Chagas disease (CD), caused by the hemoflagellate protozoan, Trypanosoma cruzi, is endemic in most countries of South and Central America, where nearly 10 million people are infected with the parasite and another 25 million are at risk of infection. Cardiac involvement is the most frequent and serious manifestation of chronic CD, and typically leads to abnormalities of conduction system, heart failure (HF), thromboembolism, and sudden death. HF is often a late manifestation of chronic CD and is associated with higher mortality than is HF from other causes. Early identification of patients with CD, therefore, would be desirable as early intervention may help improve prognosis. Inflammatory biomarkers can play a vital role in early diagnosis, as inflammation mediated by cytokines plays an important role in pathogenesis and progression of CD, and may be present even in the absence of HF.Keeping in view the inflammatory nature of CD, this study investigated the possible role of 21 different inflammatory cytokines as biomarkers for prediction and prognosis of CD. The plasma concentration of each of these cytokines was measured in a group of patients with CD, and then compared with those measured in patients with dilated cardiomyopathy (DCM) from idiopathic causes, and with control subjects. This study was the first to demonstrate cytokines such as monokine induced by interferon gamma (MIG) and stem cell growth factor beta (SCGF beta) in CD and idiopathic DCM patients with HF. Although plasma levels of cytokines like SCGF beta, hepatocyte growth factor (HGF), cutaneous T-cell attracting chemokine (CTACK), and MIG were significantly increased in CD patients with advanced HF, they were unable to show any predictive or prognostic potency in CD. Multivariate analysis was able to prognosticate a large proportion of CD and DCM patients, but it could not discriminate CD from idiopathic DCM. It is possible that some of the cytokines that were investigated here are only regulated in HF due to specific etiologies such as ischemic HF. Also, cytokines other than the ones that were investigated may play a major role in causing severe inflammation and fibrosis seen in CD.Studies in future should focus on identifying more serum inflammatory biomarkers that could be used as tools for early prediction and prognosis of CD. As CD is associated with poor prognosis, identifying patients at an early stage of the disease may help in providing effective treatment and prevent the development of HF and thus early death.
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