In silico and in vitro tests can reveal promising anti-leishmania activity for natural products and their derivatives. The aim of this study was to investigate in silico the pharmacological activities of potential new chalcones and their leishmanicidal potential in vitro. The in silico study was carried out using the PASS, MolPredictX and Molegro Virtual Docker 6.0 programs. Antiparasitic activity was assessed in axenic promastigote and amastigote forms of Leishmania braziliensis. The cytotoxicity tests used the J77G8 cell line. The chalcones exhibited 50% cytotoxic concentration values (CC50) values > 50 μM. Chalcone 4 (named FERAI) presented the best activity with concentration for 50% of promastigotes and intracellular parasites forms (EC50) of 9.75 ± 1.7 and 10.13 ± 1.7 μM for promastigote and amastigote, respectively. Reactive oxygen species (ROS) testing presented increased ROS levels in the parasite at the FERAI concentrations of 10 μM (56.33%), 20 μM (61.76%) and 30 μM (67.13%). Molecular docking revealed interactions (binding energy) between FERAI and the enzymes UDP-glycosyl pyrophosphorylase (-56.8384), dihydroorotate-dehydrogenase (-132.276) and trypanothione-reductase (-151.281). Our results demonstrated the anti-leishmanial activity of chalcones, especially FERAI, with a noted raising of ROS levels in the parasite. Molecular docking revealed dihydroorotate dehydrogenase and trypanothione reductase as potential pharmacological targets for FERAI. antileishmania anti leishmania derivatives PASS 60 6 0 6. programs braziliensis JG J G J77G line CC50 CC (CC50 5 named EC50 EC (EC50 975 9 75 9.7 17 1 7 1. 1013 13 10.1 respectively (ROS 56.33%, 5633 56.33% , 56 33 (56.33%) 2 61.76% 6176 61 76 (61.76% 3 67.13%. 6713 67.13% . 67 (67.13%) binding energy UDPglycosyl UDP glycosyl 56.8384, 568384 56.8384 8384 (-56.8384) dihydroorotatedehydrogenase 132.276 132276 132 276 (-132.276 trypanothionereductase 151.281. 151281 151.281 151 281 (-151.281) antileishmanial leishmanial CC5 (CC5 EC5 (EC5 97 9. 101 10. 563 56.33 (56.33% 61.76 617 (61.76 671 67.13 (67.13% 56838 56.838 838 (-56.8384 132.27 13227 27 (-132.27 15128 151.28 15 28 (-151.281 (CC (EC 56.3 (56.33 61.7 (61.7 67.1 (67.13 5683 56.83 83 (-56.838 132.2 1322 (-132.2 1512 151.2 (-151.28 56. (56.3 61. (61. 67. (67.1 568 56.8 8 (-56.83 132. (-132. 151. (-151.2 (56. (61 (67. (-56.8 (-132 (-151. (56 (6 (67 (-56. (-13 (-151 (5 ( (-56 (-1 (-15 (-5 (-

The phytochemical investigation of the hexane and methanol extracts from the bark of Duguetia pycnastera Sandwith (Annonaceae) afforded seven known compounds, two asarone-derived phenylpropanoids and five isoquinoline-derived alkaloids. The asarones, γ-asarone (1-allyl-2,4,5-trimethoxybenzene) and 2,4,5-trimethoxy-styrene were isolated of the hexane extract while the aporphine alkaloids, O-methylmoschatoline, lysicamine, nornuciferidine, and guatterine N-oxide, and the benzyltetrahydroisoquinoline alkaloid, (S)-reticuline were isolated of the alkaloid fraction of the methanol extract. This is the first report of these compounds in D. pycnastera. γ-Asarone is being reported for the first time in the Annonaceae. Nornuciferidine is described for the second time in the Annonaceae while guatterine N-oxide is the third register. The structures of the isolated compounds were established by extensive analyses using 1D and 2D NMR spectroscopy in combination with MS. The cytotoxic activity of the isolated compounds (except for nornuciferidine) was evaluated against cancer and non-cancerous cell lines, in which lysicamine was the most active compound, mainly against HL-60, HepG2, and K562 with IC50 values of 24.40, 28.86 and 38.75 µmol L-1, respectively.

In this study, antimicrobial activity of extracts and lupenone from A. inundata (Fabaceae, Mimosoideae), were tested. In addition, the multi-element composition of the leaves, bark and stems (heartwood) of A. inundata was evaluated using inductively coupled plasma optical emission spectrometry (ICP OES). Lupenone was isolated in the petroleum ether extract of leaves, for the first time. Biological assays were conducted to evaluate the antimicrobial (antibacterial, antifungal and antiparasitic) of extracts, their fractions and lupenone. The results showed antimicrobial and antileishmanial activity of these compounds, which may be useful for obtaining a chemical composition and biological activity database on Albizia species. For multi-element composition, we found the mean concentrations (minimum-maximum) of Al, Ca, Cr, Cu, Fe, K, Mg, Mn, Ni, P, V and Zn in the samples ranged between 0.06 and 265.41 µg g-1. Concentration ranges of Cu, Fe, Mn and Zn are large, which makes these samples as additional sources of these macronutrients.

The phytochemical investigation of the hexane extract which was obtained from the leaves of Xylopia laevigata (Annonaceae) produced six terpenes. Among these, five diterpenes named abieta-7,13-dien-3-one, ent-7β-acetoxy-16β-hydroxy-kaurane, 4-epi-cupressic acid, powerol, and labdorffianic acid B, and one oxygenated sesquiterpene, spathulenol. This is the first time these isolated diterpenes from X. laevigata have been described. The different structures belong to the abietane, kaurane, and labdane diterpenoids, and are indicative of the chemical diversity found in X. laevigata. Moreover, the diterpene ent-7β-acetoxy-16β-hydroxy-kaurane is reported herein for the first time as a natural product, and 4-epi-cupressic acid, powerol, and labdorffianic acid B are reported for the first time in the Annonaceae family. The structures of the isolated compounds were established by extensive analyses using 1D and 2D NMR spectroscopy in combination with MS. The cytotoxic activities of compounds abieta-7,13-dien-3-one, spathulenol, 4-epi-cupressic acid, and powerol were evaluated against tumor and non-tumor cell lines, in which spathulenol was found to be the most active, mainly against K562 with an IC50 value of 17.20 μmol L-1. (Annonaceae terpenes abieta7,13dien3one, abieta713dien3one abietadienone abieta 7,13 dien 3 one, 7 13 abieta-7,13-dien-3-one ent7βacetoxy16βhydroxykaurane, ent7βacetoxy16βhydroxykaurane entβacetoxyβhydroxykaurane ent 7β acetoxy 16β hydroxy kaurane β 4epicupressic epicupressic 4 epi cupressic sesquiterpene X described abietane diterpenoids Moreover product family D MS nontumor non lines active K K56 IC IC5 1720 17 20 17.2 L1. L1 L 1. 1 L-1 abieta7 13dien3one abieta7,13dien3one 713 7,1 βacetoxy βhydroxykaurane K5 172 2 17. L- dienone 71 7,

The methodology developed in this study through the acquisition of fingerprint chromatograms by liquid chromatography-diode array detector (LC-DAD), aided by principal component analysis, made it possible to assess, in a rational way, the chemical differences between six accessions of Lippia alba and to verify the influence of the method of extraction, the seasonality and the individuality of each accession on chemical composition of its extracts. Among all extracts analyzed against cancer cell lines, eight of them showed to be more promising against a human leukemia cell line (HL-60), displaying cell growth inhibition percentage ranging between 40.0 and 52.0%. In the inhibitory activity assays against acetylcholinesterase enzyme, all extracts showed weak inhibitory effect, with highlight only for six of them, which displayed inhibition ranging between 27.0 and 32.0%.

The phytochemical investigation of the alkaloid-rich fraction obtained from the leaves of Guatteria pogonopus Mart. (Annonaceae) allowed the isolation and identification for the first time in this species of: (+)-nornuciferine (1), a mixture of 1 and (+)-anonaine (2), (+)-isocorydine (3), (+)-nuciferine (4), (+)-roemerine (5), (-)-tetrahydropseudocolumbamine (6), a mixture of 6, liriodenine (9) and lysicamine (10), a mixture of 1,2,9-trimethoxy-10-hydroxyaporphine (7) and bulbocapnine (8), 9, 10, and (+)-N-methyllindicarpine (11). Compounds 6, 7, 8, and 11 have not been previously reported in the family Annonaceae. Furthermore, the formerly synthetic 1,2,9-trimethoxyaporfin-10-ol (7) is described for the first time as a natural aporphine alkaloid herein. The chemical structures were established by 1D and 2D NMR as well as in comparison with data previously reported in the literature. The cytotoxic activity of the alkaloids was evaluated against tumor (B16-F10, HepG2, HL-60, and K562) and non-tumor (PBMC) cell lines. Alkaloid 1 presented significant activity against HepG2 cell lines with IC50 of 9.60 µmol L-1 while the mixture of 6, 9 and 10 displayed strong cytotoxic activity against HL-60 and K562 cell lines with IC50 values of 3.41 an 8.50 µmol L-1, respectively.

Resumo Fundamento: Dados prévios têm demonstrado que pacientes na forma indeterminada podem apresentar fibrose miocárdica à ressonância magnética (RM). No entanto, são poucas as informações disponíveis quanto ao grau de fibrose miocárdica apresentada por esses indivíduos, o que guardaria relação com o potencial dessa variável na predição de evolução para a forma cardíaca da doença de Chagas. Objetivos: Descrever a frequência e extensão da fibrose miocárdica avaliada por RM em pacientes da forma indeterminada, comparando com as outras formas da doença. Métodos: Pacientes consecutivamente admitidos tiveram história clínica colhida e foram submetidos à realização de exames laboratoriais e RM. Resultados: Foram estudados 61 pacientes portadores da doença de Chagas, com média de idade de 58 ± 9 anos, sendo 17 pacientes na forma indeterminada, 16 na forma cardíaca sem disfunção do ventrículo esquerdo (VE) e 28 na forma com disfunção do VE. Foi considerado estatisticamente significante p < 0,05. Realce tardio foi detectado em 37 pacientes (64%). Foi identificada fibrose miocárdica em 6 indivíduos na forma indeterminada (41%; IC95% 23 - 66), proporção semelhante à observada na forma cardíaca sem disfunção do VE (44%); p = 1,0. Entre os indivíduos com fibrose, a área total do miocárdio acometida foi de 4,1% (IIQ: 2,1 - 10,7) na forma indeterminada versus 2,3% (IIQ: 1 - 5) na forma cardíaca sem disfunção do VE (p = 0,18). A fração de ejeção do ventrículo esquerdo nos indivíduos na forma indeterminada foi semelhante aos portadores da forma cardíaca sem disfunção ventricular (p = 0,09). Conclusão: A presença de fibrose na forma indeterminada da doença de Chagas tem frequência e extensão semelhante à forma cardíaca sem disfunção, o que sugere que a primeira faz parte de um espectro de doença subclínica, em vez da ausência de acometimento cardíaco.

Abstract Background: Previous data has shown that patients in the indeterminate form of Chagas disease may present myocardial fibrosis as shown on through magnetic resonance imaging (MRI). However, there is little information available regarding the degree of severity of myocardial fibrosis in these individuals. This variable has the potential to predict the evolution of Chagas’ disease into its cardiac form. Objectives: To describe the frequency and extent of myocardial fibrosis evaluated using an MRI in patients in the indeterminate form, and to compare it with other forms of the disease. Methods: Patients were admitted one after another. Their clinical history was collected and they were submitted to laboratory exams and an MRI. Results: Sixty-one patients with Chagas’ disease, with an average age of 58 ± 9 years old, 17 patients in the indeterminate form, 16 in the cardiac form without left ventricular (LV) dysfunction and 28 in the cardiac form with LV dysfunction were studied. P <0.05 was considered to be statistically significant. Late enhancement was detected in 37 patients (64%). Myocardial fibrosis was identified in 6 individuals in indeterminate form (41%; 95% CI 23-66) in a proportion similar to that observed in cardiac form without LV dysfunction (44%); p = 1.0. Among the individuals with fibrosis, the total area of the affected myocardium was 4.1% (IIQ: 2.1 - 10.7) in the indeterminate form versus 2.3% (IIQ: 1-5) in the cardiac form without LV (p = 0.18). The left ventricular fraction ejection in subjects in the indeterminate form was similar to that of the individuals in the cardiac form without ventricular dysfunction (p = 0.09). Conclusion: The presence of fibrosis in the indeterminate form of Chagas’ disease has a frequency and extension similar to that of in the cardiac form without dysfunction, suggesting that the former is part of a subclinical disease spectrum, rather than lacking cardiac involvement.

This work describes the phytochemical study of stem bark and leaves of Cenostigma macrophyllum Tul. (Leguminosae). Through usual chromatographic techniques were isolated bergenin as the primary compound of the stem bark of and from the leaves gallic acid, methyl gallate, ellagic acid, quercetin, quercetin-3-O-β-D-glucopyranoside, quercetin-3-O-(6"-O-galloyl)-β-D-glucopyranoside (tellimoside), quercetin-3-O-(6"-O-E-p-coumaroyl)-β-D-glucopyranoside (helichrysroside), agathisflavone and vitexin were obtained. The isolates were identified by spectroscopic data analysis, and bergenin showed dose-related antinociception when assessed in acetic acid-induced writhing in mice.

FUNDAMENTO: Insuficiência cardíaca (IC) causada por Doença de Chagas (DC) é uma cardiomiopatia inflamatória progressiva que afeta milhões de pessoas na América Latina. Estudos com modelos de camundongo de IC devido à DC indicam que o transplante de células mononucleares derivadas da medula óssea (TCDMO) pode reduzir a inflamação, fibrose e melhorar a função miocárdica. OBJETIVO: O propósito desse estudo foi avaliar, pela primeira vez em seres humanos, a segurança e a eficácia de TCDMO no miocárdio de pacientes com IC devido à DC. MÉTODOS: Um total de 28 pacientes com IC devido à DC (média de idade de 52,2 ± 9,9 anos) com classe funcional NYHA III e IV foram submetidos à TCDMO através de injeção coronariana. Os efeitos na fração de ejeção do ventrículo esquerdo (FEVE), capacidade funcional, qualidade de vida, arritmias e parâmetros bioquímicos, imunológicos e neuro-humorais foram avaliados. RESULTADOS: Não houve complicações diretamente relacionadas ao procedimento. A FEVE foi 20,1 ± 6,8% e 28,3 ± 7,9%, p < 0,03 a nível basal e 180 dias após o procedimento, respectivamente. No mesmo período, melhoras significantes foram observadas na classe funcional NYHA (3,1 ± 0,3 para 1,8 ± 0,5; p < 0,001), qualidade de vida (50,9 ± 11,7 para 25,1 ± 15,9; p < 0,001), e no teste de caminhada de seis minutos (355 ± 136 m para 437 ± 94 m; p < 0,01). Não houve alterações nos marcadores de ativação imune ou neurohormonais. Nenhuma complicação foi registrada. CONCLUSÃO: Nossos dados sugerem que a injeção intracoronariana de células derivadas da medula óssea é segura e potencialmente efetiva em pacientes com IC devido à DC. A extensão do benefício, entretanto, parece ser discreta e precisa ser confirmada em estudos clínicos maiores, randomizados, duplo-cegos, controlados com placebo.

BACKGROUND: Heart failure due to Chagas' disease (HFCD) is a progressive inflammatory cardiomyopathy that affects millions of individuals in Latin America. Studies using mice models of HFCD indicate that bone marrow mononuclear cell transplantation (BMCT) may reduce inflammation, fibrosis, and improve myocardial function. OBJECTIVE: The purpose of this study was to evaluate, for the first time in humans, the safety and efficacy of BMCT to the myocardium of patients with HFCD. METHODS: A total of 28 HFCD patients (mean age 52.2 ± 9.9 years) with NYHA class III and IV were submitted to BMCT through intracoronary injection. Effects on the left ventricle ejection fraction (LVEF), functional capacity, quality-of-life, arrhythmias, biochemical, immunological, and neuro-humoral parameters, were evaluated. RESULTS: There were no complications directly related to the procedure. LVEF was 20.1 ± 6.8% and 28.3 ± 7.9%, p < 0.03 at baseline and 180 days after the procedure, respectively. In the same period, significant improvements were observed in the NYHA class (3.1 ± 0.3 to 1.8 ± 0.5; p < 0.001), quality-of-life (50.9 ± 11.7 to 25.1 ± 15.9; p < 0.001), and in the six-minute walking test (355 ± 136 m to 437 ± 94 m; p < 0,01). There were no changes in markers of immune or neurohormonal activation. No complications were registered. CONCLUSION: Our data suggest that the intracoronary injection of BMCT is safe and potentially effective in patients with HFCD. The extent of the benefit, however, appears to be small and needs to be confirmed in a larger randomized, double blind, placebo controlled clinical trial.

FUNDAMENTO: La insuficiencia cardíaca (IC), causada por la enfermedad de Chagas (EC), es una cardiomiopatía inflamatoria progresiva que afecta a millones de personas en Latinoamérica. Estudios con modelos experimentales de IC en razón de la EC, nos indican que el transplante de células mononucleares derivadas de la médula ósea (TCMO), puede reducir la inflamación y la fibrosis, mejorando así la función miocárdica. OBJETIVO:El objetivo de este estudio fue evaluar, por primera vez en seres humanos, la seguridad y la eficacia del TCMO en el miocardio de pacientes con IC debido a la EC. MÉTODOS:Fueron estudiados un total de 28 pacientes con IC debido a la EC (con edad promedio 52,2 ± 9,9 años), en clases funcionales III y IV (NYHA), al TCMO por medio de una inyección coronaria. Se evaluaron los efectos en la fracción de eyección del ventrículo izquierdo (FEVI), capacidad funcional, calidad de vida, arritmias y parámetros bioquímicos, inmunológicos y neurohumorales. RESULTADOS:No se registraron complicaciones relacionadas directamente con el procedimiento. La FEVI pasó de 20,1 ± 6,8% para 28,3 ± 7,9%, p < 0,03, cuando se comparó con el período basal y 180 días después del procedimiento, respectivamente. En el mismo período, también se observaron mejorías en la clase funcional NYHA promedio (3,1 ± 0,3 para 1,8 ± 0,5; p < 0,001), puntuación de calidad de vida de Minnesota (50,9 ± 11,7 para 25,1 ± 15,9; p < 0,001), y en el test de esfuerzo de seis minutos (355 ± 136 m para 437 ± 94 m; p < 0,01). No hubo alteraciones en los marcadores de activación inflamatoria o neurohormonales. Ninguna complicación fue registrada. CONCLUSIÓN:Nuestros datos sugieren que la inyección intracoronaria de las células derivadas de la médula ósea es segura y potencialmente efectiva en pacientes con IC debido a la EC. La extensión del beneficio, sin embargo, parece ser discreta, y necesita ser confirmada en los ensayos clínicos randomizados, doble ciegos, controlados con placebo.

Physalis angulata L., Solanaceae, é uma erva anual utilizada na medicina popular em muitos países tropicais e subtropicais. Apesar dos extratos da P. angulata apresentarem uma grande variedade de substâncias, pouco é conhecido sobre a sua atividade farmacológica. Neste trabalho foi investigado a atividade antileishmania in vitro de seco-esteroides (fisalinas) purificados da P. angulata. O tratamento com as fisalinas B, F e G causou uma inibição concentração-dependente do crescimento de promastigotas de Leishmania amazonensis em cultura axênica, com valores de IC50 de 6,8, 1,4, e 9,2 μM respectivamente. A fisalina D foi menos ativa, com valores de IC50 de 30,5 μM. Foi também observada uma atividade leishmanicida em culturas de outras espécies de Leishmania (L. major, L. braziliensis e L. chagasi). Nossos resultados demonstram que as fisalinas inibem o crescimento dos promastigotas com o tratamento de espécies de Leishmania do Velho e do Novo Mundos e sugerem o potencial terapêutico destas moléculas na leishmaniose.

Physalis angulata L., Solanaceae, is an annual herb commonly used in popular medicine in many tropical and subtropical countries. P. angulata extracts contain a variety of substances, but little is known about their pharmacological activities. In this work we investigated the in vitro antileishmanial activity of seco-steroids (physalins) purified from P. angulata. Addition of physalins B, F, and G caused a concentration-dependent inhibition in the growth of L. amazonensis promastigotes, being the IC50 values were 6.8, 1.4, and 9.2 μM, respectively. Physalin D was less active and had an IC50 value of 30.5 μM. Physalins were also active in cultures of other Leishmania species (L. major, L. braziliensis, and L. chagasi). Our results demonstrate the potent antileishmanial activity of physalins in cultures of Leishmania species of the New and Old Worlds and suggest the therapeutic potential of these seco-steroids in leishmaniasis.

A família Rutaceae apresenta espécies vegetais muito bem distribuídas no Semi-Árido Brasileiro e comumente usadas em medicina popular. Espécies dessa família tem diversas atividades biológicas descritas na literatura. Neste trabalho, atividades imunomoduladora e bactericida são descritas para o extrato acetato de etila e clorofórmico de três espécies da família (Esenbeckia grandiflora Mart., Pilocarpus spicatus A.St.-Hil. e Galipea simplicifolia Schult.). Todas as amostras foram inicialmente avaliadas quanto à sua citotoxicidade, com objetivo de determinar a LC50. O potencial imunomodulador foi avaliado em culturas de esplenócitos murinos estimulados ou não com concanavalina A e também em reação mista linfocitária (RML), usando também esplenócitos de camundongos BALB/c (H-2d) imunizados com esplenócitos de camundongos C57Bl/6 (H-2b). Quatro amostras tiveram os mais elevados valores percentuais de inibição da proliferação de linfócitos ativados pela concanavalina A e foram avaliados em RML. A atividade antibacteriana dos extratos foi também avaliada e a concentração mínima inibitória (CMI) para duas amostras ativas foi de 1.0 e 5.0 mg/mL, respectivamente para as espécies Esenbeckia grandiflora Mart. and Galipea simplicifolia Schult. Assim, os dados aqui apresentados reforçam informações da literatura científica relacionados à atividade biológica para muitas espécies da família Rutaceae e incentivam outros estudos com estas visando descobrir substâncias ativas, potenciais candidatas a novos fármacos.

Rutaceae is a taxon with species very well distributed in Brazilian semi-arid area, commonly used in folk medicine. Species from this genus have diverse biological activity described in literature. In this work, immunomodulatory and bactericidal activity are described for chloroform and ethyl acetate extracts of three of them (Esenbeckia grandiflora Mart., Pilocarpus spicatus A.St.-Hil. and Galipea simplicifolia Schult.). Initially all the samples had their cytotoxicity evaluated, aiming to determine the LC50. The immunomodulatory potential was evaluated in cultures of murine splenocytes stimulated or not with concanavalin A and in a mixed lymphocyte reaction (MLR) using splenocytes from BALB/c (H-2d) mice immunized with splenocytes from C57Bl/6 (H-2b) mice. Four samples had higher values of lymphoproliferation inhibition in concanavalin A-stimulated cultures and were evaluated in MLR. The antibacterial activity of extracts was also evaluated and the minimal inhibitory concentrations (MIC) for two active samples were 1.0 and 5.0 mg/ml for extracts from Esenbeckia grandiflora Mart. and Galipea simplicifolia Schult., respectively. Thus, our results reinforce data of literature relating biological activity for many species of the Rutaceae family and encourage studies with these species aiming to discover active compounds, candidates to new medicines.

A doença de Chagas, que ocorre no México e nas Américas Central e do Sul, continua representando um grave problema de saúde pública. A prevalência global da infecção humana pelo Trypanosoma cruzi foi estimada em 16-18 milhões de casos no ano de 2005, sendo corrigida para aproximadamente 28 milhões de pessoas no ano de 2007, segundo a Organização Mundial de Saúde. A cardiopatia chagásica crônica é a forma mais comum de cardiomiopatia nas Américas Central e do Sul e a principal causa de morte por doença cardiovascular em áreas endêmicas. Até o momento não existe nenhum tratamento eficiente para esta doença a não ser o tratamento farmacológico ou o transplante cardíaco nos indivíduos que desenvolvem um quadro mais grave da doença. Trabalhos atuais têm mostrado o uso de células-tronco de várias origens em modelos animais e humanos de doenças do coração, como infarto do miocárdio, destacando uma melhora em aspectos como neovascularização, regeneração do músculo cardíaco, aumento da fração de ejeção e melhora na qualidade de vida dos indivíduos tratados. Estes dados induziram os pesquisadores a investigar os efeitos terapêuticos do transplante de células mononucleares de medula óssea em um modelo murino e em indivíduos chagásicos crônicos. Esta revisão tem por objetivo mostrar os trabalhos realizados usando a terapia celular na cardiopatia chagásica crônica.

Chagas' disease occurs throughout Mexico, Central and South America and still represents a serious threat to public health. The overall prevalence of infection by Trypanosoma cruzi was estimated at 16-18 million cases in 2005 and updated to approximately 28 million people in 2007, according to the World Health Organization. Chronic Chagas heart disease is the most common form of cardiomyopathy in Central and South America and one of the leading causes of death from cardiovascular disease in endemic areas. So far, there is no effective treatment for this disease except for heart transplantation in individuals who develop a more severe form the disease. Recent works have shown that the use of stem cells from various sources tested in animal models and in human heart diseases, including myocardial infarction, have resulted in an improvement in aspects such as vascularization, regeneration of the heart muscle, in ejection fraction and in quality of life of individuals treated. These data led researchers to investigate the effects of transplantation of bone marrow mononuclear cells in muriine models and chronic chagasic individuals. The present review aims to show the work carried out using cell therapy in chronic Chagas heart disease.

O desenvolvimento de técnicas de transplante de órgãos sólidos e de medula óssea foi um dos mais fascinantes avanços da medicina no século XX. A virada do século XXI testemunha um desdobramento também fascinante e promissor desta modalidade terapêutica: o uso de células-tronco para regenerar tecidos lesados outrora considerados irreparáveis. Resultados encorajadores de inúmeros estudos com animais de experimentação impulsionaram grupos de diversos centros no mundo a iniciar estudos clínicos com transplante de células-tronco em várias doenças, particularmente as doenças cardiovasculares e neurológicas. Embora ainda estejamos algo distante de entender o mecanismo preciso pelo qual as células-tronco regeneram órgãos lesados, os estudos publicados até o presente momento, incluindo vários estudos envolvendo seres humanos, sugerem haver um benefício real com esta terapia. O presente artigo pretende abordar os aspectos relevantes da terapia celular em doenças cardiovasculares, incluindo conceitos básicos sobre células-tronco, e os principais estudos de animais de experimentação e clínicos publicados até o presente.

Solid organ and bone marrow transplantation were two of the most fascinating treatment modalities developed in the second half of the past century. At the turn of the 21st century the use of stem cells emerge as a potential therapeutic option for diseases previously thought to be irreversible. The promising results of animal studies paved the way for several groups all around the world to investigate the role of stem cell therapy in the clinical setting. The results of these clinical trials have been published over the last couple of years, most of which dealing with cardiovascular and neurological disorders. The results of the trials published thus far are encouraging (both animal and clinical) and suggest that there may be a real benefit with this therapy, yet we are still considerably distant from a reasonable understanding of the mechanism of tissue repair by stem cells. The present article will briefly review relevant aspects of the so called regenerative medicine, focusing on cardiovascular disorders.

Apresentado o primeiro caso de transplante de célula de medula óssea para o miocárdio de um portador de insuficiência cardíaca de etiologia chagásica. Homem, 52 anos, portador de insuficiência cardíaca crônica, em classe funcional III da NYHA, apesar de terapêutica clínica otimizada. Como procedimento, foi aspirado 50 ml de medula óssea através de punção da crista ilíaca, seguidos de filtragem, separação das células mononucleares, ressuspensão e injeção intracoronariana. A fração de ejeção do ventrículo esquerdo em repouso, medida pela ventriculografia radioisotópica com hemácias marcadas, antes do transplante, era de 24% e, após 30 dias, aumentou para 32% sem alterar o esquema medicamentoso. Foram avaliados, antes e 30 dias após o procedimento, respectivamente, o diâmetro diastólico final do ventrículo esquerdo (82 mm; 76 mm); escore de qualidade de vida de Minnesota (55; 06); distância caminhada no teste de 6min (513 m; 683 m). Achados demonstraram ser possível realizar a injeção intracoronariana de célula de medula óssea, sugerindo que este procedimento é potencialmente seguro e efetivo em pacientes com insuficiência cardíaca chagásica.

We report the first case of bone marrow cell transplantation to the myocardium of a patient with heart failure due to chagas' disease. The patient is a 52-year-old man with chronic heart failure, NYHA functional class III, despite the optimized clinical therapy. The procedure consisted of aspiration of 50 mL of bone marrow through puncture of the iliac crest, followed by filtration, separation of the mononuclear cells, resuspension, and intracoronary injection. The left ventricular ejection fraction at rest, measured using radionuclide ventriculography with labeled red blood cells prior to transplantation, was 24%, and, after 30 days, it increased to 32% with no change in the medicamentous schedule. The following measurements were assessed before and 30 days after transplantation: left ventricular end diastolic diameter (82 mm and 76 mm, respectively); Minnesota living with heart failure questionaire score (55 and 06, respectively); and distance walked in the 6-minute walking test (513 m and 683 m, respectively). Our findings show that intracoronary injection of bone marrow cells may be performed, suggesting that this is a potentially safe and effective procedure in patients with due to Chagas' disease heart failure.

Inoculação de camundongos BALB/c com tripomastigotas do clone avirulento de Trypanosoma cruzi CL-14 protege contra o desenvolvimento de parasitemia e mortalidade após desafio com a cepa virulenta CL. No presente trabalho, investigamos os perfis de produção de citocinas e anticorpos induzidos por inoculação com CL-14. Grupos de camundongos foram inoculados com tripomastigotas do clone CL-14 e desafiados com a cepa CL. Camundongos inoculados com o clone CL-14 desenvolveram níveis significativamente mais baixos de IFN-<FONT FACE=Symbol>g</font> e níveis mais elevados de IgG1 após desafio com a cepa CL, em comparação com animais controles infectados com a cepa CL. Inoculação prévia com o clone CL-14 preveniu parcialmente a supressão da produção de IL-2 causada pela infecção por CL. Não foram observadas diferenças significativas quanto à produção de IL-4 por esplenócitos de camundongos inoculados com CL-14 ou controles, após desafio com a cepa CL. Os resultados indicam que a proteção contra a fase aguda da infecção por T. cruzi induzida pela inoculação com o clone CL-14 está correlacionada a um padrão de resposta T1/T2 misto, o que pode ser benéfico para o hospedeiro.

We have previously demonstrated that inoculation of BALB/c mice with trypomastigotes of CL-14, an avirulent Trypanosoma cruzi clone, prevents the development of parasitemia and mortality after challenge with virulent CL strain. In this report, we investigated the cytokine and antibody profiles induced by inoculation with CL-14 clone. Groups of mice were inoculated with trypomastigotes of CL-14 clone and challenged with infective CL strain. Challenged CL-14-inoculated mice had lower levels of IFN-<FONT FACE=Symbol>g</font> and higher production of IgG1 antibodies as compared to CL strain-infected mice. Previous inoculation with CL-14 clone partially prevented the suppression of IL-2 production caused by CL strain infection. No significant differences were found regarding IL-4 production by splenocytes from CL-14-inoculated or control groups after challenge with CL-strain. Our results show that protection against acute T. cruzi infection induced by CL-14 inoculation correlates with a balanced T1/T2 cytokine production, a profile likely to be beneficial for the host.