Clinical Assessment, Neuroimaging and Immunomarkers in Chagas Disease Study (CLINICS)
500 patients around the world
Stroke is an enormous international public health concern, particularly in the developing
world where there are limited resources available to provide for an aging population. One of
the main contributors to stroke incidence is the highly prevalent Chagas disease, a parasitic
infection affecting an estimated 18 million individuals and a major cause of heart failure in
Latin America. Chagas disease conveys stroke risk through two established mechanisms:
structural cardiac disease and chronic inflammation. Although inflammation is associated with
an increased risk of ischemic stroke and poorer outcome, its role has been largely linked to
atherogenesis. Chronic inflammation can result in endothelial dysfunction and stimulate the
hemostatic system, increasing systemic fibrin production and platelet activation. Brain
atrophy has also been associated with chronic inflammation. Adults, young and old, who
develop a secondary cardiomyopathy from Chagas are therefore at higher risk of cardioembolism
and neurodegeneration. Stroke patients usually survive, but can be left with significant
disability affecting their health status, productivity, and quality of life. These factors
impact caregivers as well. Thus, the social and economic consequences of stroke are vast.
During our R21 planning grant period, we were able to establish a collaborative
infrastructure between the research groups in Brazil and the United States and collect
preliminary data. We found an association between Chagas disease and stroke that was
independent of cardiomyopathy. Cognitive impairment and brain atrophy were also associated
with Chagas disease independently of cardiomyopathy. Biomarkers orosomucoid, neprilysin,
interleukin-6 (IL-6) and matrix metalloproteinase-9 (MMP-9) were identified as diagnostic and
therapeutic targets in Chagas disease. As part of this phase, we will address three specific
aims: (1) to establish brain magnetic resonance imaging markers of stroke risk in patients
with Chagasic congestive heart failure (CM); (2) to determine whether biomarkers can predict
stroke risk in patients with Chagasic CM; and (3) to evaluate the efficacy of antiplatelet
treatment in decreasing microembolization rate in patients with Chagasic CM. The long-term
goal of this project is to establish non-invasive methods of stroke risk stratification and
prediction of stroke outcome in patients with Chagas disease. This work will also facilitate
the development of novel anti-trypanosomal, anti-inflammatory, and antithrombotic strategies
for stroke prevention and management in Brazil.
Federal University of Bahia
1Research sites
500Patients around the world
This study is for people with
Chagas disease
Chagas disease with myocarditis
Requirements for the patient
From 18 Years
All Gender
Medical requirements
Sites
Hospital Universitário Professor Edgard Santos - HUPES
Recruiting
R. Dr. Augusto Viana, s/n - Canela, Salvador - BA, 40110-060