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The scientific challenges of Chagas disease: a chronological account based on the content of the special issues

The Memórias do Instituto Oswaldo Cruz publishes, in the May 2015 [110(3)] issue, the fourth special issue on Chagas Disease since 1999. In that year we commemorated the 90th anniversary of the discovery of the disease which was originally published in this journal in the August issue 1909. To answer the question about what lessons or solutions have these special issues delivered, we need to appraise the challenges that have been pointed out as relevant to the control of Chagas disease. Starting from 1999, we can define three time frames that span approximately 15 years (1999 issue), 10 years (2007 issue) and five years (2009 issue).

We can examine some points regarding the strategic, technical and conceptual problems around this disease in each of these special issues.

Vol. 94 (Suppl. I) September 1999 - “Chagas disease 90 years after its discovery 1909-1999” - Highlights

Morel (1999) - A thoughtful account of Chagas disease research history and challenges on its 90th discovery anniversary.

The role of scientific leadership, the national strategy for public health and the development of a scientific environment that could foster the translation of basic research achievements into solutions for Chagas disease and other health problems.

Quotes from this paper:

“Lesson to take home, #2 - Solid research findings and sound scientific evidence alone are not sufficient for establishing or imposing political priorities.”

About the future: “... will be strongly based on what is being called the new (molecular) biology, based on the information generated by the various ongoing genome projects, addressing the human, pathogen and vector genomes.”

Zingales et al. (1999) - These researchers paved the way for a molecular taxonomy of Trypanosoma cruzi strains by clustering them into two major lineages based on ribosomal DNA sequences: T. cruzi I, T. cruzi II. Nowadays, T. cruzi strains are clustered into six discrete typing units I to VI (Zingales et al. 2009).

Urbina (1999) and Gontijo et al. (1999) - Discussed the relevance of the parasitological cure and prognosis of Chagas disease. This theme has implications for solutions to the unsolved problem in Chagas disease: a “good” therapeutics from a patient perspective.

Quote from Urbina (1999)

“Current knowledge seems to indicate that eradication of T. cruzi from infected human patients and animals may be pre-requisite to arrest the evolution of the disease and to avert its irreversible long-term consequences.”

Quote from Gontijo et al. (1999)

“Evaluating cell populations in peripheral blood of patients who received specific chemotherapy is extremely important in determining the role of the parasite and the immune system in the pathological development of Chagas disease.”

Vol. 102 (Suppl. I) October 2007 - “Workshop on Epidemiological and Social Determinants Factors of Chagas Disease. Basic Information for a Surveillance and Control Policy in Latin America” - Highlights

Chagas disease control is essential in achieving priorities of the Millennium Objectives.

Migration to non-endemic countries addressed as an additional challenge to Chagas disease control.

Two out of several recommendations listed in Anonymous (2007)

“To promote applied research based on field campaigns that could generate in biological, economical, sociological and medical knowledge aimed at the protection and recovery of people at risk, infected or ill.”

“To develop sustainable alternatives to all activities associated to control, health care and surveillance.”

Vol. 104 (Suppl. I) July 2009 - “International Symposium on the Centennial of the Discovery of Chagas Disease” - Highlights

At this very particular moment in the research history of Chagas disease, hundreds of investigators shared the challenges, problems and solutions to which they have committed huge intellectual and technical efforts. As stated by Lannes-Vieira et al. (2009), it was “... an opportunity to revisit the scenario of Chagas disease prior to its discovery, the discovery context and the successes and the challenges to be faced in controlling this disease.”

Two urgent needs pointed out by Lannes-Vieira et al. (2009)

“To improve the diagnostic tools for early (parasitological, serological) diagnosis of the infection.”

“To design and search for new selective prophylactic and therapeutic tools based on T. cruzi and/or human genomic and proteomic information, guaranteeing their assessment in clinical studies.”

Vol. 110 (3) May 2015 - “Special issue on Chagas disease. Chagas disease research advancement presented at the 13th International Congress of Parasitology, Mexico City, August 2014” - Highlights from the editorial (Coura 2015)

Vector transmission is still a problem in many countries
Transmission through blood transfusion
Congenital transmission of T. cruzi
Community education
“... Chagas disease cannot be eradicated, given the diversity of its transmission scenarios.”
Oral transmission of Chagas disease: how to prevent it?

What challenges do Chagas disease researchers face now?

This retrospective view through the special issues suggest that besides the social, economical and environmental components, research on Chagas disease is focusing significant resources on two problems that still require an innovative and “patient-friendly” solution: diagnosis and therapeutics.
Paradoxically the plethora of information on T. cruzi molecular and cell biology, infection routes, vector transmission, immune response, pathogenesis, drug effects, vaccines and therapeutics, have not been converted into final solutions for this centennial problem.

Here, at the Memórias do Instituto Oswaldo Cruz, we look forward to a day when we can publish a special issue on Chagas disease having as the title (that would remind us of one those characters in Samuel Beckett's absurdist play) “Waiting for the challenges in Chagas disease!”

 

Adeilton Alves Brandão | Editor

REFERENCES

Anonymous 2007. Workshop on epidemiology and social determining factors of Chagas disease. Basic information for surveillance and control policy in Latin America. Mem Inst Oswaldo Cruz 102 (Suppl. I): 5-10.

Coura JR 2015. Special issue on Chagas disease. Mem Inst Oswaldo Cruz 110: 275-276.

Gontijo ED, Galvão LMC, Eloi-Santos S 1999. Chagas disease: criteria of cure and prognosis. Mem Inst Oswaldo Cruz 94 (Suppl. I): 357-362.

Lannes-Vieira J, Soeiro MNC, Corrêa-Oliveira R, de Araújo-Jorge TC 2009. Chagas disease centennial anniversary celebration: historical overview and prospective proposals aiming to maintain vector control and improve patient prognosis - a permanent challenge. Mem Inst Oswaldo Cruz 104 (Suppl. I): 5-7.

Morel CM 1999. Chagas disease, from discovery to control - and beyond: history, myths and lessons to take home. Mem Inst Oswaldo Cruz 94 (Suppl. I): 3-16.

Urbina JA 1999. Parasitological cure of Chagas disease: is it possible? Is it relevant? Mem Inst Oswaldo Cruz 94 (Suppl. I): 349-355.

Zingales B, Andrade SG, Briones MRS, Campbell DA, Chiari E, Fernandes O, Guhl F, Lages-Silva E, Macedo AM, Machado CR, Miles MA, Romanha AJ, Sturm NR, Tibayrenc M, Schijman AG 2009. A new consensus for Trypanosoma cruzi intraspecific nomenclature: second revision meeting recommends TcI to TcVI. Mem Inst Oswaldo Cruz 104: 1051-1054.

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