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Dantas RO. INFLUENCE OF ESOPHAGEAL MOTILITY IMPAIRMENT ON UPPER AND LOWER ESOPHAGEAL SPHINCTER PRESSURE IN CHAGAS DISEASE. ARQUIVOS DE GASTROENTEROLOGIA 2024; 61:e23174. [PMID: 38896574 DOI: 10.1590/s0004-2803.24612023-174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/23/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Chagas disease causes digestive anatomic and functional changes, including the loss of the myenteric plexus and abnormal esophageal radiologic and manometric findings. OBJECTIVE To evaluate the association of abnormal esophageal radiologic findings, cardiac changes, distal esophageal contractions, and complaints of dysphagia and constipation in upper (UES) and lower (LES) esophageal sphincter basal pressure in Chagas disease patients. METHODS The study evaluated 99 patients with Chagas disease and 40 asymptomatic normal volunteers. The patients had normal esophageal radiologic examination (n=61) or esophageal retention without an increase in esophageal diameter (n=38). UES and LES pressure was measured with the rapid pull-through method in a 4-channel water-perfused round catheter. Before manometry, the patients were asked about dysphagia and constipation and submitted to electrocardiography and chest radiography. RESULTS The amplitude of esophageal distal contraction decreased from controls to chagasic patients with esophageal retention. The proportion of failed and simultaneous contractions increased in patients with abnormal radiologic examination (P<0.01). There were no significant differences in UES and LES pressure between the groups. UES pressure was similar between Chagas disease patients with cardiomegaly (n=27, 126.5±62.7 mmHg) and those without it (n=72, 144.2±51.6 mmHg, P=0.26). Patients with constipation had lower LES pressure (n=23, 34.7±20.3 mmHg) than those without it (n=76, 42.9±20.5 mmHg, P<0.03). CONCLUSION Chagas disease patients with absent or mild esophageal radiologic involvement had no significant changes in UES and LES basal pressure. Constipation complaints are associated with decreased LES basal pressure.
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Affiliation(s)
- Roberto Oliveira Dantas
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto SP, Brasil
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2
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Durães-Oliveira J, Palma-Marques J, Moreno C, Rodrigues A, Monteiro M, Alexandre-Pires G, da Fonseca IP, Santos-Gomes G. Chagas Disease: A Silent Threat for Dogs and Humans. Int J Mol Sci 2024; 25:3840. [PMID: 38612650 PMCID: PMC11011309 DOI: 10.3390/ijms25073840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Chagas disease (CD) is a vector-borne Neglected Zoonotic Disease (NZD) caused by a flagellate protozoan, Trypanosoma cruzi, that affects various mammalian species across America, including humans and domestic animals. However, due to an increase in population movements and new routes of transmission, T. cruzi infection is presently considered a worldwide health concern, no longer restricted to endemic countries. Dogs play a major role in the domestic cycle by acting very efficiently as reservoirs and allowing the perpetuation of parasite transmission in endemic areas. Despite the significant progress made in recent years, still there is no vaccine against human and animal disease, there are few drugs available for the treatment of human CD, and there is no standard protocol for the treatment of canine CD. In this review, we highlight human and canine Chagas Disease in its different dimensions and interconnections. Dogs, which are considered to be the most important peridomestic reservoir and sentinel for the transmission of T. cruzi infection in a community, develop CD that is clinically similar to human CD. Therefore, an integrative approach, based on the One Health concept, bringing together the advances in genomics, immunology, and epidemiology can lead to the effective development of vaccines, new treatments, and innovative control strategies to tackle CD.
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Affiliation(s)
- João Durães-Oliveira
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal; (J.D.-O.); (G.S.-G.)
| | - Joana Palma-Marques
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal; (J.D.-O.); (G.S.-G.)
| | - Cláudia Moreno
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal; (J.D.-O.); (G.S.-G.)
| | - Armanda Rodrigues
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal; (J.D.-O.); (G.S.-G.)
| | - Marta Monteiro
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal; (J.D.-O.); (G.S.-G.)
- Centre for Interdisciplinary Research in Animal Health, CIISA, Faculty of Veterinary Medicine, FMV, University of Lisbon, ULisboa, 1649-004 Lisbon, Portugal; (G.A.-P.); (I.P.d.F.)
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisbon, Portugal
| | - Graça Alexandre-Pires
- Centre for Interdisciplinary Research in Animal Health, CIISA, Faculty of Veterinary Medicine, FMV, University of Lisbon, ULisboa, 1649-004 Lisbon, Portugal; (G.A.-P.); (I.P.d.F.)
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisbon, Portugal
| | - Isabel Pereira da Fonseca
- Centre for Interdisciplinary Research in Animal Health, CIISA, Faculty of Veterinary Medicine, FMV, University of Lisbon, ULisboa, 1649-004 Lisbon, Portugal; (G.A.-P.); (I.P.d.F.)
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisbon, Portugal
| | - Gabriela Santos-Gomes
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal; (J.D.-O.); (G.S.-G.)
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3
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Izquierdo-Condoy JS, Vásconez-Gonzáles J, Morales-Lapo E, Tello-De-la-Torre A, Naranjo-Lara P, Fernández R, Hidalgo MR, Escobar A, Yépez VH, Díaz AM, Oliva C, Ortiz-Prado E. Beyond the acute phase: a comprehensive literature review of long-term sequelae resulting from infectious diseases. Front Cell Infect Microbiol 2024; 14:1293782. [PMID: 38357446 PMCID: PMC10864624 DOI: 10.3389/fcimb.2024.1293782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Infectious diseases have consistently served as pivotal influences on numerous civilizations, inducing morbidity, mortality, and consequently redirecting the course of history. Their impact extends far beyond the acute phase, characterized by the majority of symptom presentations, to a multitude of adverse events and sequelae that follow viral, parasitic, fungal, or bacterial infections. In this context, myriad sequelae related to various infectious diseases have been identified, spanning short to long-term durations. Although these sequelae are known to affect thousands of individuals individually, a comprehensive evaluation of all potential long-term effects of infectious diseases has yet to be undertaken. We present a comprehensive literature review delineating the primary sequelae attributable to major infectious diseases, categorized by systems, symptoms, and duration. This compilation serves as a crucial resource, illuminating the long-term ramifications of infectious diseases for healthcare professionals worldwide. Moreover, this review highlights the substantial burden that these sequelae impose on global health and economies, a facet often overshadowed by the predominant focus on the acute phase. Patients are frequently discharged following the resolution of the acute phase, with minimal long-term follow-up to comprehend and address potential sequelae. This emphasizes the pressing need for sustained vigilance, thorough patient monitoring, strategic health management, and rigorous research to understand and mitigate the lasting economic and health impacts of infectious diseases more fully.
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4
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Baldoni NR, de Oliveira-da Silva LC, Gonçalves ACO, Quintino ND, Ferreira AM, Bierrenbach AL, Padilha da Silva JL, Pereira Nunes MC, Ribeiro ALP, Oliveira CDL, Sabino EC, Cardoso CS. Gastrointestinal Manifestations of Chagas Disease: A Systematic Review with Meta-Analysis. Am J Trop Med Hyg 2024; 110:10-19. [PMID: 38052078 DOI: 10.4269/ajtmh.23-0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/20/2023] [Indexed: 12/07/2023] Open
Abstract
The aims of this study were to estimate the prevalence of gastrointestinal manifestations among individuals with positive serology for Chagas disease (ChD) and to describe the clinical gastrointestinal manifestations of the disease. A systematic review with meta-analysis was conducted based on the criteria and recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PubMed, Scopus, Virtual Health Library, Web of Science, and Embase databases were used to search for evidence. Two reviewers independently selected eligible articles and extracted data. RStudio® software was used for the meta-analysis. For subgroup analysis, the studies were divided according to the origin of the individuals included: 1) individuals from health units were included in the health care service prevalence analysis, and 2) individuals from the general population were included in the population prevalence analysis. A total of 2,570 articles were identified, but after removal of duplicates and application of inclusion criteria, 24 articles were included and 21 were part of the meta-analysis. Most of the studies were conducted in Brazil. Radiological diagnosis was the most frequent method used to identify the gastrointestinal clinical form. The combined effect of meta-analysis studies showed a prevalence of gastrointestinal manifestations in individuals with ChD of 12% (95% CI, 8.0-17.0%). In subgroup analysis, the prevalence for studies involving health care services was 16% (95% CI, 11.0-23.0%), while the prevalence for population-based studies was 9% (95% CI, 5.0-15.0%). Megaesophagus and megacolon were the main forms of ChD presentation in the gastrointestinal form. The prevalence of gastrointestinal manifestations of ChD was 12%. Knowing the prevalence of ChD in its gastrointestinal form is an important step in planning health actions for these patients.
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Affiliation(s)
- Nayara Ragi Baldoni
- University of Itaúna, Itaúna, Brazil
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
| | | | - Ana Carolina Oliveira Gonçalves
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
| | - Nayara Dornela Quintino
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
- Divinópolis Regional Health Superintendence/Minas Gerais State Health Secretariat (SES-MG), Belo Horizonte, Brazil
| | | | - Ana Luiza Bierrenbach
- Teaching and Research Institute of Sírio-Libanês Hospital, São Paulo, Brazil
- Graduate Program, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | | | | | | | - Claudia Di Lorenzo Oliveira
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
| | - Ester Cerdeira Sabino
- Institute of Tropical Medicine, Faculty of Medicine, University of São Paulo, Brazil
| | - Clareci Silva Cardoso
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
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5
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Kaufman CD, Farré C, Biscari L, Pérez AR, Alloatti A. Trypanosoma cruzi, Chagas disease and cancer: putting together the pieces of a complex puzzle. Front Cell Dev Biol 2023; 11:1260423. [PMID: 38188016 PMCID: PMC10768204 DOI: 10.3389/fcell.2023.1260423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Considering the extensive and widespread impact on individuals, cancer can presently be categorized as a pandemic. In many instances, the development of tumors has been linked to endemic microbe infections. Among parasitic infections, Trypanosoma cruzi stands out as one of the most extensively discussed protozoans in the literature that explores the association between diseases of parasite origin and cancer. However, the effective association remains an unsolved paradox. Both the parasite, along with protozoan-derived molecules, and the associated antiparasitic immune response can induce alterations in various host cell pathways, leading to modifications in cell cycle, metabolism, glycosylation, DNA mutations, or changes in neuronal signaling. Furthermore, the presence of the parasite can trigger cell death or a senescent phenotype and modulate the immune system, the metastatic cascade, and the formation of new blood vessels. The interaction among the parasite (and its molecules), the host, and cancer undoubtedly encompasses various mechanisms that operate differentially depending on the context. Remarkably, contrary to expectations, the evidence tilts the balance toward inhibiting tumor growth or resisting tumor development. This effect is primarily observed in malignant cells, rather than normal cells, indicating a selective or specific component. Nevertheless, nonspecific bystander mechanisms, such as T. cruzi's adjuvancy or the presence of proinflammatory cytokines, may also play a significant role in this phenomenon. This work aims to elucidate this complex scenario by synthesizing the main findings presented in the literature and by proposing new questions and answers, thereby adding pieces to this challenging puzzle.
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Affiliation(s)
- Cintia Daniela Kaufman
- Instituto de Inmunología Clínica y Experimental de Rosario (IDICER), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Rosario, Rosario, Argentina
| | - Cecilia Farré
- Instituto de Inmunología Clínica y Experimental de Rosario (IDICER), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Rosario, Rosario, Argentina
- Centro de Investigación y Producción de Reactivos Biológicos, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Lucía Biscari
- Instituto de Inmunología Clínica y Experimental de Rosario (IDICER), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Rosario, Rosario, Argentina
| | - Ana Rosa Pérez
- Instituto de Inmunología Clínica y Experimental de Rosario (IDICER), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Rosario, Rosario, Argentina
| | - Andrés Alloatti
- Instituto de Inmunología Clínica y Experimental de Rosario (IDICER), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Rosario, Rosario, Argentina
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6
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Fesser A, Beilstein S, Kaiser M, Schmidt RS, Mäser P. Trypanosoma cruzi STIB980: A TcI Strain for Drug Discovery and Reverse Genetics. Pathogens 2023; 12:1217. [PMID: 37887733 PMCID: PMC10610277 DOI: 10.3390/pathogens12101217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023] Open
Abstract
Since the first published genome sequence of Trypanosoma cruzi in 2005, there have been tremendous technological advances in genomics, reverse genetics, and assay development for this elusive pathogen. However, there is still an unmet need for new and better drugs to treat Chagas disease. Here, we introduce a T. cruzi assay strain that is useful for drug research and basic studies of host-pathogen interactions. T. cruzi STIB980 is a strain of discrete typing unit TcI that grows well in culture as axenic epimastigotes or intracellular amastigotes. We evaluated the optimal parameters for genetic transfection and constructed derivatives of T. cruzi STIB980 that express reporter genes for fluorescence- or bioluminescence-based drug efficacy testing, as well as a Cas9-expressing line for CRISPR/Cas9-mediated gene editing. The genome of T. cruzi STIB980 was sequenced by combining short-read Illumina with long-read Oxford Nanopore technologies. The latter served as the primary assembly and the former to correct mistakes. This resulted in a high-quality nuclear haplotype assembly of 28 Mb in 400 contigs, containing 10,043 open-reading frames with a median length of 1077 bp. We believe that T. cruzi STIB980 is a useful addition to the antichagasic toolbox and propose that it can serve as a DTU TcI reference strain for drug efficacy testing.
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Affiliation(s)
- Anna Fesser
- Swiss Tropical and Public Health Institute, Department Medical Parasitology and Infection Biology, 4123 Allschwil, Switzerland
- University of Basel, 4001 Basel, Switzerland
| | - Sabina Beilstein
- Swiss Tropical and Public Health Institute, Department Medical Parasitology and Infection Biology, 4123 Allschwil, Switzerland
- University of Basel, 4001 Basel, Switzerland
| | - Marcel Kaiser
- Swiss Tropical and Public Health Institute, Department Medical Parasitology and Infection Biology, 4123 Allschwil, Switzerland
- University of Basel, 4001 Basel, Switzerland
| | - Remo S Schmidt
- Swiss Tropical and Public Health Institute, Department Medical Parasitology and Infection Biology, 4123 Allschwil, Switzerland
- University of Basel, 4001 Basel, Switzerland
| | - Pascal Mäser
- Swiss Tropical and Public Health Institute, Department Medical Parasitology and Infection Biology, 4123 Allschwil, Switzerland
- University of Basel, 4001 Basel, Switzerland
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7
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Lemos JM, Brito da Silva MF, Dos Santos Carvalho AM, Vicente Gil HP, Fiaia Costa VA, Andrade CH, Braga RC, Grellier P, Muratov EN, Charneau S, Moreira-Filho JT, Dourado Bastos IM, Neves BJ. Multitask learning-driven identification of novel antitrypanosomal compounds. Future Med Chem 2023; 15:1449-1467. [PMID: 37701989 DOI: 10.4155/fmc-2023-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Background: Chagas disease and human African trypanosomiasis cause substantial death and morbidity, particularly in low- and middle-income countries, making the need for novel drugs urgent. Methodology & results: Therefore, an explainable multitask pipeline to profile the activity of compounds against three trypanosomes (Trypanosoma brucei brucei, Trypanosoma brucei rhodesiense and Trypanosoma cruzi) were created. These models successfully discovered four new experimental hits (LC-3, LC-4, LC-6 and LC-15). Among them, LC-6 showed promising results, with IC50 values ranging 0.01-0.072 μM and selectivity indices >10,000. Conclusion: These results demonstrate that the multitask protocol offers predictivity and interpretability in the virtual screening of new antitrypanosomal compounds and has the potential to improve hit rates in Chagas and human African trypanosomiasis projects.
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Affiliation(s)
- Jade Milhomem Lemos
- LabChem - Laboratory of Cheminformatics, Faculty of Pharmacy, Federal University of Goiás, Goiânia,74605-170, GO, Brazil
| | - Meryck Felipe Brito da Silva
- LabChem - Laboratory of Cheminformatics, Faculty of Pharmacy, Federal University of Goiás, Goiânia,74605-170, GO, Brazil
| | - Alexandra Maria Dos Santos Carvalho
- Pathogen-Host Interface Laboratory, Department of Cell Biology, Institute of Biological Sciences, University of Brasilia, Brasilia, 70910-900, DF, Brazil
| | - Henric Pietro Vicente Gil
- LabChem - Laboratory of Cheminformatics, Faculty of Pharmacy, Federal University of Goiás, Goiânia,74605-170, GO, Brazil
| | - Vinícius Alexandre Fiaia Costa
- LabChem - Laboratory of Cheminformatics, Faculty of Pharmacy, Federal University of Goiás, Goiânia,74605-170, GO, Brazil
| | - Carolina Horta Andrade
- LabMol - Laboratory for Molecular Modeling & Drug Design, Faculty of Pharmacy, Federal University of Goiás, Goiânia, 74605-170, GO, Brazil
| | - Rodolpho Campos Braga
- InsilicAll Ltda, Av. Eng. Luis Carlos Berrini,1748 - Itaim Bibi, 04571-010, Sao Paulo, SP, Brazil
| | - Philippe Grellier
- UMR 7245 Molécules de Communication et Adaptation des Micro-organismes, Muséum National d'Histoire Naturelle, Équipe Parasites et Protistes Libres, Paris, 0575231, France
| | - Eugene N Muratov
- Laboratory for Molecular Modeling, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, 27599, NC, USA
- Department of Pharmaceutical Sciences, Federal University of Paraiba, Joao Pessoa, 58059-900, PB, Brazil
| | - Sébastien Charneau
- Department of Cell Biology, Laboratory of Biochemistry & Protein Chemistry, Institute of Biological Sciences, University of Brasilia, Brasilia, 70910-900, DF, Brazil
| | - José Teófilo Moreira-Filho
- LabMol - Laboratory for Molecular Modeling & Drug Design, Faculty of Pharmacy, Federal University of Goiás, Goiânia, 74605-170, GO, Brazil
| | - Izabela Marques Dourado Bastos
- Pathogen-Host Interface Laboratory, Department of Cell Biology, Institute of Biological Sciences, University of Brasilia, Brasilia, 70910-900, DF, Brazil
| | - Bruno Junior Neves
- LabChem - Laboratory of Cheminformatics, Faculty of Pharmacy, Federal University of Goiás, Goiânia,74605-170, GO, Brazil
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8
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Proaño A, Dumonteil E, Herrera C. Chagas Disease Diagnostic Testing in Two Academic Hospitals in New Orleans, Louisiana: A Call to Action. Trop Med Infect Dis 2023; 8:tropicalmed8050277. [PMID: 37235325 DOI: 10.3390/tropicalmed8050277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Chagas disease, caused by the protozoa parasite Trypanosoma cruzi, is an anthropozoonosis that represents a major public health problem in the Americas, affecting 7 million people with at least 65 million at risk. We sought to assess the intensity of disease surveillance based on diagnostic test requests from hospitals in New Orleans, Louisiana. We extracted information from send-out labs at two major tertiary academic hospitals in New Orleans, Louisiana, USA, from 1 January 2018 to 1 December 2020. We found that in these three years there were 27 patients for whom Chagas disease testing was ordered. Most of these patients were male (70%), with a median age of 40 years old, and their most common ethnical background was Hispanic (74%). These findings demonstrate undertesting of this neglected disease in our region. Given the low Chagas disease surveillance, we need to increase awareness, health promotion, and education among healthcare workers.
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Affiliation(s)
- Alvaro Proaño
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Eric Dumonteil
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Claudia Herrera
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
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Jha BK, Varikuti S, Verma C, Shivahare R, Bishop N, Dos Santos GP, McDonald J, Sur A, Myler PJ, Schenkman S, Satoskar AR, McGwire BS. Immunization with a Trypanosoma cruzi cyclophilin-19 deletion mutant protects against acute Chagas disease in mice. NPJ Vaccines 2023; 8:63. [PMID: 37185599 PMCID: PMC10130101 DOI: 10.1038/s41541-023-00647-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/23/2023] [Indexed: 05/17/2023] Open
Abstract
Human infection with the protozoan parasite Trypanosoma cruzi causes Chagas disease for which there are no prophylactic vaccines. Cyclophilin 19 is a secreted cis-trans peptidyl isomerase expressed in all life stages of Trypanosoma cruzi. This protein in the insect stage leads to the inactivation of insect anti-parasitic peptides and parasite transformation whereas in the intracellular amastigotes it participates in generating ROS promoting the growth of parasites. We have generated a parasite mutant with depleted expression of Cyp19 by removal of 2 of 3 genes encoding this protein using double allelic homologous recombination. The mutant parasite line failed to replicate when inoculated into host cells in vitro or in mice indicating that Cyp19 is critical for infectivity. The mutant parasite line also fails to replicate in or cause clinical disease in immuno-deficient mice further validating their lack of virulence. Repeated inoculation of mutant parasites into immuno-competent mice elicits parasite-specific trypanolytic antibodies and a Th-1 biased immune response and challenge of mutant immunized mice with virulent wild-type parasites is 100% effective at preventing death from acute disease. These results suggest that parasite Cyp19 may be candidate for small molecule drug targeting and that the mutant parasite line may warrant further immunization studies for prevention of Chagas disease.
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Affiliation(s)
- Bijay Kumar Jha
- Division of Infectious Diseases, Department of Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Sanjay Varikuti
- Departments of Pathology and Microbiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Chaitenya Verma
- Departments of Pathology and Microbiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Rahul Shivahare
- Division of Infectious Diseases, Department of Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Nicholas Bishop
- Division of Infectious Diseases, Department of Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Gregory P Dos Santos
- Department of Microbiology, Immunology and Parasitology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Jacquelyn McDonald
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Aakash Sur
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
| | - Peter J Myler
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Sergio Schenkman
- Department of Microbiology, Immunology and Parasitology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Abhay R Satoskar
- Departments of Pathology and Microbiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
| | - Bradford S McGwire
- Division of Infectious Diseases, Department of Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
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10
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Ribeiro Franco PI, do Carmo Neto JR, Miguel MP, Machado JR, Nunes Celes MR. Cancer and Trypanosoma cruzi: Tumor induction or protection? Biochimie 2023; 207:113-121. [PMID: 36368477 DOI: 10.1016/j.biochi.2022.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
Trypanosoma cruzi causes Chagas disease, a neglected disease that can be divided, overall, into acute and chronic phases. Understanding the mechanisms underlying its progression is based on the parasite-host interactions occurring during the infection. Although the pathophysiology of the main symptomatic forms of Chagas disease has been the subject of several studies, little is known about their relationship with the development of different types of cancer. Therefore, knowledge regarding the molecular aspects of infection in the host, as well as the influence of the immune response in the parasite and the host, can help to understand the association between Chagas disease and tumor development. This review aims to summarize the main molecular mechanisms related to T. cruzi-dependent carcinogenic development and the mechanisms associated with tumor protection mediated by different parasite components.
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Affiliation(s)
- Pablo Igor Ribeiro Franco
- Department of Bioscience and Technology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, 74605-050, Goiania, Goiás, Brazil.
| | - José Rodrigues do Carmo Neto
- Department of Bioscience and Technology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, 74605-050, Goiania, Goiás, Brazil
| | - Marina Pacheco Miguel
- Department of Bioscience and Technology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, 74605-050, Goiania, Goiás, Brazil; Veterinary and Animal Science School, Federal University of Goiás, 74605-050, Goiania, Goiás, Brazil
| | - Juliana Reis Machado
- Department of General Pathology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, 38025-180, Uberaba, Minas Gerais, Brazil
| | - Mara Rúbia Nunes Celes
- Department of Bioscience and Technology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, 74605-050, Goiania, Goiás, Brazil
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Rayford KJ, Cooley A, Strode AW, Osi I, Arun A, Lima MF, Misra S, Pratap S, Nde PN. Trypanosoma cruzi dysregulates expression profile of piRNAs in primary human cardiac fibroblasts during early infection phase. Front Cell Infect Microbiol 2023; 13:1083379. [PMID: 36936778 PMCID: PMC10017870 DOI: 10.3389/fcimb.2023.1083379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Trypanosoma cruzi, the etiological agent of Chagas Disease, causes severe morbidity, mortality, and economic burden worldwide. Though originally endemic to Central and South America, globalization has led to increased parasite presence in most industrialized countries. About 40% of infected individuals will develop cardiovascular, neurological, and/or gastrointestinal pathologies. Accumulating evidence suggests that the parasite induces alterations in host gene expression profiles in order to facilitate infection and pathogenesis. The role of regulatory gene expression machinery during T. cruzi infection, particularly small noncoding RNAs, has yet to be elucidated. In this study, we aim to evaluate dysregulation of a class of sncRNAs called piRNAs during early phase of T. cruzi infection in primary human cardiac fibroblasts by RNA-Seq. We subsequently performed in silico analysis to predict piRNA-mRNA interactions. We validated the expression of these selected piRNAs and their targets during early parasite infection phase by stem loop qPCR and qPCR, respectively. We found about 26,496,863 clean reads (92.72%) which mapped to the human reference genome. During parasite challenge, 441 unique piRNAs were differentially expressed. Of these differentially expressed piRNAs, 29 were known and 412 were novel. In silico analysis showed several of these piRNAs were computationally predicted to target and potentially regulate expression of genes including SMAD2, EGR1, ICAM1, CX3CL1, and CXCR2, which have been implicated in parasite infection, pathogenesis, and various cardiomyopathies. Further evaluation of the function of these individual piRNAs in gene regulation and expression will enhance our understanding of early molecular mechanisms contributing to infection and pathogenesis. Our findings here suggest that piRNAs play important roles in infectious disease pathogenesis and can serve as potential biomarkers and therapeutic targets.
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Affiliation(s)
- Kayla J. Rayford
- Department of Microbiology, Immunology, and Physiology, Meharry Medical College, Nashville, TN, United States
| | - Ayorinde Cooley
- Department of Microbiology, Immunology, and Physiology, Meharry Medical College, Nashville, TN, United States
| | - Anthony W. Strode
- Department of Microbiology, Immunology, and Physiology, Meharry Medical College, Nashville, TN, United States
| | - Inmar Osi
- Department of Microbiology, Immunology, and Physiology, Meharry Medical College, Nashville, TN, United States
| | - Ashutosh Arun
- Department of Microbiology, Immunology, and Physiology, Meharry Medical College, Nashville, TN, United States
| | - Maria F. Lima
- Biomedical Sciences, School of Medicine, City College of New York, New York, NY, United States
| | - Smita Misra
- School of Graduate Studies and Research, Meharry Medical College, Nashville, TN, United States
| | - Siddharth Pratap
- Department of Microbiology, Immunology, and Physiology, Meharry Medical College, Nashville, TN, United States
- Bioinformatics Core, School of Graduate Studies and Research, Meharry Medical College, Nashville, TN, United States
| | - Pius N. Nde
- Department of Microbiology, Immunology, and Physiology, Meharry Medical College, Nashville, TN, United States
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Bierrenbach AL, Quintino ND, Moreira CHV, Damasceno RF, Nunes MDCP, Baldoni NR, de Oliveira da Silva LC, Ferreira AM, Cardoso CS, Haikal DS, Sabino EC, Ribeiro ALP, Oliveira CDL. Hospitalizations due to gastrointestinal Chagas disease: National registry. PLoS Negl Trop Dis 2022; 16:e0010796. [PMID: 36121897 PMCID: PMC9522308 DOI: 10.1371/journal.pntd.0010796] [Citation(s) in RCA: 2] [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: 05/09/2022] [Revised: 09/29/2022] [Accepted: 09/06/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Analyze the hospitalizations of patients admitted for Chagas disease with gastro-intestinal involvement (CD-GI) in the Brazilian Unified Health System, describe the epidemiological profile, mortality and costs. METHODS This is an observational study that uses secondary data from the National Hospital Information System (SIH-SUS) for the years 2017-2019. CD-GI admissions were defined by specific ICD-10 codes that identify the main diagnosis. RESULTS From 2017 to 2019, there were 4,407 hospitalizations for CD-GI in Brazil, considering only public hospitals and those associated with the SUS. This corresponds to an average of 1,470 hospitalizations per year, or 0.6 per 100,000 inhabitants, with significant regional variation. Hospitalizations increased with age and were slightly higher in men. More than 60% were emergencies and in 50% the procedure performed was surgical. The most used code was the one for megaesophagus followed by megacolon. In-hospital mortality was 5.8% and 17.2% went to intensive care units. The median cost was USD$ 553.15 per hospitalization, and an overall cost of USD$ 812,579.98 per year to the SUS budget. CONCLUSION The numbers, rates and costs presented here are possibly underestimated but they give us an idea of the overall profile of hospitalizations due to CD-GI, which are not rare and are related to significant in-hospital mortality. CD-GI is a neglected manifestation of a neglected disease.
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Chagas Disease Megaesophagus Patients Carrying Variant MRPS18B P260A Display Nitro-Oxidative Stress and Mitochondrial Dysfunction in Response to IFN-γ Stimulus. Biomedicines 2022; 10:biomedicines10092215. [PMID: 36140315 PMCID: PMC9496350 DOI: 10.3390/biomedicines10092215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
Chagas disease (CD), caused by the protozoan parasite Trypanosoma cruzi, affects 8 million people, and around 1/3 develop chronic cardiac (CCC) or digestive disease (megaesophagus/megacolon), while the majority remain asymptomatic, in the indeterminate form of Chagas disease (ASY). Most CCC cases in families with multiple Chagas disease patients carry damaging mutations in mitochondrial genes. We searched for exonic mutations associated to chagasic megaesophagus (CME) in genes essential to mitochondrial processes. We performed whole exome sequencing of 13 CME and 45 ASY patients. We found the damaging variant MRPS18B 688C > G P230A, in five out of the 13 CME patients (one of them being homozygous; 38.4%), while the variant appeared in one out of 45 ASY patients (2.2%). We analyzed the interferon (IFN)-γ-induced nitro-oxidative stress and mitochondrial function of EBV-transformed lymphoblastoid cell lines. We found the CME carriers of the mutation displayed increased levels of nitrite and nitrated proteins; in addition, the homozygous (G/G) CME patient also showed increased mitochondrial superoxide and reduced levels of ATP production. The results suggest that pathogenic mitochondrial mutations may contribute to cytokine-induced nitro-oxidative stress and mitochondrial dysfunction. We hypothesize that, in mutation carriers, IFN-γ produced in the esophageal myenteric plexus might cause nitro-oxidative stress and mitochondrial dysfunction in neurons, contributing to megaesophagus.
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Pinto L, Schijman AG, Alonso-Padilla J, Lozano D, Torrico MC, Gamba P, Torrez M, Lozada V, Cartagena K, Sanchez J, Torrico F, Gascon J. Molecular detection and parasite load of Trypanosoma cruzi in digestive tract tissue of Chagas disease patients affected by megacolon. Acta Trop 2022; 235:106632. [PMID: 35932843 DOI: 10.1016/j.actatropica.2022.106632] [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: 03/25/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022]
Abstract
Chagas disease, caused by the Trypanosoma cruzi parasite in the Americas affects ∼ 7 million people, 30% with cardiac tissue damage and 10-15% with digestive disorders. In this study, we have developed a protocol to detect the presence of the parasite and estimate its load in resected dysfunctional tissue segments of chronically infected patients with digestive megacolon. We have included samples from 43 individuals, 38/5 with positive/negative serology for Chagas disease and digestive syndromes.. Samples of 1.5 to 2.0 cm were taken from different points of the dysfunctional digestive tract in specialized centres in Cochabamba, Bolivia. T.cruzi cultures were performed by inoculation with NNN-LIT culture medium, and genomic material was obtained from the samples formultiplex qPCR with TaqMan probes targeting satellite nuclear DNA. Cultures failed to isolate T. cruzi but qPCR reached a sensitivity of 42.1% (16/38) with all three spots and in triplicate.. A new quantification methodology using synthetic satellite DNA as quantitation standard revealed parasite loads ranging from 2.2 × 102 to 1.0 × 106 satellite DNA copies/μl. Positive samples from the distal end showed a higher parasite load. The results of the present study strengthen and add further evidence to previous findings in an experimental mouse model of chronic T. cruzi infection, providing a valuable tool to improve scientific knowledge on the relevance of the digestive tract in parasite persistence, and underlines the need of a better understanding of host-pathogen interaction in digestive tissues, considering pathophysiology, disease immunology and response to treatment.
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Affiliation(s)
| | - Alejandro G Schijman
- Laboratory of Molecular Biology of Chagas Disease, Institute for Research in Genetic Engineering and Molecular Biology (INGEBI-CONICET), Buenos Aires, Argentina
| | - Julio Alonso-Padilla
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - University of Barcelona, 08036, Barcelona, Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII)
| | - Daniel Lozano
- CEADES Foundation, Cochabamba, Bolivia.; Faculty of Medicine, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Mary Cruz Torrico
- Faculty of Medicine, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Pietro Gamba
- Pietro Gamba Foundation Anzaldo, Cochabamba, Bolivia
| | | | - Vania Lozada
- Institute of Gastroenterology Bolivian Japanese, Cochabamba, Bolivia
| | - Karina Cartagena
- Institute of Gastroenterology Bolivian Japanese, Cochabamba, Bolivia
| | - Jareth Sanchez
- Hospital "Dr. Manuel Ascencio Villarroel", Punata, Cochabamba, Bolivia
| | - Faustino Torrico
- CEADES Foundation, Cochabamba, Bolivia.; Faculty of Medicine, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Joaquim Gascon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - University of Barcelona, 08036, Barcelona, Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII)
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Valdez MB, Bernal Giménez DM, Fernández LR, Musikant AD, Ferri G, Saenz D, Di Venosa G, Casas A, Avigliano E, Edreira MM, Palermo JA. New antiparasitic derivatives of the furoquinoline alkaloids kokusaginine and flindersiamine. ChemMedChem 2022; 17:e202100784. [PMID: 35001527 DOI: 10.1002/cmdc.202100784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Indexed: 11/10/2022]
Abstract
In this work is reported the synthesis of 16 new compounds obtained from kokusaginine and flindersiamine, the main alkaloids isolated from the bark of Balfourodendron riedelianum . The activity of the compounds against axenic cultures of Trypanosoma cruzi epimastigtotes and trypomastigotes, as well as intracellular amastigotes, is described, together with their cytotoxic activity against three different human cell lines. The synthetic strategy for the preparation of the new compounds was based on the reactivity at the position C-4 of the furoquinoline core towards nucleophiles. The new derivatives were synthesized by a Buchwald-Hartwig reaction, in most cases under green, solvent free conditions. Compounds 1c and 1e displayed better in-vitro activity against trypomastigotes than benznidazole and nifurtimox (positive controls) with IC 50 < 4 µM. In addition, both compounds were not cytotoxic activity against the three human cell lines K562 (erytroleukimia), LM2 (breast cancer) and HaCat (keratinocyte). Interestingly, when evaluated against intracellular amastigotes, compound 1c was able to significantly reduce the number of this parasite form, compared to the negative control.
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Affiliation(s)
- María Belén Valdez
- Universidad de Buenos Aires Facultad de Ciencias Exactas y Naturales, UMYMFOR- Departamento de Química Orgánica, ARGENTINA
| | - Diana María Bernal Giménez
- Universidad de Buenos Aires Facultad de Ciencias Exactas y Naturales, IQUIBICEN, Departamento de Química Biológica, ARGENTINA
| | - Lucía Raquel Fernández
- Universidad de Buenos Aires Facultad de Ciencias Exactas y Naturales, UMYMFOR, Departamento de Química Orgánica, ARGENTINA
| | - Alejandro Daniel Musikant
- Universidad de Buenos Aires Facultad de Ciencias Exactas y Naturales, IQUIBICEN, Departamento de Química Biológica, ARGENTINA
| | - Gabriel Ferri
- Universidad de Buenos Aires Facultad de Ciencias Exactas y Naturales, IQUIBICEN, Departamento de Química Biológica, ARGENTINA
| | - Daniel Saenz
- CIPYP: Centro de Investigaciones Sobre Porfirinas y Porfirias, CIPYP, ARGENTINA
| | - Gabriela Di Venosa
- CIPYP: Centro de Investigaciones Sobre Porfirinas y Porfirias, CiPYP, ARGENTINA
| | - Adriana Casas
- CIPYP: Centro de Investigaciones Sobre Porfirinas y Porfirias, CIPYP, ARGENTINA
| | - Esteban Avigliano
- Universidad de Buenos Aires Facultad de Ciencias Veterinarias, INPA, ARGENTINA
| | - Martin Miguel Edreira
- Universidad de Buenos Aires Facultad de Ciencias Exactas y Naturales, IQUIBICEN, Departamento de Química Biológica, ARGENTINA
| | - Jorge A Palermo
- UMYMFOR-Facultad de Ciencias Exactas y Naturales - Universidad de Buenos Aires, Química Orgánica, Ciudad Universiaria, Pabellón 2, 1428, Buenos Aires, ARGENTINA
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Oliveira JDA, Gharib AZGE, Dantas RO. SYMPTOMS ASSOCIATED WITH DIFFERENT DEGREES OF MEGAESOPHAGUS IN CHAGAS DISEASE. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:491-494. [PMID: 34909855 DOI: 10.1590/s0004-2803.202100000-88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dysphagia is the most frequent digestive symptom in Chagas disease, although other symptoms are reported. These symptoms can be associated with the degree of radiological impairment of the esophagus and the duration of dysphagia. OBJECTIVE This investigation aimed to assess the symptoms and the time of dysphagia related to the different degrees of megaesophagus in patients with Chagas disease. METHODS A total of 29 patients aged 48 to 73 years participated in this investigation. All of them had dysphagia and a positive serum result for Chagas disease. They were submitted to the assessment of symptoms and radiological examination of the esophagus to assess the degree of megaesophagus, which ranged from I (mild change) to IV (intense change). Dysphagia was quantified with the Eating Assessment Tool (EAT-10). RESULTS Twelve (41%) patients had megaesophagus degree I, 9 (31%) had degree II, and 8 (28%) had degrees III (6) and IV (2). The intensity of dysphagia was not related to the result of the radiological examination, with EAT-10 median of 5.5 for the degree I, 9.0 for degree II, and 5.5 for degrees III and IV (P>0.25). Choking (14%), regurgitation (21%), voice complaint (21%), weight loss (17%), and odynophagia (17%) were not related to the degree of megaesophagus. Voice changes and odynophagia were related to the patients' time of dysphagia. Likewise, the frequency of symptoms and EAT-10 values were related to the duration of dysphagia. CONCLUSION The longer the patient had dysphagia, the more frequent were the symptoms reported by the patients. There was no relationship between the degrees of megaesophagus and the symptoms and intensity of dysphagia.
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Affiliation(s)
| | | | - Roberto Oliveira Dantas
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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El Gharib AZG, Dantas RO. Cross-Sectional Study of Swallowing Phases in Cases of Megaesophagus Caused by Chagas Disease. Gastroenterology Res 2021; 14:290-295. [PMID: 34804273 PMCID: PMC8577594 DOI: 10.14740/gr1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background Chagas disease, caused by the flagellate protozoan Trypanosoma cruzi, is an infectious cause of secondary achalasia and megaesophagus. Moreover, the oral and pharyngeal phases of swallowing may also be affected, which may contribute to dysphagia and increase the possibility of airway aspiration during and/or after swallowing. This cross-sectional study evaluated, with videofluoroscopy, the oral, pharyngeal, and esophageal phases of swallowing in patients with megaesophagus caused by Chagas disease. The hypothesis is that there is impairment of the pharyngeal phase of swallowing that may increase the risk of airway aspiration. Methods A total of 29 patients, aged 48 - 73 years (mean: 63.8 ± 5.1 years), with dysphagia, radiological changes in the esophagus, and positive serologic test for Chagas disease, participated in the study. They were submitted to the videofluoroscopic evaluation of oral, pharyngeal, and esophageal phases, swallowing twice 10 mL of liquid and 10 mL of thickened barium boluses. Results The most frequent findings were: oral residues and ineffective ejection in the oral phase; residues in vallecula, pharynx, and pyriform sinuses in the pharyngeal phase; abnormal esophageal motility, longer clearance, and longer transit in the esophageal phase. Laryngeal penetration was seen in 28% of the patients. Patients with increased esophageal diameter had more pharyngeal residues than patients without increased esophageal diameter. None of the patients had airway aspiration. Conclusion Megaesophagus caused by Chagas disease may affect all phases of swallowing, with an increase in oral and pharyngeal residues which suggest the impairment of oral and pharyngeal efficiency. None of the patients had airway aspiration.
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Medina-Rincón GJ, Gallo-Bernal S, Jiménez PA, Cruz-Saavedra L, Ramírez JD, Rodríguez MJ, Medina-Mur R, Díaz-Nassif G, Valderrama-Achury MD, Medina HM. Molecular and Clinical Aspects of Chronic Manifestations in Chagas Disease: A State-of-the-Art Review. Pathogens 2021; 10:pathogens10111493. [PMID: 34832648 PMCID: PMC8619182 DOI: 10.3390/pathogens10111493] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022] Open
Abstract
Chronic manifestations of Chagas disease present as disabling and life-threatening conditions affecting mainly the cardiovascular and gastrointestinal systems. Although meaningful research has outlined the different molecular mechanisms underlying Trypanosoma cruzi’s infection and the host-parasite interactions that follow, prompt diagnosis and treatment remain a challenge, particularly in developing countries and also in those where the disease is considered non-endemic. This review intends to present an up-to-date review of the parasite’s life cycle, genetic diversity, virulence factors, and infective mechanisms, as well as the epidemiology, clinical presentation, diagnosis, and treatment options of the main chronic complications of Chagas disease.
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Affiliation(s)
- Germán J. Medina-Rincón
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (S.G.-B.); (M.D.V.-A.); (H.M.M.)
- Correspondence: ; Tel.: +57-310-817-2369
| | - Sebastián Gallo-Bernal
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (S.G.-B.); (M.D.V.-A.); (H.M.M.)
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Radiology, Harvard Medical School, Boston, MA 02114, USA
| | - Paula A. Jiménez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá 111221, Colombia; (P.A.J.); (L.C.-S.); (J.D.R.)
| | - Lissa Cruz-Saavedra
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá 111221, Colombia; (P.A.J.); (L.C.-S.); (J.D.R.)
| | - Juan David Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá 111221, Colombia; (P.A.J.); (L.C.-S.); (J.D.R.)
| | - María Juliana Rodríguez
- Division of Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 110131, Colombia; (M.J.R.); (R.M.-M.)
| | - Ramón Medina-Mur
- Division of Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 110131, Colombia; (M.J.R.); (R.M.-M.)
| | - Gustavo Díaz-Nassif
- Division of Gastroenterology and Liver Diseases, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 111221, Colombia;
| | | | - Héctor M. Medina
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (S.G.-B.); (M.D.V.-A.); (H.M.M.)
- Division of Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 110131, Colombia; (M.J.R.); (R.M.-M.)
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Profiro de Oliveira JH, Arruda IES, Izak Ribeiro de Araújo J, Chaves LL, de La Rocca Soares MF, Soares-Sobrinho JL. Why do few drug delivery systems to combat neglected tropical diseases reach the market? An analysis from the technology's stages. Expert Opin Ther Pat 2021; 32:89-114. [PMID: 34424127 DOI: 10.1080/13543776.2021.1970746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Many drugs used to combat schistosomiasis, Chagas disease, and leishmaniasis (SCL) have clinical limitations such as: high toxicity to the liver, kidneys and spleen; reproductive, gastrointestinal, and heart disorders; teratogenicity. In this sense, drug delivery systems (DDSs) have been described in the literature as a viable option for overcoming the limitations of these drugs. An analysis of the level of development (TRL) of patents can help in determine the steps that must be taken for promising technologies to reach the market. AREAS COVERED This study aimed to analyze the stage of development of DDSs for the treatment of SCL described in patents. In addition, we try to understand the main reasons why many DDSs do not reach the market. In this study, we examined DDSs for drugs indicated by WHO and treatment of SCL, by performing a search for patents. EXPERT OPINION In this present work we provide arguments that support the hypothesis that there is a lack of integration between academia and industry to finance and continue research, especially the development of clinical studies. We cite the translational research consortia as the potential alternative for developing DDSs to combat NTDs.
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Affiliation(s)
| | | | | | - Luise Lopes Chaves
- Department of Pharmacy, Federal University of Pernambuco, Recife, Recife-Pernambuco
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Nanotechnological interventions for treatment of trypanosomiasis in humans and animals. Drug Deliv Transl Res 2021; 10:945-961. [PMID: 32383004 DOI: 10.1007/s13346-020-00764-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Trypanosomiasis is a parasitic infection caused by Trypanosoma. It is one of the major causes of deaths in underprivileged, rural areas of Africa, America and Asia. Depending on the parasite species responsible for the disease, it can take two forms namely African trypanosomiasis (sleeping sickness) and American trypanosomiasis (Chagas disease). The complete life-cycle stages of trypanosomes span between insect vector (tsetse fly, triatomine bug) and mammalian host (humans, animals). Only few drugs have been approved for the treatment of trypanosomiasis. Moreover, current trypanocidal therapy has major limitations of poor efficacy, serious side effects and drug resistance. Due to the lack of economic gains from tropical parasitic infection, it has always been neglected by the researchers and drug manufacturers. There is an immense need of more effective innovative strategies to decrease the deaths associated with this diseases. Nanotechnological approaches for delivery of existing drugs have shown significant improvement in efficacy with many-fold decrease in their dose. The review emphasizes on nanotechnological interventions in the treatment of trypanosomiasis in both humans and animals. Current trypanocidal therapy and their limitations have also been discussed briefly. Graphical abstract.
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Tuganbaev T, Honda K. Non-zero-sum microbiome immune system interactions. Eur J Immunol 2021; 51:2120-2136. [PMID: 34242413 PMCID: PMC8457126 DOI: 10.1002/eji.202049065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/01/2021] [Accepted: 07/08/2021] [Indexed: 12/14/2022]
Abstract
Fundamental asymmetries between the host and its microbiome in enzymatic activities and nutrient storage capabilities have promoted mutualistic adaptations on both sides. As a result, the enteric immune system has evolved so as not to cause a zero‐sum sterilization of non‐self, but rather achieve a non‐zero‐sum self‐reinforcing cooperation with its evolutionary partner the microbiome. In this review, we attempt to integrate the accumulated knowledge of immune—microbiome interactions into an evolutionary framework and trace the pattern of positive immune—microbiome feedback loops across epithelial, enteric nervous system, innate, and adaptive immune circuits. Indeed, the immune system requires commensal signals for its development and function, and reciprocally protects the microbiome from nutrient shortage and pathogen outgrowth. In turn, a healthy microbiome is the result of immune system curatorship as well as microbial ecology. The paradigms of host–microbiome asymmetry and the cooperative nature of their interactions identified in the gut are applicable across all tissues influenced by microbial activities. Incorporation of immune system influences into models of microbiome ecology will be a step forward toward defining what constitutes a healthy human microbiome and guide discoveries of novel host–microbiome mutualistic adaptations that may be harnessed for the promotion of human health.
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Affiliation(s)
- Timur Tuganbaev
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, Japan
| | - Kenya Honda
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, Japan.,RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
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Choudhury SD. Nano-Medicines a Hope for Chagas Disease! Front Mol Biosci 2021; 8:655435. [PMID: 34141721 PMCID: PMC8204082 DOI: 10.3389/fmolb.2021.655435] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
Chagas disease, is a vector-mediated tropical disease whose causative agent is a parasitic protozoan named Trypanosoma cruzi. It is a very severe health issue in South America and Mexico infecting millions of people every year. Protozoan T. cruzi gets transmitted to human through Triatominae, a subfamily of the Reduviidae, and do not have any effective treatment or preventative available. The lack of economic gains from this tropical parasitic infection, has always been the reason behind its negligence by researchers and drug manufacturers for many decades. Hence there is an enormous requirement for more efficient and novel strategies to reduce the fatality associated with these diseases. Even, available diagnosis protocols are outdated and inefficient and there is an urgent need for rapid high throughput diagnostics as well as management protocol. The current advancement of nanotechnology in the field of healthcare has generated hope for better management of many tropical diseases including Chagas disease. Nanoparticulate systems for drug delivery like poloxamer coated nanosuspension of benzimidazole have shown promising results in reducing toxicity, elevating efficacy and bioavailability of the active compound against the pathogen, by prolonging release, thereby increasing the therapeutic index. Moreover, nanoparticle-based drug delivery has shown promising results in inducing the host’s immune response against the pathogen with very few side effects. Besides, advances in diagnostic assays, such as nanosensors, aided in the accurate detection of the parasite. In this review, we provide an insight into the life cycle stages of the pathogen in both vertebrate host and the insect vector, along with an overview of the current therapy for Chagas disease and its limitations; nano carrier-based delivery systems for antichagasic agents, we also address the advancement of nano vaccines and nano-diagnostic techniques, for treatment of Chagas disease, majorly focusing on the novel perspectives in combating the disease.
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Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death. Pathogens 2021; 10:pathogens10050505. [PMID: 33922366 PMCID: PMC8145478 DOI: 10.3390/pathogens10050505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 12/16/2022] Open
Abstract
Despite nearly a century of research and accounting for the highest disease burden of any parasitic disease in the Western Hemisphere, Chagas disease (CD) is still a challenging diagnosis, primarily due to its poor recognition outside of Latin America. Although initially considered endemic to Central and South America, globalization, urbanization, and increased migration have spread the disease worldwide in the last few years, making it a significant public health threat. The international medical community’s apparent lack of interest in this disease that was previously thought to be geographically restricted has delayed research on the complex host–parasite relationship that determines myocardial involvement and its differential behavior from other forms of cardiomyopathy, particularly regarding treatment strategies. Multiple cellular and molecular mechanisms that contribute to degenerative, inflammatory, and fibrotic myocardial responses have been identified and warrant further research to expand the therapeutic arsenal and impact the high burden attributed to CD. Altogether, cardiac dysautonomia, microvascular disturbances, parasite-mediated myocardial damage, and chronic immune-mediated injury are responsible for the disease’s clinical manifestations, ranging from asymptomatic disease to severe cardiac and gastrointestinal involvement. It is crucial for healthcare workers to better understand CD transmission and disease dynamics, including its behavior on both its acute and chronic phases, to make adequate and evidence-based decisions regarding the disease. This review aims to summarize the most recent information on the epidemiology, pathogenesis, clinical presentation, diagnosis, screening, and treatment of CD, emphasizing on Chagasic cardiomyopathy’s (Ch-CMP) clinical presentation and pathobiological mechanisms leading to sudden cardiac death.
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Dantas RO. Management of Esophageal Dysphagia in Chagas Disease. Dysphagia 2021; 36:517-522. [PMID: 33855597 DOI: 10.1007/s00455-021-10297-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Abstract
Chagas disease, caused by the infection of the protozoan parasite Trypanosoma cruzi, has clinical consequences in the heart and digestive tract. The most important changes in the digestive tract occur in the esophagus (megaesophagus) and colon (megacolon). Esophageal dysfunction in Chagas disease results from damage of the esophageal myenteric plexus, with loss of esophageal peristalsis, partial or absent lower esophageal sphincter relaxation, and megaesophagus, which characterizes secondary esophageal achalasia. The treatment options for the disease are similar to those for idiopathic achalasia, consisting of diet and behavior changes, drugs, botulinum toxin, peroral endoscopic myotomy (POEM), pneumatic dilation of the lower esophageal sphincter, laparoscopic Heller myotomy, and esophagectomy. Chagas disease causes a life-threatening cardiopathy, and this should be considered when choosing the most appropriate treatment for the disease. While some options are palliative, for temporary relief of dysphagia (such as drugs, botulinum toxin, and pneumatic dilation), other therapies provide a long-term benefit. In this case, POEM stands out as a modern and successful strategy, with good results in more than 90% of the patients. Esophagectomy is the option in Chagas disease patients with advanced megaesophagus, despite the increased risk of complications. In these cases, peroral endoscopic myotomy may be an option, which needs further evaluation.
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Affiliation(s)
- Roberto Oliveira Dantas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Campus da USP, Ribeirão Preto, SP, Brazil.
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Fonseca CMB, Mendonça TGS, Pereira CFDC, de Barros GM, da Silva ABS, Cavalcante MMADS, Cruz MDSPE, Conde Júnior AM. Structure of the parotid gland in natural infection by Leishmania infantum in Canis familiaris. Arch Oral Biol 2021; 124:105077. [PMID: 33601301 DOI: 10.1016/j.archoralbio.2021.105077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to perform a histopathological, morphometric and proteomic study of the parotid gland of dogs naturally infected with Leishmania infantum treated and not treated with Allopurinol. DESIGN Parotid glands from 14 dogs were used, divided into two groups: untreated and treated with oral allopurinol (20 mg / kg, once daily for 90 days). After adequate dissection, the organs were submitted to histopathological, histomorphometric and immunohistochemical techniques, using the monoclonal anti-β-catenin antibody. RESULTS Histopathological evaluation of treated and untreated groups showed acinar hypertrophy, structural disorganization of the nucleus and cytoplasm. There was an increase in the area and perimeter of the parotid acini in the experimental groups. The immunostaining of the β-catenin protein in the membrane was severely reduced in the treated and untreated groups. CONCLUSIONS These findings suggest that Leishmania infantum infection and treatment with Allopurinol alter the tissue structure of the parotid gland in dogs, promoting an increase in the acinar volume and a decrease in the expression of β-catenin in cell membranes.
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Affiliation(s)
- Clarisse Maria Barbosa Fonseca
- Master Program in Science and Health, Universidade Federal do Piauí, Campus Ministro Petrônio Portella, CEP: 64059-550, Teresina, Piauí, Brazil.
| | - Tarsia Giabardo Silva Mendonça
- Master Program in Science and Health, Universidade Federal do Piauí, Campus Ministro Petrônio Portella, CEP: 64059-550, Teresina, Piauí, Brazil
| | - Cristian Francisco de Carvalho Pereira
- Department of Morphology, Health Sciences Center, Universidade Federal do Piauí, Campus Ministro Petrônio Portella, CEP: 64059-550, Teresina, Piauí, Brazil
| | - Gabriel Martins de Barros
- Master Program in Science and Health, Universidade Federal do Piauí, Campus Ministro Petrônio Portella, CEP: 64059-550, Teresina, Piauí, Brazil
| | - Andrezza Braga Soares da Silva
- Doctoral Program in Technologies Applied to Animals of Regional Interest, Universidade Federal do Piauí, Campus Ministro Petrônio Portella, CEP: 64059-550, Teresina, Piauí, Brazil
| | - Maria Michele Araújo de Sousa Cavalcante
- Doctoral Program in Technologies Applied to Animals of Regional Interest, Universidade Federal do Piauí, Campus Ministro Petrônio Portella, CEP: 64059-550, Teresina, Piauí, Brazil
| | - Maria do Socorro Pires E Cruz
- Department of Veterinary Morphophysiology, Center for Agricultural Sciences, Universidade Federal do Piauí, Campus Ministro Petrônio Portella, CEP: 64059-550, Teresina, Piauí, Brazil
| | - Airton Mendes Conde Júnior
- Master Program in Science and Health, Universidade Federal do Piauí, Campus Ministro Petrônio Portella, CEP: 64059-550, Teresina, Piauí, Brazil
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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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Panarelli NC. Infectious diseases of the upper gastrointestinal tract. Histopathology 2020; 78:70-87. [PMID: 33382485 DOI: 10.1111/his.14243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022]
Abstract
A broad spectrum of pathogens produce gastrointestinal disease. The ongoing spread of human immunodeficiency virus/acquired immune deficiency syndrome, the increased use of immunosuppressive therapy and the persistence of overcrowding and suboptimal sanitation in underdeveloped areas facilitate both disease transmission from environmental and foodborne sources and person-to-person transmission. Clinicians increasingly rely on endoscopic biopsy sample interpretation to diagnose gastrointestinal infections. Thus, pathologists must be aware of diagnostic features of a variety of microbial pathogens. Detection with molecular techniques also allows for correlation between infectious agents and their histopathological features, which has expanded our knowledge of the inflammatory changes produced by infectious agents. This review covers infectious disorders of the upper gastrointestinal tract encountered in surgical pathology. Clinical, endoscopic and pathological features are presented. The review emphasises morphological features of viruses, bacteria, fungi and parasites that may be found in tissue samples, and the inflammatory patterns that they produce. Differential diagnoses and useful ancillary techniques are discussed.
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Bellamoli M, Pellegrini P, de Manna ND, Genco B, Prati D, Carbonieri E, Faggian G, Ammirati E, Frigerio M, Ribichini FL. An odd couple: acalculous cholecystitis masking a fulminant myocarditis. J Cardiovasc Med (Hagerstown) 2020; 21:327-332. [PMID: 31789718 DOI: 10.2459/jcm.0000000000000909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Michele Bellamoli
- Division of Cardiology, Department of Medicine, University of Verona
| | - Paolo Pellegrini
- Complex Operative Unit of Cardiology, Azienda ULSS 9, District 4, M. Magalini Hospital, Villafranca di Verona
| | | | - Bruno Genco
- Complex Operative Unit of Emergency Department, Azienda ULSS 9, District 4, M. Magalini Hospital, Villafranca di Verona
| | - Daniele Prati
- Division of Cardiology, Department of Medicine, University of Verona
| | - Emanuele Carbonieri
- Complex Operative Unit of Cardiology, Azienda ULSS 9, District 4, M. Magalini Hospital, Villafranca di Verona
| | | | | | - Maria Frigerio
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
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Lidani KCF, Sandri TL, Castillo-Neyra R, Andrade FA, Guimarães CM, Marques EN, Beltrame MH, Gilman RH, de Messias-Reason I. Clinical and epidemiological aspects of chronic Chagas disease from Southern Brazil. Rev Soc Bras Med Trop 2020; 53:e20200225. [PMID: 33111908 PMCID: PMC7580281 DOI: 10.1590/0037-8682-0225-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/31/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Patients with Chagas disease (CD), caused by Trypanosoma cruzi, present a higher risk of developing other chronic diseases, which may contribute to CD severity. Since CD is underreported in the southern state of Paraná, Brazil, we aimed to characterize clinical and epidemiological aspects of individuals chronically infected with T. cruzi in Southern Brazil. METHODS A community hospital-based study was performed, recording clinical/demographic characteristics of 237 patients with CD from Southern Brazil. To estimate the association between different forms of CD and sociodemographic and clinical variables, multiple logistic regression models were built using the Akaike information criterion. RESULTS Mean age was 57.5 years and 59% were females. Most patients' (60%) place of origin/birth was within Paraná and they were admitted to the CD outpatient clinic after presenting with cardiac/digestive symptoms (64%). The predominant form of CD was cardiac (53%), followed by indeterminate (36%), and digestive (11%). The main electrocardiographic changes were in the right bundle branch block (39%) and left anterior fascicular block (32%). The average number of comorbidities per patient was 3.9±2.3; systemic arterial hypertension was most common (64%), followed by dyslipidemia (34%) and diabetes (19%); overlapping comorbidities were counted separately. Male sex was associated with symptomatic cardiac CD (OR=2.92; 95%CI: 1.05-8.12; p=0.040). CONCLUSIONS This study provided greater understanding of the distribution and clinical profile of CD patients in Southern Brazil, indicating a high prevalence of comorbidities among these patients who are a vulnerable group due to advanced age and substantial risk of morbidity.
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Affiliation(s)
| | - Thaisa Lucas Sandri
- University of Tübingen, Institute of Tropical Medicine, Tübingen,
BW, Germany
| | - Ricardo Castillo-Neyra
- University of Pennsylvania, Perelman School of Medicine, Department
of Biostatistics, Epidemiology & Informatics, Philadelphia, PA, USA
| | - Fabiana Antunes Andrade
- Universidade Federal do Paraná, Departamento de Patologia Médica,
Hospital de Clínicas, Curitiba, PR, Brasil
| | - Cesar Maistro Guimarães
- Universidade Federal do Paraná, Hospital de Clínicas, Unidade de
Terapia Intensiva, Curitiba, PR, Brasil
| | - Eduardo Nunes Marques
- Universidade Federal do Paraná, Departamento de Patologia Médica,
Hospital de Clínicas, Curitiba, PR, Brasil
| | - Marcia Holsbach Beltrame
- Universidade Federal do Paraná, Departamento de Genética,
Laboratório de Genética Molecular Humana, Curitiba, PR, Brasil
| | - Robert Hugh Gilman
- Johns Hopkins Bloomberg School of Public Health, Department of
International Health, Baltimore, MD, USA
| | - Iara de Messias-Reason
- Universidade Federal do Paraná, Departamento de Patologia Médica,
Hospital de Clínicas, Curitiba, PR, Brasil
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Chatelain E, Scandale I. Animal models of Chagas disease and their translational value to drug development. Expert Opin Drug Discov 2020; 15:1381-1402. [PMID: 32812830 DOI: 10.1080/17460441.2020.1806233] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION American trypanosomiasis, better known as Chagas disease, is a global public health issue. Current treatments targeting the causative parasite, Trypanosoma cruzi, are limited to two old nitroheterocyclic compounds; new, safer drugs are needed. New tools to identify compounds suitable for parasitological cure in humans have emerged through efforts in drug discovery. AREAS COVERED Animal disease models are an integral part of the drug discovery process. There are numerous experimental models of Chagas disease described and in use; rather than going through each of these and their specific features, the authors focus on developments in recent years, in particular the imaging technologies that have dramatically changed the Chagas R&D landscape, and provide a critical view on their value and limitations for moving compounds forward into further development. EXPERT OPINION The application of new technological advances to the field of drug development for Chagas disease has led to the implementation of new and robust/standardized in vivo models that contributed to a better understanding of host/parasite interactions. These new models should also build confidence in their translational value for moving compounds forward into clinical development.
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Affiliation(s)
- Eric Chatelain
- R&D Department, Drugs for Neglected Diseases Initiative (DNDi) , Geneva, Switzerland
| | - Ivan Scandale
- R&D Department, Drugs for Neglected Diseases Initiative (DNDi) , Geneva, Switzerland
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Carmo AAL, Zenobio S, Santos BC, Rocha MOC, Ribeiro ALP. Feasibility and Safety of Laparoscopic-Guided Epicardial Access for Ventricular Tachycardia Ablation. J Am Heart Assoc 2020; 9:e016654. [PMID: 32715839 PMCID: PMC7792264 DOI: 10.1161/jaha.120.016654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The usual approach to epicardial access in patients with Chagas cardiomyopathy and megacolon is surgical access to avoid bowel injury. However, there are concerns regarding its safety in cases of Chagas cardiomyopathy with reports of prolonged mechanical ventilation and high mortality in this clinical setting. The aim of this study was to examine feasibility and complication rates for ventricular tachycardia ablation performed with laparoscopic‐guided epicardial access. Methods and Results This single center study examined complication rates of the first 11 cases of ventricular tachycardia ablation in patients with Chagas cardiomyopathy, using laparoscopic guidance to access epicardial space. All 11 patients underwent epicardial VT ablation using laparoscopic‐guided epicardial access, and the complication rates were compared with historical medical reports. The main demographic features of our population were age, 63±13 years; men, 82%; and median ejection fraction, 31% (Q1=30% and Q3=46%). All patients were sent for ventricular tachycardia ablation because of medical therapy failure. The reason for laparoscopy was megacolon in 10 patients and massive liver enlargement in 1 patient. Epicardial access was achieved in all patients. Complications included 1 severe cardiogenic shock and 1 phrenic nerve paralysis. No intra‐abdominal organ injury occurred; only 1 death, which was caused by progressive heart failure, was reported more than 1 month after the procedure. Conclusions Laparoscopic‐guided epicardial access in the setting of ventricular tachycardia ablation and enlarged intra‐abdominal organ is a simple alternative to more complex surgical access and can be performed with low complication rates.
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Affiliation(s)
- Andre A L Carmo
- Hospital das Clínicas and Faculdade de Medicina Universidade Federal de Minas Gerais Minas Gerais Brazil
| | - Silvia Zenobio
- Hospital das Clínicas and Faculdade de Medicina Universidade Federal de Minas Gerais Minas Gerais Brazil
| | - Bruno C Santos
- Hospital das Clínicas and Faculdade de Medicina Universidade Federal de Minas Gerais Minas Gerais Brazil
| | - Manoel O C Rocha
- Hospital das Clínicas and Faculdade de Medicina Universidade Federal de Minas Gerais Minas Gerais Brazil
| | - Antonio L P Ribeiro
- Hospital das Clínicas and Faculdade de Medicina Universidade Federal de Minas Gerais Minas Gerais Brazil
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Chagas cardiomyopathy and heart failure: From epidemiology to treatment. Rev Port Cardiol 2020; 39:279-289. [PMID: 32532535 DOI: 10.1016/j.repc.2019.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/10/2019] [Accepted: 12/01/2019] [Indexed: 12/28/2022] Open
Abstract
Chagas disease is among the neglected tropical diseases recognized by the World Health Organization that have received insufficient attention from governments and health agencies. Chagas disease is endemic in 21 Latin America regions. Due to globalization and increased migration, it has crossed borders and reached other regions including North America and Europe. The clinical presentation of the disease is highly variable, from general symptoms to severe cardiac involvement that can culminate in heart failure. Chagas heart disease is multifactorial, and can include dilated cardiomyopathy, thromboembolic phenomena, and arrhythmias that may lead to sudden death. Diagnosis is by methods such as enzyme-linked immunosorbent assay (ELISA) and the degree of cardiac involvement should be investigated with complementary exams including ECG, chest radiography and electrophysiological study. There have been insufficient studies on which to base specific treatment for heart failure due to Chagas disease. Treatment should therefore be derived from guidelines for heart failure that are not specific for this disease. Heart transplantation is a viable option with satisfactory success rates that has improved survival.
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McNamara N, Rahmani R, Sykes ML, Avery VM, Baell J. Hit-to-lead optimization of novel benzimidazole phenylacetamides as broad spectrum trypanosomacides. RSC Med Chem 2020; 11:685-695. [PMID: 33479668 DOI: 10.1039/d0md00058b] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/12/2020] [Indexed: 12/21/2022] Open
Abstract
Trypanosoma cruzi and Trypanosoma brucei are the parasitic causative agents of Chagas disease and human African trypanosomiasis (HAT), respectively. The drugs currently used to treat these diseases are not efficacious against all stages and/or parasite sub-species, often displaying side effects. Herein, we report the SAR exploration of a novel hit, 2-(4-chlorophenyl)-N-(1-propyl-1H-benzimidazol-2-yl)acetamide previously identified from high throughput screens against T. cruzi, Trypanosoma brucei brucei and Leishmania donovani. An informative set of analogues was synthesized incorporating key modifications of the scaffold resulting in improved potency whilst the majority of compounds retained low cytotoxicity against H9c2 and HEK293 cell lines. The SAR observed against T. cruzi broadly matches that observed against T.b. brucei, suggesting the possibility for a broad-spectrum candidate. This class of compounds therefore warrants further investigation towards development as a treatment for Chagas disease and HAT.
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Affiliation(s)
- Nicole McNamara
- Medicinal Chemistry , Monash Institute of Pharmaceutical Sciences , Monash University , Parkville , Victoria 3052 , Australia .
| | - Raphael Rahmani
- Medicinal Chemistry , Monash Institute of Pharmaceutical Sciences , Monash University , Parkville , Victoria 3052 , Australia .
| | - Melissa L Sykes
- Discovery Biology , Griffith Institute for Drug Discovery , Griffith University , Brisbane Innovation Park, Don Young Road , Nathan , Queensland 4111 , Australia
| | - Vicky M Avery
- Discovery Biology , Griffith Institute for Drug Discovery , Griffith University , Brisbane Innovation Park, Don Young Road , Nathan , Queensland 4111 , Australia
| | - Jonathan Baell
- Medicinal Chemistry , Monash Institute of Pharmaceutical Sciences , Monash University , Parkville , Victoria 3052 , Australia .
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Santos É, Menezes Falcão L. Chagas cardiomyopathy and heart failure: From epidemiology to treatment. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
Parasitic diseases, such as sleeping sickness, Chagas disease and malaria, remain a major cause of morbidity and mortality worldwide, but particularly in tropical, developing countries. Controlling these diseases requires a better understanding of host-parasite interactions, including a deep appreciation of parasite distribution in the host. The preferred accumulation of parasites in some tissues of the host has been known for many years, but recent technical advances have allowed a more systematic analysis and quantifications of such tissue tropisms. The functional consequences of tissue tropism remain poorly studied, although it has been associated with important aspects of disease, including transmission enhancement, treatment failure, relapse and clinical outcome. Here, we discuss current knowledge of tissue tropism in Trypanosoma infections in mammals, describe potential mechanisms of tissue entry, comparatively discuss relevant findings from other parasitology fields where tissue tropism has been extensively investigated, and reflect on new questions raised by recent discoveries and their potential impact on clinical treatment and disease control strategies.
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Affiliation(s)
- Sara Silva Pereira
- Instituto de Medicina Molecular-João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa , Lisbon , Portugal
| | - Sandra Trindade
- Instituto de Medicina Molecular-João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa , Lisbon , Portugal
| | - Mariana De Niz
- Instituto de Medicina Molecular-João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa , Lisbon , Portugal
| | - Luisa M Figueiredo
- Instituto de Medicina Molecular-João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa , Lisbon , Portugal
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Obrenovich M, Tabrez S, Siddiqui B, McCloskey B, Perry G. The Microbiota-Gut-Brain Axis-Heart Shunt Part II: Prosaic Foods and the Brain-Heart Connection in Alzheimer Disease. Microorganisms 2020; 8:E493. [PMID: 32244373 PMCID: PMC7232206 DOI: 10.3390/microorganisms8040493] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/19/2020] [Accepted: 03/26/2020] [Indexed: 02/07/2023] Open
Abstract
There is a strong cerebrovascular component to brain aging, Alzheimer disease, and vascular dementia. Foods, common drugs, and the polyphenolic compounds contained in wine modulate health both directly and through the gut microbiota. This observation and novel findings centered on nutrition, biochemistry, and metabolism, as well as the newer insights we gain into the microbiota-gut-brain axis, now lead us to propose a shunt to this classic triad, which involves the heart and cerebrovascular systems. The French paradox and prosaic foods, as they relate to the microbiota-gut-brain axis and neurodegenerative diseases, are discussed in this manuscript, which is the second part of a two-part series of concept papers addressing the notion that the microbiota and host liver metabolism all play roles in brain and heart health.
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Affiliation(s)
- Mark Obrenovich
- Research Service, Louis Stokes Cleveland, Department of Veteran’s Affairs Medical Center, Cleveland, OH 44106, USA
- Department of Chemistry, Case Western Reserve University, Cleveland, OH 44106, USA
- The Gilgamesh Foundation for Medical Science and Research, Cleveland, OH 44116, USA;
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH 43606, USA
- Departments of Chemistry and Biological and Environmental Sciences, Cleveland State University, Cleveland, OH 44115, USA
| | - Shams Tabrez
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Bushra Siddiqui
- North East Ohio College of Medicine, Rootstown, OH 44272, USA;
| | - Benjamin McCloskey
- The Gilgamesh Foundation for Medical Science and Research, Cleveland, OH 44116, USA;
| | - George Perry
- Department of Biology, University of Texas at San Antonio, San Antonio, TX 78249, USA;
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Pavani RS, Lima LP, Lima AA, Fernandes CAH, Fragoso SP, Calderano SG, Elias MC. Nuclear export of replication protein A in the nonreplicative infective forms of
Trypanosoma cruzi. FEBS Lett 2020; 594:1596-1607. [DOI: 10.1002/1873-3468.13755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Raphael S. Pavani
- Laboratório de Ciclo Celular Instituto Butantan São Paulo Brazil
- Center of Toxins, Immune Response and Cell Signaling (CeTICS) Instituto Butantan São Paulo Brazil
| | - Loyze P. Lima
- Laboratório de Ciclo Celular Instituto Butantan São Paulo Brazil
- Center of Toxins, Immune Response and Cell Signaling (CeTICS) Instituto Butantan São Paulo Brazil
| | - André A. Lima
- Laboratório de Ciclo Celular Instituto Butantan São Paulo Brazil
- Center of Toxins, Immune Response and Cell Signaling (CeTICS) Instituto Butantan São Paulo Brazil
| | - Carlos A. H. Fernandes
- Departamento de Física e Biofísica Instituto de Biociências Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP) Botucatu Brazil
- Laboratorie de Biologie et Pharmacologie Appliquée Ecole Normale Supérieure Paris‐Saclay Cachan France
| | | | - Simone G. Calderano
- Center of Toxins, Immune Response and Cell Signaling (CeTICS) Instituto Butantan São Paulo Brazil
- Laboratório de Parasitologia Instituto Butantan São Paulo Brazil
| | - Maria Carolina Elias
- Laboratório de Ciclo Celular Instituto Butantan São Paulo Brazil
- Center of Toxins, Immune Response and Cell Signaling (CeTICS) Instituto Butantan São Paulo Brazil
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Groom ZC, Zochios V, Protopapas AD. Translating Chagasic dilating cardiomyopathy to surgical therapies: An under published global challenge. SAGE Open Med 2020; 7:2050312119895927. [PMID: 31897298 PMCID: PMC6920581 DOI: 10.1177/2050312119895927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/27/2019] [Indexed: 12/21/2022] Open
Abstract
Chagas disease is a neglected parasitic anthropozoonosis of the Americas linked to social deprivation with no hope of eradication in the future. Having been the most common non-ischemic cause of dilating cardiomyopathy in Latin America, it now spreads beyond the geographical boundaries of its vector via imported and autochthonous transmission. We review the evidence on surgery in Chagasic heart failure and offer a brief narrative on the main aspects of translational management. There is very limited literature on surgery for Chagasic heart failure, especially assist devices and transplantation. This may be attributed to the often unsurmountable economic burden of this single-system parasymphatholytic heart failure to young sufferers who commonly have very limited access to the aforementioned procedures. Chagasic heart failure offers a so far neglected translational model of parasymphatholytic non-ischemic cardiac failure.
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Affiliation(s)
- Zoe C Groom
- Costello Medical Consulting Limited, Cambridge, UK
| | - Vasileios Zochios
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, West Midlands Deanery, Birmingham, UK.,Department of Anaesthesia and Intensive Care Medicine, Glenfield Hospital, University Hospitals of Leicester National Health Service Trust, Leicester, UK
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El Gharib AZG, Berretin-Felix G, Dantas RO, Rossoni DF, de Ornelas Toledo MJ. Suprahyoid Muscle Activity in Patients with Chagasic Megaesophagus. Sci Rep 2019; 9:18786. [PMID: 31827221 PMCID: PMC6906476 DOI: 10.1038/s41598-019-55402-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/28/2019] [Indexed: 11/09/2022] Open
Abstract
The objective of this investigation was to evaluate the activity of the suprahyoid musculature during swallowing and to correlate the findings with the degree of megaesophagus, oral and pharyngeal videofluoroscopy and esophageal manometry in patients with achalasia caused by Chagas' disease. Twenty-nine patients with positive serology for Trypanosoma cruzi and dysphagia (Chagas' disease group) and 29 individuals matched by sex and age (control group) participated in the study. Surface electromyography of the suprahyoid musculature and videofluoroscopy during swallowing of paste and liquid consistencies were performed. Canonical correlation analysis of the MANOVA test results showed that the Chagas' disease group had lower electromyographic activity when compared with controls. Overlapping circles of radiological findings were found for megaesophagus. The Spearman test showed a positive correlation between the electromyographic activity in the maximum voluntary isometric contraction and the time of pharyngeal transit for both liquid (p = 0.014) and paste (p = 0.047). The logistic regression test showed no association between electromyographic activity of the suprahyoid muscles and esophageal manometry results (p > 0.05). In conclusion, individuals with chagasic megaesophagus have reduced electromyographic activity of the suprahyoid muscles during swallowing, in addition to a greater recruitment of the suprahyoid musculature with increased pharyngeal transit time.
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Affiliation(s)
| | - Giédre Berretin-Felix
- Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Roberto Oliveira Dantas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Max Jean de Ornelas Toledo
- Postgraduate Program in Health Sciences, Health Sciences Center, State University of Maringá, Maringá, PR, Brazil.,Department of Basic Health Sciences, State University of Maringá, Maringá, PR, Brazil
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Forsyth C, Meymandi S, Moss I, Cone J, Cohen R, Batista C. Proposed multidimensional framework for understanding Chagas disease healthcare barriers in the United States. PLoS Negl Trop Dis 2019; 13:e0007447. [PMID: 31557155 PMCID: PMC6762052 DOI: 10.1371/journal.pntd.0007447] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Chagas disease (CD) affects over 300,000 people in the United States, but fewer than 1% have been diagnosed and less than 0.3% have received etiological treatment. This is a significant public health concern because untreated CD can produce fatal complications. What factors prevent people with CD from accessing diagnosis and treatment in a nation with one of the world’s most advanced healthcare systems? Methodology/Principal findings This analysis of barriers to diagnosis and treatment of CD in the US reflects the opinions of the authors more than a comprehensive discussion of all the available evidence. To enrich our description of barriers, we have conducted an exploratory literature review and cited the experience of the main US clinic providing treatment for CD. We list 34 barriers, which we group into four overlapping dimensions: systemic, comprising gaps in the public health system; structural, originating from political and economic inequalities; clinical, including toxicity of medications and diagnostic challenges; and psychosocial, encompassing fears and stigma. Conclusions We propose this multidimensional framework both to explain the persistently low numbers of people with CD who are tested and treated and as a potential basis for organizing a public health response, but we encourage others to improve on our approach or develop alternative frameworks. We further argue that expanding access to diagnosis and treatment of CD in the US means asserting the rights of vulnerable populations to obtain timely, quality healthcare.
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Affiliation(s)
- Colin Forsyth
- Drugs for Neglected Diseases initiative, North America, New York, New York, United States of America
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California, United States of America
- * E-mail:
| | - Sheba Meymandi
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California, United States of America
| | - Ilan Moss
- Drugs for Neglected Diseases initiative, North America, New York, New York, United States of America
| | - Jason Cone
- Médecins sans Frontières/Doctors Without Borders USA, New York, New York, United States of America
| | - Rachel Cohen
- Drugs for Neglected Diseases initiative, North America, New York, New York, United States of America
| | - Carolina Batista
- Drugs for Neglected Diseases initiative, Latin America, Rio de Janeiro, Brazil
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Caldas IS, Santos EG, Novaes RD. An evaluation of benznidazole as a Chagas disease therapeutic. Expert Opin Pharmacother 2019; 20:1797-1807. [PMID: 31456439 DOI: 10.1080/14656566.2019.1650915] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: As benznidazole is the first-line treatment for patients with Chagas disease, rational chemotherapy strategies are required based on the critical analysis of the evidence on the relevance and applicability of this drug at different disease stages. Areas covered: The authors discuss the current understanding of benznidazole-based chemotherapy for Chagas disease, focusing specifically on epidemiology, pharmacokinetics, mechanism of action, clinical recommendations, cure criteria, and therapeutic efficacy in different phases of the disease. Expert opinion: Benznidazole shows high bioavailability after oral administration. Benznidazole at 5-8 mg/kg/day and 5-10 mg/kg/day for 30-60 days are consistent clinical recommendations for children and adults, respectively. A high correlation between negative parasitological, serological, and polymerase chain reaction (PCR) assays in long-term post-therapeutic follow-up has been consistently used to evaluate therapeutic efficacy. These methods support the evidence that the success of benznidazole-based chemotherapy is closely correlated with the phase of infection in which the treatment is administered. The greater therapeutic efficacy is obtained in acute infections, gradually worsening as the infection becomes chronic. When therapeutic failure is confirmed by any diagnostic assay, benznidazole treatment does not always ensure better long-term prognosis, and Chagas cardiomyopathy may develop as well as in untreated patients.
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Affiliation(s)
- Ivo S Caldas
- Department of Pathology and Parasitology, Institute of Biomedical Sciences, Universidade Federal de Alfenas (UNIFAL-MG) , Alfenas , Minas Gerais , Brazil
| | - Elda G Santos
- Department of Structural Biology, Institute of Biomedical Sciences, Universidade Federal de Alfenas (UNIFAL-MG) , Alfenas , Minas Gerais , Brazil
| | - Rômulo D Novaes
- Department of Structural Biology, Institute of Biomedical Sciences, Universidade Federal de Alfenas (UNIFAL-MG) , Alfenas , Minas Gerais , Brazil
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Martinez F, Perna E, Perrone SV, Liprandi AS. Chagas Disease and Heart Failure: An Expanding Issue Worldwide. Eur Cardiol 2019; 14:82-88. [PMID: 31360228 PMCID: PMC6659042 DOI: 10.15420/ecr.2018.30.2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/01/2019] [Indexed: 01/28/2023] Open
Abstract
Chagas disease, originally a South American endemic health problem, is expanding worldwide because of people migration. Its main impact is on the cardiovascular system, producing myocardial damage that frequently results in heart failure. Pathogenic pathways are mainly related to inmunoinflamatory reactions in the myocardium and, less frequently, in the gastrointestinal tract. The heart usually shows fibrosis, producing dilatation and damage of the electrogenic cardiac system. These changes result in cardiomyopathy with heart failure and frequent cardiac arrhythmias and heart blocks. Diagnosis of the disease must include a lab test to detect the parasite or its immune reactions and the usual techniques to evaluate cardiac function. Therapeutic management of Chagas heart failure does not differ significantly from the most common treatment for dilated cardiomyopathy, with special focus on arrhythmias and several degrees of heart block. Heart transplantation is reserved for end-stage cases. Major international scientific organisations are delivering recommendations for prevention and early diagnosis. This article provides an analysis of epidemiology, prevention, treatment and the relationship between Chagas disease and heart failure.
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Affiliation(s)
- Felipe Martinez
- Cordoba National University, Instituto DAMIC Córdoba, Argentina.,Docencia, Asistencia Médica e Investigación Clínica (DAMIC) Medical Institute, Rusculleda Foundation for Research Córdoba Argentina
| | - Eduardo Perna
- Coronary Care Unit and Heart Failure Division, Juana Cabral Cardiovascular Institute Corrientes, Argentina
| | - Sergio V Perrone
- El Cruce Hospital Buenos Aires, Argentina.,Argentine Catholic University Buenos Aires, Argentina
| | - Alvaro Sosa Liprandi
- Cardiovascular Division, Sanatorio Güemes Hospital Buenos Aires, Argentina.,Postgraduate Medical School in Cardiology Universidad de Buenos Aires, Argentina
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Lidani KCF, Andrade FA, Bavia L, Damasceno FS, Beltrame MH, Messias-Reason IJ, Sandri TL. Chagas Disease: From Discovery to a Worldwide Health Problem. Front Public Health 2019; 7:166. [PMID: 31312626 PMCID: PMC6614205 DOI: 10.3389/fpubh.2019.00166] [Citation(s) in RCA: 267] [Impact Index Per Article: 53.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/05/2019] [Indexed: 12/23/2022] Open
Abstract
Carlos Chagas discovered American trypanosomiasis, also named Chagas disease (CD) in his honor, just over a century ago. He described the clinical aspects of the disease, characterized by its etiological agent (Trypanosoma cruzi) and identified its insect vector. Initially, CD occurred only in Latin America and was considered a silent and poorly visible disease. More recently, CD became a neglected worldwide disease with a high morbimortality rate and substantial social impact, emerging as a significant public health threat. In this context, it is crucial to better understand better the epidemiological scenarios of CD and its transmission dynamics, involving people infected and at risk of infection, diversity of the parasite, vector species, and T. cruzi reservoirs. Although efforts have been made by endemic and non-endemic countries to control, treat, and interrupt disease transmission, the cure or complete eradication of CD are still topics of great concern and require global attention. Considering the current scenario of CD, also affecting non-endemic places such as Canada, USA, Europe, Australia, and Japan, in this review we aim to describe the spread of CD cases worldwide since its discovery until it has become a global public health concern.
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Affiliation(s)
| | - Fabiana Antunes Andrade
- Laboratory of Molecular Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Lorena Bavia
- Laboratory of Molecular Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Flávia Silva Damasceno
- Laboratory of Biochemistry of Tryps-LaBTryps, Department of Parasitology, Institute for Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Marcia Holsbach Beltrame
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná, Curitiba, Brazil
| | - Iara J Messias-Reason
- Laboratory of Molecular Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Thaisa Lucas Sandri
- Laboratory of Molecular Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
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Medeiros NI, Pinto BF, Elói-Santos SM, Teixeira-Carvalho A, Magalhães LMD, Dutra WO, Correa-Oliveira R, Gomes JAS. Evidence of Different IL-1β Activation Pathways in Innate Immune Cells From Indeterminate and Cardiac Patients With Chronic Chagas Disease. Front Immunol 2019; 10:800. [PMID: 31057540 PMCID: PMC6482163 DOI: 10.3389/fimmu.2019.00800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/26/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Chagas cardiomyopathy is the main fibrosing myocarditis among known heart diseases. Development of cardiomyopathy has been related to extracellular matrix (ECM) remodeling, which are controlled by matrix metalloproteinases (MMPs) and cytokines, especially interleukin (IL)-1β. The convertion of 31KDa inactive precursor, the proIL-1β in 17KDa active IL-1β peptide, is controlled by caspase-1-dependent pathway, associated with inflammasomes. Other caspase-1 independent mechanisms mediated by proteases, especially as MMPs, have already been described. Methods: We evaluated IL-1β activation pathways in neutrophils and monocyte subsets from patients with different clinical forms of Chagas disease1 after T. cruzi antigen stimulation by multiparameter flow cytometry. Results: Our data demonstrated that Chagas patients with the indeterminate clinical form (IND) showed increased levels of IL-1β post-stimulation as well as increased expression of MMP-2, NLRP3, and CASP1, which are associated with the classical caspase-1-dependent pathway. Conversely, patients with the cardiac clinical form (CARD) showed increased IL-1β after stimulation associated with MMP-9 and alternative caspase-1-independent pathway. Conclusions: We suggest some distinct molecular mechanisms for production of IL-1β in innate immune cells from patients with different clinical forms of Chagas disease. MMP-2 and MMP-9 gelatinases are associated with distinct disease outcomes and IL-1β production.
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Affiliation(s)
- Nayara I Medeiros
- Imunologia Celular e Molecular, Instituto René Rachou, FIOCRUZ, Belo Horizonte, Brazil.,Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bruna F Pinto
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Silvana M Elói-Santos
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, FIOCRUZ, Belo Horizonte, Brazil.,Departamento de Propedêutica Complementar, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Andréa Teixeira-Carvalho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, FIOCRUZ, Belo Horizonte, Brazil
| | - Luísa M D Magalhães
- Inflammatory Cell Dynamics Section, Center for Cancer Research, National Institute of Health, NIH, Bethesda, MD, United States
| | - Walderez O Dutra
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Instituto Nacional de Ciência e Tecnologia em Doenças Topicais - INCT-DT, Belo Horizonte, Brazil
| | - Rodrigo Correa-Oliveira
- Imunologia Celular e Molecular, Instituto René Rachou, FIOCRUZ, Belo Horizonte, Brazil.,Instituto Nacional de Ciência e Tecnologia em Doenças Topicais - INCT-DT, Belo Horizonte, Brazil
| | - Juliana A S Gomes
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Retana Moreira L, Rodríguez Serrano F, Osuna A. Extracellular vesicles of Trypanosoma cruzi tissue-culture cell-derived trypomastigotes: Induction of physiological changes in non-parasitized culture cells. PLoS Negl Trop Dis 2019; 13:e0007163. [PMID: 30789912 PMCID: PMC6383987 DOI: 10.1371/journal.pntd.0007163] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/16/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Trypanosoma cruzi is the obligate intracellular parasite that causes Chagas disease. The pathogenesis of this disease is a multifactorial complex process that involves a large number of molecules and particles, including the extracellular vesicles. The presence of EVs of T. cruzi was first described in 1979 and, since then, research regarding these particles has been increasing. Some of the functions described for these EVs include the increase in heart parasitism and the immunomodulation and evasion of the host immune response. Also, EVs may be involved in parasite adhesion to host cells and host cell invasion. METHODOLOGY/PRINCIPAL FINDINGS EVs (exosomes) of the Pan4 strain of T. cruzi were isolated by differential centrifugation, and measured and quantified by TEM, NTA and DLS. The effect of EVs in increasing the parasitization of Vero cells was evaluated and the ED50 was calculated. Changes in cell permeability induced by EVs were evaluated in Vero and HL-1 cardiomyocyte cells using cell viability techniques such as trypan blue and MTT assays, and by confocal microscopy. The intracellular mobilization of Ca2+ and the disruption of the actin cytoskeleton induced by EVs over Vero cells were followed-up in time using confocal microscopy. To evaluate the effect of EVs over the cell cycle, cell cycle analyses using flow cytometry and Western blotting of the phosphorylated and non-phosphorylated protein of Retinoblastoma were performed. CONCLUSION/SIGNIFICANCE The incubation of cells with EVs of trypomastigotes of the Pan4 strain of T. cruzi induce a number of changes in the host cells that include a change in cell permeability and higher intracellular levels of Ca2+ that can alter the dynamics of the actin cytoskeleton and arrest the cell cycle at G0/G1 prior to the DNA synthesis necessary to complete mitosis. These changes aid the invasion of host cells and augment the percentage of cell parasitization.
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Affiliation(s)
- Lissette Retana Moreira
- Instituto de Biotecnología, Grupo de Bioquímica y Parasitología Molecular, Departamento de Parasitología, Universidad de Granada, Granada, Spain
| | | | - Antonio Osuna
- Instituto de Biotecnología, Grupo de Bioquímica y Parasitología Molecular, Departamento de Parasitología, Universidad de Granada, Granada, Spain
- * E-mail:
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Payne SC, Furness JB, Stebbing MJ. Bioelectric neuromodulation for gastrointestinal disorders: effectiveness and mechanisms. Nat Rev Gastroenterol Hepatol 2019; 16:89-105. [PMID: 30390018 DOI: 10.1038/s41575-018-0078-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The gastrointestinal tract has extensive, surgically accessible nerve connections with the central nervous system. This provides the opportunity to exploit rapidly advancing methods of nerve stimulation to treat gastrointestinal disorders. Bioelectric neuromodulation technology has considerably advanced in the past decade, but sacral nerve stimulation for faecal incontinence currently remains the only neuromodulation protocol in general use for a gastrointestinal disorder. Treatment of other conditions, such as IBD, obesity, nausea and gastroparesis, has had variable success. That nerves modulate inflammation in the intestine is well established, but the anti-inflammatory effects of vagal nerve stimulation have only recently been discovered, and positive effects of this approach were seen in only some patients with Crohn's disease in a single trial. Pulses of high-frequency current applied to the vagus nerve have been used to block signalling from the stomach to the brain to reduce appetite with variable outcomes. Bioelectric neuromodulation has also been investigated for postoperative ileus, gastroparesis symptoms and constipation in animal models and some clinical trials. The clinical success of this bioelectric neuromodulation therapy might be enhanced through better knowledge of the targeted nerve pathways and their physiological and pathophysiological roles, optimizing stimulation protocols and determining which patients benefit most from this therapy.
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Affiliation(s)
- Sophie C Payne
- Bionics Institute, East Melbourne, Victoria, Australia. .,Medical Bionics Department, University of Melbourne, Parkville, Victoria, Australia.
| | - John B Furness
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Victoria, Australia
| | - Martin J Stebbing
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Victoria, Australia
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47
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Dantas RO, Cassiani RA, Santos CM, Alves LMT. WATER INGESTION DYNAMICS IN PATIENTS WITH ACHALASIA: INFLUENCE OF SEX AND AGE. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55Suppl 1:25-29. [PMID: 30184021 DOI: 10.1590/s0004-2803.201800000-43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/25/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Achalasia is a disease that affects esophageal bolus transit due to the absence of esophageal peristaltic contractions and impaired or absent relaxation of the lower esophageal sphincter. OBJECTIVE The objective of this investigation was: a) to evaluate the dynamics of water ingestion in patients with achalasia, idiopathic or caused by Chagas' disease; b) to evaluate the influence of sex and age on water ingestion dynamics. METHODS The investigation was conducted with 79 patients with achalasia (27 idiopathic and 52 Chagas' disease) and 91 healthy volunteers, all evaluated by the water-drinking test. The individuals drank, in triplicate, 50 mL of water without interruption. The time and the number of swallows for this task were counted. We also measured: (a) inter-swallow interval - the time to complete the task, divided by the number of swallows during the task; (b) swallowing rate - volume drunk divided by the time; (c) volume per swallow - volume drunk divided by the number of swallows. RESULTS Patients with achalasia took longer to ingest all the volume (mean 12.2 seconds) than healthy controls (mean 5.4 seconds), had greater number of swallows, longer interval between swallows, lower swallowing rate (5.2 mL/s vs 10.9 mL/s in controls) and lower volume per swallow (9.1 mL vs 14.4 mL in controls, P<0.01). Among healthy volunteers, women had a shorter interval between swallows and lower volume per swallow compared with men, and in the achalasia group, women had a longer interval between swallows and lower ingestion rate. No difference in the drinking test results was found between younger and older subjects in achalasia or control group. Also, no differences were observed between patients with Chagas' disease and those with idiopathic achalasia, or between patients with increased and normal esophageal diameter. CONCLUSION Patients with achalasia have difficulty in ingesting water, taking a longer time to complete the task, which is influenced by sex but not by age or severity of the disease.
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Affiliation(s)
- Roberto Oliveira Dantas
- Departamentos de Clínica Médica e de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto SP, Brasil
| | - Rachel Aguiar Cassiani
- Departamentos de Clínica Médica e de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto SP, Brasil
| | - Carla Manfredi Santos
- Departamentos de Clínica Médica e de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto SP, Brasil
| | - Leda Maria Tavares Alves
- Departamentos de Clínica Médica e de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto SP, Brasil
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48
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Bonney KM, Luthringer DJ, Kim SA, Garg NJ, Engman DM. Pathology and Pathogenesis of Chagas Heart Disease. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2018; 14:421-447. [PMID: 30355152 DOI: 10.1146/annurev-pathol-020117-043711] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chagas heart disease is an inflammatory cardiomyopathy that develops in approximately one-third of people infected with the protozoan parasite Trypanosoma cruzi. One way T. cruzi is transmitted to people is through contact with infected kissing bugs, which are found in much of the Western Hemisphere, including in vast areas of the United States. The epidemiology of T. cruzi and Chagas heart disease and the varied mechanisms leading to myocyte destruction, mononuclear cell infiltration, fibrosis, and edema in the heart have been extensively studied by hundreds of scientists for more than 100 years. Despite this wealth of knowledge, it is still impossible to predict what will happen in an individual infected with T. cruzi because of the tremendous variability in clonal parasite virulence and human susceptibility to infection and the lack of definitive molecular predictors of outcome from either side of the host-parasite equation. Further, while several distinct mechanisms of pathogenesis have been studied in isolation, it is certain that multiple coincident mechanisms combine to determine the ultimate outcome. For these reasons, Chagas disease is best considered a collection of related but distinct illnesses. This review highlights the pathology and pathogenesis of the most common adverse sequela of T. cruzi infection-Chagas heart disease-and concludes with a discussion of key unanswered questions and a view to the future.
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Affiliation(s)
- Kevin M Bonney
- Liberal Studies, Faculty of Arts and Sciences, New York University, New York, NY 10003, USA;
| | - Daniel J Luthringer
- Department of Pathology and Laboratory Medicine and Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA; , ,
| | - Stacey A Kim
- Department of Pathology and Laboratory Medicine and Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA; , ,
| | - Nisha J Garg
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas 77555-1070, USA;
| | - David M Engman
- Department of Pathology and Laboratory Medicine and Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA; , ,
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Scarim CB, de Andrade CR, da Rosa JA, dos Santos JL, Chin CM. Hydroxymethylnitrofurazone treatment in indeterminate form of chronic Chagas disease: Reduced intensity of tissue parasitism and inflammation-A histopathological study. Int J Exp Pathol 2018; 99:236-248. [PMID: 30320480 PMCID: PMC6302791 DOI: 10.1111/iep.12289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 07/25/2018] [Accepted: 08/06/2018] [Indexed: 12/24/2022] Open
Abstract
Hydroxymethylnitrofurazone (NFOH) is a nitrofurazone prodrug effective in vivo during acute infections, and it has less hepatotoxicity effect than the standard drug benznidazole (BZN) which has been used during short- and long-term treatment. In the present study, we induced the indeterminate form of Chagas disease in mice with a Y strain of Trypanosoma cruzi and analysed the histopathological data about the effects of NFOH and BZN on different tissues, including the heart, skeletal muscle, liver, kidney, colon, spleen and brain. After infection, BALB/c mice were treated with NFOH (150 mg/kg) and BZN (60 mg/kg) for 60 days and then submitted to immunosuppression using dexamethasone (5 mg/kg) for 14 days. Two trained analysts, as part of a blind evaluation, examined the results using serial sections of 3 mm diameter in two different moments. The results showed reactivation of the disease only in the infected nontreated group (POS). After treatment, amastigote nests were found in the heart, colon, liver and skeletal muscle in the POS group and in the heart and liver of the BZN group. Interestingly, amastigote nests were not found in the NFOH and NEG groups. The histopathological analysis showed fewer tissue lesions and parasite infiltrates in the NFOH group when compared with the BZN and POS groups. We have not observed any increase in the levels of hepatocellular injury biomarkers (AST/ALT) in the NFOH group. These in vivo studies show the potential for NFOH as an effective and safe compound useful as an anti-T. cruzi agent.
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Affiliation(s)
- Cauê B. Scarim
- São Paulo State University (UNESP)School of Pharmaceutical SciencesDepartment of Drugs and MedicinesLapdesf ‐ Laboratory of Research and Development of DrugsAraraquaraSão PauloBrazil
| | - Cleverton R. de Andrade
- São Paulo State University (UNESP)Faculty of DentistryDepartment of Physiology and PathologyAraraquaraSão PauloBrazil
| | - João A. da Rosa
- São Paulo State University (UNESP)School of Pharmaceutical SciencesDepartment of Biological SciencesAraraquaraSão PauloBrazil
| | - Jean L. dos Santos
- São Paulo State University (UNESP)School of Pharmaceutical SciencesDepartment of Drugs and MedicinesLapdesf ‐ Laboratory of Research and Development of DrugsAraraquaraSão PauloBrazil
| | - Chung M. Chin
- São Paulo State University (UNESP)School of Pharmaceutical SciencesDepartment of Drugs and MedicinesLapdesf ‐ Laboratory of Research and Development of DrugsAraraquaraSão PauloBrazil
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Nunes MCP, Beaton A, Acquatella H, Bern C, Bolger AF, Echeverría LE, Dutra WO, Gascon J, Morillo CA, Oliveira-Filho J, Ribeiro ALP, Marin-Neto JA. Chagas Cardiomyopathy: An Update of Current Clinical Knowledge and Management: A Scientific Statement From the American Heart Association. Circulation 2018; 138:e169-e209. [DOI: 10.1161/cir.0000000000000599] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background:
Chagas disease, resulting from the protozoan
Trypanosoma cruzi
, is an important cause of heart failure, stroke, arrhythmia, and sudden death. Traditionally regarded as a tropical disease found only in Central America and South America, Chagas disease now affects at least 300 000 residents of the United States and is growing in prevalence in other traditionally nonendemic areas. Healthcare providers and health systems outside of Latin America need to be equipped to recognize, diagnose, and treat Chagas disease and to prevent further disease transmission.
Methods and Results:
The American Heart Association and the Inter-American Society of Cardiology commissioned this statement to increase global awareness among providers who may encounter patients with Chagas disease outside of traditionally endemic environments. In this document, we summarize the most updated information on diagnosis, screening, and treatment of
T cruzi
infection, focusing primarily on its cardiovascular aspects. This document also provides quick reference tables, highlighting salient considerations for a patient with suspected or confirmed Chagas disease.
Conclusions:
This statement provides a broad summary of current knowledge and practice in the diagnosis and management of Chagas cardiomyopathy. It is our intent that this document will serve to increase the recognition of Chagas cardiomyopathy in low-prevalence areas and to improve care for patients with Chagas heart disease around the world.
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