In Situ Cellular Response Underlying Successful Treatment of Mucosal Leishmaniasis with a Combination of Pentavalent Antimonial and Pentoxifylline.

Mucosal leishmaniasis (ML) is characterized by high production of inflammatory cytokines. Administration of pentoxifylline (PTX), an inhibitor of TNF-alpha, with pentavalent antimony (Sbv), has been successfully used as alternative treatment for refractory ML. Our study aims to investigate the in situ cellular response underlying the effectiveness of this therapy, by evaluating the intensity of the inflammatory infiltrate, cellular composition, and expression of cytokines and granzyme A in lesions from ML before and after treatment with Sbv alone or in combination with PTX. Our data showed no differences in the intensity of inflammatory infiltrate comparing before and after treatment, and comparing between different treatments. However, although the number and frequency of CD4+ and CD8+ cells were not different before and after treatments or comparing different treatments, frequency of CD68+ cells decreased after treatment with Sbv + PTX, but not with Sbv. This was due to a reduction in CD68+ TNF-alpha+ and not in CD68+ IL-10+ cells. The frequency of TNF-alpha+ cells was correlated with the intensity of the inflammatory infiltrate before treatment, but this correlation was lost after treatment with Sbv + PTX. Although the total expression of granzyme A did not significantly change after treatments, a clear trend of decrease was observed after treatment with Sbv + PTX. Interestingly, patients who took longer to heal, regardless of the treatment, displayed a higher frequency of granzyme A+ cells. Our data suggest that treatment with Sbv + PTX acts in CD68+ cells reducing the expression of TNF-alpha but not IL-10, resulting in more efficient modulation of the inflammatory response, accelerating the healing process.

IL-10 and IL-10 receptor overexpression in oral giant cell lesions.

OBJECTIVE: Central giant cell lesions (CGCL) and peripheral giant cell lesions (PGCL) occur in the jaws and contain osteoclast-like giant cells and mononuclear cells positive for the macrophage marker CD68. The participation of immune-inflammatory mechanisms has been proposed in the lesions development. As IL-10 is one of the most important anti-inflammatory cytokines and it is also an inhibitory cytokine to macrophage function and bone resorption, the purpose of the present study was to investigate its expression together with its receptor (IL-10Rα) in CGCL and PGCL. STUDY DESIGN: Six fragments of CGCL and seven fragments of PGCL were obtained by surgical excision. Frozen specimens were cut and subjected to immunofluorescence staining using fluorescent-labeled anti-CD68, anti-IL-10, and anti-IL-10Rα monoclonal antibodies. Microscopic analyses were performed and the percentage of positive mononuclear and giant cells for each parameter was obtained. RESULTS: Our results revealed that all giant cells from CGCL and PGCL were CD68+ and IL-10Rα+ and that the majority was also positive for IL-10. More than 50% of the mononuclear cells from both lesions expressed IL-10Rα and the majority of these cells were CD68+ and IL-10+. CONCLUSION: Considering that IL-10 has inhibitory effects on the pathologic processes related to the development of the oral giant cell lesions, the high frequencies of cells producing this cytokine seems contradictory to these lesions growth. Investigation about the production of inflammatory cytokines as well as the IL-10 signaling pathways in oral giant cell lesions is required to elucidate the immunopathology of CGCL and PGCL.

Immunoregulatory and Effector Activities in Human Cutaneous and Mucosal Leishmaniasis: Understanding Mechanisms of Pathology.

Individuals infected with Leishmania braziliensis may develop the relatively benign localized cutaneous (CL) form or the mucosal (ML) form of the disease, which represents a more severe and mutilating variation. Interaction between parasite and host cells, as well as the genetic background of the host, are important determinants of the immune response, which is critical in determining disease outcome. Our studies over the years have been designed to determine the immunoregulatory and effector functions that culminate in the formation of lesions in CL and ML disease and how these host response factors may be better understood for design of novel therapies and prophylaxis. By studying the immune response from CL and ML patients in both the peripheral blood and in situ, we have learned much concerning the dynamics of the host-pathogen interaction that leads to the development of CL and ML. We used multiparameter flow cytometry to study the immunoregulatory profiles of the peripheral blood leukocytes, as well as laser scanning confocal microscopy to examine in situ several aspects of the local response, including the intensity of the inflammatory infiltrate, the cellular composition, inflammatory and anti-inflammatory cytokine expression, and the expression of the effector cytotoxic molecule, granzyme A, in lesions from CL and ML patients. Moreover, the application of correlative analysis between these immunological parameters has helped shed light on disease progression in CL and ML. These findings are reviewed within the context of understanding cellular and molecular mechanisms associated with the development of pathology in these diseases through a comparative analysis of the clinical forms, CL and ML, as well as of studies derived from peripheral blood and lesions.