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Creutzfeldt-Jakob disease (CJD) and new variant Creutzfeldt-Jakob disease (nvCJD) are among many of the insidious infectious diseases that are incurable once a person becomes infected. Similar to HIV in the early 1980's, very little is known about the enigmatic infectious agent. How the infectious agent is expressly transmitted is as inexplicable as CJD itself. The purpose of this study was to evaluate the extent of current research literature and other scholarly works in order to synthesize what is known about this fatal disease. The scope of this study was confined to the years 1993 to 1998. In addition to the information in the literature, consultation was sought from Yale University's Dr. L. Manuledis and a graduate student, Christopher A. Baker, was volunteered as a conduit for information on CJD/nvCJD. Three questions guided this study: 1) How are CJD/nvCJD diagnosed? 2) How is it transmitted?, and 3) What are the existing clinical recommendations for the management of CJD/nvCJD? One out of a million people are affected by it, and nvCJD has the potential of being spread by Bovine Spongiform Encephalopathy (BSE[Mad Cow]) tainted beef. Through this study I discovered that CJD and nvCJD have multiple routes for infection and current speculation remains divided on the dynamics of its transmission. Some of the literature was specialized and focused on proving the value of one discipline's diagnostic technique over another. While healthcare is shifting to a competitive business environment, my focus was on what were the most effective techniques regarding the diagnosis of it, limiting the spread of the infectious agent, and the medical management of infected patients.

No description available.

Transmissible spongiform encephalopathies (TSEs) or prion diseases are a group of fatal neurodegenerative diseases affecting humans and animal species. Prion diseases are characterized by the conversion of the host encoded prion protein (PrPC) into a disease-associated isoform (PrPSc), which (according to the prion hypothesis) is thought to be the main component of the infectious agent. PrPSc has been traditionally distinguished from PrPC by its biochemical properties, such as partial resistance to proteolysis and detergent-insolubility. In the absence of a foreign nucleic acid genome associated with prion diseases, efforts to provide a molecular basis for the biological diversity of prions have focused on biochemical characterization of PrPSc. In Creutzfeldt-Jakob disease (CJD) and other forms of human prion disease, the biochemical characterization of PrPSc has been largely restricted to the analysis of PK-resistant fragments of PrPSc (PrPres) by Western blot. However, given recent findings on the complexity of PrPSc identified in laboratory prion strains, PrPres analysis alone may not provide a complete description of PrPSc present in CJD brains. For a more complete characterization of PrPSc in human prion diseases, this study investigated biochemical properties of PrPSc in different forms of CJD by employing approaches that differ in principle from conventional Western blot analysis of PrPres. The novel biochemical approaches used in this study have identified further complexity of PrPSc accumulated in CJD brains, not only between different forms of CJD but also within single cases of individual disease entities. In this study, the two biochemical criteria most frequently used to define PrPSc (3F4 epitope accessibility versus resistance to limited proteolysis) did not always correlate, indicating probable non-uniform distribution of PK-sensitive isoform of PrPSc within the same CJD brains. In variant CJD (vCJD) brains, the thalamic region, which is characterized by distinct neuropathological features, could also be distinguished from frontal cortex and cerebellum by the sedimentation profiles of PrPC and PrPSc on sucrose step gradients. Moreover, the conformational stability of PrPSc was found not to be uniform among human prion diseases and did not correlate with PrPres type or prion protein genotype. Taken together, the results from this study provide a more complete description of PrPSc species occurring in CJD brains and contribute to a fuller understanding of the agents and the disease processes involved in humans.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13063号 / 論医博第2121号 / 新制||医||1018(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 髙橋 良輔, 教授 福原 俊一, 教授 中山 健夫 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

La maladie sporadique de Creutzfeldt-Jakob (sCJD) est une encéphalopathie spongiforme transmissible mortelle caractérisée par une large gamme de manifestations cliniques et pathologiques. Les caractéristiques pathologiques de la SDMC dépendent en grande partie de la présence d'une forme mal repliée de protéine prion cellulaire (PrPC); Connu sous le nom de PrPSC et polymorphisme (méthionine et valine) au codon 129 du gène PRNP qui code pour PrPC. Les facteurs étiologiques exacts de la MCSJ sont encore inconnus. Le génotype Codon 129 du gène PRNP et le type de PrPSC (type 1 ou type 2) influent sur l'hétérogénéité de la maladie telle que définie par des caractéristiques pathologiques spécifiques de la région qui peuvent réguler les voies moléculaires qui conduisent au développement de phénotypes pathogènes dépendants des sous-types. Dans cette étude, nous avons étudié l'ensemble de la réglementation protéomique dans la région cerebrale du cerveau des deux sous-types les plus répandus (MM1 et VV2) des patients atteints de SDMC utilisant une électrophorèse sur gel bidimensionnelle (2DE) et une spectrométrie de masse. L'analyse de toutes les taches de protéines sur les gels 2DE avec le logiciel DECODON Delta2D a révélé vingt-cinq taches de protéines différenciées et l'identification de ces taches avec MALDI-TOF MS / MS a révélé quatre-vingts trois protéines différentiellement réglementées dans les deux sous-types dans la région du cervebelle du cerveau par les patients atteints de sCJD. Quarante protéines dans le sous-type MM1 et quarante-trois protéines dans le sous-type VV2 ont été classées. Douze protéines étaient communément réglementées dans les deux sous-types, dont cinq d'entre elles présentaient une régulation expresnelle inverse et le repos sept avait une régulation expresnelle similaire dans les deux sous-types. Les trois principaux mécanismes moléculaires cellulaires réglementés dans les deux sous-types comprennent: i) le cycle cellulaire; L'expression des gènes et la mort cellulaire, ii) - la réponse au stress cellulaire / le stress oxydatif et iii) - la transduction du signal et les fonctions synaptiques La plupart des protéines sous la classification des réponses au stress cellulaire étaient associées aux fonctions moléculaires cellulaires liées au stress oxydatif. DJ-1 qui est un capteur bien connu de stress oxydatif, a également été jugé réglementé dans la catégorie des réponses au stress cellulaire. Le DJ-1 protège les cellules contre le stress oxydatif directement en translocant au noyau pour l'activation de gènes antioxydants et indirectement en activant la voie Nrf2 / ARE. Nos résultats expérimentaux ont démontré l'activation de la voie Nrf2 / ARE dans les sous-types MM1 et VV2 de sCJD. Le DJ-1 a également montré une régulation positive significative dans son expression de l'ARNm dans les sous-types MM1 et VV2 mais l'expression des protéines uniquement dans le sous-type VV2 dans le cervelet du cerveau des patients atteints de sCJD. En outre, l'expression de la protéine DJ-1 a également été augmentée au cours des stades pré-symptomatiques et symptomatiques dans le cervelet du cerveau des modèles de souris de sCJD (MM1 et VV2) et pendant le stade clinique dans les échantillons de CSF des patients atteints de SDMC. Ces résultats suggèrent l'implication du stress oxydatif lors de la pathophysiologie de la SDMC et l'utilisation de DJ-1 comme capteur potentiel de stress oxydatif pendant la phase clinique de la sCJD.

Transmissible spongiform encephalopathy (TSE) strains are defined by their biological properties on transmission to wild-type mice, specifically by their characteristic incubation periods and patterns of vacuolar pathology (‘lesion profiles’) in the brain. Whilst a single TSE strain has been identified in variant Creutzfeldt-Jakob disease (vCJD), the phenotypic heterogeneity observed in sporadic CJD (sCJD) implies the existence of multiple strains of agent. These distinct strains are proposed to be enciphered by the different conformers of abnormal prion protein (PrP), recognised as different protease resistant PrP (PrPres) types by Western blotting (type 1 or type 2) and are thought to be substantially influenced by the different prion protein gene (PRNP) codon 129 polymorphism (MM, MV and VV). To test the relationship between disease phenotype and agent strain, this study carried out a full characterisation of the sCJD agent by primary transmission of brain tissue from 27 sCJD cases (comprising all six possible combinations of PRNP codon 129 genotype and PrPres type) in panels of wild-type mice using the standard strain typing properties of incubation period and lesion profiles, plus a full analysis of PrP in the mouse brain and the PrPres molecular subtypes present. Results were directly compared with the transmission characteristics of brain tissue from 10 vCJD cases. The characterisation of the agent strain in sCJD and vCJD was extended to include analysis of subsequent mouse-to-mouse passages. In an additional investigation, wild-type mice were experimentally challenged with a wide-range of lymphoid tissues, neural tissues and biological fluids from vCJD and sCJD patients in order to investigate the extent of peripheral involvement in CJD and to determine whether the agent is subject to any tissue-specific modifications. Analysis of all 27 sCJD sources demonstrated the existence of two strains of agent, one associated with the MM1/MV1 subgroups and the other associated with the MM2 subgroup, which could be distinguished by their transmission properties in the mice. The lack of transmission in mice challenged with VV1, MV2 and VV2 tissues provided evidence of at least one further sCJD strain. In contrast, all 10 vCJD sources resulted in consistent incubation periods and lesion profiles, suggesting that all 10 patients investigated were infected with the same strain of agent. Overall, the observation that PrPres type in sCJD and vCJD was maintained on transmission is consistent with the proposition that PrPres type plays a role in enciphering strain-specific information. Experimental transmissions from peripheral tissues extended the evidence for a peripheral infection in vCJD. However, comparison of incubation periods and lesion profiles from transmission of brain and peripheral tissues showed no evidence of tissue-specific modification in the biological properties of the agent. Furthermore, the detection of low levels of infectivity in a sCJD buffy coat sample provides supporting evidence for a peripheral involvement in sCJD. This study highlights the complex relationship between disease phenotype, PRNP codon 129 genotype, PrPres type and agent strain in sCJD and vCJD. Overall, this study confirms that multiple strains of agent are associated with sCJD, some of which successfully propagate in wild-type mice but none of which are identical to the agent responsible for vCJD. Importantly, the sCJD strains identified here by their biological properties partially correlated with the current sub-classification system for sCJD which is based on the clinical and pathological phenotype of the disease.

Creutzfeldt-Jakob disease (CJD) is the commonest form of human prion disease and occurs in sporadic, genetic and acquired forms. The causative agents (prions) appear to be composed entirely of a modified host protein, the prion protein, which undergoes misfolding to a disease-associated isoform closely associated with infectivity that is resistant to conventional methods of decontamination. Prions can be transmitted from one individual to another by medical and surgical procedures, resulting in iatrogenic CJD (iCJD). The commonest cause of iCJD is the inoculation of cadaveric pituitary-derived human growth hormone (hGH) to treat growth hormone deficiency in children; this form of treatment was abandoned in 1985 after the first UK case of iCJD in a hGH recipient was identified. Seventy-eight cases of iCJD have since occurred in the UK cohort of 1849 hGH recipients, including a case in 2016. This thesis describes a comprehensive tissue-based and molecular genetic analysis of the largest series (35 cases) of UK hGH-iCJD cases reported to date, including in vitro kinetic molecular modelling of genotypic factors influencing prion transmission. The results show that the polymorphism at codon 129 of the prion protein gene strongly influences the disease incubation period in hGH-iCJD (from 7.8-32.3 years in this series) and interacts with the infectious prion strain to govern the molecular and pathological characteristics of iCJD. The findings are consistent with the hypothesis that the UK hGH-iCJD epidemic resulted from transmission of the V2 human prion strain, which is found in the second most common form of sporadic CJD. The investigation also found accumulation of the amyloid beta (Aβ) protein associated with Alzheimer’s disease (AD) in the brains and cerebral blood vessels in 18/35 hGH-iCJD patients and 5/12 control patients who had been treated with hGH, but died from causes other than iCJD. In contrast, Aβ accumulation was markedly less prevalent in age-matched patients who died from sporadic CJD (1/15 cases) and variant CJD (2/33 cases). These results are consistent with the hypothesis that Aβ, which can accumulate in the pituitary gland, was present in the inoculated hGH preparations and seeded into the brains of around 50% of all hGH recipients, producing AD-like neuropathology and cerebral amyloid angiopathy (CAA). This provides further evidence of the prion-like properties of Aβ and gives insight into the potential for possible transmission of AD/CAA. It is uncertain whether any Aβ seeding within the brains of surviving patients in the UK hGH recipient cohort will ultimately result in clinical AD; however, the CAA in these patients may be complicated by intracerebral haemorrhage resulting from rupture of the blood vessels damaged by Aβ accumulation within their walls.

Les Encéphalopathies Spongiformes transmissibles (EST) sont des maladies neurodégénératives fatales caractérisées par l’accumulation d’un conformère anormal (PrPSc) d’une protéine de l’hôte (PrP). Chez l’homme, plusieurs centaines de cas de transmissions iatrogènes de la maladie de Creutzfeldt Jakob (MCJ) ont été identifiées, notamment chez des patients ayant fait l’objetd’ une greffe de dure-mère, de cornée ou des injections d’hormones de croissance extractives. Plus récemment, plusieurs cas du variant de la maladie de Creutzfeldt Jakob (vMCJ) ont été observés chez des patients transfusés avec des produits sanguins issus de donneurs en incubation de la maladie. D’un point de vue sanitaire, l’évaluation du risque de contamination interindividuelle par des tissus ou des fluides biologiques issus de patients atteints représente un enjeu important en matière de santé publique. La première partie de notre travail a consisté à comparer la sensibilité relative de modèles de souris transgéniques sur-exprimant la PrP à celle de l’hôte conventionnel exprimant la même séquence. Les résultats obtenus ont validé le concept d’une absence d’impact du niveau d’expression de la PrP ou du fond génétique de l’hôte sur la sensibilité finale du modèle à l’infection. A l’aide de ces modèles de souris transgéniques, nous avons alors mesuré les niveaux d’infectiosité dans le sang de patients atteints de différentes formes d’’EST. Chez un patient atteint de vMCJ, nous avons mis en évidence de faibles niveaux d’infectiosité dans les concentrés de globules rouges, les leucocytes et le plasma. Nous avons également pu détecter de l’infectiosité dans le plasma issu de 2 patients atteints de sMCJ sur 4 testés. Parallèlement à ces expériences, nous avons démontré dans un modèle expérimental d’infection chez le mouton, que l’administration de 104 à 105 leucocytes suffisent à transmettre par voire transfusionnelle la maladie. Ces résultats soulignent l’intérêt et les limites de la leuco-déplétion appliquée de manière standard en médicine transfusionnelle, pour limiter les risques de transmission du vMCJ. Enfin, nous avons testé la capacité de différents outils in vitro à détecter la présence des Prions dans le sang. / Transmissible spongiform encephalopathies (TSE) are fatal neurodegenerative disorders occurring in a wide spectrum of animals. They are characterized by accumulation of abnormally folded conformers (PrPSc) derived from normal cellular PrP protein (PrP) of the host. In human, many iatrogenic transmissions of Creutzfeldt Jakob disease (CJD) have been reported after dura mater graft, corneal graft or extractive growth hormone injections, prepared from affected donors. More recently, several cases of vCJD transmissions were reported in individuals that were transfused with blood from asymptomatic donors that subsequently developed vCJD. Risk assessment of interindividual transmission with contaminated tissues or body fluids remains a major public health issue. In a first part, we validated the final pertinence of infectious titers as measured in mice overexpressing PrP to the risk of transmitting the disease in the natural host species. In a second time, we used this model to evaluate the presence of infectivity in blood from TSE affected patients. We were able to detect the presence of infectivity in erythrocytes, leukocytes, and plasma of 1 person with vCJD and in the plasma of 2 out of 4 persons whose tests were positive for sporadic CJD. We then demonstrated in a sheep TSE model, that intravenous administration of 104 to 105 leucocytes was sufficient to cause disease in recipient sheep, underlying the efficacy and potential limits of leuko-reduction processes that are currently applied in transfusion medicine to mitigate the TSE transmission risk. Finally, using the same model, we tested different in vitro methods to detect prions in blood.

One of the key molecular events in the transmissible spongiform encephalopathies or prion diseases is the conformational conversion of the cellular prion protein PrPC into the misfolded and pathogenic isoform, PrPSc. Prion diseases are fatal neurodegenerative conditions affecting humans and other animal species, which present with diverse clinical and neuropathological phenotypes. In humans, prion diseases can occur as sporadic, familial or acquired forms. Sporadic Creutzfeldt–Jakob disease (sCJD) accounts for the majority of cases. The current classification system of human prion diseases recognizes several distinct clinico-pathological entities including sCJD, variant Creutzfeldt-Jakob disease (vCJD), Gerstmann–Straussler–Scheinker syndrome, fatal familial insomnia and variably protease-sensitive proteinopathy. Prion protein gene (PRNP) mutations and polymorphisms, and PrPSc types have a profound effect on these clinico-pathological phenotypes. Prion diseases of sheep and goats, cattle, and cervids are all actual animal health problems and present potential risks to human health. Thus far the only known zoonotic prion disease is bovine spongiform encephalopathy, which has resulted in vCJD in humans. The recognition of new forms of prion diseases in animal and humans has generated increased awareness of the animal and public health risks associated with prion disease. However the mechanisms involved in prion replication, transmission, and neurodegeneration remain poorly understood. This thesis uses in vitro PrP conversion assays (protein misfolding cyclic amplification and real time quaking-induced conversion) to model different aspects of human prion replication: Molecular susceptibility, genetic compatibility, spontaneous formation and the effect of molecules that might enhance or prevent conversion were each investigated in order to obtain a better understanding of the molecular mechanism of the prion replication. I have addressed the hypothesis that the major determinant factors in prion disease pathogenesis (PRNP genetics, PrPSc types and species barriers) are intrinsic to the prion protein conversion process and their effects can be faithfully recapitulated by in vitro conversion assays. The results shows that in vitro conversion assays used in this thesis can model the combined effects of different PrP type and genotypes, can replicate aspects of cross-species transmission potential and provide information about molecular barrier to zoonotic transmission, can model de novo PrPSc formation, and can assess the potential impact of chaperones on conversion of the human prion protein. In summary, this work provides evidence that the origin, propagation and transmission of prions can be meaningfully investigated in cell-free systems.