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Racine-Brzostek SE, Cushing MM, Gareis M, Heger A, Mehta Shah T, Scully M. Thirty years of experience with solvent/detergent-treated plasma for transfusion medicine. Transfusion 2024; 64:1132-1153. [PMID: 38644541 DOI: 10.1111/trf.17836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/23/2024]
Affiliation(s)
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Michelle Gareis
- Octapharma Pharmazeutika Produktionsges.mb.H, Vienna, Austria
| | - Andrea Heger
- Octapharma Pharmazeutika Produktionsges.mb.H, Vienna, Austria
| | | | - Marie Scully
- Department of Haematology, University College London Hospital, London, UK
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2
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Prion agents (1st section). Transfusion 2024; 64 Suppl 1:S4-S18. [PMID: 38394039 DOI: 10.1111/trf.17627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 02/25/2024]
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Sweetland GD, Eggleston C, Bartz JC, Mathiason CK, Kincaid AE. Expression of the cellular prion protein by mast cells in the human carotid body. Prion 2023; 17:67-74. [PMID: 36943020 PMCID: PMC10038025 DOI: 10.1080/19336896.2023.2193128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
Prion diseases are fatal neurologic disorders that can be transmitted by blood transfusion. The route for neuroinvasion following exposure to infected blood is not known. Carotid bodies (CBs) are specialized chemosensitive structures that detect the concentration of blood gasses and provide feedback for the neural control of respiration. Sensory cells of the CB are highly perfused and densely innervated by nerves that are synaptically connected to the brainstem and thoracic spinal cord, known to be areas of early prion deposition following oral infection. Given their direct exposure to blood and neural connections to central nervous system (CNS) areas involved in prion neuroinvasion, we sought to determine if there were cells in the human CB that express the cellular prion protein (PrPC), a characteristic that would support CBs serving as a route for prion neuroinvasion. We collected CBs from cadaver donor bodies and determined that mast cells located in the carotid bodies express PrPC and that these cells are in close proximity to blood vessels, nerves, and nerve terminals that are synaptically connected to the brainstem and spinal cord.
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Affiliation(s)
- Gregory D. Sweetland
- Department of Pharmacy Sciences, School of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA
| | - Connor Eggleston
- Department of Pharmacy Sciences, School of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA
| | - Jason C. Bartz
- Department of Medical Microbiology and Immunology, School of Medicine, Creighton University, Omaha, NE, USA
| | - Candace K. Mathiason
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Anthony E. Kincaid
- Department of Pharmacy Sciences, School of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA
- Department of Medical Microbiology and Immunology, School of Medicine, Creighton University, Omaha, NE, USA
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Pozzo di Borgo A, Germain M, O'Brien SF, Delage G, Renaud C, Lewin A. Risk of variant Creutzfeldt-Jakob disease in a simulated cohort of Canadian blood donors. Vox Sang 2023; 118:738-745. [PMID: 37463691 DOI: 10.1111/vox.13493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND AND OBJECTIVES No transfusion-associated cases of variant Creutzfeldt-Jakob disease (vCJD) have occurred in more than 20 years. Yet, many countries have maintained blood donor deferral criteria for vCJD. We developed a risk simulation model to reassess the need for vCJD-related deferral criteria in Canada. MATERIALS AND METHODS The model provides results separately for Héma-Québec (HQ) and Canadian Blood Services (CBS). The model used a Monte Carlo simulation approach to estimate the risk of having a vCJD-contaminated blood donation ('risk of vCJD') in a simulated cohort of 10 million donors followed for up to 85 years. The model assumed current deferral criteria for vCJD were lifted, which would allow new 'at-risk' donors to give blood. The model accounted for disease prevalence, donors' travel/immigration history, PRNP genotype at codon 129, demographics and the type of labile blood product. RESULTS In the base case, the risk of vCJD was estimated at zero at both blood services. In the most pessimistic scenario, the risk of vCJD was 6.4 × 10-9 (i.e., 1 in 157 million donations) at HQ, or ≤1 in 77 million based on the upper bound of the 95% confidence interval (CI). At CBS, this risk was 4.8 × 10-8 (i.e., 1 in 21 million donations), or ≤1 in 16 million based on the upper bound of the 95% CI. CONCLUSION vCJD poses minimal risks to the Canadian blood supply. Current vCJD deferral criteria may, therefore, be lifted with virtually no impact on safety, while significantly expanding the donor base.
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Affiliation(s)
| | - Marc Germain
- Medical Affairs and Innovation, Héma-Québec, Québec, Québec, Canada
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Gilles Delage
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
| | - Christian Renaud
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
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Pozzo di Borgo A, Rochette S, Gaussen A, O'Brien SF, Germain M, Renaud C, Lewin A. Transmission of Variant Creutzfeldt-Jakob Disease Through Blood Transfusion and Plasma-Derived Products: A Narrative Review of Observed and Modeled Risks. Transfus Med Rev 2023; 37:150747. [PMID: 37827587 DOI: 10.1016/j.tmrv.2023.150747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 10/14/2023]
Abstract
Secondary transmission of variant Creutzfeldt-Jakob disease (vCJD) can occur through blood transfusion or receipt of plasma-derived products. However, published reviews on this topic are outdated, focused on a single country or product type, or did not comprehensively review modeling studies on the risk of transfusion-transmission. We reviewed existing data on observed and modeled risks of transfusion-transmission of vCJD. To date, five patients are suspected to have acquired clinical vCJD or a vCJD infection after receiving a blood or plasma-derived product from a donor who later developed clinical vCJD. All of these cases received a nonleukodepleted blood-derived product in the United Kingdom between 1994 and 1999. Thus, all transfusion-associated cases occurred before the adoption of universal leukodepletion in 1999, which supports the preferential tropism of vCJD for leukocytes. In descriptive cohort studies, no cases of clinical vCJD were observed over ∼13 years of follow-up. In modeling studies, the risk of collecting a contaminated donation was generally <23 per million donations, that of infection was generally <10 per million transfusions or doses, and that of clinical vCJD was generally <2 per million transfusions or doses. These low risk estimates and the two-decade long absence of new cases of transfusion-associated vCJD suggest vCJD poses minimal risks to the safety of the blood supply. Furthermore, despite concerns of a second wave driven by individuals harboring a non-MM genotype at codon 129 of PRNP, there has been only 1 autopsy-confirmed case of clinical vCJD in an MV individual in 2016. The current trend to reassess or (in some countries) fully withdraw the blood donation criteria related to vCJD therefore seems justified, safe, and may significantly expand the donor base.
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Affiliation(s)
| | - Samuel Rochette
- Medical Affairs and Innovation, Héma-Québec, Montreal, Quebec, Canada.
| | - Amaury Gaussen
- Medical Affairs and Innovation, Héma-Québec, Quebec, Quebec, Canada.
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada.
| | - Marc Germain
- Medical Affairs and Innovation, Héma-Québec, Quebec, Quebec, Canada.
| | - Christian Renaud
- Medical Affairs and Innovation, Héma-Québec, Montreal, Quebec, Canada.
| | - Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Montreal, Quebec, Canada.
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Yakovleva O, Bett C, Pilant T, Asher DM, Gregori L. Abnormal prion protein, infectivity and neurofilament light-chain in blood of macaques with experimental variant Creutzfeldt-Jakob disease. J Gen Virol 2022; 103. [PMID: 35816369 PMCID: PMC10027005 DOI: 10.1099/jgv.0.001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Transmissible spongiform encephalopathies (TSEs) are fatal neurodegenerative infections. Variant Creutzfeldt-Jakob disease (vCJD) and sporadic CJD (sCJD) are human TSEs that, in rare cases, have been transmitted by human-derived therapeutic products. There is a need for a blood test to detect infected donors, identify infected individuals in families with TSEs and monitor progression of disease in patients, especially during clinical trials. We prepared panels of blood from cynomolgus and rhesus macaques experimentally infected with vCJD, as a surrogate for human blood, to support assay development. We detected abnormal prion protein (PrPTSE) in those blood samples using the protein misfolding cyclic amplification (PMCA) assay. PrPTSE first appeared in the blood of pre-symptomatic cynomolgus macaques as early as 2 months post-inoculation (mpi). In contrast, PMCA detected PrPTSE much later in the blood of two pre-symptomatic rhesus macaques, starting at 19 and 20 mpi, and in one rhesus macaque only when symptomatic, at 38 mpi. Once blood of either species of macaque became PMCA-positive, PrPTSE persisted through terminal illness at relatively constant concentrations. Infectivity in buffy coat samples from terminally ill cynomolgus macaques as well as a sample collected 9 months before clinical onset of disease in one of the macaques was assayed in vCJD-susceptible transgenic mice. The infectivity titres varied from 2.7 to 4.3 infectious doses ml-1. We also screened macaque blood using a four-member panel of biomarkers for neurodegenerative diseases to identify potential non-PrPTSE pre-symptomatic diagnostic markers. Neurofilament light-chain protein (NfL) increased in blood before the onset of clinical vCJD. Cumulatively, these data confirmed that, while PrPTSE is the first marker to appear in blood of vCJD-infected cynomolgus and rhesus macaques, NfL might offer a useful, though less specific, marker for forthcoming neurodegeneration. These studies support the use of macaque blood panels to investigate PrPTSE and other biomarkers to predict onset of CJD in humans.
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Affiliation(s)
- Oksana Yakovleva
- US Food and Drug Administration, Center for Biologics Evaluation and Research, Office of Blood Research and Review, Division of Emerging and Transfusion-Transmitted Diseases, Silver Spring, MD 20993, USA
| | - Cyrus Bett
- US Food and Drug Administration, Center for Biologics Evaluation and Research, Office of Blood Research and Review, Division of Emerging and Transfusion-Transmitted Diseases, Silver Spring, MD 20993, USA
| | - Teresa Pilant
- US Food and Drug Administration, Center for Biologics Evaluation and Research, Office of Blood Research and Review, Division of Emerging and Transfusion-Transmitted Diseases, Silver Spring, MD 20993, USA
| | - David M Asher
- US Food and Drug Administration, Center for Biologics Evaluation and Research, Office of Blood Research and Review, Division of Emerging and Transfusion-Transmitted Diseases, Silver Spring, MD 20993, USA
| | - Luisa Gregori
- US Food and Drug Administration, Center for Biologics Evaluation and Research, Office of Blood Research and Review, Division of Emerging and Transfusion-Transmitted Diseases, Silver Spring, MD 20993, USA
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Salamat MKF, Stewart P, Brown H, Tan KBC, Smith A, de Wolf C, Alejo Blanco AR, Turner M, Manson JC, McCutcheon S, Houston EF. Subclinical infection occurs frequently following low dose exposure to prions by blood transfusion. Sci Rep 2022; 12:10923. [PMID: 35764688 PMCID: PMC9240018 DOI: 10.1038/s41598-022-15105-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/17/2022] [Indexed: 11/09/2022] Open
Abstract
Infectious prion diseases have very long incubation periods, and the role that subclinical infections play in transmission, persistence and re-emergence of these diseases is unclear. In this study, we used a well-established model of vCJD (sheep experimentally infected with bovine spongiform encephalopathy, BSE) to determine the prevalence of subclinical infection following exposure by blood transfusion from infected donors. Many recipient sheep survived for years post-transfusion with no clinical signs and no disease-associated PrP (PrPSc) found in post mortem tissue samples by conventional tests. Using a sensitive protein misfolding cyclic amplification assay (PMCA), we found that the majority of these sheep had detectable PrPSc in lymph node samples, at levels approximately 105-106 times lower than in equivalent samples from clinically positive sheep. Further testing revealed the presence of PrPSc in other tissues, including brain, but not in blood samples. The results demonstrate that subclinical infection is a frequent outcome of low dose prion infection by a clinically relevant route for humans (blood transfusion). The long term persistence of low levels of infection has important implications for prion disease control and the risks of re-emergent infections in both humans and animals.
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Affiliation(s)
- M Khalid F Salamat
- Royal (Dick) School of Veterinary Studies, The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, UK
| | - Paula Stewart
- Royal (Dick) School of Veterinary Studies, The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, UK
| | - Helen Brown
- Royal (Dick) School of Veterinary Studies, The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, UK
| | - Kyle B C Tan
- Royal (Dick) School of Veterinary Studies, The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, UK
| | - Allister Smith
- Royal (Dick) School of Veterinary Studies, The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, UK
| | - Christopher de Wolf
- Royal (Dick) School of Veterinary Studies, The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, UK
| | - A Richard Alejo Blanco
- Royal (Dick) School of Veterinary Studies, The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, UK
| | - Marc Turner
- Scottish National Blood Transfusion Service (SNBTS), The Jack Copland Centre, Edinburgh, UK
| | - Jean C Manson
- Royal (Dick) School of Veterinary Studies, The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, UK
| | - Sandra McCutcheon
- Royal (Dick) School of Veterinary Studies, The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, UK
| | - E Fiona Houston
- Royal (Dick) School of Veterinary Studies, The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, UK.
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McManus H, Seed CR, Hoad VC, Kiely P, Kaldor JM, Styles CE, Yang H, Law M, Gosbell IB. Risk of variant Creutzfeldt-Jakob disease transmission by blood transfusion in Australia. Vox Sang 2022; 117:1016-1026. [PMID: 35609012 PMCID: PMC9544957 DOI: 10.1111/vox.13290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/01/2022] [Accepted: 04/14/2022] [Indexed: 11/30/2022]
Abstract
Background and Objectives Most of the 233 worldwide cases of variant Creutzfeldt–Jakob disease (vCJD) have been reported in the United Kingdom and 3 have been associated with transfusion‐transmission. To mitigate the potential vCJD risk to blood safety, Australian Red Cross Lifeblood imposes restrictions on blood donation from people with prior residency in, or extended travel to, the United Kingdom during the risk period 1980–1996. We have modified a previously published methodology to estimate the transfusion‐transmission risk of vCJD associated with fresh component transfusion in Australia if the UK residence deferral was removed. Materials and Methods The prevalence of current pre‐symptomatic vCJD infection in the United Kingdom by age at infection and genotype was estimated based on risk of exposure to the bovine spongiform encephalopathy agent for the period 1980–1996. These results were used to estimate the age‐specific prevalence of undiagnosed, pre‐symptomatic vCJD in the Australian population in the current year due to prior UK residency or travel. The primary model outputs were the 2020 vCJD risks/unit of vCJD contamination, transfusion‐transmission (infections) and clinical cases. Results The overall (prior UK residency in and travel to United Kingdom, 1980–1996) mean risk of contamination per unit was 1 in 29,900,000. The risks of resulting vCJD transmission (infection) and clinical case were 1 in 389,000,000 and 1 in 1,450,000,000, respectively. Conclusion Our modelling suggests that removing the Lifeblood donation deferral for travel to, or UK residence, would result in virtually no increased risk of vCJD transfusion‐transmission and would be a safe and effective strategy for increasing the donor base.
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Affiliation(s)
- Hamish McManus
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Clive R Seed
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Veronica C Hoad
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Philip Kiely
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Claire E Styles
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Hong Yang
- US Food and Drug Administration, Rockville, Maryland, USA
| | - Matthew Law
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Iain B Gosbell
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia.,School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
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Bujdoso R, Smith A, Fleck O, Spiropoulos J, Andréoletti O, Thackray AM. Prion disease modelled in Drosophila. Cell Tissue Res 2022; 392:47-62. [PMID: 35092497 PMCID: PMC10113284 DOI: 10.1007/s00441-022-03586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/17/2022] [Indexed: 11/02/2022]
Abstract
AbstractPrion diseases are fatal neurodegenerative conditions of humans and various vertebrate species that are transmissible between individuals of the same or different species. A novel infectious moiety referred to as a prion is considered responsible for transmission of these conditions. Prion replication is believed to be the cause of the neurotoxicity that arises during prion disease pathogenesis. The prion hypothesis predicts that the transmissible prion agent consists of PrPSc, which is comprised of aggregated misfolded conformers of the normal host protein PrPC. It is important to understand the biology of transmissible prions and to identify genetic modifiers of prion-induced neurotoxicity. This information will underpin the development of therapeutic and control strategies for human and animal prion diseases. The most reliable method to detect prion infectivity is by in vivo transmission in a suitable experimental host, which to date have been mammalian species. Current prion bioassays are slow, cumbersome and relatively insensitive to low titres of prion infectivity, and do not lend themselves to rapid genetic analysis of prion disease. Here, we provide an overview of our novel studies that have led to the establishment of Drosophila melanogaster, a genetically well-defined invertebrate host, as a sensitive, versatile and economically viable animal model for the detection of mammalian prion infectivity and genetic modifiers of prion-induced toxicity.
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Woerman AL, Tamgüney G. Body-first Parkinson's disease and variant Creutzfeldt-Jakob disease - similar or different? Neurobiol Dis 2022; 164:105625. [PMID: 35026401 DOI: 10.1016/j.nbd.2022.105625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 10/19/2022] Open
Abstract
In several neurodegenerative disorders, proteins that typically exhibit an α-helical structure misfold into an amyloid conformation rich in β-sheet content. Through a self-templating mechanism, these amyloids are able to induce additional protein misfolding, facilitating their propagation throughout the central nervous system. This disease mechanism was originally identified for the prion protein (PrP), which misfolds into PrPSc in a number of disorders, including variant Creutzfeldt-Jakob disease (vCJD) and bovine spongiform encephalopathy (BSE). More recently, the prion mechanism of disease was expanded to include other proteins that rely on this self-templating mechanism to cause progressive degeneration, including α-synuclein misfolding in Parkinson's disease (PD). Several studies now suggest that PD patients can be subcategorized based on where in the body misfolded α-synuclein originates, either the brain or the gut, similar to patients developing sporadic CJD or vCJD. In this review, we discuss the human and animal model data indicating that α-synuclein and PrPSc misfolding originates in the gut in body-first PD and vCJD, and summarize the data identifying the role of the autonomic nervous system in the gut-brain axis of both diseases.
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Affiliation(s)
- Amanda L Woerman
- Institute for Applied Life Sciences and Department of Biology, University of Massachusetts Amherst, Amherst, MA, USA.
| | - Gültekin Tamgüney
- Institut für Physikalische Biologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany; Institute of Biological Information Processing, Structural Biochemistry (IBI-7), Forschungszentrum Jülich, Jülich, Germany.
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Wu J, Chen D, Shi Q, Dong X. Protein amplification technology: New advances in human prion disease diagnosis. BIOSAFETY AND HEALTH 2021. [DOI: 10.1016/j.bsheal.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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