Epidemiological features, echocardiographic findings, and parasite load in patients with Chagas disease

Abstract INTRODUCTION Chagas disease is a major public health problem that is endemic in Brazil and Latin America. This study aimed to determine the socioeconomic, demographic, and clinical characteristics of 171 patients (mean age, 45 years; female, 65%) with Chagas disease at Hospital Universitário de Brasília, Federal District, Brazil. METHODS We implemented this cross-sectional study using a clinical epidemiological questionnaire, electrocardiography, echocardiography, and quantitative detection of Trypanosoma cruzi DNA in blood using qRT-PCR. RESULTS Among the patients, 26.3% had a full elementary education, and 13.2% were illiterate. Most (63.6%) were economically classified as class C, and 51.5% were born in Bahia state. A total of 62.0% participants reported previous contact with the triatomine bug. The clinical forms of the disease were indeterminate (69.51%), cardiac (15.24%), digestive (10.37%), and mixed (4.88%). The most common electrocardiographic abnormality was complete right bundle branch block in association with a divisional anterosuperior block. Only 14.6% of the patients complied with benznidazole medication for at least 60 days, and 164 of them were assessed by echocardiography. The parasite load was positive in 56% of the patients. CONCLUSIONS: Chagas disease affected mostly women, with the indeterminate chronic form of the disease.

Combined parasitological and molecular-based diagnostic tools improve the detection of Trypanosoma cruzi in single peripheral blood samples from patients with Chagas disease

Abstract INTRODUCTION In order to detect Trypanosoma cruzi and determine the genetic profiles of the parasite during the chronic phase of Chagas disease (ChD), parasitological and molecular diagnostic methods were used to assess the blood of 91 patients without specific prior treatment. METHODS Blood samples were collected from 68 patients with cardiac ChD and 23 patients with an indeterminate form of ChD, followed by evaluation using blood culture and polymerase chain reaction. T . cruzi isolates were genotyped using three different genetic markers. RESULTS: Blood culture was positive in 54.9% of all patients, among which 60.3% had the cardiac form of ChD, and 39.1% the indeterminate form of ChD. There were no significant differences in blood culture positivity among patients with cardiac and indeterminate forms. Additionally, patient age and clinical forms did not influence blood culture results. Polymerase chain reaction (PCR) was positive in 98.9% of patients, although comparisons between blood culture and PCR results showed that the two techniques did not agree. Forty-two T . cruzi stocks were isolated, and TcII was detected in 95.2% of isolates. Additionally, one isolate corresponded to TcIII or TcIV, and another corresponded to TcV or TcVI. CONCLUSIONS Blood culture and PCR were both effective for identifying T. cruzi using a single blood sample, and their association did not improve parasite detection. However, we were not able to establish an association between the clinical form of ChD and the genetic profile of the parasite.

Chronic Chagas cardiomyopathy: a review of the main pathogenic mechanisms and the efficacy of aetiological treatment following the BENznidazole Evaluation for Interrupting Trypanosomiasis (BENEFIT) trial

Chagas cardiomyopathy is the most frequent and most severe manifestation of chronic Chagas disease, and is one of the leading causes of morbidity and death in Latin America. Although the pathogenesis of Chagas cardiomyopathy is incompletely understood, it may involve several mechanisms, including parasite-dependent myocardial damage, immune-mediated myocardial injury (induced by the parasite itself and by self-antigens), and microvascular and neurogenic disturbances. In the past three decades, a consensus has emerged that parasite persistence is crucial to the development and progression of Chagas cardiomyopathy. In this context, antiparasitic treatment in the chronic phase of Chagas disease could prevent complications related to the disease. However, according to the results of the BENEFIT trial, benznidazole seems to have no benefit for arresting disease progression in patients with chronic Chagas cardiomyopathy. In this review, we give an update on the main pathogenic mechanisms of Chagas disease, and re-examine and discuss the results of the BENEFIT trial, together with its limitations and implications.

Trypanosoma cruzi I genotype among isolates from patients with chronic Chagas disease followed at the Evandro Chagas National Institute of Infectious Diseases (FIOCRUZ, Brazil)

ABSTRACT INTRODUCTION: Trypanosoma cruzi is the etiologic agent of Chagas disease in humans, mainly in Latin America. Trypanosome stocks were isolated by hemoculture from patients followed at Evandro Chagas National Institute of Infectious Diseases (FIOCRUZ) and studied using different approaches. METHODS: For species and genotype identification, the stocks were analyzed by parasitological techniques, polymerase chain reaction assays targeted to specific DNA sequences, isoenzyme patterns, besides sequencing of a polymorphic locus of TcSC5D gene (one stock). RESULTS: The isolates presented typical T. cruzi morphology and usually grew well in routine culture media. Metacyclic trypomastigotes were found in cultures or experimentally infected Triatoma infestans. All isolates were pure T. cruzi cultures, presenting typical 330-bp products from kinetoplast DNA minicircles, and 250 or 200-bp amplicons from the mini-exon non-transcribed spacer. Their genetic type assignment was resolved by their isoenzyme profiles. The finding of TcI in one asymptomatic patient from Paraíba was confirmed by the sequencing assay. TcVI was found in two asymptomatic individuals from Bahia and Rio Grande do Sul. TcII was identified in six patients from Pernambuco, Bahia and Minas Gerais, who presented different clinical forms: cardiac (2), digestive with megaesophagus (1), and indeterminate (3). CONCLUSIONS: The main T. cruzi genotypes found in Brazilian chronic patients were identified in this work, including TcI, which is less frequent and usually causes asymptomatic disease, unlike that in other American countries. This study emphasizes the importance of T. cruzi genotyping for possible correlations between the parasite and patient’ responses to therapeutic treatment or disease clinical manifestations.

Commercial enzyme-linked immunosorbent assay versuspolymerase chain reaction for the diagnosis of chronic Chagas disease: a systematic review and meta-analysis

Chronic Chagas disease diagnosis relies on laboratory tests due to its clinical characteristics. The aim of this research was to review commercial enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) diagnostic test performance. Performance of commercial ELISA or PCR for the diagnosis of chronic Chagas disease were systematically searched in PubMed, Scopus, Embase, ISI Web, and LILACS through the bibliography from 1980-2014 and by contact with the manufacturers. The risk of bias was assessed with QUADAS-2. Heterogeneity was estimated with the I2 statistic. Accuracies provided by the manufacturers usually overestimate the accuracy provided by academia. The risk of bias is high in most tests and in most QUADAS dimensions. Heterogeneity is high in either sensitivity, specificity, or both. The evidence regarding commercial ELISA and ELISA-rec sensitivity and specificity indicates that there is overestimation. The current recommendation to use two simultaneous serological tests can be supported by the risk of bias analysis and the amount of heterogeneity but not by the observed accuracies. The usefulness of PCR tests are debatable and health care providers should not order them on a routine basis. PCR may be used in selected cases due to its potential to detect seronegative subjects.

Immunological response to re-infections with clones of the Colombian strain of Trypanosoma cruzi with different degrees of virulence: influence on pathological features during chronic infection in mice

Re-infections with Trypanosoma cruzi are an aggravating factor for Chagas disease morbidity. The Colombian strain of T. cruzi represents multiclonal populations formed by clonally propagating organisms with different tropisms and degrees of virulence. In the present study, the influence of successive inoculations with clones of the Colombian strain, exhibiting different degrees of virulence, on chronic myocarditis and the humoral and cellular immune responses (Col-C1 high virulence, Col-C8 medium virulence and Col-C5 low virulence) were demonstrated. Mice from three groups with a single infection were evaluated during the acute (14th-30th day) and chronic phases for 175 days. An immunofluorescence assay, ELISA and delayed type hypersensitivity (DTH) cutaneous test were also performed. Mice with a triple infection were studied on the 115th-175th days following first inoculation. The levels of IgM and IgG2a were higher in the animals with a triple infection. DTH showed a higher intensity in the inflammatory infiltrate based on the morphometric analysis during a 48 h period of the triple infection and at 24 h with a single infection. The histopathology of the heart demonstrated significant exacerbation of cardiac inflammatory lesions confirmed by the morphometric test. The humoral responses indicate a reaction to the triple infection, even with clones of the same strain.

Comparison of conventional serology and PCR methods for the routine diagnosis of Trypanosoma cruzi infection

Introduction Trypanosoma cruzi, a flagellated protozoan, is the etiologic agent of Chagas disease, and it is estimated that approximately 5 million people in Brazil are infected with this parasite. This work aimed to compare the current diagnostic methods for Chagas disease, including conventional serological (IFAT and ELISA) and molecular techniques (PCR), to introduce PCR as an auxiliary technique. Methods A total of 106 chagasic patients were evaluated: 88 from endemic areas of Parana, 6 from São Paulo, 3 from Minas Gerais, 3 from Rio Grande do Sul, 1 from Bahia and 5 from the Santa Catarina T. cruzi outbreak. The samples were analyzed by conventional serological methods (IFAT, ELISA), hemoculture and PCR to confirm Chagas disease. Results When IFAT was used to determine antibody levels, the sensitivity was 81.7% for patients with the cardiac form of the disease and 100% for the other clinical forms. In contrast, ELISA showed 84% sensitivity and 100% specificity. The use of serological and molecular techniques and their implications for the diagnosis of Chagas disease in non-endemics area are discussed. Conclusions PCR constitutes an excellent support methodology for the laboratory diagnosis of Chagas disease due to its high sensitivity and specificity. .

Chagas en gestantes y transmisión vertical / Chagas in pregnant women and vertical transmission

La enfermedad de Chagas o tripanosomiasis sudamericana, es una parasitosis crónica causada por el protozoario flagelado Tripanosoma cruzi. Este agente puede ser transmitido de la madre al hijo por vía transplacentaria durante la fase aguda y/o crónica de la infección materna. Objetivo: Evaluar la seroprevalencia de la enfermedad de Chagas en gestantes y en niños de madres seropositivas a T. cruzi y su relación con algunos factores condicionantes en el Municipio Roscio del estado Guárico. Métodos: Se realizó un estudio de tipo transversal, estudiando la enfermedad de Chagas en gestantes y en niños (as) nacidos de madres reactivas al T. cruzi. La muestra estuvo conformado por una población representada por todas las gestantes (925) que acudieron al primer control de embarazo en la red primaria de atención, y otra, por los hijos (as) (2) nacidos de madres seropositivas a T. cruzi. Resultados: Se detectaron dos gestantes reactivas utilizando Anticuerpos IgG, obteniéndose una seroprevalencia de 0,22 por ciento. Los dos hijos nacidos de estas madres reactivas resultaron No Reactivos mediante la técnica parasitológica directa (Microhematocrito), confirmando el diagnóstico con ELISA y Hemaglutinación Indirecta.

Expressão de RNAm para TLR 2, TLR 4 e citocinas em infecção experimental por cepas de Trypanosoma cruzi de diferentes origens / mRNA expression to TLR2, TLR4 and cytokines in experimental infection with Trypanosoma cruzi strain of different origins

Receptores Toll-like (TLRs), em células apresentadoras de antígenos, têm importante papel no reconhecimento microbiano e no desenvolvimento da resposta imune adaptativa. Na infecção por T. cruzi, a imunidade celular, medida pela atividade de citocinas pró-inflamatórias, como IL-12 e IFN-γ, do perfil Th1, associadas ao TNF-α, reduz a carga parasitária na fase crônica. Simultaneamente, a IL-4 e a IL-10, do perfil Th2, são responsáveis por amortecer os fortes efeitos da ação pró-inflamatória. Características do parasita, como variação antigênica e diversidade genética das linhagens de T. cruzi, também têm influência na resposta imune do hospedeiro. Assim, este estudo teve como objetivos, em infecção experimental com cepas de diferentes origens de T. cruzi: fazer a caracterização molecular das cepas; determinar os momentos evolutivos da infecção (curva de parasitemia e sobrevida) e verificar a expressão gênica relativa de TLR 2, TLR 4, IL-12p40, IFN-γ,TNF-α, IL-10 e IL-4 em cada momento da infecção. Para isso, foram utilizadas duas cepas de T. cruzi isoladas de pacientes chagásicos crônicos, ZMC e JLP, e a cepa Y de T. cruzi. Camundongos machos Balb/C foram infectados com 104 tripomastigotas/animal e distribuídos em: G1, infectados com a cepa Y; G2, infectados com a cepa ZMC; e G3, infectados com a cepa JLP de T. cruzi. Os momentos para a determinação da expressão gênica das variáveis estudadas foram definidos segundo curva de parasitemia e de sobrevida previamente realizadas: M1: 24 h p.i.; M2: início da fase aguda; M3: fase aguda; M4:momento da queda importante e de manutenção da parasitemia e M5: momento final, determinado pela curva de sobrevida.

Toll-like receptors (TLRs), in antigen-presenting cells, play an important role in microbial recognition and adaptive immune response development. In T. cruzi infection, cellular immunity, mediated by the activity of proinflammatory cytokines such as IL-12 and IFN-γ, of the Th1 profile, associated with TNF-α, reduces parasite load in the chronic phase. Simultaneously, IL-4 and IL-10, of the Th2 profile, are responsible for controlling the strong proinflammatory effects of Th1 profile. Parasite characteristics, such as antigen variation and genetic diversity of T. cruzi strains, also influence host immune response. Hence, by using experimental infection with T. cruzi strains of different origins, this study aimed at: performing the molecular characterization of the strains; determining the evolutive moments of the infection (parasitemia and survival curve) and analyzing the relative gene expression of TLR 2, TLR 4, IL-12p40, IFN-γ,TNF-α, IL-10 and IL-4 at each moment of infection. To that end, two T. cruzi strains, ZMC and JLP, isolated from chronic chagasic patients, and the Y strain of T. cruzi were used. Male Balb/C mice were infected with 104 trypomastigotes/animal and distributed into: G1, infected with the Y strain; G2, infected with the ZMC strain; and G3, infected with the JLP of T. cruzi. The moments for determination of gene expression of the studied variables were defined according to the curve of parasitemia and survival that was previously performed: M1: 24 h p.i.; M2: beginning of the acute phase; M3: acute phase; M4: moment of important decrease and maintenance of parasitemia and M5: final moment, determined by the survival curve.

Accidental infection by Trypanosoma cruzi follow-up by the polymerase chain reaction: case report / Infecção acidental pelo Trypanosoma cruzi acompanhada pela reação em cadeia da polimerase: relato de caso

We report a case of accidental infection by Trypanosoma cruzi in a 42-year-old female patient who presented an inoculation chagoma. Laboratory confirmation was based on examination of fresh blood, Giemsa-stained blood smear, immunoenzyme test (EIA-IgG), indirect immunofluorescence (IIF-IgM, IgG) and polymerase chain reaction (PCR). Only the PCR gave a positive result, and the EIA test was inconclusive. Two treatments with benznidazole were necessary. PCR was the only technique that continued to give positive results for approximately two months (65 days, or 2.2 months) following the second treatment and negative results from 96 days (3.2 months) to 850 days (28.3 months). We concluded that the presence of an inoculation chagoma and use of PCR were important and decisive for diagnosis and follow-up of the case.

Reportamos caso de infecção acidental pelo Trypanosoma cruzi em paciente do gênero feminino, 42 anos, que apresentou chagoma de inoculação. A confirmação laboratorial foi realizada pelo exame de sangue a fresco, esfregaço corado com Giemsa, imunoenzimaensaio (ELISA-IgG), imunofluorescência indireta (IFI-IgM, IgG) e reação em cadeia da polimerase (PCR). Somente a PCR foi positiva e a ELISA foi inconclusiva. Dois tratamentos com benznidazol foram necessários. PCR foi a única técnica que permaneceu positiva por aproximadamente dois meses (65 dias ou 2,2 meses) após o segundo tratamento e negativa de 96 dias (3,2 meses) a 850 dias (28,3 meses). Concluimos que a presença do chagoma de inoculação e o uso da PCR foram importantes e decisivos para o diagnóstico e o acompanhamento do caso.

Diagnosis of Chagas disease: what has been achieved? What remains to be done with regard to diagnosis and follow up studies?

In the acute phase and in the chronic forms of Chagas disease, the etiological diagnosis may be performed by detection of the parasite using direct or indirect parasitological methods and by the presence of antibodies in the serum by way of serological tests. Several techniques are easily available, ranging from the simplest wet smear preparation to immuno-enzymatic assays with recombinant antigens that will meet most diagnostic needs. Other tests under evaluation include a molecular test using polymerase chain reaction, which has shown promising results and may be used as a confirmatory test both in the acute and chronic phases of the disease. Better rapid tests are needed for diagnosis, some of which are already under evaluation. Additionally, there is a need for tools that can identify patients cured shortly after specific treatment. Other needs include a marker for prognosis and early diagnosis of congenital transmission.

Usefulness of PCR-based assays to assess drug efficacy in Chagas disease chemotherapy: value and limitations

One major goal of research on Chagas disease is the development of effective chemotherapy to eliminate the infection from individuals who have not yet developed cardiac and/or digestive disease manifestations. Cure evaluation is the more complex aspect of its treatment, often leading to diverse and controversial results. The absence of reliable methods or a diagnostic gold standard to assess etiologic treatment efficacy still constitutes a major challenge. In an effort to develop more sensitive tools, polymerase chain reaction (PCR)-based assays were introduced to detect low amounts of Trypanosoma cruzi DNA in blood samples from chagasic patients, thus improving the diagnosis and follow-up evaluation after chemotherapy. In this article, I review the main problems concerning drug efficacy and criteria used for cure estimation in treated chagasic patients, and the work conducted by different groups on developing PCR methodologies to monitor treatment outcome of congenital infections as well as recent and late chronic T. cruzi infections.

Back to the future in Chagas disease: from animal models to patient cohort studies, progress in immunopathogenesis research

Despite the wealth of information generated by trans-disciplinary research in Chagas disease, knowledge about its multifaceted pathogenesis is still fragmented. Here we review the body of experimental studies in animal models supporting the concept that persistent infection by Trypanosoma cruzi is crucial for the development of chronic myocarditis. Complementing this review, we will make an effort to reconcile seemingly contradictory results concerning the immune profiles of chronic patients from Argentina and Brazil. Finally, we will review the results of molecular studies suggesting that parasite-induced inflammation and tissue damage is, at least in part, mediated by the activities of trans-sialidase, mucin-linked lipid anchors (TLR2 ligand) and cruzipain (a kinin-releasing cysteine protease). One hundred years after the discovery of Chagas disease, it is reassuring that basic and clinical research tends to converge, raising new perspectives for the treatment of chronic Chagas disease.

Cellular and genetic mechanisms involved in the generation of protective and pathogenic immune responses in human Chagas disease

Perhaps one of the most intriguing aspects of human Chagas disease is the complex network of events that underlie the generation of protective versus pathogenic immune responses during the chronic phase of the disease. While most individuals do not develop patent disease, a large percentage may develop severe forms that eventually lead to death. Although many efforts have been devoted to deciphering these mechanisms, there is still much to be learned before we can fully understand the pathogenesis of Chagas disease. It is clear that the host's immune response is decisive in this process. While characteristics of the parasite influence the immune response, it is becoming evident that the host genetic background plays a fundamental role in the establishment of pathogenic versus protective responses. The involvement of three complex organisms, host, parasite and vector, is certainly one of the key aspects that calls for multidisciplinary approaches towards the understanding of Chagas disease. We believe that now, one hundred years after the discovery of Chagas disease, it is imperative to continue with highly interactive research in order to elucidate the immune response associated with disease evolution, which will be essential in designing prophylactic or therapeutic interventions.

Efficacy of benznidazol treatment for asymptomatic chagasic patients from state of Rio Grande do Sul evaluated during a three years follow-up

The efficacy of benznidazol on the treatment of chagasic patients from the state of Rio Grande do Sul was evaluated during a three-year follow-up. A cohort of 80 asymptomatic chronic chagasic patients or blood bank donors (49 male and 31 female) was studied. Their ages varied from 17-42 years, with a mean and a median of 30 and 35 years, respectively. The 80 patients presented positive serology, hemoculture and polymerase chain reaction (PCR). They were treated with 5 mg/Kg benznidazol twice a day for 60 days. Serological, parasitological and PCR methods were used to evaluate response. Serology was performed using commercial ELISA and indirect immunofluorescence (IFI) tests, parasitemia was monitored by hemoculture in LIT medium and PCR with primers S35/S36 was used to amplify a Trypanosoma cruzi 330 bp kDNA repetitive sequence. PCR positivity of 240 seropositive individuals was compared using DNA preparations from whole blood/guanidine EDTA (GE), buffy-coat/GE and frozen buffy-coat. Fifty non-chagasic individuals were used as negative controls. PCR positivity was 86.7 percent for the frozen buffy-coat, 71.7 percent for the GE/buffy-coat and 69.2 percent for the GE/whole blood. The hemocultures became negative just after treatment and remained negative during the three years of follow-up. In the third year after treatment, 9/80 (11.3 percent) patients presented negative PCR and, from those, four also presented negative serological tests. Furthermore, a reduction in three serological titers was observed in 27/80 (33.8 percent) of the patients treated. Taken together, the results show that four of the 80 (5.0 percent) chronic chagasic patients from the state of Rio Grande do Sul were cured after treatment with benznidazol.

Caracterização de potenciais alvos moleculares e teste de fármacos candidatos ao tratamento da doença de Chagas experimental

No ano de comemoração do centenário de descoberta da doença de Chagas ainda sãomuitos os desafios e as dificuldades na busca de novas alternativas eficazes para otratamento da doença. O objetivo deste trabalho foi caracterizar potenciais alvosmoleculares e testar fármacos candidatos para o tratamento da doença de Chagas. Comoalvos foram analisadas três enzimas: a Tiol Transferase (Tc52), a GlutamatoDesidrogenase (TcGluDH) e a Aldo/ceto Redutase (TcAKR), selecionadas a partir deprévias análises de genômica e proteômica em cepas de Trypanosoma cruzi sensíveis eresistentes ao Benzonidazol. Como potenciais fármacos, foram escolhidos trêsmedicamentos: o Tamoxifeno, a Amiodarona e o Ravuconazol, testados in vitro e in vivo,nas fases aguda e crônica da doença de Chagas experimental. Para os testes in vivo osfármacos foram utilizados isoladamente ou em combinação. Adicionalmente, foi avaliadoo efeito cooperativo do sistema imune na atividade dos inibidores da biossíntese deergosterol, Posaconazol e Ravuconazol. Os resultados mostraram que apenas a TcGluDHfoi diferencialmente expressa, apresentando uma menor expressão da proteína e dorespectivo mRNA nas cepas resistentes ao Benzonidazol em comparação com as cepassensíveis.

Para TcAKR não foi possível completar a caracterização, mas observamos umaumento no nível de mRNA nas cepas resistentes analisadas quando comparada com assensíveis. Não houve correlação entre a expressão da Tc52 e o fenótipo de resistência afármacos do T. cruzi. Nos testes de fármacos, as melhores resultados foram obtidos com aassociação Ravuconazol e Amiodarona: 60% de cura e 90% de sobrevivência doscamundongos infectados e tratados nas fases aguda e crônica. A associação entreAmiodarona e Benzonidazol não gerou efeito sinérgico ou aditivo na cura da doença deChagas experimental. O Tamoxifeno apesar de ter se mostrado potente nos testes in vitrofoi inativo in vivo. Com relação a avaliação da cooperação do sistema imune na atividadedo Posaconazol, nossos resultados mostraram uma nítida influência dos diferentes tipos delinfócitos na atividade desse fármaco assim como para o Benzonidazol. Provavelmente,esse efeito foi devido a ação preferencial desses fármacos sobre diferentes estágios doparasito, em cooperação com diferentes elementos do sistema imune. A utilização decamundongos knockout mostrou que a ausência de Interferon- reduziu a atividade doRavuconazol e Benzonidazol. O presente trabalho abre perspectivas para serem exploradas.

Caracterização de potenciais alvos moleculares e teste de fármacos candidatos ao tratamento da doença de Chagas experimental / Characterization of potential molecular targets and drug test candidates for the treatment of Chagas disease

No ano de comemoração do centenário de descoberta da doença de Chagas ainda sãomuitos os desafios e as dificuldades na busca de novas alternativas eficazes para otratamento da doença. O objetivo deste trabalho foi caracterizar potenciais alvosmoleculares e testar fármacos candidatos para o tratamento da doença de Chagas. Comoalvos foram analisadas três enzimas: a Tiol Transferase (Tc52), a GlutamatoDesidrogenase (TcGluDH) e a Aldo/ceto Redutase (TcAKR), selecionadas a partir deprévias análises de genômica e proteômica em cepas de Trypanosoma cruzi sensíveis eresistentes ao Benzonidazol. Como potenciais fármacos, foram escolhidos trêsmedicamentos: o Tamoxifeno, a Amiodarona e o Ravuconazol, testados in vitro e in vivo,nas fases aguda e crônica da doença de Chagas experimental. Para os testes in vivo osfármacos foram utilizados isoladamente ou em combinação. Adicionalmente, foi avaliadoo efeito cooperativo do sistema imune na atividade dos inibidores da biossíntese deergosterol, Posaconazol e Ravuconazol. Os resultados mostraram que apenas a TcGluDHfoi diferencialmente expressa, apresentando uma menor expressão da proteína e dorespectivo mRNA nas cepas resistentes ao Benzonidazol em comparação com as cepassensíveis.

Para TcAKR não foi possível completar a caracterização, mas observamos umaumento no nível de mRNA nas cepas resistentes analisadas quando comparada com assensíveis. Não houve correlação entre a expressão da Tc52 e o fenótipo de resistência afármacos do T. cruzi. Nos testes de fármacos, as melhores resultados foram obtidos com aassociação Ravuconazol e Amiodarona: 60% de cura e 90% de sobrevivência doscamundongos infectados e tratados nas fases aguda e crônica. A associação entreAmiodarona e Benzonidazol não gerou efeito sinérgico ou aditivo na cura da doença deChagas experimental. O Tamoxifeno apesar de ter se mostrado potente nos testes in vitrofoi inativo in vivo. Com relação a avaliação da cooperação do sistema imune na atividadedo Posaconazol, nossos resultados mostraram uma nítida influência dos diferentes tipos delinfócitos na atividade desse fármaco assim como para o Benzonidazol. Provavelmente,esse efeito foi devido a ação preferencial desses fármacos sobre diferentes estágios doparasito, em cooperação com diferentes elementos do sistema imune. A utilização decamundongos knockout mostrou que a ausência de Interferon- reduziu a atividade doRavuconazol e Benzonidazol. O presente trabalho abre perspectivas para serem exploradas.

Antichagásicos potenciais: busca racional de compostos com ação seletiva pela cruzaína / Potential antichagasic agents: rational design of compounds with selective action in cruzain

A doença de Chagas, parasitose endêmica causada pelo Trypanosoma cruzi, se apresenta como grande causa de morbimortalidade, afetando cerca de 18 milhões de pessoas no continente americano e causando 21.000 mortes, a cada ano. Atualmente, estima-se que 100 milhões de pessoas estejam sob risco de contaminação nos 18 países da área endêmica da doença. A quimioterapia contra a tripanossomíase americana é constituída por apenas dois fármacos, nifurtimox e benznidazol, que não apresentam ação adequada na fase crônica da doença. Por estas razões, é premente a necessidade de novas e mais eficazes alternativas terapêuticas. A cruzaína, mais abundante cisteíno-protease do parasita, é enzima essencial em todos os estágios de modificação celular do parasita e está, também, presente no processo de invasão e modificação do sistema imune do hospedeiro. Além disso, apresenta diferenças em relação a enzimas dessa categoria no hospedeiro. Trata-se, pois, de excelente alvo bioquímico para a pesquisa de novos agentes contra o T. cruzi. Face ao exposto e tendo-se em vista a especificidade da cruzaína, considera-se de grande interesse a compreensão do mecanismo de interação de compostos com essa enzima com o intuito de planejar derivados com atividade antichagásica potencial. O presente trabalho teve o objetivo de elucidar a afinidade de diferentes classes de compostos pela enzima, na busca racional de novos tripanomicidas. Assim, pró-fármacos peptidicos recíprocos, derivados de primaquina(PQ) e de nitrofural(NF), anteriormente sintetizados, e pró-fármacos peptidicos duplos do hidroximetilnitrofural (NFOH) planejados, e cuja síntese foi estudada, foram submetidos a estudos de modelagem molecular e de docking...

Trypanosoma cruzi ribosomal protein S4: characterization of its coding locus, analysis of transcripts, and antigenicity of the protein

Two allelic genomic fragments containing ribosomal protein S4 encoding genes (rpS4) from Trypanosoma cruzi (CL-Brener strain) were isolated and characterized. One allele comprises two complete tandem repeats of a sequence encoding an rpS4 gene. In the other, only one rpS4 gene is found. Sequence comparison to the accessed data in the genome project database reveals that our two-copy allele corresponds to a variant haplotype. However, the deduced aminoacid sequence of all the gene copies is identical. The rpS4 transcripts processing sites were determined by comparison of genomic sequences with published cDNA data. The obtained sequence data demonstrates that rpS4 genes are expressed in epimastigotes, amastigotes, and trypomastigotes. A recombinant version of rpS4 was found to be an antigenic: it was recognized by 62.5 percent of the individuals with positive serology for T. cruzi and by 93.3 percent of patients with proven chronic chagasic disease.