Distribution of CD4+RORg-T Th17 and CD25+ FOXP3+ Treg in Leprosy Patient with Reversal Reaction

*Renni Yuniati  -  Faculty of Medicine Diponegoro University, Indonesia
Riawan W  -  Faculty of Medicine Brawijaya University, Indonesia
Widasmara D  -  Faculty of Medicine Brawijaya University, Indonesia
Darmaputra IGN  -  Faculty of Medicine Udayana University, Indonesia
Arifin S  -  Faculty of Medicine Brawijaya University, Indonesia
Received: 6 Nov 2017; Published: 31 Dec 2017.
Open Access
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Section: Original Research Articles
Language: EN
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Background: One of the most common difficulties found in leprosy management is how to manage leprosy reaction, even though MDT has proven to be effective for the patients. Reversal reaction is associated with cell mediated immunity (CMI), consists of T-helper (Th) 1 and Th2 activities. Moreover, subset of CD4+ Th17 and CD25+ FOXP3 Treg were known to have an important role in leprosy’s natural history. Prior study showed a decreasing number of CD25+ FOXP3 Treg and increasing number of CD4+ Th17 in type II reversal reaction (ENL). However, the distribution of Th17 and Treg in type I reversal reaction (RR) has not yet been identified.

Objective: To compare the distribution of CD4+ Th17 and CD25+ FOXP3 Treg between RR and ENL patient groups.

Method: A total of 50 samples, consisted of 27 samples of reversal reaction (RR) and 23 samples of ENL, were collected. Observation of CD4+ RORg-T Th17 and CD25+ FOXP3 Treg were conducted with immunohistochemistry staining technique using anti FOX-P3 and anti RORg-T. Expression of CD4+ ROR-g Th17 and CD25+ FOXP3 Treg in percentage were analyzed using T-test.

Result: There is a significant difference in mean CD4+ ROR-g Th17 and IL17 cell distribution for RR patient group (14.96% and 10.72%) compared with ENL (9.12% and 4.28%). No significant difference were found between mean CD25+ FOXP3 Treg and TGF-β cell distribution in RR patient group (6.12% and 5.44%) compared with ENL group (6.16% and 5.96%).

Conclusion: There is a significant increment od CD+RORg-T Th17 and IL17 in RR patients group compared with ENL patients group. however, the distribution of CD25+ FOXP3+ Treg and TGF beta in RR has no significant difference campared with ENL.

CD4+RORg-T Th17; CD25+ FOXP3+ Treg; IL17; TGF-β; Reversal Reaction; Erythema Nodosum Leprosum

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  1. WHO Expert Committee on leprosy. Eight report. Geneva, World Health Organization, 2002 (WHO Technical Report Series, No. 968).
  2. Worobec SM. 2012. Current Approaches and Future Directions in The Treatment of Leprosy. Tropical Medicine 3:79–91.
  3. Walker SL, Lockwood DNJ. (2006). The Clinical and Immunological Features of Leprosy. from: http://bmb.oxfordjournals.org/content/77-78/1/103.full.pdf+html, 2014 Jan 4.
  4. Pandhi D, Chhabra N. 2013. New Insights in The Pathogenesis of Type 1 and Type 2 Lepra Reaction. Indian J Dermatol Venereol Leprol79(6):739-749.
  5. Bettelli E et al. T(H)-17 cells in the circle of immunity and autoimmunity. Nat Immunol. 2007;8(4):345-50.
  6. Saini C et al. CD4+ Th17 cells discriminate clinical types and constitute a third subset of non Th1, Non Th2 T cells in human leprosy. PLoS Negl Trop Dis. 2013;7(7):e2338.
  7. Sadhu S et al. Reciprocity between Regulatory T Cells and Th17 Cells: Relevance to Polarized Immunity in Leprosy. PLoS Negl Trop Dis. 2016;10(1): e0004338.
  8. Abbas AK et al. Regulatory T cells: recommendations to simplify the nomenclature. Nat Immunol. 2013;14(4): 307-8.
  9. Josefowicz SZ et al. Regulatory T cells: mechanisms of differentiation and function. Annu Rev Immunol. 2012;30: 531-64.
  10. Nath I et al. Natural suppressor cells in human leprosy: the role of HLA-D-identical peripheral lymphocytes and macrophages in the in vitro modulation of lymphoproliferative responses. Clin Exp Immunol. 1980;42(2):203-10.
  11. Saini C et al. Leprosy Reactions Show Increased Th17 Cell Activity and Reduced FOXP3+ Tregs with Concomitant Decrease in TGF-beta and Increase in IL-6. PLoS Negl Trop Dis. 2016;10(4):e0004592.
  12. Vieira AP et al. Development of Type 2, But Not Type 1, Leprosy Reactions is Associated with a Severe Reduction of Circulating and In situ Regulatory T-Cells. Am J Trop Med Hyg. 2016;94(4):721-7.