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Chen Z, Nan H, Kong Y, Chu M, Liu L, Zhang J, Wang L, Wu L. Amino Acid Substitution within Seven- Octapeptide Repeat Insertions in the Prion Protein Gene Associated with Short-Term Course. Viruses 2022; 14. [PMID: 36298800 DOI: 10.3390/v14102245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/26/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Abstract
The majority of seven-octapeptide repeat insertion (7-OPRI) carriers exhibit relatively early onset and a slowly progressive course. We have presented three cases of 7-OPRI, including two that are rapidly progressing, and compared the clinical and ancillary characteristics of the short-term and long-term disease course, as well as factors that influence disease course. The clinical and ancillary features of three new 7-OPRI patients in a Chinese pedigree were analyzed. Global data on 7-OPRI cases were then collected by reviewing the literature, and the cases were grouped according to clinical duration as per the WHO sCJD criteria, with a two-year cut-off. A Chinese pedigree has a glycine-to-glutamate substitution within the 7-OPRI insertion, which enhances the hydrophilicity of the prion protein. Two cases in this pedigree had a short disease course (consistent with the typical clinical and ancillary features of sCJD). In addition, the members of this pedigree had a later onset (p < 0.001) and shorter disease course (p < 0.001) compared to previously reported 7-OPRI cases with 129 cis-M and a similar age of onset and disease course to that of cases with 129 cis-V. The 7-OPRI cases with a shorter clinical course (n = 4) had a later onset (p = 0.021), higher rate of hyperintensity on MRI (p = 0.029) and higher frequency of 129 cis-V (p = 0.066) compared to those with a longer clinical course (n = 13). The clinical presentation of 7-OPRI is significantly heterogeneous. Codon 129 cis-V and amino acid substitution within repeat insertions are possible contributors to the short-term disease course of 7-OPRI.
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Brennecke N, Cali I, Mok TH, Speedy H, Hosszu LLP, Stehmann C, Cracco L, Puoti G, Prior TW, Cohen ML, Collins SJ, Mead S, Appleby BS. Characterization of Prion Disease Associated with a Two- Octapeptide Repeat Insertion. Viruses 2021; 13:1794. [PMID: 34578375 PMCID: PMC8473248 DOI: 10.3390/v13091794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/31/2021] [Accepted: 09/04/2021] [Indexed: 12/03/2022] Open
Abstract
Genetic prion disease accounts for 10-15% of prion disease. While insertion of four or more octapeptide repeats are clearly pathogenic, smaller repeat insertions have an unclear pathogenicity. The goal of this case series was to provide an insight into the characteristics of the 2-octapeptide repeat genetic variant and to provide insight into the risk for Creutzfeldt-Jakob disease in asymptomatic carriers. 2-octapeptide repeat insertion prion disease cases were collected from the National Prion Disease Pathology Surveillance Center (US), the National Prion Clinic (UK), and the National Creutzfeldt-Jakob Disease Registry (Australia). Three largescale population genetic databases were queried for the 2-octapeptide repeat insertion allele. Eight cases of 2-octapeptide repeat insertion were identified. The cases were indistinguishable from the sporadic Creutzfeldt-Jakob cases of the same molecular subtype. Western blot characterization of the prion protein in the absence of enzymatic digestion with proteinase K revealed that 2-octapeptide repeat insertion and sporadic Creutzfeldt-Jakob disease have distinct prion protein profiles. Interrogation of large-scale population datasets suggested the variant is of very low penetrance. The 2-octapeptide repeat insertion is at most a low-risk genetic variant. Predictive genetic testing for asymptomatic blood relatives is not likely to be justified given the low risk.
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Affiliation(s)
- Nicholas Brennecke
- Department of Neurology, Case Western Reserve University & University Hospitals Cleveland Medical, Cleveland, OH 44106, USA; (N.B.); (M.L.C.)
| | - Ignazio Cali
- Department of Pathology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
- National Prion Disease Pathology Surveillance Center (NPDPSC), Cleveland, OH 44106, USA
| | - Tze How Mok
- MRC Prion Unit at University College London, Institute of Prion Diseases, London W1W 7FF, UK; (T.H.M.); (H.S.); (L.L.P.H.); (S.M.)
| | - Helen Speedy
- MRC Prion Unit at University College London, Institute of Prion Diseases, London W1W 7FF, UK; (T.H.M.); (H.S.); (L.L.P.H.); (S.M.)
| | | | - Laszlo L. P. Hosszu
- MRC Prion Unit at University College London, Institute of Prion Diseases, London W1W 7FF, UK; (T.H.M.); (H.S.); (L.L.P.H.); (S.M.)
| | - Christiane Stehmann
- Australian National Creutzfeldt-Jakob Disease Registry, The Florey Institute, The University of Melbourne, Melbourne, VIC 3010, Australia; (C.S.); (S.J.C.)
| | - Laura Cracco
- Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, USA;
| | - Gianfranco Puoti
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
- Prion Disease Diagnosis and Surveillance Center (PDDSC), University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Thomas W. Prior
- Center for Human Genetics Laboratory, Case Western Reserve University & University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA;
| | - Mark L. Cohen
- Department of Neurology, Case Western Reserve University & University Hospitals Cleveland Medical, Cleveland, OH 44106, USA; (N.B.); (M.L.C.)
- Department of Pathology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
- National Prion Disease Pathology Surveillance Center (NPDPSC), Cleveland, OH 44106, USA
| | - Steven J. Collins
- Australian National Creutzfeldt-Jakob Disease Registry, The Florey Institute, The University of Melbourne, Melbourne, VIC 3010, Australia; (C.S.); (S.J.C.)
| | - Simon Mead
- MRC Prion Unit at University College London, Institute of Prion Diseases, London W1W 7FF, UK; (T.H.M.); (H.S.); (L.L.P.H.); (S.M.)
| | - Brian S. Appleby
- Department of Neurology, Case Western Reserve University & University Hospitals Cleveland Medical, Cleveland, OH 44106, USA; (N.B.); (M.L.C.)
- Department of Pathology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
- National Prion Disease Pathology Surveillance Center (NPDPSC), Cleveland, OH 44106, USA
- Department of Psychiatry, Case Western Reserve University & University Hospitals, Cleveland, OH 44106, USA
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Townley RA, Polsinelli AJ, Fields JA, Machulda MM, Jones DT, Graff-Radford J, Kantarci KM, Lowe VJ, Rademakers RV, Baker MC, Kumar N, Boeve BF. Longitudinal clinical, neuropsychological, and neuroimaging characterization of a kindred with a 12- octapeptide repeat insertion in PRNP: the next generation. Neurocase 2020; 26:211-219. [PMID: 32602775 PMCID: PMC7426006 DOI: 10.1080/13554794.2020.1787458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 06/18/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Highly penetrant inherited mutations in the prion protein gene (PRNP) offer a window to study the pathobiology of prion disorders. METHOD Clinical, neuropsychological, and neuroimaging characterization of a kindred. RESULTS Three of four mutation carriers have progressed to a frontotemporal dementia phenotype. Declines in neuropsychological function coincided with changes in FDG-PET at the identified onset of cognitive impairment. CONCLUSIONS AND RELEVANCE Gene silencing treatments are on the horizon and when they become available, early detection will be crucial. Longitudinal studies involving familial mutation kindreds can offer important insights into the initial neuropsychological and neuroimaging changes necessary for early detection.
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Affiliation(s)
- Ryan A. Townley
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160
| | | | - Julie A. Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA 55902
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA 55902
| | - David T. Jones
- Department of Neurology, Indiana University School of Medicine, IN, USA 46202
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA 55902
| | | | - Kejal M. Kantarci
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA 55902
| | - Val J. Lowe
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA 55902
| | | | - Matt C. Baker
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA 32224
| | - Neeraj Kumar
- Department of Neurology, Indiana University School of Medicine, IN, USA 46202
| | - Bradley F. Boeve
- Department of Neurology, Indiana University School of Medicine, IN, USA 46202
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Takada LT, Kim MO, Cleveland RW, Wong K, Forner SA, Gala II, Fong JC, Geschwind MD. Genetic prion disease: Experience of a rapidly progressive dementia center in the United States and a review of the literature. Am J Med Genet B Neuropsychiatr Genet 2017; 174:36-69. [PMID: 27943639 PMCID: PMC7207989 DOI: 10.1002/ajmg.b.32505] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 12/21/2022]
Abstract
Although prion diseases are generally thought to present as rapidly progressive dementias with survival of only a few months, the phenotypic spectrum for genetic prion diseases (gPrDs) is much broader. The majority have a rapid decline with short survival, but many patients with gPrDs present as slowly progressive ataxic or parkinsonian disorders with progression over a few to several years. A few very rare mutations even present as neuropsychiatric disorders, sometimes with systemic symptoms such as gastrointestinal disorders and neuropathy, progressing over years to decades. gPrDs are caused by mutations in the prion protein gene (PRNP), and have been historically classified based on their clinicopathological features as genetic Jakob-Creutzfeldt disease (gJCD), Gerstmann-Sträussler-Scheinker (GSS), or Fatal Familial Insomnia (FFI). Mutations in PRNP can be missense, nonsense, and octapeptide repeat insertions or a deletion, and present with diverse clinical features, sensitivities of ancillary testing, and neuropathological findings. We present the UCSF gPrD cohort, including 129 symptomatic patients referred to and/or seen at UCSF between 2001 and 2016, and compare the clinical features of the gPrDs from 22 mutations identified in our cohort with data from the literature, as well as perform a literature review on most other mutations not represented in our cohort. E200K is the most common mutation worldwide, is associated with gJCD, and was the most common in the UCSF cohort. Among the GSS-associated mutations, P102L is the most commonly reported and was also the most common at UCSF. We also had several octapeptide repeat insertions (OPRI), a rare nonsense mutation (Q160X), and three novel mutations (K194E, E200G, and A224V) in our UCSF cohort. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Leonel T. Takada
- Cognitive and Behavioral Neurology Unit, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Mee-Ohk Kim
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94107
| | - Ross W. Cleveland
- Department of Pediatrics, The University of Vermont Children’s Hospital, University of Vermont, Burlington, VT 05401
| | - Katherine Wong
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94107
| | - Sven A. Forner
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94107
| | - Ignacio Illán Gala
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jamie C. Fong
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94107
| | - Michael D. Geschwind
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94107
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