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Resende CAA, Ribeiro AJ, Gandra IB, Silva KA, Lopes LDS, Barcelos ICDS, Couto CAP, de Faria MT, Pereira SP, Xavier SR, Machado JM, da Paz MC, Chaves AT, Coelho EAF, Giunchetti RC, Chávez-Fumagalli MA, Dutra WO, Gonçalves AAM, Galdino AS. Recombinant proteins as promising antigens applied to the immunodiagnosis of Chagas disease: a scoping review. Front Microbiol 2024; 15:1420226. [PMID: 39139374 PMCID: PMC11319188 DOI: 10.3389/fmicb.2024.1420226] [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: 04/19/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is an important public health problem, occurring mainly in Latin America. The disease has a major social and economical effect, negatively impacting the life of the infected individuals, and bringing great costs to public health. An early and accurate diagnosis is essential for administration of early treatment. In addition, prognostic tests may aid disease management, decreasing hospitalization costs. However, the serological diagnostic scenario for CD still faces several challenges, making the development of new diagnostic kits a pressing matter. Facing this scenario, several researchers have expanded efforts in developing and testing new antigens, such as recombinant proteins and recombinant multiepitope proteins, with promising results. These recombinant antigens offer several advantages, such as improved sensitivity and specificity, in addition to facilitated scaling. Also, it has been possible to observe a rising number of studies using ELISA and point-of-care platforms, employing these antigens in the past few years. Among them, recombinant proteins were the most applied antigens, demonstrating great capacity to discriminate between positive and negative samples. Although fewer in number, recombinant multiepitope proteins also demonstrated an improved diagnostic performance. Indeed, a great number of studies employing these antigens showed sensitivity and specificity values above 90%, greatly impacting diagnostic accuracy. Nevertheless, despite the good results found, it is still possible to observe some bottlenecks in the development of new antigens, such as the scarcity of tests with sera from the acute phase and the variability of results in different geographic areas. In this sense, aiming to contribute to control and health programs, the continuous search for a more accurate serological diagnosis is essential, both for the acute and chronic phases of the disease.
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Affiliation(s)
- Carlos Ananias Aparecido Resende
- Microorganism Biotechnology Laboratory, National Institute of Science and Technology on Industrial Biotechnology (INCT-BI), Federal University of São João Del-Rei, Divinópolis, Brazil
| | - Anna Júlia Ribeiro
- Microorganism Biotechnology Laboratory, National Institute of Science and Technology on Industrial Biotechnology (INCT-BI), Federal University of São João Del-Rei, Divinópolis, Brazil
| | - Isadora Braga Gandra
- Microorganism Biotechnology Laboratory, National Institute of Science and Technology on Industrial Biotechnology (INCT-BI), Federal University of São João Del-Rei, Divinópolis, Brazil
| | - Kamila Alves Silva
- Microorganism Biotechnology Laboratory, National Institute of Science and Technology on Industrial Biotechnology (INCT-BI), Federal University of São João Del-Rei, Divinópolis, Brazil
| | - Lucas da Silva Lopes
- Microorganism Biotechnology Laboratory, National Institute of Science and Technology on Industrial Biotechnology (INCT-BI), Federal University of São João Del-Rei, Divinópolis, Brazil
| | - Isabelle Caroline dos Santos Barcelos
- Microorganism Biotechnology Laboratory, National Institute of Science and Technology on Industrial Biotechnology (INCT-BI), Federal University of São João Del-Rei, Divinópolis, Brazil
| | - Carolina Alves Petit Couto
- Microorganism Biotechnology Laboratory, National Institute of Science and Technology on Industrial Biotechnology (INCT-BI), Federal University of São João Del-Rei, Divinópolis, Brazil
| | - Mariana Teixeira de Faria
- Microorganism Biotechnology Laboratory, National Institute of Science and Technology on Industrial Biotechnology (INCT-BI), Federal University of São João Del-Rei, Divinópolis, Brazil
| | - Sabrina Paula Pereira
- Microorganism Biotechnology Laboratory, National Institute of Science and Technology on Industrial Biotechnology (INCT-BI), Federal University of São João Del-Rei, Divinópolis, Brazil
| | - Sandra Rodrigues Xavier
- Microorganism Biotechnology Laboratory, National Institute of Science and Technology on Industrial Biotechnology (INCT-BI), Federal University of São João Del-Rei, Divinópolis, Brazil
| | - Juliana Martins Machado
- Microorganism Biotechnology Laboratory, National Institute of Science and Technology on Industrial Biotechnology (INCT-BI), Federal University of São João Del-Rei, Divinópolis, Brazil
| | - Mariana Campos da Paz
- Laboratory of Bioactives and Nanobiotechnology, Federal University of São João Del-Rei, Divinópolis, Brazil
| | - Ana Thereza Chaves
- Postgraduate Program in Health Sciences, Infectious Diseases and Tropical Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Eduardo Antônio Ferraz Coelho
- Postgraduate Program in Health Sciences, Infectious Diseases and Tropical Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rodolfo Cordeiro Giunchetti
- Laboratory of Biology of Cell Interactions, Department of Morphology, National Institute of Science and Technology on Tropical Diseases (INCT-T), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Miguel Angel Chávez-Fumagalli
- Computational Biology and Chemistry Research Group, Vicerrectorado de Investigación, Universidad Católica de Santa María, Arequipa, Peru
| | - Walderez Ornelas Dutra
- Laboratory of Biology of Cell Interactions, Department of Morphology, National Institute of Science and Technology on Tropical Diseases (INCT-T), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana Alice Maia Gonçalves
- Microorganism Biotechnology Laboratory, National Institute of Science and Technology on Industrial Biotechnology (INCT-BI), Federal University of São João Del-Rei, Divinópolis, Brazil
| | - Alexsandro Sobreira Galdino
- Microorganism Biotechnology Laboratory, National Institute of Science and Technology on Industrial Biotechnology (INCT-BI), Federal University of São João Del-Rei, Divinópolis, Brazil
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Ferreira AM, Oliveira-da Silva LC, Cardoso CS, Oliveira CDL, Brito BODF, Bierrenbach AL, Santos ACDJ, Cruz DS, Leite SF, Jesus AB, Damasceno RF, Nunes MCP, Molina I, Haikal DSA, Sabino EC, Ribeiro ALP. Association between positive serology for COVID-19 and chagas cardiomyopathy progression: The SaMi-Trop project. Travel Med Infect Dis 2024; 61:102745. [PMID: 39048021 DOI: 10.1016/j.tmaid.2024.102745] [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: 12/26/2023] [Revised: 05/17/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Chagas Disease (CD) can cause Chagas cardiomyopathy. The new coronavirus disease (COVID-19) also affects the cardiovascular system and may worsen Chagas cardiomyopathy. However, the cardiac evolution of patients with CD infected by COVID-19 is not known. Thus, the objective of this study is to assess, within one year, whether there was cardiac progression after COVID-19 in CD. METHODS Longitudinal study with CD patients. The outcome was cardiac progression, defined as the appearance of new major changes in the current ECG compared to the previous ECG considered from the comparison of electrocardiograms (ECGs) performed with an interval of one year. Positive Anti-SARS-CoV2 Serology was the independent variable of interest. For each analysis, a final multiple model was constructed, adjusted for sociodemographic, clinical, and pandemic-related characteristics. RESULTS Of the 404 individuals included, 22.8 % had positive serology for COVID-19 and 10.9 % had cardiac progression. In the final model, positive serology for COVID-19 was the only factor associated with cardiac progression in the group as a whole (OR = 2.65; 95 % CI = 1.27-5.53) and for new-onset cardiomyopathy in the group with normal previous ECG (OR = 3.50; 95 % CI = 1.21-10.13). CONCLUSION Our study shows an association between COVID-19 and progression of Chagas cardiomyopathy, evaluated by repeated ECGs, suggesting that COVID-19 accelerated the natural history of CD.
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Affiliation(s)
- Ariela Mota Ferreira
- Department of Infectious and Parasitic Diseases, University of São Paulo, São Paulo, SP, Brazil; Postgraduate Program in Health Sciences, State University of Montes Claros, Montes Claros, MG, Brazil.
| | | | - Clareci Silva Cardoso
- Department of Medicine, Federal University of São João Del-Rei, Divinópolis, MG, Brazil
| | | | | | | | - Ana Clara de Jesus Santos
- Postgraduate Program in Health Sciences, State University of Montes Claros, Montes Claros, MG, Brazil
| | - Dardiane Santos Cruz
- Postgraduate Program in Health Sciences, State University of Montes Claros, Montes Claros, MG, Brazil
| | - Sâmara Fernandes Leite
- Postgraduate Program in Health Sciences, State University of Montes Claros, Montes Claros, MG, Brazil
| | - Andréia Brito Jesus
- Postgraduate Program in Health Sciences, State University of Montes Claros, Montes Claros, MG, Brazil
| | - Renata Fiúza Damasceno
- Superintendência Regional de Saúde de Montes Claros, Secretaria de Estado de Saúde de Minas Gerais, Montes Claros, MG, Brazil
| | | | - Israel Molina
- Postgraduate Program in Health Sciences, State University of Montes Claros, Montes Claros, MG, Brazil; Instituto René Rachou-FIOCRUZ Minas, Laboratório de Triatomíneos e Epidemiologia da Doença de Chagas, Belo Horizonte, Brazil
| | - Desirée Sant' Anna Haikal
- Postgraduate Program in Health Sciences, State University of Montes Claros, Montes Claros, MG, Brazil
| | - Ester Cerdeira Sabino
- Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Department of Internal Medicine, Faculdade de Medicina, and Telehealth Center and Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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3
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Jeung SY, An JH, Kim SS, Youn HY. Safety of Gonadal Tissue-Derived Mesenchymal Stem Cell Therapy in Geriatric Dogs with Chronic Disease. Animals (Basel) 2024; 14:2134. [PMID: 39061596 PMCID: PMC11273526 DOI: 10.3390/ani14142134] [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: 05/12/2024] [Revised: 07/08/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Ensuring the safety of mesenchymal stem cell (MSC) therapy is a fundamental requirement in clinical practice. This study aimed to assess the safety of using gonadal tissue-derived MSCs (n = 10) compared to the commonly utilized adipose tissue-derived MSCs (n = 9) in geriatric dogs with chronic diseases. All participants received allogeneic MSC therapy, and no allergic reactions due to allogeneic cell immunogenicity were noted. Both groups showed no adverse changes in physical exams or hematological parameters before and after therapy. Importantly, there were no instances of tumor formation or growth post-treatment in either group. The findings demonstrated that dogs treated with gonadal tissue-derived MSCs experienced no clinical adverse effects. However, clinical adverse effects were reported in one case of adipose tissue-derived MSC therapy. Despite limitations in monitoring beyond one year and constraints due to a small and diverse patient group, this pioneering study validates the safe use of gonadal tissue-derived MSCs in aged companion animals. It underscores the potential of utilizing tissues from neutering procedures to advance regenerative medicine and expand cell banks and therapy options for companion animals.
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Affiliation(s)
- So-Young Jeung
- VIP Animal Medical Center, Seoul 02830, Republic of Korea; (S.-Y.J.); (S.-S.K.)
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul 08826, Republic of Korea
| | - Ju-Hyun An
- Laboratory of Veterinary Emergency and Critical Care, Department of Veterinary Clinical Science, College of Veterinary Medicine, Kangwon National University, Chuncheon-si 24341, Republic of Korea;
| | - Sung-Soo Kim
- VIP Animal Medical Center, Seoul 02830, Republic of Korea; (S.-Y.J.); (S.-S.K.)
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul 08826, Republic of Korea
| | - Hwa-Young Youn
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul 08826, Republic of Korea
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Sabino EC, Nunes MCP, Blum J, Molina I, Ribeiro ALP. Cardiac involvement in Chagas disease and African trypanosomiasis. Nat Rev Cardiol 2024:10.1038/s41569-024-01057-3. [PMID: 39009679 DOI: 10.1038/s41569-024-01057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/17/2024]
Abstract
Trypanosomiases are diseases caused by various species of protozoan parasite in the genus Trypanosoma, each presenting with distinct clinical manifestations and prognoses. Infections can affect multiple organs, with Trypanosoma cruzi predominantly affecting the heart and digestive system, leading to American trypanosomiasis or Chagas disease, and Trypanosoma brucei primarily causing a disease of the central nervous system known as human African trypanosomiasis or sleeping sickness. In this Review, we discuss the effects of these infections on the heart, with particular emphasis on Chagas disease, which continues to be a leading cause of cardiomyopathy in Latin America. The epidemiology of Chagas disease has changed substantially since 1990 owing to the emigration of over 30 million Latin American citizens, primarily to Europe and the USA. This movement of people has led to the global dissemination of individuals infected with T. cruzi. Therefore, cardiologists worldwide must familiarize themselves with Chagas disease and the severe, chronic manifestation - Chagas cardiomyopathy - because of the expanded prevalence of this disease beyond traditional endemic regions.
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Affiliation(s)
- Ester Cerdeira Sabino
- Department of Pathology, Instituto de Medicina Tropical da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Maria Carmo P Nunes
- Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Johannes Blum
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Israel Molina
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Luiz P Ribeiro
- Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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5
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Khan MS, Shahid I, Bennis A, Rakisheva A, Metra M, Butler J. Global epidemiology of heart failure. Nat Rev Cardiol 2024:10.1038/s41569-024-01046-6. [PMID: 38926611 DOI: 10.1038/s41569-024-01046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Heart failure (HF) is a heterogeneous clinical syndrome marked by substantial morbidity and mortality. The natural history of HF is well established; however, epidemiological data are continually evolving owing to demographic shifts, advances in treatment and variations in access to health care. Although the incidence of HF has stabilized or declined in high-income countries over the past decade, its prevalence continues to increase, driven by an ageing population, an increase in risk factors, the effectiveness of novel therapies and improved survival. This rise in prevalence is increasingly noted among younger adults and is accompanied by a shift towards HF with preserved ejection fraction. However, disparities exist in our epidemiological understanding of HF burden and progression in low-income and middle-income countries owing to the lack of comprehensive data in these regions. Therefore, the current epidemiological landscape of HF highlights the need for periodic surveillance and resource allocation tailored to geographically vulnerable areas. In this Review, we highlight global trends in the burden of HF, focusing on the variations across the spectrum of left ventricular ejection fraction. We also discuss evolving population-based estimates of HF incidence and prevalence, the risk factors for and aetiologies of this disease, and outcomes in different geographical regions and populations.
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Affiliation(s)
| | - Izza Shahid
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Ahmed Bennis
- Department of Cardiology, The Ibn Rochd University Hospital Center, Casablanca, Morocco
| | | | - Marco Metra
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
- Baylor Scott and White Research Institute, Dallas, TX, USA.
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6
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Barbosa JMC, Pedra-Rezende Y, Mata-Santos HA, Vilar-Pereira G, Melo TGD, Ramos IP, Gibaldi D, Moreira OC, Nunes DF, Batista MM, Lannes-Vieira J, Daliry A, Salomão K. Preclinical evaluation of combined therapy with amiodarone and low-dose benznidazole in a mouse model of chronic Trypanosoma cruzi infection. Biomed Pharmacother 2024; 175:116742. [PMID: 38754265 DOI: 10.1016/j.biopha.2024.116742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
Chagasic chronic cardiomyopathy (CCC) is the primary clinical manifestation of Chagas disease (CD), caused by Trypanosoma cruzi. Current therapeutic options for CD are limited to benznidazole (Bz) and nifurtimox. Amiodarone (AMD) has emerged as most effective drug for treating the arrhythmic form of CCC. To address the effects of Bz and AMD we used a preclinical model of CCC. Female C57BL/6 mice were infected with T. cruzi and subjected to oral treatment for 30 consecutive days, either as monotherapy or in combination. AMD in monotherapy decreased the prolonged QTc interval, the incidence of atrioventricular conduction disorders and cardiac hypertrophy. However, AMD monotherapy did not impact parasitemia, parasite load, TNF concentration and production of reactive oxygen species (ROS) in cardiac tissue. Alike Bz therapy, the combination of Bz and AMD (Bz/AMD), improved cardiac electric abnormalities detected T. cruzi-infected mice such as decrease in heart rates, enlargement of PR and QTc intervals and increased incidence of atrioventricular block and sinus arrhythmia. Further, Bz/AMD therapy ameliorated the ventricular function and reduced parasite burden in the cardiac tissue and parasitemia to a degree comparable to Bz monotherapy. Importantly, Bz/AMD treatment efficiently reduced TNF concentration in the cardiac tissue and plasma and had beneficial effects on immunological abnormalities. Moreover, in the cardiac tissue Bz/AMD therapy reduced fibronectin and collagen deposition, mitochondrial damage and production of ROS, and improved sarcomeric and gap junction integrity. Our study underlines the potential of the Bz/AMD therapy, as we have shown that combination increased efficacy in the treatment of CCC.
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Affiliation(s)
- Juliana Magalhães Chaves Barbosa
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil; Laboratório de Fisiopatologia Clínica e Experimental, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Yasmin Pedra-Rezende
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil; Laboratório de Biologia das Interações, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Hílton Antônio Mata-Santos
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Laboratório de Análise e Desenvolvimento de Inibidores Enzimáticos e Laboratório Multiusuário de Análises por RMN, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Glaucia Vilar-Pereira
- Laboratório de Biologia das Interações, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Tatiana Galvão de Melo
- Laboratório de Ultraestrutura Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Isalira Peroba Ramos
- Centro Nacional de Biologia Estrutural e Bioimagem, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniel Gibaldi
- Laboratório de Biologia das Interações, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Otacilio C Moreira
- Laboratório de Virologia e Parasitologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Daniela Ferreira Nunes
- Laboratório de Virologia e Parasitologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcos Meuser Batista
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Joseli Lannes-Vieira
- Laboratório de Biologia das Interações, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Anissa Daliry
- Laboratório de Fisiopatologia Clínica e Experimental, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Kelly Salomão
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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Thangavel H, Dhanyalayam D, Kim M, Lizardo K, Sidrat T, Lopez JG, Wang X, Bansal S, Nagajyothi JF. Adipocyte-released adipomes in Chagas cardiomyopathy: Impact on cardiac metabolic and immune regulation. iScience 2024; 27:109672. [PMID: 38660407 PMCID: PMC11039351 DOI: 10.1016/j.isci.2024.109672] [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: 08/14/2023] [Revised: 03/14/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
Chronic Trypanosoma cruzi infection leads to Chagas cardiomyopathy (CCM), with varying manifestations such as inflammatory hypertrophic cardiomyopathy, arrhythmias, and dilated cardiomyopathy. The factors responsible for the increasing risk of progression to CCM are not fully understood. Previous studies link adipocyte loss to CCM progression, but the mechanism triggering CCM pathogenesis remains unexplored. Our study uncovers that T. cruzi infection triggers adipocyte apoptosis, leading to the release of extracellular vesicles named "adipomes". We developed an innovative method to isolate intact adipomes from infected mice's adipose tissue and plasma, showing they carry unique lipid cargoes. Large and Small adipomes, particularly plasma-derived infection-associated L-adipomes (P-ILA), regulate immunometabolic signaling and induce cardiomyopathy. P-ILA treatment induces hypertrophic cardiomyopathy in wild-type mice and worsens cardiomyopathy severity in post-acute-infected mice by regulating adipogenic/lipogenic and mitochondrial functions. These findings highlight adipomes' pivotal role in promoting inflammation and impairing myocardial function during cardiac remodeling in CD.
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Affiliation(s)
- Hariprasad Thangavel
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Dhanya Dhanyalayam
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Michelle Kim
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Kezia Lizardo
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Tabinda Sidrat
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | | | - Xiang Wang
- Rutgers University Molecular Imaging Core (RUMIC), Rutgers Translational Sciences, Piscataway, NJ 08854, USA
| | - Shivani Bansal
- Departnment of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Jyothi F. Nagajyothi
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
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8
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Roman-Campos D, Marin-Neto JA, Santos-Miranda A, Kong N, D’Avila A, Rassi A. Arrhythmogenic Manifestations of Chagas Disease: Perspectives From the Bench to Bedside. Circ Res 2024; 134:1379-1397. [PMID: 38723031 PMCID: PMC11081486 DOI: 10.1161/circresaha.124.324507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
Chagas cardiomyopathy caused by infection with the intracellular parasite Trypanosoma cruzi is the most common and severe expression of human Chagas disease. Heart failure, systemic and pulmonary thromboembolism, arrhythmia, and sudden cardiac death are the principal clinical manifestations of Chagas cardiomyopathy. Ventricular arrhythmias contribute significantly to morbidity and mortality and are the major cause of sudden cardiac death. Significant gaps still exist in the understanding of the pathogenesis mechanisms underlying the arrhythmogenic manifestations of Chagas cardiomyopathy. This article will review the data from experimental studies and translate those findings to draw hypotheses about clinical observations. Human- and animal-based studies at molecular, cellular, tissue, and organ levels suggest 5 main pillars of remodeling caused by the interaction of host and parasite: immunologic, electrical, autonomic, microvascular, and contractile. Integrating these 5 remodeling processes will bring insights into the current knowledge in the field, highlighting some key features for future management of this arrhythmogenic disease.
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Affiliation(s)
- Danilo Roman-Campos
- Departamento de Biofísica, Escola Paulsita de Medicina, Laboratório de Cardiobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil (D.R-C)
| | - José Antonio Marin-Neto
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Escola de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil (J.A.M-N.)
| | - Artur Santos-Miranda
- Departamento de Fisiologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil (A.S.-M)
| | - Nathan Kong
- Departamento de Biofísica, Escola Paulsita de Medicina, Laboratório de Cardiobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil (D.R-C)
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Escola de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil (J.A.M-N.)
- Departamento de Fisiologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil (A.S.-M)
- Hospital do Coração Anis Rassi, Goiânia, GO, Brazil (A.R.J.)
| | - André D’Avila
- Departamento de Biofísica, Escola Paulsita de Medicina, Laboratório de Cardiobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil (D.R-C)
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Escola de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil (J.A.M-N.)
- Departamento de Fisiologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil (A.S.-M)
- Hospital do Coração Anis Rassi, Goiânia, GO, Brazil (A.R.J.)
| | - Anis Rassi
- Hospital do Coração Anis Rassi, Goiânia, GO, Brazil (A.R.J.)
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9
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Ribeiro AJ, Silva KA, Lopes LDS, Resende CAA, Couto CAP, Gandra IB, Pereira IAG, Barcelos ICDS, Pereira SP, Xavier SR, Tavares GDSV, Machado JM, Da Paz MC, Chávez-Fumagalli MA, Coelho EAF, Giunchetti RC, Chaves AT, Dutra WO, Gonçalves AAM, Galdino AS. The use of peptides for immunodiagnosis of human Chagas disease. Amino Acids 2024; 56:35. [PMID: 38698213 PMCID: PMC11065921 DOI: 10.1007/s00726-024-03394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/10/2024] [Indexed: 05/05/2024]
Abstract
Chagas disease, caused by the protozoa Trypanosoma cruzi, continues to be a serious public health problem in Latin America, worsened by the limitations in its detection. Given the importance of developing new diagnostic methods for this disease, the present review aimed to verify the number of publications dedicated to research on peptides that demonstrate their usefulness in serodiagnosis. To this end, a bibliographic survey was conducted on the PubMed platform using the keyword "peptide" or "epitope" combined with "Chagas disease" or "Trypanosoma cruzi"; "diagno*" or "serodiagnosis" or "immunodiagnosis", without period restriction. An increasing number of publications on studies employing peptides in ELISA and rapid tests assays was verified, which confirms the expansion of research in this field. It is possible to observe that many of the peptides tested so far originate from proteins widely used in the diagnosis of Chagas, and many of them are part of commercial tests developed. In this sense, as expected, promising results were obtained for several peptides when tested in ELISA, as many of them exhibited sensitivity and specificity values above 90%. Furthermore, some peptides have been tested in several studies, confirming their diagnostic potential. Despite the promising results observed, it is possible to emphasize the need for extensive testing of peptides, using different serological panels, in order to confirm their potential. The importance of producing an effective assay capable of detecting the clinical stages of the disease, as well as new immunogenic antigens that enable new serological diagnostic tools for Chagas disease, is evident.
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Affiliation(s)
- Anna Julia Ribeiro
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei, Divinópolis, e Instituto Nacional de Ciência e Tecnologia em Biotecnologia Industrial (INCT-BI), Divinópolis, MG, 35501-296, Brazil
| | - Kamila Alves Silva
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei, Divinópolis, e Instituto Nacional de Ciência e Tecnologia em Biotecnologia Industrial (INCT-BI), Divinópolis, MG, 35501-296, Brazil
| | - Lucas da Silva Lopes
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei, Divinópolis, e Instituto Nacional de Ciência e Tecnologia em Biotecnologia Industrial (INCT-BI), Divinópolis, MG, 35501-296, Brazil
| | - Carlos Ananias Aparecido Resende
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei, Divinópolis, e Instituto Nacional de Ciência e Tecnologia em Biotecnologia Industrial (INCT-BI), Divinópolis, MG, 35501-296, Brazil
| | - Carolina Alves Petit Couto
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei, Divinópolis, e Instituto Nacional de Ciência e Tecnologia em Biotecnologia Industrial (INCT-BI), Divinópolis, MG, 35501-296, Brazil
| | - Isadora Braga Gandra
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei, Divinópolis, e Instituto Nacional de Ciência e Tecnologia em Biotecnologia Industrial (INCT-BI), Divinópolis, MG, 35501-296, Brazil
| | - Isabela Amorim Gonçalves Pereira
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, 30130-100, Brazil
| | - Isabelle Caroline Dos Santos Barcelos
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei, Divinópolis, e Instituto Nacional de Ciência e Tecnologia em Biotecnologia Industrial (INCT-BI), Divinópolis, MG, 35501-296, Brazil
| | - Sabrina Paula Pereira
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei, Divinópolis, e Instituto Nacional de Ciência e Tecnologia em Biotecnologia Industrial (INCT-BI), Divinópolis, MG, 35501-296, Brazil
| | - Sandra Rodrigues Xavier
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei, Divinópolis, e Instituto Nacional de Ciência e Tecnologia em Biotecnologia Industrial (INCT-BI), Divinópolis, MG, 35501-296, Brazil
| | - Grasiele de Sousa Viera Tavares
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, 30130-100, Brazil
| | - Juliana Martins Machado
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei, Divinópolis, e Instituto Nacional de Ciência e Tecnologia em Biotecnologia Industrial (INCT-BI), Divinópolis, MG, 35501-296, Brazil
| | - Mariana Campos Da Paz
- Laboratório de Bioativos e Nanobiotecnologia, Universidade Federal de São João Del-Rei, Divinópolis, MG, 35501-296, Brazil
| | - Miguel Angel Chávez-Fumagalli
- Computational Biology and Chemistry Research Group, Vicerrectorado de Investigación, Universidad Católica de Santa María, Arequipa, 04000, Peru
| | - Eduardo Antonio Ferraz Coelho
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, 30130-100, Brazil
| | - Rodolfo Cordeiro Giunchetti
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, e Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Belo Horizonte, MG, 31270-901, Brazil
| | - Ana Thereza Chaves
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, 30130-100, Brazil
| | - Walderez Ornelas Dutra
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, e Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Belo Horizonte, MG, 31270-901, Brazil
| | - Ana Alice Maia Gonçalves
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei, Divinópolis, e Instituto Nacional de Ciência e Tecnologia em Biotecnologia Industrial (INCT-BI), Divinópolis, MG, 35501-296, Brazil
| | - Alexsandro Sobreira Galdino
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei, Divinópolis, e Instituto Nacional de Ciência e Tecnologia em Biotecnologia Industrial (INCT-BI), Divinópolis, MG, 35501-296, Brazil.
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Rivas-Lasarte M, Ferreira JP. Heart Failure in Brazil and the Need to Measure and Take Action. J Card Fail 2024; 30:651-652. [PMID: 38016621 DOI: 10.1016/j.cardfail.2023.10.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/25/2023] [Indexed: 11/30/2023]
Affiliation(s)
- Mercedes Rivas-Lasarte
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | - João Pedro Ferreira
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal, and Université de Lorraine, Nancy, France
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Gómez-Ochoa SA, Rojas LZ, Hernández-Vargas JA, Trujillo-Cáceres SJ, Hurtado-Ortiz A, Licht-Ardila M, Guarín-Aragón MA, Rochitte CE, Morillo CA, Echeverría LE. Myocardial Fibrosis by Magnetic Resonance and Outcomes in Chagas Disease: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2024; 17:552-555. [PMID: 38127019 DOI: 10.1016/j.jcmg.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
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12
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Colle B, Demeure F, Higny J, Benoit M, Henry JP, Michaux I, Robaye B, Xhaët O, Gabriel L, Guedes A, Blommaert D, Dulieu N, Berners Y, Wery F, Droogmans S, Cosyns B, Luchian ML. Emerging Trends in Left Ventricular Thrombus: A Comprehensive Review of Non-Ischemic and Ischemic Cardiopathies, Including Eosinophilic Myocarditis, Chagas Cardiomyopathy, Amyloidosis, and Innovative Anticoagulant Approaches. Diagnostics (Basel) 2024; 14:948. [PMID: 38732361 PMCID: PMC11083388 DOI: 10.3390/diagnostics14090948] [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: 04/08/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
This comprehensive review explores the intricate aspects of left ventricular thrombus (LVT), a potential complication in both ischemic and non-ischemic cardiomyopathies. It provides a thorough understanding of left ventricular thrombus, revealing its uncommon incidence in the general population (7 cases per 10,000 patients), predominantly linked to ischemic heart diseases (ICMs) at an 80% prevalence rate. Diagnostic tools, notably transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR), demonstrate varying sensitivity but remain indispensable in specific clinical contexts related to LVT as non-invasive diagnostic modalities. A detailed comparison between ICM patients and those with non-ischemic cardiomyopathy (NICM) who have left ventricular thrombus reveals subtle distinctions with significant clinical implications. This analysis underscores the importance of these imaging techniques in distinguishing between the two conditions. Additionally, we explored the occurrence of LVT in specific non-ischemic cardiomyopathies, including Takotsubo syndrome, hypertrophic cardiomyopathy, eosinophilic myocarditis, Chagas disease, cardiac amyloidosis, and several other conditions. The article further delves into anticoagulation strategies, thoroughly examining their impact on LVT regression and patient outcomes. Pharmacological interventions, with a focus on direct oral anticoagulants, emerge as promising alternatives; however, there is insufficient information on their efficiency and safety, especially in NICM population. In conclusion, this review highlights the complex nature of LVT, incorporating a range of etiopathogenic factors, diagnostic complexities, and evolving therapeutic approaches. It emphasizes the pressing need for ongoing research in this field.
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Affiliation(s)
- Benjamin Colle
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Fabian Demeure
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Julien Higny
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Martin Benoit
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Jean-Philippe Henry
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Isabelle Michaux
- Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Benoit Robaye
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Olivier Xhaët
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Laurence Gabriel
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Antoine Guedes
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Dominique Blommaert
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Nathalie Dulieu
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Yannick Berners
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Fabian Wery
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Steven Droogmans
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Maria-Luiza Luchian
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
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Arce-Fonseca M, Mata-Espinosa D, Aranda-Fraustro A, Rosales-Encina JL, Flores-Valdez MA, Rodríguez-Morales O. Mycobacterium bovis BCG as immunostimulating agent prevents the severe form of chronic experimental Chagas disease. Front Immunol 2024; 15:1380049. [PMID: 38576607 PMCID: PMC10991741 DOI: 10.3389/fimmu.2024.1380049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/28/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction There is currently no vaccine against Chagas disease (ChD), and the medications available confer multiple side effects. Mycobacterium bovis Bacillus Calmette-Guérin (BCG) produces balanced Th1, Th2, and Th17 modulatory immune responses and has improved efficacy in controlling chronic infections through nonspecific immunity. We aimed to improve the response to infection by inducing a stronger immune response and greater protection against the parasite by trained immunity. Methods BALB/c mice were immunized with BCG subcutaneously, and 60 days later, they were infected with Trypanosoma cruzi intraperitoneally. An evaluation of the progression of the disease from the acute to the chronic stage, analyzing various aspects such as parasitemia, survival, clinical status, and humoral and cellular immune response, as well as the appearance of visceral megas and the histopathological description of target organs, was performed. Results Vaccination reduced parasitemia by 70%, and 100% survival was achieved in the acute stage; although the presentation of clinical signs was reduced, there was no increase in the antibody titer or in the differential production of the isotypes. Conclusion Serum cytokine production indicated a proinflammatory response in infected animals, while in those who received BCG, the response was balanced by inducing Th1/Th2-type cytokines, with a better prognosis of the disease in the chronic stage.
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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, Mexico City, Mexico
| | - Dulce Mata-Espinosa
- Laboratory of Experimental Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alberto Aranda-Fraustro
- Department of Pathology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - José Luis Rosales-Encina
- Laboratory of Molecular Biology, Department of Infectomics and Molecular Pathogenesis, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Mario Alberto Flores-Valdez
- Biotecnología Médica y Farmacéutica, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco, A. C., Guadalajara, Mexico
| | - Olivia Rodríguez-Morales
- Laboratory of Molecular Immunology and Proteomics, Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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14
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Gómez-Ochoa SA, Serrano-García AY, Hurtado-Ortiz A, Aceros A, Rojas LZ, Echeverría LE. A systematic review and meta-analysis of mortality in chronic Chagas cardiomyopathy versus other cardiomyopathies: higher risk or fiction? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00094-X. [PMID: 38485084 DOI: 10.1016/j.rec.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/28/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION AND OBJECTIVES Although multiple studies suggest that chronic Chagas cardiomyopathy (CCC) has higher mortality than other cardiomyopathies, the absence of meta-analyses supporting this perspective limits the possibility of generating robust conclusions. The aim of this study was to systematically evaluate the current evidence on mortality risk in CCC compared with that of other cardiomyopathies. METHODS PubMed/Medline and EMBASE were searched for studies comparing mortality risk between patients with CCC and those with other cardiomyopathies, including in the latter nonischemic cardiomyopathy (NICM), ischemic cardiomyopathy, and non-Chagas cardiomyopathy (nonCC). A random-effects meta-analysis was performed to combine the effects of the evaluated studies. RESULTS A total of 37 studies evaluating 17 949 patients were included. Patients with CCC had a significantly higher mortality risk compared with patients with NICM (HR, 2.04; 95%CI, 1.60-2.60; I2, 47%; 8 studies) and non-CC (HR, 2.26; 95%CI, 1.65-3.10; I2, 71%; 11 studies), while no significant association was observed compared with patients with ischemic cardiomyopathy (HR, 1.72; 95%CI, 0.80-3.66; I2, 69%; 4 studies) in the adjusted-measures meta-analysis. CONCLUSIONS Patients with CCC have an almost 2-fold increased mortality risk compared with individuals with heart failure secondary to other etiologies. This finding highlights the need for effective public policies and targeted research initiatives to optimally address the challenges of CCC.
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Affiliation(s)
- Sergio A Gómez-Ochoa
- Clínica de Falla Cardiaca y Trasplante Cardiaco, Fundación Cardiovascular de Colombia, Floridablanca, Colombia; Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.
| | | | | | - Andrea Aceros
- Departamento de Administración en Salud, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | - Lyda Z Rojas
- Grupo de Investigación y Desarrollo de Conocimiento en Enfermería (GIDCEN-FCV), Research Center, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | - Luis E Echeverría
- Clínica de Falla Cardiaca y Trasplante Cardiaco, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
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Scanavacca MI, Kulchetscki RM, Rochitte CE, Pisani CF. Cardiac Magnetic Resonance to Evaluate Complete Substrate Elimination after Endocardial Ventricular Tachycardia Ablation in Chagas Disease. Arq Bras Cardiol 2024; 121:e20230421. [PMID: 38422351 PMCID: PMC11098567 DOI: 10.36660/abc.20230421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/14/2023] [Accepted: 10/04/2023] [Indexed: 03/02/2024] Open
Affiliation(s)
- Mauricio I. Scanavacca
- Instituto do Coração do Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Departamento de Arritmia, São Paulo , SP – Brasil
| | - Rodrigo M. Kulchetscki
- Instituto do Coração do Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Departamento de Arritmia, São Paulo , SP – Brasil
| | - Carlos E. Rochitte
- Instituto do Coração do Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Departamento de Imagem Cardiovascular, São Paulo , SP – Brasil
| | - Cristiano F. Pisani
- Instituto do Coração do Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Departamento de Arritmia, São Paulo , SP – Brasil
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16
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Souza-Silva TG, Neves EGA, Koh C, Teixeira-Carvalho A, Araújo SS, Nunes MDCP, Gomes JDAS, Gollob KJ, Dutra WO. Correlation of blood-based immune molecules with cardiac gene expression profiles reveals insights into Chagas cardiomyopathy pathogenesis. Front Immunol 2024; 15:1338582. [PMID: 38390336 PMCID: PMC10882095 DOI: 10.3389/fimmu.2024.1338582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Understanding compartmentalized immune responses in target organs is crucial for elucidating the pathogenesis of various diseases. However, obtaining samples from affected vital organs often poses safety challenges. In this study, we aimed to investigate potential correlations between the levels of disease-associated immune molecules in the bloodstream with their gene expression profiles in the hearts of patients suffering from Chagas Cardiomyopathy (CCC). This debilitating and often fatal condition is caused by infection with the protozoan Trypanosoma cruzi. Methods Blood samples were analyzed using the Bio-Plex platform. Gene Expression Omnibus (GEO) database was used to determine gene expression profile in heart tissue from CCC and non-Chagas controls (CTRL). Results Elevated levels of inflammatory cytokines were detected in the plasma of CCC patients, and these levels correlated with clinical indicators of deteriorating cardiac function. Notably, 75% of the soluble factors assessed in the plasma exhibited a consistent relationship with their gene expression levels in the cardiac tissue of CCC patients. Analysis of interactions and signaling pathways related to these molecules revealed an overrepresentation of inflammatory pathways in both blood and heart compartments. Moreover, we identified that differentially expressed genes in CCC cardiac tissue were primarily associated with T-cell signaling pathways and correlated with the presence of CD8+ T cells in the myocardium. Discussion Our findings establish a strong correlation between relevant immune molecules and their signaling pathways in both the blood and heart tissue in CCC. This validates the use of blood as a non-invasive medium for understanding immunopathology and identifying markers for cardiac dysfunction in Chagas disease.
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Affiliation(s)
- Thaiany G. Souza-Silva
- Laboratório Biologia das Interações Celulares, Departament de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Eula G. A. Neves
- Laboratório Biologia das Interações Celulares, Departament de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carolina Koh
- Laboratório Biologia das Interações Celulares, Departament de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Silvana Silva Araújo
- Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Juliana de Assis Silva Gomes
- Laboratório Biologia das Interações Celulares, Departament de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Kenneth J. Gollob
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Instituto Nacional de Ciências e Tecnologia em Doenças Tropicais, Belo Horizonte, Brazil
| | - Walderez Ornelas Dutra
- Laboratório Biologia das Interações Celulares, Departament de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Instituto Nacional de Ciências e Tecnologia em Doenças Tropicais, Belo Horizonte, Brazil
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Nascimento BR, Naback ADN, Santos BMP, Geissbühler Y, Demacq C, Quijano M, Perel PA, Molina I, Machado IE, Cousin E, Mosser JF, Carvalho PEDP, Martins-Melo FR, Ribeiro ALP. Prevalence of clinical forms of Chagas disease: a systematic review and meta-analysis - data from the RAISE study. LANCET REGIONAL HEALTH. AMERICAS 2024; 30:100681. [PMID: 38327279 PMCID: PMC10847770 DOI: 10.1016/j.lana.2024.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/27/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024]
Abstract
Background There is a lack of up-to-date estimates about the prevalence of Chagas disease (ChD) clinical presentations and, therefore, we aimed to assess the prevalence of clinical forms of ChD among seropositive adults, pooling available data. Methods A systematic review was conducted in Medline, Embase, Biblioteca Virtual em Saúde and Cochrane databases looking for studies published from 1990 to August 2023, which investigated the prevalence of ChD clinical forms among seropositive adults, including: (i) indeterminate phase, (ii) chronic Chagas cardiomyopathy (CCM), (iii) digestive and (iv) mixed (CCM + digestive) forms. Pooled estimates and 95% confidence intervals (CI) were calculated using random-effects models. Studies quality and risk of bias was assessed with the Leboeuf-Yde and Lauritsen tool. Heterogeneity was assessed with the I2 statistic. The study was registered in the PROSPERO database (CRD42022354237). Findings 1246 articles were selected for screening and 73 studies were included in the final analysis (17,132 patients, 44% men). Most studies were conducted with outpatients (n = 50), followed by population-based studies (n = 15). The pooled prevalence of the ChD clinical forms was: indeterminate 42.6% (95% CI: 36.9-48.6), CCM 42.7% (95% CI: 37.3-48.3), digestive 17.7% (95% CI: 14.9-20.9), and mixed 10.2% (95% CI: 7.9-13.2). In population-based studies, prevalence was lower for CCM (31.2%, 95% CI: 24.4-38.9) and higher for indeterminate (47.2%, 95% CI: 39.0-55.5) form. In meta-regression, age was inversely associated with the prevalence of indeterminate (β = -0.05, P < 0.001) form, and directly associated with CCM (β = 0.06, P < 0.001) and digestive (β = 0.02, P < 0.001) forms. Heterogeneity was overall high. Interpretation Compared to previous publications, our pooled estimates show a higher prevalence of CCM among ChD seropositive patients, but similar rates of the digestive form. Funding This study was funded by the World Heart Federation, through a research collaboration with Novartis Pharma AG.
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Affiliation(s)
- Bruno Ramos Nascimento
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Serviço de Hemodinâmica, Hospital Madre Teresa, Belo Horizonte, MG, Brazil
| | - André Dias Nassar Naback
- Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | | | | | - Israel Molina
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Isis Eloah Machado
- Departamento de Medicina de Família, Saúde Mental e Coletiva, Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil
| | - Ewerton Cousin
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Jonathan F. Mosser
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | | | | | - Antonio Luiz Pinho Ribeiro
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - RAISE investigators
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Serviço de Hemodinâmica, Hospital Madre Teresa, Belo Horizonte, MG, Brazil
- Curso de Medicina, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
- World Heart Federation, Geneva, Switzerland
- Novartis Pharma AG, Basel, Switzerland
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Departamento de Medicina de Família, Saúde Mental e Coletiva, Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
- Universidade Federal do Ceará, Fortaleza, CE, Brazil
- Federal Institute of Education, Science and Technology of Ceará, Fortaleza, Brazil
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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18
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Torres DJL, Dos Santos Oliveira KK, da Silva Barros M, Moreira LR, de Freitas Firmino L, da Piedade Costa Reis de Albuquerque M, da Glória Aureliano Melo Cavalcante M, Martins SM, de Oliveira Junior WA, da Silva Rabello MC, de Lorena VMB. TNF blockers alone and associated with Benznidazole impact in vitro cytokine dynamics in chronic Chagas disease. Parasite Immunol 2024; 46:e13024. [PMID: 38385576 DOI: 10.1111/pim.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/23/2024]
Abstract
Studies involving the immune response in Chagas disease suggest an imbalance in the immune response of symptomatic patients, with an inflammatory profile dominating in Chagas heart disease, mainly by tumour necrosis factor (TNF). TNF is considered a key cytokine in immunopathology in chronic carriers in several processes during the immune response. Our work aimed to evaluate regulatory (interleukin [IL]-4 and IL-10) and inflammatory (TNF, interferon-gamma [IFN-γ], IL-2 and IL-6) cytokines in peripheral blood mononuclear cells culture supernatants. of affected patients with undetermined clinical forms-IND (n = 13) mild heart form-CARD1 (n = 13) and severe cardiac form-CARD2 (n = 16), treated in vitro with two TNF blockers, Adalimumab (ADA) and Etanercept (ETA) alone or in association with Benznidazole (BZ). The results indicate that ADA was more competent in blocking TNF (compared to ETA) in all groups but with much lower levels in the CARD2 group. ETA statistically decreased TNF levels only in the CARD2 group. IFN-γ increased in the CARD2 group after treatment with ETA relative to ADA. IL-4 had its levels decreased when treated by both drugs. IL-2 was detected in cells from CARD2 carriers compared to the NEG group after treatment with both drugs. The association with BZ decreased levels of IL-2/TNF and increased IL-4. These data reinforce the participation of TNF in severe Chagas heart disease and bring perspectives on using these blockers in the immunological treatment of Chagas disease since the use of BZ is extremely limited in these patients.
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Affiliation(s)
- Diego José Lira Torres
- Universidade Federal de Pernambuco-UFPE, Recife, Pernambuco, Brazil
- Instituto Aggeu Magalhães-IAM/Fiocruz, Recife, Pernambuco, Brazil
| | - Kamila Kássia Dos Santos Oliveira
- Universidade Federal de Pernambuco-UFPE, Recife, Pernambuco, Brazil
- Instituto Aggeu Magalhães-IAM/Fiocruz, Recife, Pernambuco, Brazil
| | - Michelle da Silva Barros
- Universidade Federal de Pernambuco-UFPE, Recife, Pernambuco, Brazil
- Instituto Aggeu Magalhães-IAM/Fiocruz, Recife, Pernambuco, Brazil
| | - Leyllane Rafael Moreira
- Universidade Federal de Pernambuco-UFPE, Recife, Pernambuco, Brazil
- Instituto Aggeu Magalhães-IAM/Fiocruz, Recife, Pernambuco, Brazil
| | - Luciane de Freitas Firmino
- Universidade Federal de Pernambuco-UFPE, Recife, Pernambuco, Brazil
- Instituto Aggeu Magalhães-IAM/Fiocruz, Recife, Pernambuco, Brazil
| | | | | | - Sílvia Marinho Martins
- Ambulatório De Doença De Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico De Pernambuco, Recife, Pernambuco, Brazil
| | - Wilson Alves de Oliveira Junior
- Ambulatório De Doença De Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico De Pernambuco, Recife, Pernambuco, Brazil
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19
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Pedrosa RC, Paulo do Vale Madeiro J, Alberto AC, Limeira GA, de Bragança Pereira B, Matos do Nascimento E, Schlindwein FS, Ng GA. Risk stratifier for sudden cardiac death beyond the left ventricular ejection fraction in Chagas cardiomyopathy. Pacing Clin Electrophysiol 2024; 47:312-320. [PMID: 38140904 DOI: 10.1111/pace.14908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/18/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) risk markers are needed in Chagas cardiomyopathy (CC). Action potential duration restitution (APDR) dynamics is capable of extracting information on cardiac regional heterogeneity. This study intends to develop a patient-specific variables-based algorithm to predict SCD in the low-intermediate subgroups of the Rassi risk score. METHODS Cross-sectional study of patients who underwent 24-h Holter for research purposes between January 1992 and February 2017. From 4-h ECG segment, RR series were generated and APDR dynamics metrics were calculated. Classification tree and sensitivity analysis were applied. As outcomes, SCD, SCD-free and non-cardiovascular death and 34 variables were included. RESULTS Two hundred twenty-one (129 in the group SCD-free, 80 in the SCD group and 12 non-cardiovascular death group) were analyzed. In the groups with and without SCD (209 patients), the median age was 66 years, 52% were female, the cardiac involvement was mild to moderate in 72% with a Rassi point median of 8 (IQ: 3 to 11). The SCD group had more ventricular remodeling and more ventricular electrical instability. The occurrence of a %beats QTend/TendQ ratio > 1 (AUC, 0.96 (95% CI 0.89-0.98) present in more than 56.7% of the 4-h ECG segments was sufficient to identify patients of the SCD subgroup. Variables representing different stages of CC were also relevant in the model. CONCLUSION It is possible to use APDR dynamics as an adjuvant in the SCD risk assessment in a subgroup of patients with a high risk of SCD and a very low risk of non-CV death with high power of discrimination.
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Affiliation(s)
- Roberto Coury Pedrosa
- Cardiology Department, Clementino Fraga Filho University Hospital/Edson Saad Heart Institute-Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Alex C Alberto
- Federal Centre for Technological Education Celso Suckow da Fonseca, Rio de Janeiro, Brazil
| | | | - Basílio de Bragança Pereira
- Federal University of Rio de Janeiro, School of Medicine and Edson Saad Heart Institute, Rio de Janeiro, Brazil
| | | | - Fernando Soares Schlindwein
- University of Leicester, School of Engineering, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Gullien André Ng
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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20
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Gómez-Ochoa SA, Rojas LZ, Echeverría LE. Winding Down the Storm: Could Empagliflozin's Ion-Dependent Mechanisms Tackle the Ventricular Arrhythmia Burden in Chronic Chagas Cardiomyopathy? Cardiovasc Drugs Ther 2024; 38:203-205. [PMID: 37843718 DOI: 10.1007/s10557-023-07510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Sergio Alejandro Gómez-Ochoa
- Heart Failure and Transplant Clinic, Fundación Cardiovascular de Colombia, Calle 155A # 23-58 Urbanización El Bosque, PO. Box 681001, Floridablanca, Colombia
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Lyda Z Rojas
- Research Group and Development of Nursing Knowledge (GIDCEN-FCV), Research Center, Fundación Cardiovascular de Colombia, Calle 155A # 23-58 Urbanización El Bosque, PO. Box 681001, Floridablanca, Colombia
| | - Luis Eduardo Echeverría
- Heart Failure and Transplant Clinic, Fundación Cardiovascular de Colombia, Calle 155A # 23-58 Urbanización El Bosque, PO. Box 681001, Floridablanca, Colombia.
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21
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de Sousa AS, Vermeij D, Ramos AN, Luquetti AO. Chagas disease. Lancet 2024; 403:203-218. [PMID: 38071985 DOI: 10.1016/s0140-6736(23)01787-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 01/15/2024]
Abstract
Chagas disease persists as a global public health problem due to the high morbidity and mortality burden. Despite the possibility of a cure and advances in transmission control, epidemiological transformations, such as urbanisation and globalisation, and the emerging importance of oral and vertical transmission mean that Chagas disease should be considered an emerging disease, with new cases occurring worldwide. Important barriers to diagnosis, treatment, and care remain, resulting in repressed numbers of reported cases, which in turn leads to inadequate public policies. The validation of new diagnostic tools and treatment options is needed, as existing tools pose serious limitations to access to health care. Integrated models of surveillance, with community and intersectional participation, embedded in the concept of One Health, are essential for control. In addition, mitigation strategies for the main social determinants of health, including difficulties imposed by migration, are important to improve access to comprehensive health care in a globalised scenario.
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Affiliation(s)
- Andréa Silvestre de Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Debbie Vermeij
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Alberto Novaes Ramos
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Alejandro O Luquetti
- Center of Studies for Chagas Disease, Hospital das Clínicas, Federal University of Goiás, Goiânia, Brazil
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22
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Kelly EA, Echeverri Alegre JI, Promer K, Hayon J, Iordanov R, Rangwalla K, Zhang JJ, Fang Z, Huang C, Bittencourt CE, Reed S, Andrade RM, Bern C, Clark EH, Whitman JD. Chagas Disease Diagnostic Practices at Four Major Hospital Systems in California and Texas. J Infect Dis 2024; 229:198-202. [PMID: 37853514 PMCID: PMC11032249 DOI: 10.1093/infdis/jiad404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Chagas disease (CD) is a parasitic disease that affects ∼300 000 people living in the United States. CD leads to cardiac and/or gastrointestinal disease in up to 30% of untreated people. However, end-organ damage can be prevented with early diagnosis and antiparasitic therapy. METHODS We reviewed electronic health records of patients who underwent testing for CD at four hospital systems in California and Texas between 2016 and 2020. Descriptive analyses were performed as a needs assessment for improving CD diagnosis. RESULTS In total, 470 patients were tested for CD. Cardiac indications made up more than half (60%) of all testing, and the most frequently cited cardiac condition was heart failure. Fewer than 1% of tests were ordered by obstetric and gynecologic services. Fewer than half (47%) of patients had confirmatory testing performed at the Centers for Disease Control and Prevention. DISCUSSION Four major hospitals systems in California and Texas demonstrated low overall rates of CD diagnostic testing, testing primarily among older patients with end-organ damage, and incomplete confirmatory testing. This suggests missed opportunities to diagnose CD in at-risk individuals early in the course of infection when antiparasitic treatment can reduce the risk of disease progression and prevent vertical transmission.
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Affiliation(s)
- Emily A Kelly
- Department of Laboratory Medicine, University of California, SanFrancisco, San Francisco, California, USA
| | | | - Katherine Promer
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, California, USA
| | - Jesica Hayon
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Roumen Iordanov
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Khuzaima Rangwalla
- School of Medicine, University of California, SanFrancisco, San Francisco, California, USA
| | - Jerry J Zhang
- School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | - Zian Fang
- School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | - Cindy Huang
- School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | | | - Sharon Reed
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, California, USA
- Department of Pathology, University of California, San Diego, San Diego, California, USA
| | - Rosa M Andrade
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, California, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Eva H Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Jeffrey D Whitman
- Department of Laboratory Medicine, University of California, SanFrancisco, San Francisco, California, USA
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23
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Moraes DN, Nascimento BR, Lima-Costa MF, Soares CPM, Ribeiro ALP. Vagal dysautonomia in patients with Chagas disease and mortality: 14-year results of a population cohort of the elderly. J Electrocardiol 2024; 82:1-6. [PMID: 37979240 DOI: 10.1016/j.jelectrocard.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Great part of Chagas disease (ChD) mortality occurs due to ventricular arrhythmias, and autonomic function (AF) may predict unfavorable outcomes. We aimed to evaluate the predictive value of AF indexes in ChD patients. METHODS The Bambuí Study of Aging is a prospective cohort of residents ≥60 years at study onset (1997), in the southeastern Brazilian city of Bambuí (15,000 inhabitants). Consented participants underwent annual follow-up visits, and death certificates were tracked. AF was assessed by the maximum expiration on minimum inspiration (E:I) ratio during ECG acquisition and by heart rate variability indices: SDRR (standard deviation of adjacent RR intervals) and RMSSD (square root of the mean of the sum of squares of the differences between adjacent RR intervals)), calculated using a computer algorithm. Cox proportional hazards regression was performed to access the prognostic value of AF indexes, expressed as terciles, for all-cause mortality, after adjustment for demographic, clinical and ECG variables. RESULTS From 1742 qualifying residents, 1000 had valid AF tests, being 321 with ChD. Among these, median age was 68 (64-74) years, and 32.5% were men. In Cox survival analyses, only SDRR was associated with all-cause mortality in non-adjusted models: SDRR (hazard ratio (HR): 1.26 (95% CI 1.08-1.47), p < 0.001), E:I ratio (HR: 1.13 (95% CI 0,98-1.31), p = 0.10) and RMSSD (HR: 0.99 (0.86-1.16), p = 0.95). After adjustment for sex and age, none of the indexes remained as independent predictors. CONCLUSION Among elderly patients with ChD, AF indexes available in this cohort were not independent predictors of 14-year mortality.
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Affiliation(s)
- Diego N Moraes
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil
| | - Bruno R Nascimento
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Serviço de Hemodinâmica, Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
| | | | - Carla Paula M Soares
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil
| | - Antonio Luiz P Ribeiro
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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24
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Antonietti L, Mariani J, Martínez MJ, Santalla M, Vensentini N, Kyle DA, de Abreu M, Tajer C, Lacunza E, Ferrero P. Circulating microRNAs as biomarkers of Chagas cardiomyopathy. Front Cardiovasc Med 2023; 10:1250029. [PMID: 38173812 PMCID: PMC10762800 DOI: 10.3389/fcvm.2023.1250029] [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: 06/29/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background Chagas cardiomyopathy (CHCM) is the most important clinical manifestation of Chagas disease. The analysis of cardiac miRNAs may contribute to predicting the progression to CHCM in Chagas indeterminate phase and/or to the differential diagnosis for cardiomyopathy. Methods We carried out a case-control study to identify circulating miRNAs associated with CHCM. We assigned 104 participants to four groups: healthy controls (HC), Chagas non-cardiomyopathy controls, CHCM cases, and ischemic cardiomyopathy controls. We performed a clinical, echocardiographic, and laboratory evaluation and profiled circulating miRNA in the serum samples. Results Differences between groups were observed in clinical variables and in the analysis of miRNAs. Compared to HC, CHCM participants had 4 over-expressed and 6 under-expressed miRNAs; miR-95-3p and miR-130b-3p were upregulated in CHCM compared with controls, Chagas non-cardiomyopathy and ischemic cardiomyopathy participants, suggesting that might be a hallmark of CHCM. Analysis of gene targets associated with cardiac injury yielded results of genes involved in arrhythmia generation, cardiomegaly, and hypertrophy. Conclusions Our data suggest that the expression of circulating miRNAs identified by deep sequencing in CHCM could be associated with different cardiac phenotypes in CHCM subjects, compared with Chagas non-CHCM, ischemic cardiomyopathy controls, and healthy controls.
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Affiliation(s)
- Laura Antonietti
- Department of Cardiology, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina
- Health Sciences Institute, Arturo Jauretche National University, Florencio Varela, Buenos Aires, Argentina
| | - Javier Mariani
- Department of Cardiology, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina
- Health Sciences Institute, Arturo Jauretche National University, Florencio Varela, Buenos Aires, Argentina
| | - María Jose Martínez
- Department of Cardiology, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina
| | - Manuela Santalla
- Cardiovascular Research Center Dr. Horacio Cingolani, Faculty of Medical Sciences, La Plata National University, La Plata, Buenos Aires, Argentina
| | - Natalia Vensentini
- Department of Cardiology, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina
| | - Diego Alfredo Kyle
- Department of Cardiology, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina
| | - Maximiliano de Abreu
- Department of Cardiology, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina
- Health Sciences Institute, Arturo Jauretche National University, Florencio Varela, Buenos Aires, Argentina
| | - Carlos Tajer
- Department of Cardiology, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina
- Health Sciences Institute, Arturo Jauretche National University, Florencio Varela, Buenos Aires, Argentina
| | - Ezequiel Lacunza
- Basic and Applied Inmunological Research, Faculty of Medical Sciences, La Plata National University, La Plata, Buenos Aires, Argentina
| | - Paola Ferrero
- Cardiovascular Research Center Dr. Horacio Cingolani, Faculty of Medical Sciences, La Plata National University, La Plata, Buenos Aires, Argentina
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Rios LE, Lokugamage N, Choudhuri S, Chowdhury IH, Garg NJ. Subunit nanovaccine elicited T cell functional activation controls Trypanosoma cruzi mediated maternal and placental tissue damage and improves pregnancy outcomes in mice. NPJ Vaccines 2023; 8:188. [PMID: 38104118 PMCID: PMC10725459 DOI: 10.1038/s41541-023-00782-z] [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: 07/05/2023] [Accepted: 11/10/2023] [Indexed: 12/19/2023] Open
Abstract
This study investigated a candidate vaccine effect against maternal Trypanosoma cruzi (Tc) infection and improved pregnancy outcomes. For this, TcG2 and TcG4 were cloned in a nanoplasmid optimized for delivery, antigen expression, and regulatory compliance (nano2/4 vaccine). Female C57BL/6 mice were immunized with nano2/4, infected (Tc SylvioX10), and mated 7-days post-infection to enable fetal development during the maternal acute parasitemia phase. Females were euthanized at E12-E17 (gestation) days. Splenic and placental T-cell responses were monitored by flow cytometry. Maternal and placental/fetal tissues were examined for parasites by qPCR and inflammatory infiltrate by histology. Controls included age/immunization-matched non-pregnant females. Nano2/4 exhibited no toxicity and elicited protective IgG2a/IgG1 response in mice. Nano2/4 signaled a splenic expansion of functionally active CD4+ effector/effector memory (Tem) and central memory (Tcm) cells in pregnant mice. Upon challenge infection, nano2/4 increased the splenic CD4+ and CD8+T cells in all mice and increased the proliferation of CD4+Tem, CD4+Tcm, and CD8+Tcm subsets producing IFNγ and cytolytic molecules (PRF1, GZB) in pregnant mice. A balanced serum cytokines/chemokines response and placental immune characteristics indicated that pregnancy prevented the overwhelming damaging immune response in mice. Importantly, pregnancy itself resulted in a significant reduction of parasites in maternal and fetal tissues. Nano2/4 was effective in arresting the Tc-induced tissue inflammatory infiltrate, necrosis, and fibrosis in maternal and placental tissues and improving maternal fertility, placental efficiency, and fetal survival. In conclusion, we show that maternal nano2/4 vaccination is beneficial in controlling the adverse effects of Tc infection on maternal health, fetal survival, and pregnancy outcomes.
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Affiliation(s)
- Lizette Elaine Rios
- Department of Microbiology and Immunology, University of Texas Medical Branch (UTMB), Galveston, TX, USA
- Department of Biochemistry and Molecular Biology, UTMB, Galveston, TX, USA
| | - Nandadeva Lokugamage
- Department of Microbiology and Immunology, University of Texas Medical Branch (UTMB), Galveston, TX, USA
| | - Subhadip Choudhuri
- Department of Microbiology and Immunology, University of Texas Medical Branch (UTMB), Galveston, TX, USA
| | - Imran Hussain Chowdhury
- Department of Microbiology and Immunology, University of Texas Medical Branch (UTMB), Galveston, TX, USA
| | - Nisha Jain Garg
- Department of Microbiology and Immunology, University of Texas Medical Branch (UTMB), Galveston, TX, USA.
- Institute for Human Infections and Immunity (IHII), UTMB, Galveston, TX, USA.
- Sealy Institute for Vaccine Sciences (SIVS), UTMB, Galveston, TX, USA.
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Ferri G, Fernández LR, Di Mario G, Musikant D, Palermo JA, Edreira MM. Host cell cAMP-Epac-Rap1b pathway inhibition by hawthorn extract as a potential target against Trypanosoma cruzi infection. Front Microbiol 2023; 14:1301862. [PMID: 38156015 PMCID: PMC10754523 DOI: 10.3389/fmicb.2023.1301862] [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: 09/25/2023] [Accepted: 11/16/2023] [Indexed: 12/30/2023] Open
Abstract
Although the two drugs currently available for the treatment of Chagas disease, Benznidazole and Nifurtimox, have proven to be effective in the acute phase of the disease, the 60-90-day treatment leads to high toxicity and unwanted side effects, presenting, in addition, a low efficacy in the chronic phase of the disease. For this reason, new therapies that are more effective are needed. In this regard, we have recently shown that the inhibition of the Epac-Rap1b pathway suppressed the cAMP-mediated host cell invasion by Trypanosoma cruzi. Interestingly, it has been described that vitexin, a natural flavone that protects against ischemia-reperfusion damage, acts by inhibiting the expression of Epac and Rap1 proteins. Vitexin can be found in plants of the genus Crataegus spp., traditionally known as hawthorn, which are of great interest considering their highly documented use as cardio-protectors. Pre-treating cells with an extract of Crataegus oxyacantha produced levels of T. cruzi invasion comparable to the ones observed for the commercially available Epac1-specific inhibitor, ESI-09. In addition, extract-treated cells exhibited a decrease in the activation of Rap1b, suggesting that the effects of the extract would be mediated by the inhibition of the cAMP-Epac-Rap1 signaling pathway. Using HPLC-HRMS2, we could confirm the presence of vitexin, and other flavones that could act as inhibitors of Epac/Rap1b, in the extracts of C. oxyacantha. Most significantly, when cells were treated with the extract of C. oxyacantha in conjunction with Nifurtimox, an increased modulation of invasion was observed.
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Affiliation(s)
- Gabriel Ferri
- CONICET-Universidad de Buenos Aires, IQUIBICEN, Ciudad de Buenos Aires, Argentina
- Laboratorio de Biología Molecular de Trypanosomas, Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos, Ciudad de Buenos Aires, Argentina
| | - Lucía R. Fernández
- Laboratorio de Biología Molecular de Trypanosomas, Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos, Ciudad de Buenos Aires, Argentina
- Departamento de Química Orgánica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
- Unidad de Microanálisis y Métodos Físicos Aplicados a la Química Orgánica (UMYMFOR), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Di Mario
- CONICET-Universidad de Buenos Aires, IQUIBICEN, Ciudad de Buenos Aires, Argentina
- Laboratorio de Biología Molecular de Trypanosomas, Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos, Ciudad de Buenos Aires, Argentina
| | - Daniel Musikant
- CONICET-Universidad de Buenos Aires, IQUIBICEN, Ciudad de Buenos Aires, Argentina
- Laboratorio de Biología Molecular de Trypanosomas, Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos, Ciudad de Buenos Aires, Argentina
| | - Jorge A. Palermo
- Departamento de Química Orgánica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
- Unidad de Microanálisis y Métodos Físicos Aplicados a la Química Orgánica (UMYMFOR), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Martin M. Edreira
- CONICET-Universidad de Buenos Aires, IQUIBICEN, Ciudad de Buenos Aires, Argentina
- Laboratorio de Biología Molecular de Trypanosomas, Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos, Ciudad de Buenos Aires, Argentina
- Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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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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Santos EF, Daltro RT, Regis-Silva CG, Pavan TBS, de Oliveira FA, da Silva ÂM, Almeida RP, Gonçalves NLS, Sampaio DD, Santos FN, Marchini FK, Celedon PAF, Zanchin NIT, Santos FLN. Assessment of Cross-Reactivity of Chimeric Trypanosoma cruzi Antigens with Crithidia sp. LVH-60A: Implications for Accurate Diagnostics. Diagnostics (Basel) 2023; 13:3470. [PMID: 37998606 PMCID: PMC10670697 DOI: 10.3390/diagnostics13223470] [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: 10/09/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
This study focuses on developing accurate immunoassays for diagnosing Chagas disease (CD), a challenging task due to antigenic similarities between Trypanosoma cruzi and other parasites, leading to cross-reactivity. To address this challenge, chimeric recombinant T. cruzi antigens (IBMP-8.1, IBMP-8.2, IBMP-8.3, and IBMP-8.4) were synthesized to enhance specificity and reduce cross-reactivity in tests. While these antigens showed minimal cross-reactivity with leishmaniasis, their performance with other trypanosomatid infections was unclear. This study aimed to assess the diagnostic potential of these IBMP antigens for detecting CD in patients with Crithidia sp. LVH-60A, a parasite linked to visceral leishmaniasis-like symptoms in Brazil. This study involved seven Crithidia sp. LVH-60A patients and three Leishmania infantum patients. The results indicated that these IBMP antigens displayed 100% sensitivity, with specificity ranging from 87.5% to 100%, and accuracy values between 90% and 100%. No cross-reactivity was observed with Crithidia sp. LVH-60A, and only one L. infantum-positive sample showed limited cross-reactivity with IBMP-8.1. This study suggests that IBMP antigens offer promising diagnostic performance, with minimal cross-reactivity in regions where T. cruzi and other trypanosomatids are prevalent. However, further research with a larger number of Crithidia sp. LVH-60A-positive samples is needed to comprehensively evaluate antigen cross-reactivity.
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Affiliation(s)
- Emily F. Santos
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (Fiocruz-BA), Salvador 40296-710, BA, Brazil; (E.F.S.); (C.G.R.-S.); (T.B.S.P.); (N.L.S.G.)
| | - Ramona T. Daltro
- Integrated Translational Program in Chagas Disease from Fiocruz (Fio-Chagas), Oswaldo Cruz Foundation (Fiocruz-RJ), Rio de Janeiro 21040-360, RJ, Brazil; (R.T.D.); (N.I.T.Z.)
| | - Carlos G. Regis-Silva
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (Fiocruz-BA), Salvador 40296-710, BA, Brazil; (E.F.S.); (C.G.R.-S.); (T.B.S.P.); (N.L.S.G.)
- Integrated Translational Program in Chagas Disease from Fiocruz (Fio-Chagas), Oswaldo Cruz Foundation (Fiocruz-RJ), Rio de Janeiro 21040-360, RJ, Brazil; (R.T.D.); (N.I.T.Z.)
| | - Tycha B. S. Pavan
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (Fiocruz-BA), Salvador 40296-710, BA, Brazil; (E.F.S.); (C.G.R.-S.); (T.B.S.P.); (N.L.S.G.)
| | - Fabrícia A. de Oliveira
- Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Aracaju 49060-676, SE, Brazil; (F.A.d.O.); (Â.M.d.S.); (R.P.A.)
| | - Ângela M. da Silva
- Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Aracaju 49060-676, SE, Brazil; (F.A.d.O.); (Â.M.d.S.); (R.P.A.)
- Department of Medicine, University Hospital (BSERH), Federal University of Sergipe, Aracaju 49060-676, SE, Brazil
| | - Roque P. Almeida
- Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Aracaju 49060-676, SE, Brazil; (F.A.d.O.); (Â.M.d.S.); (R.P.A.)
- Department of Medicine, University Hospital (BSERH), Federal University of Sergipe, Aracaju 49060-676, SE, Brazil
| | - Noilson L. S. Gonçalves
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (Fiocruz-BA), Salvador 40296-710, BA, Brazil; (E.F.S.); (C.G.R.-S.); (T.B.S.P.); (N.L.S.G.)
| | - Daniel D. Sampaio
- Brazil’s Family Health Strategy, Municipal Health Department, Tremedal City Hall, Tremedal 45170-000, BA, Brazil;
| | - Faber N. Santos
- Faculty of Medicine, Santo Agostinho College (FASA), Education Technology Healthcare, Vitória da Conquista 45028-100, BA, Brazil;
| | - Fabricio K. Marchini
- Molecular Biology Institute of Paraná, Curitiba 81350-010, PR, Brazil;
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute (ICC), Oswaldo Cruz Foundation (Fiocruz-PR), Curitiba 81350-010, PR, Brazil
| | - Paola A. F. Celedon
- Laboratory of Molecular and Systems Biology of Trypanosomatids, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz-PR), Curitiba 81350-010, PR, Brazil;
| | - Nilson I. T. Zanchin
- Integrated Translational Program in Chagas Disease from Fiocruz (Fio-Chagas), Oswaldo Cruz Foundation (Fiocruz-RJ), Rio de Janeiro 21040-360, RJ, Brazil; (R.T.D.); (N.I.T.Z.)
- Structural Biology and Protein Engineering Laboratory, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz-PR), Curitiba 81350-010, PR, Brazil
| | - Fred L. N. Santos
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (Fiocruz-BA), Salvador 40296-710, BA, Brazil; (E.F.S.); (C.G.R.-S.); (T.B.S.P.); (N.L.S.G.)
- Integrated Translational Program in Chagas Disease from Fiocruz (Fio-Chagas), Oswaldo Cruz Foundation (Fiocruz-RJ), Rio de Janeiro 21040-360, RJ, Brazil; (R.T.D.); (N.I.T.Z.)
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Vianna MVA, Ávila MR, Figueiredo PHS, Lima VP, Carvalho LMS, da Cruz Ferreira PH, de Oliveira LFF, Silva WT, de Almeida ILGI, Lacerda ACR, Mendonça VA, de Castro Faria SC, Mediano MFF, da Costa Rocha MO, Costa HS. Functional predictors of poor outcomes in Chagas cardiomyopathy: The value of end-tidal carbon dioxide at peak exercise. Heart Lung 2023; 62:152-156. [PMID: 37531867 DOI: 10.1016/j.hrtlng.2023.07.010] [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: 05/31/2023] [Revised: 07/07/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Functional impairment can be detected from the onset of heart disease in patients with Chagas cardiomyopathy (ChC) and the prognostic value of the end-tidal carbon dioxide at peak exercise (PETCO2 peak) should be investigated. OBJECTIVE To verify the prognostic value of PETCO2 peak in patients with ChC. METHODS Seventy-six patients with ChC (49.2 ± 9.8 years, NYHA I-III) were evaluated by echocardiography and Cardiopulmonary Exercise Testing. Patients were followed up to four years and the end-point was defined as cardiovascular death, stroke, or cardiac transplantation. RESULTS At the end of the follow-up period (29.0 ± 16.0 months), 16 patients (21%) had experienced adverse events. The area under the receiver operating characteristic (ROC) curve to identify the risk of adverse events by PETCO2 peak in patients with ChC was 0.83 (95% CI: 0.69 to 0.97), and the value of 32 mmHg was the optimal cut point (70% of sensitivity and 85% of specificity). In the Kaplan-Meier diagram, there was a significant difference (p<0.001) between patients with reduced (≤ 32 mmHg) and preserved PETCO2 peak (>32 mmHg). In the final Cox multivariate model, only reduced PETCO2 peak (HR 4.435; 95% CI: 1.228 to 16.016, p = 0.023) and VO2peak (HR 0.869; 95% CI: 0.778 to 0.971, p = 0.013) remained as independent predictors of poor outcome in ChC patients. CONCLUSION Reduced PETCO2 peak and VO2peak demonstrated valuable prognostic value in patients with ChC. The cutoff points for both functional variables can be used during risk stratification and may help in the development of therapeutic strategies in ChC patients.
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Affiliation(s)
- Marcus Vinícius Accetta Vianna
- Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil; Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Matheus Ribeiro Ávila
- Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Pedro Henrique Scheidt Figueiredo
- Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Vanessa Pereira Lima
- Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Liliany Mara Silva Carvalho
- Postgraduate Course of Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Paulo Henrique da Cruz Ferreira
- Postgraduate Course of Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Lucas Fróis Fernandes de Oliveira
- Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Whesley Tanor Silva
- Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | | | - Ana Cristina Rodrigues Lacerda
- Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Vanessa Amaral Mendonça
- Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Sanny Cristina de Castro Faria
- Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Manoel Otávio da Costa Rocha
- Department of Internal Medicine, Medical School and Hospital das Clinicas of the Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Henrique Silveira Costa
- Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil; Postgraduate Course of Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.
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Seferović PM, Polovina M, Rosano G, Bozkurt B, Metra M, Heymans S, Mullens W, Bauersachs J, Sliwa K, de Boer RA, Farmakis D, Thum T, Olivotto I, Rapezzi C, Linhart A, Corrado D, Tschöpe C, Milinković I, Bayes Genis A, Filippatos G, Keren A, Ašanin M, Krljanac G, Maksimović R, Skouri H, Ben Gal T, Moura B, Volterrani M, Abdelhamid M, Lopatin Y, Chioncel O, Coats AJS. State-of-the-art document on optimal contemporary management of cardiomyopathies. Eur J Heart Fail 2023; 25:1899-1922. [PMID: 37470300 DOI: 10.1002/ejhf.2979] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023] Open
Abstract
Cardiomyopathies represent significant contributors to cardiovascular morbidity and mortality. Over the past decades, a progress has occurred in characterization of the genetic background and major pathophysiological mechanisms, which has been incorporated into a more nuanced diagnostic approach and risk stratification. Furthermore, medications targeting core disease processes and/or their downstream adverse effects have been introduced for several cardiomyopathies. Combined with standard care and prevention of sudden cardiac death, these novel and emerging targeted therapies offer a possibility of improving the outcomes in several cardiomyopathies. Therefore, the aim of this document is to summarize practical approaches to the treatment of cardiomyopathies, which includes the evidence-based novel therapeutic concepts and established principles of care, tailored to the individual patient aetiology and clinical presentation of the cardiomyopathy. The scope of the document encompasses contemporary treatment of dilated, hypertrophic, restrictive and arrhythmogenic cardiomyopathy. It was based on an expert consensus reached at the Heart Failure Association online Workshop, held on 18 March 2021.
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Affiliation(s)
- Petar M Seferović
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Marija Polovina
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Biykem Bozkurt
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stephane Heymans
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wilfried Mullens
- Hasselt University, Hasselt, Belgium
- Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Karen Sliwa
- Cape Heart Institute, Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Meyer Children's Hospital and Careggi University Hospital, Florence, Italy
| | - Claudio Rapezzi
- Cardiology Centre, University of Ferrara, Ferrara, Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Aleš Linhart
- Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Domenico Corrado
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH) at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ivan Milinković
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Antoni Bayes Genis
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, CIBERCV, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Andre Keren
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Milika Ašanin
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ružica Maksimović
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Center for Radiology and Magnetic Resonance, University Clinical Center of Serbia, Belgrade, Serbia
| | - Hadi Skouri
- Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brenda Moura
- Armed Forces Hospital, Porto, & Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maurizio Volterrani
- IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University of Rome, Rome, Italy
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Faculty of Medicine, Kasr Al Ainy, Cairo University, Giza, Egypt
| | - Yuri Lopatin
- Volgograd Medical University, Cardiology Centre, Volgograd, Russian Federation
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu' Bucharest; University for Medicine and Pharmacy 'Carol Davila' Bucharest, Bucharest, Romania
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Liu Z, Ulrich vonBargen R, Kendricks AL, Wheeler K, Leão AC, Sankaranarayanan K, Dean DA, Kane SS, Hossain E, Pollet J, Bottazzi ME, Hotez PJ, Jones KM, McCall LI. Localized cardiac small molecule trajectories and persistent chemical sequelae in experimental Chagas disease. Nat Commun 2023; 14:6769. [PMID: 37880260 PMCID: PMC10600178 DOI: 10.1038/s41467-023-42247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023] Open
Abstract
Post-infectious conditions present major health burdens but remain poorly understood. In Chagas disease (CD), caused by Trypanosoma cruzi parasites, antiparasitic agents that successfully clear T. cruzi do not always improve clinical outcomes. In this study, we reveal differential small molecule trajectories between cardiac regions during chronic T. cruzi infection, matching with characteristic CD apical aneurysm sites. Incomplete, region-specific, cardiac small molecule restoration is observed in animals treated with the antiparasitic benznidazole. In contrast, superior restoration of the cardiac small molecule profile is observed for a combination treatment of reduced-dose benznidazole plus an immunotherapy, even with less parasite burden reduction. Overall, these results reveal molecular mechanisms of CD treatment based on simultaneous effects on the pathogen and on host small molecule responses, and expand our understanding of clinical treatment failure in CD. This link between infection and subsequent persistent small molecule perturbation broadens our understanding of infectious disease sequelae.
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Affiliation(s)
- Zongyuan Liu
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, USA
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA
| | - Rebecca Ulrich vonBargen
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA
- Department of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
| | | | - Kate Wheeler
- Department of Biology, University of Oklahoma, Norman, OK, USA
| | - Ana Carolina Leão
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Krithivasan Sankaranarayanan
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA
- Department of Microbiology and Plant Biology, University of Oklahoma, Norman, OK, USA
| | - Danya A Dean
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, USA
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA
| | - Shelley S Kane
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, USA
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA
| | - Ekram Hossain
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, USA
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA
| | - Jeroen Pollet
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Maria Elena Bottazzi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Peter J Hotez
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Kathryn M Jones
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
| | - Laura-Isobel McCall
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, USA.
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA.
- Department of Microbiology and Plant Biology, University of Oklahoma, Norman, OK, USA.
- Department of Chemistry and Biochemistry, San Diego State University, San Diego, CA, USA.
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Soares NM, Barreto NMPV, Farias MMB, de Lima Oliveira C, Araújo WAC, de Souza JN, Teixeira MCA, Gonçalves NLS, Sampaio DD, Pavan TBS, Celedon PAF, Zanchin NIT, Santos FLN. Seroepidemiological Survey of Chronic Chagas Disease in a Rural Community in Southern Bahia, Brazil, Using Recombinant Chimeric Antigens. Pathogens 2023; 12:1222. [PMID: 37887738 PMCID: PMC10609786 DOI: 10.3390/pathogens12101222] [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: 08/12/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 10/28/2023] Open
Abstract
Chagas disease (CD), caused by the parasite Trypanosoma cruzi, is a neglected tropical disease with life-threatening implications. In this study, we conducted a seroepidemiological survey to determine the prevalence and clinical profiles of CD in 217 individuals from an impoverished rural community in Southern Bahia, Brazil. The overall prevalence of CD in the studied community was 0.92%, detected through latent class analysis (LCA). Two individuals tested positive for anti-T. cruzi IgG, both being male farmers. One case was a 22-year-old man born in Camamu, with no evidence of congenital transmission, suggesting other routes of transmission such as vector-borne transmission due to migratory activities. The other case was a 69-year-old man born in São Felipe, who had lived in an adobe/brick house and had a pacemaker due to cardiac involvement caused by CD. The prevalence in this community was lower than expected, given the socioeconomic conditions and environmental factors that contribute to T. cruzi transmission. This could be attributed to the implementation of preventive measures and vector control programs by the Brazilian Government. However, continuous monitoring and surveillance are essential to sustain control efforts and detect any potential re-emergence of the disease. While the overall prevalence was low, the detection of positive cases underscores the need for continued surveillance and control measures in vulnerable populations, such as rural communities. Active surveillance, early diagnosis, and timely treatment are crucial in preventing disease progression and complications, thereby enhancing the effectiveness of screening and treatment programs.
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Affiliation(s)
- Neci Matos Soares
- Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil; (N.M.S.); (N.M.P.V.B.); (M.M.B.F.); (C.d.L.O.); (W.A.C.A.); (J.N.d.S.); (M.C.A.T.)
| | - Nilo Manoel Pereira Vieira Barreto
- Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil; (N.M.S.); (N.M.P.V.B.); (M.M.B.F.); (C.d.L.O.); (W.A.C.A.); (J.N.d.S.); (M.C.A.T.)
| | - Marina Morena Brito Farias
- Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil; (N.M.S.); (N.M.P.V.B.); (M.M.B.F.); (C.d.L.O.); (W.A.C.A.); (J.N.d.S.); (M.C.A.T.)
| | - Cíntia de Lima Oliveira
- Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil; (N.M.S.); (N.M.P.V.B.); (M.M.B.F.); (C.d.L.O.); (W.A.C.A.); (J.N.d.S.); (M.C.A.T.)
| | - Weslei Almeida Costa Araújo
- Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil; (N.M.S.); (N.M.P.V.B.); (M.M.B.F.); (C.d.L.O.); (W.A.C.A.); (J.N.d.S.); (M.C.A.T.)
| | - Joelma Nascimento de Souza
- Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil; (N.M.S.); (N.M.P.V.B.); (M.M.B.F.); (C.d.L.O.); (W.A.C.A.); (J.N.d.S.); (M.C.A.T.)
| | - Márcia Cristina Aquino Teixeira
- Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil; (N.M.S.); (N.M.P.V.B.); (M.M.B.F.); (C.d.L.O.); (W.A.C.A.); (J.N.d.S.); (M.C.A.T.)
| | - Noilson Lázaro Sousa Gonçalves
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (Fiocruz-BA), Salvador 40296-710, Bahia, Brazil; (N.L.S.G.); (T.B.S.P.)
| | - Daniel Dias Sampaio
- Brazil’s Family Health Strategy, Municipal Health Department, Tremedal City Hall, Tremedal 45170-000, Bahia, Brazil;
| | - Tycha Bianca Sabaini Pavan
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (Fiocruz-BA), Salvador 40296-710, Bahia, Brazil; (N.L.S.G.); (T.B.S.P.)
| | - Paola Alejandra Fiorani Celedon
- Molecular Biology of Trypanosomatids Laboratory, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz-PR), Curitiba 81310-020, Paraná, Brazil;
| | - Nilson Ivo Tonin Zanchin
- Structural Biology and Protein Engineering Laboratory, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz-PR), Curitiba 81310-020, Paraná, Brazil;
- Integrated Translational Program in Chagas Disease from Fiocruz (Fio-Chagas), Oswaldo Cruz Foundation (Fiocruz-RJ), Rio de Janeiro 21040-360, Rio de Janeiro, Brazil
| | - Fred Luciano Neves Santos
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (Fiocruz-BA), Salvador 40296-710, Bahia, Brazil; (N.L.S.G.); (T.B.S.P.)
- Integrated Translational Program in Chagas Disease from Fiocruz (Fio-Chagas), Oswaldo Cruz Foundation (Fiocruz-RJ), Rio de Janeiro 21040-360, Rio de Janeiro, Brazil
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Duque C, So J, Castro-Sesquen YE, DeToy K, Gutierrez Guarnizo SA, Jahanbakhsh F, Machaca EM, Miranda-Schaeubinger M, Chakravarti I, Cooper V, Schmidt ME, Adamo L, Marcus R, Talaat KR, Gilman RH, Mugnier MR. Immunologic changes are detectable in the peripheral blood transcriptome of clinically asymptomatic Chagas cardiomyopathy patients. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.03.560680. [PMID: 37873108 PMCID: PMC10592925 DOI: 10.1101/2023.10.03.560680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, is a neglected parasitic disease that affects approximately 6 million individuals worldwide. Of those infected, 20-30% will go on to develop chronic Chagas cardiomyopathy (CCC), and ultimately many of these individuals will progress to advanced heart failure. The mechanism by which this progression occurs is poorly understood, as few studies have focused on early CCC. In this study, we sought to understand the physiologic changes associated with T. cruzi infection and the development of CCC. We analyzed gene expression in the peripheral blood of asymptomatic Chagas patients with early structural heart disease, Chagas patients without any signs or symptoms of disease, and Chagas-negative patients with and without early structural heart disease. Our analysis shows that early CCC was associated with a downregulation of various peripheral immune response genes, with gene expression changes suggestive of reduced antigen presentation and T cell activation. Notably, these genes and processes were distinct from those of early cardiomyopathy in Chagas-negative patients, suggesting that the processes mediating CCC may be unique from those mediating progression to other cardiomyopathies. This work highlights the importance of the immune response in early CCC, providing insight into the early pathogenesis of this disease. The changes we have identified may serve as biomarkers of progression and could inform strategies for the treatment of CCC in its early stages, before significant cardiac damage has occurred.
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Affiliation(s)
- Carolina Duque
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jaime So
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yagahira E Castro-Sesquen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kelly DeToy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Fatemeh Jahanbakhsh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Edith Malaga Machaca
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Monica Miranda-Schaeubinger
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Indira Chakravarti
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Virginia Cooper
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary E Schmidt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Luigi Adamo
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Marcus
- MedStar Washington Hospital Center, Washington, D.C., USA
| | - Kawsar R Talaat
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Monica R Mugnier
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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34
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de Almeida GC, de Oliveira GB, da Silva Monte Z, Costa ÉCS, da Silva Falcão EP, Scotti L, Scotti MT, Oliveira Silva R, Pereira VRA, da Silva ED, Junior PAS, de Andrade Cavalcante MK, de Melo SJ. Structure-based design, optimization of lead, synthesis, and biological evaluation of compounds active against Trypanosoma cruzi. Chem Biol Drug Des 2023; 102:843-856. [PMID: 37455325 DOI: 10.1111/cbdd.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/18/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
Chagas' disease affects approximately eight million people throughout the world, especially the poorest individuals. The protozoan that causes this disease-Trypanosoma cruzi-has the enzyme cruzipain, which is the main therapeutic target. As no available medications have satisfactory effectiveness and safety, it is of fundamental importance to design and synthesize novel analogues that are more active and selective. In the present study, molecular docking and the in silico prediction of ADMET properties were used as strategies to optimize the trypanocidal activity of the pyrimidine compound ZN3F based on interactions with the target site in cruzipain. From the computational results, eight 4-amino-5-carbonitrile-pyrimidine analogues were proposed, synthesized (5a-f and 7g-h) and, tested in vitro on the trypomastigote form of the Tulahuen strain of T. cruzi. The in silico study showed that the designed analogues bond favorably to important amino acid residues of the active site in cruzipain. An in vitro evaluation of cytotoxicity was performed on L929 mammal cell lines. All derivatives inhibited the Tulahuen strain of T. cruzi and also exhibited lower toxicity to L929 cells. The 5e product, in particular, proved to be a potent, selective (IC50 = 2.79 ± 0.00 μM, selectivity index = 31.3) inhibitor of T. cruzi. The present results indicated the effectiveness of drugs based on the structure of the receptor, revealing the potential trypanocidal of pyrimidines. This study also provides information on molecular aspects for the inhibition of cruzipain.
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Affiliation(s)
- Gleybson Correia de Almeida
- Postgraduate Program in Pharmaceutical Sciences, Department of Pharmaceutical Sciences, Federal University of Pernambuco/UFPE, Recife, Brazil
| | - Gerliny Bezerra de Oliveira
- Postgraduate Program in Pharmaceutical Sciences, Department of Pharmaceutical Sciences, Federal University of Pernambuco/UFPE, Recife, Brazil
| | - Zenaide da Silva Monte
- Postgraduate Program in Pharmaceutical Sciences, Department of Pharmaceutical Sciences, Federal University of Pernambuco/UFPE, Recife, Brazil
| | - Érick Caique Santos Costa
- Postgraduate Program in Biological Sciences, Department of Biosciences, Federal University of Pernambuco/UFPE, Recife, Brazil
| | | | - Luciana Scotti
- Laboratory of Cheminformatics, Program of Natural and Synthetic Bioactive Products (PgPNSB), Health Sciences Center, Federal University of Paraíba, João Pessoa, Brazil
| | - Marcus Tullius Scotti
- Laboratory of Cheminformatics, Program of Natural and Synthetic Bioactive Products (PgPNSB), Health Sciences Center, Federal University of Paraíba, João Pessoa, Brazil
| | - Ricardo Oliveira Silva
- Department of Fundamental Chemistry, Center for Exact and Natural Sciences, Federal University of Pernambuco, Av. Journalist Anibal Fernandes, Recife, Brazil
| | - Valéria Rêgo Alves Pereira
- Aggeu Magalhães Research Center, Oswaldo Cruz Foundation, Federal University of Pernambuco - Campus da Av. Prof. Moraes Rego, Recife, Brazil
| | - Elis Dionisio da Silva
- Aggeu Magalhães Research Center, Oswaldo Cruz Foundation, Federal University of Pernambuco - Campus da Av. Prof. Moraes Rego, Recife, Brazil
| | - Policarpo Ademar Sales Junior
- Aggeu Magalhães Research Center, Oswaldo Cruz Foundation, Federal University of Pernambuco - Campus da Av. Prof. Moraes Rego, Recife, Brazil
| | - Marton Kaique de Andrade Cavalcante
- Aggeu Magalhães Research Center, Oswaldo Cruz Foundation, Federal University of Pernambuco - Campus da Av. Prof. Moraes Rego, Recife, Brazil
| | - Sebastião José de Melo
- Postgraduate Program in Pharmaceutical Sciences, Department of Pharmaceutical Sciences, Federal University of Pernambuco/UFPE, Recife, Brazil
- Postgraduate Program in Biological Sciences, Department of Biosciences, Federal University of Pernambuco/UFPE, Recife, Brazil
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35
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Calderon-Ramirez PM, Fernandez-Guzman D, Caira-Chuquineyra B, Mamani-García CS, Medina HM, Diaz-Arocutipa C. Exercise-based training programs for patients with chronic Chagas cardiomyopathy: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2023; 48:101256. [PMID: 37794957 PMCID: PMC10545933 DOI: 10.1016/j.ijcha.2023.101256] [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: 05/10/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 10/06/2023]
Abstract
Background We assessed the effects of exercise-based training programs (EBTP) in patients with chronic Chagas cardiomyopathy (CCC) through a systematic review and meta-analysis. Methods We conducted a search in Pubmed/Medline, Embase, Scopus, Web of Science, Cochrane Library, Virtual Health Library, and SciELO until January 2023. Randomized controlled trials (RCTs) and non-randomized intervention studies (NRIS) investigating the effects of EBTP in CCC patients were included. The primary outcomes were all-cause mortality, cardiovascular mortality, and health-related quality of life (HRQoL), and the secondary outcomes were exercise capacity by peak VO2, heart failure-related hospital admissions (HFRHA), and left ventricular ejection fraction (LVEF). Results The search strategy yielded 3617 studies. After removing duplicates and screening, eight studies (3 RCTs and 5 NRIS) involving 222 patients were included. Seven studies were conducted in Brazil. The age range was from 30 to 71 years, and 47.1% were male. Data on mortality, HRQoL, LVEF, and HFRHA were scarcely reported. The meta-analysis pooling four studies showed that the peak VO2 was significantly higher (mean difference 4.45, 95% confidence interval 3.50 to 5.39 mL/kg/min, I2 = 0%) in the EBTP group compared to the control group. Conclusion The evidence available was limited and heterogeneous. While EBTP has shown to improve HRQoL and exercise capacity, there is no conclusive information about the other proposed outcomes. These positive effects present an opportunity to provide treatment to CCC patients in low- and middle-income countries. Further studies are needed to ascertain the effects of EBTP on hard outcomes in this population.Registration number: CRD42022334060.
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Affiliation(s)
| | | | | | | | - Héctor M. Medina
- Division of Cardiology, Fundacion CardioInfantil-La Cardio, Bogota, Colombia
| | - Carlos Diaz-Arocutipa
- Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
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Elizalde Uribe IA, Osorno Gonzalez de Leon MF, Barrios Perez KV, Valle Robles DC, Lopez-Luis BA, Andrade Cuellar EN, Dominguez Valdez SI, Muñoz Arellano JE, Alvarez Camargo D, Melendez Ramirez G. Acute Myopericarditis Secondary to Chagas Disease. Cureus 2023; 15:e46301. [PMID: 37916261 PMCID: PMC10616633 DOI: 10.7759/cureus.46301] [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] [Accepted: 09/30/2023] [Indexed: 11/03/2023] Open
Abstract
American trypanosomiasis or Chagas disease is predominantly a vector-borne multisystemic infection caused by Trypanosoma cruzi, a protozoan parasite transmitted by triatomine bugs in endemic areas such as Mexico and Central and South America. Acute T. cruzi infection is mostly asymptomatic, nonetheless, in up to one-third of the patients, a mild form of the disease can be present, with nonspecific manifestations like fever, lymphadenopathy, hepatosplenomegaly, inflammation at the inoculation site (inoculation chancre) and unilateral palpebral edema (Romaña sign). Severe acute disease occurs in less than 1% of patients and includes myopericarditis and meningoencephalitis. If untreated, the acute phase can cause chronicity with cardiac and gastrointestinal involvement. We report the case of a female with occupational exposure to this parasite, who presented with acute myopericarditis, a rare form of presentation of this disease.
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Affiliation(s)
| | | | | | | | - Bruno A Lopez-Luis
- Infectious Disease, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico City, MEX
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37
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Muir D, Vargas G, Torres JR, Ávila-Agüero ML. Acute Chagas Disease Presenting as Preseptal Cellulitis. Pediatr Ann 2023; 52:e394-e397. [PMID: 37820707 DOI: 10.3928/19382359-20230829-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Chagas disease, also known as American trypanosomiasis, is caused by Trypanosoma cruzi, a parasite transmitted by hematophagous triatomine insects (subfamily Triatominae) belonging to the Reduviidae family, order Hemiptera. Infection occurs through contact with the feces of the infected vector at the site of its bite or on intact mucosa. [Pediatr Ann. 2023;52(10):e394-e397.].
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38
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Chiurillo MA, Carlson J, Bertolini MS, Raja A, Lander N. Dual localization of receptor-type adenylate cyclases and cAMP response protein 3 unveils the presence of two putative signaling microdomains in Trypanosoma cruzi. mBio 2023; 14:e0106423. [PMID: 37477489 PMCID: PMC10470820 DOI: 10.1128/mbio.01064-23] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/02/2023] [Indexed: 07/22/2023] Open
Abstract
Trypanosoma cruzi is the etiologic agent of Chagas disease, a leading cause of disability and premature death in the Americas. This parasite spends its life between a triatomine insect and a mammalian host, transitioning between developmental stages in response to microenvironmental changes. Among the second messengers driving differentiation in T. cruzi, cAMP has been shown to mediate metacyclogenesis and response to osmotic stress, but this signaling pathway remains largely unexplored in this parasite. Adenylate cyclases (ACs) catalyze the conversion of ATP to cAMP. They comprise a multigene family encoding putative receptor-type ACs in T. cruzi. Using protein sequence alignment, we classified them into five groups and chose a representative member from each group to study their localization (TcAC1-TcAC5). We expressed an HA-tagged version of each protein in T. cruzi and performed immunofluorescence analysis. A peculiar dual localization of TcAC1 and TcAC2 was observed in the flagellar distal domain and in the contractile vacuole complex (CVC), and their enzymatic activity was confirmed by gene complementation in yeast. Furthermore, TcAC1 overexpressing parasites showed an increased metacyclogenesis, a defect in host cell invasion, and a reduced intracellular replication, highlighting the importance of this protein throughout T. cruzi life cycle. These mutants were more tolerant to hypoosmotic stress and showed a higher adhesion capacity during in vitro metacyclogenesis, whereas the wild-type phenotype was restored after disrupting TcAC1 localization. Finally, TcAC1 was found to interact with cAMP response protein 3 (TcCARP3), co-localizing with this protein in the flagellar tip and CVC. IMPORTANCE We identified three components of the cAMP signaling pathway (TcAC1, TcAC2, and TcCARP3) with dual localization in Trypanosoma cruzi: the flagellar distal domain and the CVC, structures involved in cell adhesion and osmoregulation, respectively. We found evidence on the role of TcAC1 in both cellular processes, as well as in metacyclogenesis. Our data suggest that TcACs act as signal sensors and transducers through cAMP synthesis in membrane microdomains. We propose a model in which TcACs sense the harsh conditions in the triatomine hindgut (nutrient deprivation, acidic pH, osmotic stress, ionic composition, hydrophobic interactions) and become active. Synthesis of cAMP then triggers cell adhesion prior completion of metacyclogenesis, while mediating a response to osmotic stress in the parasite. These results shed light into the mechanisms driving cAMP-mediated cell differentiation in T. cruzi, while raising new questions on the activation of TcACs and the role of downstream components of this pathway.
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Affiliation(s)
- Miguel A. Chiurillo
- Department of Biological Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Joshua Carlson
- Department of Biological Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Mayara S. Bertolini
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
- Department of Cellular Biology, University of Georgia, Athens, Georgia, USA
| | - Aqsa Raja
- Department of Biological Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Noelia Lander
- Department of Biological Sciences, University of Cincinnati, Cincinnati, Ohio, USA
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39
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Vellozo NS, Matos-Silva TC, Lopes MF. Immunopathogenesis in Trypanosoma cruzi infection: a role for suppressed macrophages and apoptotic cells. Front Immunol 2023; 14:1244071. [PMID: 37662946 PMCID: PMC10469960 DOI: 10.3389/fimmu.2023.1244071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
During Trypanosoma cruzi infection, macrophages phagocytose parasites and remove apoptotic cells through efferocytosis. While macrophage 1 (M1) produces proinflammatory cytokines and NO and fights infection, M2 macrophages are permissive host cells that express arginase 1 and play a role in tissue repair. The regulation of M1 and M2 phenotypes might either induce or impair macrophage-mediated immunity towards parasite control or persistence in chronic Chagas disease. Here, we highlight a key role of macrophage activation in early immune responses to T. cruzi that prevent escalating parasitemia, heart parasitism, and mortality during acute infection. We will discuss the mechanisms of macrophage activation and deactivation, such as T cell cytokines and efferocytosis, and how to improve macrophage-mediated immunity to prevent parasite persistence, inflammation, and the development of chagasic cardiomyopathy. Potential vaccines or therapy must enhance early T cell-macrophage crosstalk and parasite control to restrain the pathogenic outcomes of parasite-induced inflammation in the heart.
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Affiliation(s)
| | | | - Marcela F. Lopes
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Lemos JM, Brito da Silva MF, Dos Santos Carvalho AM, Vicente Gil HP, Fiaia Costa VA, Andrade CH, Braga RC, Grellier P, Muratov EN, Charneau S, Moreira-Filho JT, Dourado Bastos IM, Neves BJ. Multitask learning-driven identification of novel antitrypanosomal compounds. Future Med Chem 2023; 15:1449-1467. [PMID: 37701989 DOI: 10.4155/fmc-2023-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Background: Chagas disease and human African trypanosomiasis cause substantial death and morbidity, particularly in low- and middle-income countries, making the need for novel drugs urgent. Methodology & results: Therefore, an explainable multitask pipeline to profile the activity of compounds against three trypanosomes (Trypanosoma brucei brucei, Trypanosoma brucei rhodesiense and Trypanosoma cruzi) were created. These models successfully discovered four new experimental hits (LC-3, LC-4, LC-6 and LC-15). Among them, LC-6 showed promising results, with IC50 values ranging 0.01-0.072 μM and selectivity indices >10,000. Conclusion: These results demonstrate that the multitask protocol offers predictivity and interpretability in the virtual screening of new antitrypanosomal compounds and has the potential to improve hit rates in Chagas and human African trypanosomiasis projects.
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Affiliation(s)
- Jade Milhomem Lemos
- LabChem - Laboratory of Cheminformatics, Faculty of Pharmacy, Federal University of Goiás, Goiânia,74605-170, GO, Brazil
| | - Meryck Felipe Brito da Silva
- LabChem - Laboratory of Cheminformatics, Faculty of Pharmacy, Federal University of Goiás, Goiânia,74605-170, GO, Brazil
| | - Alexandra Maria Dos Santos Carvalho
- Pathogen-Host Interface Laboratory, Department of Cell Biology, Institute of Biological Sciences, University of Brasilia, Brasilia, 70910-900, DF, Brazil
| | - Henric Pietro Vicente Gil
- LabChem - Laboratory of Cheminformatics, Faculty of Pharmacy, Federal University of Goiás, Goiânia,74605-170, GO, Brazil
| | - Vinícius Alexandre Fiaia Costa
- LabChem - Laboratory of Cheminformatics, Faculty of Pharmacy, Federal University of Goiás, Goiânia,74605-170, GO, Brazil
| | - Carolina Horta Andrade
- LabMol - Laboratory for Molecular Modeling & Drug Design, Faculty of Pharmacy, Federal University of Goiás, Goiânia, 74605-170, GO, Brazil
| | - Rodolpho Campos Braga
- InsilicAll Ltda, Av. Eng. Luis Carlos Berrini,1748 - Itaim Bibi, 04571-010, Sao Paulo, SP, Brazil
| | - Philippe Grellier
- UMR 7245 Molécules de Communication et Adaptation des Micro-organismes, Muséum National d'Histoire Naturelle, Équipe Parasites et Protistes Libres, Paris, 0575231, France
| | - Eugene N Muratov
- Laboratory for Molecular Modeling, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, 27599, NC, USA
- Department of Pharmaceutical Sciences, Federal University of Paraiba, Joao Pessoa, 58059-900, PB, Brazil
| | - Sébastien Charneau
- Department of Cell Biology, Laboratory of Biochemistry & Protein Chemistry, Institute of Biological Sciences, University of Brasilia, Brasilia, 70910-900, DF, Brazil
| | - José Teófilo Moreira-Filho
- LabMol - Laboratory for Molecular Modeling & Drug Design, Faculty of Pharmacy, Federal University of Goiás, Goiânia, 74605-170, GO, Brazil
| | - Izabela Marques Dourado Bastos
- Pathogen-Host Interface Laboratory, Department of Cell Biology, Institute of Biological Sciences, University of Brasilia, Brasilia, 70910-900, DF, Brazil
| | - Bruno Junior Neves
- LabChem - Laboratory of Cheminformatics, Faculty of Pharmacy, Federal University of Goiás, Goiânia,74605-170, GO, Brazil
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Muraca G, Ruiz ME, Gambaro RC, Scioli-Montoto S, Sbaraglini ML, Padula G, Cisneros JS, Chain CY, Álvarez VA, Huck-Iriart C, Castro GR, Piñero MB, Marchetto MI, Alba Soto C, Islan GA, Talevi A. Nanostructured lipid carriers containing benznidazole: physicochemical, biopharmaceutical and cellular in vitro studies. BEILSTEIN JOURNAL OF NANOTECHNOLOGY 2023; 14:804-818. [PMID: 37533841 PMCID: PMC10390827 DOI: 10.3762/bjnano.14.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023]
Abstract
Chagas disease is a neglected endemic disease prevalent in Latin American countries, affecting around 8 million people. The first-line treatment, benznidazole (BNZ), is effective in the acute stage of the disease but has limited efficacy in the chronic stage, possibly because current treatment regimens do not eradicate transiently dormant Trypanosoma cruzi amastigotes. Nanostructured lipid carriers (NLC) appear to be a promising approach for delivering pharmaceutical active ingredients as they can have a positive impact on bioavailability by modifying the absorption, distribution, and elimination of the drug. In this study, BNZ was successfully loaded into nanocarriers composed of myristyl myristate/Crodamol oil/poloxamer 188 prepared by ultrasonication. A stable NLC formulation was obtained, with ≈80% encapsulation efficiency (%EE) and a biphasic drug release profile with an initial burst release followed by a prolonged phase. The hydrodynamic average diameter and zeta potential of NLC obtained by dynamic light scattering were approximately 150 nm and -13 mV, respectively, while spherical and well-distributed nanoparticles were observed by transmission electron microscopy. Fourier-transform infrared spectroscopy, differential scanning calorimetry, thermogravimetric analysis, and small-angle X-ray scattering analyses of the nanoparticles indicated that BNZ might be dispersed in the nanoparticle matrix in an amorphous state. The mean size, zeta potential, polydispersity index, and %EE of the formulation remained stable for at least six months. The hemolytic effect of the nanoparticles was insignificant compared to that of the positive lysis control. The nanoparticle formulation exhibited similar performance in vitro against T. cruzi compared to free BNZ. No formulation-related cytotoxic effects were observed on either Vero or CHO cells. Moreover, BNZ showed a 50% reduction in CHO cell viability at 125 µg/mL, whereas NLC-BNZ and non-loaded NLC did not exert a significant effect on cell viability at the same concentration. These results show potential for the development of new nanomedicines against T. cruzi.
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Nguyen DM, Poveda C, Pollet J, Gusovsky F, Bottazzi ME, Hotez PJ, Jones KM. The impact of vaccine-linked chemotherapy on liver health in a mouse model of chronic Trypanosoma cruzi infection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.11.548497. [PMID: 37503013 PMCID: PMC10369866 DOI: 10.1101/2023.07.11.548497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background Chagas disease, chronic infection with Trypanosoma cruzi, mainly manifests as cardiac disease. However, the liver is important for both controlling parasite burdens and metabolizing drugs. Notably, high doses of anti-parasitic drug benznidazole (BNZ) causes liver damage. We previously showed that combining low dose BNZ with a prototype therapeutic vaccine is a dose sparing strategy that effectively reduced T. cruzi induced cardiac damage. However, the impact of this treatment on liver health is unknown. Therefore, we evaluated several markers of liver health after treatment with low dose BNZ plus the vaccine therapy in comparison to a curative dose of BNZ. Methodology Female BALB/c mice were infected with a bioluminescent T. cruzi H1 clone for approximately 70 days, then randomly divided into groups of 15 mice each. Mice were treated with a 25mg/kg BNZ, 25μg Tc24-C4 protein/5μg E6020-SE (Vaccine), 25mg/kg BNZ followed by vaccine, or 100mg/kg BNZ (curative dose). At study endpoints we evaluated hepatomegaly, parasite burden by quantitative PCR, cellular infiltration by histology, and expression of B-cell translocation gene 2(BTG2) and Peroxisome proliferator-activated receptor alpha (PPARα) by RT-PCR. Levels of alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were quantified from serum. Results Curative BNZ treatment significantly reduced hepatomegaly, liver parasite burdens, and the quantity of cellular infiltrate, but significantly elevated serum levels of ALT, AST, and LDH. Low BNZ plus vaccine did not significantly affect hepatomegaly, parasite burdens or the quantity of cellular infiltrate, but only elevated ALT and AST. Low dose BNZ significantly decreased expression of both BTG2 and PPARα, and curative BNZ reduced expression of BTG2 while low BNZ plus vaccine had no impact. Conclusions These data confirm toxicity associated with curative doses of BNZ and suggest that the dose sparing low BNZ plus vaccine treatment better preserves liver health.
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Affiliation(s)
- Duc Minh Nguyen
- Center for Comparative Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Cristina Poveda
- Texas Children’s Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jeroen Pollet
- Texas Children’s Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
| | | | - Maria Elena Bottazzi
- Texas Children’s Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
| | - Peter J. Hotez
- Texas Children’s Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
- James A. Baker III Institute for Public Policy, Rice University, Houston, Texas, United States of America
- Hagler Institute for Advanced Study at Texas A&M University, College Station, Texas, United States of America
| | - Kathryn M. Jones
- Texas Children’s Hospital Center for Vaccine Development, Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
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Jimenez A, Winokur EJ. Chagas Disease Cardiomyopathy. Dimens Crit Care Nurs 2023; 42:202-210. [PMID: 37219474 DOI: 10.1097/dcc.0000000000000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Chagas disease is a prominent neglected tropical disease endemic to many countries in Latin America. Cardiomyopathy is the most serious manifestation due to the severity and complications of heart failure. As a result of expanded immigration and globalization, there is an increased number of patients with Chagas cardiomyopathy who are being admitted to hospitals in the United States. It is imperative as a critical care nurse to be educated on the nature of Chagas cardiomyopathy as it differs from the more commonly seen ischemic and nonischemic forms. This article provides an overview of the clinical course, management, and treatment options of Chagas cardiomyopathy.
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Vattikonda K, Peterson CJ, Mulkey B, Allen B. A Case of Chagas Cardiomyopathy in Western Virginia: Worlds Away? Cureus 2023; 15:e42158. [PMID: 37602121 PMCID: PMC10438999 DOI: 10.7759/cureus.42158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Chagas cardiomyopathy, caused by the parasite Trypanosoma cruzi, is a significant cause of cardiac pathology worldwide. Though most frequently observed in Latin America, Chagas disease is present in the United States and should be considered in patients with heart block or other cardiac abnormalities and previous travel to or residence in endemic areas. Here we describe a new diagnosis of Chagas cardiomyopathy in a patient residing in Virginia with a previous residence in Mexico.
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Affiliation(s)
- Kiriti Vattikonda
- Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | | | - Benjamin Mulkey
- Cardiology, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Bradley Allen
- Cardiology, Virginia Tech Carilion School of Medicine, Roanoke, USA
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Jidling C, Gedon D, Schön TB, Oliveira CDL, Cardoso CS, Ferreira AM, Giatti L, Barreto SM, Sabino EC, Ribeiro ALP, Ribeiro AH. Screening for Chagas disease from the electrocardiogram using a deep neural network. PLoS Negl Trop Dis 2023; 17:e0011118. [PMID: 37399207 PMCID: PMC10361500 DOI: 10.1371/journal.pntd.0011118] [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: 01/23/2023] [Revised: 07/21/2023] [Accepted: 05/25/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Worldwide, it is estimated that over 6 million people are infected with Chagas disease (ChD). It is a neglected disease that can lead to severe heart conditions in its chronic phase. While early treatment can avoid complications, the early-stage detection rate is low. We explore the use of deep neural networks to detect ChD from electrocardiograms (ECGs) to aid in the early detection of the disease. METHODS We employ a convolutional neural network model that uses 12-lead ECG data to compute the probability of a ChD diagnosis. Our model is developed using two datasets which jointly comprise over two million entries from Brazilian patients: The SaMi-Trop study focusing on ChD patients, enriched with data from the CODE study from the general population. The model's performance is evaluated on two external datasets: the REDS-II, a study focused on ChD with 631 patients, and the ELSA-Brasil study, with 13,739 civil servant patients. FINDINGS Evaluating our model, we obtain an AUC-ROC of 0.80 (CI 95% 0.79-0.82) for the validation set (samples from CODE and SaMi-Trop), and in external validation datasets: 0.68 (CI 95% 0.63-0.71) for REDS-II and 0.59 (CI 95% 0.56-0.63) for ELSA-Brasil. In the latter, we report a sensitivity of 0.52 (CI 95% 0.47-0.57) and 0.36 (CI 95% 0.30-0.42) and a specificity of 0.77 (CI 95% 0.72-0.81) and 0.76 (CI 95% 0.75-0.77), respectively. Additionally, when considering only patients with Chagas cardiomyopathy as positive, the model achieved an AUC-ROC of 0.82 (CI 95% 0.77-0.86) for REDS-II and 0.77 (CI 95% 0.68-0.85) for ELSA-Brasil. INTERPRETATION The neural network detects chronic Chagas cardiomyopathy (CCC) from ECG-with weaker performance for early-stage cases. Future work should focus on curating large higher-quality datasets. The CODE dataset, our largest development dataset includes self-reported and therefore less reliable labels, limiting performance for non-CCC patients. Our findings can improve ChD detection and treatment, particularly in high-prevalence areas.
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Affiliation(s)
- Carl Jidling
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Daniel Gedon
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Thomas B. Schön
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | | | - Clareci Silva Cardoso
- Preventive Medicine, School of Medicine, Universidade Federal de São João del-Rei, Divinópolis, Brazil
| | - Ariela Mota Ferreira
- Graduate Program in Health Sciences, Universidade Estadual de Montes Claros, Montes Claros, Brazil
| | - Luana Giatti
- Preventive Medicine, School of Medicine, Clinical Hospital/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sandhi Maria Barreto
- Preventive Medicine, School of Medicine, Clinical Hospital/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ester C. Sabino
- Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Antonio L. P. Ribeiro
- Department of Internal Medicine, Faculdade de Medicina, Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antônio H. Ribeiro
- Department of Information Technology, Uppsala University, Uppsala, Sweden
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Valdés-Soto M, Burgdorf-Moisuk A, Raines J, Connolly M, Allen KE, Lineberry MW, Garner MM. TRYPANOSOMA CRUZI INFECTION IN THREE SLENDER-TAILED MEERKATS ( SURICATA SURICATTA). J Zoo Wildl Med 2023; 54:394-400. [PMID: 37428705 DOI: 10.1638/2022-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 07/12/2023] Open
Abstract
Trypanosoma cruzi is a protozoan parasite primarily transmitted by triatomine insects (Hemiptera: subfamily Reduviidae) and is the cause of Chagas disease (CD). This report describes three cases of CD in a mob of five slender-tailed meerkats (Suricata suricatta) living in an outdoor exhibit at one zoological institution in Texas. The index case was a 9.5-yr-old female that presented with ataxia, lethargy, and pleural effusion. This case was diagnosed with CD postmortem via cytology, T. cruzi PCR of whole blood and lung fluid, and histology. Blood was opportunistically collected from the remaining four meerkats 28 d after the death of the index case and tested by PCR and serology. The second case was a clinically normal 7.5-yr-old male that tested PCR and antibody positive and the third case was a clinically normal 9-yr-old female that tested PCR positive. The second animal presented depressed, with pneumonia, and with continuous shivering 53 d after blood collection, and clinically improved after treatment with antibiotics and supportive care. Fifteen days later, the animal was found minimally responsive and died shortly thereafter. Histologic examination revealed Trypanosoma sp. amastigotes in the myocardium and the tissue was positive for T. cruzi DNA. The third meerkat, which received two separate courses of benznidazole over a span of almost 2 yr, was monitored routinely by PCR and serology and appeared clinically normal until found dead on exhibit 93 d after completion of the second treatment. Myocardium was positive for T. cruzi DNA. To the authors' knowledge, this case series is the first to document Chagas disease in meerkats and features associated cytologic and histologic findings.
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Affiliation(s)
- Marcela Valdés-Soto
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Nuevo León, Francisco Villa S/ N Col. Ex Hacienda el Canadá, Escobedo, Nuevo León, México, 66050
| | | | | | | | - Kelly E Allen
- Oklahoma State University's College of Veterinary Medicine, OK 74078, USA
| | - Megan W Lineberry
- Oklahoma State University's College of Veterinary Medicine, OK 74078, USA
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Marin-Neto JA, Rassi A, Oliveira GMM, Correia LCL, Ramos Júnior AN, Luquetti AO, Hasslocher-Moreno AM, Sousa ASD, Paola AAVD, Sousa ACS, Ribeiro ALP, Correia Filho D, Souza DDSMD, Cunha-Neto E, Ramires FJA, Bacal F, Nunes MDCP, Martinelli Filho M, Scanavacca MI, Saraiva RM, Oliveira Júnior WAD, Lorga-Filho AM, Guimarães ADJBDA, Braga ALL, Oliveira ASD, Sarabanda AVL, Pinto AYDN, Carmo AALD, Schmidt A, Costa ARD, Ianni BM, Markman Filho B, Rochitte CE, Macêdo CT, Mady C, Chevillard C, Virgens CMBD, Castro CND, Britto CFDPDC, Pisani C, Rassi DDC, Sobral Filho DC, Almeida DRD, Bocchi EA, Mesquita ET, Mendes FDSNS, Gondim FTP, Silva GMSD, Peixoto GDL, Lima GGD, Veloso HH, Moreira HT, Lopes HB, Pinto IMF, Ferreira JMBB, Nunes JPS, Barreto-Filho JAS, Saraiva JFK, Lannes-Vieira J, Oliveira JLM, Armaganijan LV, Martins LC, Sangenis LHC, Barbosa MPT, Almeida-Santos MA, Simões MV, Yasuda MAS, Moreira MDCV, Higuchi MDL, Monteiro MRDCC, Mediano MFF, Lima MM, Oliveira MTD, Romano MMD, Araujo NNSLD, Medeiros PDTJ, Alves RV, Teixeira RA, Pedrosa RC, Aras Junior R, Torres RM, Povoa RMDS, Rassi SG, Alves SMM, Tavares SBDN, Palmeira SL, Silva Júnior TLD, Rodrigues TDR, Madrini Junior V, Brant VMDC, Dutra WO, Dias JCP. SBC Guideline on the Diagnosis and Treatment of Patients with Cardiomyopathy of Chagas Disease - 2023. Arq Bras Cardiol 2023; 120:e20230269. [PMID: 37377258 PMCID: PMC10344417 DOI: 10.36660/abc.20230269] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- José Antonio Marin-Neto
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Anis Rassi
- Hospital do Coração Anis Rassi , Goiânia , GO - Brasil
| | | | | | | | - Alejandro Ostermayer Luquetti
- Centro de Estudos da Doença de Chagas , Hospital das Clínicas da Universidade Federal de Goiás , Goiânia , GO - Brasil
| | | | - Andréa Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe , São Cristóvão , SE - Brasil
- Hospital São Lucas , Rede D`Or São Luiz , Aracaju , SE - Brasil
| | | | | | | | - Edecio Cunha-Neto
- Universidade de São Paulo , Faculdade de Medicina da Universidade, São Paulo , SP - Brasil
| | - Felix Jose Alvarez Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Maurício Ibrahim Scanavacca
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Magalhães Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Adalberto Menezes Lorga-Filho
- Instituto de Moléstias Cardiovasculares , São José do Rio Preto , SP - Brasil
- Hospital de Base de Rio Preto , São José do Rio Preto , SP - Brasil
| | | | | | - Adriana Sarmento de Oliveira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Ana Yecê das Neves Pinto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Andre Schmidt
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Andréa Rodrigues da Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Barbara Maria Ianni
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Carlos Eduardo Rochitte
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Hcor , Associação Beneficente Síria , São Paulo , SP - Brasil
| | | | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Marselha - França
| | | | | | | | - Cristiano Pisani
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Evandro Tinoco Mesquita
- Hospital Universitário Antônio Pedro da Faculdade Federal Fluminense , Niterói , RJ - Brasil
| | | | | | | | | | | | - Henrique Horta Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Henrique Turin Moreira
- Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | | | | | | | - João Paulo Silva Nunes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Fundação Zerbini, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | | | | | - Luiz Cláudio Martins
- Universidade Estadual de Campinas , Faculdade de Ciências Médicas , Campinas , SP - Brasil
| | | | | | | | - Marcos Vinicius Simões
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | | | | | - Maria de Lourdes Higuchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Mauro Felippe Felix Mediano
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
| | - Mayara Maia Lima
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | | | | | - Renato Vieira Alves
- Instituto René Rachou , Fundação Oswaldo Cruz , Belo Horizonte , MG - Brasil
| | - Ricardo Alkmim Teixeira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Coury Pedrosa
- Hospital Universitário Clementino Fraga Filho , Instituto do Coração Edson Saad - Universidade Federal do Rio de Janeiro , RJ - Brasil
| | | | | | | | | | - Silvia Marinho Martins Alves
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico Universitário da Universidade de Pernambuco (PROCAPE/UPE), Recife , PE - Brasil
| | | | - Swamy Lima Palmeira
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | - Vagner Madrini Junior
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | - João Carlos Pinto Dias
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
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Brociek E, Tymińska A, Giordani AS, Caforio ALP, Wojnicz R, Grabowski M, Ozierański K. Myocarditis: Etiology, Pathogenesis, and Their Implications in Clinical Practice. BIOLOGY 2023; 12:874. [PMID: 37372158 PMCID: PMC10295542 DOI: 10.3390/biology12060874] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/29/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
Myocarditis is an inflammatory disease of the myocardium caused by infectious or non-infectious agents. It can lead to serious short-term and long-term sequalae, such as sudden cardiac death or dilated cardiomyopathy. Due to its heterogenous clinical presentation and disease course, challenging diagnosis and limited evidence for prognostic stratification, myocarditis poses a great challenge to clinicians. As it stands, the pathogenesis and etiology of myocarditis is only partially understood. Moreover, the impact of certain clinical features on risk assessment, patient outcomes and treatment options is not entirely clear. Such data, however, are essential in order to personalize patient care and implement novel therapeutic strategies. In this review, we discuss the possible etiologies of myocarditis, outline the key processes governing its pathogenesis and summarize best available evidence regarding patient outcomes and state-of-the-art therapeutic approaches.
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Affiliation(s)
- Emil Brociek
- First Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (E.B.); (M.G.); (K.O.)
| | - Agata Tymińska
- First Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (E.B.); (M.G.); (K.O.)
| | - Andrea Silvio Giordani
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35-100 Padova, Italy; (A.S.G.); (A.L.P.C.)
| | - Alida Linda Patrizia Caforio
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35-100 Padova, Italy; (A.S.G.); (A.L.P.C.)
| | - Romuald Wojnicz
- Department of Histology and Cell Pathology in Zabrze, School of Medicine with the Division of Dentistry, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Marcin Grabowski
- First Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (E.B.); (M.G.); (K.O.)
| | - Krzysztof Ozierański
- First Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (E.B.); (M.G.); (K.O.)
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Kann S, Mendoza GAC, Hartmann M, Frickmann H, Kreienbrock L. Chagas Disease: Medical and ECG Related Findings in an Indigenous Population in Colombia. Trop Med Infect Dis 2023; 8:297. [PMID: 37368715 DOI: 10.3390/tropicalmed8060297] [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: 03/30/2023] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Chagas Disease (CD) is highly prevalent among the indigenous populations in the Sierra Nevada de Santa Marta, Colombia. Villages examined show prevalence rates ranging from 43.6% up to 67.4%. In the present study, associated medical conditions were assessed with a particular focus on ECG alterations. CD diagnosis was based on a rapid test, two different ELISAs, and a specific and highly sensitive Chagas real-time PCR. In both CD positive and CD negative patients, relations of the status and medical (physical examination-based, questionnaire-based) and/or electrocardiogram-based findings were investigated. As expected, CD-associated symptoms and complaints were predominantly found in CD-positive patients. Interestingly, ECG-findings were found to show the potential of leading to early CD diagnosis because ECG alterations were already seen in early stagechanges of the disease. In conclusion, although the observed ECG changes are unspecific, they should be considered as an indicator for a CD screening and, in case of positive results, an associated early treatment of the disease.
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Affiliation(s)
| | | | - Maria Hartmann
- Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health in the Human-Animal-Environment Interface, University for Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Hagen Frickmann
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital, 20359 Hamburg, Germany
| | - Lothar Kreienbrock
- Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health in the Human-Animal-Environment Interface, University for Veterinary Medicine Hannover, 30559 Hannover, Germany
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Proaño A, Dumonteil E, Herrera C. Chagas Disease Diagnostic Testing in Two Academic Hospitals in New Orleans, Louisiana: A Call to Action. Trop Med Infect Dis 2023; 8:tropicalmed8050277. [PMID: 37235325 DOI: 10.3390/tropicalmed8050277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Chagas disease, caused by the protozoa parasite Trypanosoma cruzi, is an anthropozoonosis that represents a major public health problem in the Americas, affecting 7 million people with at least 65 million at risk. We sought to assess the intensity of disease surveillance based on diagnostic test requests from hospitals in New Orleans, Louisiana. We extracted information from send-out labs at two major tertiary academic hospitals in New Orleans, Louisiana, USA, from 1 January 2018 to 1 December 2020. We found that in these three years there were 27 patients for whom Chagas disease testing was ordered. Most of these patients were male (70%), with a median age of 40 years old, and their most common ethnical background was Hispanic (74%). These findings demonstrate undertesting of this neglected disease in our region. Given the low Chagas disease surveillance, we need to increase awareness, health promotion, and education among healthcare workers.
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Affiliation(s)
- Alvaro Proaño
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Eric Dumonteil
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Claudia Herrera
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
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