Defective positioning in granulomas but not lung-homing limits CD4 T cell interactions with Mycobacterium tuberculosis infected macrophages in rhesus macaques

Protection against Mycobacterium tuberculosis (Mtb) infection requires CD4 T cells to migrate into the lung and interact with infected macrophages. In mice, less-differentiated CXCR3(+) CD4 T cells migrate into the lung and suppress growth of Mtb, while CX3CR1(+) terminally-differentiated Th1 cells accumulate in the blood vasculature and do not control pulmonary infection. Here we examine CD4 T cell differentiation and lung homing during primary Mtb infection of rhesus macaques. Mtb-specific CD4 T cells simultaneously appeared in the airways and blood ~21–28 days post-exposure, indicating that recently primed effectors are quickly recruited into the lungs after entering circulation. Mtb-specific CD4 T cells in granulomas display a tissue-parenchymal CXCR3(+)CX3CR1(−)PD-1(hi)CTLA-4(+) phenotype. However, most granuloma CD4 T cells are found within the outer lymphocyte cuff, and few localize to the myeloid cell core containing the bacilli. Using the intravascular stain approach, we find essentially all Mtb-specific CD4 T cells in granulomas have extravasated across the vascular endothelium into the parenchyma. Therefore, it is unlikely that lung-homing defects introduced by terminal differentiation limit the migration of CD4 T cells into granulomas following primary Mtb infection of macaques. However, intralesional positioning defects within the granuloma may pose a major barrier to T cell-mediated immunity during tuberculosis.