HLA DRB1*DQB1* haplotype in HTLV-I-associated familial infective dermatitis may predict development of HTLV-I-associated myelopathy/tropical spastic paraparesis

A possible causal association between infective dermatitis and HTLV-I infection was reported in 1990 and confirmed in 1992. We now report familial infective dermatitis (ID) occurring in a 26-year-old mother and her 9-year-old son. The mother was first diagnosed with ID in 1969 at the age of 2 years in the Dermatology Unit at the University Hospital of the West Indies (U.H.W.I.) in Jamaica. The elder of her 2 sons was diagnosed with ID at the age of 3 years, also at U.H.W.I. Both mother and son are HTLV-I-seropositive. A second, younger son, currently age 2 years, is also HTLV-I-seropositive, but without clinical evidence of ID. Major histocompatibility complex (MHC), class II, human leucocyte antigen (HLA) genotyping documented a shared class II haplotype, DRB1*DQB1* (1101-0301), in the mother and her 2 sons. This same haplotype has been described among Japanese patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and has been associated with a possible pathologically heightened immune response to HTLV-I infection. The presence of this haplotype in these familial ID cases with clinical signs of HAM/TSP may have contributed to their risk for development of HAM/TSP. The unaffected, HTLV-I-seropositive younger son requires close clinical follow-up.

Immunogenetics of HTLV-I/II and associated diseases

The ethnic background of human T-lymphotropic virus types I and II (HTLV-I/II) infections and associated diseases was investigated in association with human leukocyte antigens (HLA) (alleles) and haplotypes. Japanese HTLV-I carriers were characterized by two categories of HLA class I antigens (A24, A26, B7, B61, Cw1, and Cw7) and class II alleles (DRB1 *0101, 0803, 1403, 1501, and 1502 and DQB1 *0303, 0501, and 0601); one category was associated with adult T-cell leukemia (ATL) patients and the other with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients. The ATL-associated haplotypes had unique DRB1-DQB1 alleles (0901-0303, 1501-0602, 1401-0503), which were correlated with a low immune responsiveness to HTLV-I, while the HAM/TSP haplotypes had different DRB1-DQB1 alleles (0101-0501, 0803-0601, 1502-0601), which were correlated with a high immune responsiveness to HTLV-I. Both ATL- and HAM/TSP-associated haplotypes were found among HTLV-I carriers and the patients from other ethnic groups (Jamaican blacks, Andes natives, South American mestizos, and Mashhadi Jews). HLA haplotypes of HTLV-II carriers were different from those of HTLV-I carriers among South American natives. These results suggested that HTLV-I/II infections and the associated diseases might be determined by immunogenetic factors segregated with HLA alleles and haplotypes.

Primary adrenal ganglioneuroblastoma in an adult

We present here a case of adrenal incidentaloma in a 35-year-old male. Imaging technology including magnetic resonance imaging (MRI) clarified that the tumor was heterogeneous, and large in size (9x7 cm), and that it originated from the left adrenal gland. MRI scans on T1-weighted sequence showed the tumor with a low signal intensity followed by rapid contrast enhancement, whereas those on T2-weighted sequence showed markedly increased intensity. The tumor was surgically removed, and pathologic diagnosis was well-differentiated ganglioneuroblastoma. Ganglioneuroblastoma in adults is extremely rare, with only about 30 cases documented in people over the age of 20 years.

ADL structure for stroke patients in Japan based on the functional independence measure

The difficulty patterns of FIM (Functional Independence Measure) in Japan were determined and compared with patterns found in the United States to assess whether FIM can be used for worldwide comparisons of ADL (the activities of daily living). The FIM was measured for 190 stroke patients in several hospitals throughout Japan. The scores at admission and discharge were converted to an interval scale by Rasch analysis. Right and left brain lesion patients were analyzed separately. The FIM items were divided into two groups: motor items and cognitive items to minimize misfit. A degree of misfit was acceptable, except for bowel and bladder management, stairs, bathing, and expression. Motor items, eating, and bowel and bladder management were the easiest; stairs, bathing, and tub/shower transfers were the most difficult. The difficulty patterns of patients with left and right hemisphere lesions were almost identical. Bathing and tub/shower transfer were more difficult for Japanese patients than for those studied in the United States. Concerning the cognitive items, expression was easiest for patients with right hemisphere lesions but most difficult for those with left hemisphere lesions. Social interaction was easier for Japanese patients with left hemisphere lesions than the other patients. The item difficulty patterns in Japan differs slightly from those in the United States because of cultural differences. As countries show different patterns of difficulty, we must be careful when making international comparisons of FIM data converted by Rasch analysis.

Frequent mutation in pX region of HTLV-1 is observed in HAM/TSP patients, but is not specifically associated with the central nervous system lesions

Human T-cell leukemia virus type 1 (HTLV-1) is an etiologic agent of adult T-cell leukemia (ATL) and of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Recently it has been reported that defective HTLV-1 provirus was detected frequently in the central nervous system (CNS) lesions of HAM/TSP patients. Here we investigated sequence variations of the pX region of HTLV-1 in the CNS and peripheral blood lymphocytes (PBL) of the same patient. The results analyzing 9-13 clones isolated from each specimen indicated that the pX region is highly variable within a patient with HAM/TSP, and the mutations were found at almost random positions within the sequences analyzed. The frequency and pattern of those mutations did not appear to differ significantly between the CNS and PBL of the same patient, although they differed among patients. Similarly, frequent mutations were observed in an asymptomatic carrier of HTLV-1, although the variability was moderate, suggesting that the high variability of the pX sequence is not a specific event in HAM/TSP. However, one asymptomatic carrier showed much less frequent variations very similarly to an ATL patient; both of them harbored clonally expanded infected cells. Thus the apparent low variability was explained by clonal selection of a single species of the provirus by the clonal proliferation of infected cells. These results clearly indicate that mutations including defectives are not specifically associated with the CNS lesions in HAM/TSP patients, but suggest that the random mutations simply reflect the rate of viral replication in individuals and the variants were not inherited frequently.

Molecular characterization of a family of tandemly repetitive DNA sequences (pYS family) in the genus Hemitaxonus (Hymenoptera: Tenthredinidae)

Distribution of a family of tandemly repetitive sequences in Hemitaxonus japonicus (pYS family) was investigated among eight sawfly species and host races in the genus Hemitaxonus. High copy numbers of the repetitive sequences were detected in the two host plant races of H. japonicus, race Polystichum polyblepharum (race PP) and race P. tripteron (race PT), and H. sasayamensis, whereas a low copy number in H. minomensis. Comparison of the nucleotide sequences of the basic repeat units demonstrated a high degree of homology among the four tested species with high AT-rich sequences. Minor repeat units shorter than the consensus basic repeat unit of pYS family were found only in races PP and PT of H. japonicus. Analyses of their nucleotide sequences showed the occurrence of the host race specific sub-repeat units.

Re-evaluation of anti-HTLV-I Western blot assay using HTLV-I and HTLV-II serum panels

BACKGROUND

Western blot assay is accepted to be a confirmatory test of anti-HTLV-I antibodies, and several WB criteria have been proposed for confirming HTLV-I seropositivity. There is a necessity for comprehensive study on the criteria.

OBJECTIVES

This study was performed to evaluate anti-HTLV-I WB kits and feasibility of the WB criteria.

STUDY DESIGN

We tested 3 commercially available WB kits: PROBLOT HTLV-I, Eitest ATL-WB and HTLV BLOT 2.2, by a standard HTLV-I serum panel which had been established in our previous study. Sensitivity and specificity to detect each component of HTLV-I antigens were evaluated by the correlation coefficient, R-value. Specificity of the anti-HTLV-I WB kits and HTLV BLOT 2.3 was further evaluated by a standard HTLV-II serum panel established from the HTLV-I/II epidemiological surveillance of Colombian natives.

RESULTS

PROBLOT HTLV-I showed high R-values (>/=0.980) for p28, p53 and gp46, but low R-values (<0.900) for p19 and p24. Eitest ATL-WB showed a high R-value for p19, but low R-values for p53, gp46 and rgp21. HTLV BLOT 2.2 showed high R-values for p28 and recombinant gp46-I, but low R-values for p53 and gp46. The HTLV-II serum panel showed positive reactions with p24 and p19 of HTLV-I but a little if any reactions with p28 and gp46 of HTLV-I. Although these reactions could not define HTLV-II-specific WB patterns in anti-HTLV-I WB, HTLV-I- and HTLV-II-specific recombinant gp46 in HTLV BLOT 2.3 were useful to distinguish anti-HTLV-II antibodies.

CONCLUSIONS

The currently available anti-HTLV-I WB kits are sufficient for confirmatory testing of anti-HTLV-I antibodies with WHO criteria using one gag and one env positivity, but they are inadequate for anti-HTLV-II confirmatory testing.

A maternal risk factor for mother-to-child HTLV-I transmission: viral antigen-producing capacities in culture of peripheral blood and breast milk cells

We examined the relationship between productivity of HTLV-I antigen-positive cells in cultured peripheral blood mononuclear cells (PBMC) and breast milk mononuclear cells (BMMC) and the incidence of mother-to-child transmission of HTLV-I. Among 61 cases of HTLV-I carrier mothers, 17 cases were revealed to produce large numbers of HTLV-I antigen-positive cells (high HTLV-I antigen-producing mothers) whose positive rate was 9.6% in PBMC and 10.2% in BMMC, while the remaining 44 cases produced small numbers of HTLV-I antigen-positive cells (low HTLV-I antigen-producing mothers) whose positive rate was 0.3% in PBMC and 0.5% in BMMC. The HTLV-I transmission rate among children born to the high HTLV-I antigen-producing mothers was 37.5% (6/16 children from 11 mothers), while that of the low HTLV-I antigen-producing mothers was 3.2% (1/31 children from 20 mothers). The transmission rate of HTLV-I was significantly different between high and low HTLV-I antigen-producing mothers (P < 0.05). However, there was no positive relationship between anti-HTLV-I antibody titers and productivity of HTLV-I antigen-positive cells (P = 0.11). These results suggested that mother-to-child transmission of HTLV-I might be influenced by a maternally determined factor to produce HTLV-I antigen-positive cells in PBMC and BMMC of HTLV-I carrier mothers.

Characterization of a family of tandemly repetitive DNA sequences from the fern sawfly, Strongylogaster osmundae (Hymenoptera: Tenthredinidae)

A family of repetitive DNA sequences in the genome of the sawfly, Strongylogaster osmundae (Hymenoptera: Tenthredinidae) was characterized. The family consists of a tandemly arranged array whose basic repeat unit is 1.0 kb. According to the compositions and arrangements of bases, the basic repeat unit can be divided into three distinct domains. Three domains share nucleotide sequence homology of 88, 74 and 89%, respectively, between members in this family. Second domain which had lower homology with the other two domains was found characteristically rich with polypurine/polypyrimidine sequences.

HTLV-I from Iranian Mashhadi Jews in Israel is phylogenetically related to that of Japan, India, and South America rather than to that of Africa and Melanesia

A new endemic focus of human T-lymphotropic virus type I (HTLV-I) was recently reported among Mashhadi Jews, a group of immigrants from northeastern Iran to Israel. We extracted DNAs from fresh peripheral blood mononuclear cells (PBMCs) and/or gargle mouthwash from 10 HTLV-I carriers, who consisted of members of one family, and HTLV-I-associated myelopathy (HAM) and adult T-cell leukemia (ATL) patients. Long terminal repeat (LTR) regions of proviral DNAs were sequenced and analyzed phylogenetically. In a phylogenetic tree, all the Mashhadi HTLV-I isolates belonged to subtype A, one of the three subtypes of the cosmopolitan type of HTLV-I, and made a tight cluster distinct from the other isolates of subtype A from Japan, India, the Caribbean Basin, and South America. Although a few nucleotide substitutions were observed among the clones sequenced, no characteristic sequence variation was found in different disease manifestations, even in one family or different sources of DNA preparation.

Repetitive DNA sequence families in Hemitaxonus minomensis and H. athyrii (Hymenoptera; Tenthredinidae)

Families of the repetitive DNA sequences from Hemitaxonus minomensis and H. athyrii were characterized. pHMS family and pHME family in H. minomensis consist of tandemly arranged arrays whose basic repeat units are 260 bp and 330 bp, respectively. pHAE family in H. athyrii consists of a tandemly arranged array whose basic repeat unit is 330 bp. pHMS family and pHME family occupy approximately 4.8% and 0.07% of the genome of H. minomensis, respectively. By contrast, in H. athyrii, pHAE family comprise 0.04% of the genome. Nucleotide sequence comparison of these three repetitive families showed very little homology. Southern blot hybridization using six species of Hemitaxonus showed that these repetitive families are species specific.

In vitro induction of cytotoxic T lymphocytes against HTLV-I-infected T-cells from adult T-cell leukemia patients, asymptomatic HTLV-I carriers and seronegative healthy donors

We investigated an in vitro method to produce cytotoxic T lymphocytes (CTLs) against HTLV-I-infected T-cells using peripheral blood mononuclear cells (PBMC) of adult T-cell leukemia (ATL) patients, asymptomatic HTLV-I carriers (AC) and seronegative healthy donors. The PBMC were restimulated repeatedly for 4 weeks with HLA-matched HTLV-I-infected T-cells which had been pretreated at 56 degrees C for 30 min to inactivate infectious HTLV-I. The culture medium included 10-100 units/ml of recombinant lymphokines (rIL-1, rIL-2, rIL-4, rIL-6 and rIL-7) and 10% fetal calf serum in RPMI-1640 medium. The cytotoxic activity was measured against HLA-matched HTLV-I-infected T-cell lines after CD4+ or CD8+ cells were positively panned from the cultured PBMC. The PBMC of ATL, AC and healthy donors were able to produce either CD4+ or CD8+ CTLs against HTLV-I-related antigens (env, gag, p21x, p27rex and p40tax) as well as the antigen(s) of as-yet unknown specificity expressed on HTLV-I-infected T-cells. All the CTLs recognized the specific antigens in the context of either class I or class II HLA types. These results indicated that ATL patients, AC and healthy donors were immunocompetent to generate CTLs against HTLV-I-infected T-cells and probably against HTLV-I-transformed T-cells.

Detection of measles virus genome directly from clinical samples by reverse transcriptase-polymerase chain reaction and genetic variability

A simple and sensitive method for the detection of measles virus genome was developed, amplifying the regions encoding the nucleocapsid (N) protein and hemagglutinin (H) protein of measles virus by reverse transcriptase-polymerase chain reaction (RT-PCR). We examined a variety of measles patients: 28 patients with natural infection, 4 with measles encephalitis and 1 with subacute sclerosing panencephalitis (SSPE). In 28 patients with natural measles infection a single step PCR amplifying the N region resulted in a high detection rate for all plasma samples (28/28) within 3 days of the onset of rash and 80% (20/25) even on day 7 of the onset of rash and later. Within 3 days of the onset of rash, 24/25 (96.0%) of nasopharyngeal secretions (NPS) and 27/28 (96.4%) of peripheral blood mononuclear cells (PBMC) were positive for the N region PCR and the positivity rate of PCR decreased in NPS and PBMC after 7 days of the rash. In acute measles infection, measles genome was detected in all cell fractions, CD4, CD8, B cells, and monocytes/macrophages by the H gene nested PCR. Measles genome was also detected from cerebrospinal fluids (CSF) in patients with measles encephalitis, SSPE, and acute measles by the H gene nested PCR. PCR products of the N and H regions were sequenced and we confirmed the presence of measles genome. Based on the sequence data, chronological sequence differences were observed over the past 10 years. The sequences obtained from the SSPE patient were closely related to those of the wild viruses that were circulating at the time when the patient initially acquired measles. RT-PCR for NPS, PBMC, CSF, and plasma provides a useful method for the diagnosis of measles and molecular epidemiological study in addition to virus isolation.

Glandular odontogenic cyst: analysis of cytokeratin expression and clinicopathological features

The glandular odontogenic cyst (GOC) is a rare odontogenic cyst which is still controversial in regard to classification, terminology, and origin. The first Japanese case of GOC is reported. Immunohistochemical examination for expression of cytokeratins and epithelial membrane antigen by monoclonal antibodies suggested that the lining epithelium was of odontogenic origin with metaplastic mucus-laden cells. We have reviewed the literature and compared the clinicopathological findings of the reported case of GOC with those of botryoid odontogenic cysts (BOC). The anatomical location, age range, and sex of GOC cases were very similar to those of BOC. GOC appears to be a multiocular and mucoepidermoid variant of non-keratinizing odontogenic cysts, which also includes BOC. GOC should be separated from the other types of odontogenic cyst and central mucoepidermoid tumours of salivary gland origin.

An evaluation of stroke patients in rehabilitation medicine

Strokes are one of the most important subjects of clinical and research studies of rehabilitation medicine. A system for evaluating stroke patients, however, is not yet completely established. In 1980, WHO instituted International Classification of Impairments, Disabilities, and Handicaps (ICIDH). Since the introduction of the concepts of ICIDH, many studies and research on rehabilitation medicine utilizing this classification have been published. The concepts of ICIDH have been applied to some diseases of the neuro-musculo-skeletal systems such as those of stroke patients. This paper reviews the methods of functional assessment and evaluation of stroke patients categorized by using ICIDH, and also it aims at presenting a new system for evaluating the level of impairment that we originally developed.

HTLV-I proviral DNA amount correlates with infiltrating CD4+ lymphocytes in the spinal cord from patients with HTLV-I-associated myelopathy

A quantitative method utilizing polymerase chain reaction was employed to evaluate the amount of human T-cell leukemia virus type I (HTLV-I) proviral DNA in the affected spinal cords from patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Central nervous system (CNS) tissues were obtained at post-mortem from five patients with HAM/TSP, who vary in the duration of illness from 2.5-10 years, and one patient with adult T-cell leukemia (ATL), who had leukemic cell infiltration in the CNS. The presence of HTLV-I pX and pol sequences in the CNS tissues were demonstrated in all patients examined. In HAM/TSP, the proviral DNA quantified in the thoracic cord was 0.002-2 copies per 100 tissue cells, and that in the peripheral blood mononuclear cells (PBMC) was 2-8 copies per 100 PBMC. The proviral DNA amount in the thoracic cord of the patient with ATL was 0.4 copies per 100 tissue cells. An apparent propensity for the amount of integrated HTLV-I in the thoracic cord to decrease with the disease duration in patients with HAM/TSP was observed. The decline in HTLV-I proviral DNA amount in the thoracic cord lesions was paralleled with the alteration of proportion of CD4+ T lymphocytes in patients with HAM/TSP. These findings suggest that preferential virus reservoir may be infiltrating CD4+ T lymphocytes in the spinal cord lesions of patients with HAM/TSP, and HTLV-I infection in the CNS of patients is declining with the disease duration in spite of the chronic course of neurological manifestations at least in some patients with HAM/TSP.

Detection and cloning of human papillomavirus DNA associated with recurrent respiratory papillomatosis in Thailand

Recurrent respiratory papillomatosis (RRP) is highly prevalent in Thailand. In this study, we examined the presence of human papillomavirus (HPV) DNA in 25 RRP patients in Thailand by means of dot blot analysis and/or polymerase chain reaction. Eighty-four percent (21/25) of cases and 4% (1/25) of cases were positive for HPV-11 DNA and HPV-6 DNA, respectively. Three cases (3/25) were negative for all of the examined HPV types. No cases were positive for HPV-16 or 18. Furthermore, we isolated the recombinant HPV-11 DNA clone from a genomic library constructed with the DNA of RRP tissue. The restriction map of the cloned HPV DNA was identical with the map of known HPV-11 DNA. These results suggest at least that no specific HPV type or subtype is likely to be associated with RRP in Thailand.

HTLV-I messenger RNA is expressed in vivo in adult T-cell leukemia/lymphoma patients: an in situ hybridization study

Adult T-cell leukemia/lymphoma (ATLL) is a malignancy involving peripheral blood, lymph nodes, skin and other organs. Human T-cell leukemia virus type I (HTLV-I) is etiologically associated with ATLL but cannot be detected by conventional methods in fresh samples of peripheral blood and skin taken from ATLL. The aim of this study was to investigate the feasibility of an in situ hybridization technique for detection of HTLV-I mRNA in atypical lymphoid cells of peripheral blood and skin lesions of patients with ATLL. We detected variable amounts of HTLV-I tax mRNA in the nuclei and cytoplasm of these cells in fresh peripheral blood samples and skin lesions from ATLL patients, and also in asymptomatic HTLV-I infected donors to a lesser extent. Out of 10 patients with ATLL, 7 showed strong positive in situ hybridization whereas the other 3 were only weakly positive. However, in the last 3 cases, the reaction became strongly positive after cells had been cultured for 24 hr. Furthermore, all 3 asymptomatic HTLV-I-infected donors exhibited a weakly positive response in their apparently mature lymphoid cells.

Dermatophytosis in a Steller sea lion (Eumetopias jubatus)

Serious dermatophytosis caused by Trichophyton mentagrophytes was found in a Steller sea lion (Eumetopias jubatus) at Yomiuri Land Marine Aquarium in Tokyo. The external clinical signs were extensive depilation and hyperkeratosis, as well as redness and depigmentation of the skin. Histopathological findings of the skin revealed PAS positive fungal hyphae with septa in the corneum layer of the epidermis. Further microscopic examination suggested that this lesion of the skin was typical chronic dermatophytosis. Based on morphological and growth characteristics, the isolate was identified as Trichophyton mentagrophytes. It was thought that the infection was due to some factors including species and individual specific and environmental factors and so on.

Identification of human T cell leukemia virus type IIb infection in the Wayu, an aboriginal population of Colombia

Human T cell leukemia virus type II (HTLV-II) is endemic in a number of native American populations and high rates of infection have also been demonstrated in intravenous drug abusers (IVDAs). Studies of virus isolates in the latter population have shown the existence of two closely related subtypes of the virus, HTLV-IIa and HTLV-IIb. To characterize the viruses present in native Americans, we analyzed by nucleotide sequence analysis the proviruses from the Wayu, an aboriginal population residing in Colombia, South America. The results showed HTLV-IIb infection in this population, and also demonstrated remarkable conservation of sequence when compared to the proviruses in IVDAs.

Detection of alpha-interferon in nasopharyngeal secretions and sera in children infected with respiratory syncytial virus

We investigated the relationship between respiratory syncytial virus (RSV) antigen and interferon (IFN) in nasopharyngeal secretions (NPS) and sera obtained from 252 patients infected with RSV. A total of 146 (57.9%) of 252 patients had IFN in NPS with a mean titer of 28 units/ml and IFN was detected in 164 (71.6%) of 229 patients in the acute stage sera with a mean titer of 28 units/ml. IFN activities were neutralized with antiserum to IFN-alpha. RSV antigen in NPS decreased on Day 5 and later in parallel with the change of mean titer of IFN in NPS. IFN in NPS was detected in 40 to 60% of the samples with some fluctuation in the acute stage. Within 4 days IFN was detected in more than 70% of the sera whereas on Day 5 and later the IFN positivity rate decreased in sera. RSV antigen in NPS decreased in the older patient groups. No significant change of positive rate of IFN in NPS was observed in different age groups and the mean titer of IFN in NPS and sera did not vary with age, except in those younger than 3 months and older than 3 years of age.

A sero-epidemiological study on mother-to-child transmission of HTLV-I in southern Kyushu, Japan

In vertical transmission of HTLV-I the duration of breast-feeding seems to be an important risk factor. In this study, we made prospective and retrospective surveys on the rate of vertical transmission of HTLV-I in infants and their siblings born to HTLV-I seropositive mothers. The results obtained were as follows. (1) In the prospective study, 885 of the 16,283 pregnant women examined were HTLV-I seropositive, and the seropositive rate was 5.4%. The seroconversion rates of short-term (< 7 months) and long-term (> or = 7 months) breast-feeders were 3.8% (1/26 cases) and 25.0% (1/4 cases) respectively, and the rate of bottle-feeders was 5.6% (10/177 cases). Short-term breast-feeding tended to yield a lower seroconversion rate of infants. In addition, the seroconversion rate of short-term breast-feeders was nearly equal to that of bottle-feeders: 3.8% vs. 5.6%. (2) In the retrospective study, the seroconversion rates of short-term and long-term breast-feeders in their siblings were 4.5% (3/67 cases) and 14.0% (19/136 cases) respectively. There was a significant difference between the 2 groups (p < 0.01). Thus, the results of our retrospective and prospective studies suggest that short-term breast-feeding might lessen the risk of breast-milk-borne transmission of HTLV-I from carrier mothers to their children.

Six Colombian patients with adult T-cell leukemia/lymphoma

Six Colombian patients with adult T-cell leukemia/lymphoma (ATL) are presented. The clinical and hematological features, the familial clusters of human T lymphotropic virus type 1 (HTLV-I) carriers and the prognoses of the Colombian ATL patients were similar to those previously reported for Japanese ATL patients. The only difference was the mean age of onset, which was more than 20 years younger than in Japanese patients. Three patients with ATL were suffering from strongyloidiasis. In one patient it was suggested that ATL developed after horizontal transmission from his wife. In addition, there was a familial case of ATL and HAM/TSP. It seems that in some areas of Colombia, not only HTLV-I infection and HAM/TSP but also ATL are highly endemic.

Monitoring both serum amyloid protein A and C-reactive protein as inflammatory markers in infectious diseases

We examined serum amyloid protein A (SAA) and C-reactive protein (CRP) as inflammatory markers of viral and bacterial infections. Both acute-phase reactants increased in the acute stage and thereafter decreased in the convalescent stage. In viral infections, the mean serum concentrations of SAA during the acute stage were 141 mg/L in infections with adenovirus, 77 mg/L with measles virus, 63 mg/L with influenza virus, 55 mg/L with parainfluenza virus, 31 mg/L with respiratory syncytial virus, and 31 mg/L in aseptic meningitis. The mean serum concentration of CRP was 19 mg/L for adenovirus infection and < 7 mg/L in all other viral infections. The SAA concentrations were 5- to 11-fold greater than the CRP concentrations. Both the SAA and the CRP concentrations were higher in bacterial infections than in viral infections. Changes in the concentrations of serum SAA paralleled those in serum CRP in bacterial infection; during the course of viral infection, however, serum SAA tended to disappear more quickly than CRP did. SAA appears to be a clinically useful marker of inflammation in acute viral infections, with or without significant changes in the CRP concentration.

Monitoring both serum amyloid protein A and C-reactive protein as inflammatory markers in infectious diseases

We examined serum amyloid protein A (SAA) and C-reactive protein (CRP) as inflammatory markers of viral and bacterial infections. Both acute-phase reactants increased in the acute stage and thereafter decreased in the convalescent stage. In viral infections, the mean serum concentrations of SAA during the acute stage were 141 mg/L in infections with adenovirus, 77 mg/L with measles virus, 63 mg/L with influenza virus, 55 mg/L with parainfluenza virus, 31 mg/L with respiratory syncytial virus, and 31 mg/L in aseptic meningitis. The mean serum concentration of CRP was 19 mg/L for adenovirus infection and &lt; 7 mg/L in all other viral infections. The SAA concentrations were 5- to 11-fold greater than the CRP concentrations. Both the SAA and the CRP concentrations were higher in bacterial infections than in viral infections. Changes in the concentrations of serum SAA paralleled those in serum CRP in bacterial infection; during the course of viral infection, however, serum SAA tended to disappear more quickly than CRP did. SAA appears to be a clinically useful marker of inflammation in acute viral infections, with or without significant changes in the CRP concentration.

Fluctuation of HTLV-I proviral DNA in peripheral blood mononuclear cells of HTLV-I-associated myelopathy

To assess the immunopathological significance of the increased replication of human T-cell leukemia virus type I (HTLV-I) in HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) we investigated the dynamics of HTLV-I proviral DNA in peripheral blood mononuclear cells (PBMC) of HAM/TSP patients at different clinical stages. We compared the dynamics to those of asymptomatic HTLV-I carriers (AC). The estimation of the amount of HTLV-I proviral DNA was carried out by quantitative polymerase chain reaction of serially diluted DNA samples where it was feasible to titrate 0.04-80 copies per 100 PBMC. The proviral DNA quantified in six patients with HAM/TSP was 2-20 copies per 100 PBMC, while that in eight cases of AC was 0.04-8 copies per 100 PBMC. Thus, the amount of HTLV-I proviral DNA in HAM/TSP patients was 3-50 times as high as that of AC. When we followed up HAM/TSP patients for 1-3 years, the amount of HTLV-I proviral DNA fluctuated from 4 to 10-fold. These data suggest that the rate of HTLV-I replication increases in HAM/TSP and the amount of HTLV-I proviral DNA fluctuates in their clinical course. Fluctuation in the amount of HTLV-I proviral DNA may reflect dynamics of HTLV-I infected cell proliferation and immunological suppression in vivo in HAM/TSP patients.

Synovial fluid T cells in HTLV-I positive RA

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Southernmost carriers of HTLV-I/II in the world

To clarify the real distribution of HTLV-I and -II carriers among indigenous people in central and South America, blood samples collected from indigenous people in isolated regions of Southern Chile were examined. Among 199 inhabitants from Chiloe Island and Pitrufquen town, three cases (1.5%) showed positive anti-HTLV-I antibodies. Two out of the three (82-year-old male and 58-year-old female) reacted to HTLV-II-specific Gag and/or Env proteins but not to HTLV-I-specific ones. The latter case was confirmed as an HTLV-II carrier by polymerase chain reaction test.

Peopling of the Americas, founded by four major lineages of mitochondrial DNA

Nucleotide sequence analysis of the major noncoding region of human mitochondrial DNA from various races was extended with 72 Native Americans from 16 different local populations (nine populations from Chile, four from Colombia, and one each from Brazil and from Maya and Apache Indians). The sequences were determined directly from the polymerase chain reaction products. On the basis of a comparison of the 482-bp sequences in the 72 Native Americans, 43 different types of mitochondrial DNA sequences were observed. The nucleotide diversity within the Native Americans was estimated to be 1.29%, which is slightly less than the value of 1.44% from the total human population including Africans, Europeans, and Asians. Phylogenetic analysis revealed that most Native American lineages are classified into four major distinct clusters. Individuals belonging to each cluster share at least two specific polymorphic sites that are nearly absent in other human populations, indicating a unique phylogenetic position of Native Americans. A phylogenetic tree of 193 individuals including Africans, Europeans, Asians, and Native Americans indicated that the four Native American clusters are distinct and dispersed in the tree. These clusters almost exclusively consist of Native Americans--with only a few Asians, if any. We postulate that four ancestral populations gave rise to different waves of migration to the New World. From the estimated coalescence time of the Asian and Native American lineages, we infer that the first migration across the Bering landbridge took place approximately 14,000-21,000 years ago. Furthermore, sequence differences in all pairwise comparisons of Native Americans showed a bimodal distribution that is significantly different from Poisson. These results suggest that the ancestral Native American population underwent neither a severe bottleneck nor rapid expansion in population size, during the migration of people into the Americas.

Mimicry between HTLV-I and myelin basic protein: no response in HTLV-I-associated myelopathy patients

The reactivity to a peptide from the HTLV-I polyprotein (FKLPGLNSR) and a similar sequence from myelin basic protein (MBP) (FKLGGRDSR) was examined in relation to the proposal that mimicry of MBP by HTLV-I could be involved in autoimmune responses in HTLV-I-associated myelopathy (HAM). It was found that rabbit antibodies raised against the HTLV-I peptide recognised both peptides, with a titre of 1/10240 to the HTLV-I peptide and 1/5220 to the MBP peptide. Human sera from HAM patients and a HTLV-I carrier without HAM showed slightly higher responses to the HTLV-I peptide compared to the responses from uninfected human sera. HAM patients had greater responses to the HTLV-I peptide than to the similar MBP peptide and an unrelated bovine MBP peptide. There was no recognition of the peptides by peripheral blood lymphocytes from HAM patients or a HTLV-I carrier without HAM. It was concluded that although cross-reactivity was demonstrated in rabbits and the HTLV-I peptide was recognised by sera from HAM patients, the epitope does not appear to evoke a mimicking response to the similar region in MBP. Hence it is not likely to be involved in the pathogenesis of HAM through molecular mimicry.

Differences in HTLV-I integration patterns between skin lesions and peripheral blood lymphocytes of HTLV-I seropositive patients with cutaneous lymphoproliferative disorders

We examined HTLV-I integration patterns in nine cases of HTLV-I-seropositive patients with cutaneous lymphoproliferative disorders. The Southern blot on EcoRI digests of DNA revealed a discrete band of HTLV-I provirus (monoclonal integration) in either skin lesions or peripheral blood lymphocytes (PBL). Four cases showed the monoclonal integration of HTLV-I provirus only in skin lesions: one case showed only in PBL and two cases showed in both skin and PBL. The Southern blot on PstI digests of DNA revealed a 2.4 Kb band of the internal construct of HTLV-I provirus (polyclonal integration) in the PBL of EcoRI-negative samples. The difference in HTLV-I integration patterns between skin lesions and PBL in these cases suggests that the monoclonal outgrowth of HTLV-I-infected cells in the skin is causatively associated with the pathogenesis of cutaneous ATL.

Frequent clonal proliferation of human T-cell leukemia virus type 1 (HTLV-1)-infected T cells in HTLV-1-associated myelopathy (HAM-TSP)

Human T-cell leukemia virus type 1 (HTLV-1) integrates its proviruses into random sites in host chromosomal DNA. Random integration of the proviruses was observed in asymptomatic HTLV-1 carriers and patients with HTLV-1-associated myelopathy (HAM/TSP). However, clonal integration has been reported in patients with adult T-cell leukemia (ATL), including that in the smoldering, chronic, and acute states, indicating clonal expansion of infected cells. In this study, we found that about 20% of HAM/TSP patients and their seropositive family members harbored subpopulation(s) of clonally proliferated cells infected with HTLV-1, although they still maintained randomly infected cells as a major population. These clones were stable during examination periods of 4 months to 3 years. However, these carriers or HAM/TSP patients did not show any significant indication of ATL. This extremely high frequency of clonal expansion of HTLV-1-infected cells indicates that some clones of HTLV-1-infected cells have a tendency to proliferate more efficiently than the other population without malignant transformation.

Argininosuccinate synthetase gene expression in leukemias: potential diagnostic marker for blastic crisis of chronic myelocytic leukemia

Argininosuccinate synthetase (ASS) activity is hardly detected in human lymphocytes. In this study, we examined the ASS gene expression of various leukemia cells by a polymerase-chain-reaction method. We demonstrate here that (a) acute lymphocytic and acute myelocytic leukemia cells exhibit the highly elevated expression of the ASS gene and (b) chronic myelocytic leukemia (CML) in blastic crisis also exhibits the increase of ASS gene expression while CML in chronic phase, chronic lymphocytic leukemia and adult T leukemia cells show the similar level to that of normal lymphocytes. These results suggest that the ASS gene expression is of value as a diagnostic marker of acute type leukemia, particularly for blastic crisis of CML.

Cell surface phenotype of in vitro proliferating lymphocytes in HTLV-I-associated myelopathy (HAM/TSP)

The in vitro proliferation of peripheral blood lymphocytes (PBLs) without any mitogenic stimulation is one of the hallmarks of human T lymphotropic virus type I (HTLV-I) infection. Recent evidence suggests a difference in the degree of the phenomenon between HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and asymptomatic HTLV-I carriers (AC). In this article, we demonstrated several alterations in the features of the in vitro transformed lymphocytes between patients with HAM/TSP (n = 16) and AC (n = 8). The percentages of total CD8+ and CD8+CD28+ cells were significantly increased in the in vitro proliferating T lymphocytes derived from the patients with HAM/TSP when compared to those from AC. HAM/TSP was segregated from AC by the high degree of the proliferation of CD8+CD28+ cells. The expression of HTLV-I-specific antigens on the cultured PBLs was detected only in the subjects which showed low CD8+CD28+/CD4+ ratio of the in vitro proliferating lymphocytes. These findings suggest that this phenomenon distinguishes HAM/TSP from AC, not only in quantity but also in quality.

Geographical subtypes demonstrated by RFLP following PCR in the LTR region of HTLV-I

It has been demonstrated that specific mutations, localized in the long terminal repeat (LTR) region of HTLV-I, allowed to propose the existence of three HTLV-I subtypes. Because some of these mutations created or suppressed the restriction sites for ApaI, NdeI, DraI, SacI, MaeIII, and MaeII enzymes, these endonucleases were used for characterization of further 30 HTLV-I isolates. Seventeen proviral DNA from Japan, five from the Caribbean, one each from French Guyana, the United States, and China, two from Ivory Coast, and three from Zaire were tested. The DNA used were extracted from 26 in vivo peripheral blood mononuclear cell samples and from four cell lines obtained from two Japanese, one Chinese, and one North American patients. Digestions were performed on amplified DNA of the LTR region (nucleotides 31-768). The results confirm the existence of three subtypes of HTLV-I according to LTR sequences. Subtype I was observed only in patients from the Ivory Coast and Zaire. Subtype II was found in the patient from the French West Indies, and in 33% of the samples from Japan. Subtype III was most often observed in the Japanese but also in the Zairian patients.

Extent of pyramidal tract wallerian degeneration in the brain stem on MRI and degree of motor impairment after supratentorial stroke

The relationship between Wallerian degeneration in the brain stem and degree of motor impairment is discussed. Using MRI we studied 172 supratentorial stroke patients, whose motor impairment was graded according to Brunnstrom stage. Wallerian degeneration was represented by a T2 high-intensity area in the brain stem, and its cross-sectional extent was measured at the cerebral peduncle level. Wallerian degeneration was detected in 99 patients (57.6%). The area of T2 high intensity was significantly correlated with Brunnstrom stage. Multiple regression analysis showed that the upper extremity stage contributed most to the visualization of Wallerian degeneration. This is partly because the pyramidal tract participates in fine and precise movement. The extent of the area of Wallerian degeneration is found to be helpful in making a prognosis with respect to motor impairment in the upper extremity.

Expression of human T-cell lymphotropic virus type-1 gene products in the short-term cultured skin tissues of an adult T-cell leukemia/lymphoma patient with cutaneous manifestations

Adult T-cell leukemia/lymphoma (ATLL) is recognized as a disease etiologically associated with human T lymphotropic virus type-1 (HTLV-1) infection, but, neither viral replication nor specific virus antigen expression have been detected on ATLL cells distributed in organs, including skin. To examine the latent expression of HTLV-1 in the cutaneous lesions of ATLL patients, we cultured the lesional skin tissues in vitro and applied immunofluorescence staining with mouse monoclonal antibodies Lt-4, GIN-14, and F10, which react with p40tax, p19 and gp21, respectively. We recognized HTLV-1 specific antigens on clustered ATLL cells only in the deeper dermis of the skin after 24 hrs cultivation of the lesional skin tissue from an ATLL patient in RPMI-1640 medium supplemented with 20% fetal calf serum. In the electron microscope, we observed HTLV-1 like particles, 80-140 nm in diameter with envelope and core structures, in the same tissue specimen. These findings suggest that HTLV-1 gene products may be expressed in the skin lesions of ATLL patients and involved in the pathogenesis of skin eruptions in cutaneous type ATLLs. To our knowledge, this is the first report that envisages the potency of intracutaneous HTLV-1 expression in vivo.

Factors influencing the clinical type and course of myasthenia gravis

Myasthenia gravis is considered to be an autoimmune disease in which several factors reciprocally influence the clinical type and course. We investigated the relative importance of the following factors: anti-acetylcholine receptor antibody (AChR Ab), HLA, age at onset, autoimmunity, thymic abnormality, duration of treatment, change in AChR Ab titer and immunosuppressive therapy. The pretreatment-AChR Ab titer and HLA were shown to significantly influence the clinical type. On the other hand, the age at onset significantly influenced the clinical course. The finding that with an onset at less than 5-year-old there was a tendency for a good prognosis suggests an association between the immaturity of the muscle and immune systems, and the clinical course.

Interferon production during the course of Mycoplasma pneumoniae infection

In patients infected with Mycoplasma pneumoniae the development of interferon (IFN) was studied in nasopharyngeal secretions and sera. The production of IFN-gamma by lymphocytes was also investigated in response to M. pneumoniae antigen and mumps virus antigen. IFN-alpha was detected in 25 (61.0%) of 41 nasopharyngeal secretion samples and in 25 (59.5%) of 42 serum samples within 6 days after the onset of illness. IFN-alpha was significantly higher in nasopharyngeal secretions than in sera and a significant correlation was observed between the two. In most of the patients lymphocytes produced a larger amount of IFN-gamma in the convalescent stage than in the acute stage, when lymphocytes were stimulated with M. pneumoniae antigen. In some patients, however, lymphocytes did not produce IFN-gamma during the course of illness. Such lymphocytes, negative for IFN-gamma production in response to M. pneumoniae, produced IFN-gamma after the depletion of macrophages, and readdition of macrophages suppressed the production of IFN-gamma by lymphocytes. When lymphocytes were stimulated with heterogeneous antigen (mumps virus), they produced no IFN or a small amount of IFN in the acute stage of M. pneumoniae infection, and IFN production increased in the convalescent stage. Different mechanisms seem to work for homogeneous and heterogeneous antigens in the suppression of IFN production in M. pneumoniae infection.

Genetic study of ossification of the posterior longitudinal ligament in the cervical spine with human leukocyte antigen haplotype

To evaluate the genetic background of ossification of the posterior longitudinal ligament, the relationship between the presence of absence of ossification and human leukocyte antigen haplotypes was studied in 33 families of patients with ossification of the posterior longitudinal ligament. The study revealed that human leukocyte antigen haplotypes formed certain types of clusters, and that some human leukocyte antigen haplotypes were very rare in the Japanese population, suggesting the involvement of human leukocyte antigen-linked factors in the pathogenesis of ossification of the posterior longitudinal ligament of the cervical spine. In the families of these patients, ossification of the posterior longitudinal ligament was demonstrated by radiography in 56% (10/18) of the siblings. Each of these siblings shared both human leukocyte antigen haplotypes with the patient. None of those who shared only one human leukocyte antigen haplotype with the patient had developed ossification of the posterior longitudinal ligament. From these findings, the presence of both pathogenic human leukocyte antigen haplotypes is considered to be necessary for the development of ossification of the posterior longitudinal ligament, and this genetic predisposition may be activated by multiple factors, including regressive degeneration due to aging and the environment.

Expression of a rat ovary-independent mammary tumor-associated antigen defined by a monoclonal antibody, TAK-B1

A monoclonal antibody, TAK-B1, was produced by immunization of BALB/c mice with mammary carcinoma induced in inbred Sprague-Dawley rats by treatment with 7,12-dimethylbenz[a]anthracene. TAK-B1 reacted with ovary-independent mammary carcinoma cells which had been transformed from ovary-dependent mammary carcinoma cells, but did not react with original mammary carcinoma cells or with cells from mammary glands exhibiting fibrocystic changes or normal mammary glands. However, TAK-B1 reacted not only with basal cells of the epidermis and epithelial cells of the bottom portion of crypts of the small intestine in adult rats, but also with basal cells of epidermis in skin and mesenchymal cells around developing hair follicles in fetuses. We therefore classify TAK-B1 as an ovary-independent rat mammary tumor-associated antigen. Immunoelectron microscopic examinations revealed that the antigen recognized by TAK-B1 was localized in the cell surface membrane of ovary-independent mammary carcinoma cells. Immunoprecipitation assay revealed that the antigen recognized by TAK-B1 was composed of M 220,000 protein and four other minor proteins.

Repression of the Drosophila fushi tarazu (ftz) segmentation gene

The striped expression of the Drosophila segmentation gene fushi tarazu in alternate parasegments of the early embryo is controlled by the 740 bp zebra element. Among multiple protein factors that bind to the zebra element, FTZ-F2 behaves as a transcriptional repressor of ftz. Point mutations in the zebra element which disrupt FTZ-F2 binding to DNA cause ectopic expression of zebra-lacZ activity in transformed embryos. The mutant constructs are expressed from the zygotic genome in preblastoderm embryos as early as the third nuclear division cycle. This unprecedented early transcription suggests that ftz requires active repression during initial nuclear division cycles, a novel type of embryonic gene regulation. A putative FTZ-F2 cDNA clone isolated by recognition site screening of an expression library was found to be identical in sequence with the zinc finger protein tramtrack (Harrison and Travers, 1990).