Aaron Foutz1, Brian S Appleby1,2,3,4, Clive Hamlin1,2, Xiaoqin Liu1, Sheng Yang3, Yvonne Cohen1, Wei Chen1, Janis Blevins1, Cameron Fausett3, Han Wang3, Pierluigi Gambetti1, Shulin Zhang2, Andrew Hughson5, Curtis Tatsuoka3, Lawrence B Schonberger6, Mark L Cohen1,2, Byron Caughey5, Jiri G Safar1,2,3. 1. National Prion Disease Pathology Surveillance Center, Case Western Reserve University School of Medicine, Cleveland, OH. 2. Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH. 3. Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH. 4. Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH. 5. Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT. 6. National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
Abstract
OBJECTIVE: Several prion amplification systems have been proposed for detection of prions in cerebrospinal fluid (CSF), most recently, the measurements of prion seeding activity with second-generation real-time quaking-induced conversion (RT-QuIC). The objective of this study was to investigate the diagnostic performance of the RT-QuIC prion test in the broad phenotypic spectrum of prion diseases. METHODS: We performed CSF RT-QuIC testing in 2,141 patients who had rapidly progressive neurological disorders, determined diagnostic sensitivity and specificity in 272 cases that were autopsied, and evaluated the impact of mutations and polymorphisms in the PRNP gene, and type 1 or type 2 human prions on diagnostic performance. RESULTS: The 98.5% diagnostic specificity and 92% sensitivity of CSF RT-QuIC in a blinded retrospective analysis matched the 100% specificity and 95% sensitivity of a blind prospective study. The CSF RT-QuIC differentiated 94% of cases of sporadic Creutzfeldt-Jakob disease (sCJD) MM1 from the sCJD MM2 phenotype, and 80% of sCJD VV2 from sCJD VV1. The mixed prion type 1-2 and cases heterozygous for codon 129 generated intermediate CSF RT-QuIC patterns, whereas genetic prion diseases revealed distinct profiles for each PRNP gene mutation. INTERPRETATION: The diagnostic performance of the improved CSF RT-QuIC is superior to surrogate marker tests for prion diseases such as 14-3-3 and tau proteins, and together with PRNP gene sequencing the test allows the major prion subtypes to be differentiated in vivo. This differentiation facilitates prediction of the clinicopathological phenotype and duration of the disease-two important considerations for envisioned therapeutic interventions. ANN NEUROL 2017;81:79-92.
OBJECTIVE: Several prion amplification systems have been proposed for detection of prions in cerebrospinal fluid (CSF), most recently, the measurements of prion seeding activity with second-generation real-time quaking-induced conversion (RT-QuIC). The objective of this study was to investigate the diagnostic performance of the RT-QuICprion test in the broad phenotypic spectrum of prion diseases. METHODS: We performed CSF RT-QuIC testing in 2,141 patients who had rapidly progressive neurological disorders, determined diagnostic sensitivity and specificity in 272 cases that were autopsied, and evaluated the impact of mutations and polymorphisms in the PRNP gene, and type 1 or type 2 human prions on diagnostic performance. RESULTS: The 98.5% diagnostic specificity and 92% sensitivity of CSF RT-QuIC in a blinded retrospective analysis matched the 100% specificity and 95% sensitivity of a blind prospective study. The CSF RT-QuIC differentiated 94% of cases of sporadic Creutzfeldt-Jakob disease (sCJD) MM1 from the sCJD MM2 phenotype, and 80% of sCJD VV2 from sCJD VV1. The mixed prion type 1-2 and cases heterozygous for codon 129 generated intermediate CSF RT-QuIC patterns, whereas genetic prion diseases revealed distinct profiles for each PRNP gene mutation. INTERPRETATION: The diagnostic performance of the improved CSF RT-QuIC is superior to surrogate marker tests for prion diseases such as 14-3-3 and tau proteins, and together with PRNP gene sequencing the test allows the major prion subtypes to be differentiated in vivo. This differentiation facilitates prediction of the clinicopathological phenotype and duration of the disease-two important considerations for envisioned therapeutic interventions. ANN NEUROL 2017;81:79-92.
Authors: P Parchi; R Castellani; S Capellari; B Ghetti; K Young; S G Chen; M Farlow; D W Dickson; A A Sima; J Q Trojanowski; R B Petersen; P Gambetti Journal: Ann Neurol Date: 1996-06 Impact factor: 10.422
Authors: Clive Hamlin; Gianfranco Puoti; Sally Berri; Elliott Sting; Carrie Harris; Mark Cohen; Charles Spear; Alberto Bizzi; Sara M Debanne; Douglas Y Rowland Journal: Neurology Date: 2012-07-25 Impact factor: 9.910
Authors: P Sanchez-Juan; A Green; A Ladogana; N Cuadrado-Corrales; R Sáanchez-Valle; E Mitrováa; K Stoeck; T Sklaviadis; J Kulczycki; K Hess; M Bodemer; D Slivarichová; A Saiz; M Calero; L Ingrosso; R Knight; A C J W Janssens; C M van Duijn; I Zerr Journal: Neurology Date: 2006-08-22 Impact factor: 9.910
Authors: R Hecker; A Taraboulos; M Scott; K M Pan; S L Yang; M Torchia; K Jendroska; S J DeArmond; S B Prusiner Journal: Genes Dev Date: 1992-07 Impact factor: 11.361
Authors: G C Telling; P Parchi; S J DeArmond; P Cortelli; P Montagna; R Gabizon; J Mastrianni; E Lugaresi; P Gambetti; S B Prusiner Journal: Science Date: 1996-12-20 Impact factor: 47.728
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