TGF-β inhibitor therapy decreases fibrosis and stimulates cardiac improvement in a pre-clinical study of chronic Chagas' heart disease

PLoS Negl Trop Dis. 2019 Jul 31;13(7):e0007602. doi: 10.1371/journal.pntd.0007602. eCollection 2019 Jul.

Abstract

TGF-β involvement in Chagas disease cardiomyopathy has been clearly demonstrated. The TGF-β signaling pathway is activated in the cardiac tissue of chronic phase patients and is associated with an increase in extracellular matrix protein expression. The aim of this study was to investigate the effect of GW788388, a selective inhibitor of TβR1/ALK5, on cardiac function in an experimental model of chronic Chagas' heart disease. To this end, C57BL/6 mice were infected with Trypanosoma cruzi (102 parasites from the Colombian strain) and treated orally with 3mg/kg GW788388 starting at 120 days post-infection (dpi), when 100% of the infected mice show cardiac damage, and following three distinct treatment schedules: i) single dose; ii) one dose per week; or iii) three doses per week during 30 days. The treatment with GW788388 improved several cardiac parameters: reduced the prolonged PR and QTc intervals, increased heart rate, and reversed sinus arrhythmia, and atrial and atrioventricular conduction disorders. At 180 dpi, 30 days after treatment interruption, the GW3x-treated group remained in a better cardiac functional condition. Further, GW788388 treatment reversed the loss of connexin-43 enriched intercellular plaques and reduced fibrosis of the cardiac tissue. Inhibition of the TGF-β signaling pathway reduced TGF-β/pSmad2/3, increased MMP-9 and Sca-1, reduced TIMP-1/TIMP-2/TIMP-4, and partially restored GATA-6 and Tbox-5 transcription, supporting cardiac recovery. Moreover, GW788388 administration did not modify cardiac parasite load during the infection but reduced the migration of CD3+ cells to the heart tissue. Altogether, our data suggested that the single dose schedule was not as effective as the others and treatment three times per week during 30 days seems to be the most effective strategy. The therapeutic effects of GW788388 are promising and suggest a new possibility to treat cardiac fibrosis in the chronic phase of Chagas' heart disease by TGF-β inhibitors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Benzamides / therapeutic use*
  • Chagas Cardiomyopathy / drug therapy*
  • Chagas Cardiomyopathy / parasitology
  • Chagas Cardiomyopathy / pathology
  • Chronic Disease
  • Connexin 43 / metabolism
  • Disease Models, Animal
  • Female
  • Fibrosis / drug therapy
  • Heart / drug effects*
  • Heart / parasitology
  • Heart Conduction System / drug effects
  • Mice
  • Mice, Inbred C57BL
  • Parasite Load
  • Pyrazoles / therapeutic use*
  • Transforming Growth Factor beta / antagonists & inhibitors*
  • Trypanocidal Agents / therapeutic use*
  • Trypanosoma cruzi / drug effects

Substances

  • 4-(4-(3-(pyridin-2-yl)-1H-pyrazol-4-yl)pyridin-2-yl)-N-(tetrahydro-2H-pyran-4-yl)benzamide
  • Benzamides
  • Connexin 43
  • Pyrazoles
  • Transforming Growth Factor beta
  • Trypanocidal Agents

Grants and funding

This work was supported by grants from MCW-Fundação Oswaldo Cruz (FIOCRUZ), JLV-Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Temáticos/ process E-26/110.153/2013, and JLV-Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), DECIT negligenciadas/ process 403979/2012-9. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.