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Shijo M, Yoshimura M, Omae T, Hashimoto G, Mizoguchi T, Kuwashiro T, Komori T, Tsuboi Y, Saito T, Nakagawa M, Itoh K, Honda H. Altered properties of amyloidogenic prion protein in genetic Creutzfeldt-Jakob disease with PRNP V180I mutation in response to pentosan polysulfate. Brain Pathol 2023; 33:e13197. [PMID: 37525413 PMCID: PMC10467033 DOI: 10.1111/bpa.13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 06/29/2023] [Indexed: 08/02/2023] Open
Abstract
Genetic Creutzfeldt-Jakob disease (gCJD) with V180I prion protein gene (PRNP) mutation shows weaker prion protein (PrP) deposition histologically compared with sporadic CJD, and it is more difficult to detect protease-resistant prion protein in immunoblotting. However, we previously reported the autopsy case of a patient with V180I gCJD who was treated with pentosan polysulfate sodium (PPS); this case had increased protease-resistant PrP deposition. It has been suggested that PPS might reduce protease-resistant PrP; however, the detailed pharmacological and histopathological effects of PPS in humans remain unknown. We examined autopsied human brain tissue from four cases with V180I gCJD that were added to our archives between 2011 and 2021: two cases treated with PPS and two cases without PPS. We conducted a neuropathological assessment, including immunohistochemistry for PrP. We also performed immunoblotting for PrP on homogenate samples from each brain to detect protease-resistant PrP using both a conventional procedure and size-exclusion gel chromatography for the purification of oligomeric PrP. Both PPS-treated cases showed long survival time over 5 years from onset and increased PrP deposition with a characteristic pattern of coarse granular depositions and congophilic PrP microspheres, whereas the cases without PPS showed around 1-year survival from onset and relatively mild neuronal loss and synaptic PrP deposition. Although cortical gliosis seemed similar among all cases, aquaporin 4-expression as a hallmark of astrocytic function was increased predominantly in PPS cases. Immunoblotting of non-PPS cases revealed protease-resistant PrP in the oligomeric fraction only, whereas the PPS-treated cases showed clear signals using conventional procedures and in the oligomeric fraction. These unique biochemical and histopathological changes may reflect the progression of V180I gCJD and its modification by PPS, suggesting the possible existence of toxic PrP-oligomer in the pathophysiology of V180I gCJD and beneficial effects of PPS toward the aggregation and detoxication of toxic PrP-oligomer.
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Affiliation(s)
- Masahiro Shijo
- Department of Neuropathology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Internal MedicineFukuoka Dental College Medical and Dental HospitalFukuokaJapan
- Department of NeurologyKyushu Central Hospital of the Mutual Aid Association of Public School TeachersFukuokaJapan
| | - Motoi Yoshimura
- Department of Neuropathology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Tsuyoshi Omae
- Department of MedicineImazu Red Cross HospitalFukuokaJapan
| | - Go Hashimoto
- Department of Cerebrovascular Medicine and NeurologyNational Hospital Organization, Kyushu Medical CenterFukuokaJapan
| | - Tadataka Mizoguchi
- Department of Cerebrovascular Medicine and NeurologyNational Hospital Organization, Kyushu Medical CenterFukuokaJapan
| | - Takahiro Kuwashiro
- Department of Cerebrovascular Medicine and NeurologyNational Hospital Organization, Kyushu Medical CenterFukuokaJapan
| | - Takashi Komori
- Departmemnt of Laboratory Medicine and PathologyTokyo Metropolitan Neurological HospitalTokyoJapan
| | - Yoshio Tsuboi
- Department of NeurologyFukuoka UniversityFukuokaJapan
| | - Tomoko Saito
- Department of Neurology, National Hospital OrganizationOsaka Toneyama Medical CenterOsakaJapan
| | - Masanori Nakagawa
- Department of NeurologyKyoto Prefectural University of Medicine, Graduate School of Medical ScienceKyotoJapan
| | - Kyoko Itoh
- Department of Pathology and Applied NeurobiologyKyoto Prefectural University of Medicine, Graduate School of Medical ScienceKyotoJapan
| | - Hiroyuki Honda
- Department of Neuropathology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Neurology, Neuropathology Center, National Hospital OrganizationOmuta National HospitalFukuokaJapan
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Brennecke N, Cali I, Mok TH, Speedy H, Hosszu LLP, Stehmann C, Cracco L, Puoti G, Prior TW, Cohen ML, Collins SJ, Mead S, Appleby BS. Characterization of Prion Disease Associated with a Two-Octapeptide Repeat Insertion. Viruses 2021; 13:1794. [PMID: 34578375 PMCID: PMC8473248 DOI: 10.3390/v13091794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/31/2021] [Accepted: 09/04/2021] [Indexed: 12/03/2022] Open
Abstract
Genetic prion disease accounts for 10-15% of prion disease. While insertion of four or more octapeptide repeats are clearly pathogenic, smaller repeat insertions have an unclear pathogenicity. The goal of this case series was to provide an insight into the characteristics of the 2-octapeptide repeat genetic variant and to provide insight into the risk for Creutzfeldt-Jakob disease in asymptomatic carriers. 2-octapeptide repeat insertion prion disease cases were collected from the National Prion Disease Pathology Surveillance Center (US), the National Prion Clinic (UK), and the National Creutzfeldt-Jakob Disease Registry (Australia). Three largescale population genetic databases were queried for the 2-octapeptide repeat insertion allele. Eight cases of 2-octapeptide repeat insertion were identified. The cases were indistinguishable from the sporadic Creutzfeldt-Jakob cases of the same molecular subtype. Western blot characterization of the prion protein in the absence of enzymatic digestion with proteinase K revealed that 2-octapeptide repeat insertion and sporadic Creutzfeldt-Jakob disease have distinct prion protein profiles. Interrogation of large-scale population datasets suggested the variant is of very low penetrance. The 2-octapeptide repeat insertion is at most a low-risk genetic variant. Predictive genetic testing for asymptomatic blood relatives is not likely to be justified given the low risk.
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Affiliation(s)
- Nicholas Brennecke
- Department of Neurology, Case Western Reserve University & University Hospitals Cleveland Medical, Cleveland, OH 44106, USA; (N.B.); (M.L.C.)
| | - Ignazio Cali
- Department of Pathology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
- National Prion Disease Pathology Surveillance Center (NPDPSC), Cleveland, OH 44106, USA
| | - Tze How Mok
- MRC Prion Unit at University College London, Institute of Prion Diseases, London W1W 7FF, UK; (T.H.M.); (H.S.); (L.L.P.H.); (S.M.)
| | - Helen Speedy
- MRC Prion Unit at University College London, Institute of Prion Diseases, London W1W 7FF, UK; (T.H.M.); (H.S.); (L.L.P.H.); (S.M.)
| | | | - Laszlo L. P. Hosszu
- MRC Prion Unit at University College London, Institute of Prion Diseases, London W1W 7FF, UK; (T.H.M.); (H.S.); (L.L.P.H.); (S.M.)
| | - Christiane Stehmann
- Australian National Creutzfeldt-Jakob Disease Registry, The Florey Institute, The University of Melbourne, Melbourne, VIC 3010, Australia; (C.S.); (S.J.C.)
| | - Laura Cracco
- Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, USA;
| | - Gianfranco Puoti
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
- Prion Disease Diagnosis and Surveillance Center (PDDSC), University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Thomas W. Prior
- Center for Human Genetics Laboratory, Case Western Reserve University & University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA;
| | - Mark L. Cohen
- Department of Neurology, Case Western Reserve University & University Hospitals Cleveland Medical, Cleveland, OH 44106, USA; (N.B.); (M.L.C.)
- Department of Pathology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
- National Prion Disease Pathology Surveillance Center (NPDPSC), Cleveland, OH 44106, USA
| | - Steven J. Collins
- Australian National Creutzfeldt-Jakob Disease Registry, The Florey Institute, The University of Melbourne, Melbourne, VIC 3010, Australia; (C.S.); (S.J.C.)
| | - Simon Mead
- MRC Prion Unit at University College London, Institute of Prion Diseases, London W1W 7FF, UK; (T.H.M.); (H.S.); (L.L.P.H.); (S.M.)
| | - Brian S. Appleby
- Department of Neurology, Case Western Reserve University & University Hospitals Cleveland Medical, Cleveland, OH 44106, USA; (N.B.); (M.L.C.)
- Department of Pathology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
- National Prion Disease Pathology Surveillance Center (NPDPSC), Cleveland, OH 44106, USA
- Department of Psychiatry, Case Western Reserve University & University Hospitals, Cleveland, OH 44106, USA
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Shintaku M, Nakamura T, Kaneda D, Shinde A, Kusaka H, Takeuchi A, Kitamoto T. Genetic Creutzfeldt-Jakob disease-M232R with the cooccurrence of multiple prion strains, M1 + M2C + M2T: Report of an autopsy case. Neuropathology 2021; 41:206-213. [PMID: 33586250 DOI: 10.1111/neup.12722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
Genetic Creutzfeldt-Jakob disease (gCJD) with a methionine to arginine substitution at codon 232 of the prion protein gene (gCJD-M232R) is rare and has only been reported in Japan. We report an autopsy case of gCJD-M232R showing alleles of codon 129 that were homozygous for methionine and the presence of multiple strains of the protease-resistant, abnormal isoform of prion protein (PrPSc ), M1 + M2C + M2T. The patient, a 54-year-old Japanese man, died after a clinical course of 21 months characterized by slowly progressive dementia and sleep disturbance. At autopsy, the neuropil of the cerebral neocortex showed a widespread and severe spongiform change. Grape-like clusters of large confluent vacuoles were admixed with fine vacuoles. Neuronal loss was moderate, but reactive astrocytosis was mild. The dorsomedial nucleus of the thalamus and the inferior olivary nucleus showed moderate and severe neuronal loss, respectively. Many amyloid plaques were present in the cerebellar molecular layer. PrPSc deposition pattern was predominantly the synaptic type in the cerebrum and corresponded to the plaques in the cerebellum. Perivacuolar deposition was also seen. Western blot analysis of PrPSc revealed the predominance of type 2. Moreover, by employing Western blot analysis in combination with the protein misfolding cyclic amplification (PMCA) method, which selectively amplifies the minor M2T prion strain, we demonstrated the presence of M2T, in addition to M1 and M2C strains, in the brain of the patient. PMCA was a powerful method for demonstrating the presence of the M2T strain, although the amount is often small and the transmission is difficult.
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Affiliation(s)
| | | | - Daita Kaneda
- Institute of Neuropathology, Fukushimura Hospital, Toyohashi, Japan
| | - Akiyo Shinde
- Department of Neurology, Tenri Hospital, Tenri, Japan
| | - Hirofumi Kusaka
- Department of Neurology, Tanabe Neurosurgical Hospital, Fujiidera, Japan
| | - Atsuko Takeuchi
- Department of Neurological Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuyuki Kitamoto
- Department of Neurological Science, Tohoku University Graduate School of Medicine, Sendai, Japan
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Smid J, Martins VR, Landemberger MC, Riva D, Anghinah R, Nitrini R. Creutzfeldt-Jakob disease associated with a missense mutation at codon 200 of the prion protein gene in Brazil. Dement Neuropsychol 2007; 1:222-224. [PMID: 29213392 PMCID: PMC5619573 DOI: 10.1590/s1980-57642008dn10200017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Genetic Creutzfeldt-Jakob disease (gCJD) represents less than 15% of CJD cases,
and its clinical picture may be either indistinguishable from that of sporadic
CJD (sCJD) or be atypical, usually with younger onset and longer duration. We
report a case of 59-year old Brazilian man who presented rapidly progressive
cognitive decline and cerebellar ataxia. EEG revealed periodic activity. A
brother and a cousin of the patient had CJD. A point mutation at codon 200
(E200K) of the prion protein gene (PRNP) was found and death occurred 11 months
after onset of symptoms. Autopsy was not performed. The clinical presentation of
gCJD associated with E200K, which is the most frequent PRNP mutation, is quite
similar to sCDJ. This is the first report of E200K mutation in Brazil, and it is
possible that a more systematic search for its occurrence may show it to be
relatively frequent in Brazil.
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Affiliation(s)
- Jerusa Smid
- Behavioral and Cognitive Neurology Unit, Departament of Neurology, University of São Paulo School of Medicine
| | | | | | | | - Renato Anghinah
- Behavioral and Cognitive Neurology Unit, Departament of Neurology, University of São Paulo School of Medicine
| | - Ricardo Nitrini
- Behavioral and Cognitive Neurology Unit, Departament of Neurology, University of São Paulo School of Medicine
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