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Drug Repurposing in Chagas Disease: Chloroquine Potentiates Benznidazole Activity against Trypanosoma cruzi
In Vitro
and
In Vivo. Antimicrob Agents Chemother 2022; 66:e0028422. [PMID: 36314800 PMCID: PMC9664849 DOI: 10.1128/aac.00284-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Drug combinations and drug repurposing have emerged as promising strategies to develop novel treatments for infectious diseases, including Chagas disease. In this study, we aimed to investigate whether the repurposed drugs chloroquine (CQ) and colchicine (COL), known to inhibit
Trypanosoma cruzi
infection in host cells, could boost the anti-
T. cruzi
effect of the trypanocidal drug benznidazole (BZN), increasing its therapeutic efficacy while reducing the dose needed to eradicate the parasite. The combination of BZN and COL exhibited cytotoxicity to infected cells and low antiparasitic activity.
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Kratz JM, Gonçalves KR, Romera LM, Moraes CB, Bittencourt-Cunha P, Schenkman S, Chatelain E, Sosa-Estani S. The translational challenge in Chagas disease drug development. Mem Inst Oswaldo Cruz 2022; 117:e200501. [PMID: 35613156 PMCID: PMC9128742 DOI: 10.1590/0074-02760200501] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/13/2021] [Indexed: 12/20/2022] Open
Abstract
Chagas disease is a neglected tropical disease caused by the protozoan parasite Trypanosoma cruzi. There is an urgent need for safe, effective, and accessible new treatments since the currently approved drugs have serious limitations. Drug development for Chagas disease has historically been hampered by the complexity of the disease, critical knowledge gaps, and lack of coordinated R&D efforts. This review covers some of the translational challenges associated with the progression of new chemical entities from preclinical to clinical phases of development, and discusses how recent technological advances might allow the research community to answer key questions relevant to the disease and to overcome hurdles in R&D for Chagas disease.
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Affiliation(s)
- Jadel M Kratz
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Karolina R Gonçalves
- Universidade de São Paulo, Instituto de Ciências Biomédicas, Departamento de Microbiologia, São Paulo, SP, Brasil
| | - Lavínia Md Romera
- Universidade de São Paulo, Instituto de Ciências Biomédicas, Departamento de Microbiologia, São Paulo, SP, Brasil
| | - Carolina Borsoi Moraes
- Universidade Federal de São Paulo, Departamento de Ciências Farmacêuticas, Diadema, SP, Brasil
| | - Paula Bittencourt-Cunha
- Universidade de São Paulo, Instituto de Ciências Biomédicas, Departamento de Microbiologia, São Paulo, SP, Brasil.,Universidade Federal de São Paulo, Departamento de Microbiologia, Imunologia e Parasitologia, São Paulo, SP, Brasil
| | - Sergio Schenkman
- Universidade Federal de São Paulo, Departamento de Microbiologia, Imunologia e Parasitologia, São Paulo, SP, Brasil
| | - Eric Chatelain
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Sergio Sosa-Estani
- Drugs for Neglected Diseases initiative, Geneva, Switzerland.,Epidemiology and Public Health Research Centre, CIESP-CONICET, Buenos Aires, Argentina
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3
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Alves Cunha EL, Vieira da Silva Torchelsen FK, da Silva Fonseca K, Dutra Sousa LR, Abreu Vieira PM, Carneiro CM, Mauro de Castro Pinto K, Torres RM, de Lana M. Benznidazole, itraconazole, and their combination for the treatment of chronic experimental Chagas disease in dogs. Exp Parasitol 2022; 238:108266. [PMID: 35490799 DOI: 10.1016/j.exppara.2022.108266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/29/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
Treatment for Chagas disease has limited efficacy in the chronic phase. We evaluated benznidazole (BZ) and itraconazole (ITZ) individually and in association in dogs 16 months after infection with a BZ-resistant Trypanosoma cruzi strain. Four study groups (20 animals) were evaluated and treated for 60 days with BZ, ITZ, or BZ + ITZ, and maintained in parallel to control group infected and not treated (INT). All dogs were evaluated in the first, sixth, 12th, 18th and 24th months of study. Polymerase chain reaction (PCR) was negative in 2 of 3 animals in the BZ + ITZ group, 2 of 5 in the BZ group, and 4 of 5 in the ITZ group. Hemoculture performed in the 24th month was negative in all groups. Enzyme-linked immunoassay remained reactive in all treated animals. Echocardiography differentiated treated animals from control animals. Quantitative PCR analysis of cardiac tissue was negative in the BZ + ITZ and BZ groups, positive in 2 of 5 dogs in the ITZ group and in 2 of 3 dogs in the control group, but negative in colon tissue in all groups. Inflammation was significantly reduced in the right atrium and left ventricle of dogs treated with BZ + ITZ and BZ compared with those receiving ITZ alone. Fibrosis was absent in most dogs treated with BZ + ITZ, mild in those treated with BZ or ITZ alone, and intense in the control group. Parasitological and histopathological evaluations showed that BZ + ITZ treatment improved or stabilized the clinical condition of the dogs.
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Affiliation(s)
- Eleonora Lima Alves Cunha
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal de Ouro Preto (UFOP), CEP: 35400-000, Ouro Preto, MG, Brazil.
| | | | - Kátia da Silva Fonseca
- Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), CEP: 35400-000, Ouro Preto, MG, Brazil.
| | - Lucas Resende Dutra Sousa
- Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), CEP: 35400-000, Ouro Preto, MG, Brazil.
| | - Paula Melo Abreu Vieira
- Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), CEP: 35400-000, Ouro Preto, MG, Brazil.
| | - Cláudia Martins Carneiro
- Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), CEP: 35400-000, Ouro Preto, MG, Brazil.
| | | | - Rosália Morais Torres
- Faculdade de Medicina, Departmento de Clínica Médica, Universidade de Minas Gerais (UFMG), Av. Alfredo Balena, 900, CEP: 30130-100, Funcionários, Belo Horizonte, MG, Brazil.
| | - Marta de Lana
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal de Ouro Preto (UFOP), CEP: 35400-000, Ouro Preto, MG, Brazil; Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), CEP: 35400-000, Ouro Preto, MG, Brazil.
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Cevey ÁC, Mascolo PD, Penas FN, Pieralisi AV, Sequeyra AS, Mirkin GA, Goren NB. Benznidazole Anti-Inflammatory Effects in Murine Cardiomyocytes and Macrophages Are Mediated by Class I PI3Kδ. Front Immunol 2021; 12:782891. [PMID: 34925364 PMCID: PMC8675942 DOI: 10.3389/fimmu.2021.782891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Benznidazole (Bzl), the drug of choice in many countries for the treatment of Chagas disease, leads to parasite clearance in the early stages of infection and contributes to immunomodulation. In addition to its parasiticidal effect, Bzl inhibits the NF-κB pathway. In this regard, we have previously described that this occurs through IL-10/STAT3/SOCS3 pathway. PI3K pathway is involved in the regulation of the immune system by inhibiting NF-κB pathway through STAT3. In this work, the participation of PI3K in the immunomodulatory effects of Bzl in cardiac and immune cells, the main targets of Chagas disease, was further studied. For that, we use a murine primary cardiomyocyte culture and a monocyte/macrophage cell line (RAW 264.7), stimulated with LPS in presence of LY294002, an inhibitor of PI3K. Under these conditions, Bzl could neither increase SOCS3 expression nor inhibit the NOS2 mRNA expression and the release of NOx, both in cardiomyocytes and macrophages. Macrophages are crucial in the development of Chronic Chagas Cardiomyopathy. Thus, to deepen our understanding of how Bzl acts, the expression profile of M1-M2 macrophage markers was evaluated. Bzl inhibited the release of NOx (M1 marker) and increased the expression of Arginase I (M2 marker) and a negative correlation was found between them. Besides, LPS increased the expression of pro-inflammatory cytokines. Bzl treatment not only inhibited this effect but also increased the expression of typical M2-macrophage markers like Mannose Receptor, TGF-β, and VEGF-A. Moreover, Bzl increased the expression of PPAR-γ and PPAR-α, known as key regulators of macrophage polarization. PI3K directly regulates M1-to-M2 macrophage polarization. Since p110δ, catalytic subunit of PI3Kδ, is highly expressed in immune cells, experiments were carried out in presence of CAL-101, a specific inhibitor of this subunit. Under this condition, Bzl could neither increase SOCS3 expression nor inhibit NF-κB pathway. Moreover, Bzl not only failed to inhibit the expression of pro-inflammatory cytokines (M1 markers) but also could not increase M2 markers. Taken together these results demonstrate, for the first time, that the anti-inflammatory effect of Bzl depends on PI3K activity in a cell line of murine macrophages and in primary culture of neonatal cardiomyocytes. Furthermore, Bzl-mediated increase expression of M2-macrophage markers involves the participation of the p110δ catalytic subunit of PI3Kδ.
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Affiliation(s)
- Ágata C Cevey
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Microbiología, Parasitología e Inmunología, Buenos Aires, Argentina.,CONICET, Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina
| | - Paula D Mascolo
- CONICET, Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina
| | - Federico N Penas
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Microbiología, Parasitología e Inmunología, Buenos Aires, Argentina.,CONICET, Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina
| | - Azul V Pieralisi
- CONICET, Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina
| | - Aldana S Sequeyra
- CONICET, Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina
| | - Gerardo A Mirkin
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Microbiología, Parasitología e Inmunología, Buenos Aires, Argentina.,CONICET, Universidad de Buenos Aires, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Buenos Aires, Argentina
| | - Nora B Goren
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Microbiología, Parasitología e Inmunología, Buenos Aires, Argentina.,CONICET, Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina
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Echeverría LE, Marcus R, Novick G, Sosa-Estani S, Ralston K, Zaidel EJ, Forsyth C, RIbeiro ALP, Mendoza I, Falconi ML, Mitelman J, Morillo CA, Pereiro AC, Pinazo MJ, Salvatella R, Martinez F, Perel P, Liprandi ÁS, Piñeiro DJ, Molina GR. WHF IASC Roadmap on Chagas Disease. Glob Heart 2020; 15:26. [PMID: 32489799 PMCID: PMC7218776 DOI: 10.5334/gh.484] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/17/2020] [Indexed: 02/06/2023] Open
Abstract
Background Chagas Disease is a neglected tropical disease caused by the protozoan Trypanosoma cruzi, with some of the most serious manifestations affecting the cardiovascular system. It is a chronic, stigmatizing condition, closely associated with poverty and affecting close to 6 million people globally. Although historically the disease was limited to endemic areas of Latin America recent years have seen an increasing global spread. In addition to the morbidity and mortality associated with the disease, the social and economic burdens on individuals and society are substantial. Often called the 'silent killer', Chagas disease is characterized by a long, asymptomatic phase in affected individuals. Approximately 30% then go on develop chronic Chagas cardiomyopathy and other serious cardiac complications such as stroke, rhythm disturbances and severe heart failure. Methods In a collaboration of the World Hearth Federation (WHF) and the Inter-American Society of Cardiology (IASC) a writing group consisting of 20 diverse experts on Chagas disease (CD) was convened. The group provided up to date expert knowledge based on their area of expertise. An extensive review of the literature describing obstacles to diagnosis and treatment of CD along with proposed solutions was conducted. A survey was sent to all WHF Members and, using snowball sampling to widen the consultation, to a variety of health care professionals working in the CD global health community. The results were analyzed, open comments were reviewed and consolidated, and the findings were incorporated into this document, thus ensuring a consensus representation. Results The WHF IASC Roadmap on Chagas Disease offers a comprehensive summary of current knowledge on prevention, diagnosis and management of the disease. In providing an analysis of 'roadblocks' in access to comprehensive care for Chagas disease patients, the document serves as a framework from which strategies for implementation such as national plans can be formulated. Several dimensions are considered in the analysis: healthcare system capabilities, governance, financing, community awareness and advocacy. Conclusion The WHF IASC Roadmap proposes strategies and evidence-based solutions for healthcare professionals, health authorities and governments to help overcome the barriers to comprehensive care for Chagas disease patients. This roadmap describes an ideal patient care pathway, and explores the roadblocks along the way, offering potential solutions based on available research and examples in practice. It represents a call to action to decision-makers and health care professionals to step up efforts to eradicate Chagas disease.
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Affiliation(s)
| | - Rachel Marcus
- LASOCHA, Washington DC, US
- Medstar Union Memorial Hospital, Baltimore, MD, US
| | - Gabriel Novick
- Swiss Medical Group, Buenos Aires, AR
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, US
| | - Sergio Sosa-Estani
- Drugs for Neglected Diseases initiative-Latin America, Rio de Janeiro, BR
| | | | - Ezequiel Jose Zaidel
- Sanatorio Güemes, Buenos Aires, AR
- Pharmacology Department, School of Medicine, University of Buenos Aires, Buenos Aires, AR
| | - Colin Forsyth
- Drugs for Neglected Diseases initiative-Latin America, Rio de Janeiro, BR
| | - Antonio Luiz P. RIbeiro
- Internal Medicine Department, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, BR
- Hospital das Clínicas, UFMG, Belo Horizonte, BR
| | | | - Mariano Luis Falconi
- Cardiology Division, Italian Hospital of Buenos Aires, Buenos Aires, AR
- University Institute of the Italian Hospital of Buenos Aires, Buenos Aires, AR
| | - Jorge Mitelman
- Faculty of Medicine, University of Buenos Aires, Buenos Aires, AR
- School of Medicine, Barcélo University, Buenos Aires, AR
| | - Carlos A. Morillo
- Department of Cardiac Sciences, Cumming School of Medicine Division of Cardiology, Libin Cardiovascular Institute, University of Calgary, Calgary, CA
- Southeastern Alberta Region, Alberta Health Services, Foothills Medical Centre, CA
| | | | | | | | - Felipe Martinez
- National University of Cordoba, Cordoba, AR
- DAMIC Institute/Rusculleda Foundation, Cordoba, AR
| | - Pablo Perel
- World Heart Federation, Geneva, CH
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, GB
| | - Álvaro Sosa Liprandi
- Sanatorio Güemes, Buenos Aires, AR
- Medical School of Cardiology, University of Buenos Aires, Buenos Aires, AR
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Moscatelli G, Moroni S, García Bournissen F, González N, Ballering G, Schijman A, Corral R, Bisio M, Freilij H, Altcheh J. Longitudinal follow up of serological response in children treated for Chagas disease. PLoS Negl Trop Dis 2019; 13:e0007668. [PMID: 31465522 PMCID: PMC6715178 DOI: 10.1371/journal.pntd.0007668] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/28/2019] [Indexed: 01/05/2023] Open
Abstract
Background Evaluation of therapeutic response in chronic Chagas disease is a major challenge, due to prolonged persistence of Trypanosoma cruzi-specific antibodies, lack of sensitivity of parasitological tests, and need for long-term follow-up to observe negative seroconversion of conventional serological tests (CS). The objective of this study was to evaluate F2/3-ELISA serology, a promising early biomarker of therapeutic response, and T.cruzi Polymerase chain reaction (PCR) for T. cruzi Deoxyribonucleic acid (DNA), for neonatal diagnosis and evaluation of parasitemia after treatment. Methods Prospective cohort study, with three-year clinical, serological and parasitological follow-up of pediatric Chagas disease patients treated with benznidazole. Serology was evaluated by Enzyme-Linked ImmunoSorbent Assay (ELISA), Indirect hemagglutination (IHA) and F2/3-ELISA; Parasitemia by microhematocrit (MH) and PCR. Results A cohort of 107 pediatric patients treated with benznidazole was enrolled in the study. ELISA and IHA were initially reactive in 100% of patients, F2/3-ELISA serology was reactive in 80% (86/107) and 91% (97/107) had detectable parasitemia. Seventy-six (71%) patients completed at least 36 months of serological follow up after treatment. Although a similar decreasing linear trend was observed for all serological tests, F2/3-ELISA presented earlier, age dependent, negative seroconversion compared to CS. All patients reaching undetectable CS titers had previously seroreverted by F2/3-ELISA. All patients with persistently decreasing antibody titers had negative PCRs throughout the follow up period. No new cardiological lesions were observed during the 3 years follow-up period. Conclusions The data reported here, using CS, F2/3 ELISA and PCR provide support for the efficacy of benznidazole in congenital Chagas diseases. These results provide support for scaling up of screening, diagnosis and access to benznidazole treatment. Trial registration ClinicalTrials.gov 0028/04 in the Research Council, Secretary of Health Buenos Aires city Goberment. Evaluation of therapeutic response in chronic Chagas disease is a major challenge, particularly in the early post-treatment phase, due to prolonged persistence of Trypanosoma cruzi-specific antibodies and lack of sensitivity of available parasitological tests. The main limitation in evaluating Chagas disease treatment response stems from the need for long-term follow-up to observe negative seroconversion of conventional serological tests. New biomarkers of cure are needed. We evaluated F2/3-ELISA, a promising early serological marker of therapeutic response, and T.cruzi PCR for T.cruzi DNA, for neonatal diagnosis and evaluation of parasitemia after treatment. F2/3-ELISA and PCR proved to be excellent early markers of treatment response that correlate with ELISA and IHA but can identify treatment response or failure at much earlier timepoints. This information can help design future paediatric clinical trials in Chagas disease.
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Affiliation(s)
- Guillermo Moscatelli
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
- Multidisciplinary Institute for Research of Pediatric Diseases- CONICET-GCBA, Buenos Aires, Argentina
- * E-mail:
| | - Samanta Moroni
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
- Multidisciplinary Institute for Research of Pediatric Diseases- CONICET-GCBA, Buenos Aires, Argentina
| | - Facundo García Bournissen
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
- Multidisciplinary Institute for Research of Pediatric Diseases- CONICET-GCBA, Buenos Aires, Argentina
| | - Nicolás González
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Griselda Ballering
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Alejandro Schijman
- Molecular Biology Laboratory of Chagas disease, INGEBI-CONICET, Buenos Aires, Argentina
| | - Ricardo Corral
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Margarita Bisio
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Héctor Freilij
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
| | - Jaime Altcheh
- Parasitology service Ricardo Gutiérrez Children´s Hospital, Buenos Aires, Argentina
- Multidisciplinary Institute for Research of Pediatric Diseases- CONICET-GCBA, Buenos Aires, Argentina
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Müller Kratz J, Garcia Bournissen F, Forsyth CJ, Sosa-Estani S. Clinical and pharmacological profile of benznidazole for treatment of Chagas disease. Expert Rev Clin Pharmacol 2018; 11:943-957. [DOI: 10.1080/17512433.2018.1509704] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jadel Müller Kratz
- Chagas Clinical Program, Drugs for Neglected Disease initiative (DNDi), Geneva, Switzerland
| | - Facundo Garcia Bournissen
- Parasitology and Chagas Service, Buenos Aires Children Hospital Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Colin J. Forsyth
- Chagas Clinical Program, Drugs for Neglected Disease initiative (DNDi), Geneva, Switzerland
| | - Sergio Sosa-Estani
- Chagas Clinical Program, Drugs for Neglected Disease initiative (DNDi), Geneva, Switzerland
- Epidemiology and Public Health Research Center, CONICET, Buenos Aires, Argentina
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Volpini X, Ambrosio LF, Fozzatti L, Insfran C, Stempin CC, Cervi L, Motran CC. Trypanosoma cruzi Exploits Wnt Signaling Pathway to Promote Its Intracellular Replication in Macrophages. Front Immunol 2018; 9:859. [PMID: 29743880 PMCID: PMC5930390 DOI: 10.3389/fimmu.2018.00859] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/06/2018] [Indexed: 01/04/2023] Open
Abstract
During the acute phase of Trypanosoma cruzi infection, macrophages can act as host cells for the parasites as well as effector cells in the early anti-parasitic immune response. Thus, the targeting of specific signaling pathways could modulate macrophages response to restrict parasite replication and instruct an appropriate adaptive response. Recently, it has become evident that Wnt signaling has immunomodulatory functions during inflammation and infection. Here, we tested the hypothesis that during T. cruzi infection, the activation of Wnt signaling pathway in macrophages plays a role in modulating the inflammatory/tolerogenic response and therefore regulating the control of parasite replication. In this report, we show that early after T. cruzi infection of bone marrow-derived macrophages (BMM), β-catenin was activated and Wnt3a, Wnt5a, and some Frizzled receptors as well as Wnt/β-catenin pathway’s target genes were upregulated, with Wnt proteins signaling sustaining the activation of Wnt/β-catenin pathway and then activating the Wnt/Ca+2 pathway. Wnt signaling pathway activation was critical to sustain the parasite’s replication in BMM; since the treatments with specific inhibitors of β-catenin transcriptional activation or Wnt proteins secretion limited the parasite replication. Mechanistically, inhibition of Wnt signaling pathway armed BMM to fight against T. cruzi by inducing the production of pro-inflammatory cytokines and indoleamine 2,3-dioxygenase activity and by downregulating arginase activity. Likewise, in vivo pharmacological inhibition of the Wnts’ interaction with its receptors controlled the parasite replication and improved the survival of lethally infected mice. It is well established that T. cruzi infection activates a plethora of signaling pathways that ultimately regulate immune mediators to determine the modulation of a defined set of effector functions in macrophages. In this study, we have revealed a new signaling pathway that is activated by the interaction between protozoan parasites and host innate immunity, establishing a new conceptual framework for the development of new therapies.
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Affiliation(s)
- Ximena Volpini
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina.,Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), CONICET, Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba, Argentina
| | - Laura F Ambrosio
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina.,Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), CONICET, Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba, Argentina
| | - Laura Fozzatti
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina.,Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), CONICET, Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba, Argentina
| | - Constanza Insfran
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina.,Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), CONICET, Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba, Argentina
| | - Cinthia C Stempin
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina.,Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), CONICET, Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba, Argentina
| | - Laura Cervi
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina.,Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), CONICET, Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba, Argentina
| | - Claudia Cristina Motran
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina.,Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), CONICET, Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba, Argentina
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9
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Clipman SJ, Henderson-Frost J, Fu KY, Bern C, Flores J, Gilman RH. Genetic association study of NLRP1, CARD, and CASP1 inflammasome genes with chronic Chagas cardiomyopathy among Trypanosoma cruzi seropositive patients in Bolivia. PLoS One 2018; 13:e0192378. [PMID: 29438387 PMCID: PMC5810984 DOI: 10.1371/journal.pone.0192378] [Citation(s) in RCA: 12] [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: 09/28/2017] [Accepted: 01/20/2018] [Indexed: 11/23/2022] Open
Abstract
About 20–30% of people infected with Chagas disease present with chronic Chagas cardiomyopathy (CCC), the most serious and frequent manifestation of the disease, while others remain asymptomatic and often do not experience Chagas-specific mortality. It is not currently well understood what causes these differential disease outcomes, but a genetic predisposition within the host could play an important role. This study examined variants in the NLRP1, CARD, and CASP1 inflammasome genes among 62 T. cruzi seropositive patients from Bolivia (38 cases with CCC and 24 asymptomatic controls) to uncover associations with CCC. All subjects underwent a complete medical examination including electrocardiogram (EKG) and echocardiogram. After genotype calling and quality control filtering with exclusion of 3 cases and 3 controls, association analysis was performed across 76 directly genotyped SNPs in NLRP1, CARD, and CASP1 genes, adjusting for age, sex, and population stratification. One SNP (rs11651270; Bonferroni-corrected p = 0.036) corresponding to a missense mutation in NLPR1 was found to be significant after adjustment for multiple testing, and a suggestive association was seen in CARD11 (rs6953573; Bonferroni-corrected p = 0.060). Although limited by sample size, the study results suggest variations in the inflammasome, particularly in NLRP1 and CARD11, may be associated with CCC.
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Affiliation(s)
- Steven J. Clipman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Katherine Y. Fu
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, United States of America
| | - Jorge Flores
- Hospital San Juan de Dios, Santa Cruz de la Sierra, Bolivia
- Catholic University of Bolivia, Santa Cruz, Bolivia
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
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Gatto M, Oliveira LRC, De Nuzzi Dias F, Araújo Júnior JP, Lima CRG, Lordelo EP, Dos Santos RM, Kurokawa CS. Benznidazole affects expression of Th1, Th17 and Treg cytokines during acute experimental Trypanosoma cruzi infection. J Venom Anim Toxins Incl Trop Dis 2017; 23:47. [PMID: 29255475 PMCID: PMC5727918 DOI: 10.1186/s40409-017-0137-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 11/24/2017] [Indexed: 01/11/2023] Open
Abstract
Background The present study evaluated the effect of treatment with benznidazole on mRNA expression of IFN-γ, IL-17, IL-10, TGF-β and FoxP3 in spleen and heart tissue of BALB/c mice in the acute phase of an experimental infection with Trypanosoma cruzi, strains JLP or Y. Methods The mRNA expression of cytokines and parasite load were assessed by q-PCR. Dependent groups were compared using Student's paired t-test and independent groups were compared using Student's unpaired t-test. Results Infection with the JLP or Y strains increased expression of IFN-γ in the heart and of IL-10 and IL-17 in the spleen and heart compared to uninfected animals. Treatment increased the expression of IFN-γ and decreased the expression of IL-17, IL-10, TGF- β and Foxp3 in spleen and heart tissue compared to untreated infected animals. Conclusion Benznidazole can induce Th1 profile in the initial of the acute phase. The treatment decreased the parasite load in both organs, although the number of parasites in Y-strain-infected mice remained high. The data suggest that benznidazole may modulate cytokine expression in infection and can be dependent of the strain. However, treatment was not fully effective in the infection provoked by Y strain, probably due to the characteristics of the strain itself.
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Affiliation(s)
- Mariana Gatto
- Department of Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP - Univ Estadual Paulista), Av. Professor Mário Rubens Guimarães Montenegro, s/n, Distrito de Rubião Júnior, Botucatu, 18.6186-87 SP Brazil
| | - Larissa Ragozo Cardoso Oliveira
- Department of Microbiology and Immunology, Botucatu Biosciences Institute, São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, SP Brazil
| | - Fernanda De Nuzzi Dias
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP - Univ Estadual Paulista), Araraquara, SP Brazil
| | - João Pessoa Araújo Júnior
- Department of Microbiology and Immunology, Botucatu Biosciences Institute, São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, SP Brazil
| | - Carlos Roberto Gonçalves Lima
- Department of Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP - Univ Estadual Paulista), Av. Professor Mário Rubens Guimarães Montenegro, s/n, Distrito de Rubião Júnior, Botucatu, 18.6186-87 SP Brazil
| | - Eliana Peresi Lordelo
- Department of Immunology, University of Western São Paulo (Unoeste), Presidente Prudente, SP Brazil
| | - Rodrigo Mattos Dos Santos
- Department of Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP - Univ Estadual Paulista), Av. Professor Mário Rubens Guimarães Montenegro, s/n, Distrito de Rubião Júnior, Botucatu, 18.6186-87 SP Brazil
| | - Cilmery Suemi Kurokawa
- Department of Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP - Univ Estadual Paulista), Av. Professor Mário Rubens Guimarães Montenegro, s/n, Distrito de Rubião Júnior, Botucatu, 18.6186-87 SP Brazil
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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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Pinazo MJ, Pinto J, Ortiz L, Sánchez J, García W, Saravia R, Cortez MR, Moriana S, Grau E, Lozano D, Gascon J, Torrico F. A strategy for scaling up access to comprehensive care in adults with Chagas disease in endemic countries: The Bolivian Chagas Platform. PLoS Negl Trop Dis 2017; 11:e0005770. [PMID: 28820896 PMCID: PMC5576759 DOI: 10.1371/journal.pntd.0005770] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 08/30/2017] [Accepted: 07/03/2017] [Indexed: 11/19/2022] Open
Abstract
Background Bolivia has the highest prevalence of Chagas disease (CD) in the world (6.1%), with more than 607,186 people with Trypanosoma cruzi infection, most of them adults. In Bolivia CD has been declared a national priority. In 2009, the Chagas National Program (ChNP) had neither a protocol nor a clear directive for diagnosis and treatment of adults. Although programs had been implemented for congenital transmission and for acute cases, adults remained uncovered. Moreover, health professionals were not aware of treatment recommendations aimed at this population, and research on CD was limited; it was difficult to increase awareness of the disease, understand the challenges it presented, and adapt strategies to cope with it. Simultaneously, migratory flows that led Bolivian patients with CD to Spain and other European countries forced medical staff to look for solutions to an emerging problem. Intervention In this context, thanks to a Spanish international cooperation collaboration, the Bolivian platform for the comprehensive care of adults with CD was created in 2009. Based on the establishment of a vertical care system under the umbrella of ChNP general guidelines, six centres specialized in CD management were established in different epidemiological contexts. A common database, standardized clinical forms, a and a protocolized attention to adults patients, together with training activities for health professionals were essential for the model success. With the collaboration and knowledge transfer activities between endemic and non-endemic countries, the platform aims to provide care, train health professionals, and create the basis for a future expansion to the National Health System of a proven model of care for adults with CD. Results From 2010 to 2015, a total of 26,227 patients were attended by the Platform, 69% (18,316) were diagnosed with T. cruzi, 8,567 initiated anti-parasitic treatment, more than 1,616 health professionals were trained, and more than ten research projects developed. The project helped to increase the number of adults with CD diagnosed and treated, produce evidence-based clinical practice guidelines, and bring about changes in policy that will increase access to comprehensive care among adults with CD. The ChNP is now studying the Platform’s health care model to adapt and implement it nationwide. Conclusions This strategy provides a solution to unmet demands in the care of patients with CD, improving access to diagnosis and treatment. Further scaling up of diagnosis and treatment will be based on the expansion of the model of care to the NHS structures. Its sustainability will be ensured as it will build on existing local resources in Bolivia. Still human trained resources are scarce and the high staff turnover in Bolivia is a limitation of the model. Nevertheless, in a preliminary two-years-experience of scaling up this model, this limitations have been locally solved together with the health local authorities. Bolivia has the highest prevalence of Chagas disease (CD) in the world (6.1%), with more than 607,186 people with Trypanosoma cruzi infection. In Bolivia, the management of CD has been declared a national priority. In 2009, the Chagas National Program (ChNP) had neither a protocol nor a clear directive for diagnosis and treatment of adults. The Chagas Platform has been built as a model for comprehensive care of adults with CD. From 2010 to 2015, a total of 26,227 patients were attended by the Platform, 69% (18,316) were diagnosed with T. cruzi, 8,567 initiated anti-parasitic treatment, more than 1,616 health professionals were trained. More than ten research projects were developed. The project has also produced evidence-based clinical practice guidelines, and brings about changes in policy that will increase access to comprehensive care among adults with CD. The ChNP is now studying the Platform’s health care model to adapt and implement it nationwide. It is an experience of collaboration and knowledge transfer between endemic and non-endemic countries.
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Affiliation(s)
- Maria-Jesus Pinazo
- International Health Department, ISGlobal, Barcelona Center for International Health Research, (CRESIB), Hospital Clínic-Universitat de Barcelona, Spain
- * E-mail:
| | | | | | | | | | | | | | | | - Enric Grau
- International Health Department, ISGlobal, Barcelona Center for International Health Research, (CRESIB), Hospital Clínic-Universitat de Barcelona, Spain
| | | | - Joaquim Gascon
- International Health Department, ISGlobal, Barcelona Center for International Health Research, (CRESIB), Hospital Clínic-Universitat de Barcelona, Spain
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Knubel CP, Insfran C, Martinez FF, Diaz Lujan C, Fretes RE, Theumer MG, Cervi L, Motran CC. 3-Hydroxykynurenine, a Tryptophan Metabolite Generated during the Infection, Is Active Against Trypanosoma cruzi. ACS Med Chem Lett 2017; 8:757-761. [PMID: 28740612 DOI: 10.1021/acsmedchemlett.7b00169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/12/2017] [Indexed: 11/30/2022] Open
Abstract
The antiparasitic activity of 3-hydroxykynurenine (3-HK), one of the major tryptophan catabolites of the kynurenine pathway, against both Trypanosoma cruzi evolutive forms that are important for human infection, trypomastigotes (Tps) and amastigotes (Am), possible targets in the parasite and the drug toxicity to mammalian cells have been investigated. 3-HK showed a potent activity against Am with IC50 values in the micromolar concentration range, while the IC50 values to cause Tps death was ∼6000-times higher, indicating that the replicative form present in the vertebrate hosts is much more susceptible to 3-HK than bloodstream Tps. In addition, 3-HK showed activity against Tps and Am, at concentrations that did not exhibit toxicity to mammalian cells. Ultrastructural analysis and flow cytometry studies indicated that Am and Tps mitochondrion and nuclei contain 3-HK targets. The potency and selectivity of 3-HK, which is generated during T. cruzi infection in human and mice, suggest that 3-HK may be a suitable candidate for drug research and development for Chagas disease.
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Affiliation(s)
- Carolina P. Knubel
- Centro de Investigaciones
en Bioquímica Clínica e Inmunología (CIBICI),
CONICET, Departamento de Bioquímica Clínica, Facultad
de Ciencias Químicas, Universidad Nacional de Córdoba,
Haya de la Torre y Medina Allende, Ciudad Universitaria de Córdoba, Córdoba 5000, Argentina
| | - Constanza Insfran
- Centro de Investigaciones
en Bioquímica Clínica e Inmunología (CIBICI),
CONICET, Departamento de Bioquímica Clínica, Facultad
de Ciencias Químicas, Universidad Nacional de Córdoba,
Haya de la Torre y Medina Allende, Ciudad Universitaria de Córdoba, Córdoba 5000, Argentina
| | - Fernando F. Martinez
- Centro de Investigaciones
en Bioquímica Clínica e Inmunología (CIBICI),
CONICET, Departamento de Bioquímica Clínica, Facultad
de Ciencias Químicas, Universidad Nacional de Córdoba,
Haya de la Torre y Medina Allende, Ciudad Universitaria de Córdoba, Córdoba 5000, Argentina
| | - Cintia Diaz Lujan
- Instituto de Biología Celular, Facultad de Medicina, Universidad Nacional de Córdoba, Córdoba 5000, Argentina
| | - Ricardo E. Fretes
- Instituto de Biología Celular, Facultad de Medicina, Universidad Nacional de Córdoba, Córdoba 5000, Argentina
| | - Martin G. Theumer
- Centro de Investigaciones
en Bioquímica Clínica e Inmunología (CIBICI),
CONICET, Departamento de Bioquímica Clínica, Facultad
de Ciencias Químicas, Universidad Nacional de Córdoba,
Haya de la Torre y Medina Allende, Ciudad Universitaria de Córdoba, Córdoba 5000, Argentina
| | - Laura Cervi
- Centro de Investigaciones
en Bioquímica Clínica e Inmunología (CIBICI),
CONICET, Departamento de Bioquímica Clínica, Facultad
de Ciencias Químicas, Universidad Nacional de Córdoba,
Haya de la Torre y Medina Allende, Ciudad Universitaria de Córdoba, Córdoba 5000, Argentina
| | - Claudia C. Motran
- Centro de Investigaciones
en Bioquímica Clínica e Inmunología (CIBICI),
CONICET, Departamento de Bioquímica Clínica, Facultad
de Ciencias Químicas, Universidad Nacional de Córdoba,
Haya de la Torre y Medina Allende, Ciudad Universitaria de Córdoba, Córdoba 5000, Argentina
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Egüez KE, Alonso-Padilla J, Terán C, Chipana Z, García W, Torrico F, Gascon J, Lozano-Beltran DF, Pinazo MJ. Rapid diagnostic tests duo as alternative to conventional serological assays for conclusive Chagas disease diagnosis. PLoS Negl Trop Dis 2017; 11:e0005501. [PMID: 28369081 PMCID: PMC5391121 DOI: 10.1371/journal.pntd.0005501] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/13/2017] [Accepted: 03/17/2017] [Indexed: 11/24/2022] Open
Abstract
Chagas disease is caused by the parasite Trypanosoma cruzi. It affects several million people, mainly in Latin America, and severe cardiac and/or digestive complications occur in ~30% of the chronically infected patients. Disease acute stage is mostly asymptomatic and infection goes undiagnosed. In the chronic phase direct parasite detection is hampered due to its concealed presence and diagnosis is achieved by serological methods, like ELISA or indirect hemagglutination assays. Agreement in at least two tests must be obtained due to parasite wide antigenic variability. These techniques require equipped labs and trained personnel and are not available in distant regions. As a result, many infected people often remain undiagnosed until it is too late, as the two available chemotherapies show diminished efficacy in the advanced chronic stage. Easy-to-use rapid diagnostic tests have been developed to be implemented in remote areas as an alternative to conventional tests. They do not need electricity, nor cold chain, they can return results within an hour and some even work with whole blood as sample, like Chagas Stat-Pak (ChemBio Inc.) and Chagas Detect Plus (InBIOS Inc.). Nonetheless, in order to qualify a rapidly diagnosed positive patient for treatment, conventional serological confirmation is obligatory, which might risk its start. In this study two rapid tests based on distinct antigen sets were used in parallel as a way to obtain a fast and conclusive Chagas disease diagnosis using whole blood samples. Chagas Stat-Pak and Chagas Detect Plus were validated by comparison with three conventional tests yielding 100% sensitivity and 99.3% specificity over 342 patients seeking Chagas disease diagnosis in a reference centre in Sucre (Bolivia). Combined used of RDTs in distant regions could substitute laborious conventional serology, allowing immediate treatment and favouring better adhesion to it. Chagas disease is a neglected tropical disease caused by the parasite Trypanosoma cruzi. It affects 6–7 million people, mainly in Latin America. An initial asymptomatic phase make the infection go undiagnosed and untreated, silently progressing into its chronic stage. About 30% of the chronically infected patients end up developing life-threatening disruption of the heart and/or gut tissues. Two drugs are available but their efficacy diminishes the longer a person has been infected. Therefore, it is of paramount importance to achieve an early diagnosis to start treatment before symptoms advance. In the chronic stage parasite presence is intermittent and diagnosis is made by serological assays that detect parasite-specific immunoglobulins. Problem is that conventional serological techniques are laborious and require equipment and trained personnel unavailable in remote regions with high disease prevalence. To circumvent those inconveniences easy-to-use rapid diagnostic tests were developed. They return results within an hour and some work with whole blood as sample allowing diagnosis out of digital puncture. We propose that conventional assays could be substituted by whole blood-friendly rapid tests in order to achieve a conclusive Chagas disease diagnosis in remote regions. This would ease access to treatment increasing adherence rates to it.
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Affiliation(s)
- Karina E. Egüez
- Departmental Reference Laboratory, Chuquisaca Departmental Health Service (SEDES-Chuquisaca), Sucre, Bolivia
| | - Julio Alonso-Padilla
- Barcelona Institute for Global Health (ISGlobal), Centre for Research in International Health (CRESIB), Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Carolina Terán
- School of Medicine, University of San Francisco Xavier of Chuquisaca, Sucre, Bolivia; and Health Area, Simón Bolívar Andean University, Sucre, Bolivia
| | - Zenobia Chipana
- Departmental Reference Laboratory, Chuquisaca Departmental Health Service (SEDES-Chuquisaca), Sucre, Bolivia
| | | | | | - Joaquim Gascon
- Barcelona Institute for Global Health (ISGlobal), Centre for Research in International Health (CRESIB), Hospital Clinic-University of Barcelona, Barcelona, Spain
| | | | - María-Jesús Pinazo
- Barcelona Institute for Global Health (ISGlobal), Centre for Research in International Health (CRESIB), Hospital Clinic-University of Barcelona, Barcelona, Spain
- * E-mail:
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Colantonio LD, Prado N, Segura EL, Sosa-Estani S. Electrocardiographic Abnormalities and Treatment with Benznidazole among Children with Chronic Infection by Trypanosoma cruzi: A Retrospective Cohort Study. PLoS Negl Trop Dis 2016; 10:e0004651. [PMID: 27158908 PMCID: PMC4861278 DOI: 10.1371/journal.pntd.0004651] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 03/31/2016] [Indexed: 11/19/2022] Open
Abstract
Background Chronic infection by Trypanosoma cruzi could cause heart conduction disturbances. We sought to analyze electrocardiographic abnormalities among children with chronic T. cruzi infection with and without trypanocidal treatment with benznidazole. Methodology/Principal Findings We studied 111 children 6–16 years of age with asymptomatic chronic T. cruzi infection who were recruited in 1991–1992 in Salta, Argentina. Most children were randomly assigned to benznidazole 5 mg/Kg/day (n = 47) or matching placebo (n = 48) for 60 days. Remaining children (n = 16) received treatment with benznidazole 5 mg/Kg/day open-label. Electrocardiograms were obtained at baseline and in 1995–1996, 1998, 2000 and 2005, and were analyzed using the Buenos Aires method. Among the 94 children with an electrocardiogram at baseline, 8 (8.5%) had electrocardiographic abnormalities, including 4 (4.7%) children with right bundle branch block. Proportion of abnormal electrocardiograms in the full population (n = 111) remained constant over time (media follow-up 8.6 years). Multivariable adjusted prevalence ratios (95% confidence interval [95%CI]) for electrocardiographic abnormalities in 1995–1996, 1998, 2000 and 2005 comparing children treated with benznidazole versus those not treated were 2.76 (0.66, 11.60), 2.33 (0.44, 12.31), 3.06 (0.48, 19.56), and 1.94 (0.33, 11.25), respectively. Among the 86 children with a normal electrocardiogram at baseline, 16 (18.6%) developed electrocardiographic abnormalities during follow-up. The multivariable adjusted hazard ratio for incident electrocardiographic abnormalities comparing children treated with benznidazole versus those not treated was 0.68 (95%CI: 0.25, 1.88). Conclusions/Significance Electrocardiographic abnormalities are frequent among children with chronic T. cruzi infection. Treatment with benznidazole for 60 days may not be associated with less electrocardiographic abnormalities. There are few data available on the natural history of electrocardiographic abnormalities among children with chronic Trypanosoma cruzi infection. Also, few studies analyzed the effect of benznidazole to prevent electrocardiographic abnormalities in this population. In the current study, electrocardiographic abnormalities were frequent among children with chronic T. cruzi infection. Results from the current study also suggest that treatment with benznidazole may not be associated with less electrocardiographic abnormalities. The current study highlights the need of further research to prevent cardiovascular manifestations associated with chronic T. cruzi infection.
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Affiliation(s)
- Lisandro D. Colantonio
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Public Health, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Nilda Prado
- National Institute of Parasitology “Dr. Mario Fatala Chaben”-CONICET-ANLIS, Ministry of Health, Buenos Aires, Argentina
| | - Elsa L. Segura
- National Institute of Parasitology “Dr. Mario Fatala Chaben”-CONICET-ANLIS, Ministry of Health, Buenos Aires, Argentina
| | - Sergio Sosa-Estani
- National Institute of Parasitology “Dr. Mario Fatala Chaben”-CONICET-ANLIS, Ministry of Health, Buenos Aires, Argentina
- * E-mail:
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Liu Q, Zhou XN. Preventing the transmission of American trypanosomiasis and its spread into non-endemic countries. Infect Dis Poverty 2015; 4:60. [PMID: 26715535 PMCID: PMC4693433 DOI: 10.1186/s40249-015-0092-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 12/11/2015] [Indexed: 11/10/2022] Open
Abstract
American trypanosomiasis, commonly known as Chagas disease, is caused by the flagellate protozoan parasite Trypanosoma cruzi. An estimated eight million people infected with T. cruzi currently reside in the endemic regions of Latin America. However, as the disease has now been imported into many non-endemic countries outside of Latin America, it has become a global health issue. We reviewed the transmission patterns and current status of disease spread pertaining to American trypanosomiasis at the global level, as well as recent advances in research. Based on an analysis of the gaps in American trypanosomiasis control, we put forward future research priorities that must be implemented to stop the global spread of the disease.
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Affiliation(s)
- Qin Liu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, Ministry of Health;, WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, P. R. China
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, Ministry of Health;, WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, P. R. China.
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Cevey ÁC, Mirkin GA, Penas FN, Goren NB. Low-dose benznidazole treatment results in parasite clearance and attenuates heart inflammatory reaction in an experimental model of infection with a highly virulent Trypanosoma cruzi strain. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2015; 6:12-22. [PMID: 26862474 PMCID: PMC4706620 DOI: 10.1016/j.ijpddr.2015.12.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 10/29/2022]
Abstract
Chagas disease, caused by Trypanosoma cruzi, is the main cause of dilated cardiomyopathy in the Americas. Antiparasitic treatment mostly relies on benznidazole (Bzl) due to Nifurtimox shortage or unavailability. Both induce adverse drug effects (ADE) of varied severity in many patients, leading to treatment discontinuation or abandonment. Since dosage may influence ADE, we aimed to assess Bzl efficacy in terms of parasiticidal and anti-inflammatory activity, using doses lower than those previously reported. BALB/c mice infected with the T. cruzi RA strain were treated with different doses of Bzl. Parasitaemia, mortality and weight change were assessed. Parasite load, tissue infiltrates and inflammatory mediators were studied in the heart. Serum creatine kinase (CK) activity was determined as a marker of heart damage. The infection-independent anti-inflammatory properties of Bzl were studied in an in vitro model of LPS-treated cardiomyocyte culture. Treatment with 25 mg/kg/day Bzl turned negative the parasitological parameters, induced a significant decrease in IL-1β, IL-6 and NOS2 in the heart and CK activity in serum, to normal levels. No mortality was observed in infected treated mice. Primary cultured cardiomyocytes treated with Bzl showed that inflammatory mediators were reduced via inhibition of the NF-κB pathway. A Bzl dose lower than that previously reported for treatment of experimental Chagas disease exerts adequate antiparasitic and anti-inflammatory effects leading to parasite clearance and tissue healing. This may be relevant to reassess the dose currently used for the treatment of human Chagas disease, aiming to minimize ADE.
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Affiliation(s)
- Ágata Carolina Cevey
- Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM - UBA, CONICET), Argentina
| | - Gerardo Ariel Mirkin
- Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM - UBA, CONICET), Argentina
| | - Federico Nicolás Penas
- Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM - UBA, CONICET), Argentina
| | - Nora Beatriz Goren
- Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM - UBA, CONICET), Argentina.
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Valdez-Tah A, Huicochea-Gómez L, Ortega-Canto J, Nazar-Beutelspacher A, Ramsey JM. Social Representations and Practices Towards Triatomines and Chagas Disease in Calakmul, México. PLoS One 2015; 10:e0132830. [PMID: 26204555 PMCID: PMC4512683 DOI: 10.1371/journal.pone.0132830] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 06/19/2015] [Indexed: 12/20/2022] Open
Abstract
Vector-borne transmission of Trypanosoma cruzi (VBTTc) is dependent on the concomitant interaction between biological and environmental hazard over the entire landscape, and human vulnerability. Representations and practices of health-disease-care-seeking and territorial appropriation and use were analyzed for VBTTc in a qualitative ethnographic study in the Zoh-Laguna landscape, Campeche, Mexico. In-depth interviews and participatory observation explored representations and practices regarding ethno-ecological knowledge related to vector-transmission, health-disease-care-seeking, and land use processes. The population has a broad knowledge of biting insects, which they believe are all most abundant in the rainy season; the community´s proximity to natural areas is perceived as a barrier to control their abundance. Triatomines are mostly recognized by men, who have detailed knowledge regarding their occurrence and association with mammals in non-domestic fragments, where they report being bitten. Women emphasize the dermal consequences of triatomine bites, but have little knowledge about the disease. Triatomine bites and the chinchoma are "normalized" events which are treated using home remedies, if at all. The neglected condition of Chagas disease in Mexican public health policies, livelihoods which are dependent on primary production, and gender-related knowledge (or lack thereof) are structural circumstances which influence the environment and inhabitants´ living conditions; in turn, these trigger triatomine-human contact. The most important landscape practices producing vulnerability are the activities and mobility within and between landscape fragments causing greater exposure of inhabitants primarily in the dry season. A landscape approach to understanding vulnerability components of VBTTc from health-disease-care-seeking perspectives and based on territorial appropriation and use, is essential where there is continuous movement of vectors between and within all habitats. An understanding of the structural factors which motivate the population´s perceptions, beliefs, and practices and which create and maintain vulnerability is essential to develop culturally relevant and sustainable community-based VBTTc prevention and control.
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Affiliation(s)
- Alba Valdez-Tah
- Departamento de Sociedad y Cultura, El Colegio de la Frontera Sur, Campeche, Campeche, México
- Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, Tapachula, Chiapas, México
| | - Laura Huicochea-Gómez
- Departamento de Sociedad y Cultura, El Colegio de la Frontera Sur, Campeche, Campeche, México
| | - Judith Ortega-Canto
- Centro Regional de Investigaciones Biomédicas “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | | | - Janine M. Ramsey
- Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, Tapachula, Chiapas, México
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Gruendling AP, Massago M, Teston APM, Monteiro WM, Kaneshima EN, Araújo SM, Gomes ML, Barbosa MDGV, Toledo MJO. Impact of benznidazole on infection course in mice experimentally infected with Trypanosoma cruzi I, II, and IV. Am J Trop Med Hyg 2015; 92:1178-89. [PMID: 25940197 DOI: 10.4269/ajtmh.13-0690] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 11/01/2014] [Indexed: 11/07/2022] Open
Abstract
American trypanosomiasis is an emerging zoonosis in the Brazilian Amazon. Studies on benznidazole (BZ) chemotherapy with Trypanosoma cruzi from this region have great relevance, given the different discrete typing units (DTUs) that infect humans in the Amazon and other regions of Brazil. We performed a parasitological, histopathological, and molecular analysis of mice inoculated with strains of T. cruzi I, II, and IV that were BZ-treated during the acute phase of infection. Groups of Swiss mice were inoculated; 13 received oral BZ, whereas the other 13 comprised the untreated controls. Unlike parasitemia, the infectivity and mortality did not vary among the DTUs. Trypanosoma cruzi DNA was detected in all tissues analyzed and the proportion of organs parasitized varied with the parasite DTU. The BZ treatment reduced the most parasitological parameters, tissue parasitism and the inflammatory processes at all infection stages and for all DTUs. However, the number of significant reductions varied according to the DTU and infection phase.
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Affiliation(s)
- Ana Paula Gruendling
- Post-Graduate Program in Health Sciences (Programa de Pós-graduação em Ciências da Saúde), Maringá State University (Universidade Estadual de Maringá, UEM), Maringá, Paraná, Brazil; Department of Basic Health Sciences, Health Sciences Center, (Departamento de Ciências Básicas da Saúde, Centro de Ciências da Saúde), UEM, Maringá, Paraná, Brazil; Post-Graduate Program in Tropical Medicine (Programa de Pós-Graduação em Medicina Tropical), Dr. Heitor Vieira Dourado Foundation for Tropical Medicine (Fundação de Medicina Tropical Dr. Heitor Vieira Dourado)/Amazonas State University (Universidade do Estado do Amazonas), Manaus, Amazonas, Brazil
| | - Miyoko Massago
- Post-Graduate Program in Health Sciences (Programa de Pós-graduação em Ciências da Saúde), Maringá State University (Universidade Estadual de Maringá, UEM), Maringá, Paraná, Brazil; Department of Basic Health Sciences, Health Sciences Center, (Departamento de Ciências Básicas da Saúde, Centro de Ciências da Saúde), UEM, Maringá, Paraná, Brazil; Post-Graduate Program in Tropical Medicine (Programa de Pós-Graduação em Medicina Tropical), Dr. Heitor Vieira Dourado Foundation for Tropical Medicine (Fundação de Medicina Tropical Dr. Heitor Vieira Dourado)/Amazonas State University (Universidade do Estado do Amazonas), Manaus, Amazonas, Brazil
| | - Ana Paula M Teston
- Post-Graduate Program in Health Sciences (Programa de Pós-graduação em Ciências da Saúde), Maringá State University (Universidade Estadual de Maringá, UEM), Maringá, Paraná, Brazil; Department of Basic Health Sciences, Health Sciences Center, (Departamento de Ciências Básicas da Saúde, Centro de Ciências da Saúde), UEM, Maringá, Paraná, Brazil; Post-Graduate Program in Tropical Medicine (Programa de Pós-Graduação em Medicina Tropical), Dr. Heitor Vieira Dourado Foundation for Tropical Medicine (Fundação de Medicina Tropical Dr. Heitor Vieira Dourado)/Amazonas State University (Universidade do Estado do Amazonas), Manaus, Amazonas, Brazil
| | - Wuelton M Monteiro
- Post-Graduate Program in Health Sciences (Programa de Pós-graduação em Ciências da Saúde), Maringá State University (Universidade Estadual de Maringá, UEM), Maringá, Paraná, Brazil; Department of Basic Health Sciences, Health Sciences Center, (Departamento de Ciências Básicas da Saúde, Centro de Ciências da Saúde), UEM, Maringá, Paraná, Brazil; Post-Graduate Program in Tropical Medicine (Programa de Pós-Graduação em Medicina Tropical), Dr. Heitor Vieira Dourado Foundation for Tropical Medicine (Fundação de Medicina Tropical Dr. Heitor Vieira Dourado)/Amazonas State University (Universidade do Estado do Amazonas), Manaus, Amazonas, Brazil
| | - Edilson N Kaneshima
- Post-Graduate Program in Health Sciences (Programa de Pós-graduação em Ciências da Saúde), Maringá State University (Universidade Estadual de Maringá, UEM), Maringá, Paraná, Brazil; Department of Basic Health Sciences, Health Sciences Center, (Departamento de Ciências Básicas da Saúde, Centro de Ciências da Saúde), UEM, Maringá, Paraná, Brazil; Post-Graduate Program in Tropical Medicine (Programa de Pós-Graduação em Medicina Tropical), Dr. Heitor Vieira Dourado Foundation for Tropical Medicine (Fundação de Medicina Tropical Dr. Heitor Vieira Dourado)/Amazonas State University (Universidade do Estado do Amazonas), Manaus, Amazonas, Brazil
| | - Silvana M Araújo
- Post-Graduate Program in Health Sciences (Programa de Pós-graduação em Ciências da Saúde), Maringá State University (Universidade Estadual de Maringá, UEM), Maringá, Paraná, Brazil; Department of Basic Health Sciences, Health Sciences Center, (Departamento de Ciências Básicas da Saúde, Centro de Ciências da Saúde), UEM, Maringá, Paraná, Brazil; Post-Graduate Program in Tropical Medicine (Programa de Pós-Graduação em Medicina Tropical), Dr. Heitor Vieira Dourado Foundation for Tropical Medicine (Fundação de Medicina Tropical Dr. Heitor Vieira Dourado)/Amazonas State University (Universidade do Estado do Amazonas), Manaus, Amazonas, Brazil
| | - Mônica L Gomes
- Post-Graduate Program in Health Sciences (Programa de Pós-graduação em Ciências da Saúde), Maringá State University (Universidade Estadual de Maringá, UEM), Maringá, Paraná, Brazil; Department of Basic Health Sciences, Health Sciences Center, (Departamento de Ciências Básicas da Saúde, Centro de Ciências da Saúde), UEM, Maringá, Paraná, Brazil; Post-Graduate Program in Tropical Medicine (Programa de Pós-Graduação em Medicina Tropical), Dr. Heitor Vieira Dourado Foundation for Tropical Medicine (Fundação de Medicina Tropical Dr. Heitor Vieira Dourado)/Amazonas State University (Universidade do Estado do Amazonas), Manaus, Amazonas, Brazil
| | - Maria das Graças V Barbosa
- Post-Graduate Program in Health Sciences (Programa de Pós-graduação em Ciências da Saúde), Maringá State University (Universidade Estadual de Maringá, UEM), Maringá, Paraná, Brazil; Department of Basic Health Sciences, Health Sciences Center, (Departamento de Ciências Básicas da Saúde, Centro de Ciências da Saúde), UEM, Maringá, Paraná, Brazil; Post-Graduate Program in Tropical Medicine (Programa de Pós-Graduação em Medicina Tropical), Dr. Heitor Vieira Dourado Foundation for Tropical Medicine (Fundação de Medicina Tropical Dr. Heitor Vieira Dourado)/Amazonas State University (Universidade do Estado do Amazonas), Manaus, Amazonas, Brazil
| | - Max Jean O Toledo
- Post-Graduate Program in Health Sciences (Programa de Pós-graduação em Ciências da Saúde), Maringá State University (Universidade Estadual de Maringá, UEM), Maringá, Paraná, Brazil; Department of Basic Health Sciences, Health Sciences Center, (Departamento de Ciências Básicas da Saúde, Centro de Ciências da Saúde), UEM, Maringá, Paraná, Brazil; Post-Graduate Program in Tropical Medicine (Programa de Pós-Graduação em Medicina Tropical), Dr. Heitor Vieira Dourado Foundation for Tropical Medicine (Fundação de Medicina Tropical Dr. Heitor Vieira Dourado)/Amazonas State University (Universidade do Estado do Amazonas), Manaus, Amazonas, Brazil
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Machado-de-Assis GF, Diniz GA, Montoya RA, Dias JCP, Coura JR, Machado-Coelho GLL, Albajar-Viñas P, Torres RM, Lana MD. A serological, parasitological and clinical evaluation of untreated Chagas disease patients and those treated with benznidazole before and thirteen years after intervention. Mem Inst Oswaldo Cruz 2015; 108:873-80. [PMID: 24037109 PMCID: PMC3970640 DOI: 10.1590/0074-0276130122] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 07/04/2013] [Indexed: 01/05/2023] Open
Abstract
The etiological treatment of Chagas disease is recommended for all patients with acute or recent chronic infection, but controversies remain regarding the benefit of chemotherapy and interpretations of the parasitological cure after etiological treatment. This study compares the laboratory and clinical evaluations of Chagas disease patients who were diagnosed 13 years earlier. Fifty-eight Chagas disease patients (29 treated with benznidazole and 29 untreated) were matched at the time of treatment based on several variables. Conventional serology revealed the absence of seroconversion in all patients. However, lower serological titres were verified in the treated group, primarily among patients who had the indeterminate form of the disease. Haemoculture performed 13 years after the intervention was positive for 6.9% and 27.6% of the treated and untreated patients, respectively. Polymerase chain reaction tests were positive for 44.8% and 13.8% of the treated and untreated patients, respectively. Patients who presented with the indeterminate form of the disease at the beginning of the study exhibited less clinical progression (17.4%) compared with the untreated group (56.5%). Therefore, this global analysis revealed that etiological treatment with benznidazole may benefit patients with respect to the clinical progression of Chagas disease and the prognosis, particularly when administered to patients with the indeterminate form of the disease.
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22
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Oliveira-Silva JCVD, Machado-de-Assis GF, Oliveira MT, Paiva NCN, Araújo MSS, Carneiro CM, Martins-Filho OA, Martins HR, Lana MD. Experimental benznidazole treatment of Trypanosoma cruzi II strains isolated from children of the Jequitinhonha Valley, Minas Gerais, Brazil, with Chagas disease. Mem Inst Oswaldo Cruz 2015; 110:86-94. [PMID: 25742267 PMCID: PMC4371221 DOI: 10.1590/0074-02760140260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 12/04/2014] [Indexed: 11/22/2022] Open
Abstract
Trypanosoma cruzi strains from distinct geographic areas show differences in drug
resistance and association between parasites genetic and treatment response has been
observed. Considering that benznidazole (BZ) can reduce the parasite burden and
tissues damage, even in not cured animals and individuals, the goal is to assess the
drug response to BZ of T. cruzi II strains isolated from children of the
Jequitinhonha Valley, state of Minas Gerais, Brazil, before treatment. Mice infected
and treated with BZ in both phases of infection were compared with the untreated and
evaluated by fresh blood examination, haemoculture, polymerase chain reaction,
conventional (ELISA) and non-conventional (FC-ALTA) serologies. In mice treated in
the acute phase, a significant decrease in parasitaemia was observed for all strains.
Positive parasitological and/or serological tests in animals treated during the acute
and chronic (95.1-100%) phases showed that most of the strains were BZ resistant.
However, beneficial effect was demonstrated because significant reduction (p <
0.05%) and/or suppression of parasitaemia was observed in mice infected with all
strains (acute phase), associated to reduction/elimination of inflammation and
fibrosis for two/eight strains. BZ offered some benefit, even in not cured animals,
what suggest that BZ use may be recommended at least for recent chronic infection of
the studied region.
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Affiliation(s)
| | | | | | | | | | | | - Olindo Assis Martins-Filho
- Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Teófilo Otoni, MG, Brasil
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23
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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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Dutra WO, Menezes CAS, Magalhães LMD, Gollob KJ. Immunoregulatory networks in human Chagas disease. Parasite Immunol 2014; 36:377-87. [PMID: 24611805 DOI: 10.1111/pim.12107] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 02/19/2014] [Indexed: 01/11/2023]
Abstract
Chagas disease, caused by the infection with Trypanosoma cruzi, is endemic in all Latin America. Due to the increase in population migration, Chagas disease has spread worldwide and is now considered a health issue not only in endemic countries. While most chronically infected individuals remain asymptomatic, approximately 30% of the patients develop a potentially deadly cardiomyopathy. The exact mechanisms that underlie the establishment and maintenance of the cardiac pathology are not clear. However, there is consistent evidence that immunoregulatory cytokines are critical for orchestrating the immune response and thus influence disease development or control. While the asymptomatic (indeterminate) form represents a state of balance between the host and the parasite, the establishment of the cardiac form represents the loss of this balance. Analysis of data obtained from several studies has led to the hypothesis that the indeterminate form is associated with an anti-inflammatory cytokine profile, represented by high expression of IL-10, while cardiac form is associated with a high production of IFN-gamma and TNF-alpha in relation to IL-10, leading to an inflammatory profile. Here, we discuss the immunoregulatory events that might influence disease outcome, as well as the mechanisms that influence the establishment of these complex immunoregulatory networks.
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Affiliation(s)
- W O Dutra
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Belo Horizonte, MG, Brazil; Instituto Nacional de Ciência e Tecnologia - Doenças Tropicais - INCT-DT, Belo Horizonte, MG, Brazil
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Gamboa-León R, Ramirez-Gonzalez C, Pacheco-Tucuch FS, O'Shea M, Rosecrans K, Pippitt J, Dumonteil E, Buekens P. Seroprevalence of Trypanosoma cruzi among mothers and children in rural Mayan communities and associated reproductive outcomes. Am J Trop Med Hyg 2014; 91:348-53. [PMID: 24935948 DOI: 10.4269/ajtmh.13-0527] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Our objective was to determine the seroprevalence of Trypanosoma cruzi infection among mothers and children in two rural Mayan communities in Yucatan, Mexico and examine sociodemographic characteristics and adverse reproductive outcomes associated with maternal infection. We performed household surveys in the communities of Sudzal and Teya. Mothers were interviewed, and blood samples were obtained to perform rapid tests and enzyme-linked immunosorbent assays (ELISAs). We surveyed 390 mothers and 685 children. The overall seroprevalence was 2.3% among mothers and 0.4% among children. In Sudzal, we found a seroprevalence of 4.4% among mothers and 0.7% in children. In Teya, we found a seroprevalence of 0.9% among mothers and 0.3% among children. Compared with uninfected mothers, seropositive mothers reported more stillbirths (relative risk = 4.7; 95% confidence interval = 2.1-10.4). T. cruzi infection is present in these communities, and infected children indicate active transmission. Seropositivity in mothers is associated with a history of adverse reproductive outcomes.
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Affiliation(s)
- Rubi Gamboa-León
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Claudia Ramirez-Gonzalez
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Freddy S Pacheco-Tucuch
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Matthew O'Shea
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Kathryn Rosecrans
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Julia Pippitt
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Eric Dumonteil
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Pierre Buekens
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
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26
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Altcheh J, Moscatelli G, Mastrantonio G, Moroni S, Giglio N, Marson ME, Ballering G, Bisio M, Koren G, García-Bournissen F. Population pharmacokinetic study of benznidazole in pediatric Chagas disease suggests efficacy despite lower plasma concentrations than in adults. PLoS Negl Trop Dis 2014; 8:e2907. [PMID: 24853169 PMCID: PMC4031103 DOI: 10.1371/journal.pntd.0002907] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/16/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Chagas disease, caused by the parasite Trypanosoma cruzi, can lead to long term cardiac morbidity. Treatment of children with benznidazole is effective, but no pediatric pharmacokinetics data are available and clinical pharmacology information on the drug is scarce. PATIENTS AND METHODS Prospective population pharmacokinetic (PK) cohort study in children 2-12 years old with Chagas disease treated with oral benznidazole 5-8 mg/kg/day BID for 60 days. (clinicaltrials.gov #NCT00699387). RESULTS Forty children were enrolled in the study. Mean age was 7.3 years. A total of 117 samples were obtained from 38 patients for PK analysis. A one compartment model best fit the data. Weight-corrected clearance rate (CL/F) showed a good correlation with age, with younger patients having a significantly higher CL/F than older children and adults. Simulated median steady-state benznidazole concentrations, based on model parameters, were lower for children in our study than for adults and lowest for children under 7 years of age. Treatment was efficacious in the 37 patients who completed the treatment course, and well tolerated, with few, and mild, adverse drug reactions (ADRs). DISCUSSION Observed benznidazole plasma concentrations in children were markedly lower than those previously reported in adults (treated with comparable mg/kg doses), possibly due to a higher CL/F in smaller children. These lower blood concentrations were nevertheless associated to a high therapeutic response in our cohort. Unlike adults, children have few adverse reactions to the drug, suggesting that there may be a direct correlation between drug concentrations and incidence of ADRs. Our results suggest that studies with lower doses in adults may be warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT00699387.
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Affiliation(s)
- Jaime Altcheh
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Guillermo Moscatelli
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Guido Mastrantonio
- Área de Toxicología, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Provincia de Buenos Aires, Argentina
| | - Samanta Moroni
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Norberto Giglio
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Maria Elena Marson
- Área de Toxicología, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Provincia de Buenos Aires, Argentina
| | - Griselda Ballering
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Margarita Bisio
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
| | - Gideon Koren
- Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Facundo García-Bournissen
- Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, Argentina
- Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Abstract
BACKGROUND Chagas disease, a potentially fatal parasitic infection, is emerging in Europe in the context of international migration but there is little public health attention and frequent lack of clinicians' awareness. To date, there is no published information about clinical characteristics in children. METHODS We reviewed the medical files of all children (<18 years) with Chagas disease managed in 2 hospitals in Barcelona, Spain and Geneva, Switzerland between January 2004 and July 2012. RESULTS Forty-five cases were identified. Two children (4.4%) were diagnosed during the acute phase and the remaining 43 (95.6%) were in the chronic phase of the infection. All but 1 were asymptomatic. Of the 41 treated children, 40 (97.6%) completed 60 days of treatment. Thirty-five (85.4%) received benznidazole, 5 (12.2%) nifurtimox and 1 (2.4%) both drugs consecutively. There were 2 (4.9%) treatment interruptions due to adverse events. The most frequent adverse events were rash (24.4%), anorexia or insufficient weight gain (14.6%) and anemia (2.4%). Twenty-nine (64.4%) children were followed up by serology after 2 years. Five (17.2%) were cured. CONCLUSIONS Pediatric Chagas disease is an emerging health issue in Europe that requires enhanced attention. Greater emphasis should be put on screening pregnant women at risk and their newborns in case of infection along with older children and relatives. Pediatricians have a central role to play in providing families with information and offering testing in situations of risk.
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Oliveira I, Torrico F, Muñoz J, Gascon J. Congenital transmission of Chagas disease: a clinical approach. Expert Rev Anti Infect Ther 2014; 8:945-56. [DOI: 10.1586/eri.10.74] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bottieau E, Vekemans M, Van Gompel A. Therapy of vector-borne protozoan infections in nonendemic settings. Expert Rev Anti Infect Ther 2014; 9:583-608. [DOI: 10.1586/eri.11.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lepesheva GI. Design or screening of drugs for the treatment of Chagas disease: what shows the most promise? Expert Opin Drug Discov 2013; 8:1479-89. [PMID: 24079515 PMCID: PMC3867292 DOI: 10.1517/17460441.2013.845554] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Endemic in Latin America, Chagas disease is now becoming a serious global health problem, and yet has no financial viability for the pharmaceutical industry and remains incurable. In 2012, two antimycotic drugs inhibitors of fungal sterol 14α-demethylase (CYP51) - posaconazole and ravuconazole - entered clinical trials. Availability of the X-ray structure of the orthologous enzyme from the causative agent of the disease, protozoan parasite Trypanosoma cruzi, determined in complexes with posaconazole as well as with several experimental protozoa-specific CYP51 inhibitors opens an excellent opportunity to improve the situation. AREAS COVERED This article summarizes the information available in PubMed and Google on the outcomes of treatment of the chronic Chagas disease. It also outlines the major features of the T. cruzi CYP51 structure and the possible structure-based strategies for rational design of novel T. cruzi specific drugs. EXPERT OPINION There is no doubt that screenings for alternative drug-like molecules as well as mining the T. cruzi genome for novel drug targets are of great value and might eventually lead to groundbreaking discoveries. However, all newly identified molecules must proceed through the long, expensive and low-yielding drug optimization process, and all novel potential drug targets must be validated in terms of their essentiality and druggability. CYP51 is already a well-validated and highly successful target for clinical and agricultural antifungals. With minimal investments into the final stages of their development/trials, T. cruzi-specific CYP51 inhibitors can provide an immediate treatment for Chagas disease, either on their own or in combination with the currently available drugs.
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Affiliation(s)
- Galina I Lepesheva
- Vanderbilt University, Institute for Global Health, School of Medicine, Center for Structural Biology, Department of Biochemistry , 622 RRB, 23rd at Pierce, Nashville, TN 37232 , USA +1 615 343 1373 ; +1 615 322 4349 ;
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Abstract
American trypanosomiasis is a parasitic disease caused by the flagellate protozoan Trypanosoma cruzi. Chagas disease is endemic in Latin America, where an estimated 10-14 million people are infected, and an emerging disease in Europe and the USA. Trypanosoma cruzi is transmitted by blood-sucking bugs of the family Reduviidae. Rhodnius prolixus, Panstrongylus megistus, Triatoma infestans, and T. dimidiata are the main vectors in the sylvatic cycle. Non vector-borne transmission includes blood transfusion, congenital and oral transmission, transplantation, and accidental infections. Most cases of acute infection occur in childhood and are usually asymptomatic, although severe myocarditis and meningoencephalitis may occur. Approximately 30% of T. cruzi-infected people will develop the chronic stage of the disease. Chronic chagasic cardiomyopathy is characterized by progressive heart failure, arrhythmias, intraventricular conduction defects, sudden death, and peripheral thromboembolism. Acute exacerbation can occur in individuals with involvement of cellular immunity such as advanced AIDS (acquired immunodeficiency syndrome), and transplant-associated immunosuppression. Neurological involvement may present with encephalitis, meningoencephalitis, or a space-occupying cerebral lesion called chagoma. Chagas disease is a major cause of ischemic stroke in Latin America. Several epidemiological studies have found an association between T. cruzi infection and cardioembolic ischemic stroke. Benznidazole and nifurtimox are the two available trypanocide drugs against T. cruzi.
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Affiliation(s)
- Francisco Javier Carod-Artal
- Neurology Department, Raigmore Hospital, Inverness, UK and Health Sciences and Medicine Faculty, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
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Riganti J, Maqueda MG, Piñero MCB, Volonteri VI, Galimberti RL. Reactivation of Chagas' disease: cutaneous manifestations in two immunosuppressed patients. Int J Dermatol 2012; 51:829-34. [PMID: 22715827 DOI: 10.1111/j.1365-4632.2011.05224.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chagas' disease is a zoonosis caused by a protozoan agent, Trypanosoma cruzi. Patients undergoing immunosuppressive treatment due to organ transplant, malignancies, infections, or chemotherapy may reactivate a preexisting chronic or indeterminate Trypanosoma cruzi infection. METHODS We present two transplant patients who underwent reactivation of Chagas' disease with cutaneous manifestations after an augmentation in their immunosuppressive therapy. A 38-year-old man was hospitalized on day 69 after receiving an allogeneic bone marrow transplant; he developed multiple painful erythematous plaques with diffuse borders, confined to the right cheek, trunk, thigh, elbows, and feet. A 59-year-old woman with a 14-year history of Chagasic cardiomyopathy presented one month after heart transplantation with a painful infiltrated purpuric plaque on the back of her right leg. RESULTS In both cases, histologic examination of skin biopsies showed dermal infiltration with intrahistiocytic amastigotes. In one of the reported cases, the Strout method detected parasitemia. Treatments with nifurtimox (600 mg/d) in case 1 and benznidazole (400 mg/d) in case 2 were started. Fever and cutaneous lesions resolved immediately after seven days of treatment. CONCLUSIONS Reactivation of Chagas' disease is a serious complication that usually occurs in immunocompromised patients. Clinical manifestations include febrile illness occasionally associated with painful skin lesions. Early diagnosis and proper treatment can significantly improve these patients' outcome.
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Affiliation(s)
- Julia Riganti
- Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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Affiliation(s)
- Rick L Tarleton
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, United States of America.
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Sathler-Avelar R, Vitelli-Avelar DM, Elói-Santos SM, Gontijo ED, Teixeira-Carvalho A, Martins-Filho OA. Blood leukocytes from benznidazole-treated indeterminate chagas disease patients display an overall type-1-modulated cytokine profile upon short-term in vitro stimulation with Trypanosoma cruzi antigens. BMC Infect Dis 2012; 12:123. [PMID: 22625224 PMCID: PMC3519593 DOI: 10.1186/1471-2334-12-123] [Citation(s) in RCA: 26] [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: 02/13/2012] [Accepted: 05/01/2012] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Benznidazole (Bz)-chemotherapy is recommended to prevent Chagas disease progression, despite its limited efficacy during chronic disease. However, the host mechanisms underlying these benefits still remain to be elucidated. METHODS In this study, we have used short-term whole blood cultures to describe the cytokine profile of Bz-treated Indeterminate Chagas disease patients-(INDt) as compared to untreated patients-(IND). RESULTS Our findings showed that IND presented increased levels of IL-10+neutrophils, IL-12⁺ and IL-10⁺ monocytes and IFN-γ⁺NK-cells. Moreover, IND showed slight increase of IL-4⁺CD4⁺T-cells and enhanced levels of IL-10⁺CD8⁺T-cells and B-cells. Additional analysis of cytokine Low and High producers also highlighted the presence of High cytokine producers within IND, including IL-10 from CD4⁺ T-cells and IFN-γ from CD8⁺ T-cells, as compared to NI. The Bz-treatment lead to an overall cytokine down-regulation in the innate and adaptive compartments, including low levels of IL-12⁺ and IL-10⁺ neutrophils and monocytes, IFN-γ⁺NK-cells, IL-12⁺, TNF-α⁺, IFN-γ⁺ and IL-5⁺CD4⁺T-cells and IL-10⁺B-cells, along with basal levels of cytokine-expressing CD8⁺T-cells in INDt as compared to IND. The in vitro antigen stimulation shifted the cytokine profile toward a type 1-modulated profile, with increased levels of IL-12⁺ and IL-10⁺ monocytes, IFN-γ⁺ and IL-4⁺NK-cells along with TNF-α⁺ and IFN-γ⁺CD8⁺T-cells. Analysis of Low and High cytokine producers, upon in vitro antigen stimulation, further confirm these data. CONCLUSION Together, our findings showed that the Bz treatment of Indeterminate Chagas' disease patients shifts the cytokine patterns of peripheral blood monocytes, NK-cells and CD8⁺ T-cells towards a long-lasting Type-1-modulated profile that could be important to the maintenance of a non-deleterious immunological microenvironment.
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Affiliation(s)
- Renato Sathler-Avelar
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, CPqRR-FIOCRUZ, Belo Horizonte, MG, Brazil
- Unicentro Newton Paiva, Belo Horizonte, MG, Brazil
- Universidade Vale do Rio Verde, UninCor, Belo Horizonte, MG, Brazil
- Departamento de Propedêutica Complementar, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, R, Laboratório de Biomarcadores de Diagnóstico e Monitoração, CPqRR-FIOCRUZ, Av. Augusto de Lima 1715, 30190–002, Belo Horizonte, MG, Brazil
| | - Danielle Marquete Vitelli-Avelar
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, CPqRR-FIOCRUZ, Belo Horizonte, MG, Brazil
- Departamento de Propedêutica Complementar, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Silvana Maria Elói-Santos
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Propedêutica Complementar, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Eliane Dias Gontijo
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Propedêutica Complementar, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Andréa Teixeira-Carvalho
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, CPqRR-FIOCRUZ, Belo Horizonte, MG, Brazil
- Departamento de Propedêutica Complementar, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Olindo Assis Martins-Filho
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, CPqRR-FIOCRUZ, Belo Horizonte, MG, Brazil
- Departamento de Propedêutica Complementar, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Therapy of chagas disease: implications for levels of prevention. J Trop Med 2012; 2012:292138. [PMID: 22523499 PMCID: PMC3317183 DOI: 10.1155/2012/292138] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 11/26/2011] [Accepted: 11/26/2011] [Indexed: 11/29/2022] Open
Abstract
This paper reviews the evidence supporting the use of etiological treatment for Chagas disease that has changed the standard of care for patients with Trypanosoma cruzi infection in the last decades. Implications of this evidence on different levels of prevention as well as gaps in current knowledge are also discussed. In this regard, etiological treatment has shown to be beneficial as an intervention for secondary prevention to successfully cure the infection or to delay, reduce, or prevent the progression to disease, and as primary disease prevention by breaking the chain of transmission. Timely diagnosis during initial stages would allow for the prescription of appropriate therapies mainly in the primary health care system thus improving chances for a better quality of life. Based on current evidence, etiological treatment has to be considered as an essential public health strategy useful to reduce disease burden and to eliminate Chagas disease altogether.
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Hasslocher-Moreno AM, do Brasil PEAA, de Sousa AS, Xavier SS, Chambela MC, Sperandio da Silva GM. Safety of benznidazole use in the treatment of chronic Chagas' disease. J Antimicrob Chemother 2012; 67:1261-6. [PMID: 22331592 DOI: 10.1093/jac/dks027] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the safety of benznidazole use in adult patients with chronic Chagas' disease. METHODS The Naranjo algorithm was applied to classify the causality of adverse drug reactions (ADRs). RESULTS In total, 190 patients were treated with benznidazole over a period of 4-180 days (mean 58.90 ± 36.54 days) with a dose of 50-500 mg/day (221.33 ± 57.16 mg/day). Of the 190 patients treated, 93 had ADRs and 59 of these interrupted treatment. There was a higher incidence of ADRs among female and young adult patients. There was a higher incidence of ADRs during the first 30 days of treatment. Interruption of treatment was more frequent in women. Among the patients who interrupted treatment, 39 had mild ADRs, 19 had moderate ADRs and 1 had a severe ADR. There were no interruptions in treatment for 97 patients without ADRs. The survival curves indicated that the time until interruption of treatment in patients with moderate and severe ADRs was lower than in patients with mild or no ADRs. The most frequent disorders were in the skin (26.3%), gastrointestinal system (9.5%) and nervous system (5.3%). CONCLUSIONS The Naranjo algorithm was a useful tool to reduce the underreporting of ADRs. Events were common, but were associated with low morbidity and were reversible upon discontinuation of drug treatment. Moreover, there were no fatal events; therefore, benznidazole treatment was considered safe.
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Affiliation(s)
- Alejandro M Hasslocher-Moreno
- Laboratory of Clinical Research on Chagas Disease, Evandro Chagas Institute of Clinical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Salomon CJ. First century of Chagas' disease: an overview on novel approaches to nifurtimox and benzonidazole delivery systems. J Pharm Sci 2011; 101:888-94. [PMID: 22161779 DOI: 10.1002/jps.23010] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 11/08/2011] [Accepted: 11/16/2011] [Indexed: 02/02/2023]
Abstract
Hundred years after the discovery of Chagas' disease, there is a lack of effective treatment to control this neglected disease caused by the parasite Trypanosoma cruzi. The transmission is primarily through vector-borne blood transfusion or during pregnancy, producing high mortality and morbidity among poor people in many countries of Latin America. In the last decades, the efforts have been focused mainly on the elimination of vectors. At the same time, screening of blood donors in order to avoid transfusional transmission has been improved all over the world. However, Chagas' disease is still a major public health problem, with estimates of nearly 90 million people at risk of infection and more than eight million infected in 18 endemic countries. Despite the high incidence in endemic regions and the dissemination of neglected diseases in North America and Europe, to date, there are only two drugs developed and prescribed for the treatment of Chagas' disease, nifurtimox (tablets of 120 mg) and benzonidazole (tablets of 100 mg). In this review, different approaches carried out in the last decades for developing novel pharmaceutical formulations for the delivery of nifurtimox and benznidazole are discussed.
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Affiliation(s)
- Claudio J Salomon
- Area Técnica Farmacéutica, Departamento Farmacia, Facultad de Ciencias Bioquímicas y Farmacéuticas, Suipacha 531, 2000. Universidad Nacional de Rosario, IQUIR-CONICET, Rosario, Argentina.
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Bern C, Kjos S, Yabsley MJ, Montgomery SP. Trypanosoma cruzi and Chagas' Disease in the United States. Clin Microbiol Rev 2011; 24:655-81. [PMID: 21976603 PMCID: PMC3194829 DOI: 10.1128/cmr.00005-11] [Citation(s) in RCA: 468] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chagas' disease is caused by the protozoan parasite Trypanosoma cruzi and causes potentially life-threatening disease of the heart and gastrointestinal tract. The southern half of the United States contains enzootic cycles of T. cruzi, involving 11 recognized triatomine vector species. The greatest vector diversity and density occur in the western United States, where woodrats are the most common reservoir; other rodents, raccoons, skunks, and coyotes are also infected with T. cruzi. In the eastern United States, the prevalence of T. cruzi is highest in raccoons, opossums, armadillos, and skunks. A total of 7 autochthonous vector-borne human infections have been reported in Texas, California, Tennessee, and Louisiana; many others are thought to go unrecognized. Nevertheless, most T. cruzi-infected individuals in the United States are immigrants from areas of endemicity in Latin America. Seven transfusion-associated and 6 organ donor-derived T. cruzi infections have been documented in the United States and Canada. As improved control of vector- and blood-borne T. cruzi transmission decreases the burden in countries where the disease is historically endemic and imported Chagas' disease is increasingly recognized outside Latin America, the United States can play an important role in addressing the altered epidemiology of Chagas' disease in the 21st century.
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Affiliation(s)
- Caryn Bern
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Garcia-Bournissen F, Altcheh J. Antitrypanosomal therapy for chronic Chagas' disease. N Engl J Med 2011; 365:1258-9; author reply 1259. [PMID: 21991908 DOI: 10.1056/nejmc1108653] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Levy MZ, Small DS, Vilhena DA, Bowman NM, Kawai V, Cornejo del Carpio JG, Cordova-Benzaquen E, Gilman RH, Bern C, Plotkin JB. Retracing micro-epidemics of Chagas disease using epicenter regression. PLoS Comput Biol 2011; 7:e1002146. [PMID: 21935346 PMCID: PMC3174153 DOI: 10.1371/journal.pcbi.1002146] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Accepted: 06/16/2011] [Indexed: 12/03/2022] Open
Abstract
Vector-borne transmission of Chagas disease has become an urban problem in the city of Arequipa, Peru, yet the debilitating symptoms that can occur in the chronic stage of the disease are rarely seen in hospitals in the city. The lack of obvious clinical disease in Arequipa has led to speculation that the local strain of the etiologic agent, Trypanosoma cruzi, has low chronic pathogenicity. The long asymptomatic period of Chagas disease leads us to an alternative hypothesis for the absence of clinical cases in Arequipa: transmission in the city may be so recent that most infected individuals have yet to progress to late stage disease. Here we describe a new method, epicenter regression, that allows us to infer the spatial and temporal history of disease transmission from a snapshot of a population's infection status. We show that in a community of Arequipa, transmission of T. cruzi by the insect vector Triatoma infestans occurred as a series of focal micro-epidemics, the oldest of which began only around 20 years ago. These micro-epidemics infected nearly 5% of the community before transmission of the parasite was disrupted through insecticide application in 2004. Most extant human infections in our study community arose over a brief period of time immediately prior to vector control. According to our findings, the symptoms of chronic Chagas disease are expected to be absent, even if the strain is pathogenic in the chronic phase of disease, given the long asymptomatic period of the disease and short history of intense transmission. Traducción al español disponible en Alternative Language Text S1/A Spanish translation of this article is available in Alternative Language Text S1.
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Affiliation(s)
- Michael Z Levy
- Center for Clinical Epidemiology & Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
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Pérez-Ayala A, Pérez-Molina J, Norman F, Navarro M, Monge-Maillo B, Díaz-Menéndez M, Peris-García J, Flores M, Cañavate C, López-Vélez R. Chagas disease in Latin American migrants: a Spanish challenge. Clin Microbiol Infect 2011; 17:1108-13. [DOI: 10.1111/j.1469-0691.2010.03423.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Caryn Bern
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Cencig S, Coltel N, Truyens C, Carlier Y. Parasitic loads in tissues of mice infected with Trypanosoma cruzi and treated with AmBisome. PLoS Negl Trop Dis 2011; 5:e1216. [PMID: 21738811 PMCID: PMC3125148 DOI: 10.1371/journal.pntd.0001216] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 05/13/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chagas disease is one of the most important public health problems and a leading cause of cardiac failure in Latin America. The currently available drugs to treat T. cruzi infection (benznidazole and nifurtimox) are effective in humans when administered during months. AmBisome (liposomal amphotericin B), already shown efficient after administration for some days in human and experimental infection with Leishmania, has been scarcely studied in T. cruzi infection. AIMS This work investigates the effect of AmBisome treatment, administered in 6 intraperitoneal injections at various times during acute and/or chronic phases of mouse T. cruzi infection, comparing survival rates and parasitic loads in several tissues. METHODOLOGY Quantitative PCR was used to determine parasitic DNA amounts in tissues. Immunosuppressive treatment with cyclophosphamide was used to investigate residual infection in tissues. FINDINGS Administration of AmBisome during the acute phase of infection prevented mice from fatal issue. Parasitaemias (microscopic examination) were reduced in acute phase and undetectable in chronic infection. Quantitative PCR analyses showed significant parasite load reductions in heart, liver, spleen, skeletal muscle and adipose tissues in acute as well as in chronic infection. An earlier administration of AmBisome (one day after parasite inoculation) had a better effect in reducing parasite loads in spleen and liver, whereas repetition of treatment in chronic phase enhanced the parasite load reduction in heart and liver. However, whatever the treatment schedule, cyclophosphamide injections boosted infection to parasite amounts comparable to those observed in acutely infected and untreated mice. CONCLUSIONS Though AmBisome treatment fails to completely cure mice from T. cruzi infection, it impedes mortality and reduces significantly the parasitic loads in most tissues. Such a beneficial effect, obtained by administrating it over a short time, should stimulate studies on using AmBisome in association with other drugs in order to shorten recovery from T. cruzi infection.
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Affiliation(s)
- Sabrina Cencig
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Coltel
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles, Brussels, Belgium
| | - Carine Truyens
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles, Brussels, Belgium
| | - Yves Carlier
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles, Brussels, Belgium
- * E-mail:
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Barfield CA, Barney RS, Crudder CH, Wilmoth JL, Stevens DS, Mora-Garcia S, Yanovsky MJ, Weigl BH, Yanovsky J. A highly sensitive rapid diagnostic test for Chagas disease that utilizes a recombinant Trypanosoma cruzi antigen. IEEE Trans Biomed Eng 2011; 58:814-7. [PMID: 21342808 DOI: 10.1109/tbme.2010.2087334] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Improved diagnostic tests for Chagas disease are urgently needed. A new lateral flow rapid test for Chagas disease is under development at PATH, in collaboration with Laboratorio Lemos of Argentina, which utilizes a recombinant antigen for detection of antibodies to Trypanosoma cruzi. To evaluate the performance of this test, 375 earlier characterized serum specimens from a region where Chagas is endemic were tested using a reference test (the Ortho T. cruzi ELISA, Johnson & Johnson), a commercially available rapid test (Chagas STAT-PAK, Chembio), and the PATH-Lemos rapid test. Compared to the composite reference tests, the PATH-Lemos rapid test demonstrated an optimal sensitivity of 99.5% and specificity of 96.8%, while the Chagas STAT-PAK demonstrated a sensitivity of 95.3% and specificity of 99.5%. These results indicate that the PATH-Lemos rapid test shows promise as an improved and reliable tool for screening and diagnosis of Chagas disease.
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Soeiro MDNC, de Castro SL. Screening of Potential anti-Trypanosoma cruzi Candidates: In Vitro and In Vivo Studies. THE OPEN MEDICINAL CHEMISTRY JOURNAL 2011; 5:21-30. [PMID: 21629508 PMCID: PMC3103897 DOI: 10.2174/1874104501105010021] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 04/21/2010] [Accepted: 05/28/2010] [Indexed: 01/21/2023]
Abstract
Chagas disease (CD), caused by the intracellular protozoan Trypanosoma cruzi, is a parasitic illness endemic in Latin America. In the centennial after CD discovery by Carlos Chagas (1909), although it still represents an important public health problem in these affected areas, the existing chemotherapy, based on benznidazole and nifurtimox (both introduced more than four decades ago), is far from being considered ideal due to substantial toxicity, variable effect on different parasite stocks and well-known poor activity on the chronic phase. CD is considered one of the major "neglected" diseases of the world, as commercial incentives are very limited to guarantee investments for developing and discovering novel drugs. In this context, our group has been pursuing, over the last years, the efficacy, selectivity, toxicity, cellular targets and mechanisms of action of new potential anti-T. cruzi candidates screened from an in-house compound library of different research groups in the area of medicinal chemistry. A brief review regarding these studies will be discussed, mainly related to the effect on T. cruzi of (i) diamidines and related compounds, (ii) natural naphthoquinone derivatives, and (iii) megazol derivatives.
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Affiliation(s)
| | - Solange Lisboa de Castro
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21040-900, Brazil
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Altcheh J, Moscatelli G, Moroni S, Garcia-Bournissen F, Freilij H. Adverse events after the use of benznidazole in infants and children with Chagas disease. Pediatrics 2011; 127:e212-8. [PMID: 21173000 DOI: 10.1542/peds.2010-1172] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chagas disease is caused by infection with Trypanosoma cruzi. In adults, treatment with benznidazole is associated with a high incidence of adverse drug reactions (ADRs). However, in infants and children, treatment with benznidazole seems associated with a lower incidence and decreased severity of ADRs, but these effects have not been clearly characterized. OBJECTIVE We aimed to describe ADRs observed in infants and children treated with benznidazole. PATIENTS AND METHODS We conducted a prospective cohort study of infants and children in Argentina with Chagas disease treated with benznidazole. RESULTS A total of 107 infants and children diagnosed with asymptomatic Chagas disease (mean age: 6.9 years) were enrolled in the study. Sixty-two events (in 44 children) were considered benznidazole related. Mean ADR duration was 8.2 days. ADRs were mild (80.6%), moderate (16%), or severe (3.2%). Most (77.3%) ADRs were in children older than 7 years. Skin was the organ with the highest incidence of ADRs (21%), followed by the central nervous system (9%) and the gastrointestinal tract (8.5%). Also, the ADR rate was lower in infants and toddlers compared with older children (18% vs 53%) (P < .001). CONCLUSIONS Treatment with benznidazole was well tolerated in children. Most ADRs were mild and did not require treatment suspension. A strong association was observed between ADR incidence and patient age, and most ADRs occurred in children older than 7 years. We believe that anxiety over potential severe ADRs in children with Chagas disease is not justified and should not be an obstacle to using benznidazole.
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Affiliation(s)
- Jaime Altcheh
- Servicio de Parasitología y Enfermedad de Chagas, Hospital de Niños R. Gutierrez, Gallo 1330, Buenos Aires 1425, Argentina.
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Bowman NM, Kawai V, Gilman RH, Bocangel C, Galdos-Cardenas G, Cabrera L, Levy MZ, Cornejo del Carpio JG, Delgado F, Rosenthal L, Pinedo-Cancino VV, Steurer F, Seitz AE, Maguire JH, Bern C. Autonomic dysfunction and risk factors associated with Trypanosoma cruzi infection among children in Arequipa, Peru. Am J Trop Med Hyg 2011; 84:85-90. [PMID: 21212207 PMCID: PMC3005523 DOI: 10.4269/ajtmh.2011.10-0303] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 08/30/2010] [Indexed: 11/07/2022] Open
Abstract
Chagas disease affects an estimated 8 million people in Latin America. Infected individuals have 20-30% lifetime risk of developing cardiomyopathy, but more subtle changes in autonomic responses may be more frequent. We conducted a matched case-control study of children in Arequipa, Peru, where triatomine infestation and Trypanosoma cruzi infection are emerging problems. We collected data on home environment, history, physical examination, electrocardiogram, and autonomic testing. Signs of triatomine infestation and/or animals sleeping in the child's room and household members with Chagas disease were associated with increased infection risk. Electrocardiogram findings did not differ between cases and controls. However, compared with control children, infected children had blunted autonomic responses by three different measures, the Valsalva maneuver, the cold pressor test, and the orthostatic test. T. cruzi-infected children show autonomic dysfunction, although the prognostic value of this finding is not clear. Sustained vector control programs are essential to decreasing future T. cruzi infections.
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Affiliation(s)
- Natalie M Bowman
- Division of Infectious Diseases, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
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Villani FNA, da Costa Rocha MO, Nunes MDCP, Antonelli LRDV, Magalhães LMD, dos Santos JSC, Gollob KJ, Dutra WO. Trypanosoma cruzi-induced activation of functionally distinct αβ and γδ CD4- CD8- T cells in individuals with polar forms of Chagas' disease. Infect Immun 2010; 78:4421-30. [PMID: 20696836 PMCID: PMC2950361 DOI: 10.1128/iai.00179-10] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 03/29/2010] [Accepted: 07/27/2010] [Indexed: 12/31/2022] Open
Abstract
CD4(-) CD8(-) (double-negative [DN]) T cells have recently been shown to display important immunological functions in human diseases. They express γδ or αβ T-cell receptors that recognize lipid/glycolipid antigens presented via the nonclassical major histocompatibility complex molecules of the CD1 family. We recently demonstrated that while αβ DN T cells serve primarily to express inflammatory cytokines, γδ DN T cells express mainly interleukin-10 (IL-10) in patients with cutaneous leishmaniasis. We also demonstrated a correlation between DN T cells and the expression of gamma interferon in the acute phase of Trypanosoma cruzi experimental infection. In this work, we sought to investigate whether αβ or γδ DN T cells display distinct immunoregulatory potentials in patients with polar forms of human Chagas' disease. Our data showed that in vitro infection with T. cruzi leads to expansion of DN T cells in patients with the indeterminate and severe cardiac clinical forms of the disease. However, while αβ DN T cells primarily produce inflammatory cytokines in both forms of the disease, γδ DN T cells display a marked, significant increase in antigen-specific IL-10 expression in indeterminate patients relative to cardiac patients. Finally, higher frequencies of the IL-10-producing γδ DN T cells were correlated with improved clinical measures of cardiac function in the patients, suggesting a protective role for these cells in Chagas' disease. Taken together, these data show distinct functional characteristics for αβ and γδ DN T cells associated with distinct morbidity rates and clinical forms in human Chagas' disease.
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Affiliation(s)
- Fernanda Nobre Amaral Villani
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Infectious Diseases and Tropical Medicine Graduate Course, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, Instituto Oswald Cruz, FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil, SRI International, Biosciences Division, Center for Infectious Disease Research, Menlo Park, California, Graduate Program in Biosciences and Medicine, Santa Casa Hospital, Belo Horizonte, Minas Gerais, Brazil, INCT-DT, Brazil
| | - Manoel Otávio da Costa Rocha
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Infectious Diseases and Tropical Medicine Graduate Course, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, Instituto Oswald Cruz, FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil, SRI International, Biosciences Division, Center for Infectious Disease Research, Menlo Park, California, Graduate Program in Biosciences and Medicine, Santa Casa Hospital, Belo Horizonte, Minas Gerais, Brazil, INCT-DT, Brazil
| | - Maria do Carmo Pereira Nunes
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Infectious Diseases and Tropical Medicine Graduate Course, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, Instituto Oswald Cruz, FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil, SRI International, Biosciences Division, Center for Infectious Disease Research, Menlo Park, California, Graduate Program in Biosciences and Medicine, Santa Casa Hospital, Belo Horizonte, Minas Gerais, Brazil, INCT-DT, Brazil
| | - Lis Ribeiro do Valle Antonelli
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Infectious Diseases and Tropical Medicine Graduate Course, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, Instituto Oswald Cruz, FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil, SRI International, Biosciences Division, Center for Infectious Disease Research, Menlo Park, California, Graduate Program in Biosciences and Medicine, Santa Casa Hospital, Belo Horizonte, Minas Gerais, Brazil, INCT-DT, Brazil
| | - Luisa Mourão Dias Magalhães
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Infectious Diseases and Tropical Medicine Graduate Course, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, Instituto Oswald Cruz, FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil, SRI International, Biosciences Division, Center for Infectious Disease Research, Menlo Park, California, Graduate Program in Biosciences and Medicine, Santa Casa Hospital, Belo Horizonte, Minas Gerais, Brazil, INCT-DT, Brazil
| | - Janete Soares Coelho dos Santos
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Infectious Diseases and Tropical Medicine Graduate Course, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, Instituto Oswald Cruz, FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil, SRI International, Biosciences Division, Center for Infectious Disease Research, Menlo Park, California, Graduate Program in Biosciences and Medicine, Santa Casa Hospital, Belo Horizonte, Minas Gerais, Brazil, INCT-DT, Brazil
| | - Kenneth J. Gollob
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Infectious Diseases and Tropical Medicine Graduate Course, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, Instituto Oswald Cruz, FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil, SRI International, Biosciences Division, Center for Infectious Disease Research, Menlo Park, California, Graduate Program in Biosciences and Medicine, Santa Casa Hospital, Belo Horizonte, Minas Gerais, Brazil, INCT-DT, Brazil
| | - Walderez O. Dutra
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Infectious Diseases and Tropical Medicine Graduate Course, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, Instituto Oswald Cruz, FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil, SRI International, Biosciences Division, Center for Infectious Disease Research, Menlo Park, California, Graduate Program in Biosciences and Medicine, Santa Casa Hospital, Belo Horizonte, Minas Gerais, Brazil, INCT-DT, Brazil
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Apt W. Current and developing therapeutic agents in the treatment of Chagas disease. Drug Des Devel Ther 2010; 4:243-53. [PMID: 20957215 PMCID: PMC2948934 DOI: 10.2147/dddt.s8338] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Indexed: 12/21/2022] Open
Abstract
Chagas disease must be treated in all its stages: acute, indeterminate, chronic, and initial and middle determinant chronic, due to the fact that DNA of the parasite can be demonstrated by PCR in chronic cases, where optical microscopy does not detect parasites. Nifurtimox (NF) and benznidazole (BNZ) are the drugs accepted to treat humans based upon ethical considerations and efficiency. However, both the drugs produce secondary effects in 30% of the cases, and the treatment must be given for at least 30-60 days. Other useful drugs are itraconazole and posaconazole. The latter may be the drug to treat Chagas disease in the future when all the investigations related to it are finished. At present, there is no criterion of cure for chronic cases since in the majority, the serology remains positive, although it may decrease. In acute cases, 70% cure with NF and 75% with BNZ is achieved. In congenital cases, 100% cure is obtained if the treatment is performed during the first year of life. In chronic acquired cases, 20% cure and 50% improvement of the electrocardiographic changes are obtained with itraconazole.
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Affiliation(s)
- Werner Apt
- University of Chile, Faculty of Medicine, Santiago, Chile.
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50
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Tolerance of benznidazole in treatment of Chagas' disease in adults. Antimicrob Agents Chemother 2010; 54:4896-9. [PMID: 20823286 DOI: 10.1128/aac.00537-10] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Chagas' disease is an emerging public health problem in areas where the disease is not endemic. Treatment with benznidazole has shown efficacy in the acute stage of the disease, but its efficacy in the chronic stage remains controversial, and unwanted side effects are more frequent and severe in adults than in children. This study describes the profile of side effects of benznidazole in a cohort of Trypanosoma cruzi-infected patients in a European country.
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