Possible mechanisms of chronic leprosy-related arthritis
Palavras-chave:
Mycobacteria, cellular immunity, humoral immunity, leprosy arthritisResumo
A importância de agentes infecciosos na patologia humana aumentou significamente após a constatação da participação destes agentes em fenômenos auto-imunes, além da indução de processos sépticos primários. Os mecanismos pelos quais microorganismos induzem manifestações de auto-imunidade, como a artrite, tem sido investigados, especialmente os que envolvem as micobactérias como agente etiopatogênico. No modelo experimental de artrite por adjuvante e em algumas doenças inflamatórias articulares humanas, por exemplo na artrite reativa, comprovou-se o envolvimento de linfócitos T e em alguns casos da micobactéria no desencadeamento da artrite. Foi verificada reação cruzada entre a proteína de 65 quilodaltons (kD) de micobactéria e proteoglicanos da cartilagem, evidenciando um possível mecanismo na produção de artrite. A ativação de células B foi também comprovada na doença micobacteriana humana, as quais participam, da produção crônica de citocinas ou como células apresentadoras de antígeno. Em pacientes portadores de hanseníase por nós estudados, artrite periférica de padrão crônico, não relacionada a estados reacionais (eritema nodoso hansênico e reação reversa) e em pacientes considerados com hanseníase inativa foi diagnosticada. O quadro inflamatório articular estava presente em todas as formas de hanseníase inclusive nas paucibacilares. Os mecanismos que poderiam levar à artrite crônica em pacientes com hanseníase são aqui discutidos.
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Pearson CM. Development of arthritis, periarthritis and periostitis in rats given adjuvants. Proc Soc Exp Biol New York 1956;95-101.
Torisu M, Miyahara T, Shinohara N, Ohsato K, Sonozaki H. A new side effect of BCG immunotherapy: BCG induced arthritis in man. Cancer Immunol 1978;5:77-83.
Lydyard PM, Rook GAW, Tsoulfa G, Sharif M, Smith M. Is there a role for mycobacteria in the etiopathogenesis of rheumatoid arthritis? Immunol Reviews 1991;121:137-54.
De Graeff-Meeder Er, Van Der Zee R, Rijkers GT, et al. Recognition of human 60kD heat shock protein by mononuclear cells from patients with juvenile chronic arthritis. Lancet 1991;337:1368-72.
Li SG, Quayle AJ, Shen Y, et al. Mycobacteria and human heat shock protein-specific cytotoxic T lymphocytes in rheumatoid synovial inflammation. Arthr Rheum 1992;35:270-81.
Bahr GmM Rook GAW, Al-Saffar M, Van Embden JDA, Stanford JL, Behbehani K. An analysis of antibody levels to mycobacteria in relation to HLA type: Evidence for non-HLA-linked high levels of antibody to the 65 kD heat shock protein of M. tuberculosis in rheumatoid arthritis. Clin Exp Immunol 1989;74:211-5.
Van Eden W, Thole Jer, Van Der Zee R, et al. Cloning of the mycobacterial epitope recognized by T lymphocytes in adjuvant arthritis. Nature 1988;331:171-3.
Holoshitz J, Klajman A, Drucker I, et al. T lymphocytes of rheumatoid arthritis patients show augmented reactivity to a fraction of mycobacteria cross-reactive with cartilage. Lancet 1986;9:305-9.
Filley E, Andreoli A, Steele J, et al. A transient rise in agalactosyl IgG correlating with free IL-2 receptors during episodes of erythema nodosum leprosum. Clin Exp Immunol 1989;76:343-7.
Rook G. Rheumatoid arthritis, mycobacterial antigens and agalactosyl IgG. Scand J Immunol 1988;28:487-93.
Rook G, Lydyard P, Stanford JL. Mycobacteria and rheumatoid arthritis. Arth Rheum 1990;33(3):431-5.
Atkin SL, El-Ghobarey A, Kamel M, Owen JP, Dick WC. Clinical and laboratory studies of arthritis in Hansen's disease. Brit Med J 1989;298:1423-5.
Atkin SL, El-Ghobarey A, Kamel M, Owen JP, Dick WC. Clinical and laboratory studies in patients with leprosy and enthesitis. Ann Rheum Dis 1990;49:715-7.
Atkin SL, Welbury RR, Stanfield E, Beavis D, Iwais B, Dick WC. Clinical and laboratory studies of inflammatory polyarthritis in patients with leprosy in Papua New Guinea. Ann Rheum Dis 1987;46:688-90.
Cossermelli-Messina W. Abordagem reumatológica na hanseníase - Dissertação de Mestrado, Faculdade de Medicina da USP, 1992.
Whitehouse MW. Rat polyarthritis: Induction with adjuvants constituted with mycobacteria (and oils) from the environment. J Rheumatol 1992;9:494-501.
Gaston JSH, Life PF, Bailey LC, Bacon PA. In vitro responses to a 65 kilodalton mycobacterial protein by synovial T cells from inflammatory arthritis patients. J Immunol 1989;143(8):2494-500.
Gaston JSH, Life PA, Granfors K, et al. Synovial T lymphocyte recognition of organisms that trigger reactive arthritis. J Exp Med 1989;76:348-53.
Van Eden W, Holoshitz J, Nevo Z, Frenkel A, Klajman, Cohen IR. Arthritis induced by a T-lymphocyte clone that responds to mycobacterium tuberculosis and to cartilage proteoglycans. Proc Nall Acad Sci USA 1985;82:5117-20.
Quayle AJ, Wilson KB, Li SG, et al. Peptide recognition, T-cell receptor usage and HLA restriction elements of human heat-shock protein (hsp) 60 and mycobacterial 65-kDa hspreactive T-cell clones from rheumatoid synovial fluid. Eur J Immunol 1992;22:1315-1322.
Mculloch J, Lydard PM, Rook GAW. Rheumatoid arthritis: How do the theories fit the evidence. Clin Exp Immunol 1993;92:1-6.
Winfield TB. Stress proteins, arthritis, and autoimmunity. Arthr Rheum 1989;32:1497-1504.
Davenport MP, McKenzie KR, Basten A, Britton WJ. The variable C-terminal region of the mycobacterium leprae 70-kilodalton heat shock protein is the target for humoral immune responses. Infect Immunity 1992;60(3):1170-7.
Dejoy SQ, Ferguson-Chanowitz K, Oronsky AL, Zabriskie JB, Kerwar SS. Studies on the homing of mycobacterium sensitized T-lymphocytes to the synovium during passive adjuvant arthritis. Cell Immunol 1990;130:195-203.
Mican JA, Metcalfe DD. Arthritis and mast cell activation. J Allergy Clin Immunol 1990;86(4):677-83.
Holla VV, Kenetkar MV, Kolhatkar MK, Kulkarin CN. Leprous synovitis: A study of fifty cases. Int J Lepr Mycobact Dis 1983;5:29-32.
Powell CS, Swan LL. Leprosy pathologic changes observed in fifty consecutive necropsies. Am J Pathol 1955;31:1131-47.
Rook G, Stanford JL. Slow bacterial infections or autoimmunity? Immunol Today 1992;13(5):160-4.
Yang XD, Gasser J, Feige U. Prevention of adjuvant arthritis in rats by a nonapeptide from the 65 kD mycobacterial heat-shock protein. Clin Exp Immunol 1990;81:189-194.
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