An update on human T-cell leukemia virus type I (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) focusing on clinical and laboratory biomarkers.

Human T-cell leukemia virus type I (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a rare inflammatory disease causing unremitting and progressive neurological disorders, such as spastic paraparesis, neurogenic bladder, and sensory disturbance of the lower extremities. Although there is no cure, immune-modulating agents such as corticosteroids are most widely used to slow disease progression. Biomarkers for the clinical assessment of HAM/TSP should be identified because the prediction of functional prognosis and the assessment of treatment efficacy are challenging due to the slowly progressive nature of the disease. The lack of surrogate biomarkers also hampers clinical trials of new drugs. This review summarizes biomarker candidates for the clinical assessment of patients with HAM/TSP. Most of the reported biomarker candidates are associated with viral components or inflammatory mediators because immune dysregulation provoked by HTLV-1 infection is thought to cause chronic inflammation and damage the spinal cord of patients with HAM/TSP. Although information on the diagnostic accuracy of most of the reported biomarkers is insufficient, several molecules, including inflammatory mediators such as CXCL10 and neopterin in the cerebrospinal fluid, have been suggested as potential biomarkers of functional prognosis and treatment response. Several clinical trials for HAM/TSP are currently underway, and we expect that these studies will provide not only evidence pertaining to treatment, but also novel findings regarding the utility of biomarkers in this disease. The establishment of clinical biomarkers will improve patient care and promote the development of therapies for HAM/TSP.

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Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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Declaration of Competing Interest YY has a patent MEDICINE FOR TREATING OR PREVENTING HTLV-I-RELATED MYELOPATHY, AND METHOD FOR FORECASTING THE EFFECT OF ANTIBODY THERAPY FOR PATIENT OF HTLV-I-RELATED MYELOPATHY Japan patent 5552630 licensed to St. Marianna University School of Medicine, a patent Therapeutic method and medicament for htlv-1 associated myelopathy (ham) Japan patent 6310845, US9,642,910, AUS2013285970 licensed to St. Marianna University School of Medicine, Kyowa Hakko Kirin, Japan, and a patent PREVENTIVE OR THERAPEUTIC AGENT FOR HTLV-1-ASSOCIATED MYELOPATHY USING LOW-DOSE ANTI-CCR4 ANTIBODY Japan patent 6430082 licensed to St. Marianna University School of Medicine, Kyowa Hakko Kirin, Japan. The other authors declare that there are no conflicts of interest.