Reviewing the role of the dendritic Langerhans cells in the immunopathogenesis of American cutaneous leishmaniasis.

The role of dendritic Langerhans cells (LCs) in the immunopathogenesis of American cutaneous leishmaniasis (ACL) was reviewed in the light of more recent clinical and immunological features of ACL, caused by the principal human pathogenic leishmanial parasites found in Brazil: Leishmania (Viannia) braziliensis and L. (L.) amazonensis. The report shows a species-specific correlation between the LC density and the CD4+ and CD8+ T-cell profiles in the cellular infiltrate of skin lesions of ACL patients, providing the conclusion that LCs might be influencing the dichotomy of interaction between L. (V.) braziliensis and L. (L.) amazonensis with the human T-cell immune response. While L. (V.) braziliensis shows a clear tendency to direct infection to the hypersensitivity pole of the ACL clinical-immunological spectrum marked by a strong Th1-type immune response, L. (L.) amazonensis shows the opposite, directing infection to the hyposensitivity pole associated with a marked Th2-type immune response. These are probably the main immunological mechanisms of LCs regarding the immune response dichotomy that modulates infection outcome by these Leishmania parasites.