| Summary: | In this third and final article of a series, the general acceptance of the "N-Factor/Anergic Margin" theory, under other names, is reported. "Constitutional capacity to react", "genetical aptitude" and "potential immunity" stand among the numerous synonyms for the old (1937) "natural" N-Factor; "lepromatous macrophage defect", "specific defect of cell-mediated immunity" are pathogenetical explanations for the "Anergic Margin" (AM). However, "depression" and "impairment" of immunity are not included among the synonyms for the AM, as, according to the theory, energy precedes and conditions VirchowIan hanseniasis, is not caused by it. Secondary unspecific depression of cell-mediated immunity possibly exists in moderately advanced cases of Virchowian hanuPniagig, but has no relationship with the primary genetical incapacity to react to Mycobacterium hansenii, which characterizes the AM of the general population. Studies with homozygotic twins and HL-A antigens support the theory of a genetical conditioning of types of hanseniasis. Many works on the immunogenetics of the disease were inconclusive, partly due to the fact that Mitsuda-negative persons were wrongly considered as a homogeneous group, not as a heterogeneous group ranging from total energy (the AM) to the highest grades of Mitsuda responsiveness (only needing the stimulation by mycobacteria, especially Hansen's and Koch's). "N-Factor" bearers (reactors) and AM members (non-reactors) exist in the whole world, endemic and non-endemic, and constitute an ample field for research. Further investigations to clarify some of the pending questions are suggested.
|
|---|