Enfermedad de Chagas en fase crónica. Evaluación de diferentes métodos diagnósticos en una zona no endémica.

Los recientes flujos migratorios han propiciado la llegada de un número importante de personas procedentes de zonas donde la enfermedad de Chagas es endémica. El diagnóstico de laboratorio de la enfermedad de Chagas reviste unas características especiales debido a que, según la fase en la evolución de la enfermedad en la que se encuentre el paciente, se utilizarán distintas técnicas, siendo la detección de anticuerpos frente a Trypanosoma cruzi el principal método diagnóstico de la enfermedad de Chagas en fase crónica. Por tanto, en el contexto epidemiológico de la Región de Murcia, consideramos importante evaluar la eficacia de las diferentes técnicas de diagnóstico parasitológico y serológico, así como ensayar nuevos métodos serológicos basados en el empleo de péptidos recombinantes. Palabras clave: enfermedad de Chagas, métodos diagnósticos, serología Abstract Due to recent migration flows, a significant number of people from Chagas disease endemic areas has arrived to our region. Appropriate diagnostic testing for Chagas disease varies depending on the phase of disease; the detection of Trypanosoma cruzi antibodies by serological methods is still the main support for diagnosis of chronic Chagas disease. Therefore, in the epidemiological context of Murcia region (Spain), we consider important to evaluate the utility of different parasitological and serological methods and to test new serological assays based on recombinant proteins. Keywords: Chagas disease, diagnostic methods, serolog

Polymorphisms in ACE, ACE2, AGTR1 genes and severity of COVID-19 disease.

Infection by the SARS-Cov-2 virus produces in humans a disease of highly variable and unpredictable severity. The presence of frequent genetic single nucleotide polymorphisms (SNPs) in the population might lead to a greater susceptibility to infection or an exaggerated inflammatory response. SARS-CoV-2 requires the presence of the ACE2 protein to enter in the cell and ACE2 is a regulator of the renin-angiotensin system. Accordingly, we studied the associations between 8 SNPs from AGTR1, ACE2 and ACE genes and the severity of the disease produced by the SARS-Cov-2 virus. 318 (aged 59.6±17.3 years, males 62.6%) COVID-19 patients were grouped based on the severity of symptoms: Outpatients (n = 104, 32.7%), hospitalized on the wards (n = 73, 23.0%), Intensive Care Unit (ICU) (n = 84, 26.4%) and deceased (n = 57, 17.9%). Comorbidity data (diabetes, hypertension, obesity, lung disease and cancer) were collected for adjustment. Genotype distribution of 8 selected SNPs among the severity groups was analyzed. Four SNPs in ACE2 were associated with the severity of disease. While rs2074192 andrs1978124showed a protector effectassuming an overdominant model of inheritance (G/A vs. GG-AA, OR = 0.32, 95%CI = 0.12-0.82; p = 0.016 and A/G vs. AA-GG, OR = 0.37, 95%CI: 0.14-0.96; p = 0.038, respectively); the SNPs rs2106809 and rs2285666were associated with an increased risk of being hospitalized and a severity course of the disease with recessive models of inheritance (C/C vs. T/C-T/T, OR = 11.41, 95% CI: 1.12-115.91; p = 0.012) and (A/A vs. GG-G/A, OR = 12.61, 95% CI: 1.26-125.87; p = 0.0081). As expected, an older age (OR = 1.47), male gender (OR = 1.98) and comorbidities (OR = 2.52) increased the risk of being admitted to ICU or death vs more benign outpatient course. Multivariable analysis demonstrated the role of the certain genotypes (ACE2) with the severity of COVID-19 (OR: 0.31, OR 0.37 for rs2074192 and rs1978124, and OR = 2.67, OR = 2.70 for rs2106809 and rs2285666, respectively). Hardy-Weinberg equilibrium in hospitalized group for I/D SNP in ACE was not showed (p<0.05), which might be due to the association with the disease. No association between COVID-19 disease and the different AGTR1 SNPs was evidenced on multivariable, nevertheless the A/A genotype for rs5183 showed an higher hospitalization risk in patients with comorbidities. Different genetic variants in ACE2 were associated with a severe clinical course and death groups of patients with COVID-19. ACE2 common SNPs in the population might modulate severity of COVID-19 infection independently of other known markers like gender, age and comorbidities.The work was in part supported by grants from Instituto de Salud Carlos III and FEDER Union Europea, Una forma de hacer Europa (FONDOCOVID19 COV20/00420). The group of researchers is part of the Cardiovascular Research Network (CIBERCV) and the CIBER of Rare Diseases (CIBERER). The research group in “Hereditary Heart Diseases and Sudden Death” is registered at the University of Murcia and the IMIB. The Family Heart Disease Unit of the Virgen de la Arrixaca University Clinical Hospital is accredited as a Reference Unit (CSUR) by the Ministry of Health and is part of the network of European reference centers included in Guard-Heart (ERN). María Sabater has a research contract from the FFIS (Foundation for Sanitary Training and Research).S