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INFLAMMATION ENHANCES THE RISKS OF STROKE AND DEATH IN CHRONIC CHAGAS DISEASE PATIENTS
Author
Guedes, Paulo Marcos Matta
Andrade, Cléber Mesquita de
Nunes, Daniela Ferreira
Pereira, Nathalie de Sena
Queiroga, Tamyres Bernadete Dantas
Coelho, George Luiz Lins Machado
Nascimento, Manuela Sales Lima
Matta, Maria Adelaide Do Valle
Câmara, Antônia Cláudia Jácome da
Chiari, Egler
Galvão, Lúcia Maria da Cunha
Andrade, Cléber Mesquita de
Nunes, Daniela Ferreira
Pereira, Nathalie de Sena
Queiroga, Tamyres Bernadete Dantas
Coelho, George Luiz Lins Machado
Nascimento, Manuela Sales Lima
Matta, Maria Adelaide Do Valle
Câmara, Antônia Cláudia Jácome da
Chiari, Egler
Galvão, Lúcia Maria da Cunha
Affilliation
Universidade Federal do Rio Grande do Norte. Departamento de Microbiologia e Parasiologia. Natal, RN, Brasil
Universidade do Estado do Rio Grande do Norte. Departamento de Ciências Biomédicas. Mossoró, RN, Brasil.
Universidade Federal de Minas Gerais. Departamento de Parasitologia. Belo Horizonte, MG, Brasil.
Universidade Federal do Rio Grande do Norte. Departamento de Microbiologia e Parasiologia. Natal, RN, Brasil / Universidade Federal de Minas Gerais. Departamento de Parasitologia. Belo Horizonte, MG, Brasil.
Universidade Federal do Rio Grande do Norte. Departamento de Microbiologia e Parasiologia. Natal, RN, Brasil
Universidade Federal de Ouro Preto. Escola de Medicina. Ouro Preto, MG, Brasil.
Univrsidade de São Paulo. Escola de Medicina de Ribeirão Preto. Ribeirão Preto, SP, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório deUltraestrutura Celular. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio Grande do Norte. Departmaneto de Análises Clínicas e Toxicológicas. Natal, RN, Brasil.
Universidade Federal de Minas Gerais. Departamento de Parasitologia. Belo Horizonte, MG, Brasil.
Universidade do Estado do Rio Grande do Norte. Departamento de Ciências Biomédicas. Mossoró, RN, Brasil.
Universidade Federal de Minas Gerais. Departamento de Parasitologia. Belo Horizonte, MG, Brasil.
Universidade Federal do Rio Grande do Norte. Departamento de Microbiologia e Parasiologia. Natal, RN, Brasil / Universidade Federal de Minas Gerais. Departamento de Parasitologia. Belo Horizonte, MG, Brasil.
Universidade Federal do Rio Grande do Norte. Departamento de Microbiologia e Parasiologia. Natal, RN, Brasil
Universidade Federal de Ouro Preto. Escola de Medicina. Ouro Preto, MG, Brasil.
Univrsidade de São Paulo. Escola de Medicina de Ribeirão Preto. Ribeirão Preto, SP, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório deUltraestrutura Celular. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio Grande do Norte. Departmaneto de Análises Clínicas e Toxicológicas. Natal, RN, Brasil.
Universidade Federal de Minas Gerais. Departamento de Parasitologia. Belo Horizonte, MG, Brasil.
Abstract
Ischemic strokes have been implicated as a cause of death in Chagas disease patients.
Inflammation has been recognized as a key component in all ischemic processes, including
the intravascular events triggered by vessel interruption, brain damage and repair. In this
study, we evaluated the association between inflammatory markers and the death risk (DR)
and stroke risk (SR) of patients with different clinical forms of chronic Chagas disease. The
mRNA expression levels of cytokines, transcription factors expressed in the adaptive immune
response (Th1, Th2, Th9, Th17, Th22 and regulatory T cell), and iNOS were analyzed by realtime
PCR in peripheral blood mononuclear cells of chagasic patients who exhibited the indeterminate,
cardiac, digestive and cardiodigestive clinical forms of the disease, and the levels of
these transcripts were correlated with the DR and SR. Cardiac patients exhibited lowermRNA
expression levels of GATA-3, FoxP3, AHR, IL-4, IL-9, IL-10 and IL-22 but exhibited higher
expression of IFN-γ and TNF-α compared with indeterminate patients. Digestive patients
showed similar levels of GATA-3, IL-4 and IL-10 than indeterminate patients. Cardiodigestive
patients exhibited higher levels of TNF-α compared with indeterminate and digestive patients.
Furthermore, we demonstrated that patients with high DR and SR exhibited lower GATA-3,
FoxP3, and IL-10 expression and higher IFN-γ, TNF-α and iNOS mRNA expression than
patients with low DR and SR. A negative correlation was observed between Foxp3 and IL-10
mRNA expression and the DR and SR. Moreover, TNF-α and iNOS expression was positively
correlated with DR and SR. Our data suggest that an inflammatory imbalance in chronic Chagas
disease patients is associated with a high DR and SR. This study provides a better understanding
of the stroke pathobiology in the general population and might aid the development of
therapeutic strategies for controlling the morbidity and mortality of Chagas disease.
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