Long-term treatment of chronic chagasic cardioneuropathy with a mixture of gangliosides: effect on evolution of circulating antiGM1 antibodies.
Chagas disease involves a cardiac impairment, being the first alterations of autonomic disorders which affect heart rate and blood pressure control. At this stage, diminished heart rate responses to atropine and propranolol are observed. Prior studies have shown that short term ganglioside treatment improves the responses to these agents, but there is no information about the long term effect of gangliosides and the evolution of antiGM1 titers. The effects of long term treatment with gangliosides on autonomic tests in patients with chagasic cardiodisautonomy and the evolution of antiGM1 titers were studied in 90 patients (57 men, 33 women, aged 25-60 years) with positive serology for Chagas disease and electrocardiogram showing sinusal bradycardia and incomplete right branch block, without cardiomegaly, with autonomic alterations by postural and Valsalva's tests. All patients were submitted to a test that consisted of intravenous injection of atropine 0.04 mg/kg followed 3 min later by intravenous injection of propranolol 0.2 mg/kg. During these tests heart rate and blood pressure were recorded continuously. Subsequently, 30 patients were treated with 100 mg/day of a mixture of gangliosides by intramuscular injection during 15 days in a row, followed by 40 mg/day during another 75 days. Another 30 patients received continuous treatment for 12 months. The remaining 30 patients were controls. The antiGM1 antibody circulating titers were determined before the treatment, at the third and 12th month. Seventy-four patients completed the study. Before treatment, the heart rate increased, though slightly, after the injection of atropine. After 3 months of ganglioside treatment a statistically significant increase in the response to atropine was recorded. In the controls at 12 months, the response to atropine remained increased without differences between the patients treated for 3 and 12 months. The control patients did not show any modification of the heart rate response during 12 months. Both ganglioside-treated groups showed an increase in the response to propranolol. The antiGM1 titer distribution was similar in both healthy subjects and chagasic patients. None of the patients had positive antiGM1 titers in basal conditions nor significant modifications after the ganglioside treatment. Chagasic cardioneuropathy was not associated in this study with high antiGM1 antibody titers. Chagasic patients showed a diminished heart rate response to atropine as well as to propranolol. Ganglioside treatment determined an increased heart rate response, particularly after atropine. Increased heart rate response was maintained until 1 year, without differences between the patients treated for 3 and 12 months. No changes in the antiGM1 titers were observed during the ganglioside treatment.
Mitelman
J
J
Department of Cardiology, Teodoro Alvarez Hospital, Buenos Aires, Argentina.
Gimenez
L
L
Aparicio
N J
NJ
Cortelezzi
M
M
D000328:Adult; D001285:Atropine / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood*; D001342:Autonomic Nervous System Diseases / Q000188:drug therapy* / Q000276:immunology; D002598:Chagas Cardiomyopathy / Q000188:drug therapy* / Q000276:immunology; D002908:Chronic Disease; D005260:Female; D005677:G(M1) Ganglioside / Q000276:immunology*; D005732:Gangliosides / Q000008:administration & dosage* / Q000009:adverse effects; D006339:Heart Rate; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use; D013997:Time Factors
D001323:Autoantibodies; D005732:Gangliosides; D005677:G(M1) Ganglioside; D001285:Atropine; D011433:Propranolol