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To the Editor:
The viral hypothesis for ALS is an attractive one, and it was good to see the viral debate being opened again by the article by Berger et al.1 Taken with previous similar findings in the UK,2 it now seems likely that enteroviral sequences are in fact present in spinal cord tissue in a large proportion of ALS patients. The question remains, however, as to the significance of this finding. One factor that does not seem to have been considered is that denervated muscle is very sensitive to infection with certain enteroviruses.3,4⇓ Sensitivity to enteroviral infection is seen after surgical denervation as well as botulinum toxin, suggesting that synaptic transmission has a role to play in protecting striated muscle from enteroviral infection.4 Because denervated muscle in ALS is commonly reinnervated by surviving motor neurons, terminal axons of these motor neurons could readily take up enteroviral particles and transport them back to the cell body via retrograde axonal transport.5 Of interest, atrophic muscle in ALS often shows evidence of inflammation with infiltration by mononuclear cells,6 which could represent muscle infection with a virus. On the other …
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