Pre-existing Th1 immunity is abrogated by ongoing recruitment of monocytic host cells that are refractory to activation

Protective immunity against many infectious diseases develops following primary infection, called infection induced immunity (III), and provides a blueprint for vaccination. However, many vaccination strategies have failed. In the parasitic Leishmania major model of self-healing cutaneous disease, control of secondary challenge infection relies on pre-existing T helper (Th)1-dependent activation of skin-infiltrating monocytes for elimination of intracellular parasites. To better understand immune-evasion of pre-existing Th1 immunity by pathogens, we investigated the pathogen-niche established following non-healing challenge infection with the L. amazonensis parasite in a setting of pre-existing III. Following secondary challenge, pre-existing Th1 III initially controlled infection but ultimately failed. Loss of protection was not overtly STAT6- or IL-10-mediated. Rather, monocyte-lineage tracing revealed inflammatory monocyte-derived PD-L1+PD-L2+ macrophages provide an intracellular pathogen-niche and facilitate evasion of pre-existing Th1 immunity. Anti-PD-1 immune checkpoint blockade enhanced uninfected, but not infected, monocyte-derived cell activation and depletion of monocyte-derived precursors improved parasite control. These observations suggest that evasion of pre-existing Th1 immunity in this setting is not due to a failure of the Th1 response, but rather due to infected-cell intrinsic defects in activation.