title: Chagas disease: still many unsolved issues.
abstract: Over the past 20 years, the immune effector mechanisms involved in the control of Trypanosoma cruzi, as well as the receptors participating in parasite recognition by cells of the innate immune system, have been largely described. However, the main questions on the physiopathology of Chagas disease remain unanswered: "Why does the host immune system fail to provide sterile immunity?" and "Why do only a proportion of infected individuals develop chronic pathology?" In this review, we describe the mechanisms proposed to explain the inability of the immune system to eradicate the parasite and the elements that allow the development of chronic heart disease. Moreover, we discuss the possibility that the inability of infected cardiomyocytes to sense intracellular T. cruzi contributes to parasite persistence in the heart and the development of chronic pathology.
authors.affiliation: Department of Immunology, Biomedical Sciences Institute, University of São Paulo, 05508-000 São Paulo, SP, Brazil.
authors.forename: José M
authors.initials: JM
authors.lastname: Álvarez
authors.affiliation: Department of Immunology, Biomedical Sciences Institute, University of São Paulo, 05508-000 São Paulo, SP, Brazil.
authors.forename: Raissa
authors.initials: R
authors.lastname: Fonseca
authors.affiliation: Department of Immunology, Biomedical Sciences Institute, University of São Paulo, 05508-000 São Paulo, SP, Brazil.
authors.forename: Henrique
authors.initials: H
authors.lastname: Borges da Silva
authors.affiliation: Department of Parasitology, Biomedical Sciences Institute, University of São Paulo, 05508-000 São Paulo, SP, Brazil.
authors.forename: Cláudio R F
authors.initials: CR
authors.lastname: Marinho
authors.affiliation: Department of Biological Sciences, UNIFESP (Campus Diadema), 09972-270 Diadema, SP, Brazil.
authors.forename: Karina R
authors.initials: KR
authors.lastname: Bortoluci
authors.affiliation: Hospital Israelita Albert Einstein, 05652-000 São Paulo, SP, Brazil.
authors.forename: Luiz R
authors.initials: LR
authors.lastname: Sardinha
authors.affiliation: Department of Clinical and Toxicological Analyses, Faculty of Pharmaceutical Sciences, University of São Paulo, 05508-000 São Paulo, SP, Brazil.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Epiphanio
authors.affiliation: Department of Immunology, Biomedical Sciences Institute, University of São Paulo, 05508-000 São Paulo, SP, Brazil.
authors.forename: Maria Regina
authors.initials: MR
authors.lastname: D'Império Lima
mesh_terms: D000818:Animals; D014355:Chagas Disease / Q000150:complications / Q000276:immunology*; D006331:Heart Diseases / Q000209:etiology / Q000276:immunology / Q000469:parasitology; D006801:Humans; D032383:Myocytes, Cardiac / Q000276:immunology / Q000469:parasitology; D014349:Trypanosoma cruzi / Q000276:immunology / Q000472:pathogenicity
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