Multibacillary leprosy patients with high and persistent serum antibodies to leprosy IDRI diagnostic-1/LID-1: higher susceptibility to develop type 2 reactions

Abstract

Leprosy inflammatory episodes [type 1 (T1R) and type 2 (T2R) reactions] represent the major cause of irreversible nerve damage. Leprosy serology is known to be influenced by the patient's bacterial index (BI) with higher positivity in multibacillary patients (MB) and specific multidrug therapy (MDT) reduces antibody production. This study evaluated by ELISA antibody responses to leprosy Infectious Disease Research Institute diagnostic-1 (LID-1) fusion protein and phenolic glycolipid I (PGL-I) in 100 paired serum samples of 50 MB patients collected in the presence/absence of reactions and in nonreactional patients before/after MDT. Patients who presented T2R had a median BI of 3+, while MB patients with T1R and nonreactional patients had median BI of 2.5+ (p > 0.05). Anti-LID-1 and anti-PGL-I antibodies declined in patients diagnosed during T1R (p < 0.05). Anti-LID-1 levels waned in MB with T2R at diagnosis and nonreactional MB patients (p < 0.05). Higher anti-LID-1 levels were seen in patients with T2R at diagnosis (vs. patients with T1R at diagnosis, p = 0.008; vs. nonreactional patients, p = 0.020) and in patients with T2R during MDT (vs. nonreactional MB, p = 0.020). In MB patients, high and persistent anti-LID-1 antibody levels might be a useful tool for clinicians to predict which patients are more susceptible to develop leprosy T2R.

Can baseline ML Flow test results predict leprosy reactions? An investigation in a cohort of patients enrolled in the uniform multidrug therapy clinical trial for leprosy patients in Brazil

“…Bacillary load is known to directly correlate with antibody levels and with the development of leprosy reactions [2, 16, 27, 28]. Moreover, antibodies, which are abundant in MB patients, probably play a role in the pathophysiology of ENL [15–17, 39]. However, little, if anything, is known about the role of antibodies in the development of RRs and other clinical manifestations such as neuritis.…”

“…Conflicting data have been reported about the predictive value of anti-PGL-I serology for identifying patients who are at a higher risk of developing leprosy reactions. High levels of anti-PGL-I antibodies at diagnosis or after treatment have been associated with a higher risk of developing leprosy reactions [14–17], however, other studies have shown similar anti-PGL-I levels among reactional and reaction-free patients [18–20]. Therefore, whether anti PGL-I serology can be used to identify patients at risk of developing leprosy reactions remains unknown.…”

Genetic polymorphisms of the IL6 and NOD2 genes are risk factors for inflammatory reactions in leprosy

“…At the onset of the reactions, high levels of cytokines such as IL-1, IL-6, IL-12, IFN-γ, and TNF [ 2 , 5 – 12 ] have been detected either in serum or skin lesions, and recently, cytokine profiling has identified promising host biomarkers to reaction in patients from Bangladesh, Brazil, Ethiopia, and Nepal [ 13 ]. Also, anti-LID-1 antibody levels were found to be high and persistent in multibacillary leprosy patients who developed a reaction, therefore suggesting that this is a putative serological predictive tool [ 14 ].…”

Perfil clínico e epidemiológico de pacientes em reação hansênica

“…Importantly, during the course of leprosy, a significant proportion of patients develop acute inflammatory complications, known as leprosy-related reactions or reaction conditions, which are classified as type 1 and 2 reactions and defined by the host immune response to Mycobacterium leprae (8) .…”