ABSTRACT
BACKGROUND A positive Trypanosoma cruzi polymerase chain reaction (PCR) is associated with a worse prognosis in patients with chronic Chagas disease (CD). OBJECTIVES To study the association of clinical, electrocardiographic, and echocardiographic characteristics and biomarker blood levels with positive T. cruzi PCR in chronic CD. METHODS This is a single-centre observational cross-sectional study. Positive T. cruzi PCR association with clinical, electrocardiographic, and echocardiographic characteristics, and biomarker blood levels were studied by logistic regression analysis. p values < 0.05 were considered significant. FINDINGS Among 333 patients with chronic CD (56.4% men; 62 ± 10 years), T. cruzi PCR was positive in 41.1%. Stepwise multivariate logistic regression showed an independent association between positive T. cruzi PCR and diabetes mellitus {odds ratio (OR) 0.53 [95% confidence interval (CI) 0.30-0.93]; p = 0.03}, right bundle branch block [OR 1.78 (95% CI 1.09-2.89); p = 0.02], and history of trypanocidal treatment [OR 0.13 (95% CI 0.04-0.38); p = 0.0002]. Among patients with a history of trypanocidal treatment (n = 39), only four (10%) patients had a positive T. cruzi PCR. MAIN CONCLUSIONS Among several studied parameters, only diabetes mellitus, right bundle branch block, and history of trypanocidal treatment showed an independent association with positive T. cruzi PCR. History of trypanocidal treatment was a strong protective factor against a positive T. cruzi PCR.
ABSTRACT
BACKGROUND Angiogenesis has been implicated in tissue injury in several noninfectious diseases, but its role in Chagas disease (CD) physiopathology is unclear. OBJECTIVES The present study aimed to investigate the effect of Trypanosoma cruzi infection on cardiac angiogenesis during the acute phase of experimental CD. METHODS The signalling pathway involved in blood vessel formation and cardiac remodelling was evaluated in Swiss Webster mice infected with the Y strain of T. cruzi. The levels of molecules involved in the regulation of angiogenesis, such as vascular endothelial growth factor-A (VEGF-A), Flk-1, phosphorylated extracellular-signal-regulated protein kinase (pERK), hypoxia-inducible factor-1α (HIF-1α), CD31, α-smooth muscle actin (α-SMA) and also the blood vessel growth were analysed during T. cruzi infection. Hearts were analysed using conventional histopathology, immunohistochemistry and western blotting. FINDINGS In this study, our data demonstrate that T. cruzi acute infection in mice induces exacerbated angiogenesis in the heart and parallels cardiac remodelling. In comparison with noninfected controls, the cardiac tissue of T. cruzi-infected mice presented higher levels of (i) HIF-1α, VEGF-A, Flk-1 and pERK; (ii) angiogenesis; (iii) α-SMA+ cells in the tissue; and (iv) collagen -1 deposition around blood vessels and infiltrating throughout the myocardium. MAIN CONCLUSIONS We observed cardiac angiogenesis during acute experimental T. cruzi infection parallels cardiac inflammation and remodelling.
ABSTRACT
Transforming growth factor beta (TGF-β) is deeply involved on the pathogenesis of Chagas disease. Our group has been investigating the participation of this pleiotropic cytokine in different aspects of Chagas disease over the last 20 years. Important observations have been made, such as: (i) the ability of Trypanosoma cruzi in activating latent TGF-β; (ii) the potential involvement of TGF-β pathway on T. cruzi invasion of host cells; (iii) association of TGF-β with parasite intracellular replication; (iv) cardiac fibrosis development and maintenance; (v) disruption of Connexin-43 plaque structures and (vi) inflammation and immune response. In this perspective article we intend to discuss the advances of the potential use of new therapies targeting TGF-β to treat the cardiac alterations of Chagas disease-affected patients.
ABSTRACT
Estudos desenvolvidos pelo grupo nos últimos anos demonstram o envolvimento do fator transformador de crescimento beta (TGF-beta) na cardiopatia chagásica, com exacerbação dos seus níveis plasmáticos e da ativação da sua via de sinalização celular como aspectos desenvolvidos por pacientes nos estágios mais avançados da doença, associado também a níveis elevados de fibrose. Pacientes que apresentavam altos níveis de TGF-beta circulantes, após 10 anos de acompanhamento, evoluíram com pior prognóstico da doença. Recentemente, o polimorfismo no códon 10 do gene que codifica o TGF-beta1 foi descrito por influenciar na produção desta citocina. Também foi observado que, em populações da Colômbia e do Peru, o mesmo polimorfismo pode estar envolvido na susceptibilidade à infecção pelo T. cruzi. O presente trabalho avaliou o polimorfismo dos alelos do gene do TGF-beta1 em pacientes na fase crônica da doença de Chagas; incluindo a forma indeterminada e os diversos estágios da forma cardíaca e correlacionou a expressão dos diferentes alelos do TGF-beta1 com os níveis séricos desta citocina e a manifestação clínica da doença de Chagas. Para isso, 181 indivíduos entre pacientes com forma indeterminada ou cardíaca e indivíduos controle foram convidados a participar do trabalho. Foram realizadas análises de cinco polimorfismos de base única (-800 G>A, -509C>T, +10T>C, +25G>C e +263C>T) por PCR e sequenciamento das regiões de interesse. Além disso, os níveis séricos desta molécula e do peptídeo natriurético cerebral (BNP) foram dosados por ELISA. Ao analisar a frequência genotípica nos diferentes polimorfismos, observamos que a frequência do polimorfismo na posição -509 e no códon 10 eram maiores em pacientes portadores da doença que em indivíduos controle. Além disso, os genótipos CT e TT na posição -509 estão associados com altos níveis séricos do TGF-beta1...
Studies developed by our group have shown the involvement of TGF-beta in Chagas heart disease, with exacerbation of their plasma levels and the activation of its cell signaling pathway, as aspects developed by patients in later stages of the disease, also associatedwith high levels of fibrosis. Patients with higher levels of circulating TGF-beta, after 10 years of follow up, progressed with worse prognosis. Recently, the polymorphism at codon 10 in the TGF-beta 1 gene has been described to influence the production of this cytokine. It was also noted that in populations from Colombia and Peru, the same polymorphism may be involved in susceptibility to T. cruzi infection. The present study assessed the polymorphism of thealleles of the TGF-beta 1 gene in patients with chronic Chagas disease: indeterminate and the different stages of cardiac forms, correlating the expression of different alleles of TGF-beta 1, serum levels of this cytokines and the clinical outcome of Chagas disease. For this, 181 control and patients of different stages in the chronic phase of Chagas disease were invited to participate in the study. We investigated, five single nucleotide polymorphisms (-800 G> A,-509C> T + 10T> C + 25G> C and + 263C> T) by PCR and sequencing of fragments were performed. In addition, serum levels of TGF-beta 1 and BNP were measured by ELISA. We observed a significant difference in the frequency at positions -509 and codon 10. Thesegenotypes represent a risk for susceptibility to the development of Chagas disease. Furthermore, CT and TT genotypes at position -509 are associated with higher serum levelsof TGF-beta1. We found a significant association between circulating levels of BNP with the stage of CCC, but, no relationship between the levels of TGF-beta and BNP was observed. Thus, our results suggest that genetic polymorphisms at position -509 and codon 10 of the TGF-beta1 gene may be involved in the susceptibility to the development of Chagas disease...