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.

中文翻译：

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人类 T 淋巴细胞病毒 1 相关性脊髓病：人类 T 细胞嗜淋巴细胞病毒 1/2 测试和潜在生物标志物概述

人类T细胞嗜淋巴细胞病毒（HTLV)-1 相关脊髓病是由 HTLV-1 感染引起的脊髓慢性致残性炎症性疾病。HTLV-1 相关性脊髓病 (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与血液和脑脊液 (CSF) 中抗 HTLV-1 抗体或 HTLV-1 基因组检测相关的痉挛性下肢轻瘫。已经提出了新的炎症标志物用于诊断和评估 HAM 的预后。我们回顾了 HAM 的实验室诊断和潜在替代标记物。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学方法确认和分型 HTLV-1 或 HTLV-2 感染是必不可少的。鞘内抗 HTLV-1 抗体的检测和 CSF 中 HTLV-1 原病毒的定量为诊断提供了额外的证据，特别是在非典型病例或不能排除神经炎症的其他原因的情况下。血清和脑脊液中的 CXC 基序趋化因子配体 10 和新蝶呤现在正在成为具有预后价值和 HAM 监测和管理的炎症标志物。此外，神经变性的测量，例如 CSF 和血液中的神经丝轻链，也可能有助于 HAM 的预后。该综述有助于临床医生和研究人员评估临床实践中每种生物标志物的潜在益处和局限性。