As a model for the study of human atypical mycobacterial disease, we explored the basis for the prolonged mycobacteriosis in mice infected with Mycobacterium intracellulare. Two weeks after i.v. injection of mycobacteria, peritoneal macrophages were found to be activated, as indicated by their capacity to produce large amounts of superoxide anion (O2-) in response to phorbol myristate acetate (PMA) or viable M. intracellulare. However, 4 wk after infection, despite the continued presence of large numbers of mycobacteria in the spleen, macrophages from infected animals produced low amounts of O2-. Unfractionated spleen cells from mice infected 4 wk earlier produced increased amounts of interleukin 2 and interferon (IFN) when stimulated with the mitogen concanavalin A, but less of these lymphokines than unstimulated cells when exposed to antigens derived from M. intracellulare, suggesting production of an inhibitory factor. Spleen cells from infected mice were not stimulated to incorporate [3H]thymidine by exposure to mycobacterial antigens; but this unresponsiveness could be reversed by addition of indomethacin to the cultures. Additional investigation showed that macrophages from infected animals produced large amounts of prostaglandin E2 (PGE2) when stimulated by mycobacterial antigens. In vitro, such concentrations of PGE2 inhibited uptake of [3H]thymidine by stimulated spleen lymphocytes from infected animals. Thus, it seemed likely that in infected animals, macrophage-derived PG suppressed production of IFN-gamma by lymphocytes, which in turn prevented activation of the macrophages to full microbicidal activity. To test this hypothesis, we administered either indomethacin, IFN-gamma, or muramyl dipeptide to infected mice. Mice treated with each of these agents showed decreased spleen and lung weights, and decreased numbers of viable mycobacteria in these organs. These results support the concept that interaction between the host and M. intracellulare is modulated profoundly by PG and suggest that administration of agents that directly promote macrophage activation can enhance resistance to infection by this organism.

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