Department of clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Inflammation and Inflammatory Diseases division, Immunology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Expert Rev Neurother. 2023 Jul-Dec;23(12):1233-1248. doi: 10.1080/14737175.2023.2272639. Epub 2023 Dec 15.
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.
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.
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.
在感染人类 T 细胞嗜淋巴细胞病毒 1 型（HTLV-1）的 1000 万至 2000 万人中，近 2%-3%的人易患 HTLV-1 相关性脊髓病/热带痉挛性截瘫（HAM/TSP）。这是一种神经炎症性疾病，与多发性硬化症不同，其基于典型的神经系统症状、HTLV-1 感染的确认以及其他分子生物标志物。
简要回顾了 HAM/TSP 的流行病学、宿主免疫反应和分子发病机制，随后详细讨论了宿主发生 HAM/TSP 的相关危险因素，以及尝试管理策略的成败案例。
目前，尚无治疗 HAM/TSP 的有效方法。抗逆转录病毒疗法、特殊细胞因子（IFN-α）、一些抗氧化剂和同种异体骨髓移植已被用于治疗这些患者，但收效有限。在当前情况下，无症状携带者应定期由神经科医生检查，以早期发现脊髓损伤迹象。然后，确定进展速度以适应每位患者的最佳管理计划至关重要。皮质类固醇治疗对急性脊髓炎最有益。然而，进展缓慢的患者最好采用症状和物理治疗相结合的方法进行治疗。此外，应采取预防措施以减少 HTLV-1 感染的进一步传播。
