Expression of NLRP3 inflammasome in leprosy indicates immune evasion of Mycobacterium leprae

BACKGROUND Leprosy is an infectious-contagious disease caused by Mycobacterium leprae that remain endemic in 105 countries. This neglected disease has a wide range of clinical and histopathological manifestations that are related to the host inflammatory and immune responses. More recently, the inflammasome has assumed a relevant role in the inflammatory response against microbiological agents. However, the involvement of inflammasome in leprosy remains poorly understood. OBJECTIVES The aim is to associate biomarkers of inflammasome with the different immunopathological forms of leprosy. METHODS We performed an observational, cross-sectional, and comparative study of the immunophenotypic expression of inflammasome-associated proteins in immunopathological forms of leprosy of 99 skin lesion samples by immunohistochemistry. The intensity and percentage of NLRP3, Caspase-1, Caspases-4/5, interleukin-1β and interleukin-18 immunoreactivities in the inflammatory infiltrate of skin biopsies were evaluated. FINDINGS Strong expression of NLRP3 and inflammatory Caspases-4/5 were observed in lepromatous leprosy (lepromatous pole). In addition, were observed low expression of caspase-1, interleukin-1β, and interleukin-18 in tuberculoid and lepromatous leprosy. The interpolar or borderline form showed immunophenotype predominantly similar to the lepromatous pole. MAIN CONCLUSIONS Our results demonstrate that the NLRP3 inflammasome is inactive in leprosy, suggesting immune evasion of M. leprae.

The involvement of endothelial mediators in leprosy

Leprosy is a chronic infectious disease that requires better understanding since it continues to be a significant health problem in many parts of the world. Leprosy reactions are acute inflammatory episodes regarded as the central etiology of nerve damage in the disease. The activation of endothelium is a relevant phenomenon to be investigated in leprosy reactions. The present study evaluated the expression of endothelial factors in skin lesions and serum samples of leprosy patients. Immunohistochemical analysis of skin samples and serum measurements of VCAM-1, VEGF, tissue factor and thrombomodulin were performed in 77 leprosy patients and 12 controls. We observed significant increase of VCAM-1 circulating levels in non-reactional leprosy (p = 0.0009). The immunostaining of VEGF and tissue factor was higher in endothelium of non-reactional leprosy (p = 0.02 for both) than healthy controls. Patients with type 1 reaction presented increased thrombomodulin serum levels, compared with non-reactional leprosy (p = 0.02). In type 2 reaction, no significant modifications were observed for the endothelial factors investigated. The anti-inflammatory and antimicrobial activities of the endotfhelial factors may play key-roles in the pathogenesis of leprosy and should be enrolled in studies focusing on alternative targets to improve the management of leprosy and its reactions.

Modulação do metabolismo energético na hanseníase / Energy modulation in leprosy

O Mycobacterium leprae, patógeno intracelular causador da hanseníase, infecta com sucesso células da glia do sistema nervoso periférico, denominadas células de Schwann (CS). Estas células são responsáveis pela mielinização e envio de metabólitos, como o lactato e o piruvato, para os axônios, mantendo assim os processos energéticos associados à transdução de sinal nos nervos periféricos. A interação entre o bacilo e sua célula hospedeira vem sendo alvo de muitos estudos de modulação imunológica, desmielinização e de metabolismo lipídico, porém as possíveis modulações sobre o metabolismo energético destas células impostas pelo patógeno permanecem negligenciadas e desconhecidas. Para determinar estas modulações, estudamos o metabolismo energético de uma linhagem de células de Schwann humanas (ST8814) infectadas in vitro por M. leprae purificado a partir de extratos de coxim plantar de camundongos atímicos nu/nu. Analisamos processos de entrada e quebra de glicose, a fermentação, potencial elétrico mitocondrial e biossíntese de lipídios. A internalização de glicose foi avaliada através do seu análogo fluorescente 2-NBDG e o potencial elétrico mitocondrial monitorado através da sonda lipofílica catiônica TMRMPara analisar a fermentação da glicose quantificamos lactato através do kit lactato liquiform (Labtest) e analisamos a atividade da enzima lactato desidogenase (LDH) em suas duas isoformas...

Mycobacterium leprae, an intracellular pathogen which causes leprosy, is able toinfect Schwann cells (SC) in peripheral nervous system. These cells are responsible formyelination and release of metabolites such as lactate and pyruvate to axons and signaltransduction in peripheral nerves. The host-pathogen interaction in leprosy has been target ofseveral studies of immune modulation, demyelination and lipid metabolism. However,modulations on the energy metabolism of these cells during infection by mycobacteria remainunknown. Here, we performed an in vitro study of the energy metabolism in the human SCcell line ST8814 infected with M. leprae purified from footpads of athymic mice and evaluatethe glucose uptake and cleavage, fermentation, mitochondrial electrical potential and lipidbiosynthesis. The glucose uptake was evaluated using a fluorescent analog, 2-NBDG, andmitochondrial electrical potential monitored using a lipophilic cationic probe, TMRM. Also,fermentation was evaluated by lactate quantification using Liquiform kit (Labtest) and byactivity of lactate desidogenase (LDH) enzyme into its two isoforms...

Antioxidant factors, nitric oxide levels, and cellular damage in leprosy patients

Introduction The immune response caused by Mycobacterium leprae is a risk factor for the development of oxidative stress (OS) in leprosy patients. This study aimed to assess OS in leprosy patients before the use of a multidrug therapy. Methods We evaluated the nitric oxide (NO) concentration; antioxidant capacity; levels of malondialdehyde, methemoglobin and reduced glutathione; and the activity of catalase and superoxide dismutase (SOD) in leprosy patients. Results We observed lower SOD activity in these leprosy patients; however, the NO levels and antioxidant capacity were increased. Conclusions The infectious process in response to M. leprae could primarily be responsible for the OS observed in these patients. .

Leprosy, a neglected disease that causes a wide variety of clinical conditions in tropical countries

Leprosy is an ancient disease that remains endemic and continues to be a major public health problem in some tropical countries, where it has been internationally recognized as being linked to the underdevelopment conditions. The natural course of the disease covers a wide variety of clinical conditions with systemic involvement. In this paper, we review the findings obtained in studies of the pathological mechanisms of leprosy, including a survey of the literature and of our own work. The understanding and control of the wide variety of clinical conditions should help improve patient care and thus prevent the onset of physical impairment and the stigma of the disease.

Leprosy patients: neurotrophic factors and axonal markers in skin lesions / Pacientes com hanseníase: fatores neurotróficos e marcadores axonais em lesões de pele

Neurotrophins are growth factors with crucial roles in neural pathophysiology. These mediators functionally modulate nociceptive fibers, and changes in neurotrophins expression have been correlated with early loss of nociception in leprosy. This study investigated the expression of NGF, BDNF, and NT3 in dermal nerves of leprosy patients. Characterization of Remak bundles was achieved by p75NTR, and axonal markers NF-L and PGP 9.5 immunostaining. Clinical parameters of neural impairment have been evaluated by Semmes-Wenstein monofilaments. Our findings demonstrated decrease of NGF in borderline leprosy, when compared to control specimens. Similar results were observed in PGP 9.5 expression (borderline: p<0.001 and lepromatous: p<0.05) and NF-L (lepromatous: p<0.05), suggesting advanced Remak bundles degeneration in multibacillary leprosy. It has also been observed positive correlation between p75NTR and PGP 9.5, indicating association between Schwann cells and axons in Remak bundles. Present data indicate that neurotrophins imbalance may participate in the establishment of peripheral nerve damage.

Neurotrofinas são fatores de crescimento com papel fundamental na fisiopatologia neural. Esses mediadores modulam funcionalmente fibras nociceptivas. Mudanças em sua expressão têm sido relacionadas à perda precoce da nocicepção na hanseníase. Este estudo investigou a expressão de NGF, BDNF e NT3 em nervos dérmicos de pacientes hansenianos. A caracterização de fibras nervosas não mielinizadas foi feita por p75NTR e marcadores axonais NF-L e PGP 9.5. Os parâmetros clínicos de dano neural foram avaliados por monofilamentos Semmes-Wenstein. Nossos achados demonstram diminuição de NGF nos pacientes dimorfos em comparação aos controles. Resultados similares foram observados para PGP 9.5 (dimorfos: p<0,001; virchowianos: p<0,05) e NF-L (virchowianos: p<0.05), sugerindo degeneração avançada das terminações nervosas na hanseníase multibacilar. Foi observada correlação positiva entre p75NTR e PGP 9.5, indicando associação entre células de Schwann e axônios em fibras nervosas não mielinizadas. Os resultados indicam que o desequilíbrio na expressão das neurotrofinas pode participar do dano neural periférico.

Papel imunossupressor da indoleamina 2, 3 - dioxigenase na hanseníse / Immunosuppressive role of indoleamine 2, 3 - dioxygenase in leprosy

Os mecanismos que levam a ausência de resposta imune celular no pólo lepromatoso da hanseníase frente ao Mycobacterium leprae permanecem obscuros. Estudos anteriores mostraram que fatores secretados pelos macrófagos de pacientes lepromatosos inibem a proliferação de linfócitos de indivíduos saudáveis, sugerindo que fatores endógenos produzidos por células da linhagem mielóide podem exercer uma atividade supressora nas células T. Recentemente, diversos estudos têm demonstrado a participação da enzima indoleamina 2,3 dioxigenase (IDO) na supressão das células T, indicando que mudanças bioquímicas devido ao catabolismo do triptofano têm efeitos na proliferação dessas células. No presente trabalho nós demonstramos que os pacientes com a forma clínica lepromatosa apresentam uma maior expressão de IDO em biópsias de pele e maior atividade de IDO no soro quando comparados com pacientes com a forma tuberculóide e que o M. leprae induz a expressão e a atividade de IDO em monócitos de indivíduos saudáveis e de pacientes lepromatosos. Além disso, observamos que o M. leprae induz aumento na atividade de IDO nas células dendríticas derivadas de monócitos de indivíduos saudáveis e que esta atividade aumentada de IDO contribui para o aumento percentual de linfócitos expressando a molécula supressora CTLA-4, sugerindo que IDO participe na anergia T antígeno específico observada em pacientes com a forma lepromatosa da doença.

Role of PGL-I of M. leprae in TNF-alpha production by in vitro whole blood assay.

Phenolic glycolipid-I (PGL-I) is known to be a major antigen of Mycobacterium leprae. We have studied the influence of PGL-I on the production of Tumour Necrosis Factor alpha (TNF-alpha) using the in vitro whole blood assay. Armadillo-derived M. leprae (ADML) are thought to be depleted of PGL-I during the purification process. M. leprae obtained from mouse foot pad material (MFPML) has been subjected to a less rigorous purification process; their PGL-I coating is therefore believed to be more intact than that of ADML. PGL-I or ADML alone induced the secretion of minimal levels of TNF-alpha in whole blood assay; when added in combination, higher levels of this cytokine were observed. The highest TNF-alpha response was seen following stimulation with MFPML. MFP material not infected with ML did not elicit any response. The difference in TNF-alpha response shown by ADML and MFPML was postulated to be largely due to the presence of higher levels of PGL-I in MFPML. This increase in TNF-alpha production suggests that PGL-I may play a significant role in the induction of TNF-alpha during natural infection.

Potencialização do efeito metemoglobinizante da dapsona em ratos pela N-acetilcisteína / Potentiation of dapsone induced methemoglobinemia by N-acetylcysteine in rats

Dapsona (DDS) (4,4'diaminodifenilsulfona), fármaco de escolha para o tratamento da hanseníase, freqüentemente induz anemia hemolítica e metemoglobinemia. A N-hidroxilação, uma de suas principais vias de biotransformação, é constantemente relacionada com a metemoglobinemia observada com o uso do fármaco. Com o objetivo de prevenir a hemotoxicidade induzida pela DDS, N-acetilcisteína, fármaco precursor de glutationa, foi administrada em associação com DDS em ratos machos Wistar pesando 220-240 g. Os animais foram anestesiados e o sangue coletado da aorta para determinação da concentração plasmática de DDS por CLAE, determinação dos níveis de metemoglobina e de glutationa eritrocitária por espectrofotometria, e avaliação de parâmetros bioquímicos e hematológicos. Os resultados obtidos mostraram que a N-acetilcisteína potenciou o efeito metemoglobinizante da dapsona devido ao aumento de sua concentração plasmática e conseqüente aumento da formação da N-hidroxilamina. Concluímos que as interações medicamentosas com a dapsona exigem estudos individualizados a fim de evitar os efeitos adversos do fármaco.

Dapsone (DDS) (4,4'diaminodiphenylsulfone), the drug of choice for the treatment of leprosy, frequently induces hemolytic anemia and methemoglobinemia. N-hydroxylation, one of the major pathways of biotransformation, has been constantly related to the methemoglobinemia after the use of the drug. In order to prevent the dapsone-induced hemotoxicity, N-acetylcysteine, a drug precursor of glutathione, was administered in combination with DDS to male Wistar rats, weighting 220-240 g. The animals were then anaesthetized and blood was collected from the aorta for determination of plasma DDS concentration by HPLC, determination of methemoglobinemia and glutathione by spectrophotometry, and for biochemical and hematological parameters. Our results showed that N-acetylcysteine enhanced dapsone-induced methemoglobinemia due to increased dapsone plasmatic concentration and consequent increased N-hydroxylamine formation. We concluded that drug interactions with dapsone require individually studies in order to avoid undesirable effects of dapsone.

Ligand-binding prediction for ErbB2, a key molecule in the pathogenesis of leprosy.

BACKGROUND AND AIMS: Mycobacterium leprae is an obligate intracellular pathogen. Ligand-binding is an important factor in the success of chemoprevention and chemotherapy. A new drug that can inhibit M. leprae binding to and activation of, ErbB2 and Erk1/2 in primary Schwann cells is the new therapeutic option. However, the ligand-binding pattern of ErbB2 has never been clarified. METHODS: In this work, the author performed a ligand-binding prediction for ErbB2 using a new bioinformatics tool. RESULTS: According to this study, nine strong possible ligands can be identified. CONCLUSION: These sites can be useful for further drug-development studies.

Evaluacion de la produccion de citoquinas en enfermos de lepra / Evaluation of cytokine production in leprosy patients

El objetivo de este estudio fue evaluar la producción de citoquinas por células mononucleares periféricas (CMP) obtenidas de pacientes con lepra, cuando estas células son estimuladas con ConA, PPD o Myconacterium leprae. Medimos IL-2, IL-4, IFN- y e IL-6 en sobrenadantes libres de células, por enzimoinmunoensayos. Nuestros resultados no sugieren una clara associación entre una forma clínica de lepra y un perfil de secreción de citoquinas de tipo Th1 o Th2 en las CMP de los pacientes con lepra.

Study of hydration of stratum corneum in leprosy.

The study of hydration power of stratum corneum of lesions show highly significant poor water-uptake at low temperatures (p less than 0.001), a defect not recorded after removal of water soluble fractions. Secondly, the lesions show significant poor water-diffusive power (p less than 0.001). The findings suggest a qualitative alteration in the stratum corneum of leprosy patients, probably in its water-soluble protein fraction.

NADH-redutase de metemoglobina e reticulocitose / NADH-methemoglobin reductase and reticulocytosis

Os níveis de NADH-redutase de metemoglobina e de hemoglobina, bem como a taxa de reticulócitos, foram determinados em 60 hansenianos adultos (30 homens e 30 mulheres) sob sulfonoterapia. Os resultados encontrados permitiram concluir que tanto o nível de hemoglobina quanto a taxa de reticulócitos näo têm influência significativa na determinaçäo da atividade da NADH-redutase de metemoglobina, e que a atividade dessa enzima é mais alta nos pacientes do sexo feminino