Tropical Spastic Paraparesis Market: Overview

Tropical spastic paraparesis (TSP) also called as HTLV-1–associated myelopathy (HAM) is a type of tropical myeloneuropathies caused by the human T-lymphotrophic virus 1 (HTLV-1). Although initially described in tropical countries, TSP has also been found in temperate regions such as southern Japan. HTLV-1 virus belongs to the Retroviridae family, and preferentially infects CD4 lymphoid cells. The virus has been known to cause certain kinds of leukemia and lymphoma and is transmitted through exposure to infected blood, sexual contact, and use of illegal intravenous drugs. As the virus is also known to spread through breast milk, mothers infected with HTLV-1 virus must avoid breast feeding. 

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According to an article published in the journal Frontiers in Microbiology in 2012, the HTLV-1 virus is prevalent in certain regions including the Southwestern part of Japan, sub-Saharan Africa and South America, the Caribbean area, and certain areas of Middle East and Australo-Melanesia. The study also estimates that 5 million to 10 million individuals have been affected globally with HTLV1 virus, however various other publications estimate the global prevalence of 10 million to 20 million. 

HTLV-1-associated myelopathy mostly affects the spinal cord, and results in an upper motor neurone syndrome, that usually affects lower limbs. Spastic paraparesis or paraplegia is the main characteristic of the infection. Tropical spastic paraparesis results in demyelination, inflammation and necrotic lesions in spinal cord. The progressive disease is associated with degeneration of neurons in the spinal cord, and results in gradual paralysis of the lower limbs. Other rare symptoms include optic atrophy, reduced ankle reflex and cranial nerve lesions. An article published in journal Revue Neurologique in 2012, more than 90% of the tropical spastic paraparesis cases, the neurological features involved urinary bladder disturbance, spasticity and/or hyperreflexia of the lower extremities, and lower extremity muscle weakness.

Various immunoassay kits are available for diagnosis of HTLV-1 virus. Companies manufacturing such diagnostic kits include MP Biomedicals LLC, Fujirebio, Inc., Quest Diagnostics, DiaSorin S.p.A. Although the disease cannot be cured completely, medications are available for management of symptoms. Corticosteroids such as methylprednisolone are prescribed to decrease the inflammation of the spinal cord, while pain is treated with non-steroidal anti-inflammatory medications.

Symptoms of urinary dysfunction can be treated by prescribing darifenacin, oxybutynin, tamsulosin, terazosin, and other drugs which reduce the activity of bladder muscles. National Institute of Neurological Disorders and Stroke (NINDS) is currently conducting phase I clinical trials for Hu MiK-Beta-1. The investigational drug is monoclonal antibody directed toward IL-2/IL-15R-Beta Subunit which blocks IL-15 action. Washington University School of Medicine in association with Merck Sharp & Dohme Corp. is also conducting phase II trials for Raltegravir. Various other institutes are also conducting research programs for discovering new and effective treatment options for Tropical spastic paraparesis. Scientists have also tried antiretroviral agents for treatment of HTLV-1 infections. Gradual progress in the research activities is expected to launch more treatment drugs and expand the market in the future.   

Due to low and restricted geographical prevalence of the disease, the market for tropical spastic paraparesis is small. Government initiative for increasing awareness of the disease and its available treatment may curb the spread of infections. Lack of sufficient information on geographical prevalence, and epidemiology has restricted the research activities. These factors will also be responsible for a slower global market growth.    

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