Puccioni-Sohler Marzia, Poton André Rodrigues, Cabral-Castro Mauro Jorge, Yamano Yoshihisa, Taylor Graham, Casseb Jorge
Department of Internal Medicine, Escola de Medicina e Cirurgia, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Postgraduate Program, Department of Infectious and Parasitic Diseases, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
AIDS Res Hum Retroviruses. 2022 Dec;38(12):924-932. doi: 10.1089/AID.2022.0028. Epub 2022 Aug 18.
Human T cell lymphotropic virus (HTLV)-1-associated myelopathy is a chronic, disabling inflammatory disorder of the spinal cord caused by HTLV-1 infection. The diagnosis of HTLV-1-associated myelopathy (HAM) is based on clinical and laboratorial findings. The disease is characterized by the presence of spastic paraparesis associated with detection of anti-HTLV-1 antibodies or HTLV-1 genomes in blood and cerebrospinal fluid (CSF). New inflammatory markers have been proposed for the diagnosis and assessment of the prognosis of HAM. We reviewed the laboratory diagnostic and potential surrogate markers for HAM. The serological screening tests for detection of anti-HTLV-1/2 antibodies are highly sensitive and specific, but confirmation and typing of HTLV-1 or HTLV-2 infection by other serological or molecular methods are essential. Detection of intrathecal anti-HTLV-1 antibodies and quantification of the HTLV-1 provirus in CSF provide additional evidence for diagnosis especially in atypical cases or where alternative causes of neuroinflammation cannot be excluded. The CXC motif chemokine ligand 10 and neopterin in serum and CSF are now emerging as inflammatory markers with prognostic value and for HAM monitoring and management. In addition, measures of neurodegeneration, such as neurofilament light chain in the CSF and blood, may also contribute to the HAM prognosis. This review is useful for clinicians and researchers evaluating potential benefits and limitations of each biomarker in clinical practice. The advent of new markers makes it necessary to update the criteria for the best evidence-based approach and for worldwide consensus regarding the use of diagnostic and surrogate markers for HAM.
人类嗜T细胞病毒1型（HTLV-1）相关脊髓病是一种由HTLV-1感染引起的慢性、致残性脊髓炎症性疾病。HTLV-1相关脊髓病（HAM）的诊断基于临床和实验室检查结果。该疾病的特征是存在痉挛性截瘫，并伴有血液和脑脊液（CSF）中抗HTLV-1抗体或HTLV-1基因组的检测。已经提出了新的炎症标志物用于HAM的诊断和预后评估。我们综述了HAM的实验室诊断和潜在替代标志物。检测抗HTLV-1/2抗体的血清学筛查试验具有高度敏感性和特异性，但通过其他血清学或分子方法对HTLV-1或HTLV-2感染进行确认和分型至关重要。检测鞘内抗HTLV-1抗体和定量CSF中的HTLV-1前病毒为诊断提供了额外证据，特别是在非典型病例或无法排除神经炎症其他原因的情况下。血清和CSF中的CXC基序趋化因子配体10和新蝶呤正在成为具有预后价值以及用于HAM监测和管理的炎症标志物。此外，神经变性的测量指标，如CSF和血液中的神经丝轻链，也可能有助于HAM的预后评估。这篇综述对临床医生和研究人员在临床实践中评估每种生物标志物的潜在益处和局限性很有帮助。新标志物的出现使得有必要更新最佳循证方法的标准，以及就HAM诊断和替代标志物的使用达成全球共识。
