Keywords
Immune response
Monocytes
Macrophages
Immunopathogenesis
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Abstract
Objective: To analyze the role of monocytes and macrophages in modulating the immune response and determining the different clinical outcomes of Chagas disease (CD). Literature review: Monocytes and macrophages are central to the immune response to T. cruzi, acting both in the initial control of parasitemia and in the modulation of adaptive immunity. Changes in monocyte subpopulations and in the expression of costimulatory molecules may be related to the progression to symptomatic forms. In tissues, the plasticity of macrophages, influenced by cytokines, metabolism, signaling pathways, and the microenvironment, determines the balance between proinflammatory and regulatory profiles. The predominance of M2-like states and cardiac remodeling favor parasite persistence and low-intensity chronic inflammation, which characterizes the most severe clinical cases. Final considerations: Monocytes and macrophages shape the clinical evolution of CD through their functional plasticity and complex interactions with immunological, metabolic, and tissue mechanisms. Although they do not act in isolation, their contribution is decisive for the balance between parasitic control, chronic inflammation, and the development of heart disease. An integrated understanding of these processes highlights these phagocytes as potential biomarkers and targets for immunomodulatory interventions that simultaneously consider parasitic, adaptive, and microenvironmental factors.
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