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An update on leprosy immunopathogenesis: systematic review.

Marcos Jessé Abrahão Silva¹, Caroliny Soares Silva¹, Thiago Pinto Brasil²

¹Postgraduate Program in Parasitic Biology in the Amazon (PPGBPA), University of Pará State (UEPA), Belém, Brazil.

Frontiers in Immunology

|September 23, 2024

Summary

Host immune responses significantly influence leprosy severity. The adaptive immune system worsens nerve damage, while the innate immune system is crucial for initial nerve damage and fighting Mycobacterium leprae infection.

Keywords:

immunity leprosy molecular mycobacterium leprae nerve damage pathology

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Area of Science:

Immunology
Infectious Diseases
Neurology

Background:

Leprosy, caused by Mycobacterium leprae, is a chronic infection where host immunity, not bacterial factors, dictates disease severity and neuropathy.
Understanding the interplay between host immunopathology and leprosy progression is crucial for developing effective treatments.

Purpose of the Study:

To systematically review current scientific knowledge on the relationship between immunopathology and leprosy severity.
To elucidate the roles of innate and adaptive immunity in the pathogenesis of leprosy.

Main Methods:

A systematic review adhering to PRISMA 2020 guidelines was performed.
Searches were conducted in PubMed, LILACS, SciELO, and Science Direct databases for articles published between January 2011 and May 2022.
Keywords included "Leprosy/Immunology", "Cytokines", and "Mycobacterium leprae". Methodological quality was assessed using JBI checklists.

Main Results:

Forty-nine articles were included in the review.
Reduced MHC molecule release and impaired T lymphocyte response were associated with increased infection severity.
Macrophage and T helper cell differentiation, influenced by PRR activation, correlated with disease severity.
Distinct CD8+ T cell profiles and specific IgA induction by B cells were observed in severe leprosy (LL), alongside increased Treg-type CD8+ T cells contributing to anergy.

Conclusions:

The adaptive immune system exacerbates nerve damage and determines leprosy type.
The innate immune system plays a significant role in the initial nerve damage, symptomatic presentation, and critical immune responses like inflammation and bacterial clearance.