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Apt W, Arribada A, Zulantay I, Saavedra M, Muñoz C, Toro B, Vega B, Rodríguez J. Chronic Chagas cardiopathy in Chile. Importance of Trypanosoma cruzi burden and clinical evaluation. Acta Trop 2016; 162:155-166. [PMID: 27353063 DOI: 10.1016/j.actatropica.2016.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/13/2016] [Accepted: 06/21/2016] [Indexed: 01/11/2023]
Abstract
Currently there are no biological markers to indicate which individuals with chronic indeterminate period of Chagas disease develop heart disease and who will remain all his life in this phase. The aim of this survey was to determine if Trypanosoma cruzi burden is related to the presence of heart disease in patients with chronic Chagas disease. 200 patients who had not been treated, 100 with cardiopathy and 100 without, groups A and B respectively, were submitted to clinical study and electrocardiogram, Echo-Doppler was performed for group A in which all important known causes of cardiopathy were discarded. In both groups xenodiagnosis, conventional PCR and quantitative PCR were undertaken. The 100 cardiopaths had 133 electrocardiographic alterations most of them in grade II of the New York Heart Association classification. 98 cardiopaths were classified in grade I by Echo-Doppler and only 2 cases were in grade III due to low ejection fraction. The difference in average parasitemia in patients of group A and B was not significant and no statistically differences were observed between average parasitemia of cardiopaths grade II versus grade I of NYHA. This results allow to characterize same clinical, electrocardiographical and parasitological features in chagasic cardiopaths of Chile.
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Affiliation(s)
- Werner Apt
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
| | | | - Inés Zulantay
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Miguel Saavedra
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Catalina Muñoz
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Bruno Toro
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Bastián Vega
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Jorge Rodríguez
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Trypanosoma cruzi burden, genotypes, and clinical evaluation of Chilean patients with chronic Chagas cardiopathy. Parasitol Res 2015; 114:3007-18. [PMID: 25935204 PMCID: PMC4513194 DOI: 10.1007/s00436-015-4503-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/24/2015] [Indexed: 12/17/2022]
Abstract
There are currently no biomarkers to assess which patients with chronic indeterminate Chagas disease will develop heart disease and which will spend their entire life in this state. We hypothetize that the parasite burden and Trypanosoma cruzi genotypes are related to the presence of heart disease in patients with Chagas disease. This study is aimed to investigate the parasite burden and T. cruzi genotypes in chagasic cardiopaths versus chagasic individuals without cardiac involvement according to the New York Heart Association. Patients with chronic Chagas disease, 50 with and 50 without cardiopathy (controls), groups A and B, respectively, were submitted to anamnesis, physical examination, and electrocardiogram. Echo-Doppler was performed for group A; all important known causes of cardiopathy were discarded. Xenodiagnosis, conventional PCR, and quantitative PCR were performed on patients of both groups. T. cruzi genotyping was done for 25 patients of group A and 20 of group B. The 50 cardiopaths had 80 electrocardiographic alterations, most of them in grade II of the New York Heart Association classification; 49 were classified in grade I by Echo-Doppler, and only one patient was in grade III. The difference in average parasitemia in patients of groups A and B was not significant. The most frequent T. cruzi DTU found was TcV. The parasite burden and genotype of the groups with and without cardiopathy were similar. Imagen 1 Chronic chagas cardiopathy chest X-ray heart enlargement ![]()
Figure 2 Chronic Chagas cardiopathy microaneurism of left ventricle. Cineangiography ![]()
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Machado FS, Tyler KM, Brant F, Esper L, Teixeira MM, Tanowitz HB. Pathogenesis of Chagas disease: time to move on. Front Biosci (Elite Ed) 2012; 4:1743-58. [PMID: 22201990 DOI: 10.2741/495] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Trypanosoma cruzi is the etiologic agent of Chagas disease. The contributions of parasite and immune system for disease pathogenesis remain unresolved and controversial. The possibility that Chagas disease was an autoimmune progression triggered by T. cruzi infection led some to question the benefit of treating chronically T. cruzi-infected persons with drugs. Furthermore, it provided the rationale for not investing in research aimed at a vaccine which might carry a risk of inducing autoimmunity or exacerbating inflammation. This viewpoint was adopted by cash-strapped health systems in the developing economies where the disease is endemic and has been repeatedly challenged by researchers and clinicians in recent years and there is now a considerable body of evidence and broad consensus that parasite persistence is requisite for pathogenesis and that antiparasitic immunity can be protective against T. cruzi pathogenesis without eliciting autoimmune pathology. Thus, treatment of chronically infected patients is likely to yield positive outcomes and efforts to understand immunity and vaccine development should be recognized as a priority area of research for Chagas disease.
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Affiliation(s)
- Fabiana S Machado
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Belo Horizonte, Brazil
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Cunha-Neto E, Bilate AM, Hyland KV, Fonseca SG, Kalil J, Engman DM. Induction of cardiac autoimmunity in Chagas heart disease: A case for molecular mimicry. Autoimmunity 2009; 39:41-54. [PMID: 16455581 DOI: 10.1080/08916930500485002] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Up to 18 million of individuals are infected by the protozoan parasite Trypanosoma cruzi in Latin America, one third of whom will develop chronic Chagas disease cardiomyopathy (CCC) up to 30 years after infection. Cardiomyocyte destruction is associated with a T cell-rich inflammatory infiltrate and fibrosis. The presence of such lesions in the relative scarcity of parasites in the heart, suggested that CCC might be due, in part, to a postinfectious autoimmune process. Over the last two decades, a significant amount of reports of autoimmune and molecular mimicry phenomena have been described in CCC. The authors will review the evidence in support of an autoimmune basis for CCC pathogenesis in humans and experimental animals, with a special emphasis on molecular mimicry as a fundamental mechanism of autoimmunity.
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Affiliation(s)
- Edecio Cunha-Neto
- Heart Institute (InCor), Laboratory of Immunology, São Paulo, Brazil.
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Abstract
Autoimmunity occurs when the immune system recognizes and attacks host tissue. In addition to genetic factors, environmental triggers (in particular viruses, bacteria and other infectious pathogens) are thought to play a major role in the development of autoimmune diseases. In this review, we (i) describe the ways in which an infectious agent can initiate or exacerbate autoimmunity; (ii) discuss the evidence linking certain infectious agents to autoimmune diseases in humans; and (iii) describe the animal models used to study the link between infection and autoimmunity.
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Affiliation(s)
- A M Ercolini
- Department of Microbiology-Immunology and Interdepartmental Immunobiology Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Lorena VM, Verçosa AF, Machado RC, Moitinho‐Silva L, Cavalcanti MG, Silva ED, Ferreira AG, Correa‐Oliveira R, Pereira VR, Gomes YM. Cellular immune response from Chagasic patients to CRA or FRA recombinant antigens of Trypanosoma cruzi. J Clin Lab Anal 2008; 22:91-8. [PMID: 18348314 PMCID: PMC6649253 DOI: 10.1002/jcla.20209] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2007] [Indexed: 11/07/2022] Open
Abstract
We propose to analyze the relation between the cellular immune response of Chagas' disease patients after in vitro stimulation of peripheral blood mononuclear cells (PBMC) with recombinant antigens cytoplasmatic repetitive antigen (CRA) or flagellar repetitive antigen (FRA) of T. cruzi and the chronic clinical forms of disease. Cells were stimulated using phytohemagglutinin, CRA, FRA, or a soluble antigen of Epimastigota (Ag-Epi) for 24 hr, 72 hr, or 6 days. The proliferation of cells was evaluated after 6 days of culture by quantification of incorporated 3H-thymidine. Cytokines were measured in the supernatants obtained after 24 hr (tumor necrosis factor [TNF]-alpha and interleukin [IL]-4), 72 hr (IL-10), and 6 days (interferon [IFN]-gamma) using enzyme-linked immunosorbent assay (ELISA). Cells of the Chagas patients stimulated with the recombinant antigens exhibited higher proliferation responses compared with that of non-Chagas (NC) individuals. However, when proliferation was compared between patients with the cardiac form (CF) or indeterminate form (IF), it was not possible to establish a difference in the response. So far as the cytokines secreted in the culture supernatants after stimulation in vitro with T. cruzi antigens were concerned, the results showed that CRA, as well as Epi-Ag, were able to stimulate the production of TNF-alpha and IFN-gamma in Chagas patients as compared with NC individuals. However, the cytokine levels after stimulation with the T. cruzi antigens were not different between the patients with CF and IF. CRA was capable of inducing a T helper type 1 (Th1) immune response, with elevated production of TNF-alpha and IFN-gamma in Chagas patients that are carriers of CF and IF clinical forms.
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Affiliation(s)
- Virginia M.B. Lorena
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães (CPqAM)/Fiocruz, Recife‐PE, Brazil
| | - Alinne F.A. Verçosa
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães (CPqAM)/Fiocruz, Recife‐PE, Brazil
| | - Raquel C.A. Machado
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães (CPqAM)/Fiocruz, Recife‐PE, Brazil
| | - Lucas Moitinho‐Silva
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães (CPqAM)/Fiocruz, Recife‐PE, Brazil
| | - Maria G.A. Cavalcanti
- Hospital Universitário Oswaldo Cruz (HUOC)/Universidade de Pernambuco (UPE), Recife‐PE, Brazil
| | - Edimilson D. Silva
- Departamento de Reativos para Diagnóstico, Bio‐Manguinhos/Fiocruz, Rio de Janeiro‐RJ, Brazil
| | - Antonio G.P. Ferreira
- Departamento de Reativos para Diagnóstico, Bio‐Manguinhos/Fiocruz, Rio de Janeiro‐RJ, Brazil
| | - Rodrigo Correa‐Oliveira
- Laboratório de Imunologia Celular e Molecular do Centro de Pesquisas René Rachou (CPqRR)/Fiocruz, Belo Horizonte‐MG, Brazil
| | - Valéria R.A. Pereira
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães (CPqAM)/Fiocruz, Recife‐PE, Brazil
| | - Yara M. Gomes
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães (CPqAM)/Fiocruz, Recife‐PE, Brazil
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Dutra WO, Rocha MOC, Teixeira MM. The clinical immunology of human Chagas disease. Trends Parasitol 2005; 21:581-7. [PMID: 16236550 DOI: 10.1016/j.pt.2005.09.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Revised: 08/05/2005] [Accepted: 09/28/2005] [Indexed: 10/25/2022]
Abstract
Human infection with the protozoan parasite Trypanosoma cruzi leads to Chagas disease, which affects approximately 17 million people in Latin America. A significant percentage of the infected population will develop clinical symptoms or present changes in laboratory and/or image evaluation. The existence of a large spectrum of clinical manifestations--with patients ranging from asymptomatic to severe cardiac involvement--emphasizes the need to use standardized and well-defined clinical criteria among different research groups. In this article, we carry out a systematic review of the immunology in human Chagas disease, discussing recent findings in the context of a clinical perspective.
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Affiliation(s)
- Walderez O Dutra
- Department of Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Belo Horizonte, Minas Gerais 31270-901, Brazil
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de Barros-Mazon S, Guariento ME, da Silva CA, Coffman RL, Abrahamsohn IA. Differential regulation of lymphoproliferative responses to Trypanosoma cruzi antigen in patients with the cardiac or indeterminate form of Chagas disease. Clin Immunol 2004; 111:137-45. [PMID: 15093563 DOI: 10.1016/j.clim.2004.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2003] [Accepted: 01/05/2004] [Indexed: 02/01/2023]
Abstract
In the search to identify differences in the immunological response between patients with the indeterminate or cardiac form of Chagas disease, trypomastigote-specific peripheral blood mononuclear cell (PBMC) proliferative responses were studied. Suppression of lymphoproliferation occurred in both groups of patients, being more intense in those with the cardiac form. By adding to the cultures neutralizing mAbs anti-IFN-gamma, anti-IL-4, anti-IL-13, or anti-IL-10, indomethacin to block prostaglandin synthesis, NMMA as inhibitor of nitric oxide (NO) synthesis, or glutathione-peroxidase as H(2)O(2) scavenger, it was found that indomethacin augmented lymphoproliferation in both groups of patients. However, anti-IL-10 treatment increased proliferation only in PBMC cultures from patients with the cardiac form, indicating that in these patients, IL-10 was suppressing the immune response. These patients also had higher IL-10 levels in unstimulated cultures and higher PGE(2) levels in stimulated cultures. The results evidence that IL-10 regulates parasite-specific T cell responses in patients with the cardiac form, whereas regulation by prostaglandins (PG) occurs in patients with either cardiac or indeterminate form of the disease.
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Affiliation(s)
- Sílvia de Barros-Mazon
- Departamento de Patologia Clínica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, 13083-970, SP, Brazil
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de Barros-Mazon S, Guariento ME, Abrahamsohn IA. IL-12 enhances proliferation of peripheral blood mononuclear cells from Chagas' disease patients to Trypanosoma cruzi antigen. Immunol Lett 1997; 57:39-45. [PMID: 9232423 DOI: 10.1016/s0165-2478(97)00079-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Chagas' disease is caused by infection with Trypanosoma cruzi. Patients in the chronic phase of infection were grouped as belonging to the asymptomatic (or indeterminate), cardiac and cardiac plus digestive forms. Previous studies have described abnormal immune responsiveness by peripheral blood mononuclear cells (PBMC) from chronic chagasic patients. We report significant parasite antigen (T-Ag)-stimulated PBMC proliferative responses to be present in all three groups of patients. Treatment of T-Ag-stimulated cultures with rIL-12 significantly amplifies proliferative responses in all patients' groups, with similar rates of increment. IL-12 enhances T-Ag-specific lymphoproliferation without increasing proliferation of unstimulated PBMC from normal individuals or from patients. Comparatively, treatment with rIL-2 enhances both T-Ag-specific and unstimulated proliferation by PBMC from patients and normals. Thus, IL-12 acts on pre-activated cells while IL-2 also stimulates resting cells. No synergism was obtained by the combined use of IL-12 and IL-2. Therefore IL-12 can act as a more selective amplifier of T. cruzi reactive cells than IL-2. IL-12, by enhancing parasite-antigen specific immunity, could be of potential therapeutic use to control reactivated T. cruzi infections concomitant to AIDS or other situations of immunosuppression.
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Affiliation(s)
- S de Barros-Mazon
- Departamento de Patologia, Clinica da Faculdade de Ciências Médicas, UNICAMP, Campinas, SP, Brazil
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Briceño L, Mosca W. Defective production of interleukin 2 in patients with Chagas' disease. Purified IL-2 augments in vitro response in patients with chagasic cardiomyopathy. Mem Inst Oswaldo Cruz 1996; 91:601-7. [PMID: 9137745 DOI: 10.1590/s0074-02761996000500011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The production of interleukin 2 (IL-2) by peripheral blood mononuclear cells, from patients with different clinical forms of Chagas' disease and healthy controls, was evaluated after stimulation with Trypanosoma cruzi antigen, PPD and PHA. PHA induced higher production of IL-2 in infected patients than healthy controls. No differences were found between infected groups. With PPD the trend was similar, the only difference was that asymptomatic infected patients (INF) showed higher levels of IL-2 production than patients with cardiomyopathy (CDM). With T. cruzi antigen, most patients showed little or no IL-2 production at 24 hr, a peak at 48 hr and an abrupt fall at 72 hr. A similar pattern of IL-2 production was observed in INF and CDM. To evaluate the physiologic relevance of the deficit in IL-2 production, we studied the effect of non-mitogenic concentrations of IL-2 in the proliferative response to specific antigens. The addition of IL-2 only enhanced the proliferative response of CDM patients. These observations suggest that patients suffering Chagas' disease, particularly CDM, have a significant reduction in the capacity to produce IL-2. These findings could be of importance in the pathogenesis of Chagas' disease.
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Affiliation(s)
- L Briceño
- Unidad de Inmunologia Parasitaria, UNESR/UCV, Caracas, Venezuela
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Barr SC, Dennis VA, Klei TR, Norcross NL. Antibody and lymphoblastogenic responses of dogs experimentally infected with Trypanosoma cruzi isolates from North American mammals. Vet Immunol Immunopathol 1991; 29:267-83. [PMID: 1949589 DOI: 10.1016/0165-2427(91)90019-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The humoral and cellular immune responses of dogs infected with either a non-pathogenic Trypanosoma cruzi isolated from a North American dog (Tc-D) or a pathogenic T. cruzi isolate from an opossum (Tc-O) were studied over a 240 day period. Antibody to T. cruzi epimastigote antigens prepared from Tc-O or Tc-D isolates were first detected by ELISA by Day 26 post infection (PI), peaked by day 175 PI and remained elevated throughout the experimental period in both Tc-O and Tc-D infected dogs. Differences in antibody levels between infected groups were not detected. Western blot analyses were performed using Tc-O and Tc-D epimastigote antigens probed with pooled sera and sera from individual Tc-O and Tc-D infected dogs prior to infection (Day 0), and during the acute (Day 16-35 PI), indeterminate (Day 50-135 PI) and chronic (Day 235 PI) stages of infection. Generally, the patterns, number of protein bands, and temporal appearance of the protein bands identified by pooled sera and sera from individual dogs within each antigen preparation were similar. However, similarities and differences were present in antibody responses between sera from Tc-O and Tc-D infected dogs. Blastogenic responses of peripheral blood mononuclear cells (PBMC) from Tc-O and Tc-D infected dogs to mitogens (concanavalin A, phytohemagglutinin and pokeweed) were not significantly different from controls at any time during the experimental period. The PBMC from both groups of dogs were unresponsive to epimastigote antigens during the acute stage of infection. Statistically significant differences (P less than 0.05) in PBMC responsiveness from controls were observed on Days 70 and 175 PI. Responses decreased to pre-infection levels by Day 240 PI. These studies demonstrate that although two North American T. cruzi isolates have markedly different virulence for dogs, some aspects of their cellular and humoral immune responses are similar while other responses, such as antibody recognition of specific T. cruzi antigens, vary.
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Affiliation(s)
- S C Barr
- Department of Veterinary Microbiology and Parasitology, Louisiana State University, Baton Rouge 70803
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