Hypoxia promotes cytolytic activity of CD8 T cells and pathogenesis in cutaneous leishmaniasis

Abstract

Abstract Leishmaniasis is a disease caused by protozoan parasites of the genus Leishmania and the most common form of the disease is cutaneous leishmaniasis (CL). A fundamental question in CL is what regulates the development of severe disease, information that is critical to develop therapies to ameliorate disease. In a series of studies, we demonstrated CD8 T cell-dependent cytotoxicity as the main inducer of immunopathology in CL. This result was unexpected since IFN-γ production by CD8 T cells plays a protective role by promoting pathogen elimination. To resolve this paradox, we studied the CD8 T cells in different anatomic sites and found that the effector function of CD8 T cells in CL depends on their location: while CD8 T cells are cytotoxic (GzmB+) and produce little IFN-γ in leishmania lesions, CD8 T cells in the draining lymph nodes (dLN) have the opposite profile. Importantly, GzmB− CD8 T cells from dLN quickly upregulate GzmB after injection into CL lesions. By transcriptional profiling, we found that CD8 T cells in lesions and not dLN have a hypoxic signature. In vivo, we observed that leishmania lesions are hypoxic using the Oxyphor G4 oxygen probe and pimonidazole staining. In vitro, we found that induction of hypoxia was sufficient to convert GzmB− into GzmB+ CD8 T cells. In vivo, blocking the dimerization of HIF-α, a master regulator of hypoxia, with acriflavine decreased lesion development in mice. Transcriptional profiling in patients showed that hypoxia is a signature of human CL and correlates with GZMB expression. Together, our results suggest that the hypoxic microenvironment of leishmania lesions alter the function of CD8 T cells and convert protective CD8 T cells into pathogenic cytotoxic T cells. Supported by Host Defense and Microbial Biology (OSU)