The role of interleukin 17-mediated immune response in Chagas disease:High level is correlated with better left ventricular function

Interleukin 17A (IL-17A) has been associated with protective rather than pathogenic response in Chagas disease (ChD). However, it is not established whether or not IL-17A-mediated immune response is correlated with patient's left ventricular (LV) function in ChD. To address this question we have gathered cardiac functional parameters from ChD patients and analysed the possible relationship between their plasma IL-17A levels and LV function. Plasma IL-17A levels were measured by BD Cytometric Bead Array (CBA) in 240 patients with positive specific serology for Trypanosoma cruzi (T. cruzi) grouped as indeterminate (IND) and Chagas cardiomyopathy (CARD) forms. The levels of IL-17A in ChD patients were compared with 32 healthy individuals, mean age of 39 years, 50% male, that were also included as a control group (non-infected [NI]). The overall mean age of ChD patients was 46 years and 52% were male. The IND group included 95 asymptomatic patients, with ages ranging from 27 to 69 years (mean of 43 years), and 42.1% of them were male. The CARD group included 145 patients, which 58.6% were male, with ages ranging from 23 to 67 years (mean of 49). The IND group presented substantially higher levels of IL-17A, median of 26.16 (3.66-48.33) as compared to both the CARD group, median of 13.89 (3.87-34.54) (P <0.0001), and the NI group, median of 10.78 (6.23-22.26) (P <0.0001). The data analysis demonstrated that the IND group comprises a significantly greater proportion (P <0.001) of high IL-17A producers (52.6%, 50 of 95 subjects) than do the other groups. A significant direct correlation was verified between IL-17A levels and cardiac function expressed by LV ejection fraction (LVEF), LV diastolic diameter (LVDd), and body surface area (BSA)-indexed LVDd as well as ratio of the early diastolic transmitral flow velocity to early diastolic mitral annular velocity (E/e') in both groups. We demonstrated that plasma IL-17A levels has an accurate sensitivity and specificity to predict heart failure in serology-positive patients and might be a useful parameter to distinguish patients with or without cardiac impairment. This study indicates a consistent relationship between high expression of IL-17A and better LV in human chronic ChD. Our data raise the possibility that IL-17A plays an important immunomodulatory role in the chronic phase of ChD and might be involved in protection against myocardial damage

Epidemiological Scenario of Dengue in Brazil

Dengue is the most important reemerging mosquito-borne viral disease worldwide. It is caused by any of four Dengue virus types or serotypes (DENV-1 to DENV-4) and is transmitted by mosquitoes from the genus Aedes. Ecological changes have favored the geographic expansion of the vector and, since the dengue pandemic in the Asian and Pacific regions, the infection became widely distributed worldwide, reaching Brazil in 1845. The incidence of dengue in Brazil has been frequently high, and the number of cases in the country has at some point in time represented up to 60% of the dengue reported cases worldwide. This review addresses vector distribution, dengue outbreaks, circulating serotypes and genotypes, and prevention approaches being utilized in Brazil

Frequency of monocytes subsets.

<p>(A) Representative gates of flow cytometry for classification of subsets. (B) Frequency of each monocyte subsets in normal-weight (NW; n = 9) and childhood obesity (CO; n = 11). Graphs shown median with interquartile range. Significant differences (p<0.05) in the charts are identified by asterisks and connecting lines.</p

Evaluation of expression of recognition and activation molecules in monocytes and their subsets.

<p>(A) Expression of recognition molecules was determined by mean fluorescence intensity (MFI). (B) Expression of activation molecules was determined by mean fluorescence intensity (MFI). The groups evaluated were normal-weight (NW; n = 9) and childhood obesity (CO; n = 11). Significant differences (p<0.05) between monocytes subsets, intragroup, are identified by asterisks and connecting lines. Letters represent statistical differences (p<0.05) between the same subset for comparison intergroup. Graphs shown median with interquartile range.</p

Evaluation of cytokine expression in monocytes and their subsets.

<p>(A) Perceptual of classical monocytes expressing each cytokine. (B) Perceptual of intermediate monocytes expressing each cytokine. (C) Perceptual of non-classical monocytes expressing each cytokine. Graphs show median with interquartile range. Significant differences (p<0.05) are identified by asterisks. (D) Radar graph represent perceptual of each monocytes subsets expressing cytokine. The groups evaluated were normal-weight (NW; n = 9; dispersion points) and childhood obesity (CO; n = 11; bars).</p

Heatmap for correlations between inflammatory and anti-inflammatory molecules.

<p>Representative heatmap of correlation between recognition/activation molecules and clinical parameters for classical (A), intermediate (B) and non-classical monocytes (C). Representative heatmap of correlation between cytokines and clinical parameters for classical (D), intermediate (E) and non-classical monocytes (F). The groups evaluated were normal-weight (NW; n = 9) and childhood obesity (CO; n = 11).</p

Clinical parameters.

<p>Clinical parameters.</p

Clinical, eletrocardiographic, and echocardiographic characteristics of the study population.

<p>Clinical, eletrocardiographic, and echocardiographic characteristics of the study population.</p