Chagasic cardiopathy. Antibodies reacting with plasma membrane of striated muscle and endothelial cells

Exercise Training Reduces Inflammation and Fibrosis and Preserves Myocardial Function and Perfusion in a Model of Chronic Chagas Cardiomyopathy

BACKGROUND

Chronic Chagas cardiomyopathy (CCC) is caused by an inflammatory process induced by Trypanosoma cruzi, which leads to myocarditis with reactive and reparative fibrosis. CCC progresses with myocardial perfusion abnormalities and histopathological events that affect cardiorespiratory fitness (CRF).

OBJECTIVES

We evaluated the effects of aerobic physical training (APT) on myocardial perfusion and on morphological and functional impairments related with inflammation and fibrosis in Syrian hamsters with CCC. As a secondary objective, we analyzed the cross-sectional areas of the skeletal muscle.

METHODS

Hamsters with CCC and their respective controls were divided into four groups: CCC sedentary, CCC-APT, sedentary control and APT control. Seven months after infection, the animals underwent echocardiography, myocardial perfusion scintigraphy and cardiopulmonary exercise testing. Moderate-intensity APT was performed for fifty minutes, five times a week, for eight weeks. Subsequently, the animals were reassessed. Histopathological analysis was conducted after the above-mentioned procedures. The level of significance was set at 5% in all analyses (p<0.05).

RESULTS

CCC sedentary animals presented worse myocardial perfusion defects (MPD) over time, reduced left ventricle ejection fraction (LVEF) and showed more inflammation and fibrosis when compared to other groups (mixed ANOVA analysis). Conversely, APT was able to mitigate the progression of MPD, ameliorate inflammation and fibrosis and improve CRF efficiency in CCC-APT animals.

CONCLUSIONS

Our study demonstrated that APT ameliorated cardiac dysfunction, MPD, and reduced inflammation and fibrosis in CCC hamster models. Additionally, CCC-SED animals presented skeletal muscle atrophy while CCC-APT animals showed preserved skeletal muscle CSA. Understanding APT's effects on CCC's pathophysiological dimensions is crucial for future research and therapeutic interventions.

Autoimmunity in Chronic Chagas Disease: A Road of Multiple Pathways to Cardiomyopathy?

Chagas disease (CD), a neglected tropical disease caused by the protozoan Trypanosoma cruzi, affects around six million individuals in Latin America. Currently, CD occurs worldwide, becoming a significant public health concern due to its silent aspect and high morbimortality rate. T. cruzi presents different escape strategies which allow its evasion from the host immune system, enabling its persistence and the establishment of chronic infection which leads to the development of chronic Chagas cardiomyopathy (CCC). The potent immune stimuli generated by T. cruzi persistence may result in tissue damage and inflammatory response. In addition, molecular mimicry between parasites molecules and host proteins may result in cross-reaction with self-molecules and consequently in autoimmune features including autoantibodies and autoreactive cells. Although controversial, there is evidence demonstrating a role for autoimmunity in the clinical progression of CCC. Nevertheless, the exact mechanism underlying the generation of an autoimmune response in human CD progression is unknown. In this review, we summarize the recent findings and hypotheses related to the autoimmune mechanisms involved in the development and progression of CCC.

Profile of central and effector memory T cells in the progression of chronic human chagas disease

Background

Chronic Chagas disease presents several different clinical manifestations ranging from asymptomatic to severe cardiac and/or digestive clinical forms. Several studies have demonstrated that immunoregulatory mechanisms are important processes for the control of the intense immune activity observed in the chronic phase. T cells play a critical role in parasite specific and non-specific immune response elicited by the host against Trypanosoma cruzi. Specifically, memory T cells, which are basically classified as central and effector memory cells, might have a distinct migratory activity, role and function during the human Chagas disease.

Methodology/Principal Findings

Based on the hypothesis that the disease severity in humans is correlated to the quality of immune responses against T. cruzi, we evaluated the memory profile of peripheral CD4⁺ and CD8⁺ T lymphocytes as well as its cytokine secretion before and after in vitro antigenic stimulation. We evaluated cellular response from non-infected individuals (NI), patients with indeterminate (IND) or cardiac (CARD) clinical forms of Chagas disease. The expression of CD45RA, CD45RO and CCR7 surface molecules was determined on CD4⁺ and CD8⁺ T lymphocytes; the pattern of intracellular cytokines (IFN-γ, IL-10) synthesized by naive and memory cells was determined by flow cytometry. Our results revealed that IND and CARD patients have relatively lower percentages of naive (CD45RA^high) CD4⁺ and CD8⁺ T cells. However, statistical analysis of ex-vivo profiles of CD4⁺ T cells showed that IND have lower percentage of CD45RA^high in relation to non-infected individuals, but not in relation to CARD. Elevated percentages of memory (CD45RO^high) CD4⁺ T cells were also demonstrated in infected individuals, although statistically significant differences were only observed between IND and NI groups. Furthermore, when we analyzed the profile of secreted cytokines, we observed that CARD patients presented a significantly higher percentage of CD8⁺CD45RA^high IFN-γ-producing cells in control cultures and after antigen pulsing with soluble epimastigote antigens.

Conclusions

Based on a correlation between the frequency of IFN-γ producing CD8+ T cells in the T cell memory compartment and the chronic chagasic myocarditis, we propose that memory T cells can be involved in the induction of the development of the severe clinical forms of the Chagas disease by mechanisms modulated by IFN-γ. Furthermore, we showed that individuals from IND group presented more T_CM CD4⁺ T cells, which may induce a regulatory mechanism to protect the host against the exacerbated inflammatory response elicited by the infection.

Chagas disease is a parasitic infection caused by protozoan Trypanosoma cruzi that affects approximately 11 million people in Latin America. The involvement of the host's immune response on the development of severe forms of Chagas disease has not been fully elucidated. Studies on the immune response against T. cruzi infection show that the immunoregulatory mechanisms are necessary to prevent the deleterious effect of excessive immune response stimulation and consequently the fatal outcome of the disease. A recall response against parasite antigens observed in in vitro peripheral blood cell culture clearly demonstrates that memory response is generated during infection. Memory T cells are heterogeneous and differ in both the ability to migrate and exert their effector function. This heterogeneity is reflected in the definition of central (T_CM) and effector memory (T_EM) T cells. Our results suggest that a balance between regulatory and effectors T cells may be important for the progression and development of the disease. Furthermore, the high percentage of central memory CD4⁺ T cells in indeterminate patients after stimulation suggests that these cells may modulate host's inflammatory response by controlling cell migration to tissues and their effector role during chronic phase of the disease.

Innate and Acquired Immunity in the Pathogenesis of Chagas Disease

The apparent discrepancy between the intensity of inflammatory reaction and scarce number of parasites in chronic chagasic myocarditis prompt several investigators to hypothesize that an autoimmune process was involved in the pathogenesis of Chagas disease. Here, we recapitulate diverse molecular and cellular mechanisms of innate and acquired immunity involved in the control of parasite replication and in the build up of myocarditis observed during infection with Trypanosoma cruzi. In addition, we review the immunoregulatory mechanisms responsible for preventing excessive immune response elicited by this protozoan parasite. Ongoing studies in this research area may provide novel therapeutic strategies that could enhance the immunoprotective response while preventing the deleterious parasite-elicited responses observed during Chagas disease.

Role of Trypanosoma cruzi autoreactive T cells in the generation of cardiac pathology

Chagas disease, caused by Trypanosoma cruzi, affects several million people in Central and South America. About 30% of chronic patients develop cardiomyopathy probably caused by parasite persistence and/or autoimmunity. While several cross-reactive antibodies generated during mammal T. cruzi infection have been described, very few cross-reactive T cells have been identified. We performed adoptive transfer experiments of T cells isolated from chronically infected mice. The results showed the generation of cardiac pathology in the absence of parasites. We also transferred cross-reactive SAPA-specific T cells and observed unspecific alterations in heart repolarization, cardiac inflammatory infiltration, and tissue damage.

Trypanosoma cruzi-induced molecular mimicry and Chagas' disease

Chagas' disease, caused by Trypanosoma cruzi, has been considered a paradigm of infection-induced autoimmune disease. Thus, the scarcity of parasites in the chronic phase of the disease contrasts with the severe cardiac pathology observed in approximately 30% of chronic patients and suggested a role for autoimmunity as the origin of the pathology. Antigen-specific and antigen-non-specific mechanisms have been described by which T. cruzi infection might activate T and B cells, leading to autoimmunity. Among the first mechanisms, molecular mimicry has been claimed as the most important mechanism leading to autoimmunity and pathology in the chronic phase of this disease. In this regard, various T. cruzi antigens, such as B13, cruzipain and Cha, cross-react with host antigens at the B or T cell level and their role in pathogenesis has been widely studied. Immunization with those antigens and/or passive transfer of autoreactive T lymphocytes in mice lead to clinical disturbances similar to those found in Chagas' disease patients. On the other hand, the parasite is becoming increasingly detected in chronically infected hosts and may also be the cause of pathology either directly or through parasite-specific mediated inflammatory responses. Thus, the issue of autoimmunity versus parasite persistence as the cause of Chagas' disease pathology is hotly debated among many researchers in the field. We critically review here the evidence in favor of and against autoimmunity through molecular mimicry as responsible for Chagas' disease pathology from clinical, pathological and immunological perspectives.

Autoimmunity in chagas disease cardiomyopathy: Fulfilling the criteria at last?

Here, Jorge Kalil and Edécio Cunha-Neto review the recent evidence for autoimmunity in chronic Chagas cardiomyopathy (CCC) involving molecularly defined antigens and immunopathological mechanisms. They also discuss the criteria for assignment of CCC as an organ-specific autoimmune disease.

Capillary damage in skeletal muscle in advanced Chagas' disease patients

The damage to skeletal muscle capillaries in advanced Chagas' disease (stages II and III) was investigated in the vastus lateralis muscle of six patients and compared to that of six normal subjects. Capillaries were visualized by the PAS-amylase reaction and muscle fibres were classified by the ATPase histochemical method. Transmission electron microscopy was used to look for capillary alterations. The capillary-to-fibre ratio and number of capillaries adjacent to type I and type IIa fibres were decreased in the patient group. At the ultrastructural level, all patients showed capillary abnormalities, mainly basement membrane thickening and reduplication, capillary occlusion, proliferative endothelial cell cytoplasm with dense bodies, large vacuoles, altered mitochondria and prominent rough endoplasmic reticulum, as well as pericyte abnormalities. Capillary alterations are similar to those in patients affected by autoimmune diseases, suggesting an autoimmune component in the chronic phase of this disease. The reduction in capillarity may contribute to altered muscle performance in these patients.

Pathogenesis of Chagas heart disease: role of autoimmunity

Chagas heart disease is caused by infection with the protozoan parasite Trypanosoma cruzi. The apparent absence of parasites from the hearts of most individuals who succumb to this illness has led some to propose an autoimmune basis for disease pathogenesis. This hypothesis has been extremely difficult to test, because other mechanisms of tissue inflammation may coexist in the setting of active infection. Here we review the proposed mechanisms of Chagas disease pathogenesis and present new evidence in support of an autoimmune contribution to cardiac inflammation in the context of these other mechanisms. While we do not yet have a definitive answer to the autoimmunity question, we hope that our views will provide those engaged in the debate fresh perspective on this challenging issue.

Heart muscle cells share common neutral glycosphingolipids with Trypanosoma cruzi

Neutral glycosphingolipids were isolated from mouse heart muscle cells and their structures were analyzed. The molecular compositions of these glycosphingolipids were examined using column chromatography, HPTLC, GC-MS and fast atom bombardment-mass spectrometry (FAB-MS). Monohexosylceramides are a mixture of glucosyl- and galactosylceramides in a ratio of 1:1, sphingosine as the long chain base and as fatty acyl groups mainly C16, C18 saturated and C22 and C24 hydroxy fatty acids. Dihexosylceramide, identified as lactosylceramide contains C18 sphingosine and C18, C20 and C22 were the major fatty acids. No evidence for the occurrence of hydroxylated fatty acids in this glycolipid could be obtained from the GC-MS data. Our results clearly demonstrated that Trypanosoma cruzi and heart muscle cells have similar glycosphingolipid structures. In addition, heart muscle cells neutral glycosphingolipids have been shown to be immunoreactive. Antibodies reactive with each of the immunogenic glycolipids from heart cells or T. cruzi epimastigotes were present in the sera of human patients with Chagas disease as detected by ELISA. These cross-reactive antigens could be involved in the Chagasic autoimmunity.

Autoimmunity in Chagas' heart disease

The time scale dissociation between high parasitemia and tissue pathology, allied to the absence of parasites in the heart lesions of chronic Chagas' disease cardiopathy, casted doubt on the direct participation of Trypanosoma cruzi in tissue lesions. Moreover, the heart tissue lesions in chronic Chagas' disease cardiopathy are associated to an inflammatory mononuclear cell infiltrate, presumably the ultimate effectors of tissue damage. It has been hypothesized that the inflammatory cell infiltrate could mediate a delayed hypersensitivity process directed to the heart tissue components, an autoimmune response triggered by immunological cross-reactivity in the course of a protective immune response against some T. cruzi antigen homologous to heart proteins. However, little is known about the effector role of the T cells in the infiltrate, or about the nature of the antigen that lead to their accumulation in tissue. In this paper, we will review the published evidence on autoimmunity and immunological cross-reactivity between T. cruzi and the mammalian host, along with data generated in our laboratory. The definition of the precise role played by autoimmunity in the pathogenesis of Chagas' disease cardiopathy may have important consequences both for immunoprophylaxis and for the therapeutic approach of chronic Chagas' disease.

Antibodies to beta-adrenergic receptors disclosing agonist-like properties in idiopathic dilated cardiomyopathy and Chagas' heart disease

Recent studies confirm the existence of antibodies (Abs) to beta-adrenoceptors in patients with idiopathic dilated cardiomyopathy and Chagas' heart disease. These Abs can be shown to exert both stimulatory and inhibitory effects, which may play a role in the development of the cardiac abnormalities known to occur in these diseases, including advanced heart failure. The hypothesis is advanced that Chagas' heart disease and some forms of idiopathic dilated cardiomyopathy may represent, at least partially, a form of "adrenergic cardiomyopathy."

A Trypanosoma cruzi membrane protein shares an epitope with a lymphocyte activation antigen and induces crossreactive antibodies

Chagas' disease results from the infection of the protozoan parasite Trypanosoma cruzi and affects several million people in South America. Several alterations of the immune response have been described in this disease, such as severe immunosuppression of both cellular and humoral responses and massive polyclonal stimulation with the generation of autoantibodies crossreacting with host cells and tissues. We have obtained monoclonal antibodies (mAbs) from T. cruzi-infected mice that recognized a 50/55-kD antigen (GP50/55) on the T. cruzi membrane, but not in other parasites of the family Trypanosomatidae. One of these GP50/55-specific mAbs (C10) crossreacts with a 28-kD antigen (p28) expressed on the membrane of greater than 85% of activated mouse T and B lymphocytes, after in vitro activation with concanavalin A, Salmonella typhosa lipopolysaccharide, phorbol dibutyrate ester, or antigen, and on several murine T and B lymphocyte cell lines. Human T and B lymphocytes also express upon activation with phytohemagglutinin or Staphylococcus aureus Cowan I (SAC) a similar antigen recognized by mAb C10, although in a lower proportion of cells (30-40%). Furthermore, this mAb was able to suppress mouse and human T and B cell proliferation to any of those stimuli. In addition, sera from chagasic patients and T. cruzi-infected mice, but not from control patients or littermates, contain antibodies that recognize a similar p28 antigen on B lymphocytes. Furthermore, the immunoglobulin fractions of some chagasic sera also suppress the proliferation of human T lymphocytes. These results suggest a possible pathological role of autoantibodies as an alternative mechanism for T. cruzi-associated immunosuppression.

Chagas' cardioneuropathy: effect of ganglioside treatment in chronic dysautonomic patients--a randomized, double-blind, parallel, placebo-controlled study

To date, there is no effective pharmacologic treatment for Chagas' cardioneuropathy, one of the most common causes of congestive heart failure and sudden death in the world. Fifty-eight adults with positive serology for Chagas' disease and abnormal autonomic nervous system tests participated in this placebo-controlled clinical trial with Cronassial (mixed gangliosides), 40 mg daily intramuscular injection for 4 or 8 weeks. We measured postural response (heart rate, systolic and diastolic arterial blood pressure changes in response to standing); heart rate changes induced by cough and hyperventilation reflex tests; dizziness on standing; number of stress-induced arrhythmias; and periodic acid-Schiff (PAS)-positive T-lymphocyte percentage in blood samples. Cronassial is safe and significantly improves systolic blood pressure (p = 0.050) and double product responses to postural stress (p = 0.028), hyperventilation heart rate response (p = 0.007), frequency of dizziness episodes (p less than 0.001), number of arrhythmias (p = 0.033), and percentage of PAS-positive T-lymphocyte counts (p less than 0.001) compared with placebo.

Presence of cells producing antiheart autoantibodies in the inflammatory infiltrate of chronic chagasic myocarditis

Chagasic myocarditis is associated with the appearance of circulating antiheart autoantibodies. In order to find out if there was local synthesis of those antibodies we investigated, by means of a solid immunoenzymatic technique, the presence of cells secreting antibody (ASC) against syngeneic soluble heart antigens in the mononuclear cell (MNC) population isolated from the hearts of mice chronically infected with Trypanosoma cruzi. In seven animals the number of ASC ranged between 300 and 2080 per 10(6) MNC. A similar number of cells was observed when the assay was carried out with T. cruzi-soluble antigens. When the ASC were enumerated in an assay simultaneously with both antigens, their number doubled that found in the single antigen assay, suggesting that there was no cross-reactivity between the heart and the parasite antigens. These results indicate that some of the cells in the inflammatory infiltrate of chronic chagasic myocarditis synthesize IgG autoantibodies against heart antigens, a phenomenon which may lead to a local concentration of antibody large enough to induce tissue damage.

Characterization of a glycosyl-phosphatidylinositol-anchored membrane protein from Trypanosoma cruzi

Four monoclonal antibodies (MAbs) specific for Trypanosoma cruzi were obtained. Flow cytometry analysis showed that these four MAbs stained the membranes of the three main morphological forms of T. cruzi: amastigotes, trypomastigotes, and epimastigotes. The four MAbs seemed to recognize the same 50- to 55-kDa antigen that was revealed by immunoblotting. Competition experiments revealed that they defined at least two different epitopes on the molecule. The antigen was detected on the external surface of the membrane by immunoelectron microscopy. Several experiments indicated that the 50- to 55-kDa antigen recognized by these four MAbs was a glycosyl-phosphatidylinositol-anchored membrane protein. (i) The antigen could be removed from the cell surface by treatment with proteases, NaOH, HNO2, and phosphatidylinositol-specific phospholipase C (PI-PLC). (ii) The phase distribution of the antigen in Triton X-114 solutions changed drastically upon treatment with PI-PLC. The antigen was found mainly in the detergent phase in nontreated samples and in the aqueous phase in PI-PLC-digested samples. (iii) A cross-reacting determinant that was found in other glycosyl-phosphatidylinositol-anchored membrane proteins appeared after PI-PLC treatment.

Parasitic infection and autoimmunity

The studies summarized in this paper indicate that parasitic infections can serve as a trigger factor of autoimmune reactivity by several mechanisms. The relationship between parasites and autoimmunity could be manifested by the presence of autoantibodies or T-cells with autoreactivity. In spite of the evidence that has accumulated, the specific association between infection and autoimmunity is still obscure. The reasons for tissue damage in parasitic diseases are controversial. Some believe it is the result of pathogenic autoantibodies or autoreactive T-cells. Others argue against the causative role of autoimmunity in the formation of tissue lesions. The parasite itself could be the cause of tissue destruction, thus releasing high amounts of self antigens which might stimulate the autoreactivity. There is now little doubt that some degree parasite/host cross-reactivity occurs, and definition of cross-reacting antigens and epitopes is now taking place. It seems likely that a combination of events could result in cross-reactivity including: parasites themselves have cross reactive molecules and altered self antigens by adsorbing of parasite material to surrounding host cells. The mechanisms involved in parasites autoimmunity are complex and numerous, requiring a rigorous experimental approach to rationalize each step and determine its clinical importance. The developed methods in immunochemistry, monoclonal antibodies and hybridoma technology, and recombinant DNA research not only facilitate this kind of approach but also allow optimism for a successful outcome.

Presence of anti-Trypanosoma cruzi antibodies in the sera of mice with experimental autoimmune myocarditis

The existence of antigens shared in common by T. cruzi and heart muscle cells is suggested by the presence of antibodies binding to the parasite surface in the serum of mice with autoimmune myocarditis induced by immunization with syngenic heart antigens.

Chronic myocardial damage in experimental T. cruzi infection of a New World primate, Cebus sp. monkey

Eighteen Cebus apella monkeys, (juvenile and adult of both sexes) were inoculated five years ago, with three Trypanosoma cruzi strains (CA1, n = 10; Colombian, n = 4 and Tulahuen, n = 4), either by conjunctival or intraperitoneal route, once or repeatedly. Parasitological, hematological, serological, enzymatic, radiographic, electro and echocardiographic findings have been previously published and they are similar to those observed in human pathology. The most frequent electrocardiographic alteration was right branch bundle block. Six animals, chosen at random, were sacrificed. Those sacrificed 20 to 25 months post-first inoculation showed focal accumuli of leukocytes with myocytolysis. Foci of diffuse interstitial fibrosis with mild infiltrate of leukocytes among fibers were observed in the animals sacrificed 36 to 47 months post-inoculation. No parasites were seen. The lesions were more prominent in the ventricular walls and the septum. The fact that the infiltrates were predominant in the animals sacrificed at a shorter time after first inoculation and that fibrosis was more severe in those sacrificed at a longer time suggests that there is a progression of the infiltrative lesions to fibrosis, with a leukocytic activity indicative of a chronic phase. These lesions are similar to those described in human chronic Chagas' disease. This would demonstrate that this model is useful in evaluating a progress in the knowledge of the pathogenesis which is still a controversial issue, immunology, immunogenesis and chemotherapeutic agents of the chronic and indeterminate phases of this disease.

High antibody levels against mouse laminin with specificity for galactosyl-(alpha 1-3)galactose in patients with inner ear diseases

Sera of 413 patients with inner ear diseases were examined for ELISA binding to mouse laminin and compared to a normal group. Strongly enhanced antilaminin antibody reactions were observed in a large number of patients with sensorineural hearing loss (68%), tinnitus (60%), and sudden deafness (46%), but not in those with Meniere's disease (14%) or normal individuals (8%). Absorption experiments demonstrated that these antibodies are also responsible for the antisarcolemmal antibody pattern in the immunofluorescence test and for the reaction with pig kidney microsomes in the ELISA. Immunochemical studies showed that laminin binding of high or low titer in sera from patients and normal individuals is due to the Gal alpha 1-3Gal epitope present in N-linked oligosaccharides of mouse laminin. No reactions were observed with human laminin, which lacks this epitope. The findings suggest that high levels of antibodies against carbohydrate structures are triggered by persistent infections, providing some new insights about the possible cause of these diseases.

Plasma norepinephrine in Chagas' cardioneuromyopathy: a marker of progressive dysautonomia

Chronic Chagas' disease produces pathologic changes of the cardiovascular, digestive, and autonomic nervous systems. In an attempt to elucidate the nature of the dysautonomia in patients with Chagas' disease, we measured plasma norepinephrine levels, blood pressure, and heart rate, both supine and standing in 26 patients, and compared these values of patients classified according to three clinical subsets of cardiovascular manifestations with the values of nine normal volunteers and 16 patients with nonchagasic heart failure. Results suggested (1) progressive blockade of the alpha receptor in patients with Chagas' disease who have minimal clinical symptoms (group I) and in those who have ECG alterations without congestive symptoms (group II), as reflected by normal or raised plasma norepinephrine levels without change of diastolic blood pressure during standing, which indicates absent postural reflexes; and (2) blockade associated with partial denervation in patients with Chagas' disease who have class III or IV heart failure (group III), as suggested by a lower supine plasma norepinephrine level and a fall in diastolic blood pressure in the upright position. The findings of reduced plasma norepinephrine levels are in contrast to the elevated plasma norepinephrine levels in patients without Chagas' disease with class III and IV heart failure who have sympathetic hyperactivity.

Antiheart antibody-dependent cytotoxicity in the sera of mice chronically infected with Trypanosoma cruzi

Sera of mice chronically infected with Trypanosoma cruzi contain antibodies that bind to the surface of living adult syngeneic heart muscle cells. In a syngeneic system, with nonadherent spleen mononuclear cells as effector cells and cardiocytes as targets, antibody-dependent cytotoxicity (ADCC), revealed by the liberation of creatine phosphokinase from damaged cardiocytes, was observed after incorporation of serum samples from infected mice. Target damage was decreased after absorption with syngeneic myocardium, but absorption with T. cruzi epimastigotes or trypomastigotes or with syngeneic skeletal muscle had no effect on ADCC. No complement-dependent lysis against heart muscle cells was detected in the same serum samples. These observations indicate that serum from chronically chagasic mice contain antibodies that bind to the surface of living adult syngeneic cardiocytes and are able to exert ADCC, suggesting that they could play a role in the pathogenesis of the heart damage that occurs in Chagas' disease.

Immunofluorescence as an adjunct to the histopathologic diagnosis of Chagas' disease

We have developed a new indirect immunofluorescence procedure for identifying Trypanosoma cruzi amastigotes in sections of Formalin-fixed, paraffin-embedded tissue pretreated with a 0.25% trypsin solution to enhance immunofluorescence. In sections of human and mouse myocardia infected with T. cruzi and stained by this procedure, both intact amastigotes and phagocytosed amorphous antigen were intensely fluorescent and easily detected; nonspecific background fluorescence was absent or minimal. No staining occurred in similarly treated sections of Formalin-fixed, paraffin-embedded tissue that contained Histoplasma capsulatum var. capsulatum, Toxoplasma gondii, or Leishmania donovani to control specificity. Because pathology laboratories usually receive Formalin-fixed tissues for evaluation, this rapid and reliable procedure can be used to extend the diagnostic capability of conventional histopathology.

Persistence of Trypanosoma cruzi antigens in the inflammatory lesions of chronically infected mice

Different tissues and organs of mice infected with Trypanosoma cruzi trypomastigotes have been examined for the presence of parasites and parasitic antigens during both the acute and the chronic phases of infection. Specimens of skeletal and cardiac muscles, spleen, liver, brain and sciatic nerves were studied by histological and immunological methods. During the acute phase of infection, the parasites were commonly observed in these tissues. In the chronic phase of the experimental infection, pseudocysts filled with amastigotes were seen in less than 1% of the tissue sections, while immunohistological methods showed that T. cruzi antigens were present in 11% of the inflammatory infiltrates. These findings suggest that antigenic stimulation persists throughout the chronic phase, even though the parasites are not morphologically detectable.

Cellular immunity to Trypanosoma cruzi is mediated by helper T cells (CD4+)

The infection of mice with Trypanosoma cruzi has been used as an experimental model for human Chagas disease, because the murine and human infections have similar acute and chronic phases generating similar immunopathological phenomena. Histopathological studies of murine tissues showed that the inflammatory lesions were small during the acute phase and composed mainly of mononuclear cells. During the chronic phase, cellular infiltrates were clustered in large granulomata consisting of mononuclear and polynuclear neutrophil cells. Characterization of the infiltrating cells by surface markers showed that about 6% were Thyl.2+ T cells, and CD4+(Lyt 1+) T cells (T helper/DTH subset) were more numerous than CD8+(Lyt 2+) T cells. These observations suggest that delayed type hypersensitivity plays a role in the pathology of Chagas disease.

Circulating antibodies to mouse laminin in Chagas disease, American cutaneous leishmaniasis, and normal individuals recognize terminal galactosyl(alpha 1-3)-galactose epitopes

Sera from patients with American cutaneous leishmaniasis and Chagas disease and from monkeys infected with either Trypanosoma cruzi or Trypanosoma rhodesiense show, in RIAs, strong binding to mouse laminin. A distinct although weaker binding activity is also detected in normal human sera. The antibodies recognize a common carbohydrate epitope present on mouse laminin, which was assigned to a terminal galactosyl(alpha 1-3)-galactose group. Distinct crossreactions were observed with some other basement membrane proteins, rabbit glycosphingolipids, defucosylated human B blood group substance and components produced by some human tumor cells. Only little activity was, however, found on laminin obtained from human placenta. The data indicate that the antibodies arising in infectious diseases are stimulated by similar carbohydrate epitopes present on the surface of parasites. Tissue-specific occurrence of such epitopes may exist and explain the involvement of distinct tissues in autoimmune disorders.

Immunoperoxidase technique in experimental chronic chagasic myocarditis

Chagas'disease has been described as the commonest form of chronic myocarditis. An immunologic pathogenesis has been discribed for this form of the disease. So far, no immunoperoxidase technique has been used for the detection of immunological deposits in chronic experimental Chagas'myocardiopathy. Forty-one Swiss mice, three months old were inoculated intraperitoneally with doses between 10 and 10(5) Tulahuen trypomastigotes. Mice were reinoculated one month after with doses between 10² and 10(5) and sacrificed at 6 (n=21) and 9 months (n=9) after the first inoculation. ECGs were recorded before sacrifice. Immunoperoxidase technique (peroxidase-antiperoxidase method), immunofluorescence (direct and indirect) as well as histological studies were performed in myocardiums and skeletal muscles of the surviving animals. The most sensitive methods for detecting chronic chagasic infection were the routine histologic studies (73%) and the ECGs 83% and 89% on 6 and 9 mo. post-infected mice, respectively. Myocardial involvement varied from interstitial mild focal lymphocyte infiltrates up to replacement of myocytes by loose connective tissue. Atrial myocardiums (21/23, 91%) were more affected than ventricles (9/23, 39%). Typical chagasic nests were rarely found. Skeletal muscle involvement (11/18 and 7/9) varied from mild to extensive lymphocyte and plasmacell infiltrates, and necrotic fibers. The involved antigen were shown in skeletal muscles by the immunoperoxidase technique as diffusely arranged granular intracytoplasmatic deposit for both IgC and total immunoglobulins. The coincidence between this technique and histologic muscle lesions was 11/18 (61(%) in 6 mo. and 6/8 (75%) at 9 mo. post-infection. In heart, delicate granular deposits of total immunoglobulins were seen diffusely arranged within the ventricular myocytes; coincidence between immunoperoxidase technique anl histologic involvement increased from 36 to 66% in animals sacrifeced 6 and 9 mo. post-infection. This strongly stressed the increase of immunologic phenomena with the chronification of infection. Concerning sensitivity, immunoperoxidase and direct immunofluorescence were highly sensitive in skeletal muscle (100%, p < 0.01). Conversely, direct immunofluorescence technique showed poor results in heart while immunoperoxidase increased its sensitivity from 21.4% (at 6 mo.) to 66.6% (at 9 mo.) post-infection (p < 0.001). Considering the necessity of obtaining an adequate vaccine in order to prevent this disease an experimental model like this, rendering immunological reactions as revealed by the immunoperoxidase technique, would be useful.

A Trypanosoma cruzi monoclonal antibody that recognizes a superficial tubulin-like antigen

A monoclonal antibody (MAB 10), obtained from mice infected with Trypanosoma cruzi, was found to recognize a superficial antigen in living or fixed parasites. It reacted more strongly with T. cruzi than with related parasites such as T. brucei and Leishmania. In immunoblots it recognized a single trypanosoma polypeptide and also brain tubulin, both of which had the same electrophoretic mobility. Further analysis suggested that the alpha-tubulin subunit contained the epitope recognized by MAB 10. These results suggest that a surface tubulin-like protein is present is T. cruzi.

The evolution of experimental Trypanosoma cruzi cardiomyopathy in rabbits: further parasitological, morphological and functional studies

Young rabbits (1-2 months of age) inoculated with trypomastigote forms of the Colombia strain of Trypanosoma cruzi have been shown to develop cardiac pathological changes (together with parasitological and immunological alterations) which are very similar to those observed in the acute and chronic phases of Chagas' disease in man. The cardiac alterations in the acute phase are characterized grossly by slight cardiomegaly with dilatation of the right-sided chambers. Microscopically they are characterized by mild focal myocarditis. The chronic phase is characterized by moderate to marked cardiomegaly with hypertrophy and dilatation of both ventricular chambers. There is thinning of the apical region (apical aneurysm), particularly of the left ventricle. Focal myocarditis is seen microscopically with areas of myocytolytic necrosis, atrophic and hypertrophic myofibers, an inflammatory response predominantly composed of mononuclear cells and interstitial fibrosis. Cineventriculography in the left ventricle of rabbits during the chronic phase disclosed regional myocardial dysfunction, with typical apical systolic bulging. The pathogenesis of Chagasic cardiomyopathy is briefly discussed in the light of these findings. Our investigation has further shown that this animal model is particularly suitable for studies on on the mechanisms, pathology and treatment of Chagas' heart disease.

Immunopathologic studies in myocardial biopsies of patients with Chagas' disease and idiopathic cardiomyopathy

Right ventricular endomyocardial biopsies were studied in 30 patients, 15 with myocardiopathy from chronic Chagas'disease and 15 with idiopathic congestive myocardiopathy; five other myocardial samples were taken at necropsies of patients with chronic Chagas' disease. The authors tried to establish by means of direct immunofluorescence techniques whether there were immunoglobulins G, A and M, fibrinogen and C3 complement deposition in the myocardium; only one of these 30 patients exhibited a positive reaction to IgG, it was a patient with idiopathic congestive myocardiopathy. All fragments from patients with Chagas' disease showed no response to any of the fluorescent conjugates. These findings do not support the idea that anti-myoeardial antibodies have pathogenic importance in the evolution of dilated or chagasic myocardiopathies.

Evolução da cardiopatia experimentalmente induzida em coelhos infectados com Trypanosoma cruzi

Coelhos jovens de ambos os sexos (1-2 meses de idade), outbred, inoculados com tripomastigotas da cepa Colômbia de Trypanosoma cruzi desenvolveram lesões cardíacas, macro e microscópicas, além de características parasitológicas e imunológicas, muito semelhantes às observadas na doença de Chagas humana, tanto na fase aguda como na fase crônica. Na fase aguda a síndrome cardíaca caracteriza-se macroscopicamente por discreta cardiomegalia, com dilatação de câmaras direitas, e miscroscopicamente por miocardite focal pouco acentuada; na fase crônica, por cardiomegalia moderada ou acentuada, com hipertrofia e dilatação de câmaras e adelgaçamento da ponta (aneurisma apical), predominantemente do ventrículo esquerdo, e por miocardite focal, cóm áreas de necrose miocitolítica e degeneração de miocélulas, associadas a infiltrado inflamatório, principalmente composto de linfócitos, e fibrose intersticial. Devido à reprodução de aspectos da doença cardíaca chagásica humana em tempo relativamente curto, à simplicidade, à disponibilidade para múltiplos pesquisadores e ao baixo custo, o modelo representado pelo coelho constitui uma alternativa para estudos dos mecanismos, patologia e tratamento da cardiopatia chagásica.

Agent of Chagas' disease from Honduran vector capable of developing in California insects: implications for cardiologists

An exotic strain of Trypanosoma cruzi recovered from Triatoma dimidiata from Tegucigalpa, Honduras, was shown by isoenzyme studies to be closely related to the Miles' zymodeme 1 and laboratory reference strain Tehuantepec. It was injected into Swiss random-bred ICR mice. Clean Triatoma protracta nymphs and adults, which had been captured in Winters, California, fed on inoculated mice and were then examined over a 15-month period. Their feces contained multiplying epimastigote and infective trypomastigote forms of T. cruzi. This shows that exotic strains of T. cruzi can develop and survive for long periods in local California vectors. The increasing number of immigrants from Central America who enter California and other states may have public health implications in regard to the introduction of pathogenic strains that are capable of producing cardiomyopathy. Cardiologists who examine patients with cardiomyopathy from Central and South America should rule out Chagas' disease as a cause, since pathogenic T. cruzi strains are present in most Central and South American countries.

Aspectos da miocardite em chagásicos crônicos com "megas" e sem "megas" com insuficiência cardíaca congestiva

O estudo microscópico de 20 corações de chagásicos com "megas" e de outros 20 sem "megas" com insuficiência cardíaca congestiva (ICC) revelou que tanto a Jibrose quanto o exsudato inflamatório no miocárdio são discretos nos casos de "megas" e geralmente acentuados nos casos de ICC. Considerando-se que nos "megas" a ICC, a hipertrofia do miocárdio e a lesão vorticilar são fenômenos raros, nossos achados (atuais e anteriores) sugerem que estes estejam relacionados principalmente com a agressão inflamatória ao miocárdio ventricular, uma vez que a desnervação é, geralmente, mais acentuada nos casos de "megas" que nos de ICC.

The selection of antigens for the diagnosis, prognosis and evolutive study of parasitic diseases

The hypothesis is set forth that schizodeme (kDNA) typing of Trypanosoma cruzi, and possible other parasites, may be used to resolve the problem associated with the protean clinical manifestations of the disease. kDNA typing of T. cruzi clones may turn out to be useful in: (1) diagnosis; (2) prognosis; (3) production of species (generic) vaccines; (4) the study of autoimmunity. We recommend that an international culture bank of schizodeme-type T. cruzi be established.

Role of T lymphocytes in the resistance and immunopathology of experimental Chagas' disease. I. Histopathological studies

The results reported here show that Trypanosoma cruzi can parasitize almost all tissues of mice; however, the T-dependent immune response controls parasite invasion, leading undesirable immunopathological effects. Inflammatory infiltrate was rare in heart or skeletal muscle and other organs of Nu/Nu, but was abundant in tissues of Nu/+ mice. Cellular inflammatory lesions could be induced in Nude mice by the transfer of lymph node cells from Nu/+ animals infected with T. cruzi.

Heterophil nature of EVI antibody in Trypanosoma cruzi infection

Previous findings implying the autoreactive capability of circulating complement-fixing (EVI) antibodies in patients with Chagas' disease (American trypanosomiasis), under both in vitro and in vivo conditions have been irreproducible. The presence of the tissue antigens involved in the reactivity with EVI antibodies is exclusively confined to nonhuman substrates, suggesting the heterophil nature of these antibodies which, on the other hand, have also been described in human sera collected in areas free from Chagas' disease. This would preclude any direct pathogenic effect of EVI antibodies when present in the circulation, though they may be useful immunological markers of unsuspected Trypanosoma cruzi infection in endemic areas.

Antibody-dependent cytotoxicity of Trypanosoma cruzi antigen-coated mouse cell lines by eosinophils and neutrophils

Eosinophils and neutrophils are shown to be cytotoxic against two syngeneic mouse cell lines cells when these are coated with T. cruzi antigen and anti-T. cruzi antibody. Activity is detected within 5 h of incubation. Highest levels of cytotoxicity are obtained at antibody dilutions of 1:100 and 1:1000, while antiserum at 1:10 is shown to be inhibitory. Eosinophils show significant activity at an effector to target ratio of 5:1. No cytotoxicity occurs in the absence of either antigen, antibody or effector cells. This phenomenon may be a model for the tissue destruction in acute T. cruzi infection, where the lysis of trypanosomes may lead to antigen coating of host cells, followed by antibody-dependent granulocyte-mediated cytotoxicity of the host cells.