L.E. CELLS AND ANTINUCLEAR FACTORS IN LEPROSY

Lucio phenomenon and Lucio leprosy

Lucio phenomenon is a peculiar reactional state associated with Lucio leprosy; both exhibit a restricted global distribution. The exact underlying pathomechanism of Lucio phenomenon, which may be fatal at times, still needs further elaboration. A case of relapse of partially treated nodular lepromatous leprosy presenting with Lucio phenomenon is reported, along with a brief review of the literature.

Humoral immunity in Hansen's disease

For many years immune response in leprosy has been studied. Since 1960 several reports dealing with humoral immunity have been described in the literature. Different autoantibody rates occur in leprosy. There is an increase in the prevalence of autoantibodies in elderly patients with long standing disease, in lepromatous leprosy and in those with reactional states. The differences in rates among various studies are attributed to different methods and variations among patient samples concerning age, gender, polar forms, therapy and other elements. The prevalence of numerous antibodies, immune complexes, cryoglobulins and complement levels have been studied by many authors. This also highlights the importance of the more recent reviews of anti-Mycobacterium leprae glycolipid antibodies such as the anti-phenolic glycolipid-I antibodies in which titers are variable and depend on genetic factors.

The rheumatic manifestations of leprosy

We investigated the rheumatic and laboratory features in 25 patients with Hansen's disease. Sixteen (64%) developed a broad range of rheumatic manifestations, the most common being a distinctive syndrome of swollen hands observed in 10 patients (66.5%). These manifestations were more frequent in patients with lepromatous leprosy. There was no correlation between articular clinical findings and X-ray or laboratory abnormalities. A careful clinical history and the recognition of rheumatic features will help to differentiate patients with leprosy and rheumatic manifestations from those with a primary rheumatic disease.

Autoantibodies and tropical infections

Autoantibodies against diverse autoantigens have long been known to exist in the sera of several tropical infections. The introduction of monoclonal antibody technology has allowed immortalization of autoantibody secreting B-lymphocytes and subsequent analysis of these autoantibodies. This paper discusses the current literature on the induction, origins, significance and analysis of autoantibodies.

A patient with lepromatous leprosy and anticytoskeletal antibodies

Sera from 34 patients with lepromatous leprosy were screened for the presence of autoantibodies by indirect immunofluorescence using two epithelial cell lines, PTK2 and HEp2, as substrates. Indirect immunofluorescence staining of both substrates with the serum of a patient with lepromatous leprosy revealed a cytoplasmic intermediate filament staining pattern. After exposure of PTK2 cells to colchicine, the filaments collapsed into thick perinuclear coils, confirming the presence of intermediate filament reactivity. Immunofluorescence of rat fibroblasts with the same serum also revealed an intermediate filamentous staining pattern. Human keratinocytes exposed to the patient's serum revealed a diffuse cytoplasmic staining pattern. Our study suggests the presence of autoantibodies to cytoskeletal intermediate filaments or to molecules associated with vimentin and possibly keratin subunit proteins in the serum of a patient with lepromatous leprosy.

Comparison between autoantibodies in malaria and leprosy with lupus

Sera from 16 patients with falciparum malaria, 16 patients with vivax malaria and 31 patients with leprosy were tested for autoantibodies to intracellular proteins and nucleic acids. Precipitating antibodies to soluble protein extracts were not detected in any serum. Sera from malaria patients showed prominent immunofluorescence staining of the HEP2 nuclear membrane as well as frequent 75% (24/32) and intense Western blot reactivity. In contrast, only 20% and 36% of patients with leprosy had positive immunofluorescence or positive immunoblots respectively, and reactivity was weak in most cases. Neither the malaria nor leprosy sera contained autoantibodies with specificities similar to the characteristic lupus autoantibodies such as double stranded DNA (dsDNA), Ro/SSA, La/SSB, Sm, RNP and P proteins. Low levels of antibodies to single stranded (ssDNA) were however found in 11 (34%) malaria sera and in seven (23%) leprosy sera. Thirteen percent of patients with leprosy had anti-histone antibodies. These findings demonstrate considerable differences in the capacity of infectious agents to induce autoantibodies and also the infrequency with which autoantibodies characteristic of idiopathic systemic lupus erythematosus are induced.

Autoaggressive hanseniasis

I have given the name autoaggressive hanseniasis to a syndrome with immunopathologic and clinical pictures resembling autoaggressive systemic diseases observed in some cases of lepromatous and borderline hanseniasis. It is probably caused by B cell stimulation by antigenic complex of Mycobacterium leprae plus autologous tissue, along with a dysfunction of the T-suppressor lymphocytes.

Characterization of a factor in leprosy serum that inhibits the growth of mitogen-stimulated normal human lymphocytes

A factor that inhibits the growth of mitogen-stimulated lymphocytes from normal donors has been detected in the sera of patients with chronic leprosy. The inhibitory activity was detected with similar frequency in patients with tuberculoid or lepromatous leprosy, although higher levels of activity were detected in the latter. The factor reduced the growth in volume of the lymphocytes in the first 24 hr after stimulation, the synthesis of RNA during the first 3 days of culture and the replication of DNA in 72-hr cultures. All the inhibitory activity co-purified with IgG on gel filtration, ammonium sulphate fractionation and ion exchange chromatography. The activity was stable to heating at 56 degrees but labile at 100 degrees and was absorbed from serum or from purified IgG preparations by staphylococcal protein A. On gel filtration of the sera on Sephadex G-200, none of the activity appeared in the void volume, indicating that it is not due to immune complexes. We conclude that the activity is due to an IgG antibody and suggest that it is an autoantibody since the sera inhibited the growth of all donor lymphocytes tested.

Immunoglobulin deposits in leprosy skin

An immunofluorescent study was carried out on skin biopsies from 12 leprosy patients who had been suffering from the disease for periods of one to 30 years; all were treated with dapsone and clofazimine at one stage. Skin biopsies made from reactive nodular lesions showed that all 12 had IgG deposits and seven had IgM deposits in the dermal-epidermal junction. No IgA, IgE, C3 and fibrinogen were found deposited in any biopsy. All patients had significantly raised levels of serum immunoglobulins and rheumatoid factor. Anti-epithelial (eight patients) and anti-nuclear (three patients) antibodies were also found. The possible role of autoantibodies in the present findings is discussed.

The primary immune response to haemocyanin in patients with primary biliary cirrhosis

Both the humoral and cellular immune response to haemocyanin was measured in normal subjects and patients with liver disease including primary biliary cirrhosis, other forms of cholestasis, and cryptogenic cirrhosis. Significant differences in antibody titre were found 2 weeks after immunization being highest in normal subjects, less in cryptogenic cirrhosis and least in primary biliary cirrhosis. The incidence of positive skin tests, indicating the development of delayed hypersensitivity to haemocyanin, was significantly less in patients with primary biliary cirrhosis and cryptogenic cirrhosis than in those with cholestasis or the normal subjects. It is suggested that the poor antibody response seen in primary biliary cirrhosis, could be related to impaired T cell function and hence lack of the T and B cell co-operation necessary for antibody formation to some antigens.

The presence of delayed hypersensitivity to haemocyanin as measured by the skin test was compared to other tests of delayed hypersensitivity including the tuberculin skin test, DNCB sensitization and PHA-stimulated in vitro lymphocyte transformation. Of twenty patients with primary biliary cirrhosis the results of all four tests correlated in nine but did not agree in the remaining eleven patients. These results emphasize the importance of using a number of indices when assessing the degree of anergy of any one patient.

Serology in leprosy

A critical survey of the literature on serology in leprosy has shown that sera taken from lepromatous patients display some striking differences in comparison with sera from tuberculoid patients. The tests most frequently employed were complement-fixation, haemagglutination, electrophoresis, precipitation and immunofluorescence, together with a variety of antigens not only from lepromas but also from Mycobacterium tuberculosis and other actinomycetales.With the exception of the Rubino test, all these serological tests are lacking in specificity for leprosy since leprous sera have a broad range of reactivity with different antigens, including those employed in the serological diagnosis of syphilis.Some features of the leprous sera could be related to a hypersensitivity state involving circulating immune complexes, low levels of complement and the presence of antibodies similar to those found in sera from patients with autoimmune diseases.

Acute exudative arthritis in leprosy--rheumatoid-arthritis-like syndrome in association with erythema nodosum leprosum

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