Leprosy is a dynamic disease model in which distinct Mycobacterium leprae- responsive T cell subsets play an important role in host defense and control clinical and immunological spectrum. Th1 cells are associated with tuberculoid leprosy patients that have strong M. leprac -specific CMI-DTH responses. Th2 cells are expressed in lepromatous leprosy patients that are characterized by strong humoral immune responses and lack of T cell responses. Recently cytokines are thought to play immunoregulatory role in both the protection and immunopathogenesis of the host. Recombinant cytokines for immunotherapy have been used for controlling mycobacterial infections including leprosy. The diversity of T-cell subsets contributing to Th1 and Th2 cell derived cytokines, other major cytokines of the immune system, their sources, modes of action and possible therapeutic potentials are discussed.

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[in Japanese]

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Morphological findings of the cells of Mycobacterium leprae Thai-53 strain smeared on a silicon-coated slide cultured in Kirchner liquid medium, pH 7.0, enriched with adenosine, egg yolk, folinic acid, vitamin K₃, lecithin, and N-acethylglucosamine at 30 °C were demonstrated. On the basis of the results with exquisite morphological growth patterns and the increase in the amount of tempelate DNA prepared from the cultured cells, it is evident that the cells of M.leprae are capable of multiplication under cellfree in vitro conditions. The reason why the ATP content did not increase in parallel with morphological features and the increase in the DNA is presumably that the multiplication of M.leprae in this culture system was supported only by consuming the energy derived from the infected host cells.

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[in Japanese]

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In order to know leprosy chemotherapy status in Japan, three recently conducted Government-supported nation-wide survey, namely chemotherapy research group survey (Takizawa, 1994, 71 cases), follow up result of Takizawa s study (Miyagi, 1997, 59 cases) and leprosy patient registry (Goto, 1996, 130 cases) were compared and analyzed. For most fresh and relapse cases, multi-drug therapy were applied, among them rifampicin/dapsone or rifampicin/dapsone/clofazimine combinations were selected in about half of new cases and about 1/3 of relapse cases. In many cases dose and intervals were based on WHO protocol, however smaller dosage was used in some cases. Quinolone (ofloxacin) was used in 40% of cases during the therapy. Reversal reaction was observed in 7/71 cases and erythema nodosum leprosum was observed in 6/71 cases. In order to prevent chemotherapy-induced deformities, we propose a modified protocol for new cases accompanied by reactional status, which starts with clofazimine monotherapy and followed by WHO/MB.

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One of the most important points in the treatments of patients with leprosy is to heal the disease without sequelae including sensory loss. For this purpose, every available means should be performed. The treatments of patients with leprosy at the Ryukyu University Hospital were reported in this study. Most of the medications were similar to that of multi drug therapy(MDT) recommended by WHO. Some modified MDT was applied to some patients for prevention of the various sequelae caused by the peripheral nervous disorders. In addition, some assistant treatments were also perfomed at our outpatient clinic such as administrations of drugs for the improvement of the peripheral circulation expecting the bacteriostatic effect caused by rising temprature(2-3°C) of the skin lesions and expecting the recovery of the damaged peripheral nerves for the same purpose.h clofazimine monotherapy and followed by WHO/MB.

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[in Japanese]

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We have examined in leprosy in Bangladesh the change in the rate of peripheral nerve damage before and after the treatment In the well-organized NGO program where the early diagnose is given, the damage rate improves slightly during the treatment. But among the MB cases, it has been found that the damage rate taken at the time of patient's first check-up still stays high. Furthermore, during the treatment of MB cases, 72% cases show the episode of neuritis, and even during two years of observation period after treatment, 15% cases show the same episode.
Among the recurrent cases of last ten years in Oku-Komyo-en, we have looked into the ways of drugs prescribed for the treatment of previous recurrent term in the double recurrent cases.
In these prescription, the amount of each dosage was relatively a little and the prescription period was rather long. In RFP., prescription frequency was relatively high, and in DDS and CLF, they were low.
We think that the treatment of leprosy in Japan should be based on WHO's regimen. However before making Japanese regimen, it is necessary to discuss more when to finish the treatment.

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