title: The effect of antigen presenting cells on the cytokine profiles of stable and reactional lepromatous leprosy patients.
abstract: In view of varied reports on the Th1/Th2 paradigm in leprosy, we used a novel real time (RT) fluorogenic reverse transcriptase based PCR (RT-PCR) to measure cytokine expression in peripheral blood cells from lepromatous leprosy patients with stable disease and those suffering from erythema nodosum leprosum (ENL/Type II) reactions. To evaluate the role of accessory cells in Th cell differentiation, co-expression of Th cytokines interferon gamma (IFNgamma) and interleukin (IL) 4 and regulatory cytokines IL 10 and IL 12 was compared in antigen stimulated peripheral blood mononuclear cells (PBMC), cultures containing T cells reconstituted with autologous monocytes (MO) and cultures containing T cells reconstituted with autologous dendritic cells (DC). 7/8 stable lepromatous leprosy patients showed co-expression of both IFNgamma and IL 4, suggesting a Th0 or a combination of Th1 + Th2 subsets in PBMC. The RT-PCR demonstrated that stable lepromatous patients and patients in ENL had significantly higher levels of IFNgamma mRNA molecules compared to IL 4. In fact, 5/8 ENL patients had undetectable levels of IL 4 mRNA, with a skewing of the cytokine response towards a Th1-like profile. Consistent with this. IL 12p40 mRNA molecules were significantly higher in the PBMC of ENL patients compared to stable lepromatous patients (P < 0.01). Reconstitution of purified T cells with autologous DC and MO from the stable lepromatous group resulted in down regulation of IL 4 (P < 0.03 for DC and P < 0.02 for MO) and IL 10 (P < 0. 01 for DC and P < 0.02 for MO), and a consequent skewing towards a Th1 profile similar to that seen in ENL patients. The fact that accessory cells could alter the cytokine profile in the reconstituted cultures suggests that they may play a role in determining Th subset differentiation in chronic diseases, and may influence the immunological stability of such diseases.
authors.affiliation: Department of Biotechnology, All India Institute of Medical Sciences, New Delhi. indiran@hotmail.com
authors.forename: I
authors.initials: I
authors.lastname: Nath
authors.forename: N
authors.initials: N
authors.lastname: Vemuri
authors.forename: A L
authors.initials: AL
authors.lastname: Reddi
authors.forename: S
authors.initials: S
authors.lastname: Jain
authors.forename: P
authors.initials: P
authors.lastname: Brooks
authors.forename: M J
authors.initials: MJ
authors.lastname: Colston
authors.forename: R S
authors.initials: RS
authors.lastname: Misra
authors.forename: V
authors.initials: V
authors.lastname: Ramesh
mesh_terms: D000938:Antigen-Presenting Cells / Q000276:immunology*; D002454:Cell Differentiation; D016207:Cytokines / Q000096:biosynthesis* / Q000235:genetics; D004893:Erythema Nodosum / Q000276:immunology*; D006801:Humans; D015440:Leprosy, Lepromatous / Q000276:immunology*; D007963:Leukocytes, Mononuclear; D020133:Reverse Transcriptase Polymerase Chain Reaction; D018417:Th1 Cells / Q000276:immunology / Q000378:metabolism; D018418:Th2 Cells / Q000276:immunology / Q000378:metabolism
chemical_list: D016207:Cytokines