The relationship between transforming growth factor-β with erythema nodosum leprosum recurring events based on immunoglobulin-m anti phenolic glycolipid-1 and cortisol

Abstract

Background : Erythema Nodosum Leprosum (ENL) recurrent is a serious complication of leprosy immunology, that cause the inflammation of the skin, nerves and other organs. The cause and risk factor of ENL were the immunology complication reaction on leprosy. Some of those were caused by the deposition of the M.Leprae antigen and complex antibody. ENL can cause deformity and disability that make the quality of life decreased. TGF-β and IgM anti PGL-1 usually increase during recurrent ENL reaction . Objective :This study was to examine the relationship between TGF-β with recurrent ENL based on the IgM anti PGL-1 and Cortisol on leprosy patients in the Dr.H. Abdul Moeloek Hospital Lampung and Dr. Rivai Abdullah Leprosy Hospital Palembang. Subjects : There were 22 subjects leprosy patients with recurrent ENL reactions and 22 subjects unrecurrent reaction as control. Methods : This research examined the subject serum level of TGF-β by ELISA using Human TGF-β Bio legend kit (USA), IgM anti PGL-1 with the Laboratory of Leprosy Institute of Tropical Disease kit, Airlangga University Surabaya, and Cortisol using Stress Xpress Cortisol EIA kit (StressMarq Canada). Results: This research was from 44 subjects of leprosy MB type, there was 22 subjects with recurrent ENL reaction (16 male , 6 female, mean age 34.9 years old) the mean of TGF-β was 62.6 ± 30.4 pg/ml, the IgM anti PGL-1 was 2029 ±1687 µ/ml, and the Cortisol was 6.61 ± 1.99 µg/dl, and 22 subjects un-recurrent reaction as controls (15 male, 7 female, mean age 47 years old) the mean of TGF-β level was 47.2 ± 23 pg/ml, the IgM anti PGL-1 was 629 ±1043 µ/ml and the Cortisol was 5.07 ± 2.01 µg/dl. The t-independent statistic test the influence of leprosy MB type group to the recurrent ENL reaction and the un-recurrent ENL patients to TGF-β, IgM anti PGL-1 and Cortisol had p-value = 0.015, 0.001 and 0.035 (p <0.05), respectively. This means that there was a significant difference between the serum levels of TGF-β, IgM anti PGL-1 and Cortisol with the incidence of recurrent ENL reaction and unrecurrent reaction. The result of Logistic binary test of TGF-β, IgM anti PGL-1 and Cortisol was 0.25, 0.016 and 0.771. This means that IgM anti PGL-1 has correlation as variable of TGF-β with recurrent ENL. Conclusion : In this research according to statistic test there was a significant differences between the levels of TGF-β , IgM anti PGL-1 and Cortisol on the incidence of leprosy patients with the recurrent ENL reaction to the unrecurrent ENL reaction. There was a correlation between the levels of TGF-β with recurrent ENL based on the antibodyIgM anti PGL-1. The increasing levels of TGF-β and IgM anti PGL-1 level on patients with leprosy MB type can be as a predictor of the recurrent reaction.