FK506 and cyclosporin a regulate proliferation and proto-oncogene expression in HTLV-1-associated myelopathy/tropical-spastic-paraparesis-derived T cells

Myelopathy due to human T-cell leukemia virus type-1 from the donor after ABO-incompatible liver transplantation

We report the case of a 53-year-old-man who developed human T-cell leukemia virus type-1-associated myelopathy (HAM) after ABO-incompatible liver transplantation for alcoholic liver cirrhosis. The living donor was seropositive for human T-cell leukemia virus type-1 (HTLV-1) and the recipient was seronegative for HTLV-1 before transplantation. After transplantation, the recipient developed steroid-resistant acute cellular rejection, which was successfully treated using anti-thymocyte globulin, and he was eventually discharged. He underwent spinal surgery twice after the transplantation for the treatment of cervical spondylosis that had been present for a period of 9 months before the transplantation. The surgery improved his gait impairment temporarily. However, his gait impairment progressed, and magnetic resonance imaging revealed multiple sites of myelopathy. He was diagnosed with HAM 16 months after the transplantation. Pulse steroid therapy (1000mg) was administered over a period of 3 days, and his limb paresis improved. Presently, steroid therapy is being continued, with a plan to eventually taper the dose, and he is being carefully followed up at our institution. Our case suggests that liver transplantation involving an HTLV-1-positive living donor carries the risk of virus transmission and short-term development of HAM after transplantation.

Human T-cell leukemia virus type I-associated myelopathy following living-donor liver transplantation

This report describes a patient who developed human T-cell leukemia virus type I-associated myelopathy (HAM) following a living-donor liver transplantation (LDLT) for liver cirrhosis due to hepatitis C virus (HCV) infection. Both the recipient and the living donor (his sister) were human T-cell leukemia virus type I (HTLV-I) carriers. Since the LDLT, he had been treated with immunosuppressive drugs such as tacrolimus and steroids as well as interferon-alpha to prevent rejection and a recurrence of the HCV infection, respectively. Even though the HTLV-I proviral load had decreased upon interferon treatment, he developed a slowly progressive gait disturbance with urinary disturbance 2 years after the LDLT and was diagnosed with HAM. This appears to be the first report of HAM development in an HLTV-I-infected LDLT recipient.

Human T-cell lymphotrophic virus infection in organ donors: a need to reassess policy?

Human T-cell lymphotrophic virus (HTLV)-I/II infection has been considered a contra-indication to organ donation due to the risk of transmission of infection and the subsequent development of either adult T-cell leukemia or HTLV-I-associated myelopathy. However, neither the incidence of HTLV-I/II infection in organ donors nor the risk of transmission of HTLV-I/II by solid organ transplantation has been defined. Further, it is not known if HTLV infection contributes to significant morbidity in solid organ recipients. The purpose of this study was to evaluate the incidence of HTLV-I/II infection in organ donors in USA and to determine if transplanting these organs resulted in HTLV-related morbidity or mortality. We utilized the UNOS database to: (i) identify organ donors that were positive for HTLV-I or II infection between 1988 and 2000, and (ii) evaluate outcomes in the recipients of these organs. There were 25 HTLV-I/II-positive organ donors reported to UNOS between 1988 and 2000. Based on organ donors with a known HTLV-I/II status, the prevalence of HTLV-I infection in organ donors is 0.027% and the prevalence of HTLV-II is 0.064%. Twenty-two organs were transplanted from these HTLV-positive donors. There have been no reports of HTLV-I/II-related disease in the recipients with a median follow-up of 11.9 months. At our center, over the last 1.5 years there have been four multiorgan donors with false-positive HTLV-I/II screening assays, which resulted in the decision not to use organs from these donors. Based on the minimal chance of HTLV-related disease following transplantation of HTLV-I/II organs in this series, we recommend that careful consideration be given to transplanting organs from HTLV-I/II-positive organ donors.

Lymphoproliferative disorders in renal transplant patients in Japan

Post-transplantation lymphoproliferative disorders (PT-LPD) are characterized by a clinically and morphologically heterogeneous group of lymphoid proliferation occurring after organ or bone marrow transplantation. The immunodeficient state provides a basis for lymphomagenesis probably through activation of oncogenic viruses. Twenty-four patients in whom PT-LPD developed after renal transplantation in Japan were analyzed. They received hemodialysis for 4 to 226 (median 13) months before transplantation. In situ hybridization was performed to detect Epstein-Barr virus (EBV). Polymerase chain reaction and Southern hybridization with primers in the tax and pol regions of human T-cell leukemia virus type I (HTLV-1) were performed on DNA extracted from paraffin-embedded specimens. Immunohistochemical analysis revealed that 12 cases were B-cell type, 10 cases (42%) T-cell type and 2 NK-cell type. Five of the T-cell cases were classified as adult T-cell lymphoma with proven HTLV-1 genome in the tumor and seropositivity for the virus. These cases were classified as adult T-cell lymphoma (ALT). More than 80% of B-cell, 30% of T-cell and both NK/T-cell lymphomas were EBV-positive. Co-infection of EBV and HTLV-1 was found in 2 cases with ATL. These findings showed that ATL is common among Japanese renal transplant patients, which might be due to transmission of HTLV-1 via blood transfusion during hemodialysis.

HTLV-I-associated myelopathy manifested after renal transplantation

We report a patient with HTLV-I-associated myelopathy (HAM), who developed symptoms of myelopathy 4 years after cadaveric renal transplantation. Since he was seronegative before the transplantation, it is suggested that HTLV-I infection was transmitted via renal graft transplantation. He has been treated with immunosuppressive agents such as cyclosporin A (CsA), mycophenolate mofetil (MMF), and prednisolone (PSL) to prevent graft rejection. This case suggested that these immunosuppressive agents are poorly effective in suppressing either the onset or progression of HAM/TSP.

Expression of the c-myc proto-oncogene is essential for HIV-1 infection in activated T cells

We previously found that activation of primary CD4+ T cells via both the T cell antigen receptor (TCR) and CD28 is required for HIV-1 DNA to be translocated from the cytoplasm to the nucleus. Here we report that expression of c-Myc protein in CD4+ T cells is induced only after such costimulation. In addition, cyclosporin A not only inhibits nuclear import of HIV-1 DNA but also inhibits expression of c-Myc protein. Because of these correlations, we tested whether c-Myc is necessary for nuclear import of HIV-1 DNA. Specific c-myc antisense, but not sense or non-sense, phosphorothioate oligodeoxynucleotides selectively induced the accumulation of two NH2-terminally truncated c-Myc proteins and abolished HIV-1 genome entry into host nuclei. Consequently, both virus replication and HIV-1-induced apoptotic cell death were inhibited. Synthesis of viral full-length DNA was not affected. Specific c-myc antisense oligonucleotide inhibited HIV-1 infection under conditions that did not affect cell cycle entry or proliferation. Thus, c-Myc appears to regulate HIV-1 DNA nuclear import via a mechanism distinct from those controlling entry into the cell cycle.