The impact of vaccine-linked chemotherapy on liver health in a mouse model of chronicTrypanosoma cruziinfection
Authors: Nguyen Duc Minh , Poveda Cristina , Pollet Jeroen , Gusovsky Fabian , Bottazzi Maria Elena , Hotez Peter J. , Jones Kathryn M. 
Published: July 2023

Background

Chagas disease, chronic infection withTrypanosoma cruzi, mainly manifests as cardiac disease. However, the liver is important for both controlling parasite burdens and metabolizing drugs. Notably, high doses of anti-parasitic drug benznidazole (BNZ) causes liver damage. We previously showed that combining low dose BNZ with a prototype therapeutic vaccine is a dose sparing strategy that effectively reducedT. cruziinduced cardiac damage. However, the impact of this treatment on liver health is unknown. Therefore, we evaluated several markers of liver health after treatment with low dose BNZ plus the vaccine therapy in comparison to a curative dose of BNZ.

Methodology

Female BALB/c mice were infected with a bioluminescentT. cruziH1 clone for approximately 70 days, then randomly divided into groups of 15 mice each. Mice were treated with a 25mg/kg BNZ, 25µg Tc24-C4 protein/ 5µg E6020-SE (Vaccine), 25mg/kg BNZ followed by vaccine, or 100mg/kg BNZ (curative dose). At study endpoints we evaluated hepatomegaly, parasite burden by quantitative PCR, cellular infiltration by histology, and expression of B-cell translocation gene 2(BTG2) and Peroxisome proliferator-activated receptor alpha (PPARα) by RT-PCR. Levels of alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were quantified from serum.

Results

Curative BNZ treatment significantly reduced hepatomegaly, liver parasite burdens, and the quantity of cellular infiltrate, but significantly elevated serum levels of ALT, AST, and LDH. Low BNZ plus vaccine did not significantly affect hepatomegaly, parasite burdens or the quantity of cellular infiltrate, but only elevated ALT and AST. Low dose BNZ significantly decreased expression of both BTG2 and PPARα, and curative BNZ reduced expression of BTG2 while low BNZ plus vaccine had no impact.

Conclusions

These data confirm toxicity associated with curative doses of BNZ and suggest that the dose sparing low BNZ plus vaccine treatment better preserves liver health.

Author Summary

Chagas disease is a neglected tropical disease caused by the protozoal parasiteTrypanosoma cruzi, which has long-term deleterious health effects. The current treatment for Chagas disease is administering the antiparasitic drug, benznidazole. While benznidazole effectively treats the disease during the acute phase, its efficacy is reduced during chronic infection. In addition, benznidazole therapy causes significant side effects, including liver toxicity. Texas Children’s Hospital Center for Vaccine Development at Baylor College of Medicine has developed a treatment strategy that combines a prototype therapeutic vaccine with a lower dose of Benznidazole to promote a protective immune response, ameliorate the deleterious effects of the parasite, and limit the harmful side effect of the drug. We call this vaccine-linked chemotherapy, which has shown promising results regarding heart health by reducing parasite burden and pathology in the heart and improving cardiac function. This study evaluated the strategy’s effectiveness in the liver since it is the prime metabolizer of the benznidazole drug, as well as the organ of parasite clearance. Results from this study demonstrated that vaccine-linked chemotherapy causes less damage to the liver compared to curative doses of benznidazole and may be a desirable treatment strategy to preserve overall health while retaining efficacy.