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A sequential study of circulating immune complexes, complement and immunoglobulins in borderline tuberculoid leprosy
V D Ramanathan1, P Thyagi, U Ramanathan
1Tuberculosis Research Centre (ICMR), Chennai.
Insights
This study tracked immune markers in leprosy patients undergoing chemotherapy. Elevated circulating immune complexes (CIC) and IgG, with depressed complement-mediated immune complex solubilization (CMS), were observed, potentially linking to reversal reactions.
Area of Science:
- Immunology
- Infectious Diseases
- Dermatology
Background:
- Leprosy, particularly borderline tuberculoid leprosy, can involve complex immune responses.
- Reversal reactions are a significant complication during chemotherapy for leprosy.
- Understanding immune system dynamics is crucial for managing leprosy complications.
Purpose of the Study:
- To investigate sequential changes in immune markers during chemotherapy for borderline tuberculoid leprosy.
- To correlate levels of circulating immune complexes (CIC), complement fragment C3d, complement-mediated immune complex solubilization (CMS), and immunoglobulins with leprosy progression and reversal reactions.
Main Methods:
- Sequential measurements of CIC, C3d, CMS, and immunoglobulins (IgG, IgA, IgM) in 24 newly diagnosed patients over 20 months.
- Patients were categorized based on the occurrence of reversal reactions during treatment.
- Immune marker levels were analyzed in relation to treatment initiation and reactional episodes.
Main Results:
- Patients without reversal reactions showed normal C3d, IgA, and IgM levels.
- Patients experiencing reversal reactions had elevated CIC and IgG, and depressed CMS throughout the study.
- Serum C3d was initially elevated but normalized by month three in patients with reversal reactions.
Conclusions:
- Elevated CIC and IgG, alongside reduced CMS, may be implicated in the pathogenesis of reversal reactions in leprosy.
- Immune marker monitoring could offer insights into predicting or understanding leprosy reactional episodes.
Abstract:
Sequential estimates of the levels of circulating immune complexes (CIC), complement catabolic fragment C3d, complement-mediated immune complex solubilization (CMS) and immunoglobulins were made in 24 newly diagnosed with borderline tuberculoid leprosy over a 20 month period after initiation of chemotherapy. Fourteen of these patients had not suffered from reversal reactions either at the time of presentation or during the follow-up. The levels of CIC were evaluated in them from the third to the eleventh month after starting chemotherapy and immunoglobulin G (IgG) levels were evaluated up to eight months. The concentrations of C3d and immunoglobulins A (IgA) and M (IgM) were normal in these patients. The other ten patients had reversal reaction at the time of diagnosis which subsided by the third month after starting treatment. They did not have reversal reactions later. The levels of CIC and IgG were elevated and those of CMS were depressed throughout the study period. Serum C3d level was initially elevated but came down to normal by the third month while IgA and IgM levels were within normal limits. The relevance of these findings to the genesis of reversal reaction is discussed in this communication.
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