Chagas disease research and development: Is there light at the end of the tunnel?

Abstract

Chagas disease, or American trypanosomiasis, is the result of infection by the parasite Trypanosoma cruzi. It is endemic in Latin America, and spreading around the globe due to human migration. Although it was first identified more than a century ago, only two old drugs are available for treatment and a lot of questions related to the disease progression, its pathologies, and not to mention the assessment of treatment efficacy, are subject to debate and remain to be answered. Indeed, the current status of evidence and data available does not allow any absolute statement related to treatment needs and outcome for Chagas patients to be made. Although there has been some new impetus in Research and Development for Chagas disease following recent new clinical trials, there is a scientific requirement to review and challenge the current status of evidence and define basic and clinical research priorities and next steps in the field. This should ensure that the best drugs for Chagas disease are developed, but will require a focused and collaborative effort of the entire Chagas disease research community.

Keywords: Challenges; Drug discovery and development; Trypanosoma cruzi.

Fig. 1

Chagas disease progression (adapted from Tarleton¹⁴). Trypanosoma cruzi infection consists of an acute disease phase characterized by elevated parasite load (green). Immune response brings parasite load down to low/undetectable levels. Chagas disease then progresses to the chronic phase, the severity of which (blue) depends on time since infection and host immune status or genetic background. Thirty to 40% of Chagas patients in the chronic phase will develop clinical manifestations such as cardiomyopathy or megacolon; the remaining 60 to 70% will stay asymptomatic (indeterminate form of the disease). m, month; y, year.