Chagas heart disease: pathophysiologic mechanisms, prognostic factors and risk stratification

Rassi, Anis; Marin-Neto, José Antônio

doi:10.1590/s0074-02762009000900021

Cited by 157 publications

(151 citation statements)

References 48 publications

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“…3 Initially, cardiac dysfunction is characterized by conduction disorders, which can then progress to cardiomyopathy and even sudden cardiac death. 4 An estimated 1.17 million people suffer from chagasic cardiomyopathy in Latin America, 5 and it is the leading cause of cardiovascular death in persons between ages 30-50 living in endemic areas. 6 Current pharmacological treatments (nifurtimox and benznidazole) have poor efficacy beyond the acute phase of disease, with serological cure rates of only 5% to 20% in the chronic phase.…”

Section: Introductionmentioning

confidence: 99%

A therapeutic nanoparticle vaccine againstTrypanosoma cruziin a BALB/c mouse model of Chagas disease

Barry

Wang

Jones

et al. 2016

Human Vaccines & Immunotherapeutics

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Chagas disease, caused by Trypanosoma cruzi, results in an acute febrile illness that progresses to chronic chagasic cardiomyopathy in 30% of patients. Current treatments have significant side effects and poor efficacy during the chronic phase; therefore, there is an urgent need for new treatment modalities. A robust T H 1-mediated immune response correlates with favorable clinical outcomes. A therapeutic vaccine administered to infected individuals could bolster the immune response, thereby slowing or stopping the progression of chagasic cardiomyopathy. Prior work in mice has identified an efficacious T. cruzi DNA vaccine encoding Tc24. To elicit a similar protective cell-mediated immune response to a Tc24 recombinant protein, we utilized a poly(lactic-co-glycolic acid) nanoparticle delivery system in conjunction with CpG motif-containing oligodeoxynucleotides as an immunomodulatory adjuvant. In a BALB/c mouse model, the vaccine produced a T H 1-biased immune response, as demonstrated by a significant increase in antigen-specific IFNg-producing splenocytes, IgG2a titers, and proliferative capacity of CD8 C T cells. When tested for therapeutic efficacy, significantly reduced systemic parasitemia was seen during peak parasitemia. Additionally, there was a significant reduction in cardiac parasite burden and inflammatory cell infiltrate. This is the first study demonstrating immunogenicity and efficacy of a therapeutic Chagas vaccine using a nanoparticle delivery system.

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Section: Introductionmentioning

confidence: 99%

A therapeutic nanoparticle vaccine againstTrypanosoma cruziin a BALB/c mouse model of Chagas disease

Barry

Wang

Jones

et al. 2016

Human Vaccines & Immunotherapeutics

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“…Chagas disease is described as having two distinctive phases, the acute phase and the chronic phase [10], with an intermediate period known as the indeterminate phase, when patients are asymptomatic but parasite carriers. It has been estimated that approximately 30% of infected persons evolve toward the chronic phase, which may include pathological involvement/damage to the heart, esophagus and/or colon [11].…”

Section: Introductionmentioning

confidence: 99%

“…It has been estimated that approximately 30% of infected persons evolve toward the chronic phase, which may include pathological involvement/damage to the heart, esophagus and/or colon [11]. Cardiac damage is the most severe and frequent outcome [10]. Chagas cardiac disease (CCD) is also the most common cause of heart disease in Latin America and, in endemic areas, it is the first cause of cardiovascular death in subjects between 30 and 50 years old [4].…”

Section: Introductionmentioning

confidence: 99%

ELISA seroprevalence of Trypanosoma cruzi in a cohort of heart disease patients

Rodriguez

Hernandez

Garcia

et al. 2013

J Infect Dev Ctries

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Introduction: Chagas disease is the most important parasitic disease in El Salvador and Latin America. The disease has two phases: acute and chronic, with an intermediate unspecified phase. The chronic phase develops in 30% of infected persons and its most common manifestation is cardiac disease. This study aimed to obtain reference data for the prevalence of T. cruzi seropositivity in a cohort of cardiac patients. Methodology: A cross-sectional study involving consecutive heart disease patients consulting at the National Hospital Rosales was conducted over a six-month period. Congenital heart disease patients were excluded. A survey, file review, and ELISA serological test were conducted for each subject. Results: Out of 455 subjects, 76 were seropositive for T. cruzi, giving a seropositivity prevalence of 16.7%. The average age of the patients was 58.09 years and the female:male ratio was 2.79:1. No significant difference was found between T. cruzi seropositive and seronegative patients in terms of age and gender. No association between T. cruzi serological status and either area of residence or seeing vectors in the house was found. However, living in the Salvadoran western region during childhood was significantly associated with seropositivity (p = 0.003). Other factors associated with T. cruzi seropositivity included: clinical diagnosis of cardiac Chagas disease; electrocardiographic (ECG) findings of a permanent pacemaker, all atrioventricular (AV) blocks and right bundle branch block; and grade III-IV radiological cardiomegaly. Conclusions: T. cruzi seropositivity prevalence was found to be 16.7% among heart disease patients in a public reference hospital.

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“…Electrocardiographic (ECG) alterations are also observed in patients; these include diffuse ST-T repolarization changes as well as low voltage, conduction problems, left anterior hemiblock and combined blocks (Blum et al 2008). At the chronic phase, roughly 30% of patients present cardiac dysrhythmia, heart failure and thromboembolism (both systemic and pulmonary) (Rassi et al 2009). A depressed left-ventricular ejection fraction and increased left-ventricular internal dimensions have been shown to be associated with increased morbidity and mortality (Rassi et al 2006, Acquatella 2007.…”

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confidence: 99%

The benefits of using selenium in the treatment of Chagas disease: prevention of right ventricle chamber dilatation and reversion of Trypanosoma cruzi-induced acute and chronic cardiomyopathy in mice

Souza¹,

Jelicks²,

Tanowitz

et al. 2010

Mem. Inst. Oswaldo Cruz

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Chagas heart disease: pathophysiologic mechanisms, prognostic factors and risk stratification

Abstract: Chagas heart disease (CHD) results from infection with the protozoan parasite

Cited by 157 publications

References 48 publications

A therapeutic nanoparticle vaccine againstTrypanosoma cruziin a BALB/c mouse model of Chagas disease

A therapeutic nanoparticle vaccine againstTrypanosoma cruziin a BALB/c mouse model of Chagas disease

ELISA seroprevalence of Trypanosoma cruzi in a cohort of heart disease patients

The benefits of using selenium in the treatment of Chagas disease: prevention of right ventricle chamber dilatation and reversion of Trypanosoma cruzi-induced acute and chronic cardiomyopathy in mice

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