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Quaresma TC, de Aguiar Valentim L, de Sousa JR, de Souza Aarão TL, Fuzii HT, Duarte MIS, de Souza J, Quaresma JAS. Immunohistochemical Characterization of M1, M2, and M4 Macrophages in Leprosy Skin Lesions. Pathogens 2023; 12:1225. [PMID: 37887741 PMCID: PMC10610015 DOI: 10.3390/pathogens12101225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Mycobacterium leprae is the etiological agent of leprosy. Macrophages (Mφs) are key players involved in the pathogenesis of leprosy. In this study, immunohistochemical analysis was performed to examine the phenotype of Mφ subpopulations, namely M1, M2, and M4, in the skin lesions of patients diagnosed with leprosy. Based on the database of treatment-naïve patients treated between 2015 and 2019 at the Department of Dermatology of the University of the State of Pará, Belém, routine clinical screening samples were identified. The monolabeling protocol was used for M1 macrophages (iNOS, IL-6, TNF-α) and M2 macrophages (IL-10, IL-13, CD163, Arginase 1, TGF-β, FGFb), and the double-labeling protocol was used for M4 macrophages (IL-6, MMP7, MRP8, TNF-α e CD68). To confirm the M4 macrophage lineage, double labeling of the monoclonal antibodies CD68 and MRP8 was also performed. Our results demonstrated a statistically significant difference for the M1 phenotype among the Virchowian (VV) (4.5 ± 1.3, p < 0.0001), Borderline (1.6 ± 0.4, p < 0.0001), and tuberculoid (TT) (12.5 ± 1.8, p < 0.0001) clinical forms of leprosy. Additionally, the M2 phenotype showed a statistically significant difference among the VV (12.5 ± 2.3, p < 0.0001), Borderline (1.3 ± 0.2, p < 0.0001), and TT (3.2 ± 0.7, p < 0.0001) forms. For the M4 phenotype, a statistically significant difference was observed in the VV (9.8 ± 1.7, p < 0.0001), Borderline (1.2 ± 0.2, p < 0.0001), and TT (2.6 ± 0.7, p < 0.0001) forms. A significant correlation was observed between the VV M1 and M4 (r = 0.8712; p = 0.0000) and between the VV M2 × TT M1 (r = 0.834; p = 0.0002) phenotypes. The M1 Mφs constituted the predominant Mφ subpopulation in the TT and Borderline forms of leprosy, whereas the M2 Mφs showed increased immunoexpression and M4 was the predominant Mφ phenotype in VV leprosy. These results confirm the relationship of the Mφ profile with chronic pathological processes of the inflammatory response in leprosy.
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Affiliation(s)
- Tatiane Costa Quaresma
- Health Department, Center for Biological and Health Sciences, State University of Para-CCBS, UEPA, Belem 66087-662, Brazil
| | - Lívia de Aguiar Valentim
- Health Department, Center for Biological and Health Sciences, State University of Para-CCBS, UEPA, Belem 66087-662, Brazil
| | - Jorge Rodrigues de Sousa
- Health Department, Center for Biological and Health Sciences, State University of Para-CCBS, UEPA, Belem 66087-662, Brazil
| | - Tinara Leila de Souza Aarão
- Health Department, Center for Biological and Health Sciences, State University of Para-CCBS, UEPA, Belem 66087-662, Brazil
- School of Medicine, Federal University of Para-UFPA, Altamira 68440-000, Brazil
| | - Hellen Thais Fuzii
- Health Department, Tropical Medicine Center, Federal University of Para-NMT-UFPA, Belem 66055-240, Brazil
| | | | - Juarez de Souza
- Health Department, Center for Biological and Health Sciences, State University of Para-CCBS, UEPA, Belem 66087-662, Brazil
| | - Juarez Antônio Simões Quaresma
- Health Department, Center for Biological and Health Sciences, State University of Para-CCBS, UEPA, Belem 66087-662, Brazil
- School of Medicine, Federal University of Para-UFPA, Altamira 68440-000, Brazil
- Health Department, Tropical Medicine Center, Federal University of Para-NMT-UFPA, Belem 66055-240, Brazil
- School of Medicine, Sao Paulo University, Sao Paulo 01246-903, Brazil
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Farag AGA, El Askary SA, Fathy WM, Elbassal F, Azzam AA, Tayel NR, Abdul Karim SS, Shehata WA. Relationship Between sCD163 and mCD163 and Their Implication in the Detection and Typing of Leprosy. Clin Cosmet Investig Dermatol 2020; 13:379-389. [PMID: 32581565 PMCID: PMC7276209 DOI: 10.2147/ccid.s240420] [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: 11/28/2019] [Accepted: 03/17/2020] [Indexed: 11/23/2022]
Abstract
Background Leprosy is a chronic contagious disease caused by Mycobacterium lepraea. CD163 is a monocyte trans-membrane glycoprotein receptor (mCD163) that sheds from the cell surface and circulates as a soluble (serum) form (sCD163). Changes in the mCD163 and sCD163 levels could mirror the categorization of inflammatory procedure, demonstrating a possible use of CD163 as a diagnostic indicator of inflammation. Objective To investigate the possible role of CD163 (sCD163 and mCD163) in leprosy pathogenesis and to assess whether CD163 is a helpful inflammatory marker of leprosy development and typing. Patients and Methods This case control study included 70 leprosy patients and 30 healthy controls. Leprosy patients were classified according to the Madrid criteria (1953) into: tuberculoid leprosy (TT), border-line leprosy (BL), and lepromatous leprosy (LL). For all participants, complete blood count (CBC), serum CD163 using ELISA and monocytes positive for CD163 using flow cytometry were done. Results Leprosy patients had significantly low WBCs and platelet counts (p<0.001) and had significantly higher sCD163 (p=0.025) and mCD163 (p=0.042) that were highest in LL followed by BL, then TT patients (p<0.001). There was a significant positive correlation between mCD163 and sCD163 levels in leprosy patients (r=0.896, p<0.001). ROC analysis revealed a significant role of serum sCD163 and of mCD163 positive monocytes in the detection (p<0.001) and typing of leprosy (p=0.002 and p<0.001, respectively). Conclusion Both sCD163 and mCD163 positive monocytes may have an active role in leprosy pathogenesis. They could be potential biomarkers for leprosy detection and typing.
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Affiliation(s)
- Azza Gaber Antar Farag
- Dermatology, Andrology & STDs Department, Faculty of Medicine, Menoufia University, Al Menoufia, Egypt
| | - Shymaa A El Askary
- Medical Microbiology and Immunology Department, Faculty of Medicine, Menoufia University, Minufya, Egypt
| | - Waleed M Fathy
- Clinical Pathology Department, Faculty of Medicine, Menoufia University, Minufya, Egypt
| | - Fathia Elbassal
- Clinical Pathology Department, Faculty of Medicine, Menoufia University, Minufya, Egypt
| | - Ayman Ali Azzam
- Clinical Biochemistry Department, National Liver Institute, Menoufia University, Minufya, Egypt
| | - Nermin Reda Tayel
- Department of Molecular Diagnostics and Therapeutics, Genetic Engineering Biotechnology Research Institute, Sadat City, Egypt
| | | | - Wafaa Ahmed Shehata
- Dermatology, Andrology & STDs Department, Faculty of Medicine, Menoufia University, Al Menoufia, Egypt
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de Camargo RM, da Silva WL, Medeiros P, Belone ADFF, Latini ACP. Polymorphisms in the TGFB1 and IL2RA genes are associated with clinical forms of leprosy in Brazilian population. Mem Inst Oswaldo Cruz 2018; 113:e180274. [PMID: 30540075 PMCID: PMC6287188 DOI: 10.1590/0074-02760180274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/07/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Leprosy is a chronic infectious disease caused by Mycobacterium leprae, and compromises the skin and peripheral nerves. This disease has been classified as multibacillary (MB) or paucibacillary (PB) depending on the host immune response. Genetic epidemiology studies in leprosy have shown the influence of human genetic components on the disease outcomes. OBJECTIVES We conducted an association study for IL2RA and TGFB1 genes with clinical forms of leprosy based on two case-control samples. These genes encode important molecules for the immunosuppressive activity of Treg cells and present differential expressions according to the clinical forms of leprosy. Furthermore, IL2RA is a positional candidate gene because it is located near the 10p13 chromosome region, presenting a linkage peak for PB leprosy. METHODS A total of 885 leprosy cases were included in the study; 406 cases from Rondonópolis County (start population), a hyperendemic region for leprosy in Brazil, and 479 cases from São Paulo state (replication population), which has lower epidemiological indexes for the disease. We tested 11 polymorphisms in the IL2RA gene and the missense variant rs1800470 in the TGFB1 gene. FINDINGS The AA genotype of rs2386841 in IL2RA was associated with the PB form in the start population. The AA genotype of rs1800470 in TGFB1 was associated with the MB form in the start population, and this association was confirmed for the replication population. MAIN CONCLUSIONS We demonstrated, for the first time, an association data with the PB form for a gene located on chromosome 10. In addition, we reported the association of TGFB1 gene with the MB form. Our results place these genes as candidates for validation and replication studies in leprosy polarisation.
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Affiliation(s)
- Rodrigo Mendes de Camargo
- Instituto Lauro de Souza Lima, Bauru, SP, Brasil
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Medicina de Botucatu, Departamento de Doenças Tropicais e Diagnóstico por Imagem, Botucatu, SP, Brasil
| | - Weber Laurentino da Silva
- Instituto Lauro de Souza Lima, Bauru, SP, Brasil
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Medicina de Botucatu, Departamento de Doenças Tropicais e Diagnóstico por Imagem, Botucatu, SP, Brasil
| | - Priscila Medeiros
- Instituto Lauro de Souza Lima, Bauru, SP, Brasil
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Medicina de Botucatu, Departamento de Doenças Tropicais e Diagnóstico por Imagem, Botucatu, SP, Brasil
| | | | - Ana Carla Pereira Latini
- Instituto Lauro de Souza Lima, Bauru, SP, Brasil
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Medicina de Botucatu, Departamento de Doenças Tropicais e Diagnóstico por Imagem, Botucatu, SP, Brasil
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de Sousa JR, Lucena Neto FD, Sotto MN, Quaresma JAS. Immunohistochemical characterization of the M4 macrophage population in leprosy skin lesions. BMC Infect Dis 2018; 18:576. [PMID: 30442123 PMCID: PMC6238386 DOI: 10.1186/s12879-018-3478-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/31/2018] [Indexed: 12/14/2022] Open
Abstract
Background Since macrophages are one of the major cell types involved in the Mycobacterium leprae immune response, roles of the M1 and M2 macrophage subpopulations have been well defined. However, the role of M4 macrophages in leprosy or other infectious diseases caused by mycobacteria has not yet been clearly characterized. This study aimed to investigate the presence and potential role of M4 macrophages in the immunopathology of leprosy. Methods We analyzed the presence of M4 macrophage markers (CD68, MRP8, MMP7, IL-6, and TNF-α) in 33 leprosy skin lesion samples from 18 patients with tuberculoid leprosy and 15 with lepromatous leprosy by immunohistochemistry. Results The M4 phenotype was more strongly expressed in patients with the lepromatous form of the disease, indicating that this subpopulation is less effective in the elimination of the bacillus and consequently is associated with the evolution to one of the multibacillary clinical forms of infection. Conclusion M4 macrophages are one of the cell types involved in the microbial response to M. leprae and probably are less effective in controlling bacillus replication, contributing to the evolution to the lepromatous form of the disease.
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Affiliation(s)
- Jorge Rodrigues de Sousa
- Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde, Ananindeua, PA, Brazil.,Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, PA, Brazil
| | | | - Mirian Nacagami Sotto
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.,Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juarez Antonio Simões Quaresma
- Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde, Ananindeua, PA, Brazil. .,Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, PA, Brazil. .,Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Belém, PA, Brazil. .,Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, SP, Brazil. .,Núcleo de Medicina Tropical, UFPA, Av. Generalíssimo Deodoro 92, Umarizal, Belém, Pará, 66055-190, Brazil.
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Aarão TLDS, de Sousa JR, Falcão ASC, Falcão LFM, Quaresma JAS. Nerve Growth Factor and Pathogenesis of Leprosy: Review and Update. Front Immunol 2018; 9:939. [PMID: 29867937 PMCID: PMC5949531 DOI: 10.3389/fimmu.2018.00939] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/16/2018] [Indexed: 12/11/2022] Open
Abstract
Neurotrophins are a family of proteins that regulate different aspects of biological development and neural function and are of great importance in neuroplasticity. This group of proteins has multiple functions in neuronal cells, as well as in other cellular populations. Nerve growth factor (NGF) is a neurotrophin that is endogenously produced during development and maturation by multiple cell types, including neurons, Schwann cells, oligodendrocytes, lymphocytes, mast cells, macrophages, keratinocytes, and fibroblasts. These cells produce proNGF, which is transformed by proteolytic cleavage into the biologically active NGF in the endoplasmic reticulum. The present review describes the role of NGF in the pathogenesis of leprosy and its correlations with different clinical forms of the disease and with the phenomena of regeneration and neural injury observed during infection. We discuss the involvement of NGF in the induction of neural damage and the pathophysiology of pain associated with peripheral neuropathy in leprosy. We also discuss the roles of immune factors in the evolution of this pathological process. Finally, we highlight avenues of investigation for future research to broaden our understanding of the role of NGF in the pathogenesis of leprosy. Our analysis of the literature indicates that NGF plays an important role in the evolution and outcome of Mycobacterium leprae infection. The findings described here highlight an important area of investigation, as leprosy is one of the main causes of infection in the peripheral nervous system.
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Affiliation(s)
| | | | | | | | - Juarez Antônio Simões Quaresma
- Center of Health and Biological Sciences, State University of Para, Belem, Brazil.,Tropical Medicine Center, Federal University of Para, Belem, Brazil.,Evandro Chagas Institute, Ministry of Health, Ananindeua, Brazil
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de Sousa JR, Sotto MN, Simões Quaresma JA. Leprosy As a Complex Infection: Breakdown of the Th1 and Th2 Immune Paradigm in the Immunopathogenesis of the Disease. Front Immunol 2017; 8:1635. [PMID: 29234318 PMCID: PMC5712391 DOI: 10.3389/fimmu.2017.01635] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/09/2017] [Indexed: 12/15/2022] Open
Abstract
Leprosy is a chronic infectious disease whose evolution involves complex immune mechanisms of the host that influence the clinical presentation of the disease. For many years, the main interpretation of the host defense response was based on characterization of the established immune paradigm between T helper (Th) 1 and Th2 lymphocytes. However, with advances in the knowledge of immunology, new approaches have emerged along with the development of new immunological pathways that have changed the interpretation of the long-established paradigm of the polar forms of the disease, especially with the identification of new subtypes of T lymphocytes such as Th9, Th17, Th22, and Tregs. Thus, this review discusses the role of these new subtypes of T helper lymphocytes and how the development of the immune response of these cells modifies the pattern of the Th1/Th2 response in the immunopathogenesis of leprosy.
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Affiliation(s)
| | - Mirian Nacagami Sotto
- Faculty of Medicine, Department of Pathology, Sao Paulo University, São Paulo, Brazil
| | - Juarez Antonio Simões Quaresma
- Tropical Medicine Center, Federal University of Pará, Belém, Brazil.,Center of Biological and Health Sciences, State University of Pará, Belém, Brazil
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de Sousa JR, de Sousa RPM, de Souza Aarão TL, Dias LB, Oliveira Carneiro FR, Simões Quaresma JA. Response of iNOS and its relationship with IL-22 and STAT3 in macrophage activity in the polar forms of leprosy. Acta Trop 2017; 171:74-79. [PMID: 28327412 DOI: 10.1016/j.actatropica.2017.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 03/12/2017] [Accepted: 03/13/2017] [Indexed: 01/09/2023]
Abstract
Leprosy is a chronic granulomatous infection that manifests as different clinical forms related to the immunological response. The aim of the study was to evaluated the response of IL-22, STAT3, CD68 and iNOS in leprosy skin lesions. The mean number IL-22 positive cells was 12.12±1.90cells/field in the TT form and 31.31±2.91cells/field in the LL form. STAT3 positive cells was 5.29±1.96 cells/field in the TT form, while this number was 11.13±3.48cells/field in the LL form. The mean number of CD68 positive cells was 25.18±6.21cells/field in the TT form and 62.81±8.13cells/field in the LL form. Quantitative analysis of iNOS revealed a significant difference, with the mean number of cells expressing the enzyme being 30.24±2.88cells/field in the TT form compared to 35.44±4.69cells/field in the LL form. Linear correlations in lesions of TT patients showed a moderate positive correlations between CD68 and iNOS, STAT3 and Inos, IL-22 and STAT3, and IL-22 and iNOS. Our results demonstrate that these factors can act synergistically to induce a microbicidal activity in the population of macrophages in the leprosy lesions.
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Affiliation(s)
| | | | - Tinara Leila de Souza Aarão
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, Brazil; Centro de ciências Biológicas e da Saúde, Universidade do Estado do Para, Belem, Brazil
| | - Leonidas Braga Dias
- Centro de ciências Biológicas e da Saúde, Universidade do Estado do Para, Belem, Brazil
| | | | - Juarez Antonio Simões Quaresma
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, Brazil; Centro de ciências Biológicas e da Saúde, Universidade do Estado do Para, Belem, Brazil.
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de Sousa JR, de Sousa RPM, de Souza Aarão TL, Dias LB, Carneiro FRO, Fuzii HT, Quaresma JAS. In situ expression of M2 macrophage subpopulation in leprosy skin lesions. Acta Trop 2016; 157:108-14. [PMID: 26827741 DOI: 10.1016/j.actatropica.2016.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 12/12/2015] [Accepted: 01/07/2016] [Indexed: 02/08/2023]
Abstract
The clinical manifestations of the leprosy depend on host immune response and the macrophages are the primary cells involved in this process. M1 and M2 cells exhibited distinct morphology, distinct surface marker profiles, as well as different cytokine and chemokine secretion. Macrophages express receptors such as CD163, CD68, CD206, and costimulatory molecules such as CD80 and CD86, and cytokines that trigger a suppressive or inflammatory response. Thirty-three untreated patients were selected, 17 patients had the tuberculoid leprosy (TT) and 16 had the lepromatous leprosy (LL). We performed immunohistochemistry to detect IL-13, IL-10, TGF-β, FGF-β, CD163, CD68, arginase 1. M2 macrophages showed significant differences between the groups studied with increase in the expression of costimulatory molecules (CD68 and CD163), arginase 1 and cytokines (IL-10, IL-13, TGF-β and FGF-b) in the LL form. Response of M2 macrophages emerge as an alternative for a better understanding of the innate immunity in the polar forms of leprosy, highlighting the role of cytokines, arginase 1 and costimulatory molecules in the repair and suppressive responses in the lepromatous form of the disease.
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Aarão TLDS, de Sousa JR, Botelho BS, Fuzii HT, Quaresma JAS. Correlation between nerve growth factor and tissue expression of IL-17 in leprosy. Microb Pathog 2015; 90:64-8. [PMID: 26616164 DOI: 10.1016/j.micpath.2015.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/11/2015] [Accepted: 11/19/2015] [Indexed: 11/15/2022]
Abstract
Leprosy is a serious public health problem in peripheral and developing countries. Leprosy is a chronic infectious-contagious disease caused by the intracellular, bacillus Mycobacterium leprae, which causes tissue damage and demyelination of peripheral nerves. Recent studies have demonstrated the participation of new subtype's cytokines profile in the inflammatory response of leprosy. Since nerve functions are affected by inflammatory response during the course of leprosy, changes in the production of NGF and its receptor (NGF R) may be directly associated with disability and sensory loss. Skin biopsies were collected and submitted to immunohistochemistry using specific antibodies to IL-17, NGF and NGF R. Quantitative analysis of NGF, NGFR and IL-17 immunostaining showed a significant difference between the clinical forms, with higher expression of NGF and NGFR in lepromatous leprosy and IL-17 in tuberculoid leprosy. The present study showed that IL-17, in addition to stimulating an inflammatory response, negatively regulates the action of NGF and NGF R in the polar forms of the disease.
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Affiliation(s)
| | | | - Beatriz Santos Botelho
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, Para, Brazil
| | - Hellen Thais Fuzii
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, Para, Brazil
| | - Juarez Antonio Simões Quaresma
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, Para, Brazil; Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, Para, Brazil.
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