Background:
Leishmania braziliensis
, a protozoan prevalent in Brazil,
is the known causative agent of cutaneous leishmaniasis (CL). The activation
of M1 macrophages is a pivotal factor in the host's ability to eliminate the
parasite, whereas M2 macrophages may facilitate parasite proliferation. This
study analyzed the clinical outcomes of CL and the patients' immunological
profiles, focusing on the prevalence of M1 and M2 macrophages, cytokine
production, and annexin-A1 (ANXA1) expression in the lesion.
Methods:
Data were obtained by polymerase chain reaction (PCR) and histopathological,
immunofluorescence, and cytokine analyses.
Results:
Patients with exudative and cellular reaction-type (ECR)-type lesions that
healed within 90 days showed a significant increase in M1. Conversely,
patients with ECR and exudative and granulomatous reaction (EGR)types, who
healed within 180 days, showed an elevated number of M2. Cytokines
interferon (IFN)-γ and tumor necrosis factor (TNF)-α were higher in ECR
lesions that resolved within 90 days (P<0.05). In contrast, IL-9 and
IL-10 levels significantly increased in both ECR and EGR lesions that healed
after 180 days (P<0.001). The production of IL-21, IL-23 and TGF-β was
increased in patients with ECR or EGR lesions that healed after 180 days
(P<0.05). The expression of ANXA1 was higher in M2 within ECR-type
lesions in patients who healed after 180 days (P<0.05).
Conclusions:
These findings suggest that the infectious microenvironment induced by L.
braziliensis affects the differentiation of M1 and M2 macrophages, cytokine
release, and ANXA1 expression, thereby influencing the healing capacity of
patients. Therefore, histopathological and immunological investigations may
improve the selection of CL therapy.