Resumen
Introducción. Trypanosoma cruzi es el protozoario hemoflagela- do causante de la enfermedad de Chagas (ECH), un padecimiento endémico de Latinoamérica que es altamente incapacitante e in- curable. Además de su diferente distribución geográfica, las cepas de T. cruzi tienen variabilidad intraespecífica por lo que son clasi- ficadas en siente DTUs (TcI-TcVI y Tcbat) que presentan diversidad biológica, bioquímica, molecular y antigénica, que se relaciona con el desarrollo de los distintos cuadros clínicos de la enferme- dad, la eficiencia del diagnóstico y la respuesta al tratamiento. Existe una gran variabilidad en la sensibilidad y especificidad de las pruebas serodiagnósticas y hasta ahora, no existe una prue- ba estándar de oro para un diagnóstico completamente confia- ble. Objetivo. Revisar los avances obtenidos en la búsqueda de antígenos útiles para el serodiagnóstico de la ECH. Materiales y métodos. Se realizó una revisión sistemática de tipo cualitativa, de reportes relacionados al serodiagnóstico de la infección por T. cruzi encontrados en PubMed. Resultados. El serodiagnóstico convencional con antígenos del parásito completo es sensible pero no tiene alta especificidad. Por ello, se utilizan también prue- bas no convencionales con antígenos recombinantes o péptidos sintéticos que aumentan la especificidad. Distintos enfoques han permitido la identificación de moléculas con potencial diagnósti- co, mostrando la necesidad del uso de cócteles de antígenos recombinantes, mezclas de péptidos sintéticos o antígenos multiepitope para una mejor sensi- bilidad y especificidad de las pruebas y para la detección de la infección con cualquiera de los DTUs del parásito. Conclusiones. Aun cuando se han identificado diversos antígenos con po- tencial uso diagnóstico, continúan los esfuer- zos para la identificación de nuevos y mejores antígenos. Los avances recientes de la proteó- mica a gran escala acoplada a inmunoensayos e inmunogenómica, ofrecen una oportunidad en la búsqueda no solo de biomarcadores para el diagnóstico, sino también para el tratamien- to y pronóstico oportuno de la enfermedad de Chagas.
Diagnosis of Trypanosoma cruzi infection: Advances and challenges
Abstract
Introduction. Trypanosoma cruzi is the protozoan hemoflagellate that causes Chagas disease, an endemic illness in Latin America that is highly incapacitating and incurable. The parasite strains have great intraspecific variability, being classified into seven DTUs (from TcI to TcVI and Tcbat). In addition to their different geographical distribution, T. cruzi strains show biological, biochemical, molecular and antigenic diversity, which is related to the development of the different clinical symptoms of the disease, the efficiency of diagnosis and treatment response. Serodiagnosis tests show wide variation in their sensitivity and specificity, and so far, it doesn't exist a standard gold test for a completely reliable diagnosis. Objective. To review the advances made in the search for useful antigens for serodiagnosis of Chagas disease. Materials and methods. We performed a qualitative systematic review of reports related to serodiagnosis of T. cruzi infection found in PubMed. Results. Conventional serodiagnosis with complete parasite antigens is sensitive but does not have high specificity. Thus, unconventional tests with recombinant antigens or synthetic peptides that increase specificity are also used. Different approaches have allowed the identification of molecules with potential diagnostic, showing that cocktails of recombinant antigen, mixtures of synthetic peptides or multiepitope antigens are necessary for a better sensitivity and specificity of the tests and infection detection with any T. cruzi DTU. Conclusions. Even though several antigens with potential use for diagnosis have been identified, efforts continue to identify new and better antigens. Recent advances in large-scale proteomics linked with immunoassays and immunogenomics offer an opportunity in the search not only for biomarkers for diagnosis, but also for the treatment and timely prognosis of Chagas disease.
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