Anti-inflammatory drugs block cytokine mRNA accumulation in the skin and improve the clinical condition of reactional leprosy patients

The aim of this study was to investigate in what ways in vivo anti-inflammatory treatment affects cytokine mRNA expression in situ in both erythema nodosum leprosum and reversal reaction patients. Serial biopsies were collected from the patients undergoing leprosy reactions before and during pentoxifylline (n = 7) or thalidomide (n = 3) treatment for erythema nodosum leprosum and prednisone (n = 3) for reversal reaction. Clinical evolution of the skin lesion was assessed during the study and semiquantitative reverse transcription-polymerase chain reaction was used to investigate cytokine mRNA expression at the lesion site. Results showed expression of interferon-gamma, interleukin-6, interleukin-10, interleukin-12 p40, and tumor necrosis factor-alpha in all patients tested at the onset of reactional episodes, but interleukin-4 mRNA was rarely detected in the lesions (n = 4). Follow-up analysis showed that, irrespective of the drugs used, tumor necrosis factor-alpha mRNA was diminished in 10 of the 13 patients tested. A concomitant decrease of mRNA accumulation was also observed for interferon-gamma (nine of 11 patients), interleukin-6 (nine of 11), and interleukin-12 p40 (six of eight). An inhibitory effect on interleukin-10 mRNA was likewise seen after thalidomide and pentoxifylline, but not subsequent to prednisone treatment. The data also demonstrated that cytokine mRNA inhibition correlates to the resolution of the inflammatory response in situ (n = 10), whereas the persistence/enhancement of cytokine message expression after treatment was associated with worsening of the skin condition, as seen in three erythema nodosum leprosum patients whose maintenance of local inflammation was accompanied by the appearance/persistence of interleukin-4 gene expression in situ subsequent to anti-inflammatory treatment. In summary, the participation of cytokines in leprosy inflammatory episodes seems to be directly associated with the patients' clinical evolution following therapy for reaction.

Autophagy links antimicrobial activity with antigen presentation in Langerhans cells

DC, through the uptake, processing, and presentation of antigen, are responsible for activation of T cell responses to defend the host against infection, yet it is not known if they can directly kill invading bacteria. Here, we studied in human leprosy, how Langerhans cells (LC), specialized DC, contribute to host defense against bacterial infection. IFN-γ treatment of LC isolated from human epidermis and infected with Mycobacterium leprae (M. leprae) activated an antimicrobial activity, which was dependent on the upregulation of the antimicrobial peptide cathelicidin and induction of autophagy. IFN-γ induction of autophagy promoted fusion of phagosomes containing M. leprae with lysosomes and the delivery of cathelicidin to the intracellular compartment containing the pathogen. Autophagy enhanced the ability of M. leprae-infected LC to present antigen to CD1a-restricted T cells. The frequency of IFN-γ labeling and LC containing both cathelicidin and autophagic vesicles was greater in the self-healing lesions vs. progressive lesions, thus correlating with the effectiveness of host defense against the pathogen. These data indicate that autophagy links the ability of DC to kill and degrade an invading pathogen, ensuring cell survival from the infection while facilitating presentation of microbial antigens to resident T cells.

IFN-β and IL-10 induce mTOR phosphorylation and regulate IFN-γ-induced autophagy during mycobacterial infection

The ability of mycobacteria to block the antimicrobial activity through the IFN-β→IL-10 pathway is critical to suppress IFN-γ induced antimicrobial response and increase mycobacterial survival. Leprosy is an infectious disease, caused by Mycobacterium leprae and IFN-γ is prevalent in the self-limited tuberculoid (T-lep) and reversal reaction (RR) lesions, whereas, IFN-β is higher in the disseminated lepromatous (L-lep) lesions. Here we investigated the role of the IFN-β→IL-10 pathway in the regulation of the IFN-γ-induced autophagy in M. leprae-infected macrophages. IFN-γ induced 65% more colocalization of the autophagosome with M. leprae compared to media alone. IFN-β and IL-10 reduced by 60% of the colocalization of LC3 and M. leprae induced by IFN-γ. The blocking of IL-10 recovered in 70% of the IFN-γ-induced autophagosomal fusion. Autophagy is negatively regulated by the mTOR complex 1 activation and live M. leprae induced phosphorylation of mTOR in 40% compared to uninfected MDMs. IFN-γ decreased the mTOR phosphorylation in 50% compared to media alone in M. leprae-infected MDMs. IL-10 reversed in 50% the IFN-γ-inhibition of mTOR phosphorylation in M. leprae infected macrophages. The colocalization of LC3 and M. leprae PGL-1 is higher in T-lep and RR in comparison with L-lep patients. However, mTOR phosphorylation was strongly detected in L-lep lesions vs. T-lep/RR lesions. The ability of the IFN-β → IL-10 pathway to inhibit IFN-γ-induced autophagy through induction of mTOR phosphorylation can be key for mycobacterial surveillance and inhibition of antigen presentation leading to disease pathogenesis.

[Expectations of hospitalized patients as to their relationship with the nursing team]

This research has been made in infectious-parasitary disease sector of a public university hospital in Rio de Janeiro on the first semester of 1995. The logbook research has been introduced to 5 adult clients, from both sexes, who had been interned in the construction of two categories, which are: a) Category I: Feelings and expectations of the client and; b) Category II: Communication and relationship between client and nurse. The results found in the first category were: 1) Lack of affection; 2) Affection, fear and anxiety; 3) Loneliness and depression; 4) Reflection; 5) Insecurity; 6) Worry about the equipment, to be cut, to be impersonally treated, lose self-control and physical dependence. The results found in the second category were: 1) Doubts and interests in information about their disease, its evolution and how long they will stay in hospital: 2) Opportunity to express feelings and ideas; 3) Comprehension of the message given by the nurse. We emphasize the increase of interchange of information, ideas, beliefs, feelings and acts in nurse-client interaction to develop the therapeutic relationship aiming at helping the client to fulfill his basic needs.