A novel prion disease associated with diarrhea and autonomic neuropathy.

Abstract

BACKGROUND:

Human prion diseases, although variable in clinicopathological phenotype, generally present as neurologic or neuropsychiatric conditions associated with rapid multifocal central nervous system degeneration that is usually dominated by dementia and cerebellar ataxia. Approximately 15% of cases of recognized prion disease are inherited and associated with coding mutations in the gene encoding prion protein (PRNP). The availability of genetic diagnosis has led to a progressive broadening of the recognized spectrum of disease.

METHODS:

We used longitudinal clinical assessments over a period of 20 years at one hospital combined with genealogical, neuropsychological, neurophysiological, neuroimaging, pathological, molecular genetic, and biochemical studies, as well as studies of animal transmission, to characterize a novel prion disease in a large British kindred. We studied 6 of 11 affected family members in detail, along with autopsy or biopsy samples obtained from 5 family members.

RESULTS:

We identified a PRNP Y163X truncation mutation and describe a distinct and consistent phenotype of chronic diarrhea with autonomic failure and a length-dependent axonal, predominantly sensory, peripheral polyneuropathy with an onset in early adulthood. Cognitive decline and seizures occurred when the patients were in their 40s or 50s. The deposition of prion protein amyloid was seen throughout peripheral organs, including the bowel and peripheral nerves. Neuropathological examination during end-stage disease showed the deposition of prion protein in the form of frequent cortical amyloid plaques, cerebral amyloid angiopathy, and tauopathy. A unique pattern of abnormal prion protein fragments was seen in brain tissue. Transmission studies in laboratory mice were negative.

CONCLUSIONS:

Abnormal forms of prion protein that were found in multiple peripheral tissues were associated with diarrhea, autonomic failure, and neuropathy. (Funded by the U.K. Medical Research Council and others.).

• Authors: Simon Mead, Sonia Gandhi, Jon Beck, Diana Caine, Dillip Gallujipali, Christopher Carswell, Harpreet Hyare, Susan Joiner, Hilary Ayling, Tammaryn Lashley, Jacqueline M Linehan, Huda Al-Doujaily, Bernadette Sharps, Tamas Revesz, Malin K Sandberg, Mary M Reilly, Martin Koltzenburg, Alastair Forbes, Peter Rudge, Sebastian Brandner, Jason D Warren, Jonathan D F Wadsworth, Nicholas W Wood, Janice L Holton, John Collinge
• Journal: The New England journal of medicine (N Engl J Med) Vol. 369 Issue 20 Pg. 1904-14 (Nov 14 2013) ISSN: 1533-4406 [Electronic] United States
• PMID: 24224623 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• PRNP protein, human
• Prion Proteins
• Prions

Topics

• Animals
• Autonomic Nervous System Diseases (etiology, pathology)
• Brain (pathology)
• Diarrhea (etiology)
• Female
• Humans
• Longitudinal Studies
• Male
• Mice
• Mice, Transgenic
• Mutation
• Pedigree
• Phenotype
• Plaque, Amyloid (pathology)
• Prion Diseases (complications, genetics, pathology, transmission)
• Prion Proteins
• Prions (genetics)