The Liver and the Hepatic Immune Response in Trypanosoma cruzi Infection, a Historical and Updated View

Chagas disease was described more than a century ago and, despite great efforts to understand the underlying mechanisms that lead to cardiac and digestive manifestations in chronic patients, much remains to be clarified. The disease is found beyond Latin America, including Japan, the USA, France, Spain, and Australia, and is caused by the protozoan Trypanosoma cruzi. Dr. Carlos Chagas described Chagas disease in 1909 in Brazil, and hepatomegaly was among the clinical signs observed. Currently, hepatomegaly is cited in most papers published which either study acutely infected patients or experimental models, and we know that the parasite can infect multiple cell types in the liver, especially Kupffer cells and dendritic cells. Moreover, liver damage is more pronounced in cases of oral infection, which is mainly found in the Amazon region. However, the importance of liver involvement, including the hepatic immune response, in disease progression does not receive much attention. In this review, we present the very first paper published approaching the liver's participation in the infection, as well as subsequent papers published in the last century, up to and including our recently published results. We propose that, after infection, activated peripheral T lymphocytes reach the liver and induce a shift to a pro-inflammatory ambient environment. Thus, there is an immunological integration and cooperation between peripheral and hepatic immunity, contributing to disease control.

The liver plays a major role in clearance and destruction of blood trypomastigotes in Trypanosoma cruzi chronically infected mice

Intravenous challenge with Trypanosoma cruzi can be used to investigate the process and consequences of blood parasite clearance in experimental Chagas disease. One hour after intravenous challenge of chronically infected mice with 5×10⁶ trypomastigotes, the liver constituted a major site of parasite accumulation, as revealed by PCR. Intact parasites and/or parasite remnants were visualized at this time point scattered in the liver parenchyma. Moreover, at this time, many of liver-cleared parasites were viable, as estimated by the frequency of positive cultures, which considerably diminished after 48 h. Following clearance, the number of infiltrating cells in the hepatic tissue notably increased: initially (at 24 h) as diffuse infiltrates affecting the whole parenchyma, and at 48 h, in the form of large focal infiltrates in both the parenchyma and perivascular spaces. Phenotypic characterization of liver-infiltrating cells 24 h after challenge revealed an increase in Mac1⁺, CD8⁺ and CD4⁺ cells, followed by natural killer (NK) cells. As evidence that liver-infiltrating CD4⁺ and CD8⁺ cells were activated, increased frequencies of CD69⁺CD8⁺, CD69⁺CD4⁺ and CD25⁺CD122⁺CD4⁺ cells were observed at 24 and 48 h after challenge, and of CD25⁻CD122⁺CD4⁺ cells at 48 h. The major role of CD4⁺ cells in liver protection was suggested by data showing a very high frequency of interferon (IFN)-γ-producing CD4⁺ cells 24 h after challenge. In contrast, liver CD8⁺ cells produced little IFN-γ, even though they showed an enhanced potential for secreting this cytokine, as revealed by in vitro T cell receptor (TCR) stimulation. Confirming the effectiveness of the liver immune response in blood parasite control during the chronic phase of infection, no live parasites were detected in this organ 7 days after challenge.

Chagas disease, a Latin American illness caused by the protozoan parasite Trypanosoma cruzi, has only rare spontaneous cure, and in most patients a small number of parasites persists for life in the blood and tissues, leading to chronic disorders such as cardiomyopathy. In a murine model of chronic T. cruzi infection we observed that the liver plays an important role in the clearance of blood-circulating parasites. Moreover, parasite accumulation in this organ is followed by their elimination, an effect that is not immediate but seems to depend on the recruitment of leukocytes and on the local production of IFN-γ, a cytokine known to increase the T. cruzi-killing capacity of phagocytes. Our findings contribute to the knowledge of T. cruzi-host interaction, showing the participation of a non-lymphoid organ in parasite control. In addition, they contribute to understanding the multifaceted role the liver plays in the immune response.

Alterations of the microcirculatory network during the clearance of epimastigote forms of Trypanosoma cruzi: an intravital microscopic study

The distribution of epimastigote forms of Trypanosoma cruzi in the microcirculatory network and the vessel alterations were observed using an intravital microscopy technique. Immediately after intravenous inoculation of 2 x 10(6) epimastigote suspension into normal mice, parasites were seen as circulating clumps, and their retention at some sites of the endothelium of venules and capillaries was observed. Injection of 2 x 10(7) and 2 x 10(8) parasite suspensions induced, respectively, intermittent or total stasis of venules and capillaries, probably via obstruction by clumping. The mobility of epimastigotes in the clumps indicates that parasites were alive in the lumen of vessels. The retention of clumps in the capillaries, although intense, could only be observed when labeled parasites were inoculated. These results suggest that the rapid clearance of epimastigote forms of T. cruzi from the blood circulation of mice may be due to the retention of parasites to the endothelium of venules and capillaries that, in turn, may facilitate phagocytosis. This may be a mechanism by which mice are able to eliminate epimastigote forms from the circulation. These findings are consistent with our previous observations showing that epimastigotes are not lysed by complement activation but are phagocytosed and destroyed by a distinct population of blood cells.

Changes of anti-Trypanosoma cruzi antibodies after gamma-irradiation of mice in the chronic phase of the infection

The effect of sublethal whole body irradiation (800 rads) on the level and biological activities of antibodies in mice chronically infected with the CL strain of Trypanosoma cruzi was studied. Irradiated mice died, although a high parasitemia did not always preceded death. Before and after irradiation, a constant level of antibodies was detected by enzyme-linked immunosorbent assay and complement mediated lysis, but after irradiation the level of clearance antibodies was decreased. These results suggest that clearance antibodies are important in the control of the chronic phase of the infection.

How are antibodies involved in the protective mechanism of susceptible mice infected with T. cruzi?

Host resistance to Trypanosoma cruzi is dependent on both natural and acquired immune responses. During the acute phase of the infection the presence of IFN-gamma, TNF-alpha, IL-12 and GM-CSF has been closely associated with resistance, whereas TGF-ss and IL-10 have been associated with susceptibility. Several investigators have demonstrated that antibodies are responsible for the survival of susceptible animals in the initial phase of infection and for the maintenance of low levels of parasitemia in the chronic phase. However, how this occurs is not yet understood. Our results and other data in the literature support the hypothesis that the protective role of antibodies in the acute phase of infection is dependent mostly on their ability to induce removal of bloodstream trypomastigotes from the circulation in addition to other concomitant cell-mediated events.