Elevated Concentrations of CCL2 and Tumor Necrosis Factor—α in Chagasic Cardiomyopathy

Chronic myocarditis is the main pathological finding associated with Chagas disease-related morbidity. Concentrations of CCL2, CCL3, tumor necrosis factor (TNF)-α, and brain natriuretic peptide (BNP) were evaluated in plasma samples obtained from patients with different clinical forms of chronic chagasic cardiomyopathy. Patients with more-severe Chagas disease had elevated plasma concentrations of TNF-α, CCL2, and BNP, and there was a good correlation between levels of these proteins (especially TNF-α) and the degree of heart dysfunction. Indeed, TNF-α level was an excellent predictor of heart failure. Peripheral blood mononuclear cell samples obtained from patients with mild or severe chagasic cardiomyopathy produced greater amounts of TNF-α and CCL2 than did those obtained from noninfected individuals. The elevation of TNF-α and CCL2 levels in the plasma of patients appears to be secondary to the degree of heart dysfunction, whereas spontaneous production of TNF-α and CCL2 by mononuclear cells is secondary not only to heart dysfunction, but also to the underlying inflammation in the heart of chagasic patients. Measurement of the TNF-α level could be a useful tool in the identification of patients with heart dysfunction who may benefit from further investigation and treatment.