New Discovery Raises Prospect Of Diagnosing A Rare Fatal Brain Disease With A Simple Eye Test

Prion protein clumps imaged in an E. coli bacterium that was genetically engineered to produce them. National Institute of Allergy and Infectious Diseases

Aliyah Kovner 20 Nov 2018, 23:40

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare, incurable neurological disease characterized by a progressive decline in motor control and cognitive ability that leads, ultimately, to a comatose state and death. Caused by infectious misfolded proteins, sCJD is one of several poorly understood fatal brain disorders within the category of transmissible spongiform encephalopathies (TSEs) – aka prion diseases.

Because sCJD presents with diverse symptoms, wide-ranging rate of decline, and may target a variety of brain areas, physicians often struggle to diagnose the illness. This challenge makes the already devastating disease course even more frustrating for patients and their families and creates situations that are dangerous to others, as sCJD can be spread through contact with improperly sterilized medical instruments or through transplanted organs and tissue donated by deceased patients whose disease was not identified. In fact, medical investigators have found two confirmed and three suspected cases where an individual died from sCJD after receiving an infected corneal transplant.

But to make the already hazy picture of CJD more confusing, past investigations have found conflicting results on whether infectious prions are harbored in the eye. Hoping to add clarity, scientists from the University of California system and the National Institutes of Health (NIH) joined forces to conduct the most comprehensive analysis of sCJD in ocular tissue.

Their study, published in mBio, found the abnormal proteins in all 11 sCJD eyes analyzed.

"Almost half of sCJD patients develop visual disturbances, and we know that the disease can be unknowingly transmitted through corneal graft transplantation," author Dr Christina Sigurdson said in a statement. "But distribution and levels of prions in the eye were unknown. We've answered some of these questions. Our findings have implications for both estimating the risk of sCJD transmission and for development of diagnostic tests for prion diseases before symptoms become apparent."

The work was made possible by a new testing platform – the real-time quaking-induced conversion (RT-QuIC) assay, developed by co-author Byron Caughey – that can quickly and accurately detect sCJD prions in tissue and fluids.

Ryan Kissinger, NIAID
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