The ability of human neutrophils to aid in defense against pulmonary infection with Mycobacterium tuberculosis is controversial. In this study, we have shown that neutrophils respond to and phagocytose M. tuberculosis in human lesions. Neutrophils from healthy individuals were able to kill significant fractions of an inoculum of M. tuberculosis within 1 h of phagocytosis, and this ability was enhanced by tumor necrosis factor alpha but not by gamma interferon. The mycobactericidal mechanism was nonoxidative, as inhibitors of reactive oxygen or reactive nitrogen intermediates did not interfere with killing. However, the mycobactericidal mechanism was associated with increased exposure of intracellular M. tuberculosis to neutrophil defensins. In vitro, human neutrophil peptides 1 to 3 were not able to kill the bacilli even at much higher levels. These studies support the concept that human neutrophils are directly involved in defense against infection with M. tuberculosis.The observation that humans are not uniformly susceptible to infection by Mycobacterium tuberculosis may imply the existence of resistance mechanisms capable of sterilizing inhaled inoculae which operate independently of acquired immunity. Although studies with rodent models indicate that alveolar macrophages are important for containment of experimental aerogenic infections, it may be necessary to look to other effector cells to understand innate immune mechanisms which protect against human infections.There have been two reports that human neutrophils can kill virulent M. tuberculosis in vitro (5, 18). However, more-recent examinations of this issue have been unable to confirm these results (2, 10). Majeed et al. were able to demonstrate that cultured human neutrophils were able to kill an attenuated strain of M. tuberculosis, H37Ra, in a calcium-dependent manner (21). However, as H37Ra is not known to be virulent for humans, it remains important to resolve the issue of neutrophil capacity to kill virulent M. tuberculosis. Pedrosa et al. have suggested that murine neutrophils are protective against experimental infections of mice, although they found no evidence that the neutrophils phagocytosed the tubercle bacilli (27).The goal of these studies was to understand whether the neutrophil response characteristic of the earliest responses to tuberculosis (TB) infection could be effective in reducing or eliminating the inoculum. To this end, we established a model of in vitro infection of human neutrophils and characterized some of the effector mechanisms which come into play during the response of neutrophils both in vitro and during pulmonary infection of humans. We show that neutrophils in human pulmonary lesions contain intracellular M. tuberculosis, confirming a phagocytic role for neutrophils in human TB. We also show that human neutrophils can kill virulent intracellular M. tuberculosis in vitro, but with variability between individuals. Mycobactericidal activity could be stimulated by exposure of infected neutrophils to tumor necrosis facto...