Inflammatory myopathy on HTLV-I infection: case report

Immunopathogenesis and neurological manifestations associated to HTLV-1 infection

The human T lymphotropic virus type-1 (HTLV-1) was the first human retrovirus identified. The virus is transmitted through sexual intercourse, blood transfusion, sharing of contaminated needles or syringes and from mother to child, mainly through breastfeeding. In addition to the well-known association between HTLV-1 and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), several diseases and neurologic manifestations have been associated with the virus. This review was conducted through a PubMed search of the terms HTLV-1, immune response and neurological diseases. Emphasis was given to the most recent data regarding pathogenesis and clinical manifestations of HTLV-1 infection. The aim of the review is to analyze the immune response and the variety of neurological manifestations associated to HTLV-1 infection. A total of 102 articles were reviewed. The literature shows that a large percentage of HTLV-1 infected individuals have others neurological symptoms than HAM/TSP. Increased understanding of these numerous others clinical manifestations associated to the virus than adult T cell leukemia/lymphoma (ATLL) and HAM/TSP has challenged the view that HTLV-1 is a low morbidity infection.

Muscle wasting induced by HTLV-1 tax-1 protein: an in vitro and in vivo study

Besides tropical spastic paraparesis/human T-cell leukemia virus type-1 (HTLV-1)-associated myelopathy, the human retrovirus HTLV-1 causes inflammatory disorders such as myositis. Although the pathogenesis of HTLV-1-associated myositis is primarily unknown, a direct effect of cytokines or viral proteins in myocytotoxicity is suspected. We have developed an in vitro cell culture model to study the interactions between primary human muscle cells and HTLV-1 chronically infected cells. When HTLV-1-infected cell lines were added to differentiated muscle cultures, cytopathic changes such as fiber shrinking were observed as early as 1 day after contact. This was accompanied by alterations in desmin and vimentin organization, occurring in the absence of muscle cell infection but with Tax-1 present in myotubes. Cytopathic changes were also observed when infected culture supernatants were added to the muscle cells. Fiber atrophy and cytoskeletal disorganization were confirmed in muscle biopsies from two HTLV-1-infected patients with myositis. Transduction of cultured muscle cells with a lentiviral vector containing the HTLV-1 Tax gene reproduced such effects in vitro. The present data indicate that the myocytotoxicity that is observed in HTLV-1-associated myopathies can be due to a direct effect of the Tax-1 protein expressed in infected inflammatory cells, in the absence of muscle cell infection.

Hypothetical HTLV-I induction by ionizing radiation

Some laboratories have reported HTLV-I genome integration in cancer patients diagnosed with neoplasms of cervix and uterus. Usually, cancer patients undergo radiotherapy besides chemotherapy and surgery. It is hypothesized that radiation exposure would induce HTLV-I genome generation/activation, nevertheless there is not any report on experimental procedures trying to demonstrate HTLV-I gene expression in cells exposed to ionizing radiation. Anyway, earlier experimental works by Lieberman and Kaplan in 1959 succeeded to isolate retroviral particles, the radiation leukemia virus (RadLV), from thymic lymphomas of X-ray-irradiated C57BL/Ka mice, assuming that RadLV activated in the host by ionizing radiation, is released and transported to the thymus, where lymphoblasts, generated during the postradiation recovery phase, constitute an optimal target cell population for both replication of and eventual transformation by virus. Recent studies claim that besides RadLV, another retrovirus (RadLV-0) also induced by ionizing radiation is expressed and would be responsible for transformed cells of bone marrow origin. Epidemiological studies coincidentally point out to high incidence of HTLV-I infection in geographic areas displaying significant levels of radioactivity contamination as in Central Africa, Japan Islands and Mururoa Atoll. In our research work, we detected HTLV-I antibodies and viral genome integration in cancer patients of cervix and uterus and health care workers, whose had been exposed to ionizing radiation during radiotherapeutic procedures. Recombinational events among endogenous retrovirus and other retrogenic elements in the host cell genome under the bombardment of ionizing radiation from different sources could have optimized the phenomena occurrence or even ignited them to happen, generating HTLV-I genome, related viral peptides and virions. Therefore, it is feasible that exposure to ionizing radiation during therapeutic procedures could generate HTLV-I genome or induce the virus to be expressed in cells of cancer patients submitted to radiotherapy as also in healthy subjects under the same conditions, in artificial or natural radiation environment.