title: Advances in leprosy immunology and the field application: A gap to bridge.
abstract: Advances concerning the hosts' immune response to Mycobacterium leprae infection have focused on elucidating the immune pathomechanisms involved, with the hope that predictive diagnostic and prognostic parameters (biomarkers) for field use would emerge; however, improvements in our understanding of the immunologic responses to this complex disease have, to date, somewhat failed to provide the effective and robust methods for improving its predictive diagnosis in the field situation, particularly in those patients suffering from paucibacillary disease. In this contribution we have attempted to review some of the advances both in the immunology and immunopathology of leprosy, and also highlight the limited clusters of immune parameters that are now available. Most importantly, we point out the limitations that still prevail in the provision of effective biomarkers in the field situation for either: (1) the diagnosis of indeterminate disease, (2) predictive diagnosis of individuals developing reactional states, (3) monitoring efficacy of treatment, or (4) monitoring treatment of reactional states.
authors.affiliation: Lauro Souza Lima Institute, Bauru, Brazil.
authors.forename: Vania Nieto Brito
authors.initials: VN
authors.lastname: de Souza
authors.affiliation: Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Anand M
authors.initials: AM
authors.lastname: Iyer
authors.affiliation: College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Lammas
authors.affiliation: Foundation of Dermatology, Munnekeburen, The Netherlands.
authors.forename: Ben
authors.initials: B
authors.lastname: Naafs
authors.affiliation: Lauro Souza Lima Institute, Bauru, Brazil; Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. Electronic address: p.k.das@bham.ac.uk.
authors.forename: Pranab Kumar
authors.initials: PK
authors.lastname: Das
mesh_terms: D006801:Humans; D007918:Leprosy / Q000097:blood / Q000276:immunology* / Q000473:pathology*