A doença de Chagas representa um problema de saúde pública em muitos países e regiões. O tratamento consiste em fármacos tóxicos, com eficácia discutível, principalmente, na fase crônica da doença. Assim, faz-se necessário o planejamento de novos quimioterápicos, mais seguros e eficazes. Os dendrímeros são novas arquiteturas moleculares formadas por um foco central e ramificações partindo desse foco. Apresentam diversas aplicações biológicas como, por exemplo, atuar como transportadores de fármacos. Face ao exposto, o objetivo deste trabalho foi o estudo de condições para ligar o ácido anacárdico (AA) em derivado dendrimérico com potencial ação na doença de Chagas, o qual tem como foco central o ácido succínico (AS) e ramificações compostas por arginina (Arg) e lisina (Lys). Sabe-se que a cruzaína, uma cisteíno-protease do T. cruzi, catalisa a hidrólise de ligação peptídica entre lisina e arginina. A síntese dos compostos em fase sólida forneceu os derivados brutos: (1) pró-fármaco AA-K-R-NH2 e (2) G.05 AA-K(AS)-R-NH2, que foram purificados e caracterizados por Cromatografia Líquida de Alta Eficiência e espectrometria de massas. Os compostos purificados AA-K-R-NH2 e AA-K(AS)-R-NH2 apresentaram rendimentos de 34% e 47%, com pureza de 88% e 98%, respectivamente. Os resultados dos experimentos enzimáticos utilizando o AA-K-R-NH2 não foram conclusivos. Acredita-se que a baixa solubilidade e/ou baixa concentração podem ter contribuído para tal. Já na estabilidade química em pH 7,4 (que simula pH sanguíneo), pH 1,2 (que simula pH estomacal) e pH 8,5 (que simula pH intestinal), observou-se que o AA-K(AS)-R-NH2 foi estável durante as 24 h de ensaio. Estes últimos resultados são interessantes, pois espera-se que o pró-fármaco dendrimérico alcance o T. cruzi estruturalmente integro, sofrendo hidrólise e liberação do composto ativo no interior do parasita. / Chagas disease is a public health problem in many countries and regions. The treatment consists of toxic drugs, with debatable efficacy, mainly, in the chronic phase of the disease. Thus, it is necessary to plan new chemotherapeutics, safer and more effective than those drugs. Dendrimers are new molecular architectures composed by a central focus and branching from that focus. They present several biological applications, such as acting as drug carriers. Thereby, the goal of this work was the study of conditions to bind anacardic acid (AA) in a dendrimeric derivative with potential action in Chagas disease, which was composed by a central focus of succinic acid (AS) and branches of arginine (Arg) and lysine (Lys). Cruzain, a T. cruzi cysteine protease, is known to catalyze the peptide-binding hydrolysis between lysine and arginine. Synthesis of the solid phase compounds provided the crude derivatives: (1) prodrug AA-KR-NH2 and (2) G.05 AA-K(AS)-R-NH2, which were purified and characterized by High Performance Liquid Chromatography (HPLC) and mass spectrometry. The purified AA-K-R-NH2 and AA-K(AS)-R-NH2 compounds showed yields of 34% and 47%, with purity of 88% and 98% respectively. The results of the enzymatic experiments using AA-K-R-NH2 were not conclusive. It is believed that the low solubility and/or low concentration may have contributed for this. On the chemical stability at pH 7.4 (which simulates blood pH), pH 1.2 (which simulates stomach pH) and pH 8.5 (which simulates intestinal pH), it was observed that AA-K(AS)R-NH2 was stable for 24 hours. These latter results are interesting because the dendrimeric prodrug is expected to reach structurally integral T. cruzi, undergoing hydrolysis and release of the active compound within the parasite.

Uma fração considerável de pacientes com doença de Chagas, decorrente da infecção pelo protozoário Trypanosoma cruzi, desenvolve a cardiopatia crônica, que pode levar a morte. A regulação da resposta imune específica contra o parasita é essencial para controlar a atividade efetora excessiva anti-T. cruzi. Na falta dessa regulação, a resposta imune acaba por induzir lesão dos tecidos. Uma vez que, em hipótese, componentes autoimune participam da cardiopatia chagásica, a regulação da resposta poderia ser necessária para controlar a reatividade contra o próprio. Nesta tese, nós avaliamos o envolvimento das células T reguladoras (TREG) em modelo murino de doença crônica de Chagas. Na fase aguda, período em que ocorre uma forte ativação policlonal de linfócitos, observa-se um pequeno aumento no número de células esplênicas CD4+CD25+FoxP3+ TREG, no entanto, um aumento de maior magnitude ocorre nas células efetoras CD4+CD25+FoxP3-. O tratamento de camundongos na fase aguda da infecção com MoAb anti-CD25 (PC61) resulta em discreta redução no número de células TREG, mas essa não afeta os níveis de parasitemia ou patologia do coração na fase aguda. Na fase crônica, os números de células TREG dos animais crônicos retornam aos mesmos níveis dos observados nos animais não infectados, no entanto, o número de esplenócitos CD4+ está discretamente aumentado. O tratamento de camundongos crônicos com PC61 resulta em uma redução no número de células TCD4+CD25+ e uma tendência à redução no número de células CD4+FoxP3+. Mais importante, a resposta imune anti- T. cruzi, carga parasitária sistêmica e patologia cardíaca não foram consistentemente alteradas nos grupos tratados com PC61 em comparação aos tratados com o controle isotípico ou IgG de rato. O fato do tratamento com MoAb PC61 não modificar a patologia do coração de camundongos crônicos pode ser devido a depleção incompleta das células TREG, ou a um pequeno envolvimento das TREG no controle dos mecanismos efetores anti- T. cruzi. / A large fraction of patients with Chagas disease, an illness due to infection by protozoan Trypanosoma cruzi, develops chronic myocardiopathy that often leads to death. Regulation of parasite-specific immune responses is essential to control excessive anti-T. cruzi effector activity that may result in tissue damage. Moreover, because autoimmunity has been hypothesized to contribute to Chagas myocardiopathy, regulation could be also necessary to control anti-self reactivity. In this paper we evaluated the involvement of TREG in a murine model of chronic T. cruzi infection. In the acute phase, a period when there is strong polyclonal lymphocyte activation, a small increase in the number of CD4+CD25+FoxP3+ spleen cells (TREG) cells is observed, albeit of considerably lower magnitude than that of CD4+CD25+FoxP3- effector cells. Treatment of acutely-infected mice with anti-CD25 (PC61) mAb results in discrete reduction of TREG cell numbers, but it does not affect parasitaemia levels or acute phase heart pathology. At the chronic phase, TREG cells numbers return to numbers of non-infected mice, in spite that the total number of CD4+ splenocytes is discretely increased in chronic mice. Treatment of chronic mice with PC61 results in a reduction in TCD4+CD25+ cell numbers, but in a small, non significant reduction in total CD4+FoxP3+ cells. More important, the anti-T. cruzi immune response, systemic parasite load and heart pathology were not consistently altered in PC61-treated chronic mice compared to mice treated with isotypic control antibodies or normal rat IgG. Failure to modify heart pathology in PC61-treated chronic mice could be due to incomplete TREG depletion or to discrete involvement of TREG in control of the anti-T. cruzi effector mechanisms.

<p>This thesis analyses several factors affecting the control of triatomines in Guatemala. There are three synantropic triatomines in Guatemala, i.e., <i>Rhodnius prolixus</i>, <i>Triatoma dimidiata</i> and <i>T. nitida</i>. Their distibution is mainly at an altitude between 800 and 1500 m a.s.l. <i>R. prolixus</i> and <i>T. nitida</i> have localized but scaterred distibution while <i>T. dimidiata</i> is present in 21 of the 22 departments in the country. Several investigations have shown that <i>R. prolixus</i> could be relatively easily eradicated while <i>T. dimidiata</i> may be more difficult to control, since it is present in domestic, peridomestic and sylvatic environments showing high diversity and a variety of epidemiological characteristics. Based on the incidence of <i>Trypanosma cruzi</i> infection in humans in the distributional areas of the triatomines, <i>R. prolixus</i> appear to be a more competent vector than <i>T. dimidiata</i>. This is despite the fact that these vectors have similar infection rates. Inside houses, <i>R. prolixus</i> and <i>T. dimidiata</i> and in artificial environments, <i>T. ryckmani</i> and <i>T. dimidiata</i>, preferred the northern side of the walls. Therefore, selective application of insecticides should focus on walls and furniture located in the northern part of the house. House improvements reduced the infestation of triatomines, and could be used as a complement to insecticidal spraying. Although <i>T. dimidiata</i> is not an efficient vector its wide distribution, versatility in occupying different habitats and capacity to disperse render this species difficult to control in Central America. Thus, only few months after insecticidal spraying <i>T. dimidiata</i> had reinfested the domestic environments. Morphometic methodology and genetic markers have been developed to differentiate within-species populations of <i>T. dimidiata</i> and <i>T. nitida</i>. Studies on the migration patterns of sylvatic <i>T. dimidiata</i> and <i>T. ryckmani</i> have been performed in order to clarify the colonization patterns. The adults migrate, in particular, in the dry part of the year. This finding may be of help in attempts to control <i>T. dimidiata</i>.</p>

This thesis analyses several factors affecting the control of triatomines in Guatemala. There are three synantropic triatomines in Guatemala, i.e., Rhodnius prolixus, Triatoma dimidiata and T. nitida. Their distibution is mainly at an altitude between 800 and 1500 m a.s.l. R. prolixus and T. nitida have localized but scaterred distibution while T. dimidiata is present in 21 of the 22 departments in the country. Several investigations have shown that R. prolixus could be relatively easily eradicated while T. dimidiata may be more difficult to control, since it is present in domestic, peridomestic and sylvatic environments showing high diversity and a variety of epidemiological characteristics. Based on the incidence of Trypanosma cruzi infection in humans in the distributional areas of the triatomines, R. prolixus appear to be a more competent vector than T. dimidiata. This is despite the fact that these vectors have similar infection rates. Inside houses, R. prolixus and T. dimidiata and in artificial environments, T. ryckmani and T. dimidiata, preferred the northern side of the walls. Therefore, selective application of insecticides should focus on walls and furniture located in the northern part of the house. House improvements reduced the infestation of triatomines, and could be used as a complement to insecticidal spraying. Although T. dimidiata is not an efficient vector its wide distribution, versatility in occupying different habitats and capacity to disperse render this species difficult to control in Central America. Thus, only few months after insecticidal spraying T. dimidiata had reinfested the domestic environments. Morphometic methodology and genetic markers have been developed to differentiate within-species populations of T. dimidiata and T. nitida. Studies on the migration patterns of sylvatic T. dimidiata and T. ryckmani have been performed in order to clarify the colonization patterns. The adults migrate, in particular, in the dry part of the year. This finding may be of help in attempts to control T. dimidiata.

Passive exposure of children to drugs is common, but difficult to ascertain as direct studies are in many cases not possible, and currently available indirect measures of drug exposure, such as maternal reports, are likely to be inaccurate. Novel, indirect methods to evaluate drug exposure in the uterus and early life are needed, and may provide risk estimates that can be later correlated with clinical outcomes. In the studies presented here, I have applied novel methods such as measurement of hair drug concentrations and population pharmacokinetics modeling and simulation to evaluate fetal and infant exposure to drugs and potential associated risks. Testing for methamphetamine allowed demonstration, for the first time, that it freely crosses the human placenta. In contrast, analysis of paired maternal–infant hair showed limited cocaine placental transfer, in agreement with animal models. Results of hair tests from children found in marihuana grow houses and other drug operations showed that passive exposure tends to be higher in infants, likely due to higher dependence on, and proximity to care givers. We also demonstrated the importance of measuring drug metabolites to distinguish between systemic exposure to MDMA and simple external hair contamination secondary to drug present in the home environment. Finally, we developed a population pharmacokinetics and simulation approach to accurately estimate drug excretion into breast milk. This novel technique was applied to fluoxetine and to nifurtimox. Use of our approach allowed us to define, for the first time, the limited extent to which fluoxetine and nifurtimox would be expected to cross into breast milk and estimate potential degree of exposure of breastfed infants. In summary, results presented here support the value of these novel methods for the evaluation of fetal and infant drug exposure and suggest a promising value in estimating risks to children passively exposed to drugs.

Passive exposure of children to drugs is common, but difficult to ascertain as direct studies are in many cases not possible, and currently available indirect measures of drug exposure, such as maternal reports, are likely to be inaccurate. Novel, indirect methods to evaluate drug exposure in the uterus and early life are needed, and may provide risk estimates that can be later correlated with clinical outcomes. In the studies presented here, I have applied novel methods such as measurement of hair drug concentrations and population pharmacokinetics modeling and simulation to evaluate fetal and infant exposure to drugs and potential associated risks. Testing for methamphetamine allowed demonstration, for the first time, that it freely crosses the human placenta. In contrast, analysis of paired maternal–infant hair showed limited cocaine placental transfer, in agreement with animal models. Results of hair tests from children found in marihuana grow houses and other drug operations showed that passive exposure tends to be higher in infants, likely due to higher dependence on, and proximity to care givers. We also demonstrated the importance of measuring drug metabolites to distinguish between systemic exposure to MDMA and simple external hair contamination secondary to drug present in the home environment. Finally, we developed a population pharmacokinetics and simulation approach to accurately estimate drug excretion into breast milk. This novel technique was applied to fluoxetine and to nifurtimox. Use of our approach allowed us to define, for the first time, the limited extent to which fluoxetine and nifurtimox would be expected to cross into breast milk and estimate potential degree of exposure of breastfed infants. In summary, results presented here support the value of these novel methods for the evaluation of fetal and infant drug exposure and suggest a promising value in estimating risks to children passively exposed to drugs.

Made available in DSpace on 2015-03-26T13:30:40Z (GMT). No. of bitstreams: 1 texto completo.pdf: 4221966 bytes, checksum: 09f2c3231a81c4d2d8a60ef298168caa (MD5) Previous issue date: 2005-02-25 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Adults of Triatoma brasiliensis (Reduviidae) show two pairs of exocrine glands: the metasternal and the Brindley glands. The first one is located in the ventral part of the metathorax, while Brindleys glands are found in the lateral part of the superior metathorax. In both glands, the secretory cells correspond to type III, according to the classification of Noirot & Quennedey (1991). Metasternal glands present tricoid sensilla next to their external opening. In the cytoplasm of the secretory cells of these glands granules strongly stained were usually found, suggesting that these glands produce different substances than those of Brindleys glands. The substances found in the secretion of the Brindleys glands of T.brasiliensis were identified for the first time, as a mixture of five fatty acids: acetic; propanoic; isobutyric; butyric and 2-methyl-butyric acids. Isobutiric acid was found to be the most abundant compound and no qualitative or quantitative differences were observed in relation to gland contents for both sexes. Our results demonstrated that the metasternal glands of T. brasiliensis are also involved in the synthesis of volatile substances. These glands produce basically ketones and alcohols, 3-pentanone was the major constituent of the mixture found in these glands for both sexes. After their mechanical disturbance, adults of T. brasiliensis emitted a mixture of 10 different compounds consisting of ketones, alchools and fatty acids, including substances from both metasternal and Brindleys glands,. Finally, we analyzed the sexual behavior of T. brasiliensis: the copula last, in average, 6 ± 1 min and the number of male attempts to copulate varied according to the insect age. Females of T. brasiliensis showed three types of rejection in response to male attempt to copulate: flattening, abdominal movements and evasion. The analysis of the female behavior revealed that the number of rejections in response to male attempts stayed the same during the pre-feeding period. After feeding a gradual decrease in the number of rejections was observed, diminishing until reaching zero rejection at approximately the day 8 post-feeding. We suggest a behavioral mechanism in the female, after feeding, that may trigger the acceptance of the male attempt to copulate in T. brasiliensis. The relevance of the results for understanding the behavioral repertoire of the specie, particularly in the sexual context, is discussed. / As glândulas exócrinas de T. brasiliensis foram analisadas do ponto de vista morfológico e histológico no presente trabalho. Insetos adultos de Triatoma brasiliensis apresentam dois pares de glândulas exócrinas produtoras de voláteis: as glândulas metasternais, localizadas no metatoráx ventral e as glândulas de Brindley, situadas no metatórax lateral superior. Nossos resultados descrevem pela primeira vez detalhes histológicos e morfológicos destas glândulas em Triatoma brasiliensis. Em ambas glândulas metasternais e de Brindley as células secretoras seriam do tipo III, segundo classificação proposta por Noirot & Quennedey (1991). A glândula metasternal apresenta sensilas tricóides na região próxima à sua abertura externa. No citoplasma de suas células secretoras foram encontrados grânulos fortemente corados, sugerindo que esta glândula produz substâncias diferentes daquelas produzidas pelas glândulas de Brindley, que apresentam vacúolos não corados, indicando ausência de grânulos. Uma mistura de cinco ácidos graxos foi identificada: ácido acético; ácido propanóico; ácido isobutírico; ácido butírico e ácido 2-metil-butírico. O componente mais abundante foi o ácido isobutírico e nenhuma diferença qualitativa ou quantitativa entre os sexos foi observada em relação ao seu conteúdo. Nossos resultados também demonstram que as glândulas metasternais de T. brasiliensis estão envolvidas na síntese de substâncias voláteis. Estas glândulas produzem basicamente álcoois e cetonas, sendo que o principal constituinte encontrado nas glândulas de ambos os sexos foi a 3-pentanona. Durante a perturbação mecânica, adultos de T. brasiliensis liberam uma mistura de 10 componentes diferentes, constituída por ácidos, cetonas e álcoois, incluindo substâncias provenientes das glândulas metasternais e de Brindley. Paralelamente, foi analisando o comportamento sexual de T. brasiliensis. Observamos que a cópula tem uma duração média de 6 +ou- 7 min. Fêmeas desta espécie apresentaram somente três tipos de comportamento de rejeição frente ás tentativas de cópula dos machos como o achatamento corporal, os movimentos abdominais e a evasão. O número de tentativas de cópula realizadas pelos machos variou em função da idade. A análise do comportamento das fêmeas revelou que o número de rejeições em resposta às tentativas dos machos se manteve igual durante o período pré-alimentação, não sendo afetado pela sua idade. No período pós-alimentação foi observada uma mudança gradual na porcentagem de tentativas de cópula rejeitadas pelas fêmeas que, diminuiu gradativamente até atingir 0 %. Sugere-se que algum mecanismo comportamental desencadeado na fêmea dias após alimentação esteja determinando a ausência de rejeições e conseqüente aceitação da cópula em T. brasiliensis. A importância destes resultados com relação ao comportamento destes insetos, e particularmente no contexto sexual, é discutida.

Submitted by Priscila Nascimento (pnascimento@icict.fiocruz.br) on 2012-11-27T12:04:45Z No. of bitstreams: 1 marcelle-bral-de-mello.pdf: 1087389 bytes, checksum: 74eb4d07ffe50812d0cea3fd71cdf47a (MD5) / Made available in DSpace on 2012-11-27T12:04:45Z (GMT). No. of bitstreams: 1 marcelle-bral-de-mello.pdf: 1087389 bytes, checksum: 74eb4d07ffe50812d0cea3fd71cdf47a (MD5) Previous issue date: 2009 / Fundação Oswaldo Cruz. Instituto de Tecnologia em Imunobiológicos. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil. / Bio-Manguinhos produz, desde a década de 80, Kits para diagnóstico, inclusive para o diagnóstico da doença de Chagas. O kit EIE-Recombinante-Chagas, que utiliza na sua composição as proteínas recombinantes CRA e FRAdo T. cruzi, foi registrado como produto junto à ANVISA no ano de 1999. No período de renovação do registro, o Kit passou por uma avaliação prévia no INCQS, onde não foi possível alcançar condição satisfatória quanto aos níveis de sensibilidade. O presente trabalho teve por objetivo retomar a padronização deste Kitno âmbito do desenvolvimento tecnológico. Para tanto foi estabelecido a padronização de três modelos de protótipos, utilizando variações das construções disponíveis das proteínas recombinantes CRA e FRA, na forma de apresentação como antígeno e como conjugado. Posteriormente, foi avaliado o desempenho de cada protótipo, em três diferentes fases. Na primeira fase, o melhor desempenho foi apresentado pelo protótipo 3, cujos níveis de sensibilidade e especificidade foram respectivamente de 99% e 99,5% (IC 95%). Na segunda fase o nível de sensibilidade do protótipo 3 foi de 95.8% e o de especificidade 100%, mantendo a melhor condição de desempenho em relação aos demais. Na última fase, somente o protótipo 3 foi avaliado em função da indisponibilidade de volume das amostras selecionadas e os níveis de sensibilidade e especificidade encontrados de 100%.O desempenho do protótipo 2 foi insatisfatório nas duas primeiras fases de avaliação.Tendo em vista o bom desempenho alcançado pelo protótipo 3, propomos a continuação deste modelo na elaboração futura de lotes-piloto, de estudos multicêntricos e de validação, em ações conjuntas com o controle e a garantia da qualidade para a elaboração de documentação visando pedido de registro desse produto junto aos órgãos regulatórios. / Bio-Manguinhos produces, since the 80’s, a variety of kits for diagnosis, including the kit for Chagas’ disease diagnostic. The EIE-Recombinant-Chagas’ kit, which has in its constitution the recombinant proteins CRA and FRA from T. cruzi, was registered at ANVISA as a product in 1999. During the renewal of the registration period, the kit was submitted to a previous registration analysis by The National Institute for Quality Control in Health (INCQS), when it did not show satisfactory sensitivity levels. The present work aimed to remake the kit standardization process under the scope of the technological development. In order to do it, we established the standardization of three prototype models, each one using variations of available constructions from CRA and FRA recombinant proteins in the form of presentation as antigen and as conjugate. Afterwards, we evaluated the performanceof each prototype, in three different stages. In the first one, prototype 3 showed the best performance with 99% sensitivity and 99.5% specificity levels (CI 95%). In the second stage, prototype 3 levels sensitivity and specificity were 95.8% and 100% respectively, keeping the best performance condition as compared to the other two prototypes. In the last stage, only prototype 3 was assessed due to the lack of sample volumes. The reported sensitivity and specificity levels forsuch prototype were equal to 100%. The performance of prototype 2 was unsatisfactory in the first two assessment stages. Taking into account the performance achieved by prototype 3, we propose the continuation of this model for future development of pilot lots, multicenter and validation studies, in joint actions with quality assurance and quality control for the arrangement of the documents requested by the National Regulatory Agency for the registration of the product.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2016-02-04T11:32:50Z No. of bitstreams: 1 Carolina Thé Macedo Avaliação da acuracia...2015.pdf: 2036804 bytes, checksum: 926f70b1e7ec1709b317e04842607c6a (MD5) / Approved for entry into archive by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2016-02-04T11:33:56Z (GMT) No. of bitstreams: 1 Carolina Thé Macedo Avaliação da acuracia...2015.pdf: 2036804 bytes, checksum: 926f70b1e7ec1709b317e04842607c6a (MD5) / Made available in DSpace on 2016-02-04T11:33:56Z (GMT). No. of bitstreams: 1 Carolina Thé Macedo Avaliação da acuracia...2015.pdf: 2036804 bytes, checksum: 926f70b1e7ec1709b317e04842607c6a (MD5) Previous issue date: 2015 / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / Um dos principais desafios na miocardiopatia chagásica é a detecção de alterações precoces na função ventricular esquerda. A avaliação do strain pelo speckle tracking na ecocardiografia bidimensional (2-D ST) é um novo método com aplicações em diversas doenças cardíacas, tendo sido validado para pacientes com infarto do miocárdio em comparação à ressonância magnética cardíaca (RMC). Neste estudo, avaliamos a hipótese de que o strain global longitudinal (SGL) possui um valor incremental à fração de ejeção (FE) pelo método de Simpson para predição de fibrose miocárdica na RMC, em pacientes portadores de doença de Chagas (DC). Métodos: Estudo observacional, com um total de 58 pacientes portadores de DC. Todos os pacientes foram submetidos à realização de ecocardiograma convencional e com strain pelo speckle tracking, além de RMC. Resultados: A análise da curva ROC mostrou que tanto a SGL (área sob a curva: 0,78, p = 0,001) quanto a fração de ejeção (área sob a curva: 0,82, p < 0,001) tiveram significância estatística na detecção de fibrose. Em relação á porcentagem de fibrose, uma alta correlação foi observada tanto com a FE pela ecocardiografia (r = - 0,70, p < 0,001) quanto com o SGL (r = 0,64, p < 0,001). Contudo, quando ajustado pela regressão linear múltipla, o SGL perdeu a significância estatística como preditor independente de fibrose miocárdica (p = 0.111). Conclusões: SGL não possui valor incremental em relação à FE na predição de fibrose miocárdica em pacientes portadores de DC. / One of the most challenging issues of chronic Chagas disease is to provide earlier detection of heart involvement. Two-dimensional speckle tracking (2-D ST) echocardiography, a new imaging modality with useful applications in several cardiac diseases, has been validated for subjects with myocardial infarction against cardiac magnetic resonance (CMR). Here we hypothesize that the longitudinal global strain (LGS) has an incremental value to ejection fraction for predicting myocardial fibrosis in subjects with Chagas disease. Methods: This observational study comprised 58 subjects with Chagas disease, confirmed by two positive serologic tests. All subjects underwent conventional Doppler echocardiogram plus speckle tracking strain, and cardiac magnetic resonance. Results: The ROC curve analysis revealed that both LGS (Area under the curve: 0.78, p = 0.001) and ejection fraction (Area under the curve: 0.82, p < 0.001) were significant predictors of myocardial fibrosis. Regarding the percentage of fibrosis, a high correlation was observed with both ejection fraction assessed by echocardiography (r = - 0.70, p < 0.001) and LGS (r = 0.64, p < 0.001). However, when adjusted through multiple linear regression, the LGS lost statistical significance as a predictor of myocardial fibrosis (p = 0.111). Conclusions: LGS has no incremental value to conventional ejection fraction measurement in the prediction of myocardial fibrosis in subjects with Chagas disease.

Benznidazol (BZ) é uma das duas drogas usadas no tratamento da doença de Chagas. Falhas terapêuticas são observadas em muitos pacientes, que foram atribuídas, principalmente, às diferenças na suscetibilidade de cepas do Trypanosoma cruzi a essa droga. Alguns genes foram implicados na resistência induzida a BZ, mas não na resistência natural. O objetivo geral deste estudo foi investigar diferenças de expressão gênica em cepas de T. cruzi naturalmente resistentes e suscetíveis a BZ, utilizando microarranjos de DNA. Quantificamos a sensibilidade à droga em cepas de laboratório e isolados obtidos de pacientes crônicos submetidos a quimioterapia com BZ. Concluímos que os valores de CI50 não são preditivos cura. Os experimentos de microarranjos e ensaios de RT-PCR mostram que a abundância de transcritos do gene TcABCG1, foi maior em cepas naturalmente resistentes a BZ. Não observamos variação na abundância de transcritos de alguns genes implicados no fenótipo de resistência induzida. Nossos dados sugerem o envolvimento do transportador TcABCG1 na resistência a BZ. / Benznidazole (BZ) is one of the two drugs used to treat Chagas disease. Therapeutic failures were reported in many chronic patients, which were mostly attributed to different susceptibilities of Trypanosoma cruzi strains to BZ. A few genes have been implicated in the induced resistance to BZ, but none in the natural resistance. The general goal of this study was to investigate differences in gene expression between susceptible and naturally resistant T. cruzi strains employing DNA microarray technology. We have quantified the drug activity for laboratory strains and for isolates retrieved from chronic patients submitted to BZ therapy. Our results indicate that the IC50 values are not predictive of cure. The microarray and RT-PCR experiments showed the higher abundance of transcript of TcABCG1 gene in naturally resistant strains as compared to sensitive strains. We observed no variation in the transcripts levels of the genes implicated in the induced drug resistance. Our data suggest that TcABCG1 transporter may be involved in natural drug resistance in T. cruzi.