Many TIA-1+/CD8+ cells were distributed in the active inflammatory lesions; however, few cells were positive in the inactive chronic lesions. Because the protein TIA-1 has been reported in association with the induction of apoptosis in target cells, we carefully observed and found some cells undergoing apoptosis, most of them identified as CD45RO+ helper/inducer T-cells which are known as HTLV-1-harboring cells in vivo.11 These findings suggest that cytotoxic T-cell-mediated apoptosis of helper/inducer T-cells may be induced in the spinal cord of HAM/TSP patients. It is

crucially GSK3235025 important to know whether there are HTLV-1-infected cells in inflamed spinal cord lesions. HTLV-1 proviral DNA could be detected in extracted DNA from affected Gemcitabine ic50 spinal cord in HAM/TSP by PCR. The amount tended to decrease with the disease duration and this decline was paralleled with the decrease of CD4+ T-cell numbers.12 Based on these findings we applied PCR in situ hybridization (PCR-ISH) to determine which cells harbor the HTLV-1 provirus in vivo in the spinal lesions of HAM/TSP. Fresh frozen sections of the spinal cord were first immunostained with antibodies to T-cells and macrophages as well as helper/inducer T-cells, then PCR-ISH was carried out with specific primers and probed for the HTLV-1 pX region. PCR-ISH positive cells were exclusively detected among the T-cells around perivascular areas (Fig. 3)

and about 10% of infiltrated T-cells were PCR-ISH positive in active-chronic lesions.13 Expression Dapagliflozin of Tax mRNA was also detected in the infiltrated T-cells of perivascular areas.14

These data are direct demonstrations of HTLV-1 infection to infiltrated T-cells in the spinal cord lesions. T cell-mediated immune responses targeting these infected cells may be a main event occurring in the spinal cord of HAM/TSP patients. It may be reasonable to suggest that the immune responses to HTLV-1 infected cells occur in the spinal cord of HAM/TSP because high immune responsiveness to HTLV-1 has been reported in HAM/TSP. However, why do such immune responses occur preferentially in the spinal cord, especially in the middle to lower thoracic level? To understand this point, we carefully analyzed distribution of inflammatory lesions in the entire CNS.15 In the spinal cord, inflamed vessels were symmetrically distributed and accentuated in the lateral column and the ventral portion of the posterior column, especially the middle to lower thoracic level. This distribution matches with the ending area of both the central and peripheral spinal arteries (Fig. 4). In addition, the anterior spinal artery of the middle to lower thoracic level has the most distant blood supply from the main trunk of the arteries, the vertebral artery and the Adam-Kiewicz artery, from the opposite directions, and this makes blood flow slower in that area.