Distribution of iNOS expressions and TNF neutrofil cells as well as PGE2 and S100 Schwann cell dermal nerves in the erythema nodosum leprosum patients

Abstract

Background: The infiltration of neutrophil increased in the Erythema Nodusum Leprosum (ENL) which is thought to have a role in releasing the free radicals and TNFα which causes dermal nerve damage. ENL occurs in leprosy type LL and BL which has lipid droplets as a synthesis site of Prostaglandin E2 which plays a role in suppressing nerve inflammation. This study investigates neutrophil distributions that express TNFα and iNOS as well as PGE2 expressions of the S100b distributions on ENL patient’s Schwann cells.Methods: The cross sectional study used 23 samples of biopsy skin pedis of patients with MB leprosy type (10 ENL samples and 13 as control samples), from the Skin Polyclinic Sanglah Hospital, Denpasar, Indonesia. Punch biopsy of 4 mm in diameter is performed. Slides are conducted with Hematoxylin-Eosin standard staining as a structural confirmation, type of leprosy and distribution of neutrophil cells. Observation of TNFα, iNOS, PGE2, and s100b are conducted with immunohistochemistry techniques. Expression analysis is performed with immune ratio software (freeware). The PGE2, s100b, TNFα and iNOS expression percentage are put on a list, T-test is performed and IBM-SPSS 21 for Windows is used in the relationships between groups test.Results: In the present study, it was found that the distributions of neutrophil increased in the ENL compared to the ones in the control. The increased neutrophils appeared in the dermis area around the blood vessels. INOS and TNFα distributions on neutrophil cells increased significantly in the ENL. And in line with that, the s100b expressions on the ENL were significantly lower.Conclusions: The significant increase of the iNOS and TNFα neutrophil cells in the ENL may play a role in the dermal nerve damage. This study digs into the possibility of the role of Prostaglandin E2 in maintaining the peripheral nervous system on leprosy with ENL. Hence the understanding of PGE2 as the main mediator in the inflammatory process especially in the Schwann cell damage is very important.