Insights into CWD and BSE species barriers using real-time conversion
Kristen A. Davenport1, Davin M. Henderson1, Candace K. Mathiason1 and 
Edward A. Hoover1# 
+ Author Affiliations Prion Research Center, Department of Microbiology, 
Immunology and Pathology, College of Veterinary Medicine and Biomedical 
Sciences, Colorado State University, Fort Collins, CO 805231 
ABSTRACT
The propensity for trans-species prion transmission is related to the 
structural characteristics of the enciphering and new host PrP, although the 
exact mechanism remains incompletely understood. The effects of variability in 
prion protein on cross-species prion transmission have been studied with animal 
bioassays, but the influence of prion protein structure vs. host co-factors 
(e.g. cellular constituents, trafficking, and innate immune interactions) 
remains difficult to dissect. To isolate the effects of protein:protein 
interactions on trans-species conversion, we used recombinant PrPC and real-time 
quaking-induced conversion (RT-QuIC) and compared chronic wasting disease (CWD) 
and classical bovine spongiform encephalopathy (cBSE) prions. To assess the 
impact of transmission to a new species, we studied feline CWD (fCWD) and feline 
BSE (i.e. feline spongiform encephalopathy, FSE). We cross-seeded fCWD and FSE 
into each species' full-length, recombinant PrPC and measured the time required 
for conversion to the amyloid (PrPRes) form, which we describe here as the rate 
of amyloid conversion. These studies revealed that: 
(1) CWD and BSE seeded their homologous species' PrP best; 
(2) fCWD was a more efficient seed for feline rPrP than for white-tailed 
deer rPrP; 
(3) conversely, FSE more efficiently converted bovine than feline rPrP; 
(4) and CWD, fCWD, BSE, and FSE all converted human rPrP, although not as 
efficiently as homologous sCJD prions. 
These results suggest that: 
(1) at the level of protein: protein interactions, CWD adapts to a new 
species more readily than does BSE, and 
(2) the barrier preventing transmission of CWD to humans may be less robust 
than estimated. 
IMPORTANCE We demonstrate that bovine spongiform encephalopathy prions 
maintain their trans-species conversion characteristics upon passage to cats, 
but that chronic wasting disease prions adapt to the cat and are distinguishable 
from the original prion. 
***Additionally, we showed that chronic wasting disease prions are 
effective at seeding the conversion of normal human prion protein to an amyloid 
conformation, perhaps the first step in crossing the species barrier. 
 FOOTNOTES
↵#Address correspondence to Edward A. Hoover, edward.hoover@colostate.edu 
Copyright © 2015, American Society for Microbiology. All Rights Reserved. 
*** We hypothesize that both BSE prions and CWD prions passaged through 
felines will seed human recPrP more efficiently than BSE or CWD from the 
original hosts, evidence that the new host will dampen the species barrier 
between humans and BSE or CWD. The new host effect is particularly relevant as 
we investigate potential means of trans-species transmission of prion disease. 
 *** PPo3-7: Prion Transmission from Cervids to Humans is Strain-dependent 
*** Here we report that a human prion strain that had adopted the cervid 
prion protein (PrP) sequence through passage in cervidized transgenic mice 
efficiently infected transgenic mice expressing human PrP, 
*** indicating that the species barrier from cervid to humans is prion 
strain-dependent and humans can be vulnerable to novel cervid prion strains. 
PPo2-27: 
Generation of a Novel form of Human PrPSc by Inter-species Transmission of 
Cervid Prions 
*** Our findings suggest that CWD prions have the capability to infect 
humans, and that this ability depends on CWD strain adaptation, implying that 
the risk for human health progressively increases with the spread of CWD among 
cervids. 
PPo2-7: 
Biochemical and Biophysical Characterization of Different CWD Isolates 
*** The data presented here substantiate and expand previous reports on the 
existence of different CWD strains. 
Envt.07: 
Pathological Prion Protein (PrPTSE) in Skeletal Muscles of Farmed and Free 
Ranging White-Tailed Deer Infected with Chronic Wasting Disease 
***The presence and seeding activity of PrPTSE in skeletal muscle from 
CWD-infected cervids suggests prevention of such tissue in the human diet as a 
precautionary measure for food safety, pending on further clarification of 
whether CWD may be transmissible to humans. 
>>>CHRONIC WASTING DISEASE , THERE WAS NO ABSOLUTE BARRIER TO 
CONVERSION OF THE HUMAN PRION PROTEIN<<< 
*** PRICE OF CWD TSE PRION POKER GOES UP 2014 *** 
Transmissible Spongiform Encephalopathy TSE PRION update January 2, 2014 
Wednesday, January 01, 2014 
Molecular Barriers to Zoonotic Transmission of Prions 
*** chronic wasting disease, there was no absolute barrier to conversion of 
the human prion protein. 
*** Furthermore, the form of human PrPres produced in this in vitro assay 
when seeded with CWD, resembles that found in the most common human prion 
disease, namely sCJD of the MM1 subtype. 
PRION2013 CONGRESSIONAL ABSTRACTS CWD 
Sunday, August 25, 2013 
HD.13: CWD infection in the spleen of humanized transgenic mice 
***These results indicate that the CWD prion may have the potential to 
infect human peripheral lymphoid tissues. 
Oral.15: Molecular barriers to zoonotic prion transmission: Comparison of 
the ability of sheep, cattle and deer prion disease isolates to convert normal 
human prion protein to its pathological isoform in a cell-free system 
***However, they also show that there is no absolute barrier to conversion of 
human prion protein in the case of chronic wasting disease. 
PRION2013 CONGRESSIONAL ABSTRACTS CWD 
Sunday, August 25, 2013 
***Chronic Wasting Disease CWD risk factors, humans, domestic cats, blood, 
and mother to offspring transmission 
PPo3-7: 
Prion Transmission from Cervids to Humans is Strain-dependent 
Qingzhong Kong, Shenghai Huang,*Fusong Chen, Michael Payne, Pierluigi 
Gambetti and Liuting Qing Department of Pathology; Case western Reserve 
University; Cleveland, OH USA *Current address: Nursing Informatics; Memorial 
Sloan-Kettering Cancer Center; New York, NY USA 
Key words: CWD, strain, human transmission 
Chronic wasting disease (CWD) is a widespread prion disease in cervids 
(deer and elk) in North America where significant human exposure to CWD is 
likely and zoonotic transmission of CWD is a concern. Current evidence indicates 
a strong barrier for transmission of the classical CWD strain to humans with the 
PrP-129MM genotype. A few recent reports suggest the presence of two or more CWD 
strains. What remain unknown is whether individuals with the PrP-129VV/MV 
genotypes are also resistant to the classical CWD strain and whether humans are 
resistant to all natural or adapted cervid prion strains. Here we report that a 
human prion strain that had adopted the cervid prion protein (PrP) sequence 
through passage in cervidized transgenic mice efficiently infected transgenic 
mice expressing human PrP, indicating that the species barrier from cervid to 
humans is prion strain-dependent and humans can be vulnerable to novel cervid 
prion strains. Preliminary results on CWD transmission in transgenic mice 
expressing human PrP-129V will also be discussed. 
Acknowledgement Supported by NINDS NS052319 and NIA AG14359. 
PPo2-27: 
Generation of a Novel form of Human PrPSc by Inter-species Transmission of 
Cervid Prions 
Marcelo A. Barria,1 Glenn C. Telling,2 Pierluigi Gambetti,3 James A. 
Mastrianni4 and Claudio Soto1 1Mitchell Center for Alzheimer’s disease and 
related Brain disorders; Dept of Neurology; University of Texas Houston Medical 
School; Houston, TX USA; 2Dept of Microbiology, Immunology & Molecular 
Genetics and Neurology; Sanders Brown Center on Aging; University of Kentucky 
Medical Center; Lexington, KY USA; 3Institute of Pathology; Case western Reserve 
University; Cleveland, OH USA; 4Dept of Neurology; University of Chicago; 
Chicago, IL USA 
Prion diseases are infectious neurodegenerative disorders affecting humans 
and animals that result from the conversion of normal prion protein (PrPC) into 
the misfolded and infectious prion (PrPSc). Chronic wasting disease (CWD) of 
cervids is a prion disorder of increasing prevalence within the United States 
that affects a large population of wild and captive deer and elk. CWD is highly 
contagious and its origin, mechanism of transmission and exact prevalence are 
currently unclear. The risk of transmission of CWD to humans is unknown. 
Defining that risk is of utmost importance, considering that people have been 
infected by animal prions, resulting in new fatal diseases. To study the 
possibility that human PrPC can be converted into the infectious form by CWD 
PrPSc we performed experiments using the Protein Misfolding Cyclic Amplification 
(PMCA) technique, which mimic in vitro the process of prion replication. Our 
results show that cervid PrPSc can induce the pathological conversion of human 
PrPC, but only after the CWD prion strain has been stabilized by successive 
passages in vitro or in vivo. Interestingly, this newly generated human PrPSc 
exhibits a distinct biochemical pattern that differs from any of the currently 
known forms of human PrPSc, indicating that it corresponds to a novel human 
prion strain. Our findings suggest that CWD prions have the capability to infect 
humans, and that this ability depends on CWD strain adaptation, implying that 
the risk for human health progressively increases with the spread of CWD among 
cervids. 
PPo2-7: 
Biochemical and Biophysical Characterization of Different CWD Isolates 
Martin L. Daus and Michael Beekes Robert Koch Institute; Berlin, Germany 
Key words: CWD, strains, FT-IR, AFM 
Chronic wasting disease (CWD) is one of three naturally occurring forms of 
prion disease. The other two are Creutzfeldt-Jakob disease in humans and scrapie 
in sheep. CWD is contagious and affects captive as well as free ranging cervids. 
As long as there is no definite answer of whether CWD can breach the species 
barrier to humans precautionary measures especially for the protection of 
consumers need to be considered. In principle, different strains of CWD may be 
associated with different risks of transmission to humans. Sophisticated strain 
differentiation as accomplished for other prion diseases has not yet been 
established for CWD. However, several different findings indicate that there 
exists more than one strain of CWD agent in cervids. We have analysed a set of 
CWD isolates from white-tailed deer and could detect at least two biochemically 
different forms of disease-associated prion protein PrPTSE. Limited proteolysis 
with different concentrations of proteinase K and/or after exposure of PrPTSE to 
different pH-values or concentrations of Guanidinium hydrochloride resulted in 
distinct isolate-specific digestion patterns. Our CWD isolates were also 
examined in protein misfolding cyclic amplification studies. This showed 
different conversion activities for those isolates that had displayed 
significantly different sensitivities to limited proteolysis by PK in the 
biochemical experiments described above. We further applied Fourier transform 
infrared spectroscopy in combination with atomic force microscopy. This 
confirmed structural differences in the PrPTSE of at least two disinct CWD 
isolates. The data presented here substantiate and expand previous reports on 
the existence of different CWD strains. 
2012 
Envt.06: 
Zoonotic Potential of CWD: Experimental Transmissions to Non-Human Primates 
Emmanuel Comoy,1,† ValĂ©rie Durand,1 Evelyne Correia,1 Aru Balachandran,2 
JĂĽrgen Richt,3 Vincent Beringue,4 Juan-Maria Torres,5 Paul Brown,1 Bob Hills6 
and Jean-Philippe Deslys1 
1Atomic Energy Commission; Fontenay-aux-Roses, France; 2Canadian Food 
Inspection Agency; Ottawa, ON Canada; 3Kansas State University; Manhattan, KS 
USA; 4INRA; Jouy-en-Josas, France; 5INIA; Madrid, Spain; 6Health Canada; Ottawa, 
ON Canada 
†Presenting author; Email: emmanuel.comoy@cea.fr 
The constant increase of chronic wasting disease (CWD) incidence in North 
America raises a question about their zoonotic potential. A recent publication 
showed their transmissibility to new-world monkeys, but no transmission to 
old-world monkeys, which are phylogenetically closer to humans, has so far been 
reported. Moreover, several studies have failed to transmit CWD to transgenic 
mice overexpressing human PrP. Bovine spongiform encephalopathy (BSE) is the 
only animal prion disease for which a zoonotic potential has been proven. We 
described the transmission of the atypical BSE-L strain of BSE to cynomolgus 
monkeys, suggesting a weak cattle-to-primate species barrier. We observed the 
same phenomenon with a cattleadapted strain of TME (Transmissible Mink 
Encephalopathy). Since cattle experimentally exposed to CWD strains have also 
developed spongiform encephalopathies, we inoculated brain tissue from 
CWD-infected cattle to three cynomolgus macaques as well as to transgenic mice 
overexpressing bovine or human PrP. Since CWD prion strains are highly 
lymphotropic, suggesting an adaptation of these agents after peripheral 
exposure, a parallel set of four monkeys was inoculated with CWD-infected cervid 
brains using the oral route. Nearly four years post-exposure, monkeys exposed to 
CWD-related prion strains remain asymptomatic. In contrast, bovinized and 
humanized transgenic mice showed signs of infection, suggesting that CWD-related 
prion strains may be capable of crossing the cattle-to-primate species barrier. 
Comparisons with transmission results and incubation periods obtained after 
exposure to other cattle prion strains (c-BSE, BSE-L, BSE-H and cattle-adapted 
TME) will also be presented, in order to evaluate the respective risks of each 
strain. 
Envt.07: 
Pathological Prion Protein (PrPTSE) in Skeletal Muscles of Farmed and Free 
Ranging White-Tailed Deer Infected with Chronic Wasting Disease 
Martin L. Daus,1,† Johanna Breyer,2 Katjs Wagenfuehr,1 Wiebke Wemheuer,2 
Achim Thomzig,1 Walter Schulz-Schaeffer2 and Michael Beekes1 1Robert Koch 
Institut; P24 TSE; Berlin, Germany; 2Department of Neuropathology, Prion and 
Dementia Research Unit, University Medical Center Göttingen; Göttingen, Germany 
†Presenting author; Email: dausm@rki.de 
Chronic wasting disease (CWD) is a contagious, rapidly spreading 
transmissible spongiform encephalopathy (TSE) occurring in cervids in North 
America. Despite efficient horizontal transmission of CWD among cervids natural 
transmission of the disease to other species has not yet been observed. Here, we 
report a direct biochemical demonstration of pathological prion protein PrPTSE 
and of PrPTSE-associated seeding activity in skeletal muscles of CWD-infected 
cervids. The presence of PrPTSE was detected by Western- and postfixed frozen 
tissue blotting, while the seeding activity of PrPTSE was revealed by protein 
misfolding cyclic amplification (PMCA). The concentration of PrPTSE in skeletal 
muscles of CWD-infected WTD was estimated to be approximately 2000- to 
10000-fold lower than in brain tissue. Tissue-blot-analyses revealed that PrPTSE 
was located in muscle- associated nerve fascicles but not, in detectable 
amounts, in myocytes. The presence and seeding activity of PrPTSE in skeletal 
muscle from CWD-infected cervids suggests prevention of such tissue in the human 
diet as a precautionary measure for food safety, pending on further 
clarification of whether CWD may be transmissible to humans. 
P.10.15 
ADAPTATION OF CHRONIC WASTING DISEASE (CWD) INTO HAMSTERS, EVIDENCE OF A 
WISCONSIN STRAIN OF CWD 
Chad Johnson1, Judd Aiken2,3,4 and Debbie McKenzie4,5 1 Department of 
Comparative Biosciences, University of Wisconsin, Madison WI, USA 53706 2 
Department of Agriculture, Food and Nutritional Sciences, 3 Alberta Veterinary 
Research Institute, 4.Center for Prions and Protein Folding Diseases, 5 
Department of Biological Sciences, University of Alberta, Edmonton AB, Canada 
T6G 2P5 
The identification and characterization of prion strains is increasingly 
important for the diagnosis and biological definition of these infectious 
pathogens. Although well-established in scrapie and, more recently, in BSE, 
comparatively little is known about the possibility of prion strains in chronic 
wasting disease (CWD), a disease affecting free ranging and captive cervids, 
primarily in North America. We have identified prion protein variants in the 
white-tailed deer population and demonstrated that Prnp genotype affects the 
susceptibility/disease progression of white-tailed deer to CWD agent. The 
existence of cervid prion protein variants raises the likelihood of distinct CWD 
strains. Small rodent models are a useful means of identifying prion strains. We 
intracerebrally inoculated hamsters with brain homogenates and phosphotungstate 
concentrated preparations from CWD positive hunter-harvested (Wisconsin CWD 
endemic area) and experimentally infected deer of known Prnp genotypes. These 
transmission studies resulted in clinical presentation in primary passage of 
concentrated CWD prions. Subclinical infection was established with the other 
primary passages based on the detection of PrPCWD in the brains of hamsters and 
the successful disease transmission upon second passage. Second and third 
passage data, when compared to transmission studies using different CWD inocula 
(Raymond et al., 2007) indicate that the CWD agent present in the Wisconsin 
white-tailed deer population is different than the strain(s) present in elk, 
mule-deer and white-tailed deer from the western United States endemic region. 
CHRONIC WASTING DISEASE CWD 
Transmissibility to humans. 
The current state of epidemiological research suggests a rather robust 
barrier for the transmission of CWD to humans. Particularly, the surveillance of 
human prion diseases in areas with a long history of endemic CWD such as 
Colorado and Wyoming did not reveal evidence for zoonotic transmissions of the 
disease to cervid hunters or consumers of meat from elk and deer.66. Belay ED, 
Maddox RA, Williams ES, Miller MW, Gambetti P, Schonberger LB. Chronic wasting 
disease and potential transmission to humans. Emerg Infect Dis 2004; 10:977 - 
984; PMID: 15207045 [CrossRef] View all references,1111. Belay ED, Abrams J, 
Kenfield J, Weidenbach K, Maddox RA, Lawaczeck E, et al. Monitoring the 
potential transmission of chronic wasting disease to humans (Abstract Oral.40, 
Prion 2011 Oral Presentations). Prion 2011; 5:17 Supplemental Issue 
April/May/June 2011 View all references 
However, as discussed by Belay et al.66. Belay ED, Maddox RA, Williams ES, 
Miller MW, Gambetti P, Schonberger LB. Chronic wasting disease and potential 
transmission to humans. Emerg Infect Dis 2004; 10:977 - 984; PMID: 15207045 
[CrossRef] View all references 
the intensity of human exposure to CWD prions may increase due to a further 
spread and rising prevalence of the disease in cervids. Therefore, and with the 
generally long latency periods of human prion diseases in mind, previous 
epidemiological findings cannot be readily extrapolated. Until recently, 
experimental studies that pursued biochemical approaches or used transgenic mice 
to ascertain the susceptibility of humans to CWD infections consistently seemed 
to corroborate current epidemiological findings: CWD-infected cervid brain 
tissue did not seed the conversion of PrPC into PrPres in PMCA assays using 
brain homogenate from macaques or transgenic mice expressing human PrPC as test 
substrate,1212. Kurt TD, Telling GC, Zabel MD, Hoover EA. Trans-species 
amplification of PrP(CWD) and correlation with rigid loop 170N. Virology 2009; 
387:235 - 243; PMID: 19269662; http://dx.doi.org/10.1016/j.virol.2009.02.025 
[CrossRef] View all references 
and transgenic mice overexpressing human PrPC were resistant to infection 
after intracerebral challenge with CWD prions from mule deer.1313. Sandberg MK, 
Al-Doujaily H, Sigurdson CJ, Glatzel M, O'Malley C, Powell C, et al. Chronic 
wasting disease prions are not transmissible to transgenic mice overexpressing 
human prion protein. J Gen Virol 2010; 91:2651 - 2657; PMID: 20610667; http://dx.doi.org/10.1099/vir.0.024380-0 
[CrossRef] View all references 
However, a study published by Barria et al.1414. Barria MA, Telling GC, 
Gambetti P, Mastrianni JA, Soto C. Generation of a new form of human PrPSc in 
vitro by interspecies transmission from cervid prions. J Biol Chem 2011; 
286:7490 - 7495; PMID: 21209079; http://dx.doi.org/10.1074/jbc.M110.198465 
[CrossRef] View all references 
in March 2011 found that cervid PrPTSE can seed the conversion of human 
PrPC into PrPres by PMCA when the CWD agent has been previously passaged in 
vitro or in vivo. Specifically, this was demonstrated for CWD prions from 
naturally affected mule deer either passaged by serial PMCA using deer PrPC as 
conversion substrate or in transgenic mice expressing cervid PrPC. The authors 
of this study pointed out that CWD prions may undergo a gradual process of 
change and adaptation via successive passages in the cervid population. They 
concluded that the reported findings, if corroborated by infectivity assays, may 
imply “that CWD prions have the potential to infect humans and that this ability 
progressively increases with CWD spreading.” Cynomolgus macaques used as a 
primate model for testing the susceptibility of humans to CWD as close to 
reality as possible have not shown clinical signs of a prion disease at nearly 6 
years after intracerebral or peroral inoculation of CWD agents from white-tailed 
deer, Rocky Mountain elk or mule deer.1515. Race B, Meade-White KD, Miller MW, 
Barbian KD, Rubenstein R, LaFauci G, et al. Susceptibilities of nonhuman 
primates to chronic wasting disease. Emerg Infect Dis 2009; 15:1366 - 1376; 
PMID: 19788803; http://dx.doi.org/10.3201/eid1509.090253 
[CrossRef] View all references 
In contrast to macaques, squirrel monkeys were susceptible to CWD infection 
by the intracerebral route and showed even a low rate of disease transmission 
after oral challenge.1515. Race B, Meade-White KD, Miller MW, Barbian KD, 
Rubenstein R, LaFauci G, et al. Susceptibilities of nonhuman primates to chronic 
wasting disease. Emerg Infect Dis 2009; 15:1366 - 1376; PMID: 19788803; http://dx.doi.org/10.3201/eid1509.090253 
[CrossRef] View all references,1616. Marsh RF, Kincaid AE, Bessen RA, Bartz JC. 
Interspecies transmission of chronic wasting disease prions to squirrel monkeys 
(Saimiri sciureus). J Virol 2005; 79:13794 - 13796; PMID: 16227298; http://dx.doi.org/10.1128/JVI.79.21.13794-6.2005 
[CrossRef] View all references 
Since humans are phylogenetically closer related to macaques than to 
squirrel monkeys, macaques are regarded as the more relevant primate model for 
assessing the zoonotic transmissibility of CWD.1515. Race B, Meade-White KD, 
Miller MW, Barbian KD, Rubenstein R, LaFauci G, et al. Susceptibilities of 
nonhuman primates to chronic wasting disease. Emerg Infect Dis 2009; 15:1366 - 
1376; PMID: 19788803; http://dx.doi.org/10.3201/eid1509.090253 
[CrossRef] View all references 
Ongoing transmission studies in macaques. In addition to the primate study 
by Race et al.1515. Race B, Meade-White KD, Miller MW, Barbian KD, Rubenstein R, 
LaFauci G, et al. Susceptibilities of nonhuman primates to chronic wasting 
disease. Emerg Infect Dis 2009; 15:1366 - 1376; PMID: 19788803; http://dx.doi.org/10.3201/eid1509.090253 
[CrossRef] View all references 
two further studies in which macaques were challenged with tissue 
homogenates from CWD-affected cervids by intracerebral inoculation or via the 
oral route have been reported to be in progress.1717. Comoy E, Durand V, Correia 
E, Balachandran A, Richt JA, Beringue V, et al. Zoonotic potential of CWD: 
Experimental transmissions to non-human primates (Abstract Envt.06, Prion 2011 
Poster Presentations). Prion 2011; 5:101 View all references,1818. Motzkus D, 
Schulz-Schaeffer WJ, Beekes M, Schätzl HM, Jirik FR, Schmädicke AC, et al. 
Transmission of CWD to non-human primates: Interim results of a comprehensive 
study on the transmissibility to humans (Abstract Envt. 22, Prion 2011 Poster 
Presentations). Prion 2011; 5:107 Supplemental Issue April/May/June 2011 View 
all references 
The purpose, research effort, financial investment and ethical aspects of 
these studies demand an utmost experimental scrutiny, careful data analysis and 
thorough exploitation of results. This has two immediate implications: (1) Since 
the incubation period of CWD may be very long in case of primary (i.e., 
inter-species) transmission to macaques a sustained monitoring of the animals 
appears mandatory for many years despite negative interim findings. (2) 
Increasing evidence suggests the existence of different CWD agents (see below), 
and theoretically, CWD prions may also change over time thereby possibly 
altering their potential host range. Thus, CWD isolates used in individual or 
pooled inocula for the challenge of macaques should be typed as precisely as 
possible in terms of their strain characteristics and molecular identity. Other 
field isolates could then be checked for their similarity or dissimilarity to 
the macaque-tested CWD agents in order to ascertain whether or not they are 
covered by the ongoing primate risk assessments. Evidence for Distinct CWD 
Strains Jump to section Transmissible Spongiform... Exposure of Humans to CWD 
Prions CWD Risk Assessments Evidence for Distinct CWD Strains Outlook Disclosure 
of Potential Conflicts of Interest Funding Figures and Tables Biochemical 
indications for isolate-dependent structural differences of PrPTSE. In 2002 it 
was reported that glycoform patterns of PrPTSE showed differences among 
individual CWD-affected cervids.1919. Race RE, Raines A, Baron TG, Miller MW, 
Jenny A, Williams ES. Comparison of abnormal prion protein glycoform patterns 
from transmissible spongiform encephalopathy agent-infected deer, elk, sheep and 
cattle. J Virol 2002; 76:12365 - 12368; PMID: 12414979; http://dx.doi.org/10.1128/JVI.76.23.12365-8.2002 
[CrossRef] View all references 
In a variety of studies the glycosylation of PrPTSE had been previously 
established as a biochemical feature that may differ between distinct TSE 
agents.2020. Parchi P, Capellari S, Chen SG, Petersen RB, Gambetti P, Kopp N, et 
al. Typing prion isoforms. Nature 1997; 386:232 - 234; PMID: 9069279; http://dx.doi.org/10.1038/386232a0 
[CrossRef] View all references,2121. Aguzzi A, Heikenwalder M, Polymenidou M. 
Insights into prion strains and neurotoxicity. Nat Rev Mol Cell Biol 2007; 8:552 
- 561; PMID: 17585315; http://dx.doi.org/10.1038/nrm2204 
[CrossRef] View all references 
Accordingly, the finding by Race et al. possibly indicated CWD infections 
with different or multiple strains of agent, although, alternatively, it could 
also be explained by random selection from a heterogeneous population of 
CWD-affected ruminants.1919. Race RE, Raines A, Baron TG, Miller MW, Jenny A, 
Williams ES. Comparison of abnormal prion protein glycoform patterns from 
transmissible spongiform encephalopathy agent-infected deer, elk, sheep and 
cattle. J Virol 2002; 76:12365 - 12368; PMID: 12414979; http://dx.doi.org/10.1128/JVI.76.23.12365-8.2002 
[CrossRef] View all references 
Using a conformation-dependent immunoassay (CDI), Safar et al. found 
evidence for different conformations of PrPTSE in elk CWD as compared with 
white-tailed and mule deer CWD.2222. Safar JG, Scott M, Monaghan J, Deering C, 
Didorenko S, Vergara J, et al. Measuring prions causing bovine spongiform 
encephalopathy or chronic wasting disease by immunoassays and transgenic mice. 
Nat Biotechnol 2002; 20:1147 - 1150; PMID: 12389035; http://dx.doi.org/10.1038/nbt748 
[CrossRef] View all references 
However, the amino acid sequences of elk and deer PrPC differ at residues 
226 (glutamic acid in elk and glutamine in deer), and it remained to be 
established whether the structural differences detected by CDI were related to 
biologically distinct CWD strains. Isolation of CWD-associated agents causing 
distinct phenotypes in laboratory rodents. Classically, prion strains are 
differentiated based on their incubation periods in inbred mice with distinct 
PrP genotypes and by lesion profiles of the vacuolation in selected brain areas 
of reporter animals.2323. Bruce ME, Fraser H. Scrapie strain variation and its 
implications. Curr Top Microbiol Immunol 1991; 172:125 - 138; PMID: 1810707 
[CrossRef] View all references 
When Raymond et al. serially passaged a CWD inoculum from mule deer either 
in Syrian hamsters or first into transgenic mice expressing hamster PrPC, and 
then further on in hamsters, they obtained two distinct isolates termed 
SghaCWDmd-f and SghaCWDmd-s, respectively.2424. Raymond GJ, Raymond LD, 
Meade-White KD, Hughson AG, Favara C, Gardner D, et al. Transmission and 
adaptation of chronic wasting disease to hamsters and transgenic mice: evidence 
for strains. J Virol 2007; 81:4305 - 4314; PMID: 17287284; http://dx.doi.org/10.1128/JVI.02474-06 
[CrossRef] View all references 
The first isolate showed an about 5-fold shorter incubation period in 
Syrian hamsters than the latter, and the cerebral patterns of PrPTSE deposition 
and gliosis in clinically affected hamsters were also different. Based on their 
findings the authors concluded that the “cervid-derived inocula may have 
contained or diverged into at least two distinct transmissible spongiform 
encephalopathy strains.” Angers et al. transmitted CWD inocula from elk and deer 
to transgenic mice expressing cervid PrP and found that these mice were affected 
by one of two strains, referred to as CWD1 and CWD2, that caused different 
incubation times and lesion profiles.2525. Angers RC, Kang HE, Napier D, 
Browning S, Seward T, Mathiason C, et al. Prion strain mutation determined by 
prion protein conformational compatibility and primary structure. Science 2010; 
328:1154 - 1158; PMID: 20466881; http://dx.doi.org/10.1126/science.1187107 
[CrossRef] View all references 
The results of this study “appear to reflect strain constitutions in the 
natural host, rather than adaptation and divergence of progenitor strains in 
recipient mice,” according to the authors. Interestingly, CWD1 and CWD2 did not 
show recognizably different biochemical properties of their PrPTSE. The 
electrophoretic migration and glycosylation patterns as well as the stability 
characteristics after treatment with guanidine hydrochloride were 
indistinguishable for CWD1- and CWD2-associated PrPTSE. Consistent with these 
findings it has been previously reported that biologically distinct prion 
strains cannot always be differentiated by biochemical PrPTSE-typing or 
characterization of the conformational stability of PrPTSE.2626. Thomzig A, 
Spassov S, Friedrich M, Naumann D, Beekes M. Discriminating scrapie and bovine 
spongiform encephalopathy isolates by infrared spectroscopy of pathological 
prion protein. J Biol Chem 2004; 279:33847 - 33854; PMID: 15155741; http://dx.doi.org/10.1074/jbc.M403730200 
[CrossRef] View all references,2727. Peretz D, Scott MR, Groth D, Williamson RA, 
Burton DR, Cohen FE, et al. Strain-specified relative conformational stability 
of the scrapie prion protein. Protein Sci 2001; 10:854 - 863; PMID: 11274476; http://dx.doi.org/10.1110/ps.39201 
[CrossRef] View all references 
UPDATED DATA ON 2ND CWD STRAIN Wednesday, September 08, 2010 CWD PRION 
CONGRESS SEPTEMBER 8-11 2010 
OR-12: Chronic wasting disease transmission and pathogenesis in cervid and 
non-cervid Species 
Edward A. Hoover, Candace K. Mathiason, Nicholas J. Haley, Timothy D. Kurt, 
Davis M. Seelig, Nathaniel D. Denkers, Amy V. Nalls, Mark D. Zabel, and Glenn C. 
Telling 
Prion Research Program, Department of Microbiology, Immunology, and 
Pathology; Colorado State University; Fort Collins, CO USA 
Since its recognition as a TSE in the late 1970s, chronic wasting disease 
(CWD) of cervids has been distinguished by its facile spread and is now 
recognized in 18 states, 2 Canadian provinces, and South Korea. The efficient 
horizontal spread of CWD reflects a prion/host relationship that facilitates 
efficient mucosal uptake, peripheral lymphoid amplification, and dissemination 
by exploiting excretory tissues and their products, helping to establish 
indirect/environmental and well as direct (e.g., salivary) transmission. Recent 
studies from our group also support the likelihood of early life mother to 
offspring and aerosol CWD prion transmission. Studies of cervid CWD exposure by 
natural routes indicate that incubation period for detection of overt infection, 
while still uncertain, may be much longer than originally thought. 
Several non-cervid species can be infected by CWD experimentally (e.g., 
ferrets, voles, cats) with consequent species-specific disease phenotypes. The 
species-adapted prions so generated can be transmitted by mucosal, i.e., more 
natural, routes. Whether non-cervid species sympatric with deer/elk can be 
infected in nature, however, remains unknown. In vitro CWD prion amplification 
studies, in particular sPMCA, can foreshadow in vivo susceptibility and suggest 
the importance of the PrPC rigid loop region in species barrier permissiveness. 
Trans-species CWD amplification appears to broaden the host range/strain 
characteristics of the resultant prions. The origins of CWD remain unknown, 
however, the existence of multiple CWD prion strains/ quasi-species, the 
mechanisms of prion shedding/dissemination, and the relationship between sheep 
scrapie and CWD merit further investigation. 
Monday, May 23, 2011 
CDC Assesses Potential Human Exposure to Prion Diseases Travel Warning 
Public release date: 23-May-2011 
Contact: Francesca Costanzo adajmedia@elsevier.com 215-239-3249 Elsevier 
Health Sciences 
CDC assesses potential human exposure to prion diseases Study results 
reported in the Journal of the American Dietetic Association Philadelphia, PA, 
May 23, 2011 – Researchers from the Centers for Disease Control and Prevention 
(CDC) have examined the potential for human exposure to prion diseases, looking 
at hunting, venison consumption, and travel to areas in which prion diseases 
have been reported in animals. Three prion diseases in particular – bovine 
spongiform encephalopathy (BSE or “Mad Cow Disease”), variant Creutzfeldt-Jakob 
disease (vCJD), and chronic wasting disease (CWD) – were specified in the 
investigation. The results of this investigation are published in the June issue 
of the Journal of the American Dietetic Association. 
“While prion diseases are rare, they are generally fatal for anyone who 
becomes infected. More than anything else, the results of this study support the 
need for continued surveillance of prion diseases,” commented lead investigator 
Joseph Y. Abrams, MPH, National Center for Emerging and Zoonotic Infectious 
Diseases, CDC, Atlanta.”But it’s also important that people know the facts about 
these diseases, especially since this study shows that a good number of people 
have participated in activities that may expose them to infection-causing 
agents.” 
Although rare, human prion diseases such as CJD may be related to BSE. 
Prion (proteinaceous infectious particles) diseases are a group of rare brain 
diseases that affect humans and animals. When a person gets a prion disease, 
brain function is impaired. This causes memory and personality changes, 
dementia, and problems with movement. All of these worsen over time. These 
diseases are invariably fatal. Since these diseases may take years to manifest, 
knowing the extent of human exposure to possible prion diseases could become 
important in the event of an outbreak. 
CDC investigators evaluated the results of the 2006-2007 population survey 
conducted by the Foodborne Diseases Active Surveillance Network (FoodNet). This 
survey collects information on food consumption practices, health outcomes, and 
demographic characteristics of residents of the participating Emerging 
Infections Program sites. The survey was conducted in Connecticut, Georgia, 
Maryland, Minnesota, New Mexico, Oregon, and Tennessee, as well as five counties 
in the San Francisco Bay area, seven counties in the Greater Denver area, and 34 
counties in western and northeastern New York. 
Survey participants were asked about behaviors that could be associated 
with exposure to the agents causing BSE and CWD, including travel to the nine 
countries considered to be BSE-endemic (United Kingdom, Republic of Ireland, 
France, Portugal, Switzerland, Italy, the Netherlands, Germany, Spain) and the 
cumulative length of stay in each of those countries. Respondents were asked if 
they ever had hunted for deer or elk, and if that hunting had taken place in 
areas considered to be CWD-endemic (northeastern Colorado, southeastern Wyoming 
or southwestern Nebraska). They were also asked if they had ever consumed 
venison, the frequency of consumption, and whether the meat came from the wild. 
The proportion of survey respondents who reported travel to at least one of 
the nine BSE endemic countries since 1980 was 29.5%. Travel to the United 
Kingdom was reported by 19.4% of respondents, higher than to any other 
BSE-endemic country. Among those who traveled, the median duration of travel to 
the United Kingdom (14 days) was longer than that of any other BSE-endemic 
country. Travelers to the UK were more likely to have spent at least 30 days in 
the country (24.9%) compared to travelers to any other BSE endemic country. The 
prevalence and extent of travel to the UK indicate that health concerns in the 
UK may also become issues for US residents. 
The proportion of survey respondents reporting having hunted for deer or 
elk was 18.5% and 1.2% reported having hunted for deer or elk in CWD-endemic 
areas. Venison consumption was reported by 67.4% of FoodNet respondents, and 
88.6% of those reporting venison consumption had obtained all of their meat from 
the wild. These findings reinforce the importance of CWD surveillance and 
control programs for wild deer and elk to reduce human exposure to the CWD 
agent. Hunters in CWD-endemic areas are advised to take simple precautions such 
as: avoiding consuming meat from sickly deer or elk, avoiding consuming brain or 
spinal cord tissues, minimizing the handling of brain and spinal cord tissues, 
and wearing gloves when field-dressing carcasses. 
According to Abrams, “The 2006-2007 FoodNet population survey provides 
useful information should foodborne prion infection become an increasing public 
health concern in the future. The data presented describe the prevalence of 
important behaviors and their associations with demographic characteristics. 
Surveillance of BSE, CWD, and human prion diseases are critical aspects of 
addressing the burden of these diseases in animal populations and how that may 
relate to human health.” 
### 
The article is “Travel history, hunting, and venison consumption related to 
prion disease exposure, 2006-2007 FoodNet population survey” by Joseph Y. 
Abrams, MPH; Ryan A. Maddox, MPH; Alexis R Harvey, MPH; Lawrence B. Schonberger, 
MD; and Ermias D. Belay, MD. It appears in the Journal of the American Dietetic 
Association, Volume 111, Issue 6 (June 2011) published by Elsevier. 
In an accompanying podcast CDC’s Joseph Y. Abrams discusses travel, 
hunting, and eating venison in relation to prion diseases. It is available at http://adajournal.org/content/podcast. 
Thursday, May 26, 2011 
Travel History, Hunting, and Venison Consumption Related to Prion Disease 
Exposure, 2006-2007 FoodNet Population Survey 
Journal of the American Dietetic Association Volume 111, Issue 6 , Pages 
858-863, June 2011. 
Travel History, Hunting, and Venison Consumption Related to Prion Disease 
Exposure, 2006-2007 FoodNet Population Survey 
Joseph Y. Abrams, MPH, Ryan A. Maddox, MPH , Alexis R. Harvey, MPH , 
Lawrence B. Schonberger, MD , Ermias D. Belay, MD 
Accepted 15 November 2010. Abstract Full Text PDF References . 
Abstract 
The transmission of bovine spongiform encephalopathy (BSE) to human beings 
and the spread of chronic wasting disease (CWD) among cervids have prompted 
concerns about zoonotic transmission of prion diseases. Travel to the United 
Kingdom and other European countries, hunting for deer or elk, and venison 
consumption could result in the exposure of US residents to the agents that 
cause BSE and CWD. The Foodborne Diseases Active Surveillance Network 2006-2007 
population survey was used to assess the prevalence of these behaviors among 
residents of 10 catchment areas across the United States. Of 17,372 survey 
respondents, 19.4% reported travel to the United Kingdom since 1980, and 29.5% 
reported travel to any of the nine European countries considered to be 
BSE-endemic since 1980. The proportion of respondents who had ever hunted deer 
or elk was 18.5%, and 1.2% had hunted deer or elk in a CWD–endemic area. More 
than two thirds (67.4%) reported having ever eaten deer or elk meat. Respondents 
who traveled spent more time in the United Kingdom (median 14 days) than in any 
other BSE-endemic country. Of the 11,635 respondents who had consumed venison, 
59.8% ate venison at most one to two times during their year of highest 
consumption, and 88.6% had obtained all of their meat from the wild. The survey 
results were useful in determining the prevalence and frequency of behaviors 
that could be important factors for foodborne prion transmission. 
CDC 
Saturday, February 18, 2012 
Occurrence, Transmission, and Zoonotic Potential of Chronic Wasting Disease 
CDC Volume 18, Number 3—March 2012 
SNIP… 
Interspecies transmission of CWD to noncervids has not been observed under 
natural conditions. CWD infection of carcass scavengers such as raccoons, 
opossums, and coyotes was not observed in a recent study in Wisconsin (22). In 
addition, natural transmission of CWD to cattle has not been observed in 
experimentally controlled natural exposure studies or targeted surveillance (2). 
However, CWD has been experimentally transmitted to cattle, sheep, goats, mink, 
ferrets, voles, and mice by intracerebral inoculation (2,29,33). 
CWD is likely transmitted among mule, white-tailed deer, and elk without a 
major species barrier (1), and other members of the cervid family, including 
reindeer, caribou, and other species of deer worldwide, may be vulnerable to CWD 
infection. Black-tailed deer (a subspecies of mule deer) and European red deer 
(Cervus elaphus) are susceptible to CWD by natural routes of infection (1,34). 
Fallow deer (Dama dama) are susceptible to CWD by intracerebral inoculation 
(35). Continued study of CWD susceptibility in other cervids is of considerable 
interest. 
Reasons for Caution There are several reasons for caution with respect to 
zoonotic and interspecies CWD transmission. First, there is strong evidence that 
distinct CWD strains exist (36). Prion strains are distinguished by varied 
incubation periods, clinical symptoms, PrPSc conformations, and CNS PrPSc 
depositions (3,32). Strains have been identified in other natural prion 
diseases, including scrapie, BSE, and CJD (3). Intraspecies and interspecies 
transmission of prions from CWD-positive deer and elk isolates resulted in 
identification of >2 strains of CWD in rodent models (36), indicating that 
CWD strains likely exist in cervids. However, nothing is currently known about 
natural distribution and prevalence of CWD strains. Currently, host range and 
pathogenicity vary with prion strain (28,37). Therefore, zoonotic potential of 
CWD may also vary with CWD strain. In addition, diversity in host (cervid) and 
target (e.g., human) genotypes further complicates definitive findings of 
zoonotic and interspecies transmission potentials of CWD. 
Intraspecies and interspecies passage of the CWD agent may also increase 
the risk for zoonotic CWD transmission. The CWD prion agent is undergoing serial 
passage naturally as the disease continues to emerge. In vitro and in vivo 
intraspecies transmission of the CWD agent yields PrPSc with an increased 
capacity to convert human PrPc to PrPSc (30). Interspecies prion transmission 
can alter CWD host range (38) and yield multiple novel prion strains (3,28). The 
potential for interspecies CWD transmission (by cohabitating mammals) will only 
increase as the disease spreads and CWD prions continue to be shed into the 
environment. This environmental passage itself may alter CWD prions or exert 
selective pressures on CWD strain mixtures by interactions with soil, which are 
known to vary with prion strain (25), or exposure to environmental or gut 
degradation. 
Given that prion disease in humans can be difficult to diagnose and the 
asymptomatic incubation period can last decades, continued research, 
epidemiologic surveillance, and caution in handling risky material remain 
prudent as CWD continues to spread and the opportunity for interspecies 
transmission increases. Otherwise, similar to what occurred in the United 
Kingdom after detection of variant CJD and its subsequent link to BSE, years of 
prevention could be lost if zoonotic transmission of CWD is subsequently 
identified, CWD will likely continue to emerge in North America. … 
SNIP… 
Generation of a new form of human PrPSc in vitro by inter-species 
transmission from cervids prions 
Our results have far-reaching implications for human health, since they 
indicate that cervid PrPSc can trigger the conversion of human PrPC into PrPSc, 
suggesting that CWD might be infectious to humans. Interestingly our findings 
suggest that unstable strains from CWD affected animals might not be a problem 
for humans, but upon strain stabilization by successive passages in the wild, 
this disease might become progressively more transmissible to man. 
Our results also have profound implications for understanding the 
mechanisms of the prion species barrier and indicate that the transmission 
barrier is a dynamic process that depends on the strain and moreover the degree 
of adaptation of the strain. If our findings are corroborated by infectivity 
assays, they will imply that CWD prions have the potential to infect humans and 
that this ability progressively increases with CWD spreading. 
I thought your readers and hunters and those that consume the venison, 
should have all the scientific facts, personally, I don’t care what you eat, but 
if it effects me and my family down the road, it should then concern everyone, 
and the potential of iatrogenic transmission of the TSE prion is real i.e. 
‘friendly fire’, medical, surgical, dental, blood, tissue, and or products there 
from...like deer antler velvet and TSE prions and nutritional supplements there 
from, all a potential risk factor that should not be ignored or silenced. ... 
the prion gods at the cdc state that there is ; 
''no strong evidence'' 
but let's see exactly what the authors of this cwd to human at the cdc 
state ; 
now, let’s see what the authors said about this casual link, personal 
communications years ago. see where it is stated NO STRONG evidence. so, does 
this mean there IS casual evidence ???? 
“Our conclusion stating that we found no strong evidence of CWD 
transmission to humans” 
From: TSS (216-119-163-189.ipset45.wt.net) 
Subject: CWD aka MAD DEER/ELK TO HUMANS ??? 
Date: September 30, 2002 at 7:06 am PST 
From: "Belay, Ermias" 
To: 
Cc: "Race, Richard (NIH)" ; ; "Belay, Ermias" 
Sent: Monday, September 30, 2002 9:22 AM 
Subject: RE: TO CDC AND NIH - PUB MED- 3 MORE DEATHS - CWD - YOUNG HUNTERS 
Dear Sir/Madam, 
In the Archives of Neurology you quoted (the abstract of which was attached 
to your email), we did not say CWD in humans will present like variant CJD. 
That assumption would be wrong. I encourage you to read the whole article 
and call me if you have questions or need more clarification (phone: 
404-639-3091). Also, we do not claim that "no-one has ever been infected with 
prion disease from eating venison." Our conclusion stating that we found no 
strong evidence of CWD transmission to humans in the article you quoted or in 
any other forum is limited to the patients we investigated. 
Ermias Belay, M.D. Centers for Disease Control and Prevention 
-----Original Message----- 
From: 
Sent: Sunday, September 29, 2002 10:15 AM 
To: rr26k@nih.gov; rrace@niaid.nih.gov; ebb8@CDC.GOV 
Subject: TO CDC AND NIH - PUB MED- 3 MORE DEATHS - CWD - YOUNG HUNTERS 
Sunday, November 10, 2002 6:26 PM ......snip........end..............TSS 
Thursday, April 03, 2008 
A prion disease of cervids: Chronic wasting disease 
2008 1: Vet Res. 2008 Apr 3;39(4):41 
A prion disease of cervids: Chronic wasting disease 
Sigurdson CJ. 
snip... 
*** twenty-seven CJD patients who regularly consumed venison were reported 
to the Surveillance Center***, 
snip... 
full text ; 
***********CJD REPORT 1994 increased risk for consumption of veal and 
venison and lamb*********** 
CREUTZFELDT JAKOB DISEASE SURVEILLANCE IN THE UNITED KINGDOM THIRD ANNUAL 
REPORT AUGUST 1994 
Consumption of venison and veal was much less widespread among both cases 
and controls. For both of these meats there was evidence of a trend with 
increasing frequency of consumption being associated with increasing risk of 
CJD. (not nvCJD, but sporadic CJD...tss) 
These associations were largely unchanged when attention was restricted to 
pairs with data obtained from relatives. ... 
Table 9 presents the results of an analysis of these data. 
There is STRONG evidence of an association between ‘’regular’’ veal eating 
and risk of CJD (p = .0.01). 
Individuals reported to eat veal on average at least once a year appear to 
be at 13 TIMES THE RISK of individuals who have never eaten veal. 
There is, however, a very wide confidence interval around this estimate. 
There is no strong evidence that eating veal less than once per year is 
associated with increased risk of CJD (p = 0.51). 
The association between venison eating and risk of CJD shows similar 
pattern, with regular venison eating associated with a 9 FOLD INCREASE IN RISK 
OF CJD (p = 0.04). 
There is some evidence that risk of CJD INCREASES WITH INCREASING FREQUENCY 
OF LAMB EATING (p = 0.02). 
The evidence for such an association between beef eating and CJD is weaker 
(p = 0.14). When only controls for whom a relative was interviewed are included, 
this evidence becomes a little STRONGER (p = 0.08). 
snip... 
It was found that when veal was included in the model with another 
exposure, the association between veal and CJD remained statistically 
significant (p = < 0.05 for all exposures), while the other exposures ceased 
to be statistically significant (p = > 0.05). 
snip... 
In conclusion, an analysis of dietary histories revealed statistical 
associations between various meats/animal products and INCREASED RISK OF CJD. 
When some account was taken of possible confounding, the association between 
VEAL EATING AND RISK OF CJD EMERGED AS THE STRONGEST OF THESE ASSOCIATIONS 
STATISTICALLY. ... 
snip... 
In the study in the USA, a range of foodstuffs were associated with an 
increased risk of CJD, including liver consumption which was associated with an 
apparent SIX-FOLD INCREASE IN THE RISK OF CJD. By comparing the data from 3 
studies in relation to this particular dietary factor, the risk of liver 
consumption became non-significant with an odds ratio of 1.2 (PERSONAL 
COMMUNICATION, PROFESSOR A. HOFMAN. ERASMUS UNIVERSITY, ROTTERDAM). (???...TSS) 
snip...see full report ; 
Thursday, October 10, 2013 
*************CJD REPORT 1994 increased risk for consumption of veal and 
venison and lamb************** 
CJD9/10022 
October 1994 
Mr R.N. Elmhirst Chairman British Deer Farmers Association Holly Lodge 
Spencers Lane BerksWell Coventry CV7 7BZ 
Dear Mr Elmhirst, 
CREUTZFELDT-JAKOB DISEASE (CJD) SURVEILLANCE UNIT REPORT 
Thank you for your recent letter concerning the publication of the third 
annual report from the CJD Surveillance Unit. I am sorry that you are 
dissatisfied with the way in which this report was published. 
The Surveillance Unit is a completely independant outside body and the 
Department of Health is committed to publishing their reports as soon as they 
become available. In the circumstances it is not the practice to circulate the 
report for comment since the findings of the report would not be amended. In 
future we can ensure that the British Deer Farmers Association receives a copy 
of the report in advance of publication. 
The Chief Medical Officer has undertaken to keep the public fully informed 
of the results of any research in respect of CJD. This report was entirely the 
work of the unit and was produced completely independantly of the the 
Department. 
The statistical results reqarding the consumption of venison was put into 
perspective in the body of the report and was not mentioned at all in the press 
release. Media attention regarding this report was low key but gave a realistic 
presentation of the statistical findings of the Unit. This approach to 
publication was successful in that consumption of venison was highlighted only 
once by the media ie. in the News at one television proqramme. 
I believe that a further statement about the report, or indeed statistical 
links between CJD and consumption of venison, would increase, and quite possibly 
give damaging credence, to the whole issue. From the low key media reports of 
which I am aware it seems unlikely that venison consumption will suffer 
adversely, if at all. 
 http://web.archive.org/web/20030511010117/http://www.bseinquiry.gov.uk/files/yb/1994/10/00003001.pdf 
*** our results raise the possibility that CJD cases classified as VV1 may 
include cases caused by iatrogenic transmission of sCJD-MM1 prions or food-borne 
infection by type 1 prions from animals, e.g., chronic wasting disease prions in 
cervid. In fact, two CJD-VV1 patients who hunted deer or consumed venison have 
been reported (40, 41). The results of the present study emphasize the need for 
traceback studies and careful re-examination of the biochemical properties of 
sCJD-VV1 prions. *** 
snip...see full text ; 
Thursday, January 2, 2014 
*** CWD TSE Prion in cervids to hTGmice, Heidenhain Variant 
Creutzfeldt-Jacob Disease MM1 genotype, and iatrogenic CJD ??? *** 
*** The potential impact of prion diseases on human health was greatly 
magnified by the recognition that interspecies transfer of BSE to humans by beef 
ingestion resulted in vCJD. While changes in animal feed constituents and 
slaughter practices appear to have curtailed vCJD, there is concern that CWD of 
free-ranging deer and elk in the U.S. might also cross the species barrier. 
Thus, consuming venison could be a source of human prion disease. Whether BSE 
and CWD represent interspecies scrapie transfer or are newly arisen prion 
diseases is unknown. Therefore, the possibility of transmission of prion disease 
through other food animals cannot be ruled out. There is evidence that vCJD can 
be transmitted through blood transfusion. There is likely a pool of unknown size 
of asymptomatic individuals infected with vCJD, and there may be asymptomatic 
individuals infected with the CWD equivalent. These circumstances represent a 
potential threat to blood, blood products, and plasma supplies. 
Monday, August 8, 2011 
*** Susceptibility of Domestic Cats to CWD Infection *** 
Oral.29: Susceptibility of Domestic Cats to CWD Infection 
Amy Nalls, Nicholas J. Haley, Jeanette Hayes-Klug, Kelly Anderson, Davis M. 
Seelig, Dan S. Bucy, Susan L. Kraft, Edward A. Hoover and Candace K. Mathiason† 
Colorado State University; Fort Collins, CO USA†Presenting author; Email: 
ckm@lamar.colostate.edu 
Domestic and non-domestic cats have been shown to be susceptible to one 
prion disease, feline spongiform encephalopathy (FSE), thought to be transmitted 
through consumption of bovine spongiform encephalopathy (BSE) contaminated meat. 
Because domestic and free ranging felids scavenge cervid carcasses, including 
those in CWD affected areas, we evaluated the susceptibility of domestic cats to 
CWD infection experimentally. Groups of n = 5 cats each were inoculated either 
intracerebrally (IC) or orally (PO) with CWD deer brain homogenate. Between 
40–43 months following IC inoculation, two cats developed mild but progressive 
symptoms including weight loss, anorexia, polydipsia, patterned motor behaviors 
and ataxia—ultimately mandating euthanasia. Magnetic resonance imaging (MRI) on 
the brain of one of these animals (vs. two age-matched controls) performed just 
before euthanasia revealed increased ventricular system volume, more prominent 
sulci, and T2 hyperintensity deep in the white matter of the frontal hemisphere 
and in cortical grey distributed through the brain, likely representing 
inflammation or gliosis. PrPRES and widely distributed peri-neuronal vacuoles 
were demonstrated in the brains of both animals by immunodetection assays. No 
clinical signs of TSE have been detected in the remaining primary passage cats 
after 80 months pi. Feline-adapted CWD was sub-passaged into groups (n=4 or 5) 
of cats by IC, PO, and IP/SQ routes. Currently, at 22 months pi, all five IC 
inoculated cats are demonstrating abnormal behavior including increasing 
aggressiveness, pacing, and hyper responsiveness. 
*** Two of these cats have developed rear limb ataxia. Although the limited 
data from this ongoing study must be considered preliminary, they raise the 
potential for cervid-to-feline transmission in nature. 
AD.63: 
Susceptibility of domestic cats to chronic wasting disease 
Amy V.Nalls,1 Candace Mathiason,1 Davis Seelig,2 Susan Kraft,1 Kevin 
Carnes,1 Kelly Anderson,1 Jeanette Hayes-Klug1 and Edward A. Hoover1 1Colorado 
State University; Fort Collins, CO USA; 2University of Minnesota; Saint Paul, MN 
USA 
Domestic and nondomestic cats have been shown to be susceptible to feline 
spongiform encephalopathy (FSE), almost certainly caused by consumption of 
bovine spongiform encephalopathy (BSE)-contaminated meat. Because domestic and 
free-ranging nondomestic felids scavenge cervid carcasses, including those in 
areas affected by chronic wasting disease (CWD), we evaluated the susceptibility 
of the domestic cat (Felis catus) to CWD infection experimentally. Cohorts of 5 
cats each were inoculated either intracerebrally (IC) or orally (PO) with 
CWD-infected deer brain. At 40 and 42 mo post-inoculation, two IC-inoculated 
cats developed signs consistent with prion disease, including a stilted gait, 
weight loss, anorexia, polydipsia, patterned motor behaviors, head and tail 
tremors, and ataxia, and progressed to terminal disease within 5 mo. Brains from 
these two cats were pooled and inoculated into cohorts of cats by IC, PO, and 
intraperitoneal and subcutaneous (IP/SC) routes. Upon subpassage, feline-adapted 
CWD (FelCWD) was transmitted to all IC-inoculated cats with a decreased 
incubation period of 23 to 27 mo. FelCWD was detected in the brains of all the 
symptomatic cats by western blotting and immunohistochemistry and abnormalities 
were seen in magnetic resonance imaging, including multifocal T2 fluid 
attenuated inversion recovery (FLAIR) signal hyper-intensities, ventricular size 
increases, prominent sulci, and white matter tract cavitation. Currently, 3 of 4 
IP/SQ and 2 of 4 PO inoculared cats have developed abnormal behavior patterns 
consistent with the early stage of feline CWD. 
*** These results demonstrate that CWD can be transmitted and adapted to 
the domestic cat, thus raising the issue of potential cervid-to- feline 
transmission in nature. 
Tuesday, November 04, 2014 
*** Six-year follow-up of a point-source exposure to CWD contaminated 
venison in an Upstate New York community: risk behaviours and health outcomes 
2005–2011 
PO-081: Chronic wasting disease in the cat— Similarities to feline 
spongiform encephalopathy (FSE) 
FELINE SPONGIFORM ENCEPHALOPATHY FSE 
Thursday, July 03, 2014 
*** How Chronic Wasting Disease is affecting deer population and what’s the 
risk to humans and pets? 
Saturday, January 31, 2015 
European red deer (Cervus elaphus elaphus) are susceptible to Bovine 
Spongiform Encephalopathy BSE by Oral Alimentary route 
*** Singeltary reply ; 
ruminant feed ban for cervids in the United States ? 
31 Jan 2015 at 20:14 GMT 
Friday, January 30, 2015 
*** Scrapie: a particularly persistent pathogen *** 
Wednesday, April 22, 2015 
Circulation of prions within dust on a scrapie affected farm 
Friday, May 22, 2015 
Chronic Wasting Disease and Program Updates - 2014 NEUSAHA Annual Meeting 
12-14 May 2014
Thursday, July 09, 2015 
TEXAS Chronic Wasting Disease (CWD) Herd Plan for Trace-Forward Exposed 
Herd with Testing of Exposed Animals 
============
P.70: Experimental transmission of chronic wasting disease to sheep and 
goats
Gordon Mitchell, Nishandan Yogasingam, Ines Walther, and Aru Balachandran 
National and OIE Reference Laboratory for Scrapie and CWD; Canadian Food 
Inspection Agency; Ottawa, ON, Canada
The persistence of chronic wasting disease (CWD) in North American cervids, 
coupled with efforts to eradicate scrapie in sheep and goats, necessitates an 
understanding of the transmission, clinical and diagnostic characteristics of 
CWD in small ruminants. Oral and intracerebral transmission studies were 
conducted in sheep and goats using tissues from CWD-infected elk. Four lambs and 
4 goats were orally inoculated with a pooled brain and lymph node homogenate 
from a group of farmed elk with clinical CWD. At study endpoint, there was no 
evidence of primary CWD transmission in the sheep or goat tissues examined by 
ELISA, western blot and immunohistochemistry (IHC). Two lambs which were 
challenged intracerebrally with the same pooled elk inoculate displayed 
neurological signs beginning at 27 months postinoculation (mpi) and were 
euthanized within 10 d of each other at 28 mpi. Testing of tissues by ELISA and 
IHC confirmed disease transmission and revealed differences in the distribution 
and intensity of PrPd deposition between animals. Western immunoblot analysis 
identified characteristics permitting the differentiation of CWD in sheep from 
other prion diseases in small ruminants. CWD-infected tissue from the 
intracerabrally-inoculated sheep has undergone secondary passage into sheep and 
goats and currently shows no evidence of oral transmission in rectal mucosa 
biopsies at 20 mpi. These findings corroborate evidence of a significant species 
barrier preventing the oral transmission of CWD to sheep and goats, and identify 
diagnostic characteristics to enable the differentiation of prion diseases 
affecting small ruminants.
===========
P.97: Scrapie transmits to white-tailed deer by the oral route and has a 
molecular profile similar to chronic wasting disease and distinct from the 
scrapie inoculum
Justin Greenlee1, S Jo Moore1, Jodi Smith1, M Heather West Greenlee2, and 
Robert Kunkle1 1National Animal Disease Center; Ames, IA USA; 2Iowa State 
University; Ames, IA USA
The purpose of this work was to determine susceptibility of white-tailed 
deer (WTD) to the agent of sheep scrapie and to compare the resultant PrPSc to 
that of the original inoculum and chronic wasting disease (CWD). We inoculated 
WTD by a natural route of exposure (concurrent oral and intranasal (IN); n D 5) 
with a US scrapie isolate. All scrapie-inoculated deer had evidence of PrPSc 
accumulation. PrPSc was detected in lymphoid tissues at preclinical time points, 
and deer necropsied after 28 months post-inoculation had clinical signs, 
spongiform encephalopathy, and widespread distribution of PrPSc in neural and 
lymphoid tissues. Western blotting (WB) revealed PrPSc with 2 distinct molecular 
profiles. WB on cerebral cortex had a profile similar to the original scrapie 
inoculum, whereas WB of brainstem, cerebellum, or lymph nodes revealed PrPSc 
with a higher profile resembling CWD. Homogenates with the 2 distinct profiles 
from WTD with clinical scrapie were further passaged to mice expressing cervid 
prion protein and intranasally to sheep and WTD. In cervidized mice, the 2 
inocula have distinct incubation times. Sheep inoculated intranasally with WTD 
derived scrapie developed disease, but only after inoculation with the inoculum 
that had a scrapie-like profile. The WTD study is ongoing, but deer in both 
inoculation groups are positive for PrPSc by rectal mucosal biopsy.*** In 
summary, this work demonstrates that WTD are susceptible to the agent of 
scrapie, 2 distinct molecular profiles of PrPSc are present in the tissues of 
affected deer, and inoculum of either profile readily passes to deer.
=================
*** In summary, this work demonstrates that WTD are susceptible to the 
agent of scrapie, 2 distinct molecular profiles of PrPSc are present in the 
tissues of affected deer, and inoculum of either profile readily passes to deer. 
*** 
================ 
P.128: Bioassay using ovine and cervid PrP transgenic mice for 
discrimination of scrapie and CWD origins in sheep and goats
Sally Madsen-Bouterse1,*, Dongyue Zhuang2, David Schneider2, Rohana 
Dassanayake1, Aru Balachandran3, Gordon Mitchell3, and Katherine O’Rourke1 
1Department of Veterinary Microbiology and Pathology; College of Veterinary 
Medicine; Washington State University; Pullman, WA USA; 2Animal Disease Research 
Unit; Agricultural Research Service; US. Department of Agriculture; Pullman, WA 
USA; 3National and OIE Reference Laboratory for Scrapie and CWD; Canadian Food 
Inspection Agency; Ottawa Laboratory– Fallowfield; Ottawa, ON Canada
As the United States works toward the eradication of scrapie, identifying 
TSE reservoirs that could lead to disease re-emergence is imperative. 
Development of transgenic mice expressing either the ovine or cervid prion 
protein has aided characterization of scrapie and CWD, respectively. We 
hypothesize that transgenic mouse models will discern whether new incidents of 
scrapie in sheep and goats with clinical disease originated from CWD exposure. 
Two transgenic mouse lines (Tg338 and TgElk; minimum 5 mice/strain) were 
inoculated with brain homogenate from clinically affected animals including 
sheep or goats with naturally acquired classical scrapie, white-tailed deer with 
naturally acquired CWD (WTD-CWD), or sheep experimentally inoculated with 
elk-CWD (sheepelk- CWD). Transmission was assessed via survival analysis and 
western blot characterization of brain PrPres. WTD-CWD transmitted efficiently 
to TgElk with all mice culled due to clinical disease, whereas all Tg338 
remained asymptomatic at endpoint with no PrPres detected in the brain. Ovine 
and caprine scrapie transmitted poorly to TgElk with all mice asymptomatic at 
endpoint and 6.8% brain-positive for PrPres, whereas all Tg338 were culled due 
to clinical disease. Sheep elk-CWD yielded Tg338 that were all asymptomatic at 
endpoint and were all brainpositive for PrPres. However, sheepelk-CWD yielded 
TgElk with 5/22 displaying clinical disease near endpoint but 16/22 
brain-positive for PrPres. Furthermore, TgElk-PrPres molecular mass appeared 
lower when inoculated with caprine scrapie versus WTD-CWD and both molecular 
masses were yielded when inoculated with sheepelk-CWD. ***These findings suggest 
primary passage in Tg338 and TgElk could discern whether scrapie in sheep and 
goats originated from CWD exposure.
===========
P.73: Oral challenge of goats with atypical scrapie
Silvia Colussi1, Maria Mazza1, Francesca Martucci1, Simone Peletto1, 
Cristiano Corona1, Marina Gallo1, Cristina Bona1, Romolo Nonno2, Michele Di 
Bari2, Claudia D’Agostino2, Nicola Martinelli3, Guerino Lombardi3, and Pier 
Luigi Acutis1 1Istituto Zooprofilattico Sperimentale del Piemonte; Liguria e 
Valle d’Aosta; Turin, Italy; 2Istituto Superiore di Sanit a; Rome, Italy; 
3Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna; 
Brescia, Italy
Atypical scrapie transmission has been demonstrated in sheep by 
intracerebral and oral route (Simmons et al., Andreoletti et al., 2011) but data 
about goats are not available yet. In 2006 we orally challenged four goats, five 
months old, with genotype R/H and R/R at codon 154. Animals died starting from 
24 to 77 months p.i. without clinical signs. They all resulted negative for 
scrapie in CNS and peripheral tissues using Western blot and 
immunohistochemistry. Nevertheless these goats could still represent carriers. 
This hypothesis was investigated through bioassay in tg338 mice, a sensitive 
animal model for atypical scrapie infectivity. By end-point dilution titration, 
the starting inoculum contained 106.8 ID50/g. In contrast, all tissues from 
challenged goats were negative by bioassay. These negative results could be 
explained with the low infectivity of the starting inoculum, which could have 
been unable to induce disease or infectivity within our period of observation. 
However the challenge conditions could have been a bias too: as the matter of 
the fact, while the oral challenge of classical scrapie is still effective in 
sheep 6–10 months old (Andreoletti et al., 2011), Simmons et al. (2011) 
demonstrated a very short efficacy period for atypical scrapie (24 hours after 
birth), hypothesizing that natural transmission could occur mainly via milk. 
***Our work suggests that this could be true also for goats and it should be 
taken into account in oral challenges. However a low susceptibility of goats to 
atypical scrapie transmission via oral route cannot be excluded.
============= 
P.74: Transmission of experimental CH1641 scrapie to wild-type mice
Lucien van Keulen1,*, Jan Langeveld1, Corry Dolstra1, Jorg Jacobs1, Alex 
Bossers1, and Fred van Zijderveld2 1Department of Infection Biology; Central 
Veterinary Institute of Wageningen UR, Lelystad, The Netherlands; 2Department of 
Bacteriology and TSEs; Central Veterinary Institute of Wageningen UR, Lelystad, 
The Netherlands
Introduction. CH1641 was isolated in the UK in 1970 from a natural case of 
scrapie in a Cheviot sheep and was further passaged intracerebrally in sheep. 
CH1641 has been the subject of extensive research because of the biochemical 
similarities of PrPres from CH1641- and BSE-affected sheep brains. Previous 
attempts to transmit CH1641 to wild type mice have been unsuccessful. We report 
here for the first time, the positive transmission of experimental CH1641 to 
RIII mice and compare the incubation period, PrPSc profile and PrPres Western 
blot properties to those of known scrapie and BSE reference strains.
Methods. The CH1641 brain homogenate used in this study came from a pool a 
5 sheep brains which had been challenged intracerebrally with brain material 
from the third passage of CH1641 in sheep. Groups of 15–20 RIII mice were 
inoculated intracerebrally with a 10% brain homogenate of CH1641. The brains of 
the mice were examined by PrPSc profiling and triplex Western blot as reported 
previously.
Results. Surprisingly CH1641 transmitted to RIII mice with a 100% attack 
rate although with a long incubation period (794 § 149 d). The resulting PrPSc 
profile was unlike any of the profiles of the scrapie and BSE reference strains 
reported previously. Triplex Western blot pointed after first passage to a very 
low PrPres level. We observed a reduction of molecular mass of the non-glycosyl 
PrPres moiety and concomittant N-terminal 12B2 epitope signal. In comparison to 
the original CH1641 inoculum there was a lack of a dual population of 
PrPres.
===========
***The serial transmission of different scrapie isolates in these mice led 
to the propagation of prions that are phenotypically identical to those causing 
sporadic CJD (sCJD) in humans. 
***These results demonstrate that scrapie prions have a zoonotic potential 
and raise new questions about the possible link between animal and human 
prions.
Subject terms: Biological sciences• Medical research At a glance
2015
Longitudinal Detection of Prion Shedding in Saliva and Urine by 
CWD-Infected Deer by RT-QuIC 
Davin M. Henderson1, Nathaniel D. Denkers1, Clare E. Hoover1, Nina 
Garbino1, Candace K. Mathiason1 and Edward A. Hoover1# + Author 
Affiliations
1Prion Research Center, Department of Microbiology, Immunology, and 
Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado 
State University, Fort Collins, CO 80523 ABSTRACT Chronic Wasting Disease (CWD) 
is an emergent, rapidly spreading prion disease of cervids. Shedding of 
infectious prions in saliva and urine is thought to be an important factor in 
CWD transmission. To help elucidate this issue, we applied an in vitro 
amplification assay to determine the onset, duration, and magnitude of prion 
shedding in longitudinally collected saliva and urine samples from CWD-exposed 
white-tailed deer. We detected prion shedding as early as 3 months after CWD 
exposure and sustained shedding throughout the disease course. We estimated that 
a 50% lethal dose (LD50) for cervidized transgenic mice would be contained in 1 
ml of infected deer saliva or 10 ml or urine. Given the average course of 
infection and daily production of these body fluids, an infected deer would shed 
thousands of prion infectious dosesover the course of CWD infection. The direct 
and indirect environmental impact of this magnitude of prion shedding for cervid 
and non-cervid species is surely significant. 
Importance: Chronic wasting disease (CWD) is an emerging and uniformly 
fatal prion disease affecting free ranging deer and elk and now recognized in 22 
United States and 2 C anadian Provinces. It is unique among prion diseases in 
that it is transmitted naturally though wild populations. A major hypothesis for 
CWD's florid spread is that prions are shed in excreta and transmitted via 
direct or indirect environmental contact. Here we use a rapid in vitro assay to 
show that infectious doses of CWD prions are in fact shed throughout the 
multi-year disease course in deer. This finding is an important advance in 
assessing the risks posed by shed CWD prions to animals as well as humans. 
FOOTNOTES
↵#To whom correspondence should be addressed: Edward A. Hoover, Prion 
Research Center, Department of Microbiology, Immunology and Pathology, Colorado 
State University, Fort Collins, Colorado, US Email: 
edward.hoover@colostate.edu
Transmission of scrapie prions to primate after an extended silent 
incubation period 
Emmanuel E. Comoy1 , Jacqueline Mikol1 , Sophie Luccantoni-Freire1 , 
Evelyne Correia1 , Nathalie Lescoutra-Etchegaray1 , Valérie Durand1 , Capucine 
Dehen1 , Olivier Andreoletti2 , Cristina Casalone3 , Juergen A. Richt4 n1 , 
Justin J. Greenlee4 , Thierry Baron5 , Sylvie L. Benestad6 , Paul Brown1 […] 
& Jean-Philippe Deslys1 - Show fewer authors Scientific Reports 5, Article 
number: 11573 (2015) doi:10.1038/srep11573 Download Citation 
Epidemiology | Neurological manifestations | Prion diseases Received: 16 
February 2015 Accepted: 28 May 2015 Published online: 30 June 2015 ABSTRACT 
Classical bovine spongiform encephalopathy (c-BSE) is the only animal prion 
disease reputed to be zoonotic, causing variant Creutzfeldt-Jakob disease (vCJD) 
in humans and having guided protective measures for animal and human health 
against animal prion diseases. Recently, partial transmissions to humanized mice 
showed that the zoonotic potential of scrapie might be similar to c-BSE. We here 
report the direct transmission of a natural classical scrapie isolate to 
cynomolgus macaque, a highly relevant model for human prion diseases, after a 
10-year silent incubation period, with features similar to those reported for 
human cases of sporadic CJD. Scrapie is thus actually transmissible to primates 
with incubation periods compatible with their life expectancy, although fourfold 
longer than BSE. Long-term experimental transmission studies are necessary to 
better assess the zoonotic potential of other prion diseases with high 
prevalence, notably Chronic Wasting Disease of deer and elk and atypical/Nor98 
scrapie. 
snip... 
Discussion 
We describe the transmission of spongiform encephalopathy in a non-human 
primate inoculated 10 years earlier with a strain of sheep c-scrapie. Because of 
this extended incubation period in a facility in which other prion diseases are 
under study, we are obliged to consider two alternative possibilities that might 
explain its occurrence. We first considered the possibility of a sporadic origin 
(like CJD in humans). Such an event is extremely improbable because the 
inoculated animal was 14 years old when the clinical signs appeared, i.e. about 
40% through the expected natural lifetime of this species, compared to a peak 
age incidence of 60–65 years in human sporadic CJD, or about 80% through their 
expected lifetimes. Moreover, sporadic disease has never been observed in 
breeding colonies or primate research laboratories, most notably among hundreds 
of animals over several decades of study at the National Institutes of Health25, 
and in nearly twenty older animals continuously housed in our own 
facility.
The second possibility is a laboratory cross-contamination. Three facts 
make this possibility equally unlikely. First, handling of specimens in our 
laboratory is performed with fastidious attention to the avoidance of any such 
cross-contamination. Second, no laboratory cross-contamination has ever been 
documented in other primate laboratories, including the NIH, even between 
infected and uninfected animals housed in the same or adjacent cages with daily 
intimate contact (P. Brown, personal communication). Third, the cerebral lesion 
profile is different from all the other prion diseases we have studied in this 
model19, with a correlation between cerebellar lesions (massive spongiform 
change of Purkinje cells, intense PrPres staining and reactive gliosis26) and 
ataxia. The iron deposits present in the globus pallidus are a non specific 
finding that have been reported previously in neurodegenerative diseases and 
aging27. Conversely, the thalamic lesion was reminiscent of a metabolic disease 
due to thiamine deficiency28 but blood thiamine levels were within normal limits 
(data not shown). The preferential distribution of spongiform change in cortex 
associated with a limited distribution in the brainstem is reminiscent of the 
lesion profile in MM2c and VV1 sCJD patients29, but interspecies comparison of 
lesion profiles should be interpreted with caution. It is of note that the same 
classical scrapie isolate induced TSE in C57Bl/6 mice with similar incubation 
periods and lesional profiles as a sample derived from a MM1 sCJD 
patient30.
We are therefore confident that the illness in this cynomolgus macaque 
represents a true transmission of a sheep c-scrapie isolate directly to an 
old-world monkey, which taxonomically resides in the primate subdivision 
(parvorder of catarrhini) that includes humans. With an homology of its PrP 
protein with humans of 96.4%31, cynomolgus macaque constitutes a highly relevant 
model for assessing zoonotic risk of prion diseases. Since our initial aim was 
to show the absence of transmission of scrapie to macaques in the worst-case 
scenario, we obtained materials from a flock of naturally-infected sheep, 
affecting animals with different genotypes32. This c-scrapie isolate exhibited 
complete transmission in ARQ/ARQ sheep (332 ± 56 days) and Tg338 transgenic mice 
expressing ovine VRQ/VRQ prion protein (220 ± 5 days) (O. Andreoletti, personal 
communication). From the standpoint of zoonotic risk, it is important to note 
that sheep with c-scrapie (including the isolate used in our study) have 
demonstrable infectivity throughout their lymphoreticular system early in the 
incubation period of the disease (3 months-old for all the lymphoid organs, and 
as early as 2 months-old in gut-associated lymph nodes)33. In addition, scrapie 
infectivity has been identified in blood34, milk35 and skeletal muscle36 from 
asymptomatic but scrapie infected small ruminants which implies a potential 
dietary exposure for consumers.
Two earlier studies have reported the occurrence of clinical TSE in 
cynomolgus macaques after exposures to scrapie isolates. In the first study, the 
“Compton” scrapie isolate (derived from an English sheep) and serially 
propagated for 9 passages in goats did not transmit TSE in cynomolgus macaque, 
rhesus macaque or chimpanzee within 7 years following intracerebral challenge1; 
conversely, after 8 supplementary passages in conventional mice, this “Compton” 
isolate induced TSE in a cynomolgus macaque 5 years after intracerebral 
challenge, but rhesus macaques and chimpanzee remained asymptomatic 8.5 years 
post-exposure8. However, multiple successive passages that are classically used 
to select laboratory-adapted prion strains can significantly modify the initial 
properties of a scrapie isolate, thus questioning the relevance of zoonotic 
potential for the initial sheep-derived isolate. The same isolate had also 
induced disease into squirrel monkeys (new-world monkey)9. A second historical 
observation reported that a cynomolgus macaque developed TSE 6 years 
post-inoculation with brain homogenate from a scrapie-infected Suffolk ewe 
(derived from USA), whereas a rhesus macaque and a chimpanzee exposed to the 
same inoculum remained healthy 9 years post-exposure1. This inoculum also 
induced TSE in squirrel monkeys after 4 passages in mice. Other scrapie 
transmission attempts in macaque failed but had more shorter periods of 
observation in comparison to the current study. Further, it is possible that 
there are differences in the zoonotic potential of different scrapie 
strains.
The most striking observation in our study is the extended incubation 
period of scrapie in the macaque model, which has several implications. Firstly, 
our observations constitute experimental evidence in favor of the zoonotic 
potential of c-scrapie, at least for this isolate that has been extensively 
studied32,33,34,35,36. The cross-species zoonotic ability of this isolate should 
be confirmed by performing duplicate intracerebral exposures and assessing the 
transmissibility by the oral route (a successful transmission of prion strains 
through the intracerebral route may not necessarily indicate the potential for 
oral transmission37). However, such confirmatory experiments may require more 
than one decade, which is hardly compatible with current general management and 
support of scientific projects; thus this study should be rather considered as a 
case report.
Secondly, transmission of c-BSE to primates occurred within 8 years post 
exposure for the lowest doses able to transmit the disease (the survival period 
after inoculation is inversely proportional to the initial amount of infectious 
inoculum). The occurrence of scrapie 10 years after exposure to a high dose (25 
mg) of scrapie-infected sheep brain suggests that the macaque has a higher 
species barrier for sheep c-scrapie than c-BSE, although it is notable that 
previous studies based on in vitro conversion of PrP suggested that BSE and 
scrapie prions would have a similar conversion potential for human PrP38.
Thirdly, prion diseases typically have longer incubation periods after oral 
exposure than after intracerebral inoculations: since humans can develop Kuru 47 
years after oral exposure39, an incubation time of several decades after oral 
exposure to scrapie would therefore be expected, leading the disease to occur in 
older adults, i.e. the peak age for cases considered to be sporadic disease, and 
making a distinction between scrapie-associated and truly sporadic disease 
extremely difficult to appreciate.
Fourthly, epidemiologic evidence is necessary to confirm the zoonotic 
potential of an animal disease suggested by experimental studies. A relatively 
short incubation period and a peculiar epidemiological situation (e.g., all the 
first vCJD cases occurring in the country with the most important ongoing c-BSE 
epizootic) led to a high degree of suspicion that c-BSE was the cause of vCJD. 
Sporadic CJD are considered spontaneous diseases with an almost stable and 
constant worldwide prevalence (0.5–2 cases per million inhabitants per year), 
and previous epidemiological studies were unable to draw a link between sCJD and 
classical scrapie6,7,40,41, even though external causes were hypothesized to 
explain the occurrence of some sCJD clusters42,43,44. However, extended 
incubation periods exceeding several decades would impair the predictive values 
of epidemiological surveillance for prion diseases, already weakened by a 
limited prevalence of prion diseases and the multiplicity of isolates gathered 
under the phenotypes of “scrapie” and “sporadic CJD”.
Fifthly, considering this 10 year-long incubation period, together with 
both laboratory and epidemiological evidence of decade or longer intervals 
between infection and clinical onset of disease, no premature conclusions should 
be drawn from negative transmission studies in cynomolgus macaques with less 
than a decade of observation, as in the aforementioned historical transmission 
studies of scrapie to primates1,8,9. Our observations and those of others45,46 
to date are unable to provide definitive evidence regarding the zoonotic 
potential of CWD, atypical/Nor98 scrapie or H-type BSE. The extended incubation 
period of the scrapie-affected macaque in the current study also underscores the 
limitations of rodent models expressing human PrP for assessing the zoonotic 
potential of some prion diseases since their lifespan remains limited to 
approximately two years21,47,48. This point is illustrated by the fact that the 
recently reported transmission of scrapie to humanized mice was not associated 
with clinical signs for up to 750 days and occurred in an extreme minority of 
mice with only a marginal increase in attack rate upon second passage13. The low 
attack rate in these studies is certainly linked to the limited lifespan of mice 
compared to the very long periods of observation necessary to demonstrate the 
development of scrapie. Alternatively, one could estimate that a successful 
second passage is the result of strain adaptation to the species barrier, thus 
poorly relevant of the real zoonotic potential of the original scrapie isolate 
of sheep origin49. The development of scrapie in this primate after an 
incubation period compatible with its lifespan complements the study conducted 
in transgenic (humanized) mice; taken together these studies suggest that some 
isolates of sheep scrapie can promote misfolding of the human prion protein and 
that scrapie can develop within the lifespan of some primate species.
In addition to previous studies on scrapie transmission to primate1,8,9 and 
the recently published study on transgenic humanized mice13, our results 
constitute new evidence for recommending that the potential risk of scrapie for 
human health should not be dismissed. Indeed, human PrP transgenic mice and 
primates are the most relevant models for investigating the human transmission 
barrier. To what extent such models are informative for measuring the zoonotic 
potential of an animal TSE under field exposure conditions is unknown. During 
the past decades, many protective measures have been successfully implemented to 
protect cattle from the spread of c-BSE, and some of these measures have been 
extended to sheep and goats to protect from scrapie according to the principle 
of precaution. Since cases of c-BSE have greatly reduced in number, those 
protective measures are currently being challenged and relaxed in the absence of 
other known zoonotic animal prion disease. We recommend that risk managers 
should be aware of the long term potential risk to human health of at least 
certain scrapie isolates, notably for lymphotropic strains like the classical 
scrapie strain used in the current study. Relatively high amounts of infectivity 
in peripheral lymphoid organs in animals infected with these strains could lead 
to contamination of food products produced for human consumption. Efforts should 
also be maintained to further assess the zoonotic potential of other animal 
prion strains in long-term studies, notably lymphotropic strains with high 
prevalence like CWD, which is spreading across North America, and atypical/Nor98 
scrapie (Nor98)50 that was first detected in the past two decades and now 
represents approximately half of all reported cases of prion diseases in small 
ruminants worldwide, including territories previously considered as scrapie 
free. Even if the prevailing view is that sporadic CJD is due to the spontaneous 
formation of CJD prions, it remains possible that its apparent sporadic nature 
may, at least in part, result from our limited capacity to identify an 
environmental origin. 
O.05: Transmission of prions to primates after extended silent incubation 
periods: Implications for BSE and scrapie risk assessment in human populations 
Emmanuel Comoy, Jacqueline Mikol, Val erie Durand, Sophie Luccantoni, 
Evelyne Correia, Nathalie Lescoutra, Capucine Dehen, and Jean-Philippe Deslys 
Atomic Energy Commission; Fontenay-aux-Roses, France 
Prion diseases (PD) are the unique neurodegenerative proteinopathies 
reputed to be transmissible under field conditions since decades. The 
transmission of Bovine Spongiform Encephalopathy (BSE) to humans evidenced that 
an animal PD might be zoonotic under appropriate conditions. Contrarily, in the 
absence of obvious (epidemiological or experimental) elements supporting a 
transmission or genetic predispositions, PD, like the other proteinopathies, are 
reputed to occur spontaneously (atpical animal prion strains, sporadic CJD 
summing 80% of human prion cases). Non-human primate models provided the first 
evidences supporting the transmissibiity of human prion strains and the zoonotic 
potential of BSE. Among them, cynomolgus macaques brought major information for 
BSE risk assessment for human health (Chen, 2014), according to their 
phylogenetic proximity to humans and extended lifetime. We used this model to 
assess the zoonotic potential of other animal PD from bovine, ovine and cervid 
origins even after very long silent incubation periods. We recently observed the 
direct transmission of a natural classical scrapie isolate to macaque after a 
10-year silent incubation period, with features similar to some reported for 
human cases of sporadic CJD, albeit requiring fourfold longe incubation than 
BSE. Scrapie, as recently evoked in humanized mice (Cassard, 2014), is the third 
potentially zoonotic PD (with BSE and L-type BSE), ***thus questioning the 
origin of human sporadic cases. We will present an updated panorama of our 
different transmission studies and discuss the implications of such extended 
incubation periods on risk assessment of animal PD for human health.
===============
***thus questioning the origin of human sporadic cases...TSS
=============== 
Saturday, May 30, 2015 
PRION 2015 ORAL AND POSTER CONGRESSIONAL ABSTRACTS 
LATE-BREAKING ABSTRACTS
O18
Zoonotic Potential of CWD Prions
Liuting Qing1, Ignazio Cali1,2, Jue Yuan1, Shenghai Huang3, Diane Kofskey1, 
Pierluigi Gambetti1, Wenquan Zou1, Qingzhong Kong1 1Case Western Reserve 
University, Cleveland, Ohio, USA, 2Second University of Naples, Naples, Italy, 
3Encore Health Resources, Houston, Texas, USA
Chronic wasting disease (CWD) is a widespread and expanding prion disease 
in free-ranging and captive cervid species in North America. The zoonotic 
potential of CWD prions is a serious public health concern. Current literature 
generated with in vitro methods and in vivo animal models (transgenic mice, 
macaques and squirrel monkeys) reports conflicting results. The susceptibility 
of human CNS and peripheral organs to CWD prions remains largely unresolved. In 
our earlier bioassay experiments using several humanized transgenic mouse lines, 
we detected protease-resistant PrPSc in the spleen of two out of 140 mice that 
were intracerebrally inoculated with natural CWD isolates, but PrPSc was not 
detected in the brain of the same mice. Secondary passages with such 
PrPSc-positive CWD-inoculated humanized mouse spleen tissues led to efficient 
prion transmission with clear clinical and pathological signs in both humanized 
and cervidized transgenic mice. Furthermore, a recent bioassay with natural CWD 
isolates in a new humanized transgenic mouse line led to clinical prion 
infection in 2 out of 20 mice. These results indicate that the CWD prion has the 
potential to infect human CNS and peripheral lymphoid tissues and that there 
might be asymptomatic human carriers of CWD infection. 
================== 
***These results indicate that the CWD prion has the potential to infect 
human CNS and peripheral lymphoid tissues and that there might be asymptomatic 
human carriers of CWD infection.*** 
================== 
I strenuously once again urge the FDA and its industry constituents, to 
make it MANDATORY that all ruminant feed be banned to all ruminants, and this 
should include all cervids as soon as possible for the following 
reasons...
======
In the USA, under the Food and Drug Administrations BSE Feed Regulation (21 
CFR 589.2000) most material (exceptions include milk, tallow, and gelatin) from 
deer and elk is prohibited for use in feed for ruminant animals. With regards to 
feed for non-ruminant animals, under FDA law, CWD positive deer may not be used 
for any animal feed or feed ingredients. For elk and deer considered at high 
risk for CWD, the FDA recommends that these animals do not enter the animal feed 
system. 
***However, this recommendation is guidance and not a requirement by law. 
======
31 Jan 2015 at 20:14 GMT 
*** Ruminant feed ban for cervids in the United States? ***
31 Jan 2015 at 20:14 GMT 
Terry S. Singeltary Sr.

 
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