. J Antimicrob Chemother 2021; 76:1580-1592. [PMID: 33693664 PMCID: PMC8600036 DOI: 10.1093/jac/dkab054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/08/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Interruption of benznidazole therapy due to the appearance of adverse effects, which is presumed to lead to treatment failure, is a major drawback in the treatment of chronic Chagas disease. METHODS Trypanosoma cruzi-specific humoral and T cell responses, T cell phenotype and parasite load were measured to compare the outcome in 33 subjects with chronic Chagas disease treated with an incomplete benznidazole regimen and 58 subjects treated with the complete regimen, during a median follow-up period of 48 months. RESULTS Both treatment regimens induced a reduction in the T. cruzi-specific antibody levels and similar rates of treatment failure when evaluated using quantitative PCR. Regardless of the regimen, polyfunctional CD4+ T cells increased in the subjects, with successful treatment outcome defined as a decrease of T. cruzi-specific antibodies. Regardless of the serological outcome, naive and central memory T cells increased after both regimens. A decrease in CD4+ HLA-DR+ T cells was associated with successful treatment in both regimens. The cytokine profiles of subjects with successful treatment showed fewer inflammatory mediators than those of the untreated T. cruzi-infected subjects. High levels of T cells expressing IL-7 receptor and low levels of CD8+ T cells expressing the programmed cell death protein 1 at baseline were associated with successful treatment following benznidazole interruption. CONCLUSIONS These findings challenge the notion that treatment failure is the sole potential outcome of an incomplete benznidazole regimen and support the need for further assessment of the treatment protocols for chronic Chagas disease.
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Affiliation(s)
- Melisa D Castro Eiro
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, Buenos Aires, Argentina
| | - María A Natale
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, Buenos Aires, Argentina
| | - María G Alvarez
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Huifeng Shen
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, USA
| | - Rodolfo Viotti
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Bruno Lococo
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Jacqueline Bua
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, Buenos Aires, Argentina
| | - Myriam Nuñez
- Departmento de Físicomatemática, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - María C Albareda
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, Buenos Aires, Argentina
| | - Gonzalo Cesar
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, Buenos Aires, Argentina
| | - Rick L Tarleton
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, USA
| | - Susana A Laucella
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, Buenos Aires, Argentina
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
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16
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Padilla AM, Yao PY, Landry TJ, Cooley GM, Mahaney SM, Ribeiro I, VandeBerg JL, Tarleton RL. High variation in immune responses and parasite phenotypes in naturally acquired Trypanosoma cruzi infection in a captive non-human primate breeding colony in Texas, USA. PLoS Negl Trop Dis 2021; 15:e0009141. [PMID: 33788859 PMCID: PMC8041201 DOI: 10.1371/journal.pntd.0009141] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/12/2021] [Accepted: 03/22/2021] [Indexed: 11/18/2022] Open
Abstract
Trypanosoma cruzi, the causative agent of human Chagas disease, is endemic to the southern region of the United States where it routinely infects many host species. The indoor/outdoor housing configuration used in many non-human primate research and breeding facilities in the southern of the USA provides the opportunity for infection by T. cruzi and thus provides source material for in-depth investigation of host and parasite dynamics in a natural host species under highly controlled and restricted conditions. For cynomolgus macaques housed at such a facility, we used a combination of serial blood quantitative PCR (qPCR) and hemoculture to confirm infection in >92% of seropositive animals, although each method alone failed to detect infection in >20% of cases. Parasite isolates obtained from 43 of the 64 seropositive macaques were of 2 broad genetic types (discrete typing units, (DTU's) I and IV); both within and between these DTU groupings, isolates displayed a wide variation in growth characteristics and virulence, elicited host immune responses, and susceptibility to drug treatment in a mouse model. Likewise, the macaques displayed a diversity in T cell and antibody response profiles that rarely correlated with parasite DTU type, minimum length of infection, or age of the primate. This study reveals the complexity of infection dynamics, parasite phenotypes, and immune response patterns that can occur in a primate group, despite being housed in a uniform environment at a single location, and the limited time period over which the T. cruzi infections were established.
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Affiliation(s)
- Angel M. Padilla
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Phil Y. Yao
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Tre J. Landry
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Gretchen M. Cooley
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Susan M. Mahaney
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, and Center for Vector-Borne Diseases, The University of Texas Rio Grande Valley, Brownsville/Edinburg/Harlingen, Texas, United States of America
| | - Isabela Ribeiro
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - John L. VandeBerg
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, and Center for Vector-Borne Diseases, The University of Texas Rio Grande Valley, Brownsville/Edinburg/Harlingen, Texas, United States of America
| | - 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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17
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Pérez-Antón E, Egui A, Thomas MC, Carrilero B, Simón M, López-Ruz MÁ, Segovia M, López MC. A proportion of CD4+ T cells from patients with chronic Chagas disease undergo a dysfunctional process, which is partially reversed by benznidazole treatment. PLoS Negl Trop Dis 2021; 15:e0009059. [PMID: 33539379 PMCID: PMC7888659 DOI: 10.1371/journal.pntd.0009059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 02/17/2021] [Accepted: 12/22/2020] [Indexed: 12/14/2022] Open
Abstract
Background Signs of senescence and the late stages of differentiation associated with the more severe forms of Chagas disease have been described in the Trypanosoma cruzi antigen-specific CD4+ T-cell population. However, the mechanisms involved in these functions are not fully known. To date, little is known about the possible impact of benznidazole treatment on the T. cruzi-specific functional response of CD4+ T cells. Methodology/Principal findings The functional capacity of CD4+ T cells was analyzed by cytometric assays in chronic Chagas disease patients, with indeterminate form (IND) and cardiac alterations (CCC) (25 and 15, respectively) before and after benznidazole treatment. An increase in the multifunctional capacity (expression of IFN-γ, IL-2, TNF-α, perforin and/or granzyme B) of the antigen-specific CD4+ T cells was observed in indeterminate versus cardiac patients, which was associated with the reduced coexpression of inhibitory receptors (2B4, CD160, CTLA-4, PD-1 and/or TIM-3). The functional profile of these cells shows statistically significant differences between IND and CCC (p<0.001), with a higher proportion of CD4+ T cells coexpressing 2 and 3 molecules in IND (54.4% versus 23.1% and 4.1% versus 2.4%, respectively). A significant decrease in the frequencies of CD4+ T cells that coexpress 2, 3 and 4 inhibitory receptors was observed in IND after 24–48 months of treatment (p<0.05, p<0.01 and p<0.05, respectively), which was associated with an increase in antigen-specific multifunctional activity. The IND group showed, at 9–12 months after treatment, an increase in the CD4+ T cell subset coproducing three molecules, which were mainly granzyme B+, perforin+ and IFN-γ+ (1.4% versus 4.5%). Conclusions/Significance A CD4+ T cell dysfunctional process was detected in chronic Chagas disease patients, being more exacerbated in those patients with cardiac symptoms. After short-term benznidazole treatment (9–12 months), indeterminate patients showed a significant increase in the frequency of multifunctional antigen-specific CD4+ T cells. Trypanosoma cruzi infection triggers several immune mechanisms in the host that do not result in a total clearance of the parasite, the persistence of which leads to the chronicity of Chagas disease. The mechanisms by which some chronic patients remain asymptomatic or become symptomatic are not entirely clear. The aim of the present manuscript is to study the CD4+ T cell population and its functional capacity in patients with different forms of chronic disease. The obtained results indicate that cells from indeterminate patients have an enhanced multifunctional profile, which is associated with the reduced expression of inhibitory molecules. CD4+ T cells from chronic patients with cardiac alterations show lower functional activity against specific antigens of the parasite and increased coexpression of inhibitory molecules. After benznidazole treatment, antigen-specific CD4+ T cells, especially those from indeterminate patients, are more likely to show a multifunctional profile and a decline in the coexpression of inhibitory receptors. These results allow us to make progress in clarifying the mechanisms that may influence disease progression and to realize the importance of antiparasitic treatment for the enhancement of the activity of the immune system.
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Affiliation(s)
- Elena Pérez-Antón
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas; Granada, Spain
| | - Adriana Egui
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas; Granada, Spain
| | - M. Carmen Thomas
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas; Granada, Spain
| | - Bartolomé Carrilero
- Unidad Regional de Medicina Tropical, Hospital Virgen de la Arrixaca; El Palmar, Murcia, Spain
| | - Marina Simón
- Unidad Regional de Medicina Tropical, Hospital Virgen de la Arrixaca; El Palmar, Murcia, Spain
| | | | - Manuel Segovia
- Unidad Regional de Medicina Tropical, Hospital Virgen de la Arrixaca; El Palmar, Murcia, Spain
| | - Manuel Carlos López
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas; Granada, Spain
- * E-mail:
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Shen H, Forgacs D, Chapla D, Moremen KW, Wells L, Hamer SA, Tompkins SM, Ross TM, Rouphael N, Edupuganti S, Collins MH, Tarleton RL. A flexible, pan-species, multi-antigen platform for the detection and monitoring of SARS-CoV-2-specific antibody responses. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.01.20.21249279. [PMID: 33532799 PMCID: PMC7852250 DOI: 10.1101/2021.01.20.21249279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The SARS-CoV-2 pandemic and the vaccination effort that is ongoing has created an unmet need for accessible, affordable, flexible and precise platforms for monitoring the induction, specificity and maintenance of virus-specific immune responses. Herein we validate a multiplex (Luminex-based) assay capable of detecting SARS-CoV-2-specific antibodies irrespective of host species, antibody isotype, and specimen type (e.g. plasma, serum, saliva or blood spots). The well-established precision of Luminex-based assays provides the ability to follow changes in antibody levels over time to many antigens, including multiple permutations of the most common SARS-CoV-2 antigens. This platform can easily measure antibodies known to correlate with neutralization activity as well as multiple non-SARS-CoV-2 antigens such as vaccines (e.g. Tetanus toxoid) or those from frequently encountered agents (influenza), which serve as stable reference points for quantifying the changing SARS-specific responses. All of the antigens utilized in our study can be made in-house, many in E. coli using readily available plasmids. Commercially sourced antigens may also be incorporated and newly available antigen variants can be rapidly produced and integrated, making the platform adaptable to the evolving viral strains in this pandemic.
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Affiliation(s)
- Huifeng Shen
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens GA, USA
| | - David Forgacs
- Center for Vaccines and Immunology, University of Georgia, Athens GA, USA
| | - Digantkumar Chapla
- Complex Carbohydrate Research Center, University of Georgia, Athens GA, USA
| | - Kelley W. Moremen
- Complex Carbohydrate Research Center, University of Georgia, Athens GA, USA
- Department of Biochemistry, University of Georgia, Athens GA, USA
| | - Lance Wells
- Complex Carbohydrate Research Center, University of Georgia, Athens GA, USA
- Department of Biochemistry, University of Georgia, Athens GA, USA
| | - Sarah A. Hamer
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station TX, USA
| | - Stephen M. Tompkins
- Center for Vaccines and Immunology, University of Georgia, Athens GA, USA
- Department of Infectious Diseases, University of Georgia, Athens GA, USA
| | - Ted M. Ross
- Center for Vaccines and Immunology, University of Georgia, Athens GA, USA
- Department of Infectious Diseases, University of Georgia, Athens GA, USA
| | - Nadine Rouphael
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Decatur, Georgia, USA
| | - Srilatha Edupuganti
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Decatur, Georgia, USA
| | - Matthew H. Collins
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Decatur, Georgia, USA
| | - Rick L. Tarleton
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens GA, USA
- Department of Cellular Biology, University of Georgia, Athens GA, USA
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Vallejo M, Reyes PP, Martinez Garcia M, Gonzalez Garay AG. Trypanocidal drugs for late-stage, symptomatic Chagas disease (Trypanosoma cruzi infection). Cochrane Database Syst Rev 2020; 12:CD004102. [PMID: 33305846 PMCID: PMC8103997 DOI: 10.1002/14651858.cd004102.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND People with Chagas disease may develop progressive and lethal heart conditions. Drugs to eliminate the parasite Trypanosoma cruzi (T cruzi) currently carry limited therapeutic value and are used in the early stages of the disease. Extending the use of these drugs to treat chronic chagasic cardiomyopathy (CCC) has also been proposed. OBJECTIVES To assess the benefits and harms of nitrofurans and trypanocidal drugs for treating late-stage, symptomatic Chagas disease and CCC in terms of blood parasite reduction or clearance, mortality, adverse effects, and quality of life. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and LILACS databases on 12 November 2019. We also searched two clinical trials registers, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), on 3 December 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) assessing trypanocidal drugs versus placebo or no treatment for late-stage, symptomatic Chagas disease and CCC. DATA COLLECTION AND ANALYSIS We conducted the reporting of the review according the standard Cochrane methods. Two review authors independently retrieved articles, performed data extraction, and assessed risk of bias. Any disagreements were resolved by a third review author. We contacted study authors for additional information. MAIN RESULTS We included two studies in this review update. One RCT randomly assigned 26 participants to benznidazole 5 mg/kg/day; 27 participants to nifurtimox 5 mg/kg/day; and 24 participants to placebo for 30 days. The second RCT, newly included in this update, randomised 1431 participants to benznidazole 300 mg/day for 40 to 80 days and 1423 participants to placebo. We also identified one ongoing study. Benznidazole compared to placebo At five-year follow-up, low quality of the evidence suggests that there may be a benefit of benznidazole when compared to placebo for clearance or reduction of antibody titres (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.14 to 1.37; 1 trial; 1896 participants). We are uncertain about the effects of benznidazole for the clearance of parasitaemia demonstrated by negative xenodiagnosis, blood culture, and/or molecular assays due to very limited evidence. Low quality of the evidence suggests that when compared to placebo, benznidazole may make little to no difference in the risk of heart failure (RR 0.89, 95% CI 0.69 to 1.14; 1 trial; 2854 participants) and ventricular tachycardia (RR 0.80, 95% CI 0.51 to 1.26; 1 trial; 2854 participants). We found moderate quality of the evidence that adverse events increase with benznidazole when compared to placebo (RR 2.52, 95% CI 2.09 to 3.03; 1 trial; 2854 participants). Adverse effects were observed in 23.9% of patients in the benznidazole group compared to 9.5% in the placebo group. The most frequent adverse effects were: cutaneous rash, gastrointestinal symptoms, and peripheral polyneuropathy. No data were available for the outcomes of pathological demonstration of tissue parasites and quality of life. Nifurtimox compared to placebo Data were only available for this comparison for the outcome clearance or reduction of antibody titres, and we are uncertain about the effect due to very limited evidence. Regarding adverse events, one RCT mentioned in a general manner that nifurtimox caused intense adverse events, without any quantification. AUTHORS' CONCLUSIONS There is insufficient evidence to support the efficacy of the trypanocidal drugs benznidazole and nifurtimox for late-stage, symptomatic Chagas disease and CCC.
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Affiliation(s)
- Maite Vallejo
- Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1. Col. Seccion XVI, Tlalpan, Mexico
| | - Pedro Pa Reyes
- Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1. Col. Seccion XVI, Tlalpan, Mexico
| | - Mireya Martinez Garcia
- Sociomedical Research Unit, Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City, Mexico
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Buss LF, Campos de Oliveira- da Silva L, Moreira CHV, Manuli ER, Sales FC, Morales I, Di Germanio C, de Almeida-Neto C, Bakkour S, Constable P, Pinto-Filho MM, Ribeiro AL, Busch M, Sabino EC. Declining antibody levels to Trypanosoma cruzi correlate with polymerase chain reaction positivity and electrocardiographic changes in a retrospective cohort of untreated Brazilian blood donors. PLoS Negl Trop Dis 2020; 14:e0008787. [PMID: 33108390 PMCID: PMC7647114 DOI: 10.1371/journal.pntd.0008787] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/06/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Although infection with Trypanosoma cruzi is thought to be lifelong, less than half of those infected develop cardiomyopathy, suggesting greater parasite control or even clearance. Antibody levels appear to correlate with T. cruzi (antigen) load. We test the association between a downwards antibody trajectory, PCR positivity and ECG alterations in untreated individuals with Chagas disease. Methodology/Principal findings This is a retrospective cohort of T. cruzi seropositive blood donors. Paired blood samples (index donation and follow-up) were tested using the VITROS Immunodiagnostic Products Anti-T.cruzi (Chagas) assay (Ortho Clinical Diagnostics, Raritan NJ) and PCR performed on the follow-up sample. A 12-lead resting ECG was performed. Significant antibody decline was defined as a reduction of > 1 signal-to-cutoff (S/CO) unit on the VITROS assay. Follow-up S/CO of < 4 was defined as borderline/low. 276 untreated seropositive blood donors were included. The median (IQR) follow-up was 12.7 years (8.5–16.9). 56 (22.1%) subjects had a significant antibody decline and 35 (12.7%) had a low/borderline follow-up result. PCR positivity was lower in the falling (26.8% vs 52.8%, p = 0.001) and low/borderline (17.1% vs 51.9%, p < 0.001) antibody groups, as was the rate of ECG abnormalities. Falling and low/borderline antibody groups were predominantly composed of individuals with negative PCR and normal ECG findings: 64% and 71%, respectively. Conclusions/Significance Low and falling antibody levels define a phenotype of possible spontaneous parasite clearance. Infection with the single-celled parasite Trypanosoma cruzi (Chagas disease) is thought to be lifelong. However, only a third of infected people develop Chagas cardiomyopathy–the main disease manifestation. This may reflect the different extent to which individuals control the parasite, with some potentially clearing it entirely. In chronically infected immunocompetent patients, a marker of parasite burden is the quantity of antibody against T. cruzi in the blood: more parasite, more immune stimulation, more antibody. In this study we show how antibody levels change over many years in a cohort of untreated patients with Chagas disease. We find that among individuals with falling or low/borderline antibody levels there was a lower rate of parasite detection in the blood and a lower rate of cardiomyopathy. 60% of subjects with falling antibody levels had no evidence of active disease, twice as many as among patients with other antibody trajectories (stable or rising). Our findings support an account of the natural history of Chagas disease in which a proportion of those infected achieve a greater control of the parasite, with some individuals potentially clearing it completely.
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Affiliation(s)
- Lewis F. Buss
- Instituto de Medicina Tropical da Faculdade de Medicina (FMUSP) da Universidade de São Paulo, São Paulo, Brazil
| | | | - Carlos H. V. Moreira
- Instituto de Medicina Tropical da Faculdade de Medicina (FMUSP) da Universidade de São Paulo, São Paulo, Brazil
| | - Erika R. Manuli
- Instituto de Medicina Tropical da Faculdade de Medicina (FMUSP) da Universidade de São Paulo, São Paulo, Brazil
| | - Flavia C. Sales
- Instituto de Medicina Tropical da Faculdade de Medicina (FMUSP) da Universidade de São Paulo, São Paulo, Brazil
| | - Ingra Morales
- Instituto de Medicina Tropical da Faculdade de Medicina (FMUSP) da Universidade de São Paulo, São Paulo, Brazil
| | - Clara Di Germanio
- Vitalant Research Institute, San Francisco, CA, United States of America
| | | | - Sonia Bakkour
- Vitalant Research Institute, San Francisco, CA, United States of America
| | - Paul Constable
- Ortho Clinical Diagnostics, Rochester, NY, United States of America
| | - Marcelo M. Pinto-Filho
- Telehealth Center, Hospital das Clínicas, and Internal Medicine Department, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antonio L. Ribeiro
- Telehealth Center, Hospital das Clínicas, and Internal Medicine Department, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Michael Busch
- Vitalant Research Institute, San Francisco, CA, United States of America
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Ester C. Sabino
- Instituto de Medicina Tropical da Faculdade de Medicina (FMUSP) da Universidade de São Paulo, São Paulo, Brazil
- * E-mail:
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21
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New Scheme of Intermittent Benznidazole Administration in Patients Chronically Infected with Trypanosoma cruzi: Clinical, Parasitological, and Serological Assessment after Three Years of Follow-Up. Antimicrob Agents Chemother 2020; 64:AAC.00439-20. [PMID: 32571827 DOI: 10.1128/aac.00439-20] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/18/2020] [Indexed: 02/07/2023] Open
Abstract
In a pilot study, we showed that the intermittent administration of benznidazole in chronic Chagas disease patients resulted in a low rate of treatment suspension and therapeutic failure, as assessed by quantitative PCR (qPCR) at the end of treatment. Here, a 3-year posttreatment follow-up study of the same cohort of patients is presented. The treatment scheme consisted of 12 doses of benznidazole at 5 mg/kg of body weight/day in two daily doses every 5 days. Parasite load, Trypanosoma cruzi-specific antibodies, and serum chemokine levels were measured prior to treatment and after a median follow-up of 36 months posttreatment by DNA minicircle kinetoplastid and nuclear DNA satellite sequence qPCR methods, conventional serological techniques, a Luminex-based assay with recombinant T. cruzi proteins, and a cytometric bead array. At the end of follow-up, 14 of 17 (82%) patients had negative qPCR findings, whereas three of 17 (18%) had detectable nonquantifiable findings by at least one of the qPCR techniques. A decline in parasite-specific antibodies at 12 months posttreatment was confirmed by conventional serological tests and the Luminex assays. Monocyte chemoattractant protein 1 levels increased after treatment, whereas monokine induced by gamma interferon levels decreased. New posttreatment electrocardiographic abnormalities were observed in only one patient who had cardiomyopathy prior to treatment. Together, these data strengthen our previous findings by showing that the intermittent administration of benznidazole results in a low rate of treatment suspension, with treatment efficacy comparable to that of a daily dose of 5 mg/kg for 60 days.
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22
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Frade VP, Simões NS, Couto NRB, Sanches C, Oliveira CDL. Ideal benznidazole dose regimen in chronic chagasic patients: a systematic review. Rev Inst Med Trop Sao Paulo 2020; 62:e52. [PMID: 32725057 PMCID: PMC7384592 DOI: 10.1590/s1678-9946202062052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/01/2020] [Indexed: 11/22/2022] Open
Abstract
The present study aimed to review the existing literature and to evaluate the best dose regimen for benznidazole in adult patients with Chagas disease in the chronic phase. A systematic review was conducted followed by meta-analysis. Searches were performed in four databases, to include studies published until May 2019. The descriptors used were: "Chagas disease", "benznidazole", "Drug Therapy", "Pharmacokinetics", "Dose-response relationship, drug" and "Chronic disease". The meta-analysis compared studies using the standard dose of 5 mg/kg/day for 30 or 60 days. A total of 608 articles were found, 23 of which were considered eligible for this review and nine were included in the meta-analysis. The studies selected and analyzed were published between 1996 and 2018, with various benznidazole dose regimens, ranging from 2.5 mg/kg/day to 10 mg/kg/day, for 30 to 80 days of treatment. The results pointed to a great diversity of dose regimens, thus there is no consensus on the optimal dose regimen for benznidazole in the chronic phase of Chagas disease.
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Affiliation(s)
| | | | | | - Cristina Sanches
- Universidade Federal de São João del-Rei, Divinópolis, Minas Gerais, Brazil
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23
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Rial MS, Arrúa EC, Natale MA, Bua J, Esteva MI, Prado NG, Laucella SA, Salomon CJ, Fichera LE. Efficacy of continuous versus intermittent administration of nanoformulated benznidazole during the chronic phase of Trypanosoma cruzi Nicaragua infection in mice. J Antimicrob Chemother 2020; 75:1906-1916. [DOI: 10.1093/jac/dkaa101] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/10/2020] [Accepted: 02/20/2020] [Indexed: 12/30/2022] Open
Abstract
Abstract
Background
Benznidazole and nifurtimox are effective drugs used to treat Chagas’ disease; however, their administration in patients in the chronic phase of the disease is still limited, mainly due to their limited efficacy in the later chronic stage of the disease and to the adverse effects related to these drugs.
Objectives
To evaluate the effect of low doses of nanoformulated benznidazole using a chronic model of Trypanosoma cruzi Nicaragua infection in C57BL/6J mice.
Methods
Nanoformulations were administered in two different schemes: one daily dose for 30 days or one dose every 7 days, 13 times.
Results
Both treatment schemes showed promising outcomes, such as the elimination of parasitaemia, a reduction in the levels of T. cruzi-specific antibodies and a reduction in T. cruzi-specific IFN-γ-producing cells, as well as an improvement in electrocardiographic alterations and a reduction in inflammation and fibrosis in the heart compared with untreated T. cruzi-infected animals. These results were also compared with those from our previous work on benznidazole administration, which was shown to be effective in the same chronic model.
Conclusions
In this experimental model, intermittently administered benznidazole nanoformulations were as effective as those administered continuously; however, the total dose administered in the intermittent scheme was lower, indicating a promising therapeutic approach to Chagas’ disease.
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Affiliation(s)
- M S Rial
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - E C Arrúa
- Area Técnica Farmacéutica, Departamento de Farmacia, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - M A Natale
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud de la Nación, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - J Bua
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud de la Nación, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - M I Esteva
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - N G Prado
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - S A Laucella
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud de la Nación, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - C J Salomon
- Area Técnica Farmacéutica, Departamento de Farmacia, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - L E Fichera
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud de la Nación, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Pérez-Antón E, Egui A, Thomas MC, Simón M, Segovia M, López MC. Immunological exhaustion and functional profile of CD8 + T lymphocytes as cellular biomarkers of therapeutic efficacy in chronic Chagas disease patients. Acta Trop 2020; 202:105242. [PMID: 31669531 DOI: 10.1016/j.actatropica.2019.105242] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 12/11/2022]
Abstract
The lack of useful tools for detection the impact of treatment during the follow-up of chronic Chagas disease treated patients difficult the adequate care to the affected population. The objective of this study was to evaluate the functional response of CD8+ T lymphocyte population, critical for the control of Trypanosoma cruzi infection, as a possible cellular biomarker of treated Chagas disease patients. Thus, we analyzed the antigen-specific CD8+ T-cell response before and after benznidazole treatment in asymptomatic (indeterminate) and cardiac chronic Chagas disease patients. A marked dysfunctional process of the CD8+ T cell population was found in patients with an advanced pathology. Thus, the cardiac patients have a higher co-expression of inhibitory receptors and a lower antigen-specific multifunctional capacity compared with that of asymptomatic patients. Remarkably, benznidazole treatment partially reverses this functional exhaustion process of CD8+ T cells in both asymptomatic and cardiac Chagas disease patients. Thus, the co-expression of inhibitory molecules tends to be reduced after benznidazole treatment, mainly in asymptomatic patients, finding a significant drop in the expression of inhibitory receptors such as PD-1 and 2B4. In addition, the multifunctional antigen-specific response of CD8+ T cells is enhanced after treatment in chronic patients. An increase in the subset of cells with cytotoxic capacity and production of the IFN-γ cytokine was also observed in both treated asymptomatic and cardiac chronic Chagas disease patients. The results derived from this study show the improvement of the functional capacity of CD8+ T cells after treatment which could be have a positive effect on parasitic control. In addition, the phenotypic and functional profile of the CD8+ T cells described could serve as a tool for monitoring the impact of benznidazole treatment.
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Affiliation(s)
- Elena Pérez-Antón
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas, Granada, Spain
| | - Adriana Egui
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas, Granada, Spain
| | - Mª Carmen Thomas
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas, Granada, Spain
| | - Marina Simón
- Unidad Regional de Medicina Tropical, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Manuel Segovia
- Unidad Regional de Medicina Tropical, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Manuel Carlos López
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas, Granada, Spain.
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Differential phenotypic and functional profile of epitope-specific cytotoxic CD8 + T cells in benznidazole-treated chronic asymptomatic Chagas disease patients. Biochim Biophys Acta Mol Basis Dis 2019; 1866:165629. [PMID: 31816438 DOI: 10.1016/j.bbadis.2019.165629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/18/2019] [Accepted: 10/28/2019] [Indexed: 12/11/2022]
Abstract
One of the greatest challenges in Chagas disease research is the search for tools that will enable the assessment of pharmacological treatment efficacy. A recently described set of serological biomarkers composed of four parasite antigens and established criteria of treatment efficacy allowed the evaluation of the impact of benznidazole treatment a short/medium time after the treatment. In addition, cellular immunological parameters have also been described as potential indicators of the treatment response. The cytotoxic CD8+ T cells specific to five epitopes in the PFR2, PFR3, TcCA-2 and KMP11 antigens have been analysed, and these epitopes have been shown to be recognized, processed and presented in the context of a natural T. cruzi infection. In the present manuscript, we characterized these antigen-specific CD8+ T cells in indeterminate chronic Chagas disease patients both before and after (from 11 to 28 months) benznidazole treatment. The results indicate that there is a differential memory CD8+ T cell profile depending on the antigenic epitope and that the benznidazole treatment modulates the memory, differentiation and senescence phenotypes of the epitope-specific CD8+ T cells. Moreover, in these patients, the reactivity of sera against the referred set of biomarkers was evaluated. The data obtained show that the patients who met the established therapeutic efficacy criteria presented a differential phenotypic profile of the antigen-specific CD8+ T cells even prior to treatment compared to the patients who did not meet the therapeutic efficacy criteria, and this behaviour is associated with a better functionality of these CD8+ T cells.
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26
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Acosta Rodríguez EV, Araujo Furlan CL, Fiocca Vernengo F, Montes CL, Gruppi A. Understanding CD8 + T Cell Immunity to Trypanosoma cruzi and How to Improve It. Trends Parasitol 2019; 35:899-917. [PMID: 31607632 PMCID: PMC6815727 DOI: 10.1016/j.pt.2019.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 12/30/2022]
Abstract
The protozoan Trypanosoma cruzi is the causative agent of Chagas' disease, endemic in Latin America but present worldwide. Research efforts have focused on the examination of immune mechanisms that mediate host protection as well as immunopathology during this parasitic infection. The study of CD8+ T cell immunity emerges as a key aspect given the critical importance of parasite-specific CD8+ T cells for host resistance throughout the infection. In recent years, new research has shed light on novel pathways that modulate the induction, maintenance, and regulation of CD8+ T cell responses to T. cruzi. This new knowledge is setting the ground for future vaccines and/or immunotherapies. Herein, we critically review and analyze the latest results published in the field.
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Affiliation(s)
- Eva V Acosta Rodríguez
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI)-CONICET, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, X5000HUA Córdoba, Argentina.
| | - Cintia L Araujo Furlan
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI)-CONICET, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, X5000HUA Córdoba, Argentina
| | - Facundo Fiocca Vernengo
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI)-CONICET, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, X5000HUA Córdoba, Argentina
| | - Carolina L Montes
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI)-CONICET, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, X5000HUA Córdoba, Argentina
| | - Adriana Gruppi
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI)-CONICET, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, X5000HUA Córdoba, Argentina
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Pengue C, Cesar G, Alvarez MG, Bertocchi G, Lococo B, Viotti R, Natale MA, Castro Eiro MD, Cambiazzo SS, Perroni N, Nuñez M, Albareda MC, Laucella SA. Impaired frequencies and function of platelets and tissue remodeling in chronic Chagas disease. PLoS One 2019; 14:e0218260. [PMID: 31199841 PMCID: PMC6570032 DOI: 10.1371/journal.pone.0218260] [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: 11/23/2018] [Accepted: 05/29/2019] [Indexed: 01/30/2023] Open
Abstract
Chronic inflammation, as a consequence of the persistent infection with Trypanosoma cruzi, leads to continuous activation of the immune system in patients with chronic Chagas disease. We have previously shown that increased sera levels of soluble P-selectin are associated with the severity of the cardiomyopathy distinctive of chronic Chagas disease. In this study, we explored the expression of biomarkers of platelet and endothelial activation, tissue remodeling, and mediators of the coagulation cascade in patients at different clinical stages of chronic Chagas heart disease. The frequencies of activated platelets, measured by the expression of CD41a and CD62P were decreased in patients with chronic Chagas disease compared with those in uninfected subjects, with an inverse association with disease severity. Platelet activation in response to adenosine diphosphate was also decreased in T. cruzi-infected subjects. A major proportion of T. cruzi infected subjects showed increased serum levels of fibrinogen. Patients with severe cardiac dysfunction showed increased levels of endothelin-1 and normal values of procollagen I. In conclusion, chronic infection with T. cruzi induced hemostatic alterations, even in those patients who do not yet present cardiac symptoms.
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Affiliation(s)
- Claudia Pengue
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Gonzalo Cesar
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
| | | | - Graciela Bertocchi
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Bruno Lococo
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Rodolfo Viotti
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - María Ailén Natale
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
| | | | | | - Nancy Perroni
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Myriam Nuñez
- Departamento de Matemática y Física, Facultad Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina
| | - María Cecilia Albareda
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
- * E-mail: (SAL); (MCA)
| | - Susana A. Laucella
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
- * E-mail: (SAL); (MCA)
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28
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Camara EJN, Mendonca VRR, Souza LCL, Carvalho JS, Lessa RA, Gatto R, Barreto LO, Chiacchio G, Amarante E, Cunha M, Alves-Silva LS, Guimarães BAC, Barral-Netto M. Elevated IL-17 levels and echocardiographic signs of preserved myocardial function in benznidazole-treated individuals with chronic Chagas' disease. Int J Infect Dis 2018; 79:123-130. [PMID: 30528394 DOI: 10.1016/j.ijid.2018.11.369] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The immunological and clinical impact of trypanocidal treatment in chronic Chagas' disease (CCD) is unclear. METHODOLOGY AND FINDINGS Several cytokines were measured in plasma of 66 patients with CCD. Thirty-three patients had been previously treated with benznidazole and 33 had never been treated. The treated group exhibited higher levels of IL-17 (median 142.45×1.22pg/ml, P=0.025), which was the only one significantly associated with Bz treatment, especially after adjusting for time of disease and NYHA class (P=0.024; OR 1.006, 95% CI 1.001-1.010). Compared to untreated patients, the treated group exhibited higher median values of mitral annular E' lateral (13.0×10.0cm/s, P=0.038), S' infero-lateral (8.9×7.6cm/s, P=0.013), S' septal (8.5×7.4cm/s, P=0.034), mean S' (9.0×7.9cm/s, P=0.013) and tricuspid annular S' (13.3×11.1cm/s, P=0.001) and lower values of E/E' septal (7.2×9.5cm/s, P=0.049). After adjustment for time of disease and NYHA class, S' infero-lateral (P=0.031), mean S' (P=0.049) and S' tricuspid (P=0.024) persisted as significantly associated with treatment. CONCLUSION The present findings suggest that the group of CCD patients treated with Bz displayed increased plasma levels of IL-17 and preserved myocardial function, reinforcing the idea that Bz treatment may be beneficial.
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Affiliation(s)
- Edmundo J N Camara
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil; Unidade Docente Assistencial de Cardiologia (UDAC), Complexo Hospitalar Professor Edgard Santos Universidade Federal da Bahia, Salvador, Brazil
| | - Vitor R R Mendonca
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Ligia C L Souza
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Ruda A Lessa
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Ramon Gatto
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Luan O Barreto
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | - Monaliza Cunha
- Unidade Docente Assistencial de Cardiologia (UDAC), Complexo Hospitalar Professor Edgard Santos Universidade Federal da Bahia, Salvador, Brazil
| | - Luis S Alves-Silva
- Unidade Docente Assistencial de Cardiologia (UDAC), Complexo Hospitalar Professor Edgard Santos Universidade Federal da Bahia, Salvador, Brazil
| | | | - Manoel Barral-Netto
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil; Instituto Nacional de Ciência e Tecnologia em Investigação em Imunologia (iii-INCT), São Paulo, Brazil.
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29
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Egui A, Lasso P, Pérez-Antón E, Thomas MC, López MC. Dynamics of T Cells Repertoire During Trypanosoma cruzi Infection and its Post-Treatment Modulation. Curr Med Chem 2018; 26:6519-6543. [PMID: 30381063 DOI: 10.2174/0929867325666181101111819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 09/11/2018] [Accepted: 09/25/2018] [Indexed: 01/16/2023]
Abstract
Chagas disease courses with different clinical phases and has a variable clinical presentation and progression. The acute infection phase mostly exhibits a non-specific symptomatology. In the absence of treatment, the acute phase is followed by a chronic phase, which is initially asymptomatic. This chronic asymptomatic phase of the disease is characterized by a fragile balance between the host's immune response and the parasite replication. The loss of this balance is crucial for the progression of the sickness. The virulence and tropism of the T. cruzi infecting strain together to the inflammation processes in the cardiac tissue are the main factors for the establishment and severity of the cardiomyopathy. The efficacy of treatment in chronic Chagas disease patients is controversial. However, several studies carried out in chronic patients demonstrated that antiparasitic treatment reduces parasite load in the bloodstream and leads to an improvement in the immune response against the Trypanosoma cruzi parasite. The present review is mainly focused on the cellular patterns associated to the clinical status and the evolution of the disease in chronic patients, as well as the effectiveness of the treatment related to T. cruzi infection control. Therefore, an emphasis is placed on the dynamics of specific-antigens T cell subpopulations, their memory and activation phenotypes, their functionality and their contribution to pathogenesis or disease control, as well as their association with risk of congenital transmission of the parasite.
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Affiliation(s)
- Adriana Egui
- Instituto de Parasitologia y Biomedicina Lopez-Neyra, Consejo Superior de Investigaciones Científicas; Granada, Spain
| | - Paola Lasso
- Grupo de Inmunobiologia y Biologia Celular, Pontificia Universidad Javeriana; Bogota, Colombia
| | - Elena Pérez-Antón
- Instituto de Parasitologia y Biomedicina Lopez-Neyra, Consejo Superior de Investigaciones Científicas; Granada, Spain
| | - M Carmen Thomas
- Instituto de Parasitologia y Biomedicina Lopez-Neyra, Consejo Superior de Investigaciones Científicas; Granada, Spain
| | - Manuel Carlos López
- Instituto de Parasitologia y Biomedicina Lopez-Neyra, Consejo Superior de Investigaciones Científicas; Granada, Spain
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30
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Albareda MC, Natale MA, De Rissio AM, Fernandez M, Serjan A, Alvarez MG, Cooley G, Shen H, Viotti R, Bua J, Castro Eiro MD, Nuñez M, Fichera LE, Lococo B, Scollo K, Tarleton RL, Laucella SA. Distinct Treatment Outcomes of Antiparasitic Therapy in Trypanosoma cruzi-Infected Children Is Associated With Early Changes in Cytokines, Chemokines, and T-Cell Phenotypes. Front Immunol 2018; 9:1958. [PMID: 30271399 PMCID: PMC6146084 DOI: 10.3389/fimmu.2018.01958] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/08/2018] [Indexed: 12/27/2022] Open
Abstract
Background: In contrast to adults, Trypanosoma cruzi-infected children have more broadly functional Trypanosoma cruzi-specific T cells, and the total T-cell compartment exhibits fewer signs of immune exhaustion. However, not much is known about the link between immunocompetence and the treatment efficacy for human Chagas disease. Methods: Using cytokine enzyme-linked immunosorbent spot (ELISPOT) polychromatic flow cytometry, cytometric bead assay, multiplex serological assays and quantitative PCR, we evaluated T. cruzi-specific T-cell and antibody immune responses, T-cell phenotypes and parasitemia in children in the early chronic phase of Chagas disease undergoing anti-Trypanosoma cruzi treatment. Results: Treatment with benznidazole or nifurtimox induced a decline in T. cruzi-specific IFN-γ- and IL-2-producing cells and proinflammatory cytokines and chemokines. T-cell responses became detectable after therapy in children bearing T-cell responses under background levels prior to treatment. The total frequencies of effector, activated and antigen-experienced T cells also decreased following anti-T. cruzi therapy, along with an increase in T cells expressing the receptor of the homeostatic cytokine IL-7. Posttreatment changes in several of these markers distinguished children with a declining serologic response suggestive of successful treatment from those with sustained serological responses in a 5-year follow-up study. A multivariate analysis demonstrated that lower frequency of CD4+CD45RA−CCR7−CD62L− T cells prior to drug therapy was an independent indicator of successful treatment. Conclusions: These findings further validate the usefulness of alternative metrics to monitor treatment outcomes. Distinct qualitative and quantitative characteristics of T cells prior to drug therapy may be linked to treatment efficacy.
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Affiliation(s)
- María C Albareda
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
| | - María A Natale
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
| | - Ana M De Rissio
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
| | - Marisa Fernandez
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
| | | | - María G Alvarez
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Gretchen Cooley
- Center for Tropical and Emerging Global Diseases, Athens, GA, United States
| | - Huifeng Shen
- Center for Tropical and Emerging Global Diseases, Athens, GA, United States
| | - Rodolfo Viotti
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Jacqueline Bua
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
| | - Melisa D Castro Eiro
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
| | - Myriam Nuñez
- Department of Mathematical Physics, Facultad Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Laura E Fichera
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
| | - Bruno Lococo
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Karenina Scollo
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina
| | - Rick L Tarleton
- Center for Tropical and Emerging Global Diseases, Athens, GA, United States
| | - Susana A Laucella
- Instituto Nacional de Parasitología Dr. M. Fatala Chaben, Buenos Aires, Argentina.,Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
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31
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Vaccine-Linked Chemotherapy Improves Benznidazole Efficacy for Acute Chagas Disease. Infect Immun 2018; 86:IAI.00876-17. [PMID: 29311242 DOI: 10.1128/iai.00876-17] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/02/2018] [Indexed: 12/14/2022] Open
Abstract
Chagas disease affects 6 to 7 million people worldwide, resulting in significant disease burdens and health care costs in countries of endemicity. Chemotherapeutic treatment is restricted to two parasiticidal drugs, benznidazole and nifurtimox. Both drugs are highly effective during acute disease but are only minimally effective during chronic disease and fraught with significant adverse clinical effects. In experimental models, vaccines can be used to induce parasite-specific balanced TH1/TH2 immune responses that effectively reduce parasite burdens and associated inflammation while minimizing adverse effects. The objective of this study was to determine the feasibility of vaccine-linked chemotherapy for reducing the amount of benznidazole required to significantly reduce blood and tissue parasite burdens. In this study, we were able to achieve a 4-fold reduction in the amount of benznidazole required to significantly reduce blood and tissue parasite burdens by combining the low-dose benznidazole with a recombinant vaccine candidate, Tc24 C4, formulated with a synthetic Toll-like 4 receptor agonist, E6020, in a squalene oil-in-water emulsion. Additionally, vaccination induced a robust parasite-specific balanced TH1/TH2 immune response. We concluded that vaccine-linked chemotherapy is a feasible option for advancement to clinical use for improving the tolerability and efficacy of benznidazole.
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32
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The Trypomastigote Small Surface Antigen from Trypanosoma cruzi Improves Treatment Evaluation and Diagnosis in Pediatric Chagas Disease. J Clin Microbiol 2017; 55:3444-3453. [PMID: 28978686 DOI: 10.1128/jcm.01317-17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/27/2017] [Indexed: 02/06/2023] Open
Abstract
Chagas disease is caused by the protozoan parasite Trypanosoma cruzi Assessment of parasitological cure upon treatment with available drugs relies on achieving consistent negative results in conventional parasitological and serological tests, which may take years to assess. Here, we evaluated the use of a recombinant T. cruzi antigen termed trypomastigote small surface antigen (TSSA) as an early serological marker of drug efficacy in T. cruzi-infected children. A cohort of 78 pediatric patients born to T. cruzi-infected mothers was included in this study. Only 39 of the children were infected with T. cruzi, and they were immediately treated with trypanocidal drugs. Serological responses against TSSA were evaluated in infected and noninfected populations during the follow-up period using an in-house enzyme-linked immunosorbent assay (ELISA) and compared to conventional serological methods. Anti-TSSA antibody titers decreased significantly faster than anti-whole parasite antibodies detected by conventional serology both in T. cruzi-infected patients undergoing effective treatment and in those not infected. The differential kinetics allowed a significant reduction in the required follow-up periods to evaluate therapeutic responses or to rule out maternal-fetal transmission. Finally, we present the case of a congenitally infected patient with an atypical course in whom TSSA provided an early marker for T. cruzi infection. In conclusion, we showed that TSSA was efficacious both for rapid assessment of treatment efficiency and for early negative diagnosis in infants at risk of congenital T. cruzi infection. Based upon these findings we propose the inclusion of TSSA for refining the posttherapeutic cure criterion and other diagnostic needs in pediatric Chagas disease.
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33
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Castro Eiro MD, Alvarez MG, Cooley G, Viotti RJ, Bertocchi GL, Lococo B, Albareda MC, De Rissio AM, Natale MA, Parodi C, Tarleton RL, Laucella SA. The Significance of Discordant Serology in Chagas Disease: Enhanced T-Cell Immunity to Trypanosoma cruzi in Serodiscordant Subjects. Front Immunol 2017; 8:1141. [PMID: 28966620 PMCID: PMC5605634 DOI: 10.3389/fimmu.2017.01141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/30/2017] [Indexed: 02/06/2023] Open
Abstract
Background Subjects are considered infected with Trypanosoma cruzi when tested positive by at least two out of three serological tests, whereas a positive result in only one of up to three tests is termed “serodiscordant” (SD). Assessment of parasite-specific T-cell responses may help discriminate the uninfected from infected individuals among SD subjects. Methods Peripheral blood mononuclear cells from SD and seropositive (SP) subjects, who were born in areas endemic for T. cruzi infection but living in Buenos Aires city, Argentina, at the time of the study, and seronegative unexposed subjects were included for analysis. The function and phenotype of T cells were assessed by interferon-γ (IFN-γ) and interleukin (IL)-2 enzyme-linked immunospot assay and multiparameter flow cytometry. T. cruzi-specific antibodies were quantified by conventional serology and a multiplex assay format. Results SD subjects exhibited immunity cell responses to T. cruzi but in contrast to SP subjects, T cells in SD subjects more often display the simultaneous production of IFN-γ and IL-2 in response to T. cruzi antigens and have a resting phenotype. SD individuals also have higher IFN-γ spot counts, polyfunctional CD4+ T-cells enriched in IL-2 secreting cells and low levels of antibodies specific for a set of T. cruzi-derived recombinant proteins compared with the SP group. Long-term follow-up of SD individuals confirmed that humoral and T-cell responses fluctuate but are sustained over time in these subjects. T cells in SD subjects for T. cruzi infection did not recognize Leishmania antigens. Conclusion Both T-cell and humoral responses in most subjects assessed by conventional tests as SD for T. cruzi infection indicate prior exposure to infection and the establishment of immunological memory suggestive of a resolved infection.
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Affiliation(s)
- Melisa D Castro Eiro
- Instituto Nacional de Parasitología 'Dr. Mario Fatala Chabén', Buenos Aires, Argentina
| | - María G Alvarez
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Gretchen Cooley
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
| | - Rodolfo J Viotti
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | | | - Bruno Lococo
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - María C Albareda
- Instituto Nacional de Parasitología 'Dr. Mario Fatala Chabén', Buenos Aires, Argentina
| | - Ana M De Rissio
- Instituto Nacional de Parasitología 'Dr. Mario Fatala Chabén', Buenos Aires, Argentina
| | - María A Natale
- Instituto Nacional de Parasitología 'Dr. Mario Fatala Chabén', Buenos Aires, Argentina
| | - Cecilia Parodi
- Instituto de Patología Experimental (CONICET), Universidad Nacional de Salta, Salta, Argentina
| | - Rick L Tarleton
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
| | - Susana A Laucella
- Instituto Nacional de Parasitología 'Dr. Mario Fatala Chabén', Buenos Aires, Argentina.,Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
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Mateus J, Pérez-Antón E, Lasso P, Egui A, Roa N, Carrilero B, González JM, Thomas MC, Puerta CJ, López MC, Cuéllar A. Antiparasitic Treatment Induces an Improved CD8 + T Cell Response in Chronic Chagasic Patients. THE JOURNAL OF IMMUNOLOGY 2017; 198:3170-3180. [PMID: 28258194 DOI: 10.4049/jimmunol.1602095] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/07/2017] [Indexed: 01/17/2023]
Abstract
Chagas disease is a chronic infection caused by Trypanosoma cruzi, an intracellular protozoan parasite. Chronic chagasic patients (CCPs) have dysfunctional CD8+ T cells that are characterized by impaired cytokine production, high coexpression of inhibitory receptors, and advanced cellular differentiation. Most patients diagnosed in the chronic phase of Chagas disease already exhibit heart involvement, and there is no vaccination that protects against the disease. Antiparasitic treatment is controversial as to its indication for this stage of the disease. There is a lack of biological markers to evaluate the effectiveness of antiparasitic treatment, and little is known about the effect of the treatment on CD8+ T cells. Thus, the aim of the current study was to analyze the early effects of antiparasitic treatment on CD8+ T cells from CCPs with asymptomatic clinical forms of disease. To evaluate the CD8+ T cell subsets, expression of inhibitory receptors, and functionality of T cells in CCPs, PBMCs were isolated. The results showed that treatment of CCPs with the asymptomatic form of the disease induces an increase in the frequency of CD8+ central memory T cells and terminal effector T cells, a decrease in the coexpression of inhibitory receptors, an improved Ag-specific CD8+ T cell response exhibited by the individual production of IFN-γ or IL-2, and a multifunctional CD8+ T cell profile of up to four functions (IFN-γ+IL-2+Perforin+Granzyme B+). These findings suggest that, in CCPs, antiparasitic treatment improved the quality of Ag-specific CD8+ T cell responses associated with a decrease in inhibitory receptor coexpression, which could serve as biomarkers for monitoring the effectiveness of antiparasitic treatment.
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Affiliation(s)
- Jose Mateus
- Grupo Inmunobiología y Biología Celular, Pontificia Universidad Javeriana, 110231 Bogota, Colombia.,Laboratorio de Parasitología Molecular, Facultad de Ciencias, Pontificia Universidad Javeriana, 110231 Bogota, Colombia
| | - Elena Pérez-Antón
- Instituto de Parasitología y Biomedicina López Neyra, Consejo Superior de Investigaciones Científicas, 18016 Granada, Spain
| | - Paola Lasso
- Grupo Inmunobiología y Biología Celular, Pontificia Universidad Javeriana, 110231 Bogota, Colombia.,Laboratorio de Parasitología Molecular, Facultad de Ciencias, Pontificia Universidad Javeriana, 110231 Bogota, Colombia
| | - Adriana Egui
- Instituto de Parasitología y Biomedicina López Neyra, Consejo Superior de Investigaciones Científicas, 18016 Granada, Spain
| | - Nubia Roa
- Facultad de Medicina, Pontificia Universidad Javeriana, 110231 Bogota, Colombia
| | | | - John M González
- Grupo de Ciencias Básicas Médicas, Facultad de Medicina, Universidad de los Andes, 111711 Bogota, Colombia
| | - M Carmen Thomas
- Instituto de Parasitología y Biomedicina López Neyra, Consejo Superior de Investigaciones Científicas, 18016 Granada, Spain
| | - Concepción J Puerta
- Laboratorio de Parasitología Molecular, Facultad de Ciencias, Pontificia Universidad Javeriana, 110231 Bogota, Colombia
| | - Manuel C López
- Instituto de Parasitología y Biomedicina López Neyra, Consejo Superior de Investigaciones Científicas, 18016 Granada, Spain;
| | - Adriana Cuéllar
- Grupo Inmunobiología y Biología Celular, Pontificia Universidad Javeriana, 110231 Bogota, Colombia;
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Changes in the immune response after treatment with benznidazole versus no treatment in patients with chronic indeterminate Chagas disease. Acta Trop 2016; 164:117-124. [PMID: 27619190 DOI: 10.1016/j.actatropica.2016.09.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/22/2016] [Accepted: 09/08/2016] [Indexed: 12/12/2022]
Abstract
Symptomatic chronic Chagas disease affects up to 40% of patients infected with Trypanosoma cruzi. The lack of reliable early markers of cure after therapy hinders disease management and clinical trials with new drugs. We performed a study with 18 months of follow-up to compare changes in immune parameters and T. cruzi-specific immune responses as surrogate markers of response to therapy between patients treated with benznidazole and untreated patients. This was a pilot, open-label, randomised clinical trial of treatment with benznidazole versus no treatment in patients with indeterminate chronic T. cruzi infection. In both groups we investigated changes in T-cell activation, T-cell subpopulations, regulatory T-cell counts, IL6, and sCD14 levels, and T. cruzi-specific immune responses (Th1, Th2, and Th17 responses). Fourteen patients were included in the study (seven in each group). Median age was 35 years (P25-75 31-43), 57% were female, and 93% were Bolivian. Benznidazole was administered at 5mg/kg/day for 60days. Three patients discontinued benznidazole owing to adverse reactions and were not evaluated. At the end of the follow-up period, treated patients showed significantly less immune activation and lower regulatory T-cell counts, with an increased Th17 and Th1 response. This randomised pilot clinical trial administering benznidazole to patients with indeterminate chronic Chagas disease brings about changes in the adaptive immunity, leading to a general decrease in inflammatory status. This apparently beneficial response could act as the basis for monitoring new antiparasitic drugs.
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36
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Balouz V, Agüero F, Buscaglia CA. Chagas Disease Diagnostic Applications: Present Knowledge and Future Steps. ADVANCES IN PARASITOLOGY 2016; 97:1-45. [PMID: 28325368 PMCID: PMC5363286 DOI: 10.1016/bs.apar.2016.10.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chagas disease, caused by the protozoan Trypanosoma cruzi, is a lifelong and debilitating illness of major significance throughout Latin America and an emergent threat to global public health. Being a neglected disease, the vast majority of Chagasic patients have limited access to proper diagnosis and treatment, and there is only a marginal investment into R&D for drug and vaccine development. In this context, identification of novel biomarkers able to transcend the current limits of diagnostic methods surfaces as a main priority in Chagas disease applied research. The expectation is that these novel biomarkers will provide reliable, reproducible and accurate results irrespective of the genetic background, infecting parasite strain, stage of disease, and clinical-associated features of Chagasic populations. In addition, they should be able to address other still unmet diagnostic needs, including early detection of congenital T. cruzi transmission, rapid assessment of treatment efficiency or failure, indication/prediction of disease progression and direct parasite typification in clinical samples. The lack of access of poor and neglected populations to essential diagnostics also stresses the necessity of developing new methods operational in point-of-care settings. In summary, emergent diagnostic tests integrating these novel and tailored tools should provide a significant impact on the effectiveness of current intervention schemes and on the clinical management of Chagasic patients. In this chapter, we discuss the present knowledge and possible future steps in Chagas disease diagnostic applications, as well as the opportunity provided by recent advances in high-throughput methods for biomarker discovery.
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Affiliation(s)
- Virginia Balouz
- Instituto de Investigaciones Biotecnológicas - Instituto Tecnológico de Chascomús (IIB-INTECH), Universidad Nacional de San Martín (UNSAM) - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), San Martín, B 1650 HMP, Buenos Aires, Argentina
| | - Fernán Agüero
- Instituto de Investigaciones Biotecnológicas - Instituto Tecnológico de Chascomús (IIB-INTECH), Universidad Nacional de San Martín (UNSAM) - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), San Martín, B 1650 HMP, Buenos Aires, Argentina
| | - Carlos A. Buscaglia
- Instituto de Investigaciones Biotecnológicas - Instituto Tecnológico de Chascomús (IIB-INTECH), Universidad Nacional de San Martín (UNSAM) - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), San Martín, B 1650 HMP, Buenos Aires, Argentina
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Doxycycline and Benznidazole Reduce the Profile of Th1, Th2, and Th17 Chemokines and Chemokine Receptors in Cardiac Tissue from Chronic Trypanosoma cruzi-Infected Dogs. Mediators Inflamm 2016; 2016:3694714. [PMID: 27688600 PMCID: PMC5023831 DOI: 10.1155/2016/3694714] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 12/14/2022] Open
Abstract
Chemokines (CKs) and chemokine receptors (CKR) promote leukocyte recruitment into cardiac tissue infected by the Trypanosoma cruzi. This study investigated the long-term treatment with subantimicrobial doses of doxycycline (Dox) in association, or not, with benznidazole (Bz) on the expression of CK and CKR in cardiac tissue. Thirty mongrel dogs were infected, or not, with the Berenice-78 strain of T. cruzi and grouped according their treatments: (i) two months after infection, Dox (50 mg/kg) 2x/day for 12 months; (ii) nine months after infection, Bz (3,5 mg/kg) 2x/day for 60 days; (iii) Dox + Bz; and (iv) vehicle. After 14 months of infection, hearts were excised and processed for qPCR analysis of Th1 (CCL2, CCL3, CCL4, CCL5, CXCL9, and CXCL11), Th2 (CCL1, CCL17, CCL24, and CCL26), Th17 (CCL20) CKs, Th1 (CCR5, CCR6, and CXCR3), and Th2/Th17 (CCR3, CCR4, and CCR8) CKR, as well as IL-17. T. cruzi infection increases CCL1, CCL2, CCL4, CCL5, CCL17, CXCL10, and CCR5 expression in the heart. Dox, Bz, or Dox + Bz treatments cause a reversal of CK and CKR and reduce the expression of CCL20, IL-17, CCR6, and CXCR3. Our data reveal an immune modulatory effect of Dox with Bz, during the chronic phase of infection suggesting a promising therapy for cardiac protection.
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Alvarez MG, Bertocchi GL, Cooley G, Albareda MC, Viotti R, Perez-Mazliah DE, Lococo B, Castro Eiro M, Laucella SA, Tarleton RL. Treatment Success in Trypanosoma cruzi Infection Is Predicted by Early Changes in Serially Monitored Parasite-Specific T and B Cell Responses. PLoS Negl Trop Dis 2016; 10:e0004657. [PMID: 27128444 PMCID: PMC4851297 DOI: 10.1371/journal.pntd.0004657] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/31/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chagas disease is the highest impact parasitic disease in Latin America. We have proposed that changes in Trypanosoma cruzi-specific immune responses might serve as surrogate indicators of treatment success. Herein, we addressed in a long-term follow-up study whether cure achieved after treatment can be predicted by changes in non-conventional indexes of anti-parasite serological and T cell activities. METHODOLOGY/PRINCIPAL FINDINGS T. cruzi-specific T cell responses, as measured by interferon-γ ELISPOT and T. cruzi-specific antibodies assessed by ELISA, hemagglutination and immunofluorescence tests as well as by a multiplex assay incorporating 14 recombinant T. cruzi proteins were measured in 33 patients at 48-150 months post-benznidazole treatment. Cure - as assessed by conventional serological tests - was associated with an early decline in T. cruzi-specific IFN-γ-producing T cells and in antibody titers measured by the multiplex serological assay. Changes in the functional status and potential of T. cruzi-specific T cells, indicative of reduced antigen stimulation, provided further evidence of parasitological cure following benznidazole treatment. Patients showing a significant reduction in T. cruzi-specific antibodies had higher pre-therapy levels of T. cruzi-specific IFN-γ- producing T cells compared to those with unaltered humoral responses post-treatment. CONCLUSIONS/SIGNIFICANCE Monitoring of appropriate immunological responses can provide earlier and robust measures of treatment success in T. cruzi infection.
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Affiliation(s)
- María G. Alvarez
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | | | - Gretchen Cooley
- Center for Tropical and Emerging Global Diseases, Athens, Georgia, United States of America
| | - María C. Albareda
- Instituto Nacional de Parasitología Dr. Mario Fatala Chaben, Buenos Aires, Argentina
| | - Rodolfo Viotti
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | | | - Bruno Lococo
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Melisa Castro Eiro
- Instituto Nacional de Parasitología Dr. Mario Fatala Chaben, Buenos Aires, Argentina
| | - Susana A. Laucella
- Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
- Instituto Nacional de Parasitología Dr. Mario Fatala Chaben, Buenos Aires, Argentina
| | - Rick L. Tarleton
- Center for Tropical and Emerging Global Diseases, Athens, Georgia, United States of America
- * E-mail:
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Revisiting the Posttherapeutic Cure Criterion in Chagas Disease: Time for New Methods, More Questions, Doubts, and Polemics or Time to Change Old Concepts? BIOMED RESEARCH INTERNATIONAL 2015; 2015:652985. [PMID: 26583124 PMCID: PMC4637035 DOI: 10.1155/2015/652985] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/10/2015] [Indexed: 01/17/2023]
Abstract
One of the most relevant issues beyond the effectiveness of etiological treatment of Chagas disease is the lack of consensual/feasible tools to identify and certify the definitive parasitological cure. Several methods of distinct natures (parasitological, serological, and molecular) have been continuously proposed and novel perspectives are currently under investigation. Although the simultaneous use of distinct tests may offer better contributions and advances, it also leads to controversies of interpretation, with lack of mutual consent of cure criterion amongst researchers and physicians. In fact, when distinct host compartments (blood/tissues) are evaluated and explored, novel questions may arise due to the nature and sensitivity limit of each test. This short analytical review intends to present a chronological and critical overview and discuss the state-of-the-art distinct devices available for posttherapeutic cure assessment in Chagas disease, their contributions, meanings, and interpretation, aiming to point out the major gaps and propose novel insight for future perspectives of posttherapeutic management of Chagas disease patients.
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40
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Eickhoff CS, Van Aartsen D, Terry FE, Meymandi SK, Traina MM, Hernandez S, Martin WD, Moise L, De Groot AS, Hoft DF. An immunoinformatic approach for identification of Trypanosoma cruzi HLA-A2-restricted CD8(+) T cell epitopes. Hum Vaccin Immunother 2015; 11:2322-8. [PMID: 26107442 DOI: 10.1080/21645515.2015.1061160] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Chagas disease is a major neglected tropical disease caused by persistent chronic infection with the protozoan parasite Trypanosoma cruzi. An estimated 8 million people are infected with T. cruzi, however only 2 drugs are approved for treatment and no vaccines are available. Thus there is an urgent need to develop vaccines and new drugs to prevent and treat Chagas disease. In this work, we identify T cell targets relevant for human infection with T. cruzi. The trans-sialidase (TS) gene family is a large family of homologous genes within the T. cruzi genome encoding over 1,400 members. There are 12 highly conserved TS gene family members which encode enzymatically active TS (functional TS; F-TS), while the remaining TS family genes are less conserved, enzymatically inactive and have been hypothesized to be involved in immune evasion (non-functional TS; NF-TS). We utilized immunoinformatic tools to identify HLA-A2-restricted CD8(+) T cell epitopes conserved within F-TS family members and NF-TS gene family members. We also utilized a whole-genome approach to identify T cell epitopes present within genes which have previously been shown to be expressed in life stages relevant for human infection (Non-TS genes). Thirty immunogenic HLA-A2-restricted CD8(+) T cell epitopes were identified using IFN-γ ELISPOT assays after vaccination of humanized HLA-A2 transgenic mice with mature dendritic cells pulsed with F-TS, NF-TS, and Non-TS peptide pools. The immunogenic HLA-A2-restricted T cell epitopes identified in this work may serve as potential components of an epitope-based T cell targeted vaccine for Chagas disease.
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Affiliation(s)
- Christopher S Eickhoff
- a Division of Infectious Diseases, Allergy, and Immunology; Department of Internal Medicine; Saint Louis University ; Saint Louis , MO USA
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Abstract
Trypanosoma cruzi infection and Chagas disease remains among the most neglected of the neglected tropical diseases. Despite this, studies of the immune response to T. cruzi have provided new insights in immunology and guidance for approaches for prevention and treatment of the disease. T. cruzi represents one of the very best systems in which to study CD8(+) T cell biology; mice, dogs, and primates (and many other mammals) are all natural hosts for this parasite, the robust T cell responses generated in these hosts can be readily monitored using the full range of cutting edge techniques, and the parasite can be easily modified to express (or not) a variety of tags, reporters, immune enhances, and endogenous or model antigens. The infection in most hosts is characterized by vigorous and largely effective immune responses, including CD8(+) T cells capable of controlling T. cruzi at the level of the infected host cells. However, this immune control is only partially effective and most hosts maintain a low level infection for life. This review addresses the interplay of highly effective CD8(+) T cell responses with elaborate pathogen immune evasion mechanisms, including the generation and simultaneous expression of highly variant CD8(+) T cell targets and a host cell invasion mechanisms that largely eludes innate immune detection.
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Affiliation(s)
- Rick L Tarleton
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, GA, 30602, USA,
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42
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Albareda MC, Laucella SA. Modulation of Trypanosoma cruzi-specific T-cell responses after chemotherapy for chronic Chagas disease. Mem Inst Oswaldo Cruz 2015; 110:414-21. [PMID: 25993507 PMCID: PMC4489479 DOI: 10.1590/0074-02760140386] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/20/2015] [Indexed: 01/07/2023] Open
Abstract
The aim of this review is to describe the contributions of the knowledge of T-cell responses to the understanding of the physiopathology and the responsiveness to etiological treatment during the chronic phase of Chagas disease. T-helper (Th)1 and interleukin (IL)-10 Trypanosoma cruzi-specific T-cells have been linked to the asymptomatic phase or to severe clinical forms of the disease, respectively or vice versa, depending on the T. cruzi antigen source, the patient's location and the performed immunological assays. Parasite-specific T-cell responses are modulated after benznidazole (BZ) treatment in chronically T. cruzi-infected subjects in association with a significant decrease in T. cruzi-specific antibodies. Accumulating evidence has indicated that treatment efficacy during experimental infection with T. cruzi results from the combined action of BZ and the activation of appropriate immune responses in the host. However, strong support of this interaction in T. cruzi-infected humans remains lacking. Overall, the quality of T-cell responses might be a key factor in not only disease evolution, but also chemotherapy responsiveness. Immunological parameters are potential indicators of treatment response regardless of achievement of cure. Providing tools to monitor and provide early predictions of treatment success will allow the development of new therapeutic options.
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43
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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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45
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Campi-Azevedo AC, Gomes JAS, Teixeira-Carvalho A, Silveira-Lemos D, Vitelli-Avelar DM, Sathler-Avelar R, Peruhype-Magalhães V, Béla SR, Silvestre KF, Batista MA, Schachnik NCC, Correa-Oliveira R, Eloi-Santos SM, Martins-Filho OA. Etiological treatment of Chagas disease patients with benznidazole lead to a sustained pro-inflammatory profile counterbalanced by modulatory events. Immunobiology 2015; 220:564-74. [PMID: 25648688 DOI: 10.1016/j.imbio.2014.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 11/28/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
Abstract
In the present study, we characterized the phagocytic capacity, cytokine profile along with the FCγ-R and TLR expression in leukocytes from Chagas disease patients (indeterminate-IND and cardiac-CARD) before and one-year after Bz-treatment (INDT and CARDT). A down-regulation of IL-17, IFN-γ and IL-10 synthesis by neutrophils was observed in CARDT. The Bz-treatment did not impact on the expression of phagocytosis-related surface molecules or monocyte-derived cytokine profile in INDT. Although CARDT showed unaltered monocyte-phagocytic capacity, up-regulated expression of Fcγ-RI/III and TLR-4 may be related to their ability to produce IL-10 and TGF-β. Down-regulation of lymphocyte-derived cytokine was observed in INDT whereas up-regulated cytokine profile was observed for lymphocytes in CARDT. Analysis of cytokine network revealed that IND displayed a multifaceted cytokine response characterized by strong connecting axes involving pro-inflammatory/regulatory phagocytes and lymphocytes. On the other hand, CARD presented a modest cytokine network. The Bz-treatment leads to distinct cytokine network: decreasing the links in INDT, with a pivotal role of IL-10(+) monocytes and expanding the connections in CARDT. Our findings highlighted that the Bz-treatment contributes to an overall immunomodulation in INDT and induces a broad change of immunological response in CARDT, eliciting an intricate phenotypic/functional network compatible with beneficial and protective immunological events.
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Affiliation(s)
- A C Campi-Azevedo
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - J A S Gomes
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil; Laboratório de Imunologia Celular e Molecular, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil; Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil; Programa de Pós- graduação em Medicina Tropical e Infectologia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
| | - A Teixeira-Carvalho
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - D Silveira-Lemos
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - D M Vitelli-Avelar
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - R Sathler-Avelar
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - V Peruhype-Magalhães
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - S R Béla
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - K F Silvestre
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - M A Batista
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - N C C Schachnik
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - R Correa-Oliveira
- Laboratório de Imunologia Celular e Molecular, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais - INCT-DT, Brasil
| | - S M Eloi-Santos
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
| | - O A Martins-Filho
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Brasil
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46
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Urbina JA. Recent clinical trials for the etiological treatment of chronic chagas disease: advances, challenges and perspectives. J Eukaryot Microbiol 2014; 62:149-56. [PMID: 25284065 DOI: 10.1111/jeu.12184] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 09/18/2014] [Accepted: 09/18/2014] [Indexed: 01/02/2023]
Abstract
Chagas disease, a chronic systemic parasitosis caused by the Kinetoplastid protozoon Trypanosoma cruzi, is the first cause of cardiac morbidity and mortality in poor rural and suburban areas of Latin America and the largest parasitic disease burden in the continent, now spreading worldwide due to international migrations. A recent change in the scientific paradigm on the pathogenesis of chronic Chagas disease has led to a consensus that all T. cruzi-seropositive patients should receive etiological treatment. This important scientific advance has spurred the rigorous evaluation of the safety and efficacy of currently available drugs (benznidazole and nifurtimox) as well as novel anti-T. cruzi drug candidates in chronic patients, who were previously excluded from such treatment. The first results indicate that benznidazole is effective in inducing a marked and sustained reduction in the circulating parasites' level in the majority of these patients, but adverse effects can lead to treatment discontinuation in 10-20% of cases. Ergosterol biosynthesis inhibitors, such as posaconazole and ravuconazole, are better tolerated but their efficacy at the doses and treatment duration used in the initial studies was significantly lower; such results are probably related to suboptimal exposure and/or treatment duration. Combination therapies are a promising perspective but the lack of validated biomarkers of response to etiological treatment and eventual parasitological cures in chronic patients remains a serious challenge.
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Affiliation(s)
- Julio A Urbina
- Venezuelan Institute for Scientific Research, Caracas, Venezuela
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47
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Tarleton RL, Gürtler RE, Urbina JA, Ramsey J, Viotti R. Chagas disease and the london declaration on neglected tropical diseases. PLoS Negl Trop Dis 2014; 8:e3219. [PMID: 25299701 PMCID: PMC4191937 DOI: 10.1371/journal.pntd.0003219] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rick L. Tarleton
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, United States of America
- The Chagas Disease Foundation, Bogart, Georgia, United States of America
- * E-mail:
| | - Ricardo E. Gürtler
- Laboratory of Eco-Epidemiology, Department of Ecology, Genetics and Evolution, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Julio A. Urbina
- Venezuelan Institute for Scientific Research, Caracas, Venezuela
| | - Janine Ramsey
- Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, Tapachula, Chiapas, México
| | - Rodolfo Viotti
- Hospital Interzonal General de Agudos (HIGA) Eva Perón, Sección Chagas, Servicio de Cardiología, Buenos Aires, Argentina
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48
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Fernández ER, Olivera GC, Quebrada Palacio LP, González MN, Hernandez-Vasquez Y, Sirena NM, Morán ML, Ledesma Patiño OS, Postan M. Altered distribution of peripheral blood memory B cells in humans chronically infected with Trypanosoma cruzi. PLoS One 2014; 9:e104951. [PMID: 25111833 PMCID: PMC4128741 DOI: 10.1371/journal.pone.0104951] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/15/2014] [Indexed: 12/15/2022] Open
Abstract
Numerous abnormalities of the peripheral blood T cell compartment have been reported in human chronic Trypanosoma cruzi infection and related to prolonged antigenic stimulation by persisting parasites. Herein, we measured circulating lymphocytes of various phenotypes based on the differential expression of CD19, CD4, CD27, CD10, IgD, IgM, IgG and CD138 in a total of 48 T. cruzi-infected individuals and 24 healthy controls. Infected individuals had decreased frequencies of CD19+CD27+ cells, which positively correlated with the frequencies of CD4+CD27+ cells. The contraction of CD19+CD27+ cells was comprised of IgG+IgD-, IgM+IgD- and isotype switched IgM-IgD- memory B cells, CD19+CD10+CD27+ B cell precursors and terminally differentiated CD19+CD27+CD138+ plasma cells. Conversely, infected individuals had increased proportions of CD19+IgG+CD27-IgD- memory and CD19+IgM+CD27-IgD+ transitional/naïve B cells. These observations prompted us to assess soluble CD27, a molecule generated by the cleavage of membrane-bound CD27 and used to monitor systemic immune activation. Elevated levels of serum soluble CD27 were observed in infected individuals with Chagas cardiomyopathy, indicating its potentiality as an immunological marker for disease progression in endemic areas. In conclusion, our results demonstrate that chronic T. cruzi infection alters the distribution of various peripheral blood B cell subsets, probably related to the CD4+ T cell deregulation process provoked by the parasite in humans.
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Affiliation(s)
- Esteban R. Fernández
- Departamento de Investigación, Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Gabriela C. Olivera
- Departamento de Investigación, Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Luz P. Quebrada Palacio
- Departamento de Investigación, Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariela N. González
- Departamento de Investigación, Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Yolanda Hernandez-Vasquez
- Departamento de Investigación, Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Natalia María Sirena
- Centro de Enfermedad de Chagas y Patología Regional, Hospital Independencia, Santiago del Estero, Argentina
| | - María L. Morán
- Centro de Enfermedad de Chagas y Patología Regional, Hospital Independencia, Santiago del Estero, Argentina
| | - Oscar S. Ledesma Patiño
- Centro de Enfermedad de Chagas y Patología Regional, Hospital Independencia, Santiago del Estero, Argentina
| | - Miriam Postan
- Departamento de Investigación, Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
- * E-mail:
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49
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Martin DL, Marks M, Galdos-Cardenas G, Gilman RH, Goodhew B, Ferrufino L, Halperin A, Sanchez G, Verastegui M, Escalante P, Naquira C, Levy MZ, Bern C. Regional variation in the correlation of antibody and T-cell responses to Trypanosoma cruzi. Am J Trop Med Hyg 2014; 90:1074-81. [PMID: 24710614 DOI: 10.4269/ajtmh.13-0391] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, is a major cause of morbidity and mortality in Central and South America. Geographic variations in the sensitivity of serologic diagnostic assays to T. cruzi may reflect differences in T. cruzi exposure. We measured parasite-specific T-cell responses among seropositive individuals in two populations from South America with widely varying antibody titers against T. cruzi. Antibody titers among seropositive individuals were significantly lower in Arequipa, Peru compared with Santa Cruz, Bolivia. Similarly, the proportion of seropositive individuals with positive T-cell responses was lower in Peru than Bolivia, resulting in overall lower frequencies of interferon-γ (IFNγ)-secreting cells from Peruvian samples. However, the magnitude of the IFNγ response was similar among the IFNγ responders in both locations. These data indicate that immunological discrepancies based on geographic region are reflected in T-cell responses as well as antibody responses.
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Affiliation(s)
- Diana L Martin
- Centers for Disease Control and Prevention, Atlanta, Georgia; National Institutes of Health, Bethesda, Maryland; Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japones, Santa Cruz, Bolivia; Asociación Benéfica PRISMA, Lima, Peru; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Morgan Marks
- Centers for Disease Control and Prevention, Atlanta, Georgia; National Institutes of Health, Bethesda, Maryland; Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japones, Santa Cruz, Bolivia; Asociación Benéfica PRISMA, Lima, Peru; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Gerson Galdos-Cardenas
- Centers for Disease Control and Prevention, Atlanta, Georgia; National Institutes of Health, Bethesda, Maryland; Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japones, Santa Cruz, Bolivia; Asociación Benéfica PRISMA, Lima, Peru; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Robert H Gilman
- Centers for Disease Control and Prevention, Atlanta, Georgia; National Institutes of Health, Bethesda, Maryland; Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japones, Santa Cruz, Bolivia; Asociación Benéfica PRISMA, Lima, Peru; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Brook Goodhew
- Centers for Disease Control and Prevention, Atlanta, Georgia; National Institutes of Health, Bethesda, Maryland; Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japones, Santa Cruz, Bolivia; Asociación Benéfica PRISMA, Lima, Peru; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Lisbeth Ferrufino
- Centers for Disease Control and Prevention, Atlanta, Georgia; National Institutes of Health, Bethesda, Maryland; Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japones, Santa Cruz, Bolivia; Asociación Benéfica PRISMA, Lima, Peru; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Anthony Halperin
- Centers for Disease Control and Prevention, Atlanta, Georgia; National Institutes of Health, Bethesda, Maryland; Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japones, Santa Cruz, Bolivia; Asociación Benéfica PRISMA, Lima, Peru; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Gerardo Sanchez
- Centers for Disease Control and Prevention, Atlanta, Georgia; National Institutes of Health, Bethesda, Maryland; Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japones, Santa Cruz, Bolivia; Asociación Benéfica PRISMA, Lima, Peru; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Manuela Verastegui
- Centers for Disease Control and Prevention, Atlanta, Georgia; National Institutes of Health, Bethesda, Maryland; Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japones, Santa Cruz, Bolivia; Asociación Benéfica PRISMA, Lima, Peru; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Patricia Escalante
- Centers for Disease Control and Prevention, Atlanta, Georgia; National Institutes of Health, Bethesda, Maryland; Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japones, Santa Cruz, Bolivia; Asociación Benéfica PRISMA, Lima, Peru; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Cesar Naquira
- Centers for Disease Control and Prevention, Atlanta, Georgia; National Institutes of Health, Bethesda, Maryland; Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japones, Santa Cruz, Bolivia; Asociación Benéfica PRISMA, Lima, Peru; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Michael Z Levy
- Centers for Disease Control and Prevention, Atlanta, Georgia; National Institutes of Health, Bethesda, Maryland; Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japones, Santa Cruz, Bolivia; Asociación Benéfica PRISMA, Lima, Peru; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Caryn Bern
- Centers for Disease Control and Prevention, Atlanta, Georgia; National Institutes of Health, Bethesda, Maryland; Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japones, Santa Cruz, Bolivia; Asociación Benéfica PRISMA, Lima, Peru; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Arequipa Ministry of Health, Arequipa, Peru; University of Pennsylvania, Philadelphia, Pennsylvania; Universidad Peruana Cayetano Heredia, Lima, Perú
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50
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Hartley AN, Cooley G, Gwyn S, Orozco MM, Tarleton RL. Frequency of IFNγ-producing T cells correlates with seroreactivity and activated T cells during canine Trypanosoma cruzi infection. Vet Res 2014; 45:6. [PMID: 24456537 PMCID: PMC3907784 DOI: 10.1186/1297-9716-45-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 01/07/2014] [Indexed: 11/10/2022] Open
Abstract
Vaccines to prevent Trypanosoma cruzi infection in humans or animals are not available, and in many settings, dogs are an important source of domestic infection for the insect vector. Identification of infected canines is crucial for evaluating peridomestic transmission dynamics and parasite control strategies. As immune control of T. cruzi infection is dependent on humoral and cell-mediated immune responses, we aimed to define a serodiagnostic assay and T cell phenotypic markers for identifying infected dogs and studying the canine T. cruzi-specific immune response. Plasma samples and peripheral blood mononuclear cells (PBMCs) were obtained from forty-two dogs living in a T. cruzi-endemic region. Twenty dogs were known to be seropositive and nine seronegative by conventional serologic tests two years prior to our study. To determine canine seroreactivity, we tested sera or plasma samples in a multiplex bead array against eleven recombinant T. cruzi proteins. Ninety-four percent (17/18) of dogs positive by multiplex serology were initially positive by conventional serology. The frequency of IFNγ-producing cells in PBMCs responding to T. cruzi correlated to serological status, identifying 95% of multiplex seropositive dogs. Intracellular staining identified CD4+ and CD8+ T cell populations as the sources of T. cruzi lysate-induced IFNγ. Low expression of CCR7 and CD62L on CD4+ and CD8+ T cells suggested a predominance of effector/effector memory T cells in seropositive canines. These results are the first, to our knowledge, to correlate T. cruzi-specific antibody responses with T cell responses in naturally infected dogs and validate these methods for identifying dogs exposed to T. cruzi.
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Affiliation(s)
| | | | | | | | - Rick L Tarleton
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA 30602, USA.
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