Learning from lesions: patterns of tissue inflammation in leprosy.

TLDR

Leprosy presents as a spectrum linked to cell‑mediated immunity, with tuberculoid patients showing strong CD4+ responses and few lesions, whereas multibacillary lepromatous patients exhibit weak antigen responses and predominantly CD8+ T cells. The study aims to characterize T‑lymphocyte subsets and antigen‑reactive T‑cell frequencies in leprosy lesions to inform analysis of similar immune reactions in other inflammatory diseases. Monoclonal antibodies distinguishing CD4+ and CD8+ subpopulations were used to analyze T‑cell distribution within lesions across the disease spectrum. Lepromatous lesions were dominated by T‑suppressor CD8+ cells and had half of their CD4+ cells as suppressor/inducer, whereas tuberculoid lesions had helper CD4+ cells outnumbering suppressor/inducer 14:1 and a 100‑fold enrichment of antigen‑reactive T cells compared to peripheral blood.

Abstract

The clinical forms of leprosy constitute a spectrum that correlates closely with the degree of cell-mediated immunity. Patients with tuberculoid leprosy develop strong cell-mediated responses and have only a few, localized lesions, whereas patients with multibacillary lepromatous leprosy are specifically unresponsive to antigens of Myobacterium leprae. T cells of the CD4+ subset predominate in tuberculoid lesions, whereas CD8+ cells predominate in lepromatous lesions. Monoclonal antibodies that distinguish subpopulations of CD4+ and CD8+ cells were used to analyze the distribution of T cells infiltrating lesions across the disease spectrum. In lepromatous lesions, T cells of T-suppressor phenotype (9.3-) were the predominant CD8+ cells and suppressor/inducer cells (2H4+, Leu-8+) represented half of the CD4+ subset. In tuberculoid lesions, helper T cells (CD4+4B4+) outnumbered suppressor/inducer T cells by 14:1, compared with a ratio of 1.2:1 in peripheral blood. Analysis of the precursor frequency of antigen-reactive T cells permitted us to estimate that there was a 100-fold enrichment of T cells able to proliferate in response to M. leprae antigens in tuberculoid lesions (2/100), when compared with blood from the same patients. The methods used here to characterize the T-lymphocyte subsets and frequency of antigen-reactive T cells in leprosy may be useful in analyzing immunological reactions occurring in lesions of other inflammatory and autoimmune diseases.