Stroke and brain atrophy in chronic Chagas disease patients: A new theory proposition

Oliveira‐Filho, Jamary

doi:10.1590/s1980-57642009dn30100005

Cited by 12 publications

(11 citation statements)

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“…Both IL-6 and TNF-alfa production are associated with chronic Chagas disease [4,5]. Thus, we hypothesize that chronic inflammation in Chagas disease may underlie the mechanism for a progressive form of brain atrophy [8].…”

Section: Discussionmentioning

confidence: 89%

Chagas disease is independently associated with brain atrophy

et al. 2009

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Chagas disease (CD) remains a major cause of cardiomyopathy and stroke in developing countries. Brain involvement in CD has been attributed to left ventricular dysfunction, resulting in chronic brain ischemia due to hypoperfusion and/or embolic infarcts. However, cognitive impairment in CD may occur independently of cardiac disease. Therefore, we aimed to investigate head computed tomography (CT) findings in patients with Chagas disease cardiomyopathy (CDC) in comparison with other cardiomyopathies (OC). We studied 73 patients with CDC (n = 41) or OC (n = 32) matched for age and gender. These patients underwent head CT, rated by an investigator blinded to all clinical information. Head CT was rated for the presence of lacunar or territorial infarcts, as well as for measuring the total volumes of the brain, cerebellum and ventricles. Total brain volume was smaller in CDC as compared to OC patients (1,135 +/- 150 vs. 1,332 +/- 198 cm(3), P < 0.001). Cerebellar and ventricular volumes did not differ between the groups. The prevalence of brain infarcts did not differ significantly between the groups. Chagas disease was the only independent predictor of brain atrophy in the multivariable analysis (OR = 1.38; 95% CI = 1.06-1.79, P = 0.017). Chagas disease is associated with brain atrophy independent of structural cardiac disease related to cardiomyopathy. Brain atrophy, rather than multiple infarcts, may represent the main anatomical substrate of cognitive impairment in Chagas disease.

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Section: Discussionmentioning

confidence: 89%

Chagas disease is independently associated with brain atrophy

et al. 2009

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“…Thus, all patients with cryptogenic or cardioembolic stroke should be screened for T. cruzi infection if they live in or have emigrated from endemic areas, mainly South America 30 . Chronic inflammation in CD has been hypothesized as a trigger to cause vascular damage and stroke in this group of cryptogenic stroke patients with no significant systolic dysfunction or cardiac arrhythmias 31 .…”

Section: Cardiogenic Embolismmentioning

confidence: 98%

Ischemic stroke in young adults: an overview of etiological aspects

Yamamoto

2012

Arq. Neuro-Psiquiatr.

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Ischemic stroke (IS) in young adults is reported as uncommon, comprising less than 10% of all stroke patients 1 . However, In our clinical practice, we are faced not infrequently with patients aged less than 45 years who suffered a stroke, many of them with no risk factors for atherosclerosis and no ultimate clear etiological diagnosis even after a thorough investigation. This diagnostic challenge is one of the main scopes of studying and researching mechanisms of brain ischemia in young adults in addition to the dramatic personal, familial, and socio-economic consequences by affecting individuals at the top of their productive age.Although cardioembolism and cervicocephalic arterial dissection have been established as principal etiological factors of IS in young adults 2 , a systematic diagnostic approach must be applied to all patients, regarding the great number of potential causes in this group and the multifactorial nature in many of these patients.Despite more accurate diagnostic tools recently acquired in vascular imaging, hematological and genetic studies, currently, the number of young patients with cryptogenic IS remains high, performing 30-40% 3,4 . Considered an unusual cause of IS in the young two decades ago 5 , atherosclerosis has gaining projection by recent reports of significant raise in traditional risk factors as hypertension, diabetes, obesity, dyslipidemia and tabagism among hospitalized adolescents and young adults 6. Table 1 shows the main categorizations of etiologic subtypes of IS in young adults that must be considered in every young patient with IS. NoNAthERoSclERotIc ANgIopAthIES AbStRActStroke affects mainly people aged over 65 years, and atherosclerosis predominates as the main etiopathogenic factor in ischemic stroke (IS). On the other hand, cardiac embolism and arterial dissection are the most frequent causes of IS in patients aged less than 45 years. However, inappropriate control of traditional vascular risk factors in young people may be causing a significant increase of atherosclerosis-related IS in this population. Furthermore, a variety of etiologies, many of them uncommon, must be investigated. In endemic regions, neurocysticercosis and Chagas' disease deserve consideration. Undetermined cause has been still reported in as many as one third of young stroke patients.Key words: stroke, brain ischemia, young adult. RESumoA doença aterosclerótica é o fator etiopatogênico mais importante no acidente vascular cerebral isquêmico (AVCI), afecção que acomete predominantemente pessoas acima da sétima década de vida. Entretanto, nos adultos jovens a aterosclerose exibe frequência menor, sendo a embolia de origem cardíaca e as dissecções arteriais as causas mais comuns de AVCI em pacientes com até 45 anos de idade. Porém, o controle inadequado dos fatores de risco vascular nas faixas mais jovens da população pode estar levando à elevação significativa no nú-mero de infartos cerebrais associados à aterosclerose nessa faixa etária.Uma ampla gama de fatores etiológicos, muitos deles rar...

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“…In terms of pathways, KEGG pathway enrichment analysis results show that 65 key targets are also significantly enriched in diseases-related pathways such as herpes virus infection, hepatitis B, cancer, diabetes, and Chagas disease, suggesting that there may be correlations and effects between different diseases, Which has also been verified in previous research.Studies have shown that the hepatitis B core antibody (anti-HBc) positive / hepatitis B surface antigen (HBsAg) negative pattern is associated with intracranial atherosclerotic stenosis in hepatitis B virus infection [51] .In virologically suppressed HIV patients, human herpesvirus 8 (HHV-8) infection increases inflammation and activates immunity, increasing the risk of atherosclerosis [52] .With common risk factors, cancer and atherosclerosis have the same basis as metabolic or vascular abnormalities,and the theory of inflammation is the common pathological basis of both them [53] .Chronic inflammation caused by Chagas disease may trigger endothelial damage and platelet activation, accelerating atherosclerosis [54] .In the progression of atherosclerosis, the PI3K-Akt signaling pathway plays an important role in the survival, proliferation and migration of macrophages [55] ,which suggesting that HLJDD may prevent atherosclerosis by regulating PI3K-Akt signaling pathway and inhibiting the related effects of macrophages.Signaling pathways such as IL-17 signaling pathway and TNF signaling pathway are closely related to inflammatory response. Activation of IL-17 signaling pathway and TNF signaling pathway can activate downstream NF-κ B signaling pathways, leading to the production of various mediators associated with atherosclerosis, including inflammatory factors ,chemokines and others [56][57] .…”

Section: Figure7hljdd-key Active Ingredients-key Targets-pathway Netmentioning

confidence: 99%

Network Pharmacological Analysis of Huanglian Jiedu Decoction for Anti- Atherosclerosis

Wu¹,

Jiang²,

Huang³

et al. 2020

Preprint

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Objective: We aimed to predict the possible active components,key targets and pathways of Huanglian Jiedu Decoction(HLJDD) for anti-atherosclerosis. Methods: The TCMSP database was searched to obtain the active components and targets of HLJDD, the GeneCards and OMIM databases were searched to obtain related targets of atherosclerosis, and we obtain the intersection targets of them, which are the potential targets of HLJDD for anti-atherosclerosis.Application of Cytoscape 3.6.0 software to build a herbal-active ingredient-potential target regulation network.We perform protein-protein interaction(PPI) network analysis of potential targets through STRING 11.0 database and obtain the key targets,and the results of PPI network of key targets were visualized by Cytoscape3.6.0 software. Gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of the key targets were performed using STRING11.0 database, and we finally constructed the possible pharmacological network of HLJDD for anti-atherosclerosis .Results: We finally obtained 14 key active ingredients of HLJDD, 65 key targets of anti-atherosclerosis, and 14 key active ingredients corresponded to 52 of these targets. These targets are mainly involved in biological processes such as reaction to organic substance, reaction to chemical stimulation,etc.They mainly involved in biological signaling pathways such as pathways in cancer,IL-17 signaling pathway,etc. Conclusion: HLJDD may act on 52 key targets such as PTGS2, HSP90AA1 and RELA through 14 key active ingredients, and influence the signaling pathways including fluid shear stress and atherosclerosis,PI3K-Akt signaling pathway,IL-17 signaling pathway,AGE-RAGE signaling pathway in diabetic complications,TNF signaling pathway,etc.Thus, it may play an anti-atherosclerosis role by inhibiting inflammatory reaction, oxidative stress and improving hemodynamics,etc.

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Stroke and brain atrophy in chronic Chagas disease patients: A new theory proposition

Cited by 12 publications

References 28 publications

Chagas disease is independently associated with brain atrophy

Chagas disease is independently associated with brain atrophy

Ischemic stroke in young adults: an overview of etiological aspects

Network Pharmacological Analysis of Huanglian Jiedu Decoction for Anti- Atherosclerosis

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