B-cell subsets in leprosy lesions: unraveling the complex interplay.

Background: Leprosy is a chronic infectious disease marked by complex immune interactions, yet the roles of specific B-lymphocyte subsets in its pathology are poorly understood.

Objectives: To investigate the presence and distribution of B-cell subsets, including B1 cells, Marginal Zone (MZ) B-cells, Regulatory B-cells (Bregs), and Effector-1 B-cells (Be1), across different clinical forms of leprosy and reactional states.

Methods: Immunohistochemical and morphometric analyses were performed on skin lesions from patients with various clinical presentations of leprosy.

Results: CD20+ B-cells were abundant in tuberculoid lesions, whereas MZB-1 expression varied significantly among leprosy subtypes. Type 1 Reaction (T1R) lesions exhibited significantly higher counts of B1 and MZ B-cells compared to Type 2 Reaction (T2R), lepromatous leprosy (LL), and indeterminate leprosy (I). Expression patterns of PAX5/MZB-1 and PAX5/CD5 suggested a dominant presence of these cells in the Th1 pole. Be1 cells, strongly linked to Th1 immune response, were also more abundant in Th1 clinical presentations (tuberculoid and T1R leprosy). Although Bregs were generally scarce, they were most frequently observed in T1R.

Study limitations: This study was limited by the relatively small number of cases analyzed per clinical subtype and reactional state.

Conclusions: This is the first study to document the presence and distribution of these specific B-cell subsets in leprosy lesions. The findings suggest distinct roles for B-lymphocyte subtypes, particularly at the tuberculoid pole and during Type 1 reactions.