High rate of HTLV-II infection in seropositive i.v. drug abusers in New Orleans

Identification of immunodominant epitopes in envelope glycoprotein of human T lymphotropic virus type II

A series of synthetic peptides derived from the envelope glycoprotein of human T lymphotropic virus type II (HTLV-II) was used in an enzyme immunoassay to determine the immunodominant epitopes of envelope glycoprotein. Of the 11 synthetic peptides spanning the external glycoprotein of HTLV-II (gp52) and the 3 from the transmembrane protein (gp21), 3 peptides from gp52 (termed Env-20(85-102), Env-202(173-209), and Env-203(219-256] reacted with most of the polymerase chain reaction-confirmed HTLV-II specimens (83, 95, and 76%, respectively); all other peptides reacted minimally with these specimens. Env-202(173-209) reacted with a greater percentage (91 to 100%) of specimens from different risk groups, including intravenous drug users (n = 30), North American Indians (n = 13), Guaymi Indians from Panama (n = 22), and routine U.S. blood donors (n = 34), when compared with Env-20(85-102) (73 to 100%) or Env-203(219-256) (68 to 83%). Furthermore, Env-20(85-102) and Env-202(173-209) had some reactivity (8-25%) with sera from HTLV-I-infected individuals, whereas Env-203(219-256) reacted with 58% of HTLV-I specimens. We conclude that peptides Env-20(85-102) and Env-202(173-209) represent the type-specific immunodominant epitopes of HTLV-II external glycoprotein.

Presence of HTLV-I proviral DNA in central nervous system of patients with HTLV-I-associated myelopathy

The polymerase chain reaction (PCR) method was used to determine the presence and amount of human T lymphotropic virus type I (HTLV-I) proviral DNA in central nervous system (CNS) tissue obtained at autopsy from 6 patients with HTLV-I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP), 1 patient with adult T-cell leukemia (ATL) and CNS infiltration of leukemic cells, and 9 control subjects with other neurological disorders. HTLV-I pX and env but not pol DNA were detected in CNS tissue from 5 of 6 patients with HAM/TSP. The ATL samples were positive for pX, env, and pol DNA by PCR. None of the control samples was consistently positive for HTLV-I by PCR, but all showed positive bands on beta-globin PCR. Quantitative PCR combined with histological studies showed no correlation between HTLV-I proviral DNA amounts and extent of perivascular mononuclear cell infiltration in the HAM/TSP CNS. Also, the amounts of pX and probably env DNA were greater in the HAM/TSP samples than in the ATL sample, although the extent of mononuclear cell infiltration was far less in the HAM/TSP samples than in the ATL sample. Therefore, in addition to infiltrating mononuclear cells, constituent cells of the CNS may harbor the HTLV-I genome, at least in the pX and env regions, in patients with HAM/TSP.

Human T-cell leukemia virus type-I/II (HTLV-I/II) serologic testing: the importance of assaying for the full complement of viral antigens

Seventy-one Japanese adult T-cell leukemia (ATL) patients and 411 Japanese asymptomatic patients from HTLV-I endemic regions of southern Japan were found to be seropositive by radioimmunoprecipitation assay (RIPA). Of these 482 positive controls, 62% of ATL patients and 67% of the asymptomatic seropositive patients were found to harbor antibodies to p40x. Additionally, 333 preselected Japanese blood donors who were identified as seropositive by particle agglutination (PA) assay were further tested for antibodies to HTLV-I/II gene encoded envelope (env) or group specific antigens (gag) by means of enzyme-linked immunosorbent assay (ELISA) and RIPA. Concordance between ELISA and RIPA was noted in 318 samples (92.5%). Discordance between ELISA and RIPA was observed in 15 sera (7.5%)--2 were seropositive by ELISA and seronegative by RIPA and 13 were seronegative by ELISA and seropositive by RIPA. Seven of these 13 samples (53.8%) contained antibodies to p40x by RIPA and may represent ELISA false negatives on the basis of both clinical and laboratory data. Current HTLV-I/II ELISA kits may yield false negative results. Additional research into the development of rapid detection cost-efficient assays that test for the full compliment of viral antigens is needed.

Human T-cell leukemia virus type II Rex binding and activity require an intact splice donor site and a specific RNA secondary structure

The human T-cell leukemia virus type II (HTLV-II) regulatory protein Rex augments cytoplasmic levels of unspliced gag-pol mRNA by acting through a Rex-responsive element (RxRE) in the long terminal repeat. Purified Rex protein binds to long terminal repeat mRNA. Here, using an immunobinding assay to measure the binding of Rex protein to mutated RxRE RNAs, we show that efficient Rex binding requires a stem-bulge-loop RNA secondary structure (nucleotides [nt] 465 to 500) and specific sequences both within the stem-bulge (nt 470 to 476) and within a conserved upstream splice donor site (nt 449 to 455). Rex function in a transient transfection expression system correlates with Rex protein-RxRE RNA binding. The ability of HTLV-II Rex to interact directly with the HTLV-II splice donor site suggests that HTLV-II Rex may increase expression of unspliced gag-pol mRNA, in part, by inhibiting splicing.

Detection of HBV DNA in non-A, non-B hepatic tissues using the polymerase chain reaction assay

The polymerase chain reaction (PCR) followed by Southern blotting was used to examine the presence of hepatitis B virus (HBV) DNA in non-cancerous liver tissue specimens from 22 Japanese hepatocellular carcinoma (HCC) patients, who were negative for HBV surface antigen (HBsAg). By Southern blot analysis, HBV DNA was negative in all 22 patients, but it was detected by the PCR in 8 of the 15 patients who were positive for antibodies against HBsAg or HBV core antigen. Seven patients who were negative for those antibodies were also negative for HBV DNA by the PCR. These results suggest that HBV may be involved in the etiology of the liver disease of some patients with what is presently classified as non-A, non-B hepatitis, if they are positive for HBV antibodies.

Differential antibody responsiveness to p19 gag results in serological discrimination between human T lymphotropic virus type I and type II

A new algorithm based upon the differential antibody responses to two gag gene products (p19 and p24) of human T lymphotropic virus (HTLV) has been suggested for serologic discrimination of HTLV type I (HTLV-I) and type II (HTLV-II) [Lillihoj et al., 1990]. To evaluate the practical usefulness of this algorithm, serum specimens from HTLV-seropositive individuals whose infection was confirmed by PCR analysis to be HTLV-I (n = 60) or HTLV-II (n = 61) were analyzed by western blot. The intensities of the antibody response to p24gag and p19gag were scored by one individual without prior knowledge of PCR results. According to the algorithm, specimens with p19 greater than or equal to p24 were classified as HTLV-I, whereas specimens with p19 less than p24 were classified as HTLV-II. Of 60 PCR confirmed HTLV-I specimens, 56 had p19 greater than or equal to p24 (93%) while 4 had p19 less than p24. Of 61 PCR confirmed HTLV-II specimens, 56 had p19 less than p24 (92%) and 5 had p19 greater than or equal to p24. The overall accuracy of serologic differentiation when using this algorithm was 92%, as 4 of 60 HTLV-I (7%) and 5 of 61 HTLV-II (8%) could have been wrongly classified. Although the differential antibody response to p19gag and p24gag provides a simple means of serologically distinguishing between HTLV-I and HTLV-II infection in population-based epidemiological studies, in a clinical context more accurate means of confirmation are required. The dominant p19gag responses were mapped to the C-terminus of p19 (p19(102-117)).(ABSTRACT TRUNCATED AT 250 WORDS)

Overt and latent HIV 1 and HTLV-I infection in cohorts of at high risk individuals in Argentina

We conducted a survey using serology and polymerase chain reaction assays to detect HIV 1 and/or HTLV-I antibodies and viral DNA, respectively, in 113 intravenous drug abusers and in 62 sexually active high risk individuals attending two Drug Addict Centres and a Centre for Venereal Diseases in Buenos Aires, Argentina. At the time of the survey 137 of these subjects were known to be HIV 1 seropositive but none of them was symptomatic. Serological tests for HTLV-I were found to be positive in 38 (21.7%) of the HIV 1 positive individuals, whereas all of the 38 HIV 1 seronegative subjects were also seronegative for HTLV-I antibodies. Gene amplification assays carried out in blood sample DNA from the 38 HIV 1/HTLV-I seronegative individuals, revealed HIV 1 DNA in six out of 28 intravenous drug abusers (21.5%). One subject (2.6%) was positive for both HIV 1 and HTLV-I DNA sequences, whereas four (10.5%) showed HTLV-I DNA only. To determine whether these individuals were infected with HTLV-I and/or HTLV-II, DNA samples were also amplified with HTLV-II specific primers and no evidence of HTLV-II infection was observed. None of the subjects seroconverted according to conventional serological tests during the 2 year follow-up period. The 10 seronegative subjects belonging to the sexual risk group were negative for both HIV 1 and HTLV-I in polymerase chain reaction assays. We conclude that not only HIV 1, but also HTLV-I is a widely spread infection in intravenous drug abusers and sexually active high risk individuals in Argentina.(ABSTRACT TRUNCATED AT 250 WORDS)

Viruses in human cancers

Viruses may contribute to the development of human tumors by different mechanisms: indirectly by inducing immunosuppression or by modifying the host cell genome without persistence of viral DNA; directly by inducing oncoproteins or by altering the expression of host cell proteins at the site of viral DNA integration. Human cancers associated with papillomavirus, hepatitis B virus, Epstein-Barr virus, and human T cell leukemia-lymphoma virus infections are responsible for approximately 15 percent of the worldwide cancer incidence. Cancer of the cervix and hepatocellular carcinoma account for about 80 percent of virus-linked cancers. Because experimental and epidemiologic data imply a causative role for viruses, particularly in cervical and liver cancer, viruses must be thought of as the second most important risk factor for cancer development in humans, exceeded only by tobacco consumption.

Gene amplification by polymerase chain reaction in dermatology

The polymerase chain reaction (PCR) is another new powerful technique in molecular biology that has begun to open new perspectives in modern science and also in dermatology. This brief report will therefore elucidate the general principles of the polymerase chain reaction, as well as its limitations and possible pitfalls. Furthermore an overview will be provided on the impact of PCR on molecular biologic approaches in oncology, immunology, and human genetics. The use of the method as a tool to detect microorganisms particularly viruses and bacteria, in cutaneous tissue and it potential other future applications are described as well. Because PCR is automated and is being more and more established in routine laboratories, physicians and scientists should be familiar with the basic principles and potential uses of this methodology.

Significance of human T-lymphotropic virus type I indeterminant serological findings among healthy individuals

Follow-up studies on 67 blood donors with indeterminant serological findings for human T-lymphotropic virus (HTLV) type I by standard immunoassays showed no evidence of infection by polymerase chain reaction analysis for HTLV-I or HTLV-II nucleic acids or by antibody reactivity to a unique HTLV-I recombinant envelope protein, MTA-4. Among HTLV-I- or -II-infected individuals, a history of blood transfusion, past residence in established HTLV-I endemic areas or some association with intravenous drug use were common. In contrast, 85% of indeterminant cases had none of these risk factors. These observations suggest that healthy individuals with indeterminant serology for HTLV-I should not require additional studies.

Transformation of CD8+ T-cells producing a strong cytopathic effect on CD4+ T-cells through syncytium formation by HTLV-II

Human T-cell leukemia virus type II (HTLV-II) is thought to play an important role in the development of CD8+ T-cell malignancies resembling hairy cell leukemia. In this study, dramatic cytopathic effects characterized by syncytium formation in various CD4+ T-cell lines were observed upon their cocultivation with HTLV-II infected T-cells. The HTLV-II infected T-cells, however, did not die as a result of syncytium formation. HTLV-II also transformed CD4+ T-cells and CD8+ T-cells at various coculture ratios. Furthermore, sera from anti-HTLV-II antibody-positive specific carriers inhibited syncytium formation in the CD4+ T-cells. These results suggest that HTLV-II infection may contribute to the pathogenesis of associated CD8+ T-cell malignancies.

Identification of human immunodeficiency virus envelope gene sequences influencing viral entry into CD4-positive HeLa cells, T-leukemia cells, and macrophages

Infectious recombinant viruses were constructed from three molecularly cloned human immunodeficiency virus (HIV) strains varying in cell tropism. All recombinants showed a high infectivity titer on phytohemagglutinin-stimulated normal T lymphocytes. However, a 120-bp region of the envelope gene including the area of the V3 hypervariable loop was found to influence infectivity titer on both clone 1022 CD4-positive HeLa cells and CD4-positive CEM leukemia cells. Infectivity for macrophages was more complex. All viruses replicated in macrophages to a low level, but viral sequences both inside and outside the V3 loop region influenced the efficiency of replication. Two experiments showed that the mechanism of restriction of infection of 1022 cells by HIV strain JR-CSF was related to lack of virus entry. First, productive virus infection occurred after transfection of 1022 cells with viral plasmid DNA. Second, the nonpermissive HIV strain JR-CSF could infect 1022 cells when pseudotyped with the envelope of other retroviruses, including human T-cell leukemia virus type I (HTLV-I), HTLV-II, and amphotropic murine leukemia virus. These results demonstrate the possibility that unexpected cell types might be infected with HIV in human patients coinfected with HIV and HTLV-I or HTLV-II.

HTLV-1 envelope sequences from Brazil, the Caribbean, and Romania: clustering of sequences according to geographic origin and variability in an antibody epitope

We sequenced the envelope genes of Human T-cell leukemia type I viruses (HTLV-I) derived from five Brazilian, two Caribbean, and one Romanian case of adult T-cell leukemia after amplification of the complete env gene by PCR. A comparison with previously reported HTLV-I sequences revealed that, although highly homologous, no two env sequences were identical. All envelope sequences differed from each other by 0.3-2.1% nucleotide differences. The five Brazilian sequences clustered together and were about as different from each other (0.5-0.75% nucleotide difference) as were three previously reported Japanese sequences (0.7-0.95%). In contrast, sequences of Caribbean origin were less homogeneous (0.5-1.9% nucleotide differences within this group). The Romanian sequence was not significantly more divergent than any of the others and was closest to our two Caribbean sequences. We observed two changes in a region (aa 176-209) which has previously been shown to contain a linear antibody epitope recognized by most human sera from seropositive individuals. One of these changes affects the binding of monoclonal antibodies to this epitope demonstrating the variability of an antibody epitope in the HTLV-I envelope.

Synthetic peptide-based immunoassays for distinguishing between human T-cell lymphotropic virus type I and type II infections in seropositive individuals

Until now, serologic tests that distinguish the closely related human T-cell lymphotropic virus types I (HTLV-I) and II (HTLV-II) infections have not been available. Synthetic peptide assays, employing peptides derived from the core and envelope proteins of HTLV-I and HTLV-II (SynthEIA and Select-HTLV tests), were evaluated for the ability to serologically discriminate HTLV-I and HTLV-II infections. Of 32 HTLV-I- and 57 HTLV-II-positive serum specimens from individuals whose infections were confirmed by polymerase chain reaction, the SynthEIA test categorized 29 (91%) as HTLV-I and 50 (88%) as HTLV-II, and 10 (11%) were nontypeable. In contrast, the Select-HTLV test categorized 32 (100%) as HTLV-I and 55 (96%) as HTLV-II, and 2 (2%) were nontypeable. The specificity of both the assays in seropositive serum specimens was 100% in that none of the specimens were incorrectly classified. Additional serum specimens obtained from clinically diseased patients from the United States (n = 8) and asymptomatic carriers and patients from Japan (an endemic population for HTLV-I; n = 40) were categorized as HTLV-I by at least one of the assays, while serum specimens from Guaymi Indians from Panama (an endemic population for HTLV-II; n = 13) were categorized as HTLV-II. Thus, peptide enzyme immunoassays appear to represent a simple technique employing chemically synthesized antigens for discrimination between antibodies of HTLV-I and HTLV-II.

Use of PCR amplification for diagnosis of HTLV-I infection after blood transfusion

We studied the seroconversion to human T-cell leukemia virus type-1 (HTLV-I) in two immunocompromised patients after transfusions of cellular blood components. One patient produced IgM antibodies against the viral p19 protein 149 days post-transfusion (a serum on day 43 was negative). Both patients showed indeterminate Western-blots (IgG anti-p19 and anti-gp46 but no anti-p24). Using the polymerase chain reaction (PCR) with two primer pairs (SK43/44 and SK54/56), we demonstrated HTLV-I infection prior to seroconversion. This infection was confirmed by Southern blot.

Prevalence of HTLV-I and HTLV-II infection in Gabon, Africa: comparison of the serological and PCR results

A cluster sampling survey was performed in 1989 in Libreville, Gabon, to determine HTLV-I and HTLV-II prevalence and to compare the efficacy of polymerase chain reaction (PCR) and serology in detecting HTLV-I and HTLV-II infections. A total of 322 sera from adults were tested by ELISA and by Western blot (WB). The WB patterns were interpreted according to WHO criteria and those of the manufacturer. PCR analysis using primer pairs in the gag and pol region, with a specific probe for HTLV-I and HTLV-II, was performed on the lymphocytes of the 322 adults. In addition, 134/322 samples were re-tested with tax primers, in a second laboratory. Using WHO criteria, 8/322 (2.5%) samples were positive on WB and 25 were indeterminate; with the criteria of the kit, 26/322 (8.1%) were positive and 7 were indeterminate by WB. By PCR, 13 (4%) samples were positive, including 12 for HTLV-I (3.7%) and one for HTLV-II (0.3%). All 8 seropositive samples (by the WHO criteria) were positive by PCR, as were 4 out of 25 indeterminate samples. Only one out of 289 seronegative samples was positive by PCR. In contrast, only 12/26 positive samples by the kit criteria were confirmed by PCR. These results confirm the relatively high HTLV-I/II seroprevalence observed in Gabon. HTLV-I infection is preponderant, but HTLV-II is also present. The WHO criteria for WB give a better fit with PCR results than the kit criteria for WB. In the absence of a specific confirmatory test and based on the uncommon "seronegative" HTLV-I/II infection, the indication for PCR appears limited to the positive WB samples (to differentiate HTLV-I and II infection) and to the indeterminate WB samples.

Serological discrimination between HTLV-I and HTLV-II antibodies by ELISA using synthetic peptides as antigens

Using the peptides from amino acids 100-130 of the HTLV-I gag protein, 175-199 of the HTLV-I env protein and the corresponding peptides of HTLV-II (amino acids 106 to 135 of the gag protein and 171 to 196 of the env protein), we tested for reactivity against antibodies by enzyme immunoassay in sera from HTLV-I and HTLV-II carriers. The peptides derived from the env proteins have high specificity for antibody binding. The peptide based on amino acids 175-199 of HTLV-I reacted with antibodies in sera from all HTLV-I carriers, and the peptide composed of amino acids 171-196 of HTLV-II reacted with antibodies in sera from all HTLV-II carriers. For the peptides derived from the gag proteins, we observed some cross-reactivity in sera from persons with anti-HTLV-I and anti-HTLV-II, due to antibody binding to the peptide corresponding to 12 amino acids from the C-terminal end of the gag protein. Separate enzyme immunoassays that used the four synthetic peptides as antigens clearly distinguished between serum with antibodies to HTLV-I or HTLV-II in various individuals and excluded false positive results using the particle agglutination assay that used a whole-virus lysate of HTLV-I as antigen.

Syndrome of severe skin disease, eosinophilia, and dermatopathic lymphadenopathy in patients with HTLV-II complicating human immunodeficiency virus infection

Two intravenous drug users dually infected with human immunodeficiency virus type 1 (HIV-1) and human T-cell leukemia virus type II (HTLV-II) developed an unusual severe dermatitis characterized by progressive brawny induration, fissuring, and ulceration of the skin, with an associated CD8 cell infiltration in one patient. Both patients had persistent eosinophilia. Lymph node biopsy revealed dermatopathic lymphadenopathy, an unusual pathologic finding in HIV-1 infection but one seen in association with mycosis fungoides and other skin disorders. Two new isolates of HTLV-II virus were established from these patients and were identified as HTLV-II by Southern blotting. This type of skin disease and lymph node pathology has not been found in other intravenous drug users who have been infected with HIV-1 alone or in patients in other risk groups for HIV-1 infection. HTLV-II may play a role in this unique new disease pattern in patients infected with HIV-1.

Absence of HTLV-I and HTLV-II infection in prostitutes in the area of Seville, Spain

Infection with human retroviruses other than HIV in Spain has only been reported in isolated cases in African immigrants and intravenous drug abusers infected with HTLV-I. The status of the prostitute population is unknown. The sera of 88 prostitutes in Seville were therefore tested for HIV, HTLV-I and HTLV-II, and relevant epidemiological data were collected on the health status, sexual practices etc. In the prostitute population studied 2.5% of the non-intravenous drug abusers and 20% of the intravenous drug abusers were positive for HIV. However, infection with HTLV-I/II could not be demonstrated in any of them.

Human immunodeficiency virus type 2 vpx protein augments viral infectivity

The genomes of HIV and SIV are complex and contain several accessory genes which modulate viral replication and pathogenicity. One of these genes, vpx, is unique to the HIV-2/SIV group of viruses and encodes a virion-associated protein of unknown function. To examine the function of vpx, we constructed a vpx-deficient HIV-2 proviral clone and characterized its in vitro biological properties. Following transfection into immortalized T-cell lines, vpx-mutant HIV-2 was fully replication competent and exhibited growth kinetics and cytopathic properties equivalent to wild-type HIV-2. In addition, vpx-deficient virions were indistinguishable from wild-type HIV-2 in ultrastructure, composition of major structural proteins, and reverse transcriptase activity. In PHA-stimulated normal peripheral blood mononuclear cells (PBMCs), however, vpx-deficient virus replicated at substantially lower titers and required a 100- to 1000-fold higher inoculum to establish a productive infection. This defect was localized to early events in the viral life cycle since vpx-deficient virus exhibited a 5- to 10-fold reduction in initial (single cycle) viral DNA synthesis following acute infection of primary PBMCs. Paradoxically, in long-term (9-23 months) cultures of immortalized T-cells (SupT1) continuous high level replication of vpx-deficient, but not wild-type, virus was observed, indicating less efficient viral spread and cell killing and a more attenuated phenotype of vpx-deficient HIV-2. Taken together, these results demonstrate that vpx is required for the production of fully infectious and cytopathic HIV-2 virions and that it functions early in the viral life cycle by facilitating viral entry and/or reverse transcription. The pronounced replicative defect of vpx-deficient HIV-2 in primary PBMCs but not in short-term cultures of immortalized T-cell lines emphasizes the need to characterize the properties of nonessential HIV accessory gene products in natural target cells.

Identification of type-specific linear epitopes in the glycoproteins gp46 and gp21 of human T-cell leukemia viruses type I and type II using synthetic peptides

Synthetic peptides of 20-25 amino acids were employed in enzyme-linked immunosorbent assays to identify linear epitopes in the external glycoprotein gp46 and the transmembrane glycoprotein gp21 of human T-cell leukemia/lymphotropic viruses type I (HTLV-I) and II (HTLV-II). Ten linear epitopes were identified in the HTLV-I glycoproteins, seven in gp46 and three in gp21. Three major linear epitopes were identified in the gp46 of HTLV-II. Peptides representing linear epitopes of gp46 were found to be sensitive and specific for the detection of antibody and permit serological identification and differentiation of HTLV-I and HTLV-II infections.

Serological and molecular evidence of infection by human T-cell lymphotropic virus type II in Italian drug addicts by use of synthetic peptides and polymerase chain reaction

Infection with human T lymphotropic virus type I (HTLV-I) is associated with specific forms of tumours and neurological disorders, but the pathogenic activity of HTLV-II is not yet established. Moreover, due to high crossreactivity between the two viruses, differential diagnosis is not readily achieved. To discriminate between HTLV-I and HTLV-II infections, we employed synthetic peptides specific for HTLV-I and HTLV-II env regions, and the polymerase chain reaction (PCR). In a series of 962 intravenous drug addicts (IVDAs) and 50 patients with haematological malignancies, 51 and 2 samples, respectively, were reactive against HTLV-I proteins; among these, HTLV-I infection was confirmed only in 1 patient with adult T-cell lymphoma, while HTLV-II infections were identified in 6 out of 14 PCR-tested IVDAs. These findings provide evidence of HTLV-II infection among Italian IVDAs. The differentiation between HTLV-I and HTLV-II infections may contribute to a better understanding of HTLV-II pathogenicity in man.

Relative prevalence and risk factors of HTLV-I and HTLV-II infection in US blood donors

The clinical significance of human T-cell lymphotropic virus type II (HTLV-II) infection, unlike that of HTLV-I, is unknown, and the major known association of HTLV-II seropositivity is with intravenous drug abuse. Screening of blood donors for HTLV-I, now routine in North America, does not distinguish this retrovirus from HTLV-II. To find out more about the seroepidemiology of and risk factors for HTLV I and II, blood from 480,000 volunteer donors in five geographically separate US urban centres was tested for antibodies to HTLV-I/II and HIV-1. Confirmed HTLV-I/II seropositive donors were then followed up by DNA amplification to distinguish type I from type II and by interviews focusing on possible risk factors. HTLV seroprevalence was 3.3 times greater than that for HIV-1 (0.043% vs 0.013%). DNA amplification on 65 of the 207 HTLV-I/II seropositive donors revealed that 34 (52%) had HTLV-II infection and 28 (43% had HTLV-I; 3 samples were uninformative. Interviews of 49 donors showed that whereas HTLV-I was principally associated with donor origin from endemic regions, the major risk factor for HTLV-II infection was intravenous drug use. The surprisingly high rate of HTLV-II infection in US blood donors raises important public health and donor counselling issues since HTLV-I infection is associated with adult T-cell leukaemia and a neurological disorder while the pathogenicity of HTLV-II is as yet unclear.

Low prevalence of human T-cell leukaemia virus-I and -II infection among drug users in Amsterdam, The Netherlands

The prevalence of human T-cell leukaemia virus-I and -II infection was studied in a cohort of 346 intravenous and nonintravenous drug users in Amsterdam. Three participants (0.86%) had antibodies to HTLV-I by two commercially available HTLV-I enzyme immunoassays (EIA). Infection in these three subjects was confirmed by radioimmunoprecipitation assay. In the immunoblot study, only two of the three subjects were considered positive, since the serum of the third subject had antibodies to p24 only. By means of the polymerase chain reaction two participants (male intravenous drug users infected with human immunodeficiency virus; HIV) appeared to be infected with HTLV-I and one subject (a male nonintravenous drug user from Surinam) with HTLV-II. It is concluded that HTLV-I and HTLV-II circulate sporadically among drug users in Amsterdam and that risky injecting behaviour, which led to an HIV epidemic among intravenous drug users, has not led so far to an appreciable transmission of the other retroviruses among this group.

Human T-cell leukemia virus (HTLV) type II Rex protein binds specifically to RNA sequences of the HTLV long terminal repeat but poorly to the human immunodeficiency virus type 1 Rev-responsive element

The human T-cell leukemia viruses (HTLVs) encode a trans-regulatory protein, Rex, which differentially regulates viral gene expression by controlling the cytoplasmic accumulation of viral mRNAs. Because of insufficient amounts of purified protein, biochemical characterization of Rex activity has not previously been performed. Here, utilizing the baculovirus expression system, we purified HTLV type II (HTLV-II) Rex from the cytoplasmic fraction of recombinant baculovirus-infected insect cells by heparin-agarose chromatography. We directly demonstrated that Rex specifically bound HTLV-II 5' long terminal repeat RNA in both gel mobility shift and immunobinding assays. Sequences sufficient for Rex binding were localized to the R-U5 region of the HTLV-II 5' long terminal repeat and correlate with the region required for Rex function. The human immunodeficiency virus type 1 (HIV-1), has an analogous regulatory protein, Rev, which directly binds to and mediates its action through the Rev-responsive element located within the HIV-1 env gene. We demonstrated that HTLV-II Rex rescued an HIV-1JR-CSF Rev-deficient mutant, although inefficiently. This result is consistent with a weak binding activity to the HIV-1 Rev-responsive element under conditions in which it efficiently bound the HTLV-II long terminal repeat RNA.

Identification of a recombinant HTLV-II envelope protein for serological detection of HTLV-II carriers

To understand the pathogenic potential and the true extent of human T-cell leukemia virus type II (HTLV-II) infection, it is important to develop a specific HTLV-II antigen-based serological test. Plasmid pIIB was constructed and induced in Escherichia coli to express a recombinant protein (RP) containing 140 amino acids (amino acid residues 96 to 235) from the middle region of the HTLV-II exterior envelope glycoprotein gp52. Serum samples from polymerase chain reaction-confirmed HTLV-II-infected people, HTLV-I carriers, and adult T-cell leukemia (ATL) patients were tested for antibody reactivity to RP-IIB by Western blot assay. The results showed all 27 HTLV-II carriers, 10 of 20 HTLV-I carriers, and 4 of 17 (23.5%) ATL patients had antibody reactivities to RP-IIB. The difference in rates of seropositivity to RP-IIB between HTLV-II carriers (100%) and HTLV-I-infected people (carriers plus ATL patients) (37.8%) is statistically significant (Fisher's exact test, p = 4.30E-08).

Limited sequence variation in human T-lymphotropic virus type 1 isolates from North American and African patients

Nucleotide sequences were determined from the env genes of three HTLV-I clones derived from two North American patients and one African patient with adult T-cell leukemia/lymphoma (ATLL). In addition, sequences from the pX region, between env and the 3'LTR, were determined from one of these isolates. These data were compared to sequences derived from HTLV-I isolates of two Japanese ATLL patients, a Japanese patient with HTLV-I-associated myelopathy or tropical spastic paraparesis (HAM/TSP) and a Caribbean ATLL patient. Nucleotide sequence variation was found to be less than 6% in coding and noncoding regions. Predicted amino acid sequences varied between 0.6 and 1.8% in the envelope, 0-3.7% in rex, 0.8-2.5% in the tax gene product, and 3-14.0% in the pX-I open reading frame. Comparisons of the predicted amino acid sequences of the surface envelope protein (SU-gp46) suggest that the variation between isolates of different geographical origins is greater than that between isolates obtained from the same region of the world.

Regulation of HTLV-II gene expression by Rex involves positive and negative cis-acting elements in the 5'long terminal repeat

Regulation of human T-cell leukemia virus type II (HTLV-II) gene expression by the trans-acting viral protein, Rex, is mediated through specific cis-acting sequences in the HTLV-II long terminal repeat (LTR). Augmentation of 5' LTR-linked gene expression by Rex requires two distinct cis-acting elements: one termed the "Rex-responsive element" (RxRE), which allows Rex to overcome the inhibitory effect of a second, termed the "cis-acting repressive sequences" (CRS). The HTLV-II RxRE is located between nt +91 and +317 relative to the cap site in the R/U5 region of the 5'LTR, and the HTLV-II CRS is contained within the RxRE from nt +208 to +317, which is downstream of the splice donor site, in the R/U5 region of the 5' LTR. Deletion of the CRS results in significantly increased cytoplasmic levels of LTR-linked mRNA independent of the presence of Rex. Our results show that Rex acts post-transcriptionally and induces a shift from nucleus to cytoplasm of gag/pol mRNA, the only HTLV-II mRNA that contains both the RxRE and the CRS in the 5' LTR-derived leader sequence.

Human T-cell lymphotrophic virus in California's injection drug users

Human T-cell lymphotrophic virus I (HTLV-I) and human T-cell lymphotrophic virus II (HTLV-II) are closely related retroviruses that are highly prevalent in injection drug users (IDUs). The bulk of infection in this group probably occurs with HTLV-II, with a lower prevalence of HTLV-I. HTLV-I is known to cause adult T-cell leukemia/lymphoma and tropical spastic paraparesis. HTLV-II has not been proven to cause any human pathology, but may be immunosuppressive and is almost indistinguishable serologically from HTLV-I. As with human immunodeficiency virus (HIV), infection with these viruses is likely to be lifelong and the disease may have a latent period of many years. Unlike HIV, HTLV-I and/or HTLV-II are not likely to be transmitted from mother to child prenatally, and usually require breast-feeding for vertical transmission. It is likely that HTLV-I and/or HTLV-II has been prevalent in IDUs for far longer than the HIV epidemic. HTLV-I and/or HTLV-II are relevant to the AIDS epidemic in that they may function as biologic markers of behavioral risk status for HIV infection in IDUs or their sexual partners, and they may accelerate the course of HIV infection in persons coinfected with HTLV-I and/or HTLV-II and HIV. Coinfection will be more likely as the HIV epidemic progresses. Pregnant addicts entering outpatient methadone maintenance treatment in San Francisco County or Contra Costa County during 1990 were found to have an HTLV-II prevalence of 21% (n = 24). Important issues in counseling infected methadone patients are described.

Characterization of immunodominant epitopes of gag and pol gene-encoded proteins of human T-cell lymphotropic virus type I

A series of synthetic peptides derived from the corresponding regions of the gag, pol, and env proteins of human T-cell lymphotropic virus types I (HTLV-I) and II (HTLV-II) were used in an enzyme immunoassay to map the immunodominant epitopes of HTLV. Serum specimens from 79 of 87 (91%) HTLV-I-infected patients reacted with the synthetic peptide Gag-1a (amino acids [a.a.] 102 to 117) derived from the C terminus of the p19gag protein of HTLV-I. Minimal cross-reactivity (11%) was observed with serum specimens from HTLV-II-infected patients. Peptide Pol-3, encoded by the pol region of HTLV-I (a.a. 487 to 502), reacted with serum specimens from both HTLV-I- and HTLV-II-infected patients (94 and 86%, respectively). The antibody levels to Pol-3 were significantly higher (P less than 0.01) in patients with HTLV-I-associated myelopathy/tropical spastic paraparesis than in either adult T-cell leukemia patients or HTLV-I-positive asymptomatic carriers. None of the other peptides studied demonstrated significant binding to serum specimens obtained from HTLV-I- or HTLV-II-infected individuals. While Gag-1a did not react with serum specimens from normal controls, Pol-3 demonstrated some reaction with specimens from seronegative individuals (11.4%). The antibodies to Gag-1a and Pol-3 in serum specimens from HTLV-I-infected patients could be specifically inhibited by the corresponding synthetic peptides and by a crude HTLV-I antigen preparation, indicating that these peptides mimic native epitopes present in HTLV-I proteins that are recognized by serum antibodies from HTLV-I- and -II-infected individuals.

Human T-cell lymphotropic virus type I and II in transfusion medicine

As a consequence of migrating populations, IV drug use and, to a lesser extent, blood transfusions, endemic HTLV-I and HTLV-II infections have spread to nonendemic geographic regions. Although the risk that a person infected with HTLV-I will develop significant disease--even over a lifetime--is estimated to be relatively low, our awareness of the serious diseases associated with other retroviruses requires a cautious approach to blood transfusion. Reports from Japan and the United States indicate that programs testing donated blood and excluding units with HTLV-I antibodies have been highly successful in interrupting the spread of HTLV-I by transfusions. One unanticipated outcome of testing large numbers of people in the United States for HTLV-I antibodies has been recognition of the relatively high prevalence of HTLV-II infection, particularly among IV drug users. The long-term effects of HTLV-II infection are also unknown. Until the natural history and clinical consequences of HTLV-II infection are clearly understood, it is only prudent that blood donated by persons identified to be HTLV-II carriers also be excluded.

Human T-cell leukemia virus infection in non-intravenous drug using HIV seropositive men in Los Angeles

Sera from 634 homosexual men with Western blot-confirmed human immunodeficiency virus (HIV) infection were subjected to radioimmunoprecipation assay (RIPA) using an HTLV-I-infected human T-cell line (SLB-I). Sera obtained from Japanese adult T-cell leukemia patients, noninfected healthy individuals served as positive and negative controls. HIV-infected groups were comprised of asymptomatic homosexuals (n = 131), AIDS-related complex (n = 115), Kaposi's sarcoma (n = 300), AIDS-defining opportunistic infections (n = 76), and high-grade lymphomas (n = 12). Only two patients were known to be intravenous drug users. No instances of dual retroviral infection were detected. As a corollary, no cross reactivity between HTLV and HIV gene products was noted by RIPA. We conclude that HTLV infection is uncommon among select groups of HIV seropositive homosexuals who do not engage in intravenous drug abuse. Additional studies examining the seroprevalence and consequence of HTLV infection in broader based populations at risk for retroviral infection are required.

Characterization of a variant of human T-lymphotropic virus type I isolated from a healthy member of a remote, recently contacted group in Papua New Guinea

We report the characterization of a variant of human T-lymphotropic virus type I (HTLV-I) isolated from an interleukin 2-dependent, CD8+ T-cell line derived from peripheral blood mononuclear cells of a healthy member of a remote, recently contacted hunter-horticulturalist group (Hagahai) in Madang province of Papua New Guinea. Antigenic characterization of this variant, designated PNG-1, by immunofluorescence, indicated no expression of gag-encoded proteins p19 and p24 (even after incubation with 5-bromo-2'-deoxyuridine), using monoclonal and polyclonal antibodies against HTLV-I gag gene products. Virus-specific proteins of 15, 19, 46, 53, and 61/68 kDa were demonstrated by Western blot analysis, using sera from patients with serologically and/or virologically confirmed HTLV-I myeloneuropathy, sera from HTLV-I-infected rabbits, and antibodies prepared against the C terminus of the major envelope glycoprotein gp46. Restriction endonuclease maps of PNG-1 proviral DNA differed from that of a prototype strain of HTLV-I (MT-2), but, as verified by polymerase chain reaction, PNG-1 was definitely HTLV-I, not HTLV-II. Nucleotide sequencing and further molecular genetic studies of this variant may provide insights into the origin and evolution of HTLV-I.

Spontaneous lymphocyte proliferation in HTLV-II infection

We measured lymphocyte proliferation in the absence of antigenic stimulation in 45 HTLV-II infected, 9 HTLV-I infected, and 19 HTLV-I seronegative intravenous drug users (IVDU). Lymphocyte proliferation was higher in IVDUs infected with HTLV-II than in seronegative IVDUs but lower than among those infected with HTLV-I. Higher rates of proliferation were also associated with needle sharing, CD4+ and IL2R+ lymphocyte counts, and HTLV-I antibody titres.

Increased HTLV-I proviral DNA in HTLV-I-associated myelopathy: a quantitative polymerase chain reaction study

Using the polymerase chain reaction, we quantitated the amount of human T-lymphotropic virus type I (HTLV-I) proviral DNA in peripheral blood mononuclear cells from 18 patients with HTLV-I--associated myelopathy/tropical spastic paraparesis; 17 HTLV-I carriers without HTLV-I--associated myelopathy/tropical spastic paraparesis, with or without other autoimmune or inflammatory diseases; and 19 seronegative control subjects. The HTLV-I proviral DNA was 10- to 100-fold higher in the patients and in the HTLV-I carriers without HAM/TSP who had autoimmune or inflammatory diseases than in the carriers without autoimmune or inflammatory diseases. The patients who had had onset of myelopathy at a younger age (15 to 39 years) had an extremely high level of HTLV-I proviral DNA in the early phase, as compared with findings in those with a late onset of myelopathy (at 44 to 61 years). The large increase in HTLV-I proviral DNA in peripheral blood mononuclear cells is presumably closely related to the development of autoimmune or inflammatory processes in HTLV-I carriers, including HTLV-I--associated myelopathy/tropical spastic paraparesis.

Evaluation of enzyme immunoassays for antibody to human T-lymphotropic viruses type I/II

To evaluate the sensitivity and specificity of HTLV-I/II assays, serum from 1100 pregnant Haitian women was tested with seven commercially available HTLV I/II assays. Serum that was found to be reactive in any assay was analysed by western blot and all indeterminate samples were further characterised by radioimmunoprecipitation assays (RIPA). 59 (5.4%) samples were HTLV I/II antibody positive by western blot and/or RIPA. The sensitivity of these seven assays ranged from 93.2% to 100%. with the 'Recombinant HTLV-I' (Cambridge Bioscience) and 'Serodia HTLV-I' (Fujirebio) assays having the highest sensitivity (100%). The specificity of these assays ranged from 98.4% to 100%, with the Abbott assay having the highest specificity (99.5%, 100%) according to two different methods of evaluation. Whether the antigens used in any assay were whole disrupted virus or recombinant gene products made no difference. The low positive predictive values of some of these assays (71.8-91.7%), even in a high prevalence population, and the need for RIPA to test indeterminate sera, indicate that for routine screening of blood donors there is still room for improvement both in screening and confirmatory assays for HTLV-I/II.

Rex transregulation of human T-cell leukemia virus type II gene expression

The Rex protein of the human T-cell leukemia virus type II (HTLV-II), Rex-II, plays a central role in regulating the expression of the structural genes of this retrovirus. Rex-II acts posttranscriptionally by inducing the cytoplasmic expression of the incompletely spliced viral mRNAs that encode the Gag and Env structural proteins and the enzymes derived from the pol gene. We now define a 295-nucleotide cis-acting regulatory element within the 3' long terminal repeat of HTLV-II that is required for the effects of Rex-II. This Rex-II response element (RexIIRE) corresponds to a predicted, highly stable RNA secondary structure and functions when present in the sense but not in the antisense orientation. The RexIIRE confers responsiveness not only to Rex-II but also to the Rex protein of HTLV-I. Deletion and substitution mutagenesis of the RexIIRE permitted identification of a small subregion within the larger element critically required for Rex-II responsiveness and further suggested that the structurally distinct RexIIREs generated from the 5' and 3' long terminal repeats of HTLV-II may differentially regulate the cytoplasmic expression of unspliced gag-pol and singly spliced env mRNAs. While the Rev protein of human immunodeficiency virus type 1 fails to function via the RexIIRE, the Rex-II protein, like Rex-I, can functionally replace the Rev protein of human immunodeficiency virus type 1 via its interaction with the Rev response element (RevRE).

Pseudotyping with human T-cell leukemia virus type I broadens the human immunodeficiency virus host range

Several epidemiologic and clinical studies suggest that patients coinfected with human immunodeficiency virus (HIV), the primary etiologic agent in AIDS, and other viruses, such as cytomegalovirus or human T-cell leukemia virus (HTLV), have a more severe clinical course than those infected with HIV alone. Cells infected with two viruses can, in some cases, give rise to phenotypically mixed virions with altered or broadened cell tropism and could therefore account for some of these findings. Such pseudotypes could alter the course of disease by infecting more tissues than are normally infected by HIV. We show here that HIV type 1 (HIV-1) efficiently incorporates the HTLV type I (HTLV-I) envelope glycoprotein and that both HIV-1 and HTLV-II accept other widely divergent envelope glycoproteins to form infectious pseudotype viruses whose cellular tropisms and relative abilities to be transmitted by cell-free virions or by cell contact are determined by the heterologous envelope. We also show that the mechanism by which virions incorporate heterologous envelope glycoproteins is independent of the presence of the homologous glycoprotein or heterologous gag proteins. These results may have important implications for the mechanism of HIV pathogenesis.

In situ hybridization detection of HTLV-I RNA in peripheral blood mononuclear cells of TSP/HAM patients and their spouses

This is the first report of the direct detection of HTLV-I RNA in uncultured peripheral blood mononuclear cells (PBMNC's) of patients with tropical spastic paraparesis and HTLV-I-associated myelopathy (TSP/HAM) and their spouses, using the technique of in situ hybridization. Twenty-one Colombian patients were tested, all of whom had antibodies to HTLV-I; the presence of HTLV-I proviral DNA in their PBMNC's was confirmed by the polymerase chain reaction technique. Of the 21 patients 15 had a clinical diagnosis of tropical spastic paraparesis (TSP/HAM), 5 were asymptomatic relatives, and 1 patient had leukemia. In situ hybridization was positive in samples from 5 patients; 2 of these were TSP/HAM patients and the other 3 were healthy wives of TSP/HAM patients. This study demonstrates for the first time that viral RNA is expressed in uncultured PBMNC's of some patients with TSP/HAM in whom proviral DNA is also present; furthermore, the detection of HTLV-I RNA in the blood of female partners of TSP/HAM patients clearly illustrates the high likelihood of HTLV-I transmission through sexual contact.

Co-infection with HIV-I and HTLV-I/II In Intravenous Drug Users in Suburban New York City, With Comparison to Other Geographic Areas

Co-infection with human T-lymphotropic virus types I or II (HTLV-I or -II) may be a cofactor in the progression of human immunodeficiency virus (HIV) infection. We assessed the frequency of simultaneous infection with these retroviruses among intravenous drug users from Westchester County, N.Y., a suburb of New York City. Comparison was made with similar studies in the United States and Europe.

The epidemiology of HTLV-I infection

It has been 10 years since the discovery of the human T-cell lymphotropic virus type I (HTLV-I), the first human retrovirus. During the past decade, significant progress has been made in understanding the transmission of the virus and defining its geographic distribution. It has been shown conclusively that HTLV-I is a causal factor in the induction of both adult T-cell leukemia/lymphoma and HTLV-I-associated myelopathy. However, the pathogenesis of each of these conditions is not clear, and in the light of the evidence of immune dysfunction seen among carriers of the infection, it is likely that other associated diseases will be identified. The challenge in the next decade will be to develop and implement therapeutic interventions among carriers to prevent such diseases as well as to curtail transmission within endemic populations.

Serological and molecular survey for HTLV-I infection in a high-risk Middle Eastern group

To define the extent of human T-cell leukaemia virus (HTLV-I) infection among a group of Jewish immigrants to Israel with an increased frequency of adult T-cell leukaemia, various serological and molecular screening methods, including enzyme-linked immunosorbent assay (ELISA) for anti-HTLV-I, ELISA for antibody to recombinant HTLV-I p40tax protein, and molecular detection of infection by polymerase chain reaction (PCR) amplification of HTLV-I proviral DNA from peripheral blood mononuclear cell DNA, were used. By HTLV-I ELISA the overall rate of infection was 12% (24 of 208) among immigrants from Khurusan, northeastern Iran; no HTLV-I carriers were detected among 111 unselected Jewish immigrants from other parts of Iran. There was unexplained clustering of HTLV-I infection within a cohort of 32 elderly women of similar geographic origin in a home for old people--14 were seropositive by ELISA and 19 of 29 were positive by PCR. The findings in this newly identified high-risk population suggest that in addition to ELISA, other screening techniques may be required to detect all carriers in high-risk populations.

Normal expression of p55 interleukin 2 receptor (CD25) by lymphocytes from former blood donors seropositive for human T lymphotropic virus

Dysregulated expression of the p55 interleukin 2 receptor (CD25) is characteristic of adult T cell leukemia (ATL) associated with human T lymphotropic virus (HTLV) infection. In order to determine if similar changes characterize HTLV infection in the apparent absence of ATL, CD25 expression by peripheral blood lymphocytes from HTLV-seropositive former blood donors was measured using a sensitive dual-color cytofluorometric assay. When comparing the HTLV-seropositive group (N = 19) and a seronegative control group (N = 20), no significant differences were observed in either the proportions of the major lymphocyte subsets (CD3, CD4, CD8, CD19, CD16/56) coexpressing CD25 or the phenotypic distribution of CD25+ cells among these lymphocyte subsets. Similarly, the total percentages of CD3, CD4, CD8, and CD19 cell subsets were unchanged; however, the percentage of CD16/56+ cells was significantly decreased in the HTLV group and reflected a decrease in the percentage of CD16/56 cells lacking CD25. These findings indicate that HTLV infection without ATL is characterized by normal CD25 expression by lymphocytes and a decreased percentage of lymphocytes with a phenotype characteristic of natural killer cells.