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Alves Cunha EL, Vieira da Silva Torchelsen FK, da Silva Fonseca K, Dutra Sousa LR, Abreu Vieira PM, Carneiro CM, Mauro de Castro Pinto K, Torres RM, de Lana M. Benznidazole, itraconazole, and their combination for the treatment of chronic experimental Chagas disease in dogs. Exp Parasitol 2022; 238:108266. [PMID: 35490799 DOI: 10.1016/j.exppara.2022.108266] [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: 01/22/2022] [Revised: 03/29/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
Treatment for Chagas disease has limited efficacy in the chronic phase. We evaluated benznidazole (BZ) and itraconazole (ITZ) individually and in association in dogs 16 months after infection with a BZ-resistant Trypanosoma cruzi strain. Four study groups (20 animals) were evaluated and treated for 60 days with BZ, ITZ, or BZ + ITZ, and maintained in parallel to control group infected and not treated (INT). All dogs were evaluated in the first, sixth, 12th, 18th and 24th months of study. Polymerase chain reaction (PCR) was negative in 2 of 3 animals in the BZ + ITZ group, 2 of 5 in the BZ group, and 4 of 5 in the ITZ group. Hemoculture performed in the 24th month was negative in all groups. Enzyme-linked immunoassay remained reactive in all treated animals. Echocardiography differentiated treated animals from control animals. Quantitative PCR analysis of cardiac tissue was negative in the BZ + ITZ and BZ groups, positive in 2 of 5 dogs in the ITZ group and in 2 of 3 dogs in the control group, but negative in colon tissue in all groups. Inflammation was significantly reduced in the right atrium and left ventricle of dogs treated with BZ + ITZ and BZ compared with those receiving ITZ alone. Fibrosis was absent in most dogs treated with BZ + ITZ, mild in those treated with BZ or ITZ alone, and intense in the control group. Parasitological and histopathological evaluations showed that BZ + ITZ treatment improved or stabilized the clinical condition of the dogs.
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Affiliation(s)
- Eleonora Lima Alves Cunha
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal de Ouro Preto (UFOP), CEP: 35400-000, Ouro Preto, MG, Brazil.
| | | | - Kátia da Silva Fonseca
- Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), CEP: 35400-000, Ouro Preto, MG, Brazil.
| | - Lucas Resende Dutra Sousa
- Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), CEP: 35400-000, Ouro Preto, MG, Brazil.
| | - Paula Melo Abreu Vieira
- Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), CEP: 35400-000, Ouro Preto, MG, Brazil.
| | - Cláudia Martins Carneiro
- Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), CEP: 35400-000, Ouro Preto, MG, Brazil.
| | | | - Rosália Morais Torres
- Faculdade de Medicina, Departmento de Clínica Médica, Universidade de Minas Gerais (UFMG), Av. Alfredo Balena, 900, CEP: 30130-100, Funcionários, Belo Horizonte, MG, Brazil.
| | - Marta de Lana
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal de Ouro Preto (UFOP), CEP: 35400-000, Ouro Preto, MG, Brazil; Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), CEP: 35400-000, Ouro Preto, MG, Brazil.
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Marins-Dos-Santos A, Ayres-Silva JDP, Antunes D, Moreira CJDC, Pelajo-Machado M, Alfaro D, Zapata AG, Bonomo AC, Savino W, de Meis J, Farias-de-Oliveira DA. Oral Trypanosoma cruzi Acute Infection in Mice Targets Primary Lymphoid Organs and Triggers Extramedullary Hematopoiesis. Front Cell Infect Microbiol 2022; 12:800395. [PMID: 35402296 PMCID: PMC8990980 DOI: 10.3389/fcimb.2022.800395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/24/2022] [Indexed: 12/03/2022] Open
Abstract
During the acute phase of Chagas disease, Trypanosoma cruzi circulation through the bloodstream leads to high tissue parasitism in the host. In primary lymphoid organs, progenitor cell reduction paralleled transient immunosuppression. Herein we showed that acute oral infection in mice promotes diffuse parasitism in bone marrow cells at 14 and 21 days post-infection (dpi), with perivascular regions, intravascular regions, and regions near the bone being target sites of parasite replication. Phenotypic analysis of hematopoietic differentiation in the bone marrow of infected mice showed that the cell number in the tissue is decreased (lineage-negative and lineage-positive cells). Interestingly, analysis of hematopoietic branching points showed that hematopoietic stem and progenitor cells (HSPCs) were significantly increased at 14 dpi. In addition, the pool of progenitors with stem plasticity (HSC-MPP3), as well as multipotent progenitors (MPPs) such as MPP4, also showed this pattern of increase. In contrast, subsequent progenitors that arise from MPPs, such as common lymphoid progenitors (CLPs), lymphoid-primed MPPs (LMPPs), and myeloid progenitors, were not enhanced; conversely, all presented numeric decline. Annexin V staining revealed that cell death increase in the initial hematopoietic branching point probably is not linked to CLPs and that myeloid progenitors decreased at 14 and 21 dpi. In parallel, our investigation provided clues that myeloid progenitor decrease could be associated with an atypical expression of Sca-1 in this population leading to a remarkable increase on LSK-like cells at 14 dpi within the HSPC compartment. Finally, these results led us to investigate HSPC presence in the spleen as a phenomenon triggered during emergency hematopoiesis due to mobilization or expansion of these cells in extramedullary sites. Splenocyte analysis showed a progressive increase in HSPCs between 14 and 21 dpi. Altogether, our study shows that the bone marrow is a target tissue in T. cruzi orally infected mice, leading to a hematopoietic disturbance with LSK-like cell bias accounting on HSPCs possibly affecting myeloid progenitor numbers. The LMPP and CLP reduction converges with defective thymocyte development. Lastly, it is tempting to speculate that the extramedullary hematopoiesis seen in the spleen is a mechanism involved in the hematological maintenance reported during the acute phase of oral T. cruzi infection.
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Affiliation(s)
- Alessandro Marins-Dos-Santos
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Brazilian National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Dina Antunes
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Brazilian National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Marcelo Pelajo-Machado
- Brazilian National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Laboratory of Pathology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - David Alfaro
- Department of Cell Biology, Faculty of Biology, Complutense University of Madrid, Madrid, Spain
| | - Agustín G. Zapata
- Department of Cell Biology, Faculty of Biology, Complutense University of Madrid, Madrid, Spain
| | - Adriana Cesar Bonomo
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Brazilian National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Rio de Janeiro Research Network on Neuroinflammation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Wilson Savino
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Brazilian National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Rio de Janeiro Research Network on Neuroinflammation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- *Correspondence: Wilson Savino, ; ; Désio Aurélio Farias-de-Oliveira, ;
| | - Juliana de Meis
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Brazilian National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Rio de Janeiro Research Network on Neuroinflammation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Désio Aurélio Farias-de-Oliveira
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Brazilian National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Rio de Janeiro Research Network on Neuroinflammation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- *Correspondence: Wilson Savino, ; ; Désio Aurélio Farias-de-Oliveira, ;
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Lascano F, García Bournissen F, Altcheh J. Review of pharmacological options for the treatment of Chagas disease. Br J Clin Pharmacol 2022; 88:383-402. [PMID: 33314266 DOI: 10.1111/bcp.14700] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/09/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022] Open
Abstract
Chagas disease (CD) is a worldwide problem, with over 8 million people infected in both rural and urban areas. CD was first described over a century ago, but only two drugs are currently available for CD treatment: benznidazole (BZN) and nifurtimox (NF). Treating CD-infected patients, especially children and women of reproductive age, is vital in order to prevent long-term sequelae, such as heart and gastrointestinal dysfunction, but this aim is still far from being accomplished. Currently, the strongest data to support benefit-risk considerations come from trials in children. Treatment response biomarkers need further development as serology is being questioned as the best method to assess treatment response. This article is a narrative review on the pharmacology of drugs for CD, particularly BZN and NF. Data on drug biopharmaceutical characteristics, safety and efficacy of both drugs are summarized from a clinical perspective. Current data on alternative compounds under evaluation for CD treatment, and new possible treatment response biomarkers are also discussed. Early diagnosis and treatment of CD, especially in paediatric patients, is vital for an effective and safe use of the available drugs (i.e. BZN and NF). New biomarkers for CD are urgently needed for the diagnosis and evaluation of treatment efficacy, and to guide efforts from academia and pharmaceutical companies to accelerate the process of new drug development.
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Affiliation(s)
- Fernanda Lascano
- Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Gobierno de la Ciudad de la Nación Argentina, Buenos Aires, Argentina.,Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Facundo García Bournissen
- Division of Pediatric Clinical Pharmacology, Department of Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Jaime Altcheh
- Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Gobierno de la Ciudad de la Nación Argentina, Buenos Aires, Argentina.,Servicio de Parasitología y Chagas, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
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Díaz-Bello Z, de Noya BA, Muñoz-Calderón A, Ruiz-Guevara R, Mauriello L, Colmenares C, Moronta E, Aponte M, Ramírez JL, Noya-González O. Ten-year follow-up of the largest oral Chagas disease outbreak. Laboratory biomarkers of infection as indicators of therapeutic failure. Acta Trop 2021; 222:106034. [PMID: 34224715 DOI: 10.1016/j.actatropica.2021.106034] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/17/2021] [Accepted: 06/28/2021] [Indexed: 01/03/2023]
Abstract
Trypanosoma cruzi uses various mechanisms of infection to access humans. Since 1967, food contaminated with metacyclic trypomastigotes has triggered several outbreaks of acute infection of Chagas disease by oral transmission. Follow-up studies to assess the effectiveness of anti-parasitic treatment of oral outbreaks are rather scarce. Here, we report a 10-year laboratory follow-up using parasitological, serological, and molecular tests of 106 individuals infected in 2007 of the largest known outbreak of orally transmitted Chagas disease, which occurred in Caracas city, Venezuela. Before treatment (2007), specific IgA, IgM and IgG, were found in 71% (75/106), 90% (95/106) and 100% (106/106), respectively, in addition to 21% (9/43) parasitemia, Complement Mediated Lysis (CML) in 98% (104/106) and 79% (34/43) parasitic DNA for PCR. Blood culture detected parasitemia up to 18 months post-treatment in 6% (6/106) of the patients. In 2017, the original number of cases in the follow-up decreased by 46% and due to the country's economic situation, not all the trials could be carried out in the entire population. During follow-up, IgA and IgM disappeared promptly, with IgM persisting in 19% (20/104) of the patients three years after treatment. The anti-T. cruzi IgG remained positive 10 years later in 41% (20/49) of the individuals evaluated. CML remained positive seven years later in 79% (65/82) of the cases. PCR positive cases decreased after treatment but progressively recovered, being positive in 69% (32/46) of the individuals evaluated in 2017. The group of children (under 18 years of age) showed the highest PCR positivity with 76% (26/34) of the cases, but their parasitic load tended to diminish, while in adults the parasitic load regained their initial values. The simultaneous evaluation of serological tests and PCR of the patients allowed us to separate patients among responders and non-responders to the anti-parasitic treatment, and this information prompted us to apply a second anti-parasitic treatment in the group of non-responders. In this population not subjected to the like lihood of re-infection, adult patients were more likely to be non-responders when compared to children. These results suggest that rigorous laboratory follow-up with T. cruzi infectious biomarkers is essential to detect cases of parasite persistence.
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Niborski LL, Potenza M, Chirivi RGS, Simonetti L, Ossowski MS, Grippo V, May M, Staquicini DI, Parodi-Talice A, Robello C, Comini MA, Alonso GD, Raats JMH, Gómez KA. Recombinant antibody against Trypanosoma cruzi from patients with chronic Chagas heart disease recognizes mammalian nervous system. EBioMedicine 2021; 63:103206. [PMID: 33429173 PMCID: PMC7809174 DOI: 10.1016/j.ebiom.2020.103206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/15/2020] [Accepted: 11/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To deeply understand the role of antibodies in the context of Trypanosoma cruzi infection, we decided to characterize A2R1, a parasite antibody selected from single-chain variable fragment (scFv) phage display libraries constructed from B cells of chronic Chagas heart disease patients. METHODS Immunoblot, ELISA, cytometry, immunofluorescence and immunohistochemical assays were used to characterize A2R1 reactivity. To identify the antibody target, we performed an immunoprecipitation and two-dimensional electrophoresis coupled to mass spectrometry and confirmed A2R1 specific interaction by producing the antigen in different expression systems. Based on these data, we carried out a comparative in silico analysis of the protein target´s orthologues, focusing mainly on post-translational modifications. FINDINGS A2R1 recognizes a parasite protein of ~50 kDa present in all life cycle stages of T. cruzi, as well as in other members of the kinetoplastid family, showing a defined immunofluorescence labeling pattern consistent with the cytoskeleton. A2R1 binds to tubulin, but this interaction relies on its post-translational modifications. Interestingly, this antibody also targets mammalian tubulin only present in brain, staining in and around cell bodies of the human peripheral and central nervous system. INTERPRETATION Our findings demonstrate for the first time the existence of a human antibody against T. cruzi tubulin capable of cross-reacting with a human neural protein. This work re-emphasizes the role of molecular mimicry between host and parasitic antigens in the development of pathological manifestations of T. cruzi infection.
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Affiliation(s)
- Leticia L Niborski
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Mariana Potenza
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | | | | | - Micaela S Ossowski
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Vanina Grippo
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | - Maria May
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Daniela I Staquicini
- Departamento de Microbiología, Inmunología e Parasitología, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Adriana Parodi-Talice
- Unidad de Biología Molecular, Institut Pasteur de Montevideo, Montevideo, Uruguay; Sección Genética, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - Carlos Robello
- Unidad de Biología Molecular, Institut Pasteur de Montevideo, Montevideo, Uruguay; Departamento de Bioquímica, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Marcelo A Comini
- Group Redox Biology of Trypanosomes, Institut Pasteur de Montevideo, Montevideo, Uruguay
| | - Guillermo D Alonso
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina
| | | | - Karina A Gómez
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina.
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Lychnopholide in Poly(d,l-Lactide)- Block-Polyethylene Glycol Nanocapsules Cures Infection with a Drug-Resistant Trypanosoma cruzi Strain at Acute and Chronic Phases. Antimicrob Agents Chemother 2020; 64:AAC.01937-19. [PMID: 31988096 DOI: 10.1128/aac.01937-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/20/2019] [Indexed: 12/18/2022] Open
Abstract
Chagas disease remains neglected, and current chemotherapeutics present severe limitations. Lychnopholide (LYC) at low doses loaded in polymeric poly(d,l-lactide)-block-polyethylene glycol (PLA-PEG) nanocapsules (LYC-PLA-PEG-NC) exhibits anti-Trypanosoma cruzi efficacy in mice infected with a partially drug-resistant strain. This study reports the efficacy of LYC-PLA-PEG-NC at higher doses in mice infected with a T. cruzi strain resistant to benznidazole (BZ) and nifurtimox (NF) treated at both the acute phase (AP) and the chronic phase (CP) of infection by the oral route. Mice infected with the T. cruzi VL-10 strain were treated by the oral route with free LYC (12 mg/kg of body weight/day), LYC-PLA-PEG-NC (8 or 12 mg/kg/day), or BZ at 100 mg/kg/day or were not treated (controls). Treatment efficacy was assessed by hemoculture (HC), PCR, enzyme-linked immunosorbent assay (ELISA), heart tissue quantitative PCR (qPCR), and histopathology. According to classical cure criteria, treatment with LYC-PLA-PEG-NC at 12 mg/kg/day cured 75% (AP) and 88% (CP) of the animals, while at a dose of 8 mg/kg/day, 43% (AP) and 43% (CP) were cured, showing dose-dependent efficacy. The negative qPCR results for heart tissue and the absence of inflammation/fibrosis agreed with the negative results obtained by HC and PCR. Thus, the mice treated with the highest dose could be considered 100% cured, in spite of a low ELISA reactivity in some animals. No cure was observed in animals treated with free LYC or BZ or the controls. These results are exceptional in terms of experimental Chagas disease chemotherapy and provide evidence of the outstanding contribution of nanotechnology in mice infected with a T. cruzi strain totally resistant to BZ and NF at both phases of infection. Therefore, LYC-PLA-PEG-NC has great potential as a new treatment for Chagas disease and deserves further investigations in clinical trials.
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Bern C, Messenger LA, Whitman JD, Maguire JH. Chagas Disease in the United States: a Public Health Approach. Clin Microbiol Rev 2019; 33:e00023-19. [PMID: 31776135 PMCID: PMC6927308 DOI: 10.1128/cmr.00023-19] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Trypanosoma cruzi is the etiological agent of Chagas disease, usually transmitted by triatomine vectors. An estimated 20 to 30% of infected individuals develop potentially lethal cardiac or gastrointestinal disease. Sylvatic transmission cycles exist in the southern United States, involving 11 triatomine vector species and infected mammals such as rodents, opossums, and dogs. Nevertheless, imported chronic T. cruzi infections in migrants from Latin America vastly outnumber locally acquired human cases. Benznidazole is now FDA approved, and clinical and public health efforts are under way by researchers and health departments in a number of states. Making progress will require efforts to improve awareness among providers and patients, data on diagnostic test performance and expanded availability of confirmatory testing, and evidence-based strategies to improve access to appropriate management of Chagas disease in the United States.
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Affiliation(s)
- Caryn Bern
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Jeffrey D Whitman
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - James H Maguire
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Cunha ELA, Torchelsen FKVDS, Cunha LM, Oliveira MT, Reis LES, Fonseca KDS, Vieira PMA, Carneiro CM, Lana M. Benznidazole, itraconazole and their combination in the treatment of acute experimental Chagas disease in dogs. MethodsX 2019; 6:2544-2552. [PMID: 31908981 PMCID: PMC6939041 DOI: 10.1016/j.mex.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/07/2019] [Indexed: 12/03/2022] Open
Abstract
Chagas disease (CD) is a serious public health problem in Latin America and its treatment remains neglected. Benznidazole (BZ) available in Brazil, presents serious side effects and low therapeutic efficacy at chronic phase. This study evaluated the therapeutic efficacy of BZ, itraconazole (ITZ) and BZ + ITZ in dogs infected with VL-10 T. cruzi strain in the acute phase (Ethic protocol number 2013/28). Twenty young mongrel dogs were inoculated with 2.0 × 103 blood trypomastigotes/kg and divided into four groups: treated with BZ, ITZ and BZ + ITZ for 60 days, and control group (INT-infected not treated). The parasitemia of the BZ + ITZ and BZ groups were similar and showed significant reduction compared to the INT group. The ITZ group also showed significant parasitemia reduction compared to the INT group. For cure control the global analysis of hemoculture (HC), blood PCR, conventional serology (CS-ELISA), heart qPCR and histopathology revealed that BZ + ITZ lead to more reduction of parasitemia during the acute phase and heart qPCR positivity, less cardiac damage and total survival than BZ or ITZ. Moreover, two other dogs, one treated with ITZ and other treated with BZ + ITZ, were always negative in all parasitological tests what indicates parasitological cure or that these dogs are in process of cure. •BZ + ITZ lead to more reduction of parasitemia, total survival, less heart qPCR positivity and cardiac damage.•According to the classic cure criterion cure was observed only in one dog submitted to BZ + ITZ treatment.•Two dogs, one treated with ITZ and other treated with BZ + ITZ were always parasitologically negative.
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Affiliation(s)
- Eleonora Lima Alves Cunha
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), CampusUniversitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
| | - Fernanda Karoline Vieira da Silva Torchelsen
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), CampusUniversitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
- Programa de Pós-Graduação em Ciências Farmacêuticas (CiPHARMA), Escola de Farmácia, Universidade Federal de Ouro Preto (UFOP), Brazil
| | - Lucas Maciel Cunha
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), CampusUniversitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
| | - Maykon Tavares Oliveira
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), CampusUniversitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
| | - Levi Eduardo Soares Reis
- Programa de Pós-Graduação em Ciências Farmacêuticas (CiPHARMA), Escola de Farmácia, Universidade Federal de Ouro Preto (UFOP), Brazil
| | - Kátia da Silva Fonseca
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), CampusUniversitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
| | - Paula Melo Abreu Vieira
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), CampusUniversitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
| | - Cláudia Martins Carneiro
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), CampusUniversitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
- Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto (UFOP), Campus Universitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
| | - Marta Lana
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), CampusUniversitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
- Programa de Pós-Graduação em Ciências Farmacêuticas (CiPHARMA), Escola de Farmácia, Universidade Federal de Ouro Preto (UFOP), Brazil
- Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto (UFOP), Campus Universitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
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Activity of the sesquiterpene lactone goyazensolide against Trypanosoma cruzi in vitro and in vivo. Parasitology 2019; 147:108-119. [PMID: 31455451 DOI: 10.1017/s0031182019001276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The current drugs for Chagas disease treatment present several limitations. METHODS The sesquiterpene lactone goyazensolide (GZL) was evaluated regarding to cytotoxicity and trypanocidal activity against amastigotes, selectivity index (SI) in vitro, acute toxicity and anti-Trypanosoma cruzi activity in vivo. RESULTS The in vitro cytotoxicity in H9c2 cells was observed at doses >250 ng mL-1 of GZL and the SI were of 52.82 and 4.85 (24 h) and of 915.00 and 41.00 (48 h) for GZL and BZ, respectively. Nephrotoxicity and hepatotoxicity were not verified. Treatment with GZL of mice infected with CL strain led to a significant decrease of parasitaemia and total survival at doses of 1 and 3 mg kg-1 day-1 by oral and IV, respectively. This last group cured 12.5% of the animals (negativation of HC, PCR, qPCR and ELISA). Animals infected with Y strain showed significant decrease of parasitaemia and higher negativation in all parasitological tests in comparison to BZ and control groups, but were ELISA reactive, as well as the BZ group, but mice treated with 5.0 mg kg-1 day-1 by oral were negative in parasitological tests and survived. CONCLUSION GZL was more active against T. cruzi than benznidazole in vitro and presented important therapeutic activity in vivo in both T. cruzi strains.
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Cunha ELA, Torchelsen FKVDS, Cunha LM, de Oliveira MT, Fonseca KDS, Vieira PMA, Carneiro CM, de Lana M. Benznidazole, itraconazole and their combination in the treatment of acute experimental chagas disease in dogs. Exp Parasitol 2019; 204:107711. [PMID: 31254494 DOI: 10.1016/j.exppara.2019.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/02/2019] [Accepted: 05/27/2019] [Indexed: 02/05/2023]
Abstract
Chagas disease (CD) is a serious public health problem in Latin America and its treatment remains neglected. Benznidazole (BZ), the only drug available in Brazil, presents serious side effects and low therapeutic efficacy, especially at the chronic phase. The last clinical trials demonstrated that the first generation of azole compounds were less successful than BZ in CD chemotherapy, which stimulated studies of these compounds associated to BZ and nifurtimox (NF). This study evaluated the therapeutic efficacy of BZ, itraconazole (ITZ) and their combination (BZ + ITZ) in dogs infected with the VL-10 T. cruzi strain in the acute phase of the disease. Twenty young mongrel dogs were inoculated with 2.0 × 103 blood trypomastigotes/kg and divided into four groups: treated with BZ, ITZ and BZ + ITZ for 60 days, and control group (INT). The parasitemia of the BZ + ITZ and BZ groups were similar and showed significant reduction compared to the INT group. The group treated with ITZ also showed significant parasitemia reduction compared to the INT group. The global analysis of hemoculture (HC), blood PCR, conventional serology (CS-ELISA), heart qPCR and histopathology techniques, used in the post-treatment evaluation, revealed that BZ + ITZ combination lead to a more reduction of parasitemia during the acute phase and heart qPCR positivity, less cardiac damage (inflammation and fibrosis in the left ventricle) and total survival. According to the classical cure criteria one animal treated with BZ + ITZ can be considered cured in its final evaluation and two other dogs, one of this group and one treated with ITZ were in process of cure. At least for BZ-resistant T. cruzi strains such as VL-10, BZ + ITZ was not effective to induce parasitological cure or a profound and sustained reduction of the parasite burden in blood and infected organs.
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Affiliation(s)
- Eleonora Lima Alves Cunha
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), Campus Universitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
| | - Fernanda Karoline Vieira da Silva Torchelsen
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), Campus Universitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil; Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto (UFOP), Campus Universitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, UFOP, Brazil
| | - Lucas Maciel Cunha
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), Campus Universitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
| | - Maykon Tavares de Oliveira
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), Campus Universitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
| | - Kátia da Silva Fonseca
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), Campus Universitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
| | - Paula Melo Abreu Vieira
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), Campus Universitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil
| | - Cláudia Martins Carneiro
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), Campus Universitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil; Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto (UFOP), Campus Universitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, UFOP, Brazil
| | - Marta de Lana
- Programa de Pós-Graduação em Ciências Biológicas, Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto (UFOP), Campus Universitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, Brazil; Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto (UFOP), Campus Universitário Morro do Cruzeiro, Bairro Bauxita, CEP: 35400-000, Ouro Preto, MG, UFOP, Brazil.
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D’Ávila DA, Galvão LMC, Sousa GR, Britto C, Moreira OC, Chiari E. Monitoring the parasite load in chronic Chagas disease patients: comparison between blood culture and quantitative real time PCR. PLoS One 2018; 13:e0208133. [PMID: 30496249 PMCID: PMC6264508 DOI: 10.1371/journal.pone.0208133] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/12/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite the improvements in diagnostic tools for detection of Trypanosoma cruzi in human blood samples, the isolation of parasite from bloodstream in the chronic phase of Chagas disease is challenging. Thus, there is an increasing interest in the development of strategies that allow an accurate monitoring of the parasite load in bloodstream of Chagas disease patients. Given that, the comparison of a classical diagnostic method such as blood culture and multiplex quantitative real-time PCR (qPCR) was few explored so far. Therefore, this study aimed to compare the detection and quantification of T. cruzi load in the circulating blood of patients with chronic Chagas disease, using blood culture and qPCR techniques. METHODS⁄PRINCIPAL FINDINGS The multiplex real-time quantitative PCR assay (qPCR) based on TaqMan technology was evaluated in 135 blood samples from 91 patients with chronic Chagas disease presenting indeterminate (asymptomatic, n = 23) and cardiac (chronic cardiomyopathy, n = 68) forms, in comparison with the classical blood culture (BC) technique. The total positivity of qPCR and BC was 58.5% and 49.6%, respectively. The median parasite load of all positive patients was 1.18 [0.39-4.23] par. eq.⁄mL, ranging from 0.01 to 116.10 par. eq.⁄mL. We did not find significant differences between T. cruzi load with age and distinct clinical manifestations of patients. CONCLUSIONS/SIGNIFICANCE Our data suggest that qPCR can be an auxiliary tool for studies that require T. cruzi isolation from the bloodstream of patients with chronic Chagas disease, after the establishment of a parasite load cut-off that guarantees a relative success rate of parasite isolation using BC technique.
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Affiliation(s)
- Daniella Alchaar D’Ávila
- Programa de Pós-Graduação em Parasitologia, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lúcia Maria C. Galvão
- Programa de Pós-Graduação em Parasitologia, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Giovane R. Sousa
- Section on Immunobiology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States of America
| | - Constança Britto
- Laboratório de Biologia Molecular e Doenças Endêmicas, Instituto Oswaldo Cruz, FIOCRUZ, RJ, Brazil
| | - Otacilio C. Moreira
- Laboratório de Biologia Molecular e Doenças Endêmicas, Instituto Oswaldo Cruz, FIOCRUZ, RJ, Brazil
| | - Egler Chiari
- Programa de Pós-Graduação em Parasitologia, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Use of Tc-rCRP as a target for lytic antibody titration after experimental Trypanosoma cruzi infection. Exp Parasitol 2017; 184:103-108. [PMID: 29246832 DOI: 10.1016/j.exppara.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/19/2017] [Accepted: 12/11/2017] [Indexed: 11/24/2022]
Abstract
Experimental Chagas disease has been used as a model to identify several host/parasite interaction factors involved in immune responses to Trypanosoma cruzi infection. One of the factors inherent to this parasite is the complement regulatory protein (Tc-CRP), a major epitope that induces production of lytic antibodies during T. cruzi infections. Previous studies have evaluated the function of Tc-CRP as an antigenic marker via ELISAs, which demonstrated high sensitivity and specificity when compared to other methods. Therefore, this study aimed to assess and compare the levels of lytic antibodies induced by this protein following experimental infection using different T. cruzi strains. Our results demonstrated that infections induced by strains isolated from vectors resulted in subpatent parasitaemia and low reactivity, as assessed by Tc-rCRP ELISAs. On the other hand, mice inoculated with T. cruzi strains isolated from patients developed patent parasitaemia, and presented elevated lytic antibodies titres, as measured by Tc-rCRP ELISA. In addition, comparison between different mouse lineages demonstrated that Balb/c mice were more reactive than C57BL/6 mice in almost all types of infections, except those infected by the AQ-4 strain. Parasites from the Hel strain generated the greatest lytic antibody response in all evaluated models. Therefore, application of sensitive techniques for monitoring immune responses would enable us to establish growth curves for lytic antibodies during the course of the infection, and allow us to discriminate between T. cruzi strains that originate from different hosts.
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13
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Málaga-Machaca ES, Romero-Ramirez A, Gilman RH, Astupiña-Figueroa S, Angulo N, Florentini A, Lovon-Luque CJ, Gonza RA, del Carpio-Sanz A, Cabello I, Camargo R, Recuenco F, Barrueta-Soria LA, Verastegui MR, Calderon M, Mayta H. Polyclonal antibodies for the detection of Trypanosoma cruzi circulating antigens. PLoS Negl Trop Dis 2017; 11:e0006069. [PMID: 29121659 PMCID: PMC5705163 DOI: 10.1371/journal.pntd.0006069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 11/28/2017] [Accepted: 10/24/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Detection of Trypanosoma cruzi antigens in clinical samples is considered an important diagnostic tool for Chagas disease. The production and use of polyclonal antibodies may contribute to an increase in the sensitivity of immunodiagnosis of Chagas disease. METHODOLOGY/PRINCIPAL FINDINGS Polyclonal antibodies were raised in alpacas, rabbits, and hens immunized with trypomastigote excreted-secreted antigen, membrane proteins, trypomastigote lysate antigen and recombinant 1F8 to produce polyclonal antibodies. Western blot analysis was performed to determine specificity of the developed antibodies. An antigen capture ELISA of circulating antigens in serum, plasma and urine samples was developed using IgY polyclonal antibodies against T. cruzi membrane antigens (capture antibody) and IgG from alpaca raised against TESA. A total of 33 serum, 23 plasma and 9 urine samples were analyzed using the developed test. Among serum samples, compared to serology, the antigen capture ELISA tested positive in 55% of samples. All plasma samples from serology positive subjects were positive in the antigen capture ELISA. All urine positive samples had corresponding plasma samples that were also positive when tested by the antigen capture ELISA. CONCLUSIONS Polyclonal antibodies are useful for detection of circulating antigens in both the plasma and urine of infected individuals. Detection of antigens is direct evidence of the presence of the parasite, and could be a better surrogate of current infection status.
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Affiliation(s)
- Edith S. Málaga-Machaca
- Infectious Diseases Research Laboratory, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Alessandra Romero-Ramirez
- Infectious Diseases Research Laboratory, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Robert H. Gilman
- Infectious Diseases Research Laboratory, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Asociación Benéfica PRISMA, Lima, Perú
| | - Sofía Astupiña-Figueroa
- Infectious Diseases Research Laboratory, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Noelia Angulo
- Infectious Diseases Research Laboratory, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Alejandro Florentini
- Infectious Diseases Research Laboratory, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Cinthya J. Lovon-Luque
- Departamento de Medicina, Facultad de Medicina Humana, Universidad Católica de Santa María, Arequipa, Perú
| | - Remo A. Gonza
- Infectious Diseases Research Laboratory, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Ada del Carpio-Sanz
- Departamento de Medicina, Facultad de Medicina Humana, Universidad Católica de Santa María, Arequipa, Perú
| | - Inés Cabello
- Departamento Académico de Salud Animal y Salud Pública, Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Rosina Camargo
- Departamento Académico de Salud Animal y Salud Pública, Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Fernando Recuenco
- Departamento Académico de Salud Animal y Salud Pública, Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Liliam A. Barrueta-Soria
- Infectious Diseases Research Laboratory, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Manuela R. Verastegui
- Infectious Diseases Research Laboratory, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Maritza Calderon
- Infectious Diseases Research Laboratory, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Holger Mayta
- Infectious Diseases Research Laboratory, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Asociación Benéfica PRISMA, Lima, Perú
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Oliveira MTD, Branquinho RT, Alessio GD, Mello CGC, Nogueira-de-Paiva NC, Carneiro CM, Toledo MJDO, Reis AB, Martins-Filho OAM, Lana MD. TcI, TcII and TcVI Trypanosoma cruzi samples from Chagas disease patients with distinct clinical forms and critical analysis of in vitro and in vivo behavior, response to treatment and infection evolution in murine model. Acta Trop 2017; 167:108-120. [PMID: 27908747 DOI: 10.1016/j.actatropica.2016.11.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/11/2016] [Accepted: 11/24/2016] [Indexed: 01/10/2023]
Abstract
The clonal evolution of Trypanosoma cruzi sustains scientifically the hypothesis of association between parasite's genetic, biological behavior and possibly the clinical aspects of Chagas disease in patients from whom they were isolated. This study intended to characterize a range of biological properties of TcI, TcII and TcVI T. cruzi samples in order to verify the existence of these associations. Several biological features were evaluated, including in vitro epimastigote-growth, "Vero"cells infectivity and growth, along with in vivo studies of parasitemia, polymorphism of trypomastigotes, cardiac inflammation, fibrosis and response to treatment by nifurtimox during the acute and chronic murine infection. The global results showed that the in vitro essays (acellular and cellular cultures) TcII parasites showed higher values for all parameters (growth and infectivity) than TcVI, followed by TcI. In vivo TcII parasites were more virulent and originated from patients with severe disease. Two TcII isolates from patients with severe pathology were virulent in mice, while the isolate from a patient with the indeterminate form of the disease caused mild infection. The only TcVI sample, which displayed low values in all parameters evaluated, was also originated of an indeterminate case of Chagas disease. Response to nifurtimox was not associated to parasite genetic and biology, as well as to clinical aspects of human disease. Although few number of T. cruzi samples have been analyzed, a discreet correlation between parasite genetics, biological behavior in vitro and in vivo (murine model) and the clinical form of human disease from whom the samples were isolated was verified.
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Affiliation(s)
- Maykon Tavares de Oliveira
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil
| | - Renata Tupinambá Branquinho
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (CIPHARMA), Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil
| | - Gláucia Diniz Alessio
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil
| | - Carlos Geraldo Campos Mello
- Programa de Pós-Graduação em Ciências Farmacêuticas (CIPHARMA), Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil
| | - Nívia Carolina Nogueira-de-Paiva
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil
| | - Cláudia Martins Carneiro
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (CIPHARMA), Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil; Departamento de Análises Clínicas, Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil
| | - Max Jean de Ornelas Toledo
- Departamento de Ciências Básicas da Saúde-Parasitologia, Universidade Estadual de Maringá, CEP: 87020-900, Maringá, Paraná, PR, Brazil
| | - Alexandre Barbosa Reis
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (CIPHARMA), Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil; Departamento de Análises Clínicas, Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil
| | | | - Marta de Lana
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (CIPHARMA), Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil; Departamento de Análises Clínicas, Escola de Farmácia, Campus Universitário Morro do Cruzeiro, Universidade Federal de Ouro Preto, CEP: 35400-000 Ouro Preto, MG, Brazil.
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15
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Alarcón de Noya B, Colmenares C, Díaz-Bello Z, Ruiz-Guevara R, Medina K, Muñoz-Calderón A, Mauriello L, Cabrera E, Montiel L, Losada S, Martínez J, Espinosa R, Abate T. Orally-transmitted Chagas disease: Epidemiological, clinical, serological and molecular outcomes of a school microepidemic in Chichiriviche de la Costa, Venezuela. Parasite Epidemiol Control 2016; 1:188-198. [PMID: 29988179 PMCID: PMC5991850 DOI: 10.1016/j.parepi.2016.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 11/15/2022] Open
Abstract
Oral transmission of Trypanosoma cruzi is a frequent cause of acute Chagas disease (ChD). In the present cross-sectional study, we report the epidemiological, clinical, serological and molecular outcomes of the second largest outbreak of oral ChD described in the literature. It occurred in March 2009 in Chichiriviche de la Costa, a rural seashore community at the central littoral in Venezuela. The vehicle was an artisanal guava juice prepared at the local school and Panstrongylus geniculatus was the vector involved. TcI genotype was isolated from patients and vector; some showed a mixture of haplotypes. Using molecular markers, parasitic loads were high. Eighty-nine cases were diagnosed, the majority (87.5%) in school children 6-15 years of age. Frequency of symptomatic patients was high (89.9%) with long-standing fever in 87.5%; 82.3% had pericardial effusion detected by echocardiogram and 41% had EKG abnormalities. Three children, a pregnant woman and her stillborn child died (5.6% mortality). The community was addressed by simultaneous determination of specific IgG and IgM, confirmed with indirect hemagglutination and lytic antibodies. Determination of IgG and IgA in saliva had low sensitivity. No individual parasitological or serological technique diagnosed 100% of cases. Culture and PCR detected T. cruzi in 95.5% of examined individuals. Based on the increasing incidence of oral acute cases of ChD, it appears that food is becoming one of the most important modes of transmission in the Amazon, Caribbean and Andes regions of America.
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Affiliation(s)
- Belkisyolé Alarcón de Noya
- Sección de Inmunología Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
- Cátedra de Parasitología, Escuela de Medicina “Luis Razetti”, Universidad Central de Venezuela, Venezuela
| | - Cecilia Colmenares
- Sección de Inmunología Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
- Cátedra de Parasitología, Escuela de Medicina “Luis Razetti”, Universidad Central de Venezuela, Venezuela
| | - Zoraida Díaz-Bello
- Sección de Inmunología Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
| | - Raiza Ruiz-Guevara
- Cátedra de Parasitología, Escuela de Medicina “Luis Razetti”, Universidad Central de Venezuela, Venezuela
| | - Karen Medina
- Postgrado Nacional de Parasitología, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
| | - Arturo Muñoz-Calderón
- Sección de Inmunología Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
| | - Luciano Mauriello
- Sección de Inmunología Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
| | - Elida Cabrera
- Servicio de Cardiología Infantil, Hospital Militar “Dr. Carlos Arvelo”, Venezuela
| | - Luís Montiel
- Dirección de Epidemiología, Ministerio del Poder Popular para la Salud, Venezuela
| | - Sandra Losada
- Sección de Biohelmintiasis, Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
| | - Jetzi Martínez
- Dirección de Epidemiología, Estado Vargas, Ministerio del Poder Popular para la Salud, Venezuela
| | - Raúl Espinosa
- Servicio de Cardiología, Hospital “Miguel Pérez Carreño”, Venezuela
| | - Teresa Abate
- Sección de Biología Molecular, Instituto de Medicina Tropical, Facultad de Medicina, Universidad Central de Venezuela, Venezuela
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Pinazo MJ, Posada EDJ, Izquierdo L, Tassies D, Marques AF, de Lazzari E, Aldasoro E, Muñoz J, Abras A, Tebar S, Gallego M, de Almeida IC, Reverter JC, Gascon J. Altered Hypercoagulability Factors in Patients with Chronic Chagas Disease: Potential Biomarkers of Therapeutic Response. PLoS Negl Trop Dis 2016; 10:e0004269. [PMID: 26727000 PMCID: PMC4700971 DOI: 10.1371/journal.pntd.0004269] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 11/06/2015] [Indexed: 11/19/2022] Open
Abstract
Thromboembolic events were described in patients with Chagas disease without cardiomyopathy. We aim to confirm if there is a hypercoagulable state in these patients and to determine if there is an early normalization of hemostasis factors after antiparasitic treatment. Ninety-nine individuals from Chagas disease-endemic areas were classified in two groups: G1, with T.cruzi infection (n = 56); G2, healthy individuals (n = 43). Twenty-four hemostasis factors were measured at baseline. G1 patients treated with benznidazole were followed for 36 months, recording clinical parameters and performance of conventional serology, chemiluminescent enzyme-linked immunosorbent assay (trypomastigote-derived glycosylphosphatidylinositol-anchored mucins), quantitative polymerase chain reaction, and hemostasis tests every 6-month visits. Prothrombin fragment 1+2 (F1+2) and endogenous thrombin potential (ETP) were abnormally expressed in 77% and 50% of infected patients at baseline but returned to and remained at normal levels shortly after treatment in 76% and 96% of cases, respectively. Plasmin-antiplasmin complexes (PAP) were altered before treatment in 32% of G1 patients but normalized in 94% of cases several months after treatment. None of the patients with normal F1+2 values during follow-up had a positive qRT-PCR result, but 3/24 patients (13%) with normal ETP values did. In a percentage of chronic T. cruzi infected patients treated with benznidazole, altered coagulation markers returned into normal levels. F1+2, ETP and PAP could be useful markers for assessing sustained response to benznidazole.
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Affiliation(s)
- Maria-Jesus Pinazo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | - Elizabeth de Jesus Posada
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | - Luis Izquierdo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | - Dolors Tassies
- Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alexandre-Ferreira Marques
- Border Biomedical Research Center, Department of Biological Sciences, University of Texas at El Paso, El Paso, Texas, United States of America
- Universidade Federal de Minas Gerais, Departamento de Parasitologia, Belo Horizonte, Minas Gerais, Brazil
| | - Elisa de Lazzari
- Health Biostatistics, ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | - Edelweiss Aldasoro
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | - Jose Muñoz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | - Alba Abras
- Laboratori de Parasitologia, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Silvia Tebar
- Laboratori de Parasitologia, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Gallego
- Laboratori de Parasitologia, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
- Barcelona Institute for Global Health, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Igor Correia de Almeida
- Border Biomedical Research Center, Department of Biological Sciences, University of Texas at El Paso, El Paso, Texas, United States of America
| | - Joan-Carles Reverter
- Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joaquim Gascon
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
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Revisiting the Posttherapeutic Cure Criterion in Chagas Disease: Time for New Methods, More Questions, Doubts, and Polemics or Time to Change Old Concepts? BIOMED RESEARCH INTERNATIONAL 2015; 2015:652985. [PMID: 26583124 PMCID: PMC4637035 DOI: 10.1155/2015/652985] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/10/2015] [Indexed: 01/17/2023]
Abstract
One of the most relevant issues beyond the effectiveness of etiological treatment of Chagas disease is the lack of consensual/feasible tools to identify and certify the definitive parasitological cure. Several methods of distinct natures (parasitological, serological, and molecular) have been continuously proposed and novel perspectives are currently under investigation. Although the simultaneous use of distinct tests may offer better contributions and advances, it also leads to controversies of interpretation, with lack of mutual consent of cure criterion amongst researchers and physicians. In fact, when distinct host compartments (blood/tissues) are evaluated and explored, novel questions may arise due to the nature and sensitivity limit of each test. This short analytical review intends to present a chronological and critical overview and discuss the state-of-the-art distinct devices available for posttherapeutic cure assessment in Chagas disease, their contributions, meanings, and interpretation, aiming to point out the major gaps and propose novel insight for future perspectives of posttherapeutic management of Chagas disease patients.
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18
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Izquierdo L, Marques AF, Gállego M, Sanz S, Tebar S, Riera C, Quintó L, Aldasoro E, Almeida IC, Gascon J. Evaluation of a chemiluminescent enzyme-linked immunosorbent assay for the diagnosis of Trypanosoma cruzi infection in a nonendemic setting. Mem Inst Oswaldo Cruz 2015; 108:928-31. [PMID: 24271047 PMCID: PMC3970649 DOI: 10.1590/0074-0276130112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 06/19/2013] [Indexed: 11/22/2022] Open
Abstract
The disappearance of lytic, protective antibodies (Abs) from the serum of patients with Chagas disease is accepted as a reliable indicator of parasitological cure. The efficiency of a chemiluminescent enzyme-linked immunosorbent assay based on a purified, trypomastigote-derived glycosylphosphatidylinositol-anchored mucin antigen for the serologic detection of lytic Abs against Trypanosoma cruzi was evaluated in a nonendemic setting using a panel of 92 positive and 58 negative human sera. The technique proved to be highly sensitive {100%; 95% confidence interval (CI) = 96-100} and specific (98.3%; 95% CI = 90.7-99.7), with a kappa score of 0.99. Therefore, this assay can be used to detect active T. cruzi infection and to monitor trypanosomicidal treatment.
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Affiliation(s)
- Luis Izquierdo
- Barcelona Centre for International Health Research, Hospital Clinic
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Dutra WO, Menezes CAS, Magalhães LMD, Gollob KJ. Immunoregulatory networks in human Chagas disease. Parasite Immunol 2014; 36:377-87. [PMID: 24611805 DOI: 10.1111/pim.12107] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 02/19/2014] [Indexed: 01/11/2023]
Abstract
Chagas disease, caused by the infection with Trypanosoma cruzi, is endemic in all Latin America. Due to the increase in population migration, Chagas disease has spread worldwide and is now considered a health issue not only in endemic countries. While most chronically infected individuals remain asymptomatic, approximately 30% of the patients develop a potentially deadly cardiomyopathy. The exact mechanisms that underlie the establishment and maintenance of the cardiac pathology are not clear. However, there is consistent evidence that immunoregulatory cytokines are critical for orchestrating the immune response and thus influence disease development or control. While the asymptomatic (indeterminate) form represents a state of balance between the host and the parasite, the establishment of the cardiac form represents the loss of this balance. Analysis of data obtained from several studies has led to the hypothesis that the indeterminate form is associated with an anti-inflammatory cytokine profile, represented by high expression of IL-10, while cardiac form is associated with a high production of IFN-gamma and TNF-alpha in relation to IL-10, leading to an inflammatory profile. Here, we discuss the immunoregulatory events that might influence disease outcome, as well as the mechanisms that influence the establishment of these complex immunoregulatory networks.
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Affiliation(s)
- W O Dutra
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Belo Horizonte, MG, Brazil; Instituto Nacional de Ciência e Tecnologia - Doenças Tropicais - INCT-DT, Belo Horizonte, MG, Brazil
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20
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Fernández ER, Olivera GC, Quebrada Palacio LP, González MN, Hernandez-Vasquez Y, Sirena NM, Morán ML, Ledesma Patiño OS, Postan M. Altered distribution of peripheral blood memory B cells in humans chronically infected with Trypanosoma cruzi. PLoS One 2014; 9:e104951. [PMID: 25111833 PMCID: PMC4128741 DOI: 10.1371/journal.pone.0104951] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/15/2014] [Indexed: 12/15/2022] Open
Abstract
Numerous abnormalities of the peripheral blood T cell compartment have been reported in human chronic Trypanosoma cruzi infection and related to prolonged antigenic stimulation by persisting parasites. Herein, we measured circulating lymphocytes of various phenotypes based on the differential expression of CD19, CD4, CD27, CD10, IgD, IgM, IgG and CD138 in a total of 48 T. cruzi-infected individuals and 24 healthy controls. Infected individuals had decreased frequencies of CD19+CD27+ cells, which positively correlated with the frequencies of CD4+CD27+ cells. The contraction of CD19+CD27+ cells was comprised of IgG+IgD-, IgM+IgD- and isotype switched IgM-IgD- memory B cells, CD19+CD10+CD27+ B cell precursors and terminally differentiated CD19+CD27+CD138+ plasma cells. Conversely, infected individuals had increased proportions of CD19+IgG+CD27-IgD- memory and CD19+IgM+CD27-IgD+ transitional/naïve B cells. These observations prompted us to assess soluble CD27, a molecule generated by the cleavage of membrane-bound CD27 and used to monitor systemic immune activation. Elevated levels of serum soluble CD27 were observed in infected individuals with Chagas cardiomyopathy, indicating its potentiality as an immunological marker for disease progression in endemic areas. In conclusion, our results demonstrate that chronic T. cruzi infection alters the distribution of various peripheral blood B cell subsets, probably related to the CD4+ T cell deregulation process provoked by the parasite in humans.
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Affiliation(s)
- Esteban R. Fernández
- Departamento de Investigación, Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Gabriela C. Olivera
- Departamento de Investigación, Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Luz P. Quebrada Palacio
- Departamento de Investigación, Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariela N. González
- Departamento de Investigación, Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Yolanda Hernandez-Vasquez
- Departamento de Investigación, Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Natalia María Sirena
- Centro de Enfermedad de Chagas y Patología Regional, Hospital Independencia, Santiago del Estero, Argentina
| | - María L. Morán
- Centro de Enfermedad de Chagas y Patología Regional, Hospital Independencia, Santiago del Estero, Argentina
| | - Oscar S. Ledesma Patiño
- Centro de Enfermedad de Chagas y Patología Regional, Hospital Independencia, Santiago del Estero, Argentina
| | - Miriam Postan
- Departamento de Investigación, Instituto Nacional de Parasitología “Dr. Mario Fatala Chabén”, Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
- * E-mail:
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Serna C, Lara JA, Rodrigues SP, Marques AF, Almeida IC, Maldonado RA. A synthetic peptide from Trypanosoma cruzi mucin-like associated surface protein as candidate for a vaccine against Chagas disease. Vaccine 2014; 32:3525-32. [PMID: 24793944 DOI: 10.1016/j.vaccine.2014.04.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 04/01/2014] [Accepted: 04/14/2014] [Indexed: 01/15/2023]
Abstract
Chagas disease, caused by Trypanosoma cruzi, is responsible for producing significant morbidity and mortality throughout Latin America. The disease has recently become a public health concern to nonendemic regions like the U.S. and Europe. Currently there are no fully effective drugs or vaccine available to treat the disease. The mucin-associated surface proteins (MASPs) are glycosylphosphatidylinositol (GPI)-anchored glycoproteins encoded by a multigene family with hundreds of members. MASPs are among the most abundant antigens found on the surface of the infective trypomastigote stage of T. cruzi, thus representing an attractive target for vaccine development. Here we used immunoinformatics to select a 20-mer peptide with several predicted overlapping B-cell, MHC-I, and MHC-II epitopes, from a MASP family member expressed on mammal-dwelling stages of T. cruzi. The synthetic MASP peptide conjugated to keyhole limpet hemocyanin (MASPpep-KLH) was tested in presence or not of an adjuvant (alum, Al) as a vaccine candidate in the C3H/HeNsd murine model of T. cruzi infection. In considerable contrast to the control groups receiving placebo, Al, or KLH alone or the group immunized with MASPpep-KLH/Al, the group immunized with MASPpep-KLH showed 86% survival rate after challenge with a highly lethal dose of trypomastigotes. As evaluated by quantitative real-time polymerase chain reaction, MASPpep-KLH-immunized animals had much lower parasite load in the heart, liver, and spleen than control animals. Moreover, protected animals produced trypanolytic, protective antibodies, and a cytokine profile conducive to resistance against parasite infection. Finally, in vivo depletion of either CD4(+) or CD8(+) T cells indicated that the latter are critical for protection in mice immunized with MASPpep-KLH. In summary, this new peptide-based vaccine with overlapping B- and T-cell epitopes is able to control T. cruzi infection in mice by priming both humoral and cellular immunity.
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Affiliation(s)
- Carylinda Serna
- Border Biomedical Research Center, Department of Biological Sciences, University of Texas at El Paso, El Paso, TX, United States
| | - Joshua A Lara
- Border Biomedical Research Center, Department of Biological Sciences, University of Texas at El Paso, El Paso, TX, United States
| | - Silas P Rodrigues
- Border Biomedical Research Center, Department of Biological Sciences, University of Texas at El Paso, El Paso, TX, United States
| | - Alexandre F Marques
- Border Biomedical Research Center, Department of Biological Sciences, University of Texas at El Paso, El Paso, TX, United States; Department of Parasitology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Igor C Almeida
- Border Biomedical Research Center, Department of Biological Sciences, University of Texas at El Paso, El Paso, TX, United States.
| | - Rosa A Maldonado
- Border Biomedical Research Center, Department of Biological Sciences, University of Texas at El Paso, El Paso, TX, United States.
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Requena-Méndez A, López MC, Angheben A, Izquierdo L, Ribeiro I, Pinazo MJ, Gascon J, Muñoz J. Evaluating Chagas disease progression and cure through blood-derived biomarkers: a systematic review. Expert Rev Anti Infect Ther 2014; 11:957-76. [DOI: 10.1586/14787210.2013.824718] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Fabbro D, Velazquez E, Bizai ML, Denner S, Olivera V, Arias E, Pravia C, Ruiz AM. Evaluation of the ELISA-F29 test as an early marker of therapeutic efficacy in adults with chronic Chagas disease. Rev Inst Med Trop Sao Paulo 2013; 55:S0036-46652013000300167. [PMID: 23740013 DOI: 10.1590/s0036-46652013000300005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 12/03/2012] [Indexed: 11/22/2022] Open
Abstract
This work compared the time at which negative seroconversion was detected by conventional serology (CS) and by the ELISA-F29 test on a cohort of chronic chagasic patients treated with nifurtimox or benznidazole. A retrospective study was performed using preserved serum from 66 asymptomatic chagasic adults under clinical supervision, and bi-annual serological examinations over a mean follow-up of 23 years. Twenty nine patients received trypanocide treatment and 37 remained untreated. The ELISA-F29 test used a recombinant antigen which was obtained by expressing the Trypanosoma cruzi flagellar calcium-binding protein gene in Escherichia coli. Among the untreated patients, 36 maintained CS titers. One patient showed a doubtful serology in some check-ups. ELISA-F29 showed constant reactivity in 35 out of 37 patients and was negative for the patient with fluctuating CS. The treated patients were divided into three groups according to the CS titers: in 13 they became negative; in 12 they decreased and in four they remained unchanged. ELISA-F29 was negative for the first two groups. The time at which negativization was detected was significantly lower for the ELISA-F29 test than for CS, 14.5 ± 5.7 and 22 ± 4.9 years respectively. Negative seroconversion was observed in treated patients only. The results obtained confirm that the ELISA-F29 test is useful as an early indicator of negative seroconversion in treated chronic patients.
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Affiliation(s)
- Diana Fabbro
- Centro de Investigaciones sobre Endemias Nacionales, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral (UNL), Casilla de Correo 242, Santa Fe, Argentina.
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González-Tomé MI, Rivera M, Camaño I, Norman F, Flores-Chávez M, Rodríguez-Gómez L, Fumadó V, García-López Hortelano M, López-Vélez R, González-Granado LI, García-Burguillo A, Santos MDM, Ávila O. Recomendaciones para el diagnóstico, seguimiento y tratamiento de la embarazada y del niño con enfermedad de Chagas. Enferm Infecc Microbiol Clin 2013; 31:535-42. [DOI: 10.1016/j.eimc.2012.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 09/13/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
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Evaluation of nifurtimox treatment of chronic Chagas disease by means of several parasitological methods. Antimicrob Agents Chemother 2013; 57:4518-23. [PMID: 23836179 DOI: 10.1128/aac.00227-13] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Currently, evaluation of drug efficacy for Chagas disease remains a controversial issue with no consensus. In this work, we evaluated the parasitological efficacy of Nifurtimox treatment in 21 women with chronic Chagas disease from an area of endemicity in Chile who were treated according to current protocols. Under pre- and posttherapy conditions, blood (B) samples and xenodiagnosis (XD) samples from these patients were subjected to analysis by real-time PCR targeting the nuclear satellite DNA of Trypanosoma cruzi (Sat DNA PCR-B, Sat DNA PCR-XD) and by PCR targeting the minicircle of kinetoplast DNA of T. cruzi (kDNA PCR-B, kDNA PCR-XD) and by T. cruzi genotyping using hybridization minicircle tests in blood and fecal samples of Triatoma infestans feed by XD. In pretherapy, kDNA PCR-B and kDNA PCR-XD detected T. cruzi in 12 (57%) and 18 (86%) cases, respectively, whereas Sat DNA quantitative PCR-B (qPCR-B) and Sat DNA qPCR-XD were positive in 18 cases (86%) each. Regarding T. cruzi genotype analysis, it was possible to observe in pretherapy the combination of TcI, TcII, and TcV lineages, including mixtures of T. cruzi strains in most of the cases. At 13 months posttherapy, T. cruzi DNA was detectable in 6 cases (29.6%) and 4 cases (19.1%) by means of Sat DNA PCR-XD and kDNA PCR-XD, respectively, indicating treatment failure with recovery of live parasites refractory to chemotherapy. In 3 cases, it was possible to identify persistence of the baseline genotypes. The remaining 15 baseline PCR-positive cases gave negative results by all molecular and parasitological methods at 13 months posttreatment, suggesting parasite response. Within this follow-up period, kDNA PCR-XD and Sat DNA qPCR-XD proved to be more sensitive tools for the parasitological evaluation of the efficacy of Nifurtimox treatment than the corresponding PCR methods performed directly from blood samples.
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Use of an enzyme-linked immunosorbent assay that utilizes the Tc13Tul antigen of Trypanosoma cruzi to monitor patients after treatment with benznidazole. Diagn Microbiol Infect Dis 2013; 76:197-205. [DOI: 10.1016/j.diagmicrobio.2013.02.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/19/2013] [Accepted: 02/07/2013] [Indexed: 11/22/2022]
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Salgado-Jiménez B, Arce-Fonseca M, Baylón-Pacheco L, Talamás-Rohana P, Rosales-Encina JL. Differential immune response in mice immunized with the A, R or C domain from TcSP protein of Trypanosoma cruzi or with the coding DNAs. Parasite Immunol 2013; 35:32-41. [PMID: 23106492 DOI: 10.1111/pim.12017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 10/17/2012] [Indexed: 11/26/2022]
Abstract
In a murine model of experimental Trypanosoma cruzi (H8 strain) infection, we investigated the induction of protective immunity against the domains [amino (A), repeats (R) and carboxyl (C)] of the surface protein (SP), a member of the trans-sialidase (TS) superfamily. Recombinant proteins and plasmid DNA coding for the respective proteins were used to immunize BALB/c mice, and the humoral response and cytokine levels were analysed. Immunization with the recombinant proteins induced higher levels of anti-TcSP antibodies than immunization with the corresponding DNAs, and analysis of serum cytokines showed that immunization with both recombinant proteins and naked DNA resulted in a Th1-Th2 mixed T-cell response. Mice immunized with either recombinant proteins or plasmid DNA were infected with blood trypomastigotes. The recombinant protein-immunized mice showed a variable reduction in peak parasitemia, and most died by day 60. Only the pBKTcSPR-immunized mice exhibited a significant reduction in peak parasitemia and survived the lethal challenge. DNA-based immunization with DNA coding for the repeats domain of TcSP is a good candidate for the development of a vaccine against experimental T. cruzi infection.
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Affiliation(s)
- B Salgado-Jiménez
- Departamento de Infectómica y Patogénesis Molecular, Centro de Investigación y de Estudios Avanzados del IPN, México, D.F, México
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Machado-de-Assis GF, Silva AR, Do Bem VAL, Bahia MT, Martins-Filho OA, Dias JCP, Albajar-Viñas P, Torres RM, Lana M. Posttherapeutic cure criteria in Chagas' disease: conventional serology followed by supplementary serological, parasitological, and molecular tests. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:1283-91. [PMID: 22739694 PMCID: PMC3416099 DOI: 10.1128/cvi.00274-12] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 06/15/2012] [Indexed: 11/20/2022]
Abstract
We performed a critical study of conventional serology, followed by supplementary serological, parasitological, and molecular tests, to assess the response to etiologic treatment of Chagas' disease. A group of 94 Chagas' disease patients treated with benznidazole at least 10 years earlier were evaluated from the laboratory and clinical points of view. When conventional serology (enzyme-linked immunosorbent assay [ELISA], indirect immunofluorescence [IIF], and indirect hemagglutination [IHA]) and classic criteria (consistent results with any two of the three tests) or more rigorous criteria (consistent results from the three tests) were used, 10.6% and 8.5% of patients were considered treated and cured (TC) by classic and rigorous criteria, respectively. Patients were then evaluated using supplementary (recombinant ELISA and Trypanosoma cruzi excreted-secreted antigen blotting [TESA-blot]), parasitological (hemoculture), and molecular (PCR) tests. The results of recombinant ELISA were similar to those with the rigorous criterion (three consistent test results). The TESA-blot group showed a higher percentage (21.3%) of negative results than the groups defined by either cure criterion. Hemoculture and PCR gave negative results for all treated and cured (TC) patients, regardless of the criterion used. Recombinant ELISA and TESA-blot tests showed negative results for 70% and 87.5% of the patients categorized as TC by the classic and three-test criteria, respectively. For patients with discordant conventional serology, the supplementary serological and molecular tests were the decisive factor in determining therapeutic failure. Clinical evaluation showed that 62.5% of TC patients presented with the indeterminate form of the disease. Additionally, treated patients with negative TESA-blot results should be reevaluated later with all methodologies used here to verify whether TESA-blot is a reliable way to determine early parasitological cure of Chagas' disease.
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Affiliation(s)
- G F Machado-de-Assis
- Núcleo de Pesquisas em Ciências Biológicas (NUPEB), Instituto de Ciências Exatas e Biológicas (ICEB), Universidade Federal de Ouro Preto (UFOP), Ouro Preto, Brazil.
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Teixeira ARL, Hecht MM, Guimaro MC, Sousa AO, Nitz N. Pathogenesis of chagas' disease: parasite persistence and autoimmunity. Clin Microbiol Rev 2011; 24:592-630. [PMID: 21734249 PMCID: PMC3131057 DOI: 10.1128/cmr.00063-10] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Acute Trypanosoma cruzi infections can be asymptomatic, but chronically infected individuals can die of Chagas' disease. The transfer of the parasite mitochondrial kinetoplast DNA (kDNA) minicircle to the genome of chagasic patients can explain the pathogenesis of the disease; in cases of Chagas' disease with evident cardiomyopathy, the kDNA minicircles integrate mainly into retrotransposons at several chromosomes, but the minicircles are also detected in coding regions of genes that regulate cell growth, differentiation, and immune responses. An accurate evaluation of the role played by the genotype alterations in the autoimmune rejection of self-tissues in Chagas' disease is achieved with the cross-kingdom chicken model system, which is refractory to T. cruzi infections. The inoculation of T. cruzi into embryonated eggs prior to incubation generates parasite-free chicks, which retain the kDNA minicircle sequence mainly in the macrochromosome coding genes. Crossbreeding transfers the kDNA mutations to the chicken progeny. The kDNA-mutated chickens develop severe cardiomyopathy in adult life and die of heart failure. The phenotyping of the lesions revealed that cytotoxic CD45, CD8(+) γδ, and CD8α(+) T lymphocytes carry out the rejection of the chicken heart. These results suggest that the inflammatory cardiomyopathy of Chagas' disease is a genetically driven autoimmune disease.
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Affiliation(s)
- Antonio R L Teixeira
- Chagas Disease Multidisciplinary Research Laboratory, University of Brasilia, Federal District, Brazil.
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Olivieri BP, Vasconcellos R, Nóbrega A, Minoprio P, Kaveri SV, Araújo-Jorge TC. Intravenous immunoglobulin increases survival time in the acute phase of experimental Chagas disease. Parasite Immunol 2010; 32:464-9. [PMID: 20500678 DOI: 10.1111/j.1365-3024.2010.01212.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Chagas disease induced by Trypanosoma cruzi (Tc) infection is an important cause of mortality and morbidity affecting the cardiovascular system for which presently available therapies are insufficient and largely inadequate. Intravenous immunoglobulin (IVIg) is a therapeutic preparation containing normal polyspecific IgG obtained from plasma pools of several thousand healthy donors and is used in several autoimmune, inflammatory and infectious diseases. In the study of heart from mice chronically infected with Tc, we observed that IVIg restores type 1 atrioventricular block or bradycardia. In the present study, we investigated the effects of IVIg in acute Tc infection. Intravenous immunoglobulin administration after the first week of infection was associated with an increase in survival time. Taken together, results observed in the chronic and in the acute phase associate IVIg treatment with a favourable outcome in T. cruzi infection.
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Affiliation(s)
- B P Olivieri
- Laboratory of Innovations in Therapy, Education and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Pereira KS, Schmidt FL, Barbosa RL, Guaraldo AMA, Franco RMB, Dias VL, Passos LAC. Transmission of chagas disease (American trypanosomiasis) by food. ADVANCES IN FOOD AND NUTRITION RESEARCH 2010; 59:63-85. [PMID: 20610174 DOI: 10.1016/s1043-4526(10)59003-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In April 2009, the centenary of the discovery of the American trypanosomiasis, or Chagas disease, was celebrated. A hundred years after the discovery, little has been invested in diagnostics and treatment because the disease affects mainly poor people in developing countries. However, some changes in the epidemiology of the disease are of great importance today. Chagas disease transmitted through food is a public health concern in all areas where there is a reservoir of Trypanosoma cruzi in wild animals (e.g., mammals and marsupials) and/or where infected triatomine bugs are in contact with human food source items (especially fruits and vegetables). Recently, several outbreaks of illness related to the ingestion of food contaminated with T. cruzi have been recorded in Brazil, Colombia, and Venezuela.
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Affiliation(s)
- Karen Signori Pereira
- Departamento de Engenharia Bioquímica, Escola de Química, Centro de Tecnologia Bloco Sala E203, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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