De Alba-Alvarado Mariana, Salazar-Schettino Paz María, Jiménez-Álvarez Luis, Cabrera-Bravo Margarita, García-Sancho Cecilia, Zenteno Edgar, Vazquez-Antona Clara, Cruz-Lagunas Alfredo, Zúñiga Joaquín, Bucio-Torres Martha Irene
Department of Microbiology and Parasitology, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
Acta Trop. 2018 Feb;178:134-141. doi: 10.1016/j.actatropica.2017.11.009. Epub 2017 Nov 24.
In Chagas disease the clinical, acute and chronic manifestations are the result of the interaction between the parasite and the host factors. The balance between inflammatory and anti-inflammatory immune responses is essential for the increase or resolution of the manifestations in individuals infected with T. cruzi. To identify if children with chronic Chagas disease and heart injury is related with non-regulated Th1, Th2 and Th17 responses. We included 31 children with T. cruzi confirmed chronic infection from endemic areas of Mexico. Subsequently, they were separated according to their ECHO and ECG results into three groups according to the severity of cardiac involvement. Circulating Th1, Th2 and Th17 cytokine profiles were performed by Luminex assays and the results were analyzed by bivariate and multivariable analysis. Patients were classified in asymptomatic chronic (group 1, N=12); individuals with IRBBB in ECG and incipient lesions in ECHO (Group 2, N=8) and Patients with severe chronic symptomatic disease (Group 3, N=11). The analysis of immune mediators revealed that patients with severe cardiac manifestations had significant higher levels (p <0.05) of Th17 related cytokines including IL-17 and IL-6 as well as IFN-γ and IL-2. Also patients with severe cardiomyopathy exhibit increased levels of IL-13 (p <0.05) after multivariate analysis. High levels of Th17 related cytokines including IL-17, IFN-γ, IL-6 and IL-2 and pro-fibrotic factors such as IL-13 could be associated to the severity of cardiac involvement in children with chronic T. cruzi infection. These cytokines could be useful as indicators for the early identification of cardiac damage associated to the T. cruzi infection.
在恰加斯病中，临床急性和慢性表现是寄生虫与宿主因素相互作用的结果。炎症和抗炎免疫反应之间的平衡对于克氏锥虫感染个体中症状的加重或缓解至关重要。为了确定慢性恰加斯病合并心脏损伤的儿童是否与不受调控的Th1、Th2和Th17反应有关。我们纳入了31名来自墨西哥流行地区的经证实为克氏锥虫慢性感染的儿童。随后，根据他们的超声心动图（ECHO）和心电图（ECG）结果，按照心脏受累的严重程度将他们分为三组。通过Luminex检测法检测循环中的Th1、Th2和Th17细胞因子谱，并通过双变量和多变量分析对结果进行分析。患者被分为无症状慢性组（第1组，N = 12）；心电图有不完全性右束支传导阻滞（IRBBB）且超声心动图有早期病变的个体（第2组，N = 8）和患有严重慢性症状性疾病的患者（第3组，N = 11）。免疫介质分析显示，有严重心脏表现的患者中，包括白细胞介素-17（IL-17）和白细胞介素-6（IL-6）以及干扰素-γ（IFN-γ）和白细胞介素-2（IL-2）在内的与Th17相关的细胞因子水平显著更高（p <0.05）。多变量分析后还发现，患有严重心肌病的患者白细胞介素-13（IL-13）水平升高（p <0.05）。包括IL-17、IFN-γ、IL-6和IL-2在内的高水平Th17相关细胞因子以及诸如IL-13等促纤维化因子可能与慢性克氏锥虫感染儿童的心脏受累严重程度有关。这些细胞因子可作为早期识别与克氏锥虫感染相关心脏损伤的指标。
