Increased angiogenesis parallels cardiac tissue remodelling in experimental acute Trypanosoma cruzi infection.

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.

Increased angiogenesis parallels cardiac tissue remodelling in experimental acute Trypanosoma cruzi infection

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.

Flow Cytometry Immunophenotyping for Diagnostic Orientation and Classification of Pediatric Cancer Based on the EuroFlow Solid Tumor Orientation Tube (STOT).

Early diagnosis of pediatric cancer is key for adequate patient management and improved outcome. Although multiparameter flow cytometry (MFC) has proven of great utility in the diagnosis and classification of hematologic malignancies, its application to non-hematopoietic pediatric tumors remains limited. Here we designed and prospectively validated a new single eight-color antibody combination-solid tumor orientation tube, STOT-for diagnostic screening of pediatric cancer by MFC. A total of 476 samples (139 tumor mass, 138 bone marrow, 86 lymph node, 58 peripheral blood, and 55 other body fluid samples) from 296 patients with diagnostic suspicion of pediatric cancer were analyzed by MFC vs. conventional diagnostic procedures. STOT was designed after several design-test-evaluate-redesign cycles based on a large panel of monoclonal antibody combinations tested on 301 samples. In its final version, STOT consists of a single 8-color/12-marker antibody combination (CD99-CD8/numyogenin/CD4-EpCAM/CD56/GD2/smCD3-CD19/cyCD3-CD271/CD45). Prospective validation of STOT in 149 samples showed concordant results with the patient WHO/ICCC-3 diagnosis in 138/149 cases (92.6%). These included: 63/63 (100%) reactive/disease-free samples, 43/44 (98%) malignant and 4/4 (100%) benign non-hematopoietic tumors together with 28/38 (74%) leukemia/lymphoma cases; the only exception was Hodgkin lymphoma that required additional markers to be stained. In addition, STOT allowed accurate discrimination among the four most common subtypes of malignant CD45- CD56++ non-hematopoietic solid tumors: 13/13 (GD2++ numyogenin- CD271-/+ nuMyoD1- CD99- EpCAM-) neuroblastoma samples, 5/5 (GD2- numyogenin++ CD271++ nuMyoD1++ CD99-/+ EpCAM-) rhabdomyosarcomas, 2/2 (GD2-/+ numyogenin- CD271+ nuMyoD1- CD99+ EpCAM-) Ewing sarcoma family of tumors, and 7/7 (GD2- numyogenin- CD271+ nuMyoD1- CD99- EpCAM+) Wilms tumors. In summary, here we designed and validated a new standardized antibody combination and MFC assay for diagnostic screening of pediatric solid tumors that might contribute to fast and accurate diagnostic orientation and classification of pediatric cancer in routine clinical practice.

Effect of Posaconazole in an in vitro model of cardiac fibrosis induced by Trypanosoma cruzi.

Posaconazole (POS) is an inhibitor of ergosterol biosynthesis in clinical use for treating invasive fungal infections. POS has potent and selective anti-Trypanosoma cruzi activity and has been evaluated as a possible treatment for Chagas disease. Microtissues are a 3D culture system that has been shown to reproduce better tissue architecture and functionality than cell cultures in monolayer (2D). It has been used to evaluate chemotropic response as in vitro disease models. We previously developed an in vitro model that reproduces aspects of cardiac fibrosis observed in Chagas cardiomyopathy, using microtissues formed by primary cardiac cells infected by the T. cruzi, here called T. cruzi fibrotic cardiac microtissue (TCFCM). We also showed that the treatment of TCFCM with a TGF-ß pathway inhibitor reduces fibrosis. Here, we aimed to evaluate the effect of POS in TCFCM, observing parasite load and molecules involved in fibrosis. To choose the concentration of POS to be used in TCFCM we first performed experiments in a monolayer of primary cardiac cell cultures and, based on the results, TCFCM was treated with 5 nM of POS for 96 h, starting at 144 h post-infection. Our previous studies showed that at this time the TCFCM had established fibrosis, resulting from T. cruzi infection. Treatment with POS of TCFCM reduced 50 % of parasite load as observed by real-time PCR and reduced markedly the fibrosis as observed by western blot and immunofluorescence, associated with a strong reduction in the expression of fibronectin and laminin (45 % and 54 %, respectively). POS treatment also changed the expression of proteins involved in the regulation of extracellular matrix proteins (TGF-ß and TIMP-4, increased by 50 % and decreased by 58 %, respectively) in TCFCM. In conclusion, POS presented a potent trypanocidal effect both in 2D and in TCFCM, and the reduction of the parasite load was associated with a reduction of fibrosis in the absence of external immunological effectors.

Proteins involved on TGF-ß pathway are up-regulated during the acute phase of experimental Chagas disease.

Studies developed by our group in the last years have shown the involvement of TGF-ß in acute and chronic Chagas heart disease, with elevated plasma levels and activated TGF-ß cell signaling pathway as remarkable features of patients in the advanced stages of this disease, when high levels of cardiac fibrosis is present. Imbalance in synthesis and degradation of extracellular matrix components is the basis of pathological fibrosis and TGF-ß is considered as one of the key regulators of this process. In the present study, we investigated the activity of the TGF-ß signaling pathway, including receptors and signaling proteins activation in the heart of animals experimentally infected with Trypanosoma cruzi during the period that mimics the acute phase of Chagas disease. We observed that T. cruzi-infected animals presented increased expression of TGF-ß receptors. Overexpression of receptors was followed by an increased phosphorylation of Smad2/3, p38 and ERK. Furthermore, we correlated these activities with cellular factors involved in the fibrotic process induced by TGF-ß. We observed that the expression of collagen I, fibronectin and CTGF were increased in the heart of infected animals on day 15 post-infection. Correlated with the increased TGF-ß activity in the heart, we found that serum levels of total TGF-ß were significantly higher during acute infection. Taken together, our data suggest that the commitment of the heart associates with increased activity of TGF-ß pathway and expression of its main components. Our results, confirm the importance of this cytokine in the development and maintenance of cardiac damage caused by T. cruzi infection.

Cruzipain Activates Latent TGF-ß from Host Cells during T. cruzi Invasion.

Several studies indicate that the activity of cruzipain, the main lysosomal cysteine peptidase of Trypanosoma cruzi, contributes to parasite infectivity. In addition, the parasitic invasion process of mammalian host cells is described to be dependent on the activation of the host TGF-ß signaling pathway by T. cruzi. Here, we tested the hypothesis that cruzipain could be an important activator of latent TGF-ß and thereby trigger TGF-ß-mediated events crucial for the development of Chagas disease. We found that live epimastigotes of T. cruzi, parasite lysates and purified cruzipain were able to activate latent TGF-ß in vitro. This activation could be inhibited by the cysteine peptidase inhibitor Z-Phe-Ala-FMK. Moreover, transfected parasites overexpressing chagasin, a potent endogenous cruzipain inhibitor, prevented latent TGF-ß activation. We also observed that T. cruzi invasion, as well as parasite intracellular growth, were inhibited by the administration of Z-Phe-Ala-FMK or anti-TGF-ß neutralizing antibody to Vero cell cultures. We further demonstrated that addition of purified cruzipain enhanced the invasive activity of trypomastigotes and that this effect could be completely inhibited by addition of a neutralizing anti-TGF-ß antibody. Taken together, these results demonstrate that the activities of cruzipain and TGF-ß in the process of cell invasion are functionally linked. Our data suggest that cruzipain inhibition is an interesting chemotherapeutic approach for Chagas disease not only because of its trypanocidal activity, but also due to the inhibitory effect on TGF-ß activation.

Tratamento da fibrose induzida pela infecção por Trypanosoma cruzi com composto inibidor da via de TGF-beta em modelo tridimensional de cultivo de células cardíacas / Treatment of t. cruzi-induced fibrosis with a tgf-β signaling inhibitor compound using a three-dimensional model of cardiac cells culture

A doença de Chagas é a principal causa de lesões cardíacas em jovens adultos economicamente produtivos em áreas endêmicas da América Latina. A cardiopatia chagásica (CC) se caracteriza como uma doença progressivamente debilitante, na qual o TGF-beta desempenha papel fundamental para o desenvolvimento da fibrose e hipertrofia cardíacas, através da regulação de componentes da matriz extracelular (MEC), tais como a fibronectina, as metaloproteases (MMPs) e os inibidores teciduais das MMPs (TIMPs). No presente estudo, foi verificada a capacidade do inibidor farmacológico da via de TGF-beta, SB-431542, em restaurar o equilíbrio da MEC, rompido pela infecção por T. cruzi, e os prováveis mecanismos envolvidos neste processo. Para tal, utilizamos um modelo tridimensional (3D) de cultivo de células cardíacas (denominados esferóides cardíacos), capaz de mimetizar aspectos da arquitetura e fisiologia do tecido cardíaco. O tratamento dos esferóides cardíacos infectados por T. cruzi com SB-431542 resultou na redução parcial da hipertrofia e fibrose dos esferóides cardíacos, por mecanismos envolvendo a redução na expressão de TIMP-1, o aumento na atividade das MMPs 2 e 9, a redução na expressão da fibronectina e a redução da carga parasitáriaAtravés de uma abordagem proteômica, conseguimos ainda identificar outras proteínas possivelmente envolvidas no processo de reversão da fibrose e hipertrofia dos esferóides cardíacos a partir do tratamento com SB-431542, como as integrinas, fibulinas, proteínas de ligação ao selênio, a titina, entre outras. Além disso, as análises proteômicas nos permitiram identificar alguns dos componentes moleculares envolvidos no processo de remodelamento do tecido cardíaco disparado pela infecção por T. cruzi, auxiliando assim, na compreensão dos mecanismos associados à progressão da hipertrofia e da fibrose ao longo do desenvolvimento da CC...

Chagas disease represents the leading cause of cardiac lesions in economicallyproductive adults in endemic areas of Latin America. Chagasic cardiomyopathy (CC)is a progressive dysfunctional illness, in which TGF-beta plays a central role indevelopment of fibrosis and hypertrophy through regulation of extracellular matrix(ECM) components, such as fibronectin, matrix metalloproteinases (MMPs) and tissueinhibitors of metalloproteinases (TIMPs). In the present study we tested the efficacy ofa pharmacological inhibitor of TGF-beta signaling pathway, SB-431542, in restoring ECMbalance disrupted by T. cruzi infection and the possible mechanisms involved in thisprocess. For that, we used a three-dimensional (3D) model of cardiac cells culture(named cardiac spheroids) that can mimic aspects of architecture and physiology ofliving cardiac tissues better than conventional two-dimensional (2D) models.Treatment of T. cruzi-infected-cardiac spheroids with SB-431542 resulted in areduction of spheroids hypertrophy and fibrosis by mechanisms involving a decreasein the expression of TIMP-1, an increase in the activities of MMP-2 and MMP-9, areduction in the expression of fibronectin and a reduction of parasite load. Moreover,we identified through a proteomic approach, other proteins possibly involved inreversion of fibrosis and hypertrophy of cardiac spheroids after treatment with SB-431542, such as integrins, fibulins, selenium binding proteins and titin, among others.In addition, the proteomic analysis allowed us to identify molecular componentsinvolved in tissue remodeling generated by T. cruzi infection, assisting in thecomprehension of mechanisms related to fibrosis and hypertrophy progression duringCC’s development...

Estudo da modulação de proteínas de Trypanosoma cruzi em resposta ao estímulo de TGF-Beta: uma abordagem proteômica / Study of protein modulation in Trypanosoma cruzi in response to TGF-beta stimuli: a proteomic approach

Estudos recentes mostraram que TGF-Beta está envolvido na cardiopatia chagásica aguda e crônica. O aumento de seus níveis plasmáticos e a ativação da sua via de sinalização celular são aspectos peculiares da doença chagásica crônica. Além do seu relevante papel na patologia chagásica, também se observou que esta citocina está intimamente associada ao T. cruzi como um regulador de diferentes etapas de seu ciclo de vida. Trabalhos anteriores demonstraram que T. cruzi é capaz de ativar TGF-Beta latente, utilizando-o na invasão às células hospedeiras e que amastigotas de T. cruzi se ligam e internalizam TGF-Beta recombinante, estando este evento relacionado à capacidade de proliferação de amastigotas e sua diferenciação em tripomastigotas no final do ciclo intracelular. Este conjunto de informações nos levou ao questionamento de quais moléculas de T. cruzi poderiam estar envolvidas nos processos de proliferação e diferenciação celular frente ao estímulo por TGF-Beta. Neste sentido, o presente projeto tem por principal objetivo a caracterização de moléculas responsivas ao estímulo de TGF-Beta através de uma abordagem fosfoproteômica. Para tal, extratos de proteínas totais de epimastigotas de T. cruzi (cepa Y), incubadas ou não com TGF-Beta, foram preparados durante a fase exponencial de crescimento do parasito. Evidenciamos que a dose ótima de TGF-Beta para maior indução de fosforilação seria de 5 ng/ml. Em seguida, o tempo ótimo de indução com TGF-Beta (1, 5, 15, 30 e 60 minutos) foi testado e concluímos que as diferenças entre os padrões de fosforilação são muitos sutis em géis unidimensionais, nos fazendo optar pela análise exclusiva dos perfis em géis bidimensionais de 7 cm com faixa de pH 3-10 não-linear. A avaliação dos perfis bidimensionais demonstrou diferenças nos padrões de fosforilação entre os tempos estudados, nos levando a manter um estudo de cinética de tempo. As imagens dos géis foram analisadas e algumas das proteínas consideradas responsivas a TGF-Beta foram identificadas por espectrometria de massas. Observamos que as proteínas de choque térmico, tubulinas, desidrogenases, enolases, ciclofilina A, GrpE, cruzipaína, fator de elongamento 1-alfa, fator de iniciação eucariótica 5a, entre outras, têm sua fosforilação e/ou expressão moduladas em resposta a TGF-Beta. Buscamos correlacionar a função já descrita na literatura para cada proteína com seu possível papel na sinalização intracelular disparada por TGF-Beta, em concordância com o comportamento de fosforilação e/ou expressão apresentado em nossas análises. Por último, foi avaliado se a adição de TGF-beta a culturas de epimastigotas teria algum efeito sobre a proliferação dos parasitos. Verificamos que a adição de TGF-Beta promoveu um aumento de até 73% no crescimento dos parasitos nas primeiras 24 horas de estudo. O conjunto de dados obtidos contribui para a elucidação dos mecanismos moleculares relacionados à sinalização de TGF-Beta, proporcionando uma fonte para detecção de novos alvos terapêuticos para a doença de Chagas.