Immunohistochemical study of lepromin reaction in healthy adults

The continuing challenges of leprosy

Leprosy is best understood as two conjoined diseases. The first is a chronic mycobacterial infection that elicits an extraordinary range of cellular immune responses in humans. The second is a peripheral neuropathy that is initiated by the infection and the accompanying immunological events. The infection is curable but not preventable, and leprosy remains a major global health problem, especially in the developing world, publicity to the contrary notwithstanding. Mycobacterium leprae remains noncultivable, and for over a century leprosy has presented major challenges in the fields of microbiology, pathology, immunology, and genetics; it continues to do so today. This review focuses on recent advances in our understanding of M. leprae and the host response to it, especially concerning molecular identification of M. leprae, knowledge of its genome, transcriptome, and proteome, its mechanisms of microbial resistance, and recognition of strains by variable-number tandem repeat analysis. Advances in experimental models include studies in gene knockout mice and the development of molecular techniques to explore the armadillo model. In clinical studies, notable progress has been made concerning the immunology and immunopathology of leprosy, the genetics of human resistance, mechanisms of nerve injury, and chemotherapy. In nearly all of these areas, however, leprosy remains poorly understood compared to other major bacterial diseases.

Ultraviolet radiation decreases the granulomatous response to lepromin in humans

Ultraviolet radiation (UVR) modulates cellular immunity in humans and experimental animals and can interfere with immune responses against infectious agents in animal models. We used the lepromin reaction, a cell-mediated immune response to antigens of Mycobacterium leprae, to determine whether UVR affects the cellular immune response to an infectious agent in humans. We selected 29 healthy, lepromin-positive contacts of leprosy patients and determined their minimal erythema dose (MED) of UVR. Immediately afterward, each subject was injected with 0.1 ml of lepromin in two areas of the buttocks: one at the site that had received twice the MED of UVR and the other on the contralateral, unirradiated site. The irradiated site was given twice the MED every 4 d for a total of five treatments. One week after the last irradiation, both lepromin reactions were measured and biopsied. The size of the lepromin-induced granulomas was significantly reduced in the irradiated site, as was the number of lymphocytes. Immunohistochemical analysis showed a depletion in the number of infiltrating cells and a lower percentage of T cells, particularly the CD4+ subpopulation, in granulomas formed in UV-irradiated skin. This study demonstrates that local UV irradiation reduces the granulomatous reaction to lepromin in sensitized individuals. These findings are of clinical relevance because of the fundamental role played by the delayed-type hypersensitivity response in defense against intracellular pathogens and because of potential increases in the amount of UVR in sunlight reaching the earth's surface.