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Fontes JLM, Khouri R, Reinaldo LGC, Hassegawa EMA, Meneses Filho AJ, de Melo CVB, Ramos PIP, de Deus Moura R, Pagliari C, Santos M, Araújo RJC, Van Weyenbergh J, de Freitas LAR, Costa CHN, dos-Santos WLC. An integrated analysis of the structural changes and gene expression of spleen in human visceral leishmaniasis with and without HIV coinfection. PLoS Negl Trop Dis 2024; 18:e0011877. [PMID: 38843306 PMCID: PMC11265696 DOI: 10.1371/journal.pntd.0011877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 07/23/2024] [Accepted: 04/30/2024] [Indexed: 07/24/2024] Open
Abstract
The spleen plays a pivotal role in the pathogenesis of visceral leishmaniasis. In severe forms of the disease, the spleen undergoes changes that can compromise its function in surveilling blood-circulating pathogens. In this study, we present an integrated analysis of the structural and gene expression alterations in the spleens of three patients with relapsing visceral leishmaniasis, two of whom were coinfected with HIV. Our findings reveal that the IL6 signaling pathway plays a significant role in the disorganization of the white pulp, while BCL10 and ICOSLG are associated with spleen organization. Patients coinfected with HIV and visceral leishmaniasis exhibited lower splenic CD4+ cell density and reduced expression of genes such as IL15. These effects may contribute to a compromised immune response against L. infantum in coinfected individuals, further impacting the structural organization of the spleen.
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Affiliation(s)
- Jonathan L. M. Fontes
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
- Departamento de Patologia e Medicina Legal, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Ricardo Khouri
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
| | | | | | | | - Caroline V. B. de Melo
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
- Departamento de Patologia e Medicina Legal, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | | | - Rafael de Deus Moura
- Departamento de Medicina Especializada, Universidade Federal do Piauí, Teresina, Piauí, Brazil
| | - Carla Pagliari
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Marta Santos
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
| | - Raimundo José C. Araújo
- Departamento de Medicina Especializada, Universidade Federal do Piauí, Teresina, Piauí, Brazil
| | | | | | - Carlos Henrique N. Costa
- Instituto de Doenças Tropicais Natan Portela, Universidade Federal do Piauí, Teresina, Piauí, Brazil
| | - Washington L. C. dos-Santos
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
- Departamento de Patologia e Medicina Legal, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Silva RVS, Uliana SRB, Yasunaka JKUY, Veloso CS, Sousa E, Ferreira MML, Carvalho VS, Ferreira GR, Costa DL, Costa CHN. Low Plasma Lipids Are Associated with Relapsing and Lethal Visceral Leishmaniasis in HIV-Infected Patients. Pathogens 2024; 13:450. [PMID: 38921748 PMCID: PMC11206293 DOI: 10.3390/pathogens13060450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/27/2024] Open
Abstract
Visceral leishmaniasis (VL) results from protozoa Leishmania infantum and L. donovani infection. This study investigated whether host factors would explain the relapses. First, susceptibility to amphotericin B of L. infantum isolates was evaluated in vitro. Then, clinical data and the lipid profile of patients with relapsing and non-relapsing VL were assessed. Susceptibility to amphotericin B was similar between the isolates. CD4+ lymphocytes were reduced in both groups of patients in the first episode and with relapsing VL. Still, the strongest blood cell indicator associated with relapses was low total lymphocyte counts. Total plasma cholesterol, high-density lipoprotein, low-density lipoprotein, and, uniquely, triglycerides of the six individuals in the first episode and twenty-three with relapsing VL were lower in relapsing patients than those in the first episode. Deceased patients had extremely low low-density lipoprotein. After CD4+ decreases, lymphocyte CD8+ reduction is the final stage of immunological failure. The lower lipid concentrations appear to be secondary to the depletion of fat stores by inflammation-induced cachexia and fat exhaustion provoked by the co-occurrence of both diseases, which can finally lead to death.
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Affiliation(s)
- Renata V. S. Silva
- Laboratório de Leishmanioses, Departamento de Medicina Comunitária, Universidade Federal do Piauí, Teresina 64002-510, PI, Brazil;
| | - Silvia R. B. Uliana
- Laboratório de Leishmanioses, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo 05508-090, SP, Brazil; (S.R.B.U.); (J.K.U.Y.Y.)
| | - Jenicer K. U. Y. Yasunaka
- Laboratório de Leishmanioses, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo 05508-090, SP, Brazil; (S.R.B.U.); (J.K.U.Y.Y.)
| | - Cláudio S. Veloso
- Instituto de Doenças Tropicais “Natan Portella”, Teresina 64002-510, PI, Brazil; (C.S.V.); (D.L.C.)
| | - Emille Sousa
- Laboratório de Leishmanioses, Centro de Inteligência em Agravos Emergentes e Negligenciados, Teresina 64002-510, PI, Brazil; (E.S.); (M.M.L.F.)
| | - Maria M. L. Ferreira
- Laboratório de Leishmanioses, Centro de Inteligência em Agravos Emergentes e Negligenciados, Teresina 64002-510, PI, Brazil; (E.S.); (M.M.L.F.)
| | - Vivianne S. Carvalho
- Centro de Diagnóstico, “Dr. Raul Bacellar”, Fundação Municipal de Saúde, Teresina 64600-000, PI, Brazil;
| | - Gabriel R. Ferreira
- Department of Microbiology-Infectious Disease and Immunology, Faculty of Medicine, University Laval, Quebec, QC G1V 0A6, Canada;
| | - Dorcas L. Costa
- Instituto de Doenças Tropicais “Natan Portella”, Teresina 64002-510, PI, Brazil; (C.S.V.); (D.L.C.)
- Laboratório de Leishmanioses, Centro de Inteligência em Agravos Emergentes e Negligenciados, Teresina 64002-510, PI, Brazil; (E.S.); (M.M.L.F.)
- Departamento de Mãe e Filho, Universidade Federal do Piauí, Teresina 64002-510, PI, Brazil
| | - Carlos H. N. Costa
- Instituto de Doenças Tropicais “Natan Portella”, Teresina 64002-510, PI, Brazil; (C.S.V.); (D.L.C.)
- Laboratório de Leishmanioses, Centro de Inteligência em Agravos Emergentes e Negligenciados, Teresina 64002-510, PI, Brazil; (E.S.); (M.M.L.F.)
- Departamento de Medicina Comunitária, Universidade Federal do Piauí, Teresina 64002-510, PI, Brazil
- Laboratório de Pesquisas em Leishmanioses, Centro de Investigações em Agravos Tropicais Emergentes e Negligenciados, Instituto de Doenças Tropicais “Natan Portella”, Universidade Federal do Piauí, Rua Artur de Vasconcelos 151, Teresina 64002-510, PI, Brazil
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Karampas G, Koulouraki S, Daikos GL, Nanou C, Aravantinos L, Eleftheriades M, Metallinou D, Christopoulos P. Visceral Leishmaniasis in a Twin Pregnancy: A Case Report and Review of the Literature. J Clin Med 2024; 13:2400. [PMID: 38673673 PMCID: PMC11051246 DOI: 10.3390/jcm13082400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Visceral leishmaniasis (VL), often referred to as kala-azar, is quite rare in developed countries during pregnancy. Only few studies have evaluated its impact on perinatal outcome. It is caused primarily by Leishmania donovani or Leishmania infantum and presents with a wide spectrum of clinical manifestations from cutaneous ulcers to multisystem disease. Differential diagnosis is challenging as symptoms and signs are insidious, mimicking other diseases. Misdiagnosis can result in severe adverse perinatal outcomes, even maternal/neonatal death. Early treatment with liposomal amphotericin-B (LAmB) is currently the first choice with adequate effectiveness. We report a rare case of VL in a twin pregnancy with onset at the second trimester, presenting with periodic fever with rigors, right flank pain, and gradual dysregulation of all three cell lines. The positive rK39 enzyme-linked immunosorbent assay test confirmed the diagnosis. Treatment with LAmB resulted in clinical improvement within 48 h and in the delivery of two late-preterm healthy neonates with no symptoms or signs of vertical transmission. The one-year follow-up, of the mother and the neonates, was negative for recurrence. To our knowledge, this is the first reported case of VL in a twin pregnancy, and consequently treatment and perinatal outcome are of great importance.
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Affiliation(s)
- Grigorios Karampas
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - Sevasti Koulouraki
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - George L. Daikos
- Mitera Hospital, 6, Erythrou Stavrou Str., 151 23 Athens, Greece;
| | - Christina Nanou
- Department of Midwifery, University of West Attica, 122 43 Athens, Greece;
| | - Leon Aravantinos
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - Makarios Eleftheriades
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
| | - Dimitra Metallinou
- Department of Midwifery, University of West Attica, 122 43 Athens, Greece;
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (G.K.); (S.K.); (L.A.); (M.E.); (P.C.)
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Reinaldo LGC, Araújo Júnior RJC, Diniz TM, Moura RDD, Meneses Filho AJ, Furtado CVVDM, Dos Santos WLC, Costa DL, Eulálio KD, Ferreira GR, Costa CHN. The spleen is the graveyard of CD4+ cells in patients with immunological failure of visceral leishmaniasis and AIDS. Parasit Vectors 2024; 17:132. [PMID: 38491526 PMCID: PMC10941596 DOI: 10.1186/s13071-024-06151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/22/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL), or kala-azar, is a common comorbidity in patients with AIDS in endemic areas. Many patients continue to experiences relapses of VL despite virological control, but with immunological failure. These patients remain chronically symptomatic with hypersplenism, for example with anemia, leukopenia, and thrombocytopenia, and are at risk of severe co-infection due to low CD4+ count. Therefore, in this study, splenectomized patients with VL and HIV infection were investigated to understand why the CD4+ count fails to recover in these patients, evaluating the importance of spleen mass for hypersplenism and immunological failure. METHODS From a retrospective open cohort of 13 patients who had previously undergone splenectomy as salvage therapy for relapsing VL, 11 patients with HIV infection were investigated. This study compared the patients' complete blood cell count (CBC) and CD4+ and CD8+ cell counts before and after splenectomy with respect to spleen weight. RESULTS CBC was substantially improved after splenectomy, indicating hypersplenism. However, to the best of our knowledge, this is the first study to show that spleen mass is strongly and negatively correlated with CD4+ cell count (ρ = -0.71, P = 0.015). CONCLUSIONS This finding was unexpected, as the spleen is the most extensive lymphoid tissue and T-lymphocyte source. After reviewing the literature and reasoning, we hypothesized that the immunological failure was secondary to CD4+ loss initially by apoptosis in the spleen induced by productive HIV infection and, subsequently, by pyroptosis sustained by parasitic infection in spleen macrophages.
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Affiliation(s)
| | | | - Thiago Melo Diniz
- University Hospital of the Federal University of Piauí, Teresina, Brazil
| | - Rafael de Deus Moura
- University Hospital of the Federal University of Piauí, Teresina, Brazil
- Department of Community Medicine, Federal University of Piauí, Teresina, Brazil
| | | | | | | | - Dorcas Lamounier Costa
- Maternal and Child Department, Federal University of Piauí, Teresina, Brazil
- Intelligence Center for Emerging and Neglected Tropical Diseases, Teresina, Brazil
| | | | - Gabriel R Ferreira
- Department of Microbiology-Infectious Disease and Immunology, Faculty of Medicine, University Laval, Laval, QC, Canada
| | - Carlos Henrique Nery Costa
- Department of Community Medicine, Federal University of Piauí, Teresina, Brazil.
- Instituto de Doenças Tropicais Natan Portella, Teresina, Brazil.
- Intelligence Center for Emerging and Neglected Tropical Diseases, Teresina, Brazil.
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Catarino JDS, de Oliveira RF, Silva MV, Sales-Campos H, de Vito FB, da Silva DAA, Naves LL, Oliveira CJF, Rodrigues DBR, Rodrigues V. Genetic variation of FcγRIIa induces higher uptake of Leishmania infantum and modulates cytokine production by adherent mononuclear cells in vitro. Front Immunol 2024; 15:1343602. [PMID: 38455048 PMCID: PMC10917923 DOI: 10.3389/fimmu.2024.1343602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/01/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Single nucleotide variations (SNVs) are specific genetic variations that commonly occur in a population and often do not manifest phenotypically. However, depending on their location and the type of nucleotide exchanged, an SNV can alter or inhibit the function of the gene in which it occurs. Immunoglobulin G (IgG) receptor genes have exhibited several polymorphisms, including rs1801274, which is found in the FcgRIIa gene. The replacement of A with T results in a Histidine (H) to Arginine (R) substitution, altering the affinity of the IgG receptor for IgG subtypes and C-reactive protein (CRP). In this study, we analyzed rs1801274 and its functional implications concerning L. Infantum uptake and cytokine production. Methods We genotyped 201 individuals from an endemic area for visceral leishmaniasis to assess the presence of rs1801274 using Taqman probes for a candidate gene study. Additionally, we included seventy individuals from a non-endemic area for a functional study. Subsequently, we isolated and cultivated one-week adherent mononuclear cells (AMCs) derived from the peripheral blood of participants residing in the non-endemic region in the presence of L. infantum promastigotes, with and without antigen-specific IgG and/or CRP. We analyzed the rate of phagocytosis and the production of nitric oxide (NO), tumor necrosis factor (TNF)-a, interleukin (IL)-10, IL-12 p70, IL-1b, IL- 6, and IL-8 in the culture supernatants. Results and discussion In participants from the endemic region, the A/G (H/R isoform) heterozygous genotype was significantly associated with susceptibility to the disease. Furthermore, SNVs induced a change in the phagocytosis rate in an opsonin-dependent manner. Opsonization with IgG increased the production of IL-10, TNF-a, and IL-6 in AMCs with the H/R isoform, followed by a decrease in NO production. The results presented here suggest that the rs1801274 polymorphism is linked to a higher susceptibility to visceral leishmaniasis.
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Affiliation(s)
- Jonatas da Silva Catarino
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Rafael Faria de Oliveira
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Marcos Vinicius Silva
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Helioswilton Sales-Campos
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, GO, Brazil
| | - Fernanda Bernadelli de Vito
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Djalma Alexandre Alves da Silva
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Lucila Langoni Naves
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Carlo José Freire Oliveira
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Denise Bertulucci Rocha Rodrigues
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Virmondes Rodrigues
- Laboratory of Immunology, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
- National Institute of Neuroimmuno Modulation, Rio de Janeiro, Brazil
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De Cerqueira MAF, Pinheiro AMR, Costa DL, Costa CHN. Association between clinical outcomes, peripheral blood and cytomorphologic features of bone marrow in visceral leishmaniasis. Hematol Transfus Cell Ther 2024:S2531-1379(23)02601-9. [PMID: 38272737 DOI: 10.1016/j.htct.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/07/2023] [Accepted: 10/21/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION An intracellular parasite of mononuclear phagocytes, mainly distributed in the bone marrow and the spleen, causes visceral leishmaniasis. Complete blood count (CBC) reveals the poorly understood pathogenesis of anemia, leukopenia and thrombocytopenia. Our study aimed to compare the CBC with bone marrow cytomorphological features and their association with clinical outcomes to clarify this relevant issue. METHODS The CBC and bone marrow of 118 patients were described by two hematologists and compared to check their association with each other and mortality. RESULTS Peripheral cytopenias were common findings, particularly anemia, as seen in almost all patients. No relationship was found between values of hemoglobin, neutrophils and platelet count with fatal outcomes. The bone marrow was normocellular in 61.9% of the cases. Dysplasia figures were frequent and 49.1% of the samples had dysgranulopoiesis. Additionally, erythroid hyperplasia was found in 72% of the patients with severe anemia. Patients with reduced bone marrow cellularity, erythroid hypercellularity and dyserythropoiesis seem to have a riskier disease. CONCLUSION The study results suggest that the bone marrow of patients with visceral leishmaniasis manifests a reactional pattern to the inflammatory event, thereby modulating cytokines and other colony growth factors. This compensatory response may be dysplastic and ineffective and generate peripheral cytopenias of varying intensity. Further studies are needed to clarify the signaling pathways involved, which may be used as therapeutic tools in the future.
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Affiliation(s)
| | | | - Dorcas Lamounier Costa
- Instituto de Doenças Tropicais Nathan Portella (IDTNP), Teresina, Brazil; Universidade Federal do Piauí (UFPI). Teresina, PI, Brazil
| | - Carlos Henrique Nery Costa
- Instituto de Doenças Tropicais Nathan Portella (IDTNP), Teresina, Brazil; Universidade Federal do Piauí (UFPI). Teresina, PI, Brazil
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Costa CHN, Chang KP, Costa DL, Cunha FVM. From Infection to Death: An Overview of the Pathogenesis of Visceral Leishmaniasis. Pathogens 2023; 12:969. [PMID: 37513817 PMCID: PMC10384967 DOI: 10.3390/pathogens12070969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/02/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Kala-azar, also known as visceral leishmaniasis (VL), is a disease caused by Leishmania infantum and L. donovani. Patients experience symptoms such as fever, weight loss, paleness, and enlarged liver and spleen. The disease also affects immunosuppressed individuals and has an overall mortality rate of up to 10%. This overview explores the literature on the pathogenesis of preclinical and clinical stages, including studies in vitro and in animal models, as well as complications and death. Asymptomatic infection can result in long-lasting immunity. VL develops in a minority of infected individuals when parasites overcome host defenses and multiply in tissues such as the spleen, liver, and bone marrow. Hepatosplenomegaly occurs due to hyperplasia, resulting from parasite proliferation. A systemic inflammation mediated by cytokines develops, triggering acute phase reactants from the liver. These cytokines can reach the brain, causing fever, cachexia and vomiting. Similar to sepsis, disseminated intravascular coagulation (DIC) occurs due to tissue factor overexpression. Anemia, hypergammaglobulinemia, and edema result from the acute phase response. A regulatory response and lymphocyte depletion increase the risk of bacterial superinfections, which, combined with DIC, are thought to cause death. Our understanding of VL's pathogenesis is limited, and further research is needed to elucidate the preclinical events and clinical manifestations in humans.
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Affiliation(s)
- Carlos H N Costa
- Centro de Investigações em Agravos Tropicais Emergentes e Negligenciados, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Rua Artur de Vasconcelos 151-Sul, Teresina 64002-510, PI, Brazil
| | - Kwang-Poo Chang
- Department of Microbiology/Immunology, Center for Cancer Cell Biology, Immunology & Infection, Chicago Medical School, Rosalind Franklin University, North Chicago, IL 60064, USA
| | - Dorcas L Costa
- Centro de Investigações em Agravos Tropicais Emergentes e Negligenciados, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Rua Artur de Vasconcelos 151-Sul, Teresina 64002-510, PI, Brazil
| | - Francisco Valmor M Cunha
- Departament of Physiotherapy, Centro Universitário Uninovafapi, Rua Vitorino Orthiges Fernandes, 6123-Uruguai, Teresina 64073-505, PI, Brazil
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Porcino GN, Bladergroen MR, Dotz V, Nicolardi S, Memarian E, Gardinassi LG, Nery Costa CH, Pacheco de Almeida R, Ferreira de Miranda Santos IK, Wuhrer M. Total serum N-glycans mark visceral leishmaniasis in human infections with Leishmania infantum. iScience 2023; 26:107021. [PMID: 37485378 PMCID: PMC10362369 DOI: 10.1016/j.isci.2023.107021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/07/2023] [Accepted: 05/30/2023] [Indexed: 07/25/2023] Open
Abstract
Visceral leishmaniasis (VL) is a clinical form of leishmaniasis with high mortality rates when not treated. Diagnosis suffers from invasive techniques and sub-optimal sensitivities. The current (affordable) treatment with pentavalent antimony as advised by the WHO is possibly harmful to the patient. There is need for an improved diagnosis to prevent possibly unnecessary treatment. N-glycan analysis may aid in diagnosis. We evaluated the N-glycan profiles from active VL, asymptomatic infections (ASYMP) and controls from non-endemic (NC) and endemic (EC) areas. Active VL has a distinct N-glycome profile that associates with disease severity. Our study suggests that the observed glycan signatures could be a valuable additive to diagnosis and assist in identifying possible markers of disease and understanding the pathogenesis of VL. Further studies are warranted to assess a possible future role of blood glycome analysis in active VL diagnosis and should aim at disease specificity.
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Affiliation(s)
- Gabriane Nascimento Porcino
- Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14049-900, Brazil
| | - Marco René Bladergroen
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden 2333 ZA, the Netherlands
| | - Viktoria Dotz
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden 2333 ZA, the Netherlands
| | - Simone Nicolardi
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden 2333 ZA, the Netherlands
| | - Elham Memarian
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden 2333 ZA, the Netherlands
| | - Luiz Gustavo Gardinassi
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brazil
| | | | - Roque Pacheco de Almeida
- Departamento de Medicina, Programa de Pós-Graduação em Ciências da Saúde – PPGCS, Universidade Federal de Sergipe, Aracajú 49060-100, Brazil
| | | | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden 2333 ZA, the Netherlands
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Divenuto F, Pavia G, Marascio N, Barreca GS, Quirino A, Matera G. Role of Treg, Breg and other cytokine sets in host protection and immunopathology during human leishmaniasis: Are they potential valuable markers in clinical settings and vaccine evaluation? Acta Trop 2023; 240:106849. [PMID: 36731621 DOI: 10.1016/j.actatropica.2023.106849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/02/2023]
Abstract
Leishmaniasis is a vector-borne disease caused by obligate intracellular protozoan parasites that can infect humans and other mammals. Pro- and anti-inflammatory cytokines are important regulators of innate and specific responses in Leishmania infection. Resistance to leishmaniasis is related to T helper 1 (Th1) response with the production of pro-inflammatory cytokines: IL-12, IL-1β, IFN-γ, TNF-α, IL-2 leading to activation of macrophages and parasite killing. Instead, a more intense Th2 (IL-4, IL-5, IL-13), Treg (IL-10 and TGF-β) and Breg response (IL-10 and IL-35) are related to parasite persistence through the inhibition of macrophage activation, which promotes the escape from host immune system. Interestingly, a cytokine involved in the parasite killing in one form of leishmaniasis may be "pathogen friendly" in another form of the disease. To date, few studies are focusing on the role of Treg and Breg cytokines in human models of leishmaniasis; therefore, further investigations are needed to clarify their potential role in the diagnosis and prognosis of such protozoan infections, as well as in the development of vaccines against leishmaniasis. This review summarizes the current knowledge about the role of cytokines produced by Th1, Th2, Treg, and Breg cells involved in Leishmania disease progression and host protection. Some cytokines might play a role as diagnostic and prognostic clinical markers, or they could represent a novel approach leading to new anti-leishmaniasis therapies. Overall, advances in knowledge of the complex network of cytokines secreted by immune cells could help to better understand signaling pathways and host immune responses during Leishmania infection. This approach would allow these mediators to be used as therapeutic strategies against leishmaniasis.
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Affiliation(s)
- Francesca Divenuto
- Clinical Microbiology Unit, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Grazia Pavia
- Clinical Microbiology Unit, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Nadia Marascio
- Clinical Microbiology Unit, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | | | - Angela Quirino
- Clinical Microbiology Unit, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy.
| | - Giovanni Matera
- Clinical Microbiology Unit, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
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10
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Rodrigues GF, Alcântara LS, Barros JPB, de Lima ACS, Campos MB, Moraes C, Ferreira AF, Matta VLR, Laurenti MD, Corbett CEP, Silveira FT, Gomes CMC. In situ expression of Th17 immunologic mediators in American cutaneous leishmaniasis caused by Leishmania (V.) braziliensis and Leishmania (L.) amazonensis in the Brazilian Amazon. FRONTIERS IN TROPICAL DISEASES 2023. [DOI: 10.3389/fitd.2023.1067595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
American cutaneous leishmaniasis (ACL) presents a wide spectrum of clinical and immunopathological manifestations. In Brazil, Leishmania (L.) amazonensis[La] and Leishmania(V.)braziliensis[Lb] show the highest pathogenic potential for humans causing different clinical forms: localized cutaneous leishmaniasis (LCL : Lb/La), anergic diffuse cutaneous leishmaniasis (ADCL : La) and mucocutaneous leishmaniasis (MCL : Lb). ADCL and MCL are the most severe forms and infection leads to a cellular immune response at the hyposensitivity and hypersensitivity poles. Th17-cells are involved in the ACL pathogenesis, are derived from naïve TCD4+ cells regulated by RORγt, differentiate in presence of IL-6, TGF-β, IL- 1β, IL-23 and express IL-17. Aim of this study was to characterize the cellular immune response mediated by Th17-profile cells through in situ determination of the expression of RORγt, IL-17, IL-6, TGF-β, IL-1β, and IL-23 in the ACL clinical-immunopathological spectrum caused by L.(L.)amazonensis and L.(V.)braziliensis. Biopsies of skin and mucosal lesions from forty patients including ADCL(n=8), LCL[La](n=17), LCL[Lb](n=9) and MCL(n=6), were examined by immunohistochemistry. The immunostained cells density (cells/mm2) was determined in image analysis system using AxionVision 4.8 software (Zeiss). As the disease evolution time (DET) was different among ACL patients, the effect of DET on the expression of immunological markers was evaluated in different clinical forms and histopathological changes, using ANCOVA. Our results showed significantly increased expression of RORγt, IL-17, IL-6, IL-1β and IL-23 in patients with ACL polar forms (ADCL and MCL); higher TGF-β expression was found in ADCL. DET influenced the expression of RORγt and IL-6 in: clinical forms of ACL and in categories of parasitism. DET also affected the production of RORγt, IL-17, IL-6, TGF-β and IL-1β in types of inflammatory infiltrate, evidencing that DET had effect on the expression of Th17 profile cytokines in ACL. Together, the expression of immunological mediators of Th17 profile in the ACL spectrum, as well as the DET effect, demonstrate the participation of this cell lineage in the immunopathogenesis of ACL, mainly in the polar and more severe forms of ACL spectrum. The dubious role played by Th17-cells may favors immune response suppression and parasitic persistence in ADCL, while in MCL it contributes to an exacerbated immune response and parasite scarcity.
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11
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Mahor H, Mukherjee A, Sarkar A, Saha B. Anti-leishmanial therapy: Caught between drugs and immune targets. Exp Parasitol 2023; 245:108441. [PMID: 36572088 DOI: 10.1016/j.exppara.2022.108441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/12/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
Leishmaniasis is an enigmatic disease that has very restricted options for chemotherapy and none for prophylaxis. As a result, deriving therapeutic principles for curing the disease has been a major objective in Leishmania research for a long time. Leishmania is a protozoan parasite that lives within macrophages by subverting or switching cell signaling to the pathways that ensure its intracellular survival. Therefore, three groups of molecules aimed at blocking or eliminating the parasite, at least, in principle, include blockers of macrophage receptor- Leishmania ligand interaction, macrophage-activating small molecules, peptides and cytokines, and signaling inhibitors or activators. Macrophages also act as an antigen-presenting cell, presenting antigen to the antigen-specific T cells to induce activation and differentiation of the effector T cell subsets that either execute or suppress anti-leishmanial functions. Three groups of therapeutic principles targeting this sphere of Leishmania-macrophage interaction include antibodies that block pro-leishmanial response of T cells, ligands that activate anti-leishmanial T cells and the antigens for therapeutic vaccines. Besides these, prophylactic vaccines have been in clinical trials but none has succeeded so far. Herein, we have attempted to encompass all these principles and compose a comprehensive review to analyze the feasibility and adoptability of different therapeutics for leishmaniasis.
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Affiliation(s)
- Hima Mahor
- National Centre for Cell Science, Ganeshkhind, Pune, 411007, India
| | - Arka Mukherjee
- Trident Academy of Creative Technology, Bhubaneswar, 751024, Odisha, India
| | - Arup Sarkar
- Trident Academy of Creative Technology, Bhubaneswar, 751024, Odisha, India
| | - Bhaskar Saha
- National Centre for Cell Science, Ganeshkhind, Pune, 411007, India; Trident Academy of Creative Technology, Bhubaneswar, 751024, Odisha, India.
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12
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Abstract
Visceral leishmaniasis (VL) is a potentially fatal disease caused mainly by Leishmania infantum in South America and Leishmania donovani in Asia and Africa. Disease outcomes have been associated with patient genotype, nutrition, age, sex, comorbidities, and coinfections. In this study, we examine the effects of parasite genetic variation on VL disease severity in Brazil. We collected and sequenced the genomes of 109 L. infantum isolates from patients in northeastern Brazil and retrieved matching patient clinical data from medical records, including mortality, sex, HIV coinfection, and laboratory data (creatinine, hemoglobin, and leukocyte and platelet counts). We identified genetic differences between parasite isolates, including single nucleotide polymorphisms (SNPs), small insertions/deletions (indels), and variations in genic, intergenic, and chromosome copy numbers (copy number variants [CNVs]). To describe associations between the parasite genotypes and clinical outcomes, we applied quantitative genetics methods of heritability and genome-wide association studies (GWAS), treating clinical outcomes as traits that may be influenced by parasite genotype. Multiple aspects of the genetic analysis indicate that parasite genotype affects clinical outcomes. We estimate that parasite genotype explains 83% chance of mortality (narrow-sense heritability [h2] = 0.83 ± 0.17) and has a significant relationship with patient sex (h2 = 0.60 ± 0.27). Impacts of parasite genotype on other clinical traits are lower (h2 ≤ 0.34). GWAS analysis identified multiple parasite genetic loci that were significantly associated with clinical outcomes; 17 CNVs were significantly associated with mortality, two with creatinine, and one with bacterial coinfection, jaundice, and HIV coinfection, and two SNPs/indels and six CNVs were associated with age, jaundice, HIV and bacterial coinfections, creatinine, and/or bleeding sites. Parasite genotype is an important factor in VL disease severity in Brazil. Our analysis indicates that specific genetic differences between parasites act as virulence factors, enhancing risks of severe disease and mortality. More detailed understanding of these virulence factors could be exploited for novel therapies. IMPORTANCE Multiple factors contribute to the risk of mortality from visceral leishmaniasis (VL), including, patient genotype, comorbidities, and nutrition. Many of these factors are influenced by socioeconomic biases. Our work suggests that the virulence of the infecting parasite is an important risk factor for mortality. We pinpoint some specific genomic markers that are associated with mortality, which can lead to a greater understanding of the molecular mechanisms that cause severe VL disease, to the identification of genetic markers for virulent parasites, and to the development of drug and vaccine therapies.
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13
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Immune Impairment Associated with Vitamin A Deficiency: Insights from Clinical Studies and Animal Model Research. Nutrients 2022; 14:nu14235038. [PMID: 36501067 PMCID: PMC9738822 DOI: 10.3390/nu14235038] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Vitamin A (VA) is critical for many biological processes, including embryonic development, hormone production and function, the maintenance and modulation of immunity, and the homeostasis of epithelium and mucosa. Specifically, VA affects cell integrity, cytokine production, innate immune cell activation, antigen presentation, and lymphocyte trafficking to mucosal surfaces. VA also has been reported to influence the gut microbiota composition and diversity. Consequently, VA deficiency (VAD) results in the imbalanced production of inflammatory and immunomodulatory cytokines, intestinal inflammation, weakened mucosal barrier functions, reduced reactive oxygen species (ROS) and disruption of the gut microbiome. Although VAD is primarily known to cause xerophthalmia, its role in the impairment of anti-infectious defense mechanisms is less defined. Infectious diseases lead to temporary anorexia and lower dietary intake; furthermore, they adversely affect VA status by interfering with VA absorption, utilization and excretion. Thus, there is a tri-directional relationship between VAD, immune response and infections, as VAD affects immune response and predisposes the host to infection, and infection decreases the intestinal absorption of the VA, thereby contributing to secondary VAD development. This has been demonstrated using nutritional and clinical studies, radiotracer studies and knockout animal models. An in-depth understanding of the relationship between VAD, immune response, gut microbiota and infections is critical for optimizing vaccine efficacy and the development of effective immunization programs for countries with high prevalence of VAD. Therefore, in this review, we have comprehensively summarized the existing knowledge regarding VAD impacts on immune responses to infections and post vaccination. We have detailed pathological conditions associated with clinical and subclinical VAD, gut microbiome adaptation to VAD and VAD effects on the immune responses to infection and vaccines.
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14
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Magalhães LS, Melo EV, Damascena NP, Albuquerque ACB, Santos CNO, Rebouças MC, Bezerra MDO, Louzada da Silva R, de Oliveira FA, Santos PL, da Silva JS, Lipscomb MW, da Silva ÂM, de Jesus AR, de Almeida RP. Use of N-acetylcysteine as treatment adjuvant regulates immune response in visceral leishmaniasis: Pilot clinical trial and in vitro experiments. Front Cell Infect Microbiol 2022; 12:1045668. [PMID: 36506010 PMCID: PMC9730326 DOI: 10.3389/fcimb.2022.1045668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022] Open
Abstract
This investigation aimed to assess the effect of N-acetylcysteine (NAC) as an adjuvant treatment to alleviate visceral leishmaniasis (VL). The present work includes both blinded randomized clinical intervention and experimental in vitro studies. The clinical trial included 60 patients with VL randomly allocated into two groups: a test group (n = 30) treated with meglumine antimoniate plus NAC (SbV + NAC) and a control group (n = 30) treated with meglumine antimoniate only (SbV). The primary outcome was clinical cure (absence of fever, spleen and liver sizes reduction, and hematological improvement) in 180 days. The cure rate did not differ between the groups; both groups had similar results in all readout indices. The immunological parameters of the patients treated with SbV + NAC showed higher sCD40L in sera during treatment, and the levels of sCD40L were negatively correlated with Interleukin-10 (IL-10) serum levels. In addition, data estimation showed a negative correlation between the sCD40L levels and the spleen size in patients with VL. For the in vitro experiments, peripheral blood mononuclear cells (PBMCs) or PBMC-derived macrophages from healthy donors were exposed to soluble Leishmania antigen (SLA) or infected with stationary promastigotes of Leishmania infantum in the presence or absence of NAC. Results revealed that NAC treatment of SLA-stimulated PBMCs reduces the frequency of monocytes producing IL-10 and lowers the frequency of CD4+ and CD8+ T cells expressing (pro-)inflammatory cytokines. Together, these results suggest that NAC treatment may modulate the immune response in patients with VL, thus warranting additional investigations to support its case use as an adjuvant to antimony therapy for VL.
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Affiliation(s)
- Lucas Sousa Magalhães
- Laboratory of Immunology and Molecular Biology, University Hospital, Federal University of Sergipe, Aracaju, Brazil,Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil,Sector of Parasitology and Pathology, Biological and Health Sciences Institute, Federal University of Alagoas, Maceió, Brazil
| | - Enaldo Vieira Melo
- Department of Medicine, University Hospital-Empresa Brasileira de Serviços Hospitalares (EBSERH), Federal University of Sergipe, Aracaju, Brazil
| | - Nayra Prata Damascena
- Department of Medicine, University Hospital-Empresa Brasileira de Serviços Hospitalares (EBSERH), Federal University of Sergipe, Aracaju, Brazil
| | - Adriana Cardoso Batista Albuquerque
- Department of Medicine, University Hospital-Empresa Brasileira de Serviços Hospitalares (EBSERH), Federal University of Sergipe, Aracaju, Brazil
| | - Camilla Natália Oliveira Santos
- Laboratory of Immunology and Molecular Biology, University Hospital, Federal University of Sergipe, Aracaju, Brazil,Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | - Mônica Cardozo Rebouças
- Laboratory of Immunology and Molecular Biology, University Hospital, Federal University of Sergipe, Aracaju, Brazil
| | - Mariana de Oliveira Bezerra
- Laboratory of Immunology and Molecular Biology, University Hospital, Federal University of Sergipe, Aracaju, Brazil,Department of Medicine, University Hospital-Empresa Brasileira de Serviços Hospitalares (EBSERH), Federal University of Sergipe, Aracaju, Brazil
| | - Ricardo Louzada da Silva
- Laboratory of Immunology and Molecular Biology, University Hospital, Federal University of Sergipe, Aracaju, Brazil,Department of Health Education, Federal University of Sergipe, Lagarto, Brazil
| | - Fabricia Alvisi de Oliveira
- Laboratory of Immunology and Molecular Biology, University Hospital, Federal University of Sergipe, Aracaju, Brazil
| | - Priscila Lima Santos
- Laboratory of Immunology and Molecular Biology, University Hospital, Federal University of Sergipe, Aracaju, Brazil,Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil,Department of Health Education, Federal University of Sergipe, Lagarto, Brazil
| | - João Santana da Silva
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Ângela Maria da Silva
- Laboratory of Immunology and Molecular Biology, University Hospital, Federal University of Sergipe, Aracaju, Brazil,Department of Medicine, University Hospital-Empresa Brasileira de Serviços Hospitalares (EBSERH), Federal University of Sergipe, Aracaju, Brazil
| | - Amélia Ribeiro de Jesus
- Laboratory of Immunology and Molecular Biology, University Hospital, Federal University of Sergipe, Aracaju, Brazil,Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil,Department of Medicine, University Hospital-Empresa Brasileira de Serviços Hospitalares (EBSERH), Federal University of Sergipe, Aracaju, Brazil,Immunology Institute of Investigation (iii), National Institute of Science and Technology (INCT), Brazilian Research and Technology Council (CNPq), São Paulo, Brazil
| | - Roque Pacheco de Almeida
- Laboratory of Immunology and Molecular Biology, University Hospital, Federal University of Sergipe, Aracaju, Brazil,Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil,Department of Medicine, University Hospital-Empresa Brasileira de Serviços Hospitalares (EBSERH), Federal University of Sergipe, Aracaju, Brazil,Immunology Institute of Investigation (iii), National Institute of Science and Technology (INCT), Brazilian Research and Technology Council (CNPq), São Paulo, Brazil,*Correspondence: Roque Pacheco de Almeida,
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15
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Cavalcante KKDS, Almeida CP, Boigny RN, Cavalcante FRA, Correia FGS, Florêncio CMGD, Alencar CH. Epidemiological and clinical factors associated with lethality from Human Visceral Leishmaniasis in Northeastern Brazil, 2007 to 2018. Rev Inst Med Trop Sao Paulo 2022; 64:e52. [PMID: 36074447 PMCID: PMC9448254 DOI: 10.1590/s1678-9946202264052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
Human Visceral Leishmaniasis (HVL) presents a subacute clinical evolution with systemic involvement, which can result in high case fatality, especially among untreated individuals or those with low socioeconomic status. This study aimed to identify epidemiological and clinical factors associated with HVL case fatality in the Ceara State, from 2007 to 2018. This is an analytical cross-sectional study. The bivariate analysis was performed by Stata 15.1 using Pearson’s Chi-square or Fisher’s exact test; and Poisson regression for age-controlled multivariate analysis. From 2007 to 2018, there were 4,863 new confirmed cases and 343 deaths from HVL (case fatality rate=7.05%). The risk factors associated with case fatalities were: age group (RR=8.69; 95%CI:3.56-21.20); black population (RR=2.21; 95%CI:1.45-3.35); jaundice symptoms (RR=1.72; 95%CI:1.38-2.14); edema (RR=2.62; 95%CI:2.10-3.26) and hemorrhagic phenomena (RR=1.63; 95%CI:1.26-2.10); and no prescription drug intake (RR=4.03; 95%CI:2.98-5.46). Treatment with pentavalent antimonial was a protective factor (RR=0.35; 95%CI:0.27-0.45). The number of deaths increased among the elderly, illiterate, urban residents, and black skin color individuals. The drugs pentavalent antimonial and amphotericin B showed an association with death, but were not considered causal factors. Treatment failure led to a high risk of death. In multivariate analysis, the risk factors for fatal cases were age group, black skin, symptoms of jaundice, edema and hemorrhagic phenomena; and failure to take the prescription drugs. Treatment with pentavalent antimonial was shown to be a protective factor. Knowing the factors associated with the fatality of VL-HIV cases may help to improve public policies, in order to refine the epidemiological surveillance program and, consequently, prevent deaths related to the disease in Ceara.
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Affiliation(s)
| | - Clarice Pessoa Almeida
- Universidade Federal do Ceará, Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Fortaleza, Ceará, Brazil
| | - Reagan Nzundu Boigny
- Universidade Federal do Ceará, Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Fortaleza, Ceará, Brazil
| | | | | | | | - Carlos Henrique Alencar
- Universidade Federal do Ceará, Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Fortaleza, Ceará, Brazil
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16
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Guedes DL, da Silva ED, Castro MCAB, Júnior WLB, Ibarra-Meneses AV, Tsoumanis A, Adriaensen W, van Griensven J, Pereira VRA, de Medeiros ZM. Comparison of serum cytokine levels in symptomatic and asymptomatic HIV-Leishmania coinfected individuals from a Brazilian visceral leishmaniasis endemic area. PLoS Negl Trop Dis 2022; 16:e0010542. [PMID: 35714136 PMCID: PMC9246190 DOI: 10.1371/journal.pntd.0010542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 06/30/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Visceral leishmaniasis (VL) remains an important infectious disease worldwide. VL-HIV coinfected individuals can present with atypical clinical forms of VL and have a high risk of VL relapse. Some cytokines have been described as potential markers to diagnose active VL and to predict the severity of the cases. However, few studies have included VL-HIV coinfected patients. We aimed to characterize the levels of several cytokines among VL-HIV coinfected individuals living in a VL-endemic area in Northeast Brazil. Methods This was a retrospective, cross-sectional study, aiming to estimate the levels of various cytokines in symptomatic and asymptomatic VL-HIV coinfected individuals. There were 134 study participants (35 symptomatic VL-HIV, 75 asymptomatic VL-HIV, and 24 healthy controls), all ≥ 18 years-old. Serum cytokine levels (interferon-γ, tumor necrosis factor, and interleukins 2, 4, 6, 10, and 17A) were quantified using the Becton Dickinson-BD’s Cytometric Bead Array (CBA) system. Results The population mainly consisted of men (64.9%), with a median age of 35 (27–41) years. Asymptomatic individuals were younger (p = 0.013), with more years of education (p < 0.001), and were more often on antiretroviral therapy (p < 0.001) than those in the symptomatic group. Hemoglobin levels (p < 0.001), lymphocytes (p < 0.001) and CD4 count (p < 0.001) were lower in symptomatic individuals, while HIV viral loads were higher (p < 0.001). In the symptomatic VL-HIV coinfected group, we observed increased serum levels of IL-17A, IL-6, and IL-10 compared to asymptomatic patients and the healthy controls. There were no differences in the levels of all cytokines between asymptomatic VL-HIV coinfected individuals and the healthy controls. Conclusions Higher serum levels of IL-17A, IL-6, and IL-10 cytokines were observed in symptomatic coinfected individuals but not in asymptomatically infected individuals. More studies among HIV-positive persons are needed to better understand the role of serum cytokines for prognosis, to define cure and predict VL relapses in VL-HIV coinfected individuals. Visceral leishmaniasis (VL) is a parasitic disease, classified as a neglected disease by the World Health Organization. It is present in more than 60 countries in four continents, with most tropical and subtropical countries affected. Without treatment, the disease is fatal. HIV-positive persons are especially affected by VL, with a worst prognosis. One of the main complications is the frequent reactivation of the disease even after successful treatment (VL relapse). Up to now, it is not clear why and when these reactivations occur, and many researches are trying to find some biological markers to answer this. Cytokines are one of these markers that may explain the progression of the disease. In this study, we compared the level of several key cytokines in symptomatic VL-HIV coinfected patients, asymptomatic VL-HIV coinfected individuals, and healthy controls living in a VL-endemic region in Northeastern Brazil. The serum cytokine levels were higher in symptomatic patients when compared with asymptomatic and healthy controls. More studies following VL-HIV patients are necessary to understand how these cytokines and the other biomarkers vary over time and whether they can predict VL relapse, and also the progression and the prognosis of the disease.
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Affiliation(s)
- Diego Lins Guedes
- Department of Parasitology, Aggeu Magalhães Institute–Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
- Curso de medicina, Núcleo de Ciências da Vida, Centro Acadêmico do Agreste, Universidade Federal de Pernambuco, Caruaru, Pernambuco, Brazil
- * E-mail:
| | - Elis Dionísio da Silva
- Department of Immunology, Aggeu Magalhães Institute–Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
| | - Maria Carolina Accioly Brelaz Castro
- Department of Immunology, Aggeu Magalhães Institute–Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
- Parasitology Laboratory, Federal University of Pernambuco, Vitoria de Santo Antão, Pernambuco, Brazil
| | - Walter Lins Barbosa Júnior
- Department of Parasitology, Aggeu Magalhães Institute–Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
| | - Ana Victoria Ibarra-Meneses
- Département de pathologie et microbiologie. Faculté de médecine vétérinaire. Université de Montréal, Saint-Hyacinthe, QC, Canada
- The Research Group on Infectious Diseases in Production Animals (GREMIP), Faculty of Veterinary Medicine, Université de Montréal, Montreal, Canada
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Wim Adriaensen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Valéria Rêgo Alves Pereira
- Department of Immunology, Aggeu Magalhães Institute–Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
| | - Zulma Maria de Medeiros
- Department of Parasitology, Aggeu Magalhães Institute–Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil
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17
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Costa-Madeira JC, Trindade GB, Almeida PHP, Silva JS, Carregaro V. T Lymphocyte Exhaustion During Human and Experimental Visceral Leishmaniasis. Front Immunol 2022; 13:835711. [PMID: 35585983 PMCID: PMC9108272 DOI: 10.3389/fimmu.2022.835711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/07/2022] [Indexed: 11/18/2022] Open
Abstract
A key point of immunity against protozoan Leishmania parasites is the development of an optimal T cell response, which includes a low apoptotic rate, high proliferative activity and polyfunctionality. During acute infection, antigen-specific T cells recognize the pathogen resulting in pathogen control but not elimination, promoting the development and the maintenance of a population of circulating effector cells that mount rapid response quickly after re-exposure to the parasite. However, in the case of visceral disease, the functionality of specific T cells is lost during chronic infection, resulting in inferior effector functions, poor response to specific restimulation, and suboptimal homeostatic proliferation, a term referred to as T cell exhaustion. Multiple factors, including parasite load, infection duration and host immunity, affect T lymphocyte exhaustion. These factors contribute to antigen persistence by promoting inhibitory receptor expression and sustained production of soluble mediators, influencing suppressive cell function and the release of endogenous molecules into chronically inflamed tissue. Together, these signals encourage several changes, reprogramming cells into a quiescent state, which reflects disease progression to more severe forms, and development of acquired resistance to conventional drugs to treat the disease. These points are discussed in this review.
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Affiliation(s)
- Juliana C. Costa-Madeira
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University from São Paulo, Ribeirão Preto, Brazil
| | - Gabrielly B. Trindade
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University from São Paulo, Ribeirão Preto, Brazil
| | - Paulo H. P. Almeida
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University from São Paulo, Ribeirão Preto, Brazil
| | - João S. Silva
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University from São Paulo, Ribeirão Preto, Brazil
- Fiocruz-Bi-Institutional Translational Medicine Project, Ribeirão Preto, Brazil
| | - Vanessa Carregaro
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University from São Paulo, Ribeirão Preto, Brazil
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18
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Forrester S, Goundry A, Dias BT, Leal-Calvo T, Moraes MO, Kaye PM, Mottram JC, Lima APCA. Tissue Specific Dual RNA-Seq Defines Host-Parasite Interplay in Murine Visceral Leishmaniasis Caused by Leishmania donovani and Leishmania infantum. Microbiol Spectr 2022; 10:e0067922. [PMID: 35384718 PMCID: PMC9045295 DOI: 10.1128/spectrum.00679-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 01/22/2023] Open
Abstract
Visceral leishmaniasis is associated with hepato-splenomegaly and altered immune and hematological parameters in both preclinical animal models and humans. We studied mouse experimental visceral leishmaniasis caused by Leishmania infantum and Leishmania donovani in BALB/c mice using dual RNA-seq to investigate the transcriptional response of host and parasite in liver and spleen. We identified only 4 species-specific parasite expressed genes (SSPEGs; log2FC >1, FDR <0.05) in the infected spleen, and none in the infected liver. For the host transcriptome, we found 789 differentially expressed genes (DEGs; log2FC >1, FDR <0.05) in the spleen that were common to both infections, with IFNγ signaling and complement and coagulation cascade pathways highly enriched, and an additional 286 and 186 DEGs that were selective to L. donovani and L. infantum infection, respectively. Among those, there were network interactions between genes of amino acid metabolism and PPAR signaling in L. donovani infection and increased IL1β and positive regulation of fatty acid transport in L. infantum infection, although no pathway enrichment was observed. In the liver, there were 1,939 DEGs in mice infected with either L. infantum or L. donovani in comparison to uninfected mice, and the most enriched pathways were IFNγ signaling, neutrophil mediated immunity, complement and coagulation, cytokine-chemokine responses, and hemostasis. Additionally, 221 DEGs were selective in L. donovani and 429 DEGs in L. infantum infections. These data show that the host response for these two visceral leishmaniasis infection models is broadly similar, and ∼10% of host DEGs vary in infections with either parasite species. IMPORTANCE Visceral leishmaniasis (VL) is caused by two species of Leishmania parasites, L. donovani in the Old World and L. infantum in the New World and countries bordering the Mediterranean. Although cardinal features such as hepato-splenomegaly and alterations in blood and immune function are evident, clinical presentation may vary by geography, with for example severe bleeding often associated with VL in Brazil. Although animal models of both L. donovani and L. infantum have been widely used to study disease pathogenesis, a direct side-by-side comparison of how these parasites species impact the infected host and/or how they might respond to the stresses of mammalian infection has not been previously reported. Identifying common and distinct pathways to pathogenesis will be important to ensure that new therapeutic or prophylactic approaches will be applicable across all forms of VL.
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Affiliation(s)
- Sarah Forrester
- York Biomedical Research Institute, Department of Biology, University of York, York, England, United Kingdom
| | - Amy Goundry
- York Biomedical Research Institute, Department of Biology, University of York, York, England, United Kingdom
- Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruna Torres Dias
- Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Paul M. Kaye
- York Biomedical Research Institute, Hull York Medical School, University of York, York, England, United Kingdom
| | - Jeremy C. Mottram
- York Biomedical Research Institute, Department of Biology, University of York, York, England, United Kingdom
| | - Ana Paula C. A. Lima
- Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Bomfim LGS, Magalhães LS, Rodrigues LS, Barreto AS, Santos CNO, dos Santos PL, Corrêa CB, Fukutani KF, Filho DC, da Silva AM, Lipscomb MW, de Moura TR. TREM-1 Expression on the Surface of Neutrophils in Patients With Visceral Leishmaniasis Is Associated With Immunopathogenesis. Front Cell Infect Microbiol 2022; 12:863986. [PMID: 35402286 PMCID: PMC8988227 DOI: 10.3389/fcimb.2022.863986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022] Open
Abstract
Visceral leishmaniasis (VL) is a systemic chronic and potentially fatal disease for humans. Mechanisms related to the dysregulation of the inflammatory response may be involved in both the pathogenesis and prognosis of VL. Triggering Receptor Expressed on Myeloid Cells-1 (TREM-1) is a receptor constitutively expressed on neutrophils and monocyte subsets. The protein serves to regulate and amplify inflammatory responses. This study aimed to evaluate the expression profile of TREM-1 on the surface of neutrophils from patients with VL at varying time points during leishmanicidal treatment. For this purpose, neutrophils were isolated from the peripheral blood of patients with VL at different stages of treatment, which include 0, 7, and 30 days after treatment. Surface TREM-1 expression was assessed by immunophenotyping neutrophil populations. In addition, the association of TREM-1 expression on the surface of neutrophils with clinical and laboratory parameters and serum levels of inflammatory mediators was also evaluated. Results demonstrate a lower surface expression of TREM-1 in VL patients in the absence of treatment. However, increased levels of TREM-1 expression were observed 7 and 30 days after the start of treatment, with levels similar to those of healthy controls. TREM-1 expression was directly correlated with lymphocyte and erythrocyte count and indirectly correlated with spleen and liver size. Furthermore, elevated levels of TREM-1 expression were also correlated with lower serum levels of interleukin (IL)-22. Taken together, these results suggest that infection by Leishmania infantum leads to depressed TREM-1 expression on the neutrophil surface and may contribute to the inflammatory imbalance that characterizes active VL disease.
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Affiliation(s)
| | - Lucas Sousa Magalhães
- Laboratory of Molecular Biology and Immunology, Federal University of Sergipe, Aracaju, Brazil
| | | | - Aline Silva Barreto
- Laboratory of Molecular Biology and Immunology, Federal University of Sergipe, Aracaju, Brazil
| | - Camilla Natália Oliveira Santos
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology and Immunology, Federal University of Sergipe, Aracaju, Brazil
| | - Priscila Lima dos Santos
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Department of Health Education, Federal University of Sergipe, Lagarto, Brazil
| | - Cristiane Bani Corrêa
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Department of Morphology, Federal University of Sergipe, São Cristóvão, Brazil
| | | | - Dalmo Correia Filho
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | | | | | - Tatiana Rodrigues de Moura
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Department of Morphology, Federal University of Sergipe, São Cristóvão, Brazil
- *Correspondence: Tatiana Rodrigues de Moura,
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20
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Pharmacological evaluation of anti-arthritic potential of terpinen-4-ol using in vitro and in vivo assays. Inflammopharmacology 2022; 30:945-959. [PMID: 35320496 DOI: 10.1007/s10787-022-00960-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/24/2022] [Indexed: 02/07/2023]
Abstract
Terpinen 4-ol, a phytochemical is a monoterpene which has been reported for its anti-inflammatory effect. Present research was planned to check its effect against arthritis through in vitro and in vivo models. Terpinen 4-ol was evaluated through in-vitro procedures including blocking of protein (BSA and egg albumin) denaturation and human RBC membrane stabilization. In in vivo study, terpinen 4-ol (15, 30 and 60 mg/kg) was evaluated using formaldehyde and CFA arthritic models. Terpinen 4-ol significantly inhibited increase in paw and joint swelling as compared to diseased group. Terpinen 4-ol showed remarkable antioxidant effect (SOD, reducing power) and also improved body weight, haematological, histopathological and radiological parameters in CFA model. Also, moreover, the excess production of IL-1β, TNF-α, IRAK, and NF-kB were noticeably attenuated in all terpinen 4-ol treated rats, however, IL-17 and IL-10 were distinctly increased compared to arthritic control rats in RT-PCR. Also, terpinen 4-ol showed promising antioxidant effect in DPPH assay. Henceforth, it might be concluded that terpinen 4-ol has anti-arthritic effect which can be attributed to the downregulation of pro-inflammatory cytokines.
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21
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Ittyachen A, Xavier V, Baby B, George J. Covid-19 and leptospirosis, pulmonary involvement and response to steroids: A comparative observational study from a rural Tertiary care center in Kerala. J Family Med Prim Care 2022; 11:294-298. [PMID: 35309671 PMCID: PMC8930173 DOI: 10.4103/jfmpc.jfmpc_1414_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background: COVID-19 is an emerging infectious disease with a global outreach. Leptospirosis is a zoonotic disease mainly confined to tropical areas. In both cases, most of those affected are asymptomatic or have only mild respiratory disease. Those who turn critical develop acute respiratory distress syndrome (ARDS) and/or multiple-organ failure occurs rapidly, with high fatality. Methodology: This is a retrospective observational study from 2020 involving COVID-19 and leptospirosis patients. The data were collected using a semi-structured proforma, and analysis was performed using Easy R (EZR) software. Results: There were five patients with COVIDC-19 and four patients with leptospirosis; with pulmonary involvement. All the patients were males. There was no significant difference in age, the onset of pulmonary involvement, time of initiation of steroids, duration of steroids, and outcome between the two groups. However, in the case of COVID-19, it took a longer period for clearing of infiltrates. Conclusion: Though COVID-19 and leptospirosis are two different diseases, both of them show a similar life-saving response to steroids, the common factor in the pathogenesis being cytokine storm. Primary care physicians in tropical areas of the world should be aware of the similarities between these two diseases, especially the initial clinical presentation, the pathogenesis, and the response to steroids.
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22
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Barros-Gonçalves TDD, Saavedra AF, da Silva-Couto L, Ribeiro-Romão RP, Bezerra-Paiva M, Gomes-Silva A, Carvalho VF, Da-Cruz AM, Pinto EF. Increased levels of cortisol are associated with the severity of experimental visceral leishmaniasis in a Leishmania (L.) infantum-hamster model. PLoS Negl Trop Dis 2021; 15:e0009987. [PMID: 34813597 PMCID: PMC8651114 DOI: 10.1371/journal.pntd.0009987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 12/07/2021] [Accepted: 11/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Several infectious diseases are associated with hypothalamic-pituitary-adrenal (HPA) axis disorders by elevating circulating glucocorticoids (GCs), which are known to have an immunosuppressive potential. We conducted this study in golden hamsters, a suitable model for human visceral leishmaniasis (VL), to investigate the relationship of Leishmania (L.) infantum infection on cortisol production and VL severity. Methods L. infantum-infected (n = 42) and uninfected hamsters (n = 30) were followed-up at 30, 120, and 180 days post-infection (dpi). Plasma cortisol was analyzed by radioimmunoassay and cytokines, inducible nitric oxide synthase (iNOS), and arginase by RT-qPCR. Results All hamsters showed splenomegaly at 180 dpi. Increased parasite burden was associated with higher arginase expression and lower iNOS induction. Cortisol levels were elevated in infected animals in all-time points evaluated. Except for monocytes, all other leucocytes showed a strong negative correlation with cortisol, while transaminases were positively correlated. Immunological markers as interleukin (IL)-6, IL-1β, IL-10, and transforming growth-factor-β (TGF-β) were positively correlated to cortisol production, while interferon-γ (IFN-γ) presented a negative correlation. A network analysis showed cortisol as an important knot linking clinical status and immunological parameters. Conclusions These results suggest that L. infantum increases the systemic levels of cortisol, which showed to be associated with hematological, biochemical, and immunological parameters associated to VL severity. Visceral leishmaniasis (VL) is an infectious disease that is common in most tropical countries. VL has high morbidity and leads to death if not properly treated. In Brazil, Leishmania (Leishmania) infantum is the main causative agent of VL. Golden hamsters have proven to be a suitable model for VL. Despite the importance of hypothalamic-pituitary-adrenal (HPA) axis disturbances in infectious disease, few studies have addressed this issue in VL. In this study, we showed that L. infantum-infected hamsters present augmented levels of plasmatic cortisol in association with increased spleen parasite burden. Indeed, a strong positive correlation was observed between cortisol and biochemical parameters (AST/ALT/ALP) related to liver damage, as well as pro-inflammatory cytokines (IL-6 and IL-1β), anti-inflammatory cytokines (IL-10 and TGF-β), and the arginase enzyme that may favor the progression of infection. On the other side, cortisol was negatively correlated with leucocytes, except monocytes, and with IFN-γ and iNOS, which are involved in parasite-killing macrophage function. These results shed light on an unexplored aspect of VL pathogenesis, which is the importance of cortisol production in the disease-associated immune dysfunction.
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Affiliation(s)
| | - Andrea F. Saavedra
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Luzinei da Silva-Couto
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Raquel P. Ribeiro-Romão
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Milla Bezerra-Paiva
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Adriano Gomes-Silva
- Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil
| | - Vinicius F. Carvalho
- Laboratório de Inflamação, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia em Neuroimunomodulação (INCT-NIM), CNPq, Rio de Janeiro, Brazil
| | - Alda Maria Da-Cruz
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia em Neuroimunomodulação (INCT-NIM), CNPq, Rio de Janeiro, Brazil
- Disciplina de Parasitologia-DMIP, Faculdade de Ciências Médicas, UERJ, Rio de Janeiro, Brazil
- Rede de Pesquisas em Saúde do Estado do Rio de Janeiro/FAPERJ, Rio de Janeiro, Brazil
| | - Eduardo F. Pinto
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
- Rede de Pesquisas em Saúde do Estado do Rio de Janeiro/FAPERJ, Rio de Janeiro, Brazil
- * E-mail:
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23
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Rodrigues LS, Barreto AS, Bomfim LGS, Gomes MC, Ferreira NLC, da Cruz GS, Magalhães LS, de Jesus AR, Palatnik-de-Sousa CB, Corrêa CB, de Almeida RP. Multifunctional, TNF-α and IFN-γ-Secreting CD4 and CD8 T Cells and CD8 High T Cells Are Associated With the Cure of Human Visceral Leishmaniasis. Front Immunol 2021; 12:773983. [PMID: 34777391 PMCID: PMC8581227 DOI: 10.3389/fimmu.2021.773983] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022] Open
Abstract
Visceral leishmaniasis (VL) is a chronic and often fatal disease caused by protozoans of the genus Leishmania that affects millions of people worldwide. Patients with symptomatic VL have an impaired anti-Leishmania-specific CD4+ T-cell response, which is reversed after clinical cure. In contrast, the quality of the CD4+ and CD8+ T-cell responses involved in resistance and/or cure of VL relies on the capability of these cells to activate polyfunctional and memory responses, which are associated with the simultaneous production of three cytokines: IFN-γ, IL-2, and TNF-α. Models for the development of CD4 and CD8 T-cell quality in memory and protection to leishmaniasis have been described previously. We aimed to assess the functionality of the T cells involved in the recovery of the immune suppression throughout the VL treatment. Therefore, we cultured peripheral blood mononuclear cells (PBMCs) from VL patients and healthy controls in vitro with soluble Leishmania antigen (SLA). Cell surface markers and intracellular cytokine production were determined on days 7, 14, 21, 30, 60, 90, and 180 after the beginning of chemotherapy. We observed that the frequencies of CD4+TNF-α+IFN-γ+ and the multifunctional CD4+IL-2+TNF-α+IFN-γ+, together with CD4+TNF-α+ and CD4+IFN-γ+ T cells, increased throughout and at the end of the treatment, respectively. In addition, enhanced frequencies of CD8+IL-2+TNF-α+IFN-γ+ and CD8+TNF-α+IFN-γ T cells were also relevant in the healing process. Noteworthy, the frequencies of the CD4+ and CD8 central-memory T cells, which produce IL-2, TNF-α, and IFN-γ and ensure the memory response against parasite reinfection, are significantly enhanced in cured patients. In addition, the subset of the non-functional CD8Low population is predominant in VL untreated patients and decreases along the chemotherapy treatment. In contrast, a CD8High subset increased towards the cure. Furthermore, the cure due to treatment with meglumine antimoniate or with liposomal amphotericin B was associated with the recovery of the T-cell immune responses. We described the evolution and participation of functional T cells during the treatment of patients with VL. Our results disclosed that the clinical improvement of patients is significantly associated with the participation of the CD4+ and CD8+ cytokine-secreting T cells.
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Affiliation(s)
- Lorranny Santana Rodrigues
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), National Insitute of Science and Technology (INCT), National Council for Scientific and Technological Development (CNPq), Aracaju, Brazil.,Graduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil
| | - Aline Silva Barreto
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), National Insitute of Science and Technology (INCT), National Council for Scientific and Technological Development (CNPq), Aracaju, Brazil.,Graduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil.,Division of Immunology and Molecular Biology Laboratory, University Hospital/Brazilian Hospital Services Company (EBSERH), Federal University of Sergipe, Sergipe, Brazil
| | - Lays Gisele Santos Bomfim
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), National Insitute of Science and Technology (INCT), National Council for Scientific and Technological Development (CNPq), Aracaju, Brazil.,Graduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil
| | - Marcos Couto Gomes
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), National Insitute of Science and Technology (INCT), National Council for Scientific and Technological Development (CNPq), Aracaju, Brazil
| | - Nathalia Luisa Carlos Ferreira
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), National Insitute of Science and Technology (INCT), National Council for Scientific and Technological Development (CNPq), Aracaju, Brazil
| | - Geydson Silveira da Cruz
- Graduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil.,Division of Immunology and Molecular Biology Laboratory, University Hospital/Brazilian Hospital Services Company (EBSERH), Federal University of Sergipe, Sergipe, Brazil
| | - Lucas Sousa Magalhães
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), National Insitute of Science and Technology (INCT), National Council for Scientific and Technological Development (CNPq), Aracaju, Brazil.,Graduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil
| | - Amélia Ribeiro de Jesus
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), National Insitute of Science and Technology (INCT), National Council for Scientific and Technological Development (CNPq), Aracaju, Brazil.,Graduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil.,Division of Immunology and Molecular Biology Laboratory, University Hospital/Brazilian Hospital Services Company (EBSERH), Federal University of Sergipe, Sergipe, Brazil
| | - Clarisa B Palatnik-de-Sousa
- Graduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil.,Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro, Immunology Investigative Institute (III), National Insitute of Science and Technology (INCT), National Council for Scientific and Technological Development (CNPq), Rio de Janeiro, Brazil
| | - Cristiane Bani Corrêa
- Graduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil.,Laboratory of Biology and Immunology of Cancer and Leishmania, Department of Morphology, Federal University of Sergipe, São Cristóvão, Brazil
| | - Roque Pacheco de Almeida
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), National Insitute of Science and Technology (INCT), National Council for Scientific and Technological Development (CNPq), Aracaju, Brazil.,Graduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil.,Division of Immunology and Molecular Biology Laboratory, University Hospital/Brazilian Hospital Services Company (EBSERH), Federal University of Sergipe, Sergipe, Brazil
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24
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Sengupta S, Chatterjee M. IgG3 and IL10 are effective biomarkers for monitoring therapeutic effectiveness in Post Kala-Azar Dermal Leishmaniasis. PLoS Negl Trop Dis 2021; 15:e0009906. [PMID: 34758028 PMCID: PMC8580238 DOI: 10.1371/journal.pntd.0009906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background The assessment of chemotherapeutic responses in Post Kala-azar Dermal Leishmaniasis (PKDL), especially its macular form is challenging, emphasizing the necessity for ‘test of cure’ tools. This study explored the diagnostic and prognostic potential of IgG subclasses and associated cytokines for monitoring the effectiveness of chemotherapy in PKDL. Methods Participants included PKDL cases at (a) disease presentation, (b) immediately at the end of treatment (12 weeks for Miltefosine or 3 weeks for Liposomal Amphotericin B, LAmB and (c) at any time point 6 months later, for estimating anti-leishmanial immunoglobulin (Ig, IgG, IgM, IgG1, IgG2 and IgG3) and cytokines (IL-10, IL-6). Results In PKDL, Ig levels were elevated, with IgG3 and IL-10 being the major contributors. Miltefosine decreased both markers substantially and this decrease was sustained for at least six months. In contrast, LAmB failed to decrease IgG3 and IL-10, as even after six months, their levels remained unchanged or even increased. Conclusions In PKDL, IgG3 and IL-10 proved to be effective predictors of responsiveness to chemotherapy and may be considered as a non invasive alternative for longitudinal monitoring. Post Kala-azar Dermal Leishmaniasis (PKDL) is a dermal condition that occurs in East Africa and South Asia, the latter in 5–10% of patients after apparent cure from Visceral Leishmaniasis (VL). Till date, conventional knowledge in South Asia was that the polymorphic form of PKDL comprising of macules, papules and nodules was the predominant disease form, constituting 85–90%. However, since 2014, implementation of active-case surveillance led to unearthing of a large number of macular, hypopigmented cases, and was reported to contribute to nearly 50% of the disease burden. In particular, the macular form poses a diagnostic dilemma as microscopically parasites are difficult to identify in their lesions, and repigmentation occurs months after parasite clearance, emphasizing the need for developing non-invasive approaches for measurement of parasite burden. Till date, no formal clinical trial for treatment of PKDL has been undertaken where the parasite load was quantified and treatment remains empirical. This is primarily due to PKDL cases being unwilling to provide a repeat skin biopsy once their lesions have declined. Therefore, in cases where treatment failure occurs, it cannot be precisely identified, and could potentially lead to these cases becoming mobile disease reservoirs, thereby adversely impacting on the ongoing VL elimination programme. This study addressed this critical lacuna, where it was established that in both clinical types of PKDL, circulating levels of IgG3 and IL-10 can be considered as effective markers for monitoring treatment outcome. At disease presentation, the raised levels of IgG subclasses and associated cytokines (IL-10 and IL-6) declined following therapy with Miltefosine, the maximum decrease being with IgG3 along with IL-10; importantly, this decrease was sustained for at least six months. In contrast, LAmB failed to decrease the levels of immunoglobulins and associated cytokines even six months after completion of treatment; in fact the antibody levels either increased or remained unchanged. Taken together, this study has established the potential of IgG3 and IL10 as a non-invasive alternative for monitoring of chemotherapeutic responses in PKDL.
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Affiliation(s)
- Shilpa Sengupta
- Dept. of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Mitali Chatterjee
- Dept. of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
- * E-mail:
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25
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Shi Q, Huang M, Li X, Zheng X, Wang F, Zou Y, Wang L, Jia J. Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection. PLoS Negl Trop Dis 2021; 15:e0009944. [PMID: 34735436 PMCID: PMC8594843 DOI: 10.1371/journal.pntd.0009944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/16/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Visceral leishmaniasis (VL) could progress to secondary hemophagocytic lymphohistiocytosis (HLH), which is a rare but life-threatening condition with poor prognosis. So far, the clinical and laboratory characteristics of VL associated HLH have not been well elucidated. Method and findings In this study, we retrospectively analyzed the clinical and laboratory profiles between 17 patients with VL associated HLH and 27 patients with VL alone admitted at the Beijing Friendship Hospital, Capital Medical University from May 2016 to March 2021. In addition to the identification of Leishmania infection, hemophagocytosis was identified in bone marrow in the most cases of VL associated HLH (15/17). The patients with VL associated HLH had higher chances of bleeding, hepatomegaly, thrombocytopenia, hypertriglyceridemia, hyperferritinemia, hypofibrinogenemia, elevated secretion of soluble IL-2 receptor or lower NK cell activity compared to patients with VL only. Furthermore, patients with VL associated HLH had higher inflammation status associated with higher levels of Th1 (TNF-α, IFN-γ, IL-1beta, IL-6, IL-8, IL-12p70), Th2 (IL-4) and Th17 cytokines (IL-17, IL-23) in the peripheral blood, and higher parasite load (qPCR and parasite culture). All 27 VL cases were totally recovered after being treated with Sodium Stibogluconate, five of the 17 patients with VL associated HLH died even after timely treatment with anti-parasite and immunosuppressive chemotherapy. Conclusion Without appropriate treatment, visceral leishmaniosis could develop to secondary HLH. The parasite culturing and qPCR detection of bone marrow samples facilitates the diagnosis of VL associated HLH in addition to other findings of HLH. Prompt treatment with anti-Leishmania and immunosuppressive chemotherapy is critical to reduce the mortality of VL associated HLH. Hemophagocytic lymphohistiocytosis (HLH) is a rare but life-threatening syndrome characterized by pro-inflammatory cytokine secretion, hyperinflammatory and multiple organ damages. Visceral leishmaniasis (VL) is a well-known cause of infection associated HLH and result in fatal consequence. However, it is not well characterized for the clinical and laboratory features of the visceral leishmaniasis associated HLH. In this study, we presented that, compared to the VL alone, patients with VL associated HLH had higher chances of bleeding, hepatomegaly, thrombocytopenia, hypertriglyceridemia, hyperferritinemia, hypofibrinogenemia, elevated secretion of soluble IL-2 receptor or lower NK cell activity. Moreover, patients with VL associated HLH also had higher levels of Th1, Th2 and Th17 cytokines in the sera and had higher parasite load in the bone marrow specimen. More cases with VL associated HLH had hepatosplenomegaly with iron overload in the magnetic resonance imaging. In the therapeutic strategy, besides the anti-Leishmania treatment, anti-inflammatory therapy to reduce cytokine storm and excessive immune responses facilitated the remission in the VL associated HLH cases.
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Affiliation(s)
- Qi Shi
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
| | - Minjun Huang
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, P.R. China
| | - Xiaoli Li
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, P.R. China
| | - Xiaoyan Zheng
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, P.R. China
| | - Fei Wang
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, P.R. China
| | - Yang Zou
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, P.R. China
| | - Lei Wang
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, P.R. China
- * E-mail:
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing, P.R. China
- National Clinical Research Center of Digestive Diseases, Beijing, P.R. China
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Ferreira GR, Santos-Oliveira JR, Silva-Freitas ML, Honda M, Costa DL, Da-Cruz AM, Costa CHN. Biomarkers of disease severity in patients with visceral leishmaniasis co-infected with HIV. Cytokine 2021; 149:155747. [PMID: 34715475 DOI: 10.1016/j.cyto.2021.155747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 12/30/2022]
Abstract
Visceral leishmaniasis (VL) is caused by the protozoan Leishmania spp, transmitted by sand fly bites. VL is one of the deadliest tropical infection diseases, yet the coinfection with HIV virus drastically increases relapses, treatment failure and mortality. The concomitant action of these two pathogens leads to high cellular activation independently of the progression to AIDS. In addition, microbial translocation and bacterial infections are thought to contribute worsening the clinical picture. Identifying biomarkers associated with disease severity is of interest for clinical management of patients with VL-HIV/AIDS. Thus, we analyzed in the sera several markers including interleukins (IL-1β, IL-6, IL-8, and IL-17), interferon-γ (IFN- γ), tumor necrosis factor (TNF), lipopolysaccharide (LPS), soluble CD14 (sCD14), macrophage migration inhibitory factor (MIF) and intestinal fatty acid-binding protein (IFABP). These markers were compared with disease severity in 24 patients with VL/HIV presenting different clinical outcomes. Disease severity was defined by the probability of death calculated using a score set system derived by the Kala-Cal® software. Probability of death ranged from 3.7% to 97.9%, with median of 28.8%. Five patients died (20%). At the univariate analysis, disease severity was correlated with TNF, IFN-γ and sCD14. LPS was positively correlated with sCD14 specifically in patients with low CD4+ count (CD4+ T-cell <200 cells/mL). Most importantly, the multivariate analysis including LPS, CD4+count and sCD14 showed that sCD14 was the only independent predictor for disease severity and death. Altogether, our results indicated that sCD14 is a powerful marker of pathogenicity and death for patients with VL-HIV/AIDS.
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Affiliation(s)
- Gabriel Reis Ferreira
- Department of Microbiology-Infectious Disease and Immunology, Faculty of Medicine, University Laval, Quebec, Canada; Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil.
| | | | | | | | - Dorcas Lamounier Costa
- Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil; Centro de Inteligência em Agravos Tropicais Emergentes e Negligenciados, Teresina, Brazil; Universidade Federal do Piauí, Teresina, Brazil
| | | | - Carlos Henrique Nery Costa
- Leishmaniasis Research Laboratory at Natan Portella Tropical Diseases Institute, Teresina, Brazil; Centro de Inteligência em Agravos Tropicais Emergentes e Negligenciados, Teresina, Brazil; Universidade Federal do Piauí, Teresina, Brazil
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27
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Teles LDF, Viana AG, Cardoso MS, Pinheiro GRG, Bento GA, Lula JF, Soares TDCM, Fujiwara RT, Carvalho SFGD. Evaluation of medullary cytokine expression and clinical and laboratory aspects in severe human visceral leishmaniasis. Parasite Immunol 2021; 43:e12880. [PMID: 34558674 DOI: 10.1111/pim.12880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/09/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Visceral leishmaniasis (VL) is a serious public health problem. The factors that can determine whether VL develops and progresses to severe form have not been fully identified, but a specific cellular immune response appears to play a key role. Therefore, understanding immunopathogenesis can be useful in preventing a serious clinical outcome. MATERIALS AND METHODS Bone marrow samples were collected from patients with severe VL (SVL) or non-severe VL (NSVL). Cytokine levels and parasitic load were analysed by RT-qPCR. There is a statistically significant difference in the leukocyte parameter in patients with SVL and NSVL compared with the control patients (p = .006 and p = .014, respectively). RESULTS Urea, alanine transaminase and albumin parameters had a significant difference p = .036, p = .039 and p = .017, respectively, between SVL and NSVL. Although high levels of IFN-γ, IL-10, IL-6 and TNF-α were present in all groups of individuals with VL, they were not statistically associated with severity. In patients with active VL, IFN-γ and IL-10 were associated, respectively, with a reduction and increase in the parasite load, strong and significant positive association between IFN-γ and IL-10 (rho = .627 and p = .003). CONCLUSION This study demonstrates that VL stimulates an non-dichotomized inflammatory response between Th1/Th2 and that bone marrow is an important tissue for immune regulation.
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Affiliation(s)
- Leandro de Freitas Teles
- Centro de Pesquisa em Doenças Infecciosas. Hospital, Universitário Clemente de Faria, Universidade Estadual de Montes Claros-MG, Brazil
| | - Agostinho Gonçalves Viana
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais-MG, Brazil
| | - Mariana Santos Cardoso
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais-MG, Brazil
| | | | - Gabriele Ariadine Bento
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais-MG, Brazil
| | - Jamille Fernandes Lula
- Centro de Pesquisa em Doenças Infecciosas. Hospital, Universitário Clemente de Faria, Universidade Estadual de Montes Claros-MG, Brazil
| | - Tânia de Cássia Moreira Soares
- Centro de Pesquisa em Doenças Infecciosas. Hospital, Universitário Clemente de Faria, Universidade Estadual de Montes Claros-MG, Brazil
| | - Ricardo Toshio Fujiwara
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais-MG, Brazil
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Monteiro MJDSD, da Silva MNP, Paiva ADA, Marreiro DDN, Luzia LA, Henriques GS, Rondó PHDC, Sene IDS, de Almeida ATA, Costa CHN, Costa DL. Nutritional status and vitamin A and zinc levels in patients with kala-azar in Piauí, Brazil. Rev Soc Bras Med Trop 2021; 54:e08002020. [PMID: 34495261 PMCID: PMC8437443 DOI: 10.1590/0037-8682-0800-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/26/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Malnutrition and kala-azar (or visceral leishmaniasis) are significant public health problems in different parts of the world. Immunity and susceptibility to infectious and parasitic diseases are directly linked to the host's nutritional state, but little is known about the interaction between nutrition and kala-azar. This study aimed to evaluate nutritional status with kala-azar and correlate these findings with the clinical and laboratory manifestations of the disease, and zinc and retinol levels. METHODS This was a cross-sectional study of 139 patients with kala-azar. Nutritional status classification was performed according to international recommendations. Parametric or nonparametric tests were applied whenever indicated in a two-sided test with a 5% significance level. RESULTS Weight loss and malnutrition were more frequent in adults. Body mass index-for-age, fat area of the arm, and upper arm muscle area were significantly associated with probability of death. The presence of human immunodeficiency virus, hepatomegaly, and splenomegaly was correlated with nutritional assessment. Blood leukocyte and lymphocyte, serum creatine, and vitamin A levels were significantly higher in adult men. Vitamin A levels were highly associated with the level of hemoglobin and C-reactive protein (CRP) in multivariate analysis. All patients had reduced plasma zinc levels, but this finding had no association with the outcome variables. CONCLUSIONS Malnutrition was correlated with severe disease and was more prevalent in older people with kala-azar. Vitamin A deficiency was associated with hemoglobin and CRP. Zinc levels were reduced in patients with kala-azar.
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Affiliation(s)
| | - Maria Nauside Pessoa da Silva
- Universidade Federal do Piauí, Programa de Pós-Graduação em Biotecnologia, Rede Nordeste de Biotecnologia, Teresina, PI, Brasil
| | | | | | - Liania Alves Luzia
- Universidade de São Paulo, Laboratório de Micronutrientes, São Paulo, SP, Brasil
| | - Gilberto Simeone Henriques
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Laboratório Experimental de Nutrição, Belo Horizonte, MG, Brasil
| | | | - Ingridi de Souza Sene
- Universidade Federal do Piauí, Laboratório de Pesquisas em Leishmanioses, Teresina, PI, Brasil
- Laboratório de Anatomia Patológica e Biologia Molecular, Teresina, PI, Brasil
| | | | - Carlos Henrique Nery Costa
- Universidade Federal do Piauí, Laboratório de Pesquisas em Leishmanioses, Teresina, PI, Brasil
- Centro de Inteligência para Agravos Tropicais Emergentes e Negligenciados, Teresina, PI, Brasil
- Universidade Federal do Piauí, Departamento de Medicina Comunitária, Teresina, PI, Brasil
| | - Dorcas Lamounier Costa
- Universidade Federal do Piauí, Laboratório de Pesquisas em Leishmanioses, Teresina, PI, Brasil
- Centro de Inteligência para Agravos Tropicais Emergentes e Negligenciados, Teresina, PI, Brasil
- Universidade Federal do Piauí, Departamento Materno-Infantil, Teresina, PI, Brasil
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29
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Melo MBG, Cunha LCS, Barreto CSP, de Oliveira Mendonça FA, Santos MLB, Sacramento D, de Jesus AR, Almeida RP, Dos Santos PL. Leishmania infantum (syn. L. chagasi) parasites affect the release of soluble CD14 by infected macrophages. Parasitol Res 2021; 120:3325-3330. [PMID: 34351491 DOI: 10.1007/s00436-021-07258-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
Functionally, cluster of differentiation 14 (CD14) is a co-receptor of the complex formed by lipopolysaccharide (LPS) and LPS-binding protein expressed on the membrane of a variety of cells. However, CD14 can be shed from the cell membrane into the circulation as soluble CD14 (sCD14) upon cell activation. Previously, our group reported that elevated sCD14 serum levels were associated with the clinical and laboratory findings in the context of visceral leishmaniasis (VL), but not in the context of LPS stimulation or bacterial infection. In the present study, we investigated the secretion dynamics of sCD14 in the context of Leishmania infantum (syn. L. chagasi) in vitro infection. Macrophages from treated VL patients and delayed-type hypersensitivity positive (DTH+) subjects were infected with L. infantum (syn. L. chagasi) promastigotes, and the infection index was evaluated (number of amastigotes per 100 infected macrophages). Additionally, the levels of sCD14, Inteleukin (IL)10, IL-6 and tumour necrosis factor alpha (TNF-α) were measured in the culture supernatants using the Luminex assay. Interestingly, the release of sCD14 was inversely correlated with the L. infantum (syn. L. chagasi) infection index. Of note, the release of sCD14 was upregulated and downregulated in the context of infected macrophages from DTH+ subjects and treated VL patients, respectively. Additionally, we also observed that the levels of sCD14 in the culture supernatants were positively correlated with the levels of TNF-α, IL-6 and IL-10. Therefore, our data suggest that macrophages from treated VL patients and DTH+ subjects respond differently to L. infantum (syn. L. chagasi) infection in the context of the release of sCD14; therefore, the release of sCD14 may be associated with the outcome of VL.
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Affiliation(s)
- Michelle Barreto Gomes Melo
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil
| | - Luana Celina Seraphim Cunha
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil
| | - Cárcia Santana Passos Barreto
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil
| | | | - Micheli Luize Barbosa Santos
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil
| | - Danielle Sacramento
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil
| | - Amélia Ribeiro de Jesus
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil.,Instituto de Investigação Em Imunologia, 05403-900, São Paulo, São Paulo, Brasil
| | - Roque Pacheco Almeida
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil.,Instituto de Investigação Em Imunologia, 05403-900, São Paulo, São Paulo, Brasil
| | - Priscila Lima Dos Santos
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil.
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30
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High levels of anti-Leishmania IgG3 and low CD4 + T cells count were associated with relapses in visceral leishmaniasis. BMC Infect Dis 2021; 21:369. [PMID: 33874901 PMCID: PMC8056614 DOI: 10.1186/s12879-021-06051-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/08/2021] [Indexed: 01/10/2023] Open
Abstract
Background Visceral leishmaniasis (VL) is severe and potentially fatal. Brazil is one of the countries with the greatest endemicity for the disease in the world. The reduction of CD4+ T lymphocytes, B cells activation and high levels of inflammatory cytokines (IL-6/IL-8/TNF/IL-1β), plasma LPS, soluble CD14, anti-Leishmania IgG3 and low leptin levels are involved in the immunopathogenesis of VL, most associated with severe VL. Despite relapses occurring in about 4–5% of patients with VL not associated with HIV infection, the factors underlying relapses are little known. Our aim was to identify clinical, laboratory and immunological parameters that may be associated with recurrences in VL. Methods Fifteen VL patients recruited from Hospital Eduardo de Menezes (BH-MG) were grouped into relapsing (R-VL, n = 5) and non-relapsing (NR-VL, n = 10) and evaluated during active disease, immediately after treatment (post-treatment) and 6 months post-treatment (6mpt). Clinical and laboratory data obtained from medical records were correlated with CD4+ and CD8+ T cell counts and anti-Leishmania Igs and IL-6 plasma levels and compared to those parameters of ten healthy controls. Results During the active phase of VL, despite similarity in the clinical symptoms, the rates of thrombocytopenia, elevated transaminases (AST and ALT) and hyperbilirubinemia were higher in the NR-VL group compared to R-VL (p < 0.05), a profile reversed during the post-treatment phase. All patients had low CD4+ T counts in active phase, however, NR-VL patients had a higher gain of this cell type than R-VL in the post-treatment (p < 0.05). There was a significant reduction in IgG3 levels during the follow-up in the NR-VL group compared to the R-VL, especially at 6mpt (p < 0.05). In addition, IgG3 levels were negatively correlated with CD4+ T counts in the R-VL group (r = − 0.52). Elevated levels of IL-6 were observed in active VL and correlated with clinical markers of severity. Conclusions During active phase of VL, the NR-VL patients presented more severe laboratorial abnormalities compared to R-VL, probably because the latter had already received previous treatment. On the other hand, R-VL exhibited greater impairment of immune reconstitution and a high degree of B lymphocyte activation, which must be a factor that favored relapses. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06051-5.
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31
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Samant M, Sahu U, Pandey SC, Khare P. Role of Cytokines in Experimental and Human Visceral Leishmaniasis. Front Cell Infect Microbiol 2021; 11:624009. [PMID: 33680991 PMCID: PMC7930837 DOI: 10.3389/fcimb.2021.624009] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/22/2021] [Indexed: 12/16/2022] Open
Abstract
Visceral Leishmaniasis (VL) is the most fatal form of disease leishmaniasis. To date, there are no effective prophylactic measures and therapeutics available against VL. Recently, new immunotherapy-based approaches have been established for the management of VL. Cytokines, which are predominantly produced by helper T cells (Th) and macrophages, have received great attention that could be an effective immunotherapeutic approach for the treatment of human VL. Cytokines play a key role in forming the host immune response and in managing the formation of protective and non-protective immunities during infection. Furthermore, immune response mediated through different cytokines varies from different host or animal models. Various cytokines viz. IFN-γ, IL-2, IL-12, and TNF-α play an important role during protection, while some other cytokines viz. IL-10, IL-6, IL-17, TGF-β, and others are associated with disease progression. Therefore, comprehensive knowledge of cytokine response and their interaction with various immune cells is very crucial to determine appropriate immunotherapies for VL. Here, we have discussed the role of cytokines involved in VL disease progression or host protection in different animal models and humans that will determine the clinical outcome of VL and open the path for the development of rapid and accurate diagnostic tools as well as therapeutic interventions against VL.
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Affiliation(s)
- Mukesh Samant
- Cell and Molecular Biology Laboratory, Department of Zoology, Kumaun University, Almora, India
| | - Utkarsha Sahu
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
| | - Satish Chandra Pandey
- Cell and Molecular Biology Laboratory, Department of Zoology, Kumaun University, Almora, India
| | - Prashant Khare
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
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Salih OAMM, Nail AM, Modawe GA, Swar MO, Ahmed MH, Khalil A, Satti AB, Abuzeid N. Risk Factors of Inpatients Mortality of Visceral Leishmaniasis, Khartoum State, Sudan. J Glob Infect Dis 2020; 12:135-140. [PMID: 33343164 PMCID: PMC7733432 DOI: 10.4103/jgid.jgid_25_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/05/2020] [Accepted: 04/14/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Visceral leishmaniasis (VL) is one of the common infections in Sudan and can be associated with an increase in morbidity and mortality. The aim of this study was to assess the risk factors associated with mortality and morbidity with VL. Materials and Methods: This is a cross-sectional hospital-based study that recruited 150 patients with VL from two centers in Khartoum. Secondary data were extracted from the patient records, and data were analyzed using SPSS version 24.0. Results: The study included 2.5% of infants, 39.4% children, and 58% of adults. Male represents 77.3% of the cohort, and total mortality was 16%. Among the death reported 12.5% in infants, 16.7% were children, and 70.8% were in adults. Laboratory parameters significantly associated with mortality in univariate analysis were low white cell count, low platelets, high creatinine, and high liver enzymes. While risk factors such as infant, male, acquired infection from Eastern Sudan or White Nile, weight loss, morbid diseases, and concomitant bacterial infections were also associated with significant mortality in univariate analysis. Importantly, logistic regression analysis revealed significant association with infant (P = 0.02), concomitant bacterial infections (P = 0.003), comorbid disease (P = 0.001), low total blood cell count (P = 0.018), low platelets (P = 0.013), and high aspartate transaminase/alanine aminotransferase (P = 0.013). Conclusion: Health education and awareness are needed in terms of prevention and control, especially with high mortality seen in the infant. Treatment of underlying co-morbid diseases and bacterial infections are important to enhance survival. Patients with Leishmania are vulnerable; therefore, regular routine blood tests are an essential part of management to manage complications such as renal, hepatic failure, or severe anemia.
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Affiliation(s)
| | - Abdelsalam M Nail
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Sudan
| | - Gad Allah Modawe
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Sudan
| | - Mohamed Osman Swar
- Department of Pediatrics and Child Health, School of Medicine, Ahfad University for Women, Sudan
| | - Mohamed H Ahmed
- Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire, UK
| | - Atif Khalil
- Department of Nephrology, Noble Hospital, Isle of Man, UK
| | - Abdelsalam Basheir Satti
- Department of Microbiology, Faculty of Medical Laboratory Sciences, Omdurman Islamic University, Omdurman, Sudan
| | - Nadir Abuzeid
- Department of Microbiology, Faculty of Medical Laboratory Sciences, Omdurman Islamic University, Omdurman, Sudan
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Almeida AC, Elias ABR, Marques MP, de Melo GC, da Costa AG, Figueiredo EFG, Brasil LW, Rodrigues-Soares F, Monteiro WM, de Lacerda MVG, Lanchote VL, Suarez-Kurtz G. Impact of Plasmodium vivax malaria and antimalarial treatment on cytochrome P450 activity in Brazilian patients. Br J Clin Pharmacol 2020; 87:1859-1868. [PMID: 32997351 DOI: 10.1111/bcp.14574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/02/2020] [Accepted: 09/15/2020] [Indexed: 12/26/2022] Open
Abstract
AIMS To investigate the impact of Plasmodium vivax malaria and chloroquine-primaquine chemotherapy on CYP2D6 and CYP2C19 activity in patients from the Brazilian Amazon. METHODS Adult patients (n = 30) were given subtherapeutic doses of CYP2D6 and CYP2C19 phenotypic probes metoprolol (10 mg) and omeprazole (2 mg) in three different stages of vivax malaria illness: acute disease (study phase 1), post chemotherapy (phase 2) and convalescence (stage 3). Plasma concentrations of probes and CYP-hydroxylated metabolites (α-OH metoprolol and 5-OH omeprazole) were measured using LC/MS/MS. Two pharmacokinetic metrics were used to estimate CYP activity: (a) ratio of plasma concentrations of probe/metabolite at 240 minutes after administration of the probes and (b) ratio of areas under the time-concentration curves for probe/metabolite (AUC0-12h ). For statistical analysis, the pharmacokinetic metrics were normalized to the respective values in phase 3. Taqman assays were used for CYP2D6 and CYP2C19 genotyping. Cytokines levels were measured using cytometric bead array. RESULTS Both pharmacokinetic metrics for metoprolol and omeprazole, and plasma concentrations of cytokines IL-6, IL-8 and IL-10 varied significantly across the three study phases (ANOVA P < 0.0001). Post hoc tests showed greater metoprolol:α-OH metoprolol ratios in phases 1 and 2 compared to phase 3, larger omeprazole:5-OH omeprazole ratios in phase 1 than in phases 2 and 3, and higher circulating IL-6, IL-8 and IL-10 in phase 1 than in phases 2 and 3. CONCLUSION P. vivax malaria and treatment altered CYP2D6 and CYP2C19 metabolic phenotypes. CYP2C19 inhibition is attributed to a higher level of circulating proinflammatory cytokines, while suppression of CYP2D6 is ascribed mainly to chloroquine exposure.
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Affiliation(s)
- Anne Cristine Almeida
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | | | - Maria Paula Marques
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Gisely Cardoso de Melo
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Allyson Guimarães da Costa
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil.,Departamento de Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas, Manaus, Amazonas, Brazil
| | - Erick Frota Gomes Figueiredo
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Larissa Wanderley Brasil
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Fernanda Rodrigues-Soares
- Departamento de Patologia, Genética e Evolução, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Wuelton Marcelo Monteiro
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Marcus Vinicius Guimarães de Lacerda
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.,Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
| | - Vera Lucia Lanchote
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
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S Lima S, Cavalcante Braz D, Costa Silva V, J C Farias T, Zacarias DA, da Silva JC, Costa CHN, Costa DL. Biomarkers of the early response to treatment of visceral leishmaniasis: A prospective cohort study. Parasite Immunol 2020; 43:e12797. [PMID: 32984951 DOI: 10.1111/pim.12797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/14/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Early biomarkers of the response to treatment are lacking and may help to reduce mortality by the vector-borne disease visceral leishmaniasis (VL). METHODS A prospective cohort study was conducted to investigate plasma cytokines and clinical laboratory data as biomarkers of the early response to specific treatment for VL in 36 patients. RESULTS The mean interleukin 6 (IL-6) concentration on the 7th day was 2.3% of the pre-treatment concentration, interleukin 10 (IL-10) was 8.0%, and interleukin 8 (IL-8) was 8.2%. On the 7th day, IL-10 was below half of the pre-treatment concentration in 100.0%, IL-8 in 95.5% and IL-6 in 90.9%. The spleen and liver sizes, haemoglobin, interleukin 1 beta (IL-1β) and tumour necrosis factor alpha (TNF-α) showed a slower recovery. Fever disappeared in 91% on the 7th day, 69.4% had a normal white cell count, and 77.8% had a normal platelet value by this time. CONCLUSIONS The plasma cytokines IL-6, IL-10 and IL-8 were demonstrated to be excellent markers of the early response to VL treatment and if tested before the 7th day, will likely prove to be better than fever measurement.
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Affiliation(s)
- Simone S Lima
- Maternal and Childhood Department, Federal University of Piauí, Teresina, Brazil
| | - Débora Cavalcante Braz
- Pharmacy Course, Federal University of Piauí, Teresina, Brazil.,Laboratory of Leishmaniasis, Natan Portella Institute of Tropical Medicine, Teresina, Brazil
| | - Vladimir Costa Silva
- Laboratory of Leishmaniasis, Natan Portella Institute of Tropical Medicine, Teresina, Brazil.,Intelligence Center for Emerging and Neglected Tropical Diseases (CIATEN), Teresina, Brazil
| | - Teresinha J C Farias
- Laboratory of Leishmaniasis, Natan Portella Institute of Tropical Medicine, Teresina, Brazil
| | - Danielle Alves Zacarias
- Laboratory of Leishmaniasis, Natan Portella Institute of Tropical Medicine, Teresina, Brazil
| | | | - Carlos Henrique Nery Costa
- Laboratory of Leishmaniasis, Natan Portella Institute of Tropical Medicine, Teresina, Brazil.,Intelligence Center for Emerging and Neglected Tropical Diseases (CIATEN), Teresina, Brazil.,Department of Community Medicine, Federal University of Piauí, Teresina, Brazil
| | - Dorcas Lamounier Costa
- Maternal and Childhood Department, Federal University of Piauí, Teresina, Brazil.,Laboratory of Leishmaniasis, Natan Portella Institute of Tropical Medicine, Teresina, Brazil.,Intelligence Center for Emerging and Neglected Tropical Diseases (CIATEN), Teresina, Brazil
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35
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França ADO, Soares LS, Pompilio MA, Tozetti IA, Bonin CM, Dorval MEMC. Cytokine profile in Leishmania-positive blood donors. PLoS One 2020; 15:e0238933. [PMID: 32966326 PMCID: PMC7511012 DOI: 10.1371/journal.pone.0238933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/26/2020] [Indexed: 12/03/2022] Open
Abstract
Serum levels of interleukin 2 (IL-2), interleukin 4 (IL-4), interleukin 6 (IL-6), interleukin 10 (IL-10), interleukin 17 (IL-17), interferon gamma (IFN-γ), tumor necrosis factor α (TNF-α), and interleukin 1β (IL-1β), cytokines involved in the immune response, were investigated in 75 Leishmania-positive blood donors living in endemic areas. Based on their status in 2011 and 2015, the subjects were clustered into three groups: positive for at least one diagnostic method in both years, but lacking clinical progression to disease (G1); positive on at least one method in 2011 but negative in 2015 (G2); negative on all methods in both years (G3). Donors were interviewed for sociodemographic data collection and underwent clinical evaluation and laboratory tests. Serum cytokines were quantified using a CBA Flex set (BD Biosciences). Significant differences were found for all the cytokines evaluated, with lower concentrations in consistently Leishmania-negative individuals. The exception was IFN-γ, with similar levels among all donors. No changes consistent with active disease were observed in the laboratory results for Leishmania-positive donors who underwent clinical evaluation, none of whom progressed to disease. This suggests that infection control is associated with serum IL-17 levels. Resolution of Leishmania infection in positive donors may be related to high levels of IL-17 and low levels of IL-10, highlighting the role played by IL-17 in asymptomatic Leishmania-infected individuals.
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Affiliation(s)
- Adriana de Oliveira França
- Laboratory of Clinical Parasitology, Graduate Program in Infectious and Parasitic Diseases, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
- * E-mail:
| | - Luana Silva Soares
- Laboratory of Immunology, Universidade Católica Dom Bosco, Campo Grande, MS, Brazil
| | - Mauricio Antonio Pompilio
- Hélio Mandetta School of Medicine, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Inês Aparecida Tozetti
- Laboratory of Immunobiology, Institute of Biosciences, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Camila Mareti Bonin
- Laboratory of Immunobiology, Institute of Biosciences, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
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36
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Saha B, Pai K, Sundar S, Bhattacharyya M, Bodhale NP. The drug resistance mechanisms in Leishmania donovani are independent of immunosuppression. Cytokine 2020; 145:155300. [PMID: 32978033 DOI: 10.1016/j.cyto.2020.155300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
The protozoan parasite L. donovani resides inside macrophages as amastigotes and inflicts a potentially lethal disease visceral leishmaniasis (VL). Due to absence of a vaccine, chemotherapy with antimonials, amphotericin B, miltefosine or paromomycin remains the only option for treating VL. Prolonged treatment with a single drug resulted in parasite strains resistant to each of these drugs. As immuno-suppression characterizes the disease, we examined whether eliciting immunosuppressive cytokines is a mechanism of manifestation of drug-resistance. We infected BALB/c mice with the clinical isolates of L. donovani- BHU1066 (sensitive), NS2 (antimony-resistant), BHU1064 (miltefosine-resistant), BHU919 (Amphotericin B-resistant) and BHU1020 (paromomycin-resistant)- from the respective drug-unresponsive patients and assessed splenic parasite load and production of pro-inflammatory and anti-inflammatory cytokines. Although the splenic parasite loads in the drug-resistant L. donovani-infected BALB/c mice were higher than that observed in the drug-sensitive parasites-infected mice, the cytokine profiles were not significantly different between these two sets of mice. The drug-resistance in L. donovani results from innate drug modulation but perhaps not from host immune-suppressive cytokines.
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Affiliation(s)
- Baibaswata Saha
- Centre of Advanced Study, Department of Zoology, Savitribai Phule Pune University, Pune 411007, India
| | - Kalpana Pai
- Centre of Advanced Study, Department of Zoology, Savitribai Phule Pune University, Pune 411007, India
| | - Shyam Sundar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | | | - Neelam Prakash Bodhale
- Jagadis Bose National Science Talent Search, Kolkata 700107, India; National Centre for Cell Science, Ganeshkhind, Pune 411007, India.
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37
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Abstract
Human visceral leishmaniasis (HVL) cases are important public health problems due to their zoonotic aspect, with high rates of morbidity and mortality in Brazil. The aim of this this study was to identify spatial patterns in both rates of HVL cases in Brazilian states during the period from 2006 to 2015. This is an ecological study, using geoprocessing tools to create choropleth maps, based on secondary data from open access platforms, to identify priority areas for control actions of the disease. Data were collected in 2017 and analysed according to the global and local Moran's I, using TerraView 4.2.2 software. Similar clusters were observed in neighbouring municipalities in thematic maps of HVL, suggesting spatial similarity in the distribution of the disease in humans mainly in the North and Northeast Regions, which concentrate the states with the highest rates of HVL. Heterogeneous spatial patterns were observed in the distribution of HVL, which show municipalities that need higher priority in the intensification of disease surveillance and control strategies.
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38
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Moravej A, Choopanizadeh M, Pourabbas B, Pouladfar G, Kalani M. Treatment effects on IL‐9+CD4+ T cells and the cytokines influencing IL‐9 production in paediatric visceral leishmaniasis. Parasite Immunol 2020; 42:e12787. [DOI: 10.1111/pim.12787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Ali Moravej
- Department of Immunology Fasa University of Medical Sciences Fasa Iran
| | - Maral Choopanizadeh
- Professor Alborzi Clinical Microbiology Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Bahman Pourabbas
- Professor Alborzi Clinical Microbiology Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Gholamreza Pouladfar
- Professor Alborzi Clinical Microbiology Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Mehdi Kalani
- Professor Alborzi Clinical Microbiology Research Center Shiraz University of Medical Sciences Shiraz Iran
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39
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Aquino SR, Diniz LFB, Queiroz IT, Cunha MA, Justo AM, Silva ED, Pereira VRA, Medeiros ZM, Carmo RF. Case Report: Severe Visceral Leishmaniasis in a Patient with HIV Coinfection Undergoing Treatment for Erythema Nodosum Leprosum. Am J Trop Med Hyg 2020; 103:2253-2256. [PMID: 32901606 DOI: 10.4269/ajtmh.20-0567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report a case of visceral leishmaniasis (VL)/HIV coinfection in a patient undergoing regular antiretroviral therapy and treatment with thalidomide for erythema nodosum leprosum. He presented at a health service with high fever, chills, asthenia, pale skin, lower limb edema, hepatomegaly, and splenomegaly. Visceral leishmaniasis was confirmed by direct examination, and serological and molecular tests. Serum levels of Th1/Th2 cytokines were measured. The patient began treatment with liposomal amphotericin B, with good clinical response; however, VL recurred 6 months later. Treatment was reinitiated, maintaining secondary prophylaxis with liposomal amphotericin B. The patient showed clinical improvement with important recovery of CD4+ T-lymphocyte count.
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Affiliation(s)
- Samuel R Aquino
- Hospital Universitário da Universidade Federal do Vale do São Francisco, Petrolina, Brazil.,Programa de Pós-Graduação em Ciências da Saúde e Biológicas, Universidade Federal do Vale do São Francisco, Petrolina, Brazil
| | - Lucyo F B Diniz
- Hospital Universitário da Universidade Federal do Vale do São Francisco, Petrolina, Brazil
| | | | | | - Alda M Justo
- Colegiado de Enfermagem, Universidade de Pernambuco Campus Petrolina, Petrolina, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife, Brazil
| | | | | | - Zulma M Medeiros
- Instituto Aggeu Magalhães, Recife, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife, Brazil
| | - Rodrigo F Carmo
- Programa de Pós-Graduação em Biociências, Universidade Federal do Vale do São Francisco, Petrolina, Brazil.,Programa de Pós-Graduação em Ciências da Saúde e Biológicas, Universidade Federal do Vale do São Francisco, Petrolina, Brazil
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40
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Barbosa Júnior WL, Justo AM, Aguiar Dos Santos AM, de Lorena VMB, do Carmo RF, de Melo FL, de Medeiros ZM, Vasconcelos LRS. Higher levels of TNF and IL-4 cytokines and low miR-182 expression in visceral leishmaniasis-HIV co-infected patients. Parasite Immunol 2020; 42:e12701. [PMID: 31990371 DOI: 10.1111/pim.12701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Abstract
AIMS The aim of the present study was to assess serum cytokine and miRNA expression in visceral leishmaniasis-HIV (VL-HIV) co-infection and HIV mono-infection. METHODS AND RESULTS We analysed 113 serum samples from HIV patients in areas endemic for leishmaniasis. The diagnosis of VL was confirmed in 65 of these 113 samples. The VL-HIV and HIV groups presented significant differences regarding haemoglobin level (P < .0001), lymphocyte count (P = .0444), white blood cell count (P = .0108), weight loss (P = .0310), HIV load (P < .0001) and CD4+ T-lymphocytes count (P = .0003). Levels of IL-6 and IL-10, IFN-γ and IL-6, IFN-γ and IL-10, TNF and IL-2 were positively correlated in VL-HIV co-infection, indicating higher serum levels of TNF and IL-4 (P < .0001). In addition, miR-182 expression was found to be significantly higher in HIV (P = .009), miR-210 exhibited no statistically significant difference between groups, and nonexpression of miR-122 was found in both groups. CONCLUSION Together, TNF, IL-4 and miR-182 may represent circulatory biomarkers of VL-HIV co-infection.
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Affiliation(s)
| | - Alda Maria Justo
- Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, Brazil
| | | | | | | | - Fábio Lopes de Melo
- Department of Parasitology, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
| | - Zulma Maria de Medeiros
- Department of Parasitology, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil.,Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, Brazil
| | - Luydson Richardson Silva Vasconcelos
- Department of Parasitology, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil.,Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, Brazil
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41
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Sosa-Ochoa W, Zúniga C, Chaves LF, Araujo Flores GV, Sandoval Pacheco CM, Ribeiro da Matta VL, Pereira Corbett CE, Tobias Silveira F, Dalastra Laurenti M. Clinical and Immunological Features of Human Leishmania (L.) infantum-Infection, Novel Insights Honduras, Central America. Pathogens 2020; 9:pathogens9070554. [PMID: 32664223 PMCID: PMC7399949 DOI: 10.3390/pathogens9070554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 11/16/2022] Open
Abstract
Leishmania (Leishmania) infantum is the etiological agent of both American visceral leishmaniasis (AVL) and non-ulcerated cutaneous leishmaniasis (NUCL) in Honduras. Although AVL is the most severe clinical form of infection, recent studies have shown that human immune response to parasite infection can result in a clinical-immunological spectrum. The overall prevalence rate of infection and clinical-immunological profiles of the L. (L.) infantum infection in Amapala municipality, South Honduras was determined. We examined 576 individuals with diagnosis based on combined ELISA (IgG/IgM) and DTH assays. We also used genus-specific kDNA PCR and Hsp70 PCR-RFLP for NUCL cases. Clinical evaluation found 82% asymptomatic and 18% symptomatic individuals. All symptomatic cases (n = 104) showing NUCL were positive for parasites. We identified L. (L.) infantum species in 100% of the skin lesion scrapings and in 90% of the blood samples from NUCL cases studied. A total of 320 asymptomatic individuals were exposed (ELISA+ and/or DTH+), providing an overall L. (L.) infantum prevalence of 73.6%. Clinical, parasitological, and immunological evaluations suggest seven infection profiles, three asymptomatic and four symptomatic. This represents the first report on clinical and immunological features of human L. (L.) infantum-infection in Amapala municipality, Honduras.
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Affiliation(s)
- Wilfredo Sosa-Ochoa
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo 01246-903, SP, Brazil; (W.S.-O.); (G.V.A.F.); (C.M.S.P.); (V.L.R.d.M.); (C.E.P.C.)
- Microbiology Research Institute, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras
| | - Concepción Zúniga
- Department of Health Surveillance, University School Hospital, Tegucigalpa 11101, Honduras;
| | - Luis Fernando Chaves
- Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Tres Ríos 4-2250, Cartago, Costa Rica;
| | - Gabriela Venicia Araujo Flores
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo 01246-903, SP, Brazil; (W.S.-O.); (G.V.A.F.); (C.M.S.P.); (V.L.R.d.M.); (C.E.P.C.)
| | - Carmen Maria Sandoval Pacheco
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo 01246-903, SP, Brazil; (W.S.-O.); (G.V.A.F.); (C.M.S.P.); (V.L.R.d.M.); (C.E.P.C.)
| | - Vania Lúcia Ribeiro da Matta
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo 01246-903, SP, Brazil; (W.S.-O.); (G.V.A.F.); (C.M.S.P.); (V.L.R.d.M.); (C.E.P.C.)
| | - Carlos Eduardo Pereira Corbett
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo 01246-903, SP, Brazil; (W.S.-O.); (G.V.A.F.); (C.M.S.P.); (V.L.R.d.M.); (C.E.P.C.)
| | - Fernando Tobias Silveira
- Parasitology Department, Evandro Chagas Institute (Surveillance Secretary of Health, Ministry of Health), Belém 66090-000, PA, Brazil;
- Tropical Medicine Institute, Pará Federal University, Belém 66075-110, PA, Brazil
| | - Marcia Dalastra Laurenti
- Laboratory of Pathology of Infectious Diseases, Medical School, São Paulo University, São Paulo 01246-903, SP, Brazil; (W.S.-O.); (G.V.A.F.); (C.M.S.P.); (V.L.R.d.M.); (C.E.P.C.)
- Correspondence:
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42
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Comparative study of the use of miltefosine, miltefosine plus allopurinol, and allopurinol in dogs with visceral leishmaniasis. Exp Parasitol 2020; 217:107947. [PMID: 32628971 DOI: 10.1016/j.exppara.2020.107947] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/12/2020] [Accepted: 07/02/2020] [Indexed: 01/12/2023]
Abstract
Visceral leishmaniasis (VL) is an infectious disease caused by the protozoan parasite Leishmania (Leishmania) infantum, an intracytoplasmic parasite that affects humans and other species of domestic and wild mammals. In Brazil, the treatment of canine visceral leishmaniasis (CVL) with miltefosine has been implemented since 2016, and the reports on the clinical and immunological conditions of treated dogs are scarce. Thus, this study aimed to assess and monitor the clinical, laboratory, and immunological condition of dogs with CVL before (D0) and after (D29) using three pharmacotherapeutic protocols: miltefosine monotherapy (Milteforan™, Virbac) (G1), miltefosine plus allopurinol (G2), and allopurinol monotherapy (G3). Forty-five dogs with CVL were assigned to one of three treatment groups. The dogs were evaluated for clinical signs, was well as haematological, biochemical, serological, and cytokine levels. Significant reduction in clinical scores was observed in all protocols, with no differences between groups. We did not observe a clinical cure in any of the dogs in the groups. Haematological and biochemical parameters showed slow recovery, with better results observed in G2. Anti-Leishmania antibody titre remained increased in all groups. The quantification of serum cytokines demonstrated a mixed Th1/Th2 profile in CVL. The IL-2 levels decreased in all groups after treatment. Evaluation of IFN-y and IL-10 did not show changes in the groups analysed, and it did not contribute to short term therapeutic monitoring. All therapeutic protocols promoted, to varying degrees, an improvement in the general condition (clinical signs, haematological, and biochemical levels) of the animals. Through clinical-pathological exams, we found that the combination of miltefosine plus allopurinol promoted better effects in the short-term, representing the best choice for the treatment of CVL, even when compared to the only therapeutic protocol allowed in Brazil, miltefosine monotherapy. Through the quantification of cytokines, IL-2 proved to be a potential therapeutic marker for the monitoring and follow-up of dogs with CVL.
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43
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Gedda MR, Singh B, Kumar D, Singh AK, Madhukar P, Upadhyay S, Singh OP, Sundar S. Post kala-azar dermal leishmaniasis: A threat to elimination program. PLoS Negl Trop Dis 2020; 14:e0008221. [PMID: 32614818 PMCID: PMC7332242 DOI: 10.1371/journal.pntd.0008221] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Leishmaniasis remains a public health concern around the world that primarily affects poor folks of the developing world spanning across 98 countries with mortality of 0.2 million to 0.4 million annually. Post kala-azar dermal leishmaniasis (PKDL) is the late skin manifestation of visceral leishmaniasis (VL). It has been reported that about 2.5% to 20% of patients recovered from VL develop PKDL having stilted macular or nodular lesions with parasites. In the Indian subcontinent (ISC), it manifests a few months after recovery from VL, though in Africa it can occur simultaneously with VL or a little later. New cases of PKDL are also observed without prior VL in the ISC. These individuals with PKDL represent an important but largely neglected reservoir of infection that perpetuates anthroponotic Leishmania donovani transmission in the ISC and can jeopardize the VL elimination program as these cases can infect the sand flies and spread the endemic. Therefore, it becomes imperative to eradicate PKDL as a part of the VL elimination program. With the limited treatment options besides little knowledge on PKDL, this review stands out in focusing on different aspects that should be dealt for sustained VL elimination.
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Affiliation(s)
- Mallikarjuna Rao Gedda
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
- Center for Cellular Engineering, NIH Clinical Center, Bethesda, Maryland, United States of America
| | - Bhawana Singh
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Dhiraj Kumar
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
- Department of Zoology, Rameshwar College, BRA Bihar University, Muzaffarpur, India
| | - Abhishek Kumar Singh
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Prasoon Madhukar
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shreya Upadhyay
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Om Prakash Singh
- Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Shyam Sundar
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Prospection of immunological biomarkers for characterization and monitoring of asymptomatic Leishmania ( Leishmania) infantum infection. Parasitology 2020; 147:1124-1132. [PMID: 32460936 DOI: 10.1017/s0031182020000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In areas endemic for Leishmania infantum, an asymptomatic infection may be an indicator of the extent of transmission. The main goal of this study was to evaluate the applicability of measuring circulating immunological biomarkers as an alternative strategy to characterize and monitor L. infantum asymptomatic infections in combination with serological methods. To this end, 179 children from a region endemic for visceral leishmaniasis (VL), aged 1-10 years old, selected from a cross-sectional study, were identified as asymptomatic (n = 81) or uninfected (n = 98) by qPCR and/or serological tests (ELISA using L. infantum soluble antigen and rK39), and, together with serum samples of children diagnosed with VL (n = 43), were subjected to avidity tests and cytokine levels measurement. Avidity rates (AR) ranging from 41 to 70% were found in 29 children (66%) from the asymptomatic group. On the other hand, high AR (above 70%) were observed in 27 children (64%) from the VL group. Logistic Regression and Classification and Regression Tree (CART) analyses demonstrated that lower AR and IFN-γ production associated with higher IL-17A levels were hallmarks in asymptomatic L. infantum infections. Therefore, this study proposes an association of immunological biomarkers that can be used as a complementary strategy for the characterization and monitoring of asymptomatic VL infections in children living in endemic areas.
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45
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Silva-Freitas ML, Corrêa-Castro G, Cota GF, Giacoia-Gripp C, Rabello A, Teixeira Dutra J, de Vasconcelos ZFM, Savino W, Da-Cruz AM, Santos-Oliveira JR. Impaired Thymic Output Can Be Related to the Low Immune Reconstitution and T Cell Repertoire Disturbances in Relapsing Visceral Leishmaniasis Associated HIV/AIDS Patients. Front Immunol 2020; 11:953. [PMID: 32508833 PMCID: PMC7251171 DOI: 10.3389/fimmu.2020.00953] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Visceral leishmaniasis/HIV-co-infected patients (VL/HIV) accounts for around 8% of VL reported cases in Brazil. Relapses of Leishmania infection after anti-leishmanial treatment constitute a great challenge in the clinical practice because of the disease severity and drug resistance. We have shown that non-relapsing-VL/HIV (NR-) evolved with increase of CD4+ T-cell counts and reduction of activated CD4+ and CD8+ T cells after anti-leishmanial treatment. This immune profile was not observed in relapsing-VL/HIV patients (R-), indicating a more severe immunological compromising degree. Elevated activation status may be related to a deficient immune reconstitution and could help to explain the frequent relapses in VL/HIV co-infection. Our aim was to evaluate if this gain of T cells was related to changes in the peripheral TCRVβ repertoire and inflammatory status, as well as the possible thymus involvement in the replenishment of these newly formed T lymphocytes. Methods: VL/HIV patients, grouped into non-relapsing (NR- = 6) and relapsing (R- = 12) were evaluated from the active phase up to 12 months post-treatment (mpt). HIV-infected patients (non-VL) and healthy subjects (HS) were included. The TCRVβ repertoire was evaluated ex vivo by flow cytometry, whereas the plasmatic cytokine levels were assessed by Luminex assay. To evaluate the thymic output, DNA was extracted from PBMCs for TCR rearrangement excision circles (TREC) quantification by qPCR. Results: VL/HIV cases presented an altered mobilization profile (expansions or retractions) of the TCRVβ families when compared to HS independent of the follow-up phase (p < 0.05). TCRVβ repertoire on CD4+ T-cells was more homogeneous in the NR-VL/HIV cases, but heterogeneous on CD8+ T-cells, since different Vβ-families were mobilized. NR-VL/HIV had the inflammatory pattern reduced after 6 mpt. Importantly, VL/HIV patients showed number of TREC copies lower than controls during all follow-up. An increase of recent thymic emigrants was observed in NR-VL/HIV individuals at 10 mpt compared to R- patients (p < 0.01), who maintained lower TREC contents than the HIV controls. Conclusions: VL/HIV patients that maintain the thymic function, thus generating new T-cells, seem able to replenish the T lymphocyte compartment with effector cells, then enabling parasite control.
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Affiliation(s)
- Maria Luciana Silva-Freitas
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Gabriela Corrêa-Castro
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.,Núcleo de Ciências Biomédicas Aplicadas, Instituto Federal de Educação, Ciência e Tecnologia Do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
| | - Glaucia Fernandes Cota
- Centro de Referência em Leishmanioses, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Brazil
| | - Carmem Giacoia-Gripp
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Ana Rabello
- Centro de Referência em Leishmanioses, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Brazil
| | - Juliana Teixeira Dutra
- Laboratório de Alta Complexidade, Instituto Nacional de Saúde da Mulher, da Criança e Do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Zilton Farias Meira de Vasconcelos
- Laboratório de Alta Complexidade, Instituto Nacional de Saúde da Mulher, da Criança e Do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Wilson Savino
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,Rede de Pesquisas em Saúde Do Estado Do Rio de Janeiro/FAPERJ, Rio de Janeiro, Brazil
| | - Alda Maria Da-Cruz
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,Rede de Pesquisas em Saúde Do Estado Do Rio de Janeiro/FAPERJ, Rio de Janeiro, Brazil.,Disciplina de Parasitologia/DMIP, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Joanna Reis Santos-Oliveira
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.,Núcleo de Ciências Biomédicas Aplicadas, Instituto Federal de Educação, Ciência e Tecnologia Do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
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Lima L, Vasconcelos-Dos-Santos T, Campos M, Ramos PK, Gomes C, Laurenti M, da Matta V, Corbett C, Silveira F. New record of preclinical diagnosis of American visceral leishmaniasis in Amazonian Brazil encourages optimizing disease control. Parasite Epidemiol Control 2020; 10:e00154. [PMID: 32435706 PMCID: PMC7232079 DOI: 10.1016/j.parepi.2020.e00154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 12/30/2022] Open
Abstract
The clinical-immunological spectrum of human Leishmania (L.) infantum chagasi-infection in Amazonian Brazil has recently been reviewed based on the combined use of the delayed-type hypersensitivity (DTH) and indirect fluorescence antibody test (IFAT-IgG/IgM), both with homologous L. (L.) infantum chagasi-antigens, and associated with the clinical evaluation of infected individuals. This diagnostic approach has allowed to identify the broadest clinical-immunological spectrum of human L. (L.) infantum chagasi-infection composed by five clinical-immunological profiles of infection: three asymptomatic, 1) Asymptomatic Infection (AI) [DTH+/++++, IFAT−], 2) Subclinical Resistant Infection (SRI) [DTH+/++++, IFAT+/++], and 3) Indeterminate Initial Infection (III) [DTH−, IFAT+/++], and two symptomatic ones, 4) Symptomatic Infection (SI) [=American visceral leishmaniasis - AVL] and, 5) Subclinical Oligosymptomatic Infection (SOI), both with the same immune profile [DTH−, IFAT+++/++++]. Herein, we confirm for the third time the preclinical diagnosis of AVL through IgM-antibody response in an early asymptomatic case of infection (profile III), a 17-year-old boy who evolved to AVL (=profile SI) six weeks after the initial infection diagnosis, confirming that the combined use of DTH and IFAT-(IgG/IgM) assays associated with the clinical evaluation of infected individuals is potentially useful for monitoring human L. (L.) infantum chagasi-infection in endemic areas as well as optimizing AVL control.
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Affiliation(s)
- Luciana Lima
- Parasitology Department, Evandro Chagas Institute, Ananindeua, Para State, Brazil
| | | | - Marliane Campos
- Parasitology Department, Evandro Chagas Institute, Ananindeua, Para State, Brazil
| | - Patrícia Karla Ramos
- Parasitology Department, Evandro Chagas Institute, Ananindeua, Para State, Brazil
| | - Claudia Gomes
- Pathology Department, Medical School of São Paulo University, São Paulo, São Paulo State, Brazil
| | - Marcia Laurenti
- Pathology Department, Medical School of São Paulo University, São Paulo, São Paulo State, Brazil
| | - Vania da Matta
- Pathology Department, Medical School of São Paulo University, São Paulo, São Paulo State, Brazil
| | - Carlos Corbett
- Pathology Department, Medical School of São Paulo University, São Paulo, São Paulo State, Brazil
| | - Fernando Silveira
- Parasitology Department, Evandro Chagas Institute, Ananindeua, Para State, Brazil.,Nucleus of Tropical Medicine, Federal University of Pará, Belém, Para State, Brazil
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Ribeiro CV, Rocha BFB, Oliveira E, Teixeira-Carvalho A, Martins-Filho OA, Murta SMF, Peruhype-Magalhães V. Leishmania infantum induces high phagocytic capacity and intracellular nitric oxide production by human proinflammatory monocyte. Mem Inst Oswaldo Cruz 2020; 115:e190408. [PMID: 32321156 PMCID: PMC7164402 DOI: 10.1590/0074-02760190408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/14/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The mechanism of resistance to SbIII in Leishmania is complex, multifactorial and involves not only biochemical mechanisms, but also other elements, such as the immune system of the host. OBJECTIVES In this study, putative changes in the immunological profile of human monocytes infected with wild-type (WT) and antimony (SbIII)-resistant Leishmania (Viannia) braziliensis and Leishmania (Leishmania) infantum lines were evaluated. METHODS Susceptibility assays WT and SbIII-resistant L. braziliensis and L. infantum were performed using lines THP-1 human monocytic lineage. Phagocytic capacity, cytokine profile, intracellular nitric oxide (NO) production and surface carbohydrate residues profile were performed in peripheral blood monocytes by flow cytometry. FINDINGS The phagocytic capacity and intracellular NO production by classical (CD14++CD16-) and proinflammatory (CD14++CD16+) monocytes were higher in the presence of L. infantum lines compared to L. braziliensis lines. The results also highlight proinflammatory monocytes as the cellular subpopulation of major relevance in a phagocytosis event and NO expression. It is important to note that L. infantum induced a proinflammatory cytokine profile characterised by higher levels of TNF-α in culture supernatant than L. braziliensis. Conversely, both Leishmania lines induce high levels of IL-6 in culture supernatant. Analysis of the expression profile of surface carbohydrates showed that L. braziliensis presents 4.3-fold higher expression of galactose(β1,4)N-acetylglucosamine than L. infantum line. Interestingly, the expression level of α-N-acetylgalactosamine residues was 2-fold lower in the SbIII-resistant L. braziliensis line than its counterpart WT line, indicating differences in surface glycoconjugates between these lines. MAIN CONCLUSIONS Our results showed that L. braziliensis and L. infantum induce different innate immune responses and a highly inflammatory profile, which is characteristic of infection by L. infantum, the species associated with visceral disease.
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Affiliation(s)
- Christiana Vargas Ribeiro
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Grupo de Genômica Funcional e Proteômica de Leishmania spp. e Trypanosoma cruzi, Belo Horizonte, MG, Brasil
| | - Bruna Fonte Boa Rocha
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Grupo de Genômica Funcional e Proteômica de Leishmania spp. e Trypanosoma cruzi, Belo Horizonte, MG, Brasil
| | - Edward Oliveira
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Grupo de Genômica Funcional e Proteômica de Leishmania spp. e Trypanosoma cruzi, Belo Horizonte, MG, Brasil
| | - Andrea Teixeira-Carvalho
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Grupo Integrado de Pesquisas em Biomarcadores, Belo Horizonte, MG, Brasil
| | - Olindo Assis Martins-Filho
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Grupo Integrado de Pesquisas em Biomarcadores, Belo Horizonte, MG, Brasil
| | - Silvane Maria Fonseca Murta
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Grupo de Genômica Funcional e Proteômica de Leishmania spp. e Trypanosoma cruzi, Belo Horizonte, MG, Brasil
| | - Vanessa Peruhype-Magalhães
- Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Grupo Integrado de Pesquisas em Biomarcadores, Belo Horizonte, MG, Brasil
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Risk factors for in-hospital mortality from visceral leishmaniasis: A case-control study. J Infect Public Health 2020; 13:538-543. [DOI: 10.1016/j.jiph.2019.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/26/2019] [Accepted: 10/10/2019] [Indexed: 02/06/2023] Open
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TLR4 abrogates the Th1 immune response through IRF1 and IFN-β to prevent immunopathology during L. infantum infection. PLoS Pathog 2020; 16:e1008435. [PMID: 32210480 PMCID: PMC7135367 DOI: 10.1371/journal.ppat.1008435] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/06/2020] [Accepted: 02/25/2020] [Indexed: 12/26/2022] Open
Abstract
A striking feature of human visceral leishmaniasis (VL) is chronic inflammation in the spleen and liver, and VL patients present increased production levels of multiple inflammatory mediators, which contribute to tissue damage and disease severity. Here, we combined an experimental model with the transcriptional profile of human VL to demonstrate that the TLR4-IFN-β pathway regulates the chronic inflammatory process and is associated with the asymptomatic form of the disease. Tlr4-deficient mice harbored fewer parasites in their spleen and liver than wild-type mice. TLR4 deficiency enhanced the Th1 immune response against the parasite, which was correlated with an increased activation of dendritic cells (DCs). Gene expression analyses demonstrated that IRF1 and IFN-β were expressed downstream of TLR4 after infection. Accordingly, IRF1- and IFNAR-deficient mice harbored fewer parasites in the target organs than wild-type mice due to having an increased Th1 immune response. However, the absence of TLR4 or IFNAR increased the serum transaminase levels in infected mice, indicating the presence of liver damage in these animals. In addition, IFN-β limits IFN-γ production by acting directly on Th1 cells. Using RNA sequencing analysis of human samples, we demonstrated that the transcriptional signature for the TLR4 and type I IFN (IFN-I) pathways was positively modulated in asymptomatic subjects compared with VL patients and thus provide direct evidence demonstrating that the TLR4-IFN-I pathway is related to the nondevelopment of the disease. In conclusion, our results demonstrate that the TLR4-IRF1 pathway culminates in IFN-β production as a mechanism for dampening the chronic inflammatory process and preventing immunopathology development. Visceral leishmaniasis (VL) is one of the most lethal neglected tropical diseases and is caused by Leishmania parasites. Most subjects infected with Leishmania present subclinical VL symptoms, and their immune response is mediated by Th1 cells and immunoregulatory mechanisms. However, when infection progresses to disease, VL patients present increased levels of inflammatory mediators in the serum which are related to the severity of disease. During infection, Toll-like receptors (TLRs) interact with Leishmania parasites and contribute to the outcome of the disease. Herein, we report that TLR4 signaling hampers the chronic immune response during VL to prevent immunopathology. TLR4 triggers the activation of IRF1 and thus induces the transcription of IFN-β, which in turn acts directly on Th1 cells to limit the production of IFN-γ. In addition, a transcription analysis of human VL samples provides direct evidence demonstrating that the TLR4-IFN-I pathway is related to the asymptomatic form of the disease. Collectively, our findings reveal that TLR4 hampers the Th1 immune response through IRF1 and IFN-β to prevent immunopathology during VL.
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50
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Pro-Cellular Exhaustion Markers are Associated with Splenic Microarchitecture Disorganization and Parasite Load in Dogs with Visceral Leishmaniasis. Sci Rep 2019; 9:12962. [PMID: 31506501 PMCID: PMC6736856 DOI: 10.1038/s41598-019-49344-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022] Open
Abstract
In canine visceral leishmaniasis (CVL), splenic white pulp (SWP) disorganization has been associated with disease progression, reduced cytokine and chemokine expression and failure to control the parasite load. This profile is compatible with the cellular exhaustion previously shown in human visceral leishmaniasis. The present study aimed to evaluate the in situ expression of cellular exhaustion markers and their relation to clinical signs, SWP disorganization and parasite load. Forty dogs naturally infected by Leishmania infantum were grouped according to levels of SWP organization and parasite load. SWP disorganization was associated with reductions in the periarteriolar lymphatic sheath and lymphoid follicles/mm2 and worsening of the disease. Apoptotic cells expressing CTLA-4+ increased in dogs with disorganized SWP and a high parasite load. In the same group, PD-L1 and LAG-3 gene expression were reduced. A higher number of CD21+TIM-3+ B cells was detected in disorganized spleens than in organized spleens. Apoptosis is involved in periarteriolar lymphatic sheath reduction and lymphoid follicle atrophy and is associated with CTLA-4+ cell reductions in the splenic tissue of dogs with visceral leishmaniasis (VL). Failure to control the parasite load was observed, suggesting that cell exhaustion followed by T and B cell apoptosis plays a role in the immunosuppression observed in CVL.
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