Cellular immune response to Mycobacterium leprae infection in human immunodeficiency virus-infected individuals.

The immune responses to Mycobacterium leprae and other mycobacterial antigens were studied in 11 leprosy patients with concurrent human immunodeficiency virus type 1 (HIV-1) infection. Three patients manifested borderline lepromatous leprosy, and eight patients had borderline tuberculoid (BT) leprosy. Despite the low CD4+ T-cell count in the peripheral blood, no histologic or phenotypic change in the cellular infiltrate in either the lepromatous or tuberculoid lesions was observed when compared with HIV-1-negative patients. Lepromatous lesions contained heavily parasitized macrophages and few CD8+ T cells. Lesions from the patients with BT leprosy showed extensive CD4+ T-cell infiltration despite a significant reduction in CD4+ T-cell counts in the peripheral blood. No acid-fast bacilli were detected in the tuberculoid lesions. HIV-1 infection did not alter the lack of response in lepromatous leprosy to M. leprae antigens either in vitro or in vivo. In contrast, the skin test response to M. leprae antigens as well as the in vitro lymphoproliferative responses to mycobacterial antigens that are usually seen in patients with tuberculoid leprosy were abrogated in the BT HIV-1+ patients. However, production of gamma interferon in response to the same stimuli was preserved in most of the patients. Analysis of cytokine gene expression showed activation of additional cytokine genes in the unstimulated peripheral blood cells of patients with both leprosy and HIV-1 infections as compared with cells from patients with leprosy alone. These results suggest that granuloma formation in leprosy can be independent of the impaired CD4+ T-cell response of the HIV-1 infection. Furthermore, in HIV-1+ individuals with M. leprae infection, activation of cytokine genes is observed even when the circulating CD4+ T-cell count is significantly reduced.     

Major proteins of mycobacterial strain ICRC and Mycobacterium leprae, identified by antibodies in sera from leprosy patients and their contacts.

Sera from leprosy patients across the clinical spectrum, healthy contacts, tuberculosis patients, and healthy donors were tested for their reactivity with antigens of mycobacterial strain ICRC (a cultivable mycobacterium) and Mycobacterium leprae by immunoprecipitation technique. Using M. leprae antigens, it was not possible to distinguish between reactivities of sera from lepromatous, borderline lepromatous, borderline tuberculoid, and tuberculoid leprosy patients. All these sera identified M. antigens with molecular masses of 47, 36, 21, and 14 kDa. When the same sera were tested for their reactivities with antigens of mycobacterial strain ICRC, several differences were observed. The 21-kDa antigen of mycobacterial strain ICRC was exclusively precipitated by sera from all lepromatous leprosy patients and from those undergoing erythema nodosum leprosum reaction. Sera from all the other donors tested failed to identify the 21-kDa antigen of mycobacterial strain ICRC. The 14-kDa protein of mycobacterial strain ICRC was identified by sera from a few lepromatous leprosy patients (5 of 26) and all their contacts. Our studies indicate that antigens present on cultivable mycobacteria rather than species-specific antigens may prove to be useful in the serodiagnosis of leprosy.     

In situ demonstration of Mycobacterium leprae antigens in leprosy lesions using monoclonal antibodies

Cryostat sections of skin and nerve lesions of leprosy were stained with monoclonal antibodies recognising Mycobacterium leprae antigens and indirect immunofluorescence. In both the tuberculoid and lepromatous lesions, PGL1, 55-65-kDa, 17-kDa protein antigens and cross-reactive non-protein antigens were present. 65-kDa antigens were seen mainly in the skin lesions of lepromatous leprosy. The infiltrates in both the skin and nerve granulomas of tuberculoid and lepromatous leprosy showed membranous staining with monoclonal antibodies recognising PGL1 and 55-65-kDa antigens. Bacilli in the lesions and the cells in the lymph node granulomas of patients with tuberculosis or the infiltrates in the lesions of tinea corporis or sections of normal skin did not show any staining with these monoclonal antibodies. These results confirm that M. leprae antigens are present and are expressed on the infiltrating cells of leprosy lesions.     

CD1-positive epidermal Langerhans cells in regressed tuberculoid and lepromatous leprosy lesions.

A comparison was made of the numbers of epidermal Langerhans cells in active and regressed lesions of tuberculoid and lepromatous leprosy using the OKT6 and OKIa monoclonal antibodies. A reduction in the numbers of CD1+ epidermal Langerhans cells was noticed in the regressed lesions of both the tuberculoid and lepromatous leprosy lesions unlike the active lesions. The majority of infiltrates in both types of regressed lesions were HLA-DR+ and CD1-.     

Co-stimulatory signals increase the reactivity of gammadelta T cells towards mycobacterial antigens

Although it has been shown that gammadelta T lymphocytes are able to react with different cell-associated or soluble antigens, the immune repertoire of these cells appears to be skewed to the recognition of mycobacterial antigens. We have studied the number and reactivity of gammadelta T cells towards several mycobacterial antigens in patients with tuberculosis and leprosy, as well as their healthy contacts and control individuals. We found an increased number of Vdelta2+ cells in healthy contacts (PPD+ and lepromin+) and tuberculoid leprosy patients. The gammadelta T cells from lepromatous leprosy showed a decreased response to all antigens tested, but some of these patients exhibited a significant response to the 30-kD glycoprotein of Mycobacterium tuberculosis. Interestingly, the reactivity of gammadelta T cells against mycobacterial antigens was significantly increased by costimulatory signals generated through CD7, LFA-1, CD50 and CD69 in all groups. However, signalling through CD69 did not enhance the responsiveness of gammadelta lymphocytes from lepromatous patients. On the other hand, the in vitro blockade of IL-10 with a specific antibody enhanced the cell proliferation of gammadelta lymphocytes from lepromatous leprosy patients, whereas exogenous IL-10 had an opposite effect in most individuals studied. These results suggest the potential role of different cell membrane receptors in the regulation of gammadelta T cell proliferation induced by mycobacteria, as well as the possible involvement of IL-10 in this phenomenon.     

T cell subsets in leprosy lesions: in situ characterization using monoclonal antibodies

Cryostat sections of dermal lesions from 30 untreated leprosy patients were studied by indirect immunofluorescence using monoclonal antibodies defining T cell subsets and Ia like antigens. Most lymphocytes in leprosy lesions were positive for OKT3 and Ia like antigens indicating thereby the presence of activated T cells. Maximal numbers of these cells were seen in localized paucibacillary tuberculoid leprosy lesions in close association with epithelioid cells. A decline in their numbers was observed over the leprosy spectrum with a marked reduction in disseminated, multi-bacillary, lepromatous leprosy where only scattered OKT3+ cells were visualized. OKT4 and OKT8 positive cells defining T cell subsets, were frequently found within the OKT3+ lymphocytes throughout the leprosy spectrum. The ratio of OKT4+/OKT8+ cells ranged from 1.2 to 5.0 in tuberculoid and from 0.2 to 1.0 in lepromatous lesions. Macrophages in the granulomas stained intensely with anti-Ia antisera. Ia like antigens were expressed to the same degree on macrophages with or without intracellular acid fast bacilli.     

CD1-positive epidermal Langerhans cells in skin reactions to autologous peripheral-blood-derived mononuclear cells in leprosy patients

A comparison was made on the characteristics of the infiltrates, the number and distribution of CD1-positive epidermal Langerhans cells (LC) at the sites of skin reaction induced by autologous peripheral-blood-derived mononuclear cells (PBMC) in leprosy patients. Clinically and histologically, the skin reaction was well expressed in tuberculoid patients as compared to lepromatous patients, erythema nodosum leprosum (ENL) patients and contacts. The quantum of lymphocytes in the infiltrates was maximal in the tuberculoid patients and it was minimal in lepromatous and ENL patients. The number and distribution of LC in the tuberculoid patients was significantly higher in the PBMC-inoculated sites as compared to control sites over 24 h. In contrast, no difference in the number and distribution of LC was noticed in the lepromatous and ENL patients. These observations indicate that the lymphocytes of tuberculoid patients in contrast to lepromatous leprosy patients are capable of sustenance in the local micro-environments of the skin and an effective interaction may be possible between LC and PBMC.     

Circulating T-cell numbers and their mitogenic potential in leprosy--correlation with mycobacterial load.

The effect of treatment and mycobacterial load on circulating T-cell numbers and their functional ability was investigated in forty-one patients with leprosy. Both early binding T cells and their responses to phytohaemagglutinin (PHA), concanavalin A (Con A) and pokeweed mitogen (PWM) were profoundly and uniformly depressed in untreated, and partially treated, bacilleferous lepromatous leprosy (LL) patients as compared with normal subjects and tuberculoid patients. On elimination of mycobacteria, subsequent to chemotherapy, LL patients regain normality in T-cell numbers and their functions. On the other hand, the specific response of lymphocytes to M. leprae did not alter with decrease in mycobacterial load. It appears that the decrease in T-cell numbers and the deficit in their mitogenic potential is a secondary consequence of disease and is related to the antigenic load in patients with lepromatous leprosy.     

Restoration of defective cytokine activity within lepromatous leprosy lesions

Immunohistological studies of tuberculoid leprosy lesions (TT-lesions) showed a dense, well organized granuloma consisting of a central area with epitheloid and giant cells containing interferon-gamma (IFN-Gamma) and CD3+, CD4+ T helper/inducer (Th/i) cells, a considerable proportion of which expressed the interleukin-2-receptor (IL-2 R). This central area was surrounded by round cells which consisted mainly of CD3+/CD8+ T cytotoxic/suppressor (Tc/s) lymphocytes. The overlying keratinocytes (KC) were strongly positive for HLA-DR antigens on the surface, indicating high intralesional IFN-Gamma activity. In contrast, lepromatous leprosy lesions (LL-lesions) showed a disorganized infiltrate composed by foamy cells and round cells, the latter mainly expressing the CD3+/CD8+ phenotype. IFN-Gamma activity could not be detected within the lesions. The KC overlying the infiltrate were consistently negative for HLA/DR reactivity pointing to a defective intralesional IFN-Gamma production in LL patients. Two out of four patients with LL leprosy could be sensitized with dinitrochlorobenzene (DNCB). The eliciting of DNCB skin reactions within the LL-lesion led to the recruitment of new infiltrating cells; the resulting infiltrate resembled a local reversal towards the tuberculoid pole of leprosy.     

Radiolabelled M. leprae resident in human macrophage cultures as an in vitro indicator of effective immunity in human leprosy

Twelve strains of human derived, freshly extracted M. leprae maintained within human macrophages showed a 2.1-13.2-fold increase in the incorporation of 3H-thymidine compared to parallel cultures containing heat-killed bacilli of the same strain. The addition of antigen stimulated lymphokines from five paucibacillary, tuberculoid leprosy patients resulted in the inhibition of the uptake of the radiolabel by 49-87%. Minimal, or no, inhibition was noted in the presence of similar culture supernatants from five bacilliferous lepromatous leprosy individuals. The results indicate that in contrast to lepromatous leprosy, tuberculoid patients possess antigen reactive lymphocytes which modulate macrophage function through soluble products. Attention is drawn to a rapid and sensitive in vitro method with potential for studying the immunological mechanisms leading to bacterial killing in human leprosy.     

CD2 expression and function in lepromatous leprosy.

Leprosy is a spectral disease in which clinical presentation is thought to be related to the host immune response. Previous investigations have suggested that selective unresponsiveness to Mycobacterium leprae in patients with lepromatous leprosy is due to the presence of M. leprae-specific T-suppressor cells. However, it has recently been suggested that CD2 modulation was the mechanism for the observed impaired immune response in lepromatous patients. Therefore, we studied the expression of CD2 and CD3 on lymphocytes in lepromatous skin lesions and peripheral blood mononuclear cells (PBMC). Using immunohistochemical techniques, we found that virtually all of the CD3+ cells in leprosy skin lesions expressed CD2. In addition, indirect immunofluorescence flow cytometry demonstrated that most CD3+ cells in the peripheral blood possessed the CD2 marker, suggesting that CD2 expression of T-lymphocytes is normal. T-cell activation using paired anti-T11(2) and anti-T11(3) or anti-CD3 monoclonal antibodies demonstrated similar 3H-thymidine incorporation and gamma interferon production in the PBMC of lepromatous patients in comparison with the PBMC of their contacts and tuberculoid patients. However, lepromatous PBMC did not proliferate or produce gamma interferon in response to M. leprae. Our data suggest not only that CD2 expression is normal on T lymphocytes in lepromatous leprosy skin lesions but also that CD2 expression in peripheral blood lymphocytes is functional in T-cell activation. Defective CD2 modulation does not appear to be the mechanism for specific unresponsiveness in lepromatous leprosy.     

The mycobacterial secreted antigen 85 complex possesses epitopes that are differentially expressed in human leprosy lesions and Mycobacterium leprae-infected armadillo tissues.

The granulomatous skin lesions in leprosy are thought to be initiated by the immune response to certain antigens of the causative agent, Mycobacterium leprae. The antigen 85 complex is one of the major targets in the immune response to M. leprae infection. In the present study, a panel of previously characterized monoclonal antibodies (MAbs) (3A8, Rb2, A4g4, A2h11, Pe12, and A3c12) reacting with different epitopes of the 85 complex proteins of Mycobacterium tuberculosis and M. leprae was employed in a comparative immunohistological analysis to demonstrate the in situ expression of 85 complex antigenic epitopes in leprosy lesions across the clinical spectrum and in M. leprae-infected armadillo liver tissues. These MAbs showed a heterogeneous staining pattern in a given leprosy lesion. In highly bacilliferous borderline and lepromatous leprosy lesions, MAbs Rb2, A4g4, A2h11, and Pe12 stained clear rod-shaped M. leprae bacilli within macrophages, and the degree of staining correlated with the bacillary index of the lesion. On the other hand, MAbs 3A8 and A3c12 staining was mostly seen as a diffuse staining pattern within interstitial spaces and on the membranes of the infiltrated cells but not the bacilli. In paucibacillary borderline and tuberculoid leprosy lesions, only 3A8, Rb2, and A3c12 showed distinct staining in association with infiltrates in the granuloma. None of these MAbs showed any detectable reaction with control nonleprosy skin lesions, while MAb A3c12 positively stained the granulomas of both leprosy and control specimens. In situ reactivity of these MAbs with M. leprae-infected armadillo liver tissues also showed a heterogeneous staining pattern. Interestingly, a clear difference in expression of these epitopes was observed between armadillo tissues and human leprosy lesions. By immunogold ultracytochemistry, we further showed the differential localization of these MAb-reactive epitopes on the cell surface, in the cytosol, and at the vicinity of M. leprae within Kupffer cells of armadillo liver tissues. Our results indicate that these antigenic epitopes of the antigen 85 complex are differentially expressed in leprosy lesions and infected armadillo tissues and that they could be target determinants in the immunopathological responses during M. leprae infection.     

The cell cycle and related concepts in cell proliferation

The epithelioid cell granuloma in high resistant tuberculoid (TT) leprosy was contrasted with the pure macrophage granuloma of anergic lepromatous leprosy (LL) by evaluating various immunological factors operating in these lesions. The immunoperoxidase technique using antisera to immunoglobulin IgG, IgM, complement C₃, C₃d and C₁q and other products of macrophage secretion, lysozyme, plasminogen, a₁ antitrypsin and C-reactive protein and of la antigens revealed peak levels in tissues of most of these factors in both types of granuloma. The tuberculoid response was linked to low antigenic load and Ia-like antigen and the lepromatous response was secondary to a high antigenic load in the absence of Ia antigen. Complement and other mediators were found intracellularly in both tuberculoid and lepromatous granulomas, but extracellilarly only in tuberculoid lesions. This may indicate local hypersensitivity in the tuberculoid granuloma. It is suggested that the mediators in LL macrophages remain bound to the lipids of mycobacterial degeneration in the phagocytic vacuole. Secretory cells were differently sited in the two types of granulomas: peripheral in epithelioid cell lesions and central around capillaries over the whole lesion in pure macrophage granulomas of LL. In tuberculoid leprosy many of the central vessels in the granuloma were obliterated. C₁q was found in fibroblasts. However, the marked absence of fibrosis in any of the lesions of leprosy, except following severe reactions, casts some doubt on the link which has been postulated between epithelioid cells and fibroblasts as an explanation of fibrosis in granulomas.     

Immunologic unresponsiveness in leprosy is mediated by modulation of E-receptor

By using an indirect immunofluorescence technique with OKT3 and OKT11 monoclonal antibodies, the percentage of CD2 positive cells was found to be reduced in the peripheral blood of bacterial index positive lepromatous leprosy patients; however, in these patients, CD3 positive cells were at the normal level. Further CD2 positive cells attained the normal proportion in lepromatous patients when mycobacterial load was reduced. Both CD2 and CD3 receptors were expressed at the normal level in tuberculoid leprosy patients. Prior treatment of peripheral blood mononuclear cells from healthy controls with Mycobacterium leprae significantly decreased the percentage of CD2 but not CD3 positive cells. Such a modulation of CD2 on T cells also resulted in blocking the lymphoproliferative response induced by mitogen and antigen. These results suggest that there is a strong correlation between CD2 modulation and immunologic unresponsiveness in leprosy.     

Leprosy-specific B-cells within cellular infiltrates in active leprosy lesions

Leprosy is a spectral disease with polar lepromatous and tuberculoid forms correlating with enhanced humoral and cell-mediated immunity, respectively, against Mycobacterium leprae and the borderline forms, borderline lepromatous, midborderline, and borderline tuberculoid showing in-between clinical and immunological characteristics. Histopathologically, the cellular infiltrates of leprosy lesions show predominantly the presence of interacting T-cells and antigen presenting cells like macrophages, whereas the presence of B-cells has only been sporadically reported. The present study demonstrates by immunohistochemical techniques the presence of B-cells, including plasma cells, in active lesions from lepromatous leprosy, skin smear negative borderline lepromatous, and paucibacillary borderline tuberculoid leprosy. Furthermore, the study demonstrates the in situ production of M leprae-specific antibodies from BT lesions using an organotypic skin explant culture model. Finally, analysis of the cytokine release profile in supernatants of lesional organotypic skin cultures showed a microenvironment conducive to the differentiation and maturation of B-cells. The results demonstrate the presence of different functionally active B-cell stages within lesions of patients with leprosy, including borderline tuberculoid patients, which could secrete anti-M leprae-specific antibodies. However, their role in leprosy pathology remains to be elucidated.     

The involvement of dendritic cells in the cutaneous lesions associated with tuberculoid and lepromatous leprosy.

Full thickness skin biopsies were examined from 12 untreated leprosy patients and included five borderline tuberculoid (BT leprosy), five borderline lepromatous (BL leprosy) and two subpolar lepromatous leprosy cases. The non-lymphoid mononuclear cells present in the dermal infiltrates were analysed with immunohistological techniques using monoclonal antibodies (MoAb) which in normal tissues identify subpopulations of macrophage-like cells in tissue sections; RFD2 (recognizing all and monocytes/macrophages), RFD1 (recognizing interdigitating cells), NA1/34 (recognizing Langerhans cells) and RFD7 (recognizing only mature tissue macrophages). It was observed that using these MoAb no single cell type was unique to a particular state of the disease but that major differences in the proportions of these non-lymphoid mononuclear cells existed between BT leprosy and BL and LL leprosy. In BL leprosy lesions RFD2+ macrophages were the major cell type although a significant number (15-30%) of RFD1+ macrophage-like cells were also present. In contrast, in the dermal infiltrates of BT leprosy, RFD1+ cells were the predominant cell type (45-55%). The distribution of NA1/34+ Langerhans cells and the expression of Class II major histocompatibility (MHC) antigens was characteristically different in BT, BL and LL leprosy. The relationship between the presence and phenotype of cells considered to be involved in antigen presentation is discussed in relationship to the different clinical states in leprosy.     

Immunohistologic assessment of cytokine production of infiltrating cells in various forms of leprosy.

The aim of this study was to determine cytokines in human leprosy lesions by means of immunohistologic examination. Cryostat sections of skin biopsies from 57 patients with various forms of leprosy were immunostained according to the APAAP method, using monoclonal antibodies against interleukin-1 beta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), and, in addition, against CD 1 antigen. Granulomas in biopsies of untreated patients with tuberculoid leprosy showed large amounts of cells positive for IL-1 beta, TNF-alpha, IFN-gamma, and CD 1, whereas no positive signals could be detected in untreated patients with lepromatous leprosy. However, in those biopsies obtained from lepromatous leprosy patients undergoing chemotherapy, positive staining for cytokines as well as subepidermal Langerhans cells increased to a detectable amount. Remarkably, in tuberculoid leprosy patients, the number of IL-1 beta--positive cells did not vary under therapy, while the number of TNF-alpha and IFN-gamma reactive cells decreased. These results suggest that immunohistologic determination of cytokines in combination with the assessment of subepidermal Langerhans cells in human leprosy lesions may be used as a parameter for the patient's status of cell-mediated immunity under chemotherapeutic treatment.     

Enzyme-linked immunosorbent assay for distinguishing serological responses of lepromatous and tuberculoid leprosies to the 29/33-kilodalton doublet and 64-kilodalton antigens of Mycobacterium tuberculosis.

Immunoblot assays for the antibodies to Mycobacterium tuberculosis sonic extracts showed that all serum specimens of 40 lepromatous and of 28 tuberculoid leprosy patients reacted in a significant manner to 29/33-kilodalton (kDa) doublet and 64-kDa antigens, respectively. By using an enzyme-linked immunosorbent assay, we observed a significantly high immunoglobulin G antibody titer to the purified M. tuberculosis 29/33-kDa doublet and 64-kDa antigens in lepromatous and tuberculoid leprosy patients, respectively, as compared with normal subjects and tuberculosis patients. This enzyme-linked immunosorbent assay serology may be useful for distinguishing two polar types of leprosy and for diagnosing leprosy in general.     

The role of interleukin-2 (IL-2) in the specific unresponsiveness of lepromatous leprosy to Mycobacterium leprae: studies in vitro and in vivo

The role of IL-2 in the immunological deficiency of lepromatous leprosy patients towards Mycobacterium leprae have been studied further. After initial stimulation with M. leprae + IL-2, lepromatous lymphocytes could be restimulated with M. leprae alone. The specificity of the responses obtained varied. Some patients gave a stronger response to BCG as compared to M. leprae, while in others a stronger response to M. leprae as compared to BCG was obtained. Studies of the composition of lymphocytes in dermal infiltrates subsequent to injection of killed M. leprae revealed that in both tuberculoid and lepromatous patients, early accumulation of cell staining for both IL-2 receptor and IL-2 were seen. However, with time IL-2 receptor and IL-2 staining lymphocytes diminished in lepromatous infiltrates, while these were maintained in tuberculoid lesions.     

Immunological significance of changes in lymph nodes across the leprosy spectrum

Seventy-seven lymph nodes were examined histologically from sixty-two leprosy patients representing the whole range of the disease spectrum from the high resistance form (tuberculoid) to the specific immunity deficiency form (lepromatous). At the lepromatous end of the spectrum paracortical areas were infiltrated with undifferentiated cells of the histiocyte–macrophage series which failed to eliminate mycobacteria. As resistance to infection increased across the leprosy spectrum, histiocytes became more differentiated eventually appearing epithelioid. This was paralleled by increasing numbers of small lymphocytes in the paracortical areas. In the borderline tuberculoid form of the disease an appearance was seen similar to that found in sarcoidosis. In polar tuberculoid leprosy where there is a high degree of cellular immunity, paracortical areas were well developed and populated with lymphocytes and immunoblasts. The immunological significance of these findings are discussed, especially the relation of the changes in morphological appearance of cells of the histiocyte series to the ability of the patient to develop cell-mediated immune reactions.