Resposta imune celular e humoral a proteínas recombinantes do Mycobacterium leprae em pacientes com hanseníase após a multidrogaterapia e em pacientes com outras dermatoses

• Autor(a) principal: Freitas, Aline de Araújo
• Data de Publicação: 2015
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UFG
• dARK ID: ark:/38995/001300000dw4c
• Texto Completo: http://repositorio.bc.ufg.br/tede/handle/tede/6602
• topic: Hanseníase; Multidrogaterapia; Dermatoses; Leprosy; Multidrugtherapy; Dermatoses; CIENCIAS BIOLOGICAS::IMUNOLOGIA

Leprosy is a complex dermato-neurological disease that presents multiple clinical forms and its differential diagnosis requires clinical expertise. The clinical manifestations in leprosy are defined by the type of imune response developed by the patient: cellular/Th1 or humoral/Th2 in paucibacillary/PB and multibacillary disease respectively. Multidrugtherapy (MDT) is considered efficacious however its impact on the immune responses of PB and MB leprosy patients remains unknown. Currently no single laboratory test is capable to detect all clinical forms of leprosy and laboratory tests are not available to aid the differential diagnosis. This study evaluated the impact of MDT on both cell-mediated immunity (CMI) and antibody responses by the follow up of untreated PB and MB leprosy patients evaluated at 2 time points after MDT using a panel of recombinants M. leprae proteins (rML). At diagnosis, PB patients produced interferon gamma (IFNγ), and MB patients exhibited low or absent response. Shortly after MDT, IFNγ production was observed only to LID-1 in PB and MB leprosy patients (p<0,05). Almost 2 years after MDT, IFNγ levels declined in PB and MB patients. Most untreated PB patients were seronegative to PGL-I and rML, remaining so after MDT. Most untreated MB patients were seropositive to all antigens, and IgG to rMLs declined after MDT. Reduction in antigen-specific CMI in PB and in antibody response in MB patients may help monitor MDT effectiveness but may also have a role in the risk of relapse/reinfection. This study also evaluated the usefulness of cellular test (Whole blood assay – WBA to LID-1) and serology to PGL-I and LID-1 to differential diagnosis of leprosy. Newly diagnosed and untreated PB and MB leprosy patients, patients with other dermatoses clinically suspect of leprosy and healthy endemic individuals were recruited in two geographic areas of Brazil (Goiânia and Fortaleza). Higher IFN levels to LID-1 were detected in PB leprosy patients when compared to all other study groups: MB patients (p<0.0001), other dermatoses (p=0.0008) and endemic controls (p<0.0001). In MB patients, the seroreactivity to LID-1 and PGL-I was statistically different from: PB leprosy (p<0.0001), other dermatoses (p<0.0001) and endemic controls (p<0.0001). The IFN detection by WBA-LID-1 and the serology to PGL-I and LID-1 were able to discriminate leprosy patients from patients with other dermatoses indicating their utility for the differential diagnosis of leprosy.