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Hinton SM. Preventing Vertical Transmission of Chagas Disease: An Emerging Public Health Issue in Perinatal Care. J Midwifery Womens Health 2024; 69:888-896. [PMID: 39188043 DOI: 10.1111/jmwh.13682] [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: 08/28/2024]
Abstract
Chagas [shah-guhs] disease, caused by the Trypanosoma cruzi parasite, presents a growing concern for health care providers overseeing perinatal care in the United States due to existing and expanding vector-borne transmission and population migration. This life-threatening disease can be transmitted vertically during pregnancy, although adequate testing and treatment can effectively reduce morbidity and mortality caused by Chagas disease. This article presents an overview of the disease burden in the United States and its implications for perinatal care providers including recommended testing and treatment practices and the information needed for patient education and shared decision-making regarding the management of care for individuals at risk of Chagas disease. Being informed about Chagas disease and its implications is needed for all individuals providing perinatal care and is especially critical for those overseeing the care of refugee and immigrant populations.
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Affiliation(s)
- Sarah M Hinton
- Commonsense Childbirth, Winter Garden, Florida
- Academy of Continuing Education, Midwives College of Utah, Salt Lake City, Utah
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2
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Llerena-Velastegui J, Lopez-Usina A, Mantilla-Cisneros C. Advances in the Understanding and Treatment of Chronic Chagas Cardiomyopathy. Cardiol Res 2024; 15:340-349. [PMID: 39420972 PMCID: PMC11483117 DOI: 10.14740/cr1665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/04/2024] [Indexed: 10/19/2024] Open
Abstract
Chronic Chagas cardiomyopathy (CCC) poses significant health challenges not only in Latin America but also in non-endemic regions due to global migration. The complexity and severity of CCC call for an updated and thorough review to inform clinical practices and direct future research efforts. This review seeks to consolidate current knowledge on CCC, emphasizing diagnostic, therapeutic, and prognostic facets to facilitate better management and understanding of the disease. An exhaustive examination was conducted, analyzing peer-reviewed articles published between January 2020 and April 2024, sourced from prominent medical databases such as PubMed and Scopus. The review delineates crucial aspects of CCC pathophysiology, evaluates patient outcomes, identifies diagnostic challenges, and assesses treatment efficacy. Our findings prompt the need for revised clinical guidelines and stress the importance of continued research to enhance therapeutic strategies and disease comprehension. It is imperative that future studies address these identified gaps to advance patient care and treatment options for CCC.
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Affiliation(s)
- Jordan Llerena-Velastegui
- Medical School, Pontifical Catholic University of Ecuador, Quito, Ecuador
- Research Center, Center for Health Research in Latin America (CISeAL), Quito, Ecuador.
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Echeverría LE, Serrano-García AY, Rojas LZ, Berrios-Bárcenas EA, Gómez-Mesa JE, Gómez-Ochoa SA. Mechanisms behind the high mortality rate in chronic Chagas cardiomyopathy: Unmasking a three-headed monster. Eur J Heart Fail 2024. [PMID: 39327798 DOI: 10.1002/ejhf.3460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/16/2024] [Accepted: 08/22/2024] [Indexed: 09/28/2024] Open
Abstract
Chagas disease is a neglected tropical disease caused by the parasite Trypanosoma cruzi. Chronic Chagas cardiomyopathy (CCC), the most severe form of target organ involvement in Chagas disease, is characterized by a complex pathophysiology and a unique phenotype that differentiates it from other cardiomyopathies, highlighting its worse prognosis compared to other aetiologies of heart failure. The three pathophysiological mechanisms with the largest impact on this differential mortality include rapidly progressive heart failure, a high incidence of stroke, and a high burden of ventricular arrhythmias. However, despite significant advances in understanding the unique molecular circuits underlying these mechanisms, the new knowledge acquired has not been efficiently translated into specific diagnostic and therapeutic approaches for this unique cardiomyopathy. The lack of dedicated clinical trials and the limited CCC-specific risk stratification tools available are evidence of this reality. This review aims to provide an updated perspective of the evidence and pathophysiological mechanisms associated with the higher mortality observed in CCC compared to other cardiomyopathies and highlight opportunities in the diagnostic and therapeutic approaches of the disease.
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Affiliation(s)
- Luis E Echeverría
- Heart Failure and Transplant Clinic, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | | | - Lyda Z Rojas
- Research Center, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | - Enrique A Berrios-Bárcenas
- Outpatient Clinic, Cardiovascular Risk Factors Clinic, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, Mexico
| | - Juan Esteban Gómez-Mesa
- Department of Cardiology, Fundación Valle del Lili, Universidad Icesi, Faculty of Medicine, Cali, Colombia
| | - Sergio A Gómez-Ochoa
- Heart Failure and Transplant Clinic, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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Veluswami K, Rao S, Aggarwal S, Mani S, Balasubramanian A. Unraveling the Missing Pieces: Exploring the Gaps in Understanding Chagas Cardiomyopathy. Cureus 2024; 16:e66955. [PMID: 39280489 PMCID: PMC11401617 DOI: 10.7759/cureus.66955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 09/18/2024] Open
Abstract
Chagas cardiomyopathy affects a considerable number of patients infected with the protozoan Trypanosoma cruzi (T. cruzi) and remains one of the most neglected tropical diseases despite being a significant contributor to morbidity and mortality in both endemic regions of Latin America and non-endemic countries like the United States. Since its discovery almost a century ago, knowledge gaps still exist in the mechanisms involved in the pathogenesis of Chagas cardiomyopathy, and numerous challenges exist in its diagnosis and treatment. This article reviews the main pathogenetic mechanisms involved in the progression of Chagas cardiomyopathy, which has been proposed as a result of years of research. It also emphasizes the challenges involved in the diagnosis of the asymptomatic indeterminate phase and has focused on several diagnostic techniques, including echocardiography, electrocardiogram (ECG), magnetic resonance imaging (MRI), and nuclear imaging in diagnosing symptomatic Chagas cardiomyopathy. In this article, we have also provided a brief overview of the current treatment of Chagas cardiomyopathy, which is not etiology-specific but instead derived from the knowledge acquired from the treatment of other cardiomyopathies.
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Affiliation(s)
| | - Sudipta Rao
- Internal Medicine, JSS Medical College, Mysore, IND
| | | | - Sweatha Mani
- Internal Medicine, K.A.P. Viswanatham Government Medical College, Tiruchirappalli, IND
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Carrero JC, Espinoza B, Huerta L, Silva-Miranda M, Guzmán-Gutierrez SL, Dorazco-González A, Reyes-Chilpa R, Espitia C, Sánchez S. Introducing the NUATEI Consortium: A Mexican Research Program for the Identification of Natural and Synthetic Antimicrobial Compounds for Prevalent Infectious Diseases. Pharmaceuticals (Basel) 2024; 17:957. [PMID: 39065807 PMCID: PMC11280322 DOI: 10.3390/ph17070957] [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: 06/07/2024] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
The need for new drugs to treat human infections is a global health concern. Diseases like tuberculosis, trypanosomiasis, amoebiasis, and AIDS remain significant problems, especially in developing countries like Mexico. Despite existing treatments, issues such as resistance and adverse effects drive the search for new alternatives. Herein, we introduce the NUATEI research consortium, made up of experts from the Institute of Biomedical Research at UNAM, who identify and obtain natural and synthetic compounds and test their effects against human pathogens using in vitro and in vivo models. The consortium has evaluated hundreds of natural extracts and compounds against the pathogens causing tuberculosis, trypanosomiasis, amoebiasis, and AIDS, rendering promising results, including a patent with potential for preclinical studies. This paper presents the rationale behind the formation of this consortium, as well as its objectives and strategies, emphasizing the importance of natural and synthetic products as sources of antimicrobial compounds and the relevance of the diseases studied. Finally, we briefly describe the methods of the evaluation of the compounds in each biological model and the main achievements. The potential of the consortium to screen numerous compounds and identify new therapeutic agents is highlighted, demonstrating its significant contribution to addressing these infectious diseases.
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Affiliation(s)
- Julio César Carrero
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (B.E.); (L.H.); (C.E.)
| | - Bertha Espinoza
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (B.E.); (L.H.); (C.E.)
| | - Leonor Huerta
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (B.E.); (L.H.); (C.E.)
| | - Mayra Silva-Miranda
- CONAHCyT-Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.S.-M.); (S.-L.G.-G.)
| | - Silvia-Laura Guzmán-Gutierrez
- CONAHCyT-Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.S.-M.); (S.-L.G.-G.)
| | - Alejandro Dorazco-González
- Departmento de Química Inorgánica, Instituto de Química, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico;
| | - Ricardo Reyes-Chilpa
- Departamento de Productos Naturales, Instituto de Química, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico;
| | - Clara Espitia
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (B.E.); (L.H.); (C.E.)
| | - Sergio Sánchez
- Departamento de Biología Molecular y Biotecnología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico;
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Calderon-Ramirez PM, Fernandez-Guzman D, Caira-Chuquineyra B, Mamani-García CS, Medina HM, Diaz-Arocutipa C. Exercise-based training programs for patients with chronic Chagas cardiomyopathy: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2023; 48:101256. [PMID: 37794957 PMCID: PMC10545933 DOI: 10.1016/j.ijcha.2023.101256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 10/06/2023]
Abstract
Background We assessed the effects of exercise-based training programs (EBTP) in patients with chronic Chagas cardiomyopathy (CCC) through a systematic review and meta-analysis. Methods We conducted a search in Pubmed/Medline, Embase, Scopus, Web of Science, Cochrane Library, Virtual Health Library, and SciELO until January 2023. Randomized controlled trials (RCTs) and non-randomized intervention studies (NRIS) investigating the effects of EBTP in CCC patients were included. The primary outcomes were all-cause mortality, cardiovascular mortality, and health-related quality of life (HRQoL), and the secondary outcomes were exercise capacity by peak VO2, heart failure-related hospital admissions (HFRHA), and left ventricular ejection fraction (LVEF). Results The search strategy yielded 3617 studies. After removing duplicates and screening, eight studies (3 RCTs and 5 NRIS) involving 222 patients were included. Seven studies were conducted in Brazil. The age range was from 30 to 71 years, and 47.1% were male. Data on mortality, HRQoL, LVEF, and HFRHA were scarcely reported. The meta-analysis pooling four studies showed that the peak VO2 was significantly higher (mean difference 4.45, 95% confidence interval 3.50 to 5.39 mL/kg/min, I2 = 0%) in the EBTP group compared to the control group. Conclusion The evidence available was limited and heterogeneous. While EBTP has shown to improve HRQoL and exercise capacity, there is no conclusive information about the other proposed outcomes. These positive effects present an opportunity to provide treatment to CCC patients in low- and middle-income countries. Further studies are needed to ascertain the effects of EBTP on hard outcomes in this population.Registration number: CRD42022334060.
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Affiliation(s)
| | | | | | | | - Héctor M. Medina
- Division of Cardiology, Fundacion CardioInfantil-La Cardio, Bogota, Colombia
| | - Carlos Diaz-Arocutipa
- Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
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Saldivar MA, Michelen YE, Milla L, Kalogeropoulos AP, Sin E, Hellman HL, Gilman RH, Marcos LA. Seroprevalence of Chagas Disease among People of Latin American Descent Living in Suffolk County, Long Island, New York. Am J Trop Med Hyg 2023; 109:319-321. [PMID: 37460089 PMCID: PMC10397435 DOI: 10.4269/ajtmh.23-0258] [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: 04/28/2023] [Accepted: 06/01/2023] [Indexed: 08/04/2023] Open
Abstract
This cross-sectional study estimated a one-time point seroprevalence rate of Chagas disease among people of Latin American descent in Suffolk County, Long Island, New York. Subjects who met the inclusion criteria were screened using the Chagas Detect Plus Rapid Test (InBios, Seattle, WA) with confirmation via Trypanosoma cruzi enzyme immunoassay and T. cruzi immunoblot assay. Administration of a questionnaire regarding demographics and risk factors followed. A seroprevalence rate of 10.74% was found. Identified risk factors included prior residence in a palm leaf house (odds ratio [OR], 10.42; P = 0.003; 95% CI, 2.18-49.76), residence in a house with triatomines (OR, 9.03; P = 0.006; 95% CI, 1.90-42.88), and history of triatomine bite (OR, 9.52; P = 0.009; 95% CI, 1.75-51.77). Our findings emphasize the importance of this frequently underdiagnosed disease and help highlight the importance of early screening among high-risk populations.
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Affiliation(s)
- Miguel A. Saldivar
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, New York
| | - Yamil E. Michelen
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, New York
| | - Lucia Milla
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, New York
| | - Andreas P. Kalogeropoulos
- Division of Cardiology, Department of Internal Medicine, Stony Brook University, Stony Brook, New York
| | - Eric Sin
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, New York
| | - Harriet L. Hellman
- Department of Pediatrics, Hampton Community Health Care, Southampton, New York
| | - Robert H. Gilman
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Luis A. Marcos
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, New York
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York
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Jimenez A, Winokur EJ. Chagas Disease Cardiomyopathy. Dimens Crit Care Nurs 2023; 42:202-210. [PMID: 37219474 DOI: 10.1097/dcc.0000000000000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Chagas disease is a prominent neglected tropical disease endemic to many countries in Latin America. Cardiomyopathy is the most serious manifestation due to the severity and complications of heart failure. As a result of expanded immigration and globalization, there is an increased number of patients with Chagas cardiomyopathy who are being admitted to hospitals in the United States. It is imperative as a critical care nurse to be educated on the nature of Chagas cardiomyopathy as it differs from the more commonly seen ischemic and nonischemic forms. This article provides an overview of the clinical course, management, and treatment options of Chagas cardiomyopathy.
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Chronic Trypanosoma cruzi infection activates the TWEAK/Fn14 axis in cardiac myocytes and fibroblasts driving structural and functional changes that affect the heart. Exp Parasitol 2023; 248:108491. [PMID: 36841467 DOI: 10.1016/j.exppara.2023.108491] [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: 08/08/2022] [Revised: 01/04/2023] [Accepted: 02/18/2023] [Indexed: 02/25/2023]
Abstract
Sustained interaction between the cytokine tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and its functional receptor, fibroblast growth factor-inducible 14 (Fn14), has been linked to cardiovascular disorders. Chagas cardiomyopathy, elicited by Trypanosoma cruzi infection, is associated with chronic inflammation, fibrosis and hypertrophy. This study aimed to explore the involvement of the TWEAK/Fn 14 axis in development of Chagas heart disease. Parasite infection in vitro triggered Fn14 overexpression in atrial HL-1 myocytes and cardiac MCF fibroblasts. Fn14 levels were also increased in heart tissue from C57BL/6 mice at 130 days post-infection, particularly in myocytes and fibroblasts. Concurrently, TWEAK expression in circulating monocytes from this group was higher than that determined in uninfected controls. TWEAK/Fn14 interaction was functional in myocytes and fibroblasts isolated from infected hearts, leading to TNF receptor-associated factor 2 (TRAF2)-mediated activation of nuclear factor kappa B (NFκB) signaling. Ex vivo stimulation of both cell types with recombinant TWEAK for 24 h boosted the NFκB-regulated production of proinflammatory/profibrotic mediators (IL-1β, IL-6, TNF-α, IL-8, CCL2, CCL5, MMP-2, MMP-9, ICAM-1, E-selectin) involved in chronic T. cruzi cardiomyopathy. We further evaluated the therapeutic potential of the soluble decoy receptor Fn14-Fc to interfere with TWEAK/Fn14-dependent pathogenic activity. Fn14-Fc treatment of chronically infected mice was effective in neutralizing the ligand and reverting electrocardiographic abnormalities, maladaptive inflammation, adverse remodeling and hypertrophy in myocardium. Altogether, these findings suggest that sustained TWEAK/Fn14 induction by persistent T. cruzi infection is implicated in cardiopathogenesis and make TWEAK/Fn14 axis a promising target for the treatment of chronic Chagas heart disease.
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González-Herrera F, Clayton NS, Guzmán-Rivera D, Carrillo I, Castillo C, Catalán M, Anfossi R, Quintero-Pertuz H, Quilaqueo ME, Olea-Azar C, Rivera-Meza M, Kemmerling U, Ridley AJ, Vivar R, Maya JD. Statins change the cytokine profile in Trypanosoma cruzi-infected U937 macrophages and murine cardiac tissue through Rho-associated kinases inhibition. Front Immunol 2023; 13:1035589. [PMID: 36713380 PMCID: PMC9874148 DOI: 10.3389/fimmu.2022.1035589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Chronic Chagasic cardiomyopathy (CCC), caused by the protozoan Trypanosoma cruzi, is the most severe manifestation of Chagas disease.CCC is characterized by cardiac inflammation and fibrosis caused by a persistent inflammatory response. Following infection, macrophages secrete inflammatory mediators such as IL-1β, IL-6, and TNF-α to control parasitemia. Although this response contains parasite infection, it causes damage to the heart tissue. Thus, the use of immunomodulators is a rational alternative to CCC. Rho-associated kinase (ROCK) 1 and 2 are RhoA-activated serine/threonine kinases that regulate the actomyosin cytoskeleton. Both ROCKs have been implicated in the polarization of macrophages towards an M1 (pro-inflammatory) phenotype. Statins are FDA-approved lipid-lowering drugs that reduce RhoA signaling by inhibiting geranylgeranyl pyrophosphate (GGPP) synthesis. This work aims to identify the effect of statins on U937 macrophage polarization and cardiac tissue inflammation and its relationship with ROCK activity during T. cruzi infection. Methods PMA-induced, wild-type, GFP-, CA-ROCK1- and CA-ROCK2-expressing U937 macrophages were incubated with atorvastatin, or the inhibitors Y-27632, JSH-23, TAK-242, or C3 exoenzyme incubated with or without T. cruzi trypomastigotes for 30 min to evaluate the activity of ROCK and the M1 and M2 cytokine expression and secretion profiling. Also, ROCK activity was determined in T. cruzi-infected, BALB/c mice hearts. Results In this study, we demonstrate for the first time in macrophages that incubation with T. cruzi leads to ROCK activation via the TLR4 pathway, which triggers NF-κB activation. Inhibition of ROCKs by Y-27632 prevents NF-κB activation and the expression and secretion of M1 markers, as does treatment with atorvastatin. Furthermore, we show that the effect of atorvastatin on the NF-kB pathway and cytokine secretion is mediated by ROCK. Finally, statin treatment decreased ROCK activation and expression, and the pro-inflammatory cytokine production, promoting anti-inflammatory cytokine expression in chronic chagasic mice hearts. Conclusion These results suggest that the statin modulation of the inflammatory response due to ROCK inhibition is a potential pharmacological strategy to prevent cardiac inflammation in CCC.
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Affiliation(s)
- Fabiola González-Herrera
- Molecular and Clinical Pharmacology Program, Instituto de Ciencias Biomédicas, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Natasha S. Clayton
- School of Cellular and Molecular Medicine, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Daniela Guzmán-Rivera
- Escuela de Farmacia, Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile
| | - Ileana Carrillo
- Molecular and Clinical Pharmacology Program, Instituto de Ciencias Biomédicas, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Christian Castillo
- Núcleo de Investigación Aplicada en Ciencias Veterinarias y Agronómicas, Facultad de Medicina Veterinaria y Agronomía, Universidad de Las Américas, Santiago, Chile
| | - Mabel Catalán
- Molecular and Clinical Pharmacology Program, Instituto de Ciencias Biomédicas, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Renatto Anfossi
- Molecular and Clinical Pharmacology Program, Instituto de Ciencias Biomédicas, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Helena Quintero-Pertuz
- Molecular and Clinical Pharmacology Program, Instituto de Ciencias Biomédicas, Faculty of Medicine, University of Chile, Santiago, Chile
| | - María Elena Quilaqueo
- Department of Chemical Pharmacology and Toxicology, Faculty of Chemical and Pharmaceutical Sciences, University of Chile, Santiago, Chile
| | - Claudio Olea-Azar
- Department of Inorganic and Analytical Chemistry, Faculty of Chemical and Pharmaceutical Sciences, University of Chile, Santiago, Chile
| | - Mario Rivera-Meza
- Department of Chemical Pharmacology and Toxicology, Faculty of Chemical and Pharmaceutical Sciences, University of Chile, Santiago, Chile
| | - Ulrike Kemmerling
- Integrative Biology Program, Instituto de Ciencias Biomédicas, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Anne J. Ridley
- School of Cellular and Molecular Medicine, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Raúl Vivar
- Molecular and Clinical Pharmacology Program, Instituto de Ciencias Biomédicas, Faculty of Medicine, University of Chile, Santiago, Chile,*Correspondence: Juan Diego Maya, ; Raúl Vivar,
| | - Juan Diego Maya
- Molecular and Clinical Pharmacology Program, Instituto de Ciencias Biomédicas, Faculty of Medicine, University of Chile, Santiago, Chile,*Correspondence: Juan Diego Maya, ; Raúl Vivar,
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Montalvo-Ocotoxtle IG, Rojas-Velasco G, Rodríguez-Morales O, Arce-Fonseca M, Baeza-Herrera LA, Arzate-Ramírez A, Meléndez-Ramírez G, Manzur-Sandoval D, Lara-Romero ML, Reyes-Ortega A, Espinosa-González P, Palacios-Rosas E. Chagas Heart Disease: Beyond a Single Complication, from Asymptomatic Disease to Heart Failure. J Clin Med 2022; 11:7262. [PMID: 36555880 PMCID: PMC9784121 DOI: 10.3390/jcm11247262] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Chagas cardiomyopathy (CC), caused by the protozoan Trypanosoma cruzi, is an important cause of cardiovascular morbidity and mortality in developing countries. It is estimated that 6 to 7 million people worldwide are infected, and it is predicted that it will be responsible for 200,000 deaths by 2025. The World Health Organization (WHO) considers Chagas disease (CD) as a Neglected Tropical Disease (NTD), which must be acknowledged and detected in time, as it remains a clinical and diagnostic challenge in both endemic and non-endemic regions and at different levels of care. The literature on CC was analyzed by searching different databases (Medline, Cochrane Central, EMBASE, PubMed, Google Scholar, EBSCO) from 1968 until October 2022. Multicenter and bioinformatics trials, systematic and bibliographic reviews, international guidelines, and clinical cases were included. The reference lists of the included papers were checked. No linguistic restrictions or study designs were applied. This review is intended to address the current incidence and prevalence of CD and to identify the main pathogenic mechanisms, clinical presentation, and diagnosis of CC.
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Affiliation(s)
- Isis G. Montalvo-Ocotoxtle
- Cardiovascular Critical Care Unit, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Gustavo Rojas-Velasco
- Cardiovascular Critical Care Unit, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Olivia Rodríguez-Morales
- Department of Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Minerva Arce-Fonseca
- Department of Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Luis A. Baeza-Herrera
- Cardiovascular Critical Care Unit, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Arturo Arzate-Ramírez
- Cardiovascular Critical Care Unit, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Gabriela Meléndez-Ramírez
- Magnetic Resonance Imaging Department, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Daniel Manzur-Sandoval
- Cardiovascular Critical Care Unit, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Mayra L. Lara-Romero
- Academic Department of Health Sciences, School of Sciences, Universidad de las Américas Puebla, Ex Hacienda Sta. Catarina Mártir S/N. San Andrés Cholula, Puebla 72810, Mexico
| | - Antonio Reyes-Ortega
- Cardiovascular Critical Care Unit, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Patricia Espinosa-González
- Cardiovascular Critical Care Unit, National Institute of Cardiology “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Erika Palacios-Rosas
- Academic Department of Health Sciences, School of Sciences, Universidad de las Américas Puebla, Ex Hacienda Sta. Catarina Mártir S/N. San Andrés Cholula, Puebla 72810, Mexico
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Pharmaceutical agents for the treatment of Chagas disease: patenting trends in 2016-2021 period. Pharm Pat Anal 2022; 11:97-110. [PMID: 35861035 DOI: 10.4155/ppa-2022-0005] [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: 11/17/2022]
Abstract
American trypanosomiasis is a neglected tropical disease and an endemic problem in 21 Latin American countries, whose treatment relies on only two US FDA-approved drugs: benznidazole and nifurtimox. Patent literature reveals vital information on new trends in therapies for various diseases, including Chagas disease. The authors used the patent databases of the world's major patent offices to generate an overview of patent trends related to the treatment of Chagas disease. A total of 50 patent families were collected and grouped as 'small molecules', 'pharmaceutical compositions of known compounds' and vaccines. From the results and interpretation, it can be concluded that the treatment of Chagas disease receives little attention in the field of patents and that the upward trend is minimal.
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Soeiro MDNC. Perspectives for a new drug candidate for Chagas disease therapy. Mem Inst Oswaldo Cruz 2022; 117:e220004. [PMID: 35293439 PMCID: PMC8923671 DOI: 10.1590/0074-02760220004] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 12/21/2022] Open
Abstract
Chagas disease (CD), a neglected tropical illness caused by the protozoan Trypanosoma cruzi, affects more than 6 million people mostly in poor areas of Latin America. CD has two phases: an acute, short phase mainly oligosymptomatic followed to the chronic phase, a long-lasting stage that may trigger cardiac and/or digestive disorders and death. Only two old drugs are available and both present low efficacy in the chronic stage, display side effects and are inactive against parasite strains naturally resistant to these nitroderivatives. These shortcomings justify the search for novel therapeutic options considering the target product profile for CD that will be presently reviewed besides briefly revisiting the data on phosphodiesterase inhibitors upon T. cruzi.
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Abstract
Transforming growth factor-β (TGFβ) isoforms are upregulated and activated in myocardial diseases and have an important role in cardiac repair and remodelling, regulating the phenotype and function of cardiomyocytes, fibroblasts, immune cells and vascular cells. Cardiac injury triggers the generation of bioactive TGFβ from latent stores, through mechanisms involving proteases, integrins and specialized extracellular matrix (ECM) proteins. Activated TGFβ signals through the SMAD intracellular effectors or through non-SMAD cascades. In the infarcted heart, the anti-inflammatory and fibroblast-activating actions of TGFβ have an important role in repair; however, excessive or prolonged TGFβ signalling accentuates adverse remodelling, contributing to cardiac dysfunction. Cardiac pressure overload also activates TGFβ cascades, which initially can have a protective role, promoting an ECM-preserving phenotype in fibroblasts and preventing the generation of injurious, pro-inflammatory ECM fragments. However, prolonged and overactive TGFβ signalling in pressure-overloaded cardiomyocytes and fibroblasts can promote cardiac fibrosis and dysfunction. In the atria, TGFβ-mediated fibrosis can contribute to the pathogenic substrate for atrial fibrillation. Overactive or dysregulated TGFβ responses have also been implicated in cardiac ageing and in the pathogenesis of diabetic, genetic and inflammatory cardiomyopathies. This Review summarizes the current evidence on the role of TGFβ signalling in myocardial diseases, focusing on cellular targets and molecular mechanisms, and discussing challenges and opportunities for therapeutic translation.
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Affiliation(s)
- Nikolaos G Frangogiannis
- The Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, NY, USA.
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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: 10] [Impact Index Per Article: 3.3] [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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Nolan MS, Aguilar D, Misra A, Gunter SM, Erickson T, Gorchakov R, Rivera H, Montgomery SP, Murray KO. Trypanosoma cruzi in Nonischemic Cardiomyopathy Patients, Houston, Texas, USA. Emerg Infect Dis 2021; 27:1958-1960. [PMID: 34152952 PMCID: PMC8237890 DOI: 10.3201/eid2707.203244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To investigate possible cardiac manifestations of Chagas disease, we tested 97 Latinx patients with nonischemic cardiomyopathy in Houston, Texas, USA, for Trypanosoma cruzi infection. We noted a high prevalence of underdiagnosed infection and discrepant results in clinical diagnostic assays. Latinx cardiac patients in the United States would benefit from laboratory screening for T. cruzi infection.
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