Transmission of kuru and Creutzfeldt-Jakob disease to marmoset monkeys

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.

Infectious prion diseases in humans: cannibalism, iatrogenicity and zoonoses

In contrast with other neurodegenerative disorders associated to protein misfolding, human prion diseases include infectious forms (also called transmitted forms) such as kuru, iatrogenic Creutzfeldt-Jakob disease and variant Creutzfeldt-Jakob disease. The transmissible agent is thought to be solely composed of the abnormal isoform (PrP(Sc)) of the host-encoded prion protein that accumulated in the central nervous system of affected individuals. Compared to its normal counterpart, PrP(Sc) is β-sheet enriched and aggregated and its propagation is based on an autocatalytic conversion process. Increasing evidence supports the view that conformational variations of PrP(Sc) encoded the biological properties of the various prion strains that have been isolated by transmission studies in experimental models. Infectious forms of human prion diseases played a pivotal role in the emergence of the prion concept and in the characterization of the very unconventional properties of prions. They provide a unique model to understand how prion strains are selected and propagate in humans. Here, we review and discuss how genetic factors interplay with strain properties and route of transmission to influence disease susceptibility, incubation period and phenotypic expression in the light of the kuru epidemics due to ritual endocannibalism, the various series iatrogenic diseases secondary to extractive growth hormone treatment or dura mater graft and the epidemics of variant Creutzfeldt-Jakob disease linked to dietary exposure to the agent of bovine spongiform encephalopathy.

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.

Experimental kuru in Macaca nemestrina: new anatomical data

In Macaca nemestrina inoculated intracerebrally by a pin-point injection with a strain of kuru Kupenota (2nd passage), the lesions consisted of spongiosis of neuropile with severe astrocytic hyperplasia, located in the grey matter of cerebral hemispheres (cortex, neostriatum). In all cases, the distribution of lesions was asymmetrical, predominating on the side of injection. These results suggest that kuru agent could be replicate around the injection site, but the influence of the host and/or the strain could not be excluded.

Neurologic involvement in seven patients with Behçet's disease

Of 25 patients with Behçet's disease seen in five years at the Mayo Clinic, seven had central nervous system involvement. The mean interval from onset of Behçet's disease to central nervous system involvement was 1.3 years, and the mean period of observation thereafter was 3.8 years. All patients had headache and fever during or preceding exacerbations of the central nervous system disease, and all had cerebrospinal fluid pleocytosis (white cell counts ranged from 6 to 490/mm3) with predominant lymphocytosis. The mean cerebrospinal fluid protein level was 55 mg/dl, and gamma globulin was less than 15 per cent in six patients. Results of cerebrospinal fluid, lesional and serologic studies for bacterial, fungal and viral agents were negative. Clinical findings included corticospinal tract disease (five patients), cerebellar ataxia (four patients), pseudobulbar palsy (three patients) and transient ocular palsies (three patients). All these occurred in concert with the systemic phases, especially aphthosis. Corticosteroid therapy was used in six patients, cyclophosphamide therapy in two and azathioprine therapy in two. The neurologic manifestations tended to recur when dosages of the drugs were lowered and established central nervous system damage could not be reversed. The case histories suggest that steroids, when used promptly and in sufficient dosage (up to 60 mg prednisone), are effective in reducing or preventing progression of central nervous system disease. Three patients died, one from Pneumocystis carinii infection, one from neurologic disease and another from presumed myocardial infarction. The central nervous system involvement in Behçet's disease should be diagnosed earlier, and it can be if attention is given to other systemic criteria, that is, aphthous stomatitis, aphthous genital lesions, cutaneous vasculitis, uveitis and synovitis.