SPLENIC CYTOKINE RESPONSES IN INDIAN KALA-AZAR BEFORE AND AFTER TREATMENT

Cytokine mRNA levels were measured in serial splenic aspirates from 27 patients with visceral leishmaniasis during monotherapy with interfer on-gamma (IFN-gamma, n = 9), sodium antimony gluconate (SAG; n = 8), o r amphotericin B lipid complex (ABLC; n = 10). At baseline, mRNA for I FN-gamma was detected in 18 (86%) of 21 patients, and mRNA for interle ukin (IL)-10 and IL-4 was detected in 21 (100%) and 10 (48%) of 21 pat ients, respectively. With IFN-gamma treatment alone, levels of IFN-gam ma mRNA decreased by day 10 and then returned to baseline levels; IL-1 0 mRNA levels were high throughout treatment. In the SAG and ABLC grou ps, levels of IFN-gamma and IL-10 mRNA decreased significantly. Polari zed Th2 cell type responses do not appear to develop in Indian kala-az ar; instead, there is an initial mixed Th1-Th2 cell picture. With succ essful treatment and resolution of infection, both components of the i mmune response appear to involute.