1
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In silico designing of a recombinant multi-epitope antigen for leprosy diagnosis. J Genet Eng Biotechnol 2022; 20:128. [PMID: 36053342 PMCID: PMC9440174 DOI: 10.1186/s43141-022-00411-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/25/2022] [Indexed: 11/29/2022]
Abstract
Background Leprosy
is caused by Mycobacterium leprae and Mycobacterium lepromatosis. Most of the affected population lives in low-income countries and may take up to 10 years to show any clinical signs, which is how physicians diagnose it. However, due to progressive cell damage, early diagnosis is very important. The best way to confirm leprosy is through bacilloscopic, which only confirms the diagnosis and has low accuracy or PCR, that requires specialized operators and is expensive. Since the bacteria are fastidious and do not grow in any culture media, therefore, diagnosing leprosy in the lab is still a challenge. In this concern, a recombinant multi-epitope protein can be a beneficial strategy in the management of the diagnosis, as diverse immunogenic epitopes are precisely selected to detect specific antibodies. Therefore, the purposes of the present study were to select immunogenic epitopes from different relevant proteins, with immunogenic properties, and then to construct a recombinant multi-epitope protein that accuses the presence of the antibodies in the early stages of the disease, making it more than appropriate to be applied as a diagnostic tool. Results We selected 22 common proteins from both species and, using bioinformatics tools, predicted B and T cell epitopes. After multiple filtering and analyzing, we ended up with 29 epitopes {MHC-I (total 18) and MHC-II (total 11)} from 10 proteins, which were then merged into one construct. Its secondary and tertiary structures were also predicted and refined to comprise the amino acid residues in the best conformation possible. The multi-epitope protein construct was stable, non-host homologous, non-allergic, non-toxic, and elicit humoral and cellular responses. It has conformational B cell epitopes and potential to elicit IFN-γ, IL-4, and IL-10 secretion. Conclusions This novel recombinant multi-epitope protein constructed using the common epitopes from M. leprae and M. lepromatosis has a huge immunological potential, is stable, and can be lyophilized to be used in ELISA plates or even in biosensors, which are user-friendly diagnosis tools, facilitating translation into human sample tests. Supplementary Information The online version contains supplementary material available at 10.1186/s43141-022-00411-7.
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2
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Froes LAR, Sotto MN, Trindade MAB. Leprosy: clinical and immunopathological characteristics. An Bras Dermatol 2022; 97:338-347. [PMID: 35379512 PMCID: PMC9133310 DOI: 10.1016/j.abd.2021.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022] Open
Abstract
Leprosy, a disease caused by Mycobacterium leprae, has polymorphic neurocutaneous manifestations strongly correlated with the host immune response. Peripheral neural damage can lead to sensory and motor losses, as well as deformities of the hands and feet. Both innate and acquired immune responses are involved, but the disease has been classically described along a Th1/Th2 spectrum, where the Th1 pole corresponds to the more limited presentations and the Th2 to the multibacillary ones. The aim of this review is to discuss this dichotomy in light of the current knowledge of the cytokines, T helper subpopulations, and regulatory T cells involved in each presentation of leprosy. The text will also address leprosy reactions related to increased inflammatory activity in both limited and multibacillary presentations, leading to exacerbation of chronic signs and symptoms and/or the development of new ones. Despite the efforts of many research groups around the world, there is no standardized serological test/biological marker for diagnosis so far, even in endemic areas, which could contribute to the eradication of leprosy.
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3
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Yuan YH, Liu J, You YG, Chen XH, Yuan LC, Wen Y, Li HY, Zhang Y. Transcriptomic Analysis of Mycobacterium leprae-Stimulated Response in Peripheral Blood Mononuclear Cells Reveal Potential Biomarkers for Early Diagnosis of Leprosy. Front Cell Infect Microbiol 2022; 11:714396. [PMID: 34993156 PMCID: PMC8724050 DOI: 10.3389/fcimb.2021.714396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
We aimed to identify an unique host transcriptional signature in peripheral blood mononuclear cells (PBMCs) in response to Mycobacterium leprae antigens to distinguish between patients with leprosy and non-leprosy controls for early diagnosis of the disease. Sixteen individuals were enrolled in the discovery cohort [eight patients with leprosy, comprising four multibacillary (MB) and four paucibacillary (PB); and eight non-leprosy controls, comprising four healthy house contacts (HHCs) and four endemic controls (ECs)]. The differences in the transcriptome response of PBMCs to M. leprae sonicate antigen were evaluated between leprosy patients and non-leprosy controls, and 12 differentially expressed genes (CCL2/MCP-1, IL-8, JAKM, ATP, ND1, SERP, FLJ10489, LINC00659, LOC34487, LOC101928143, MIR22, and NCF1C) were identified. The accuracy of the 12 differentially expressed genes was further validated for the diagnosis of leprosy using real-time quantitative PCR in 82 individuals (13 MB, 10 PB, 37 HHCs, and 22 ECs) in the validation cohort. We found that a 5 gene signature set IL-8, CCL2/MCP-1, SERP, LINC00659 and FLJ10489 had a suitable performance in discriminating leprosy from ECs. In addition, elevated expression of IL-8, CCL2/MCP-1, SERP and LINC00659 was associated with MB diagnosis compared with ECs, whereas increased expression of IL-8, CCL2/MCP-1, SERP and FLJ10489 was found to be useful biomarkers for PB diagnosis from ECs. Moreover, we found decreased expression of NCF1C among leprosy patients could distinguish leprosy from HHCs, whereas higher expression of CCL2 among MB than PB could distinguish different leprosy patients. In conclusion, among the 12 candidate host genes identified, a three gene signature IL-8, CCL2/MCP-1, and SERP showed the best performance in distinguishing leprosy patients from healthy controls. These findings may have implications for developing a rapid blood-based test for early diagnosis of leprosy.
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Affiliation(s)
- You-Hua Yuan
- Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University and People's Hospital of Henan University, Zhengzhou, China
| | - Jian Liu
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Yuan-Gang You
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Xiao-Hua Chen
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Lian-Chao Yuan
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Yan Wen
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Huan Ying Li
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Ying Zhang
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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4
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Abstract
Leprosy is a disease caused by Mycobacterium leprae (ML) with diverse clinical manifestations, which are strongly correlated with the host's immune response. Skin lesions may be accompanied by peripheral neural damage, leading to sensory and motor losses, as well as deformities of the hands and feet. Both innate and acquired immune responses are involved, but the disease has been classically described along a Th1/Th2 spectrum, where the Th1 pole corresponds to the most limited presentations and the Th2 to the most disseminated ones. We discuss this dichotomy in the light of current knowledge of cytokines, Th subpopulations and regulatory T cells taking part in each leprosy presentation. Leprosy reactions are associated with an increase in inflammatory activity both in limited and disseminated presentations, leading to a worsening of previous symptoms or the development of new symptoms. Despite the efforts of many research groups around the world, there is still no adequate serological test for diagnosis in endemic areas, hindering the eradication of leprosy in these regions.
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Affiliation(s)
| | - Maria Angela Bianconcini Trindade
- Departamento de Patologia, University of Sao Paulo, São Paulo, Brazil.,Imunodermatologia, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
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5
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do Carmo Gonçalves A, Hungria EM, Freitas AA, Sékula-Bührer S, Gomes CM, Coelho AC, Nascimento LB, de Araújo Stefani MM. Leprosy surveillance study in a highly endemic Brazilian area using leprosy specific serologic tests and IFNγ whole blood assay. Eur J Clin Microbiol Infect Dis 2020; 39:2345-2360. [PMID: 32666479 DOI: 10.1007/s10096-020-03979-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/02/2020] [Indexed: 01/22/2023]
Abstract
This surveillance study evaluated leprosy-serologic tests and the IFNγ whole-blood-assay/WBA as adjunct diagnostic tools. Previously diagnosed leprosy index cases, intradomiciliary, peridomiciliary contacts from a Brazilian endemic area were enrolled during domiciliary visits. Physical evaluation was performed by trained nurses and leprosy diagnosis confirmed by expert dermatologist. ELISA detected IgM anti-PGL-I, IgG anti-LID-1, and IgM/IgG anti-ND-O-LID antibodies. Heparinized WBA plasma stimulated with LID-1, 46f + LID-1, ML0276 + LID-1 (24 h, 37 °C, 5% CO2) was tested for human IFNγ (QuantiFERON®-TB Gold/QFT-G; Qiagen). The survey included 1731 participants: 44 leprosy index cases, 64 intradomiciliary, 1623 peridomiciliary contacts. Women represented 57.7%, median age was 32 years, 72.2% had BCG scar. Leprosy prevalence was higher in intradomiciliary (8.57%) versus peridomiciliary contacts (0.67%), p < 0.001. Among 23 suspects, five leprosy cases were confirmed: 4 multibacillary/MB and 1 paucibacillary/PB. Leprosy incidence was 0.30%: 1.56% in intradomiciliary versus 0.25% in peridomiciliary (p = 0.028). Seropositivity rates were 1.9% to PGL-I, 4.9% to LID-1, and 1.0% to ND-O-LID. LID-1 positivity was higher in all groups; incident cases were LID-1 seropositive. ND-O-LID positivity was higher in intra- versus peridomiciliary contacts (p = 0.022). IFNγ WBA (40 index cases, 19 suspects, 35 intradomiciliary, 74 peridomiciliary contacts) showed higher LID-1/WBA positivity in peridomiciliary contacts (p > 0.05); significant differences among groups were seen with 46f + LID-1 but 0276 + LID-1 induced higher IFNγ levels. Incident cases were LID-1 seropositive, while IFNγ-WBA had marginal diagnostic application. As seropositivity indicates exposed individuals at higher risk of disease development, the utility of serologic screening for surveillance and prophylactic measures remains to be demonstrated.
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Affiliation(s)
- Aline do Carmo Gonçalves
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Emerith Mayra Hungria
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Aline Araújo Freitas
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Samira Sékula-Bührer
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Ana Cecília Coelho
- Superintendência de Vigilância em Saúde, Secretaria Municipal de Saúde de Goiânia, Goiânia, Goiás, Brazil
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6
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da Silva CR, Sampaio LHF, Costa MB, de Paula Carneiro Cysneiros MA, Sadissou IA, de Oliveira Rodrigues Castilho ML, de Moraes JB, Donadi EA, Wastoswki IJ. Analysis of HLA-G protein expression in leprosy. Immunogenetics 2020; 72:333-337. [PMID: 32556498 DOI: 10.1007/s00251-020-01168-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
The aim of this study was to evaluate the expression of human leukocyte antigen G (HLA-G) in leprosy. Biopsy and serum samples were collected from 18 patients presenting with leprosy and from healthy controls. Samples were analyzed using immunohistochemistry and ELISA techniques. HLA-G expression was observed in biopsy samples of all patients. The healthy control samples were consistently negative for HLA-G expression. Control plasma samples displayed significantly higher HLA-G expression than those from the patients (p < 0.01). These results are the first demonstration of the expression of HLA-G in leprosy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Isabela Jubé Wastoswki
- Universidade Estadual de Goiás (UEG), Goiânia, Goiás, Brazil. .,Molecular Immunology Laboratory/UEG-UnU Laranjeiras, Av. Prof. Alfredo de Castro, S/N, Chácara do Governador, Goiânia, Goiás, CEP: 74855-130, Brazil.
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7
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Chen X, You YG, Yuan YH, Yuan LC, Wen Y. Host immune responses induced by specific Mycobacterium leprae antigens in an overnight whole-blood assay correlate with the diagnosis of paucibacillary leprosy patients in China. PLoS Negl Trop Dis 2019; 13:e0007318. [PMID: 31017900 PMCID: PMC6481774 DOI: 10.1371/journal.pntd.0007318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/20/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leprosy, caused by Mycobacterium leprae, affects over 200,000 people annually worldwide and remains endemic in the ethnically diverse, mountainous and underdeveloped southwestern provinces of China. Delayed diagnosis of leprosy persists in China, thus, additional knowledge to support early diagnosis, especially early diagnosis of paucibacillary (PB) patients, based on the host immune responses induced by specific M. leprae antigens is needed. The current study aimed to investigate leprosy patients and controls in Southwest China by comparing supernatants after stimulation with specific M. leprae antigens in an overnight whole-blood assay (WBA) to determine whether host markers induced by specific M. leprae antigens improve the diagnosis or discrimination of PB patients with leprosy. METHODOLOGY/PRINCIPAL FINDINGS Leprosy patients [13 multibacillary (MB) patients and 7 PB patients] and nonleprosy controls [21 healthy household contacts (HHCs), 20 endemic controls (ECs) and 19 tuberculosis (TB) patients] were enrolled in this study. The supernatant levels of ten host markers stimulated by specific M. leprae antigens were evaluated by overnight WBA and multiplex Luminex assays. The diagnostic value in PB patients and ECs and the discriminatory value between PB patients and HHCs or TB patients were evaluated by receiver operator characteristics (ROC) analysis. ML2044-stimulated CXCL8/IL-8 achieved the highest sensitivity of 100%, with a specificity of 73.68%, for PB diagnosis. Compared to single markers, a 3-marker combination model that included ML2044-induced CXCL8/IL-8, CCL4/MIP-1 beta, and IL-6 improved the diagnostic specificity to 94.7% for PB patients. ML2044-stimulated IL-4 and CXCL8/IL-8 achieved the highest sensitivity (85.71% and 100%) and the highest specificity (95.24% and 84.21%) for discriminating PB patients from HHCs and TB patients, respectively. CONCLUSIONS Our findings suggest that the host markers induced by specific M. leprae antigens in an overnight WBA increase diagnostic and discriminatory value in PB patients with leprosy, with a particularly strong association with interleukin 8.
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Affiliation(s)
- Xiaohua Chen
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
- * E-mail: (XC); (YW)
| | - Yuan-Gang You
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - You-Hua Yuan
- Department of Laboratory, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Lian C. Yuan
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Yan Wen
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
- * E-mail: (XC); (YW)
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8
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Bezerra-Santos M, do Vale-Simon M, Barreto AS, Cazzaniga RA, de Oliveira DT, Barrios MR, Ferreira AR, Santos-Bio NC, Reed SG, de Almeida RP, Corrêa CB, Duthie MS, de Jesus AR. Mycobacterium leprae Recombinant Antigen Induces High Expression of Multifunction T Lymphocytes and Is Promising as a Specific Vaccine for Leprosy. Front Immunol 2018; 9:2920. [PMID: 30631322 PMCID: PMC6315144 DOI: 10.3389/fimmu.2018.02920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/28/2018] [Indexed: 11/13/2022] Open
Abstract
Leprosy is a chronic disease caused by M. leprae infection that can cause severe neurological complications and physical disabilities. A leprosy-specific vaccine would be an important component within control programs but is still lacking. Given that multifunctional CD4 T cells [i.e., those capable of simultaneously secreting combinations of interferon (IFN)-γ, interleukin (IL)-2, and tumor necrosis factor (TNF)] have now been implicated in the protective response to several infections, we tested the hypothesis if a recombinant M. leprae antigen-specific multifunctional T cells differed between leprosy patients and their healthy contacts. We used whole blood assays and peripheral blood mononuclear cells to characterize the antigen-specific T cell responses of 39 paucibacillary (PB) and 17 multibacillary (MB) leprosy patients and 31 healthy household contacts (HHC). Cells were incubated with either crude mycobacterial extracts (M. leprae cell sonicate–MLCS) and purified protein derivative (PPD) or recombinant ML2028 protein, the homolog of M. tuberculosis Ag85B. Multiplex assay revealed antigen-specific production of IFN-γ and IL-2 from cells of HHC and PB, confirming a Th1 bias within these individuals. Multiparameter flow cytometry then revealed that the population of multifunctional ML2028-specific T cells observed in HHC was larger than that observed in PB patients. Taken together, our data suggest that these multifunctional antigen-specific T cells provide a more effective response against M. leprae infection that prevents the development of leprosy. These data further our understanding of M. leprae infection/leprosy and are instructive for vaccine development.
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Affiliation(s)
- Márcio Bezerra-Santos
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju, Brazil.,Department of Health Education, Federal University of Sergipe, Lagarto, Brazil
| | - Marise do Vale-Simon
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju, Brazil
| | - Aline Silva Barreto
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju, Brazil
| | | | | | - Mônica Rueda Barrios
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju, Brazil
| | - Alex Ricardo Ferreira
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju, Brazil.,Infectious Disease Research Institute, Seattle, WA, United States
| | - Nanci C Santos-Bio
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju, Brazil.,Infectious Disease Research Institute, Seattle, WA, United States
| | - Steven G Reed
- Instituto de Investigação em Imunologia, INCT-CNPq, São Paulo, Brazil
| | - Roque Pacheco de Almeida
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju, Brazil.,Infectious Disease Research Institute, Seattle, WA, United States.,Department of Medicine, Federal University of Sergipe, Aracaju, Brazil
| | - Cristiane Bani Corrêa
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju, Brazil
| | - Malcolm S Duthie
- Instituto de Investigação em Imunologia, INCT-CNPq, São Paulo, Brazil
| | - Amélia Ribeiro de Jesus
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju, Brazil.,Infectious Disease Research Institute, Seattle, WA, United States.,Department of Medicine, Federal University of Sergipe, Aracaju, Brazil
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9
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Santos MB, de Oliveira DT, Cazzaniga RA, Varjão CS, Dos Santos PL, Santos MLB, Correia CB, Faria DR, Simon MDV, Silva JS, Dutra WO, Reed SG, Duthie MS, de Almeida RP, de Jesus AR. Distinct Roles of Th17 and Th1 Cells in Inflammatory Responses Associated with the Presentation of Paucibacillary Leprosy and Leprosy Reactions. Scand J Immunol 2017; 86:40-49. [PMID: 28426172 DOI: 10.1111/sji.12558] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/13/2017] [Indexed: 01/08/2023]
Abstract
It is well established that helper T cell responses influence resistance or susceptibility to Mycobacterium leprae infection, but the role of more recently described helper T cell subsets in determining severity is less clear. To investigate the involvement of Th17 cells in the pathogenesis of leprosy, we determined the immune profile with variant presentations of leprosy. Firstly, IL-17A, IFN-γ and IL-10 were evaluated in conjunction with CD4+ T cell staining by confocal microscopy of lesion biopsies from tuberculoid (TT) and lepromatous leprosy (LL) patients. Secondly, inflammatory cytokines were measured by multiplex assay of serum samples from Multibacillary (MB, n = 28) and Paucibacillary (PB, n = 23) patients and household contacts (HHC, n = 23). Patients with leprosy were also evaluated for leprosy reaction occurrence: LR+ (n = 8) and LR- (n = 20). Finally, peripheral blood mononuclear cells were analysed by flow cytometry used to determine the phenotype of cytokine-producing cells. Lesions from TT patients were found to have more CD4+ IL-17A+ cells than those from LL patients. Higher concentrations of IL-17A and IL-1β were observed in serum from PB than MB patients. The highest serum IFN-γ concentrations were, however, detected in sera from MB patients that developed leprosy reactions (MB LR+ ). Together, these results indicate that Th1 cells were associated with both the PB presentation and also with leprosy reactions. In contrast, Th17 cells were associated with an effective inflammatory response that is present in the PB forms but were not predictive of leprosy reactions in MB patients.
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Affiliation(s)
- M B Santos
- Laboratory of Molecular Biology, Universidade Federal de Sergipe (UFS), Sao Cristovao, Brazil.,Infectious Diseases Research Institute (IDRI), Seattle, WA, USA
| | - D T de Oliveira
- Laboratory of Molecular Biology, Universidade Federal de Sergipe (UFS), Sao Cristovao, Brazil
| | - R A Cazzaniga
- Laboratory of Molecular Biology, Universidade Federal de Sergipe (UFS), Sao Cristovao, Brazil
| | - C S Varjão
- Laboratory of Molecular Biology, Universidade Federal de Sergipe (UFS), Sao Cristovao, Brazil
| | - P L Dos Santos
- Laboratory of Molecular Biology, Universidade Federal de Sergipe (UFS), Sao Cristovao, Brazil
| | - M L B Santos
- Laboratory of Molecular Biology, Universidade Federal de Sergipe (UFS), Sao Cristovao, Brazil
| | - C B Correia
- Laboratory of Molecular Biology, Universidade Federal de Sergipe (UFS), Sao Cristovao, Brazil
| | - D R Faria
- Laboratory of Biologia das Interações Celulares, Department of Morphology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - M do V Simon
- Laboratory of Molecular Biology, Universidade Federal de Sergipe (UFS), Sao Cristovao, Brazil
| | - J S Silva
- Department of Biochemistry and Immunology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - W O Dutra
- Laboratory of Biologia das Interações Celulares, Department of Morphology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - S G Reed
- Infectious Diseases Research Institute (IDRI), Seattle, WA, USA
| | - M S Duthie
- Infectious Diseases Research Institute (IDRI), Seattle, WA, USA
| | - R P de Almeida
- Laboratory of Molecular Biology, Universidade Federal de Sergipe (UFS), Sao Cristovao, Brazil.,Departament of Medicine (UFS), Sergipe, Brazil.,Instituto de Investigacão em Imunologia, INCT, CNPq, São Paulo, Brazil
| | - A R de Jesus
- Laboratory of Molecular Biology, Universidade Federal de Sergipe (UFS), Sao Cristovao, Brazil.,Departament of Medicine (UFS), Sergipe, Brazil.,Instituto de Investigacão em Imunologia, INCT, CNPq, São Paulo, Brazil
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10
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Antigen-specific secretion of IFNγ and CXCL10 in whole blood assay detects Mycobacterium leprae infection but does not discriminate asymptomatic infection from symptomatic leprosy. Diagn Microbiol Infect Dis 2017; 87:328-334. [DOI: 10.1016/j.diagmicrobio.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 11/24/2022]
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11
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Freitas AA, Hungria EM, Costa MB, Sousa ALOM, Castilho MLO, Gonçalves HS, Pontes MAA, Duthie MS, Stefani MMA. Application of Mycobacterium Leprae-specific cellular and serological tests for the differential diagnosis of leprosy from confounding dermatoses. Diagn Microbiol Infect Dis 2016; 86:163-8. [PMID: 27506457 DOI: 10.1016/j.diagmicrobio.2016.07.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/13/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
Mycobacterium leprae-specific serological and cell-mediated-immunity/CMI test were evaluated for the differential diagnosis of multibacillary/MB, and paucibacillary/PB leprosy from other dermatoses. Whole-blood assay/WBA/IFNγ stimulated with LID-1 antigen and ELISA tests for IgG to LID-1 and IgM to PGL-I were performed. WBA/LID-1/IFNγ production was observed in 72% PB, 11% MB leprosy, 38% dermatoses, 40% healthy endemic controls/EC. The receiver operating curve/ROC for WBA/LID-1 in PB versus other dermatoses showed 72.5% sensitivity, 61.5% specificity and an area-under-the-curve/AUC=0.75; 74% positive predictive value/PPV, 59% negative predictive value/NPV. Anti PGL-I serology was positive in 67% MB, 8% PB leprosy, 6% of other dermatoses; its sensitivity for MB=66%, specificity=93%, AUC=0.89; PPV=91%, NPV=72%. Anti-LID-1 serology was positive in 87% MB, 7% PB leprosy, all other participants were seronegative; 87.5% sensitivity for MB, 100% specificity, AUC=0.97; PPV=100%, NPV=88%. In highly endemic areas anti-LID-1/PGL-I serology and WBA/LID-1-represent useful tools for the differential diagnosis of leprosy from other confounding dermatoses.
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Affiliation(s)
- Aline Araújo Freitas
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Brazil
| | - Emerith Mayra Hungria
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Brazil
| | - Maurício Barcelos Costa
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Brazil
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Duthie MS, Balagon MF. Combination chemoprophylaxis and immunoprophylaxis in reducing the incidence of leprosy. Risk Manag Healthc Policy 2016; 9:43-53. [PMID: 27175099 PMCID: PMC4854245 DOI: 10.2147/rmhp.s76058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Leprosy is a complex infectious disease caused by Mycobacterium leprae that is a leading cause of nontraumatic peripheral neuropathy. Current control strategies, with a goal of early diagnosis and treatment in the form of multidrug therapy, have maintained new case reports at ~225,000 per year. Diagnostic capabilities are limited and even with revisions to multidrug therapy regimen, treatment can still require up to a year of daily drug intake. Although alternate chemotherapies or adjunct immune therapies that could provide shorter or simpler treatment regimen appear possible, only a limited number of trials have been conducted. More proactive strategies appear necessary in the drive to elimination. As a prevention strategy, most chemoprophylaxis campaigns to date have provided about a 2-year protective window. Vaccination, in the form of a single bacillus Calmette–Guérin (BCG) immunization, generally provides ~50% reduction in leprosy cases. Adapting control strategies to provide both chemoprophylaxis and immunoprophylaxis has distinct appeal, with chemoprophylaxis theoretically buttressed by vaccination to generate immediate protection that can be sustained in the long term. We also discuss simple assays measuring biomarkers as surrogates for disease development or replacements for invasive, but not particularly sensitive, direct measures of M. leprae infection. Such assays could facilitate the clinical trials required to develop these new chemoprophylaxis, immunoprophylaxis strategies, and transition into wider use.
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Affiliation(s)
| | - Marivic F Balagon
- Cebu Skin Clinic, Leonard Wood Memorial Center for Leprosy Research, Cebu City, the Philippines
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Freitas AA, Oliveira RM, Hungria EM, Cardoso LPV, Sousa ALOM, Costa MB, Reed SG, Duthie MS, Stefani MMA. Alterations to antigen-specific immune responses before and after multidrug therapy of leprosy. Diagn Microbiol Infect Dis 2015; 83:154-61. [DOI: 10.1016/j.diagmicrobio.2015.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/23/2015] [Accepted: 06/29/2015] [Indexed: 11/30/2022]
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Clark EAS, Esplin S, Torres L, Turok D, Yoder BA, Varner MW, Winter S. Prevention of recurrent preterm birth: role of the neonatal follow-up program. Matern Child Health J 2014; 18:858-63. [PMID: 23817726 DOI: 10.1007/s10995-013-1311-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Preterm birth (PTB) is a public health crisis in need of effective preventative strategies. Multi-disciplinary Neonatal Follow-up Programs (NFPs) provide health services to preterm infants at high risk for developmental problems after discharge from US newborn intensive care units. We aimed to determine whether NFPs are a potentially effective venue for specialized maternal counseling and intervention aimed at reducing the high rate of recurrent PTB in this population. This prospective case series enrolled women with preterm children evaluated in the Utah Department of Health NFP, 2010-2012. Women were interviewed, received Maternal Fetal Medicine (MFM) counseling services, and maternal and neonatal records were abstracted. We assessed maternal demographics, medical history, and characteristics of the index pregnancy. We calculated the proportion of women with knowledge of PTB recurrence risk and available prevention strategies, and assessed current contraceptive use and reproductive plans. Ninety-six women with a history of early PTB (≤26 weeks and/or birth weight < 1,250 g) were evaluated. Nearly 1 in 5 women (19.8 %) evaluated reported sexual activity, desire to avoid pregnancy, and no current contraceptive use, and were therefore at imminent risk of unintended pregnancy. Of women without permanent contraception, only 24.3 % were aware of their individual PTB recurrence risk. Of women with a history of spontaneous PTB, only 4 % were aware of effective pharmacologic preventative strategies. Introduction of MFM consultation as part NFP multi-disciplinary services is a novel approach with the potential to reduce recurrent PTB in an exceptionally high-risk population.
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Affiliation(s)
- Erin A S Clark
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Suite 2B200, 30 N 1900 E, Salt Lake City, UT, USA,
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Evaluation of novel tools to facilitate the detection and characterization of leprosy patients in China. BIOMED RESEARCH INTERNATIONAL 2014; 2014:371828. [PMID: 25184137 PMCID: PMC4145546 DOI: 10.1155/2014/371828] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 07/18/2014] [Accepted: 07/18/2014] [Indexed: 11/18/2022]
Abstract
Leprosy is the disabling outcome of chronic infection with Mycobacterium leprae. The disease often evades early detection, particularly now that fewer clinicians are able to confidently diagnose the disease following the integration of leprosy control measures within general health services in many countries. Although leprosy is officially eliminated in China, endemic regions remain in some difficult-to-reach, underdeveloped areas in Southwest China. In order to better understand the extent of M. leprae infection and identify new leprosy cases in a timely manner, simple tools that can detect infection and the early disease are required. In this report we evaluated the performance of antigen-specific ELISA, the NDO-LID rapid diagnostic test, and antigen-specific whole blood assays (WBA) as potential diagnostic tools. Our data support the use of antibody detection tests and WBA to facilitate the diagnosis of multibacillary and paucibacillary leprosy, respectively. These tools could be invaluable for increased, but simplified, monitoring of individuals in order to provide referrals for clinical exam and early leprosy diagnosis.
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Oliveira RM, Hungria EM, de Araújo Freitas A, de Sousa ALOM, Costa MB, Reed SG, Duthie MS, Stefani MMA. Synergistic antigen combinations for the development of interferon gamma release assays for paucibacillary leprosy. Eur J Clin Microbiol Infect Dis 2014; 33:1415-24. [DOI: 10.1007/s10096-014-2077-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/31/2014] [Indexed: 02/07/2023]
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Duthie MS, Saunderson P, Reed SG. The potential for vaccination in leprosy elimination: new tools for targeted interventions. Mem Inst Oswaldo Cruz 2013; 107 Suppl 1:190-6. [PMID: 23283471 DOI: 10.1590/s0074-02762012000900027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/17/2012] [Indexed: 05/27/2023] Open
Abstract
Despite the huge effort and massive advances toward the elimination of leprosy over the last two decades, the disease has proven stubborn; new case detection rates have stabilised over the last few years and leprosy remains endemic in a number of localised regions. The American Leprosy Missions and Infectious Disease Research Institute have undertaken a large research effort aimed at developing new tools and a vaccine to continue the push for leprosy elimination. In this paper, we outline our strategy for the integration of rapid diagnostic tests and lab-based assays to facilitate the detection of early or asymptomatic leprosy cases, as well as the efficient and focused implementation of chemoprophylaxis and immunisation to intervene in leprosy development and transmission.
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Lucena-Silva N, Teixeira MAG, Ramos ADL, de Albuquerque RS, Diniz GTN, Mendes-Junior CT, Castelli EC, Donadi EA. The +3187A/G HLA-G polymorphic site is associated with polar forms and reactive reaction in leprosy. Mol Genet Genomic Med 2013; 1:123-30. [PMID: 24498610 PMCID: PMC3865579 DOI: 10.1002/mgg3.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/01/2013] [Accepted: 05/02/2013] [Indexed: 01/16/2023] Open
Abstract
Considering that variability in immune response genes has been associated with susceptibility to leprosy and with disease severity, leprosy presents clinicopathological variants that are highly associated with the immune response, HLA-G has a well-recognized role in the modulation of the immune response, and polymorphisms at the 3′ untranslated region (UTR) of the HLA-G gene may influence HLA-G production, we studied the polymorphic sites at the 3′ UTR of the HLA-G gene in leprosy and their association with disease severity. We evaluated by sequencing analysis the allele, genotype, and haplotype frequencies of the 3′ UTR HLA-G polymorphic sites (14-bpINDEL/+3003C-T/+3010C-G/+3027A-C/+3035C-T/+3142C-G/+3187A-G/+3196C-G) in 146 individuals presenting reactive leprosy from a highly endemic area, and associated with bacillary load and the type of reactive leprosy. A total of 128 healthy subjects were also studied. Allele, genotype, and haplotype frequencies for the 3′ UTR HLA-G polymorphisms in leprosy patients did not differ from those observed in healthy donors. The +3187A allele was responsible for protection against the development of multibacillary leprosy in a dominant model (AA + AG)/GG, OR = 0.11, P = 0.018), and the +3187A allele and +3187A-A genotype were overrepresented in type II reactive leprosy reaction. The effect of genetic factors on leprosy susceptibility may be hidden by environmental components in highly endemic areas. The HLA-G + 3187A polymorphic site, which is related to unstable mRNA production, was associated with the development of polar forms of leprosy and reactive leprosy reaction.
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Affiliation(s)
- N Lucena-Silva
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz 50670-420, Recife-PE, Brazil ; Laboratório de Biologia Molecular, Departamento de Oncologia Pediátrica, Hospital IMIP 50070-550, Recife-PE, Brazil ; Divisão de Imunologia Clínica, Departamento de Medicina, Escola de Medicina de Ribeirão Preto, Universidade de São Paulo 14040-900, Ribeirão Preto-SP, Brazil
| | - M A G Teixeira
- Departamento de Dermatologia da Universidade de Pernambuco e Centro Integrado de Saúde Amaury de Medeiros, Secretaria de Saúde de Pernambuco 52030-010, Recife-PE, Brazil
| | - A de L Ramos
- Laboratório de Biologia Molecular, Departamento de Oncologia Pediátrica, Hospital IMIP 50070-550, Recife-PE, Brazil
| | - R S de Albuquerque
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz 50670-420, Recife-PE, Brazil ; Divisão de Imunologia Clínica, Departamento de Medicina, Escola de Medicina de Ribeirão Preto, Universidade de São Paulo 14040-900, Ribeirão Preto-SP, Brazil
| | - G T N Diniz
- Laboratorio de Métodos Quantitativos, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz 50670-420, Recife-PE, Brazil
| | - C T Mendes-Junior
- Departamento de Química, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo 14040-901, Ribeirão Preto-SP, Brazil
| | - E C Castelli
- Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Goias - UFG 74001-970, Goiânia-GO, Brazil
| | - E A Donadi
- Divisão de Imunologia Clínica, Departamento de Medicina, Escola de Medicina de Ribeirão Preto, Universidade de São Paulo 14040-900, Ribeirão Preto-SP, Brazil
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