Thakur Vishal, Narang Tarun, Bishnoi Anuradha, Dhawan Garima, Sharma Ankur, Saikia Uma Nahar, Razmi T Muhammad, Dogra Sunil, Handa Sanjeev, Modi Manish
Department of Dermatology, Venereology, and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Indian Dermatol Online J. 2024 Jun 26;15(4):599-604. doi: 10.4103/idoj.idoj_233_23. eCollection 2024 Jul-Aug.
Subclinical involvement of nerves may sometimes be present much before the overt clinical manifestations become apparent. Protein gene product (PGP) 9.5, a ubiquitin-C-terminal hydrolase, has been widely used as a marker to study the involvement of peripheral nerve fibers in many diseases.
To evaluate the change in cutaneous nerve fiber staining and distribution from pre-treatment and post completion of multidrug therapy through the expression of PGP9.5 and to assess PGP9.5 as a marker of treatment response.
In this prospective single-center observational study, skin biopsy was taken in patients with leprosy, having areas of nerve function impairment (NFI), based on findings of nerve conduction studies (NCSs), but not having lesions or impaired tactile or thermal impairment clinically. The thin nerve fiber density in the clinically normal skin in areas supplied by nerve showing changes of sensory neuropathy was evaluated to study the density of the fibers. A second biopsy was taken at the end of treatment from a site near the previous site to assess the changes in intra-epidermal nerve fiber staining and distribution.
Thirty-three patients were recruited in the present study (24 males and 9 females). Pre-treatment, 27 patients had abnormal NCSs, while six patients did not have any evidence of neuropathy on NCSs. Staining for nerve fibers using PGP9.5; in the epidermis was positive in five patients pre-treatment and 11 patients post treatment ( = 0.181). Staining in the dermis revealed positivity in 14 pre-treatment, which increased to 18 post treatment ( = 0.342). Adnexae showed positivity in five patients pre-treatment and increased to 17 post treatment ( = 0.005).
A reduced PGP9.5 staining in the epidermal, dermal, and adnexal regions was seen in leprosy patients, which improved post treatment. Thus, PGP9.5 may serve as a marker of NFI and treatment response.
在明显的临床表现出现之前，神经的亚临床受累有时可能就已存在。蛋白基因产物（PGP）9.5是一种泛素C末端水解酶，已被广泛用作研究多种疾病中外周神经纤维受累情况的标志物。
通过PGP9.5的表达评估多药治疗前和治疗结束后皮肤神经纤维染色及分布的变化，并评估PGP9.5作为治疗反应标志物的情况。
在这项前瞻性单中心观察性研究中，根据神经传导研究（NCS）结果，对患有神经功能损害（NFI）区域但临床上没有病变或触觉或热觉受损的麻风病患者进行皮肤活检。评估感觉神经病变发生变化的神经所支配区域内临床正常皮肤中的细神经纤维密度，以研究纤维密度。在治疗结束时，从先前部位附近的一个部位进行第二次活检，以评估表皮内神经纤维染色及分布的变化。
本研究招募了33名患者（24名男性和9名女性）。治疗前，27名患者的NCS异常，而6名患者在NCS上没有任何神经病变的证据。使用PGP9.5对神经纤维进行染色；治疗前表皮中有5名患者呈阳性，治疗后有11名患者呈阳性（P = 0.181）。真皮中的染色显示治疗前有14名患者呈阳性，治疗后增加到18名（P = 0.342）。附属器在治疗前有5名患者呈阳性，治疗后增加到17名（P = 0.005）。
麻风病患者在表皮、真皮和附属器区域的PGP9.5染色减少，治疗后有所改善。因此，PGP9.5可能作为NFI和治疗反应的标志物。
