Leishmania donovani parasites interact with gamma/delta+ human peripheral blood T cells and induce susceptibility to NK cell-mediated lysis

We recently reported that Leishmania donovani infect the human T-cell line in vitro. To examine whether primary human T cells could be infected by this parasite, a direct interaction of the peripheral blood T cells with L. donovani was examined. The percentage of gamma/delta+ T cells was markedly increased when in vitro generated normal human T-cell blasts were cultured with L. donovani amastigotes. About 30% of the gamma/delta+ T cells in the parasite exposed T-cell blasts expressed parasite antigens intracellularly without detectable intracellular parasites. Parasite exposed T-cell blasts had a reduced surface expression of HLA-DR and were lysed by the sorted CD56+ cells. In contrast, neither L. donovani amastigotes nor T-cell blasts exposed to heat killed amastigotes and/or were sensitive to the NK cell-mediated lysis. Of interest is that about 10% CD3+ peripheral blood T cells in two out of three Indian Kala-azar patients tested expressed intracellular L. donovani antigens.     

The effect of BCG-vaccine upon experimental visceral leishmaniasis in hamsters

Stimulation with Bacillus Calmette-Guerin (BCG) vaccine has been reported to enhance resistance of mice against Leishmania donovani infection. Such infection is usually lethal in hamsters, thus providing a more stringent animal model to assess the effect of BCG upon visceral leishmaniasis. Animals receive two IP injections (2-8 X 10(7) BCG) pre or post IC challenge with 4 X 10(6) amastigotes. Controls received BCG alone (with no infection) or were untreated (NT). Pretreated animals exhibited significantly fewer (P less than 0.05) hepatic or splenic amastigotes than NT animals at days 7, 14, and 28 post challenge, but most BCG treated hamsters died earlier than NT. Post treated hamsters showed no significant reduction in parasite burdens, or in median time to death as compared to NT group. Hamsters which received BCG but were not infected appeared healthy during the study. The reason for increased susceptibility of BCG-treated hamsters to disease is not clear, but observed pathologic complications of L. donovani infected hamsters appear to be exacerbated by BCG stimulation.     

Susceptibility of 3H-thymidine-prelabelled Leishmania donovani amastigotes and promastigotes to the cytotoxic activity of peritoneal, splenic and liver macrophages

C57BL/6 macrophage populations from spleen and liver, the main organs for the manifestation of visceral leishmaniasis, were investigated for their ability to perform spontaneous phagocytosis-associated killing of 3H-thymidine (3H-TdR)-prelabelled L. donovani amastigotes and promastigotes. The results showed that organ macrophages from spleen and liver killed L. donovani amastigotes and promastigotes spontaneously with high efficiency. This consistent finding was first detectable at 2-3 h, and the reaction was completed at 12 h. This type of killing was strongly enhanced when spleen and liver macrophages were activated. This phagocytosis-associated killing mechanism may contribute, to a large extent, in maintaining the infection under control in vivo, by drastically reducing the amount of parasites that is required to establish intracellular parasitism. To be able to assay phagocytosis-associated destruction of both promastigotes and amastigotes, a reproducible system for the production in vitro of Leishmania donovani amastigotes by the macrophage cell-line J774 was developed. The DNA of the Leishmania amastigotes was labelled with 3H-TdR with high efficiency. The spontaneous label release of prelabelled L. donovani amastigotes was comparable to that of prelabelled promastigotes over an assay period of 24 h.     

Immunochemotherapy for Leishmania donovani infection in golden hamsters: combinatorial action of poly ICLC plus L-arginine and sodium stibogluconate (Stibanate).

We demonstrate that golden hamsters infected with Leishmania donovani amastigotes develop the capacity to eliminate intracellular pathogens on treatment with low-dose standard antileishmanial sodium stibogluconate (Stibanate) in combination with polyinosinic-polycytidilic acid stabilized with polylysine and carboxymethycellulose (poly ICLC), a potent inducer of interferon (IFN) and immune enhancer, plus L-arginine. Data suggest that low doses of both Stibanate and poly ICLC plus L-arginine provide marginal inhibition against L. donovani infection in golden hamsters. When given in combination, however, a significant inhibition was achieved without toxicity, as all the animals survived up to 45 or 60 days. These results suggest that combination therapy using Stibanate and poly ICLC plus L-arginine may be very effective in reducing the dose of Stibanate and, hence, its dose-dependent toxicity in clinical situations.     

Comparative proteome analysis of Leishmania donovani at different stages of transformation from promastigotes to amastigotes

To pass through its life cycle, protozoan parasites of the genus Leishmania have to differentiate from promastigotes to amastigotes. The molecular basis underiving this major transformation is poorly understood. One way to study this phenomenon is to isolate and characterize proteins that are specifically expressed in one of the two stages of the life cycle or during the stage differentiation. Using two-dimensional gel electrophoresis, we mapped the Leishmania donovani proteome during stage differentiation to identify stage-specific proteins and regulons. A protocol for extracting proteins of both promastigote and amastigote L. donovani cells was developed, which is compatible with isoelectric focusing. Up to 400 L. donovani protein spots were visualized on a silver-stained gel. Metabolic labeling of the cells was used to compare directly the protein synthesis pattern with the protein level pattern. The silver-stained images of L. donovani cells harvested on different days of stage differentiation were compared to the corresponding autoradiographs. A marked decrease in protein synthesis during stage differentiation from promastigotes to amastigotes was observed. The stained protein pattern as well as the protein pattern on the autoradiograph changed dramatically, especially after day 3 (about 24 h after pH shift) of transformation.     

Multiplication of Leishmania in human macrophages in vitro.

To facilitate in vitro studies of the immunology of human leishmaniasis, we developed a method of growing pathogenic Leishmania in human monocyte-derived macrophages. After 6 days of incubation, adherent mononuclear cells were infected with Leishmania donovani amastigotes obtained from infected hamster spleen cells or with L. tropica amastigotes obtained from infected BALB/c tissue mouse footpad. Forty-eight percent of the macrophages were initially infected, with a mean of 3.0 amastigotes per infected macrophage. After 6 days of incubation, 59% of macrophages were infected and contained 8.8 amastigotes per infected macrophage, representing 2.9-fold multiplication. Electron microscopy revealed the presence of dividing parasites within phagolysosomes. These observations indicate that Leishmania survive and multiply within human monocyte-derived macrophages despite fusion of secondary lysosomes with the parasitophorous vacuole.     

Modulation of CD11C+ splenic dendritic cell functions in murine visceral leishmaniasis: correlation with parasite replication in the spleen

BALB/c mice resolve Leishmania donovani infection in the liver over an 8-12-week period. However, after an initial phase of 2-4 weeks where increases in parasite load are not readily detectable, parasite numbers in the spleen begin to increase reaching maximum levels at 16 weeks post-infection. Thereafter, parasite replication in the spleen is controlled and BALB/c mice maintain this residual parasite load in the spleen for many months, without further increase. We evaluated functions of CD11C+ splenic dendritic cells throughout the course of L. donovani infection in the spleen of BALB/c mice. Unlike the dendritic cell (DC)-specific antigen DEC-205, CD11C was not up-regulated on macrophages during visceral leishmaniasis. No appreciable impairment of splenic DC functions was observed when this antigen-presenting cell subset was purified from 30-day post-infected mice. Significant impairment in inducing allogeneic mixed lymphocyte reaction (MLR) and presenting L. donovani antigens or keyhole limpet haemocyanin (KLH) to specific T cells was observed with CD11C+ splenic DC purified from 60-day post-infected mice. Functional impairment of splenic DC at 60 days post-infection correlated with their reduced surface expression of major histocompatibility complex (MHC) class II molecules, impairment of interleukin-12 (IL-12) production and to their ability to suppress interferon-gamma (IFN-gamma) production by Leishmania antigen-primed T cells. Of interest, the impairment of splenic DC in presenting Leishmania antigens or KLH to specific T cells was corrected at 120 days post-infection, and correlated with their up-regulation of MHC class II expression, IL-12 production, induction of IFN-gamma by Leishmania antigen-primed T cells and the onset of control over splenic parasite replication in vivo. These results indicate that functional integrity of DC may be important in controlling L. donovani infection.     

Disruption of the murine interleukin-4 gene inhibits disease progression during Leishmania mexicana infection but does not increase control of Leishmania donovani infection.

The growths of both cutaneous leishmaniasis and visceral leishmaniasis caused by Leishmania mexicana and Leishmania donovani, respectively, were measured in interleukin-4 (IL-4) knockout mice (IL-4-/-) and compared with those of similarly infected wild-type (IL-4+/+) control mice. While large, nonhealing, cutaneous lesions containing large numbers of parasites developed in IL-4+/+ mice subcutaneously infected with 5 x 10(6) L. mexicana amastigotes in the shaven rump, in IL-4-/- mice no lesions whatsoever developed and parasites were difficult to detect. Systemic spread and metastasis were also noted in IL-4+/+ but not IL-4-/- mice. In contrast, IL-4-/- mice infected intravenously with 10(7) L. donovani amastigotes were found to have consistently higher parasite burdens in their livers throughout infection than did their wild-type counterparts. However, these differences were only significant at 15 days postinfection. While the results reported here pertaining to L. donovani largely support previous studies, those related to L. mexicana provide new observations. The immunological responses of IL-4-/- and IL-4+/+ mice infected with L. mexicana were, therefore, examined both in vivo and in vitro. Although neither IL-4-/- nor IL-4+/+ mice infected with L. mexicana produced parasite-specific immunoglobulin G2a antibodies, IL-4+/+ mice, unlike IL-4-/- mice, developed significant immunoglobulin G1 antibody titers as infection progressed, indicating a Th2-influenced response in wild-type mice. In addition, IL-4-/- mice, unlike IL-4+/+ mice, developed a significant delayed-type hypersensitivity response, indicating a Th1-influenced response in IL-4-/- mice. Following in vitro stimulation, splenocytes from IL-4+/+ mice infected with L. mexicana displayed significantly higher antigen-specific proliferative responses than did IL-4-/- mice. However, gamma interferon production as measured from the supernatants of the in vitro splenocyte cultures of IL-4-/- mice was significantly higher than that from IL-4+/+ mice. This again would indicate a predominantly Th1-influenced response in the absence of a Th2 response in IL-4-/- mice infected with L. mexicana. On the other hand, at the same time point, draining lymph node cells from IL-4+/+ mice produced significantly higher quantities of IL-5 than did those from IL-4-/- mice following in vitro antigenic stimulation.(ABSTRACT TRUNCATED AT 400 WORDS)     

Immunogenicity of soluble and particulate antigens from Leishmania donovani: effect of glucan as an adjuvant.

The protective efficacy of glucan as an adjuvant with killed promastigotes of Leishmania donovani was compared with that of soluble or particulate fractions of the parasite. When these vaccine preparations were injected either intravenously or subcutaneously in CF-1 mice, glucan potentiated resistance against L. donovani infections as reflected by significant reductions in hepatic amastigote counts relative to infected control mice. The leishmanial antigens alone afforded no protection. Serum direct agglutination titers to leishmanial antigens were highest in all groups given the vaccine intravenously, whereas the delayed-type hypersensitivity response to the antigen was positive only in groups immunized subcutaneously with glucan as an adjuvant. Some index of protection and immune response against visceral infection with the parasite was seen in groups vaccinated with glucan and soluble antigens. However, the protection afforded by glucan and particulate antigens of L. donovani more closely paralleled the resistance of mice treated with glucan and unfractionated killed promastigotes. Further antigenic analysis of particulate fractions of L. donovani may optimize effective immunization when used with appropriate adjuvants, e.g., glucan.     

Leishmaniasis in beige mice.

The courses of two protozoal diseases, cutaneous and visceral leishmaniasis, were examined in three groups of C57BL/6J mice. One group of mice was homozygous recessive for the beige gene (bg/bg). Beige mice are the genetic homologue of the human Chédiak-Higashi syndrome and, among other defects, are profoundly deficient in natural killer cell activity. Wild-type (+/+) mice, which respond to experimental cutaneous or visceral leishmaniasis by eventually eliminating their parasites, and heterozygous beige (bg/+) mice served as controls; both are phenotypically normal in natural killer cell activity, which is particularly high in the spleen. In bg/bg mice, the course of Leishmania tropica, a causative agent of cutaneous leishmaniasis, was similar to that in control mice after both primary and challenge inoculations. All groups of mice expressed similar humoral and cellular immune responses to L. tropica antigen. However, bg/bg mice failed to eliminate amastigotes of Leishmania donovani, a causative agent of visceral leishmaniasis, from their spleens over an observation period of 56 days, in contrast to bg/+ and +/+ controls. Similar levels of anti-leishmanial antibody were produced by all groups of mice, and all mice responded comparably to footpad injections of L. donovani antigen. The results of this study suggest a possible role for natural killer cells in recovery from L. donovani but not from L. tropica infection.     

Comparison of T-cell responses in self-limiting versus progressive visceral Leishmania donovani infections in golden hamsters.

Leishmania donovani infection in golden hamsters was studied as a model for human kala-azar. After intradermal inoculation of L. donovani amastigotes, hamsters developed positive skin reactions (delayed-type hypersensitivity [DTH]) to parasite antigens and lymphoid cells from these hamsters proliferated to parasite antigens in vitro and transferred DTH reactivity to normal recipients. In contrast, hamsters infected by the intracardial route developed progressive visceral infections and failed to respond to skin test antigens. Spleen cells, lymph node cells, and peripheral blood lymphocytes (PBLs) from these hamsters were unresponsive to parasite antigens in vitro, and spleen cells failed to transfer DTH to normal recipients. Spleen cells, but not PBLs, displayed depressed responses to T-cell mitogens and also suppressed the proliferative response of cells from hamsters inoculated intradermally. Removal of adherent cells restored the capacity of spleen cells, but not PBLs, to respond to parasite antigens. The nonadherent population of these spleen cells also transferred DTH to normal recipients. The adherent suppressor cells, which have the characteristics of macrophages, appear to be localized to the spleen and are apparently not responsible for the failure of peripheral lymphoid cells to respond to antigen. These studies suggest that hamsters with visceral infections develop a population of antigen-reactive cells and that in the absence of suppression these cells may express functional activities, including the capacity to elicit DTH responses.     

Host-parasite relationship in murine leishmaniasis: pathophysiological and immunological changes.

The host-parasite relationship in human visceral leishmaniasis remains poorly understood. In the present study, pathophysiological and immunological changes were examined in BALB/c mice infected with Leishmania donovani. These animals developed chronic infection with massive hepatosplenomegaly and hypergammaglobulinemia. In contrast to mice inoculated with 0.8 X 10(6) or 4 X 10(6) amastigotes, mice infected with 20 X 10(6) amastigotes failed to reduce liver parasite loads during 2 to 8 weeks of observation. At 8 weeks, liver size was increased by 26, 63, and 94%, respectively, in groups infected with 0.8 X 10(6), 4 X 10(6), or 20 X 10(6) amastigotes. Serum immunoglobulin G and M levels at 8 weeks in animals with the heaviest infection were increased by 53 and 80%, respectively, compared with controls. Specific antileishmanial antibodies were detected in the absence of antigen-specific delayed-type hypersensitivity or in vitro lymphocyte responses. Infection did not suppress the in vivo responses of mice to the non-parasite-related antigens sperm whale myoglobin or pneumococcal polysaccharide. Splenic mononuclear cell responses to phytohemagglutinin were suppressed as early as 2 weeks, and by 8 weeks, mice infected with 0.8 X 10(6), 4 X 10(6), or 20 X 10(6) amastigotes had phytohemagglutinin responses which were, respectively, 27.7, 13.9, and 15.8% of controls. Decreased phytohemagglutinin responses could not be related to reductions in splenic T cells; however, splenic B cells and macrophages were increased at 8 weeks of infection. The course of L. donovani infection and disease in BALB/c mice resembles events occurring in humans and should prove useful in defining mechanisms of immune alterations in visceral leishmaniasis.     

The respiratory burst is not required for killing of intracellular and extracellular parasites by a lymphokine-activated macrophage cell line

The macrophage cell line, IC-21, was found to be incapable of producing the oxygen products associated with the respiratory burst. However, IC-21 cells were activated by lymphokine (LK) to kill intracellular (Leishmania donovani amastigotes) and extracellular (Schistosoma mansoni larvae) parasites, as well as tumor cells. In each case, the cytotoxicity exhibited by activated IC-21 cells and activated peritoneal macrophages was indistinguishable. However, nonactivated IC-21 cells were unable to kill L. donovani log-growth phase promastigotes, while nonactivated peritoneal macrophages destroyed greater than 90% of the initial infection. These results indicate that amastigotes and schistosome larvae are susceptible to killing by nonoxidative cytotoxic mechanism induced by lymphokine activation but, on the other hand, support the concept that the killing of log-growth phase promastigotes by nonactivated cells is dependent upon the respiratory burst. We propose that the IC-21 cell line may be a useful model for studying nonoxidative killing functions of activated macrophages.     

免疫小鼠及正常小鼠巨噬细胞对利什曼无鞭毛期的吞噬作用

内脏利什曼原虫主要寄生在巨噬细胞系统的单核吞噬细胞内,在一般情况下其无鞭毛期能抵抗巨噬细胞的杀灭作用。 为了观察经杜氏利什曼原虫免疫后的小鼠其巨噬细胞的作用,我们采用了CFW纯系小鼠,经不同免疫方法于免疫后不同时间观察了体外培养中巨噬细胞的吞噬功能。实验采用的巨噬细胞与杜氏利什曼原虫前鞭毛期的比例为1:4。从每24小时吞噬功能的结果表明,经利什曼鞭毛体纯抗原免疫及福氏佐剂加利什曼抗原免疫的两组小鼠,均以免疫后3周的吞噬率最高,分别为72％及96％;两组吞噬指数的均值±SD(4.46±1.72,6.99±4.36)亦较正常组小鼠(1.68±1.25,1.72±1.15)为高,并具有显著差异(P<0.05)。提示了特异性抗原以及与佐剂合并具有对吞噬功能的激活作用。实验并观察了巨噬细胞内利什曼原虫无鞭毛期的活力作用,从吞噬原虫后20小时开始至 144小时,正常小鼠巨噬细胞内的无鞭毛期再经三恩氏培养基培养后均能恢复为前鞭毛期,而经免疫小鼠巨噬细胞内的利什曼原虫无鞭毛期在72小时后即消失活力。 另外,对小鼠腹腔巨噬细胞吞噬利什曼原虫的动态亦作了仔细观察。 实验结果说明了经过免疫的小鼠,由于被淋巴细胞激活后的巨噬细胞能杀死利什曼原虫,巨噬细胞在宿主对感染应答中是一个重要部分,对于探索黑热病的免疫机理具有一     

Isolation and purification of amastigotes ofTrypanosoma cruzi from cultured Vero cells

A method is described for the isolation and purification of the intracellular amastigotes ofTrypanosoma cruzi from cultured Vero cells. Host cells were infected with metacyclic forms obtained in Grace's medium. Six days after infection, the cells were subjected to treatment with trypsin to obtain the intracellular forms. The parasites were collected and purified by Percoll discontinuous gradient centrifugation.     

Non-specific and specific stimulation of resistance against Leishmania donovani in C57BL/6 mice

Stimulation by intravenous injections of glucan, a beta 1,3 polyglucose, provided a significant degree of resistance in mice against Leishmania donovani. The response of C57BL/6 animals was dose-dependent. A single glucan injection before or after infection induced significant resistance but to a lesser degree than two or three injections. Immunization by injections of formalin-killed promastigotes with glucan via the subcutaneous or intravenous routes provided greater resistance than glucan or dead parasites alone against subsequent infection with viable parasites. Subcutaneous immunization with promastigotes from cultures passaged 10 times in vitro and those from cultures maintained for 25 passages elicited a similar degree of resistance against infection and induced positive skin test responsiveness against leishmanial antigen prior to infection.     

Effect of intralesional treatment with emetine hydrochloride on Leishmania (Viannia) braziliensis in hamsters

The therapeutic effect of the emetine hydrochloride alkaloid administered intralesionally was compared with that of standard parenteral treatment with Glucantime in outbred male hamsters experimentally infected with 4 x 10(3) amastigotes of Leishmania (Viannia) braziliensis. Both chemotherapeutic agents reduced significantly (P < 0.01) the average lesion sizes in experimental animals in comparison with those untreated. The alkaloid infiltration was found to be as effective as the antimonial injection for clinical resolution. The ultrastructural effects on the Leishmania parasites exposed to emetine were observed mainly in the inner cytoplasm, which appeared disorganized, pycnotic and with loss of morphological definition; however, any known emetine hydrochloride action mechanism factor could not be directly related with ultrastructure effects detected on leishmanial parasites. Smears, conventional histopathology, culture in NNN medium and indirect immunoperoxidase method showed viable amastigotes in nodules and/or scars of all the evaluated hamsters 75 to 230 days after the end of treatment. These findings suggest that measurement of the size of cutaneous leishmania lesions does not appear to be a valid criterion for evaluating the efficiency of chemotherapy in experimental LT. Detection of leishmania parasites in the lesion scars, supports the hypothesis that man could be considered as an domestic reservoir.     

Mesangial proliferative glomerulonephritis associated with progressive amyloid deposition in hamsters experimentally infected with Leishmania donovani.

In the present work, 42 golden hamsters (Mesocricetus auratus) were infected by intracardiac injection of 5 X 10(6) amastigote forms of Leishmania donovani. Another group of 28 animals served as uninfected controls. Six hamsters of the infected group and four hamsters of the control group were selected randomly and sacrificed at Days 7, 14, 21, 28, 35, 42, and 49 after inoculation. The kidneys were studied by light microscopy, immunofluorescence and electron microscopy. The levels of serum and urinary immunoglobulins were determined. None of the control hamsters had kidney lesions. Light-microscopically the kidneys of infected hamsters showed a marked mesangial proliferation from Day 7 after infection. These changes were more pronounced at Day 21, when a discrete infiltration of mononuclear cells was frequent. These glomerular changes diminished after Day 28 and were replaced by deposits of amyloid. In the beginning these deposits were in the mesangium and progressively became more extensive, involving capillary loops, Bowman's capsule, and interstitium. The immunofluorescence study showed L donovani antigens and hamster immunoglobulins, primarily in the mesangial areas, by Days 7-14 after infection. These deposits extended into contiguous loops from Day 21 to Day 28. In the last 2 weeks the fluorescent staining for L donovani antigens remained intensely positive, whereas the staining for hamster immunoglobulins became moderate to slightly positive. The ultrastructural study revealed mesangial proliferation, mesangial and paramesangial electron-dense deposits, and amyloidosis in the glomeruli of infected animals. The serum immunoglobulins increased from Day 7 after infection, reaching a peak at Day 21 and falling thereafter until Day 49 to near control values. Immunoglobulins were detected in the urine of infected hamsters at day 21, increasing in amount thereafter. Since L donovani antigens and immunoglobulins were identified in the glomerular lesions, it is likely that they are implicated in the pathogenesis of the mesangial proliferative glomerulonephritis in hamsters experimentally infected with L donovani. The glomerular changes may also explain the loss of immunoglobulins in the urine and the consequent lowering of serum immunoglobulin levels.     

Amastigote stage-specific monoclonal antibodies against Leishmania major.

Monoclonal antibodies were produced against gamma-irradiated amastigotes of Leishmania major. Five antibodies (T16 through T20) were selected which reacted in enzyme-linked immunoassays with the intracellular stage of the parasite. These antibodies did not react with promastigotes of L. major or Leishmania donovani. One of the monoclonal antibodies (T16) reacted with amastigotes of Leishmania mexicana amazonensis and L. donovani. Western blotting (immunoblotting) and immunoprecipitation of [35S]methionine-labeled amastigotes demonstrates that T16 reacted with multiple L. major amastigote components between 12 and 180 kilodaltons. Antibody T20 was shown to recognize a low-molecular-mass doublet (less than 26 kilodaltons) in both [14C]leucine- and [35S]methionine-labeled amastigotes. A protein of less than 180 kilodaltons was also weakly recognized by T17, T19, and T20 in metabolically labeled amastigotes. This protein reacted strongly with T16. The reactive antigens could be identified on the surface of amastigotes isolated from the lesions of infected mice and on newly transformed amastigotes within 24 h after the infection of mouse peritoneal macrophages by promastigotes. These monoclonal antibodies should prove useful for the diagnosis of L. major in human tissue biopsies.     

Effect of treatment with BCG on the course of visceral leishmaniasis in BALB/c mice.

Intravenous inoculation of BCG was found to be both prophylactic and therapeutic in BALB/c mice against challenge with amastigotes of Leishmania donovani. Spleens and livers of mice inoculated with BCG maintained total parasite burdens at significantly lower levels when compared to controls. BCG administered intravenously 14 days prior to and on the same day of protozoan challenge was more protective than vaccine given 30 and 14 days prior to challenge. A level of 10(7) viable units of BCG provided more protection against challenge with parasites than did 10(6) viable units. BCG given the same route as the challenge dose of amastigotes provided more protection than if administered via some other route. BCG given to mice with an already established infection was shown to significantly reduce their parasite burdens.