Where do we stand on the autoimmunity hypothesis of Chagas disease?

The question posed in the title elicits as much controversy today as it did when I wrote about this subject in the first issue of Parasitology Today 20 years ago. A consensus is now emerging that Trypanosoma cruzi, the etiological agent of Chagas disease, bears primary responsibility for producing chagasic pathology. Whether one or more of the autoimmune events described in human and experimental Chagas disease can contribute to, or aggravate, this pathology is the current question.

Views on the autoimmunity hypothesis for Chagas disease pathogenesis.

Initially, the notion that the pathogenesis of Chagas disease has an autoimmune component was based on the finding that sera from Trypanosoma cruzi-infected patients or laboratory animals contain antibodies that recognize both parasite and host tissue antigens. Subsequent work suggested that T lymphocytes from chagasic patients and animals also displayed such cross-reactivity. However, the autoimmunity hypothesis has remained controversial because of experimental pitfalls, incomplete or inadequate controls, difficulties in reproducing some key results, and a lack of persuasive evidence that the cross-reactive antibodies or lymphocytes can truly effect the multifaceted pathological features of Chagas disease. Whether the immunologic autoreactivities described to date cause chagasic pathology or result from it is another unresolved question. Discussed herein are the most recent contributions to this topic and the reservations they have raised.

The Trypanosoma cruzi membrane glycoprotein AGC10 inhibits human lymphocyte activation by a mechanism preceding translation of both, interleukin-2 and its high-affinity receptor subunits.

Like living Trypanosoma cruzi, its AGC10 membrane glycoprotein inhibits interleukin-2 (IL-2) secretion and membrane expression of CD25, CD122, and CD132 (the components of the high-affinity IL-2 receptor) by activated human lymphocytes. Since these molecules are required for effective lymphocyte division, we explored the molecular mechanism underlying these alterations. In the presence of AGC10 the cytoplasmic levels of IL-2 protein of CD4(+) and CD8(+) blood lymphocytes stimulated with phorbol myristate acetate (PMA) plus ionomycin were markedly reduced. AGC10 also decreased the intracellular levels of CD25, CD122, and CD132 in CD4(+) and CD8(+) cells stimulated with the T-cell mitogen phytohemagglutinin (PHA). These results indicated that the AGC10-induced alterations preceded IL-2 secretion and transport of IL-2 receptor components to the cell membrane. Supporting this view were the substantially diminished levels of IL-2, CD25, CD122, and CD132 mRNA found in AGC10-containing cultures of PHA-activated lymphocytes. These decreases were not due to increased mRNA instability. Thus, the rates of decay for each of these mRNA species were comparable in the presence or absence of AGC10, suggesting a mechanism involving transcription inhibition. AGC10 targeted an early lymphocyte activation event since inhibition of lymphoproliferation subsided when AGC10 was added to cultures at or after 20 h post-activation. AGC10 also caused large reductions in the mRNA levels of cyclin D2 and cdk4, both critical for progression through G1. These results show for the first time that AGC10-induced inhibition of lymphoproliferation entails curtailed biosynthesis of IL-2 and, IL-2 receptor molecules, and suggest that the effect involves inhibition of gene transcription.

Molecular basis of Trypanosoma cruzi-induced immunosuppression. Altered expression by activated human lymphocytes of molecules which regulate antigen recognition and progression through the cell cycle

The mechanisms by which Trypanosoma cruzi causes dysfunction in normal human lymphocytes was studied by using an in vitro system in which purified parasites and normal peripheral blood mononuclear cells are co-cultured in the presence or absence of mitogens. Our results have shown that T. cruzi impairs the expression of receptors for interleukin-2 (IL-2R) and transferrin, activated lymphocyte membrane molecules which play key roles in controlling progression through the cell cycle. T. cruzi also downregulates the expression of constitutive lymphocyte molecules (e.g., CD4, and CD8) involved in the interactions between antigen-presenting cells and T lymphocytes as well as the expression of T cell receptor (TCR) and CD3 molecules. The latter molecular structures are physically associated and are responsible for signaling and transducing activation events resulting from antigen binding. Stimulated B lymphocytes also display reduced IL-2R expression in the presence of T. cruzi. In contrast, neither the expression of EA-1 molecules by T lymphocytes nor that of CD19 and CD20 molecules by B lymphocytes is affected by this parasite. Thus, the T. cruzi effects are selective, not indiscriminate. The activated T cell populations affected by T. cruzi show concomitant reductions in the levels of expression of IL-2R and CD4, IL-2R and CD8, IL-2R and CD3 or IL-2R and TCR as well as in their capacity to proliferate; 3H-thymidine uptake decreases and there is a massive arrest of cells at the G0/G1a phase of the cell cycle. The immunosuppressive effects of T. cruzi are reproduced by a protein molecule(s) released spontaneously by the parasite termed TIF (for trypanosomal immunosuppressive factor). We report herein that TIF does not compete with IL-2 for binding to IL-2R and that shedding of IL-2R is decreased in the presence of T. cruzi. Moreover, the intracellular level of IL-2R was found to be lower than that found in control cells cultured in the absence of parasites. These results suggest that suppressed IL-2R reflects a modification induced by T. cruzi at a time coinciding with or preceding IL-2R mRNA translation. Studies are underway to identify the earliest process targeted by T. cruzi