1
|
Ascari LM, Rocha SC, Gonçalves PB, Vieira TCRG, Cordeiro Y. Challenges and Advances in Antemortem Diagnosis of Human Transmissible Spongiform Encephalopathies. Front Bioeng Biotechnol 2020; 8:585896. [PMID: 33195151 PMCID: PMC7606880 DOI: 10.3389/fbioe.2020.585896] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/28/2020] [Indexed: 12/18/2022] Open
Abstract
Transmissible spongiform encephalopathies (TSEs), also known as prion diseases, arise from the structural conversion of the monomeric, cellular prion protein (PrPC) into its multimeric scrapie form (PrPSc). These pathologies comprise a group of intractable, rapidly evolving neurodegenerative diseases. Currently, a definitive diagnosis of TSE relies on the detection of PrPSc and/or the identification of pathognomonic histological features in brain tissue samples, which are usually obtained postmortem or, in rare cases, by brain biopsy (antemortem). Over the past two decades, several paraclinical tests for antemortem diagnosis have been developed to preclude the need for brain samples. Some of these alternative methods have been validated and can provide a probable diagnosis when combined with clinical evaluation. Paraclinical tests include in vitro cell-free conversion techniques, such as the real-time quaking-induced conversion (RT-QuIC), as well as immunoassays, electroencephalography (EEG), and brain bioimaging methods, such as magnetic resonance imaging (MRI), whose importance has increased over the years. PrPSc is the main biomarker in TSEs, and the RT-QuIC assay stands out for its ability to detect PrPSc in cerebrospinal fluid (CSF), olfactory mucosa, and dermatome skin samples with high sensitivity and specificity. Other biochemical biomarkers are the proteins 14-3-3, tau, neuron-specific enolase (NSE), astroglial protein S100B, α-synuclein, and neurofilament light chain protein (NFL), but they are not specific for TSEs. This paper reviews the techniques employed for definite diagnosis, as well as the clinical and paraclinical methods for possible and probable diagnosis, both those in use currently and those no longer employed. We also discuss current criteria, challenges, and perspectives for TSE diagnosis. An early and accurate diagnosis may allow earlier implementation of strategies to delay or stop disease progression.
Collapse
Affiliation(s)
- Lucas M. Ascari
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stephanie C. Rocha
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Priscila B. Gonçalves
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tuane C. R. G. Vieira
- Institute of Medical Biochemistry Leopoldo de Meis, National Institute of Science and Technology for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yraima Cordeiro
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
2
|
Fiorini M, Iselle G, Perra D, Bongianni M, Capaldi S, Sacchetto L, Ferrari S, Mombello A, Vascellari S, Testi S, Monaco S, Zanusso G. High Diagnostic Accuracy of RT-QuIC Assay in a Prospective Study of Patients with Suspected sCJD. Int J Mol Sci 2020; 21:ijms21030880. [PMID: 32019068 PMCID: PMC7038328 DOI: 10.3390/ijms21030880] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 12/13/2022] Open
Abstract
The early and accurate in vivo diagnosis of sporadic Creutzfeldt–Jakob disease (sCJD) is essential in order to differentiate CJD from treatable rapidly progressive dementias. Diagnostic investigations supportive of clinical CJD diagnosis include magnetic resonance imaging (MRI), electroencephalogram (EEG), 14-3-3 protein detection, and/or real-time quaking-induced conversion (RT-QuIC) assay positivity in the cerebrospinal fluid (CSF) or in other tissues. The total CSF tau protein concentration has also been used in a clinical setting for improving the CJD diagnostic sensitivity and specificity. We analyzed 182 CSF samples and 42 olfactory mucosa (OM) brushings from patients suspected of having sCJD with rapidly progressive dementia (RPD), in order to determine the diagnostic accuracy of 14-3-3, the total tau protein, and the RT-QuIC assay. A probable and definite sCJD diagnosis was assessed in 102 patients. The RT-QuIC assay on the CSF samples showed a 100% specificity and a 96% sensitivity, significantly higher compared with 14-3-3 (84% sensitivity and 46% specificity) and tau (85% sensitivity and 70% specificity); however, the combination of RT-QuIC testing of the CSF and OM samples resulted in 100% sensitivity and specificity, proving a significantly higher accuracy of RT-QuIC compared with the surrogate biomarkers in the diagnostic setting of patients with RPD. Moreover, we showed that CSF blood contamination or high protein levels might interfere with RT-QuIC seeding. In conclusion, we provided further evidence that the inclusion of an RT-QuIC assay of the CSF and OM in the diagnostic criteria for sCJD has radically changed the clinical approach towards the diagnosis.
Collapse
Affiliation(s)
- Michele Fiorini
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
- Correspondence:
| | - Giorgia Iselle
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
| | - Daniela Perra
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
| | - Matilde Bongianni
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
| | - Stefano Capaldi
- Department of Biotechnology, University of Verona, Cà Vignal 1, Strada Le Grazie 15, 37134 Verona, Italy;
| | - Luca Sacchetto
- Surgery, Dentistry, Maternity and Infant Department, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy;
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
| | - Aldo Mombello
- Diagnostics and Public Health Department, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy;
| | - Sarah Vascellari
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy;
| | - Silvia Testi
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
| | - Salvatore Monaco
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
| | - Gianluigi Zanusso
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
| |
Collapse
|
3
|
Kaelber N, Bett C, Asher DM, Gregori L. Quaking-induced conversion of prion protein on a thermal mixer accelerates detection in brains infected with transmissible spongiform encephalopathy agents. PLoS One 2019; 14:e0225904. [PMID: 31830760 PMCID: PMC6908438 DOI: 10.1371/journal.pone.0225904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/14/2019] [Indexed: 11/18/2022] Open
Abstract
Detection of misfolded prion protein, PrPTSE, in biological samples is important to develop antemortem tests for transmissible spongiform encephalopathies (TSEs). The real-time quaking-induced conversion (RT-QuIC) assay detects PrPTSE but requires dedicated equipment and relatively long incubation times when applied to samples containing extremely low levels of PrPTSE. It was shown that a microplate shaker with heated top (Thermomixer-C) accelerated amplification of PrPTSE in brain suspensions of 263K scrapie and sporadic Creutzfeldt-Jakob disease (sCJD). We expanded the investigation to include TSE agents previously untested, including chronic wasting disease (CWD), macaque-adapted variant CJD (vCJD) and human vCJD, and we further characterized the assays conducted at 42°C and 55°C. PrPTSE from all brains containing the TSE agents were successfully amplified using a truncated hamster recombinant protein except for human vCJD which required truncated bank vole recombinant protein. We compared assays conducted at 42°C on Thermomixer-C, Thermomixer-R (without heated top) and on a fluorimeter used for RT-QuIC. QuIC on Thermomixer-R achieved in only 18 hours assay sensitivity similar to that of RT-QuIC read at 60 hours (or 48 hours with sCJD). QuIC on Thermomixer-C required 24 hours to complete and the endpoint titers of some TSEs were 10-fold lower than those obtained with RT-QuIC and Thermomixer-R. Conversely, at 55°C, the reactions with sCJD and CWD on Thermomixer-C achieved the same sensitivity as with RT-QuIC but in shorter times. Human vCJD samples tested at higher temperatures gave rise to high reactivity in wells containing normal control samples. Similarly, reactions on Thermomixer-R were unsuitable at 55°C. The main disadvantage of Thermomixers is that they cannot track formation of PrP fibrils in real time, a feature useful in some applications. The main advantages of Thermomixers are that they need shorter reaction times to detect PrPTSE, are easier to use, involve more robust equipment, and are relatively affordable. Improvements to QuIC using thermal mixers may help develop accessible antemortem TSE tests.
Collapse
Affiliation(s)
- Nadine Kaelber
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, United States of America
| | - Cyrus Bett
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, United States of America
| | - David M. Asher
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, United States of America
| | - Luisa Gregori
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, United States of America
- * E-mail:
| |
Collapse
|
4
|
Paciotti S, Bellomo G, Gatticchi L, Parnetti L. Are We Ready for Detecting α-Synuclein Prone to Aggregation in Patients? The Case of "Protein-Misfolding Cyclic Amplification" and "Real-Time Quaking-Induced Conversion" as Diagnostic Tools. Front Neurol 2018; 9:415. [PMID: 29928254 PMCID: PMC5997809 DOI: 10.3389/fneur.2018.00415] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/22/2018] [Indexed: 11/23/2022] Open
Abstract
The accumulation and deposition of α-synuclein aggregates in brain tissue is the main event in the pathogenesis of different neurodegenerative disorders grouped under the term of synucleinopathies. They include Parkinson's disease, dementia with Lewy bodies and multiple system atrophy. To date, the diagnosis of any of these disorders mainly relies on the recognition of clinical symptoms, when the neurodegeneration is already in an advanced phase. In the last years, several efforts have been carried out to develop new diagnostic tools for early diagnosis of synucleinopathies, with special interest to Parkinson's disease. The Protein-Misfolding Cyclic Amplification (PMCA) and the Real-Time Quaking-Induced Conversion (RT-QuIC) are ultrasensitive protein amplification assays for the detection of misfolded protein aggregates. Starting from the successful application in the diagnosis of human prion diseases, these techniques were recently tested for the detection of misfolded α-synuclein in brain homogenates and cerebrospinal fluid samples of patients affected by synucleinopathies. So far, only a few studies on a limited number of samples have been performed to test PMCA and RT-QuIC diagnostic reliability. Neverthless, these assays have shown very high sensitivity and specificity in detecting synucleinopathies even at the pre-clinical stage. Despite the application of PMCA and RT-QuIC for α-synuclein detection in biological fluids is very recent, these techniques seem to have the potential for identifying subjects that will be likely to develop synucleinopathies.
Collapse
Affiliation(s)
- Silvia Paciotti
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Giovanni Bellomo
- Magnetic Resonance Center (CERM), University of Florence, Sesto Fiorentino, Italy
| | - Leonardo Gatticchi
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Lucilla Parnetti
- Laboratory of Clinical Neurochemistry, Department of Medicine, University of Perugia, Perugia, Italy
| |
Collapse
|
5
|
Berrone E, Corona C, Mazza M, Costassa EV, Faro ML, Properzi F, Guglielmetti C, Maurella C, Caramelli M, Deregibus MC, Camussi G, Casalone C. Detection of cellular prion protein in exosomes derived from ovine plasma. J Gen Virol 2015; 96:3698-3702. [PMID: 26399471 PMCID: PMC4804764 DOI: 10.1099/jgv.0.000291] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 09/18/2015] [Indexed: 01/01/2023] Open
Abstract
Prion protein (PrP) is present at extremely low levels in the blood of animals and its detection is complicated by the poor sensitivity of current standard methodologies. Interesting results have been obtained with recent advanced technologies that are able to detect minute amounts of the pathological PrP (PrPSc), but their efficiency is reduced by various factors present in blood. In this study, we were able to extract cellular PrP (PrPC) from plasma-derived exosomes by a simple, fast method without the use of differential ultracentrifugation and to visualize it by Western blotting, reducing the presence of most plasma proteins. This result confirms that blood is capable of releasing PrP in association with exosomes and could be useful to better study its role in the pathogenesis of transmissible spongiform encephalopathies.
Collapse
Affiliation(s)
- Elena Berrone
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Via Bologna 148, 10154 Turin, Italy
| | - Cristiano Corona
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Via Bologna 148, 10154 Turin, Italy
| | - Maria Mazza
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Via Bologna 148, 10154 Turin, Italy
| | - Elena Vallino Costassa
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Via Bologna 148, 10154 Turin, Italy
| | - Monica Lo Faro
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Via Bologna 148, 10154 Turin, Italy
| | - Francesca Properzi
- Department of Cellular Biology and Neuroscience, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Chiara Guglielmetti
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Via Bologna 148, 10154 Turin, Italy
| | - Cristiana Maurella
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Via Bologna 148, 10154 Turin, Italy
| | - Maria Caramelli
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Via Bologna 148, 10154 Turin, Italy
| | - Maria Chiara Deregibus
- Department of Internal Medicine and Molecular Biotechnology Center, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - Giovanni Camussi
- Department of Internal Medicine and Molecular Biotechnology Center, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - Cristina Casalone
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Via Bologna 148, 10154 Turin, Italy
| |
Collapse
|
6
|
Vetrugno V, Puopolo M, Cardone F, Capozzoli F, Ladogana A, Pocchiari M. The future for treating Creutzfeldt–Jakob disease. Expert Opin Orphan Drugs 2014. [DOI: 10.1517/21678707.2015.994605] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|