1
|
Saab L, DiCapua D, Zubair AS. HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP): Case based discussion of risk factors, clinical, and therapeutic considerations. J Neurol Sci 2024; 459:122973. [PMID: 38520941 DOI: 10.1016/j.jns.2024.122973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/06/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
HTLV-1 is a retrovirus virus that infects CD4+ T cells. Most people with HTLV-1 infection remain asymptomatic but some may develop conditions such as HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) or adult T-cell leukemia/lymphoma. HAM/TSP is characterized by progressive spasticity and weakness of the lower extremities, as well as loss of bladder control and sensory disturbances. The risk of developing HAM/TSP is associated with the duration of infection and the proviral load. There is currently no cure for the disease but medications can help manage symptoms and slow the progression of the disease. This is the case of a 66-year-old female who presented with nonspecific symptoms of weakness and spasticity in a hospital in Connecticut and was subsequently diagnosed with HAM/TSP. The patient's diagnosis highlights the importance of considering diseases previously confined to specific endemic regions in a globalized world where increased emigration and population mixing can occur. Early identification and management of such cases is essential for optimizing patient outcomes and quality of life.
Collapse
Affiliation(s)
- Lea Saab
- Department of Neurology, Yale University School of Medicine, 20 York Street, New Haven, CT, 06510, USA
| | - Daniel DiCapua
- Department of Neurology, Yale University School of Medicine, 20 York Street, New Haven, CT, 06510, USA
| | - Adeel S Zubair
- Department of Neurology, Yale University School of Medicine, 20 York Street, New Haven, CT, 06510, USA.
| |
Collapse
|
2
|
Nagahori T, Shiraishi W, Nishikawa M, Matsuyoshi A, Ogura T, Yamada Y, Takahashi K, Suzuki T, Nakamichi K, Hashimoto T, Hatano T. A human T-lymphotropic virus-1 carrier who developed progressive multifocal leukoencephalopathy following immunotherapy for sarcoidosis: a case report. BMC Neurol 2023; 23:52. [PMID: 36726087 PMCID: PMC9893603 DOI: 10.1186/s12883-023-03094-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy (PML) is a devastating demyelinating disorder of the central nervous system caused by opportunistic infection of the JC virus (JCV). CASE PRESENTATION A 58-year-old Japanese woman was admitted to our hospital for aphasia. She had a 5-year history of untreated sarcoidosis and was a human T cell lymphotropic virus-1 (HTLV-1) carrier. Serum angiotensin-converting enzyme, soluble interleukin-2 receptor, lysozyme, and calcium levels were elevated. JCV-DNA was not detected in cerebrospinal fluid by PCR testing. Skin biopsy revealed noncaseating granuloma formation. Bilateral multiple nodular lesions were present on chest X-ray. Brain magnetic resonance imaging showed left frontal and temporal lesions without gadolinium enhancement. As we suspected that systemic sarcoidosis had developed into neurosarcoidosis, we started steroid and infliximab administration. After treatment, the chest X-ray and serum abnormalities ameliorated, but the neurological deficits remained. At 1 month after immunotherapy, she developed right hemiparesis. Cerebrospinal fluid was positive for prototype (PML-type) JCV on repeated PCR testing. Brain biopsy revealed demyelinating lesions with macrophage infiltration, atypical astrocytes, and JCV antigen-positive cells. We diagnosed her with PML and started mefloquine, leading to partial remission. CONCLUSIONS Sarcoidosis and HTLV-1 infection both affect T cell function, especially CD4+ T cells, and may developped the patient's PML. The comorbidity of sarcoidosis, PML, and HTLV-1 infection has not been reported, and this is the world's first report of PML associated with HTLV-1 infection and sarcoidosis.
Collapse
Affiliation(s)
- Takashi Nagahori
- grid.415432.50000 0004 0377 9814Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Wataru Shiraishi
- grid.415432.50000 0004 0377 9814Department of Neurology, Kokura Memorial Hospital, Fukuoka, Japan ,Shiraishi Internal Medicine Clinic, Fukuoka, Japan
| | - Masafumi Nishikawa
- grid.415432.50000 0004 0377 9814Department of Neurology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Ayano Matsuyoshi
- grid.415432.50000 0004 0377 9814Department of Neurology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Takenori Ogura
- grid.415432.50000 0004 0377 9814Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yui Yamada
- grid.415432.50000 0004 0377 9814Department of Pathology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Kenta Takahashi
- grid.410795.e0000 0001 2220 1880Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tadaki Suzuki
- grid.410795.e0000 0001 2220 1880Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kazuo Nakamichi
- grid.410795.e0000 0001 2220 1880Department of Virology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tetsuya Hashimoto
- grid.415432.50000 0004 0377 9814Department of Neurology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Taketo Hatano
- grid.415432.50000 0004 0377 9814Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| |
Collapse
|
3
|
Mulherkar TH, Gómez DJ, Sandel G, Jain P. Co-Infection and Cancer: Host–Pathogen Interaction between Dendritic Cells and HIV-1, HTLV-1, and Other Oncogenic Viruses. Viruses 2022; 14:v14092037. [PMID: 36146843 PMCID: PMC9503663 DOI: 10.3390/v14092037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Dendritic cells (DCs) function as a link between innate and adaptive immune responses. Retroviruses HIV-1 and HTLV-1 modulate DCs to their advantage and utilize them to propagate infection. Coinfection of HTLV-1 and HIV-1 has implications for cancer malignancies. Both viruses initially infect DCs and propagate the infection to CD4+ T cells through cell-to-cell transmission using mechanisms including the formation of virologic synapses, viral biofilms, and conduits. These retroviruses are both neurotrophic with neurovirulence determinants. The neuropathogenesis of HIV-1 and HTLV-1 results in neurodegenerative diseases such as HIV-associated neurocognitive disorders (HAND) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Infected DCs are known to traffic to the brain (CNS) and periphery (PNS, lymphatics) to induce neurodegeneration in HAND and HAM/TSP patients. Elevated levels of neuroinflammation have been correlated with cognitive decline and impairment of motor control performance. Current vaccinations and therapeutics for HIV-1 and HTLV-1 are assessed and can be applied to patients with HIV-1-associated cancers and adult T cell leukemia/lymphoma (ATL). These diseases caused by co-infections can result in both neurodegeneration and cancer. There are associations with cancer malignancies and HIV-1 and HTLV-1 as well as other human oncogenic viruses (EBV, HBV, HCV, HDV, and HPV). This review contains current knowledge on DC sensing of HIV-1 and HTLV-1 including DC-SIGN, Tat, Tax, and current viral therapies. An overview of DC interaction with oncogenic viruses including EBV, Hepatitis viruses, and HPV is also provided. Vaccines and therapeutics targeting host–pathogen interactions can provide a solution to co-infections, neurodegeneration, and cancer.
Collapse
Affiliation(s)
- Tania H. Mulherkar
- Department of Microbiology and Immunology, Drexel University, College of Medicine, 2900 Queen Lane, Philadelphia, PA 19129, USA
| | - Daniel Joseph Gómez
- Department of Microbiology and Immunology, Drexel University, College of Medicine, 2900 Queen Lane, Philadelphia, PA 19129, USA
- Department of Biological Sciences, California State University, 25800 Carlos Bee Blvd, Hayward, CA 94542, USA
| | - Grace Sandel
- Department of Microbiology and Immunology, Drexel University, College of Medicine, 2900 Queen Lane, Philadelphia, PA 19129, USA
| | - Pooja Jain
- Department of Microbiology and Immunology, Drexel University, College of Medicine, 2900 Queen Lane, Philadelphia, PA 19129, USA
- Correspondence:
| |
Collapse
|
4
|
Gomes YCP, Freitas NL, Souza FS, Sandim V, Pereira DA, Nogueira FCS, Echevarria-Lima J, Leite ACCB, Lima MASD, Silva MTT, Araújo AQC, Vicente ACP, Espíndola OM. Chitotriosidase 1 in the cerebrospinal fluid as a putative biomarker for HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) progression. Front Immunol 2022; 13:949516. [PMID: 36052089 PMCID: PMC9424492 DOI: 10.3389/fimmu.2022.949516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is an inflammatory neurodegenerative disease that affects motor, urinary, intestinal, and sensory functions. Typically, HAM/TSP is slowly progressive, but it may vary from limited motor disability after decades (very slow progression) to loss of motor function in a few years from disease onset (rapid). In this study, we aimed to identify prognostic biomarkers for HAM/TSP to support patient management. Thus, proteomic analysis of the cerebrospinal fluid (CSF) was performed with samples from HTLV-1 asymptomatic carriers (AC) (n=13) and HAM/TSP patients (n=21) with rapid, typical, and very slow progression using quantitative label-free liquid chromatography/tandem mass spectrometry. Enrichment analyses were also carried out to identify key biological processes associated with distinct neurological conditions in HTLV-1 infection. Candidate biomarkers were validated by ELISA in paired CSF and serum samples, and samples from HTLV-1-seronegative individuals (n=9) were used as controls. CSF analysis identified 602 proteins. Leukocyte/cell activation, immune response processes and neurodegeneration pathways were enriched in rapid progressors. Conversely, HTLV-1 AC and HAM/TSP patients with typical and very slow progression had enriched processes for nervous system development. Differential expression analysis showed that soluble vascular cell adhesion molecule 1 (sVCAM-1), chitotriosidase 1 (CHIT1), and cathepsin C (CTSC) were upregulated in HAM/TSP. However, only CHIT1 was significantly elevated after validation, particularly in HAM/TSP rapid progressors. In contrast, none of these biomarkers were altered in serum. Additionally, CSF CHIT1 levels in HAM/TSP patients positively correlated with the speed of HAM/TSP progression, defined as points in the IPEC-2 HAM/TSP disability scale per year of disease, and with CSF levels of phosphorylated neurofilament heavy chain, neopterin, CXCL5, CXCL10, and CXCL11. In conclusion, higher CSF levels of CHIT1 were associated with HAM/TSP rapid progression and correlated with other biomarkers of neuroinflammation and neurodegeneration. Therefore, we propose CHIT1 as an additional or alternative CSF biomarker to identify HAM/TSP patients with a worse prognosis.
Collapse
Affiliation(s)
- Yago Côrtes Pinheiro Gomes
- Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- *Correspondence: Otávio Melo Espíndola, ; Yago Côrtes Pinheiro Gomes,
| | - Nicole Lardini Freitas
- Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Flávia Santos Souza
- Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Vanessa Sandim
- Institute of Medical Biochemistry Leopoldo de Meis (IBqM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Denise Abreu Pereira
- Program of Cellular and Molecular Oncobiology (POCM), National Institute of Cancer (INCA), Rio de Janeiro, Brazil
| | - Fábio César Sousa Nogueira
- Laboratory of Proteomics, Laboratory for the Support of Technological Development (LADETEC), Institute of Chemistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Proteomics Unit, Institute of Chemistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Juliana Echevarria-Lima
- Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | - Marcus Tulius Teixeira Silva
- Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Abelardo Queiroz Campos Araújo
- Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | | | - Otávio Melo Espíndola
- Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- *Correspondence: Otávio Melo Espíndola, ; Yago Côrtes Pinheiro Gomes,
| |
Collapse
|
5
|
Liberato de Matos SNF, Ladeia-Rocha G, Neto JAC, de Oliveira CJV, Neto CA, Passos L, Oliveira-Filho J, Carvalho EM. Diffusion tensor imaging metrics in diagnosis of
HTLV‐1‐associated
myelopathy. Ann Clin Transl Neurol 2022; 9:488-496. [PMID: 35263043 PMCID: PMC8994983 DOI: 10.1002/acn3.51521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sheila N F Liberato de Matos
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador.,UniFTC, Salvador, Bahia, Brazil
| | | | - José Abraão Carneiro Neto
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - Cassius J V de Oliveira
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | | | - Lúcia Passos
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - Jamary Oliveira-Filho
- Neurology Service, Professor Edgard Santos University Hospital, Salvador, Bahia, Brazil.,Instituto de Ciências da Saúde, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Edgar M Carvalho
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador.,Laboratório de Pesquisas Clínicas (LAPEC), Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Bahia, Brazil.,National Institute of Science and Technology in Tropical Diseases (INCT-DT), CNPq, Brazil
| |
Collapse
|
6
|
Bastos Ferreira AP, do Nascimento ADFS, Sampaio Rocha-Filho PA. Cerebral and spinal cord changes observed through magnetic resonance imaging in patients with HTLV-1-associated myelopathy/tropical spastic paraparesis: a systematic review. J Neurovirol 2022; 28:1-16. [PMID: 34981435 DOI: 10.1007/s13365-021-01043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 11/21/2021] [Accepted: 12/09/2021] [Indexed: 11/27/2022]
Abstract
To verify brain and spinal changes using magnetic resonance imaging in patients with HTLV-1-associated myelopathy/tropical spastic paraparesis. This was a systematic review. The descriptors used were tropical spastic paraparesis and magnetic resonance image. The keyword HTLV-1-associated myelopathy was also used. Twenty-three articles were included: 16 detected brain changes and 18 detected spinal changes. White matter lesions were the most frequent finding in the brain. Brain injuries were most frequently identified in the periventricular region, in the subcortical region, in the centrum semiovale, in the brain stem, and corpus callosum. Atrophy was the most frequent finding of the spinal cord, affecting the thoracic and cervical regions, and was associated with a longer evolution of myelopathy. White matter lesions in these regions were also observed. Cortical white matter lesions and thoracic spinal cord atrophy were the most frequently reported changes in patients with HTLV-1-associated myelopathy.
Collapse
Affiliation(s)
- Ana Patrícia Bastos Ferreira
- Post-Graduation Program in Neuropsychiatry and Behavioral Sciences (Posneuro), Federal University of Pernambuco (UFPE), Recife, Brazil.,Rua Carlos Pereira Falcão, 1136, Recife, 51021-350, Brazil
| | - Ana Dolores Firmino Santos do Nascimento
- Post-Graduation Program in Neuropsychiatry and Behavioral Sciences (Posneuro), Federal University of Pernambuco (UFPE), Recife, Brazil.,Rua Arlindo Gouveia, 145, Recife, 50720-595, Brazil
| | - Pedro Augusto Sampaio Rocha-Filho
- Division of Neuropsychiatry, Federal University of Pernambuco (UFPE), Recife, Brazil. .,Rua General Joaquim Inácio, Pernambuco- CEP, 1412 - Edifício The Plaza Business Center, Recife, Sala, 83052011-270, Brazil.
| |
Collapse
|
7
|
Ahmadi Ghezeldasht S, Shamsian SAA, Gholizadeh Navashenaq J, Miri R, Ashrafi F, Mosavat A, Rezaee SA. HTLV-1 oncovirus-host interactions: From entry to the manifestation of associated diseases. Rev Med Virol 2021; 31:e2235. [PMID: 33742509 DOI: 10.1002/rmv.2235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 12/19/2022]
Abstract
Human T lymphotropic virus type-1 (HTLV-1) is a well-known human oncovirus, associated with two life-threatening diseases, adult T cell leukaemia/lymphoma (ATL) and HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). The study of this oncogenic virus is significant from two different aspects. First, HTLV-1 can be considered as a neglected public health problem, which may spread slowly worldwide. Second, the incidence of HTLV-1 associated diseases due to oncogenic effects and deterioration of the immune system towards autoimmune diseases are not fully understood. Furthermore, knowledge about viral routes of transmission is important for considering potential interventions, treatments or vaccines in endemic regions. In this review, novel characteristics of HTLV-1, such as the unusual infectivity of virions through the virological synapse, are discussed in the context of the HTLV-1 associated diseases (ATL and HAM/TSP).
Collapse
Affiliation(s)
- Sanaz Ahmadi Ghezeldasht
- Inflammation and Inflammatory Diseases Division, Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ali Akbar Shamsian
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Mashhad, Iran
| | | | - Raheleh Miri
- Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Mashhad, Iran
| | - Fereshteh Ashrafi
- Department of Animal Science, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Arman Mosavat
- Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Mashhad, Iran
| | - Seyed Abdolrahim Rezaee
- Inflammation and Inflammatory Diseases Division, Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
8
|
Human T-cell Leukemia Virus Type 1 and Strongyloides stercoralis: Partners in Pathogenesis. Pathogens 2020; 9:pathogens9110904. [PMID: 33137906 PMCID: PMC7692131 DOI: 10.3390/pathogens9110904] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/07/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022] Open
Abstract
Infection with human T-cell leukemia/lymphoma virus type 1 (HTLV-1) has been associated with various clinical syndromes including co-infection with Strongyloides stercoralis, which is an intestinal parasitic nematode and the leading cause of strongyloidiasis in humans. Interestingly, HTLV-1 endemic areas coincide with regions citing high prevalence of S. stercoralis infection, making these communities optimal for elucidating the pathogenesis of co-infection and its clinical significance. HTLV-1 co-infection with S. stercoralis has been observed for decades in a number of published patient cases and case series; however, the implications of this co-infection remain elusive. Thus far, data suggest that S. stercoralis increases proviral load in patients co-infected with HTLV-1 compared to HTLV-1 infection alone. Furthermore, co-infection with HTLV-1 has been associated with shifting the immune response from Th2 to Th1, affecting the ability of the immune system to address the helminth infection. Thus, despite this well-known association, further research is required to fully elucidate the impact of each pathogen on disease manifestations in co-infected patients. This review provides an analytical view of studies that have evaluated the variation within HTLV-1 patients in susceptibility to S. stercoralis infection, as well as the effects of strongyloidiasis on HTLV-1 pathogenesis. Further, it provides a compilation of available clinical reports on the epidemiology and pathology of HTLV-1 with parasitic co-infection as well as data from mechanistic studies suggesting possible immunopathogenic mechanisms. Furthermore, specific areas of potential future research have been highlighted to facilitate advancing understanding of the complex interactions between these two pathogens.
Collapse
|
9
|
Spasticity distribution and severity in individuals with HTLV-1-associated myelopathy/tropical spastic paraparesis. J Neurovirol 2020; 27:857-863. [PMID: 33021698 DOI: 10.1007/s13365-020-00911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/15/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
In individuals with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), spasticity is one of the main symptoms. The neurological signs of the disease are well defined, but details of how spasticity appears in these individuals have not been well explored. To describe spasticity location and severity of HAM/TSP individuals. Cross-sectional study with individuals older than 18 years, diagnosed with HAM/TSP and with lower limb spasticity. Pregnant women, individuals with other associated neurological diseases, and those using antispastic drugs were not included. Spasticity was assessed by the Modified Ashworth Scale (MAS), applied to the abductor, adductor, flexor, and extensor muscles of the hips, flexors, and extensors of the knees, dorsiflexors, plantiflexors, evertors, and inverters of the foot. Thirty participants were included. The plantiflexor muscles (90%), knee extensors (80%), knee flexors (63,3%), and adductors (50%) were most frequently affected by spasticity. Twenty-three (76.7%) individuals had mixed spasticity, 5 (16.7%) with distal spasticity and 2 (6.7%) with proximal spasticity. MAS was similar between the lower limbs in at least 6 of the 10 muscle groups of each individual. Spasticity was mostly mixed in the lower limbs, with more frequently mild severity. The individuals were partially symmetrical between the lower limbs. The most affected muscle groups were the plantiflexors, knee extensors and flexors and the hip adductors, consecutively, being predominantly symmetrical.
Collapse
|
10
|
Rajaei T, Farajifard H, Rezaee SA, Azarpazhooh MR, Mahmoudi M, Valizadeh N, Rafatpanah H. Different roles of CXCR1 and CXCR2 in HTLV-1 carriers and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients. Med Microbiol Immunol 2018; 208:641-650. [PMID: 30341468 DOI: 10.1007/s00430-018-0568-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 10/09/2018] [Indexed: 12/24/2022]
Abstract
One of the prominent features of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is the excessive recruitment of leukocytes to the central nervous system (CNS), which leads to an inflammatory response-with chemokines and their receptors playing the main role in this recruitment. The aim of the study was to examine the relation of CXCR1 and CXCR2, both of which are involved in the trafficking of lymphocytes into the CNS, with the outcome of HTLV-1 infection. The mRNA levels of CXCR1 and CXCR2 were examined in peripheral blood mononuclear cells (PBMCs) of HAM/TSP patients, HTLV-1 asymptomatic carriers (ACs), and healthy controls (HCs). Furthermore, the frequency of CD4+ and CD8+ T cells expressing CXCR1 and CXCR2 was evaluated in the studied groups. The results of the present study showed a substantial increase in the mean mRNA expression of CXCR2 in the HAM/TSP patients compared to the HCs and ACs (p < 0.001). A positive correlation was also found between PVL and CXCR2 mRNA expression in the total population of HTLV-1-infected subjects (R = 0.526, p < 0.001). Moreover, the percentage of CD8+ CXCR2-expressing cells was higher in HAM/TSP patients compared to ACs and HCs (p < 0.05, p < 0.01, respectively). Although the percentage of CD4+ CXCR2-expressing cells was higher in HAM/TSP patients than in ACs and HCs, a significant difference was only found between HAM/TSP patients and HCs (p < 0.05). No significant difference in the CXCR1 mRNA expression was observed in the studied groups. The frequency of the CD8+ CXCR1- and CD4+ CXCR1-expressing cells was significantly lower in HAM/TSP patients than in ACs and HCs (p < 0.001 and p < 0.01, respectively). In conclusion, the high frequency of CXCR2 CD8+ T cells and the high levels of CXCR2 mRNA expression in HAM/TSP patients are associated with disease pathogenesis, while the high frequencies of CXCR1 T cells in ACs might suggest that these cells act as effector CD8 T cells and are involved in controlling the viral spread and modulation of the immune response.
Collapse
Affiliation(s)
- Taraneh Rajaei
- Immunology Research Center, Division of Inflammation and Inflammatory Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Farajifard
- Department of Immunology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Abdolrahim Rezaee
- Immunology Research Center, Division of Inflammation and Inflammatory Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mahmoud Mahmoudi
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narges Valizadeh
- Immunology Research Center, Division of Inflammation and Inflammatory Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Houshang Rafatpanah
- Immunology Research Center, Division of Inflammation and Inflammatory Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
11
|
Anderson MR, Pleet ML, Enose-Akahata Y, Erickson J, Monaco MC, Akpamagbo Y, Velluci A, Tanaka Y, Azodi S, Lepene B, Jones J, Kashanchi F, Jacobson S. Viral antigens detectable in CSF exosomes from patients with retrovirus associated neurologic disease: functional role of exosomes. Clin Transl Med 2018; 7:24. [PMID: 30146667 PMCID: PMC6110307 DOI: 10.1186/s40169-018-0204-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/06/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND HTLV-1 infects over 20 million people worldwide and causes a progressive neuroinflammatory disorder in a subset of infected individuals called HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). The detection of HTLV-1 specific T cells in the cerebrospinal fluid (CSF) suggests this disease is immunopathologically mediated and that it may be driven by viral antigens. Exosomes are microvesicles originating from the endosomal compartment that are shed into the extracellular space by various cell types. It is now understood that several viruses take advantage of this mode of intercellular communication for packaging of viral components as well. We sought to understand if this is the case in HTLV-1 infection, and specifically if HTLV-1 proteins can be found in the CSF of HAM/TSP patients where we know free virus is absent, and furthermore, if exosomes containing HTLV-1 Tax have functional consequences. RESULTS Exosomes that were positive for HTLV-1 Tax by Western blot were isolated from HAM/TSP patient PBMCs (25/36) in ex vivo cultures by trapping exosomes from culture supernatants. HTLV-1 seronegative PBMCs did not have exosomes with Tax (0/12), (Fisher exact test, p = 0.0001). We were able to observe HAM/TSP patient CSF (12/20) containing Tax+ exosomes but not in HTLV-1 seronegative MS donors (0/5), despite the absence of viral detection in the CSF supernatant (Fisher exact test p = 0.0391). Furthermore, exosomes cultivated from HAM/TSP PBMCs were capable of sensitizing target cells for HTLV-1 specific CTL lysis. CONCLUSION Cumulatively, these results show that there are HTLV-1 proteins present in exosomes found in virus-free CSF. HAM/TSP PBMCs, particularly CD4+CD25+ T cells, can excrete these exosomes containing HTLV-1 Tax and may be a source of the exosomes found in patient CSF. Importantly, these exosomes are capable of sensitizing an HTLV-1 specific immune response, suggesting that they may play a role in the immunopathology observed in HAM/TSP. Given the infiltration of HTLV-1 Tax-specific CTLs into the CNS of HAM/TSP patients, it is likely that exosomes may also contribute to the continuous activation and inflammation observed in HAM/TSP, and may suggest future targeted therapies in this disorder.
Collapse
Affiliation(s)
- Monique R Anderson
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, 22901, USA.,Viral Immunology Section, Neuroimmunology Branch, National Institute for Neurological Disease and Stroke, National Institutes of Health, 10 Center Drive Rm 5C103, Bethesda, MD, 20892, USA
| | - Michelle L Pleet
- Laboratory of Molecular Virology, George Mason University, Manassas, VA, 20110, USA
| | - Yoshimi Enose-Akahata
- Viral Immunology Section, Neuroimmunology Branch, National Institute for Neurological Disease and Stroke, National Institutes of Health, 10 Center Drive Rm 5C103, Bethesda, MD, 20892, USA
| | - James Erickson
- Laboratory of Molecular Virology, George Mason University, Manassas, VA, 20110, USA
| | - Maria Chiara Monaco
- Laboratory of Molecular Medicine and Neuroscience, National Institutes for Neurological Disease and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Yao Akpamagbo
- Laboratory of Molecular Virology, George Mason University, Manassas, VA, 20110, USA
| | - Ashley Velluci
- Viral Immunology Section, Neuroimmunology Branch, National Institute for Neurological Disease and Stroke, National Institutes of Health, 10 Center Drive Rm 5C103, Bethesda, MD, 20892, USA
| | - Yuetsu Tanaka
- Department of Immunology, University of the Ryukyus Graduate School of Medicine, Okinawa, 903-0125, Japan
| | - Shila Azodi
- Viral Immunology Section, Neuroimmunology Branch, National Institute for Neurological Disease and Stroke, National Institutes of Health, 10 Center Drive Rm 5C103, Bethesda, MD, 20892, USA
| | - Ben Lepene
- Ceres Nanosciences, Manassas, VA, 20109, USA
| | - Jennifer Jones
- Vaccine Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Fatah Kashanchi
- Laboratory of Molecular Virology, George Mason University, Manassas, VA, 20110, USA
| | - Steven Jacobson
- Viral Immunology Section, Neuroimmunology Branch, National Institute for Neurological Disease and Stroke, National Institutes of Health, 10 Center Drive Rm 5C103, Bethesda, MD, 20892, USA.
| |
Collapse
|
12
|
Spinal cord hypometabolism associated with infection by human T-cell lymphotropic virus type 1(HTLV-1). PLoS Negl Trop Dis 2018; 12:e0006720. [PMID: 30148843 PMCID: PMC6128630 DOI: 10.1371/journal.pntd.0006720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 09/07/2018] [Accepted: 07/25/2018] [Indexed: 12/14/2022] Open
Abstract
Background HTLV-1 infection is endemic in Brazil. About 1 to 2% of the Brazilian population is estimated to be infected, but most infected HTLV-1 individuals do not know about their own infection, which favors the continuity of sexual and vertical virus transmission. In addition, HTLV-1 associated central nervous system diseases and their pathophysiologic mechanisms are not fully understood. This study aimed to evaluate the correlation of spinal cord metabolism, viral and inflammatory profiles with features of neurological presentation in HTLV-1 infected individuals. Methodology This is a cross-sectional study of a cohort including 48 HTLV-1 infected individuals clinically classified as asymptomatic-AG (N = 21), symptomatic-SG (N = 11) and HAM/TSP-HG (N = 16) and a nested case-control study with HTLV-1 infected individuals-HIG (N = 48) and HTLV-1 non infected controls-CG (N = 30) that had their spinal cord analysed by Positron Emission Tomography with 18F-Fluordeoxyglucose (18F-FDG PET/CT). HTLV-1 infected individuals had 18F-FDG PET/CT results analyzed with clinical and demographic data, proviral load, cytokines and chemokines in the blood and cerebrospinal fluid (CSF). Principal Findings 18F-FDG PET/CT showed hypometabolism in the thoracic spinal cord in HTLV-1 infected individuals. The method had an accuracy of 94.4% to identify HAM/TSP. A greater involvement of the thoracic spinal cord was observed, although hypometabolism was also observed in the cervical spinal cord segment in HTLV-1 infected individuals. Individuals with HAM/TSP showed a pro-inflammatory profile in comparison to asymptomatic and symptomatic groups, with a higher level of Interferon-inducible T-cell alpha chemoattractant (ITAC/CXCL11), IL-6, IL-12p70 in the plasma; and ITAC, IL-4, IL-5, IL-8 (CXCL8) and TNF-alpha in the CSF. Using regression, thoracic spinal cord SUV (standardized uptake value) and CSF ITAC level were identified as the HAM/TSP predictors in the multivariate model. Conclusions 18F-FDG PET/CT imaging showed spinal cord hypometabolism in most HTLV-1 infected individuals, even in the asymptomatic HTLV-1 group. Thoracic spinal cord hypometabolism and CSF-ITAC levels were identified predictors of HAM/TSP. Significance Our findings suggested that in most HTLV-1 infected individuals there was compromise of central nervous system (CNS) structures despite of the lack of clinical symptoms. To explain the found hypometabolism, the role of microcirculatory and metabolic factors in the pathogenesis of neurological diseases associated with HTLV-1 infection must be further investigated. It is paramount to evaluate the central nervous function and to compare the performance among HTLV-1 infected individuals considered asymptomatic to the uninfected controls. For the past 30 years, human T-cell lymphotropic virus type-1 (HTLV-1) has been isolated and associated with neoplastic, inflammatory, and infectious diseases. It is known that the neurological disorder associated with HTLV-1 comprises HTLV-1-associated myelopathy (HAM/TSP) or any other isolated signals and symptoms. Despite all the knowledge accumulated so far, the association of neurological diseases to HTLV-1 infection remains difficult and neglected. We designed this study in order to assess the degree of neurological impairment associated with HTLV-1 infection through a metabolic evaluation with 18F-FDG PET/CT. Our results evidenced a more pronounced hypometabolism in the spinal cord of individuals with neurological impairment, but also evidenced hypometabolism in asymptomatic HTLV-1 infected individuals. We believe that areas of the CNS with lower circulatory and perfusional balance are more vulnerable to HTLV-1 infection. Mechanisms of cellular entry of the virus may be associated with loss of microcirculatory homeostasis and predisposition to a breakdown of the blood-brain barrier in these areas. Further studies are still necessary to shed light on the mechanisms associated with brain and spinal hypometabolism.
Collapse
|
13
|
HTLV-1 proviral load in cerebrospinal fluid may not be a good marker to differentiate asymptomatic carriers with high proviral load in blood from HAM/TSP patients. J Neurovirol 2018; 24:432-438. [DOI: 10.1007/s13365-018-0632-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/28/2018] [Accepted: 03/11/2018] [Indexed: 12/13/2022]
|
14
|
Mozhgani SH, Zarei-Ghobadi M, Teymoori-Rad M, Mokhtari-Azad T, Mirzaie M, Sheikhi M, Jazayeri SM, Shahbahrami R, Ghourchian H, Jafari M, Rezaee SA, Norouzi M. Human T-lymphotropic virus 1 (HTLV-1) pathogenesis: A systems virology study. J Cell Biochem 2018; 119:3968-3979. [PMID: 29227540 DOI: 10.1002/jcb.26546] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/01/2017] [Indexed: 12/31/2022]
Abstract
The main mechanisms of interaction between Human T-lymphotropic virus type 1 (HTLV-1) and its hosts in the manifestation of the related disease including HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) and Adult T-cell leukemia/lymphoma (ATLL) are yet to be determined. It is pivotal to find out the changes in the genes expression toward an asymptomatic or symptomatic states. To this end, the systems virology analysis was performed. Firstly, the differentially expressed genes (DEGs) were taken pairwise among the four sample sets of Normal, Asymptomatic Carriers (ACs), ATLL, and HAM/TSP. Afterwards, the protein-protein interaction networks were reconstructed utilizing the hub genes. In conclusion, the pathways of cells proliferation and transformation were identified in the ACs state. In addition to immune pathways in ATLL, the inflammation and cancer pathways were discened in both diseases of ATLL and HAM/TSP. The outcomes can specify the genes involved in the pathogenesis and help to design the drugs in the future.
Collapse
Affiliation(s)
- Sayed-Hamidreza Mozhgani
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Zarei-Ghobadi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Majid Teymoori-Rad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Talat Mokhtari-Azad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mirzaie
- Department of Applied Mathematics, Faculty of Mathematical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohsen Sheikhi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed-Mohammad Jazayeri
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Shahbahrami
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohieddin Jafari
- Drug Design and Bioinformatics Unit, Medical Biotechnology Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Seyed-Abdolrahim Rezaee
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Norouzi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
15
|
HTLV-1 Infection and Neuropathogenesis in the Context of Rag1 -/-γc -/- (RAG1-Hu) and BLT Mice. J Neuroimmune Pharmacol 2017; 12:504-520. [PMID: 28374110 DOI: 10.1007/s11481-017-9740-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/23/2017] [Indexed: 12/13/2022]
Abstract
To date, the lack of a suitable small animal model has hindered our understanding of Human T-cell lymphotropic virus (HTLV)-1 chronic infection and associated neuropathogenesis defined as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The host immune response plays a critical role in the outcome of HTLV-1 infection, which could be better tested in the context of humanized (hu) mice. Thus, we employ here the Balb/c-Rag1-/-γc-/- or Rag1 as well as Bone marrow-Liver-Thymic (BLT) mouse models for engraftment of human CD34+ hematopoietic stem cells. Flow cytometry and histological analyses confirmed reconstitution of Rag1 and BLT mice with human immune cells. Following HTLV-1 infection, proviral load (PVL) was detected in the blood of Rag-1 and BLT hu-mice as early as 2 weeks post-infection (wpi) with sustained elevation in the subsequent weeks followed by Tax expression. Additionally, infection was compared between adult and neonatal Rag1 mice with both PVL and Tax expression considerably higher in the adult Rag1 mice as compared to the neonates. Establishment of peripheral infection led to lymphocytic infiltration with concomitant Tax expression and resulting myelin disruption within the central nervous system of infected mice. In addition, up-regulation in the expression of several immune checkpoint mediators such as programmed cell death-1 (PD-1), T-cell Ig and ITIM domain (TIGIT), and T cell Ig and mucin domain-3 protein (Tim-3) were observed on CD8+ T cells in various organs including the CNS of infected hu-mice. Collectively, these studies represent the first attempt to establish HTLV-1 neuropathogenesis in the context of Rag-1 and BLT hu-mice as potential novel tools for understanding HTLV-1 neuropathogenesis and testing of novel therapies such as immune checkpoint blockade in the amelioration of chronic HTLV-1 infection.
Collapse
|
16
|
Levin MC, Lee S, Gardner LA, Shin Y, Douglas JN, Salapa H. Autoantibodies to heterogeneous nuclear ribonuclear protein A1 (hnRNPA1) cause altered 'ribostasis' and neurodegeneration; the legacy of HAM/TSP as a model of progressive multiple sclerosis. J Neuroimmunol 2016; 304:56-62. [PMID: 27449854 DOI: 10.1016/j.jneuroim.2016.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/06/2016] [Indexed: 12/23/2022]
Abstract
Several years following its discovery in 1980, infection with human T-lymphotropic virus type 1 (HTLV-1) was shown to cause HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP), a disease biologically similar to progressive forms of multiple sclerosis (MS). In this manuscript, we review some of the clinical, pathological, and immunological similarities between HAM/TSP and MS with an emphasis on how autoantibodies to an RNA binding protein, heterogeneous nuclear ribonuclear protein A1 (hnRNP A1), might contribute to neurodegeneration in immune mediated diseases of the central nervous system.
Collapse
Affiliation(s)
- Michael C Levin
- Veterans Administration Medical Center, Memphis, TN, USA; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Anatomy/Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Sangmin Lee
- Veterans Administration Medical Center, Memphis, TN, USA; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lidia A Gardner
- Veterans Administration Medical Center, Memphis, TN, USA; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yoojin Shin
- Veterans Administration Medical Center, Memphis, TN, USA; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joshua N Douglas
- Veterans Administration Medical Center, Memphis, TN, USA; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Anatomy/Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hannah Salapa
- Veterans Administration Medical Center, Memphis, TN, USA; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Anatomy/Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
17
|
Abstract
The human T cell lymphotropic virus type 1 (HTLV-1) is a retrovirus that infects 10-20 million persons around the world. Initially associated with the hematological malignancy adult T cell leukemia/lymphoma (ATLL), HTLV-1 is also the cause of a chronic progressive myelopathy named "HTLV-1-associated myelopathy/tropical spastic paraparesis" (HAM/TSP). HAM/TSP arises as the tip of the iceberg of an assortment of neurological syndromes triggered by the virus such as inflammatory myopathies, polyneuropathies, amyotrophic lateral sclerosis (ALS)-like syndromes, dysautonomia, and cognitive impairment. HAM/TSP typifies a chronic progressive spastic paraparesis with neurogenic bladder and minimal sensory signs. The neuropathology of HAM/TSP is concentrated in the thoracic spinal cord and is typically biphasic. Initially, there is a perivascular lymphocytic cuffing and mild parenchymal mononuclear infiltrates. Subsequently, this is replaced by gliosis and scarring. The neuropathogenesis of HTLV-1 is still partially understood. At present, the therapy of HAM/TSP remains basically symptomatic.
Collapse
Affiliation(s)
- Abelardo Q-C Araujo
- The Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Brazilian Ministry of Health, Av. Brasil 4365, Rio de Janeiro, RJ, 21040-360, Brazil,
| |
Collapse
|
18
|
Ishihara M, Araya N, Sato T, Saichi N, Fujii R, Yamano Y, Ueda K. A plasma diagnostic model of human T-cell leukemia virus-1 associated myelopathy. Ann Clin Transl Neurol 2015; 2:231-40. [PMID: 25815350 PMCID: PMC4369273 DOI: 10.1002/acn3.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/09/2014] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Human T-cell leukemia virus-1 (HTLV-1) associated myelopathy/tropic spastic paraparesis (HAM/TSP) is induced by chronic inflammation in spinal cord due to HTLV-1 infection. Cerebrospinal fluid (CSF) neopterin or proviral load are clinically measured as disease grading biomarkers, however, they are not exactly specific to HAM/TSP. Therefore, we aimed to identify HAM/TSP-specific biomarker molecules and establish a novel less-invasive plasma diagnostic model for HAM/TSP. METHODS Proteome-wide quantitative profiling of CSFs from six asymptomatic HTLV-1 carriers (AC) and 51 HAM/TSP patients was performed. Fourteen severity grade biomarker proteins were further examined plasma enzyme-linked immunosorbent assay (ELISA) assays (n = 71). Finally, we constructed three-factor logistic regression model and evaluated the diagnostic power using 105 plasma samples. RESULTS Quantitative analysis for 1871 nonredundant CSF proteins identified from 57 individuals defined 14 CSF proteins showing significant correlation with Osame's motor disability score (OMDS). Subsequent ELISA experiments using 71 plasma specimens confirmed secreted protein acidic and rich in cysteine (SPARC) and vascular cell adhesion molecule-1 (VCAM-1) demonstrated the same correlations in plasma (R = -0.373 and R = 0.431, respectively). In this training set, we constructed a HAM/TSP diagnostic model using SPARC, VCAM1, and viral load. Sensitivity and specificity to diagnose HAM/TSP patients from AC (AC vs. OMDS 1-11) were 85.3% and 81.1%, respectively. Importantly, this model could be also useful for determination of therapeutic intervention point (OMDS 1-3 + AC vs. OMDS 4-11), exhibiting 80.0% sensitivity and 82.9% specificity. INTERPRETATION We propose a novel less-invasive diagnostic model for early detection and clinical stratification of HAM/TSP.
Collapse
Affiliation(s)
- Makoto Ishihara
- Division of Biosciences, Functional Proteomics Center, Graduate School of Frontier Sciences, The University of Tokyo Tokyo, Japan
| | - Natsumi Araya
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine Kawasaki, Japan
| | - Tomoo Sato
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine Kawasaki, Japan
| | - Naomi Saichi
- Division of Biosciences, Functional Proteomics Center, Graduate School of Frontier Sciences, The University of Tokyo Tokyo, Japan
| | - Risa Fujii
- Division of Biosciences, Functional Proteomics Center, Graduate School of Frontier Sciences, The University of Tokyo Tokyo, Japan
| | - Yoshihisa Yamano
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine Kawasaki, Japan
| | - Koji Ueda
- Division of Biosciences, Functional Proteomics Center, Graduate School of Frontier Sciences, The University of Tokyo Tokyo, Japan
| |
Collapse
|
19
|
Anderson MR, Enose-Akahata Y, Massoud R, Ngouth N, Tanaka Y, Oh U, Jacobson S. Epigenetic modification of the FoxP3 TSDR in HAM/TSP decreases the functional suppression of Tregs. J Neuroimmune Pharmacol 2014; 9:522-32. [PMID: 24845974 DOI: 10.1007/s11481-014-9547-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/04/2014] [Indexed: 11/27/2022]
Abstract
HTLV-1 is a human retrovirus that is associated with the neuroinflammatory disorder HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). In these patients, HTLV-1 is primarily found in the CD4(+)CD25(+) T cell subset (Regulatory T cells:Tregs), which is responsible for peripheral immune tolerance and is known to be dysfunctional in HAM/TSP. Recent evidence suggests that FoxP3 expression and function is determined epigenetically through DNA demethylation in the Treg-specific demethylated region (TSDR). We analyzed the methylation of the TSDR in PBMCs, CD4(+) T cells, and CD4(+)CD25(+) T cells from normal healthy donors (NDs) and HAM/TSP patients. We demonstrated that there is decreased demethylation in analyzed PBMCs and CD4(+)CD25(+) T cells from HAM/TSP patients as compared to NDs. Furthermore, decreased TSDR demethylation was associated with decreased functional suppression by Tregs. Additionally, increased HTLV-1 Tax expression in HAM/TSP PBMC culture correlated with a concomitant decline in FoxP3 TSDR demethylation. Overall, we suggest that HTLV-1 infection decreases Treg functional suppressive capacity in HAM/TSP through modification of FoxP3 TSDR demethylation and that dysregulated Treg function may contribute to HAM/TSP disease pathogenesis.
Collapse
Affiliation(s)
- Monique R Anderson
- Neuroimmunology Branch, Viral Immunological Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive Rm 5C103, Bethesda, MD, 20892, USA
| | | | | | | | | | | | | |
Collapse
|
20
|
Manifestazioni neurologiche associate al virus HTLV-1. Neurologia 2014. [DOI: 10.1016/s1634-7072(14)67222-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
21
|
Barros N, Risco J, Rodríguez C, Sánchez C, González E, Tanaka Y, Gotuzzo E, White AC, Montes M. CD4+ T cell subsets and Tax expression in HTLV-1 associated diseases. Pathog Glob Health 2014; 107:202-6. [PMID: 23816512 DOI: 10.1179/2047773213y.0000000091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Human T lymphotropic virus type 1 (HTLV-1) infection displays variable clinical manifestations. These include inflammatory diseases such as HTLV-1 associated myelopathy (HAM) or immunosuppressive conditions such as Strongyloides stercoralis hyperinfection. The viral protein, Tax causes activation and proliferation of T cells. We hypothesize that the expression of Tax in T cell subsets characterizes the clinical manifestations of HTLV-1. To test this hypothesis, we measured T helper 1 effector cells and regulatory T cells (Tregs) among Tax expressing lymphocytes from peripheral blood mononuclear cells (PBMCs) of 32 HTLV-1 infected patients with HAM, with S. stercoralis co-infection or with asymptomatic infection. We observed increased ratios of Th1/Treg among Tax expressing lymphocytes in HAM patients. These data suggest that the expression of Tax among the different target cells may explain the variable presentation of HTLV-1.
Collapse
Affiliation(s)
- Nicolas Barros
- Instituto de Medicina Tropical, Alexander von Humboldt, Universidad Peruana, Cayetano Heredia in Lima, Lima, Peru
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
|
23
|
Matos Cunha LC, Campelo Tavares M, Tierra Criollo CJ, Labanca L, Cardoso dos Santos Couto Paz C, Resende Martins H, de Freitas Carneiro-Proietti AB, Utsch Goncalves D. Contribution of Galvanic Vestibular Stimulation for the Diagnosis of HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis. J Clin Neurol 2013; 9:252-8. [PMID: 24285967 PMCID: PMC3840136 DOI: 10.3988/jcn.2013.9.4.252] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 04/04/2013] [Accepted: 04/04/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Galvanic vestibular stimulation (GVS) is a low-cost and safe examination for testing the vestibulospinal pathway. Human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a slowly progressive disease that affects the vestibulospinal tract early in its course. This study compared the electromyographic (EMG) responses triggered by GVS of asymptomatic HTLV-1-infected subjects and subjects with HAM/TSP. METHODS Bipolar galvanic stimuli (400 ms and 2 mA) were applied to the mastoid processes of 39 subjects (n=120 stimulations per subject, with 60 from each lower limb). Both the short latency (SL) and medium latency (ML) components of the EMG response were recorded from the soleus muscles of 13 healthy, HTLV-1-negative adults (56±5 years, mean±SD), and 26 individuals infected with HTLV-1, of whom 13 were asymptomatic (56±8 years) and 13 had HAM/TSP (60±6 years). RESULTS The SL and ML EMG components were 55±4 and 112±10 ms, respectively, in the group of healthy subjects, 61±6 and 112±10 ms and in the HTLV-1-asymptomatic group, and 67±8 and 130±3 ms in the HAM/TSP group (p=0.001). The SL component was delayed in 4/13 (31%) of the examinations in the HTLV-1-asymptomatic group, while the ML component was normal in all of them. In the HAM/TSP group, the most common alteration was the absence of waves. CONCLUSIONS A pattern of abnormal vestibular-evoked EMG responses was found in HTLV-1-neurological disease, ranging from delayed latency among asymptomatic carriers to the absence of a response in HAM/TSP. GVS may contribute to the early diagnosis and monitoring of nontraumatic myelopathies.
Collapse
Affiliation(s)
| | | | | | - Ludimila Labanca
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | |
Collapse
|
24
|
Trindade BC, Sorgi CA, Nicolete LDDF, Malta TM, Pinto MT, Takayanagui OM, Covas DT, Filho OAM, Kashima S, Faccioli LH. Leukotrienes are upregulated and associated with human T-lymphotropic virus type 1 (HTLV-1)-associated neuroinflammatory disease. PLoS One 2012; 7:e51873. [PMID: 23284797 PMCID: PMC3527467 DOI: 10.1371/journal.pone.0051873] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 11/12/2012] [Indexed: 01/17/2023] Open
Abstract
Leukotrienes (LTs) are lipid mediators involved in several inflammatory disorders. We investigated the LT pathway in human T-lymphotropic virus type 1 (HTLV-1) infection by evaluating LT levels in HTLV-1-infected patients classified according to the clinical status as asymptomatic carriers (HACs) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients. Bioactive LTB4 and CysLTs were both increased in the plasma and in the supernatant of peripheral blood mononuclear cell cultures of HTLV-1-infected when compared to non-infected. Interestingly, CysLT concentrations were increased in HAM/TSP patients. Also, the concentration of plasma LTB4 and LTC4 positively correlated with the HTLV-1 proviral load in HTLV-1-infected individuals. The gene expression levels of LT receptors were differentially modulated in CD4+ and CD8+ T cells of HTLV-1-infected patients. Analysis of the overall plasma signature of immune mediators demonstrated that LT and chemokine amounts were elevated during HTLV-1 infection. Importantly, in addition to CysLTs, IP-10 was also identified as a biomarker for HAM/TSP activity. These data suggest that LTs are likely to be associated with HTLV-1 infection and HAM/TSP development, suggesting their putative use for clinical monitoring.
Collapse
MESH Headings
- Adult
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/metabolism
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- Cells, Cultured
- Chemokines/genetics
- Chemokines/metabolism
- Female
- Human T-lymphotropic virus 1/immunology
- Human T-lymphotropic virus 1/pathogenicity
- Humans
- Leukocytes, Mononuclear/immunology
- Leukocytes, Mononuclear/metabolism
- Leukocytes, Mononuclear/virology
- Leukotrienes/genetics
- Leukotrienes/metabolism
- Male
- Middle Aged
- Paraparesis, Tropical Spastic/immunology
- Paraparesis, Tropical Spastic/metabolism
- Paraparesis, Tropical Spastic/virology
- Proviruses/genetics
- RNA, Messenger/genetics
- Real-Time Polymerase Chain Reaction
- Receptors, Leukotriene/genetics
- Receptors, Leukotriene/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Viral Load
Collapse
Affiliation(s)
- Bruno Caetano Trindade
- Laboratório de Inflamação e Imunologia das Parasitoses, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Sao Paulo, Brazil
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | - Carlos Artério Sorgi
- Laboratório de Inflamação e Imunologia das Parasitoses, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | | | - Tathiane Maistro Malta
- Instituto Nacional de Ciência e Tecnologia em Células-Tronco e Terapia Celular/Hemocentro de Ribeirão Preto, Ribeirão Preto, Sao Paulo, Brazil
| | - Mariana Tomazini Pinto
- Instituto Nacional de Ciência e Tecnologia em Células-Tronco e Terapia Celular/Hemocentro de Ribeirão Preto, Ribeirão Preto, Sao Paulo, Brazil
| | - Osvaldo Massaiti Takayanagui
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Dimas Tadeu Covas
- Instituto Nacional de Ciência e Tecnologia em Células-Tronco e Terapia Celular/Hemocentro de Ribeirão Preto, Ribeirão Preto, Sao Paulo, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Olindo Assis Martins Filho
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | - Simone Kashima
- Instituto Nacional de Ciência e Tecnologia em Células-Tronco e Terapia Celular/Hemocentro de Ribeirão Preto, Ribeirão Preto, Sao Paulo, Brazil
| | - Lúcia Helena Faccioli
- Laboratório de Inflamação e Imunologia das Parasitoses, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Sao Paulo, Brazil
- * E-mail:
| |
Collapse
|
25
|
Levin MC, Lee S, Gardner LA, Shin Y, Douglas JN, Groover CJ. Pathogenic mechanisms of neurodegeneration based on the phenotypic expression of progressive forms of immune-mediated neurologic disease. Degener Neurol Neuromuscul Dis 2012; 2:175-187. [PMID: 30890887 PMCID: PMC6065584 DOI: 10.2147/dnnd.s38353] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Considering there are no treatments for progressive forms of multiple sclerosis (MS), a comprehensive understanding of the role of neurodegeneration in the pathogenesis of MS should lead to novel therapeutic strategies to treat it. Many studies have implicated viral triggers as a cause of MS, yet no single virus has been exclusively shown to cause MS. Given this, human and animal viral models of MS are used to study its pathogenesis. One example is human T-lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Importantly, HAM/TSP is similar clinically, pathologically, and immunologically to progressive MS. Interestingly, both MS and HAM/TSP patients were found to make antibodies to heterogeneous nuclear ribonucleoprotein (hnRNP) A1, an RNA-binding protein overexpressed in neurons. Anti-hnRNP A1 antibodies reduced neuronal firing and caused neurodegeneration in neuronal cell lines, suggesting the autoantibodies are pathogenic. Further, microarray analyses of neurons exposed to anti-hnRNP A1 antibodies revealed novel pathways of neurodegeneration related to alterations of RNA levels of the spinal paraplegia genes (SPGs). Mutations in SPGs cause hereditary spastic paraparesis, genetic disorders clinically indistinguishable from progressive MS and HAM/TSP. Thus, there is a strong association between involvement of SPGs in neurodegeneration and the clinical phenotype of progressive MS and HAM/TSP patients, who commonly develop spastic paraparesis. Taken together, these data begin to clarify mechanisms of neurodegeneration related to the clinical presentation of patients with chronic immune-mediated neurological disease of the central nervous system, which will give insights into the design of novel therapies to treat these neurological diseases.
Collapse
Affiliation(s)
- Michael C Levin
- Veterans Administration Medical Center, Memphis, TN, USA,
- Departments of Neurology,
- Neuroscience, University of Tennessee Health Science Center, Memphis, TN, USA,
| | - Sangmin Lee
- Veterans Administration Medical Center, Memphis, TN, USA,
- Departments of Neurology,
| | - Lidia A Gardner
- Veterans Administration Medical Center, Memphis, TN, USA,
- Departments of Neurology,
| | - Yoojin Shin
- Veterans Administration Medical Center, Memphis, TN, USA,
- Departments of Neurology,
| | - Joshua N Douglas
- Veterans Administration Medical Center, Memphis, TN, USA,
- Neuroscience, University of Tennessee Health Science Center, Memphis, TN, USA,
| | - Chassidy J Groover
- Veterans Administration Medical Center, Memphis, TN, USA,
- Departments of Neurology,
| |
Collapse
|
26
|
Zihlmann KF, de Alvarenga AT, Casseb J. Living invisible: HTLV-1-infected persons and the lack of care in public health. PLoS Negl Trop Dis 2012; 6:e1705. [PMID: 22720112 PMCID: PMC3373594 DOI: 10.1371/journal.pntd.0001705] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 05/08/2012] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Human T-cell lymphotropic virus type 1 (HTLV-1) infection is intractable and endemic in many countries. Although a few individuals have severe symptoms, most patients remain asymptomatic throughout their lives and their infections may be unknown to many health professionals. HTLV-1 can be considered a neglected public health problem and there are not many studies specifically on patients' needs and emotional experiences. OBJECTIVE To better understand how women and men living with HTLV-1 experience the disease and what issues exist in their healthcare processes. METHODS A qualitative study using participant observation and life story interview methods was conducted with 13 symptomatic and asymptomatic patients, at the outpatient clinic of the Emilio Ribas Infectious Diseases Institute, in Sao Paulo, Brazil. RESULTS AND DISCUSSION The interviewees stated that HTLV-1 is a largely unknown infection to society and health professionals. Counseling is rare, but when it occurs, focuses on the low probability of developing HTLV-1 related diseases without adequately addressing the risk of infection transmission or reproductive decisions. The diagnosis of HTLV-1 can remain a stigmatized secret as patients deny their situations. As a consequence, the disease remains invisible and there are potentially negative implications for patient self-care and the identification of infected relatives. This perception seems to be shared by some health professionals who do not appear to understand the importance of preventing new infections. CONCLUSIONS Patients and medical staff referred that the main focus was the illness risk, but not the identification of infected relatives to prevent new infections. This biomedical model of care makes prevention difficult, contributes to the lack of care in public health for HTLV-1, and further perpetuates the infection among populations. Thus, HTLV-1 patients experience an "invisibility" of their complex demands and feel that their rights as citizens are ignored.
Collapse
|
27
|
[HTLV-1-associated myelopathy/tropical spastic paraparesis: a differential diagnosis in multiple sclerosis]. DER NERVENARZT 2012; 83:1028-34. [PMID: 22588562 DOI: 10.1007/s00115-012-3565-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Human T-cell lymphotropic virus 1 (HTLV-1) associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a neurological disease caused by infection with HTLV-1. The disorder is very rare in Europe but endemic in many parts of the world. The pathogenesis is not clearly characterized but is based on a possibly immune-mediated injury of the cervicothoracic spinal cord. Clinically, HAM/TSP constitutes a slowly progressive spastic paraparesis associated with bladder dysfunction and often mimics the course of autoimmune and neurodegenerative diseases. The diagnosis is based on typical symptoms as well as detection of HTLV-1 specific antibodies and proviral HTLV-1 DNA or HTLV-1 RNA. The therapy is limited to symptomatic treatment. Transmission of HTLV-1 can occur vertically by breast feeding, through sexual contact or via infected blood products. Based on a clinical case report, we present here a current review on the pathophysiology, epidemiology, clinical manifestations, diagnosis and treatment of HAM/TSP.
Collapse
|
28
|
Tropical spastic paraparesis and HTLV-1 associated myelopathy: Clinical, epidemiological, virological and therapeutic aspects. Rev Neurol (Paris) 2012; 168:257-69. [DOI: 10.1016/j.neurol.2011.12.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 09/16/2011] [Accepted: 12/06/2011] [Indexed: 12/14/2022]
|
29
|
|
30
|
The epidemiology of human retrovirus-associated illnesses. THE MOUNT SINAI JOURNAL OF MEDICINE, NEW YORK 2011; 104:167-80. [PMID: 2880289 DOI: 10.1007/s13149-011-0174-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 05/31/2011] [Indexed: 10/17/2022]
Abstract
Human T-cell leukemia/lymphoma virus type 1 (HTLV-1) was the first oncogenic human retrovirus discovered in 1980. It is estimated that around 10-20 million people are infected with HTLV-1 worldwide. However, HTLV-1 is not a ubiquitous virus. Indeed, HTLV-1 is present throughout the world with clusters of high endemicity including mainly southern Japan, the Caribbean region, parts of South America and intertropical Africa, with foci in the Middle East and Australia. The origin of this puzzling geographical repartition is probably linked to a founder effect in certain human groups. In the high endemic areas, 0.5 to 50% of the people have antibodies against HTLV-1 antigens. HTLV-1 seroprevalence increases with age, especially in women. HTLV-1 has 3 modes of transmission: mother to child, mainly through prolonged breastfeeding (> 6 months); sexual, mainly but not exclusively occurring from male to female; and by blood products contaminated by infected lymphocytes. HTLV-1 is mainly the etiological agent of two very severe diseases: a malignant T CD4+ cell lymphoproliferation of very poor prognosis, named adult T-cell leukemia/lymphoma (ATLL), and a chronic neuro-myelopathy named tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM). HTLV-1 is also associated with rare anterior uveitis, infective dermatitis and myositis in some high HTLV-1 endemic areas. The repartition of the different molecular subtypes or genotypes is mainly linked to the geographical origin of the infected persons but not to the associated pathology. HTLV-1 possesses a remarkable genetic stability probably linked to viral amplification via clonal expansion of infected cells rather than by reverse transcription. This stability can be used as a molecular tool to gain better insights into the origin, evolution and modes of dissemination of HTLV-1 and infected populations. HTLV-1 originated in humans through interspecies transmission from STLV-1, a very closely related retrovirus, highly endemic in several populations of apes and Old World monkeys.
Collapse
|