Peripheral blood mononuclear cells from leprosy patients and normal individuals were analysed for their ability to lyse autologous macrophages pulsed with the Mycobacterium leprae 10 kDa heat shock protein (hsp10), an antigen considered to have an important role in the protective responses in leprosy. Strong cytotoxic responses, with an involvement of gammadelta T and class-I and class-II restricted alphabeta T cells and/or CD16+56+ cells, were observed in normal individuals, paucibacillary (PB) and those multibacillary (MB) patients with undetectable bacillary load. On the contrary, only a weak class-II restricted cytotoxic response was observed in those MB patients with positive bacillary load (MB(+)). Simultaneous addition of IFNgamma plus TNFalpha and IL-12 during hsp10 stimulation could partially upregulate the low cytotoxic response observed in MB(+) by enhancing class-II restricted T cell activity and by development of gammadelta T and/or CD16+56+ cell activity. Our results suggest that the ability to mount an effective cytotoxic response against hsp10-pulsed macrophages in leprosy patients is closely related to the patient's bacterial load and not to the clinical form of the disease.