Terapia de Resgate com Nifurtimox e Dipiridamol na Miocardite Chagásica Aguda Grave com Insuficiência Cardíaca em Camundongos NMRI / Rescue Therapy with Nifurtimox and Dipyridamole for Severe Acute Chagas Myocarditis with Congestive Heart Failure in NMRI Albino Mice

Fundamento: A doença de Chagas é um problema de saúde global, sendo necessário o desenvolvimento de novos protocolos terapêuticos. Nosso grupo demonstrou recentemente que o nifurtimox associado ao dipiridamol tem efeitos curativos em camundongos com doença de Chagas aguda. Neste estudo, avaliamos o efeito deste protocolo terapêutico em camundongos chagásicos com insuficiência cardíaca. Objetivo: Avaliar se o nifurtimox e o dipiridamol são úteis no tratamento de resgate em camundongos com miocardite chagásica aguda com insuficiência cardíaca. Métodos: Foram divididos em três grupos 42 camundongos com miocardite chagásica aguda e insuficiência cardíaca congestiva: Controle Chagas (n = 11); Nif-Dip, tratados com nifurtimox e dipiridamol (n = 14); e Nif-Dip-Insuficiência Cardíaca, tratados com nifurtimox e dipiridamol, associados com digoxina, furosemida e captopril (n = 17). As doses de nifurtimox e dipiridamol foram de 40 e 30mg/kg/dia, respectivamente, durante 6 semanas. Os camundongos foram submetidos a avaliações clínicas, eletrocardiográficas, hemoparasitológicas e histopatológicas. Resultados: Observou-se menor mortalidade no Grupo Nif-Dip (n = 4; 28,57%) em relação ao Controle Chagas (n = 6; 54,54%) e ao Nif-Dip-Insuficiência Cardíaca (n = 9; 52,9%). Clinicamente, os camundongos tratados com nifurtimox e dipiridamol aumentaram o peso corporal e melhoraram a insuficiência cardíaca, sem mostrar esplenomegalia. Nestes grupos, foram erradicadas as parasitemias e os parasitas teciduais; a fibrose, a miocitólise, o infiltrado de células inflamatórias e os mastócitos diminuíram. Os distúrbios de repolarização, os intervalos QRS e o QT prolongados, o aumento da amplitude da onda S e a dissociação atrioventricular foram revertidos pelo tratamento. Conclusão: O tratamento com nifurtimox e dipiridamol pode ser usado no resgate em camundongos com doença chagásica aguda grave, já que o nifurtimox teve atividade tripanocida, e o dipiridamole potenciou seu efeito. O dipiridamol seria útil na insuficiência cardíaca chagásica

Background: Chagas disease is a global health problem; therefore, the development of new therapeutic protocols is necessary. Our group recently demonstrated that nifurtimox associated with dipyridamole has curative effects in mice with acute Chagas disease. In this study, we assess the effect of this therapeutic protocol in chagasic mice with heart failure. Objective: To evaluate whether nifurtimox and dipyridamole are useful to rescue mice with severe acute chagasic myocarditis with heart failure. Methods: 42 mice with acute chagasic myocarditis and congestive heart failure were divided into three groups: control chagas (n = 11), Nif-Dip treated with nifurtimox and dipyridamole (n = 14) and Nif-Dip-heart failure treated with nifurtimox and dipyridamole associated with digoxin, furosemide, and captopril (n = 17). Nifurtimox and dipyridamole doses were 40 and 30 mg/kg/day, respectively, for 6 weeks. Mice underwent clinical, electrocardiographic, hemoparasitological and histopathological assessments. Results: Lower mortality in Nif-Dip (28.57%; n = 4) compared to control chagas (54.54%; n = 6) and Nif-Dip-heart failure (52.9%; n = 9) was observed. Clinically, nifurtimox and dipyridamole-treated mice increased body weight and improved heart failure without splenomegaly. In these groups, parasitemia and tissue parasites were eradicated; fibrosis, myocytolysis, inflammatory cell infiltrate and mast cells decreased. Repolarization disorders, prolonged QRS and QT intervals, increase of S wave amplitude and atrioventricular dissociation were reversed by the treatment. Conclusion: Nifurtimox with dipyridamole can rescue NMRI mice from severe acute chagas disease, as nifurtimox showed trypanocidal activity and dipyridamole potentiated its effect. Dipyridamole would be useful in chagasic heart failure

O-glicosilación incompleta en células cancerígenas y parásitos: Importancia biomédica / Incomplete O-glycosylation in cancer cells and parasites: biomedical significance

Durante la carcinogénesis ocurren modificaciones importantes en la glicosilación, entre ellas la elongación incompleta de las cadenas sacarídicas con uniones de tipo O y la exposición de antígenos que en condiciones normales estaban ocultos, los cuales son reconocidos por componentes de la respuesta inmune que promueven o limitan el crecimiento tumoral. Diversos estudios reportan que estructuras asociadas a tumor tales como los antígenos Tn y sialil-Tn se expresan en algunos parásitos protozoarios y helmintos, planteando numerosas interrogantes a nivel de la interacción parásito-hospedador. Considerando que existe una correlación negativa entre ciertas infecciones parasitarias y el desarrollo de cáncer, los antígenos de O-glicosilación incompleta obtenidos de parásitos podrían ser potenciales blancos en la inmunoterapia del cáncer.

During carcinogenesis important modifications in glycosylation occur, among them incomplete elongation of the saccharide chains with type O bonds and the exposure of antigens that were hidden under normal conditions, which are recognized by components of the immune system which promote or limit tumor growth. Several studies report that tumor-associated structures, such as Tn and sialil-Tn, are expressed in some parasites protozoa and helminths, and pose many questions regarding parasite-host interaction. Considering the negative correlation between certain parasite infections and cancer development, antigens from incomplete O-glycosylation obtained from parasites could be potential targets in cancer immunotherapy.

[Adenosine deaminase in severe combined immunodeficiency syndrome]. / Adenosin deaminasa en el síndrome de inmunodeficiencia combinada severa.

Adenosine deaminase is an enzyme of the purine metabolism whose function is to convert adenosine to inosine and deoxyadenosine to deoxyinosine. The ecto-ADA1 binding to the cell surface through CD26 contributes to the regulation of cytokines and stimulates the proliferation of T cells by activating CD45. The deficiency of this enzyme generates the severe combined immunodeficiency syndrome, characterized by the accumulation of deoxyadenosine and adenine metabolites, which have toxic effects on lymphocytes, affecting DNA synthesis and consequently, clonal expansion. Early diagnosis of this immunodeficiency is essential, as it significantly reduces morbidity and mortality associated with recurrent infections. Recent advances in molecular biology and genetics have led to the identification of genetic defects of many primary immunodeficiencies and the development of promising diagnostic tools and treatment.

[Effect of congenital infection by Trypanosoma cruzi on intrauterine development and the fetal-neonatal immune response]. / Efecto de la infección congénita por Trypanosoma cruzi sobre el desarrollo intrauterino y la respuesta inmune fetal-neonatal.

In congenital infection by Trypanosoma cruzi, morbidity and mortality vary from asymptomatic cases to severe clinical forms of the disease. It has been found that there is no specific clinical profile in newborns infected by T. cruzi, since during intrauterine development diverse pathological changes take place, causing alterations in the serological and parasitological profiles. Some intrinsic factors of the host, such as: the placental barrier and the ability of both, mother and fetus, to develop a specific immune response to control parasite multiplication, could be involved in such differences. Another possibility includes the genetic polymorphism of T. cruzi, since it is considered that strains of greater virulence can cross the placenta more easily and are more pathogenic to the fetus and/or the neonate.

Adenosin deaminasa en el síndrome de inmunodeficiencia combinada severa / Adenosine deaminase in severe combined immunodeficiency syndrome

La Adenosin deaminasa es una enzima del metabolismo de las purinas cuya función es transformar la adenosina en inosina y la desoxiadenosina en desoxiinosina. La unión de ecto-ADA1 a la superficie celular a través de CD26 contribuye a la regulación de citocinas y estimula la proliferación de células T mediante la activación de CD45. La deficiencia de esta enzima genera el síndrome de inmunodeficiencia combinada severa, caracterizado por la acumulación de metabolitos de adenina y desoxiadenosina, los cuales tienen efectos tóxicos sobre los linfocitos, afectando así la síntesis de ADN y en consecuencia la expansión clonal. Un diagnóstico temprano de esta inmunodeficiencia es esencial ya que reduce notablemente la morbilidad y mortalidad asociada con infecciones recurrentes. Los avances recientes en biología molecular y genética han conducido a la identificación de los defectos genéticos de muchas de las inmunodeficiencias primarias y al desarrollo de herramientas de diagnóstico y tratamiento prometedoras.

Adenosine deaminase is an enzyme of the purine metabolism whose function is to convert adenosine to inosine and deoxyadenosine to deoxyinosine. The ecto-ADA1 binding to the cell surface through CD26 contributes to the regulation of cytokines and stimulates the proliferation of T cells by activating CD45. The deficiency of this enzyme generates the severe combined immunodeficiency syndrome, characterized by the accumulation of deoxyadenosine and adenine metabolites, which have toxic effects on lymphocytes, affecting DNA synthesis and consequently, clonal expansion. Early diagnosis of this immunodeficiency is essential, as it significantly reduces morbidity and mortality associated with recurrent infections. Recent advances in molecular biology and genetics have led to the identification of genetic defects of many primary immunodeficiencies and the development of promising diagnostic tools and treatment.

Efecto de la infección congénita por Trypanosoma cruzi sobre el desarrollo intrauterino y la respuesta inmune fetal-neonatal / Effect of congenital infection by Trypanosoma cruzi on intrauterine development and the fetal-neonatal immune response

En la infección congénita por Trypanosoma cruzi la morbilidad y mortalidad varían desde casos asintomáticos hasta severos cuadros clínicos de la enfermedad. En recién nacidos infectados por T. cruzi se ha encontrado que no existe un perfil clínico determinado, puesto que durante el desarrollo intrauterino se producen diversas alteraciones, presentándose cambios en el perfil serológico y parasitológico. Algunos factores intrínsecos del hospedador, tales como: la barrera placentaria y la capacidad tanto de la madre como del feto de desarrollar una respuesta inmune específica capaz de controlar la multiplicación parasitaria podrían estar involucrados en tales diferencias. Otra posibilidad incluye el polimorfismo genético de T. cruzi, pues se considera que las cepas de mayor virulencia pueden atravesar con mayor facilidad la placenta y son más patógenas para el feto y/o neonato.

In congenital infection by Trypanosoma cruzi, morbidity and mortality vary from asymptomatic cases to severe clinical forms of the disease. It has been found that there is no specific clinical profile in newborns infected by T. cruzi, since during intrauterine development diverse pathological changes take place, causing alterations in the serological and parasitological profiles. Some intrinsic factors of the host, such as: the placental barrier and the ability of both, mother and fetus, to develop a specific immune response to control parasite multiplication, could be involved in such differences. Another possibility includes the genetic polymorphism of T. cruzi, since it is considered that strains of greater virulence can cross the placenta more easily and are more pathogenic to the fetus and/or the neonate.

[Determination of the specificity of seric IgA produced in response to antigens of Leishmania (Leishmania) mexicana in murine leishmaniasis]. / Determinación de la especificidad de IgA sérica producida en respuesta a antígenos de Leishmania (Leishmania) mexicana en leishmaniosis murina.

In experimental leishmaniasis, the role of antibodies is not entirely clear, as some authors consider that these proteins are not involved in protection against infection. However, histopathological studies in human and experimental leishmaniasis lesions, show plasma cell infiltrates positive for IgA and secretion of IgM, IgG and IgA could mediate the formation of immune complexes with parasite antigens or self components, favoring necrosis leading to the elimination of the parasite. In this study, we determined if the serum IgA in the murine model has specific reactivity against antigens of Leishmania (Leishmania) mexicana of diagnostic utility. To do this, we used mice either susceptible or resistant to cutaneous leishmaniasis, and demonstrated by indirect ELISA that serum IgA is elevated in susceptible mice compared with that produced by resistant mice. Although other studies in murine models show that the serum IgG from mice infected with L. (L) mexicana present cross reactivity with unrelated parasite antigens derived from Trypanosoma cruzi, the analysis of the specificity of IgA by antigens of L. (L) mexicana and T. cruzi, by Western Blot, showed that the IgA serum of mice infected with T. cruzi reacts too with antigens of L. (L) mexicana. These findings suggest that IgA may be useful for the clinical management and prognosis of the disease.

Determinación de la especificidad de IgA sérica producida en respuesta a antígenos de Leishmania (Leishmania) mexicana en leishmaniosis murina / Determination of the specificity of seric IgA produced in response to antigens of Leishmania (Leishmania) mexicana in murine leishmaniasis

En la leishmaniosis experimental, la función de los anticuerpos no está completamente clara, ya que algunos autores consideran que dichas proteínas no participan en la protección contra la infección; sin embargo, estudios histopatológicos en lesiones con leishmaniosis humana y experimental, muestran infiltrados de células plasmáticas positivas para IgA y secreción de IgM, IgG e IgA que podrían mediar la formación de complejos inmunológicos con antígenos parasitarios o propios, favoreciendo la necrosis lo que conlleva a la eliminación del parásito. En este trabajo se determinó si la IgA sérica en el modelo murino posee reactividad específica contra antígenos de Leishmania (Leishmania) mexicana de utilidad diagnóstica. Para ello, se utilizaron ratones susceptibles y resistentes a leishmaniosis cutánea, demostrándose mediante ELISA indirecta que la IgA sérica de ratones susceptibles es elevada en comparación con la producida por ratones resistentes. Aunque otros estudios en modelos murinos demuestran que la IgG sérica de ratones infectados con L. (L) mexicana presenta reactividad cruzada con antígenos parasitarios no relacionados obtenidos de Trypanosoma cruzi, al analizar la especificidad de IgA por antígenos de L. (L) mexicana y T. cruzi, mediante Western Blot, se demostró que la IgA sérica de ratones infectados con T. cruzi también reaccionan con antígenos de L. (L) mexicana, estos hallazgos sugieren que la IgA puede ser útil para el manejo clínico y pronóstico de la enfermedad.

In experimental leishmaniasis, the role of antibodies is not entirely clear, as some authors consider that these proteins are not involved in protection against infection. However, histopathological studies in human and experimental leishmaniasis lesions, show plasma cell infiltrates positive for IgA and secretion of IgM, IgG and IgA could mediate the formation of immune complexes with parasite antigens or self components, favoring necrosis leading to the elimination of the parasite. In this study, we determined if the serum IgA in the murine model has specific reactivity against antigens of Leishmania (Leishmania) mexicana of diagnostic utility. To do this, we used mice either susceptible or resistant to cutaneous leishmaniasis, and demonstrated by indirect ELISA that serum IgA is elevated in susceptible mice compared with that produced by resistant mice. Although other studies in murine models show that the serum IgG from mice infected with L. (L) mexicana present cross reactivity with unrelated parasite antigens derived from Trypanosoma cruzi, the analysis of the specificity of IgA by antigens of L. (L) mexicana and T. cruzi, by Western Blot, showed that the IgA serum of mice infected with T. cruzi reacts too with antigens of L. (L) mexicana. These findings suggest that IgA may be useful for the clinical management and prognosis of the disease.

[Trypanosoma cruzi infection in pregnant mice induces a cellular immune response with citokines production in their fetuses]. / La infección por Trypanosoma cruzi en ratones gestantes induce una respuesta inmune celular con producción de citocinas en sus fetos.

The objective of this study was to detect the cytokines IFN-gamma, IL-4 and IL-10 expressed by CD4+ T cells in tissues of fetal mice with acute chagasic infection. For this, we examined the fetuses of NMRI mice whose mothers were infected with 22x10(3) metacyclic trypomastigotes of the M/HOM/BRA/53/Y strain of T. cruzi and made pregnant during the acute phase of infection. For the detection and localization of inflammatory infiltrates, nest parasites, antigens of T. cruzi a nd cytokines w eused hematoxylin-eosin techniques, peroxidase-anti-peroxidase and immunofluorescence. The immunohistochemical study revealed the presence of inflammatory infiltrates and antigens with amastigote nests in fetal skeletal muscle. CD4 + T cells producing IFN-gamma, as well as deposits of IFN-gamma and IL-10, were detected in sections of placenta, heart and skeletal muscle of fetuses of mice infected, while CD4+/IL-10+ was found only in skeletal muscle; in addition, deposits of IL-4 were detected only in placentas of healthy mice. These results indicate that fetuses are capable of generating their own immune response to antigens transmitted by their mother, which induces the secretion of cytokines and that, acting in synergy with the maternal antibodies, confer them a state of protection against infection; and that the transmission of the parasite depends on factors specific to each mother, which may modify its ability to control such transmission at the placental or systemic levels.

La infección por Trypanosoma cruzi en ratones gestantes induce una respuesta inmune celular con producción de citocinas en sus fetos / Trypanosoma cruzi infection in pregnant mice induces a cellular immune response with citokines production in their fetuses

El objetivo del presente estudio fue detectar las citocinas IFN-g, IL-4 e IL-10 expresadas por células T CD4+ en tejidos de fetos de ratones con infección chagásica aguda. Para ello, se examinaron fetos de ratones NMRI cuyas madres fueron infectadas con 22×10³ tripomastigotes metacíclicos de la cepa M/HOM/BRA/53/Y de T. cruzi y preñadas durante la fase aguda de la infección. Para la detección y localización de infiltrados inflamatorios, nidos de parásitos, antígenos de T. cruzi y citocinas se emplearon las técnicas de hematoxilina-eosina, peroxidasa-anti-peroxidasa e inmunofluorescencia indirecta. Se detectaron infiltrados inflamatorios y antígenos con nidos de amastigotes en el músculo esquelético fetal. Células T CD4+ productoras de IFN-g así como depósitos de IFN-g e IL-10 fueron detectados en las secciones de placenta, corazón y músculo esquelético de fetos de ratones infectadas, mientras que células CD4+/IL-10+ se encontraron sólo en músculo esquelético, adicionalmente se detectaron depósitos de IL-4 sólo en placentas de ratones sanas. Estos resultados indican que el feto es capaz de generar una respuesta inmune propia frente a antígenos transmitidos por su madre, lo cual induce la secreción de citocinas que actuando en sinergia con los anticuerpos maternos le confieren un estado de protección contra la infección, y que la transmisión del parásito depende de factores específicos de cada madre, la cual puede modificar su capacidad de controlar tal transmisión ya sea a nivel placentario o sistémico.

The objective of this study was to detect the cytokines IFN-g, IL-4 and IL-10 expressed by CD4+ T cells in tissues of fetal mice with acute chagasic infection. For this, we examined the fetuses of NMRI mice whose mothers were infected with 22×10³ metacyclic trypomastigotes of the M/HOM/BRA/53/Y strain of T. cruzi and made pregnant during the acute phase of infection. For the detection and localization of inflammatory infiltrates, nest parasites, antigens of T. cruzi and cytokines we used hematoxylin-eosin techniques, peroxidase-anti-peroxidase and immunofluorescence. The immunohistochemical study revealed the presence of inflammatory infiltrates and antigens with amastigote nests in fetal skeletal muscle. CD4 + T cells producing IFN-g, as well as deposits of IFN-g and IL-10, were detected in sections of placenta, heart and skeletal muscle of fetuses of mice infected, while CD4+/IL-10+ was found only in skeletal muscle; in addition, deposits of IL-4 were detected only in placentas of healthy mice. These results indicate that fetuses are capable of generating their own immune response to antigens transmitted by their mother, which induces the secretion of cytokines and that, acting in synergy with the maternal antibodies, confer them a state of protection against infection; and that the transmission of the parasite depends on factors specific to each mother, which may modify its ability to control such transmission at the placental or systemic levels.

Adenosin deaminasa como molécula coestimuladora y marcador de inmunidad celular / Adenosine deaminase as costimulatory molecule and marker of cellular immunity

La adenosin deaminasa (ADA), es una enzima del metabolismo de las purinas que ha sido objeto de mucho interés debido a que el defecto congénito de esta enzima causa el síndrome de inmunodeficiencia combinada severa. Una de las tres isoformas de la enzima (ecto-ADA) es capaz de unirse a la glicoproteína CD26 y a los receptores de adenosina A1 y A2B. La interacción ADA-CD26 produce una señal coestimuladora en los eventos de activación de las células T y en la secreción de IFN-g, TNF-a e IL-6. Durante dicha activación la actividad de la enzima está regulada de manera positiva por IL-2 e IL-12 y negativamente por IL-4, basado en un mecanismo de translocación. Diversos estudios señalan que los niveles séricos y plasmáticos de ADA se elevan en algunas enfermedades causadas por microorganismos que infectan principalmente a los macrófagos; así como en trastornos hipertensivos, lo cual podría representar un mecanismo compensatorio como consecuencia de la elevación de los niveles de adenosina y la liberación de mediadores hormonales e inflamatorios estimulados por la hipoxia.

Adenosine deaminase (ADA) is an enzyme of purine metabolism which has been the subject of much interest because the congenital defect of this enzyme causes severe combined immunodeficiency syndrome. One of the three isoforms of the enzyme (ecto-ADA) is capable of binding to the glycoprotein CD26 and adenosine receptors A1 and A2B. ADA-CD26 interaction produces a costimulatory signal in the events of T cell activation and secretion of IFN-g, TNF-a and IL-6. During this activation, the enzyme activity is regulated positively by IL-2 and IL-12 and negatively by IL-4, based on the mechanism of translocation. Diverse studies suggest that seric and plasmatic levels of ADA rise in some diseases caused by microorganisms infecting mainly the macrophages and in hypertensive disorders, which may represent a compensatory mechanism resulting from increased adenosine levels and the release of hormones and inflammatory mediators estimulated by hipoxia.

[Adenosine deaminase as costimulatory molecule and marker of cellular immunity]. / Adenosin deaminasa como molécula coestimuladora y marcador de inmunidad celular.

Adenosine deaminase (ADA) is an enzyme of purine metabolism which has been the subject of much interest because the congenital defect of this enzyme causes severe combined immunodeficiency syndrome. One of the three isoforms of the enzyme (ecto-ADA) is capable of binding to the glycoprotein CD26 and adenosine receptors A1 and A2B. ADA-CD26 interaction produces a costimulatory signal in the events of T cell activation and secretion of IFN-gamma, TNF-alpha and IL-6. During this activation, the enzyme activity is regulated positively by IL-2 and IL-12 and negatively by IL-4, based on the mechanism of translocation. Diverse studies suggest that seric and plasmatic levels of ADA rise in some diseases caused by microorganisms infecting mainly the macrophages and in hypertensive disorders, which may represent a compensatory mechanism resulting from increased adenosine levels and the release of hormones and inflammatory mediators estimulated by hipoxia.

[Detection of Trypanosoma cruzi DNA in the placenta and fetuses of mice with Chagasic acute infection]. / Detección de ADN de Trypanosoma cruzi en la placenta y fetos de ratones con infección chagásica aguda.

The objective of the present study was to detect the presence of Trypanosoma cruzi DNA in the placenta and fetal tissues of NMRI mice (Mus musculus) inoculated with 22 x 10(3) trypomastigotes metacyclic of the M/HOM/BRA/53/Y strain by intraperitoneal route. Mice were pregnant in the acute phase of the infection. The course of patent parasitemia by T. cruzi was evaluated before mating and during pregnancy. At day twenty of gestation, animals were sacrificed and the fetuses and their placentas were removed to evaluate T. cruzi infection. Samples of fetal placenta, heart and skeletal muscle were fixed in 10%, formalin, included in paraffin and stained with hematoxilin and eosin (HE). The histopathological study of sections of fetal tissues revealed inflammatory infiltrates with mononuclear and polymorphonuclear cells and without parasitism in these tissues. The amplification of T. cruzi DNA by Polymerase Chain Reaction (PCR) showed a positive reaction in 18% of placental tissue of pregnant infected mice. The samples of heart and skeletal muscle of the fetuses of mothers infected with T. cruzi did not show the presence T. cruzi DNA. The placenta and skeletal muscle of the fetuses analyzed by Peroxidase anti Peroxidase inmunostaining showed T. cruzi antigens in those tissues. Negative results by PCR in fetal tissues might be related with the virulence and tropism associated with the biological and genetic characteristic Of the T. cruzi strain used in the experimental infection of female mice.

Transmisión congénita por Trypanosoma cruzi: aspectos de la respuesta inmune fetal / Congenital transmission of Trypanosoma cruzi: Aspects of the fetal immune response

La respuesta inmune mediada por células en neonatos y fetos de madres infectadas por Trypanosoma cruzi ha sido objeto de estudio en modelos murinos, existiendo datos que apoyan la idea de que el sistema inmune fetal puede ser competente. Esta revisión sintetiza los resultados obtenidos en estudios multidisciplinarios sobre casos de enfermedad de Chagas congénito, los cuales señalan que dicha afección depende del equilibrio entre complejos fenómenos, tales como la respuesta inmune adaptativa en la madre de tipo Th2 asociada a altas parasitemias, la invasión de la placenta y el cordón umbilical por los parásitos y la respuesta inmune específica en el feto caracterizada por una activación de células T CD8+ productoras de IFN-γ capaces de limitar la multiplicación del parásito, así como la morbi mortalidad y los linajes de mayor virulencia del parásito que pudieran atravesar con facilidad la placenta y llegar a ser más patógenos para el feto/neonato

The cell-mediated immune response in infants and fetuses of mothers infected with Trypanosoma cruzi has been studied in mouse models and there are data supporting the idea that the fetal immune system may be competent. This review synthesizes the results obtained from multidisciplinary studies of cases of congenital Chagas disease, which indicate that this condition depends on the equilibrium between complex phenomena, such as a maternal type Th2 adaptative immune response associated with high parasitemia, the invasion of placental and umbilical cord by parasites and a fetal specific immune response characterized by an activation of CD8 T cells producing IFN-gamma able to limit parasite multiplication and morbidity/mortality; and that in lineages of higher virulence the parasite could easily cross the placenta and be more pathogenic to the fetus/neonate

Anomalías morfológicas y estructurales en fetos de ratones con infección aguda experimental por Trypanosoma cruzi / Morphological and structural anomalies in fetuses of mice with acute experimental infection by Trypanosoma cruzi

El presente estudio muestra el desarrollo de fetos de ratones hembras NMRI inoculadas con la cepa M/HOM/BRA/53/Y de trypanosoma cruzi y preñadas durante la fase aguda de la infección. Altos niveles de parasitemias fueron observados en las ratones con 30 días post-infección y 20 días de gestación, en comparación con las detectadas en los ratones vírgenes e infectadas con T. cruzi. En 3 de los fetos (15%) provenientes de dos madres infectadas/gestantes con altas parasitemias, se observaron signos de anomalías congénitas morfológicas y estructurales músculo-esqueléticas. Presentándose en uno de los fetos la formación de dos protuberancias, una sobre el lado dorsal del cuerpo y la otra en la base de la pata inferior izquierda, en otro de los fetos, la pata derecha se desarrolló sobre el lado derecho de la cara y en un tercer feto se formó una protuberancia en la pata anterior izquierda a nivel de la región subescapular. El estudio histopatológico con hematoxilina y eosina de los tejidos muscular esquelético y cardíaco, mostró en el 10% (2/20) de los tejidos fetales, intenso infiltrado celular mononuclear con predominio de linfocitos, macrófagos o histiocitos y monocitos entre las fibras musculares y cardíacas, con discreta miositis y miocarditis. Con la técnica de peroxidada anti peroxidada se observaron abundantes depósitos antigénicos, tanto en placenta como en músculo esquelético de los fetos con alteraciones morfológicas. En los ratones infectadas/gestantes los fetos presentaron reducción del peso corporal y retardo en el crecimiento fetal, así como reducción en el número de fetos de 10 en comparación con 14 fetos de mayor tamaño y aspecto normal desarrollados en las ratonas sanas preñadas.

The present study shows the development of the fetuses from pregnant female mice NMRI inoculated with M/HOM/BRA/53/Y Trypanosoma cruzi strain. The infection revealed the highest levels of patent parasitemia in mice with 30 days postinfection and 20 days of pregnancy in comparison with infected unmated mice. Three fetuses (15%) from two infected mice with high levels of parasitemia, showed morphological and structural muscularskeletal congenital anomalies. Two protuberances were observed, one on the dorsal side of the body, and the other on the left footpad base. In another fetus his right footpad came out from the right part of his face and in the 3rd one it was observed a lump in the left leg, above the level subscapular region. The histophatological study with hematoxilin-eosin staining of skeletal muscle and cardiac tissue, showed in 10% (2/20) of the mice, inflammatory infiltrate with lymphocytes, macrophages and monocytes into muscular and cardiac fibers, with discrete myositis and myocarditis. Peroxidase anti-peroxidase staining showed T. cruzi antigens in placenta and skeletal muscle of the fetuses with morphological alterations. In the pregnant mice, fetuses also showed both, loss of weight and growth retardation, as well as reduction of the number of fetuses to 10 in comparison with 14 fetuses in normal and healthy pregnant mice.

CD40/CD40L expression in leukocytes from chronic granulomatous disease patients.

Chronic granulomatous disease (CGD) is an inherited disorder caused by defects in the NADPH oxidase complex, which generates superoxide, the precursor of hydrogen peroxide (H(2)O(2)) and other reactive oxygen derivatives with microbicidal activity. Because CGD patients are at risk of chronic inflammatory manifestations, including inflammatory bowel disease and autoimmune diseases, and it is not clear whether these pathologies are exclusively secondary to altered superoxide production, or whether distinct immunologic defects are involved, we explored cell proliferation, lymphocyte cell counts, immunoglobulin levels, presence of autoimmune antibodies and expression of costimulatory molecules in leukocytes from CGD patients. We found that CGD patients have a diminished phytohemagglutinin-induced proliferation of blood mononuclear cells. Following stimulation with PMA plus ionomycin, a reduced percentage of CD40L expression in T lymphocytes and a diminished expression of CD40 molecules in neutrophils were observed on leukocytes from these patients. Our results suggest an altered interplay between elements of innate and adaptive immunity in CGD patients, which may be reflected in an increased susceptibility to opportunistic infections.

Antigen-induced regulatory T cells in HBV chronically infected patients.

T cell response against HBV is vigorous in patients with acute hepatitis who clear the virus, whereas it is weak and narrowly focused in patients with chronic disease. We report that following incubation with HBcAg, a population of CD4+FoxP3+ cells expressing phenotypic markers of both natural and induced Tregs, can be antigen-induced from peripheral mononuclear cells. Conversely, naive and naturally immune subjects did not increase CD4+FoxP3+ Tregs following stimulation with HBcAg, supporting the idea that natural Tregs are able to respond specifically to HBV antigen. Furthermore, increased frequencies of antigen-induced CD4+FoxP3+IL-10+ Tregs correlated with viral load, suggesting that antigen-induced Tregs could contribute to an inadequate response against the virus, leading to chronic infection and support the view that specific natural Tregs may be implicated in host immune tolerance during HBV infection.

[Pattern of T cell activation in absence of protective immunity against hepatitis B virus. Review]. / Patrón de activación de linfocitos T en ausencia de respuesta protectora contra el virus dela hepatitis B. Revisión.

Hepatitis B is an important cause of morbidity and mortality around the world. One-third of the world's population has been estimated to be infected with hepatitis B virus (HBV). A significant amount of evidence suggests that both humoral and cellular immune responses are important to eliminate the virus and that, cellular immunity is involved in the pathogenesis of the disease. Vaccination with HBsAg is considered as the main strategy for effective control of the infection and viral transmission. However, approximately 5-10% of immunized individuals fail to elicit detectable specific antibodies and remain at risk for hepatitis B infection. In this work we have reviewed the current status in the pathogenesis of the disease and the mechanisms described to explain nonresponsiveness to the vaccine as well. Since nonresponders to the vaccine are at risk for the infection, a common mechanism to explain the absence or inappropriate immune response to virus components is proposed. Within the suggested model an impaired activation of T lymphocytes against viral antigens, both in nonresponders to vaccination and chronically infected patients, is described. These observations could be consistent with potential differences in the MHC/Ag presentation; therefore contributing to our understanding of the altered T helper response as an underlying mechanism for the lack of protective immunity against VHB.

[Role of human immunodeficiency virus in leukocytes apoptosis from infected patients]. / Papel del virus de la inmunodeficiencia humana en 1a apoptosis de leucocitos de pacientes infectados.

The hallmark of the immunodeficiency virus infection is a progressive detriment of the immune response which has been associated to a gradual loss of its responsible components, in particularly, CD4 positive T cells. Although this cell population is considered the main target of the virus, there is a recent deal of interest in studying other components that may not be targets of the virus, but are important elements to control infectious microorganisms and that have been demonstrated to be altered during HIV infection. Neutrophils (PMN) are innate immune components that play a fundamental role against HIV infection and these cells have been described as functionally altered during AIDS. It has been suggested that such a dysfunction could be attributed to an increased susceptibility of these cells to accelerated spontaneous apoptosis. However, the underlying mechanisms that induce programmed cell death of neutrophils remain unknown. In previous works we have explored some events involved during cell death of neutrophils from HIV infected patients. It is the purpose of this work to review the current knowledge of apoptosis signals in neutrophils and to discuss our own data about some mechanisms involved in spontaneous and Fas mediated apoptosis, which may contribute to understand neutrophils dysfunction during HIV infection.

Papel del virus de la inmunodeficiencia humana en la apoptosis de leucocitos de pacientes infectados / Role of human immunodeficiency virus in leukocytes apoptosis from infected patients

La infección por el virus de la inmunodeficiencia humana (VIH) se caracteriza por el deterioro progresivo de la respuesta inmune, asociado a una pérdida gradual de los elementos que la generan, especialmente de los linfocitos T CD4+. Aunque estas células son el principal blanco del virus, en la actualidad existe gran interés por el estudio de otros elementos celulares, que se encuentran alterados y que contribuyen al deterioro del paciente. Dentro de este grupo de células se encuentran los polimorfonucleares (PMN), células fundamentales en la defensa innata contra el VIH y cuya función está alterada en el curso de la enfermedad. Probablemente la causa de este deterioro se debe, en parte, a un incremento en su susceptibilidad para sufrir apoptosis espontánea; sin embargo, no han sido dilucidados los mecanismos involucrados en generar muerte celular programada en los neutrófilos de pacientes VIH positivos. En trabajos previos, hemos explorado algunos eventos asociados con la muerte de los neutrófilos de pacientes infectados. Este artículo tiene como objetivo principal profundizar en los eventos involucrados en la apoptosis espontánea e inducida vía Fas, que pudieran estar implicados en el deterioro de los PMN durante la infección por el VIH