title: Zinc/copper imbalance reflects immune dysfunction in human leishmaniasis: an ex vivo and in vitro study.
abstract: BACKGROUND
  The process of elimination of intracellular pathogens, such as Leishmania, requires a Th1 type immune response, whereas a dominant Th2 response leads to exacerbated disease. Experimental human zinc deficiency decreases Th1 but not Th2 immune response. We investigated if zinc and copper levels differ in different clinical forms of leishmaniasis, and if these trace metals might be involved in the immune response towards the parasite.
  
  
  METHODS
  Blood was collected from 31 patients with either localized cutaneous (LCL), mucosal (ML) or visceral (VL) leishmaniasis, as well as from 25 controls from endemic and non-endemic areas. Anti-Leishmania humoral and cellular immune response were evaluated by quantifying specific plasma IgG, lymphoproliferation and cytokine production, respectively. Plasma levels of Cu and Zn were quantified by atomic absorption spectrophotometry.
  
  
  RESULTS
  A significant decrease in plasma Zn was observed in all three patient groups (p < 0.01 for LCL and ML, p < 0.001 for VL), as compared to controls, but only VL (7/10) and ML (1/7) patients displayed overt Zn deficiency. Plasma Cu was increased in LCL and VL (p < 0.001) but not in ML, and was strongly correlated to anti-Leishmania IgG (Spearman r = 0.65, p = 0.0028). Cu/Zn ratios were highest in patients with deficient cellular (VL<<LCL<ML) and exacerbated humoral (VL>LCL>ML) immune response. Ex vivo production of parasite-induced IFN-gamma was negatively correlated to plasma Cu levels in LCL (r = -0.57, p = 0.01). In vitro, increased Cu levels inhibited IFN-gamma production.
  
  
  CONCLUSIONS
  1. Zn deficiency in VL and ML indicate possible therapeutic administration of Zn in these severe forms of leishmaniasis. 2. Plasma Cu positively correlates to humoral immune response across patient groups. 3. Environmentally or genetically determined increases in Cu levels might augment susceptibility to infection with intracellular pathogens, by causing a decrease in IFN-gamma production.
authors.affiliation: LIMI, Gonçalo Moniz Research Center -Oswaldo Cruz Foundation (FIOCRUZ), Rua Waldemar Falcao 121, 40295-001 Salvador-BA, Brazil. johan@cpqgm.fiocruz.br
authors.forename: Johan
authors.initials: J
authors.lastname: Van Weyenbergh
authors.forename: Gisélia
authors.initials: G
authors.lastname: Santana
authors.forename: Argemiro
authors.initials: A
authors.lastname: D'Oliveira
authors.forename: Anibal F
authors.initials: AF
authors.lastname: Santos
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Costa
authors.forename: Edgar M
authors.initials: EM
authors.lastname: Carvalho
authors.forename: Aldina
authors.initials: A
authors.lastname: Barral
authors.forename: Manoel
authors.initials: M
authors.lastname: Barral-Netto
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000913:Antibodies, Protozoan / Q000097:blood; D016022:Case-Control Studies; D003300:Copper / Q000008:administration & dosage / Q000097:blood* / Q000172:deficiency; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D007074:Immunoglobulin G / Q000097:blood; D007371:Interferon-gamma / Q000096:biosynthesis; D007891:Leishmania / Q000276:immunology; D007896:Leishmaniasis / Q000097:blood / Q000276:immunology*; D008213:Lymphocyte Activation; D008297:Male; D018417:Th1 Cells / Q000276:immunology; D018418:Th2 Cells / Q000276:immunology; D015032:Zinc / Q000097:blood* / Q000172:deficiency
chemical_list: D000913:Antibodies, Protozoan; D007074:Immunoglobulin G; D003300:Copper; D007371:Interferon-gamma; D015032:Zinc