An unusual structure in Kuru brain

Kuru, the First Human Prion Disease

Kuru, the first human prion disease was transmitted to chimpanzees by D. Carleton Gajdusek (1923–2008). In this review, we summarize the history of this seminal discovery, its anthropological background, epidemiology, clinical picture, neuropathology, and molecular genetics. We provide descriptions of electron microscopy and confocal microscopy of kuru amyloid plaques retrieved from a paraffin-embedded block of an old kuru case, named Kupenota. The discovery of kuru opened new vistas of human medicine and was pivotal in the subsequent transmission of Creutzfeldt–Jakob disease, as well as the relevance that bovine spongiform encephalopathy had for transmission to humans. The transmission of kuru was one of the greatest contributions to biomedical sciences of the 20th century.

Kuru: a journey back in time from papua new Guinea to the neanderthals' extinction

Kuru, the first human transmissible spongiform encephalopathy was transmitted to chimpanzees by D. Carleton Gajdusek (1923-2008). In this review, I briefly summarize the history of this seminal discovery along its epidemiology, clinical picture, neuropathology and molecular genetics. The discovery of kuru opened new windows into the realms of human medicine and was instrumental in the later transmission of Creutzfeldt-Jakob disease and Gerstmann-Sträussler-Scheinker disease as well as the relevance that bovine spongiform encephalopathy had for transmission to humans. The transmission of kuru was one of the greatest contributions to biomedical sciences of the 20th century.

Kuru: genes, cannibals and neuropathology

Kuru was the first human transmissible spongiform encephalopathy (TSE) or prion disease identified, occurring in the Fore linguistic group of Papua New Guinea. Kuru was a uniformly fatal cerebellar ataxic syndrome, usually followed by choreiform and athetoid movements. Kuru imposed a strong balancing selection on the Fore population, with individuals homozygous for the 129 Met allele of the gene (PRNP) encoding for prion protein (PrP) being the most susceptible. The decline in the incidence of kuru in the Fore has been attributed to the exhaustion of the susceptible genotype and ultimately by discontinuation of exposure via cannibalism. Neuropathologically, kuru-affected brains were characterized by widespread degeneration of neurons, astroglial and microglial proliferation, and the presence of amyloid plaques. These early findings have been confirmed and extended by recent immunohistochemical studies for the detection of the TSE-specific PrP (PrP). Confocal laser microscopy also showed the concentration of glial fibrillary acidic protein-positive astrocytic processes at the plaque periphery. The fine structure of plaques corresponds to that described earlier by light microscopy. The successful experimental transmission of kuru led to the awareness of its similarity to Creutzfeldt-Jakob disease and Gerstmann-Sträussler-Scheinker disease and formed a background against which the recent epidemics of iatrogenic and variant Creutzfeldt-Jakob disease could be studied.

Human prion diseases: from Kuru to variant Creutzfeldt-Jakob disease

Transmissible spongiform encephalopathies (TSEs) or prion diseases are the names given to the group of fatal neurodegenerative disorders that includes kuru, Creutzfeldt-Jakob disease (CJD), Gerstmann-Sträussler-Scheinker disease (GSS), fatal and sporadic familial insomnia and the novel prion disease variable protease-sensitive prionopathy (PSPr) in humans. Kuru was restricted to natives of the Foré linguistic group in Papua New Guinea and spread by ritualistic endocannibalism. CJD appears as sporadic, familial (genetic or hereditary) and infectious (iatrogenic) forms. Variant CJD is a zoonotic CJD type and of major public health importance, which resulted from transmission from bovine spongiform encephalopathy (BSE) through ingestion of contaminated meat products. GSS is a slowly progressive hereditary autosomal dominant disease and the first human TSE in which a mutation in a gene encoding for prion protein (PrP) was discovered. The rarest human prion disease is fatal insomnia, which may occur, in genetic and sporadic form. More recently a novel prion disease variable protease-sensitive prionopathy (PSPr) was described in humans.TSEs are caused by a still incompletely defined infectious agent known as a "prion" which is widely regarded to be an aggregate of a misfolded isoform (PrP(Sc)) of a normal cellular glycoprotein (PrP(c)). The conversion mechanism of PrP(c) into PrP(Sc) is still not certain.

Tubulovesicular structures: what are they really?

The tubulovesicular structures (TVS) are the only structures unique at the level of thin-section electron microscopy for all TSEs so far examined. They were first described in NIH Swiss mice infected intracerebrally with the "Chandler" strain of scrapie by David-Ferreira et al. in 1968 [Proc. Soc. Exp. Biol. Med. 127:313-320]. TVS were described as "particles and rods ranging in diameter from 320 to 360 A(o)." The exact topology of TVS is not entirely clear. In most published electron micrographs, TVS appeared as spheres measuring between 20 and 40 nm in diameter. The number of neuritic processes containing TVS increases through the incubation period and has been shown to correlate with the incubation period and titre of infectivity in three longitudinal disease studies of scrapie and CJD. These studies, therefore, suggest that TVS may represent a primary pathogenetic event rather than a pathological product of disease. The predominant theory of the scrapie agent is now the "prion hypothesis" and its derivatives, which implies that a conformationally altered abnormal isoform (PrP(Sc) or PrP*) of a normal cellular membrane glycoprotein (PrP(c)) is the agent and its accumulation merely mimicks replication. If an abnormal fraction of PrP is indeed the infectious agent, (although it is no longer suggested in some quarters that protease resistant fraction of PrP(Sc) is the agent). The absence of stainable PrP in TVS, however, would indicate that they are not the ultrastructural correlate of the agent. However, TVS appear to be specific and unique to the TSEs, appearing before the earliest pathological changes and increasing in line with incubation period or titre. The very existence of TVS and their correlation with infectivity, therefore, urgently needs an explanation.

Cerebellar lamellar bodies in two strains of murine scrapie

Lamellar inclusion bodies have been described by other authors in the granular layer of the cerebellum of people suffering from the unconventional slow-virus disease of kuru and were thought to be associated with the disease. In this study, these bodies were also found in mice infected with scrapie, which belongs to the same group of diseases, as well as their age-matched controls.