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Brand S, Ko EJ, Viayna E, Thompson S, Spinks D, Thomas M, Sandberg L, Francisco AF, Jayawardhana S, Smith VC, Jansen C, De Rycker M, Thomas J, MacLean L, Osuna-Cabello M, Riley J, Scullion P, Stojanovski L, Simeons FRC, Epemolu O, Shishikura Y, Crouch SD, Bakshi TS, Nixon CJ, Reid IH, Hill AP, Underwood TZ, Hindley SJ, Robinson SA, Kelly JM, Fiandor JM, Wyatt PG, Marco M, Miles TJ, Read KD, Gilbert IH. Discovery and Optimization of 5-Amino-1,2,3-triazole-4-carboxamide Series against Trypanosoma cruzi. J Med Chem 2017; 60:7284-7299. [PMID: 28844141 PMCID: PMC5601362 DOI: 10.1021/acs.jmedchem.7b00463] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
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Chagas’
disease, caused by the protozoan parasite Trypanosoma
cruzi, is the most common cause of cardiac-related
deaths in endemic regions of Latin America. There is an urgent need
for new safer treatments because current standard therapeutic options,
benznidazole and nifurtimox, have significant side effects and are
only effective in the acute phase of the infection with limited efficacy
in the chronic phase. Phenotypic high content screening against the
intracellular parasite in infected VERO cells was used to identify
a novel hit series of 5-amino-1,2,3-triazole-4-carboxamides (ATC).
Optimization of the ATC series gave improvements in potency, aqueous
solubility, and metabolic stability, which combined to give significant
improvements in oral exposure. Mitigation of a potential Ames and hERG liability ultimately led to two promising compounds, one of which demonstrated significant suppression of parasite burden in a mouse model of Chagas’ disease.
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Affiliation(s)
- Stephen Brand
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Eun Jung Ko
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Elisabet Viayna
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Stephen Thompson
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Daniel Spinks
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Michael Thomas
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Lars Sandberg
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Amanda F Francisco
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine , Keppel Street, London WC1E 7HT, U.K
| | - Shiromani Jayawardhana
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine , Keppel Street, London WC1E 7HT, U.K
| | - Victoria C Smith
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Chimed Jansen
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Manu De Rycker
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - John Thomas
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Lorna MacLean
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Maria Osuna-Cabello
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Jennifer Riley
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Paul Scullion
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Laste Stojanovski
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Frederick R C Simeons
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Ola Epemolu
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Yoko Shishikura
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Sabrinia D Crouch
- Diseases of the Developing World, GlaxoSmithKline , Calle Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Tania S Bakshi
- GlaxoSmithKline , 1250 South Collegeville Road, PO Box 5089, Collegeville, Pennsylvania 19426-0989, United States
| | - Christopher J Nixon
- GlaxoSmithKline , 1250 South Collegeville Road, PO Box 5089, Collegeville, Pennsylvania 19426-0989, United States
| | - Iain H Reid
- Medicines Research Centre, GlaxoSmithKline , Gunnels Wood Road, Stevenage, Hertfordshire SG1 2NY, U.K
| | - Alan P Hill
- Medicines Research Centre, GlaxoSmithKline , Gunnels Wood Road, Stevenage, Hertfordshire SG1 2NY, U.K
| | - Tim Z Underwood
- Medicines Research Centre, GlaxoSmithKline , Gunnels Wood Road, Stevenage, Hertfordshire SG1 2NY, U.K
| | - Sean J Hindley
- Medicines Research Centre, GlaxoSmithKline , Gunnels Wood Road, Stevenage, Hertfordshire SG1 2NY, U.K
| | - Sharon A Robinson
- David Jack Centre for R&D, GlaxoSmithKline , Park Road, Ware, Hertfordshire SG12 0DP, United Kingdom
| | - John M Kelly
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine , Keppel Street, London WC1E 7HT, U.K
| | - Jose M Fiandor
- Diseases of the Developing World, GlaxoSmithKline , Calle Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Paul G Wyatt
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Maria Marco
- Diseases of the Developing World, GlaxoSmithKline , Calle Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Timothy J Miles
- Diseases of the Developing World, GlaxoSmithKline , Calle Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Kevin D Read
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
| | - Ian H Gilbert
- Drug Discovery Unit, Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee , Sir James Black Centre, Dundee DD1 5EH, U.K
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Rosen A, Ison MG. Screening of living organ donors for endemic infections: Understanding the challenges and benefits of enhanced screening. Transpl Infect Dis 2016; 19:e12633. [PMID: 27862705 DOI: 10.1111/tid.12633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 12/30/2022]
Abstract
Living organ donor candidates are screened for medical and psychosocial contraindications to donation. One important goal of this process is to prevent donor-derived infectious diseases transmissions. These transmissions are exceptionally rare, but have the potential to cause significant morbidity and mortality. The Organ Procurement and Transplantation Network now requires each recovery hospital to develop a protocol for evaluating living donors for tuberculosis and other geographically-defined endemic pathogens, including Trypanosoma cruzi (the causative pathogen of Chagas' disease), Strongyloides stercoralis, and West Nile Virus (WNV), in addition to universal screening for blood-borne pathogens. Enhanced screening requirements were developed in response to the changing epidemiology and endemicity of these diseases, as well as recent case reports of donor-derived disease transmission. Living organ donor disease screening presents a number of unique challenges to clinicians and policy-makers, including deciding which donors to test, which testing modality to use, when to test, and appropriate interpretation of results. This review will analyze the epidemiology of T. cruzi, S. stercoralis, and WNV, the assays available for screening for these diseases, and the subsequent impact on the living organ donor process . This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Amanda Rosen
- Northwestern University Transplant Outcomes Research Collaborative, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael G Ison
- Northwestern University Transplant Outcomes Research Collaborative, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Divisions of Infectious Diseases & Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Vertanous T, Czer LSC, de Robertis M, Kiankhooy A, Kobashigawa J, Esmailian F, Trento A. Leading Efforts to Increase Organ Donation Through Professionalization of Organ Procurement Organizations and Establishment of Organ and Tissue Donor Registries. Transplant Proc 2016; 48:10-4. [PMID: 26915835 DOI: 10.1016/j.transproceed.2015.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/30/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The influence of new donor registrations through the California Organ and Tissue Donor Registry on the local OneLegacy Organ Procurement Organization (OPO) was examined during a 6-year period. METHODS Publicly available data from Donate Life America for California were examined for the 6 calendar years of 2009-2014. Performance data from OneLegacy for the same 6 years for organ donors and number of transplants were also examined. The donor designation rate (DDR) was defined as the rate at which new individuals joined the state donor registry as a percentage of all driver licenses and ID cards issued within a calendar year. The total donor designation (TDD) was defined as the sum of the new and existing people who were registered organ donors. Donor designation share (DDS) was the total number of designated donors as a percentage of all residents of the state who were ≥18 years old. The business practices and educational efforts of the OneLegacy OPO were examined as well. RESULTS In California, from 2009 through 2014, the DDR was 25.5%-28%. When added to the existing donor registrations, the TDD and DDS increased each year from 2009 through 2014. With the current level of growth, it is projected that California will be able to reach a DDS of 50% by 2017. For the OneLegacy OPO, designated donors from the California Organ and Tissue Donor Registry made up 15% of the total donations in 2009, and 39% of the total donations in 2014, increasing by ∼5% each year since 2009. By increasing professionalization and transparency, and widening its educational and training efforts, OneLegacy was able to take advantage of an increasing percentage of donors who were designated donors and to increase the overall number of donors and organs transplanted, becoming one of the largest OPOs in the nation. CONCLUSIONS This can be a model for OPOs in other donor service areas, and it may set the stage for the United States to serve as an example to the global community in the practice of organ donation.
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Affiliation(s)
- T Vertanous
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - L S C Czer
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, California.
| | - M de Robertis
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - A Kiankhooy
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - J Kobashigawa
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - F Esmailian
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - A Trento
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
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Abstract
PURPOSE OF REVIEW The diagnosis and management of acute and chronic infections with the microorganism Trypanosoma cruzi, which causes Chagas disease, is important in solid organ transplantation in both endemic and nonendemic countries. In this review, we examine recently published data on the topic of Chagas disease in solid organ transplantation, with an emphasis on data relevant to heart transplantation. RECENT FINDINGS Most people with chronic T. cruzi infection have the intermediate form of disease, but approximately 2% of infected persons will progress to Chagas cardiomyopathy per year. The risk of T. cruzi transmission with liver or kidney transplantation appears to be substantially less than that with heart transplantation. For patients with Chagas cardiomyopathy undergoing heart transplant, a structured clinical and laboratory monitoring protocol is necessary to monitor for T. cruzi reactivation. Recent data indicate that laboratory monitoring of peripheral blood with polymerase chain reaction testing can identify reactivation prior to the occurrence of symptoms and allograft injury. SUMMARY Transplant clinicians should exercise vigilance in surveillance for Chagas disease in both organ donors and recipients. Although Chagas disease may seem uncommon, it is pervasive in endemic and several nonendemic countries, including the United States and Spain.
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Use of Kidneys From Trypanosoma Cruzi–Infected Donors in Naive Transplant Recipients Without Prophylactic Therapy. Transplantation 2014; 97:e3-4. [DOI: 10.1097/01.tp.0000437673.86339.82] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kransdorf EP, Czer LSC, Luthringer DJ, Patel JK, Montgomery SP, Velleca A, Mirocha J, Zakowski PC, Zabner R, Gaultier CR, Qvarnstrom Y, Benedict T, Steurer F, Bosserman E, Paddock CD, Rafiei M, Kobashigawa JA. Heart transplantation for Chagas cardiomyopathy in the United States. Am J Transplant 2013; 13:3262-8. [PMID: 24165397 PMCID: PMC10183729 DOI: 10.1111/ajt.12507] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/12/2013] [Accepted: 09/12/2013] [Indexed: 01/25/2023]
Abstract
Since an initial case in 2006, we noted multiple patients undergoing heart transplantation (HTx) for Chagas cardiomyopathy (CC) at our transplant program. The clinical characteristics, laboratory results and outcomes of patients with CC undergoing HTx in the United States have not been reported previously. In 2010, we implemented a systematic screening and management program for patients undergoing HTx for CC. Before HTx, all patients with idiopathic dilated cardiomyopathy who were born in a Chagas disease endemic country were screened for Trypanosoma cruzi (TC) infection with serology. After HTx, monitoring for TC reactivation was performed using clinical visits, echocardiography, endomyocardial biopsy and serial whole blood polymerase chain reaction (PCR) testing. Between June 2006 and January 2012, 11 patients underwent HTx for CC. One patient was empirically treated due to the presence of TC amastigotes in explanted cardiac tissue. Two patients experienced allograft dysfunction due to TC reactivation and three patients experienced subclinical reactivation (positive PCR results), which were treated. Chagas disease is a common cause of dilated cardiomyopathy in patients from endemic countries undergoing HTx at a transplant program in the United States. Reactivation is common after transplantation and can cause adverse outcomes.
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Wallace JA, Miller L, Beavis A, Baptista CAC. Chagas Disease: A Proposal for Testing Policy for Solid-Organ Transplant in the United States. Prog Transplant 2013; 23:272-7. [DOI: 10.7182/pit2013712] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chagas disease is caused by the parasite Trypanosoma cruzi. The disease is difficult to detect because of the asymptomatic pathogenesis after infection. Chagas disease is endemic throughout much of Mexico, Central America, and South America, but human migration patterns are bringing the pathogen to the United States. The disease currently affects 16 to 18 million people with approximately 50000 deaths annually in these countries. In the United States, national screening of the blood supply was instituted in early 2007, and more than 1000 donors with T cruzi infection have been identified within the past 3 years of testing. It was observed that out of the 58 organ procurement organizations in the United States, only 4 required mandatory testing of every donor for Chagas disease. It was estimated that as of 2009, approximately 409 000 residents are living with Chagas disease, and in a 22-year span, approximately 300 patients may have contracted Chagas disease through transplant. Proposed solutions to the current testing method include automatic testing based on the medical social history questionnaire, testing of all recipients for Chagas disease, testing all persons of Latin descent, or testing of all organ donors.
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Affiliation(s)
| | - Linda Miller
- The University of Toledo College of Medicine, Toledo, Ohio
| | - Andrew Beavis
- The University of Toledo College of Medicine, Toledo, Ohio
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Design of e-pharmacophore models using compound fragments for the trans-sialidase of Trypanosoma cruzi: screening for novel inhibitor scaffolds. J Mol Graph Model 2013; 45:84-97. [PMID: 24012872 DOI: 10.1016/j.jmgm.2013.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/31/2013] [Accepted: 08/06/2013] [Indexed: 11/23/2022]
Abstract
Chagas' is a fatal disease that affects millions of people worldwide. The lack of safe and effective treatments for Chagas' highlights the need for the discovery of new drugs to fight the disease. Trypanosoma cruzi, the parasitic cause of Chagas' disease, synthesizes a trans-sialidase (TcTS) enzyme responsible for the transfer of sialic acids from the host cell surface to glycoconjugates on the parasitic cell surface. TcTS has no human analogs and is vital to the life cycle of T. cruzi, making TcTS an important enzyme for drug design against Chagas' disease. We use fragment docking to generate various e-pharmacophore hypotheses depicting protein residues important for ligand binding. Virtual screening of the ZINC Clean Leads database with more than 4 million compounds using the e-pharmacophore models found 82 potential inhibitors of TcTS. Molecular dynamics and free energy of binding calculations were used to rank the compounds based on their affinity for TcTS. Two compounds-ZINC13359679 and ZINC02576132-were found to be the most promising lead candidates for TcTS inhibition, and their binding modes are analyzed in detail.
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Chong PP, Razonable RR. Diagnostic and Management Strategies for Donor-derived Infections. Infect Dis Clin North Am 2013; 27:253-70. [DOI: 10.1016/j.idc.2013.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
PURPOSE OF REVIEW To provide an updated perspective of the most common parasitic infections occurring in solid-organ transplant (SOT) recipients. RECENT FINDINGS Parasitic infections are an emerging problem in SOT programs and represent a diagnostic and therapeutic challenge. Transplantation in endemic areas - including medical tourism, international travel and migration - justify the necessity of considering parasitic infections in the differential diagnosis of posttransplant complications. Molecular techniques, such as PCR, may improve the diagnostic accuracy and help during the follow-up. SUMMARY Parasitic infections are an uncommon but potentially severe complication in SOT recipients. An increase of donors emigrated from tropical areas and more posttransplant patients traveling to endemic areas have led to a rise in parasitic infections reported among SOT recipients. Transplant physicians should get familiar with parasitic infections and promote adherence to preventive measures in SOT recipients.
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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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Batista DDGJ, Batista MM, de Oliveira GM, Britto CC, Rodrigues ACM, Stephens CE, Boykin DW, Soeiro MDNC. Combined treatment of heterocyclic analogues and benznidazole upon Trypanosoma cruzi in vivo. PLoS One 2011; 6:e22155. [PMID: 21814568 PMCID: PMC3144210 DOI: 10.1371/journal.pone.0022155] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 06/16/2011] [Indexed: 11/18/2022] Open
Abstract
Chagas disease caused by Trypanosoma cruzi is an important cause of mortality and morbidity in Latin America but no vaccines or safe chemotherapeutic agents are available. Combined therapy is envisioned as an ideal approach since it may enhance efficacy by acting upon different cellular targets, may reduce toxicity and minimize the risk of drug resistance. Therefore, we investigated the activity of benznidazole (Bz) in combination with the diamidine prodrug DB289 and in combination with the arylimidamide DB766 upon T. cruzi infection in vivo. The oral treatment of T.cruzi-infected mice with DB289 and Benznidazole (Bz) alone reduced the number of circulating parasites compared with untreated mice by about 70% and 90%, respectively. However, the combination of these two compounds decreased the parasitemia by 99% and protected against animal mortality by 100%, but without providing a parasitological cure. When Bz (p.o) was combined with DB766 (via ip route), at least a 99.5% decrease in parasitemia levels was observed. DB766+Bz also provided 100% protection against mice mortality while Bz alone provided about 87% protection. This combined therapy also reduced the tissular lesions induced by T. cruzi infection: Bz alone reduced GPT and CK plasma levels by about 12% and 78% compared to untreated mice group, the combination of Bz with DB766 resulted in a reduction of GPT and CK plasma levels of 56% and 91%. Cure assessment through hemocultive and PCR approaches showed that Bz did not provide a parasitological cure, however, DB766 alone or associated with Bz cured ≥13% of surviving animals.
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Affiliation(s)
| | - Marcos Meuser Batista
- Laboratório de Biologia Celular, Fundação Oswaldo Cruz-Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Gabriel Melo de Oliveira
- Laboratório de Biologia Celular, Fundação Oswaldo Cruz-Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Constança Carvalho Britto
- Laboratório de Biologia Molecular e Doenças Endêmicas, Fundação Oswaldo Cruz-Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Chad E. Stephens
- Department of Chemistry and Physics, Augusta State University, Augusta, Georgia, United States of America
| | - David W. Boykin
- Department of Chemistry, Georgia State University, Atlanta, Georgia, United States of America
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Batista MV, Pierrotti LC, Abdala E, Clemente WT, Girão ES, Rosa DRT, Ianhez LE, Bonazzi PR, Lima AS, Fernandes PFCBC, Pádua-Neto MV, Bacchella T, Oliveira APP, Viana CFG, Ferreira MS, Shikanai-Yasuda MA. Endemic and opportunistic infections in Brazilian solid organ transplant recipients. Trop Med Int Health 2011; 16:1134-42. [DOI: 10.1111/j.1365-3156.2011.02816.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Roca C, Pinazo MJ, López-Chejade P, Bayó J, Posada E, López-Solana J, Gállego M, Portús M, Gascón J. Chagas disease among the Latin American adult population attending in a primary care center in Barcelona, Spain. PLoS Negl Trop Dis 2011; 5:e1135. [PMID: 21572511 PMCID: PMC3082512 DOI: 10.1371/journal.pntd.0001135] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Accepted: 02/14/2011] [Indexed: 01/23/2023] Open
Abstract
Background/Aims The epidemiology of Chagas disease, until recently confined to areas of
continental Latin America, has undergone considerable changes in recent
decades due to migration to other parts of the world, including Spain. We
studied the prevalence of Chagas disease in Latin American patients treated
at a health center in Barcelona and evaluated its clinical phase. We make
some recommendations for screening for the disease. Methodology/Principal Findings We performed an observational, cross-sectional prevalence study by means of
an immunochromatographic test screening of all continental Latin American
patients over the age of 14 years visiting the health centre from October
2007 to October 2009. The diagnosis was confirmed by serological methods:
conventional in-house ELISA (cELISA), a commercial kit (rELISA) and ELISA
using T cruzi lysate (Ortho-Clinical Diagnostics) (oELISA).
Of 766 patients studied, 22 were diagnosed with T. cruzi
infection, showing a prevalence of 2.87% (95% CI,
1.6–4.12%). Of the infected patients, 45.45% men and
54.55% women, 21 were from Bolivia, showing a prevalence in the
Bolivian subgroup (n = 127) of 16.53%
(95% CI, 9.6–23.39%). All the infected patients were in a chronic phase of Chagas disease:
81% with the indeterminate form, 9.5% with the cardiac form
and 9.5% with the cardiodigestive form. All patients infected with
T. cruzi had heard of Chagas disease in their country
of origin, 82% knew someone affected, and 77% had a
significant history of living in adobe houses in rural areas. Conclusions We found a high prevalence of T. cruzi infection in
immigrants from Bolivia. Detection of T.
cruzi–infected persons by screening programs in non-endemic
countries would control non-vectorial transmission and would benefit the
persons affected, public health and national health systems. Chagas disease is a parasitic infection caused by the protozoan
Trypanosoma cruzi, and is becoming an emerging health
problem in non-endemic areas because of growing population movements. The
clinical manifestations of chronic T. cruzi infection include
the latent form (the indeterminate chronic form), the cardiac form, the
digestive or cardiodigestive form, and sudden death. Therefore, many diagnoses
of Chagas disease are based on epidemiological suspicion rather than on clinical
signs and symptoms. This study showed that the prevalence of Chagas disease in
Latin American patients attending at a health center in Barcelona is
2,87% and the highest prevalence was found among Bolivian patients
(16,53%). All the infected patients were in a chronic phase of Chagas
disease. Detection of T. cruzi–infected persons by
screening programs in non-endemic countries would control non-vectorial
transmission and would benefit the persons affected, public health and national
health systems. The data obtained in this study and the experiences described
elsewhere suggest that it is advisable to perform Chagas disease screening in
non-endemic countries on all patients from continental Latin America who:
(1)have a suggestive epidemiologic history, (2)are pregnant, (3)are
immunosuppressed, (4)have symptoms suggestive of Chagas disease, or (5)request
screening.
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Affiliation(s)
- Carme Roca
- El Clot Primary Care Center, Institut Català de la Salut, Universitat de Barcelona, Barcelona, Spain.
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16
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Chin-Hong PV, Schwartz BS, Bern C, Montgomery SP, Kontak S, Kubak B, Morris MI, Nowicki M, Wright C, Ison MG. Screening and treatment of chagas disease in organ transplant recipients in the United States: recommendations from the chagas in transplant working group. Am J Transplant 2011; 11:672-80. [PMID: 21401868 DOI: 10.1111/j.1600-6143.2011.03444.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Donor-derived transmission of Trypanosoma cruzi, the etiologic agent of Chagas disease, has emerged as an issue in the United States over the past 10 years. Acute T. cruzi infection causes substantial morbidity and mortality in the posttransplant setting if not recognized and treated early. We assembled a working group of transplant infectious disease specialists, laboratory medicine specialists, organ procurement organization representatives and epidemiologists with expertise in Chagas disease. Based on review of published and unpublished data, the working group prepared evidence-based recommendations for donor screening, and follow-up testing and treatment of recipients of organs from infected donors. We advise targeted T. cruzi screening of potential donors born in Mexico, Central America and South America. Programs can consider transplantation of kidneys and livers from T. cruzi-infected donors with informed consent from recipients. However, we recommend against heart transplantation from infected donors. For other organs, we recommend caution based on the anticipated degree of immunosuppression. Our recommendations stress the need for systematic monitoring of recipients by polymerase chain reaction, and microscopy of buffy coat and advance planning for immediate antitrypanosomal treatment if recipient infection is detected. Data on management and outcomes of all cases should be collected to inform future guidelines and to assist in coordination with public health authorities.
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Affiliation(s)
- P V Chin-Hong
- Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA.
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17
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Schwartz BS, Paster M, Ison MG, Chin-Hong PV. Organ donor screening practices for Trypanosoma cruzi infection among US Organ Procurement Organizations. Am J Transplant 2011; 11:848-51. [PMID: 21426487 DOI: 10.1111/j.1600-6143.2011.03436.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Donor-derived Trypanosoma cruzi infection in solid organ transplant recipients is associated with significant morbidity and mortality. Little is known about T. cruzi screening practices among U.S. organ procurement organizations (OPOs). We distributed a questionnaire to all U.S. OPO directors, requesting data on T. cruzi screening strategies, laboratory methods, number of donors screened, disposition of organs from positive donors and attitudes toward screening. Fifty-eight (100%) U.S. OPOs responded to the survey. Donor screening began in 2002 and is presently performed by 11 (19%) OPOs. Among screening OPOs, four screen all donors and seven use a risk-based strategy. Three different T. cruzi serology tests are used for donor screening. During 2008, 9/993 (0.9%) donors screened positive by a T. cruzi screening test, 6/9 (66%) had confirmatory tests performed and 4/6 (66%) had positive confirmatory tests. These results led to the nonuse of five donors and 17 organs. Five organs from three seropositive donors were transplanted in 2008 without recognized disease transmission. Variability of T. cruzi donor screening strategies, laboratory methods and disposition of organs from positive donors currently exists. Further research is needed to identify the risk of donor-derived T. cruzi infections to help inform the best screening strategy.
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Affiliation(s)
- B S Schwartz
- Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA.
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18
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Abstract
Chagas disease, or American trypanosomiasis, is a parasitic infection caused by the flagellate protozoan Trypanosoma cruzi, an organism that is endemic to Latin America. While Chagas disease is primarily a vector-borne illness, new cases are emerging in non-endemic areas due to globalization of immigration and non-vectorial transmission routes. This article discusses the mode of transmission, evolving epidemiology, pathogenesis, diagnosis, treatment and prevention and control of the disease.
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Abstract
Parasitic infections are an uncommon but potentially severe complication in solid organ transplant (SOT) recipients. An increase in donors who have emigrated from tropical areas and more transplant recipients traveling to endemic areas have led to a rise in parasitic infections reported among SOT recipients. Clinicians should include these infections in their differential diagnosis and promote adherence to preventive measures in SOT recipients.
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20
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Morris MI, Fischer SA, Ison MG. Infections Transmitted by Transplantation. Infect Dis Clin North Am 2010; 24:497-514. [DOI: 10.1016/j.idc.2010.02.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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21
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Rodríguez-Guardado A, Rodríguez M, Alonso P, Seco C, Flores-Chavez M, Mejuto P, Cartón JA. Serological screening of Chagas disease in an immigrant population in Asturias, Spain proceeding from Chagas-endemic areas. ACTA ACUST UNITED AC 2009; 41:774-6. [DOI: 10.1080/00365540903161523] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Transplantation and tropical infectious diseases. Int J Infect Dis 2009; 14:e189-96. [PMID: 19647464 DOI: 10.1016/j.ijid.2009.04.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 04/03/2009] [Accepted: 04/14/2009] [Indexed: 02/08/2023] Open
Abstract
The number of transplant recipients with tropical infectious diseases is growing due to increasing international travel and the rising number of transplants taking place in the tropics and subtropics. With increases in population migration, the prevalence of individuals infected with geographically restricted organisms also rises. There are three potential categories of tropical infections in transplant patients: (1) donor-related infections transmitted by the graft or through transfusion of blood products; (2) reactivation or recrudescence of latent infections in the donor recipient; and (3) de novo acquisition of infection in the post-transplant period through the traditional route of infection. We present an overall discussion of the association of parasitic (protozoa and helminths) and non-parasitic (viral, bacterial, and fungal) tropical infectious diseases and solid-organ and hematopoietic transplantation. We also suggest potential screening guidelines for some of these tropical infections.
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23
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Milei J, Guerri-Guttenberg RA, Grana DR, Storino R. Prognostic impact of Chagas disease in the United States. Am Heart J 2009; 157:22-9. [PMID: 19081392 DOI: 10.1016/j.ahj.2008.08.024] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 08/25/2008] [Indexed: 11/28/2022]
Abstract
A prior publication from our group reported the fact that Chagas disease is underdiagnosed. This review will summarize several aspects of Chagas disease in the United States including modes of transmission, which will demonstrate that clinicians should be more aware of the disease and its consequences. Trypanosoma cruzi is present in many animal species spread throughout most of the United States. Chagas disease also reaches the North American continent through immigration, making it more frequent than expected. Apart from immigration, non-endemic countries should be aware of transmissions through blood transfusions, organ transplantations, or mother-to-child infections. In conclusion, it is possible that many chagasic cardiomyopathies are being misdiagnosed as "primary dilated idiopathic cardiomyopathies." Recognizing that there is an evident threat of Chagas disease present in the United States will allow an increase of clinician's awareness and hence will permit to correctly diagnose and treat this cardiomyopathy. Health authorities should guarantee a generalized screening of T cruzi of blood donors, before organ donations, and of pregnant women who were born or have lived in endemic areas.
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Affiliation(s)
- José Milei
- Instituto de Investigaciones Cardiológicas Prof Dr Alberto C Taquini (ININCA), Facultad de Medicina, Universidad de Buenos Aires (UBA)-Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
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24
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Hyland KV, Asfaw SH, Olson CL, Daniels MD, Engman DM. Bioluminescent imaging of Trypanosoma cruzi infection. Int J Parasitol 2008; 38:1391-400. [PMID: 18511053 DOI: 10.1016/j.ijpara.2008.04.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 03/31/2008] [Accepted: 04/03/2008] [Indexed: 11/18/2022]
Abstract
Chagas disease, caused by infection with the protozoan parasite Trypanosoma cruzi, is a major public health problem in Central and South America. The pathogenesis of Chagas disease is complex and the natural course of infection is not completely understood. The recent development of bioluminescence imaging technology has facilitated studies of a number of infectious and non-infectious diseases. We developed luminescent T. cruzi to facilitate similar studies of Chagas disease pathogenesis. Luminescent T. cruzi trypomastigotes and amastigotes were imaged in infections of rat myoblast cultures, which demonstrated a clear correlation of photon emission signal strength to the number of parasites used. This was also observed in mice infected with different numbers of luminescent parasites, where a stringent correlation of photon emission to parasite number was observed early at the site of inoculation, followed by dissemination of parasites to different sites over the course of a 25-day infection. Whole animal imaging from ventral, dorsal and lateral perspectives provided clear evidence of parasite dissemination. The tissue distribution of T. cruzi was further determined by imaging heart, spleen, skeletal muscle, lungs, kidneys, liver and intestines ex vivo. These results illustrate the natural dissemination of T. cruzi during infection and unveil a new tool for studying a number of aspects of Chagas disease, including rapid in vitro screening of potential therapeutical agents, roles of parasite and host factors in the outcome of infection, and analysis of differential tissue tropism in various parasite-host strain combinations.
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Affiliation(s)
- Kenneth V Hyland
- Department of Microbiology - Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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25
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Martín-Dávila P, Fortún J, López-Vélez R, Norman F, Montes de Oca M, Zamarrón P, González MI, Moreno A, Pumarola T, Garrido G, Candela A, Moreno S. Transmission of tropical and geographically restricted infections during solid-organ transplantation. Clin Microbiol Rev 2008; 21:60-96. [PMID: 18202437 PMCID: PMC2223841 DOI: 10.1128/cmr.00021-07] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
In recent years, the increasing number of donors from different regions of the world is providing a new challenge for the management and selection of suitable donors. This is a worldwide problem in most countries with transplantation programs, especially due to the increase in immigration and international travel. This paper elaborates recommendations regarding the selection criteria for donors from foreign countries who could potentially transmit tropical or geographically restricted infections to solid-organ transplant recipients. For this purpose, an extensive review of the medical literature focusing on viral, fungal, and parasitic infections that could be transmitted during transplantation from donors who have lived or traveled in countries where these infections are endemic has been performed, with special emphasis on tropical and imported infections. The review also includes cases described in the literature as well as risks of transmission during transplantation, microbiological tests available, and recommendations for each infection. A table listing different infectious agents with their geographic distributions and specific recommendations is included.
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Affiliation(s)
- P Martín-Dávila
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Ctra. Colmenar km. 9,100, 28034 Madrid, Spain.
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26
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Exotic donor-transmitted infections in solid-organ transplantation: can seemingly random events inform policy? Curr Opin Organ Transplant 2007. [DOI: 10.1097/mot.0b013e3282f14a40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Oliveira FORD, Alves CR, Calvet CM, Toma L, Bouças RI, Nader HB, Castro Côrtes LMD, Krieger MA, Meirelles MDNSL, Souza Pereira MCD. Trypanosoma cruzi heparin-binding proteins and the nature of the host cell heparan sulfate-binding domain. Microb Pathog 2007; 44:329-38. [PMID: 18037261 DOI: 10.1016/j.micpath.2007.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 10/15/2007] [Accepted: 10/16/2007] [Indexed: 10/22/2022]
Abstract
Trypanosoma cruzi invasion is mediated by receptor-ligand recognition between the surfaces of both parasite and target cell. We have previously demonstrated the role of heparan sulfate proteoglycan in the attachment and invasion of T. cruzi in cardiomyocytes. Herein, we have isolated the T. cruzi heparin-binding proteins (HBP-Tc) and investigated the nature of cardiomyocyte heparan sulfate (HS)-binding site to the parasite surface ligand. Two major heparin-binding proteins with molecular masses of 65.8 and 59 kDa were observed in total extract of amastigote and trypomastigote forms of T. cruzi. Hydrophobic [S(35)]methionine labeled proteins eluted from heparin-sepharose affinity chromatography also revealed both proteins in trypomastigotes but only the 59 kDa is strongly recognized by biotin-conjugated glycosaminoglycans. Competition assays were performed to analyze the role of sulfated proteoglycans, including heparin, keratan sulfate and both acetylated and highly sulfated domains of heparan sulfate, in the recognition and invasion process of T. cruzi. Significant inhibitions of 84% and 35% in the percentage of infection were revealed after treatment of the parasites with heparin and the N-acetylated/ N-sulfated heparan sulfate domain, respectively, suggesting the important role of the glycuronic acid and NS glucosamine domain of the HS chain in the recognition of the HBP-Tc during the T. cruzi-cardiomyocyte interaction.
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28
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da Silveira ABM, D'Avila Reis D, de Oliveira EC, Neto SG, Luquetti AO, Poole D, Correa-Oliveira R, Furness JB. Neurochemical coding of the enteric nervous system in chagasic patients with megacolon. Dig Dis Sci 2007; 52:2877-83. [PMID: 17385032 DOI: 10.1007/s10620-006-9680-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 11/07/2006] [Indexed: 12/09/2022]
Abstract
Neuronal destruction has been considered the hallmark of pathogenic mechanisms in chagasic megacolon. Characterization of neuropeptides in the enteric nervous system from chagasic patients with megacolon could elucidate some aspects of the development of this syndrome. In the present work we demonstrate the changes in expression of neuropeptides and neurochemical markers present in neuronal plexuses from the colons of chagasic patients with megacolon. Sections of frozen tissue samples were immunohistochemically labeled for anticalretinin, cChaT, substance P, VIP, NOS, and NPY. Immunoreactivity was observed using a confocal microscope. Our results demonstrate that in chagasic patients with megacolon, inhibitory motor neurons (VIP and NOS immunoreactive) are preferentially destroyed by Trypanosoma cruzi and/or the inflammatory process. These results suggest a selective destruction of enteric neurons in the colon of chagasic patients with megacolon, pointing to an important discovery in the mechanism of pathogenesis of Chagas' disease.
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Affiliation(s)
- A B M da Silveira
- Department of Morphology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 627, Pampulha, Belo Horizonte, Minas Gerais, CEP, 31270-901, Brazil.
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29
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Hanford EJ, Zhan FB, Lu Y, Giordano A. Chagas disease in Texas: Recognizing the significance and implications of evidence in the literature. Soc Sci Med 2007; 65:60-79. [PMID: 17434248 DOI: 10.1016/j.socscimed.2007.02.041] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Indexed: 11/26/2022]
Abstract
Chagas disease is endemic and is recognized as a major health problem in many Latin American countries. Despite the parallels between socio-economic and environmental conditions in Texas and much of Latin America, Chagas disease is not a notifiable human disease in Texas. Based on extensive review of related literature, this paper seeks to recognize the evidence that Chagas Disease is endemic to Texas but the epidemiological, parasitological and entomological patterns of Chagas disease in Texas are both different from and parallel to other endemic regions. We find that with a growing immigrant human reservoir, the epidemiological differences may be reduced and result in increasing incidence of the disease. Chagas disease should be recognized as an emerging disease among both immigrant and indigenous populations. Without proper actions, Chagas disease will place increasing burden on the health care system. Current medical treatments consist of chemotherapies that carry the risk of serious side effects; curing the potentially fatal disease remains equivocal. Therefore, as shown in South America, prevention is paramount and can be successfully achieved through intervention and education. We conclude that biogeographical research is needed to (1) distinguish the dynamic evolution of the agent-vector-host system, (2) document locations with greater risk and identify mechanisms responsible for observed changes in risk, and (3) assist in developing a model for Triatomid vector-borne disease in states like Texas where the disease is both endemic and may be carried by a sizeable immigrant population. Tracking of Chagas disease and planning for appropriate health care services would also be aided by including Chagas disease on the list of reportable diseases for humans.
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Affiliation(s)
- Elaine Jennifer Hanford
- Department of Geography, Texas Center for Geographic Information Science, Texas State University, Texas, San Marcos, TX 78666, USA.
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30
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Buekens P, Almendares O, Carlier Y, Dumonteil E, Eberhard M, Gamboa-Leon R, James M, Padilla N, Wesson D, Xiong X. Mother-to-Child Transmission of Chagas’ Disease in North America: Why Don’t We Do More? Matern Child Health J 2007; 12:283-6. [PMID: 17602289 DOI: 10.1007/s10995-007-0246-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 06/11/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Mothers with Chagas' disease can transmit Trypanosoma cruzi to their fetuses, who often become carriers of the infection and are then at risk of developing severe cardiac disease later in the course of their lives. If identified early enough after birth, the infected newborns can be treated and cured. Our objective was to review the data available in Canada, Mexico, and the United States and to discuss the need for prevention programs. METHODS We reviewed the literature and estimated the number of seropositive mothers and newborns infected by T. cruzi. RESULTS We estimate that about 40,000 pregnant women and 2,000 newborns are likely to be infected by T. cruzi in North America. We have not identified any ongoing prevention programs. CONCLUSIONS Mother-to-child transmission of T. cruzi has all the characteristics required to be a public health priority, as it is relatively frequent, severe, identifiable, and treatable. In reality, it is a neglected disease and a missed opportunity. It is urgent to better understand the epidemiology of mother-to-child transmission of T. cruzi in North America and to develop effective prevention programs.
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Affiliation(s)
- Pierre Buekens
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2430, New Orleans, LA 70112, USA.
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31
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Caballero ZC, Sousa OE, Marques WP, Saez-Alquezar A, Umezawa ES. Evaluation of serological tests to identify Trypanosoma cruzi infection in humans and determine cross-reactivity with Trypanosoma rangeli and Leishmania spp. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2007; 14:1045-9. [PMID: 17522327 PMCID: PMC2044488 DOI: 10.1128/cvi.00127-07] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Five commercially available enzyme-linked immunosorbent assays (ELISAs), one in-house ELISA, and two hemagglutination assays were evaluated to determine their diagnostic accuracy for Chagas' disease in two studies. In study 1, ELISA kits showed 100% sensitivity, but specificities ranged from 82.84% to 100% when leishmaniasis cases were included and from 95.57% to 100% when leishmaniasis cases were excluded. Kits using recombinant antigens or synthetic peptides are more specific than those using crude extracts from Trypanosoma cruzi epimastigote forms. Kits evaluated in Panama, in study 2, showed 75% to 100% sensitivity and 97.12% to 100% specificity. These data were obtained by using a Western blot assay with T. cruzi trypomastigote excreted-secreted antigens as a reference test to confirm T. cruzi infection.
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Affiliation(s)
- Zuleima C Caballero
- Instituto de Medicina Tropical de São Paulo and Departamento de Medicina Preventiva da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar 470, CEP 05403-000, São Paulo, Brazil
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32
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da Silveira ABM, Lemos EM, Adad SJ, Correa-Oliveira R, Furness JB, D'Avila Reis D. Megacolon in Chagas disease: a study of inflammatory cells, enteric nerves, and glial cells. Hum Pathol 2007; 38:1256-64. [PMID: 17490721 DOI: 10.1016/j.humpath.2007.01.020] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 01/12/2007] [Accepted: 01/19/2007] [Indexed: 11/22/2022]
Abstract
After acute infestation with the Chagas disease parasite, Trypanosoma cruzi, some patients who are serologically positive develop chronic megacolon and megaesophagus, whereas others are symptom-free. Chagas disease with gastrointestinal involvement involves an inflammatory invasion of the enteric plexuses and degeneration of enteric neurons. It is known that glial cells can be involved in enteric inflammatory responses. The aims were to determine the nature of any difference in lymphocytic invasion, enteric neurons, and enteric glial cells in seropositive individuals with and without megacolon. We have compared colonic tissue from serologically positive individuals with and without symptoms and from seronegative controls. Subjects with megacolon had significantly more CD-57 natural killer cells and TIA-1 cytotoxic lymphocytes within enteric ganglia, but numbers of CD-3 and CD-20 immunoreactive cells were not significantly elevated. The innervation of the muscle was substantially reduced to about 20% in megacolon, but asymptomatic seropositive subjects were not different to seronegative controls. Glial cell loss occurred equally in symptomatic and unaffected seropositive subjects, although the proportion with glial fibrillary acidic protein was greater in seropositive, nonsymptomatic subjects. Development of megacolon after acute infection with T cruzi is associated with maintained invasion of enteric ganglia with cytotoxic T cells and loss of muscle innervation, but changes in glial cell numbers are not associated with progression of enteric neuropathy.
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Affiliation(s)
- Alexandre Barcelos Morais da Silveira
- Department of Morphology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, CEP: 31270-901 Pampulha, Belo Horizonte, Minas Gerais, Brazil.
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33
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Kotton CN. Zoonoses in Solid-Organ and Hematopoietic Stem Cell Transplant Recipients. Clin Infect Dis 2007; 44:857-66. [PMID: 17304461 DOI: 10.1086/511859] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 11/25/2006] [Indexed: 02/05/2023] Open
Abstract
Numerous reports exist of the transmission of zoonoses to humans during and after solid-organ and hematopoietic stem cell transplantation. Donor-derived infections of numerous etiologies, including West Nile virus infection, Chagas disease, toxoplasmosis, rabies, lymphocytic choriomeningitis virus infection, and infection due to Brucella species have been reported. Most zoonoses occur as a primary infection after transplantation, and immunocompromised patients are more likely to experience significant morbidity and mortality from these infections. Risks of zoonotic infection in the posttransplantation period could be reduced by patient education. Increased recognition of the risks of zoonoses, as well as the advent of molecular biology-based testing, will potentially augment diagnostic aptitude. Documented zoonotic infection as it affects transplantation will be the primary focus of this review.
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Affiliation(s)
- Camille N Kotton
- Transplant and Immunocompromised Host Section, Infectious Diseases Division, Massachusetts General Hospital, Boston, MA 02114, USA.
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34
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da Silveira ABM, Adad SJ, Correa-Oliveira R, Furness JB, D'Avila Reis D. Morphometric study of eosinophils, mast cells, macrophages and fibrosis in the colon of chronic chagasic patients with and without megacolon. Parasitology 2007; 134:789-96. [PMID: 17288632 DOI: 10.1017/s0031182007002296] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The mechanisms involved in the pathogenesis of chagasic megacolon are not completely characterized. Although autoimmunity may play a role in the pathogenesis of Chagas' disease, recent studies suggest a positive association of tissue parasitism, inflammation, and severity of lesions. The aim of this study was to evaluate the role of inflammatory cells and the occurrence of fibrosis in the colon of chagasic patients with and without megacolon. Samples from 26 patients were randomly selected and paraffin-embedded tissue blocks were sectioned and evaluated by histology and immunohistochemistry to analyse the occurrence and relation among eosinophils, mast cells, macrophages and fibrosis. Section analyses showed that the presence of eosinophils and mast cells in the analysed inflammatory cells has a direct correlation with fibrosis density in the chagasic megacolon. These data suggest that the megacolon's pathogenesis is based on a continuous process of cell damage. Our data propose that eosinophils, mast cells and macrophages may have a direct connection with the occurrence of fibrosis in the colon of chagasic patients. We believe that potential therapeutic agents against these cells could avoid the fibrosis process and contribute to prevent the development of chagasic megacolon.
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Affiliation(s)
- A B M da Silveira
- Department of Morphology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Brazil.
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