title: Cortisol and proinflammatory cytokine profiles in type 1 (reversal) reactions of leprosy.
abstract: OBJECTIVE
  Cortisol levels in the circulation and at the sites of peripheral inflammation regulate type 1 (Reversal) reactions in leprosy akin to delayed type hypersensitivity reactions (DTH). In this study we determine the extent to which the differential mRNA expression of genes encoding cortisone-cortisol shuttle enzymes (11 β hydroxysteriod dehydrogenase I & II (11 β HSD I & II)), circulatory levels of proinflammatory cytokines (IL-6, IL-7, IP-10, IL-17F, IL-23, TNF-α, IL-1β, PDGF BB and CRP) and cortisol are associated with development of type 1 reactions in leprosy.
  
  
  METHODS
  Urine, blood and incisional skin biopsy samples from site of lesions were collected from 49 newly diagnosed untreated leprosy cases in T1R and 51 cases not in reaction (NR). mRNA expression levels of genes encoding 11 β HSD I & II in skin biopsy samples were determined by realtime PCR. Cortisol levels from the lesional skin biopsies, serum and urine samples and serum proinflammatory cytokine levels were measured using ELISA.
  
  
  RESULTS
  The mean expression ratios of 11 β HSD I & II are significantly lower in leprosy cases with T1R when compared to the NR leprosy cases. Cortisol levels in lesional skin biopsies and in urine are significantly lower (p=0.001) in leprosy cases with T1R. Serum cytokine levels of IP-10, IL-17F, IL-IL-6 and TNF-α are significantly higher (p<0.05) in leprosy cases with T1R when compared the NR leprosy cases.
  
  
  CONCLUSIONS
  Our study indicated an association of urinary and lesional skin cortisol levels with the manifestation of T1R in leprosy. IP-10, IL-17F, IL-6 and TNF-α can be potential prognostic serological markers and gene expression markers for early detection of type 1 reactions in leprosy.
authors.affiliation: Stanley Browne Laboratory, The Leprosy Mission Community Hospital, Nand Nagri, New Delhi 110093, India. Electronic address: sundeepchaitanya@gmail.com.
authors.forename: V S
authors.initials: VS
authors.lastname: Chaitanya
authors.forename: M
authors.initials: M
authors.lastname: Lavania
authors.forename: A
authors.initials: A
authors.lastname: Nigam
authors.forename: R P
authors.initials: RP
authors.lastname: Turankar
authors.forename: I
authors.initials: I
authors.lastname: Singh
authors.forename: I
authors.initials: I
authors.lastname: Horo
authors.forename: U
authors.initials: U
authors.lastname: Sengupta
authors.forename: R S
authors.initials: RS
authors.lastname: Jadhav
mesh_terms: D043205:11-beta-Hydroxysteroid Dehydrogenase Type 1 / Q000235:genetics / Q000276:immunology / Q000378:metabolism; D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2 / Q000235:genetics / Q000276:immunology / Q000378:metabolism; D042842:11-beta-Hydroxysteroid Dehydrogenases; D000293:Adolescent; D000328:Adult; D054357:Chemokine CXCL10 / Q000097:blood; D016207:Cytokines / Q000097:blood / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015870:Gene Expression / Q000276:immunology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000276:immunology* / Q000652:urine; D006969:Hypersensitivity, Immediate / Q000097:blood / Q000276:immunology / Q000652:urine; D018836:Inflammation Mediators / Q000097:blood / Q000276:immunology*; D020381:Interleukin-17 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007918:Leprosy / Q000097:blood / Q000276:immunology* / Q000652:urine; D008297:Male; D008875:Middle Aged; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012867:Skin / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D055815:Young Adult
chemical_list: D054357:Chemokine CXCL10; D016207:Cytokines; D018836:Inflammation Mediators; D020381:Interleukin-17; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D043205:11-beta-Hydroxysteroid Dehydrogenase Type 1; D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2; D042842:11-beta-Hydroxysteroid Dehydrogenases; D006854:Hydrocortisone
keywords: 11 β Hydroxysteriod dehydrogenase; Glucocorticoids; Inflammation; Proinflammatory cytokines; Ridley Jopling classification; Type 1 reaction