Simvastatin and Benznidazole-Mediated Prevention of Trypanosoma cruzi-Induced Endothelial Activation: Role of 15-epi-lipoxin A4 in the Action of Simvastatin

Trypanosoma cruzi is the causal agent of Chagas Disease that is endemic in Latin American, afflicting more than ten million people approximately. This disease has two phases, acute and chronic. The acute phase is often asymptomatic, but with time it progresses to the chronic phase, affecting the heart and gastrointestinal tract and can be lethal. Chronic Chagas cardiomyopathy involves an inflammatory vasculopathy. Endothelial activation during Chagas disease entails the expression of cell adhesion molecules such as E-selectin, vascular cell adhesion molecule-1 (VCAM-1) and intercellular cell adhesion molecule-1 (ICAM-1) through a mechanism involving NF-κB activation. Currently, specific trypanocidal therapy remains on benznidazole, although new triazole derivatives are promising. A novel strategy is proposed that aims at some pathophysiological processes to facilitate current antiparasitic therapy, decreasing treatment length or doses and slowing disease progress. Simvastatin has anti-inflammatory actions, including improvement of endothelial function, by inducing a novel pro-resolving lipid, the 5-lypoxygenase derivative 15-epi-lipoxin A4 (15-epi-LXA4), which belongs to aspirin-triggered lipoxins. Herein, we propose modifying endothelial activation with simvastatin or benznidazole and evaluate the pathways involved, including induction of 15-epi-LXA4. The effect of 5 μM simvastatin or 20 μM benznidazole upon endothelial activation was assessed in EA.hy926 or HUVEC cells, by E-selectin, ICAM-1 and VCAM-1 expression. 15-epi-LXA4 production and the relationship of both drugs with the NFκB pathway, as measured by IKK-IKB phosphorylation and nuclear migration of p65 protein was also assayed. Both drugs were administered to cell cultures 16 hours before the infection with T. cruzi parasites. Indeed, 5 μM simvastatin as well as 20 μM benznidazole prevented the increase in E-selectin, ICAM-1 and VCAM-1 expression in T. cruzi-infected endothelial cells by decreasing the NF-κB pathway. In conclusion, Simvastatin and benznidazole prevent endothelial activation induced by T. cruzi infection, and the effect of simvastatin is mediated by the inhibition of the NFκB pathway by inducing 15-epi-LXA4 production.Author Summary: Chagas disease, caused by the protozoan Trypanosoma cruzi, affects more than 10 million people in Latin America. In the chronic phase, a lethal complication may develop: Chronic Chagasic Cardiomyopathy. In this condition the vascular lining, the endothelium, is involved and participates in disease progression. Benznidazole is the current treatment for Chagas disease. However, other useful drugs could be added to Chagas disease chemotherapy to improve associated processes such as endothelial dysfunction, thus decreasing length and adverse events of the conventional therapy. Simvastatin, a drug that decreases blood cholesterol, also has anti-inflammatory effects and improves endothelial function. Thus, we studied the effect of simvastatin and benznidazole on endothelial cells and their relation with the production 15-epi-lipoxin A4, an anti-inflammatory molecule. We found that simvastatin and benznidazole decreased endothelial activation since they reduced the adhesion of inflammatory cells. Simvastatin and benznidazole inhibited NFκB pathway, which is pro-inflammatory and in the case of simvastatin, this effect was mediated by the production of 15-epi-lipoxin A4. Thus, we provide the bases that support the future use of simvastatin in the treatment of cardiac Chagas disease.