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Sardana K, Muddebihal A, Scollard DM, Khurana A. Implications of drug resistance in leprosy: disease course, reactions and the use of novel drugs. Int J Dermatol 2024. [PMID: 39258760 DOI: 10.1111/ijd.17470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 08/21/2024] [Indexed: 09/12/2024]
Abstract
Leprosy remains a significant neglected tropical disease despite the goal of elimination having been achieved in various endemic nations over the past two decades. Reactional episodes complicate the disease course, resulting in deformities and disability. The main aim of treatment is to kill Mycobacterium leprae and decrease the bacterial load, which could help prevent further bacilli transmission. A major concern in breaking the chain of transmission and possibly for recurrent reactions is the role of drug-resistant bacilli. Though some data is available on the background prevalence of drug resistance in leprosy, there is a paucity of studies that look for resistance specifically in leprosy reactions. Administration of long-term steroids or immunosuppressants for chronic and recurrent responses in the presence of drug resistance has the twin effect of perpetuating the multiplication of resistant bacilli and encouraging the dissemination of leprosy. The increasing trend of prescribing second-line drugs for leprosy or type 2 reactions without prior assessment of drug resistance can potentially precipitate a severe public health problem as this can promote the development of resistance to second-line drugs as well. A comprehensive multicenter study, including drug resistance surveillance testing in cases of reactions, is necessary, along with the current measures to stop the spread of leprosy. Here, we have detailed the history of drug resistance in leprosy, given pointers on when to suspect drug resistance, described the role of resistance in reactions, methods of resistance testing, and the management of resistant cases with second-line therapy.
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Affiliation(s)
- Kabir Sardana
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Aishwarya Muddebihal
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Ananta Khurana
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Muddebihal A, Sardana K, Khurana A, Sachdeva S, Singh I, Ahuja M, Sharma R. A prospective case control study of resistance to rifampicin, dapsone and ofloxacin in Type 1 and Type 2 leprosy reactions and the therapeutic impact of modified treatment regimen on reactions. J Eur Acad Dermatol Venereol 2023; 37:e149-e151. [PMID: 36308057 DOI: 10.1111/jdv.18709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 10/25/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Aishwarya Muddebihal
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Ananta Khurana
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Soumya Sachdeva
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Itu Singh
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India
| | - Madhvi Ahuja
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India
| | - Rahul Sharma
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India
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3
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Shaver TB, Samynathan A, Shokri T. Saddle-Nose Deformity in the Setting of Diffuse Cutaneous Lesions in an African American Man. JAMA Otolaryngol Head Neck Surg 2022; 148:879-880. [PMID: 35862040 DOI: 10.1001/jamaoto.2022.1848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Timothy B Shaver
- Department of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Archana Samynathan
- Department of Dermatology, George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Tom Shokri
- Department of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC
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4
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Alakad R, Nofal A, Assaf M. Atypisches Erythema nodosum leprosum: Diagnostische und therapeutische Aspekte. J Dtsch Dermatol Ges 2021; 19:1133-1144. [PMID: 34390149 DOI: 10.1111/ddg.14449_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/28/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Rania Alakad
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Ägypten.,Member of Interactive Dermatology Foundation Research group
| | - Ahmad Nofal
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Ägypten.,Member of Interactive Dermatology Foundation Research group
| | - Magda Assaf
- Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Ägypten.,Member of Interactive Dermatology Foundation Research group
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Zheng Y, Xing HY, Zhu ZG, Zhu HH, Zhang F, Gao X, Gao J, Hu Q, Fang Y. Identification of sensitive indicators in immune response for leprosy affected patients: An observational clinical study of safety and immunogenicity of influenza vaccine. Medicine (Baltimore) 2021; 100:e26744. [PMID: 34397815 PMCID: PMC8341344 DOI: 10.1097/md.0000000000026744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 04/07/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Cured leprosy patients have special physical conditions, which could pose challenges for safety and immunogenicity after immunization. We performed an observational clinical study aimed to identify the safety and immunogenicity of influenza vaccine in cured leprosy patients. A total of 65 participants from a leprosarium were recruited into leprosy cured group or control group, and received a 0.5 ml dose of the inactivated split-virion trivalent influenza vaccine and a follow-up 28 days proactive observation of any adverse events. Hemagglutination and hemagglutination inhibition test was performed to evaluate serum antibody titer, flow cytometry was conducted to screen of cytokines level. The total rate of reactogenicity was 0.0% [0/41] in leprosy cured group and 37.5% [9/24] in control group. The seroconversion rate for H1N1 was difference between leprosy cured group and control group (41.83% vs 79.17%, P = .0082), but not for H3N2 (34.25% vs 50.00%, P = .4468). At day 0, leprosy cured group have relatively high concentration of interleukin-6, interleukin-10, tumor necrosis factor, interferon-γ, and interleukin-17 compared to control group. The interleukin-2 concentration increased 2 weeks after vaccination compared to pre-vaccination in leprosy cured group, but declined in control group (0.92 pg/ml vs -0.02 pg/ml, P = .0147). Leprosy cured group showed a more rapid down-regulation of interleukin-6 when influenza virus was challenged compared to control group (-144.38 pg/ml vs -11.52 pg/ml, P < .0001). Subgroup analysis revealed that the immunization administration declined interleukin-17 concentration in Tuberculoid type subgroup, but not in Lepromatous type subgroup or control group. Clinically cured leprosy patients are relatively safe for influenza vaccine. Leprosy cured patient have immune deficit in producing antibody. Interleukin-6 and interleukin-17 were 2 sensitive indicators in immune response for leprosy affected patients. The identification of indicators might be help management of leprosy and used as predictive markers in leprosy early symptom monitoring.
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Affiliation(s)
- Yi Zheng
- Department of Leprosy, Wuhan Institute of Dermatology and Venereology, Wuhan, China
| | - Hong-yi Xing
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng-Gang Zhu
- Department of Immunization, Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Hong-Hao Zhu
- Department of Immunization, Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Fang Zhang
- Department of Leprosy, Wuhan Institute of Dermatology and Venereology, Wuhan, China
| | - Xia Gao
- Department of Leprosy, Wuhan Institute of Dermatology and Venereology, Wuhan, China
| | - Jun Gao
- Department of Leprosy, Wuhan Institute of Dermatology and Venereology, Wuhan, China
| | - Quan Hu
- Department of Leprosy, Wuhan Institute of Dermatology and Venereology, Wuhan, China
| | - Yuan Fang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Alakad R, Nofal A, Assaf M. Atypical presentations of erythema nodosum leprosum: Diagnostic and therapeutic aspects. J Dtsch Dermatol Ges 2021; 19:1133-1143. [PMID: 34033221 DOI: 10.1111/ddg.14449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/28/2021] [Indexed: 11/28/2022]
Abstract
Classic erythema nodosum leprosum (ENL) is characterized clinically by abrupt eruption of tender erythematous nodules, papules and plaques. Variable atypical patterns have been described, for example pustular, bullous, ulcerative, necrotic and Sweet's syndrome-like ENL. We aim to review previously reported cases of atypical ENL addressing the diagnostic and therapeutic aspects of these uncommon presentations. A search of medical literature for all cases of atypical ENL was conducted in the PubMed database till 2020. Data of patients with atypical ENL were collected and analyzed to describe the epidemiological, clinico-histological and therapeutic features. The major five clinically described presentations of atypical ENL include vesiculo-bullous lesions (46 % of patients), ulcero-necrotic lesions (41 %), erythema multiforme-like lesions (28 %), Sweet's syndrome-like lesions (11 %) and pustules (9 %). The skin lesions were accompanied by fever and constitutional symptoms in all patients. Oral steroids and thalidomide were the main lines of therapy in most of the reported patients. Dermatologists and pathologists should keep in mind the clinical variability of ENL to avoid misdiagnosis and delayed management. Early recognition can help control disease progression and save the patients from further complications.
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Affiliation(s)
- Rania Alakad
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Member of Interactive Dermatology Foundation Research group
| | - Ahmad Nofal
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Member of Interactive Dermatology Foundation Research group
| | - Magda Assaf
- Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Member of Interactive Dermatology Foundation Research group
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Mas Rusyati LM, Hatta M, Widiana IGR, Adiguna MS, Wardana M, Dwiyanti R, Noviyanti RA, Sabir M, Yasir Y, Paramita S, Junita AR, Primaguna MR. Higher Treg FoxP3 and TGF-β mRNA Expression in Type 2 Reaction ENL (Erythema Nodosum Leprosum) Patients in Mycobacterium leprae Infection. Open Microbiol J 2020. [DOI: 10.2174/1874434602014010304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Aim:
The pathology of leprosy is determined by the host immune response to Mycobacterium leprae. Almost 40% of patients with leprosy undergo immune-mediated inflammatory episodes such as type 1 reactions and Erythema Nodosum Leprosum (ENL or type 2 reactions). Regulatory T (Treg) is a subset of T cells that are involved in the immune response. Treg cells express Forkhead Box P3 (FoxP3), which plays a role in suppressing the immune response. FoxP3 may work alongside Transforming Growth Factor Beta (TGF-β) to down-regulate T cells responses, leading to the antigen-specific anergy associated with leprosy, whereas ENL occurrs mostly in multibacillary leprosy patients. Based on that, the aim of our study was to analyze Treg FoxP3 and TGF-β mRNA expression in type 2 reactions ENL with Mycobacterium leprae infection.
Methods:
Forty-nine newly diagnosed multibacillary (MB) leprosy patients attending the Dermatovenereology Clinic of Leprosy Subdivision, Sanglah General Hospital, Denpasar, Indonesia, were included in the study. The study group consists of 25 leprosy patients with ENL and 24 non-ENL leprosy patients. Twenty-five patients were included in the study as healthy controls. In this study, Treg FoxP3 and TGF-β mRNA expressions were identified with the Real-time PCR method. Analysis of Variant (ANOVA), Chi-square test and odds ratio (OR) calculation were used; p<0.05 was considered statistically significant.
Results:
The result of this study showed that the mean of Treg FoxP3 mRNA expression was 13.3 ± 2.9 on ENL leprosy patients, 11.6 ± 4.1 on non-ENL, and 9.3 ± 1.2 on healthy controls. The mean of TGF-β mRNA expression was 11.7 ± 2.7 on ENL leprosy patients, 9.5 ± 3.6 on non-ENL, and 9.3 ± 1.2 in healthy patients. Statistical analysis for Treg FoxP3 and TGF-β mRNA level between ENL, non-ENL patients and healthy control group showed significance at p<0.05.
Conclusion:
From this study, it was concluded that higher Treg FoxP3 and TGF-β mRNA expressions were found in type 2 reaction ENL patients with Mycobacterium leprae infection. The role played by Treg FoxP3 and TGF-β in type 2 reaction episodes can possibly provide a new target for the treatment of this still-challenging complication of leprosy. Further studies are required to determine the involvement of other cytokines in type 2 reaction ENL patients.
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Labuda SM, Williams SH, Mukasa LN, McGhee L. Hansen's Disease and Complications among Marshallese Persons Residing in Northwest Arkansas, 2003-2017. Am J Trop Med Hyg 2020; 103:1810-1812. [PMID: 32901601 PMCID: PMC7646809 DOI: 10.4269/ajtmh.20-0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/26/2020] [Indexed: 11/07/2022] Open
Abstract
Persons from the Republic of the Marshall Islands have among the highest rates of Hansen's disease (HD) in the world; the largest Marshallese community in the continental United States is in northwest Arkansas. In 2017, the HD Ambulatory Care Clinic in Springdale, Arkansas, informed the Arkansas Department of Health (ADH) that Marshallese persons with HD had severe disease with frequent complications. To characterize their illness, we reviewed ADH surveillance reports of HD among Marshallese persons in Arkansas treated during 2003-2017 (n = 42). Hansen's Disease prevalence among Marshallese in Arkansas (11.7/10,000) was greater than that in the general U.S. population. Complications included arthritis (38%), erythema nodosum leprosum (21%), and prolonged treatment lasting > 2 years (40%). The majority (82%) of patients treated for > 2 years had documented intermittent therapy. Culturally appropriate support for therapy and adherence is needed in Arkansas.
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Affiliation(s)
- Sarah M. Labuda
- Arkansas Department of Health, Little Rock, Arkansas
- Epidemic Intelligences Service, Centers for Diseases Control and Prevention, Atlanta, Georgia
| | | | | | - Linda McGhee
- University of Arkansas for the Medical Sciences, Northwest Regional Campus, Fayetteville, Arkansas
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9
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Luo Y, Tanigawa K, Kawashima A, Ishido Y, Ishii N, Suzuki K. The function of peroxisome proliferator-activated receptors PPAR-γ and PPAR-δ in Mycobacterium leprae-induced foam cell formation in host macrophages. PLoS Negl Trop Dis 2020; 14:e0008850. [PMID: 33075048 PMCID: PMC7595635 DOI: 10.1371/journal.pntd.0008850] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/29/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022] Open
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae). In lepromatous leprosy (LL), skin macrophages, harboring extensive bacterial multiplication, gain a distinctive foamy appearance due to increased intracellular lipid load. To determine the mechanism by which M. leprae modifies the lipid homeostasis in host cells, an in vitro M. leprae infection system, using human macrophage precursor THP-1 cells and M. leprae prepared from the footpads of nude mice, was employed. RNA extracted from skin smear samples of patients was used to investigate host gene expressions before and after multidrug therapy (MDT). We found that a cluster of peroxisome proliferator-activated receptor (PPAR) target genes associated with adipocyte differentiation were strongly induced in M. leprae-infected THP-1 cells, with increased intracellular lipid accumulation. PPAR-δ and PPAR-γ expressions were induced by M. leprae infection in a bacterial load-dependent manner, and their proteins underwent nuclear translocalization after infection, indicating activation of PPAR signaling in host cells. Either PPAR-δ or PPAR-γ antagonist abolished the effect of M. leprae to modify host gene expressions and inhibited intracellular lipid accumulation in host cells. M. leprae-specific gene expressions were detected in the skin smear samples both before and after MDT, whereas PPAR target gene expressions were dramatically diminished after MDT. These results suggest that M. leprae infection activates host PPAR signaling to induce an array of adipocyte differentiation-associated genes, leading to accumulation of intracellular lipids to accommodate M. leprae parasitization. Certain PPAR target genes in skin lesions may serve as biomarkers for monitoring treatment efficacy. Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae). Lipid-enriched intracellular environment is important for the parasitization of M. leprae. During anti-leprosy treatment, chemotherapy-killed bacilli can remain in host tissues for a long time, making it difficult to determine the treatment efficacy by Zeihl-Nelson’s staining-based bacterial index (BI) test. In this study, we found that host peroxisome proliferator-activated receptor (PPAR) signaling is responsible for modification of intracellular lipid homeostasis to accommodate M. leprae parasitization in host macrophages. In skin smear samples of patients, M. leprae-derived gene expressions were detected both before and after anti-leprosy treatment, whereas human PPAR target gene expressions were dramatically diminished after the treatment. These results further our understanding of M. leprae intracellular parasitization, and suggest that PPAR signaling may be a novel therapeutic target for treating M. leprae infection and monitoring the expressions of certain PPAR target genes in skin lesions may be helpful to evaluate the treatment efficacy and recurrent infection.
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Affiliation(s)
- Yuqian Luo
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Kazunari Tanigawa
- Department of Molecular Pharmaceutics, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Akira Kawashima
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Yuko Ishido
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Norihisa Ishii
- Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Koichi Suzuki
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
- Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
- * E-mail:
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10
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Current updates on dental perspectives of leprosy - Revisited. Dis Mon 2019; 66:100918. [PMID: 31813526 DOI: 10.1016/j.disamonth.2019.100918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The present review summarizes the current updates on dental perspectives on leprosy and the affording factors that are responsible for the prevalence of caries and periodontal diseases in leprosy. It also highlights immunopathological phenomena and reactional episodes of leprosy that occur due to daedal interactions between the perio-odontopathic bacteria and M. leprae. In addition, a brief introduction, historiography, classification and clinicopathological aspects are also been covered.
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The Role, Involvement and Function(s) of Interleukin-35 and Interleukin-37 in Disease Pathogenesis. Int J Mol Sci 2018; 19:ijms19041149. [PMID: 29641433 PMCID: PMC5979316 DOI: 10.3390/ijms19041149] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/01/2018] [Accepted: 03/04/2018] [Indexed: 12/12/2022] Open
Abstract
The recently identified cytokines-interleukin (IL)-35 and interleukin (IL)-37-have been described for their anti-inflammatory and immune-modulating actions in numerous inflammatory diseases, auto-immune disorders, malignancies, infectious diseases and sepsis. Either cytokine has been reported to be reduced and in some cases elevated and consequently contributed towards disease pathogenesis. In view of the recent advances in utilizing cytokine profiles for the development of biological macromolecules, beneficial in the management of certain intractable immune-mediated disorders, these recently characterized cytokines (IL-35 and IL-37) offer potential as reasonable targets for the discovery of novel immune-modulating anti-inflammatory therapies. A detailed comprehension of their sophisticated regulatory mechanisms and patterns of expression may provide unique opportunities for clinical application as highly selective and target specific therapeutic agents. This review seeks to summarize the recent advancements in discerning the dynamics, mechanisms, immunoregulatory and anti-inflammatory actions of IL-35 and IL-37 as they relate to disease pathogenesis.
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12
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Regulatory T cells: Friends or foe in human Mycobacterium leprae infection? Immunobiology 2017; 223:397-404. [PMID: 29150026 DOI: 10.1016/j.imbio.2017.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 11/12/2017] [Accepted: 11/12/2017] [Indexed: 12/22/2022]
Abstract
Regulatory T cells (Tregs) are known to control immune responses by suppressing the antigen-presenting and effector T cells. Some mechanisms adopted by Tregs in combating Mycobacterium infections have been proposed. Nevertheless, in M. leprae infection, also known as leprosy or Hansen's disease, the role of Tregs has not been completely elucidated. Using multicolor flow cytometry, we evaluated the expression of different cell surface and intracellular molecules present in Tregs from peripheral blood samples of leprosy patients. Before initiating treatment, thirteen new cases of leprosy were grouped according to the Ridley-Jopling classification in to the paucibacilary (PB) or multibacilary (MB) group. Fifteen non-infected individuals (NI) were included as control subjects. Tregs were higher in the MB group than in the NI group. Tregs also co-expressed high amounts of PD1 and PDL-1, indicating that these cells could induce apoptosis of effector cells and simultaneously prevent their own apoptosis. Our data showed that compared to the NI group, Tregs from the PB group expressed higher levels of CD95L, which may be associated with other apoptotic pathways that may decrease Tregs in these patients. Correlation analysis reinforced that PD1 and CD95L are efficient apoptosis' pathway that decreased levels of Tregs in the NI and PB groups. We also observed significant differences in cytokine expression of Tregs from the PB and MB groups. Compared to the NI group, Tregs from the MB group showed higher IL-17 expression; however, compared to the PB group, the expression of IL-10 in Tregs from the MB group was lower, suggesting inefficient control of inflammation. Therefore, we concluded that different pathways were involved in Treg-induced suppression of leprosy. Moreover, Treg-mediated regulation of inflammation via IL-10 and IL-17 expression in leprosy patients was inefficient. Thus, we propose that during M. leprae infection, Tregs may impair the immune responses elicited against this bacillus, favor bacterial replication, and aid in persistence of a disseminated multibacillary disease.
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13
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Cassirer-Costa F, Medeiros NI, Chaves AT, Lyon S, Coelho-Dos-Reis JGA, Ribeiro-Junior AF, Correa-Oliveira R, Rocha MOC, Gomes JAS. Cytokines as biomarkers to monitoring the impact of multidrug therapy in immune response of leprosy patients. Cytokine 2017; 97:42-48. [PMID: 28570932 DOI: 10.1016/j.cyto.2017.05.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 11/16/2022]
Abstract
Leprosy or Hansen's disease is a chronic infectious disease of the skin and nerves, caused by the intracellular bacilli Mycobacterium leprae. It is characterized by a spectrum of clinical forms depending on the host's immune response to M. leprae. Patients with tuberculoid (TT) leprosy have strong cell-mediated immunity (CMI) with elimination of the bacilli, whereas patients with lepromatous (LL) leprosy exhibit defective CMI to M. leprae. Despite advances in the understanding of the pathogenesis of leprosy and the development of new therapeutic strategies, there is a need for the identification of biomarkers which be used for early diagnosis and to discrimination between different forms of the disease, as prognostic markers. Here, we analyzed the serum levels of IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-17A, IFN-γ and TNF in order to address the contribution of these cytokines in late phase of M. leprae infection, and the impact of multidrug therapy (MDT). Our results demonstrated that patients of LL group presented higher expression of serum levels of inflammatory cytokines before MDT, while TT patients presented a balance between inflammatory and regulatory cytokines. MDT changes the profile of serum cytokines in M. leprae infected patients, as evidenced by the cytokine network, especially in TT patients. LL patients displayed a multifaceted cytokine system characterized by strong connecting axes involving inflammatory/regulatory molecules, while TT patients showed low involvement of regulatory cytokines in network overall. Cytokines can be identified as good biomarkers of the impact of MDT on the immune system and the effectiveness of treatment.
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Affiliation(s)
- Fábio Cassirer-Costa
- Programa de Pós-graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Nayara I Medeiros
- Imunologia Celular e Molecular, Centro de Pesquisa René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil; Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ana T Chaves
- Programa de Pós-graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Sandra Lyon
- Departamento de Dermatologia, Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes, Belo Horizonte, Brazil
| | - Jordana G A Coelho-Dos-Reis
- Grupo Integrado de Pesquisa em Biomarcadores, Centro de Pesquisa René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
| | - Atvaldo F Ribeiro-Junior
- Programa de Pós-graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rodrigo Correa-Oliveira
- Imunologia Celular e Molecular, Centro de Pesquisa René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais - INCT-DT, Brazil
| | - Manoel O C Rocha
- Programa de Pós-graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Juliana A S Gomes
- Programa de Pós-graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Sharma I, Singh A, Mishra AK, Singh L, Ramesh V, Saxena S. Is CXCL10/CXCR3 axis overexpression a better indicator of leprosy type 1 reaction than inducible nitric oxide synthase? Indian J Med Res 2015; 142:681-9. [PMID: 26831417 PMCID: PMC4774065 DOI: 10.4103/0971-5916.174554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND & OBJECTIVES Leprosy type 1 reactions (T1R) are acute episodes of immune exacerbation that are a major cause of inflammation and nerve damage. T1R are diagnosed clinically and supported by histopathology. No laboratory marker is currently available that can accurately predict a T1R. Increased plasma and tissue expression of inducible nitric oxide synthase (i-NOS) and chemokine CXCL10 have been demonstrated in T1R. We studied the gene expression and immunoexpression of i-NOS, CXCL10 and its receptor CXCR3 in clinically and histopathologically confirmed patients with T1R and compared with non-reactional leprosy patients to understand which biomarker has better potential in distinguishing reaction from non-reaction. METHODS Gene expression of i-NOS, CXCL10 and CXCR3 was studied in 30 skin biopsies obtained from patients with borderline tuberculoid (BT), mid-borderline (BB) and borderline lepromatous (BL) leprosy with and without T1R by real-time PCR. Further validation was done by immunohistochemical expression on 60 borderline leprosy biopsies with and without T1R. RESULTS Of the 120 patients histopathological evaluation confirmed T1R in 65 (54.2%) patients. CXCR3 gene expression was significantly (P<0.05) higher in BT- and BB-T1R patients compared to those without T1R. The CXCL10 gene expression was significantly higher (P<0.05) in BB leprosy with T1R but the difference was not significant in patients with BT with or without T1R. Immunoexpression for CXCR3 was significant in both BB-T1R and BB (P<0.001) and BT and BT-T1R (P<0.001). Immunoexpression of CXL10 was significant only in differentiating BB from BB-T1R leprosy (P<0.01) and not the BT cases. i-NOS immunoexpression was not useful in differentiating reactional from non-reactional leprosy. INTERPRETATION & CONCLUSIONS Both CXCL10 and CXCR3 appeared to be useful in differentiating T1R reaction in borderline leprosy while CXCR3 alone differentiated BT from BT-T1R. CXCR3 may be a potentially useful immunohistochemical marker to predict an impending T1R.
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Affiliation(s)
- Ira Sharma
- National Institute of Pathology (ICMR), New Delhi, India
| | - Avninder Singh
- National Institute of Pathology (ICMR), New Delhi, India
| | | | - L.C. Singh
- National Institute of Pathology (ICMR), New Delhi, India
| | - V. Ramesh
- Department of Dermatology, Venereology & Leprology, VMMC & Safdarjung Hospital, New Delhi, India
| | - Sunita Saxena
- National Institute of Pathology (ICMR), New Delhi, India
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15
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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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16
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Ladavière C, Gref R. Toward an optimized treatment of intracellular bacterial infections: input of nanoparticulate drug delivery systems. Nanomedicine (Lond) 2015; 10:3033-3055. [PMID: 26420270 DOI: 10.2217/nnm.15.128] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Intracellular pathogenic bacteria can lead to some of the most life-threatening infections. By evolving a number of ingenious mechanisms, these bacteria have the ability to invade, colonize and survive in the host cells in active or latent forms over prolonged period of time. A variety of nanoparticulate systems have been developed to optimize the delivery of antibiotics. Main advantages of nanoparticulate systems as compared with free drugs are an efficient drug encapsulation, protection from inactivation, targeting infection sites and the possibility to deliver drugs by overcoming cellular barriers. Nevertheless, despite the great progresses in treating intracellular infections using nanoparticulate carriers, some challenges still remain, such as targeting cellular subcompartments with bacteria and delivering synergistic drug combinations. Engineered nanoparticles should allow controlling drug release both inside cells and within the extracellular space before reaching the target cells.
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Affiliation(s)
- Catherine Ladavière
- UMR CNRS 5223, IMP, Université Lyon 1, INSA de Lyon, 69100 Villeurbanne, France
| | - Ruxandra Gref
- Institute of Molecular Sciences, UMR CNRS 8214, Université Paris-Saclay, 91400 Orsay, France
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17
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Keswani RK, Yoon GS, Sud S, Stringer KA, Rosania GR. A far-red fluorescent probe for flow cytometry and image-based functional studies of xenobiotic sequestering macrophages. Cytometry A 2015; 87:855-67. [PMID: 26109497 PMCID: PMC4553085 DOI: 10.1002/cyto.a.22706] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/20/2015] [Accepted: 05/22/2015] [Indexed: 01/17/2023]
Abstract
Clofazimine (CFZ) is an optically active, red-colored chemotherapeutic agent that is FDA approved for the treatment of leprosy and is on the World Health Organization's list of essential medications. Interestingly, CFZ massively accumulates in macrophages where it forms crystal-like drug inclusions (CLDIs) after oral administration of the drug in animals and humans. The analysis of the fluorescence spectra of CLDIs formed by resident tissue macrophages revealed that CFZ, when accumulated as CLDIs, undergoes a red shift in fluorescence excitation (from Ex: 540-570 to 560-600 nm) and emission (Em: 560-580 to 640-700 nm) signal relative to the soluble and free-base crystal forms of CFZ. Using epifluorescence microscopy, CLDI(+) cells could be identified, relative to CLDI(-) cells, based on a >3-fold increment in mean fluorescence signal at excitation 640 nm and emission at 670 nm. Similarly, CLDI(+) cells could be identified by flow cytometry, based on a >100-fold increment in mean fluorescence signal using excitation lasers at 640 nm and emission detectors >600 nm. CLDI's fluorescence excitation and emission was orthogonal to that of cell viability dyes such as propidium iodide and 4,6-diamidino-2-phenylindole dihydrochloride (DAPI), cellular staining dyes such as Hoechst 33342 (nucleus) and FM 1-43 (plasma membrane), as well as many other fluorescently tagged antibodies used for immunophenotyping analyses. In vivo, >85% of CLDI(+) cells in the peritoneal exudate were F4/80(+) macrophages and >97% of CLDI(+) cells in the alveolar exudate were CD11c(+). Most importantly, the viability of cells was minimally affected by the presence of CLDIs. Accordingly, these results establish that CFZ fluorescence in CLDIs is suitable for quantitative flow cytometric phenotyping analysis and functional studies of xenobiotic sequestering macrophages.
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Affiliation(s)
- Rahul K. Keswani
- Department of Pharmaceutical Sciences College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI 48109
| | - Gi Sang Yoon
- Department of Pharmaceutical Sciences College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI 48109
| | - Sudha Sud
- Department of Pharmaceutical Sciences College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI 48109
| | - Kathleen A. Stringer
- Department of Clinical, Social and Administrative Sciences College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI 48109
| | - Gus R. Rosania
- Department of Pharmaceutical Sciences College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI 48109
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18
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Inflammatory Mediators of Leprosy Reactional Episodes and Dental Infections: A Systematic Review. Mediators Inflamm 2015; 2015:548540. [PMID: 26339136 PMCID: PMC4539113 DOI: 10.1155/2015/548540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/19/2015] [Indexed: 11/17/2022] Open
Abstract
Reactional episodes in leprosy are a result of complex interactions between the immune system, Mycobacterium leprae, and predisposing factors, including dental infections. To determine the main inflammatory mediators in the immunopathological process of dental infections and leprosy reactions, we conducted a systematic review of primary literature published between 1996 and 2013. A three-stage literature search was performed (Stage I, "leprosy reactions" and "inflammatory mediators"; Stage II, "dental infections" and "inflammatory mediators"; and Stage III, "leprosy reactions," "dental infections," and "inflammatory mediators"). Of the 911 eligible publications, 10 were selected in Stage I, 68 in Stage II, and 1 in Stage III. Of the 27 studied inflammatory mediators, the main proinflammatory mediators were IL-6, IFN-γ, TNF-α, IL-1β, and IL-17; the main anti-inflammatory mediators were IL-10 and IL-4. Serum IL-6 and TNF-α concentrations were significant during periodontal and reactional lesion evolution; IFN-γ and IL-1β were associated with types 1 and 2 reactions and chronic periodontal disease. The proinflammatory mediators in dental infections and leprosy reactions, especially IL-6 and TNF-α, were similar across studies, regardless of the laboratory technique and sample type. IFN-γ and IL-1β were significant for leprosy reactions and periodontal diseases. This pattern was maintained in serum.
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19
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Silva PES, Costa PS, Ávila MP, Suhadolnik MLS, Reis MP, Salgado APC, Lima MFR, Chartone-Souza E, Nascimento AMA. Leprous lesion presents enrichment of opportunistic pathogenic bacteria. SPRINGERPLUS 2015; 4:187. [PMID: 25918684 PMCID: PMC4405507 DOI: 10.1186/s40064-015-0955-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 03/31/2015] [Indexed: 02/05/2023]
Abstract
Leprosy is a chronic infectious disease that remains a major challenge to public health in endemic countries. Increasing evidence has highlighted the importance of microbiota for human general health and, as such, the study of skin microbiota is of interest. But while studies are continuously revealing the complexity of human skin microbiota, the microbiota of leprous cutaneous lesions has not yet been characterized. Here we used Sanger and massively parallel small sub-unit rRNA (SSU) rRNA gene sequencing to characterize the microbiota of leprous lesions, and studied how it differs from the bacterial skin composition of healthy individuals previously described in the literature. Taxonomic analysis of leprous lesions revealed main four phyla: Proteobacteria, Firmicutes, Bacteroidetes, and Actinobacteria, with Proteobacteria presenting the highest diversity. There were considerable differences in the distribution of Proteobacteria, Bacteroidetes, Firmicutes, and Actinobacteria, with the first two phyla enriched and the other markedly diminished in the leprous lesions, when compared with healthy skin. Propionibacterium, Corynebacterium and Staphylococcus, resident and abundant in healthy skin, were underrepresented in skin from leprous lesions. Most of the taxa found in skin from leprous lesions are not typical in human skin and potentially pathogenic, with the Burkholderia, Pseudomonas and Bacillus genera being overrepresented. Our data suggest significant shifts of the microbiota with emergence and competitive advantage of potentially pathogenic bacteria over skin resident taxa.
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Affiliation(s)
- Paulo ES Silva
- />Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, CEP: 31270-901 Minas Gerais Brazil
| | - Patrícia S Costa
- />Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, CEP: 31270-901 Minas Gerais Brazil
| | - Marcelo P Ávila
- />Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, CEP: 31270-901 Minas Gerais Brazil
| | - Maria Luíza S Suhadolnik
- />Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, CEP: 31270-901 Minas Gerais Brazil
| | - Mariana P Reis
- />Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, CEP: 31270-901 Minas Gerais Brazil
| | - Ana Paula C Salgado
- />Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, CEP: 31270-901 Minas Gerais Brazil
| | - Mário FR Lima
- />Laboratório Hermes Pardini, Rua Aimorés, 66 Belo Horizonte, CEP: 30140-070 Minas Gerais Brazil
| | - Edmar Chartone-Souza
- />Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, CEP: 31270-901 Minas Gerais Brazil
| | - Andréa MA Nascimento
- />Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, CEP: 31270-901 Minas Gerais Brazil
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de Lima Silveira E, de Sousa JR, de Sousa Aarão TL, Fuzii HT, Dias Junior LB, Carneiro FRO, Quaresma JAS. New immunologic pathways in the pathogenesis of leprosy: role for Th22 cytokines in the polar forms of the disease. J Am Acad Dermatol 2015; 72:729-30. [PMID: 25773413 DOI: 10.1016/j.jaad.2014.11.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/17/2014] [Accepted: 11/19/2014] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | - Hellen Thais Fuzii
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem-PA, Brazil
| | | | | | - Juarez Antonio Simões Quaresma
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem-PA, Brazil; Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem-PA, Brazil.
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21
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Abed N, Couvreur P. Nanocarriers for antibiotics: a promising solution to treat intracellular bacterial infections. Int J Antimicrob Agents 2014; 43:485-96. [PMID: 24721232 DOI: 10.1016/j.ijantimicag.2014.02.009] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 02/07/2014] [Indexed: 10/25/2022]
Abstract
In the field of antibiotherapy, intracellular infections remain difficult to eradicate mainly due to the poor intracellular penetration of most of the commonly used antibiotics. Bacteria have quickly understood that their intracellular localisation allows them to be protected from the host immune system, but also from the action of antimicrobial agents. In addition, in most cases pathogens nestle in professional phagocytic cells, and can even use them as a 'Trojan horse' to induce a secondary site of infection thereby causing persistent or recurrent infections. Thus, new strategies had to be considered in order to counteract these problems. Amongst them, nanocarriers loaded with antibiotics represent a promising approach. Nowadays, it is possible to encapsulate, incorporate or even conjugate biologically active molecules into different families of nanocarriers such as liposomes or nanoparticles in order to deliver antibiotics intracellularly and hence to treat infections. This review gives an overview of the variety of nanocarriers developed to deliver antibiotics directly into infected cells.
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Affiliation(s)
- Nadia Abed
- Faculté de Pharmacie, Institut Galien UMR CNRS 8612, Université Paris-Sud XI, 5 rue Jean-Baptiste Clément, 92296 Châtenay-Malabry Cedex, France
| | - Patrick Couvreur
- Faculté de Pharmacie, Institut Galien UMR CNRS 8612, Université Paris-Sud XI, 5 rue Jean-Baptiste Clément, 92296 Châtenay-Malabry Cedex, France.
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