Radiological Changes in the Spinal Cord and Brain of Patients with HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP)

• Published in: Pathogens (Basel) 2024-10, Vol.13 (11), p.920
• Main Authors: Stack, Emily H, Okar, Serhat V, Wu, Tianxia, Stack, Mallory, Mina, Yair, Gaitán, María, Azodi, Shila, Frazier, Will, Ohayon, Joan, Cortese, Irene C M, Reich, Daniel S, Nair, Govind, Jacobson, Steven
• Format: Article
• Language: English
• Subjects: Atrophy; Automation; Brain; central nervous system atrophy; Central nervous system diseases; Disability; Health aspects; Hereditary spastic paraplegia; Histopathology; HTLV-1-associated myelopathy; Magnetic resonance imaging; Multiple sclerosis; Nervous system diseases; Neurological diseases; Patients; Principal components analysis; Quality control; Spinal cord; spinal cord atrophy; Substantia alba; Thorax; Tissues; Tropical spastic paraparesis; Tumor necrosis factor-TNF; white matter hyperintensities
• ISSN: 2076-0817; 2076-0817
• DOI: 10.3390/pathogens13110920

HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic, progressive neurological disorder and shares many radiological and clinical features with other more prevalent myelopathies. Here, we quantified spinal cord and brain volumes in adults with HAM/TSP in comparison with healthy volunteers (HVs) and individuals diagnosed with relapsing-remitting or progressive multiple sclerosis (RRMS or P-MS). Clinical disability and MRI were assessed in 24 HVs, 43 HAM/TSP subjects, and 46 MS subjects. Spinal cord cross-sectional area (SCCSA) and brain tissue volumes were measured and compared. HAM/TSP subjects had significantly lower SCCSA corresponding to cervical levels 2 and 3 (C2-3) (54.0 ± 8 mm ), cervical levels 4 and 5 (C4-5) (57.8 ± 8 mm ), and thoracic levels 4 to 9 (T4-9) (22.7 ± 4 mm ) and significantly elevated brain white matter hyperintensity (WMH) fraction (0.004 ± 0.008) compared to the HVs (C2-3: 69.4 ± 8 mm , C4-5: 75.1 ± 9 mm , T4-9: 34.1 ± 4 mm ; all < 0.0001; and WMH: 0.0005 ± 0.0007; < 0.001). In the HAM/TSP subjects, SCCSA at all levels but not WMH showed a significant correlation with clinical disability scores. WMH in HAM/TSP subjects, therefore, may not be related to clinical disability. SCCSA in our limited RRMS cohort was higher than the HAM/TSP cohort (C2-3: 67.6 ± 8 mm , C4-5: 72.7 ± 9 mm , T4-9: 33.4 ± 5 mm ; all < 0.0001) and WMH was lower than in P-MS subjects ( = 0.0067). Principal component analysis suggested that SCCSA and WMH may be used to differentiate HAM/TSP from MS. Understanding these differences msay help establish early diagnostic criteria for HAM/TSP patients.