Claudia Maria de Castro Gomes

Human cutaneous leishmaniasis: interferon-dependent expression of double-stranded RNA-dependent protein kinase (PKR) via TLR2

We investigated the type I interferon (IFN‐1)/PKR axis in the outcome of the Leishmania (Leishmania) amazonensis infection, along with the underlying mechanisms that trigger and sustain this signaling pathway. Reporter assays of cell extracts from RAW‐264.7 macrophages infected with L. (L.) amazonensis or HEK‐293T cells cotransfected with TLR2 and PKR promoter constructions were employed. Primary macrophages of TLR2‐knockout (KO) or IFNR‐KO mice were infected, and the levels of PKR, IFN‐1, and superoxide dismutase 1 (SOD1) transcript levels were investigated and compared. Immunohistochemical analysis of human biopsy lesions was evaluated for IFN‐1 and PKR‐positive cells. Leishmania infection increased the expression of PKR and IFN‐β on induction of PKR‐promoter activity. The observed effects required the engagement of TLR2. TLR2‐KO macrophages expressed low IFN‐β and PKR levels postinfection with a reduced parasite load. We also revealed the requirement of PKR signaling for Leishmania‐induced IFN‐1 expression, responsible for sustaining PKR expression and enhancing infection. Moreover, during infection, SOD1 transcripts increased and were also enhanced when IFN‐1 was added to the cultures. Remarkably, SOD1 expression was abrogated in infected, dominant‐negative PKR‐expressing cells. Finally, lesions of patients with anergic diffuse cutaneous leishmaniasis exhibited higher levels of PKR/IFN‐1‐expressing cells compared to those with single cutaneous leishmaniasis. In summary, we demonstrated the mechanisms and relevance of the IFN‐1/PKR axis in the Leishmania infection.—De Carvalho Vivarini, A., Pereira, R. M. S., Dias Teixeira, K. L., Calegari‐Silva, T. C., Bellio, M., Laurenti, M. D., Corbett, C. E. P., de Castro Gomes, C. M., Soares, R. P., Mendes Silva, A., Silveira, F. T., Lopes, U. G. Human cutaneous leishmaniasis: interferon‐dependent expression of double‐stranded RNA‐kinase (PKR) via TLR2. FASEB J. 25, 4162–4173 (2011). www.fasebj.org

Serum cytokine profile in the subclinical form of visceral leishmaniasis

The factors determining the development or not of visceral leishmaniasis (VL) have not been completely identified, but a Leishmania-specific cellular immune response seems to play a fundamental role in the final control of infection. Few studies are available regarding the production of cytokines in the subclinical form of VL, with only the production of IFN-gamma and TNF-alpha known. The aim of the present study was to identify immunological markers for the oligosymptomatic or subclinical form of VL. A prospective cohort study was conducted on 784 children aged 0 to 5 years from an endemic area in the State of Maranhão, Brazil, between January 1998 and December 2001. During 30 consecutive months of follow-up, 33 children developed the oligosymptomatic form of the disease and 12 the acute form. During the clinical manifestations, serum cytokine levels were determined in 27 oligosymptomatic children and in nine patients with the acute form using a quantitative sandwich enzyme immunoassay. In the subclinical form of VL, variable levels of IL-2 were detected in 52.3% of the children, IL-12 in 85.2%, IFN-gamma in 48.1%, IL-10 in 88.9%, and TNF-alpha in 100.0%, with the last two cytokines showing significantly lower levels than in the acute form. IL-4 was not detected in oligosymptomatic individuals. Multiple discriminant analysis used to determine the profile or combination of cytokines predominating in the subclinical form revealed both a Leishmania resistance (Th1) and susceptibility (Th2) profile. The detection of both Th1 and Th2 cytokine profiles explains the self-limited evolution accompanied by the discrete alterations observed for the subclinical form of VL.

Insulin-like growth factor (IGF)-I affects parasite growth and host cell migration in experimental cutaneous leishmaniasis.

While the control or progression of leishmaniasis depends on host immune responses, the initial inflammatory process represents a key event. This process involves the participation of several cytokines and growth factors induced during inflammation as well as factors already present at the site of infection such as insulin‐like growth factor (IGF)‐I. We have previously demonstrated a potential role for IGF‐I in experimental cutaneous leishmaniasis based on the significant increase in lesion size seen in mice injected with Leishmania promastigotes preactivated with IGF‐I. In the present study we show that preactivation of Leishmania (Leishmania) amazonensis promastigotes with IGF‐I induces an increase in the actual number of parasites at the lesion site from seven days postinfection, in addition to a more intense inflammatory infiltrate. There was a higher numerical density of polymorphonuclear neutrophils from 3 to 24 h, and of mononuclear cells from 48 h of infection onward. A higher density of polymorphonuclear neutrophils and mononuclear cells harboring parasites was also observed. The most important observation, however, was that more parasites per cell were present, revealing that IGF‐I appears to favour parasite growth within the macrophages. These results strongly suggest an important role for IGF‐I in the development of cutaneous leishmaniasis, where it influences both the inflammatory process and parasite growth.

Leishmania (V.) braziliensis and L. (L.) amazonensis promote differential expression of dendritic cells and cellular immune response in murine model

The expression of Langerhans cell (LC) and dermal dendritic cell (dDC) as well as T CD4+ and CD8+ immune responses was evaluated in the skin of BALB/c mice experimentally infected by L. (L.) amazonensis (La) and L. (V.) braziliensis (Lb). At 4th and 8th weeks post infection (PI), skin biopsies were collected to determine the parasite load and CD207+, CD11c+, CD4+, CD8+, iNOS+ cellular densities. Cytokine (IFN‐γ, IL‐4 and IL‐10) profiles were also analysed in draining lymph node. At 4th week, the densities of CD207+ and CD11c+ were higher in the La infection, while in the Lb infection, these markers revealed a significant increase at 8th week. At 4th week, CD4+ and CD8+ were higher in the La infection, but at 8th week, there was a substantial increase in both markers in the Lb infection. iNOS+ was higher in the Lb infection at 4th and 8th weeks. In contrast, the parasite load was higher in the La infection at 4th and 8th weeks. The concentration of IFN‐γ was higher in the Lb infection, but IL‐4 and IL‐10 were higher in the La infection at 4th and 8th weeks. These results confirm the role of the Leishmania species in the BALB/c mice disease characterized by differences in the expression of dendritic cells and cellular immune response.

Severe visceral leishmaniasis in children: the relationship between cytokine patterns and clinical features

INTRODUCTION The relationship between severe clinical manifestations of visceral leishmaniasis (VL) and immune response profiles has not yet been clarified, despite numerous studies on the subject. This study aimed to investigate the relationship between cytokine profiles and the presence of immunological markers associated with clinical manifestations and, particularly, signs of severity, as defined in a protocol drafted by the Ministry of Health (Brazil). METHODS We conducted a prospective, descriptive study between May 2008 and December 2009. This study was based on an assessment of all pediatric patients with VL who were observed in a reference hospital in Maranhão. RESULTS Among 27 children, 55.5% presented with more than one sign of severity or warning sign. Patients without signs of severity or warning signs and patients with only one warning sign had the highest interferon-gamma (IFN-γ) levels, although their interleukin 10 (IL-10) levels were also elevated. In contrast, patients with the features of severe disease had the lowest IFN-γ levels. Three patients who presented with more than two signs of severe disease died; these patients had undetectable interleukin 2 (IL-2) and IFN-γ levels and low IL-10 levels, which varied between 0 and 36.8pg/mL. CONCLUSIONS Our results showed that disease severity was associated with low IFN-γ levels and elevated IL-10 levels. However, further studies with larger samples are needed to better characterize the relationship between disease severity and cytokine levels, with the aim of identifying immunological markers of active-disease severity.

Host-biting rate and susceptibility of some suspected vectors to Leishmania braziliensis

BackgroundAmerican tegumentary leishmaniasis is a serious Brazilian public health problem. This diseases is attributed to seven species of Leishmania, however, the majority of cases are associated with Leishmania braziliensis. Some phlebotomine species have been implicated in the transmission of this parasite, nonetheless only Psychodopygus wellcomei has had its vectorial competence demonstrated. Thus this study sought to assess some parameters related to the vectorial capacity of anthropophilic species of sand fly occurring in São Paulo state: Pintomyia fischeri, Migonemyia migonei Nyssomyia intermedia, Nyssomyia whitmani, Expapillata firmatoi and Psychodopygus ayrozai, under laboratory conditions. These parameters were the duration of the gonotrophic cycle, proportion of females which feed on hamster, the rate of infection by L. braziliensis and the duration of the extrinsic incubation period.MethodsThe sandflies were collected in three regions of the São Paulo state: Greater São Paulo and the Mogi Guaçu and Iporanga municipalities. To assess the proportion of engorged females the insects were fed on hamsters to estimate the duration of the gonotrophic cycle. To estimate the susceptibility to infection of each species, their females were fed on hamsters infected with Leishmania braziliensis and dissected to ascertain the localization of the flagellates and estimate the extrinsic incubation period.ResultsLow hamster attractiveness to Ps. ayrozai was observed. A high proportion of engorged females was observed when the hamster had its whole body exposed. The gonotrophic cycle ranged between three and eight days. Mg. migonei, Pi. fischeri, Ny. neivai, Ny. intermedia, Ny. whitmani and Ex.firmatoi presented susceptibility to infection by L. braziliensis. The highest infection rate (34.4%) was observed for Ny. whitmani and the lowest for Ny. intermedia (6.6%). Mg. migonei presented late-stage infection forms on the fifth day after feeding, but in the other species these forms were observed as from the fourth day.ConclusionsOur results, together with other parameters of their behavior under natural conditions, suggest the potential role of Ex. firmatoi as vector of this parasite and reinforce that of Mg. migonei, Pi. fischeri, Ny. neivai, Ny. intermedia and Ny. whitmani in the areas in which they occur.

Susceptibility of peritoneal macrophage from different species of neotropical primates to Ex vivo Leishmania (L.) infantum chagasi-infection

This study examined the susceptibility of peritoneal macrophage (PM) from the Neotropical primates: Callithrix jacchus, Callithrix penicillata, Saimiri sciureus, Aotus azarae infulatus and Callimico goeldii to ex vivo Leishmania (L.) infantum chagasi-infection, the etiological agent of American visceral leishmaniasis (AVL), as a screening assay for evaluating the potential of these non-human primates as experimental models for studying AVL. The PM-susceptibility to infection was accessed by the PM-infection index (PMI) at 24, 72 h and by the mean of these rates (FPMI), as well as by the TNF-α, IL-12 (Capture ELISA) and Nitric oxide (NO) responses (Griess method). At 24h, the PMI of A. azarae infulatus (128) was higher than those of C. penicillata (83), C. goeldii (78), S. sciureus (77) and C. jacchus (55). At 72h, there was a significant PMI decrease in four monkeys: A. azarae infulatus (128/37), C. penicillata (83/38), S. sciureus (77/38) and C. jacchus (55/12), with exception of C. goeldii (78/54). The FPMI of A. azarae infulatus (82.5) and C. goeldii (66) were higher than C. jacchus (33.5), but not higher than those of C. penicillata (60.5) and S. sciureus (57.5). The TNF-a response was more regular in those four primates which decreased their PMI at 24/72 h: C. jacchus (145/122 pg/mL), C. penicillata (154/130 pg/mL), S. sciureus (164/104 pg/mL) and A. azarae infulatus (154/104 pg/mL), with exception of C. goeldii (38/83 pg/mL). The IL-12 response was mainly prominent in A. infulatus and C. goeldii which presented the highest FPMI and, the NO response was higher in C. goeldii, mainly at 72 h. These findings strongly suggest that these New World primates have developed a resistant innate immune response mechanism capable of controlling the macrophage intracellular growth of L. (L.) i. chagasi-infection, which do not encourage their use as animal model for studying AVL.

Differential Recruitment of Dendritic Cells Subsets to Lymph Nodes Correlates with a Protective or Permissive T-Cell Response during Leishmania (Viannia) Braziliensis or Leishmania (Leishmania) Amazonensis Infection

Leishmania (L.) amazonensis (La) and L. (V.) braziliensis (Lb) are responsible for a large clinical and immunopathological spectrum in human disease; while La may be responsible for anergic disease, Lb infection leads to cellular hypersensitivity. To better understand the dichotomy in the immune response caused by these Leishmania species, we evaluated subsets of dendritic cells (DCs) and T lymphocyte in draining lymph nodes during the course of La and Lb infection in BALB/c mice. Our results demonstrated a high involvement of DCs in La infection, which was characterized by the greater accumulation of Langerhans cells (LCs); conversely, Lb infection led to an increase in dermal DCs (dDCs) throughout the infection. Considering the T lymphocyte response, an increase of effector, activated, and memory CD4+ T-cells was observed in Lb infection. Interleukin- (IL-) 4- and IL-10-producing CD4+and CD8+ T-cells were present in both La and Lb infection; however, interferon- (IFN-) γ-producing CD4+and CD8+ T-cells were detected only in Lb infection. The results suggest that during Lb infection, the dDCs were the predominant subset of DCs that in turn was associated with the development of Th1 immune response; in contrast La infection was associated with a preferential accumulation of LCs and total blockage of the development of Th1 immune response.

Preclinical diagnosis of American visceral leishmaniasis during early onset of human Leishmania (L.) infantum chagasi-infection

Abstract American visceral leishmaniasis (AVL) is an infectious disease, often with long-duration evolution, caused by Leishmania (L.) infantum chagasi. However, although the disease is considered the major clinical manifestation of the link between L. (L.) i. chagasi and the human immune response, we have recently identified five clinical–immunological profiles of infection in the Brazilian Amazon: three asymptomatic (Asymptomatic Infection — AI, Sub-clinical Resistant Infection — SRI, and Indeterminate Initial Infection — III), and two symptomatic ones [Symptomatic Infection — SI ( = AVL) and Sub-clinical Oligosymptomatic Infection — SOI]. We confirm here the preclinical diagnosis of AVL through the IgM-antibody response in a case of an early infection (profile III) that evolved to the full disease after 6 weeks.

Dynamic of the Cellular Immune Response at the Dermal Site of Leishmania (L.) amazonensis and Leishmania (V.) braziliensis Infection in Sapajus apella Primate

The purpose of this study was to characterize the immunopathological response in the skin of S. apella infected with Leishmania (L.) amazonensis and L. (V.) braziliensis parasites, the main causative agents of localized cutaneous leishmaniasis in South America. In infected animals, amastigote forms of L. (L.) amazonensis could be detected till 120 days postinfection (PI), while, in L. (V.) braziliensis infection, parasites could be detected until 180 days PI in the skin sections. CD20+ cells were detected throughout the experimental time in both groups as well as in CD3+ cells, which appeared to be activated because high densities of inducible nitric oxide synthase (iNOS+) cells were detected at 60 and 90 days PI in both studied groups. After 60 and 120 days PI, decrease in iNOS+ cells was observed in L. (L.) amazonensis and L. (V.) braziliensis, respectively, which was associated with parasite clearance. Increase in lysozyme+ cells was observed during the experimental infections, which also can be associated with parasite killing.