Experimental challenge of cattle with German atypical bovine spongiform encephalopathy (BSE) isolates

For almost two decades after the discovery of the first bovine spongiform encephalopathy (BSE) case, it was generally accepted that only one BSE strain existed globally. However, in 2004, two novel BSE forms (L-type and H-type) were separately identified in two different European Member States, forms that differed from the classical (C-type) form by their biochemical properties and by the pattern of PrP(Sc) deposition as determined by immunohistochemistry (IHC). 60 atypical BSE cases have been identified worldwide as of November 2010, including one H- and one L-type BSE case each in Germany. However, it was not known whether the biological properties (pathogenesis and agent distribution, as well as transmissibility to other species) of these novel forms were the same as in classical BSE cases. Eleven calves were thus challenged intracranially, five with the German H-type and six with German L-type BSE cases. The experimental design and the clinical studies, followed by laboratory testing, are described in this manuscript.

Value of prenatal ultrasound and magnetic resonance imaging in assessment of congenital primary cytomegalovirus infection

OBJECTIVE

To evaluate the outcome of pregnancies with proven and well-dated primary cytomegalovirus (CMV) infection with and without abnormal fetal ultrasound and magnetic resonance imaging (MRI) findings.

METHODS

This was a prospective study of 38 singleton pregnancies with proven vertical transmission of CMV and prenatal ultrasound and MRI examinations. Entry requirements included precise dating of the pregnancy and known time of maternal infection. Neonatal follow-up was a strict requirement, all neonates having eye fundus examination, a brain ultrasound scan and a hearing evaluation. All children were followed up by specialists in child development.

RESULTS

Primary CMV infection occurred during the first trimester in 10 patients, the second trimester in 19 and the third trimester in nine. Twenty-four of 29 patients with first- or second-trimester infections delivered; the other five underwent termination of pregnancy (TOP). Three patients had abnormal sonographic findings with normal MRI. Of these, two had damage to the auditory system. In both cases, infection occurred during the first trimester. In 16 patients with first- or second-trimester infection, both ultrasound and MRI exams were normal; there was one TOP but all other cases had favorable outcome, with normal hearing and developmental evaluations. The outcome of five pregnancies with subtle MRI findings and normal ultrasound exam was also favorable. None of the children infected during the third trimester was affected.

CONCLUSION

The outcome of congenital primary CMV infection with normal prenatal ultrasound and MRI exams is favorable. The prognostic value of subtle MRI findings is limited and when such findings are isolated, termination of pregnancy is unlikely to be justified.

Intraoperative assessment of kidney allograft perfusion by laser-assisted indocyanine green fluorescence videography

BACKGROUND

Kidney allograft function crucially depends on the quality of organ perfusion. Duplex sonography, however, frequently reveals hypoperfused segments that remained undetectable to visual inspection intraoperatively. To date, no imaging system supplementing the surgeon's experience has achieved clinical acceptance. The present work examines whether laser-assisted indocyanine green (ICG) fluorescence-videography can be used as a safe and sensitive technique for the intraoperative assessment of renal allograft perfusion.

METHODS

Intraoperative assessment of organ perfusion by laser-assisted ICG fluorescence videography (IC-VIEW) was performed in 10 consecutive de novo renal transplantations. The IC-VIEW system allows the visualization of graft perfusion by the fluorescein dye ICG that emits infrared light after exposure to laser light.

RESULTS

Perfusion measurements were successful in all 10 transplant recipients. Fluorescence videography produced brilliant, sharply contrasted images of the organs, allowing the detection of even small perfusion deficits. Remarkably, this technique detected 1 large perfusion defect that had remained imperceptible to visual inspection. Repositioning of the graft led to a homogeneous overall perfusion. There were no complications with the ICG injection or the imaging device.

CONCLUSION

Laser-assisted ICG fluorescence videography is a feasible and safe technique for the intraoperative assessment of renal allograft perfusion.

The macromolecular neutron diffractometer (MaNDi) at the Spallation Neutron Source, Oak Ridge: enhanced optics design, high-resolution neutron detectors and simulated diffraction

The macromolecular neutron diffractometer MaNDi is currently under construction at the first target station of the Spallation Neutron Source at Oak Ridge National Laboratory. This instrument will collect neutron diffraction data from small single crystals (0.1–1 mm3) with lattice constants between 100 and 300 Å, as well as data from less well ordered systems such as fibers. A focusing neutron guide has been designed to filter the high-energy neutron component of the spectrum and to provide a narrow beam with a wide spectral window and angular divergence almost insensitive to neutron wavelength. The system includes a final interchangeable section of neutron guide and two slits, which enable tuning of the horizontal and vertical beam divergence between 0.12 and 0.80° (full width at half-maximum) at the sample position. This allows the trading of intensity for resolution, depending on the scientific requirements. Efforts to enhance and develop suitable high-resolution neutron detectors at an affordable price are also discussed. Finally, the parameters of the neutron guide and detectors were used to simulate diffraction from a large unit cell.

HIV-induced immune activation: pathogenesis and clinical relevance - summary of a workshop organized by the German AIDS Society (DAIG e.v.) and the ICH Hamburg, Hamburg, Germany, November 22, 2008

This manuscript is communicated by the German AIDS Society (DAIG) http://www.daignet.de. It summarizes a series of presentations and discussions during a workshop on immune activation due to HIV infection. The workshop was held on November 22^nd 2008 in Hamburg, Germany. It was organized by the ICH Hamburg under the auspices of the German AIDS Society (DAIG e.V.).

Effect of targeting normal fasting glucose levels with basal insulin glargine on glycaemic variability and risk of hypoglycaemia: a randomized, controlled study in patients with early Type 2 diabetes

AIMS

The purpose of this sub-study of the Outcome Reduction with Initial Glargine Intervention (ORIGIN) trial was to determine efficacy and safety of targeting normal fasting plasma glucose (FPG) levels in patients with early Type 2 diabetes treated with insulin glargine in comparison with standard care.

METHODS

Participants were randomly allocated to insulin or standard care. Insulin was titrated to reach FPG <or= 5.3 mmol/l. Two years after randomization in a small subset (43 glargine, 32 standard care), continuous glucose measurement (CGMS System Gold), including a test meal, was performed. Sixteen volunteers with normal oral glucose tolerance test (OGTT) served as control subjects. Objectives were glycaemic variability, standard deviation (sd), mean amplitude of glucose excursion (MAGE) with postprandial glucose excursion after the test meal, time spent < 3.0 mmol/l interstitial glucose.

RESULTS

Participants allocated to insulin and standard care had FPG levels of 5.3 and 6.1 mmol/l (P = 0.019) and glycated haemoglobin (HbA(1c)) 5.7% and 5.9%, respectively (P < 0.025). Time (min/24 h) spent at low glucose levels was not significantly different between groups (30.6 +/- 83.8 min control subjects, 33.7 +/- 75.1 min insulin, 10.6 +/- 50.6 min standard care). Standard deviation and MAGE were similar for glargine and standard care, but significantly higher than in control subjects. If FPG was < 5.3 mmol/l, the postprandial glucose excursion was in the range seen in control subjects.

CONCLUSIONS

Treatment to target of FPG < 5.3 mmol/l with insulin glargine was not associated with significantly increased risk of hypoglycaemia. Strict control of FPG with insulin glargine was effective to control postprandial glucose excursion, but had no significant effect on sd and MAGE.

Treatment during primary HIV infection does not lower viral set point but improves CD4 lymphocytes in an observational cohort

Objective

To investigate if early treatment of primary HIV-1 infection (PHI) reduces viral set point and/or increases CD4 lymphocytes.

Methods

Analysis of two prospective multi-centre PHI cohorts. HIV-1 RNA and CD4 lymphocytes in patients with transient treatment were compared to those in untreated patients. Time to CD4 lymphocyte decrease below 350/μl after treatment stop or seroconversion was calculated using Kaplan-Meier and Cox-PH-regression analyses.

Results

156 cases of PHI were included, of which 100 had received transient HAART (median treatment time 9.5 months) and 56 remained untreated. Median viral load (563000 cop/ml vs 240000 cop/ml; p < 0.001) and median CD4 lymphocyte (449/μl vs. 613/μl; p < 0.01) differed significantly between treated and untreated patients. Median viral load was 38056 copies/ml in treated patients (12 months after treatment stop) and 52880 copies/ml in untreated patients (12 months after seroconversion; ns). Median CD4 lymphocyte change was +60/μl vs. -86/μl (p = 0.01). Median time until CD4 lymphocytes decreased to < 350/μl (including all patients with CD4 lymphocytes < 500/μl during seroconversion) was 20.7 months in treated patients after treatment stop and 8.3 months in untreated patents after seroconversion (p < 0.01). Cox-PH analyses adjusting for baseline VL, CD4 lymphocytes, stage of early infection and symptoms confirmed these differences.

Conclusions

Treatment during PHI did not lower viral set point. However, patients treated during seroconversion had an increase in CD4 lymphocytes, whereas untreated patients experienced a decrease in CD4 lymphocytes. Time until reaching CD4 lymphocytes < 350/μl was significantly shorter in untreated than in treated patients including patients with CD4 lymphocytes < 500/μl during seroconversion.

Stability of the circular Couette flow of a ferrofluid in an axial magnetic field: influence of polydispersity

The gap between two concentric rotating cylinders is filled with a ferrofluid. A homogeneous magnetic field is applied parallel to the cylinder axis. The stability of the circular Couette flow is analyzed with different models that take into account the polydispersity of the ferrofluid to a varying degree. Their results are compared and their merits are discussed.

MR imaging of familial Creutzfeldt-Jakob disease: a blinded and controlled study

BACKGROUND AND PURPOSE

The E200K mutation of the PRNP (prion protein) gene is the most common cause of familial Creutzfeldt-Jakob disease (fCJD), which has imaging and clinical features that are similar to the sporadic form. The purpose of this study was to conduct a controlled and blinded evaluation of the sensitivity and specificity of MR imaging in this unique population.

MATERIALS AND METHODS

We compared the MR imaging characteristics of 15 early stage familial CJD patients (age, 60 +/- 7 years) with a group of 22 healthy subjects from the same families (age, 61 +/- 8 years). MR imaging included diffusion-weighted imaging (DWI), T2-weighted fast spin-echo imaging, and a fluid-attenuated inversion recovery (FLAIR) sequence. The scans were rated for abnormalities by an experienced neuroradiologist blind to diagnosis, group assignment, age, and sex.

RESULTS

Thirteen of 15 fCJD subjects had abnormal MR imaging. FLAIR signal intensity abnormality in the caudate or putamen nuclei demonstrated a sensitivity of 87% and specificity of 91%. DWI abnormality in the caudate nucleus showed a sensitivity of 73% and a specificity of 100%. Abnormalities in the thalamus (6 patients), cingulate gyrus (6 patients), frontal lobes (4 patients), and occipital lobes (3 patients) were best detected with DWI. No signal intensity abnormalities were demonstrated in the cerebellum. T2-weighted and T1-weighted sequences were uninformative.

CONCLUSIONS

FLAIR and DWI abnormalities in the caudate nucleus and putamen offer the best sensitivity and specificity for diagnosing fCJD. Our findings support recent recommendations that MR imaging should be added to the diagnostic evaluation of CJD.

Immunolocalisation of the uterine secretory proteins uterocalin, uteroferrin and uteroglobin in the mare's uterus and placenta throughout pregnancy

Previous studies have shown that the equine uterus produces many progesterone-dependent proteins throughout gestation. In particular, uterocalin and uteroferrin are detectable using electrophoresis or blot analyses but information regarding the immunohistochemical placental distribution of these two proteins is rare and information regarding uteroglobin is still lacking. The aim of the present study was to co-immunolocalise these three secretory proteins in the mare's uterus throughout gestation in an effort to understand their functional role in the maintenance of pregnancy. Therefore, endometrial biopsy samples were obtained from 20 pregnant mares between 16 and 309 days of gestation and labelled immunohistochemically for uteroglobin, uteroferrin and uterocalin. Uteroferrin remained detectable in almost every endometrial gland at all stages but with an increase in staining intensity as gestation advanced. The most progesterone-dependent protein, uterocalin, showed variable staining throughout gestation with the most intense labelling in early pregnancy and during the period of endometrial cup reaction. Uteroglobin secretion was only detectable in traces and only in individual glands throughout gestation. The results indicate that uterocalin and uteroferrin, but not uteroglobin, may play important roles in supplying nutrients for the conceptus, thereby contributing to the maintenance of pregnancy. However, further investigations are necessary to understand the role of uteroglobin during gestation.

Kinetics of G-protein-coupled receptor signals in intact cells

G-protein-coupled receptors (GPCRs) are the largest group of cell surface receptors. They are stimulated by a variety of stimuli and signal to different classes of effectors, including several types of ion channels and second messenger-generating enzymes. Recent technical advances, most importantly in the optical recording with energy transfer techniques--fluorescence and bioluminescence resonance energy transfer, FRET and BRET--, have permitted a detailed kinetic analysis of the individual steps of the signalling chain, ranging from ligand binding to the production of second messengers in intact cells. The transfer of information, which is initiated by ligand binding, triggers a signalling cascade that displays various rate-controlling steps at different levels. This review summarizes recent findings illustrating the speed and the complexity of this signalling system.

[Psychosomatic rehabilitation of in-patients with somatoform disorders and of patients with social-medically relevant problems: results of a two-year follow-up]

The success of psychosomatic rehabilitation based on psychoanalytical therapy was analyzed within the framework of a two-year follow-up in patients with somatoform disorders and in patients with social-medically relevant problems, who had been on sick leave for more than six months. Both groups of patients are often considered to be difficult. They were compared with patients of other diagnostic categories and with patients with shorter periods of sick leave. All in all, the physical and mental state of health showed lasting improvement, and demands on the health service and frequency of days off sick decreased. Patients with somatoform disorders partly proved to be more seriously affected at the time of admission, treatment outcomes, however, were to a great extent comparable to patients of other diagnostic categories. Patients who had been on sick leave for more than six months were found to have been more seriously affected at the time of admission and also to have been unable to benefit from rehabilitation to the same degree as those with shorter periods of sick leave. The success of rehabilitation does not seem to depend so much on diagnostic categories but rather on the duration of disablement. In cases of inability to work a specific treatment that pays greater attention to the somatic concept of illness as well as the low level of motivation for psychotherapy in this patient group could lead to better treatment outcomes.

Übertragbare spongiforme Enzephalopathien bei Tieren – ein Update

Scrapie bei Schafen und Ziegen ist seit mehr als 250 Jahren bekannt. Dennoch rückte die Gruppe der transmissiblen spongiformen Enzephalopathien (TSE) erst nach dem Auftreten der bovinen spongiformen Enzephalopathie (BSE) im Vereinigten Königreich Ende der 1980er Jahre und dem einige Jahre später geführten Nachweis der übertragbarkeit des BSE-Erregers auf den Menschen in den 1990er Jahren vermehrt in das wissenschaftliche und öffentliche Interesse.Weltweit wurden mehr als 180000 BSE-Fälle bei Rindern diagnostiziert, davon die überwiegende Zahl im Vereinigten Königreich. Diese massive Infektion von Tieren mit dem BSE-Erreger erfolgte durch die unzureichende Inaktivierung und Verfütterung kontaminierter Futtermittel tierischen Ursprungs. Angesichts der seit 2001 zurückgehenden Zahl von BSE-Fällen in der gesamten EU und seit 2002 auch in Deutschland scheint das BSE-Geschehen bei Rindern heute unter Kontrolle. Anders verhält es sich mit den Scrapie-Fällen bei kleinen Wiederkäuern, deren endemische Verbreitung in den meisten EU-Mitgliedsstaaten durch die Einführung eines aktiven überwachungsprogramms aufgedeckt wurde. Dieses Programm führte auch zur Feststellung so genannter atypischer Scrapiefälle. Atypische Scrapie-Ausbrüche wurden bis dato in fast allen EU-Mitgliedsstaaten und zahlenmäßig häufiger als klassische Scrapie-Ausbrüche diagnostiziert. Daneben wurden mittlerweile auch zwei weitere BSE-Typen gefunden, die sich von den vom Vereinigten Königreich ausgangenen Fällen unterscheiden. Dieser Artikel fasst die aktuellen Erkenntnisse zur Epidemiologie, Pathogenese und Diagnostik von Scrapie und BSE zusammen.

Unintentional exposure of neonates to conventional radiography in the Neonatal Intensive Care Units

OBJECTIVE

To evaluate the extent of unintentional exposure to X-rays performed during routine diagnostic procedures in the Neonatal Intensive Care Units (NICUs).

STUDY DESIGN

During a 1-month period, 157 consecutive neonates from five level-III NICUs were recruited for this study. The mean birth weight was 1747+/-911 g (range: 564-4080 g), and gestational age was 31.6+/-3.6 weeks (range: 24-41 weeks). A total of 500 radiographs were performed including chest (68%), abdomen (17%) and combined chest and abdomen (15%). The average number of radiographs taken per infant was 4.2+/-3.6 (range: 1-21). Unintentional inclusion of body regions other than those ordered was determined by comparing the areas that should be included in the radiation field according to International recommendations, to those that appeared in the actual radiograph.

RESULT

A comparison of the recommended borders to the actual boundaries of the radiographs taken show an additional exposure to radiation in all three procedures: 85% of chest radiographs also included the whole abdomen, 64% of abdomen radiographs included both thigh and upper chest and 62% of chest and abdomen radiograph included the thigh. (The range in all procedures was from ankle to upper head.) Between 2 and 20% of the relevant targeted body tissues were not included in the exposed fields resulting in missing data. The gonads of both sexes were exposed in 7% in all chest X-rays. Among male infants, the testes were exposed in 31% of plain abdomen radiographs and 34% of chest and abdomen radiographs.

CONCLUSION

In the NICUs participating in the study, neonates are currently being exposed to X-ray radiation in nonrelevant body regions. Higher awareness and training of the medical teams and radiographers are required to minimize unnecessary exposure of newborns to ionizing radiation.

Maintenance of indinavir by dose adjustment in HIV-1-infected patients with indinavir-related toxicity

OBJECTIVE

Treatment with indinavir/ritonavir (IDV/RTV) is very effective but hampered by frequent development of IDV-associated adverse events (mainly nephrotoxicity and skin changes). We tested whether dose reduction of IDV guided by therapeutic drug monitoring resulted in improved tolerability without compromising antiviral efficacy.

PATIENTS

HIV-infected patients with any IDV/RTV regimen who suffer from IDV-related adverse events were included. Viral load had to be adequately controlled for at least 2 months prior to inclusion. Dose reduction from 800 mg to 600 or 400 mg IDV b.i.d. followed a specified protocol. IDV-related toxicity and IDV plasma concentrations were monitored for 24 weeks. IDV concentrations were quantified with a validated high performance liquid chromatography method.

RESULTS

Twenty patients were included. Reasons for inclusion were: skin abnormalities 11, nephrotoxicity five, metabolic disturbances three, and hypertension one. IDV dose could be lowered to 400 mg b.i.d. in 13, to 600 mg b.i.d. in two patients. Five patients discontinued the treatment. Overall tolerability improved with respect to incidence and severity of adverse events. Median trough concentrations decreased from 1.02 mg/l (range 0.08-7.1) at baseline to 0.48 mg/l (0.11-1.4) after 24 weeks (p = 0.03) and remained above the critical threshold of 0.1 mg/l at any time after dose reduction. There was no change of CD4 cell counts or viral suppression. There were no significant changes in other laboratory parameters (creatinine, bilirubin, triglycerides, cholesterol, blood count, and urinalysis).

CONCLUSION

Dose reduction of IDV improved tolerability of IDV-containing highly active antiretroviral treatment (HAART). Sufficient IDV trough concentrations were maintained in all patients as was virologic control.

Heparanase and Survivin—potential markers of aggressiveness of colon cancers

14524

Background: Survivin is an inhibitor of apoptosis and specifically expressed in several human cancers. Heparanase seems to play an important role in cancer metastasis, angiogenesis and regulation of COX-2 expression. The purpose of this pilot study was to evaluate whether there is a difference in the level of survivin and heparanase expression in paraffin-embedded tissue from patients with colon cancer with and without metastasis. Methods: Paraffin-embedded tissue samples were obtained from 32 patients with primary colon tumors with (n = 15) and without liver metastases (n = 17) at the time of diagnosis. After laser capture microdissection direct quantitative real-time reverse transcriptase PCR (RT-PCR, TaqMan™) assays were performed in triplicates to determine survivin and heparanase gene expression levels. Gene expression was normalized with beta-Actin. Decision tree analysis was used to assess whether higher levels of these genes are associated with the existence of metastasis. Results: Neither survivin nor heparanase gene expression alone showed a significant relationship with the pM-Stage, although the detection levels of heparanase showed a tendency towards significant correlation with the existence of liver metastasis (p = 0.06). Decision tree analysis was used to split patients into two groups based on cut-off values of gene expression most closely associated with the pM-stage. The groupings determined by this analysis were significantly differently correlated with metastasis by Spearman’s test (p=0.03). Conclusions: Our results show that high expression levels of both survivin and heparanase in paraffin- embedded tissue are significantly correlated with the pM-Stage in this patient cohort. In conclusion, using intratumoral survivin and heparanase gene expression levels might be useful to identify patients at risk for liver metastasis. Prospective and larger clinical studies are warranted to validate our preliminary findings.

No significant financial relationships to disclose.

Evolving characteristics of toxoplasmosis in patients infected with human immunodeficiency virus-1: clinical course and Toxoplasma gondii-specific immune responses

Toxoplasmic encephalitis (TE) is the most important opportunistic infection of the central nervous system in patients infected with human immunodeficiency virus (HIV)-1. This study evaluated the effect of highly active anti-retroviral therapy (HAART) and Toxoplasma gondii-specific immune responses on the occurrence of TE. The clinical characteristics of all patients diagnosed with TE in two centres since 1990 (n = 140) were analysed. Patients were grouped according to the date of diagnosis (period 1, 1990-1993; period 2, 1994-1996; period 3, 1997 onwards). Immune responses to T. gondii were evaluated in a subgroup (n = 12) by interferon (IFN)-gamma-specific ELISPOT tests. There were marked differences in the estimated Kaplan-Meier overall survival (OS), with a 1-year OS (5-year OS) of 41% (7%) in period 1, 56% (29%) in period 2, and 90% (78%) in period 3 (p <0.0001). In period 3, TE was found to be the first AIDS-defining illness more frequently than in earlier periods (74% vs. 38%, p 0.0002). Persistent neurological deficits caused by TE were present in 37% of the patients. Patients with an acute episode of TE or a TE relapse had significantly lower responses in the T. gondii-specific ELISPOT than patients who discontinued maintenance therapy and were relapse-free (p 0.0044). Survival of HIV patients with TE has improved markedly since the introduction of HAART, but persistent neurological deficits are often present in surviving patients. While preventive therapy remains essential, evaluation of T. gondii-specific immune responses may be an important step in improving estimates of the individual risk of TE and TE relapses.

Use of quantum-point-contact high-electron-mobility-transistors for time domain multiplexing of large arrays of high impedance low temperature bolometers

The use of a multiplexing readout for an array of bolometers simplifies the electronics and wiring, so making the readout of large arrays of bolometers (>100) feasible. Here we describe a time domain multiplexing technique and its performance based on the use of quantum-point-contact high-electron-mobility-transistors as low temperature (to approximately 100 mK) switches for measuring high impedance (5...70 MOmega) resistances and sensors. The presented system is well matched to ground based millimetric astronomy demands.

Prenatal diagnosis of malformations of cortical development by dedicated neurosonography

OBJECTIVE

Malformations of cortical development (MCD) are rarely diagnosed in utero. We describe and compare the ultrasonographic and pathology findings in a cohort of fetuses with MCD.

METHODS

Fetuses with MCD were identified among all fetuses evaluated for suspected brain anomalies at the Fetal Neurology Clinic, and the ultrasonographic findings were compared with the results of the pathology examination.

RESULTS

We suspected the presence of MCD by ultrasonography in 23 fetuses. The mean gestational age at the time of ultrasound diagnosis was 26.2 (range, 18-40) weeks. The ultrasonographic findings leading to the diagnosis of MCD were abnormally overdeveloped gyri and sulci for gestational age (n = 7), delay in sulcation (n = 5), abnormally thin cortex (n = 5) abnormally wide and broad sulci (n = 3), bulging into the lateral ventricle (n = 1), cortical cleft (n = 1), and multiple intraparenchymal echogenic nodules (n = 1). All fetuses had associated central nervous system (CNS) and/or non-CNS anomalies. Pathology examination (performed in 17 fetuses) confirmed MCD in 16.

CONCLUSIONS

Cortical malformations can be diagnosed in utero by ultrasonography based on the presence of specific deviations from the normal pattern of development. The identified cases may represent the more severe forms in the MCD spectrum. The pathology findings do not always conform to the current classification systems of MCD but help in differentiating between possible genetic and acquired etiologies and in some cases provide a definitive syndromic diagnosis.

Atypical BSE in Germany--proof of transmissibility and biochemical characterization

Intensive active surveillance has uncovered two atypical German BSE cases in older cattle which resemble the two different atypical BSE phenotypes that have recently been described in France (designated H-type) and Italy (designated L-type or BASE). The H-type is characterized by a significantly higher molecular size, but a conventional glycopattern of the proteinase K treated abnormal prion protein (PrP(Sc)), while the L-type PrP(Sc) has only a slightly lower molecular size and a distinctly different glycopattern. In this paper we describe the successful transmission of both German atypical BSE cases to transgenic mice overexpressing bovine PrP(C). Upon challenge with the L-type, these mice developed BSE after a substantially shorter incubation period than any classical BSE transmission using these mice to date. In contrast, the incubation period was distinctly prolonged when these mice were challenged with the H-type. PrP(Sc) accumulated in the brains of these mice were of the same atypical BSE type that had been used for the transmission. These atypical cases suggest the possible existence of sporadic BSE cases in bovines. It is thus feasible that the BSE epidemic in the UK could have also been initiated by an intraspecies transmission from a sporadic BSE case.