Abstract
BackgroundThe ILEP Nerve Function Impairment in Reaction (INFIR) is a cohort study designed to identify predictors of reactions and nerve function impairment (NFI) in leprosy.Aim of the StudyAntibodies to mycobacteria, nerve components and serum cytokine were measured as potential markers for their possible association with reactions and NFI.Patients and Methods303 newly diagnosed leprosy patients from two centres in North India were enrolled. Antibodies to PGL-1, LAM (IgG1 and IgG3), ceramide, S100 and TNFα levels were measured using ELISA techniques.ResultsS-100, PGL IgG and IgM antibody levels were lowest in patients with BT leprosy and highest in patients with lepromatous leprosy. LAM IgG1 and LAM IgG3 antibody levels were highest in patients with BL leprosy. Ceramide antibody levels were not correlated with type of leprosy. Levels of all the antibodies tested and TNF α were lowest in patients with only skin reaction. PGL IgM antibody levels were elevated in patients with skin reactions and NFI. Old sensory NFI is associated with significant elevation of PGL IgG, LAM IgG and S100 antibody levels.ConclusionThese results reveal that the antibody response to mycobacterial antigens, nerve antigens and cytokines are in a dynamic flux and could collectively contribute to NFI in leprosy. The association of multiple markers with old NFI may indicate the contribution of different pathological processes.
Highlights
Leprosy is a chronic granulomatous disease affecting skin and nerve
PGL IgM antibody levels were elevated in patients with skin reactions and nerve function impairment (NFI)
Old sensory NFI is associated with significant elevation of PGL IgG, LAM IgG and S100 antibody levels
Summary
Leprosy is a chronic granulomatous disease affecting skin and nerve. There is a range of clinical and immunological responses to infection with Mycobacterium leprae and the disease manifests as a spectrum. At the tuberculoid end of the spectrum there is a well developed immune response and mycobacteria are eliminated with a granulomatous response in skin and nerve which may produce severe destruction of peripheral nerves[1]. Mycobacterial antigens are presented to the immune system and initiate a T cell response with macrophage activation and the production of pro-inflammatory cytokines. This inflammation in peripheral nerves produces local destruction of nerve structures, with subsequent loss of nerve function, which puts patients at risk of developing impairments. Various cohort studies have identified clinical risk factors for the development of nerve damage. The ILEP Nerve Function Impairment in Reaction (INFIR) is a cohort study designed to identify predictors of reactions and nerve function impairment (NFI) in leprosy
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