The human T-lymphotropic virus type I (HTLV-I
IntroductionInfection with the retrovirus human T-lymphotropic virus type I (HTLV-I) is associated with the development of HTLV-Iassociated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukemia/lymphoma (ATLL). HAM/TSP is an immune-mediated inflammatory disorder of the central nervous system that leads to progressive neurologic disability in affected individuals. 1 A key mechanism in the pathogenesis of HAM/TSP is considered to be the HTLV-I-induced immune activation that supports the establishment of central nervous system inflammation. 2 Immune activation is a hallmark of HAM/TSP, as evidenced by the increased expression of lymphocyte activation markers, the induction of pro-inflammatory cytokines, and spontaneous lymphoproliferation. [3][4][5] The HTLV-I-encoded transactivating protein Tax is thought to play a role in the immune activation associated with HAM/TSP by activating hostsignaling molecules such as the cyclic AMP-responsive elementbinding protein, the serum response factor, and the nuclear factor-B (NF-B), thereby up-regulating the expression of pro-inflammatory cytokines and/or their receptors. 6 The activation of the NF-B pathway is considered a key event in the HTLV-I-induced leukemogenesis leading to ATLL, 7 but the contribution of the NF-B pathway to the pathogenesis of HAM/TSP has not been fully defined.The NF-B proteins, which include the RelA (p65), c-Rel, RelB, NF-B1 (p105/p50), and NF-B2 (100/p52) subunits, comprise a family of Rel-homology domain-containing transcription factors that play a key role in regulating inflammation. 8 NF-B signaling occurs by activation of either the canonical or the noncanonical pathways, leading to nuclear translocation of the RelA/p50 or RelB/p52 heterodimers, respectively. 9 Key signaling events involve the release of NF-B subunits from the cytoplasmic sequestration by the inhibitor of NF-B (IB), the subsequent nuclear translocation, and the binding of NF-B heterodimers to NF-B response elements that ultimately lead to gene transcription. The HTLV-I protein Tax is capable of activating both the canonical and the noncanonical NF-B pathways by interacting with the IB kinase subunits, leading to the release of NF-B from cytoplasmic sequestration. 10,11 The NF-B-dependent induction of pro-inflammatory cytokines such as [13][14][15]14 and the induction of IL-2 receptor␣ (IL-2R␣) 15 in HTLV-I-infected cells suggests that NF-B activation may play a critical role in the development of diseases associated with HTLV-I infection.To further define the contribution of NF-B activation to the pathogenesis of HAM/TSP, we compared NF-B activation in peripheral blood mononuclear cells (PBMCs) from subjects with HAM/TSP against that of healthy donors, and examined the relationship of HTLV-I viral protein expression and NF-B activation. We developed several series of novel inhibitor of NF-B targeting the DNA-binding Rel transcription factors. [16][17][18] To define the contribution of NF-B activation to immune...