Placenta, Trypanosoma cruzi , and Congenital Chagas Disease
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THE PLACENTA, TROPICAL DISEASES, AND PREGNANCIES (D SCHWARTZ, SECTION EDITOR)
Placenta, Trypanosoma cruzi, and Congenital Chagas Disease Yves Carlier 1,2
&
Alejandro G. Schijman 3 & Ulrike Kemmerling 4
# Springer Nature Switzerland AG 2020
Abstract Purpose of Review Why around 5% of Trypanosoma cruzi–infected pregnant women transmit the parasite to their offspring whereas 95% do not? Answers to this main question are needed in order to improve the programs aiming to control or eliminate congenital Chagas disease (CCD), which has become an important global public health problem. Recent Findings Turnover of syncitiotrophoblast as a new innate defense mechanism of placenta and analyses of transcriptomic responses of placental genes and of new parasite DNA sequences have allowed a re-evaluation of the relationship between parasite diversity, placental tropism, and CCD transmission. Summary A synthetic view of the gradual interactions between the human placenta facing up the parasites present in the maternal blood and the occurrence and severity of CCD is proposed. Further researches on the role of parasite molecular diversity, maternal microbiomes, transfers of parasite and placenta exovesicles, and genetic features of infected mothers should improve our understanding of such maternal-fetal complex relationship. Keywords Congenital Chagas disease . Congenital infection with Trypanosoma cruzi . Trypanosoma cruzi–placenta interactions . Maternal-fetal transmission of Trypanosoma cruzi . Maternal immune responses to Trypanosoma cruzi . Fetal/neonatal immune responses to Trypanosoma cruzi
Introduction Congenital Chagas disease (CCD), caused by maternal-fetal/ neonatal transmission of the parasite Trypanosoma cruzi, is This article is part of the Topical Collection on The Placenta, Tropical Diseases, and Pregnancies
frequently a silent disease with potential long-term consequences. It results from complex interactions between the parasite (virulence), the strengths and weaknesses of the placental barrier and of maternal and fetal/neonatal immune responses [1, 2••, 3••]. The present review will focus on such interactions highlighting mainly the central role of human placenta.
* Yves Carlier [email protected]
Congenital Chagas Disease at a Glance
* Ulrike Kemmerling [email protected]
CCD can arise in both acute and chronic phases of maternal infection, be recurrent at each pregnancy (i.e., during all the fertile period of woman life), and occur from one generation to another. This pattern of transmission, leading to family clustering of congenital transmission cases, facilitates uncontrolled spread of Chagas disease (CD) over time. So CCD remains an important global and neglected public health problem [1, 2••, 3••]. WHO estimates that 1,125,000 women in fertile age are infected with T. cruzi with an incidence of congenital infection of 8668 cases/year in the 21 Latin American countries where CD is currently endemic (with nearly 50% of CCD cases grouped in Mexico, Argentina, and Colombia) [4]. Most cases of con
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