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Ferreira QR, Novaes AF, Santana CS, Umeda AS, de Souza Nascimento JO, de Freitas Santos JPM, Fernandes LA, Moura MN, Amorim RL, Cavalcanti VN, da Cruz ALB, Barreto FK, Costa DT. Neurological aspects of HTLV-1 infection: symptoms in apparently asymptomatic carriers. J Neurovirol 2024:10.1007/s13365-024-01197-9. [PMID: 38653958 DOI: 10.1007/s13365-024-01197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 04/25/2024]
Abstract
Human T-lymphotropic virus type 1 (HTLV-1) is classically associated with the HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), although the mechanisms of this neurological disorder remain unclear. In addition, some patients who develop "minor" neurological signs that do not meet diagnostic criteria for HAM/TSP are classified as asymptomatic carriers. This study aims to demonstrate the neurological symptoms of Brazilian patients living with HTLV-1 classified as not-HAM.TSP. This observational study evaluated patients treated in an HTLV reference center in Bahia, Brazil, between February 2022 and July 2023. The data were obtained through the analysis of medical records and neurological consultation. Those individuals classified as HAM/ TSP were excluded from this study. 74 patients were submitted to a careful neurological evaluation: 23 HAM/TSP, 22 were classified with intermediate syndrome (IS), and 29 were oligosymptomatic. Self-reported symptoms were significantly more common in the IS group, including urinary symptoms such as nocturia, urgency, incontinence, dysuria, weakness, paresthesia, lumbar pain, xerostomia, and xerophthalmia. Physical examination findings consistent with reduced vibratory and tactile sensitivity were more common in the IS group (p = 0.017 and p = 0.013). Alterations in the V and VIII cranial nerves were present in both groups. HTLV-1 can lead to the development of important neurological signs and symptoms in apparently asymptomatic individuals. This data highlights the need for more research into the neurological aspects of HTLV-1 infection and emphasizes the importance of early diagnosis, treatment, and support for individuals living with this virus.
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Affiliation(s)
- Qesya Rodrigues Ferreira
- Universidade Federal da Bahia - Instituto Multidisciplinar em Saúde, 45029-094, Vitória da Conquista, Bahia, Brazil
| | - Ana Flávia Novaes
- Universidade Federal da Bahia - Instituto Multidisciplinar em Saúde, 45029-094, Vitória da Conquista, Bahia, Brazil
| | - Carolina Souza Santana
- Universidade Federal da Bahia - Instituto Multidisciplinar em Saúde, 45029-094, Vitória da Conquista, Bahia, Brazil
| | - Arthur Shigueru Umeda
- Universidade Federal da Bahia - Instituto Multidisciplinar em Saúde, 45029-094, Vitória da Conquista, Bahia, Brazil
| | | | | | - Larissa Alves Fernandes
- Universidade Federal da Bahia - Instituto Multidisciplinar em Saúde, 45029-094, Vitória da Conquista, Bahia, Brazil
| | - Matheus Nascimento Moura
- Universidade Federal da Bahia - Instituto Multidisciplinar em Saúde, 45029-094, Vitória da Conquista, Bahia, Brazil
| | - Rebeca Leão Amorim
- Universidade Federal da Bahia - Instituto Multidisciplinar em Saúde, 45029-094, Vitória da Conquista, Bahia, Brazil
| | - Vinícius Nogueira Cavalcanti
- Faculdade de Saúde Santo Agostinho - Campus Vitória da Conquista, 45028-100, Vitória da Conquista, Bahia, Brazil
| | - Ariana Leal Borges da Cruz
- Universidade Federal da Bahia - Instituto Multidisciplinar em Saúde, 45029-094, Vitória da Conquista, Bahia, Brazil
| | - Fernanda Khouri Barreto
- Universidade Federal da Bahia - Instituto Multidisciplinar em Saúde, 45029-094, Vitória da Conquista, Bahia, Brazil.
| | - Davi Tanajura Costa
- Universidade Federal da Bahia - Instituto Multidisciplinar em Saúde, 45029-094, Vitória da Conquista, Bahia, Brazil
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XCL1, a serum biomarker in neurological diseases; HTLV-1-associated myelopathy and multiple sclerosis. Microb Pathog 2023; 174:105962. [PMID: 36572194 DOI: 10.1016/j.micpath.2022.105962] [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: 04/30/2022] [Revised: 08/14/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022]
Abstract
The XCL1-XCR1 axis has a potential role in the recruitment of immune cells to the site of inflammation. The present study aimed to examine the relation of XCL1 serum levels with Multiple sclerosis (MS) and HTLV-1-associated myelopathy (HAM), as chronic inflammatory diseases of the central nervous system (CNS). DNA was extracted to evaluate HTLV-1 proviral load (PVL) using real-time PCR. Serum levels of XCL1 was determined by using an ELISA assay. The serum level of XCL1 was significantly higher in patients with HAM than that of asymptomatic carriers (ACs) and healthy controls (HCs) (p < 0.001 and p < 0.0001, respectively) and was also higher in MS patients compared to HCs (p < 0.0001). Moreover, the concentration of XCL1 serum level was significantly different between the ACs and HCs group (p < 0.0001). In conclusion, increased expression of XCL1 might contribute to the migration of autoreactive T cells to the central nervous system and play a critical role in the development and pathogenesis of inflammatory neurological diseases including HAM and MS.
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de Paula JJ, Romanelli LC, de Faria RCV, Proietti AB, Malloy-Diniz LF, Romano-Silva MA, de Miranda DM, Nicolato R. Cognitive impairment in the HTLV-1 infection: a comparative study associated with functional performance. J Neurovirol 2021; 27:849-856. [PMID: 32955704 DOI: 10.1007/s13365-020-00905-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 06/30/2020] [Accepted: 08/28/2020] [Indexed: 12/01/2022]
Abstract
Human T cell leukemia virus type-I (HTLV-1) infection courses with a myelopathy, the tropical spastic paraparesis (HAM/TSP). In a case-control study, we compared the neuropsychological profile and functional characteristics in two case HTLV-1-infected groups (asymptomatic and with HAM/TSP) with a control group negative for HTLV-1. Subjects were paired for age, sex, and educational features. The case group differed from control group in neuropsychological measures such as in episodic memory recall, executive functions, and fine motor dexterity measure. Individuals with HAM/TSP have more depressive symptoms and worst performance in activities of daily living (ADL) presenting a less functionality. In multivariate models, the fine motor performance, the executive functioning, the recognition memory, and the depressive symptoms explained part of the variance in functionality. Those findings may contribute to understand of everyday life impairments and limitations of HTLV-1-infected population and to organize the rehabilitation. Once more, based in neuropsychological and functional data, we can reaffirm that HTLV-1 is never a benign condition, but sometimes it is only in a stage coursing with less symptoms.
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Affiliation(s)
- Jonas Jardim de Paula
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | | | - Renata Caetano Vieira de Faria
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Leandro Fernandes Malloy-Diniz
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marco Aurélio Romano-Silva
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Debora Marques de Miranda
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Departamento de Pediatria Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rodrigo Nicolato
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Dysregulation of immune gene expression profiles during HTLV-1 infection. Meta Gene 2021. [DOI: 10.1016/j.mgene.2021.100944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Zargari R, Mahdifar M, Mohammadi A, Vahidi Z, Hassanshahi G, Rafatpanah H. The Role of Chemokines in the Pathogenesis of HTLV-1. Front Microbiol 2020; 11:421. [PMID: 32231656 PMCID: PMC7083101 DOI: 10.3389/fmicb.2020.00421] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/27/2020] [Indexed: 12/16/2022] Open
Abstract
Human T cell leukemia virus type 1 (HTLV-1) is a human retrovirus that is associated with two main diseases: HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T cell leukemia/lymphoma (ATL). Chemokines are highly specialized groups of cytokines that play important roles in organizing, trafficking, homing, and in the migration of immune cells to the bone marrow, lymphoid organs and sites of infection and inflammation. Aberrant expression or function of chemokines, or their receptors, has been linked to the protection against or susceptibility to specific infectious diseases, as well as increased the risk of autoimmune diseases and malignancy. Chemokines and their receptors participate in pathogenesis of HTLV-1 associated diseases from inflammation in the central nervous system (CNS) which occurs in cases of HAM/TSP to T cell immortalization and tissue infiltration observed in ATL patients. Chemokines represent viable effective prognostic biomarkers for HTLV-1-associated diseases which provide the early identification of high-risk, treatment possibilities and high-yielding clinical trials. This review focuses on the emerging roles of these molecules in the outcome of HTLV-1-associated diseases.
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Affiliation(s)
- Razieh Zargari
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Mahdifar
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asadollah Mohammadi
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Zohreh Vahidi
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Houshang Rafatpanah
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Mashhad, Iran
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Casavilca-Zambrano S, Alarcon JO, Boluda S. Non-neoplastic neurological and ophthalmological disease. Semin Diagn Pathol 2020; 37:110-113. [DOI: 10.1053/j.semdp.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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] [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.
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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:
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Rosadas C, Taylor GP. Mother-to-Child HTLV-1 Transmission: Unmet Research Needs. Front Microbiol 2019; 10:999. [PMID: 31134031 PMCID: PMC6517543 DOI: 10.3389/fmicb.2019.00999] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/18/2019] [Indexed: 02/04/2023] Open
Abstract
Mother-to-child transmission (MTCT) of Human T-cell lymphotropic virus type 1 (HTLV-1) causes lifelong infection. At least 5–10 million individuals worldwide are currently living with HTLV-1. Studies of regional variation are required to better understand the contribution of MTCT to the global burden of infection. Although most infected individuals remain asymptomatic ∼10% develop high morbidity, high mortality disease. Infection early in life is associated with a higher risk of disease development. Adult T-cell leukemia (ATL), which is caused by HTLV-1 and has a median survival of 8 months is linked to MTCT, indeed evidence of ATL following infection as an adult is sparse. Infective dermatitis also only occurs following neonatal infection. Whilst HTLV-1-associated myelopathy (HAM) follows sexual and iatrogenic infection approximately 30% of patients presenting with HAM/TSP acquired the infection through their mothers. HAM/TSP is a disabling neurodegenerative disease that greatly impact patient’s quality of life. To date there is no cure for HTLV-1 infection other than bone marrow transplantation for ATL nor any measure to prevent HTLV-1 associated diseases in an infected individual. In this context, prevention of MTCT is expected to contribute disproportionately to reducing both the incidence of HTLV-1 and the burden of HTLV-1 associated diseases. In order to successfully avoid HTLV-1 MTCT, it is important to understand all the variables involved in this route of infection. Questions remain regarding frequency and risk factors for in utero peri-partum transmission whilst little is known about the efficacy of pre-labor cesarean section to reduce these infections. Understanding the contribution of peripartum infection to the burden of disease will be important to gauge the risk-benefit of interventions in this area. Few studies have examined the impact of HTLV-1 infection on fertility or pregnancy outcomes nor the susceptibility of the mother to infection during pregnancy and lactation. Whilst breast-feeding is strongly associated with transmission and avoidance of breast-feeding a proven intervention little is known about the mechanism of transmission from the breast milk to the infant and there have been no clinical trials of antiretroviral therapy (ARV) to prevent this route of transmission.
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Affiliation(s)
- Carolina Rosadas
- Retrovirology and GU Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Graham P Taylor
- Retrovirology and GU Medicine, Department of Medicine, Imperial College London, London, United Kingdom
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Schor D, Porto LC, Roma EH, Quintana MDSB, Fabricio-Silva GM, Bonecini-Almeida MG, Araújo AQC, Andrada-Serpa MJ. Lack of association between single-nucleotide polymorphisms of pro- and anti-inflammatory cytokines and HTLV-1-associated myelopathy / tropical spastic paraparesis development in patients from Rio de Janeiro, Brazil. BMC Infect Dis 2018; 18:593. [PMID: 30466392 PMCID: PMC6251227 DOI: 10.1186/s12879-018-3510-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/08/2018] [Indexed: 01/16/2023] Open
Abstract
Background HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a progressive neurological and inflammatory disease, associated with HTLV-1 infection. HAM/TSP neurological disease is a consequence of an inflammatory reaction, and adaptive immune responses, through the secretion of anti-inflammatory and pro-inflammatory cytokines, play an important role in the outcome of infection and disease progression. Studies addressing the association between cytokines functional single nucleotide polymorphisms and HAM/TSP development are scarce. Methods The genetic polymorphisms of cytokine genes were evaluated in HAM/TSP patients (n = 68) and in asymptomatic HTLV-1 positive carriers (n = 83) from Rio de Janeiro, Brazil, in a case-control study. HTLV-1 infected patients were genotyped for SNPs in five cytokine genes: TNFA-308G/A, IL6-174G/C, IFNG + 874 T/A, TGFB at the codons + 10 T/C and + 25G/C, IL10-592C/A and -819C/T, and -1082A/G and proviral load (PVL) was quantified. Associations between genotypes, haplotypes, clinical outcome and pro viral load were evaluated. Results Lack of association between the cytokine polymorphisms and disease outcome was observed. The genotypes TNFA-308GG, IL6-174GG/GC, IL10-592AA and -819CC and TGFb1 high producers phenotypes were correlated with higher PVL in HAM/TSP patients versus asymptomatic carriers. Conclusions We did not observe association between cytokine polymorphisms and risk for HAM/TSP development in Brazilian HTLV-1 infected individuals, regardless of differences in PVL between HAM/TSP versus asymptomatic carriers in specific cytokine polymorphisms.
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Affiliation(s)
- Doris Schor
- Laboratory of Immunology and Immunogenetics in Infectious Diseases, Evandro Chagas National Institute of Infectious Diseases, FIOCRUZ, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil.,Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute of Infectious Diseases, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Luís Cristóvão Porto
- Histocompatibility and Cryopreservation Laboratory, Policlinica Piquet Carneiro, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - Eric Henrique Roma
- Laboratory of Immunology and Immunogenetics in Infectious Diseases, Evandro Chagas National Institute of Infectious Diseases, FIOCRUZ, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil.
| | | | - Gustavo Milson Fabricio-Silva
- Histocompatibility and Cryopreservation Laboratory, Policlinica Piquet Carneiro, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - Maria Gloria Bonecini-Almeida
- Laboratory of Immunology and Immunogenetics in Infectious Diseases, Evandro Chagas National Institute of Infectious Diseases, FIOCRUZ, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Abelardo Queiroz-Campos Araújo
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute of Infectious Diseases, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Maria Jose Andrada-Serpa
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute of Infectious Diseases, FIOCRUZ, Rio de Janeiro, RJ, Brazil
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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.
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