Lepromatous leprosy patients experiencing erythema nodosum lepro sum (ENL) have been reported to have an increase in the ratio of circulating T-helper to T-suppressor cells (H : S ratio). Thalidomide is an effective drug in the management of ENL. To determine if thalidomide affected cells of the immunoregulatory system, B cells, T cells, T-suppressor cells, T-helper and natural killer cells in the blood of the healthy males were enumerated. Thalidomide induced a decrease in the T-helper to T-suppressor cell ratio. The decrease was due to a significant reduction in the percentage and absolute number ofT-helper cells and an apparent increase in the percentage and absolute number of T-suppressor cells. B cells and natural killer cells were not affected. Thalidomide's ability to decrease the H: S ratio in healthy individuals suggests that it may act in ENL by reducing an elevation of that ratio.
Summary Thalidomide enhances de novo IgM antibody synthesis in mice to DNP Ficoll. The immunocompetent cells responsive to thymic independent antigens like DNP-Ficoll are macrophages and the B lymphocytes. Enhancement ofimmunores ponsiveness to DNP-Ficoll seems to be due to augmentation of macrophage fu nction by thalidomide.Since 1965, thalidomide has been used in alleviating the signs and symptoms of a major medical complication of lepromatous leprosy, erythema nodosum lepro sum (ENL).I Histologically, the hallmarks of ENL lesions are vasculitis or vascular necrosis, oedema and inflammation with infiltrates of neutrophils affecting the entire dermis and subcutaneous fa t.2 The factor or fa ctors that trigger the influx of neutrophils is unknown. For thalidomide to be effective in ENL, it must interfere with one or more of the essential steps in the pathogenesis of this syndrome.Since it has been suggested that ENL is an immune complex mediated disease,3, 4 we have investigated the effect of thalidomide on humoral immunolo gical responses. Thalidomide significantly inhibits an IgM but · not an IgG response in mice to the T-cell-dependent antigen, sheep erythrocytes; it also selectively decreases serum IgM concentrations among leprosy patients being treated fo r their ENL. 5 These observations have prompted us to speculate that a clinically relevant site of action fo r thalidomide in ENL is on the synthesis ofIgM antibody. If thalidomide acts on immunocompetent cells, the cell target of the drug must be among the macrophage, IgM antibody fo rming B cell and helper or suppressor lymphocytes.0305-75 18/85/056297 + 05 SO 1 .00
Summary My cobacterium /eprae was isolated fr om skin-punch biopsies of 2 untreated lepromatous leprosy patients. The bacteria were enumerated, diluted lO-fold and cultured in Middlebrook 7H9 medium supplemented with albumin, dextrose, catalase and 14 C-palmitic acid. The cultures were incubated at 33°C in a modified Buddemeyer radiorespiratory detection vessel. Those cultures containing at least 10 7 mycobacteria demonstrated a progressive evolution of 14 C02 .
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