T-cell activation is a key event in the establishment of immune responses directed toward intracellular pathogens. Depending on the functional capacity of the activated T cells, the fate of the infection may take different paths either toward a protective or a pathogenic outcome. While it is important that a strong, activated immune response is elicited early on in the infection in order to eliminate (or control) the pathogen, the further control of this activation is necessary to reestablish homeostasis, avoiding tissue damage (17, 25). One hallmark of most parasitic infections is that the great majority of individuals are able to trigger innate immunity and elicit an activated T-cell response during the acute infection, leading to the control of the parasite and establishment of a chronic infection. Interestingly, while many individuals develop severe forms of parasitic diseases once infection progresses to the chronic phase, most patients develop relatively mild forms, allowing for a host-parasite coexistence. One such example is observed upon human infection with the protozoan parasite Trypanosoma cruzi, which leads to Chagas' disease. As a result of thousands of years of coevolution between human host and the parasite (6), most infected individuals develop an asymptomatic, or “indeterminate” (I), form of Chagas' disease. This form is characterized by a lack of clinical signs and symptoms and has been associated predominantly with a modulatory cellular immune response based on cytokine profiles and downregulatory molecule expression (5, 20, 48, 49, 51). Chronic patients may also develop symptomatic clinical forms, mainly with digestive or cardiac alterations. Differential geographical prevalence of Chagas' disease clinical forms has been reported. In Brazil, 15 to 30% of Chagas' patients display the cardiac form, which is present in 20 states, while the digestive cases, observed in about 10% of infected individuals, have been reported in four states in the central region of the country (53). The digestive form is frequently found in Chile but is practically absent in Central America (42). These geographical differences might be related, in part, to host genetics and immune responses of local human populations, but it is believed that they are also related to the genetic diversity of T. cruzi strains (11). Different strains of parasite display tropism for different tissues, and, thus, an important factor determining the clinical course of disease might be the specific pool of infecting clones and their specific tropisms (29). However, a possible role for environmental, nutritional, and immunological aspects of the host cannot be discounted. While digestive and cardiac forms present significant morbidity, the cardiac form is the one associated with highest mortality. It is caused by neuronal and cardiomyocyte damage, ultimately resulting in ventricular dilation and subsequent functional heart failure, which can lead to death (44). Cardiac patients display a T-cell-mediated inflammatory response in situ (13, 24, 41), which is responsible for the pathology; this inflammatory profile is also observed in circulating activated T cells found at high frequencies in these patients (2, 16, 19, 32). Although it is clear that a plethora of parasite and host factors influences the clinical outcome of Chagas' disease, recent studies have suggested that activation of functionally distinct T-cell populations in T. cruzi-infected individuals may be responsible for the establishment of different clinical forms (17, 20). Thus, identifying these populations and the factors responsible for their activation will be critical for driving immune-based interventions to prevent pathology. While the great majority of T cells express either the CD4 or the CD8 molecules, which are important for stabilizing the peptide-major histocompatibility complex (MHC) complex and which favor T-cell activation, a minority population of T cells that do not express CD4 or CD8 molecules has been identified in humans (8, 10, 27, 37). These double-negative (DN) T cells have been shown to be important sources of immunoregulatory cytokines in human leishmaniasis (4), to display modulatory functions (38), but also, under different circumstances, to display cytolytic activity (10, 36). A subpopulation of DN T cells is activated through the engagement of αβ or γδ T-cell receptors (TCRs) in the recognition of nonclassical MHC molecules of the CD1 family, presenting lipid or glycolipid antigens (36). This particular lipid/glycolipid antigenic recognition, as well as the immunoregulatory potential and susceptibility to chronic stimulation of these cells, highlights the important role these cells play in parasitic infections. In our work with Bottrel et al., we determined that DN lymphocytes were the second most prevalent cell type producing gamma interferon (IFN-γ) in human cutaneous leishmaniasis and that this IFN-γ production was seen after short-term cultures with medium alone, as well as after stimulation with soluble Leishmania antigen (SLA) (9). The novel work of Antonelli et al. went on to demonstrate that DN T cells composed of two different cell populations are present in the blood of individuals infected with Leishmania braziliensis and that DN T cells expressing the αβ TCR displayed a profile consistent with activation of leishmanicidal and inflammatory activities (higher IFN-γ and tumor necrosis factor alpha [TNF-α]) while the DN subpopulation expressing γδ TCR had a modulatory potential via higher production of interleukin-10 (IL-10) (4). Interestingly, IFN-γ production has been associated with pathogenic responses in human leishmaniasis in more than one clinical form (3, 7, 22). We recently demonstrated that rats infected with the CL-Brenner clone of T. cruzi displayed a marked increase in the frequency of circulating DN T cells during the acute phase of infection (33). Taken together, these data led to the question of the role that DN T-cell subpopulations play in the clinical dichotomy of chronic human Chagas' disease. To answer these questions, we investigated the immunoregulatory potential of DN T cells in patients with the two polar forms of Chagas' disease: indeterminate (I) and dilated cardiac (DC). Our data demonstrated that although no quantitative differences were seen with regard to the nonstimulated frequency of DN αβ and γδ T-cell subpopulations between patients and nonchagasic individuals, in vitro infection with trypomastigote forms of T. cruzi induced a marked increase in the frequency of these cells from chagasic patients. Moreover, the expanded αβ DN T cells displayed a greater inflammatory potential from cardiac patients than from indeterminate patients. This was accompanied by a greater down-modulatory ratio of IL-10 to inflammatory cytokine frequencies by γδ DN T cells from individuals with indeterminate disease, suggesting distinct roles for these cells in modulating the response in chronic Chagas' disease. Finally, we observed a correlation between higher frequencies of IL-10-producing γδ DN T cells and improved clinical measures of cardiac function, suggesting a protective role for these cells in human Chagas' disease. These data indicate that functionally distinct DN T cells are present in Chagas' disease patients and that they are associated with the resulting morbidity of the disease.