The effect of systemic corticosteroid therapy on the expression of toll-like receptor 2 and toll-like receptor 4 in the cutaneous lesions of leprosy Type 1 reactions

BACKGROUND

Leprosy is complicated by immunological reactions which can occur before, during and after successful completion of multidrug therapy. Genetic studies have suggested that polymorphisms in toll-like receptors (TLRs) may affect the susceptibility of an individual with leprosy to developing Type 1 reactions.

OBJECTIVES

To examine the gene and protein expression of TLRs in the cutaneous lesions of leprosy Type 1 reactions at the onset of reaction and during systemic corticosteroid therapy.

METHODS

Patients who were being treated for leprosy type 1 reactions with corticosteroids as part of a randomized controlled trial of corticosteroid treatment had skin biopsies performed before, during and at the end of treatment. The gene and protein expression of TLR2 and TLR4 were measured.

RESULTS

We have demonstrated that the gene hARP-P0 is a suitable control gene for TLR gene expression studies in this population. The gene and protein expression of TLR2 and TLR4 were both reduced significantly during corticosteroid treatment.

CONCLUSIONS

This is the first study to examine the expression of TLR2 and TLR4 in vivo in individuals experiencing leprosy Type 1 reactions. The data support the possibility of an important role for TLR2 and TLR4 in the pathogenesis of this important complication of leprosy.

Mortality due to dapsone hypersensitivity syndrome complicating multi-drug therapy for leprosy in Nepal

Dapsone is a component of multi-drug therapy (MDT) for the treatment of all types of leprosy. It is known that dapsone hypersensitivity syndrome (DHS) complicates the treatment in a proportion of patients. We performed a retrospective study of patients commenced on MDT between 1990 and 2006; 2% developed DHS and 0.25% died due to DHS.