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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
Sato T, Nagai M, Watanabe O, Misu T, Takenouchi N, Ohkubo R, Ishihara S, Tsuboi Y, Katsuno M, Nakagawa M, Matsushita T, Aso Y, Matsuura E, Tokashiki T, Mukaino A, Adachi H, Nakanishi K, Yamaguchi Y, Yamaguchi S, Yamano Y. Multicenter, randomized, double-blind, placebo-controlled phase 3 study of mogamulizumab with open-label extension study in a minimum number of patients with human T-cell leukemia virus type-1-associated myelopathy. J Neurol 2024:10.1007/s00415-024-12239-x. [PMID: 38430272 DOI: 10.1007/s00415-024-12239-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 03/03/2024]
Abstract
Human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic neurodegenerative disease. This multicenter, randomized phase 3 study evaluated the efficacy and safety of 0.3 mg/kg intravenous mogamulizumab, a monoclonal antibody targeting-CC chemokine receptor 4, every 12 weeks in HAM/TSP patients. This study comprised a 24-week double-blind, placebo-controlled period, 24-week open-label period, and extension treatment period. The primary endpoint was the proportion of patients with a ≥ 1-grade improvement in the Osame motor disability score (OMDS). Secondary endpoints were changes in HTLV-1 proviral load, 10-m timed walk, cerebrospinal fluid (CSF) neopterin levels, and safety. The exploratory endpoint was CSF chemokine C-X-C motif ligand 10 (CXCL10) levels. Thirty-four and 33 patients were randomized to mogamulizumab and placebo arms, respectively. At the end of the double-blind period, no significant difference was found in the OMDS improvement rate or other secondary efficacy endpoints assessing motor activities. However, the mogamulizumab arm showed a significant decrease in HTLV-1 proviral load (- 59.39 ± 29.91% vs. placebo 2.32 ± 36.31%) and CSF neopterin (p < 0.001)/CXCL10 levels (p = 0.004). The baseline OMDS pattern and the 60-80% HTLV-1 proviral load reduction were sustained through the open-label and extension treatment periods. Although a higher incidence of rash (69.2%) was reported, the safety profile was similar compared with a previous phase 1/2a study. We found no significant difference in clinical benefit; however, mogamulizumab may provide long-term clinical benefit by preventing disease progression, as CSF neopterin/CXCL10 levels are associated with long-term prognosis in HAM/TSP.Clinical Trial Registration Number: NCT03191526 (registered date: 6-June-2017).
Collapse
Affiliation(s)
- Tomoo Sato
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masahiro Nagai
- Department of Neurology and Clinical Pharmacology, Ehime University Hospital, Toon, Japan
| | - Osamu Watanabe
- Department of Neurology, Kagoshima City Hospital, Kagoshima, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Hospital, Sendai, Japan
| | - Norihiro Takenouchi
- Department of Microbiology and Department of Neurology, Kansai Medical University, Hirakata, Japan
| | - Ryuichi Ohkubo
- Department of Neurology, Fujimoto General Hospital, Miyakonojo, Japan
| | - Satoshi Ishihara
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University, Fukuoka, Japan
| | - Masahisa Katsuno
- Department of Neurology, and Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanori Nakagawa
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuya Matsushita
- Department of Neurology, Neurological Institute Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Aso
- Department of Neurology, Oita Prefectural Hospital, Oita, Japan
| | - Eiji Matsuura
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takashi Tokashiki
- Division of Neurology, National Hospital Organization Okinawa National Hospital, Ginowan, Japan
| | - Akihiro Mukaino
- Department of Molecular Neurology and Therapeutics, Kumamoto University Hospital, Kumamoto, Japan
| | - Hiroaki Adachi
- Department of Neurology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Kaoru Nakanishi
- Clinical Development, R&D Division, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Yusuke Yamaguchi
- Clinical Development, R&D Division, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Saaya Yamaguchi
- Clinical Development, R&D Division, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Yoshihisa Yamano
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan.
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan.
| |
Collapse
|
3
|
Mashkani B, Jalili Nik M, Rezaee SA, Boostani R. Advances in the treatment of human T-cell lymphotropic virus type-I associated myelopathy. Expert Rev Neurother 2023; 23:1233-1248. [PMID: 37933802 DOI: 10.1080/14737175.2023.2272639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Nearly 2-3% of those 10 to 20 million individuals infected with the Human T-cell lymphotropic virus type-1 (HTLV-1); are predisposed to developing HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). It is a neuro-inflammatory disease; differentiated from multiple sclerosis based on the presence of typical neurologic symptoms, confirmation of HTLV-1 infection, and other molecular biomarkers. AREAS COVERED A brief review of the epidemiology, host immune responses, and molecular pathogenesis of HAM/TSP is followed by detailed discussions about the host-related risk factors for developing HAM/TSP and success/failure stories of the attempted management strategies. EXPERT OPINION Currently, there is no effective treatment for HAM/TSP. Anti-retroviral therapy, peculiar cytokines (IFN-α), some anti-oxidants, and allograft bone marrow transplantation have been used for treating these patients with limited success. Under current conditions, asymptomatic carriers should be examined periodically by a neurologist for early signs of spinal cord injury. Then it is crucial to determine the progress rate to adapt the best management plan for each patient. Corticosteroid therapy is most beneficial in those with acute myelitis. However, slow-progressing patients are best managed using a combination of symptomatic and physical therapy. Additionally, preventive measures should be taken to decrease further spread of HTLV-1 infection.
Collapse
Affiliation(s)
- Baratali Mashkani
- Department of clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Jalili Nik
- Department of clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Abdolrahim Rezaee
- Inflammation and Inflammatory Diseases division, Immunology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Boostani
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
4
|
Koseki A, Araya N, Yamagishi M, Yamauchi J, Yagishita N, Takao N, Takahashi K, Kunitomo Y, Honma D, Araki K, Uchimaru K, Sato T, Yamano Y. EZH1/2 dual inhibitors suppress HTLV-1-infected cell proliferation and hyperimmune response in HTLV-1-associated myelopathy. Front Microbiol 2023; 14:1175762. [PMID: 37378292 PMCID: PMC10291084 DOI: 10.3389/fmicb.2023.1175762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Background Human T-cell leukemia virus type 1 (HTLV-1) causes HTLV-1-associated myelopathy (HAM), adult T-cell leukemia/lymphoma (ATL), HTLV-1-associated uveitis, and pulmonary diseases. Although both HAM and ATL show proliferation of infected cells, their pathogeneses are quite different. In particular, the pathogenesis of HAM is characterized by hyperimmune responses to HTLV-1-infected cells. Recently, we demonstrated the overexpression of histone methyltransferase EZH2 in ATL cells and the cytotoxic effects of EZH2 inhibitors and EZH1/2 dual inhibitors on these cells. However, these phenomena have never been studied in HAM. Furthermore, what effect these agents have on the hyperimmune response seen in HAM is completely unknown. Methods In this study, we investigated histone methyltransferase expression levels in infected cell populations (CD4+ and CD4+CCR4+ cells) from patients with HAM using microarray and RT-qPCR analyses. Next, using an assay system that utilizes the spontaneous proliferation characteristic of peripheral blood mononuclear cells derived from patients with HAM (HAM-PBMCs), we investigated the effects of EZH2 selective inhibitors (GSK126 and tazemetostat) and EZH1/2 dual inhibitors (OR-S1 and valemetostat, also known as DS-3201), particularly on cell proliferation rate, cytokine production, and HTLV-1 proviral load. We also examined the effect of EZH1/2 inhibitors on the proliferation of HTLV-1-infected cell lines (HCT-4 and HCT-5) derived from patients with HAM. Results We found elevated expression of EZH2 in CD4+ and CD4+CCR4+ cells from patients with HAM. EZH2 selective inhibitors and EZH1/2 inhibitors significantly inhibited spontaneous proliferation of HAM-PBMC in a concentration-dependent manner. The effect was greater with EZH1/2 inhibitors. EZH1/2 inhibitors also reduced the frequencies of Ki67+ CD4+ T cells and Ki67+ CD8+ T cells. Furthermore, they reduced HTLV-1 proviral loads and increased IL-10 levels in culture supernatants but did not alter IFN-γ and TNF-α levels. These agents also caused a concentration-dependent inhibition of the proliferation of HTLV-1-infected cell lines derived from patients with HAM and increased annexin-V(+)7-aminoactinomycin D(-) early apoptotic cells. Conclusion This study showed that EZH1/2 inhibitors suppress HTLV-1-infected cell proliferation through apoptosis and the hyperimmune response in HAM. This indicates that EZH1/2 inhibitors may be effective in treating HAM.
Collapse
Affiliation(s)
- Akihito Koseki
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Neurology, Yaizu City Hospital, Yaizu, Japan
| | - Natsumi Araya
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Makoto Yamagishi
- Laboratory of Tumor Cell Biology, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Junji Yamauchi
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoko Yagishita
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoki Takao
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Katsunori Takahashi
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasuo Kunitomo
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Daisuke Honma
- Oncology Research Laboratories, Daiichi Sankyo, Co., Ltd., Tokyo, Japan
| | - Kazushi Araki
- Early Clinical Development Department, Daiichi Sankyo, Co., Ltd., Tokyo, Japan
| | - Kaoru Uchimaru
- Laboratory of Tumor Cell Biology, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Tomoo Sato
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihisa Yamano
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| |
Collapse
|
5
|
Dixon L, McNamara C, Dhasmana D, Taylor GP, Davies N. Imaging Spectrum of HTLV-1–Related Neurologic Disease. Neurol Clin Pract 2023; 13:e200147. [PMID: 37066106 PMCID: PMC10092304 DOI: 10.1212/cpj.0000000000200147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/23/2023] [Indexed: 03/29/2023]
Abstract
Purpose of ReviewHuman T-cell lymphotropic virus type 1 (HTLV-1)–associated myelopathy (HAM) is a well-recognized neurologic complication of HTLV-1. Beyond HAM, several other neurologic manifestations are increasingly recognized, including acute myelopathy, encephalopathy, and myositis. The clinical and imaging features of these presentations are less well understood and potentially underdiagnosed. In this study, we summarize the imaging features of HTLV-1–related neurologic disease, providing both a pictorial review and pooled series of the less well-recognized presentations.Recent Findings35 cases of acute/subacute HAM and 12 cases of HTLV-1–related encephalopathy were found. In subacute HAM, cervical and upper thoracic longitudinally extensive tranverse myelitis was noted, while in HTLV-1–related encephalopathy, confluent lesions in the frontoparietal white matter and along the corticospinal tracts were the most prevalent finding.SummaryThere are varied clinical and imaging presentations of HTLV-1–related neurologic disease. Recognition of these features aids early diagnosis where therapy may have the greatest benefit.
Collapse
Affiliation(s)
- Luke Dixon
- Department of Neuroradiology (LD, CM), Imperial College Healthcare NHS Trust, London, UK; National Centre for Human Retrovirology (DD, GPT, ND), Imperial College Healthcare NHS Trust, London, UK; Section of Virology, Department of Infectious Disease (GPT), Imperial College London, UK; Department of Neurology (GPT), Imperial College Healthcare NHS Trust, London, UK; Department of Neurology (GPT), Chelsea and Westminster Hospital NHS Trust, London, UK
| | - Cillian McNamara
- Department of Neuroradiology (LD, CM), Imperial College Healthcare NHS Trust, London, UK; National Centre for Human Retrovirology (DD, GPT, ND), Imperial College Healthcare NHS Trust, London, UK; Section of Virology, Department of Infectious Disease (GPT), Imperial College London, UK; Department of Neurology (GPT), Imperial College Healthcare NHS Trust, London, UK; Department of Neurology (GPT), Chelsea and Westminster Hospital NHS Trust, London, UK
| | - Divya Dhasmana
- Department of Neuroradiology (LD, CM), Imperial College Healthcare NHS Trust, London, UK; National Centre for Human Retrovirology (DD, GPT, ND), Imperial College Healthcare NHS Trust, London, UK; Section of Virology, Department of Infectious Disease (GPT), Imperial College London, UK; Department of Neurology (GPT), Imperial College Healthcare NHS Trust, London, UK; Department of Neurology (GPT), Chelsea and Westminster Hospital NHS Trust, London, UK
| | - Graham P Taylor
- Department of Neuroradiology (LD, CM), Imperial College Healthcare NHS Trust, London, UK; National Centre for Human Retrovirology (DD, GPT, ND), Imperial College Healthcare NHS Trust, London, UK; Section of Virology, Department of Infectious Disease (GPT), Imperial College London, UK; Department of Neurology (GPT), Imperial College Healthcare NHS Trust, London, UK; Department of Neurology (GPT), Chelsea and Westminster Hospital NHS Trust, London, UK
| | - Nicholas Davies
- Department of Neuroradiology (LD, CM), Imperial College Healthcare NHS Trust, London, UK; National Centre for Human Retrovirology (DD, GPT, ND), Imperial College Healthcare NHS Trust, London, UK; Section of Virology, Department of Infectious Disease (GPT), Imperial College London, UK; Department of Neurology (GPT), Imperial College Healthcare NHS Trust, London, UK; Department of Neurology (GPT), Chelsea and Westminster Hospital NHS Trust, London, UK
| |
Collapse
|
6
|
Legrand N, McGregor S, Bull R, Bajis S, Valencia BM, Ronnachit A, Einsiedel L, Gessain A, Kaldor J, Martinello M. Clinical and Public Health Implications of Human T-Lymphotropic Virus Type 1 Infection. Clin Microbiol Rev 2022; 35:e0007821. [PMID: 35195446 DOI: 10.1128/cmr.00078-21] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Human T-lymphotropic virus type 1 (HTLV-1) is estimated to affect 5 to 10 million people globally and can cause severe and potentially fatal disease, including adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The burden of HTLV-1 infection appears to be geographically concentrated, with high prevalence in discrete regions and populations. While most high-income countries have introduced HTLV-1 screening of blood donations, few other public health measures have been implemented to prevent infection or its consequences. Recent advocacy from concerned researchers, clinicians, and community members has emphasized the potential for improved prevention and management of HTLV-1 infection. Despite all that has been learned in the 4 decades following the discovery of HTLV-1, gaps in knowledge across clinical and public health aspects persist, impeding optimal control and prevention, as well as the development of policies and guidelines. Awareness of HTLV-1 among health care providers, communities, and affected individuals remains limited, even in countries of endemicity. This review provides a comprehensive overview on HTLV-1 epidemiology and on clinical and public health and highlights key areas for further research and collaboration to advance the health of people with and at risk of HTLV-1 infection.
Collapse
|
7
|
Yamauchi J, Tanabe K, Sato T, Nakagawa M, Matsuura E, Tsuboi Y, Tamaki K, Sakima H, Ishihara S, Ohta Y, Matsumoto N, Kono K, Yagishita N, Araya N, Takahashi K, Kunitomo Y, Nagasaka M, Coler-Reilly A, Hasegawa Y, Araujo A, Jacobson S, Grassi MFR, Galvão-Castro B, Bland M, Taylor GP, Martin F, Yamano Y. Efficacy of Corticosteroid Therapy for HTLV-1-Associated Myelopathy: A Randomized Controlled Trial (HAMLET-P). Viruses 2022; 14:136. [PMID: 35062340 DOI: 10.3390/v14010136] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023] Open
Abstract
Corticosteroids are most commonly used to treat HTLV-1-associated myelopathy (HAM); however, their clinical efficacy has not been tested in randomized clinical trials. This randomized controlled trial included 8 and 30 HAM patients with rapidly and slowly progressing walking disabilities, respectively. Rapid progressors were assigned (1:1) to receive or not receive a 3-day course of intravenous methylprednisolone in addition to oral prednisolone therapy. Meanwhile, slow progressors were assigned (1:1) to receive oral prednisolone or placebo. The primary outcomes were a composite of ≥1-grade improvement in the Osame Motor Disability Score or ≥30% improvement in the 10 m walking time (10 mWT) at week 2 for rapid progressors and changes from baseline in 10 mWT at week 24 for slow progressors. In the rapid progressor trial, all four patients with but only one of four without intravenous methylprednisolone achieved the primary outcome (p = 0.14). In the slow progressor trial, the median changes in 10 mWT were −13.8% (95% CI: −20.1–−7.1; p < 0.001) and −6.0% (95% CI: −12.8–1.3; p = 0.10) with prednisolone and placebo, respectively (p for between-group difference = 0.12). Whereas statistical significance was not reached for the primary endpoints, the overall data indicated the benefit of corticosteroid therapy. (Registration number: UMIN000023798, UMIN000024085)
Collapse
|
8
|
Dykie A, Wijesinghe T, Rabson AB, Madugula K, Farinas C, Wilson S, Abraham D, Jain P. Human T-cell Leukemia Virus Type 1 and Strongyloides stercoralis: Partners in Pathogenesis. Pathogens 2020; 9:E904. [PMID: 33137906 DOI: 10.3390/pathogens9110904] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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
|
Pluta A, Jaworski JP, Douville RN. Regulation of Expression and Latency in BLV and HTLV. Viruses 2020; 12:E1079. [PMID: 32992917 DOI: 10.3390/v12101079] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022] Open
Abstract
Human T-lymphotrophic virus type 1 (HTLV-1) and Bovine leukemia virus (BLV) belong to the Deltaretrovirus genus. HTLV-1 is the etiologic agent of the highly aggressive and currently incurable cancer adult T-cell leukemia (ATL) and a neurological disease HTLV-1-associated myelopathy (HAM)/tropical spastic paraparesis (TSP). BLV causes neoplastic proliferation of B cells in cattle: enzootic bovine leucosis (EBL). Despite the severity of these conditions, infection by HTLV-1 and BLV appear in most cases clinically asymptomatic. These viruses can undergo latency in their hosts. The silencing of proviral gene expression and maintenance of latency are central for the establishment of persistent infection, as well as for pathogenesis in vivo. In this review, we will present the mechanisms that control proviral activation and retroviral latency in deltaretroviruses, in comparison with other exogenous retroviruses. The 5′ long terminal repeats (5′-LTRs) play a main role in controlling viral gene expression. While the regulation of transcription initiation is a major mechanism of silencing, we discuss topics that include (i) the epigenetic control of the provirus, (ii) the cis-elements present in the LTR, (iii) enhancers with cell-type specific regulatory functions, (iv) the role of virally-encoded transactivator proteins, (v) the role of repressors in transcription and silencing, (vi) the effect of hormonal signaling, (vii) implications of LTR variability on transcription and latency, and (viii) the regulatory role of non-coding RNAs. Finally, we discuss how a better understanding of these mechanisms may allow for the development of more effective treatments against Deltaretroviruses.
Collapse
|
10
|
Yamauchi J, Araya N, Yagishita N, Sato T, Yamano Y. An update on human T-cell leukemia virus type I (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) focusing on clinical and laboratory biomarkers. Pharmacol Ther 2020; 218:107669. [PMID: 32835825 DOI: 10.1016/j.pharmthera.2020.107669] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 12/14/2022]
Abstract
Human T-cell leukemia virus type I (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a rare inflammatory disease causing unremitting and progressive neurological disorders, such as spastic paraparesis, neurogenic bladder, and sensory disturbance of the lower extremities. Although there is no cure, immune-modulating agents such as corticosteroids are most widely used to slow disease progression. Biomarkers for the clinical assessment of HAM/TSP should be identified because the prediction of functional prognosis and the assessment of treatment efficacy are challenging due to the slowly progressive nature of the disease. The lack of surrogate biomarkers also hampers clinical trials of new drugs. This review summarizes biomarker candidates for the clinical assessment of patients with HAM/TSP. Most of the reported biomarker candidates are associated with viral components or inflammatory mediators because immune dysregulation provoked by HTLV-1 infection is thought to cause chronic inflammation and damage the spinal cord of patients with HAM/TSP. Although information on the diagnostic accuracy of most of the reported biomarkers is insufficient, several molecules, including inflammatory mediators such as CXCL10 and neopterin in the cerebrospinal fluid, have been suggested as potential biomarkers of functional prognosis and treatment response. Several clinical trials for HAM/TSP are currently underway, and we expect that these studies will provide not only evidence pertaining to treatment, but also novel findings regarding the utility of biomarkers in this disease. The establishment of clinical biomarkers will improve patient care and promote the development of therapies for HAM/TSP.
Collapse
Affiliation(s)
- Junji Yamauchi
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Natsumi Araya
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoko Yagishita
- 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
| | - Yoshihisa Yamano
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan; Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
| |
Collapse
|
11
|
Prates G, Assone T, Corral M, Baldassin MPM, Mitiko T, Silva Sales FC, Haziot ME, Smid J, Fonseca LAM, de Toledo Gonçalves F, Penalva de Oliveira AC, Casseb J. Prognosis Markers for Monitoring HTLV-1 Neurologic Disease. Neurol Clin Pract 2020; 11:134-140. [PMID: 33842066 DOI: 10.1212/cpj.0000000000000866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/20/2020] [Indexed: 12/24/2022]
Abstract
Background Human T-cell lymphotropic virus type 1 (HTLV-1) infection is associated not only with some severe manifestations, such as HTLV-1-associated myelopathy (HAM) and ATLL, but also with other, less severe conditions. Some studies have reported neurologic manifestations that did not meet all the criteria for the diagnosis of HAM in individuals infected with HTLV-1; these conditions may later progress to HAM or constitute an intermediate clinical form, between asymptomatic HTLV-1 carriers and those with full myelopathy. This study evaluated the prognostic value and looked for a possible association of those parameters with the intermediate syndrome (IS) status and HAM status. Methods Proviral load (PVL), spontaneous lymphoproliferation, interferon (IFN)-γ spontaneous production was quantified in samples of asymptomatic and HAM patients, as well as patients with IS. Results The critical age range was 50-60 years for IS outcome and more of 60 years for HAM outcome, with an increased risk of 2.5-fold for IS and 6.8-fold for HAM. IFN-γ was increased in patients with IS compared with asymptomatic carriers (ACs) (p = 0.007) and in patients with HAM compared with ACs (p = 0.03). Lymphoproliferation was increased in patients with HAM vs ACs (p = 0.0001) and patients with IS (p = 0.0001). PVL was similar between groups. Conclusion IFN-γ has high specificity of prediction of subject remain asymptomatic compared with PVL and lymphoproliferation assay tests. IFN-γ has been shown to be a biomarker of progression to intermediate stage and to HAM. The association of other markers with manifestations associated with HTLV-1 infection that does not meet the HAM criteria should be verified.
Collapse
Affiliation(s)
- Gabriela Prates
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Tatiane Assone
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Marcelo Corral
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Maíra P M Baldassin
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Tatiane Mitiko
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Flávia C Silva Sales
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Michel E Haziot
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Jerusa Smid
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Luiz A M Fonseca
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Fernanda de Toledo Gonçalves
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Augusto C Penalva de Oliveira
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Jorge Casseb
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| |
Collapse
|
12
|
Shoeibi A, Mojtabavi S, Boostani R, Sheikh Andalibi MS, Rafatpanah H, Etemadi M, Poursina Z, Ghahremani A. Acupuncture in the treatment of HTLV-I-associated myelopathy / tropical spastic Paraparesis. J Neurovirol 2020; 26:415-21. [PMID: 32350814 DOI: 10.1007/s13365-019-00805-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/26/2019] [Accepted: 09/16/2019] [Indexed: 10/24/2022]
Abstract
We investigate the possible effects of acupuncture on the improvement of neurological problems in HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP)disease. Twenty patients with HAM/TSP were studied in this pre and post-test clinical trial. Urinary incontinence, global motor disability, spasticity, and pain severity were evaluated before, one month, and three-month after the intervention. Analyses demonstrated a significant reduction of urinary symptoms one month after acupuncture (P = 0.023). A significant improvement was observed in patients' pain and the spasticity at the upper extremity joints, one and three-month after the intervention (P < 0.05). This study suggests that body acupuncture can be used as a complementary treatment to improve HAM/TSP neurological symptoms.
Collapse
|
13
|
Gonzalez Trujillo F, Parra Cortes K, Álvarez Pareja Y, Onate J. Human T-cell Lymphotropic Virus Type I Associated with Amyotrophic Lateral Sclerosis Syndrome: Immunopathological Aspects and Treatment Options. Cureus 2020; 12:e7531. [PMID: 32377479 PMCID: PMC7198105 DOI: 10.7759/cureus.7531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Human T-cell lymphotropic virus type I (HTLV-I) is a retrovirus related to infectious myelopathies, neoplasms, lymphomas, leukemias, and amyotrophic lateral sclerosis (ALS). It is acquired through sexual transmission, transfusion of blood products, and breastfeeding. The increased expression of human endogenous retrovirus K (HERV-K) in the brain tissue of patients with ALS has been demonstrated, a finding that supports the relationship between the virus and this disease. Therapeutic options include supportive measures and symptomatic treatment with anti-inflammatory medications including steroids, cyclosporines, pentoxifylline, danazol, interferons, and vitamin C. New management proposals are being implemented with valproic acid that acts to facilitate the recognition of the virus by the immune system and with zidovudine antivirals focused on reducing viral load. The purpose of this paper is to describe a clinical case that exhibits clinical signs and evidence of motor neuron compromise as described in electrophysiology studies along with positive laboratory tests for the HTLV-I virus.
Collapse
Affiliation(s)
| | | | | | - Jose Onate
- Internal Medicine, Clínica de Occidente, Jamundi, COL
| |
Collapse
|
14
|
Yamauchi J, Sato T, Yagishita N, Araya N, Hasegawa D, Tsutsumi S, Nagasaka M, Coler-Reilly A, Inoue E, Takata A, Hasegawa Y, Yamano Y. Use of cerebrospinal fluid CXCL10 and neopterin as biomarkers in HTLV-1-associated myelopathy/tropical spastic paraparesis treated with steroids. J Neurol Neurosurg Psychiatry 2020; 91:321-323. [PMID: 31662348 DOI: 10.1136/jnnp-2019-321955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/09/2019] [Accepted: 10/16/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Junji Yamauchi
- 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
| | - Naoko Yagishita
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Natsumi Araya
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Daisuke Hasegawa
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shuntaro Tsutsumi
- Department of Advanced Medical Innovation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Misako Nagasaka
- Department of Advanced Medical Innovation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan.,Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA
| | - Ariella Coler-Reilly
- Department of Advanced Medical Innovation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Eisuke Inoue
- Medical Informatics, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Ayako Takata
- Department of Preventive Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasuhiro Hasegawa
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihisa Yamano
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| |
Collapse
|
15
|
Silva TR, Labanca L, Caporali JFDM, Santos MAR, de Resende LM, Scoralick Dias RT, Utsch Gonçalves D. Ocular vestibular evoked myogenic potential (VEMP) reveals mesencephalic HTLV-1-associated neurological disease. PLoS One 2019; 14:e0217327. [PMID: 31881022 PMCID: PMC6934290 DOI: 10.1371/journal.pone.0217327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/29/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose Vestibular Myogenic Evoked Potential (VEMP) evaluates vestibulo-ocular and vestibulo-collic reflexes involved in the function of the otolithic organs and their afferent pathways. We compared the results of cervical and ocular VEMP in HTLV-1 associated myelopathy (HAM) and HTLV-1-asymptomatic infection. Participants and methods This cross-sectional study included 52 HTLV-1-infected individuals (26 HAM and 26 asymptomatic carriers) and 26 seronegative controls. The groups were similar regarding age and gender. Participants underwent simultaneous ocular and cervical VEMP. The stimulus to generate VEMP was a low-frequency tone burst sound tone burst, with an intensity of 120 decibels normalized hearing level, bandpass filter from 10 to 1,500 Hertz (Hz), with 100 stimuli at 500 Hz and 50 milliseconds recording time. The latencies of the electrophysiological waves P13 and N23 for cervical VEMP and N10 and P15 waves for ocular VEMP were compared among the groups. The absence or delay of the electrophysiological waves were considered abnormal results. Results Ocular VEMP was similar among the groups for N10 (p = 0.375) and different for P15 (p≤0.001). Cervical VEMP was different for P13 (p = 0.001) and N23 (p = 0.003). About ocular VEMP, in the HTLV-1-asymptomatic group, normal waves were found in 23(88.5%) individuals; in HAM group, normal waves were found in 7(26.9%). About cervical VEMP, 18(69.2%) asymptomatic carriers presented normal waves and only 3(11.5%) patients with HAM presented normal waves. Abnormalities in both VEMPs were found in 1(3.8%) asymptomatic carrier and in 16(61.5%) patients with HAM. Conclusion Neurological impairment in HAM was not restricted to the spinal cord. The mesencephalic connections, tested by ocular VEMP, have been also altered. Damage of the oculomotor system, responsible for eye stabilization during head and body movements, may explain why dizziness is such a frequent complaint in HAM.
Collapse
Affiliation(s)
- Tatiana Rocha Silva
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ludimila Labanca
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Júlia Fonseca de Morais Caporali
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marco Aurélio Rocha Santos
- Programa de Pós-Graduação em Ciências Fonoaudiológicas, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luciana Macedo de Resende
- Programa de Pós-Graduação em Ciências Fonoaudiológicas, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rafael Teixeira Scoralick Dias
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Denise Utsch Gonçalves
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| |
Collapse
|
16
|
Tsutsumi S, Sato T, Yagishita N, Yamauchi J, Araya N, Hasegawa D, Nagasaka M, Coler-Reilly ALG, Inoue E, Takata A, Yamano Y. Real-world clinical course of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Japan. Orphanet J Rare Dis 2019; 14:227. [PMID: 31639014 PMCID: PMC6802124 DOI: 10.1186/s13023-019-1212-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022] Open
Abstract
Background As human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a rare chronic neurological disease, large scale studies to collect continuous clinical data have been difficult to conduct. Therefore, the incidence of comorbidities and drug utilization data remain unknown. When conducting trials to develop new drugs in rare disease such as HAM/TSP, historical control data obtained from registry studies would be useful, as cohorts in rare disease tend to be small. Long-term follow-up of patients with a chronic disease can also be challenging. In this study, we addressed the following two goals using registry data on patients (n = 486) enrolled in the Japanese HAM/TSP patient registry “HAM-net” from 2012 to 2016: 1) to clarify the epidemiological information of HAM/TSP such as the incidence of comorbidities and drug utilization and 2) to provide the real-world data on changes in lower limb motor dysfunction. Results In HAM-net-registered patients, common comorbidities were fractures, herpes zoster, and uveitis, with incidences of 55.5, 10.4, and 6.5, respectively, per 1000 person-years. Every year, oral steroid treatment was administered in 48.2–50.7% of the HAM-net-registered patients and interferon-α treatment was used in 2.6–3.5% of patients. The median dose of oral prednisolone was low at 5.0 mg/day. The incidence of fractures and herpes zoster tended to be higher in the steroid-treated group than in the untreated group (fractures: 61.0 vs. 48.3, herpes zoster: 12.7 vs. 8.8, per 1000 person-years). The analysis of chronological change in Osame motor disability score (OMDS) indicated that the mean change in OMDS was + 0.20 [95% confidence intervals (CI): 0.14–0.25] per year in the one-year observation group (n = 346) and + 0.57 (95% CI: 0.42–0.73) over four years in the four-year observation group (n = 148). Significant deterioration of OMDS was noted in all subgroups with varying steroid use status. Conclusions This study revealed the incidence of comorbidities and drug utilization data in patients with HAM/TSP using registry data. Furthermore, this study provided real-world data on chronological changes in lower limb motor dysfunction in patients with HAM/TSP, indicating the utility of these data as historical controls.
Collapse
Affiliation(s)
- Shuntaro Tsutsumi
- Department of Advanced Medical Innovation, St. Marianna University Graduate School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 2168512, Japan
| | - Tomoo Sato
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 2168512, Japan
| | - Naoko Yagishita
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 2168512, Japan
| | - Junji Yamauchi
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 2168512, Japan
| | - Natsumi Araya
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 2168512, Japan
| | - Daisuke Hasegawa
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 2168512, Japan
| | - Misako Nagasaka
- Department of Advanced Medical Innovation, St. Marianna University Graduate School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 2168512, Japan.,Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Ariella L G Coler-Reilly
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 2168512, Japan
| | - Eisuke Inoue
- Medical Informatics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ayako Takata
- Department of Preventive Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihisa Yamano
- Department of Advanced Medical Innovation, St. Marianna University Graduate School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 2168512, Japan. .,Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 2168512, Japan.
| |
Collapse
|
17
|
Tamaki K, Sato T, Tsugawa J, Fujioka S, Yagishita N, Araya N, Yamauchi J, Coler-Reilly ALG, Nagasaka M, Hasegawa Y, Yamano Y, Tsuboi Y. Cerebrospinal Fluid CXCL10 as a Candidate Surrogate Marker for HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis. Front Microbiol 2019; 10:2110. [PMID: 31572323 PMCID: PMC6749079 DOI: 10.3389/fmicb.2019.02110] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/27/2019] [Indexed: 11/13/2022] Open
Abstract
Human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a debilitating, progressive disease without effective treatment; therefore, development of disease modifying therapy that improves long-term functional outcomes is an unmet need for patients. However, it is virtually impossible to consider this as a primary endpoint in clinical trials owing to the prolonged disease course. Therefore, development of surrogate markers that help predict the effectiveness of new interventions is essential. Currently, several candidate surrogate markers have been identified for HAM/TSP. Cerebrospinal fluid (CSF) C-X-C motif chemokine 10 (CXCL10) is involved in the pathogenesis of HAM/TSP and was shown to correlate with disease progression. However, it remains unclear whether changes in CSF CXCL10 levels are observed in response to treatment and whether these correlate with prognosis. Here we investigated several markers, including CSF CXCL10, in this respect. Data pertaining to patient characteristics and results of motor function evaluation and CSF examination of 13 HAM/TSP patients who received steroid treatment were retrospectively analyzed. Osame motor disability scores (OMDS), 10 m walking time, and CSF levels of CXCL10, neopterin, total protein, cell counts, and anti-HTLV-1 antibody titer were compared before and after steroid therapy. Levels of all CSF markers, with the exception of cell count, were significantly decreased after treatment. Nine of the 13 patients (69.2%) showed improvement in OMDS and were considered responders. Pre-treatment CSF levels of CXCL10 and anti-HTLV-1 antibody titer in responders were higher than those in non-responders (p = 0.020 and p = 0.045, respectively). Patients who continued low-dose oral prednisolone maintenance therapy after methylprednisolone pulse therapy showed sustained improvement in OMDS and CSF CXCL10 and neopterin levels lasting for 2 years. In contrast, OMDS and the CSF marker levels in patients who discontinued treatment returned to pre-treatment levels. This rebound phenomenon was also observed in patients who discontinued oral prednisolone therapy independently of pulse therapy. Our findings suggest that CSF CXCL10 may serve as a therapy-response and therapy-predictive marker for HAM/TSP. In addition, since decrease in CSF CXCL10 level was associated with good functional prognosis, CSF CXCL10 is a potential surrogate marker for treatment of HAM/TSP.
Collapse
Affiliation(s)
- Keiko Tamaki
- Department of Neurology, Fukuoka University, Fukuoka, Japan
| | - Tomoo Sato
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Jun Tsugawa
- Department of Neurology, Fukuoka University, Fukuoka, Japan
| | | | - Naoko Yagishita
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Natsumi Araya
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Junji Yamauchi
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ariella L G Coler-Reilly
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Misako Nagasaka
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, United States.,Department of Advanced Medical Innovation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Yasuhiro Hasegawa
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihisa Yamano
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan.,Department of Advanced Medical Innovation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University, Fukuoka, Japan
| |
Collapse
|
18
|
Sato T, Yagishita N, Tamaki K, Inoue E, Hasegawa D, Nagasaka M, Suzuki H, Araya N, Coler-Reilly A, Hasegawa Y, Tsuboi Y, Takata A, Yamano Y. Proposal of Classification Criteria for HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis Disease Activity. Front Microbiol 2018; 9:1651. [PMID: 30090093 PMCID: PMC6068401 DOI: 10.3389/fmicb.2018.01651] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/02/2018] [Indexed: 12/11/2022] Open
Abstract
Human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a rare chronic neuroinflammatory disease. While the disease usually progresses slowly without remission, there is a subgroup of patients with rapid progression and another subgroup with very slow progression. However, there have been no reports to date that have successfully determined the criteria to differentiate these subgroups. Therefore, we initially conducted a statistical modeling analysis to explore representative patterns of disease progression using data from our nationwide HAM/TSP patient registration system (“HAM-net”). The latent class mixed model analysis on the retrospective data (n = 205) of disease progression measured by the change in Osame Motor Disability Score from the onset of the disease to diagnosis demonstrated three representative progression patterns of HAM/TSP. Next, to test the effect of the progression rate at the initial phase of the disease on long-term prognosis, we divided 312 “HAM-net” registered patients into three groups (rapid, slow, and very slow progressors) based on the progression rate, then analyzed long-term functional prognosis of each group using the Kaplan–Meier method. Our data clearly demonstrated that the rapid progression at the early phase of the disease is an important poor prognostic factor. Moreover, to determine the biomarkers capable of discriminating the difference in disease activity, we compared the value of potential biomarkers of HAM/TSP among rapid (n = 15), slow (n = 74), very slow (n = 7), and controls (non-HAM/TSP patients, n = 18). The cerebrospinal fluid (CSF) levels of neopterin and C-X-C motif chemokine 10 (CXCL10) were the most valuable markers to discriminate among rapid, slow, and very slow progressors. To differentiate between rapid and slow progressors, the cut-off values of neopterin and CXCL10 were determined to be 44 pmol/mL and 4400 pg/mL, respectively. Furthermore, to differentiate between slow and very slow progressors, these values were determined to be 5.5 pmol/mL and 320 pg/mL, respectively. Notably, we found that CSF levels of these markers in very slow progressors were within the reference range. Thus, we propose a new classification criteria for disease activity of HAM/TSP that may contribute to improving the treatment algorithm for HAM/TSP.
Collapse
Affiliation(s)
- Tomoo Sato
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoko Yagishita
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Keiko Tamaki
- Department of Neurology, Fukuoka University, Fukuoka, Japan
| | - Eisuke Inoue
- Medical Informatics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Daisuke Hasegawa
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Misako Nagasaka
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, United States.,Department of Advanced Medical Innovation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Hiroko Suzuki
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Natsumi Araya
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ariella Coler-Reilly
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasuhiro Hasegawa
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University, Fukuoka, Japan
| | - Ayako Takata
- Department of Preventive Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihisa Yamano
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan.,Department of Advanced Medical Innovation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| |
Collapse
|
19
|
Einsiedel L, Purcell D, Schinke S, Haynes K, Taylor GP, Martin F. Highlights from the HTLV-1 symposium at the 2017 Australasian HIV and AIDS Conference held jointly with the 2017 Australasian Sexual Health Conference, November 2017, Canberra, Australia. J Virus Erad 2018; 4:48-50. [PMID: 29568554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We are pleased to report on the inaugural HTLV-1 symposium at the 2017 Australasian HIV and AIDS Conference joint with 2017 Australasian Sexual Health Conference in Canberra, Australia. Our understanding of HTLV-1 epidemiology, pathogenesis, laboratory diagnostics and treatment options for HTLV-1 diseases has advanced tremendously over the last 40 years. However, the awareness of healthcare providers and the general population about HTLV-1, and the effective promotion and implementation of HTLV-1 transmission-prevention strategies, lag behind current knowledge. Here we present a summary of the symposium, plenary and poster presentations on HTLV-1.
Collapse
Key Words
- HTLV-1, HTLV-1-associated myelopathy/tropical spastic paraparesis, HAM/TSP, ATL, adult T cell leukaemia/lymphoma, human T leukaemic virus type 1, bronchiectasis, bronchiolitis, mortality, Australia, sexual transmission, treatment, service provision, patient feedback, serology
Collapse
|
20
|
Einsiedel L, Purcell D, Schinke S, Haynes K, Taylor GP, Martin F. Highlights from the HTLV-1 symposium at the 2017 Australasian HIV and AIDS Conference held jointly with the 2017 Australasian Sexual Health Conference, November 2017, Canberra, Australia. J Virus Erad 2018; 4:48-50. [DOI: 10.1016/s2055-6640(20)30242-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
21
|
Futsch N, Mahieux R, Dutartre H. HTLV-1, the Other Pathogenic Yet Neglected Human Retrovirus: From Transmission to Therapeutic Treatment. Viruses 2017; 10:v10010001. [PMID: 29267225 PMCID: PMC5795414 DOI: 10.3390/v10010001] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022] Open
Abstract
Going back to their discovery in the early 1980s, both the Human T-cell Leukemia virus type-1 (HTLV-1) and the Human Immunodeficiency Virus type-1 (HIV-1) greatly fascinated the virology scene, not only because they were the first human retroviruses discovered, but also because they were associated with fatal diseases in the human population. In almost four decades of scientific research, both viruses have had different fates, HTLV-1 being often upstaged by HIV-1. However, although being very close in terms of genome organization, cellular tropism, and viral replication, HIV-1 and HTLV-1 are not completely commutable in terms of treatment, especially because of the opposite fate of the cells they infect: death versus immortalization, respectively. Nowadays, the antiretroviral therapies developed to treat HIV-1 infected individuals and to limit HIV-1 spread among the human population have a poor or no effect on HTLV-1 infected individuals, and thus, do not prevent the development of HTLV-1-associated diseases, which still lack highly efficient treatments. The present review mainly focuses on the course of HTLV-1 infection, from the initial infection of the host to diseases development and associated treatments, but also investigates HIV-1/HTLV-1 co-infection events and their impact on diseases development.
Collapse
Affiliation(s)
- Nicolas Futsch
- International Center for Research in Infectiology, Retroviral Oncogenesis Laboratory, INSERM U1111-Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, F-69007 Lyon, France.
- Equipe labellisée "Ligue Nationale Contre le Cancer", France.
| | - Renaud Mahieux
- International Center for Research in Infectiology, Retroviral Oncogenesis Laboratory, INSERM U1111-Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, F-69007 Lyon, France.
- Equipe labellisée "Ligue Nationale Contre le Cancer", France.
| | - Hélène Dutartre
- International Center for Research in Infectiology, Retroviral Oncogenesis Laboratory, INSERM U1111-Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, F-69007 Lyon, France.
- Equipe labellisée "Ligue Nationale Contre le Cancer", France.
| |
Collapse
|
22
|
Saito M, Sejima H, Naito T, Ushirogawa H, Matsuzaki T, Matsuura E, Tanaka Y, Nakamura T, Takashima H. The CC chemokine ligand (CCL) 1, upregulated by the viral transactivator Tax, can be downregulated by minocycline: possible implications for long-term treatment of HTLV-1-associated myelopathy/tropical spastic paraparesis. Virol J 2017; 14:234. [PMID: 29202792 PMCID: PMC5715538 DOI: 10.1186/s12985-017-0902-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/23/2017] [Indexed: 11/23/2022] Open
Abstract
Background Chemokine (C-C motif) ligand 1 (CCL1) is produced by activated monocytes/ macrophages and T-lymphocytes, and acts as a potent attractant for Th2 cells and a subset of T-regulatory (Treg) cells. Previous reports have indicated that CCL1 is overexpressed in adult T-cell leukemia cells, mediating an autocrine anti-apoptotic loop. Because CCL1 is also known as a potent chemoattractant that plays a major role in inflammatory processes, we investigated the role of CCL1 in the pathogenesis of human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Results The results showed that: (1) CCL1 was preferentially expressed in HAM/TSP-derived HTLV-1-infected T-cell lines, (2) CCL1 expression was induced along with Tax expression in the Tax-inducible T-cell line JPX9, (3) transient Tax expression in an HTLV-1-negative T-cell line activated the CCL1 gene promoter, (4) plasma levels of CCL1 were significantly higher in patients with HAM/TSP than in HTLV-1-seronegative patients with multiple sclerosis and HTLV-1-infected asymptomatic healthy carriers, and (5) minocycline inhibited the production of CCL1 in HTLV-1-infected T-cell lines. Conclusions The present results suggest that elevated CCL1 levels may be associated with the pathogenesis of HAM/TSP. Although further studies are required to determine the in vivo significance, minocycline may be considered as a potential candidate for the long-term treatment of HAM/TSP via its anti-inflammatory effects, which includes the inhibition of CCL1 expression.
Collapse
Affiliation(s)
- Mineki Saito
- Department of Microbiology, Kawasaki Medical School, 577 Matsushima, Okayama, 701-0192, Japan.
| | - Hiroe Sejima
- Department of Microbiology, Kawasaki Medical School, 577 Matsushima, Okayama, 701-0192, Japan
| | - Tadasuke Naito
- Department of Microbiology, Kawasaki Medical School, 577 Matsushima, Okayama, 701-0192, Japan
| | - Hiroshi Ushirogawa
- Department of Microbiology, Kawasaki Medical School, 577 Matsushima, Okayama, 701-0192, Japan
| | - Toshio Matsuzaki
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Eiji Matsuura
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yuetsu Tanaka
- Department of Immunology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Okinawa, 903-0215, Japan
| | - Tatsufumi Nakamura
- Department of Social Work, Faculty of Human and Social Studies, Nagasaki International University, 2825-7 Huis Ten Bosch Machi, Sasebo, Nagasaki, 859-3298, Japan
| | - Hiroshi Takashima
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| |
Collapse
|