Introduction
Materials and methods
Cases, inclusion criteria and tissue specimens
Study ID | ABC score (Hyman et al. [26]) | Hybrid protocol (from Love et al. [39]) | |||||
---|---|---|---|---|---|---|---|
A | B | C | Parenchymal CAA | Meningeal CAA | Capillary CAA | Vasculopathy | |
hGH-iCJD 4 | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
hGH-iCJD 5 | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
hGH-iCJD 6 | 0 | 0 | 0 | 1 | 2 | 0 | 0 |
hGH-iCJD 8 | 0 | 0 | 0 | 2 | 2 | 0 | 0 |
hGH-iCJD 9 | 0 | 0 | 0 | 1 | 2 | 0 | 0 |
hGH-iCJD 10 | 1 | 0 | 1 | 2 | 2 | 0 | 0 |
hGH-iCJD 12 | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
hGH-iCJD 15 | 1 | 0 | 0 | 2 | 2 | 0 | 0 |
hGH-iCJD 16 | 1 | 0 | 2 | 1 | 2 | 0 | 0 |
hGH-iCJD 18 | 1a
| 0 | 2 | 2 | 2 | 1 | 0 |
hGH-iCJD 19 | 1 | 0 | 0 | 2 | 2 | 0 | 0 |
hGH-iCJD 26 | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
hGH-iCJD 29 | 0 | 0 | 0 | 2 | 2 | 0 | 0 |
hGH-iCJD 31 | 1 | 0 | 1 | 1 | 2 | 0 | 0 |
hGH-iCJD 32 | 1 | 0 | 1 | 2 | 3 | 0 | 0 |
hGH-iCJD 33 | 1 | 0 | 0 | 2 | 2 | 0 | 0 |
hGH-iCJD 34 | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
hGH-iCJD 35 | 1a
| 0 | 0 | 0 | 0 | 0 | 0 |
hGH-control6 | 1a
| 0 | 0 | 0 | 0 | 0 | 0 |
hGH-control7 | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
hGH-control9 | 0 | 0 | 0 | 2 | 2 | 0 | 0 |
hGH-control10 | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
hGH-control11 | 1a
| 0 | 2 | 3 | 3 | 1 | 1 |
sCJD14 | 0 | 0 | 0 | 1 | 2 | 0 | 0 |
vCJD22 | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
vCJD32 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Antibodies and immunohistochemical analysis
Assessment of CNS tissues for prion-related pathology
Assessment of Aβ and phospho-tau pathology
Immunohistochemistry for apoE and apoE-4
APOE genotype and apoE-4 phenotype | hGH-iCJD | hGH control | ||
---|---|---|---|---|
CNS Aβ accumulation | CNS Aβ accumulation | |||
Positive | Negativea
| Positive | Negativea
| |
2/2 | 0 | 0 | 0 | 0 |
2/3 | 1 | 1 | 0 | 0 |
2/4 | 0 | 0 | 0 | 0 |
3/3 | 8 | 6 | 1 | 0 |
3/4 | 4 | 2 | 1 | 0 |
4/4 | 0 | 0 | 0 | 0 |
ApoE4 +veb (IHC)a
| 0 | 0 | 1 | 0 |
ApoE4 −veb (IHC)a
| 5 | 0 | 2 | 0 |
Total | 18 | 9 | 5 | 0 |
Paraffin-embedded tissue blot
APOE genotyping
Exome sequencing and analysis
Western blotting with sodium phosphotungstic acid precipitation
Statistical analysis
Results
Clinical features
Neuropathological phenotype in hGH-iCJD and hDM-iCJD
Atypical neuropathology in hGH-iCJD
Co-pathology and Aβ accumulation in hGH-iCJD and hGH controls
Phospho-tau, α-synuclein and TDP-43 pathology
Correlations with Aβ pathology in hGH-treated patients
APOE genotype and apoE-4 phenotype analysis
Exome sequencing
hGH-iCJD and hGH control non-CNS tissues
Discussion
Neuropathological phenotypes of UK hGH-iCJD patients and comparison with sCJD
Peripheral pathogenesis in hGH-iCJD
CNS Aβ in hGH-iCJD and hGH control cases and associations with Alzheimer’s disease
Factors influencing CNS Aβ accumulation in hGH recipients
Study references | Jaunmuktane et al. [29] | Frontzek et al. [16] | Kovacs et al. [36] | Hamaguchi et al. [22] | This study | |
---|---|---|---|---|---|---|
Clinical phenotype | CJD | CJD | CJD | CJD | CJD | Not CJD |
Cause of iCJD | hGH | hDM | hDM | hDM | hGH | None |
Number of cases | 8 | 7 | 2a
| 16 | 33b
| 12 |
Other autopsy tissues examined | No | No | Yes | No | Yes | Yes |
Non-CJD autopsy tissues examined | Pituitary gland: 55 cases | No | Dura mater: 84 cases | No | hGH control cases—see Online Resources Table 4 | |
Genetic analysis |
APOE + AD genes | No |
APOE + AD genes |
APOE
|
APOE + AD genes | |
Number with Aβ parenchymal deposits | 4 + 2 focal | 5 | 2a
| 13 | 12 | 4 |
Morphology and distribution of Aβ deposits described | Yes, with quantitative analysis | No | Yes, in detail | Subpial Aβ accumulation plaque morphology not included | Yes, in detail | |
Age of cases with parenchymal Aβ | 5th decade—51 years | 28–63 | 28, 33 | 35–81 | 27–45 | 30–45 |
Age of cases <40 years with parenchymal Aβ | 36 (focal deposits) | 28, 33 | 28, 33 | 35, 39 | 27–38 | 30–37 |
Number with Aβ CAA | 3 + 1 focal | 5 | 2a
| 11 | 14 | 2 |
Age of cases with Aβ CAA | 5th decade—51 years | 28–63 | 28, 33 | 35–81 | 20–37 | 42–45 |
Age of cases <40 years with Aβ CAA | None | 28, 33 | 28–33 | 35–39 | 20–37 | None |
AD-related phospho-tau pathology | No | No | No | Yes—details given | Yes—details given | |
Statistically significant difference from sCJD | Yes | Yes | Yes | Yes | Yes—and also from vCJD |