Leukemia Research Vol. 8. No. 3, lap. 501-5~4, 1984. 0145-2126/845.3.00 ÷ 0.00 Printed in Great Britain. © 1984 Pergamon Press Ltd.

B R I E F R E P O R T

P R E V A L E N C E O F H T L V - S P E C I F I C S U R I N A M E M I G R A N T S T O T H E

A N T I B O D I E S I N N E T H E R L A N D S

MARJORIE ROBERT-GUROFF,* ROEL A. COUTINHO,I" ALT W. ZADELHOFF,:~ FLORRY A. VYTH-DREESE§ and PHILIP ROMKE§

*Laboratory of Tumor Cell Biology, National Cancer Institute, Bethesda, MD 20205, U.S.A.

tDepartment of Public Health and :[;Methadone Maintenance Program, Municipal Health Service, Amsterdam, The Netherlands; and §Division of Immunology, The Netherlands Cancer Institute,

Amsterdam, The Netherlands

(Received 12 December 1983. Accepted 15 December 1983)

Abstraet--Sera of 98 participants in a methadone maintenance programme, all recent Surinam emigrants to the Netherlands, were examined for antibodies to disrupted HTLV using the ELISA technique. Twelve per cent of the donors possessed HTLV-specific antibodies with a range of titre from 41 to 20,000. Sera of 26 control Dutch drug users lacked such antibodies with the exception of one female who subsequently was found to reside with a Surinam male. Intravenous drug use was not a factor in these studies. These data indicate that HTLV circulates within the Surinam community in the Netherlands. More broadly, these results show that the region of the Caribbean endemic for HTLV extends as far south as Surinam. Furthermore, an antibody prevalence of 12% for clinically healthy donors with non-malignant disease suggests that the Caribbean has an in- cidence of HTLV infection approaching, if not equal to, that of southwestern Japan.

Key words: Human T-cell ieukemia/lymphoma virus, natural human antibodies.

INTRODUCTION

THE HUMAN T-cell leukemia virus (HTLV), a type-C retrovirus associated with a subset of adult T-cell malignancies [4, 6], is endemic in southwestern Japan and the Caribbean region [l, 2, 6, 8]. While serologic studies have demonstrated that HTLV also occurs in parts of Africa [7, 12] and South America [10; F. Merino et al., in preparation], infection by the retrovirus has been less frequently observed in the United States and Europe [6]. Antibody positive individuals in the United States often tend to cluster in the southeastern region near the Caribbean [3]. One of the few reports on European HTLV-positive ATL patients concerned Caribbean emigrants to the United Kingdom [5]. Recently, a patient with T-CLL originating from Surinam but living in the Netherlands was shown to be HTLV positive. Evidence of HTLV infection included expression of HTLV p19 by the patient's T cells [13, 14], and detection of serum antibodies to HTLV proteins, not only in the patient but also in several family members [15]. In order to determine if the region of the Caribbean endemic for HTLV might extend to Surinam, a South American coastal nation adjacent to the Caribbean, we examined readily available sera from residents of the Surinam emigrant community in the Netherlands for HTLV-specific antibodies.

Abbreviations: HTLV, human T-cell leukemia/lymphoma virus; ELISA, enzyme-linked immunosorbent assay.

Correspondence to: Dr M. Robert-Guroff, Laboratory of Tumor Cell Biology, National Cancer Institute, Building 37, Room 6A09, Bethesda, MD 20205, U.S.A. ~' 1984. U.S. Govt.

501

502 MARJORIE ROBERT-GUROFF e t al.

M A T E R I A L S A N D M E T H O D S

Sera were collected in 1979 from Surinam participants in an Amsterdam methadone maintenance programme and were stored frozen. Sera of Dutch methadone users were collected in 1980 and were similarly stored. Antibodies to HTLV were detected using an ELISA technique with disrupted HTLV as test antigen [11]. Confir- mation that observed antibody reactivities were specific for HTLV antigens was obtained by competition ex- periments using extracts of HTLV-producing and non-producing cells and fetal calf serum [9]. Only sera whose reactivity could be significantly decreased by competition with extracts containing HTLV proteins but not by ex- tracts of normal PHA-stimulated human peripheral blood lymphocytes or by fetal calf serum proteins were scored positive. Antibody titres are expressed as the reciprocal of the serum dilution at which the absorbance of the test serum at 490 nm equals the absorbance of a standard negative serum diluted 20-fold.

R E S U L T S

Twelve o f the 98 sera o f S u r i n a m emig ran t s in A m s t e r d a m assayed possessed H T L V - specif ic a n t i b o d y . A n t i b o d y t i t res r anged over a p p r o x . 500-fold , with a geome t r i c m e a n o f 520. The charac te r i s t i cs o f the S u r i n a m se rum d o n o r s a re l is ted in Tab le 1; de ta i l ed

TABLE I. CHARACTERISTICS OF SURINAM DRUG USERS IN AMSTERDAM EXAMINED FOR HTLV-SpECIFIC ANTIBODIES

Characteristic Presence of antibody to HTLV

Positive cases Negative cases (n = 12) (n = 86)

Mean age in years 28.2 + 4.8 (12)* 26.4 + 5.7 (62) Sex 75~e male (12) 90% male (60) Born in Surinam 100*To (12) 95% (57) Years of residence

in Netherlands 6.7 4- 3.3 (10) 7.3 4- 4.3 (54) Intravenous drug use 0% (10) 15% (34) Range of antibody titre 41-20,000 Geometric mean titre 520

*Number in parentheses indicates number of cases for which the characteristic was known.

d e m o g r a p h i c d a t a was unava i l ab l e fo r a p p r o x , one - th i rd o f the a n t i b o d y nega t ive dono r s . Al l a n t i b o d y pos i t ive d o n o r s were b o r n in S u r i n a m . N o d i f fe rence in years o f res idence in

the N e t h e r l a n d s was obse rved be tween the a n t i b o d y pos i t ive vs a n t i b o d y nega t ive in- d iv iduals . The m e a n age o f b o t h g roups was a lso s imi lar . N o n e o f the 12 pos i t ive d o n o r s were i .e . d rug users; all o f t hem were h a b i t u a l smoker s o f hero in .

A s a c o n t r o l g r o u p , sera o f 26 Du tch i .v. d rug users were assayed . Al l except one were a n t i b o d y negat ive . In te res t ing ly , the a n t i b o d y pos i t ive case, who had an a n t i b o d y t i t re o f 1850, was a Du tch female who res ided with a S u r i n a m male . Se rum has no t yet been o b t a i n e d f r o m this con tac t .

D I S C U S S I O N

These d a t a ind ica te tha t H T L V is p reva len t a m o n g the S u r i n a m c o m m u n i t y in the Ne the r l ands , c o m p a r e d to the na t ive Du tch p o p u l a t i o n . Twelve per cent o f the Su r ina m d o n o r s tes ted were H T L V - p o s i t i v e c o m p a r e d to on ly 1 o f 26 Du tch dono r s . The one pos i t ive Du tch ind iv idua l c a n n o t be cons ide red rep resen ta t ive o f the Du tch c o m m u n i t y due to her c lose con t ac t with a Su r iname r . W e have p rev ious ly r epo r t ed the increased

HTLV antibodies in Surinam emigrants 503

incidence of HTLV antibody positive individuals among relatives of known HTLV- positive patients [8,15]. Compared to random healthy donors, family members exhibit about a four-fold greater antibody prevalence.

Approximately 40,000 Surinamers reside in Amsterdam. The vast majority emigrated around the time of Surinam's independence in 1975. The average length of time the serum donors tested here had resided in Amsterdam was seven years. Thus, the 12070 antibody prevalence of these recent emigrants is presumably indicative of the HTLV prevalence in Surinam itself. This prevalence in a group with non-malignant disease is considerably higher than the 4°70 prevalence previously reported for normal donors of St. Vincent's Island in the Caribbean [6], and approaches rates observed among healthy donors of southwestern Japan [8]. The data reported here together with the remarkable HTLV- association seen in newly diagnosed leukemia/lymphoma cases in Jamaica, where 70070 were HTLV antibody positive [1], indicates that the Caribbean is as endemic for HTLV as is Japan. Furthermore, a comparison of the 12070 prevalence of the Surinam emigrants with the 4070 prevalence of the St. Vincent's normals is reminiscent of the sharp local dif- ferences in HTLV prevalence previously observed in Japan [8] and Venezuela [10; F. Merino et al., in preparation]. Factors contributing to these local restrictions in HTLV spread are under investigation.

One might argue that because the Surinam drug-using community maintains relatively close contact, the 12070 antibody prevalence might be artificially elevated. Further serologic tests of representative donors of the larger Surinam community in Amsterdam will answer this point. Nevertheless, these preliminary investigations confirm previous findings [13,14,15] and indicate that HTLV circulates among the Surinam emigrants residing in the Netherlands and highlights an area for fruitful study. Careful epidemiologic investigations monitoring HTLV infection as the Surinam emigrants in- teract with the Netherland natives will allow analysis of natural transmission of HTLV by both vertical (i.e. congenital, milk-borne) and horizontal routes as well as study of several factors regulating transmission of HTLV, especially the effects of any racial or genetic susceptibilities.

Acknowledgments--The authors thank Ms Monica Brown, Mrs Nel Albrecht van Lent and Ms Marie Anne van Haleru for excellant technical assistance.

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