A nation-wide sero-epidemiologic survey of adult T-cell leukemia virus (ATLV), detected es anti-ATLA (ATLV-associated antigen), was made in Japan. Sera from adult donors in 15 different locations were screened for anti-ATLA. High incidences (6 to 37%) of antibody-positive donors were found in seven regions, one in northern Japan, and the others in southwestern regions. These areas are ATLV-endemic areas corresponding to ATL-endemic areas. Examination of sera from healthy donors aged 6 to 80 years in ATL-endemic areas showed an age-dependent increase of seropositive donors with a maximum of about 30% at 40 years of age. Anti-ATLA was found in all but two of 142 patients with ATL. Anti-ATLA-positive patients with ATL were mainly found in ATLV-endemic areas, and only a few in ATL-nonendemic areas. Six patients with cutaneous T-cell lymphoma in ATLV-nonendemic areas gave a negative reaction for anti-ATLA. The geometric mean titer of anti-ATLA of patients with ATL was higher than that of healthy donors.

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The relationship between strongyloidiasis and HTLV-I was investigated in Okinawa, an area where both conditions are endemic. Thirty-six patients with strongyloidiasis were seropositive for HTLV-I and suffered from several related clinical complications. Fourteen of these patients (39%) were shown to have monoclonal integration of HTLV-I proviral DNA in their blood lymphocytes, a condition designated as "smouldering" adult T-cell leukaemia (ATL). Monoclonal integration of proviral DNA correlated with an increased CD4/CD8 ratio and the presence of abnormal lymphocytes in the peripheral blood, and with a trend for greater severity of the parasitic infection. Although the immunodeficiency caused by HTLV-I could predispose to hyperinfestation by Strongyloides, it is also possible that both the parasitic and the retroviral infestations are important co-factors leading to the development of ATL.

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Urinary coproporphyrin isomers were measured in 17 patients with Rotor's syndrome, 65 phenotypically normal relatives of 14 patients from eight families, and 21 normal subjects. coproporphyrin I was elevated in Rotor's syndrome (p less than 0.001) and, to a lesser degree, in phenotypically normal parents (p less than 0.005), children, and siblings (p less than 0.025) as compared to normal controls. Coproporphyrin III in patients, parents, and children did not differ from that in normal controls. Genetic analysis was consistent with transmission of Rotor's syndrome as an autosomal recessive trait with respect to urinary excretion of coproporphyrin I. After i.v. injection of delta-aminolevulinic acid, urinary coproporphyrin I increased to a similar extent in Rotor's syndrome and in normal subjects; urinary coproporphyrin III excretion was less in Rotor's syndrome than in normal subjects.