Evaluating Chagas disease progression and cure through blood-derived biomarkers: a systematic review

Abstract

This article reviews the usefulness of various types of blood-derived biomarkers that are currently being studied to predict the progression of Chagas disease in patients with the indeterminate form, to assess the efficacy of antiparasitic drugs and to identify early cardiac and gastrointestinal damage. The authors used a search strategy based on MEDLINE, Cochrane Library Register for systematic review, EmBase, Global Health and LILACS databases. Out of 1716 screened articles, only 166 articles were eligible for final inclusion. The authors classified the biomarkers according to their biochemical structure and primary biological activity in four groups: i) markers of inflammation and cellular injury, ii) metabolic biomakers, iii) prothrombotic biomarkers and iv) markers derived from specific antigens of the parasite. Several potential biomarkers might have clinical potential for the detection of early cardiopathy. Such capacity is imperative in order to detect high-risk patients who require intensive monitoring and earlier therapy. Prospective studies with longer follow-ups are needed for the appraisal of biomarkers assessing clinical or microbiological cure after therapy. At the same time, studies evaluating more than one biomarker are useful to compare the efficacy among them given the lack of a recognized gold standard.

Chagas disease research and development: Is there light at the end of the tunnel?

“…cruzi antibodies (lytic antibodies, anti-Tc24, multiplex serological analysis to name but a few), or the host response (Anti- T . cruzi T-cell responses, transcriptomics, differential gene expression and non-specific markers) have not led to a major breakthrough [45], [46].…”

Inflammatory and cardiac biomarkers are differentially expressed in clinical stages of Chagas disease

“…Biomarkers are urgently needed in the case of T. cruzi infection since there is a long clinically silent period from acute infection to development of clinical signs and symptoms of chronic Chagas which occur in ~30% of infected individuals [6]. During the early phase, vector-derived and blood-form parasite trypomastigotes actively infect macrophages and tissue, forming intracytoplasmic cyst-like collections.…”

A Parasite Biomarker Set for Evaluating Benznidazole Treatment Efficacy in Patients with Chronic Asymptomatic Trypanosoma cruzi Infection

“…The lack of appropriate clinical and biomarker tools limits the direct measurement of the treatment efficacy for many neglected tropical diseases. In the case of Chagas disease, one of the greatest current challenges is the establishment of early markers that allow for the evaluation of the therapeutic efficacy of the available (benznidazole and nifurtimox) and newly proposed drugs (34,35). Existing serological tests have high sensitivity and specificity and are able to diagnose chronic patients via the conversion to negative serology that is associated with parasitological cure (36).…”