Programa de Farmacología Molecular y Clínica, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Programa em Ciências da Saúde, Doenças Infecciosas e Medicina Tropical/ Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
PLoS Negl Trop Dis. 2021 Nov 16;15(11):e0009978. doi: 10.1371/journal.pntd.0009978. eCollection 2021 Nov.
Chagas disease, caused by the protozoan Trypanosoma cruzi, is endemic in Latin America and is widely distributed worldwide because of migration. In 30% of cases, after years of infection and in the absence of treatment, the disease progresses from an acute asymptomatic phase to a chronic inflammatory cardiomyopathy, leading to heart failure and death. An inadequate balance in the inflammatory response is involved in the progression of chronic Chagas cardiomyopathy. Current therapeutic strategies cannot prevent or reverse the heart damage caused by the parasite. Aspirin-triggered resolvin D1 (AT-RvD1) is a pro-resolving mediator of inflammation that acts through N-formyl peptide receptor 2 (FPR2). AT-RvD1 participates in the modification of cytokine production, inhibition of leukocyte recruitment and efferocytosis, macrophage switching to a nonphlogistic phenotype, and the promotion of healing, thus restoring organ function. In the present study, AT-RvD1 is proposed as a potential therapeutic agent to regulate the pro-inflammatory state during the early chronic phase of Chagas disease.
METHODOLOGY/PRINCIPAL FINDINGS: C57BL/6 wild-type and FPR2 knock-out mice chronically infected with T. cruzi were treated for 20 days with 5 μg/kg/day AT-RvD1, 30 mg/kg/day benznidazole, or the combination of 5 μg/kg/day AT-RvD1 and 5 mg/kg/day benznidazole. At the end of treatment, changes in immune response, cardiac tissue damage, and parasite load were evaluated. The administration of AT-RvD1 in the early chronic phase of T. cruzi infection regulated the inflammatory response both at the systemic level and in the cardiac tissue, and it reduced cellular infiltrates, cardiomyocyte hypertrophy, fibrosis, and the parasite load in the heart tissue.
CONCLUSIONS/SIGNIFICANCE: AT-RvD1 was shown to be an attractive therapeutic due to its regulatory effect on the inflammatory response at the cardiac level and its ability to reduce the parasite load during early chronic T. cruzi infection, thereby preventing the chronic cardiac damage induced by the parasite.
恰加斯病由原生动物克氏锥虫引起,在拉丁美洲流行,并因移民而广泛分布于世界各地。在 30%的病例中,经过多年的感染且未经治疗,疾病会从急性无症状期进展为慢性炎症性心肌病,导致心力衰竭和死亡。炎症反应的不平衡参与了慢性恰加斯心肌病的进展。目前的治疗策略不能预防或逆转寄生虫引起的心脏损伤。阿司匹林诱导的分辨率 D1(AT-RvD1)是一种炎症的促解决介质,通过 N 甲酰肽受体 2(FPR2)发挥作用。AT-RvD1 参与细胞因子产生的修饰、白细胞募集和吞噬作用的抑制、巨噬细胞向非炎症表型的转换以及愈合的促进,从而恢复器官功能。在本研究中,AT-RvD1 被提议作为一种潜在的治疗剂,以调节恰加斯病慢性早期的促炎状态。
方法/主要发现:用 5μg/kg/天 AT-RvD1、30mg/kg/天苯硝唑或 5μg/kg/天 AT-RvD1 和 5mg/kg/天苯硝唑联合治疗慢性感染 T. cruzi 的 C57BL/6 野生型和 FPR2 敲除小鼠 20 天。在治疗结束时,评估免疫反应、心脏组织损伤和寄生虫负荷的变化。在 T. cruzi 感染的慢性早期阶段给予 AT-RvD1 可调节全身和心脏组织中的炎症反应,并减少细胞浸润、心肌细胞肥大、纤维化和心脏组织中的寄生虫负荷。
结论/意义:由于 AT-RvD1 对心脏水平的炎症反应具有调节作用,并能在早期慢性 T. cruzi 感染时降低寄生虫负荷,从而预防寄生虫引起的慢性心脏损伤,因此被认为是一种有吸引力的治疗方法。