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. 2012 Nov 9:3:389.
doi: 10.3389/fmicb.2012.00389. eCollection 2012.

Clinical pathophysiology of human T-lymphotropic virus-type 1-associated myelopathy/tropical spastic paraparesis

Yoshihisa Yamano  1 , Tomoo Sato
Affiliations

Clinical pathophysiology of human T-lymphotropic virus-type 1-associated myelopathy/tropical spastic paraparesis

Yoshihisa Yamano et al. Front Microbiol. .

Abstract

Human T-lymphotropic virus type 1 (HTLV-1), a human retrovirus, is the causative agent of a progressive neurological disease termed HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). HAM/TSP is a chronic inflammatory disease of the central nervous system and is characterized by unremitting myelopathic symptoms such as spastic paraparesis, lower limb sensory disturbance, and bladder/bowel dysfunction. Approximately 0.25-3.8% of HTLV-1-infected individuals develop HAM/TSP, which is more common in women than in men. Since the discovery of HAM/TSP, significant advances have been made with respect to elucidating the virological, molecular, and immunopathological mechanisms underlying this disease. These findings suggest that spinal cord invasion by HTLV-1-infected T cells triggers a strong virus-specific immune response and increases proinflammatory cytokine and chemokine production, leading to chronic lymphocytic inflammation and tissue damage in spinal cord lesions. However, little progress has been made in the development of an optimal treatment for HAM/TSP, more specifically in the identification of biomarkers for predicting disease progression and of molecular targets for novel therapeutic strategies targeting the underlying pathological mechanisms. This review summarizes current clinical and pathophysiological knowledge on HAM/TSP and discusses future focus areas for research on this disease.

Keywords: HAM/TSP; HTLV-1; diagnosis; epidemiology; pathogenesis; prognosis; retrovirus; treatment.

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Figures

Figure 1
Figure 1
Flow chart for clinical diagnosis of HAM/TSP. EIA, enzyme immunoassay; PA, particle agglutination; PBMCs, peripheral blood mononuclear cells; PCR, polymerase chain reaction.
Figure 2
Figure 2
Cellular mechanisms underlying pathogenesis of human T-lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). CNS, central nervous system. *HTLV-1.
Figure 3
Figure 3
A schematic representation of the clinical course of human T-lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP).
See this image and copyright information in PMC

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