A live Leishmania major vaccine containing CpG motifs induces the de novo generation of Th17 cells in C57BL/6 mice

Cutaneous leishmaniasis produces open sores that lead to scarring and disfiguration. We have reported that vaccination of C57BL/6 mice with live Leishmania major plus CpG DNA (Lm/CpG) prevents lesion development and provides long‐term immunity. Our current study aims to characterize the components of the adaptive immune response that are unique to Lm/CpG. We find that this vaccine enhances the proliferation of CD4⁺ Th17 cells, which contrasts with the highly polarized Th1 response caused by L. major alone; the Th17 response is dependent upon release of vaccine‐induced IL‐6. Neutralization of IFN‐γ and, in particular, IL‐17 caused increased parasite burdens in Lm/CpG‐vaccinated mice. IL‐17R‐deficient Lm/CpG‐vaccinated mice develop lesions, and display decreased IL‐17 and IFN‐γ, despite normal IL‐12, production. Neutrophil accumulation is also decreased in the IL‐17R‐deficient Lm/CpG‐vaccinated mice but Treg numbers are augmented. Our data demonstrate that activation of immune cells through CpG DNA, in the presence of live L. major, causes the specific induction of Th17 cells, which enhances the development of a protective cellular immunity against the parasite. Our study also demonstrates that vaccines combining live pathogens with immunomodulatory molecules may strikingly modify the natural immune response to infection in an alternative manner to that induced by killed or subunit vaccines.     

c-Rel promotes type 1 and type 17 immune responses during Leishmania major infection

Recent studies demonstrated the crucial role of c‐Rel in directing Treg lineage commitment and its involvement in T helper 1 (Th1) cell‐mediated autoimmune inflammation. We thus wondered whether these opposite functions of c‐Rel influence the course of antiparasitic immune responses against Leishmania major, an accepted model for the impact of T‐cell subsets on disease outcome. Here we show that c‐Rel‐deficient (rel^?/?) mice infected with L. major displayed dramatically exacerbated leishmaniasis and enhanced parasite burdens. In contrast to WT mice, IFN‐γ and IL‐17 production in response to L. major antigens was severely impaired in rel^?/? mice. Reconstitution of Rag1^?/? T‐cell deficient mice with rel^?/? CD4⁺ T cells followed by L. major infection demonstrated that c‐Rel‐deficient T cells mount normal Th1 responses and are able to contain the infection. Similarly, Th1 differentiation of naïve CD4⁺ cells in vitro was normal. Notably, a selective defect in IL‐12 and IL‐23 production was observed in rel^?/? DCs compared with their WT counterparts. In conclusion, our data suggest that the expression of c‐Rel in myeloid cells is essential for clearance of L. major and that this c‐Rel‐mediated effect is dominant over the lack of Tregs.     

L‐Arginine deprivation impairs Leishmania major‐specific T‐cell responses

The amino acid L ‐arginine plays a crucial role in the regulation of immune responses. We have recently shown that uncontrolled replication of Leishmania parasites at the site of pathology correlates with high levels of arginase activity in nonhealing leishmaniasis and that this elevated arginase activity causes local depletion of L ‐arginine. To further our understanding of the impact of L ‐arginine deprivation in experimental leishmaniasis, here we characterize in detail the effects of L ‐arginine deprivation on antigen‐specific T cells and MΦ. The results of our study show that decrease of L ‐arginine levels in the extracellular milieu affects the biological activities of Leishmania major‐specific T cells, both at the level of the magnitude and the quality of their responses. L. major‐specific CD4⁺ T cells rendered hyporesponsive by L ‐arginine deprivation can be partially rescued by addition of exogenous L ‐arginine to produce IL‐4 and IL‐10, but not to produce IFN‐γ. Furthermore, our results show that L ‐arginine deprivation also greatly impacts parasite growth in activated macrophages. In summary, our results suggest that L ‐arginine levels affect both Th cell responses and parasite replication.     

The Nlrp3 inflammasome,IL‐1β, and neutrophil recruitment are required for susceptibility to a nonhealing strain of Leishmania major in C57BL/6 mice

Infection of C57BL/6 mice with most Leishmania major strains results in a healing lesion and clearance of parasites from the skin. Infection of C57BL/6 mice with the L. major Seidman strain (LmSd), isolated from a patient with chronic lesions, despite eliciting a strong Th1 response, results in a nonhealing lesion, poor parasite clearance, and complete destruction of the ear dermis. We show here that in comparison to a healing strain, LmSd elicited early upregulation of IL‐1β mRNA and IL‐1β‐producing dermal cells and prominent neutrophil recruitment to the infected skin. Mice deficient in Nlrp3, apoptosis‐associated speck‐like protein containing a caspase recruitment domain, or caspase‐1/11, or lacking IL‐1β or IL‐1 receptor signaling, developed healing lesions and cleared LmSd from the infection site. Mice resistant to LmSd had a stronger antigen‐specific Th1 response. The possibility that IL‐1β might act through neutrophil recruitment to locally suppress immunity was supported by the healing observed in neutropenic Genista mice. Secretion of mature IL‐1β by LmSd‐infected macrophages in vitro was dependent on activation of the Nlrp3 inflammasome and caspase‐1. These data reveal that Nlrp3 inflammasome‐dependent IL‐1β, associated with localized neutrophil recruitment, plays a crucial role in the development of a nonhealing form of cutaneous leishmaniasis in conventionally resistant mice.     

Complete protection against experimental visceral leishmaniasis with complete soluble antigen from attenuated Leishmania donovani promastigotes involves Th1‐immunity and down‐regulation of IL‐10

Compared with cutaneous leishmaniasis, vaccination against visceral leishmaniasis has received limited attention. Most available drugs are toxic, and relapse after cure remains a chronic problem. Growing limitations in available chemotherapeutic strategies due to emerging resistant strains and lack of an effective vaccine strategy against visceral leishmaniasis deepens the crisis. Complete soluble antigen (CSA), from a β1‐4 galactosyltransferase expressing attenuated Leishmania donovani parasite, induced protection against subsequent challenge and during active infections. CSA immunization was effective against both pentavalent antimony sensitive and resistant strains of L. donovani. Majority (～85%) of the immunized animals showed sterile protection. Resolution of the disease required the presence of T cells, and the recovered animals remained immune to re‐challenge. Control of the parasites was dependent on type 1 CD4⁺ helper cells, which evolved in the presence of IL‐12 and activated macrophages through the production of IFN‐γ. Immunity was adoptively transferable and was dependent on both CD4⁺ and CD8⁺ cells. CSA immunization led to enhanced IFN‐γ production, while suppressing the IL‐10 production. However, CSA immunization did not abrogate IL‐4 production. Our results accentuate the need to establish a favorable cellular immunity while intervening with the development of Th2 cells during leishmania infection.     

Parasite dose determines the Th1/Th2 nature of the response to Leishmania major independently of infection route and strain of host or parasite

Leishmania major causes cutaneous leishmaniasis in mice and man. Infection of mice with relatively low or high numbers of parasites leads respectively to parasite containment, associated with a Th1, cell-mediated response, or progressive disease, associated with a Th2, antibody response in all circumstances studied. These include different parasite strains, different routes of infection, and different hosts previously classified as susceptible, resistant or of intermediate susceptibility. This dose dependency appears to reflect a general rule. We argue that this rule may allow the design of a vaccination strategy that is effective among a genetically diverse population, and that it imposes severe constraints upon proposals for the nature of the “decision criterion” determining whether antigen induces a Th1 or Th2 response.     

The induction of a protective response in Leishmania major-infected BALB/c mice with anti-CD40 mAb

A protective immune response to the intracellular parasite Leishmania major requires the development of a Th1 CD4⁺ T cell phenotype. We demonstrate herein that BALB/c mice, which normally develop a susceptible Th2 response to L. major infection, are protected when co-injected with an agonistic anti-murine CD40 mAb. Anti-CD40 mAb-mediated protection in this system was found to be T cell dependent, since it was not observed in C57BL/ 6 × 129 mice that were rendered T cell deficient (TCR β^–/– × TCR δ^–/–) and L. major susceptible. Anti-CD40 mAb stimulation of L. major-infected BALB/c mice was accompanied by increased IL-12 and IFN-γ production in draining lymphnodes, analyzed either by direct expression, or in an antigen-specific in vitro recall assay. The protective role of these cytokines was indicated by the finding that anti-CD40 mAb-mediated protection of L. major-infected BALB/c mice could be reversed by co-treating the animals with neutralizing anti-IL-12 and/or anti-IFN-γ mAb. Collectively, these data suggest that BALB/c mice develop a protective Th1 CD4⁺ T cell response to L. major infection when co-injected with anti-CD40 mAb. While the CD40-CD40L interaction has been previously shown to be vital in the control of murine Leishmaniasis, the current study establishes in vivo that anti-CD40 mAb treatment alone is sufficient to protect BALB/c mice from L. majorinfection and raises the possibility of utilizing this approach for vaccination strategies.     

Tracking antigen‐specific CD4+ T cells throughout the course of chronic Leishmania major infection in resistant mice

Primary Leishmania major infection typically produces cutaneous lesions that not only heal but also harbor persistent parasites. While the opposing roles of CD4⁺ T‐cell‐derived IFN‐γ and IL‐10 in promoting parasite killing and persistence have been well established, how these responses develop from naïve precursors has not been directly monitored throughout the course of infection. We used peptide:Major Histocompatibility Complex class II (pMHCII) tetramers to investigate the endogenous, parasite‐specific primary CD4⁺ T‐cell response to L. major in mice resistant to infection. Maximal frequencies of IFN‐γ⁺ CD4⁺ T cells were observed in the spleen and infected ears within a month after infection and were maintained into the chronic phase. In contrast, peak frequencies of IL‐10⁺ CD4⁺ T cells emerged within 2 weeks of infection, persisted into the chronic phase, and accumulated in the infected ears but not the spleen, via a process that depended on local antigen presentation. T helper type‐1 (Th1) cells, not Foxp3⁺ regulatory T cells, were the chief producers of IL‐10 and were not exhausted. Therefore, tracking antigen‐specific CD4⁺ T cells revealed that IL‐10 production by Th1 cells is not due to persistent T‐cell antigen receptor stimulation, but rather driven by early antigen encounter at the site of infection.     

Selective down-regulation of Th2 immune responses following treatment with antigen-coupled splenocytes

Intravenous injection of antigen-coupled splenocytes has been widely used to induce specific tolerance to a variety of antigens. In this study, we investigated the effects of such a treatment on Th1 and Th2 antigen-specific immune responses. Using both well-characterized model antigens and crude homogenates from Leishmania major promastigotes, we found that intravenous injection of antigen-coupled splenocytes strongly down-regulated antigen-specific Th2 responses but had no or only moderate effects on Th1 responses. Because the susceptibility of inbred strains of mice to murine leishmaniasis has been found to be correlated with a strong Th2 response against parasite antigens, we investigated whether administration of splenocytes chemically coupled to parasite antigens could protect susceptible mice from murine leishmaniasis. We found that this was indeed the case and further demonstrated that protection was associated with a strong decrease in the number of parasite-specific Th2-like cells. Because administration of antigen-coupled splenocytes is believed to induce ligation of the T cell receptor complex without inducing a co-stimulatory signal, our results further suggest that priming of Th1 cells is less dependent on co-stimulatory signals than the priming of Th2 cells.     

Transgenic Expression of CXCR3 on T Cells Enhances Susceptibility to Cutaneous Leishmania major Infection by Inhibiting Monocyte Maturation and Promoting a Th2 Response

Cutaneous leishmaniasis, caused mainly by Leishmania major, an obligate intracellular parasite, is a disfiguring disease characterized by large skin lesions and is transmitted by a sand fly vector. We previously showed that the chemokine receptor CXCR3 plays a critical role in mediating resistance to cutaneous leishmaniasis caused by Leishmania major. Furthermore, T cells from L. major-susceptible BALB/c but not L. major-resistant C57BL/6 mice fail to efficiently upregulate CXCR3 upon activation. We therefore examined whether transgenic expression of CXCR3 on T cells would enhance resistance to L. major infection in susceptible BALB/c mice. We generated BALB/c and C57BL/6 transgenic mice, which constitutively overexpressed CXCR3 under a CD2 promoter, and then examined the outcomes with L. major infection. Contrary to our hypothesis, transgenic expression of CXCR3 (CXCR3^Tg) on T cells of BALB/c mice resulted in increased lesion sizes and parasite burdens compared to wild-type (WT) littermates after L. major infection. Restimulated lymph node cells from L. major-infected BALB/c-CXCR3^Tg mice produced more interleukin-4 (IL-4) and IL-10 and less gamma interferon (IFN-γ). Cells in draining lymph nodes from BALB/c-CXCR3^Tg mice showed enhanced Th2 and reduced Th1 cell accumulation associated with increased neutrophils and inflammatory monocytes. However, monocytes displayed an immature phenotype which correlated with increased parasite burdens. Interestingly, transgenic expression of CXCR3 on T cells did not impact the outcome of L. major infection in C57BL/6 mice, which mounted a predominantly Th1 response and spontaneously resolved their infection similar to WT littermates. Our findings demonstrate that transgenic expression of CXCR3 on T cells increases susceptibility of BALB/c mice to L. major.     

Re-examination of the immunosuppressive mechanisms mediating non-cure of Leishmania infection in mice

Summary: The interleukin (IL)‐4 driven, polarized T‐helper 2 cell (Th2) response that controls non‐healing infection with Leishmania major in BALB/c mice has long been embraced as the underlying principle with which to consider the pathogenesis of non‐healing and systemic forms of leishmaniasis in humans. The inability, however, to reveal a Th2 polarity associated with non‐curing clinical disease has suggested that alternative cells and cytokines are involved in susceptibility. In this review, various mouse models of non‐curing infection with L. major and other Leishmania species are re‐examined in the context of the suppression mediated by IL‐10 and regulatory T (Treg) cells. These activities are revealed in L. major‐infected BALB/c IL‐4 knockout (KO) and IL‐4Rα KO mice and especially in non‐cure resistant mice that do not default to a Th2 pathway as a result of inherent defects in Th1 differentiation. In contrast to the extreme BALB/c susceptibility arising from an aberrant Th2 response, non‐cure in resistant mice arises from an imbalance in Treg cells that are activated in the context of an ongoing Th1 response and whose primary function may be to suppress the immunopathology associated with persistent antiparasite responses in infected tissues.     

Interleukin-4 transgenic mice of resistant background are susceptible to Leishmania major infection

The outcome of cutaneous leishmaniasis is dependent on the balance of Th1 and Th2 cells. In the murine model, Th1 cells are host-protective whereas the Th2 cells are disease-promoting. However, the in vivo role of interleukin-4 (IL-4), a signature product of Th2 cells, is uncertain. We compared the course of Leishmania major infection in the genetically resistant 129/Sv mice and the mutant 129/Sv mice transgenic for the murine IL-4 gene under the control of the immunoglobulin heavy chain enhancer and promoter. We report here that in contrast to their wild-type parents, the IL-4 transgenic mice are susceptible to L. major infection. This is associated with the development of inexorably progressive lesions and parasite loads. Spleen cells from infected transgenic mice produced significantly higher levels of IL-4 but lower amounts of interferon-γ when stimulated in vitro with leishmanial antigens compared to those from infected normal 129/Sv mice. Furthermore, sera from the infected transgenic mice contained higher levels of IL-4 and IgE than the sera of infected normal 129/Sv mice. These results, therefore, establish in a new animal model that IL-4 promotes disease development in murine cutaneous leishmaniasis.     

Mast cells are activated by Staphylococcus aureus in vitro but do not influence the outcome of intraperitoneal S. aureus infection in vivo

Staphylococcus aureus is a major pathogen that can cause a broad spectrum of serious infections including skin infections, pneumonia and sepsis. Peritoneal mast cells have been implicated in the host response towards various bacterial insults and to provide mechanistic insight into the role of mast cells in intraperitoneal bacterial infection we here studied the global effects of S. aureus on mast cell gene expression. After co‐culture of peritoneal mast cells with live S. aureus we found by gene array analysis that they up‐regulate a number of genes. Many of these corresponded to pro‐inflammatory cytokines, including interleukin‐3, interleukin‐13 and tumour necrosis factor‐α. The cytokine induction in response to S. aureus was confirmed by ELISA. To study the role of peritoneal mast cells during in vivo infection with S. aureus we used newly developed Mcpt5‐Cre⁺ × R‐DTA mice in which mast cell deficiency is independent of c‐Kit. This is in contrast to previous studies in which an impact of mast cells on bacterial infection has been proposed based on the use of mice whose mast cell deficiency is a consequence of defective c‐Kit signalling. Staphylococcus aureus was injected intraperitoneally into mast‐cell‐deficient Mcpt5‐Cre⁺ × R‐DTA mice using littermate mast‐cell‐sufficient mice as controls. We did not observe any difference between mast‐cell‐deficient and control mice with regard to weight loss, bacterial clearance, inflammation or cytokine production. We conclude that, despite peritoneal mast cells being activated by S. aureus in vitro, they do not influence the in vivo manifestations of intraperitoneal S. aureus infection.     

T‐cell‐specific deletion of gp130 renders the highly susceptible IL‐10‐deficient mouse resistant to intestinal nematode infection

Gp130 is the common receptor of the IL‐6 family of cytokines and is involved in many biological processes, including acute phase response, inflammation and immune reactions. To investigate the role of gp130 under inflammatory conditions, T‐cell‐specific conditional gp130 mice were first bred to the IL‐10‐deficient background and were then infected with the gastrointestinal nematode Trichuris muris. While IL‐10^?/? mice were highly susceptible to T. muris, developed a mixed Th1/Th17 response and displayed severe inflammation of the caecum, infection of mice with an additional T‐cell‐specific deletion of gp130 signalling completely reversed the phenotype. These mice showed an accelerated worm expulsion that was associated with the rapid generation of a strong Th2 immune response and a significant increase in Foxp3‐expressing Treg. Therefore, gp130 signalling in T cells regulates a switch between proinflammatory and pathogenic Th1/Th17 cells and regulatory Th2/Treg in vivo. Taken together, the data demonstrate that gp130 signalling in T cells is a positive regulator of inflammatory processes, favouring the Th1/Th17 axis.     

Mast cells protect against airway Mycoplasma pneumoniae under allergic conditions

Background Infection with Mycoplasma pneumoniae (Mp) in asthma can occur both acutely and chronically with an associated Th2 inflammatory response and/or increased numbers of bronchial mast cells. Mast cells have previously been shown to promote mycoplasma clearance in mice; however, it is unknown whether mast cells would aid Mp clearance under allergic conditions. Objective Our aim was to determine the impact of allergic inflammation on mast cell‐mediated lung Mp clearance. Furthermore, as we have previously demonstrated an essential role for IL‐6 in lung Mp clearance we also investigated the role of mast cell‐derived IL‐6. Methods Mast cell‐deficient (WBB6F1/J‐Kit^W/Kit^W‐v) mice were challenged with ovalbumin to induce airway inflammation before Mp infection. The role of mast cell‐derived IL‐6 in bacterial clearance was further investigated by reconstitution of mast cell‐deficient mice with IL‐6^?/? mast cells. Results Allergic mast cell‐deficient mice exhibited increased lung Mp burden compared with control littermates. Intravenous adoptive transfer of wild‐type and IL‐6^?/? mast cells significantly improved Mp clearance in mast cell‐deficient mice. Acutely after Mp infection, allergen‐challenged mast cell‐deficient mice had increased levels of the pro‐inflammatory cytokines IL‐6 and TNF‐α in the bronchoalveolar lavage (BAL) fluid. The total number of neutrophils was also increased in mast cell‐deficient mice. Conclusions Our results establish that mast cells aid host defense against Mp in an allergic setting and that while IL‐6 is necessary for lung Mp clearance, mast cell‐derived IL‐6 is not required. Cite this as: N. M. Michels, H. W. Chu, S. C. LaFasto, S. R. Case, M. N. Minor and R. J. Martin, Clinical & Experimental Allergy, 2010 (40) 1406–1413.     

Deficiency of prolactin‐inducible protein leads to impaired Th1 immune response and susceptibility to Leishmania major in mice

Although the strategic production of prolactin‐inducible protein (PIP) at several ports of pathogen entry into the body suggests it might play a role in host defense, no study has directly implicated it in immunity against any infectious agent. Here, we show for the first time that PIP deficiency is associated with reduced numbers of CD4⁺ T cells in peripheral lymphoid tissues and impaired CD4⁺ Th1‐cell differentiation in vitro. In vivo, CD4⁺ T cells from OVA‐immunized, PIP‐deficient mice showed significantly impaired proliferation and IFN‐γ production following in vitro restimulation. Furthermore, PIP‐deficient mice were highly susceptible to Leishmani major infection and failed to control lesion progression and parasite proliferation. This susceptibility was associated with impaired NO production and leishmanicidal activity of PIP KO macrophages following IFN‐γ and LPS stimulation. Collectively, our findings implicate PIP as an important regulator of CD4⁺ Th1‐cell‐mediated immunity.     

Cross‐presenting dendritic cells are required for control of Leishmania major infection

Leishmania major infection induces self‐healing cutaneous lesions in C57BL/6 mice. Both IL‐12 and IFN‐γ are essential for the control of infection. We infected Jun dimerization protein p21SNFT (Batf3 ^?/? ) mice (C57BL/6 background) that lack the major IL‐12 producing and cross‐presenting CD8α⁺ and CD103⁺ DC subsets. Batf3^?/? mice displayed enhanced susceptibility with larger lesions and higher parasite burden. Additionally, cells from draining lymph nodes of infected Batf3^?/? mice secreted less IFN‐γ, but more Th2‐ and Th17‐type cytokines, mirrored by increased serum IgE and Leishmania‐specific immunoglobulin 1 (Th2 indicating). Importantly, CD8α⁺ DCs isolated from lymph nodes of L. major‐infected mice induced significantly more IFN‐γ secretion by L. major‐stimulated immune T cells than CD103⁺ DCs. We next developed CD11c‐diptheria toxin receptor: Batf3^?/? mixed bone marrow chimeras to determine when the DCs are important for the control of infection. Mice depleted of Batf‐3‐dependent DCs from day 17 or wild‐type mice depleted of cross‐presenting DCs from 17–19 days after infection maintained significantly larger lesions similar to mice whose Batf‐3‐dependent DCs were depleted from the onset of infection. Thus, we have identified a crucial role for Batf‐3‐dependent DCs in protection against L. major.     

Murine model of chronic L. (Viannia) panamensis infection: Role of IL‐13 in disease

Leishmania (Viannia) organisms are the most prevalent etiologic agents of human cutaneous leishmaniasis in the Americas. Nevertheless, our knowledge of the immunological mechanisms exploited by L. (Viannia) organisms remains limited and the mechanisms underlying disease are not well understood. Here, we report the development of a BALB/c mouse model of L. (V.) panamensis infection that is able to reproduce chronic disease, with persistent infection and clinically evident lesions for over 1 year. The immune response of the mouse resembles that found for L. (V.) panamensis‐infected patients with chronic and recurrent lesions, presenting a mixed Th1/Th2 response with the presence of TNF‐α, IFN‐γ, IL‐10 and IL‐13. Using immunodeficient mice, the critical role for IL‐13 and/or IL‐4Rα in determining susceptibility to chronic infection was evident. With the induction of healing in the immunodeficient mice, increases in IFN‐γ and IL‐17 were found, concomitant with parasite control and elimination. Specifically, increases in CD4⁺ (but not CD8⁺) T cells producing IFN‐γ were observed. These results suggest that IL‐13 represents an important target for disease control of L. (V.) panamensis infection. This murine model should be useful to further understand the pathology associated with chronic disease and to develop methods for the treatment and prevention of leishmaniasis caused by L. (Viannia) parasites.     

Synergy between activated Leishmania major-specific CD4+ T lymphocytes and bone-marrow-derived cells in the exacerbation of murine cutaneous leishmaniasis

Mechanisms of exaberbation of murine cutaneous leishmaniasis mediated by Leishmania major-specific CD4⁺ T lymphocytes were studied. Using a limiting dilution assay for the quantification of Leishmania parasites, the infected tissues (footpad) of lethally irradiated mice were found to contain tenfold less parasites at four days of infection than the footpads of infected unirradiated animals. Injection of bone marrow cells depleted of T cells into irradiated mice at the site of infection led to an increase in parasite numbers to levels equivalent to those seen in unirradiated mice. After injection of either L. major-specific CD4⁺ T cells, previously shown to exacerbate cutaneous leishmaniasis, into the infected footpad or the intravenous (i.v.) injection of bone marrow cells depleted of T cells, the numbers of parasites in lesions of irradiated mice never reached the values found in unirradiated control mice. In contrast, the concomitant transfer of CD4⁺ T-cell populations in situ and bone marrow cells depleted of T cells intravenously led to an increase in parasite loads in irradiated mice up to levels comparable to those of the unirradiated mice. This suggested that recruitment of myelomonocytic cells at the site of the lesions plays a role in the exacerbation of murine cutaneous leishmaniasis mediated by these CD4⁺ T lymphocytes. Finally, a similar effect was observed with T cells specific for an antigen unrelated to Leishmania, provided that this antigen was added to the L. major infecting inoculum.