INTRODUCTION
Erythema nodosum leprosum (ENL) is an inflammatory
event that can occur in patients with multibacillary leprosy.
In the skin lesions of ENL, immune complexes and split
products of activated complement are found1,2along with numerous
polymorphonuclear cells.3 The factor(s) that precipitate ENL
are not known, and it is thought (by some) to be a manifestation of
an immune complex mediated hypersensitivity reaction.
Hastings4 suggested that release of mycobacterium antigens
from infected macrophages may be a factor that initiates ENL.
The M. leprae antigen(s) may complex with specific antibodies or
natural or cross-reactive antibodies initiating complement fixation
by the classical pathway or the microbial debris may activate
complement by the alternative pathway, or mannose-bindinglectin
pathway. There is direct and indirect evidence to suggest
that split products of activated complement are participants in the
ENL reaction. Direct evidence was provided by Wemambu,5 who
described deposits of immunoglobulin and complement in ENL
lesions. Bjorvatn6 demonstrated significantly increased levels of
C3b, a catabolic fragment of activated C3, in the plasma of 70 percent
of patients with ENL but in only 18 percent of patients not
in reaction. Saha7 suggested that complement activation during
ENL most likely occurs by the alternative pathway. Sera from 20
patients with ENL were collected at the first visit, and four weeks
after successful therapy with steroids. After assaying the 20 paired
samples they found that the C3 level after remission of ENL rose,
ranging from 13 to 22 percent during therapy. Serum levels of C1q
and C4 did not alter significantly during ENL and also showed no
difference in patients on ENL therapy.
When used under proper guidelines, thalidomide is the
treatment of choice for ENL. Thalidomide is a drug that has anti-
inflammatory properties which are especially evident in the
treatment of ENL. Thalidomide could suppress ENL and prevent
the egress of inflammatory polymorphonuclear cells into the lesions
by inhibiting the activation of complement. Since the split
products from activated complement can orchestrate immunological
and inflammatory processes, we wanted to determine
if thalidomide could suppress the activation of complement. To
do this, we first incubated normal serum with M. leprae or with
zymosan in the presence of thalidomide. The remaining residual
functional C was then determined by defining the dilution
of the serum required lyses 50 percent of the rabbit antibody
sensitized sheep cells (CH'50 Titer or the CH50 Units).
METHODS AND MATERIALS
Thalidomide
Thalidomide, provided by Celgene Corporation (Summit, NJ),
was dissolved in DMSO or aqueous solutions of 0.85% saline
