1983年にLancasterらは,重症らい菌感染ヌードマウスの足蹠に多型核白血球の集団巣が存在し,また肝にもENLに類似した病巣が見られることを報告している。著者は上記の所見がヒトのENLに相当するものかどうかを解明するために,らい菌感染ヌードマウスに治らい薬を投与したとき,上記の多型白血球集団巣がどのように変化するか,また同病巣部に免疫複合体が存在するかどうかを検索した。
らい菌感染ヌードマウスにDDSまたはリファンピシンを投与して組織学的なENL症状を誘導する試みは不成功に終った。また,ENLの発生機序として重視されている免疫複合体をらい菌感染ヌードマウスの病巣内に検出することはできなかった。多型核白血球集団巣の存在だけではENL発生の症状であると結論するには不充分である。ヌードマウスにおいてENLを発生させることは不成功に終ったが,本研究から以下の結論を下すことができた。
1) 飼料に0.003%の割合にランプレンを添加し,らい菌感染後18週の比較的早期からヌードマウスに投与しても,多型核白血球集団巣の発生は完全には抑制されなかった。
2) 多型核白血球集団巣の発生はDDSまたはリファンピシンの投与では増強されず,ランプレンの長期投与でやや軽減した。
3) 早期から開始し,長期間持続したランプレンの投与は,ヌードマウスのらい腫性病変部に明らかな治癒機転をもたらした。
ENL反応の発生機序を更に解明するためには,今後ヌードマウスにT cellサブセットを移入して行う実験が有意義であろうということが示唆された。

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我々は,系統の異なるマウスを用いて,二極型の鼠らいを作製し,それぞれの病型におけるマクロファージの中のライソゾームの変化に関する研究を行った。ハワイ株鼠らい菌(Mycobacterium lepraemurium)1×10⁷をC57BL/6N, CBA/J, C57BL/6N(nu/⁺).およびC57 BL/6N (nu/nu)マウスの胸骨部皮下に接種した。生じた肉芽腫性病変の凍結切片上でGomoriのazo-dye methodにより酸フォスファターゼおよびアルカリフォスファターゼを組織化学的に検索した。主として酸フォスファターゼをマーカーとしてライソゾームを電顕的レベルで検索することができた。その結果,鼠らい菌に対して抵抗性を有する系統のマウスで見られる,免疫学的に活性化されたマクロファージ中では,ライソゾームの構造が保持され,酸フォスファターゼ活性が,ライソゾーム内に局在して見られた。このような所見は,ヒトのT型(類結核型)で観察された所見と同一であった。しかしながら,免疫学的な機能に異常のある系統のマウスに出現したマクロファージ中では,ライソゾームの形態が破壊され,膜構造が失われ,酸フォスファターゼ活性が細胞質内にび慢性に出現するのが見られた。この所見は,やはりヒトで,L型(らい腫らい)で観察された結果と同一の成績であった。ライソゾームの形態と機能に関しては,鼠らいはヒトのらいを研究するための,良い実験モデルになりうることが示唆された。

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A survey was conducted by direct interview of patients visiting the Leprosy patients Welfare Society old Mahapalika building (the old hospital for the leprosy patients) in Agra City, U. P. State, India, from the end of July to August in both 1984 and 1985, for a total of six weeks.
The purpose of the survey was to observe and analyze the family size and members, education, religion of the patients and their individual attitudes toward leprosy.
A total of 705 people was interviewed. Here, out of them, 278 Hindu married patients were selected to analyze the influence of being leprosy to the children number of them. Further, a total of 523 married healthy people in a village of Agra suburb and 99 married patients visiting the same building were selected to observe the influence of religion, location of residence and leprosy disease itself to the number of their children.
Out of 278 patients, 207 were husbands and 71 were wives. All of them dropped in the age group of 15-49 years old and did not have the relation of a couple each other. Lepromatous cases were more dominant than in the result of usual village survey and it showed a good result of clinical education for lepromatous leprosy patients particularly. Many of them lived in villages and were occupied in agriculture and the concerning works.
The ratio of patient having children after starting of the disease was 26% for husband and 34% for wife group. The difference between the ratios was thought due to the different physiological influence of the disease according to the sex which they belong to. In both groups, a higher ratio of them was obtained for the urban people and it suggested the difference in general conception toward the disease between urban and rural location of residence.
The number of children obtained in healthy period of patient showed an influence to the birth of children after starting of the disease. In wife group, following groups of children number in healthy period; less than 2, 3-5, more than 6, showed different ratio of the patient having children in the disease period. In husband group, the difference of the ratio was not clearly shown.
There was observed a particular influence of married and diseased age of patient to the child birth after starting of the disease. In husband group diseased before 24 years old, the ratio of patient having children after starting of the disease decreased according to increasing of the marriage age. For the result, there was thought the influence of some factors; education, literacy, knowledge and recognition of the disease.
The average of children number for healthy Hindu husband and healthy Muslim husband were 3.3 and 4.2 respectively, and there was obtained significant difference between the ratios. The healthy groups showed larger average number of children than the patient group usually.
The number of children in each family will have a big influence to the population problem in India under the present situation of progressing family planning.

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The invasion of M. leprae to the peripheral nervous system makes the main signs and symptoms of leprosy as the reflucts of many kind of reactions. In recent Japan, most doctors, working at leprosaria, can only see the arrested-disease patients with the manifestation of deformed appearances of face and extremities and with various neuralgias, instead of active typical signs.
In this paper, the authors reported the effective treatment for neuralgias from which the patients have been suffering during their lives of leprosy, and also shortly discussed the pathogenesis of painful neuralgias associated with acute nerve swelling in the arrested-disease.
The two thirds of about 200 cases of chronic neuralgias treated with long term administration of pen-oral methylcobalamine (methylated Vitamine B₁₂) were well improved and could be broken away from anodynes.
The Phantom limb pain-like neuralgias which is characterized by sudden and severe onset at the areas of arteficial legs of extremities or faces with complete sensory loss were well controlled by carbamazepine.
60 neuralgias in patients with lepromatous leprosy were associated with acute nerve swellings. Except 5 cases, tender and swollen nerves were found in clinically arrested stage, in other words, indifferent from clinical ENL. The careful examination could reveal the phenomenon especially at more proximal and deeper site of the nerve than those happened in usual ENL.
They were treated with perineural injection method with methylcobalamin and glucocortico-steroid, resulting in complete healing of neuralgias and also in preventing the disturbances of nerve functions.
Histopathological study of peripheral nerves derived from autopsied cases with arrested disease, revealed the findings as follows ; 1) M. leprae and their fragments, usually gathering around vessels, are never completely cleaned out by anti-leprosy drugs, 2) the relatively fresh nerve swellings seem to be the immunological reactions participated in the arterioles surrounded by edema, sometimes forming single fasciclar swelling and also forming Renaut's-like bodies in cases.
From the definition of ENL, the possible mechanism of ENL occuring only in the nerve fascicle(s) in arrested disease patients without M. leprae for a long period in the dermal tissues, were discussed in accordance with the continuous anti-leprosy treatment, because 90% of the cases had been given drugs though more than 80% of them were arrested. If so, the inducer of ENL only in the nerves might be the continuous drug administration.
Whether the anti-leprosy treatment should continue or not for arrested patients is the question for the authors, who are nonspecial leprologists.

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