Mycobacterium tuberculosis multi-drug-resistant strain M induces IL-17(+) IFNγ(-) CD4(+) T cell expansion through an IL-23 and TGF-β-dependent mechanism in patients with MDR-TB tuberculosis.

We have reported previously that T cells from patients with multi-drug-resistant tuberculosis (MDR-TB) express high levels of interleukin (IL)-17 in response to the MDR strain M (Haarlem family) of Mycobacterium tuberculosis (M. tuberculosis). Herein, we explore the pathways involved in the induction of Th17 cells in MDR-TB patients and healthy tuberculin reactors [purified protein derivative healthy donors (PPD(+) HD)] by the M strain and the laboratory strain H37Rv. Our results show that IL-1β and IL-6 are crucial for the H37Rv and M-induced expansion of IL-17(+) interferon (IFN)-γ(-) and IL-17(+) IFN-γ(+) in CD4(+) T cells from MDR-TB and PPD(+) HD. IL-23 plays an ambiguous role in T helper type 1 (Th1) and Th17 profiles: alone, IL-23 is responsible for M. tuberculosis-induced IL-17 and IFN-γ expression in CD4(+) T cells from PPD(+) HD whereas, together with transforming growth factor (TGF-β), it promotes IL-17(+) IFN-γ(-) expansion in MDR-TB. In fact, spontaneous and M. tuberculosis-induced TGF-β secretion is increased in cells from MDR-TB, the M strain being the highest inducer. Interestingly, Toll-like receptor (TLR)-2 signalling mediates the expansion of IL-17(+) IFN-γ(-) cells and the enhancement of latency-associated protein (LAP) expression in CD14(+) and CD4(+) T cells from MDR-TB, which suggests that the M strain promotes IL-17(+) IFN-γ(-) T cells through a strong TLR-2-dependent TGF-β production by antigen-presenting cells and CD4(+) T cells. Finally, CD4(+) T cells from MDR-TB patients infected with MDR Haarlem strains show higher IL-17(+) IFN-γ(-) and lower IL-17(+) IFN-γ(+) levels than LAM-infected patients. The present findings deepen our understanding of the role of IL-17 in MDR-TB and highlight the influence of the genetic background of the infecting M. tuberculosis strain on the ex-vivo Th17 response.