Impact of the Use of Benznidazole Followed by Antioxidant Supplementation in the Prevalence of Ventricular Arrhythmias in Patients With Chronic Chagas Disease: Pilot Study

Abstract

Patients with chronic Chagas disease have a higher prevalence of premature ventricular contraction (PVC) because of immunoinflammatory response magnified by the increased oxidative stress. Thus, the sequential treatment with benznidazole (BZN) and antioxidants can reduce the prevalence of PVC. We wish to establish whether the etiological treatment of Chagas disease followed by supplementation with the antioxidant vitamins E and C decreases the prevalence of PVC in these patients. A sample of 41 patients with chronic Chagas disease at different stages of the heart disease was selected for the treatment against the causative agent using BZN (5 mg·kg·d, minimum dose 300 mg daily) for 2 months followed by supplementation with antioxidants such as vitamins E (800 UI/d) and C (500 mg/d) for 6 months. The prevalence of PVC was observed by conducting 24-hour Holter. To evaluate the oxidative status of the patients, serum markers of oxidative stress like glutathione peroxidase, superoxide dismutase, catalase, glutathione reductase, and glutathione S-transferase were measured, and also reduced glutathione, vitamin E, and markers of tissue damage like thiobarbituric acid reactive substances and protein carbonyl. A decrease in the prevalence of PVC in patients with advanced Chagas heart disease was observed (5391 vs. 1185, P = 0.0068). This reduction was followed by decrease of serum markers of oxidative stress. In patients with a lower degree of cardiac damage, the reduction on prevalence of PVC was not significant. The etiological treatment with BZN followed by supplementation with antioxidant vitamins E and C reduces episodes of PVC in patients with severe Chagas heart disease.

Benefits of Ascorbic Acid in Association with Low-Dose Benznidazole in Treatment of Chagas Disease

“…In a clinical trial, Barbosa et al (26) showed that AA associated with BZ at a clinical dosage has a therapeutic impact on the reduction of ventricular arrhythmias in chronic chagasic patients with an advanced degree of cardiac damage. Nevertheless, studies combining low doses of BZ and AA are still poorly explored.…”

ROS and Trypanosoma cruzi: Fuel to infection, poison to the heart

“…The interference with parasite burden, interstitial fibrosis, inflammatory infiltrates, and cardiac hypertrophy may either accompany functional improvement or not [ 56 , 62 , 80 , 86 ]. A first antioxidant tested as a therapy to Chagas disease was vitamin E. It reversed oxidative damage [ 88 ] and, along with benznidazole, prevented oxidative damage and reduced the incidence of premature ventricular contraction (PVC) [ 89 ]. Selenium is being tried as a therapy [ 90 ], and we expect that soon indirect antioxidants that act through Nrf2 or SIRT1 pathways should find their way to clinical trials.…”

Effects of Selenium treatment on cardiac function in Chagas heart disease: Results from the STCC randomized Trial

“…In the natural course of CD [9] , especially in CCC, a chronic inflammation increases the oxidative status of the infected person, as indicated by biomarkers such as glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase, glutathione reductase, glutathione S-transferase, reduced glutathione, vitamin E, thiobarbituric acid reactive substances and protein carbonyl [ 10 , 11 ]. Heart disease progression in CD is also followed by a decrease in Se status [12] .…”