Five biopsies from 2 leprosy patients, tuberculoid (TT), and polar lepromatous (LLp), were studies using immunoperoxidase procedures with monoclonal antibodies. Immunohi-stochemical patterns of them were remarkably differrent. In a TT patient, epithelioid cells and helper/inducer T (Leu 3a+) cells made the central core of a granuloma surrounded by suppressor/cytotoxic T (T8+) cells and B cells, indicating a possible immune-mediated cell response. The distribution of B cells suggests that not only T but also B cells may take part in the formation of the granuloma. In contrast, helper/inducer cells, suppressor/cyto-toxic cells, and macrophages of a LLp patient were admixed uniformly at the site of the lesion, indicating a poor immune response. Although the ENL skin lesion of this LLp patient did not eliminate the bacilli, HLA-DR expression by keratinocytes and increased numbers of helper/inducer cells found in an ENL lesion, comparable to the findings of TT leprosy, suggests that a cell mediated immune response may play some role in the pathogenesis of ENL reaction.

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In-and out-patients with leprosy in Okinawa were surveyed by using the following im-munological tests: cutaneous reaction to Mitsuda's lepromin (40 million bacilli/ml) (LPR), lymphocyte transformation test with Dharmendara's antigen (DL-LTT), that with phyto-hemagglutinin (PHA-LTT), fluorescent leprosy antibody absorption test (FLA-ABS) and Leproagglutination test with cardiolipin-lecithin antigen (LAT). A correlation between two tests and a relationship between the test and personal or family history or clinical finding of the patients were evaluated by non-parametric statistics. Spearman's rank cor-relation coefficient was significant between LPR and DL-LTT, while a reverse correlation was found beween LPR and FLA-ABS, DL-LTT and FLA-ABS, and DL-LTT and LAT, respectively.
High reactivity in PHA-LTT was found in almost all of patients, irrespective of type and stage of leprosy, suggesting general immune responsiveness of leprosy patients in Okinawa. The other tests showed a significant difference in the mean rank of reaction values according to clinical findings such as type and stage of leprosy, property of skin lesion, loss of eyebrow, and bacteriological test. The use of LPR and DL-LTT for the study of cell-mediated immunity in leprosy was therefore confirmed. FLA-ABS was found useful for early serodiagnosis, while LAT for the study of autoimmunity in leprosy.
None of these immunological tests showed significant difference among the subgroups of patients classified by the following items: presence or absence of consanguineous patient with leprosy, living place, place of onset, presence or absence of neural symptoms such as the enlargement of peripheral nerve, claw hand and facial palsy, ocular and nasal involvement, ENL in lepromatous and borderline leprosy and conditions in the treatment. On the other hand, LPR showed higher reactivity in female than in male, in the patients at home than those discharged, and in the patients with drop foot than those without. Higher reactivity of DL-LTT was also found in male than in female and in the patients with plantar ulcer than those without. FLA-ABS reactivity was significantly higher in the discharged patients than the inpatients, in the period of 5 to 9 years after onset than that of 20 or more years, but the reactivity was lower in the patients with drop foot than those without. LAT reactivity was significantly higher in the 30-39 years old patients than 0-19 years old, and in the patients with physical work than those with mental. These findings were discussed by comparing with those described in the previous papers of this series and from immunological point of view on leprosy.

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The skin samples of each palm side and dorsum side of finger, nose and peripheral nerves running under the finger skin at the area between proximal phalanx and distal pha-lanx of mangabey monkey A022 and rhesus monkey A125 were studied by histopathologi-cal methods (semithin section and light microscopic findings).
Results found about this study were as follows.
1. In spite of the existance of a large amount of leprosy bacilli at the areas of corium and subcutis, some of Meissner's corpuscles, Vater-Pacinian corpuscles (or Golgi-Mazzoni's corpuscles) and Krauze's end bulbs-like structures were observed.
2. Occasionally, several intracytoplasmic foamy structures containing a large amount of leprosy bacilli were observed at the shallow and deep layers of stratum papillare of cor-ium, where leprosy bacilli were not so remarkable as shown on Figure 4. So, it was thought that the affinity of leprosy bacilli to free nerve endings should be existant there.
3. Some of M, arrector pili were kept in good condition in spite of the existence of multiplying leprosy bacilli around the hair follicles.
4. It was thought that the histopathological findings of the fascicles of cutaneous nerves were classified to 4 patterns.
The first pattern of histopathological finding of the cutaneous nerve was shown as A on Figure 25. In this pattern observed in almost of all the fascicles locating at the subcutis, no leprosy bacillus was observed inside the fascicles, and the nerve fibers were kept in good condition.
The second pattern observed in almost of all the fascicles located at the corium, was shown as B on Figure 25. In this pattern, a large amount of leprosy bacilli were observed inside the fascicles, and the nerve fibers were often kept in good condition.
The third pattern observed in almost of all the fascicles located at the deep layer of corium and subcutis, was shown as C on Figure 25. In this pattern, not only multiplying leprosy bacilli but also remarkable fibrosis were found inside one fascicle, and many nerve fibers disappeared by the existence of the bacilli and fibrosis.
The final pattern observed in almost of all the fascicles located at the deep layer ofcorium and subcutis, was shown as D on Figure 25. In this pattern, remarkable fibrosis was observed inside the fascicles, and the nerve fibers often disappeared by the existence of fibrosis.
5. Inside the fascicles of peripheral nerves running under the skins of palm side and dorsum side of fingers (N, digitaris palmaris proprii, ramus dorsalis N. ulnaris, N. uln-aris, N, digitaris palmaris radialis proprii, etc), a large amount of leprosy bacilli were observed, but the fibrosis was not so remarkable.
6. Remarkable fibrosis was sometimes observed inside the small nerve fascicles runn-ing between the deep layer of subcutis and N. digitalis dorsalis proprii of little finger. And, some young myelinated nerve fibers were observed in spite of the existence of a large amount of intracytoplasmic foamy structures containing leprosy bacilli inside the fas-cicles of N, digitaris palmaris proprii running at middle phalanx of little finger.
7. Many organs of Hoyer-Grosser were intact, but blood vessels of the organs were often obliterated. It was thought the histopathological finding of the organs caused to the ischemia of the skin.
From these results, the problems of peripheral sensory nerve paralysis in leprosy, espe-cially "individual disturbance of sensibility" and "pattern of ripped gloves (or ripped so-cks, )" were discussed in this paper.

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Histopathological finding of left n. peroneus superficialis, left rami calcanei medialis (n, tibialis), left n. medianus, left ramus superficialis, n. radialis and left rami musculares, m, palmaris brevis of african green monkey 8182 (Delta Regional Primate Research Center, USA) were studied by semithin section method. African green monkey 8182 was inoculated with leprosy bacilli isolated from lepromata of mangabey monkey A 015-natural infection.
The length of period between date of inoculum and date of death of the monkey was about 5 years.

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