Paramyxoviruses and Paget's disease: the affirmative view.

Evidence has accumulated over the past 20 years to implicate paramyxoviruses in the etiopathology of Paget's disease. In the USA, the predominant virus detected is MV, whereas in northwestern England, CDV is most prevalent. The viruses are known to be easily spread by aerosol transmission to the respiratory tissues, from which they gain entry to the skeletal tissues via the hematopoietic system. Another characteristic of these viruses is their ability to persist at very low levels, thus evading the host immune response. Further studies have shown that IL-6, c-fos, and Bcl-2 are all elevated in Paget's disease--all of these factors can be activated by virally induced ROS. The genetic predisposition to Paget's disease and the perplexing focal nature of the disorder can also be explained by viral infection. Finally, the bisphosphonates, the class of drugs used so successfully to treat Paget's disease, have been shown to act, at least in part, by counteracting two of the major effects of the viruses in Paget's disease. The weight of evidence in support of a viral etiology for Paget's disease is overwhelming.