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We are dedicated to networking between prion experts, with the aim of effective containment of disease. Our principal activity is the publication of carefully edited interdisciplinary information on prion diseases. SVISS Consulting also focuses on inactivation of prions and on the history of research on prion diseases in humans and animals.
1 Historical Introduction B. Hörnlimann, D. Riesner, H. Kretzschmar, R. G. Will, S. C. MacDiarmid, G. A. H. Wells, and M. P. Alpers 1.1 Introduction 1.2 The cause of prion diseases 1.3 Scrapie: archetype of all prion diseases 1.4 Transmissible mink encephalopathy 1.5 Chronic wasting disease in North American cervids 1.6 Creutzfeldt-Jakob disease and other human prion diseases 1.7 The scrapie-kuru connection 1.8 Etiological variety of prion diseases 1.9 New prion diseases 1.10 Prion diseases and contagion 1.11 Summary: traits common to all human and animal prion diseases 1.12 Synopsis of events, discoveries and findings since 1732
2 The History of Kuru Research B. Hörnlimann 2.1 Introduction 2.2 From the stone age to the present: the Fore people 2.3 Discovery of kuru 2.4 The “Tukabu” ritual 2.5 The beginning of kuru research 2.6 A kuru hospital in Okapa 2.7 The spread of kuru 2.8 The pathological picture 2.9 The diet of the Fore 2.10 The geographical spread of the epidemic and the phylogenetic relations among kuru victims 2.11 The ancestral cult 2.12 Social impact 2.13 The discovery of transmissibility 2.14 The answers to the questions
3 History of Prion Research S. B. Prusiner 3.1 Introduction 3.2 Animals and humans affected 3.3 In search of the cause 3.4 Amazing discovery 3.5 Prion diseases can be inherited 3.6 One protein, two shapes 3.7 Treatment ideas emerge 3.8 The mystery of “strains” 3.9 Breaking the barrier 3.10 The list may grow 3.11 Striking similarities
Topic II Molecular Biology and Genetics
4 The Physical Nature of the Prion D. Riesner 4.1 Introduction 4.2 The prion model and its nomenclature 4.3 The virus hypothesis 4.4 The virino hypothesis 4.5 The nucleic acid problem
5 Folding of the Recombinant Prion Protein R. Glockshuber, J. Stöhr, and D. Riesner 5.1 Introduction 5.2 Folding of recombinant PrPc 5.3 The role of the single disulfide bond of PrP 5.4 Influence of point mutations linked with inherited human prion diseases on the thermodynamic stability of recombinant PrPc 5.5 Outlook
6 Structural Studies of Prion Proteins S. Schwarzinger, D. Willbold, and J. Ziegler 6.1 Introduction 6.2 Structure of the globular domain of PrPc 6.3 Structural studies of full-length PrP 6.4 NMR studies on isolated structural features of PrP 6.5 High pressure NMR 6.6 Structural studies of PrPSc
7 Function of Cellular Prion Protein in Copper Homeostasis and Redox Signaling at the Synapse J. Herms and H. Kretzschmar 7.1 Introduction 7.2 Cellular location of PrPc 7.3 Protein interactions with PrPc 7.4 PrPc binds copper(II) ions 7.5 Functional relevance of copper binding of PrPc at the synapse 7.6 Neuroprotective role of the prion protein in response to copper and oxidative stress 7.7 Redox signaling by PrPC modulates intracellular calcium homeostasis and synaptic function
8 The Scrapie Isoform of the Prion Protein PrPSc Compared to the Cellular Isoform PrPc D. Riesner 8.1 Introduction 8.2 Biological and immunological properties of PrPSc 8.3 Chemical, biochemical, and physical properties of PrPSc 8.4 Structure of PrPSc 8.5 In vitro conversion of PrP and the generation of infectivity 8.6 Models of prion replication 8.7 Infectious, sporadic, and familial etiology of prion diseases
9 The Phylogeny of Mammalian and Nonmammalian Prion Proteins H. M. Schätzl 9.1 Introduction 9.2 The organization of the PrP gene 9.3 Comparative analysis of PrP genes and prion proteins
10 Knockouts and Transgenic Mice in Prion Research E. Flechsig, I. Hegyi, A. J. Raeber, A. Cozzio, A. Aguzzi, and C. Weissmann 10.1 Introduction 10.2 Generation and properties of PrP knockout mice 10.3 Transgenesis and gene replacement 10.4 Reverse genetics: studies on the structure–function relationship of PrP 10.5 Transgenic approaches to study intervention strategies against prion diseases 10.6 Investigating the mechanism of prion propagation by ectopic expression of PrP
11 Transplantation as a Tool in Prion Research E. Flechsig, I. Hegyi, A. J. Raeber, A. Cozzio, A. Aguzzi, and C. Weissmann 11.1 Introduction 11.2 Prion-infected neurografts fail to cause neuropathological changes in PrP knockout mice 11.3 Spread of prions in the central nervous system requires PrPC-expressing tissue 11.4 Spread of prions from extracerebral sites to the CNS
12 Prion Strains M. H. Groschup, A. Gretzschel, and T. Kuczius 12.1 Introduction 12.2 Definition of the term “prion strain” 12.3 Characteristics of prion strains 12.4 Adaptation and selection 12.5 Known prion strains in different species 12.6 Explanatory approaches with regard to the development and existence of prion strains
Topic III Portraits of Prion Diseases
13 Portrait of Kuru B. Hörnlimann and M. P. Alpers 13.1 History of kuru 13.2 Forms or variants of kuru 13.3 Incubation period, transmissibility, and susceptibility of kuru 13.4 Clinical signs of kuru and course of disease of kuru 13.5 Differential diagnoses of kuru 13.6 Epidemiology of kuru 13.7 Pathology of kuru 13.8 Is kuru a new disease? 13.9 Risk factors of kuru 13.10 Surveillance, prevention, and control of kuru 13.11 Editor’s note
14 Portrait of Creutzfeldt-Jakob Disease H. Budka 14.1 History of CJD 14.2 Forms or variants of Creutzfeldt-Jakob Disease 14.3 Incubation period, transmissibility, and susceptibility of CJD 14.4 Clinical signs of CJD and course of disease 14.5 Differential diagnoses of CJD 14.6 Epidemiology of CJD 14.7 Pathology of CJD 14.8 Is CJD a new disease? 14.9 Risk factors of CJD 14.10 Surveillance, prevention, and control of CJD
15 Portrait of Variant Creutzfeldt-Jakob Disease R. G. Will and J. W. Ironside 15.1 History of vCJD 15.2 Forms or variants 15.3 Incubation period, transmissibility, and susceptibility of vCJD 15.4 Clinical signs of vCJD and course of disease 15.5 Differential diagnoses of vCJD 15.6 Epidemiology of vCJD 15.7 Pathology of vCJD 15.8 Is vCJD a new disease? 15.9 Risk factors of vCJD 15.10 Surveillance, prevention, and control of vCJD
16 Portrait of Gerstmann-Sträussler-Scheinker Disease H. Budka 16.1 History of GSS 16.2 Forms or variants of GSS 16.3 Incubation period, transmissibility, and susceptibility of GSS 16.4 Clinical signs of GSS and course of disease 16.5 Differential diagnoses of GSS 16.6 Epidemiology of GSS 16.7 Pathology of GSS 16.8 Is GSS a new disease? 16.9 Risk factors of GSS 16.10 Surveillance, prevention, and control of GSS
17 Portrait of Fatal Familial Insomnia and Sporadic Fatal Insomnia H. Budka and E. Gelpi 17.1 History of FFI and SFI 17.2 Forms or variants of FFI and SFI 17.3 Incubation period, transmissibility, and susceptibility of FFI and SFI 17.4 Clinical signs of FFI and SFI and course of disease 17.5 Differential diagnoses of FFI and SFI 17.6 Epidemiology of FFI and SFI 17.7 Pathology of FFI and SFI 17.8 Are FFI and SFI new diseases? 17.9 Risk factors of FFI and SFI 17.10 Surveillance, prevention, and control of FFI and SFI
18 Portrait of Scrapie in Sheep and Goat B. Hörnlimann, L. v. Keulen, M. J. Ulvund, and R. Bradley 18.1 History of scrapie 18.2 Forms or variants of scrapie agent strains 18.3 Incubation period, transmissibility, and susceptibility of scrapie 18.4 Clinical signs of scrapie and course of disease 18.5 Differential diagnoses of scrapie 18.6 Epidemiology of scrapie 18.7 Pathology of scrapie 18.8 Is scrapie a new disease? 18.9 Risk factors 18.10 Surveillance, prevention, and control of scrapie
19 Portrait of Bovine Spongiform Encephalopathy in Cattle and Other Ungulates B. Hörnlimann, J. Bachmann, and R. Bradley 19.1 History of BSE 19.2 Forms or variants of BSE 19.3 Incubation period, transmissibility, and susceptibility of BSE 19.4 Clinical signs of BSE and course of disease 19.5 Differential diagnoses of BSE 19.6 Epidemiology of BSE 19.7 Pathology and Pathogenesis of BSE 19.8 Is BSE a new diseases? 19.9 Risk factors of BSE 19.10 Surveillance, prevention, and control of BSE
20 Portrait of Prion Diseases in Zoo Animals J. K. Kirkwood and A. A. Cunningham 20.1 History 20.2 Forms or variants of prion diseases in zoo animals 20.3 Incubation period, transmissibility, and susceptibility 20.4 Clinical signs and course of disease 20.5 Differential diagnoses 20.6 Epidemiology 20.7 Pathology 20.8 Are prion diseases of zoo animals new? 20.9 Risk factors 20.10 Surveillance, prevention, and control
21 Portrait of Chronic Wasting Disease in Deer Species E. S. Williams† and M. W. Miller 21.1 History of CWD 21.2 Forms or variants of CWD 21.3 Incubation period, transmissibility, and susceptibility of CWD 21.4 Clinical signs of CWD and course of disease 21.5 Differential diagnoses of CWD 21.6 Epidemiology of CWD 21.7 Pathology of CWD 21.8 Is CWD a new prion disease? 21.9 Risk factors of CWD 21.10 Surveillance, prevention, and control of CWD
22 Portrait of Transmissible Mink Encephalopathy W. J. Hadlow 22.1 History of TME 22.2 Forms or variants of TME 22.3 Incubation period, transmissibility, and susceptibility of TME 22.4 Clinical signs of TME and course of disease 22.5 Differential diagnoses of TME 22.6 Epidemiology of TME 22.7 Pathology of TME 22.8 Is TME a new disease? 22.9 Risk factors of TME 22.10 Surveillance, prevention, and control of TME
23 Portrait of Transmissible Feline Spongiform Encephalopathy M. Hewicker-Trautwein and R. Bradley 23.1 History of FSE 23.2 Forms or variants of FSE 23.3 Incubation period, transmissibility, and susceptibility of FSE 23.4 Clinical signs of FSE and course of disease 23.5 Differential diagnoses of FSE 23.6 Epidemiology of FSE 23.7 Pathology of FSE 23.8 Is FSE a new disease? 23.9 Risk factors of FSE 23.10 Surveillance, prevention, and control of FSE
24 Portrait of Experimental BSE in Pigs G. A. H. Wells, S. A. C. Hawkins, J. Pohlenz†, and D. Matthews 24.1 History of BSE in pigs 24.2 Forms or variants of experimental BSE in pigs 24.3 Incubation period, transmission, and susceptibility 24.4 Clinical signs and course of disease 24.5 Differential diagnoses 24.6 Epidemiology 24.7 Pathology of BSE in pigs 24.8 Is there a TSE of pigs? 24.9 Risk factors 24.10 Surveillance, prevention, and control
25 Portrait of a Spongiform Encephalopathy in Birds and the Transmissibility of Mammalian Prion Diseases to Birds G. A. H. Wells, J. Pohlenz†, S. A. C. Hawkins, and D. Matthews 25.1 History of prion disease in ostriche (?) 25.2 Avian prion diseases? 25.3 Transmission studies on prion diseases in birds 25.4 Clinical signs and course of the SE of ostriches 25.5 Differential diagnoses of the SE of ostriches 25.6 Epidemiology of the SE of ostriches 25.7 Pathology of the SE of ostriches 25.8 What is the significance of the SE of ostriches? 25.9 Risk factors and prevention of prion disease in birds 25.10 Surveillance of TSE in birds
Topic IV Pathology
26 Pathology and Genetics of Human Prion Diseases H. Kretzschmar and P. Parchi 26.1 Introduction 26.2 Neuropathologic features of prion diseases in humans 26.3 PrPSC in non-neuronal tissues 26.4 The human prion protein and prion protein gene (PRNP) 26.5 Neuropathological phenotypes of human prion diseases 26.6 Genetics of human prion diseases: phenotypes of familial (genetic) prion diseases
27 The Pathology of Prion Diseases in Animals G. A. H. Wells, S. J. Ryder, and W. J. Hadlow 27.1 Introduction 27.2 Pathology of scrapie in sheep and goats 27.3 Pathology of transmissible mink encephalopathy (TME) 27.4 Pathology of chronic wasting disease 27.5 Pathology of bovine spongiform encephalopathy 27.6 Pathology of BSE in non domestic captive ungulate species 27.7 Pathology of feline spongiform encephalopathy
28 Pathophysiology of Prion Diseases Following Peripheral Infection W. J. Schulz-Schaeffer, H. Kretzschmar, and M. Beekes 28.1 Introduction 28.2 Administration of the pathogen in animal experiments 28.3 Cell culture experiments 28.4 Peripheral paths of infection 28.5 Significance of the hematopoetic system, in particular the spleen 28.6 Species-specific differences 28.7 Neuronal spread of infection to the central nervous system
Topic V Surveillance, Clinical Aspects and Diagnostics
29 Introduction to the Surveillance of Human Prion Diseases B. Hörnlimann, H. Kretzschmar, R. G. Will, O. Windl, and H. Budka 29.1 Introduction 29.2 Surveillance of patients on an out-patient and in-patient basis 29.3 Surveillance in neuropathological laboratories and diagnostic laboratories 29.4 International cooperation and the importance of national health authorities 29.5 Epidemiological surveillance and case control studies 29.6 The problem of possible phenotypic variation of disease caused by BSE prions in humans
30 Clinical Findings in Human Prion Diseases M. Sturzenegger and R. G. Will 30.1 Introduction 30.2 Differential diagnosis and additional paraclinical investigations 30.3 Clinical features of Creutzfeldt–Jakob disease 30.4 Clinical features of variant CJD 30.5 Clinical features of Gerstmann–Sträussler–Scheinker disease 30.6 Clinical features of fatal familial insomnia 30.7 Clinical features of sporadic fatal insomnia 30.8 Clinical features of kuru 30.9 Annex: historical classification
31 Clinical Diagnostic Methods for the Diagnosis ofHuman Prion Diseases I. Zerr 31.1 Introduction 31.2 Electroencephalogram 31.3 Analysis of cerebrospinal fluid 31.4 Imaging techniques 31.5 Sensitivity of clinical diagnostic tests in distinct molecular CJD subtypes 31.6 Diagnostic procedure
32 Introduction to Surveillance of Animal Prion Diseases B. Hörnlimann, M. G. Doherr, D. Matthews, and S. C. MacDiarmid 32.1 Introduction 32.2 Passive surveillance of animal prion diseases 32.3 “Active” surveillance of animal prion diseases
33 Clinical Findings in Bovine Spongiform Encephalopathy E. Schicker, U. Braun, B. Hörnlimann, and T. Konold 33.1 Introduction 33.2 Clinical history and course of the disease 33.3 Differential diagnosis of BSE 33.4 General clinical examination findings 33.5 Neurological examination findings 33.6 Laboratory findings 33.7 Examination at abattoirs – a diagnostic challenge
34 Clinical Findings in Scrapie M. J. Ulvund 34.1 Introduction 34.2 Case history 34.3 Findings of the general clinical examination 34.4 Differential diagnoses 34.5 Course of the disease 34.6 Findings of neurological examinations 34.7 Laboratory findings
35 Diagnosis of Bovine Spongiform Encephalopathy by Immunological Methods A. J. Raeber, M. Moser, and B. Oesch 35.1 Introduction 35.2 Properties of the normal and disease-associated form of the prion protein 35.3 Rapid tests approved by European authorities 35.4 Ante mortem TSE test development 35.5 Identification of atypical BSE strains
Topic VI Epidemiology
36 Epidemiology and Risk Factors of Creutzfeldt-Jakob Disease I. Zerr and S. Poser† 36.1 Introduction 36.2 Descriptive epidemiology 36.3 Risk factors for sporadic CJD 36.4 Epidemiology and risk factors of acquired forms of CJD
37 Creutzfeldt-Jakob Disease in Germany I. Zerr, S. Poser†, and H. Kretzschmar 37.1 Introduction 37.2 German CJD surveillance study 37.3 CJD epidemiology in Germany 37.4 Prognostic factors in sporadic CJD
38 The Epidemiology of Kuru M. P. Alpers and B. Hörnlimann 38.1 Introduction 38.2 Frequency of cases and progression of the epidemic 38.3 The geographical spread and related cultural events 38.4 Distribution according to sex and age 38.5 Socio-cultural background of the sex- and age-specific distribution 38.6 Explanation for the survival time curve (time of infection and infectious dose) 38.7 Explanation of kuru cases among children (modes of infection) 38.8 Conclusion and present significance of kuru
39 The Course of the BSE Epidemic – Retrospective Epidemiological Considerations B. Hörnlimann, Judith B. Ryan, and S. C. MacDiarmid 39.1 Introduction 39.2 Basic epidemiological data on BSE in the UK 39.3 The factors that determined the course of the epidemic
40 The Causes of the BSE Epidemic S. Dahms and B. Hörnlimann 40.1 Introduction 40.2 The case-series study: development of the feed borne hypothesis 40.3 The case-control study: investigations on the feed borne hypothesis
Topic VII Transmissibility
41 The Experimental Transmissibility of Prions and Infectivity Distribution in the Body M. H. Groschup, M. Geissen and A. Buschmann 41.1 Introduction 41.2 Brief historical overview 41.3 Design of experimental transmission studies 41.4 Experimental transmissibility of human prion diseases 41.5 Experimental transmissibility of animal prion diseases 41.6 Infectivity distribution in peripheral organs 41.7 Pathegonesis studies
42 The Iatrogenic and “Natural” Transmissibility of Prion Diseases M. H. Groschup, B. Hörnlimann, and A. Buschmann 42.1 Introduction 42.2 Natural transmission within one species 42.3 Natural transmission of scrapie to other species 42.4 Natural transmission of BSE to other species 42.5 Iatrogenic transmission in human and veterinary medicine 42.6 Genetically determined susceptibility
Topic VIII Agent Inactivation
43 Inactivation in Practice – Risk Assessment and Validation for Food Gelatin S. C. MacDiarmid 43.1 Introduction 43.2 Raw materials 43.3 Dilution 43.4 Acid treatment 43.5 Alkaline treatment 43.6 Further acid treatment 43.7 Extraction of gelatine 43.8 Experimental studies 43.9 Conclusions
44 Chemical Disinfection and Inactivation of Prions B. Hörnlimann, W. J. Schulz-Schaeffer, K. Roth, Zheng-Xin Y., H. Müller, R. C. Oberthür and D. Riesner 44.1 Introduction 44.2 Basic knowledge regarding the chemical inactivation of prions 44.3 Prerequisites for the efficiency of chemical disinfactants 44.4 Testing for prion depletion and inactivation efficiency 44.5 Chemical disinfactants suitable for the inactivation of prions 44.6 Chemical disinfactants unsuitable or less suitable for the inactivation of prions
45 Thermal Inactivation of Prions R. C. Oberthür, H. Müller, and D. Riesner 45.1 Introduction 45.2 Physical chemistry of heat inactivitation of complex biological structures 45.3 Kinetics of thermal denaturation and inactivation 45.4 Experimental setup for the thermal inactivation of a specimen 45.5 Results of inactivation studies 45.6 Inactivation of prions under oleochemical conditions 45.7 Practical and theoretical implications
Topic IX Prevention
46 Prevention of Prion Diseases in the Production of Medicinal Products, Medical Devices, and Cosmetics M. Ruffing, H. Windemann, and J. Schäfer 46.1 Introduction 46.2 Regulations to prevent the transmission of prion diseases by medicinal products and cosmetics 46.3 Evaluation of the risk of medicinal products transmitting prion diseases 46.4 Regulations for specific materials used in the production of medicinal products 46.5 Regulations to prevent the transmission of prion diseases by medical devices
47 Prevention of the Transmission of Prion Diseases in Healthcare Settings B. Hörnlimann, G. Pauli, K. Lemmer, M. Beekes, and M. Mielke 47.1 Introduction 47.2 Patient care 47.3 Risk of accidental occupational transmission in nosocomial and other healthcare settings 47.4 Iatrogenic transmission of humans TSEs: retrospective findings and current risk assessment 47.5 Preventive measures for handling CSF and tissue samples 47.6 Transmission through blood and blood products 47.7 Precautionary measures to minimize the risk of transmission via surgical interventions on patients with an evident or potential risk of CJD or vCJD 47.8 Disinfection and sterilization of instruments and materials 47.9 Decontamination of instruments following surgery on patients without any specific signs or symptoms pointing to a risk of transmission 47.10 Prevention in specific areas 47.11 Handling of corpses prior to interment 47.12 Waste disposal in hospitals and laboratories
48 Precautionary Measures for Autopsies Performed in Cases of Suspected Prion Disease W. J. Schulz-Schaeffer, A. Giese, and H. Kretzschmar 48.1 Introduction 48.2 Performing the autopsy 48.3 Decontamination and resistance of the infectious agent
49 Prevention of Prion Diseases in Research Laboratories A. J. Raeber and A. Aguzzi 49.1 Introduction 49.2 Risk categorization of prions 49.3 Risk assessment for work with prions and prion proteins 49.4 Risk classification for work with prions and prion proteins 49.5 Containment of laboratory work with prions 49.6 Inactivation of prions in research laboratories 49.7 Post-exposure prophylaxis following spills and accidents 49.8 Further useful information
Topic X Risk Assessment
50 Evidence for a Link between the New Variant of Creutzfeldt-Jakob Disease and Bovine Spongiform Encephalopathy M. E. Bruce, R. G. Will, J. W. Ironside, and H. Fraser 50.1 Introduction 50.2 TSE strain discrimination in mice 50.3 Transmissions of Animal TSEs to mice 50.4 Transmissions of vCJD and sCJD to mice 50.5 Conclusions
51 Risk Assessment of Transmitting Prion Diseases through Blood, Cornea, and Dura Mater J. Löwer and Th. R. Kreil 51.1 Introduction 51.2 Blood 51.3 Cornea 51.4 Dura Mater
52 BSE Risk Assessment and Minimization R. C. Oberthür, A. A. de Koeijer, B. E. C. Schreuder, and S. C. MacDiarmid 52.1 Introduction 52.2 Definition of the term “risk” 52.3 Dose-response relationship in BSE 52.4 Reproduction number 52.5 Reproduction number in Great Britain over time 52.6 BSE risk minimization within the cattle population 52.7 BSE risk minimization from cattle to humans 52.8 Control of the efficiency of BSE risk minimization
53 BSE control – Internationally Recommended Approaches S. C. MacDiarmid, P. Infanger, and B. Hörnlimann 53.1 Introduction 53.2 Measures in response to the first case of BSE in a country 53.3 Measures for surveillance, prevention, and control of a BSE epidemic
54 Atypical Scrapie-Nor98 S. L. Benestad and B. Bratberg 54.1 Introduction 54.2 TSE surveillance program launched for small ruminants 54.3 Particularity of clinical signs of atypical scrapie 53.4 Particularity of genetics 54.5 Particularity of the pathology 54.6 Particularity of the diagnosis 54.7 The origin of atypical scrapie
55 Scrapie Control – Internationally Recommended Approaches M. G. Doherr and N. Hunter 55.1 Introduction 55.2 Criteria to asses the scrapie status of a country or region 55.3 Disease monitoring 55.4 Measures to control scrapie in a country or region 55.5 Historical scrapie situation and potential import routes 55.6 National animal identification and tracing system 55.7 Genetic influences
56 The PrP Genotype as a Marker for Scrapie Susceptibility in Sheep N. Hunter and A. Bossers 56.1 Introduction 56.2 Sheep PrP gene (Prnp) and its variantions 56.3 Sheep PrP genotypes and association with susceptibility to TSEs 56.4 Methods of genotyping sheep
57 Scrapie Control at the National Level: The Norwegian Example K. R. Alvseike, I. Melkild, and K. Thorud 57.1 Introduction 57.2 Number of scrapie cases in Norway 57.3 Scrapie surveillance 57.4 Control and eradication of scrapie 57.5 Scrapie prevention
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