Expression of MHC Class I, II and CD1 in the Vascular Endothelial Cells and Dermal Inflammatory Cells of Leprosy Skin Lesions / 대한피부과학회지

BACKGROUND: The recent experimental observations suggested that location of M. leprae in the Schwann cells was mediated by epineurial and endoneurial endothelial cells, giving M. leprae access to the inner compartment of nerves and thus to Schwann cells. CD1 is a family of nonpolymorphic beta2-microglobulin-associated transmembrane glycoproteins that is structurally related to classical MHC Ag-presenting molecules, but is encoded by a separate genetic locus. Recent reports have described that human T cells specifically recognize foreign lipid and glycolipid antigens presented by CD1 proteins. Thus, it appeared likely that CD1 represents the key component of a MHC - independent pathway for antigen presentation to T cells. OBJECTIVE: we observed expression of antigen presenting molecules, such as MHC class I, II and CD1, in the vascular endothelial cells and inflammatory cells of leprosy skin lesion. METHODS: MHC class I, II and CD1 expression were studied using immunohistochemical stains. RESULTS: 1. In immunohistochemical stain of HLA-A, B, C, the level of expression in vascular endothelial cells of the borderline tuberculoid leprosy is higher than that of borderline lepromatous leprosy, but lower than that of normal skin tissue. 2. In HLA-A,B,C expression of the inflammatory cells, the level of borderline tuberculoid leprosy is higher than that of borderline lepromatous leprosy and of normal skin tissue(p>0.05). 3. Expression levels of HLA-DP, DQ, DR on endothelial cells decrease significantly in order of normal tissue, borderline tuberculoid leprosy, borderline lepromatous leprosy, lepromatous leprosy(p<0.05). 4. Expression levels of HLA-DP, DQ, DR on inflammatory cells decrease in order of lepromatous leprosy, borderline lepromatous leprosy, borderline tuberculoid leprosy, normal tissue, but statistical significance did not exist. 5. In immunohistochemical stains of CD1b, 3 sections of all 4 normal skin sections and 1 section of 3 borderline tuberculoid leprosy sections showed focal positivity on the dermal inflammtory cells, but borderline lepromatous leprosy sections did not show any positive inflammatory cells. 6. Epidermal Langerhans cells showed positivity on immunohistochemical stains of CD1a and CD1b. CONCLUSION: These results suggest that expression of MHC class I and II on the vascular endothelial cells and expression of CD1b on the inflammatory cells decrease in order of immunity of lepromatous skin lesion and that vascular enothelial cells play an important role in the pathogenesis of leprosy.

An Autopsy Case of Tracheal Agenesis Type 2

Tracheal agenesis is the rare and uniformly lethal anomaly that presents with severe respiratory distress and aphonia after birth. In this anomaly, the trachea is usually absent and air is reaching the bronchi through a communication with the esophagus. The diagnosis should be suspected in a nowborn infant with respiratory distress whose intubation is difficult. We report an autopy case of tracheal agenesis, type 2 in a female newborn infant: Complete tracheal agenesis with the fistula between the esophagus and the carina. Associated anomalies were bilobed right lung, Meckel's divericulum and ventricular septal defect.

Prognostic factors and renal survival rates in IgA nephropathy

A retrospective study of 223 patients with IgA nephropathy (IgAN) was performed to clarify the prognostic factors and the renal survival rates of the disease. One hundred twenty-two patients were followed-up for more than 6 months after their renal biopsy (mean follow-up duration: 43.0 months), and 20 of them (16.4%) had progressed to end-stage renal disease (ESRD). Using univariate analysis, 8 risk factors (2 clinical and 6 histopathological findings) for developing ESRD were identified: renal insufficiency at initial presentation (serum creatinine > or = 1.5 mg/dl); heavy proteinuria(> or = 3.5 gm/day); moderate to severe histopathologic findings such as class IV/V lesions by W.H.O. classification, mesangial hypercellularity, glomerular sclerosis, interstitial infiltration, interstitial fibrosis, and tubular atrophy. In multivariate regression analysis, class IV/V lesions and renal insufficiency at initial presentation were the independent prognostic factors of IgAN. The renal survival rates were 100% at 1 year, 97.0% at 3 years, and 78.9% at 5 years. In conclusion, it seems that about 20% of IgAN patients have a risk to progress to ESRD within 5 years, and a careful follow-up is recommended especially in patients who have either renal insufficiency at the time of presentation or severe renal pathology (class IV/V lesions).