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prion diseases
CBN III
33
Medical
Graduate
02/19/2011

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Term
what are prions?
Definition
proteinaceous infectious particles - which aggregate over time, forming conformations which are difficult to break down once they have formed.
Term
what was the first documentation of prion disease in humans?
Definition
creutzfeldt-jacob disease in 1921. symptoms: dementia, gait problems, ataxia, speech issues were evident. this term is still used for most prion disease except that derived from beef.
Term
what is kuru?
Definition
a transmissible spongiform encephalopathy due to cannibalism first described in 1950's papua new guinea
Term
when was the connection between prion disease and proteins made?
Definition
~1980
Term
where do prions come from? what are the different forms?
Definition
they are encoded by chr 20, which codes for a 250 AA, membrane associated, glycosylated, synaptic membrane protein of neurons (can help schwann cells myelinate neurons). *PrPc = nonpathogenic cellular form. *PrPSc = pathogenic form - aggregates to form rod-like particles (brain homogenates of PrPSc cause disease upon injection).
Term
what characterizes the aggregates formed by prions?
Definition
they form aggregates w/a high degree of beta pleated sheet conformation - makes them very difficult to digest by proteases. 10% form amyloid plaques which simply describes non specific protein accumulation (different than amyloid beta plaques seen in alzheimer's).
Term
what characterizes the PrPc prion form?
Definition
45% alpha helix, no beta sheet. protease sensitive. soluble in nondenaturing agents.
Term
what characterizes the PrPSc prion form?
Definition
30% alpha helix, 45% beta sheet. protease resistant. insoluble in nondenaturing agents.
Term
how was prion disease determined to be different than that due to a virus?
Definition
agents which work against proteins (denaturing agents) affected PrPSc, but had no effect on viruses. enzymatic tx using DNAase/RNAase had no effect on prions, but did on viruses. determined that the scrapie prion is different than a virus.
Term
what does it mean to say prions are well conserved w/in animal populations?
Definition
each species makes its own conformation of prion. the BSE (bovine spongiform encephalopathy) prion has high homology to the human form - meaning it can cause human disease (new variant CJD).
Term
can there be a genetic predisposition for developing prion disease?
Definition
yes, but this is rare. usually due to inherited point mutations or possibly somatic mutations.
Term
what does it mean that prions are resistant to UV radiation?
Definition
this is a good sign that only a protein is involved.
Term
is synthetically produced mutant PrP which contains beta sheet structure and is protease resistance infectious?
Definition
no, this implies a possible chaperone. PrPSc induces a conformational change in PrPc likely using a species specific RNA or some other substance (has been replicated in lab). RNA levels of a specific kind (that for the erythroid differentiation related factor - EDRF) have found to be lower in BSE-infected animals = EDRF may be a good diagnostic marker.
Term
can PrPSc interact w/normal cells?
Definition
yes - it converts normal protein to an abnormal structure which has a high beta pleated sheet conformation (protease resistant). this aggregation eventually kills the cell which is eventually resorbed. astrocytes then wall these areas of resorption off = spongy tissue appearance. **there is not a massive inflammatory response.
Term
what happens if you block (normal) PrPc in a cell (via inhibition of microRNAs)?
Definition
this doesn't seem to affect the body *other than rendering it immune to the effects of PrPSc
Term
what are the animal forms of prion disease?
Definition
scrapie: sheep infected from pasture w/placental tissue carrying the agent?. BSE: due to bone meal from sheep offal for cattle feed. if humans eat the affected sheep they will not get disease, but if they eat cows which ate the sheep = humans will get the disease.
Term
what characterizes kuru?
Definition
brains from people in papau new guinea were found to resemble CJD after they ate CNS parts of dead tribe members. sometimes the disease would present several decades later.
Term
is disease due to prions inflammatory?
Definition
no
Term
what are the 4 types of CJD?
Definition
iatrogenic, familial, sporadic, and new variant.
Term
what characterizes iatrogenic CJD?
Definition
accidental transmission from corneal transplants, contaminated EEG electrodes/sx instruments, dura mater grafts, GH and human gonadotropin (pituitary gland harbors prions). bleach not autoclaving will decontaminate prions.
Term
what characterizes familial CJD?
Definition
this is due to point mutations on chr 20 and only accounts for ~10% of CJD.
Term
what characterizes sporadic CJD?
Definition
this is due to: spontaneous conversion of PrPc -> PrPSc, an environmental insult = somatic mutation, or prions transmitted from an animal. 300 cases in the US. if pts are homozygous in the gene for prion protein which codes for methionine or valine at a particular codon it will increase CJD risk. thought to target the lymphoreticular system (then taken to the nervous system), however PrPSc has been found in muscle tissue as well.
Term
what characterizes new variant CJD?
Definition
this characterizes disease seen in pts who ate beef infected w/BSE. pts were 17-55 y/o, developed late dementia, PrPSc plaques resembled those seen in kuru, but there was **absence of EEG features seen in typical CJD. BSE prions when injected into mice: could get the disease and then extract out the abnormal prions and their conformation was consistent with what was found with BSE cow brain (proven transmissible).
Term
what characterizes the link between CJD and alzheimer's?
Definition
one study found 3-5% of those diagnosed with AD actually had CJD
Term
what is important about chronic wasting disease of elk?
Definition
it was shown that *muscle tissue* from elk w/chronic wasting disease (CJD variant) could infect mice and cause them to produce the same abnormal prions (unknown if this will lead to full-blown CJD).
Term
what is gerstmann-straussler-scheinker disease (GSS)?
Definition
an inherited form of prion disease which shows up in the 4-5th decade. initial symptoms: cerebellar ataxia/motor problems.
Term
what is fatal familial insomnia?
Definition
pts have inability to sleep and dysautonomia - due to severe selective atrophy of the thalamus.
Term
what characterizes incidence of CJD?
Definition
1/1,000,000. usually pts are 40-70 y/o.
Term
what characterizes the pathology due to CJD?
Definition
**non-inflammatory lesions, vacuoles (spongiform degeneration of neurons), astrogliosis, neuronal loss, and ~10% have amyloid plaques containing PrPSc
Term
which cells are thought to take up prion proteins?
Definition
the follicular dendritic cells (in spleen, peyer's patches). this suggests that inflammation and/or infections should reduce the distance between the FDCs and the nerves - facilitating prion disease susceptibility. FDCs positioned naturally close to sympathetic nerves may hasten neuroinvasion.
Term
what are diagnostics for prion disease?
Definition
based on exam of brain tissue, some cases have characteristic EEGs, PrPSc detected immunologically from brain homogenates, prenatal screening for some inherited types, and bioassay (put sample tissue in mouse - takes at least a year). also: Ab testing, histochemistry, western blots, and ELISA.
Term
can PrPSc be transmitted through blood transfusion?
Definition
yes. but leukoreduction can be used to get rid of WBCs - lowers risk of transmission.
Term
what is therapy for CJD?
Definition
nothing yet. tetracycline might inactivate PrPSc. acridine, phenothiazine and psychotropic drugs might stabilize PrPc.
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