Avaliação do etilismo no perfil inflamatórios de pacientes em diferentes condições para a Doença de Chagas

Abstract

Chagas disease is a parasitic infection caused by the protozoan Trypanosoma cruzi and transmitted by triatomine vectors. In the past, it was restricted to Latin American countries, but increasing migration has changed this panorama and it is now reported on practically every continent in the world. Clinical manifestations can occur in the acute and chronic phases, with a special focus on the more severe forms that may cause potentially fatal cardiac and/or gastrointestinal involvement. The pathophysiology of Chagas disease is complex, involving a variety of elements of the immune response, such as antibodies, CD8+ and CD4+ T lymphocytes, as well as pro-inflammatory cytokines during the acute phase. However, as the disease progresses to the chronic phase, the immune response is characterised by the predominant activity of Th1 cytokines, with low expression of the Th2 profile, especially in patients with cardiac and gastrointestinal exacerbations. It can be challenging to diagnose and treat the disease at an early stage, as the initial symptoms are often mild and many cases are only identified in the chronic phase. In this phase, pharmacological treatment presents a challenge. The addition of unhealthy lifestyle habits, such as alcohol consumption, may contribute to the worsening course of the disease. In light of these considerations, it became apparent that there was a need to gain a deeper understanding of the potential impact of alcohol consumption on the immune response during the course of Chagas disease. This led to the development of two products, the result of a collaborative effort between various research groups. In the first study, an integrative literature review was carried out with the aim of reporting the various biomarkers described for Chagas cardiomyopathy. This included an attempt to describe the clinical and pathophysiological significance of these biomarkers in different contexts. The study aimed to synthesise and integrate the main scientific evidence available in the literature on the subject, in order to provide a comprehensive overview. It seems that the biomarkers BNP, NT-proBNP, Troponin, and CKMB, which relate to the severity and risk of Chagas cardiomyopathy, show consistent associations. It would appear that there is a significant association between MMP-2, MMP-9, TNF-α, IL-6, IL-8, IL-10 and the progression of heart disease. The biomarkers BNP, NT-proBNP, troponin and CKMB, which have been linked to the severity and risk of Chagas cardiomyopathy, demonstrated consistent associations. Furthermore, MMP-2, MMP-9, TNF-α, IL-6, IL-8 and IL-10 were identified as having significant associations. Other biomarkers, such as galectin-3 and DHEA-S, also exhibited significant associations, which could potentially lead to new diagnostic approaches. The second article sought to assess the potential impact of alcohol consumption on the levels of biomarkers involved in the context of inflammation and cardiac aggravation in CD. A comparative statistical and correlation analysis was carried out on serum samples from patients in the National Heart Lung and Blood Institute (NHLBI) Retrovirus Epidemiology Donor Study-II (REDS-II), with the aim of presenting interesting results. The biomarkers sVCAM, sICAM, MMP, MPO, IL-1β, IL-6 and INFγ yielded some interesting results in different groups, including alcoholics and non-alcoholics. Nevertheless, it is notable that the correlation indices observed in the groups of alcohol consumers were somewhat higher. These findings suggest that there may be a potential link between alcohol consumption and the progression of inflammation. While the results are certainly interesting, further studies would undoubtedly help to elucidate the possible mechanisms and impact of these alterations on the progression of Chagas disease.