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Castro JT, Brito R, Hojo-Souza NS, Azevedo B, Salazar N, Ferreira CP, Junqueira C, Fernandes AP, Vasconcellos R, Cardoso JM, Aguiar-Soares RDO, Vieira PMA, Carneiro CM, Valiate B, Toledo C, Salazar AM, Caballero O, Lannes-Vieira J, Teixeira SR, Reis AB, Gazzinelli RT. ASP-2/Trans-sialidase chimeric protein induces robust protective immunity in experimental models of Chagas' disease. NPJ Vaccines 2023; 8:81. [PMID: 37258518 DOI: 10.1038/s41541-023-00676-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
Abstract
Immunization with the Amastigote Surface Protein-2 (ASP-2) and Trans-sialidase (TS) antigens either in the form of recombinant protein, encoded in plasmids or human adenovirus 5 (hAd5) confers robust protection against various lineages of Trypanosoma cruzi. Herein we generated a chimeric protein containing the most immunogenic regions for T and B cells from TS and ASP-2 (TRASP) and evaluated its immunogenicity in comparison with our standard protocol of heterologous prime-boost using plasmids and hAd5. Mice immunized with TRASP protein associated to Poly-ICLC (Hiltonol) were highly resistant to challenge with T. cruzi, showing a large decrease in tissue parasitism, parasitemia and no lethality. This protection lasted for at least 3 months after the last boost of immunization, being equivalent to the protection induced by DNA/hAd5 protocol. TRASP induced high levels of T. cruzi-specific antibodies and IFNγ-producing T cells and protection was primarily mediated by CD8+ T cells and IFN-γ. We also evaluated the toxicity, immunogenicity, and efficacy of TRASP and DNA/hAd5 formulations in dogs. Mild collateral effects were detected at the site of vaccine inoculation. While the chimeric protein associated with Poly-ICLC induced high levels of antibodies and CD4+ T cell responses, the DNA/hAd5 induced no antibodies, but a strong CD8+ T cell response. Immunization with either vaccine protected dogs against challenge with T. cruzi. Despite the similar efficacy, we conclude that moving ahead with TRASP together with Hiltonol is advantageous over the DNA/hAd5 vaccine due to pre-existing immunity to the adenovirus vector, as well as the cost-benefit for development and large-scale production.
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Affiliation(s)
- Julia T Castro
- Centro de Tecnologia em Vacinas, Universidade Federal de Minas Gerais, Parque Tecnológico de Belo Horizonte, Belo Horizonte, Brazil
- Centro de Pesquisas Rene Rachou, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
- Plataforma de Medicina Translacional, Fundação Oswaldo Cruz-Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
| | - Rory Brito
- Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Natalia S Hojo-Souza
- Centro de Tecnologia em Vacinas, Universidade Federal de Minas Gerais, Parque Tecnológico de Belo Horizonte, Belo Horizonte, Brazil
- Centro de Pesquisas Rene Rachou, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
| | - Bárbara Azevedo
- Centro de Pesquisas Rene Rachou, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
| | - Natalia Salazar
- Centro de Tecnologia em Vacinas, Universidade Federal de Minas Gerais, Parque Tecnológico de Belo Horizonte, Belo Horizonte, Brazil
| | | | - Caroline Junqueira
- Centro de Tecnologia em Vacinas, Universidade Federal de Minas Gerais, Parque Tecnológico de Belo Horizonte, Belo Horizonte, Brazil
- Centro de Pesquisas Rene Rachou, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
| | - Ana Paula Fernandes
- Centro de Tecnologia em Vacinas, Universidade Federal de Minas Gerais, Parque Tecnológico de Belo Horizonte, Belo Horizonte, Brazil
| | | | | | | | | | | | - Bruno Valiate
- Centro de Tecnologia em Vacinas, Universidade Federal de Minas Gerais, Parque Tecnológico de Belo Horizonte, Belo Horizonte, Brazil
- Centro de Pesquisas Rene Rachou, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
| | - Cristiane Toledo
- Centro de Pesquisas Rene Rachou, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
| | | | | | | | - Santuza R Teixeira
- Centro de Tecnologia em Vacinas, Universidade Federal de Minas Gerais, Parque Tecnológico de Belo Horizonte, Belo Horizonte, Brazil
| | | | - Ricardo T Gazzinelli
- Centro de Tecnologia em Vacinas, Universidade Federal de Minas Gerais, Parque Tecnológico de Belo Horizonte, Belo Horizonte, Brazil.
- Centro de Pesquisas Rene Rachou, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil.
- Plataforma de Medicina Translacional, Fundação Oswaldo Cruz-Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.
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Almeida-Silva J, Menezes DS, Fernandes JMP, Almeida MC, Vasco-Dos-Santos DR, Saraiva RM, Viçosa AL, Perez SAC, Andrade SG, Suarez-Fontes AM, Vannier-Santos MA. The repositioned drugs disulfiram/diethyldithiocarbamate combined to benznidazole: Searching for Chagas disease selective therapy, preventing toxicity and drug resistance. Front Cell Infect Microbiol 2022; 12:926699. [PMID: 35967878 PMCID: PMC9372510 DOI: 10.3389/fcimb.2022.926699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/27/2022] [Indexed: 12/20/2022] Open
Abstract
Chagas disease (CD) affects at least 6 million people in 21 South American countries besides several thousand in other nations all over the world. It is estimated that at least 14,000 people die every year of CD. Since vaccines are not available, chemotherapy remains of pivotal relevance. About 30% of the treated patients cannot complete the therapy because of severe adverse reactions. Thus, the search for novel drugs is required. Here we tested the benznidazole (BZ) combination with the repositioned drug disulfiram (DSF) and its derivative diethyldithiocarbamate (DETC) upon Trypanosoma cruzi in vitro and in vivo. DETC-BZ combination was synergistic diminishing epimastigote proliferation and enhancing selective indexes up to over 10-fold. DETC was effective upon amastigotes of the BZ- partially resistant Y and the BZ-resistant Colombiana strains. The combination reduced proliferation even using low concentrations (e.g., 2.5 µM). Scanning electron microscopy revealed membrane discontinuities and cell body volume reduction. Transmission electron microscopy revealed remarkable enlargement of endoplasmic reticulum cisternae besides, dilated mitochondria with decreased electron density and disorganized kinetoplast DNA. At advanced stages, the cytoplasm vacuolation apparently impaired compartmentation. The fluorescent probe H2-DCFDA indicates the increased production of reactive oxygen species associated with enhanced lipid peroxidation in parasites incubated with DETC. The biochemical measurement indicates the downmodulation of thiol expression. DETC inhibited superoxide dismutase activity on parasites was more pronounced than in infected mice. In order to approach the DETC effects on intracellular infection, peritoneal macrophages were infected with Colombiana trypomastigotes. DETC addition diminished parasite numbers and the DETC-BZ combination was effective, despite the low concentrations used. In the murine infection, the combination significantly enhanced animal survival, decreasing parasitemia over BZ. Histopathology revealed that low doses of BZ-treated animals presented myocardial amastigote, not observed in combination-treated animals. The picrosirius collagen staining showed reduced myocardial fibrosis. Aminotransferase de aspartate, Aminotransferase de alanine, Creatine kinase, and urea plasma levels demonstrated that the combination was non-toxic. As DSF and DETC can reduce the toxicity of other drugs and resistance phenotypes, such a combination may be safe and effective.
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Affiliation(s)
- Juliana Almeida-Silva
- Innovations in Therapies, Education and Bioproducts Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Diego Silva Menezes
- Parasite Biology Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
| | - Juan Mateus Pereira Fernandes
- Innovations in Therapies, Education and Bioproducts Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Márcio Cerqueira Almeida
- Parasite Biology Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
| | - Deyvison Rhuan Vasco-Dos-Santos
- Innovations in Therapies, Education and Bioproducts Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Roberto Magalhães Saraiva
- Laboratory of Clinical Research on Chagas Disease, Evandro Chagas Infectious Disease Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Alessandra Lifsitch Viçosa
- Experimental Pharmacotechnics Laboratory, Department of Galenic Innovation, Institute of Drug Technology - Farmanguinhos, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Sandra Aurora Chavez Perez
- Project Management Technical Assistance, Institute of Drug Technology - Farmanguinhos, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Sônia Gumes Andrade
- Experimental Chagas Disease Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
| | - Ana Márcia Suarez-Fontes
- Innovations in Therapies, Education and Bioproducts Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Marcos André Vannier-Santos
- Innovations in Therapies, Education and Bioproducts Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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Jansen AM, Xavier SCDC, Roque ALR. Landmarks of the Knowledge and Trypanosoma cruzi Biology in the Wild Environment. Front Cell Infect Microbiol 2020; 10:10. [PMID: 32117794 PMCID: PMC7016096 DOI: 10.3389/fcimb.2020.00010] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/10/2020] [Indexed: 12/13/2022] Open
Abstract
Trypanosomatids are ancient parasitic eukaryotes that still maintain prokaryotic characteristics. Trypanosoma cruzi, a primarily wild mammal parasite, infected humans already long before European colonization of the Americas. T. cruzi heterogeneity remains an unsolved question, and until now, it has still not been possible to associate T. cruzi genotypes with any biological or epidemiological feature. One of the first biochemical attempts to cluster the T. cruzi subpopulations recognized three main subpopulations (zymodemes) that have been associated with the transmission cycles in the wild (Z1; Z3) and in the domestic environment (Z2). The description of wild mammal species harboring Z2 two decades later challenged this assemblage attempt. Currently, the genotypes of T. cruzi are assembled in seven discrete typing units (DTUs). The biology of T. cruzi still shows novelties such as the description of epimastigotes multiplying and differentiating to metacyclic trypomastigotes in the lumen of the scent glands of Didelphis spp. and the capacity of the true meiosis in parallel to clonal reproduction. The study of the transmission cycle among wild animals has broken paradigms and raised new questions: (i) the interaction of the T. cruzi DTUs with each of its mammalian host species displays peculiarities; (ii) the impact of mixed genotypes and species on the transmissibility of one or another species or on pathogenesis is still unknown; (iii) independent T. cruzi transmission cycles may occur in the same forest fragment; (iv) the capacity to act as a reservoir depends on the peculiarities of the host species and the parasite genotype; and (v) faunistic composition is a defining trait of the T. cruzi transmission cycle profile. The development of models of environmental variables that determine the spatial distribution of the elements that make up T. cruzi transmission by spatial analysis, followed by map algebra and networking, are the next steps toward interpreting and dealing with the new profile of Chagas disease with its many peculiarities. There is no way to solve this neglected disease once and for all if not through a multidisciplinary look that takes into account all kinds of human and animal activities in parallel to environmental variations.
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Affiliation(s)
- Ana Maria Jansen
- Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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MacLean LM, Thomas J, Lewis MD, Cotillo I, Gray DW, De Rycker M. Development of Trypanosoma cruzi in vitro assays to identify compounds suitable for progression in Chagas' disease drug discovery. PLoS Negl Trop Dis 2018; 12:e0006612. [PMID: 30001347 PMCID: PMC6057682 DOI: 10.1371/journal.pntd.0006612] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/24/2018] [Accepted: 06/14/2018] [Indexed: 01/08/2023] Open
Abstract
Chagas' disease is responsible for significant mortality and morbidity in Latin America. Current treatments display variable efficacy and have adverse side effects, hence more effective, better tolerated drugs are needed. However, recent efforts have proved unsuccessful with failure of the ergosterol biosynthesis inhibitor posaconazole in phase II clinical trials despite promising in vitro and in vivo studies. The lack of translation between laboratory experiments and clinical outcome is a major issue for further drug discovery efforts. Our goal was to identify cell-based assays that could differentiate current nitro-aromatic drugs nifurtimox and benznidazole from posaconazole. Using a panel of T. cruzi strains including the six major lineages (TcI-VI), we found that strain PAH179 (TcV) was markedly less susceptible to posaconazole in vitro. Determination of parasite doubling and cycling times as well as EdU labelling experiments all indicate that this lack of sensitivity is due to the slow doubling and cycling time of strain PAH179. This is in accordance with ergosterol biosynthesis inhibition by posaconazole leading to critically low ergosterol levels only after multiple rounds of division, and is further supported by the lack of effect of posaconazole on the non-replicative trypomastigote form. A washout experiment with prolonged posaconazole treatment showed that, even for more rapidly replicating strains, this compound cannot clear all parasites, indicative of a heterogeneous parasite population in vitro and potentially the presence of quiescent parasites. Benznidazole in contrast was able to kill all parasites. The work presented here shows clear differentiation between the nitro-aromatic drugs and posaconazole in several assays, and suggests that in vitro there may be clinically relevant heterogeneity in the parasite population that can be revealed in long-term washout experiments. Based on these findings we have adjusted our in vitro screening cascade so that only the most promising compounds are progressed to in vivo experiments.
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Affiliation(s)
- Lorna M. MacLean
- Drug Discovery Unit, Wellcome Centre for Anti-Infectives Research, School of Life Sciences, University of Dundee, Dundee, United Kingdom
- * E-mail: (LML); (DWG)
| | - John Thomas
- Drug Discovery Unit, Wellcome Centre for Anti-Infectives Research, School of Life Sciences, University of Dundee, Dundee, United Kingdom
| | - Michael D. Lewis
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ignacio Cotillo
- GlaxoSmithKline, Diseases of the Developing World, Tres Cantos, Madrid, Spain
| | - David W. Gray
- Drug Discovery Unit, Wellcome Centre for Anti-Infectives Research, School of Life Sciences, University of Dundee, Dundee, United Kingdom
- * E-mail: (LML); (DWG)
| | - Manu De Rycker
- Drug Discovery Unit, Wellcome Centre for Anti-Infectives Research, School of Life Sciences, University of Dundee, Dundee, United Kingdom
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Stillwaggon E, Perez-Zetune V, Bialek SR, Montgomery SP. Congenital Chagas Disease in the United States: Cost Savings through Maternal Screening. Am J Trop Med Hyg 2018; 98:1733-1742. [PMID: 29714163 PMCID: PMC6086189 DOI: 10.4269/ajtmh.17-0818] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors through transfusions, transplants, insect feces in food, and from mother to child during gestation. Congenital infection could perpetuate Chagas disease indefinitely, even in countries without vector transmission. An estimated 30% of infected persons will develop lifelong, potentially fatal, cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment of Chagas disease in the United States. We constructed a decision-analytic model to find the lower cost option, comparing costs of testing and treatment, as needed, for mothers and infants with the lifetime societal costs without testing and the consequent morbidity and mortality due to lack of treatment or late treatment. We found that maternal screening, infant testing, and treatment of Chagas disease in the United States are cost saving for all rates of congenital transmission greater than 0.001% and all levels of maternal prevalence above 0.06% compared with no screening program. Newly approved diagnostics make universal screening cost saving with maternal prevalence as low as 0.008%. The present value of lifetime societal savings due to screening and treatment is about $634 million saved for every birth year cohort. The benefits of universal screening for T. cruzi as part of routine prenatal testing far outweigh the program costs for all U.S. births.
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Affiliation(s)
| | - Victoria Perez-Zetune
- International Finance Division, Board of Governors of the Federal Reserve System, Washington, District of Columbia
| | - Stephanie R Bialek
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Beer MF, Frank FM, Germán Elso O, Ernesto Bivona A, Cerny N, Giberti G, Luis Malchiodi E, Susana Martino V, Alonso MR, Patricia Sülsen V, Cazorla SI. Trypanocidal and leishmanicidal activities of flavonoids isolated from Stevia satureiifolia var. satureiifolia. PHARMACEUTICAL BIOLOGY 2016; 54:2188-2195. [PMID: 26983579 DOI: 10.3109/13880209.2016.1150304] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Context Chagas' disease and leishmaniasis produce significant disability and mortality with great social and economic impact. The genus Stevia (Asteraceae) is a potential source of antiprotozoal compounds. Objective Aerial parts of four Stevia species were screened on Trypanosoma cruzi. Stevia satureiifolia (Lam.) Sch. Bip. var. satureiifolia (Asteraceae) dichloromethane extract was selected for a bioassay-guided fractionation in order to isolate its active compounds. Additionally, the antileishmanial activity and the cytotoxicity of these compounds on mammalian cells were assessed. Materials and methods The dichloromethane extract was fractionated by column chromatography. The isolated compounds were evaluated using concentrations of 0-100 μg/mL on T. cruzi epimastigotes and on Leishmania braziliensis promastigotes for 72 h, on trypomastigotes and amastigotes of T. cruzi for 24 h and 120 h, respectively. The compounds' cytotoxicity (12.5-500 μg/mL) was assessed on Vero cells by the MTT assay. The structure elucidation of each compound was performed by spectroscopic methods and HPLC analysis. Results The dichloromethane extracts of Stevia species showed significant activity on T. cruzi epimastigotes. The flavonoids eupatorin (1.3%), cirsimaritin (1.9%) and 5-desmethylsinensetin (1.5%) were isolated from S. satureiifolia var. satureiifolia extract. Eupatorin and 5-desmethylsinensetin showed IC50 values of 0.2 and 0.4 μg/mL on T. cruzi epimastigotes and 61.8 and 75.1 μg/mL on trypomastigotes, respectively. The flavonoid 5-desmethylsinensetin showed moderate activity against T. cruzi amastigotes (IC50 value = 78.7 μg/mL) and was the most active compound on L. braziliensis promastigotes (IC50 value = 37.0 μg/mL). Neither of the flavonoids showed cytotoxicity on Vero cells, up to a concentration of 500 μg/mL.
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Affiliation(s)
- María Florencia Beer
- a Instituto de Química y Metabolismo del Fármaco (IQUIMEFA) (UBA-CONICET), Facultad de Farmacia y Bioquímica , Universidad de Buenos Aires , Buenos Aires , Argentina
- b Instituto de Tecnología Química (INTEQUI-CONICET) , Universidad Nacional de San Luis , San Luis , Argentina
| | - Fernanda Maria Frank
- c Cátedra de Inmunología, Instituto de Estudios de la Inmunidad Humoral (IDEHU) (UBA-CONICET) , Facultad de Farmacia y Bioquímica , Buenos Aires , Argentina
- d Instituto de Microbiología y Parasitología Médica (IMPaM) (UBA-CONICET) , Facultad de Medicina , Buenos Aires , Argentina
| | - Orlando Germán Elso
- a Instituto de Química y Metabolismo del Fármaco (IQUIMEFA) (UBA-CONICET), Facultad de Farmacia y Bioquímica , Universidad de Buenos Aires , Buenos Aires , Argentina
- c Cátedra de Inmunología, Instituto de Estudios de la Inmunidad Humoral (IDEHU) (UBA-CONICET) , Facultad de Farmacia y Bioquímica , Buenos Aires , Argentina
| | - Augusto Ernesto Bivona
- c Cátedra de Inmunología, Instituto de Estudios de la Inmunidad Humoral (IDEHU) (UBA-CONICET) , Facultad de Farmacia y Bioquímica , Buenos Aires , Argentina
- d Instituto de Microbiología y Parasitología Médica (IMPaM) (UBA-CONICET) , Facultad de Medicina , Buenos Aires , Argentina
| | - Natacha Cerny
- c Cátedra de Inmunología, Instituto de Estudios de la Inmunidad Humoral (IDEHU) (UBA-CONICET) , Facultad de Farmacia y Bioquímica , Buenos Aires , Argentina
- d Instituto de Microbiología y Parasitología Médica (IMPaM) (UBA-CONICET) , Facultad de Medicina , Buenos Aires , Argentina
| | - Gustavo Giberti
- a Instituto de Química y Metabolismo del Fármaco (IQUIMEFA) (UBA-CONICET), Facultad de Farmacia y Bioquímica , Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Emilio Luis Malchiodi
- c Cátedra de Inmunología, Instituto de Estudios de la Inmunidad Humoral (IDEHU) (UBA-CONICET) , Facultad de Farmacia y Bioquímica , Buenos Aires , Argentina
- d Instituto de Microbiología y Parasitología Médica (IMPaM) (UBA-CONICET) , Facultad de Medicina , Buenos Aires , Argentina
| | - Virginia Susana Martino
- a Instituto de Química y Metabolismo del Fármaco (IQUIMEFA) (UBA-CONICET), Facultad de Farmacia y Bioquímica , Universidad de Buenos Aires , Buenos Aires , Argentina
- e Cátedra de Farmacognosia, Facultad de Farmacia y Bioquímica , Universidad de Buenos Aires , Buenos Aires , Argentina
| | - María Rosario Alonso
- a Instituto de Química y Metabolismo del Fármaco (IQUIMEFA) (UBA-CONICET), Facultad de Farmacia y Bioquímica , Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Valeria Patricia Sülsen
- a Instituto de Química y Metabolismo del Fármaco (IQUIMEFA) (UBA-CONICET), Facultad de Farmacia y Bioquímica , Universidad de Buenos Aires , Buenos Aires , Argentina
- e Cátedra de Farmacognosia, Facultad de Farmacia y Bioquímica , Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Silvia Ines Cazorla
- c Cátedra de Inmunología, Instituto de Estudios de la Inmunidad Humoral (IDEHU) (UBA-CONICET) , Facultad de Farmacia y Bioquímica , Buenos Aires , Argentina
- d Instituto de Microbiología y Parasitología Médica (IMPaM) (UBA-CONICET) , Facultad de Medicina , Buenos Aires , Argentina
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Urbina JA. Recent clinical trials for the etiological treatment of chronic chagas disease: advances, challenges and perspectives. J Eukaryot Microbiol 2014; 62:149-56. [PMID: 25284065 DOI: 10.1111/jeu.12184] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 09/18/2014] [Accepted: 09/18/2014] [Indexed: 01/02/2023]
Abstract
Chagas disease, a chronic systemic parasitosis caused by the Kinetoplastid protozoon Trypanosoma cruzi, is the first cause of cardiac morbidity and mortality in poor rural and suburban areas of Latin America and the largest parasitic disease burden in the continent, now spreading worldwide due to international migrations. A recent change in the scientific paradigm on the pathogenesis of chronic Chagas disease has led to a consensus that all T. cruzi-seropositive patients should receive etiological treatment. This important scientific advance has spurred the rigorous evaluation of the safety and efficacy of currently available drugs (benznidazole and nifurtimox) as well as novel anti-T. cruzi drug candidates in chronic patients, who were previously excluded from such treatment. The first results indicate that benznidazole is effective in inducing a marked and sustained reduction in the circulating parasites' level in the majority of these patients, but adverse effects can lead to treatment discontinuation in 10-20% of cases. Ergosterol biosynthesis inhibitors, such as posaconazole and ravuconazole, are better tolerated but their efficacy at the doses and treatment duration used in the initial studies was significantly lower; such results are probably related to suboptimal exposure and/or treatment duration. Combination therapies are a promising perspective but the lack of validated biomarkers of response to etiological treatment and eventual parasitological cures in chronic patients remains a serious challenge.
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Affiliation(s)
- Julio A Urbina
- Venezuelan Institute for Scientific Research, Caracas, Venezuela
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8
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Franco-Paredes C. The growing challenge of leishmaniasis in travelers. Travel Med Infect Dis 2014; 12:559-60. [PMID: 25468527 DOI: 10.1016/j.tmaid.2014.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Carlos Franco-Paredes
- Phoebe Putney Memorial Hospital, Albany, GA, United States; Hospital Infantil de Mexico, Federico Gomez, Mexico City, Mexico.
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9
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Cazorla SI, Matos MN, Cerny N, Ramirez C, Alberti AS, Bivona AE, Morales C, Guzmán CA, Malchiodi EL. Oral multicomponent DNA vaccine delivered by attenuated Salmonella elicited immunoprotection against American trypanosomiasis. J Infect Dis 2014; 211:698-707. [PMID: 25160983 DOI: 10.1093/infdis/jiu480] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We have reported that attenuated Salmonella (S) carrying plasmids encoding the cysteine protease cruzipain (Cz) protects against Trypanosoma cruzi infection. Here, we determined whether immunoprotection could be improved by the oral coadministration of 3 Salmonella carrying the plasmids that encode the antigens Cz, Tc52, and Tc24. SCz+STc52+STc24-immunized mice presented an increased antibody response against each antigen compared with those in the single antigen-immunized groups, as well as higher trypomastigotes antibody-mediated lyses and cell invasion inhibition compared with controls. SCz+STc52+STc24-immunized and -challenged mice rendered lower parasitemia. Weight loss after infection was detected in all mice except those in the SCz+STc52+STc24 group. Moreover, cardiomyopathy-associated enzyme activity was significantly lower in SCz+STc24+STc52-immunized mice compared with controls. Few or no abnormalities were found in muscle tissues of SCz+STc24+STc52-immunized mice, whereas controls presented with inflammatory foci, necrosis, and amastigote nests. We conclude that a multicomponent approach that targets several invasion and metabolic mechanisms improves protection compared with single-component vaccines.
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Affiliation(s)
- Silvia I Cazorla
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Dr. R. A. Margni, Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad de Buenos Aires (CONICET-UBA), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires Instituto de Microbiología y Parasitología Médica (IMPaM), UBA-CONICET and Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, UBA
| | - Marina N Matos
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Dr. R. A. Margni, Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad de Buenos Aires (CONICET-UBA), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires Instituto de Microbiología y Parasitología Médica (IMPaM), UBA-CONICET and Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, UBA
| | - Natacha Cerny
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Dr. R. A. Margni, Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad de Buenos Aires (CONICET-UBA), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires Instituto de Microbiología y Parasitología Médica (IMPaM), UBA-CONICET and Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, UBA
| | - Carolina Ramirez
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Dr. R. A. Margni, Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad de Buenos Aires (CONICET-UBA), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires Instituto de Microbiología y Parasitología Médica (IMPaM), UBA-CONICET and Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, UBA
| | - Andrés Sanchez Alberti
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Dr. R. A. Margni, Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad de Buenos Aires (CONICET-UBA), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires Instituto de Microbiología y Parasitología Médica (IMPaM), UBA-CONICET and Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, UBA
| | - Augusto E Bivona
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Dr. R. A. Margni, Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad de Buenos Aires (CONICET-UBA), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires Instituto de Microbiología y Parasitología Médica (IMPaM), UBA-CONICET and Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, UBA
| | - Celina Morales
- Departamento de Patología, Facultad de Medicina UBA, Instituto de Fisiopatología Cardiovascular, Buenos Aires, Argentina
| | - Carlos A Guzmán
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Emilio L Malchiodi
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Dr. R. A. Margni, Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad de Buenos Aires (CONICET-UBA), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires Instituto de Microbiología y Parasitología Médica (IMPaM), UBA-CONICET and Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, UBA
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De Maio FG, Llovet I, Dinardi G. Chagas disease in non-endemic countries: ‘sick immigrant’ phobia or a public health concern? CRITICAL PUBLIC HEALTH 2013. [DOI: 10.1080/09581596.2013.836589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vasconcelos JF, Souza BSF, Lins TFS, Garcia LMS, Kaneto CM, Sampaio GP, Alcântara AC, Meira CS, Macambira SG, Ribeiro‐dos‐Santos R, Soares MBP. Administration of granulocyte colony‐stimulating factor induces immunomodulation, recruitment of T regulatory cells, reduction of myocarditis and decrease of parasite load in a mouse model of chronic Chagas disease cardiomyopathy. FASEB J 2013; 27:4691-702. [DOI: 10.1096/fj.13-229351] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Juliana F. Vasconcelos
- Centro de Pesquisas Gonçalo MonizFundação Oswaldo CruzSalvadorBahiaBrazil
- Centro de Biotecnologia e Terapia CelularHospital São RafaelSalvadorBahiaBrazil
| | - Bruno S. F. Souza
- Centro de Pesquisas Gonçalo MonizFundação Oswaldo CruzSalvadorBahiaBrazil
- Centro de Biotecnologia e Terapia CelularHospital São RafaelSalvadorBahiaBrazil
| | - Thayse F. S. Lins
- Centro de Pesquisas Gonçalo MonizFundação Oswaldo CruzSalvadorBahiaBrazil
| | | | - Carla M. Kaneto
- Centro de Biotecnologia e Terapia CelularHospital São RafaelSalvadorBahiaBrazil
- Universidade Estadual de Santa CruzIlhéusBahiaBrazil
| | - Geraldo P. Sampaio
- Centro de Biotecnologia e Terapia CelularHospital São RafaelSalvadorBahiaBrazil
| | | | - Cássio S. Meira
- Centro de Pesquisas Gonçalo MonizFundação Oswaldo CruzSalvadorBahiaBrazil
| | - Simone G. Macambira
- Centro de Pesquisas Gonçalo MonizFundação Oswaldo CruzSalvadorBahiaBrazil
- Centro de Biotecnologia e Terapia CelularHospital São RafaelSalvadorBahiaBrazil
- Universidade Federal da BahiaSalvadorBahiaBrazil
| | | | - Milena B. P. Soares
- Centro de Pesquisas Gonçalo MonizFundação Oswaldo CruzSalvadorBahiaBrazil
- Centro de Biotecnologia e Terapia CelularHospital São RafaelSalvadorBahiaBrazil
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12
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Lee BY, Bacon KM, Wateska AR, Bottazzi ME, Dumonteil E, Hotez PJ. Modeling the economic value of a Chagas' disease therapeutic vaccine. Hum Vaccin Immunother 2012; 8:1293-301. [PMID: 22894964 DOI: 10.4161/hv.20966] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The health burden of Chagas' disease (resulting from Trypanosoma cruzi infection) in Latin America (estimated to outweigh that of malaria by 5-fold and affect 2-6 million people in Mexico alone) has motivated development of therapeutic vaccines to prevent infection progression to severe disease. Our economic model for a Chagas' therapeutic vaccine in Mexico suggests that a vaccine would be highly cost-effective and in many cases economically dominant (providing both cost savings and health benefits) throughout a range of protection durations, severe adverse event risk, and dosing regimens and would be most likely to provide a positive return on investment if the vaccine prevented (rather than delayed) the onset of cardiomyopathy.
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Affiliation(s)
- Bruce Y Lee
- Public Health Computational and Operations Research, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Abstract
Chagas disease has emerged as an important health problem in the Americas and, with globalization, in other parts of the world. Drug therapy for this parasitic infection has remained largely ineffective, especially in chronic stages of the disease. However, developments in experimental therapy might signal an important advance for the management of patients with Chagas disease. Herein, we review studies on the potential use of the benzofuran derivatives amiodarone and dronedarone in patients with Chagas disease. These agents have a dual role, not only as primary antiarrhythmic drugs, but also as antiparasitic agents. We believe that this 'kill two birds with one stone' approach represents a new tactic for the treatment of Chagas disease using currently approved drugs.
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Manganese(II) complexes with N4-methyl-4-nitrobenzaldehyde, N4-methyl-4-nitroacetofenone, and N4-methyl-4-nitrobenzophenone thiosemicarbazone: Investigation of in vitro activity against Trypanosoma cruzi. Polyhedron 2010. [DOI: 10.1016/j.poly.2010.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Parasitic infections previously seen only in developing tropical settings can be currently diagnosed worldwide due to travel and population migration. Some parasites may directly or indirectly affect various anatomical structures of the heart, with infections manifested as myocarditis, pericarditis, pancarditis, or pulmonary hypertension. Thus, it has become quite relevant for clinicians in developed settings to consider parasitic infections in the differential diagnosis of myocardial and pericardial disease anywhere around the globe. Chagas' disease is by far the most important parasitic infection of the heart and one that it is currently considered a global parasitic infection due to the growing migration of populations from areas where these infections are highly endemic to settings where they are not endemic. Current advances in the treatment of African trypanosomiasis offer hope to prevent not only the neurological complications but also the frequently identified cardiac manifestations of this life-threatening parasitic infection. The lack of effective vaccines, optimal chemoprophylaxis, or evidence-based pharmacological therapies to control many of the parasitic diseases of the heart, in particular Chagas' disease, makes this disease one of the most important public health challenges of our time.
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Abstract
A hundred years from its description, Chagas cardiomyopathy remains a challenging disease. Although successful vector-control strategies have decreased the incidence of Chagas disease in several Latin American countries, both migration to urban areas and immigration have spread the disease worldwide; and now, blood transfusion, organ transplantation, and vertical transmission are a concern. The pathogenesis of Chagas cardiomyopathy involves complex host-parasite interactions, where low-grade but incessant systemic infection and triggered autoimmune reaction are the main mechanisms for its development, with the contribution of autonomic damage and microvascular disturbances. Chagas cardiomyopathy is the most important clinical presentation of Chagas disease and comprises a wide range of manifestations, including heart failure, arrhythmias, heart blocks, sudden death, thromboembolism, and stroke. Recently, simple clinical prognostic scores have been developed to identify high-risk patients and help with management. The treatment of Chagas cardiomyopathy focuses mostly on managing heart failure, arrhythmias, and thromboembolism. The role of specific antiparasitic therapy in the chronic form is not yet defined, and a randomized trial is now under way to address this crucial point. In this article, we review the main clinical aspects of Chagas cardiomyopathy and underscore some upcoming challenges for the appropriate control, diagnosis, and management of this complex disease.
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Affiliation(s)
- Andréia Biolo
- Division of Cardiology, Hospital de Clínicas de Porto Alegre and Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Fiches maladies. MÉDECINE DES VOYAGES MÉDECINE TROPICALE 2009. [PMCID: PMC7151805 DOI: 10.1016/b978-2-294-70867-1.00055-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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