Centennial history of prion diseases / 中华神经医学杂志

Prion diseases, also known as transmissible spongiform encephalopathies (TSEs), are a rare group of transmissible and fatal neurodegenerative diseases. Since Creutzfeldt-Jakob disease was first officially named in 1992, prion diseases in humans have been studied for 100 years. From the confusion of clinical symptoms to the description of typical histopathological changes, the "prion hypothesis", and the discovery of prion diseases-related genes, the recognition and researches of prion diseases have been penetrating deeply, and prion diseases have gradually received more and more attention in neurology as a group of fatal neurodegenerative diseases, including Creutzfeldt-Jakob disease and its variants, Kuru's disease, Gerstmann-Straussler-Scheinker syndrome, and fatal familial insomnia. Based on the discovery of Creutzfeldt-Jakob disease, this article elaborates the discovery of characteristic pathological changes of prion diseases, verification of infectiability, discovery of prion protein and PRNP gene, and the clinical manifestations, pathological changes and gene mutation types of various subtypes of prion diseases. It is intended to review the research history of prion diseases to help clinical colleagues understanding the progress and dilemma of diagnosis and treatment of the diseases.

Enfermedad de Creutzfeldt-Jakob de origen genético: serie de casos en la Patagonia Argentina / Creutzfeldt-Jakob syndrome of genetic origin: series of cases in the Argentinian Patagonia

La enfermedad de Creutzfeldt-Jakob (CJD) es un desorden neurodegenerativo poco frecuente con una incidencia estimada en 1 por cada 1.000.000 por año, típicamente caracterizado por demencia rápidamente progresiva, ataxia, mioclonus y cambios de comportamiento. Las enfermedades genéticas priónicas se desarrollan debido a mutaciones en el gen de proteína priónica PRNP. Entre el 10 y el 15% corresponden a formas familiares que se transmiten con patrón autosómico dominante con alta penetrancia. La mutación más frecuente a nivel mundial es la E200K (glutamato por lisina). Se reportan cuatro familias con CJD que fueron atendidas en el Hospital Provincial Neuquén en el año 2018. Tres de los cuatro casos índice tenían historia familiar de trastornos neurológicos y psiquiátricos pero estos datos no fueron jerarquizados en la evaluación inicial del caso. Se consideró la consulta genética por la edad temprana de presentación de la enfermedad. En todos los casos la consulta fue solicitada por el neurólogo. Los síntomas iniciales que presentaron los pacientes fueron insomnio pertinaz y depresión con pobre respuesta a la medicación psiquiátrica habitual. En todos los casos la progresión de la enfermedad fue rápida con desórdenes visuales, mioclonías, ataxia, demencia y pérdida del lenguaje. El análisis de los pedigrees permitió identificar ciento cuarenta personas que potencialmente podrían portar el gen y desarrollar la enfermedad en algún momento de la vida adulta. En todos los casos se identificó la mutación E200K. En la región existe una frecuencia aumentada de CJD. Debe ser investigada en los pacientes con síntomas neuropsiquiátricos e historia familiar sospechosa. Los estudios genéticos confirman el diagnóstico en los pacientes y permite identificarlos en individuos en etapa presintomática. Esto plantea un desafío para el asesoramiento genético familiar y para evitar la transmisión iatrogénica del trastorno.

Creutzfeldt-Jakob disease (CJD) is an uncommon neurodegenerative disorder with an incidence of 1 per 1,000,000 in humans per year, typically characterized by rapidly progressive dementia, ataxia, myoclonus and behavioral changes. Genetic prion diseases, which develop due to a mutation in the prion protein gene (PRNP), account for an estimated 10 to 15% of all CJD cases. Familial CJD is transmitted with an autosomal dominant inheritance pattern with high penetrance. Worldwide, the most common mutation is E200K (glutamate to lysine). We report four families with CJD assisted in Neuquén Hospital in 2018. Three of the four index cases had family history of neurological and psychiatric illness, though data was not taken into consideration at the moment of evaluation of the new cases. The most significant data recorded for a genetic consultation was when the problem had started, and it was required by a neurologist. The initial symptoms were persistent insomnia and depression with poor response to habitual psychiatric medication. Impoverishment is fast with visual disorder, myoclonias, ataxia, dementia and loss of language. Pedigree analysis allowed the identification of 144persons with the gene potential, who can develop the disease at any time in their adulthood. In all cases, mutation E200K was identified. There is a region of increased frequency of CJD. There must be suspicion on patients with neuropsychiatric symptoms and suspected family history(familiar background). Finding of the mutation confirms the diagnosis in patients and allows the identification on pre-symptomatic individuals. Challenge is posed on gene advice and to avoid iatrogenic disorder transmission.

Atypical Gerstmann-Str(a)ussler-Scheinker syndrome caused by PRNP P102L mutation: a case report and literature review / 中华神经科杂志

Objective To improve the clinician's recognition of Gerstmann-Str(a)ussler-Scheinker syndrome (GSS).Methods The detailed clinical information,neuropsychological examination,cerebrospinal fluid examination,imaging characteristics,electroencephalogram examination and gene detection were analyzed in a case of GSS similar to Creutzfeldt-Jakob disease (CJD) in symptomatology.The differences between the two different prion diseases were compared in combination with the literature review.Results The patient is a 62-year-old woman,with cerebellar ataxia as the first symptom,followed by rapid dementia,accompanied by pyramidal and extrapyramidal signs.Magnetic resonance imaging showed hyper-intense signal in diffusion weighted imaging in caudatum and cortical ribboning,and protein 14-3-3was negative.PRNP gene analysis showed P102L gene mutation.Conclusions The typical clinical manifestation of GSS is hereditary ataxia followed by cognitive decline of varying severity.Detection of PRNP plays an important role in the diagnosis of GSS.

Atypical Gerstmann-Sträussler-Scheinker syndrome caused by PRNP P102L mutation: a case report and literature review / 中华神经科杂志

Objective@#To improve the clinician′s recognition of Gerstmann-Sträussler-Scheinker syndrome (GSS).@*Methods@#The detailed clinical information, neuropsychological examination, cerebrospinal fluid examination, imaging characteristics, electroencephalogram examination and gene detection were analyzed in a case of GSS similar to Creutzfeldt-Jakob disease (CJD) in symptomatology. The differences between the two different prion diseases were compared in combination with the literature review.@*Results@#The patient is a 62-year-old woman, with cerebellar ataxia as the first symptom, followed by rapid dementia, accompanied by pyramidal and extrapyramidal signs. Magnetic resonance imaging showed hyper-intense signal in diffusion weighted imaging in caudatum and cortical ribboning, and protein 14-3-3 was negative. PRNP gene analysis showed P102L gene mutation.@*Conclusions@#The typical clinical manifestation of GSS is hereditary ataxia followed by cognitive decline of varying severity. Detection of PRNP plays an important role in the diagnosis of GSS.

Report of eight cases of familial fatal insomnia / 中华神经科杂志

Objective To investigate the clinical features,polysomnography,imaging examination,genetic analysis and laboratory examination of eight patients with familial fatal insomnia (FFI).Methods The clinical data,neuropsychological examination,results of cerebrospinal fluid analysis,imaging examination and polysomnography of eight patients with FFI in Xuanwu Hospital,Capital Medical University from 2009 to 2018 were retrospectively analyzed and summarized.Results Among the eight FFI patients,there were 3 males and 5 females,the onset age being (49.8+14.3) years (19 to 64 years) and the course of disease being eight to 18 months.D178N mutation in the PRNP gene of chromosome 20 and 129 amino acid polymorphisms of M/M were found in genetic examination in all the eight patients,of which five patients had family history.All the patients had sleep disorders,sleep-related involuntary movement,sleep-related dyspnea,laryngeal stridor.All the patients showed rapid progressive dementia with or without symptoms or signs of psychosis,ataxia,pyramidal and extrapyramidal.All the eight patients had progressive sympathetic symptoms,including hypertension,sweating,tachycardia,irregular breathing,and dysarthria.Cerebrospinal fluid 14-3-3 protein was found positive in one patient,and negative in seven patients.Electroencephalograph showed diffuse slow wave and non periodic synchronous discharge.Single-photon emission computed tomography or 18F fluorodeoxyglucose positron emission tomography showed decreased thalamic glucose metabolism in three patients.Seven patients showed decreased total sleep time,sleep awakening cycle disorder,especially the reduction or loss of rapid eye movement,laryngeal stridor and involuntary movement in polysomnography.Conclusions FFI is characterized by sleep disorder,sleep-related involuntary movement,dyspnea,laryngosis,rapid progressive dementia and sympathetic symptoms.The family history,polysomnography and positron emission tomography are helpful for the diagnosis of FFI.PRNP gene detection can confirm the diagnosis of FFI.

Characteristics of Creutzfeldt-Jakob disease cases in Shaanxi Province,China, 2011-2015 / 中国人兽共患病学报

We investigated the epidemiological and clinical characteristics,to provide evidence for the control and prevention of Creutzfeldt-Jakob disease (CJD) in Shaanxi Province,China.Clinical and epidemiological datas on 49 suspicious CJD patients from 7 hospitals in Shaanxi Province from 2011 to 2015 was collected.Blood and cerebral spinal fluid (CSF) specimens from the cases were gathered.For CSF sample,14-3-3 protein were tested by Western blot.For blood sample,PCR and sequencing were used,and then the mutation of PRNP gene and the polymorphism of 129 and 219 amino acids were analyzed.It showed that a total number of 16 probable and 4 possible sporadic CJD patients,and 1 familial CJD case were identified.Among these cases,neither geographic nor occupational-related ones were found.The median age of onset for the probable sporadic CJD cases was 62 years old,and the gender ratio of male to female was 1.29 to 1.The most initial symptom was rapid progressive dementia,which accounted for 47.62％ of the CJD patients.This report indicates that the main type of CJD in Shaanxi Province is sporadic CJD with its distinctive characteristics including geography distribution,occupation,gender ratio and age of onset.

Building and identification of prion gene eukaryotic expression vector of human / 重庆医学

Objective To constructan eukaryotic expression recombinant plasmid named pEGFP-N2-PRNP .Methods Total RNA was extracted from alzheimer (AD) disease peripheral blood ,and the PRNP gene was amplified by reverse transcription-poly-merase chain reaction(RT-PCR) .By using gene recombination technique ,human PRNP cDNA was inserted into retroviral vector pEGFP-N2 .The recombinant plasmid was identified by a pair of specified primers containing the restriction sites of Xho Ⅰ and EcoRⅠ .Results The PRNP gene could be obtained by RT-PCR ,the recombinant plasmid was identified by restriction endonucle-ase analysis ,PCR and sequence analysis ,and the expression vector pEGFP-N2-PRNP ,which could be stably expressed in SH-SY5Y cells .Conclusion The recombinant plasmid pEGFP-N2-PRNP is constructed successfully ,Which offers a basic for the further re-search on PRNP biological fuction .

Detection of prion protein gene mutation in a pedigree with fatal familial insomnia from Guangdong province and the clinical manifestations of the disease / 中华神经医学杂志

Objective To investigate the clinical features fatal familial insomnia (FFI) and detection of the prion protein (PRNP) gene mutation in a family with FFI from Guangdong province.Methods The clinical features were analyzed in 2 patients from the family with FFI. The PRNP gene mutation was detected by using PCR and DNA sequence analysis in the proband. Results The main symptoms of the proband were characterized by progressive sleep impairment, behavior and cognitive dysfunctions; myoclonus was appeared in the late period of the disease and the whole durations of the disease were 9 months. The elder brother of the proband had the similar clinical manifestations with the duration of 11 months. The prion protein D178N mutation and also homozygous for Met in the 129 codon were found in the proband. Conclusion The typical clinical manifestations can help the diagnosis of FFI and the technique of PRNP gene mutation detection could provide a definite diagnosis.

Study on the characteristics of patients with Creutzfeldt-Jakob disease under 2008 surveillance data in China / 中华流行病学杂志

Objective To describe the epidemiological and clinical characteristics of Creutzfeldt-Jakob disease (CJD) in China. Methods Clinical and epidemical data on patients from China CJD surveillance network was analyzed. Blood and cerebral spinal fluid (CSF) specimens from these patients were collected. Western blot assay was used to detect 14-3-3 protein in CSF, PCR and sequencing assay were used for analyzing the polymorphism of 129 amino acid and mutation of PRNP gene. Results A total number of 31 probable and 11 possible sporadic CJD patients were identified. Additionally, one patient with Gerstmann-Straussler-Scheinker syndrome (GSS) and 2 familial CJD cases were identified. No geographic- or occupational-related events were observed among these cases. The mean age of onset on the probable or possible CJD patients were 56.7 and 57.4 years old, with sex ratios of the probable CJD patients as 8:9 and the possible one as 5:6 respectively. Rapid progressive dementia was the main foremost symptom, presenting in 33.3% of the CJD patients. Probable CJD patients showed more clinical manifestations than those possible ones. Conclusion Geography distribution, occupation, ratio of gender and the mean onset age of the CJD eases in 2008 were consistent with the characteristics of the sporadic CJD.