A study led by Dr. Joaquím Gascón, director of the Chagas Disease Initiative at ISGlobal and María Jesús Pinazo, researcher at ISGlobal, shows that patients with chronic Chagas disease display high levels of several coagulation factors and that such levels decrease as a result of therapeutic treatment. The study, published in PLOS Neglected Tropical Diseases, suggests that these factors could be useful markers for assessing therapeutic responses in chronic patients.

Thromboembolic events have been described in patients with Chagas disease and not all of them are due to cardiac complications. This has led to the hypothesis that such patients have a greater tendency to coagulate, likely as a result of chronic infection by the T. cruzi parasite. In the present study, the researchers investigated levels of more than 20 haemostatic factors (i.e. that regulate coagulation) in patients chronically infected with T. cruzi, and evaluated whether such levels changed upon treatment with benznidazol, over a period of 36 months. They identified three factors (prothrombin fragments 1 and 2, ETP, and plasmin-antiplasmin complexes or PAP) that were abnormally expressed but were normalized shortly after treatment in most patients.

The authors conclude that patients with chronic T. cruzi infection have a potential hypercoagulable state, regardless of cardiologic or digestive damage. Furthermore, the coagulation factors identified could be used as surrogate markers to evaluate short-term responses to treatment. However, the authors acknowledge that the decrease in the levels of such factors could also be explained by a decrease in parasite levels or other drug effects.

To date, there are no reliable prognostic and progression biomarkers for chronic Chagas disease. The identification of markers such as those described in this study, will considerably facilitate the testing of new drugs to treat this neglected disease.

About 6 to 7 million people are estimated to be infected with Trypanosoma cruzi worldwide, mostly in Latin America, where it is mainly transmitted through contact with faeces of triatomine bugs. Up to 30% of chronically infected people develop cardiac alterations and up to 10% suffer from digestive and/or neurological alterations. There is no vaccine for the disease.

Reference

Pinazo MJ, Posada Ede J, Izquierdo L et al. Altered Hypercoagulability Factors in Patients with Chronic Chagas Disease: Potential Biomarkers of Therapeutic Response. PLoS Negl Trop Dis. 2016 Jan 4;10(1):e0004269.

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