Presence of a macrophage-mediated suppressor cell mechanism during cell-mediated immune response in experimental visceral leishmaniasis.

In susceptible BALB/c mice, systemic intracellular infection with Leishmania donovani provokes generation of adherent spleen cells which can suppress both mitogen- and specific-antigen-stimulated T-cell responses. To characterize the responsible suppressor cell, we irradiated (2,000 R) adherent spleen cells from L. donovani-infected mice or treated them with anti-Thy-1.2 antibody plus complement. Neither anti-T-cell treatment diminished the capacity to inhibit lymphocyte proliferative activity. In addition, as judged by morphologic and functional criteria, 80 to 90% of the adherent cells appeared to be macrophages. Four observations suggested an immunopathogenic role for these suppressor macrophages. (i) Their appearance and disappearance paralleled the establishment and resolution of L. donovani visceral infection in vivo. (ii) Suppressive effects included inhibition of production of the macrophage-activating lymphokine gamma interferon (IFN-gamma). (iii) On transfer into immune mice, suppressor macrophages impaired naturally acquired resistance to L. donovani. (iv) Inhibition of macrophage prostaglandin metabolism by indomethacin reduced suppressor activity in vitro and resulted in a 50% decrease in parasite visceral replication in vivo. In addition, prophylactic cyclophosphamide treatment inhibited the development of suppressor macrophages, and under these conditions visceral infection was rapidly controlled. These results suggested that disseminated L. donovani infection provokes a macrophage-mediated suppressor mechanism which appears to contribute to establishment of visceral leishmaniasis in a susceptible host.

Patients at risk for AIDS-related opportunistic infections. Clinical manifestations and impaired gamma interferon production.

We studied 81 men (79 homosexuals and 2 drug abusers) with persistent lymphadenopathy to determine whether those at risk for AIDS-related opportunistic infections could be identified prospectively. (Sixty-nine of 76 [91 per cent] had antibodies to human T-cell lymphotropic virus Type III [HTLV-III], and 76 of 79 [96 per cent] had abnormal T4/T8 cell ratios.) During the follow-up period (mean +/- S.E.M., 12.9 +/- 0.5 months; range, 8 to 19), infections developed in none of 38 patients with lymphadenopathy alone and in only 1 of 15 (7 per cent) with antecedent herpes zoster infection; however, 13 of 28 (46 per cent) with lymphadenopathy accompanied by constitutional symptoms or oral candidiasis or both had opportunistic infections within the follow-up period. Among the results of various T-cell assays, only antigen-stimulated lymphocyte proliferation and gamma interferon generation, which were absent or barely measurable in those in whom AIDS ultimately developed, were of prognostic value. T cells from 15 patients, 11 of whom had constitutional symptoms or thrush, failed to generate antigen-induced gamma interferon; infections developed in 10 of these 15 (67 per cent) within a mean of 8.2 months. These results suggest that patients with AIDS-related complex who are at risk for opportunistic infections within a year can be identified by correlating clinical manifestations with antigen-stimulated T-cell responses--in particular, with the production of gamma interferon.