☆ 4.6 Article

Longitudinal study of patients with chronic Chagas cardiomyopathy in Brazil (SaMi-Trop project): a cohort profile

BMJ OPEN (2016)

Journal

BMJ OPEN

Volume 6, Issue 5, Pages -

Publisher

BMJ PUBLISHING GROUP

DOI: 10.1136/bmjopen-2016-011181

Keywords

Chagas disease; Cohort Studies; Biomarkers; CHEMICAL PATHOLOGY

Funding

National Institutes of Health (NIH) [P50 AI098461-02]
Brazilian National Research Council, CNPq [467043/2014-0]
State Funding Agency of Minas Gerais, FAPEMIG [REDE 018-14]
CNPq
CAPES Foundation, Ministry of Education Brazil [BEX 2477/15-7]
NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES [U19AI098461, P50AI098461] Funding Source: NIH RePORTER

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Abstract

Purpose We have established a prospective cohort of 1959 patients with chronic Chagas cardiomyopathy to evaluate if a clinical prediction rule based on ECG, brain natriuretic peptide (BNP) levels, and other biomarkers can be useful in clinical practice. This paper outlines the study and baseline characteristics of the participants. Participants The study is being conducted in 21 municipalities of the northern part of Minas Gerais State in Brazil, and includes a follow-up of 2years. The baseline evaluation included collection of sociodemographic information, social determinants of health, health-related behaviours, comorbidities, medicines in use, history of previous treatment for Chagas disease, functional class, quality of life, blood sample collection, and ECG. Patients were mostly female, aged 50-74years, with low family income and educational level, with known Chagas disease for >10years; 46% presented with functional class >II. Previous use of benznidazole was reported by 25.2% and permanent use of pacemaker by 6.2%. Almost half of the patients presented with high blood cholesterol and hypertension, and one-third of them had diabetes mellitus. N-terminal of the prohormone BNP (NT-ProBNP) level was >300pg/mL in 30% of the sample. Findings to date Clinical and laboratory markers predictive of severe and progressive Chagas disease were identified as high NT-ProBNP levels, as well as symptoms of advanced heart failure. These results confirm the important residual morbidity of Chagas disease in the remote areas, thus supporting political decisions that should prioritise in addition to epidemiological surveillance the medical treatment of chronic Chagas cardiomyopathy in the coming years. The SAo Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) represents a major challenge for focused research in neglected diseases, with knowledge that can be applied in primary healthcare. Future plans We will continue following this patients' cohort to provide relevant information about the development and progression of Chagas disease in remotes areas, with social and economic inequalities. Trial registration number NCT02646943; Pre-results.

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Blood DNA methylation marks discriminate Chagas cardiomyopathy disease clinical forms

Pauline Brochet, Barbara Ianni, Joao P. S. Nunes, Amanda F. Frade, Priscila C. Teixeira, Charles Mady, Ludmila R. P. Ferreira, Andreia Kuramoto, Cristina W. Pissetti, Bruno Saba, Darlan D. S. Candido, Fabricio Dias, Marcelo Sampaio, Jose A. Marin-Neto, Abilio Fragata, Ricardo C. F. Zaniratto, Sergio Siqueira, Giselle D. L. Peixoto, Vagner O. C. Rigaud, Paula Buck, Rafael R. Almeida, Hui Tzu Lin-Wang, Andre Schmidt, Martino Martinelli, Mario H. Hirata, Eduardo Donadi, Virmondes Rodrigues Junior, Alexandre C. Pereira, Jorge Kalil, Lionel Spinelli, Edecio Cunha-Neto, Christophe Chevillard

Summary: This study proposes two sets of DNA methylation biomarkers that can predict the occurrence and stage of Chagas disease cardiomyopathy. Using machine learning algorithms, predictions in a test cohort achieved an accuracy of over 95%. These biomarkers are also associated with immune response, nervous system, ion transport, and ATP synthesis pathways.

FRONTIERS IN IMMUNOLOGY (2022)