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Infection and Immunity, April 2004, p. 2350-2357, Vol. 72, No. 4
0019-9567/04/$08.00+0 DOI: 10.1128/IAI.72.4.2350-2357.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
Department of Immunology, Instituto de Ciências Biomédicas,1 Department of Pathology, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, São Paulo, Brazil,2 Instituto Gulbenkian de Ciência, Oeiras, Portugal3
Received 4 October 2003/ Returned for modification 16 November 2003/ Accepted 17 December 2003
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Chagas disease pathogenesis has been attributed to autoimmunity (5, 6, 15, 17-19), but this issue still remains controversial (22, 31). Several pieces of evidence suggest that, independently of the eventual contribution of an autoimmune component, pathology relates to persistence of T. cruzi parasites at the affected organs where they evoke a chronic inflammatory process (3, 13, 22, 27, 31). According to this view, the level of chronic commitment of a particular organ reflects to a certain extent its local parasite load. This parameter depends on parasite elements, such as virulence, inoculum size (11), tropism (1, 12, 26, 28), immunogenicity, and systemic and local host factors, such as those controlling the magnitude and quality of the anti-T. cruzi immune response (24, 25, 30).
Characterization of the host elements contributing to the occurrence of chronic lesions is an important goal, which may have inestimable prognostic value for chronic patients. Such characterization can be approached through the study of genetic crosses derived from parental strains with high and low susceptibilities to developing T. cruzi-induced pathology. With the above objective in mind, in this study we have approached the identification of such polar mouse strains during the chronic infection with the Sylvio X10/4 clone. This parasite was chosen both because it is a clone with stable biological characteristics (16) and because it does not cause a symptomatic acute disease but does induce chronic cardiac lesions incorporating several pathological features of the human chagasic cardiomyopathy.
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Parasite screening. In the acute phase of infection, parasitemias were determined by microscopic examination of 5-µl blood samples collected from the tail vein with a heparinized capillary tube. In the chronic phase of infection, the presence of T. cruzi parasites in the blood, liver, or heart was detected by searching for trypomastigotes in aliquots of blood (0.1 ml) or tissue homogenates (approximately 10 mg of tissue) cultured in triplicate, at 28°C, for a month, in axenic liver infusion tryptose (LIT) medium. To avoid blood contamination of heart and liver tissue samples, the inferior cava vein of chronically infected mice was sectioned above the diaphragm and connected through the left ventricle to a KDS 200 Two-Syringe Infusion Pump (KD Scientific, New Hope, Pa.), which delivered sterile phosphate-buffered saline for 5 min, at a flow rate of 2 ml/min.
ELISA for parasite specific antibodies. Anti-T. cruzi serum antibodies were quantified by enzyme-linked immunosorbent assay (ELISA). In brief, 96-well flat-bottom microtest plates were coated overnight (4°C) with a T. cruzi extract (50 µg/ml) obtained from the supernatant of tissue culture trypomastigotes of the Sylvio X10/4 clone subjected to several freeze-thawing cycles. Plates were saturated with 1% gelatin for 1 h. After washing, 50 µl of mouse serum samples (diluted 1/100 to 1/400 for immunoglobulin G1 [IgG1] and 1/1,000 to 1/4,000 for IgG2a) were added and left for 1 h at room temperature. The assays were developed by adding goat anti-mouse IgG1 or IgG2a biotinylated antibodies (Southern Biotechnology Associates, Birmingham, Ala.) followed by a peroxidase-avidin conjugate and O-phenylenediamine (Sigma Chemical Co., St. Louis, Mo.). Enzyme reaction mixtures were developed for 10 min and blocked with 3 N HCl (50 µl/well). A Dynatech reader (Dynatech Laboratories Inc., Chantilly, Va.) using a 450-nm-wavelength filter quantified the absorbance values.
Histopathological analysis. Tissue specimens from chronically infected mice were collected and fixed in paraformaldehyde for further processing. Paraffin-embedded tissue sections were stained with hematoxylin-eosin and examined in a light microscope. Six nonconsecutive slides from the heart, liver, and quadriceps muscle of each mouse were examined in a blind fashion. Areas of inflammatory infiltrates in the myocardium, pericardium, endocardium, liver, or striated muscle were quantified using an image analysis system (Image Pro Plus Media Cybernetics, Silver Spring, Md.). The sum of infiltrated areas in the six slides was calculated for each mouse. The final individual score was expressed in square micrometers of inflammatory infiltrates per square millimeter of examined tissue.
Statistical analysis. The differences between the groups of mice used in this study were determined by the Kruskal-Wallis test.
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FIG. 1. Intensity of inflammation in the heart, liver, and striated muscle of chronically infected mice from different strains. Mice were infected i.p. with 106 Sylvio X10/4 trypomastigotes, and the infiltrated areas were evaluated at day 200 postinfection, as described in Materials and Methods. Each bar represents the mean ± SE (error bar) of individual values (n = 5).
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FIG. 2. Examples of lesions in the heart, liver, and striated muscle of C3H/HePAS and A/J mice infected for 200 days with 106 Sylvio X10/4 trypomastigotes. (A) Heart section of a C3H/HePAS infected mouse displaying intense cardiac pathology with pronounced mononuclear infiltration at the pericadium and myocardium. (B) Heart section of an A/J infected mouse showing no inflammation. (C) Absence of liver lesions in a C3H/HePAS infected mouse. (D) Intense hepatitis in an A/J infected mouse. Inflammatory infiltrates of different intensities in the striated muscle of C3H/HePAS (E)- and A/J (F)-infected mice. Bar, 50 µm; magnification, x17.
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TABLE 1. Tissue parasitism in the chronic phase of T. cruzi infectiona
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FIG. 3. Parasite nest in the myocardium of C3H/HePAS mice infected for 200 days with 106 Sylvio X10/4 trypomastigotes. A magnified picture of the pseudocyst can be seen in the insert. Bar, 50 µm; magnification, x17.
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The skeletal muscle of chronically infected A/J, C3H/HePAS, and C57BL/6 mice showed moderate degrees of myositis and degenerating fibers (Fig. 1 and 2E and F). Among these mouse strains, A/J mice displayed the higher number of inflammatory foci. In the striated muscle, parasite nests were observed in only 1 out of 21 chronically infected A/J mice (4.8%), while no amastigote could be detected in chronically infected C3H/HePAS mice (Table 1) or mice from the other strains (data not shown).
Most importantly, regarding the predominance of heart and liver inflammatory lesions, chronically infected C3H/HePAS and A/J mice exhibited a clearly distinct pathology, as illustrated in Fig. 4. Pathology in C3H/HePAS mice was focused on the heart, whereas the disease affected the liver of A/J mice. Moreover, no difference was observed in the intensity of heart or liver infiltrates between male and female chronically infected C3H/HePAS or A/J mice (data not shown).
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FIG. 4. Analysis of inflammatory infiltrates in the heart, liver, and striated muscle of chronically infected C3H/HePAS and A/J mice. Cumulative data of various experiments done at various times from day 120 to 600 after infection with 106 Sylvio X10/4 trypomastigotes are shown. Each dot represents one mouse and mean values are indicated by horizontal lines. Infiltrated areas were evaluated as described in Materials and Methods.
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FIG. 5. Cumulative mortality curves of C3H/HePAS and A/J mice infected i.p. with 106 Sylvio X10/4 trypomastigotes/mouse (20 mice/group).
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Histopathology of F1 (A/J x C3H/HePAS) and F2 (A/J x C3H/HePAS) chronically infected mice. To investigate the inheritance patterns of T. cruzi-induced inflammatory lesions observed in the heart of C3H/HePAS mice and in the liver of A/J mice, we analyzed F1 (A/J x C3H/HePAS) mice and 71 cohorts of F2 (A/J x C3H/HePAS) mice.
Analysis of the F1 generation revealed that both heart and liver pathologies were recessive traits with reduced penetrance in the heterozygous mice (Fig. 6). In the F2 (A/J x C3H/HePAS) generation, it was possible to identify animals that displayed heart and liver pathology, animals that had only liver pathology, and animals without pathology (Fig. 7). Despite the absence of pathology in some chronically infected F1 and F2 mice, these animals were not cured as they kept titers of anti-T. cruzi IgG2a antibodies in serum as high as those observed in parental chronically infected A/J and C3H/HePAS mice (Fig. 8). Moreover, in all these mice, IgG2a-specific antibodies predominated over those of the IgG1 subclass, suggesting a similar Th1/Th2 imbalance.
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FIG. 6. Analysis of inflammatory infiltrates in the heart and liver of chronically infected F1 (A/J x C3H/HePAS) and F2 (A/J x C3H/HePAS) mice. Mice from the F1 and F2 generations, as well as from parental controls, were infected for 200 days with 106 Sylvio X10/4 trypomastigotes. Each dot represents one mouse, and median valuesare indicated by horizontal lines. Infiltrated areas were evaluated as described in Materials and Methods.
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FIG. 7. Genetic heterogeneity in heart and liver pathology of F2 (A/J x C3H/HePAS) chronically infected mice. The figure represents the correlation of heart and liver pathologies in 71 mice at day 200 of infection. Tissue inflammation is represented on each axis as the log10 of the infiltrated area.
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FIG. 8. Parasite-specific antibodies in the serum of C3H/HePAS, A/J, F1 (A/J x C3H/HePAS), and F2 (A/J x C3H/HePAS) chronically infected mice and in noninfected age-matched C3H/HePAS and A/J controls. Mice from the F1 and F2 generations, as well as from parental controls, were infected with 106 Sylvio X10/4 trypomastigotes. At day 200 after infection, mice were bled and their sera were analyzed by ELISA with T. cruzi antigen to determine the level of specific IgG2a and IgG1 antibodies.
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In this study, we evaluated the ability of different individuals (different inbred mouse strains) to develop heart, liver, and striated muscle pathology, during the chronic phase of infection with Sylvio X10/4 T. cruzi clone. A notable observation was the finding that different mouse strains chronically infected with a single parasite clone displayed inflammatory lesions in distinct organs, with the heart and the liver being selectively affected in chronically infected C3H/HePAS and A/J mice. Thus, while the majority of chronically infected C3H/HePAS mice showed intense heart pathology, these animals exhibited very low levels of or no liver inflammatory lesions. By contrast, all chronically infected A/J mice presented intense infiltrates in the liver but no heart pathology. A/J mice also showed higher levels of inflammation in the skeletal muscles compared with chronically infected C3H/HePAS mice, but these differences were not as evident as those found for the liver. Chronically infected BALB/c and C57BL/6 mice showed a pathology pattern similar to that of A/J mice, and chronically infected DBA/2 mice showed no signs of pathology. To our knowledge, this is the first description showing that the genetic background of mice determines a clear-cut polarity in the organ targeted by T. cruzi-induced chronic pathology. The fact that Sylvio X10/4 infection in C3H/HePAS mice partially recapitulates the cardiac lesions observed in the human disease, while in the other mouse strains it determines no lesions or distinct pathology phenotypes, reinforces the convenience of this model for determining the genes involved in Chagas disease pathology.
Histopathological analysis of chronic infected mice also revealed the presence of amastigote nests in the hearts of C3H/HePAS mice, but not in those of A/J mice. Differences in heart parasitism in these strains were confirmed by culturing heart homogenate samples in LIT medium, a procedure that detected parasites in 38.5 and 0% of C3H/HePAS and A/J hearts, respectively. The correlation between heart parasitism and development of cardiac lesions support the current hypothesis for the pathogenesis of Chagas disease, according to which pathology mainly results from the immune response to locally persisting parasites (3, 13, 22, 27). This hypothesis, however, was based on studies where tissue parasitism was evaluated by immunohistochemistry or PCR, two approaches that can be criticized for the fact that parasite antigens or DNA may remain in the lesions for extended periods of time. Such an argument cannot be applied to our study, since live parasites were grown from the heart tissue or observed in the myocardium as amastigote nests with no degeneration signs. Therefore, our results reveal that the occurrence of cardiac infiltrates correlates with the presence of live T. cruzi at the heart, corroborating the notion that local parasite persistence is the primary cause of Chagas disease.
The intensity of heart parasitism could reflect the level of systemic parasitism or the existence of local factors that control parasite replication in the cardiac tissue. In our study, systemic parasitism was apparently similar in chronically infected C3H/HePAS and A/J mice, as positive LIT cultures were obtained from their blood at comparable frequencies. Therefore, we suggest that these mice could vary in terms of local tissue factors that operate either by promoting the colonization of the heart (8, 14, 20) or by providing innate or adaptive local effector mechanisms that result in the in situ destruction of parasites. Candidates for these hypothetical effector mechanisms could be nitric oxide production by myocytes (9), expression of class I major histocompatibility complex molecules, and presentation of parasite peptides by endothelial cells and myocytes (32) or local production of chemokines (23), among other possibilities.
The notion that local persistence of T. cruzi parasites, in the long run, propitiates a higher incidence of inflammatory infiltrates fits with our observations in the heart (and probably in the striated muscle), but it does not totally match our findings in the liver. Parasites were not detected in the hepatic tissue of chronically infected miceneither by direct histological examination nor by culture of liver tissue in LIT medium. Most importantly, chronically infected A/J mice exhibited an intense inflammatory response in the liver that could not be associated with the presence of live parasites. A possible explanation for this discrepancy is that liver inflammation observed in these mice, instead of being the consequence of a higher local parasitism, is determined by the immune response to antigens from blood trypomastigotes that have been removed and destroyed by liver phagocytes.
To study the inheritance patterns of T. cruzi-induced chronic lesions we analyzed first- and second-generation intercrosses of the A/J x C3H/HePAS mouse strains. We observed that resistance to pathology in both heart and liver are reduced-penetrance phenotypes in the first-generation intercross. In the second generation, the lack of a strict correlation between the pathology in the two organs suggests that the genetic control of the two pathologies is not identical. In fact, the phenotype spread of the two phenotypes across the F2 generation strongly suggests that both these traits are polygenic in nature. It is therefore possible some genetic factors segregating in the cross could be common to both organ pathologies while others would be organ-pathology specific.
Our data show that development of chronic lesions after infection with the Sylvio X10/4 T. cruzi clone may depend on the genetic background of the host. Therefore, these genetic crosses will be used to perform genetic analysis and mapping the T. cruzi pathology phenotypes. This approach has been successfully followed in the identification of susceptibility genetic factors in murine models of other infectious diseases, as is the case for malaria (4).
Studies of genetic susceptibility to Chagas disease are scarce. Recently published work with a murine model focused on the resistance to acute T. cruzi infection, not addressing the development of chronic pathology that is the hallmark of the human disease (7). By contrast, the animal models described here may permit the identification of the genetic factors controlling resistance and susceptibility to the development of chronic-phase pathology that may bring important contributions to understand the pathogenesis of the Chagas disease chronic lesions in humans.
Financial support was provided by FAPESP (02/03133-7) CAPES/GRICES (104.03) and CNPq.
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