Kaposi's sarcoma, oncogenic viruses, and iron

Iron is required for many cellular processes, but it is also toxic in excess quantities. Therefore, iron homeostasis and utilization must be strictly maintained, and defects in iron absorption or transport result in iron depletion or accumulation. Most research has been directed to enteral and placental transfer of iron, but little is known about iron entry through the skin. We present evidence that exposure to wet clay soils in Africa is an important risk factor for Kaposi's sarcoma (KS) and speculate that iron may be responsible for soil toxicity contributing to the pathogenesis of KS.

Evidence gathered from case control studies and related investigations in Uganda between 1995 and 1998 are summarized.

A large case control study of KS in HIV-infected adults disclosed affluence and mobility that suggest enhanced sexual exposure to human herpesvirus-8, the putative aetiologic agent of KS. Another study in endemic KS (HIV-negative) also showed affluence and mobility as risk factors. In addition, barefoot exposure to wet soil was an important risk factor for men with endemic KS. Other studies point to diminish delayed hypersensitivity in the lower limbs of KS patients. Geographic similarities of KS to podoconiosis (non-filarial elephantiasis) in Africa implicate soil absorbtion through the skin in the pathogenesis of KS and podoconiosis.

The hypothesis of soil exposure as a risk for endemic KS has been strengthened by recent investigation. Particulate soil exposure may cause localized microtrauma and inflammation, predisposing to KS on the extremities in HHV-8 infected men. A role for iron toxicity is yet to be determined.