Leprosy Mailing List (LML) Archives, 2013Leprosy Mailing List archives & Documents from 2013
Mailing Address for LML: editorlml(at)gmail.com
Date: 18 February 2013
Ref.: Leprosy infection and disease
From: Dr. Ben Naafs, The Netherlands
To start an important discussion on LML: one of the major enigmas in leprosy is why in a highly endemic society some persons develop leprosy and others not.
For years people believed that the inherited immune system was the key in this process, although already early in 1978 Stoner et all doubted that. Over the years many authors and researchers showed some influence of both the innate and adaptive immunity on the classification. But not why some persons develop leprosy and others not.
Some geneticists and leprologists reasoned that M.leprae has a small genome and could only live inside some cells by using the genetics of that cell to produce the nutrients and enzymes which M.leprae needs to survive and multiply. Rambukana et all have recently shown that M.leprae can manipulate a host cell indeed. Interesting is that many HIV patients do not develop leprosy. However, HIV patients do harbor and develop more often leprosy than the general population. It is thus not only the immunity.
I throw at you the following theory:
A person is infected by M.leprae; this has to pass the first hurdle, the innate immunity. Passing this the bacillus needs the genetics (determining the milieu interieur) of the host cell: Swann cell, macrophage, smooth muscle cell, or liver cell to survive and multiply. Then the antigenic determinants are presented to the adaptive immune system, which determines whether someone heals or gets one of the manifestations of the leprosy spectrum.
With warm regards
dr Ben Naafs
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