Implications of Serum Anti-Ceramide Antibodies and Interleukin 4 on Nerve Damage and Physical Impairments Among Leprotic Patients: A Case-Controlled Study

March 2022 | Volume 21 | Issue 3 | Original Article | 284 | Copyright © March 2022


Published online February 28, 2022

Mohamed S. Zaky MD,a Zakaria M. Obaid MD,a Mohammad A. Khedr MD,b Hala A. El-Sokkary MD,a Mohamed L. Elsaie MDc

aDepartment of Dermatology, Venereology and Andrology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
bDepartment of Clinical Pathology, Faculty of Medicine, Al-Azhar University; Cairo, Egypt
cDepartment of Dermatology, Medical Research and Clinical Research Institute, National Research Centre, Egypt

Abstract
Background: Leprosy is a chronic granulomatous disease affecting skin and nerves with a range of clinical and immunological responses. Objectives: The study aimed to identify levels of IL-4 and antibodies to ceramide in the sera of leprosy patients and healthy subjects using enzyme linked immunosorbent assay (ELISA) to evaluate their possible role in disease severity and their correlation to nerve involvement and physical impairments.
Methods: This study included 25 patients with multibacillary leprosy, 25 with paucibacillary, and 25 healthy controls who were subjected to history taking, clinical examination, and identification of sites and morphology of skin lesions, nerve examination, eye examination, as well as sensory examination. Slit skin smear examination was used for diagnosing paucibacillary (PB) and multibacillary (MB) leprosy cases. Anti-ceramide antibody (ACA) and IL-4 titers were estimated and correlated with the type of leprosy, disease duration, nerve damage, and disabilities.
Results: Serum ACA and IL-4 levels were significantly higher in MB than its level in PB leprotic patients and controls. A significant positive correlation was established between nerve affection; physical impairments and serum levels of ACA and IL-4.
Conclusion: Levels of ACA and IL-4 can impact nerve affection in leprotic patients and can serve as potential biomarkers of disease progression

J Drugs Dermatol. 2022;21(3):284-291. doi:10.36849/JDD.5543

INTRODUCTION

Leprosy is a chronic granulomatous disease caused by mycobacterium leprae (M. Leprae) with a specific predilection to cutaneous and neural tissue. Immunologic and inflammatory changes result in a wide range of skin and nerve tissue manifestations that end up with neural destruction and physical impairments.1

The concentration and adhesion of M. Leprae to the extracellular matrix of Schwann cells can result in irreversible damage of neural tissue and consequently in nerve functions. It is therefore of utmost importance to identify and early treat leprotic affections to limit significant disabilities.2

Anti-neural antibodies are known to play a role in the immunopathogenesis of nerve damage in leprosy. Ceramide is a glycosphingolipid that is expressed as a surface determinant of myelin. Antibodies to ceramide or related neural components of the myelin sheath may be associated with extensive nerve damage.3

Multibacillary leprosy (MB) (Lepromatous) is Th2 mediated condition as opposed to paucibacillary leprosy (PB) which is a Th1 predominately mediated condition. In multibacillary leprosy, there is an inhibition of IL-12 signals as well as the increased response of IL-4 with subsequent disease progression.4

In MB leprosy patients, both IL-4 and anti-ceramide antibody titres increase, however, the mechanisms by which the cellular immune response and the whole spectrum of cytokine release remains to be fully elucidated.5

The present study aimed to evaluate IL-4 and antibodies to ceramide in the sera of leprosy patients and healthy subjects using enzyme linked immunosorbent assay (ELISA) to determine their possible role and correlation of their severity in nerve damage.
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