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Pinto J, Skjefte M, Alonso-Padilla J, Lozano Beltran DF, Pinto LV, Casellas A, Arteaga Terrazas ME, Toledo Galindo KA, Challapa Quechover R, Escobar Caballero M, Perez Salinas A, Castellón Jimenez M, Sanz S, Gascón J, Torrico F, Pinazo MJ. Five-year serological and clinical evolution of chronic Chagas disease patients in Cochabamba, Bolivia. PLoS Negl Trop Dis 2023; 17:e0011498. [PMID: 38157376 PMCID: PMC10756508 DOI: 10.1371/journal.pntd.0011498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Chagas disease, caused by the parasite Trypanosoma cruzi, is a neglected infectious disease that exerts the highest public health burden in the Americas. There are two anti-parasitic drugs approved for its treatment-benznidazole and nifurtimox-but the absence of biomarkers to early assess treatment efficacy hinders patients´ follow-up. METHODOLOGY/PRINCIPAL FINDINGS We conducted a longitudinal, observational study among a cohort of 106 chronically T. cruzi-infected patients in Cochabamba (Bolivia) who completed the recommended treatment of benznidazole. Participants were followed-up for five years, in which we collected clinical and serological data, including yearly electrocardiograms and optical density readouts from two ELISAs (total and recombinant antigens). Descriptive and statistical analyses were performed to understand trends in data, as well as the relationship between clinical symptoms and serological evolution after treatment. Our results showed that both ELISAs documented average declines up to year three and slight inclines for the following two years. The recorded clinical parameters indicated that most patients did not have any significant changes to their cardiac or digestive symptoms after treatment, at least in the timeframe under investigation, while a small percentage demonstrated either a regression or progression in symptoms. Only one participant met the "cure criterion" of a negative serological readout for both ELISAs by the final year. CONCLUSIONS/SIGNIFICANCE The study confirms that follow-up of benznidazole-treated T. cruzi-infected patients should be longer than five years to determine, with current tools, if they are cured. In terms of serological evolution, the single use of a total antigen ELISA might be a more reliable measure and suffice to address infection status, at least in the region of Bolivia where the study was done. Additional work is needed to develop a test-of-cure for an early assessment of drugs´ efficacy with the aim of improving case management protocols.
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Affiliation(s)
- Jimy Pinto
- Fundación Ciencia y Estudios Aplicados para el Desarrollo en Salud y Medio Ambiente (CEADES), Cochabamba, Bolivia
| | - Malia Skjefte
- Harvard TH Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts, United States of America
| | - Julio Alonso-Padilla
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
| | - Daniel Franz Lozano Beltran
- Fundación Ciencia y Estudios Aplicados para el Desarrollo en Salud y Medio Ambiente (CEADES), Cochabamba, Bolivia
- Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Lilian Victoria Pinto
- Fundación Ciencia y Estudios Aplicados para el Desarrollo en Salud y Medio Ambiente (CEADES), Cochabamba, Bolivia
| | - Aina Casellas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
| | - Mery Elena Arteaga Terrazas
- Fundación Ciencia y Estudios Aplicados para el Desarrollo en Salud y Medio Ambiente (CEADES), Cochabamba, Bolivia
| | | | - Roxana Challapa Quechover
- Fundación Ciencia y Estudios Aplicados para el Desarrollo en Salud y Medio Ambiente (CEADES), Cochabamba, Bolivia
| | - María Escobar Caballero
- Fundación Ciencia y Estudios Aplicados para el Desarrollo en Salud y Medio Ambiente (CEADES), Cochabamba, Bolivia
| | - Alejandra Perez Salinas
- Fundación Ciencia y Estudios Aplicados para el Desarrollo en Salud y Medio Ambiente (CEADES), Cochabamba, Bolivia
| | - Mario Castellón Jimenez
- Fundación Ciencia y Estudios Aplicados para el Desarrollo en Salud y Medio Ambiente (CEADES), Cochabamba, Bolivia
| | - Sergi Sanz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
| | - Joaquim Gascón
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
| | - Faustino Torrico
- Fundación Ciencia y Estudios Aplicados para el Desarrollo en Salud y Medio Ambiente (CEADES), Cochabamba, Bolivia
- Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - María Jesús Pinazo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
- Drugs for Neglected Diseases Initiative (DNDi), Geneve, Switzerland
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de Alba Alvarado MC, Torres Gutiérrez E, Cabrera Bravo M, Zenteno Galindo E, Villarreal Muñoz JA, Salazar Schettino PM, Bucio Torres MI. Main Cardiac Histopathologic Alterations in the Acute Phase of Trypanosoma cruzi Infection in a Murine Model. Pathogens 2023; 12:1084. [PMID: 37764892 PMCID: PMC10534729 DOI: 10.3390/pathogens12091084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/06/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
Symptoms in the acute phase of Chagas disease are usually mild and nonspecific. However, after several years, severe complications like dilated heart failure and even death may arise in the chronic phase. Due to the lack of specific symptoms in the acute phase, the aim of this work was to describe and analyze the cardiac histopathology during this phase in a CD1 mouse model by assessing parasitism, fibrotic damage, and the presence and composition of a cellular infiltrate, to determine its involvement in the pathogenesis of lesions in the cardiac tissue. Our results indicate that the acute phase lasts about 62 days post-infection (dpi). A significant increase in parasitemia was observed since 15 dpi, reaching a maximum at 33 dpi (4.1 × 106). The presence of amastigote nests was observed at 15-62 dpi, with a maximum count of 27 nests at 35 dpi. An infiltrate consisting primarily of macrophages and neutrophils was found in the cardiac tissue within the first 30 days, but the abundance of lymphocytes showed an 8 ≥ fold increase at 40-62 dpi. Unifocal interstitial fibrosis was identified after 9 dpi, which subsequently showed a 16 ≥ fold increase at 40-60 dpi, along with a 50% mortality rate in the model under study. The increased area of fibrotic lesions revealed progression in the extent of fibrosis, mainly at 50-62 dpi. The presence of perivasculitis and thrombus circulation disorders was seen in the last days (62 dpi); finally, cases of myocytolysis were observed at 50 and 62 dpi. These histopathological alterations, combined with collagen deposition, seem to lead to the development of interstitial fibrosis and damage to the cardiac tissue during the acute phase of infection. This study provides a more complete understanding of the patterns of histopathological abnormalities involved in the acute phase, which could help the development of new therapies to aid the preclinical tests of drugs for their application in Chagas disease.
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Affiliation(s)
- Mariana C. de Alba Alvarado
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Coyoacán, Mexico City 04510, Mexico; (M.C.d.A.A.); (E.T.G.); (M.C.B.)
| | - Elia Torres Gutiérrez
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Coyoacán, Mexico City 04510, Mexico; (M.C.d.A.A.); (E.T.G.); (M.C.B.)
| | - Margarita Cabrera Bravo
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Coyoacán, Mexico City 04510, Mexico; (M.C.d.A.A.); (E.T.G.); (M.C.B.)
| | - Edgar Zenteno Galindo
- Departamento de Bioquímica, Facultad de Medicina, Universidad Nacional Autónoma de México, Coyoacán, Mexico City 04510, Mexico;
| | - José Antonio Villarreal Muñoz
- División de Investigación, Secretaria General, Facultad de Medicina, Universidad Nacional Autónoma de México, Coyoacán, Mexico City 04510, Mexico;
| | - Paz María Salazar Schettino
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Coyoacán, Mexico City 04510, Mexico; (M.C.d.A.A.); (E.T.G.); (M.C.B.)
| | - Martha Irene Bucio Torres
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Coyoacán, Mexico City 04510, Mexico; (M.C.d.A.A.); (E.T.G.); (M.C.B.)
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Arce-Fonseca M, Gutiérrez-Ocejo RA, Rosales-Encina JL, Aranda-Fraustro A, Cabrera-Mata JJ, Rodríguez-Morales O. Nitazoxanide: A Drug Repositioning Compound with Potential Use in Chagas Disease in a Murine Model. Pharmaceuticals (Basel) 2023; 16:826. [PMID: 37375773 DOI: 10.3390/ph16060826] [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: 05/11/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Chagas disease (ChD), caused by Trypanosoma cruzi, is the most serious parasitosis in the western hemisphere. Benznidazole and nifurtimox, the only two trypanocidal drugs, are expensive, difficult to obtain, and have severe side effects. Nitazoxanide has shown to be effective against protozoa, bacteria, and viruses. This study aimed to evaluate the nitazoxanide efficacy against the Mexican T. cruzi Ninoa strain in mice. Infected animals were orally treated for 30 days with nitazoxanide (100 mg/kg) or benznidazole (10 mg/kg). The clinical, immunological, and histopathological conditions of the mice were evaluated. Nitazoxanide- or benznidazole-treated mice had longer survival and less parasitemia than those without treatment. Antibody production in the nitazoxanide-treated mice was of the IgG1-type and not of the IgG2-type as in the benznidazole-treated mice. Nitazoxanide-treated mice had significantly high IFN-γ levels compared to the other infected groups. Serious histological damage could be prevented with nitazoxanide treatment compared to without treatment. In conclusion, nitazoxanide decreased parasitemia levels, indirectly induced the production of IgG antibodies, and partially prevented histopathological damage; however, it did not show therapeutic superiority compared to benznidazole in any of the evaluated aspects. Therefore, the repositioning of nitazoxanide as an alternative treatment against ChD could be considered, since it did not trigger adverse effects that worsened the pathological condition of the infected mice.
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Affiliation(s)
- Minerva Arce-Fonseca
- Laboratory of Molecular Immunology and Proteomics, Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Rodolfo Andrés Gutiérrez-Ocejo
- Laboratory of Molecular Immunology and Proteomics, Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - José Luis Rosales-Encina
- Department of Infectomics and Molecular Pathogenesis, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Av. Insituto Politécnico Nacional, Av. Instituto Politécnico Nacional No. 2508, Col. San Pedro Zacatenco, Gustavo A. Madero, Mexico City 07360, Mexico
| | - Alberto Aranda-Fraustro
- Department of Pathology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Juan José Cabrera-Mata
- Laboratory of Molecular Immunology and Proteomics, Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Olivia Rodríguez-Morales
- Laboratory of Molecular Immunology and Proteomics, Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
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Cutshaw MK, Sciaudone M, Bowman NM. Risk Factors for Progression to Chronic Chagas Cardiomyopathy: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2023; 108:791-800. [PMID: 36848894 PMCID: PMC10076993 DOI: 10.4269/ajtmh.22-0630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/19/2022] [Indexed: 03/01/2023] Open
Abstract
Approximately one-third of people with chronic Trypanosoma cruzi infection develop Chagas cardiomyopathy, which carries a poor prognosis. Accurate prediction of which individuals will go on to develop Chagas cardiomyopathy remains elusive. We performed a systematic review of literature comparing characteristics of individuals with chronic Chagas disease with or without evidence of cardiomyopathy. Studies were not excluded on the basis of language or publication date. Our review yielded a total of 311 relevant publications. We further examined the subset of 170 studies with data regarding individual age, sex, or parasite load. A meta-analysis of 106 eligible studies indicated that male sex was associated with having Chagas cardiomyopathy (Hedge's g: 1.56, 95% CI: 1.07-2.04), and a meta-analysis of 91 eligible studies indicated that older age was associated with having Chagas cardiomyopathy (Hedge's g: 0.66, 95% CI: 0.41-0.91). A meta-analysis of four eligible studies did not find an association between parasite load and disease state. This study provides the first systematic review to assess whether age, sex, and parasite load are associated with Chagas cardiomyopathy. Our findings suggest that older and male patients with Chagas disease are more likely to have cardiomyopathy, although we are unable to identify causal relationships due to the high heterogeneity and predominantly retrospective study designs in the current literature. Prospective, multidecade studies are needed to better characterize the clinical course of Chagas disease and identify risk factors for progression to Chagas cardiomyopathy.
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Affiliation(s)
| | - Michael Sciaudone
- Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, Louisiana
| | - Natalie M. Bowman
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Venturini G, Alvim JM, Padilha K, Toepfer CN, Gorham JM, Wasson LK, Biagi D, Schenkman S, Carvalho VM, Salgueiro JS, Cardozo KHM, Krieger JE, Pereira AC, Seidman JG, Seidman CE. Cardiomyocyte infection by Trypanosoma cruzi promotes innate immune response and glycolysis activation. Front Cell Infect Microbiol 2023; 13:1098457. [PMID: 36814444 PMCID: PMC9940271 DOI: 10.3389/fcimb.2023.1098457] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
Introduction Chagas cardiomyopathy, a disease caused by Trypanosoma cruzi (T. cruzi) infection, is a major contributor to heart failure in Latin America. There are significant gaps in our understanding of the mechanism for infection of human cardiomyocytes, the pathways activated during the acute phase of the disease, and the molecular changes that lead to the progression of cardiomyopathy. Methods To investigate the effects of T. cruzi on human cardiomyocytes during infection, we infected induced pluripotent stem cell-derived cardiomyocytes (iPSC-CM) with the parasite and analyzed cellular, molecular, and metabolic responses at 3 hours, 24 hours, and 48 hours post infection (hpi) using transcriptomics (RNAseq), proteomics (LC-MS), and metabolomics (GC-MS and Seahorse) analyses. Results Analyses of multiomic data revealed that cardiomyocyte infection caused a rapid increase in genes and proteins related to activation innate and adaptive immune systems and pathways, including alpha and gamma interferons, HIF-1α signaling, and glycolysis. These responses resemble prototypic responses observed in pathogen-activated immune cells. Infection also caused an activation of glycolysis that was dependent on HIF-1α signaling. Using gene editing and pharmacological inhibitors, we found that T. cruzi uptake was mediated in part by the glucose-facilitated transporter GLUT4 and that the attenuation of glycolysis, HIF-1α activation, or GLUT4 expression decreased T. cruzi infection. In contrast, pre-activation of pro-inflammatory immune responses with LPS resulted in increased infection rates. Conclusion These findings suggest that T. cruzi exploits a HIF-1α-dependent, cardiomyocyte-intrinsic stress-response activation of glycolysis to promote intracellular infection and replication. These chronic immuno-metabolic responses by cardiomyocytes promote dysfunction, cell death, and the emergence of cardiomyopathy.
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Affiliation(s)
- Gabriela Venturini
- Department of Genetics, Harvard Medical School, Boston, MA, United States,Laboratory of Genetics and Molecular Cardiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Juliana M. Alvim
- Laboratory of Genetics and Molecular Cardiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Kallyandra Padilha
- Laboratory of Genetics and Molecular Cardiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Christopher N. Toepfer
- Department of Genetics, Harvard Medical School, Boston, MA, United States,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom,Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Joshua M. Gorham
- Department of Genetics, Harvard Medical School, Boston, MA, United States
| | - Lauren K. Wasson
- Department of Genetics, Harvard Medical School, Boston, MA, United States
| | | | - Sergio Schenkman
- Department of Microbiology, Immunology and Parasitology, Escola Paulista de Medicina, São Paulo, Brazil
| | | | | | | | - Jose E. Krieger
- Laboratory of Genetics and Molecular Cardiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Alexandre C. Pereira
- Department of Genetics, Harvard Medical School, Boston, MA, United States,Laboratory of Genetics and Molecular Cardiology, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Christine E. Seidman
- Department of Genetics, Harvard Medical School, Boston, MA, United States,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States,Howard Hughes Medical Institute, Chevy Chase, MD, United States,*Correspondence: Christine E. Seidman,
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Chagas Heart Disease: Beyond a Single Complication, from Asymptomatic Disease to Heart Failure. J Clin Med 2022; 11:jcm11247262. [PMID: 36555880 PMCID: PMC9784121 DOI: 10.3390/jcm11247262] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Chagas cardiomyopathy (CC), caused by the protozoan Trypanosoma cruzi, is an important cause of cardiovascular morbidity and mortality in developing countries. It is estimated that 6 to 7 million people worldwide are infected, and it is predicted that it will be responsible for 200,000 deaths by 2025. The World Health Organization (WHO) considers Chagas disease (CD) as a Neglected Tropical Disease (NTD), which must be acknowledged and detected in time, as it remains a clinical and diagnostic challenge in both endemic and non-endemic regions and at different levels of care. The literature on CC was analyzed by searching different databases (Medline, Cochrane Central, EMBASE, PubMed, Google Scholar, EBSCO) from 1968 until October 2022. Multicenter and bioinformatics trials, systematic and bibliographic reviews, international guidelines, and clinical cases were included. The reference lists of the included papers were checked. No linguistic restrictions or study designs were applied. This review is intended to address the current incidence and prevalence of CD and to identify the main pathogenic mechanisms, clinical presentation, and diagnosis of CC.
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Poncini CV, Benatar AF, Gomez KA, Rabinovich GA. Galectins in Chagas Disease: A Missing Link Between Trypanosoma cruzi Infection, Inflammation, and Tissue Damage. Front Microbiol 2022; 12:794765. [PMID: 35046919 PMCID: PMC8762303 DOI: 10.3389/fmicb.2021.794765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/25/2021] [Indexed: 11/25/2022] Open
Abstract
Trypanosoma cruzi, the protozoan parasite causative agent of Chagas disease, affects about seven million people worldwide, representing a major global public health concern with relevant socioeconomic consequences, particularly in developing countries. In this review, we discuss the multiple roles of galectins, a family of β-galactoside-binding proteins, in modulating both T. cruzi infection and immunoregulation. Specifically, we focus on galectin-driven circuits that link parasite invasion and inflammation and reprogram innate and adaptive immune responses. Understanding the dynamics of galectins and their β-galactoside-specific ligands during the pathogenesis of T. cruzi infection and elucidating their roles in immunoregulation, inflammation, and tissue damage offer new rational opportunities for treating this devastating neglected disease.
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Affiliation(s)
- Carolina V. Poncini
- Laboratorio de Inmunología Celular e Inmunopatología de Infecciones, Instituto de Investigaciones en Microbiología y Parasitología Medica, Universidad de Buenos Aires-Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
- Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Alejandro F. Benatar
- Servicio de Citometría de Flujo, Instituto de Medicina Experimental (IMEX), Academia Nacional de Medicina, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Karina A. Gomez
- Laboratorio de Biología e Inmunología de las Infecciones por Tripanosomátidos, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Gabriel A. Rabinovich
- Laboratorio de Glicomedicina, Instituto de Biología y Medicina Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
- Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
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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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Noguera Zayas LP, Rüegg S, Torgerson P. The burden of zoonoses in Paraguay: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009909. [PMID: 34727113 PMCID: PMC8589157 DOI: 10.1371/journal.pntd.0009909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/12/2021] [Accepted: 10/15/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Underestimation of zoonoses is exacerbated in low and middle-income countries due mainly to inequalities with serious consequences in healthcare. This is difficult to gauge and reduce the impact of those diseases. Our study focuses on Paraguay, where the livestock industry is one of the major components of the country's economy. Therefore, the rationale of this study was to develop a case study in Paraguay to estimate the dual impact of zoonotic diseases on both the human health and animal health sector and thus determine the societal burden of such diseases. METHODOLOGY/PRINCIPAL FINDINGS We conducted a systemic review (including a meta-analysis) to assess the burden of zoonoses in Paraguay, including official reports and grey literature of disease incidence and prevalence. We estimated the Disability Adjusted Life Years (DALYs) and Zoonosis Disability Adjusted Life Years (zDALYs) to measure the difference between the current health status and the desired health situation of animals and the Paraguayan population based on 50 zoonotic diseases suggested by the WHO (World Health Organization), OIE (World Organization for Animal Health) and the National Health in Paraguay. The total DALYs represent 19,384 (95% CI: from 15,805 to 29,733), and zDALYs, 62,178 (95% CI: from 48,696 to 77,188). According to the results, the priority pathogens for DALYs are E. coli, Trypanosoma cruzi, Leishmania spp, and Toxoplasma gondii. When we include the additional animal health burden, the most important pathogens are Brucella spp, E. coli, Trypanosoma cruzi, and Fasciola hepatica for zDALYs. CONCLUSION/SIGNIFICANCE This is the first study to integrate DALYs and zDALYs with important clues related to the health status of Paraguay. Through DALYs and zDALYs, our perspective becomes more complete because we consider not only human health but also animal health. This is important for setting priorities in disease control, especially in a society where livestock contribute significantly to the economy and to human well-being.
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Affiliation(s)
- Liz Paola Noguera Zayas
- Section of Epidemiology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
- Epidemiology and Biostatistics, Life Science Zürich Graduate School, University of Zürich, Zürich, Switzerland
| | - Simon Rüegg
- Section of Epidemiology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Paul Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
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10
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Structural improvement of new thiazolyl-isatin derivatives produces potent and selective trypanocidal and leishmanicidal compounds. Chem Biol Interact 2021; 345:109561. [PMID: 34174251 DOI: 10.1016/j.cbi.2021.109561] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 05/24/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022]
Abstract
Neglected diseases are a group of transmissible diseases that occur mostly in countries in tropical climates. Among this group, Chagas disease and leishmaniasis stand out, considered threats to global health. Treatment for these diseases is limited. Therefore, there is a need for new therapies against these diseases. In this sense, our proposal consisted of developing two series of compounds, using a molecular hybridization of the heterocyclic isatin and thiazole. The isatin and thiazole ring are important scaffold for several biological disorders, including antiparasitic ones. Herein, thiazolyl-isatin has been synthesized from respective thiosemicarbazone or phenyl-thiosemicarbazone, being some of these new thiazolyl-isatin toxic for trypomastigotes without affecting macrophages viability. From this series, compounds 2e (IC50 = 4.43 μM), 2j (IC50 = 2.05 μM), 2l (IC50 = 4.12 μM) and 2m (1.72 μM) showed the best anti-T. cruzi activity for trypomastigote form presenting a selectivity index higher than Benznidazole (BZN). Compounds 2j, 2l and 2m were able to induce a significantly labelling compatible with necrosis in trypomastigotes. Analysis by scanning electron microscopy showed that T. cruzi trypomastigote cells treated with the compound 2m from IC50 concentrations, promoted changes in the shape, flagella and surface of body causing of the parasite dead. Concerning leishmanicidal evaluation against L. amazonensis and L. infantum, compounds 2l (IC50 = 7.36 and 7.97 μM, respectively) and 2m (6.17 and 6.04 μM, respectively) showed the best activity for promastigote form, besides showed a higher selectivity than Miltefosine. Thus, compounds 2l and 2m showed dual in vitro trypanosomicidal and leishmanicidal activities. A structural activity relationship study showed that thiazolyl-isatin derivatives from phenyl-thiosemicarbazone (2a-m) were, in general, more active than thiazolyl-isatin derivatives from thiosemicarbazone (1a-g). Crystallography studies revealed a different configuration between series 1a-g and 2a-m. The configuration and spatial arrangement divergent between the two sub-series could explain the improved biological activity profile of 2a-m sub-series.
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11
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Singh A, Cohen B, Sturzoiu T, Vallabhaneni S, Shirani J. Recent trends in hospital admissions and outcomes of cardiac Chagas disease in the United States. Int J Crit Illn Inj Sci 2021; 10:134-139. [PMID: 33409128 PMCID: PMC7771622 DOI: 10.4103/ijciis.ijciis_85_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/14/2020] [Accepted: 06/09/2020] [Indexed: 11/11/2022] Open
Abstract
Background: Chagas disease (CD), caused by Trypanosoma cruzi, has been increasingly encountered as a cause of cardiovascular disease in the United States. We aimed to examine trends of hospital admissions and cardiovascular outcomes of cardiac CD (CCD). Methods: Search of 2003-2011 Nationwide Inpatient Sample database identified 949 (age 57±16 years, 51% male, 72.5% Hispanic) admissions for CCD. Results: A significant increase in the number of admissions for CCD was noted during the study period (OR=1.054; 95% CI=1.028-1.081; P< 0.0001); 72% were admitted to Southern and Western hospitals. Comorbidities included hypertension (40%), coronary artery disease (28%), hyperlipidemia (26%), tobacco use (12%), diabetes (9%), heart failure (5%) and obesity (2.2%). Cardiac abnormalities noted during hospitalization included atrial fibrillation (27%), ventricular tachycardia (23%), sinoatrial node dysfunction (5%), complete heart block (4%), valvular heart disease (6%)] and left ventricular aneurysms (5%). In-hospital mortality was 3.2%. Other major adverse events included cardiogenic shock in 54 (5.7%), cardiac arrest in 30 (3.2%), acute heart failure in 88 (9.3%), use of mechanical circulatory support in 29 (3.1%), and acute stroke in 34 (3.5%). Overall, 63% suffered at least one adverse event. Temporary (2%) and permanent (3.5%) pacemakers, implantable cardioverter defibrillators (10%), and cardiac transplant (2.1%) were needed for in-hospital management. Conclusions: Despite the remaining concerns about lack of awareness of CCD in the US, an increasing number of hospital admissions were reported from 2003-2011. Serious cardiovascular abnormalities were highly prevalent in these patients and were frequently associated with fatal and nonfatal complications.
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Affiliation(s)
- Amitoj Singh
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Brianna Cohen
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Tudor Sturzoiu
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | | | - Jamshid Shirani
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
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Alberca RW, Yendo TM, Leuzzi Ramos YÁ, Fernandes IG, Oliveira LDM, Teixeira FME, Beserra DR, de Oliveira EA, Gozzi-Silva SC, Andrade MMDS, Branco ACCC, Pietrobon AJ, Pereira NZ, de Brito CA, Orfali RL, Aoki V, Duarte AJDS, Benard G, Sato MN. Case Report: COVID-19 and Chagas Disease in Two Coinfected Patients. Am J Trop Med Hyg 2020; 103:2353-2356. [PMID: 33025877 PMCID: PMC7695072 DOI: 10.4269/ajtmh.20-1185] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
American trypanosomiasis, also named Chagas disease (CD), is an anthropozoonosis caused by the protozoan parasite Trypanosoma cruzi. The disease affects millions of people worldwide, leading yearly to approximately 50,000 deaths. COVID-19, generated by SARS-CoV-2, can lead to lymphopenia and death. We hereby describe the first report of two patients with CD and COVID-19 coinfection, from hospitalization until patients' death.
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Affiliation(s)
- Ricardo Wesley Alberca
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Tatiana Mina Yendo
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Yasmim Álefe Leuzzi Ramos
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Iara Grigoletto Fernandes
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luana de Mendonça Oliveira
- Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Franciane Mouradian Emidio Teixeira
- Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Danielle Rosa Beserra
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Emily Araujo de Oliveira
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sarah Cristina Gozzi-Silva
- Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Milena Mary de Souza Andrade
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Anna Cláudia Calvielli Castelo Branco
- Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Anna Julia Pietrobon
- Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nátalli Zanete Pereira
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Cyro Alves de Brito
- Technical Division of Medical Biology, Adolfo Lutz Institute, Immunology Center, São Paulo, Brazil
| | - Raquel Leão Orfali
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valéria Aoki
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alberto José da Silva Duarte
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Gil Benard
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria Notomi Sato
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
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Abstract
Compared with the general population, myocardial infarction (MI) survivors have a higher risk of mortality in the first year after the index event.The aim of this study was to determine the associations between variables obtained during the index admission and 1-year all-cause mortality on follow-up.A cohort of 296 patients was enrolled in the study, with a median age of 63.8 ± 12.68 years. All patients received a coronary angiography and stent implantation by percutaneous coronary intervention. Each variable was tested for association with all-cause mortality, using chi-square tests for categorical and binary variables and t tests for continuous variables. The relative prognostic power of each significant variable was further evaluated by logistic regression before and after adjustment for differences in baseline characteristics.Patients who were deceased after 1-year of MI had significantly higher mean age, increased prevalence of diabetes, and elevated heart rate as compared to those who were surviving. Univariate analysis indicated that patient mortality within 1-year of MI was strongly correlated with higher rates of pump failure on admission (P < .0001), bleeding complications (P = .02), the severity of coronary artery disease measured by Gensini score (P = .04), and decreased left ventricular ejection fraction (LVEF) (P < .0001). After adjustment of baseline variables, only pump failure (P = .006) and reduced LVEF (P < .0001) were independently associated with 1-year mortality.Our study shows that LVEF dysfunction and pump failure are independent predictors of 1-year all-cause post-MI mortality, while the severity of coronary artery disease and bleeding did not qualify as independent predictors. Also, age, history of diabetes, and elevated heart rate may be used as markers for increased mortality rates.
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14
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DNA Vaccine Treatment in Dogs Experimentally Infected with Trypanosoma cruzi. J Immunol Res 2020; 2020:9794575. [PMID: 32455143 PMCID: PMC7222601 DOI: 10.1155/2020/9794575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/08/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023] Open
Abstract
Chagas disease is a chronic and potentially lethal disorder caused by the parasite Trypanosoma cruzi, and an effective treatment has not been developed for chronic Chagas disease. The objective of this study was to determine the effectiveness of a therapeutic DNA vaccine containing T. cruzi genes in dogs with experimentally induced Chagas disease through clinical, pathological, and immunological analyses. Infection of Beagle dogs with the H8 T. cruzi strain was performed intraperitoneally with 3500 metacyclic trypomastigotes/kg body weight. Two weeks after infection, plasmid DNA immunotherapy was administered thrice at 15-day intervals. The clinical (physical and cabinet studies), immunological (antibody and cytokine profiles and lymphoproliferation), and macro- and microscopic pathological findings were described. A significant increase in IgG and cell proliferation was recorded after immunotherapy, and the highest stimulation index (3.02) was observed in dogs treated with the pBCSSP4 plasmid. The second treatment with both plasmids induced an increase in IL-1, and the third treatment with the pBCSSP4 plasmid induced an increase in IL-6. The pBCSP plasmid had a good Th1 response regulated by high levels of IFN-gamma and TNF-alpha, whereas the combination of the two plasmids did not have a synergistic effect. Electrocardiographic studies registered lower abnormalities and the lowest number of individuals with abnormalities in each group treated with the therapeutic vaccine. Echocardiograms showed that the pBCSSP4 plasmid immunotherapy preserved cardiac structure and function to a greater extent and prevented cardiomegaly. The two plasmids alone controlled the infection moderately by a reduction in the inflammatory infiltrates in heart tissue. The immunotherapy was able to reduce the magnitude of cardiac lesions and modulate the cellular immune response; the pBCSP treatment showed a clear Th1 response; and pBCSSP4 induced a balanced Th1/Th2 immune response that prevented severe cardiac involvement. The pBCSSP4 plasmid had a better effect on most of the parameters evaluated in this study; therefore, this plasmid can be considered an optional treatment against Chagas disease in naturally infected dogs.
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15
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Molina-Morant D, Fernández ML, Bosch-Nicolau P, Sulleiro E, Bangher M, Salvador F, Sanchez-Montalva A, Ribeiro ALP, de Paula AMB, Eloi S, Correa-Oliveira R, Villar JC, Sosa-Estani S, Molina I. Efficacy and safety assessment of different dosage of benznidazol for the treatment of Chagas disease in chronic phase in adults (MULTIBENZ study): study protocol for a multicenter randomized Phase II non-inferiority clinical trial. Trials 2020; 21:328. [PMID: 32293523 PMCID: PMC7158046 DOI: 10.1186/s13063-020-4226-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/03/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chagas disease (CD) continues to be a neglected infectious disease with one of the largest burdens globally. Despite the modest cure rates in adult chronic patients and its safety profile, benznidazole (BNZ) is still the drug of choice. Its current recommended dose is based on nonrandomized studies, and efficacy and safety of the optimal dose of BNZ have been scarcely analyzed in clinical trials. METHODS/DESIGN MULTIBENZ is a phase II, randomized, noninferiority, double-blind, multicenter international clinical trial. A total of 240 patients with Trypanosoma CD in the chronic phase will be recruited in four different countries (Argentina, Brazil, Colombia, and Spain). Patients will be randomized to receive BNZ 150 mg/day for 60 days, 400 mg/day for 15 days, or 300 mg/day for 60 days (comparator arm). The primary outcome is the efficacy of three different BNZ therapeutic schemes in terms of dose and duration. Efficacy will be assessed according to the proportion of patients with sustained parasitic load suppression in peripheral blood measured by polymerase chain reaction. The secondary outcomes are related to pharmacokinetics and drug tolerability. The follow-up will be 12 months from randomization to end of study participation. Recruitment was started in April 2018. CONCLUSION This is a clinical trial conducted for the assessment of different dose schemes of BNZ compared with the standard treatment regimen for the treatment of CD in the chronic phase. MULTIBENZ may help to clarify which is the most adequate BNZ regimen in terms of efficacy and safety, predicated on sustained parasitic load suppression in peripheral blood. TRIAL REGISTRATION ClinicalTrials.gov, NCT03191162. Registered on 19 June 2017.
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Affiliation(s)
- D Molina-Morant
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, P° Vall d'Hebron 119, Edifici Mediterrània, VHIR, 08035, Barcelona, Spain
| | - M L Fernández
- Departamento de Clínica, Patología y Tratamiento, Instituto Nacional de Parasitología Dr. Mario Fatala Chaben, Ministerio de Salud y Desarrollo Social, Buenos Aires, Argentina
| | - P Bosch-Nicolau
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, P° Vall d'Hebron 119, Edifici Mediterrània, VHIR, 08035, Barcelona, Spain
| | - E Sulleiro
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Bangher
- Instituto de Cardiología de Corrientes Juana Francisca Cabral (Argentina), Corrientes, Argentina
| | - F Salvador
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, P° Vall d'Hebron 119, Edifici Mediterrània, VHIR, 08035, Barcelona, Spain
| | - A Sanchez-Montalva
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, P° Vall d'Hebron 119, Edifici Mediterrània, VHIR, 08035, Barcelona, Spain
| | - A L P Ribeiro
- Programa de Pós-graduação Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - A M B de Paula
- Laboratory of Health Science, Postgraduate Program in Health Sciences, Universidade Estadual de Montes Claros (Unimontes), Montes Claros, MG, Brazil
| | - S Eloi
- Programa de Pós-graduação em Patologia, Departamento de Propedêutica Complementar, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Faculdade de Medicina da Universidade José do Rosário Vellano, Belo Horizonte, Brazil
| | - R Correa-Oliveira
- René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
| | - J C Villar
- Faculty of Health Sciences, Universidad Autónoma de Bucaramanga and Research Department, Bucaramanga, Colombia
- Fundación Cardioinfantil - Instituto de Cardiología, Bogotá, Colombia
| | - S Sosa-Estani
- Chagas Clinical Program, Drugs for Neglected Disease initiative (DNDi), Geneva, Switzerland
- Epidemiology and Public Health Research Center, CONICET, Buenos Aires, Argentina
| | - I Molina
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, P° Vall d'Hebron 119, Edifici Mediterrània, VHIR, 08035, Barcelona, Spain.
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Rodríguez-Morales O, Roldán FJ, Vargas-Barrón J, Parra-Benítez E, Medina-García MDL, Vergara-Bello E, Arce-Fonseca M. Echocardiographic Findings in Canine Model of Chagas Disease Immunized with DNA Trypanosoma cruzi Genes. Animals (Basel) 2020; 10:E648. [PMID: 32283649 PMCID: PMC7222844 DOI: 10.3390/ani10040648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023] Open
Abstract
Chagas disease (ChD) is considered an emerging disease in the USA and Europe. Trypanosoma cruzi genes encoding a trans-sialidase protein and an amastigote-specific glycoprotein were tested as vaccines in canine model. The aim for this study was determining the prophylactic effect of these genes in experimentally infected dogs by echocardiography evaluation to compare with our findings obtained by other techniques published previously. Low fractional-shortening values of non-vaccinated dogs suggested an impairment in general cardiac function. Low left ventricular ejection fraction values found in infected dogs suggested myocardial injury regardless of whether they were vaccinated. Low left ventricular diastolic/systolic diameters suggested that progressive heart damage or heart dilation could be prevented by DNA vaccination. Systolic peak time was higher in non-vaccinated groups, increasing vulnerability to malignant arrhythmias and sudden death. High left ventricular volume suggested a decrease in wall thickness that might lead to increased size of the heart cavity, except in the pBCSP plasmid-vaccinated dogs. There was an echocardiographic evidence of left ventricular dilation and reduction in systolic function in experimental chagasic dogs. Echocardiography allowed a more complete follow-up of the pathological process in the living patient than with other techniques like electrocardiography, anatomopathology, and histopathology, being the method of choice for characterizing the clinical stages of ChD.
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Affiliation(s)
- Olivia Rodríguez-Morales
- Department of Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico; (O.R.-M.); (E.P.-B.); (M.d.L.M.-G.); (E.V.-B.)
| | - Francisco-Javier Roldán
- Department of Echocardiography, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico; (F.-J.R.); (J.V.-B.)
| | - Jesús Vargas-Barrón
- Department of Echocardiography, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico; (F.-J.R.); (J.V.-B.)
| | - Enrique Parra-Benítez
- Department of Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico; (O.R.-M.); (E.P.-B.); (M.d.L.M.-G.); (E.V.-B.)
| | - María de Lourdes Medina-García
- Department of Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico; (O.R.-M.); (E.P.-B.); (M.d.L.M.-G.); (E.V.-B.)
| | - Emilia Vergara-Bello
- Department of Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico; (O.R.-M.); (E.P.-B.); (M.d.L.M.-G.); (E.V.-B.)
| | - Minerva Arce-Fonseca
- Department of Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico; (O.R.-M.); (E.P.-B.); (M.d.L.M.-G.); (E.V.-B.)
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Garvil MP, Furtado TCDS, Lima NBD, Marteleto MVM, Faria JBD, Rodrigues DBR, Pereira SADL. Although with intact mucosa at colonoscopy, chagasic megacolons have an overexpression of Gal-3. EINSTEIN-SAO PAULO 2020; 18:eAO5105. [PMID: 32159607 PMCID: PMC7046340 DOI: 10.31744/einstein_journal/2020ao5105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 09/11/2019] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the density of anti-galectin-3-immunostained cells, collagen percentage, mast cell density and presence of pathological processes in intestinal muscle biopsies of patients. Methods Thirty-five patients who underwent intestinal biopsy were selected from 1997 to 2015. Patients were divided into three groups: chagasic patients with mucosal lesion (n=13), chagasic patients with intact mucosa (n=12) and non-chagasic patients with no mucosal lesion (n=10). Histological processing of the biopsied fragments and immunohistochemistry for galectin-3 were performed. Additional sections were stained with hematoxylin and eosin to evaluate the general pathological processes, picrosirius for evaluation of collagen and toluidine blue to evaluate the mast cell density. Results Patients of mucosal lesion group had a significantly higher frequency of ganglionitis and myositis when compared to the chagasic patients with intact mucosa and non-chagasic group. The density of anti-galectin-3-immunostained cells was significantly higher in the chagasic patients with intact mucosa group when compared to the non-chagasic group. The group of chagasic patients with intact mucosa presented a higher percentage of collagen in relation to the patients with mucosal lesion and to the non-chagasic group, with a significant difference. There was no significant difference in mast cell density among the three groups. Conclusion The higher density of anti-galectin-3-immunostained cells in patients in the chagasic patients with intact mucosa group suggested the need for greater attention in clinical evaluation of these patients, since this protein is associated with neoplastic transformation and progression.
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Affiliation(s)
| | | | | | | | | | - Denise Bertulucci Rocha Rodrigues
- Universidade de Uberaba , Uberaba , MG , Brazil .,Centro de Educação Profissional - Cefores, Universidade Federal do Triângulo Mineiro , Uberaba , MG , Brazil
| | - Sanívia Aparecida de Lima Pereira
- Universidade de Uberaba , Uberaba , MG , Brazil .,Centro de Educação Profissional - Cefores, Universidade Federal do Triângulo Mineiro , Uberaba , MG , Brazil
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18
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Duque TL, Siqueira MS, Travassos LH, Moreira OC, Bozza PT, Melo RC, Henriques-Pons A, Menna-Barreto RF. The induction of host cell autophagy triggers defense mechanisms against Trypanosoma cruzi infection in vitro. Eur J Cell Biol 2020; 99:151060. [DOI: 10.1016/j.ejcb.2019.151060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 11/06/2019] [Accepted: 11/19/2019] [Indexed: 01/21/2023] Open
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19
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Duque TLA, Cascabulho CM, Oliveira GM, Henriques-Pons A, Menna-Barreto RFS. Rapamycin Treatment Reduces Acute Myocarditis Induced by Trypanosoma cruzi Infection. J Innate Immun 2019; 12:321-332. [PMID: 31801138 DOI: 10.1159/000504322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 10/16/2019] [Indexed: 12/15/2022] Open
Abstract
Chagas disease affects millions of people mainly in Latin America and is a protozoan illness caused by the parasite Trypanosoma cruzi. Chagasic cardiomyopathy is the leading cause of mortality of infected patients, due to compromised electrical and mechanical cardiac function induced by tissue remodeling, especially fibrosis, and lymphocytic infiltration. Some cellular biochemical pathways can be protective to the heart, and we tested if the in vivo activation of the autophagic machinery by rapamycin could reduce parasite-induced myocarditis. Regarding the expression of LC3, an autophagy marker, we observed its upregulation in the cardiac tissue of infected untreated mice. However, after rapamycin treatment, an autophagy inducer, infected mice showed reduced electrical cardiac dysfunctions, myocarditis, cardiac damage, and reduced production of pro-inflammatory cytokines by the heart. On the other hand, the parasite's life cycle was not affected, and we observed no modulations in cardiac tissue or blood parasitemia. Our data indicate that, at least partially, autophagy induction controls inflammation in the heart¸ illustrating the complexity of the pathways that concur to the development of the infection.
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Affiliation(s)
- Thabata L A Duque
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil.,Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Cynthia M Cascabulho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Gabriel M Oliveira
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Andrea Henriques-Pons
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
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20
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Sanmarco LM, Eberhardt N, Bergero G, Quebrada Palacio LP, Adami PM, Visconti LM, Minguez ÁR, Hernández-Vasquez Y, Carrera Silva EA, Morelli L, Postan M, Aoki MP. Monocyte glycolysis determines CD8+ T cell functionality in human Chagas disease. JCI Insight 2019; 4:123490. [PMID: 31479429 DOI: 10.1172/jci.insight.123490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/21/2019] [Indexed: 12/21/2022] Open
Abstract
Chagas disease is a lifelong pathology resulting from Trypanosoma cruzi infection. It represents one of the most frequent causes of heart failure and sudden death in Latin America. Herein, we provide evidence that aerobic glycolytic pathway activation in monocytes drives nitric oxide (NO) production, triggering tyrosine nitration (TN) on CD8+ T cells and dysfunction in patients with chronic Chagas disease. Monocytes from patients exhibited a higher frequency of hypoxia-inducible factor 1α and increased expression of its target genes/proteins. Nonclassical monocytes are expanded in patients' peripheral blood and represent an important source of NO. Monocytes entail CD8+ T cell surface nitration because both the frequency of nonclassical monocytes and that of NO-producing monocytes positively correlated with the percentage of TN+ lymphocytes. Inhibition of glycolysis in in vitro-infected peripheral blood mononuclear cells decreased the inflammatory properties of monocytes/macrophages, diminishing the frequency of IL-1β- and NO-producing cells. In agreement, glycolysis inhibition reduced the percentage of TN+CD8+ T cells, improving their functionality. Altogether, these results clearly show that glycolysis governs oxidative stress on monocytes and modulates monocyte-T cell interplay in human chronic Chagas disease. Understanding the pathological immune mechanisms that sustain an inflammatory environment in human pathology is key to designing improved therapies.
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Affiliation(s)
- Liliana María Sanmarco
- Universidad Nacional de Córdoba, Facultad de Ciencias Químicas, Departamento de Bioquímica Clínica, Córdoba, Argentina.,Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Córdoba, Argentina
| | - Natalia Eberhardt
- Universidad Nacional de Córdoba, Facultad de Ciencias Químicas, Departamento de Bioquímica Clínica, Córdoba, Argentina.,Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Córdoba, Argentina
| | - Gastón Bergero
- Universidad Nacional de Córdoba, Facultad de Ciencias Químicas, Departamento de Bioquímica Clínica, Córdoba, Argentina.,Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Córdoba, Argentina
| | | | - Pamela Martino Adami
- Laboratorio de Amiloidosis y Neurodegeneración, Fundación Instituto Leloir, Buenos Aires, Argentina.,Instituto de Investigaciones Bioquímicas de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Laura Marina Visconti
- Hospital Nuestra Señora de la Misericordia, Córdoba, Argentina.,Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, II Cátedra de Infectología, Córdoba, Argentina
| | | | | | - Eugenio Antonio Carrera Silva
- Laboratorio de Trombosis Experimental, Instituto de Medicina Experimental, Academia Nacional de Medicina, CONICET, Buenos Aires, Argentina
| | - Laura Morelli
- Laboratorio de Amiloidosis y Neurodegeneración, Fundación Instituto Leloir, Buenos Aires, Argentina.,Instituto de Investigaciones Bioquímicas de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Miriam Postan
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chabén," Buenos Aires, Argentina
| | - Maria Pilar Aoki
- Universidad Nacional de Córdoba, Facultad de Ciencias Químicas, Departamento de Bioquímica Clínica, Córdoba, Argentina.,Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Córdoba, Argentina
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21
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Nonaka CKV, Macêdo CT, Cavalcante BRR, Alcântara ACD, Silva DN, Bezerra MDR, Caria ACI, Tavora FRF, Neto JDDS, Noya-Rabelo MM, Rogatto SR, Ribeiro Dos Santos R, Souza BSDF, Soares MBP. Circulating miRNAs as Potential Biomarkers Associated with Cardiac Remodeling and Fibrosis in Chagas Disease Cardiomyopathy. Int J Mol Sci 2019; 20:E4064. [PMID: 31434314 PMCID: PMC6721092 DOI: 10.3390/ijms20164064] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 12/21/2022] Open
Abstract
Chagas disease (CD) affects approximately 6-7 million people worldwide, from which 30% develop chronic Chagas cardiomyopathy (CCC), usually after being asymptomatic for years. Currently available diagnostic methods are capable of adequately identifying infected patients, but do not provide information regarding the individual risk of developing the most severe form of the disease. The identification of biomarkers that predict the progression from asymptomatic or indeterminate form to CCC, may guide early implementation of pharmacological therapy. Here, six circulating microRNAs (miR-19a-3p, miR-21-5p, miR-29b-3p, miR-30a-5p, miR-199b-5p and miR-208a-3p) were evaluated and compared among patients with CCC (n = 28), CD indeterminate form (n = 10) and healthy controls (n = 10). MiR-19a-3p, miR-21-5p, and miR-29b-3p were differentially expressed in CCC patients when compared to indeterminate form, showing a positive correlation with cardiac dysfunction, functional class, and fibrosis, and a negative correlation with ejection fraction and left ventricular strain. Cardiac tissue analysis confirmed increased expression of microRNAs in CCC patients. In vitro studies using human cells indicated the involvement of these microRNAs in the processes of cardiac hypertrophy and fibrosis. Our study suggests that miRNAs are involved in the process of cardiac fibrosis and remodeling presented in CD and indicate a group of miRNAs as potential biomarkers of disease progression in CCC.
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Affiliation(s)
- Carolina Kymie Vasques Nonaka
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, 41253-190 Salvador, Brazil
- Gonçalo Moniz Institute, FIOCRUZ, 40296-710 Salvador, Brazil
- D'Or Institute for Research and Education (IDOR), 22281-100 Rio de Janeiro, Brazil
| | - Carolina Thé Macêdo
- Gonçalo Moniz Institute, FIOCRUZ, 40296-710 Salvador, Brazil
- Department of Cardiology, São Rafael Hospital, 41253-190 Salvador, Brazil
| | - Bruno Raphael Ribeiro Cavalcante
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, 41253-190 Salvador, Brazil
- Gonçalo Moniz Institute, FIOCRUZ, 40296-710 Salvador, Brazil
- D'Or Institute for Research and Education (IDOR), 22281-100 Rio de Janeiro, Brazil
| | | | - Daniela Nascimento Silva
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, 41253-190 Salvador, Brazil
- Gonçalo Moniz Institute, FIOCRUZ, 40296-710 Salvador, Brazil
| | | | - Alex Cleber Improta Caria
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, 41253-190 Salvador, Brazil
- Federal University of Bahia, UFBA, 40231-300 Salvador, Brazil
| | | | | | | | - Silvia Regina Rogatto
- Department of Clinical Genetics, Vejle Hospital, Institute of Regional Health Research, University of Southern Denmark, 7100 Vejle, Denmark
| | - Ricardo Ribeiro Dos Santos
- Gonçalo Moniz Institute, FIOCRUZ, 40296-710 Salvador, Brazil
- National Institute of Science and Technology for Regenerative Medicine, 21941-902 Rio de Janeiro, Brazil
| | - Bruno Solano de Freitas Souza
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, 41253-190 Salvador, Brazil
- Gonçalo Moniz Institute, FIOCRUZ, 40296-710 Salvador, Brazil
- D'Or Institute for Research and Education (IDOR), 22281-100 Rio de Janeiro, Brazil
- National Institute of Science and Technology for Regenerative Medicine, 21941-902 Rio de Janeiro, Brazil
| | - Milena Botelho Pereira Soares
- Gonçalo Moniz Institute, FIOCRUZ, 40296-710 Salvador, Brazil.
- National Institute of Science and Technology for Regenerative Medicine, 21941-902 Rio de Janeiro, Brazil.
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22
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Could pre-infection exercise training improve the efficacy of specific antiparasitic chemotherapy for Chagas disease? Parasitology 2019; 146:1655-1664. [PMID: 31362797 DOI: 10.1017/s0031182019000970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Considering a potential exercise-drug interaction, we investigated whether exercise training could improve the efficacy of specific antiparasitic chemotherapy in a rodent model of Chagas disease. Wistar rats were randomized into five groups: sedentary and uninfected (CT); sedentary and infected (SI); sedentary, infected and treated (SIT); trained and infected (TI); trained, infected and treated (TIT). After 9-weeks running training, the animals were infected with T. cruzi and followed up for 4 weeks, receiving 100 mg kg-1 day-1 benznidazole. No evidence of myocarditis was observed in CT animals. TI animals exhibited reduced parasitemia, myocarditis, and reactive tissue damage compared to SI animals, in addition to increased IFN-γ, IL-4, IL-10, heart non-protein antioxidant (NPA) levels and glutathione-s transferase activity (P < 0.05). The CT, SIT and TIT groups presented similar reductions in parasitemia, cytokines (IFN-γ, TNF-α, IL-4, IL-10, IL-17 and MCP-1), inflammatory infiltrate, oxidative heart damage and antioxidant enzymes activity compared to SI and TI animals, as well as reduced heart microstructural remodeling (P < 0.05). By modulating heart inflammation and redox metabolism, exercise training exerts a protective effect against T. cruzi infection in rats. However, the antiparasitic and cardioprotective effects of benznidazole chemotherapy are more pronounced, determining similar endpoints in sedentary and trained T. cruzi-infected rats.
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23
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Ayyappan JP, lizardo K, Wang S, Yurkow E, Nagajyothi JF. Inhibition of ER Stress by 2-Aminopurine Treatment Modulates Cardiomyopathy in a Murine Chronic Chagas Disease Model. Biomol Ther (Seoul) 2019; 27:386-394. [PMID: 30879276 PMCID: PMC6609105 DOI: 10.4062/biomolther.2018.193] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/17/2019] [Accepted: 01/25/2019] [Indexed: 12/12/2022] Open
Abstract
Trypanosoma cruzi infection results in debilitating cardiomyopathy, which is a major cause of mortality and morbidity in the endemic regions of Chagas disease (CD). The pathogenesis of Chagasic cardiomyopathy (CCM) has been intensely studied as a chronic inflammatory disease until recent observations reporting the role of cardio-metabolic dysfunctions. In particular, we demonstrated accumulation of lipid droplets and impaired cardiac lipid metabolism in the hearts of cardiomyopathic mice and patients, and their association with impaired mitochondrial functions and endoplasmic reticulum (ER) stress in CD mice. In the present study, we examined whether treating infected mice with an ER stress inhibitor can modify the pathogenesis of cardiomyopathy during chronic stages of infection. T. cruzi infected mice were treated with an ER stress inhibitor 2-Aminopurine (2AP) during the indeterminate stage and evaluated for cardiac pathophysiology during the subsequent chronic stage. Our study demonstrates that inhibition of ER stress improves cardiac pathology caused by T. cruzi infection by reducing ER stress and downstream signaling of phosphorylated eukaryotic initiation factor (P-elF2α) in the hearts of chronically infected mice. Importantly, cardiac ultrasound imaging showed amelioration of ventricular enlargement, suggesting that inhibition of ER stress may be a valuable strategy to combat the progression of cardiomyopathy in Chagas patients.
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Affiliation(s)
- Janeesh Plakkal Ayyappan
- Department of Microbiology, Biochemistry and Molecular Genetics, Public Health Research Institute, New Jersey Medical School, Newark, NJ 07103,
USA
| | - Kezia lizardo
- Department of Microbiology, Biochemistry and Molecular Genetics, Public Health Research Institute, New Jersey Medical School, Newark, NJ 07103,
USA
| | - Sean Wang
- Rutgers Molecular Imaging Center, Piscataway, NJ 08854,
USA
| | - Edward Yurkow
- Rutgers Molecular Imaging Center, Piscataway, NJ 08854,
USA
| | - Jyothi F Nagajyothi
- Department of Microbiology, Biochemistry and Molecular Genetics, Public Health Research Institute, New Jersey Medical School, Newark, NJ 07103,
USA
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24
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Melendez-Ramirez G, Soto ME, Velasquez Alvarez LC, Meave A, Juarez-Orozco LE, Guarner-Lans V, Morales JL. Comparison of the amount and patterns of late enhancement in Chagas disease according to the presence and type of ventricular tachycardia. J Cardiovasc Electrophysiol 2019; 30:1517-1525. [PMID: 31172602 DOI: 10.1111/jce.14015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/19/2019] [Accepted: 06/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ventricular tachycardia (VT) is one of the main predictors of mortality in Chagas cardiomyopathy (CC). Although the substrate of sustained and nonsustained-VT (NS-VT) seems to be the same, little is known about the distribution of late enhancement (LE). Our aim was to compare the clinical findings and the amount and patterns of LE in Chagas disease according to the presence and type of VT. METHODS AND RESULTS Magnetic resonance imaging was performed in 54 Chagas seropositive patients: 8 indeterminate and 46 with CC of whom 15 were without VT, 13 with NS-VT, and 18 with sustained-VT (S-VT). There were 31 males (57%), mean age was 55.9 ± 12.2 years. LE was found in 87% of all patients and in 50%, 80%, and 100% of the indeterminate, without VT and VT groups, respectively. The percentage of LE increased progressively in the indeterminate, CC without VT, and CC with VT groups; without a significant difference between NS-VT and S-VT (0.93%, 15.2%, 23.2%, and 21.4%, respectively). The amount of LE increased with the functional class. LE in the basal and mid lateral wall was more frequent in VT, without difference between S-VT and NS-VT. The only predictor of VT was the percentage of LE, odds ratio (OR), 6.2; (95% confidence interval [CI], 3.7-28.4; P = .01) with a cutoff of Odds Ratio 17.1%. CONCLUSIONS The amount of LE increases in relation to the clinical stage of the disease and its functional class in Chagas seropositive patients. The amount of LE was the main predictor of VT, without difference between S-VT and NS-VT.
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Affiliation(s)
| | - Maria Elena Soto
- Department of Immunology, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico, Mexico
| | | | - Aloha Meave
- Department Magnetic Resonance, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico, Mexico
| | - Luis Eduardo Juarez-Orozco
- Turku PET Centre, Turku University Hospital, University of Turku, Turku, Finland.,Department of Experimental Cardiology, University Medical Center Groningen, The Netherlands
| | - Veronica Guarner-Lans
- Department of Physiology, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico, Mexico
| | - Jose Luis Morales
- Department of Electrophysiology, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico, Mexico
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25
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Libisch MG, Faral-Tello P, Garg NJ, Radi R, Piacenza L, Robello C. Early Trypanosoma cruzi Infection Triggers mTORC1-Mediated Respiration Increase and Mitochondrial Biogenesis in Human Primary Cardiomyocytes. Front Microbiol 2018; 9:1889. [PMID: 30166980 PMCID: PMC6106620 DOI: 10.3389/fmicb.2018.01889] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/27/2018] [Indexed: 12/31/2022] Open
Abstract
Chagasic chronic cardiomyopathy is one of the most frequent and severe manifestations of Chagas disease, caused by the parasite Trypanosoma cruzi. The pathogenic and biochemical mechanisms responsible for cardiac lesions remain not completely understood, although it is clear that hypertrophy and subsequent heart dilatation is in part caused by the direct infection of cardiomyocytes. In this work, we evaluated the initial response of human cardiomyocytes to T. cruzi infection by transcriptomic profiling. Immediately after infection, cardiomyocytes dramatically change their gene expression patterns, up regulating most of the genes encoding for respiratory chain, oxidative phosphorylation and protein synthesis. We found that these changes correlate with an increase in basal and maximal respiration, as well as in spare respiratory capacity, which is accompanied by mitochondrial biogenesis pgc-1α independent. We also demonstrate that these changes are mediated by mTORC1 and reversed by rapamycin, resembling the molecular mechanisms described for the non-chagasic hypertrophic cardiomyopathy. The results of the present work identify that early during infection, the activation of mTORC1, mitochondrial biogenesis and improvement in oxidative phosphorylation are key biochemical changes that provide new insights into the host response to parasite infection and the pathogenesis of chronic chagasic cardiomyopathy. The finding that this phenotype can be reversed opens a new perspective in the treatment of Chagas disease, through the identification of host targets, and the use of combined parasite and host targeted therapies, in order to prevent chagasic cardiomyopathy.
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Affiliation(s)
- M Gabriela Libisch
- Laboratory of Host-Pathogen Interactions-UBM, Institut Pasteur de Montevideo, Montevideo, Uruguay
| | - Paula Faral-Tello
- Laboratory of Host-Pathogen Interactions-UBM, Institut Pasteur de Montevideo, Montevideo, Uruguay
| | - Nisha J Garg
- Department of Microbiology and Immunology, The University of Texas Medical Branch, Galveston, TX, United States
| | - Rafael Radi
- Departamento de Bioquímica, Center for Free Radical and Biomedical Research, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Lucía Piacenza
- Departamento de Bioquímica, Center for Free Radical and Biomedical Research, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Carlos Robello
- Laboratory of Host-Pathogen Interactions-UBM, Institut Pasteur de Montevideo, Montevideo, Uruguay.,Departamento de Bioquímica, Center for Free Radical and Biomedical Research, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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26
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Marino VSP, Dumont SM, Mota LDG, Braga DDS, Freitas SSD, Moreira MDCV. Sympathetic Dysautonomia in Heart Failure by 123I-MIBG: comparison between Chagasic, non-Chagasic and heart transplant patients. Arq Bras Cardiol 2018; 111:182-190. [PMID: 30088556 PMCID: PMC6122917 DOI: 10.5935/abc.20180124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/23/2018] [Indexed: 01/23/2023] Open
Abstract
Background Heart failure (HF) is a severe public health problem because of its high
morbidity and mortality and elevated costs, thus requiring better
understanding of its course. In its complex and multifactorial pathogenesis,
sympathetic hyperactivity plays a relevant role. Considering that
sympathetic dysfunction is already present in the initial phases of chronic
Chagas cardiomyopathy (CCC) and frequently associated with a worse
prognosis, we assumed it could be more severe in CCC than in
cardiomyopathies of other etiologies (non-CCC). Objectives To assess the cardiac sympathetic dysfunction 123I-MIBG) of HF,
comparing individuals with CCC to those with non-CCC, using heart transplant
(HT) patients as denervated heart parameters. Methods We assessed 76 patients with functional class II-VI HF, being 25 CCC (17
men), 25 non-CCC (14 men) and 26 HT (20 men), by use of cardiac
123I-metaiodobenzylguanidine 123I-MIBG)
scintigraphy, estimating the early and late heart-to-mediastinum ratio (HMR)
of 123I-MIBG uptake and cardiac washout (WO%). The 5%
significance level was adopted in the statistical analysis. Results The early and late HMR values were 1.73 ± 0.24 and 1.58 ± 0.27,
respectively, in CCC, and 1.62 ± 0.21 and 1.44 ± 0.16 in
non-CCC (p = NS), being, however, higher in HT patients (p < 0.001). The
WO% values were 41.65 ± 21.4 (CCC), 47.37 ± 14.19% (non-CCC)
and 43.29 ± 23.02 (HT), p = 0.057. The late HMR values showed a
positive weak correlation with left ventricular ejection fraction (LVEF) in
CCC and non-CCC (r = 0.42 and p = 0.045; and r = 0.49 and p = 0.015,
respectively). Conclusion Sympathetic hyperactivity 123I-MIBG) was evidenced in patients
with class II-IV HF, LVEF < 45%, independently of the HF etiology, as
compared to HT patients.
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Affiliation(s)
| | - Sandra Monetti Dumont
- Departamento de Anatomia e Imagem da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brazil
| | - Luciene das Graças Mota
- Departamento de Anatomia e Imagem da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brazil
| | - Daniela de Souza Braga
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brazil
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27
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Lizardo K, Ayyappan JP, Cui MH, Balasubramanya R, Jelicks LA, Nagajyothi JF. High fat diet aggravates cardiomyopathy in murine chronic Chagas disease. Microbes Infect 2018; 21:63-71. [PMID: 30071300 DOI: 10.1016/j.micinf.2018.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/29/2018] [Accepted: 07/07/2018] [Indexed: 01/04/2023]
Abstract
Infection with Trypanosoma cruzi, the etiologic agent in Chagas disease, may result in heart disease. Over the last decades, Chagas disease endemic areas in Latin America have seen a dietary transition from the traditional regional diet to a Western style, fat rich diet. Previously, we demonstrated that during acute infection high fat diet (HFD) protects mice from the consequences of infection-induced myocardial damage through effects on adipogenesis in adipose tissue and reduced cardiac lipidopathy. However, the effect of HFD on the subsequent stages of infection - the indeterminate and chronic stages - has not been investigated. To address this gap in knowledge, we studied the effect of HFD during indeterminate and chronic stages of Chagas disease in the mouse model. We report, for the first time, the effect of HFD on myocardial inflammation, vasculopathy, and other types of dysfunction observed during chronic T. cruzi infection. Our results show that HFD perturbs lipid metabolism and induces oxidative stress to exacerbate late chronic Chagas disease cardiac pathology.
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Affiliation(s)
- Kezia Lizardo
- Department of Microbiology, Biochemistry and Molecular Genetics, Public Health Research Institute, New Jersey Medical School, Newark, USA
| | - Janeesh Plakkal Ayyappan
- Department of Microbiology, Biochemistry and Molecular Genetics, Public Health Research Institute, New Jersey Medical School, Newark, USA
| | - Min-Hui Cui
- Department of Radiology, Albert Einstein College of Medicine, 1300, Morris Park Avenue, Bronx, NY, USA; Department of Medicine, Albert Einstein College of Medicine, 1300, Morris Park Avenue, Bronx, NY, USA
| | | | - Linda A Jelicks
- Department of Medicine, Albert Einstein College of Medicine, 1300, Morris Park Avenue, Bronx, NY, USA
| | - Jyothi F Nagajyothi
- Department of Microbiology, Biochemistry and Molecular Genetics, Public Health Research Institute, New Jersey Medical School, Newark, USA.
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28
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Binding capacity of mannose-binding lectin (MBL) is associated with the severity of chronic Chagas cardiomyopathy. Parasitol Int 2018; 67:593-596. [PMID: 29775825 DOI: 10.1016/j.parint.2018.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 11/20/2022]
Abstract
Chagas disease (CD) is a global problem. Currently, it affects approximately 15 million individuals in Latin America. It is well know that the human immune response is related to different clinical manifestations. Mannose binding lectin (MBL) plays an important role in innate immunity, and it mediates the phagocytosis and complement-mediated destruction of pathogens. The binding capacity is enhanced by the oligomerization of MBL. In this study, we evaluated the serum concentration and the binding capacity of MBL in patients with chronic chagasic cardiomyopathy. A total of 77 patients with chronic CD were included with indeterminate (n = 19), mild cardiac (n = 29) and severe cardiac (n = 29) forms. The serum concentration and the binding capacity were measured using enzyme-linked immunosorbent assays (ELISA). There was no significant difference in the serum MBL levels between the groups of patients. However, we found a relationship between the binding capacity and the groups studied. Our results suggest that binding capacity of MBL could be an indicator of clinical manifestation in Chronic Chagas cardiomyopathy. Furthermore, combined with the Mannose Binding Index results in a useful clinical tool for management of Chronic Chagas Patients.
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29
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Saraiva ÁPB, Miranda RM, Valente RPP, Araújo JO, Souza RNB, Costa CHS, Oliveira ARS, Almeida MO, Figueiredo AF, Ferreira JEV, Alves CN, Honorio KM. Molecular description of α-keto-based inhibitors of cruzain with activity against Chagas disease combining 3D-QSAR studies and molecular dynamics. Chem Biol Drug Des 2018; 92:1475-1487. [PMID: 29682904 DOI: 10.1111/cbdd.13313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/11/2018] [Accepted: 03/24/2018] [Indexed: 11/27/2022]
Abstract
In this work, a group of α-keto-based inhibitors of the cruzain enzyme with anti-chagas activity was selected for a three-dimensional quantitative structure-activity relationship study (3D-QSAR) combined with molecular dynamics (MD). Firstly, statistical models based on Partial Least Square (PLS) regression were developed employing comparative molecular field analysis (CoMFA) and comparative molecular similarity indices analysis (CoMSIA) descriptors. Validation parameters (q2 and r2 )for the models were, respectively, 0.910 and 0.997 (CoMFA) and 0.913 and 0.992 (CoMSIA). In addition, external validation for the models using a test group revealed r2pred = 0.728 (CoMFA) and 0.971 (CoMSIA). The most relevant aspect in this study was the generation of molecular fields in both favorable and unfavorable regions based on the models developed. These fields are important to interpret modifications necessary to enhance the biological activities of the inhibitors. This analysis was restricted considering the inhibitors in a fixed conformation, not interacting with their target, the cruzain enzyme. Then, MD was employed taking into account important variables such as time and temperature. MD helped describe the behavior of the inhibitors and their properties showed similar results as those generated by QSAR-3D study.
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Affiliation(s)
- Ádria P B Saraiva
- Instituto Federal de Educação, Ciência e Tecnologia do Pará, Campus Belém, Pará, Amazônia, Brazil
| | - Ricardo M Miranda
- Instituto Federal de Educação, Ciência e Tecnologia do Pará, Campus Belém, Pará, Amazônia, Brazil
| | - Renan P P Valente
- Instituto Federal de Educação, Ciência e Tecnologia do Pará, Campus Belém, Pará, Amazônia, Brazil
| | - Jéssica O Araújo
- Instituto Federal de Educação, Ciência e Tecnologia do Pará, Campus Belém, Pará, Amazônia, Brazil
| | - Rutelene N B Souza
- Instituto Federal de Educação, Ciência e Tecnologia do Pará, Campus Belém, Pará, Amazônia, Brazil
| | | | | | - Michell O Almeida
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Antonio F Figueiredo
- Instituto Federal de Educação, Ciência e Tecnologia do Pará, Campus Castanhal, Pará, Amazônia, Brazil
| | - João E V Ferreira
- Instituto Federal de Educação, Ciência e Tecnologia do Pará, Campus Tucuruí, Pará, Amazônia, Brazil
| | - Cláudio Nahum Alves
- Instituto Federal de Educação, Ciência e Tecnologia do Pará, Campus Castanhal, Pará, Amazônia, Brazil
| | - Kathia M Honorio
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, SP, Brazil.,Centro de Ciências Naturais e Humanas - Universidade Federal do ABC (UFABC), Santo André, São Paulo, Brazil
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Díaz-Viraqué F, Chiribao ML, Trochine A, González-Herrera F, Castillo C, Liempi A, Kemmerling U, Maya JD, Robello C. Old Yellow Enzyme from Trypanosoma cruzi Exhibits In Vivo Prostaglandin F 2α Synthase Activity and Has a Key Role in Parasite Infection and Drug Susceptibility. Front Immunol 2018; 9:456. [PMID: 29563916 PMCID: PMC5845897 DOI: 10.3389/fimmu.2018.00456] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 02/20/2018] [Indexed: 01/26/2023] Open
Abstract
The discovery that trypanosomatids, unicellular organisms of the order Kinetoplastida, are capable of synthesizing prostaglandins raised questions about the role of these molecules during parasitic infections. Multiple studies indicate that prostaglandins could be related to the infection processes and pathogenesis in trypanosomatids. This work aimed to unveil the role of the prostaglandin F2α synthase TcOYE in the establishment of Trypanosoma cruzi infection, the causative agent of Chagas disease. This chronic disease affects several million people in Latin America causing high morbidity and mortality. Here, we propose a prokaryotic evolutionary origin for TcOYE, and then we used in vitro and in vivo experiments to show that T. cruzi prostaglandin F2α synthase plays an important role in modulating the infection process. TcOYE overexpressing parasites were less able to complete the infective cycle in cell culture infections and increased cardiac tissue parasitic load in infected mice. Additionally, parasites overexpressing the enzyme increased PGF2α synthesis from arachidonic acid. Finally, an increase in benznidazole and nifurtimox susceptibility in TcOYE overexpressing parasites showed its participation in activating the currently anti-chagasic drugs, which added to its observed ability to confer resistance to hydrogen peroxide, highlights the relevance of this enzyme in multiple events including host-parasite interaction.
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Affiliation(s)
| | - María Laura Chiribao
- Unidad de Biología Molecular, Institut Pasteur de Montevideo, Montevideo, Uruguay.,Departamento de Bioquímica, Facultad de Medicina Universidad de la República, Montevideo, Uruguay
| | - Andrea Trochine
- Unidad de Biología Molecular, Institut Pasteur de Montevideo, Montevideo, Uruguay
| | - Fabiola González-Herrera
- Programa de Farmacología Molecular y Clínica - ICBM, Facultad de Medicina Universidad de Chile, Santiago de Chile, Chile
| | - Christian Castillo
- Programa de Anatomía y Biología del Desarrollo - ICBM, Facultad de Medicina Universidad De Chile, Santiago de Chile, Chile
| | - Ana Liempi
- Programa de Anatomía y Biología del Desarrollo - ICBM, Facultad de Medicina Universidad De Chile, Santiago de Chile, Chile
| | - Ulrike Kemmerling
- Programa de Anatomía y Biología del Desarrollo - ICBM, Facultad de Medicina Universidad De Chile, Santiago de Chile, Chile
| | - Juan Diego Maya
- Programa de Farmacología Molecular y Clínica - ICBM, Facultad de Medicina Universidad de Chile, Santiago de Chile, Chile
| | - Carlos Robello
- Unidad de Biología Molecular, Institut Pasteur de Montevideo, Montevideo, Uruguay.,Departamento de Bioquímica, Facultad de Medicina Universidad de la República, Montevideo, Uruguay
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Linhares-Lacerda L, Granato A, Gomes-Neto JF, Conde L, Freire-de-Lima L, de Freitas EO, Freire-de-Lima CG, Coutinho Barroso SP, Jorge de Alcântara Guerra R, Pedrosa RC, Savino W, Morrot A. Circulating Plasma MicroRNA-208a as Potential Biomarker of Chronic Indeterminate Phase of Chagas Disease. Front Microbiol 2018; 9:269. [PMID: 29559958 PMCID: PMC5845676 DOI: 10.3389/fmicb.2018.00269] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 02/06/2018] [Indexed: 11/13/2022] Open
Abstract
Chagas cardiomyopathy is the most severe clinical manifestation of chronic Chagas disease. The disease affects most of the Latin American countries, being considered one of the leading causes of morbidity and death in the continent. The pathogenesis of Chagas cardiomyopathy is very complex, with mechanisms involving parasite-dependent cytopathy, immune-mediated myocardial damage and neurogenic disturbances. These pathological changes eventually result in cardiac myocyte hypertrophy, arrhythmias, congestive heart failure and stroke during chronic infection phase. Herein, we show that miR-208a, a microRNA that is a key factor in promoting cardiovascular dysfunction during cardiac hypertrophy processes of heart failure, has its circulating levels increased during chronic indeterminate phase when compared to cardiac (CARD) clinical forms in patients with Chagas disease. In contrast, we have not found altered serum levels of miR-34a, a microRNA known to promote pro-apoptotic role in myocardial infarction during degenerative process of cardiac injuries thus indicating intrinsic differences in the nature of the mechanisms underlying the heart failure triggered by Trypanosoma cruzi infection. Our findings support that the chronic indeterminate phase is a progressive phase involved in the genesis of chagasic cardiopathy and point out the use of plasma levels of miR-208a as candidate biomarker in risk-prediction score for the clinical prognosis of Chagas disease.
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Affiliation(s)
- Leandra Linhares-Lacerda
- Departamento de Imunologia, Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Alessandra Granato
- Departamento de Imunologia, Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - João Francisco Gomes-Neto
- Departamento de Imunologia, Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luciana Conde
- Departamento de Imunologia, Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Freire-de-Lima
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elisangela O de Freitas
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Celio G Freire-de-Lima
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Shana P Coutinho Barroso
- Instituto de Pesquisas Biomédicas, Hospital Naval Marcílio Dias, Marinha do Brasil, Rio de Janeiro, Brazil
| | | | - Roberto C Pedrosa
- Instituto do Coração Edson Saad, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wilson Savino
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM), Rio de Janeiro, Brazil
| | - Alexandre Morrot
- Faculdade de Medicina, Centro de Pesquisas em Tuberculose, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Laboratório de Imunopatologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
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Iacobas DA, Iacobas S, Tanowitz HB, Campos de Carvalho A, Spray DC. Functional genomic fabrics are remodeled in a mouse model of Chagasic cardiomyopathy and restored following cell therapy. Microbes Infect 2018; 20:185-195. [PMID: 29158000 DOI: 10.1016/j.micinf.2017.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/06/2017] [Accepted: 11/09/2017] [Indexed: 02/07/2023]
Abstract
We previously found that, in a mouse model of Chagas cardiomyopathy, 18% of the 9390 quantified unigenes were significantly regulated by Trypanosoma cruzi infection. However, treatment with bone marrow-derived mononuclear cells (MNCs) resulted in 84% transcriptomic recovery. We have applied new algorithms to reanalyze these datasets with respect to specific pathways [Chagas disease (CHAGAS), cardiac muscle contraction (CMC) and chemokine signaling (CCS)]. In addition to the levels of expression of individual genes we also calculated gene expression variability and coordination of expression of each gene with all others. These additional measures revealed changes in the control of transcript abundances and gene networking in CHAGAS and restoration following MNC treatment, not accessible using the conventional approach limited to the average expression levels. Moreover, our weighted pathway regulation analysis incorporated the contributions of all affected genes, eliminating the arbitrary cut-off criteria of fold-change and/or p-value for significantly regulated genes. The new analyses revealed that T. cruzi infection had large transcriptomic consequences for the CMC pathway and triggered a huge cytokine signaling. Remarkably, MNC therapy not only restored normal expression levels of numerous genes, but it also recovered most of the CHAGAS, CMC and CCS fabrics that were altered by the infection.
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Affiliation(s)
- Dumitru A Iacobas
- Department of Pathology, New York Medical College School of Medicine, 15 Dana Rd, Valhalla, NY, USA; Center for Computational Systems Biology at Prairie View A&M University, TX 77446, USA.
| | - Sanda Iacobas
- Department of Pathology, New York Medical College School of Medicine, 15 Dana Rd, Valhalla, NY, USA
| | - Herbert B Tanowitz
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx NY, USA; Department of Pathology, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx NY, USA
| | - Antonio Campos de Carvalho
- Center for Computational Systems Biology at Prairie View A&M University, TX 77446, USA; Laboratório de Cardiologia Celular e Molecular, Instituto de Biofisica Carlos Chagas Filho, Rio de Janeiro, Brazil
| | - David C Spray
- Center for Computational Systems Biology at Prairie View A&M University, TX 77446, USA; Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx NY, USA
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Leiby DA, Nguyen ML, Proctor MC, Townsend RL, Stramer SL. Frequency of Trypanosoma cruzi parasitemia among infected blood donors with a potential association between parasite lineage and transfusion transmission. Transfusion 2017; 57:1426-1432. [PMID: 28295355 DOI: 10.1111/trf.14082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 01/23/2017] [Accepted: 01/30/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Trypanosoma cruzi is endemic to the Americas where it demonstrates multiple lineages over a vast geographic range (i.e., United States to Argentina). These lineages possess divergent geographic and biologic characteristics, including variations in disease manifestations. Herein, we report the frequency of parasitemia among seropositive US blood donors and the potential association between parasite lineage and transfusion transmission. STUDY DESIGN AND METHODS Blood donors identified as T. cruzi seropositive during screening were enrolled in follow-up studies, including hemoculture testing and a risk factor questionnaire. Positive hemocultures were expanded to obtain sufficient parasites for molecular lineage determination and analysis. Country of birth, obtained from the questionnaire, was used to predict parasite lineage in the absence of demonstrable parasitemia for infected donors. RESULTS Eighteen (6.8%) of 263 seropositive donors were hemoculture positive. Among the 17 hemocultures expanded for lineage determination, TcV was identified more frequently (n = 12), compared to TcI (n = 2), TcII (n = 1), and TcVI (n = 2). When presumptive parasite lineages were compared to hemoculture results, only two of 157 (1.3%) TcI versus 13 of 38 (34.2%) TcII/TcV/TcVI non-US donors were parasitemic; three of 44 (6.8%) US donors were TcV or TcVI. CONCLUSIONS Based on lineage determination for donors with parasitemia; hemoculture positivity associated with presumptive parasite lineage; and implicated donors from US, Canadian, and Spanish transfusion cases, donors from Southern South America are significantly more likely to have parasitemia and transmit infection to blood recipients (TcII, TcV, or TcVI vs. TcI). Thus, parasite lineage may be associated with risk of transfusion-transmitted T. cruzi.
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Affiliation(s)
- David A Leiby
- Transmissible Diseases Department, American Red Cross Holland Laboratory, Rockville, Maryland
| | - Megan L Nguyen
- Transmissible Diseases Department, American Red Cross Holland Laboratory, Rockville, Maryland
| | - Melanie C Proctor
- Transmissible Diseases Department, American Red Cross Holland Laboratory, Rockville, Maryland
| | | | - Susan L Stramer
- Scientific Support Office, American Red Cross, Gaithersburg, Maryland
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Martí‐Carvajal AJ, Kwong JSW. Pharmacological interventions for treating heart failure in patients with Chagas cardiomyopathy. Cochrane Database Syst Rev 2016; 7:CD009077. [PMID: 27388039 PMCID: PMC6457883 DOI: 10.1002/14651858.cd009077.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chagas disease-related cardiomyopathy is a major cause of morbidity and mortality in Latin America. Despite the substantial burden to the healthcare system, there is uncertainty regarding the efficacy and safety of pharmacological interventions for treating heart failure in people with Chagas disease. This is an update of a Cochrane review published in 2012. OBJECTIVES To assess the clinical benefits and harms of current pharmacological interventions for treating heart failure in people with Chagas cardiomyopathy. SEARCH METHODS We updated the searches in the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, Issue 1), MEDLINE (Ovid; 1946 to to February Week 1 2016), EMBASE (Ovid; 1947 to 2016 Week 07), LILACS (1982 to 15 February 2016), and Web of Science (Thomson Reuters; 1970 to 15 February 2016). We checked the reference lists of included papers. We applied no language restrictions. SELECTION CRITERIA We included randomised clinical trials (RCTs) that assessed the effects of pharmacological interventions to treat heart failure in adult patients (18 years or older) with symptomatic heart failure (New York Heart Association classes II to IV), regardless of the left ventricular ejection fraction stage (reduced or preserved), with Chagas cardiomyopathy. We did not apply limits to the length of follow-up. Primary outcomes were all-cause mortality, cardiovascular mortality at 30 days, time-to-heart decompensation, disease-free period (at 30, 60, and 90 days), and adverse events. DATA COLLECTION AND ANALYSIS Two authors independently performed study selection, 'Risk of bias' assessment and data extraction. We estimated relative risk (RR) and 95% confidence intervals (CIs) for dichotomous outcomes. We measured statistical heterogeneity using the I² statistic. We used a fixed-effect model to synthesize the findings. We contacted authors for additional data. We developed 'Summary of findings' (SoF) tables and used GRADE methodology to assess the quality of the evidence. MAIN RESULTS In this update, we identified one new trial. Therefore, this version includes three trials (108 participants). Two trials compared carvedilol against placebo and another assessed rosuvastatin versus placebo. All trials had a high risk of bias.Meta-analysis of two trials showed a lower proportion of all-cause mortality in the carvedilol groups compared with the placebo groups (RR 0.69; 95% CI 0.12 to 3.88, I² = 0%; 69 participants; very low-quality evidence). Neither of the trials reported on cardiovascular mortality, time-to-heart decompensation, or disease-free periods.One trial (30 participants) found no difference in hospital readmissions (RR 1.00; 95% CI 0.31 to 3.28; very low-quality of evidence) or reported adverse events (RR 0.92; 95% CI 0.67 to 1.27; very low-quality of evidence) between the carvedilol and placebo groups.There was very low-quality evidence from two trials of inconclusive effects on quality of life (QoL) between the carvedilol and placebo groups. One trial (30 participants) assessed QoL with the Minnesota Living With Heart Failure Questionnaire (21 items; item scores range from 0 to 5; a lower MLHFQ score is better). The MD was -14.74; 95% CI -24.75 to -4.73. The other trial (39 participants) measured QoL with the Medical Outcomes Study 36-item short-form health survey (SF-36; item scores range from 0 to 100; higher SF-36 score is better). Data were not provided.One trial (39 participants) assessed the effect of rosuvastatin versus placebo. The trial did not report on any primary outcomes or adverse events. There was very low-quality evidence of uncertain effects on QoL (no data were provided). AUTHORS' CONCLUSIONS This first update of our review found very low-quality evidence for the effects of either carvedilol or rosuvastatin, compared with placebo, for treating heart failure in people with Chagas disease. The three included trials were underpowered and had a high risk of bias. There were no conclusive data to support or reject the use of either carvedilol or rosuvastatin for treating Chagas cardiomyopathy. Unless randomised clinical trials provide evidence of a treatment effect, and the trade-off between potential benefits and harms is established, policy-makers, clinicians, and academics should be cautious when recommending or administering either carvedilol or rosuvastatin to treat heart failure in people with Chagas disease. The efficacy and safety of other pharmacological interventions for treating heart failure in people with Chagas disease remains unknown.
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Affiliation(s)
| | - Joey SW Kwong
- West China Hospital, Sichuan UniversityChinese Evidence‐Based Medicine CenterNo. 37, Guo Xue XiangChengduSichuanChina610041
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de Moraes Gomes PAT, de Oliveira Barbosa M, Farias Santiago E, de Oliveira Cardoso MV, Capistrano Costa NT, Hernandes MZ, Moreira DRM, da Silva AC, Dos Santos TAR, Pereira VRA, Brayner Dos Santosd FA, do Nascimento Pereira GA, Ferreira RS, Leite ACL. New 1,3-thiazole derivatives and their biological and ultrastructural effects on Trypanosoma cruzi. Eur J Med Chem 2016; 121:387-398. [PMID: 27295485 DOI: 10.1016/j.ejmech.2016.05.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/05/2016] [Accepted: 05/22/2016] [Indexed: 12/27/2022]
Abstract
In previous studies, the compound 3-(bromopropiophenone) thiosemicarbazone was described as a potent anti-Trypanosoma cruzi and cruzain inhibitor. In view to optimize this activity, 1,3-thiazole core was used as building-block strategy to access new lead generation of anti T. cruzi agents. In this way a series of thiazole derivatives were synthesized and most of these derivatives exhibited antiparasitic activity similar to benznidazole (Bzd). Among them, compounds (1c) and (1g) presented better selective index (SI) than Bzd. In addition, compounds showed inhibitory activity against the cruzain protease. As observed by electron microscopy, compound (1c) treatment caused irreversible and specific morphological changes on ultrastructure organization of T. cruzi, demonstrating that this class of compounds is killing parasites.
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Affiliation(s)
| | - Miria de Oliveira Barbosa
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, 50740-520, Recife, PE, Brazil
| | - Edna Farias Santiago
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, 50740-520, Recife, PE, Brazil
| | | | - Natáli Tereza Capistrano Costa
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, 50740-520, Recife, PE, Brazil
| | - Marcelo Zaldini Hernandes
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, 50740-520, Recife, PE, Brazil
| | | | - Aline Caroline da Silva
- Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, CEP 50670-420, Recife, PE, Brazil
| | | | | | | | - Glaécia Aparecida do Nascimento Pereira
- CAPES Foundation, Ministry of Education of Brazil, Brasília, DF, Brazil; Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, CEP 31270-901, Belo Horizonte, MG, Brazil
| | - Rafaela Salgado Ferreira
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, CEP 31270-901, Belo Horizonte, MG, Brazil
| | - Ana Cristina Lima Leite
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, 50740-520, Recife, PE, Brazil.
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Benatar AF, García GA, Bua J, Cerliani JP, Postan M, Tasso LM, Scaglione J, Stupirski JC, Toscano MA, Rabinovich GA, Gómez KA. Galectin-1 Prevents Infection and Damage Induced by Trypanosoma cruzi on Cardiac Cells. PLoS Negl Trop Dis 2015; 9:e0004148. [PMID: 26451839 PMCID: PMC4599936 DOI: 10.1371/journal.pntd.0004148] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/17/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic Chagas cardiomyopathy caused by Trypanosoma cruzi is the result of a pathologic process starting during the acute phase of parasite infection. Among different factors, the specific recognition of glycan structures by glycan-binding proteins from the parasite or from the mammalian host cells may play a critical role in the evolution of the infection. METHODOLOGY AND PRINCIPAL FINDINGS Here we investigated the contribution of galectin-1 (Gal-1), an endogenous glycan-binding protein abundantly expressed in human and mouse heart, to the pathophysiology of T. cruzi infection, particularly in the context of cardiac pathology. We found that exposure of HL-1 cardiac cells to Gal-1 reduced the percentage of infection by two different T. cruzi strains, Tulahuén (TcVI) and Brazil (TcI). In addition, Gal-1 prevented exposure of phosphatidylserine and early events in the apoptotic program by parasite infection on HL-1 cells. These effects were not mediated by direct interaction with the parasite surface, suggesting that Gal-1 may act through binding to host cells. Moreover, we also observed that T. cruzi infection altered the glycophenotype of cardiac cells, reducing binding of exogenous Gal-1 to the cell surface. Consistent with these data, Gal-1 deficient (Lgals1-/-) mice showed increased parasitemia, reduced signs of inflammation in heart and skeletal muscle tissues, and lower survival rates as compared to wild-type (WT) mice in response to intraperitoneal infection with T. cruzi Tulahuén strain. CONCLUSION/SIGNIFICANCE Our results indicate that Gal-1 modulates T. cruzi infection of cardiac cells, highlighting the relevance of galectins and their ligands as regulators of host-parasite interactions.
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Affiliation(s)
- Alejandro F. Benatar
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LabMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Gabriela A. García
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
| | - Jacqeline Bua
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
| | - Juan P. Cerliani
- Laboratorio de Inmunopatología, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Miriam Postan
- Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben”, Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
| | - Laura M. Tasso
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LabMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Jorge Scaglione
- Hospital Pedro de Elizalde, Servicio de Cardiología, Sección Electrofisiología, Buenos Aires, Argentina
| | - Juan C. Stupirski
- Laboratorio de Inmunopatología, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Marta A. Toscano
- Laboratorio de Inmunopatología, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Gabriel A. Rabinovich
- Laboratorio de Inmunopatología, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
- Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Karina A. Gómez
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LabMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
- * E-mail:
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Diagnostic Challenges of Chagas Cardiomyopathy and CMR Imaging. Glob Heart 2015; 10:181-7. [DOI: 10.1016/j.gheart.2015.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/18/2015] [Accepted: 07/09/2015] [Indexed: 11/18/2022] Open
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Espíndola JWP, Cardoso MVDO, Filho GBDO, Oliveira e Silva DA, Moreira DRM, Bastos TM, Simone CAD, Soares MBP, Villela FS, Ferreira RS, Castro MCABD, Pereira VRA, Murta SMF, Sales Junior PA, Romanha AJ, Leite ACL. Synthesis and structure–activity relationship study of a new series of antiparasitic aryloxyl thiosemicarbazones inhibiting Trypanosoma cruzi cruzain. Eur J Med Chem 2015; 101:818-35. [DOI: 10.1016/j.ejmech.2015.06.048] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 11/28/2022]
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Sabino EC, Ribeiro AL, Lee TH, Oliveira CL, Carneiro-Proietti AB, Antunes AP, Menezes MM, Ianni BM, Salemi VM, Nastari L, Fernandes F, Sachdev V, Carrick DM, Deng X, Wright D, Gonçalez TT, Murphy EL, Custer B, Busch MP. Detection of Trypanosoma cruzi DNA in blood by PCR is associated with Chagas cardiomyopathy and disease severity. Eur J Heart Fail 2015; 17:416-23. [PMID: 25678239 DOI: 10.1002/ejhf.220] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/30/2014] [Accepted: 11/07/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The significance of detection of Trypanosoma cruzi DNA in blood of antibody-positive patients for risk of development of Chagas heart disease is not well established. The objective of this study was to compare detection of T. cruzi DNA with known clinical and laboratory markers of Chagas cardiomyopathy (CC) severity. METHODS This is a case-control study nested within a retrospective cohort developed in Brazil to understand the natural history of Chagas disease. The study enrolled 499 T. cruzi seropositive blood donors (SP-BD) and 488 frequency matched seronegative control donors (SN-BD) who had donated between 1996 and 2002, and 101 patients with clinically diagnosed CC. In 2008-2010 all enrolled subjects underwent a health questionnaire, medical examination, electrocardiograms and echocardiograms and polymerase chain reaction (PCR) analyses. A blinded panel of three cardiologists adjudicated the outcome of CC. Trypanosoma cruzi kinetoplast minicircle sequences were amplified by real-time PCR using an assay with a sensitivity of one parasite per 20 mL of blood. All testing was performed on coded samples. RESULTS Rates of PCR detection of T. cruzi DNA were significantly (P = 0.003) higher in CC patients and SP-BD diagnosed with CC (79/105 [75.2 %]) compared with SP-BD without CC (143/279 [51.3%]). The presence of parasitaemia was significantly associated with known markers of disease progression such as QRS and QT interval duration, lower left ventricular ejection fraction, higher left ventricular index mass, and elevated troponin and NTpro-BNP levels. CONCLUSION Trypanosoma cruzi PCR positivity is associated with presence and severity of cardiomyopathy, suggesting a direct role of parasite persistence in disease pathogenesis.
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Affiliation(s)
- E C Sabino
- Department of Infectious Disease and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil; Fundação Pró-Sangue Hemocentro de Sao Paulo, São Paulo, Brazil
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Mukherjee S, Mukhopadhyay A, Andriani G, Machado FS, Ashton AW, Huang H, Weiss LM, Tanowitz HB. Trypanosoma cruzi invasion is associated with trogocytosis. Microbes Infect 2015; 17:62-70. [PMID: 25448052 PMCID: PMC4302017 DOI: 10.1016/j.micinf.2014.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 01/17/2023]
Abstract
Trogocytosis was originally thought to be restricted to the interaction of cells of the immune system with cancer cells. Such membrane exchanges are probably a general process in cell biology, and membrane exchange has been demonstrated to occur between non-immune cells within an organism. Herein, we report that membrane and protein exchange, consistent with trogocytosis, between Trypanosoma cruzi (both the Brazil and Tulahuen strains) and the mammalian cells it infects. Transfer of labeled membrane patches was monitored by labeling of either parasites or host cells, i.e. human foreskin fibroblasts and rat myoblasts. Trypomastigotes and amastigotes transferred specific surface glycoproteins to the host cells along with membranes. Exchange of membranes between the parasite and host cells occurred during successful invasion. Extracellular amastigotes did not transfer membrane patches and were did not transfer either membranes or proteins to the host cells. Membrane exchange was also found to occur between interacting epimastigotes in cell-free culture and may be important in parasite-parasite interactions as well. Further studies should provide new insights into pathogenesis and provide targets for therapeutic intervention.
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Affiliation(s)
- Shankar Mukherjee
- Department of Pathology, Albert Einstein College of Medicine, NY, USA.
| | - Aparna Mukhopadhyay
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, NY, USA; Department of Physiology, Presidency University, Kolkata, India
| | | | - Fabiana Simão Machado
- Program in Health Sciences, Infectious Diseases and Tropical Medicine/Interdisciplinary, Laboratory of Medical Investigation, Faculty of Medicine, and the Department of Biochemistry and Immunology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Anthony W Ashton
- Division of Perinatal Research, Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, N.S.W., Australia
| | - Huan Huang
- Department of Pathology, Albert Einstein College of Medicine, NY, USA
| | - Louis M Weiss
- Department of Pathology, Albert Einstein College of Medicine, NY, USA; Department of Medicine, Albert Einstein College of Medicine, NY, USA
| | - Herbert B Tanowitz
- Department of Pathology, Albert Einstein College of Medicine, NY, USA; Department of Medicine, Albert Einstein College of Medicine, NY, USA.
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Jasmin, Jelicks LA, Tanowitz HB, Peters VM, Mendez-Otero R, de Carvalho ACC, Spray DC. Molecular imaging, biodistribution and efficacy of mesenchymal bone marrow cell therapy in a mouse model of Chagas disease. Microbes Infect 2014; 16:923-935. [PMID: 25218054 PMCID: PMC4360918 DOI: 10.1016/j.micinf.2014.08.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/17/2014] [Accepted: 08/26/2014] [Indexed: 02/08/2023]
Abstract
Chagasic cardiomyopathy, resulting from infection with the parasite Trypanosoma cruzi, was discovered more than a century ago and remains an incurable disease. Due to the unique properties of mesenchymal stem cells (MSC) we hypothesized that these cells could have therapeutic potential for chagasic cardiomyopathy. Recently, our group pioneered use of nanoparticle-labeled MSC to correlate migration with its effect in an acute Chagas disease model. We expanded our investigation into a chronic model and performed more comprehensive assays. Infected mice were treated with nanoparticle-labeled MSC and their migration was correlated with alterations in heart morphology, metalloproteinase activity, and expression of several proteins. The vast majority of labeled MSC migrated to liver, lungs and spleen whereas a small number of cells migrated to chagasic hearts. Magnetic resonance imaging demonstrated that MSC therapy reduced heart dilatation. Additionally metalloproteinase activity was higher in heart and other organs of infected mice. Protein expression analyses revealed that connexin 43, laminin γ1, IL-10 and INF-γ were affected by the disease and recovered after cell therapy. Interestingly, MSC therapy led to upregulation of SDF-1 and c-kit in the hearts. The beneficial effect of MSC therapy in Chagas disease is likely due to an indirect action of the cells of the heart, rather than the incorporation of large numbers of stem cells into working myocardium.
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Affiliation(s)
- Jasmin
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, RJ, Brazil
- Dept. of Neuroscience, Albert Einstein College of Medicine, NY, USA
| | - Linda A Jelicks
- Dept. of Physiology and Biophysics, Albert Einstein College of Medicine, NY, USA
| | - Herbert B Tanowitz
- Dept. of Pathology, Albert Einstein College of Medicine, NY, USA
- Dept. of Medicine, Albert Einstein College of Medicine, NY, USA
| | - Vera Maria Peters
- Centro de Biologia da Reprodução, Universidade Federal de Juiz de Fora, MG, Brazil
| | - Rosalia Mendez-Otero
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Antonio C Campos de Carvalho
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, RJ, Brazil
- Dept. of Neuroscience, Albert Einstein College of Medicine, NY, USA
| | - David C Spray
- Dept. of Neuroscience, Albert Einstein College of Medicine, NY, USA
- Dept. of Pathology, Albert Einstein College of Medicine, NY, USA
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Alvarenga Americano do Brasil PE, Pereira de Souza A, Hasslocher-Moreno AM, Xavier SS, Lambert Passos SR, de Fátima Ramos Moreira M, Santini de Oliveira M, Sperandio da Silva GM, Magalhães Saraiva R, Santos de Aguiar Cardoso C, de Sousa AS, Mediano MFF, Bonecini de Almeida MDG, da Cruz Moreira O, Britto C, de Araújo-Jorge TC. Selenium Treatment and Chagasic Cardiopathy (STCC): study protocol for a double-blind randomized controlled trial. Trials 2014; 15:388. [PMID: 25284194 PMCID: PMC4197263 DOI: 10.1186/1745-6215-15-388] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/05/2014] [Indexed: 12/18/2022] Open
Abstract
Background Heart disease progression occurs in 30% of patients with chronic Trypanosoma cruzi infection. Supplementation with selenium (Se) in animal model of T. cruzi infection produced promising results. There is evidence that patients with Chagas heart disease have lower Se levels than healthy individuals and patients with T. cruzi infection without of cardiac disease. The aim of this investigation is to estimate the effect of Se treatment on prevention of heart disease progression in patients with chagasic cardiopathy. Methods The Selenium Treatment and Chagasic Cardiopathy trial is a superiority, double-blind, placebo-controlled, randomized clinical trial. The eligibility criteria are as follows: (1) a Chagas disease diagnosis confirmed by serology; (2) segmental, mild or moderate global left ventricular systolic dysfunction; and (3) age between 18 and 65 years. The exclusion criteria are as follows: (1) pregnancy, (2) diabetes mellitus, (3) tobacco use, (4) alcohol abuse, (5) evidence of nonchagasic heart disease, (6) depression, (7) dysphagia with evidence of food residues in the esophagus, (8) dysphagia with weight loss higher than 15% of usual weight in the last four months and/or (9) conditions that may result in low protocol adherence. The intervention will be 100 μg of sodium selenite once daily for 365 consecutive days compared to placebo. The following are the primary outcomes to be measured: (1) the trajectories of the left ventricular ejection fraction in the follow-up period; (2) reduction of heart disease progression rates, with progression defined as a 10% decrease in left ventricular ejection fraction; and (3) rate of hospital admissions attributable to dysrhythmia, heart failure or stroke due to Chagas disease. One hundred thirty patients will be randomly allocated into either the intervention or placebo group at a ratio of 1:1. The sequence allocation concealment and blinding were planned to be conducted with the strategy of numbered boxes. Both patients and health-care providers will remain blinded to the intervention groups during the 5 years of follow-up. Discussion If Se treatment reduces the progression of Chagas cardiopathy, the inclusion of this micronutrient in the daily diet can improve the therapeutic regimen for this neglected tropical disease at low cost. Trial registration Clinical Trials.gov ID: NCT00875173 (registered 20 October 20 2008).
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Affiliation(s)
- Pedro Emmanuel Alvarenga Americano do Brasil
- Chagas Disease Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21040-360, Brazil.
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43
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Respiratory sinus arrhythmia in Chagas disease. Auton Neurosci 2014; 185:149-51. [DOI: 10.1016/j.autneu.2014.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 07/20/2014] [Accepted: 07/29/2014] [Indexed: 11/19/2022]
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Induction of IL-12 production in human peripheral monocytes by Trypanosoma cruzi Is mediated by glycosylphosphatidylinositol-anchored mucin-like glycoproteins and potentiated by IFN- γ and CD40-CD40L interactions. Mediators Inflamm 2014; 2014:345659. [PMID: 25120285 PMCID: PMC4120781 DOI: 10.1155/2014/345659] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 06/16/2014] [Indexed: 12/04/2022] Open
Abstract
Chagas disease, caused by the protozoan parasite Trypanosoma cruzi (T. cruzi), is characterized by immunopathology driven by IFN-γ secreting Th1-like T cells. T. cruzi has a thick coat of mucin-like glycoproteins covering its surface, which plays an important role in parasite invasion and host immunomodulation. It has been extensively described that T. cruzi or its products—like GPI anchors isolated from GPI-anchored mucins from the trypomastigote life cycle stage (tGPI-mucins)—are potent inducers of proinflammatory responses (i.e., cytokines and NO production) by IFN-γ primed murine macrophages. However, little is known about whether T. cruzi or GPI-mucins exert a similar action in human cells. We therefore decided to further investigate the in vitro cytokine production profile from human mononuclear cells from uninfected donors exposed to T. cruzi as well as tGPI-mucins. We observed that both living T. cruzi trypomastigotes and tGPI-mucins are potent inducers of IL-12 by human peripheral blood monocytes and this effect depends on CD40-CD40L interaction and IFN-γ. Our findings suggest that the polarized T1-type cytokine profile seen in T. cruzi infected patients might be a long-term effect of IL-12 production induced by lifelong exposure to T. cruzi tGPI-mucins.
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Montgomery SP, Starr MC, Cantey PT, Edwards MS, Meymandi SK. Neglected parasitic infections in the United States: Chagas disease. Am J Trop Med Hyg 2014; 90:814-818. [PMID: 24808250 PMCID: PMC4015570 DOI: 10.4269/ajtmh.13-0726] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Chagas disease, which is caused by the protozoan parasite Trypanosoma cruzi, can lead to severe cardiac and gastrointestinal disease. Most persons acquire this infection through contact with vector bugs carrying T. cruzi in endemic areas of Latin America. Infection can also be acquired by congenital, transfusion, transplantation, and foodborne transmission. Although an estimated 300,000 persons with Chagas disease live in the United States, little is known about the burden of chagasic heart disease. It is not known how often congenital or vector-borne transmission of T. cruzi occurs in the United States, although it is known that infected mothers and infected vector bugs are found in this country. Better diagnostic tests and treatment drugs are needed to improve patient care, and research is needed to define transmission risks and develop strategies to prevent new infections and reduce the burden of disease.
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Affiliation(s)
- Susan P. Montgomery
- *Address correspondence to Susan P. Montgomery, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-06, Atlanta, GA 30333. E-mail:
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Vieira HGS, Grynberg P, Bitar M, Pires SDF, Hilário HO, Macedo AM, Machado CR, de Andrade HM, Franco GR. Proteomic analysis of Trypanosoma cruzi response to ionizing radiation stress. PLoS One 2014; 9:e97526. [PMID: 24842666 PMCID: PMC4026238 DOI: 10.1371/journal.pone.0097526] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 04/22/2014] [Indexed: 11/18/2022] Open
Abstract
Trypanosoma cruzi, the causative agent of Chagas disease, is extremely resistant to ionizing radiation, enduring up to 1.5 kGy of gamma rays. Ionizing radiation can damage the DNA molecule both directly, resulting in double-strand breaks, and indirectly, as a consequence of reactive oxygen species production. After a dose of 500 Gy of gamma rays, the parasite genome is fragmented, but the chromosomal bands are restored within 48 hours. Under such conditions, cell growth arrests for up to 120 hours and the parasites resume normal growth after this period. To better understand the parasite response to ionizing radiation, we analyzed the proteome of irradiated (4, 24, and 96 hours after irradiation) and non-irradiated T. cruzi using two-dimensional differential gel electrophoresis followed by mass spectrometry for protein identification. A total of 543 spots were found to be differentially expressed, from which 215 were identified. These identified protein spots represent different isoforms of only 53 proteins. We observed a tendency for overexpression of proteins with molecular weights below predicted, indicating that these may be processed, yielding shorter polypeptides. The presence of shorter protein isoforms after irradiation suggests the occurrence of post-translational modifications and/or processing in response to gamma radiation stress. Our results also indicate that active translation is essential for the recovery of parasites from ionizing radiation damage. This study therefore reveals the peculiar response of T. cruzi to ionizing radiation, raising questions about how this organism can change its protein expression to survive such a harmful stress.
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Affiliation(s)
| | - Priscila Grynberg
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Embrapa Recursos Genéticos e Biotecnologia, Brasília, Distrito Federal, Brazil
| | - Mainá Bitar
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Simone da Fonseca Pires
- Departamento de Parasitologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Heron Oliveira Hilário
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Andrea Mara Macedo
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carlos Renato Machado
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Hélida Monteiro de Andrade
- Departamento de Parasitologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Glória Regina Franco
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Conformational restriction of aryl thiosemicarbazones produces potent and selective anti-Trypanosoma cruzi compounds which induce apoptotic parasite death. Eur J Med Chem 2014; 75:467-78. [DOI: 10.1016/j.ejmech.2014.02.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/30/2014] [Accepted: 02/02/2014] [Indexed: 11/21/2022]
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Johndrow C, Nelson R, Tanowitz H, Weiss LM, Nagajyothi F. Trypanosoma cruzi infection results in an increase in intracellular cholesterol. Microbes Infect 2014; 16:337-44. [PMID: 24486184 DOI: 10.1016/j.micinf.2014.01.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/06/2014] [Accepted: 01/13/2014] [Indexed: 01/25/2023]
Abstract
Chagasic cardiomyopathy caused by Trypanosoma cruzi is a major health concern in Latin America and among immigrant populations in non-endemic areas. T. cruzi has a high affinity for host lipoproteins and uses the low density lipoprotein receptor (LDLr) for invasion. Herein, we report that T. cruzi infection is associated with an accumulation of LDL and cholesterol in tissues in both acute and chronic murine Chagas disease. Similar findings were observed in tissue samples from a human case of Chagasic cardiomyopathy. T. cruzi infection of cultured cells displayed increased invasion with increasing cholesterol levels in the medium. Studies of infected host cells demonstrated alterations in their cholesterol regulation. T. cruzi invasion/infection via LDLr appears to be involved in changes in intracellular cholesterol homeostasis. The observed changes in intracellular lipids and associated oxidative stress due to these elevated lipids may contribute to the development of Chagasic cardiomyopathy.
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Affiliation(s)
| | - Randin Nelson
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA; Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Herbert Tanowitz
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA; Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Louis M Weiss
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA; Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Fnu Nagajyothi
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA.
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de Sá LAB, Rassi S, Batista MAL. Is conventional cardiac pacing harmful in patients with normal ventricular function? Arq Bras Cardiol 2013; 101:545-53. [PMID: 24145393 PMCID: PMC4106813 DOI: 10.5935/abc.20130205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 07/16/2013] [Accepted: 07/22/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Right ventricular pacing may be deleterious in patients with left ventricular dysfunction, but in patients with normal function the impact of this stimulation triggering clinically relevant ventricular dysfunction is not fully established. OBJECTIVES To evaluate the clinical, echocardiographic findings of patients with previously normal left ventricular function underwent implantation of a pacemaker. METHODS Observational, cross-sectional study with 20 patients, who underwent implantation of pacemaker, prospectively followed-up, with the following inclusion criteria: normal left ventricular function defined by echocardiography and ventricular pacing higher than 90%. Were evaluated functional class (FC) (New York Heart Association), 6-minute walk test (6MWT), B-type natriuretic peptide (BNP), echocardiographic assessment (conventional and dyssynchrony parameters), and quality of life questionnaire (QLQ) (SF-36). The assessment was performed at ten days (t1), four months (t2), eight months (t3), 12 months (t4) and 24 months (t5). RESULTS Conventional echocardiographic parameters and dyssynchrony parameters showed statistically significant variation over time. The 6MWT, FC, and BNP showed worsening at the end of two years. QLQ showed initial improvement and worsening at the end of two years. CONCLUSION The implantation of conventional pacemaker was associated with worsening in functional class, worsening in walk test, increased BNP levels, increased duration of QRS, and worsening in some domains of the QLQ at the end of two years. There were no changes in echocardiography measurements (conventional and asynchrony measures).
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50
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Stem cell therapy for the treatment of parasitic infections: is it far away? Parasitol Res 2013; 113:607-12. [DOI: 10.1007/s00436-013-3689-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 11/07/2013] [Indexed: 12/16/2022]
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