High levels of T lymphocyte activation in Leishmania-HIV-1 co-infected individuals despite low HIV viral load

<p>Abstract</p> <p>Background</p> <p>Concomitant infections may influence HIV progression by causing chronic activation leading to decline in T-cell function. In the Americas, visceral (AVL) and tegumentary leishmaniasis (ATL) have emerged as important opportunistic infections in HIV-AIDS patients and both of those diseases have been implicated as potentially important co-factors in disease progression. We investigated whether leishmaniasis increases lymphocyte activation in HIV-1 co-infected patients. This might contribute to impaired cellular immune function.</p> <p>Methods</p> <p>To address this issue we analyzed CD4⁺T absolute counts and the proportion of CD8⁺T cells expressing CD38 in <it>Leishmania</it>/HIV co-infected patients that recovered after anti-leishmanial therapy.</p> <p>Results</p> <p>We found that, despite clinical remission of leishmaniasis, AVL co-infected patients presented a more severe immunossupression as suggested by CD4⁺T cell counts under 200 cells/mm³, differing from ATL/HIV-AIDS cases that tends to show higher lymphocytes levels (over 350 cells/mm³). Furthermore, five out of nine, AVL/HIV-AIDS presented low CD4⁺T cell counts in spite of low or undetectable viral load. Expression of CD38 on CD8⁺T lymphocytes was significantly higher in AVL or ATL/HIV-AIDS cases compared to HIV/AIDS patients without leishmaniasis or healthy subjects.</p> <p>Conclusions</p> <p><it>Leishmania </it>infection can increase the degree of immune system activation in individuals concomitantly infected with HIV. In addition, AVL/HIV-AIDS patients can present low CD4⁺T cell counts and higher proportion of activated T lymphocytes even when HIV viral load is suppressed under HAART. This fact can cause a misinterpretation of these laboratorial markers in co-infected patients.</p

IFNG +874T/A polymorphism is not associated with American tegumentary leishmaniasis susceptibility but can influence Leishmania induced IFN-γ production

<p>Abstract</p> <p>Background</p> <p>Interferon-gamma is a key cytokine in the protective responses against intracellular pathogens. A single nucleotide polymorphism (SNP) located in the first intron of the human IFN-γ gene can putatively influence the secretion of cytokine with an impact on infection outcome as demonstrated for tuberculosis and other complex diseases. Our aim was to investigate the putative association of IFNG+874T/A SNP with American tegumentary leishmaniasis (ATL) and also the influence of this SNP in the secretion of IFN-γ <it>in vitro</it>.</p> <p>Methods</p> <p>Brazilian ATL patients (78 cutaneous, CL, and 58 mucosal leishmaniasis, ML) and 609 healthy volunteers were evaluated. The genotype of +874 region in the IFN-γ gene was carried out by Amplification Refractory Mutational System (ARMS-PCR). <it>Leishmania</it>-induced IFN-γ production on peripheral blood mononuclear cell (PBMC) culture supernatants was assessed by ELISA.</p> <p>Results</p> <p>There are no differences between +874T/A SNP frequency in cases and controls or in ML versus CL patients. Cutaneous leishmaniasis cases exhibiting AA genotype produced lower levels of IFN-γ than TA/TT genotypes. In mucosal cases, high and low IFN-γ producers were clearly demonstrated but no differences in the cytokine production was observed among the IFNG +874T or A carriers.</p> <p>Conclusion</p> <p>Our results suggest that +874T/A polymorphism was not associated with either susceptibility or severity to leishmaniasis. Despite this, IFNG +874T/A SNP could be involved in the pathogenesis of leishmaniasis by influencing the amount of cytokine released by CL patients, although it could not prevent disease development. On the other hand, it is possible that in ML cases, other potential polymorphic regulatory genes such as TNF-α and IL-10 are also involved thus interfering with IFN-γ secretion.</p

Verbal Learning and Memory Deficits across Neurological and Neuropsychiatric Disorders: Insights from an ENIGMA Mega Analysis

Deficits in memory performance have been linked to a wide range of neurological and neuropsychiatric conditions. While many studies have assessed the memory impacts of individual conditions, this study considers a broader perspective by evaluating how memory recall is differentially associated with nine common neuropsychiatric conditions using data drawn from 55 international studies, aggregating 15,883 unique participants aged 15-90. The effects of dementia, mild cognitive impairment, Parkinson\u27s disease, traumatic brain injury, stroke, depression, attention-deficit/hyperactivity disorder (ADHD), schizophrenia, and bipolar disorder on immediate, short-, and long-delay verbal learning and memory (VLM) scores were estimated relative to matched healthy individuals. Random forest models identified age, years of education, and site as important VLM covariates. A Bayesian harmonization approach was used to isolate and remove site effects. Regression estimated the adjusted association of each clinical group with VLM scores. Memory deficits were strongly associated with dementia and schizophrenia

Verbal Learning and Memory Deficits across Neurological and Neuropsychiatric Disorders: Insights from an ENIGMA Mega Analysis.

Deficits in memory performance have been linked to a wide range of neurological and neuropsychiatric conditions. While many studies have assessed the memory impacts of individual conditions, this study considers a broader perspective by evaluating how memory recall is differentially associated with nine common neuropsychiatric conditions using data drawn from 55 international studies, aggregating 15,883 unique participants aged 15–90. The effects of dementia, mild cognitive impairment, Parkinson’s disease, traumatic brain injury, stroke, depression, attention-deficit/hyperactivity disorder (ADHD), schizophrenia, and bipolar disorder on immediate, short-, and long-delay verbal learning and memory (VLM) scores were estimated relative to matched healthy individuals. Random forest models identified age, years of education, and site as important VLM covariates. A Bayesian harmonization approach was used to isolate and remove site effects. Regression estimated the adjusted association of each clinical group with VLM scores. Memory deficits were strongly associated with dementia and schizophrenia (p \u3c 0.001), while neither depression nor ADHD showed consistent associations with VLM scores (p \u3e 0.05). Differences associated with clinical conditions were larger for longer delayed recall duration items. By comparing VLM across clinical conditions, this study provides a foundation for enhanced diagnostic precision and offers new insights into disease management of comorbid disorders

Verbal Learning and Memory Deficits across Neurological and Neuropsychiatric Disorders: Insights from an ENIGMA Mega Analysis.

Deficits in memory performance have been linked to a wide range of neurological and neuropsychiatric conditions. While many studies have assessed the memory impacts of individual conditions, this study considers a broader perspective by evaluating how memory recall is differentially associated with nine common neuropsychiatric conditions using data drawn from 55 international studies, aggregating 15,883 unique participants aged 15-90. The effects of dementia, mild cognitive impairment, Parkinson's disease, traumatic brain injury, stroke, depression, attention-deficit/hyperactivity disorder (ADHD), schizophrenia, and bipolar disorder on immediate, short-, and long-delay verbal learning and memory (VLM) scores were estimated relative to matched healthy individuals. Random forest models identified age, years of education, and site as important VLM covariates. A Bayesian harmonization approach was used to isolate and remove site effects. Regression estimated the adjusted association of each clinical group with VLM scores. Memory deficits were strongly associated with dementia and schizophrenia (p 0.05). Differences associated with clinical conditions were larger for longer delayed recall duration items. By comparing VLM across clinical conditions, this study provides a foundation for enhanced diagnostic precision and offers new insights into disease management of comorbid disorders

T-cell responses associated with resistance to Leishmania infection in individuals from endemic areas for Leishmania (Viannia) braziliensis

Subclinical or asymptomatic infection is documented in individuals living in endemic areas for leishmaniasis suggesting that the development of an appropriate immune response can control parasite replication and maintain tissue integrity. A low morbidity indicates that intrinsic factors could favor resistance to Leishmania infection. Herein, leishmanial T-cell responses induced in subjects with low susceptibility to leishmaniasis as asymptomatic subjects were compared to those observed in cured cutaneous leishmaniasis (CCL) patients, who controlled the disease after antimonial therapy. All of them have shown maintenance of specific long-term immune responses characterized by expansion of higher proportions of CD4+ as compared to CD8+ Leishmania reactive T-lymphocytes. Asymptomatic subjects had lower indexes of in vitro Leishmania induced lym-phoproliferative responses and interferon-gamma (IFN-γ) production in comparison to CCL patients. On the other hand, interleukin (IL-10) production was much higher in asymptomatics than in CCL, while no differences in IL-5 levels were found. In conclusion, long lived T-cell responses achieved by asymptomatic individuals differed from those who had developed symptomatic leishmaniasis in terms of intensity of lymphocyte activation (proliferation or IFN-γ) and regulatory mechanisms (IL-10). The absence of the disease in asymptomatics could be explained by their intrinsic ability to create a balance between immunoregulatory (IL-10) and effector cytokines (IFN-γ), leading to parasite destruction without producing skin tissue damage. The establishment of profiles of cell-mediated immune responses associated with resistance against Leishmania infection is likely to make new inroads into understanding the long-lived immune protection against the disease

Mem Inst T-cell responses associated with resistance to Leishmania infection in individuals from endemic areas for Leishmania (Viannia) braziliensis

Subclinical or asymptomatic infection is documented in individuals living in endemic areas for leishmaniasis suggesting that the development of an appropriate immune response can control parasite replication and maintain tissue integrity. A low morbidity indicates that intrinsic factors could favor resistance to Leishmania infection. Herein, leishmanial T-cell responses induced in subjects with low susceptibility to leishmaniasis as asymptomatic subjects were compared to those observed in cured cutaneous leishmaniasis (CCL) patients, who controlled the disease after antimonial therapy. All of them have shown maintenance of specific long-term immune responses characterized by expansion of higher proportions of CD4 + as compared to CD8 + Leishmania reactive T-lymphocytes. Asymptomatic subjects had lower indexes of in vitro Leishmania induced lymphoproliferative responses and interferon-gamma (IFN-γ) production in comparison to CCL patients. On the other hand, interleukin (IL-10) production was much higher in asymptomatics than in CCL, while no differences in IL-5 levels were found. In conclusion, long lived T-cell responses achieved by asymptomatic individuals differed from those who had developed symptomatic leishmaniasis in terms of intensity of lymphocyte activation (proliferation or IFN-γ) and regulatory mechanisms (IL-10). The absence of the disease in asymptomatics could be explained by their intrinsic ability to create a balance between immunoregulatory (IL-10) and effector cytokines (IFN-γ), leading to parasite destruction without producing skin tissue damage. The establishment of profiles of cell-mediated immune responses associated with resistance against Leishmania infection is likely to make new inroads into understanding the long-lived immune protection against the disease. Key words: asymptomatic infection -Leishmania (Viannia) braziliensis -cured leishmaniasis -cytokines -T-cell subsetslong term immunity (Grimaldi Jr &amp; MacMahon-Pratt 1991). The spectrum of the clinical presentation ranges from self-healing or benign cutaneous lesions to more severe forms, such as disseminated lesions or mucosal involvement Studies conducted in mice and humans have unequivocally shown that a major T-cell driven component underlies the establishment of acquired immunity and protection against re-infection ( The majority of ATL patients develop cutaneous leishmaniasis (CL) infection or asymptomatic individuals in endemic areas suggests that infected individuals can control Leishmania replication preventing the development of the disease. In this connection, the maintenance of Leishmania specific long-term immunity in asymptomatic subjects reinforces the idea that frequent parasite stimuli can confer protection against Leishmania re-infection or reactivation in individuals from endemic areas In asymptomatic individuals low levels of IFN-γ and TNF-α are induced contrasting with the strong production of these cytokines observed during active leishmaniasis In this study, leishmanial T-cell responses induced in asymptomatic subjects were compared to those observed in clinically cured patients. Our aim was to establish profiles of T-cell phenotypes and cytokines associated with resistance to leishmaniasis. We believe that such profiles can provide a better insight into the immunological mechanisms associated with protection against the disease. SUBJECTS, MATERIALS, AND METHODS Studied population -Twenty-eight individuals from endemic areas for L. (V.) braziliensis (Lb) infection in the state of Rio de Janeiro were studied. The subjects were divided into two groups: 11 asymptomatic subjects (4 males and 7 females, mean age ± SD = 40.2 ± 21 years, median = 37 years), 17 cured CL patients (CCL) evaluated 1-17 years after the end of therapy (8 males and 9 females, mean age ± SD = 42.5 ± 14.2 years, median = 40 years). Asymptomatic individuals had no clinical past history of skin ulcer suggestive of leishmaniasis. Subclinical infection was determined by in vitro evidence of induction of cellular responses to leishmanial antigens (lymphocyte activation-proliferation and/or IFN-γ production). CCL patients were diagnosed with leishmaniasis confirmed by clinical, parasitological, and/ or immunological tests and achieved clinical cure after successful antimonial therapy Sera from asymptomatic subjects or cured patients were non-reactive for the presence of Leishmania specific IgM and IgG immunoglobulins by indirect immunofluorescence. This study was approved by the Ethic Committee of the Fundação Oswaldo Cruz. Informed consent was obtained from all individuals. Lymphocyte proliferative response (LPR) assaysPeripheral blood mononuclear cells (PBMC) were used in LPR assays as previously described Phenotypic analysis -For obtaining leishmanial antigen-reactive T-cells, PBMC (3 × 10 6 per well) were in vitro cultured in 24-well flat-bottomed plates (Nunc) in the presence of the equivalent of 5 × 10 6 disrupted Lb promastigotes under conditions previously described. After five days in culture, cells were harvested and washed, and then blast cells were separated by centrifugation over discontinuous Percoll gradient (Sigma). For phenotypic analysis, Lb-reactive blast T-cells were incubated in the presence of 5 µl of monoclonal antibodies (Coulter Corporation, Hialeah, FL, US) for CD3 + (CD3-RD1), CD4 + (T4-FITC), and CD8 + (T8-RD1). After incubation, the cells were washed three times and resuspended in a fixing solution containing 1% paraformaldehyde in PBS prior to flow cytometric analysis. Blast cells were defined by forward and side-scatter gating. Each sample was run and data was analyzed with EXPO32 software in an EPICS ALTRA flow cytometer (Beckman-Coulter, Miami, US). Each culture&apos;s supernatant was collected on day 3 to test IL-5 and IL-10 concentrations and on day 5 to test IFN-γ concentration. Supernatants were stored at -20°C until use. Cytokine measurement -Cytokine assays were performed by enzyme-linked immunosorbent assay (ELISA). Monoclonal antibodies and recombinant cytokines were purchased from BD Biosciences Pharmingen, San Diego, CA, US. All samples were tested in duplicate and compared to standard curves to determine the cytokine concentration. The procedures were performed according to the manufacture&apos;s instructions, and the concentration was analyzed using SOFTmax PRO 4.0 program (Life Sciences Edition, Molecular Devices Corporation, US). Results were expressed in picograms per milliliter. The minimum cytokine levels detected were 62.5 pg/ml for IFNγ, 31.2 pg/ml for IL-10, and 15.6 pg/ml for IL-5. Statistical analysis -The Mann-Whitney test was used to compare the results for three groups. The analysis was performed by GraphPad InstatV2.04 (GraphPad Software, San Diego, CA, US) and SPSS (8.0 for Windows) softwares. The results were expressed as mean ± standard deviation and/or median. Mem Inst Oswaldo Cruz, Rio de Janeiro RESULTS LPR of PBMC stimulated in vitro with Lb-Ag -The LPR induced by Lb-Ag was positive (stimulation index ≥ 2.5) in all CCL patients (SI = 15.7 ± 14.7, median = 10.4, n = 17) and asymptomatic subjects (SI = 9.3 ± 9.8, median = 6.2, n = 11) Phenotypic characterization of Lb-reactive T-cells -T lymphocytes preferentially proliferated in response to leishmanial antigens: asymptomatic individuals (T CD3 + = 78 ± 14.7%, median = 78%, n = 02) and CCL patients (T CD3 + = 50 ± 21.7%, median = 49.4%, n = 14). A clear preferential induction of CD4 + over CD8 + T cells was observed in all analyzed groups: asymptomatic individuals -T CD4 + = 43.8 ± 19.8% (median = 47.6%, n = 10) and T CD8 + = 37.6 ± 13% (median = 35.3%, n = 10); CCL patients -T CD4 + = 29.5 ± 20% (median = 23.2%, n = 14), and T CD8 + = 13.8 ± 6.7% (median = 11.5%, n = 14). Higher percentages of CD4 + (p = 0.02) and CD8 + T-cells (p &lt; 0.0001) were observed in asymptomatic individuals as compared to CCL Cytokine production by PBMC stimulated in vitro with Lb-Ag -The mean levels of IFN-γ in the cell culture supernatants from asymptomatic individuals (1282 ± 972 pg/ml, median = 1064 pg/ml, n = 11) were lower than those observed CCL patients (1975 ± 2054 pg/ml, median = 1670 pg/ml, n = 17) (p &gt; 0.05). We found that among CCL there were high and low IFN-γ producers, and this cytokine was not detectable in three patients In contrast, IL-10 levels were significantly higher for asymptomatic individuals (733 ± 233 pg/ml, median = 698 pg/ml, n = 7) in comparison to CCL patients (416 ± 188 pg/ml, median = 403 pg/ml, n = 10) (p = 0.009). IL-5 production was observed in CCL patients (91.3 ± 71.3 pg/ml, median = 42 pg/ml, n = 11), but this cytokine was only detected in two out of nine asymptomatic subjects (45.2 ± 17.8 pg/ml). Immunity in asymptomatic human leishmaniasis • Rita C Bittar et al