how can it be, HOW CAN IT BE $$$ not a word about CJD GSS FFI VPSPR TSE 
Prions that I saw...absolutely crazy, WE ARE MISSING THE BIGGER PICTURE!
 
Preventable Tragedies: Superbugs and How Ineffective Monitoring of Medical Device Safety Fails Patients REPORT
 
United States Senate 
 
HEALTH, EDUCATION, LABOR, AND PENSIONS COMMITTEE 
 
Patty Murray, Ranking Member
 
Minority Staff Report January 13, 2016 
 
 
06.09.15 Murray Presses Scope Manufacturer Linked to Superbug Outbreak at 
Virginia Mason For Answers, Accountability
 
Murray indicates “growing concern” in letters to manufacturers of medical 
scopes linked to antibiotic resistant infections across the country 
 
(Washington, D.C.) – Today, Senate Health, Education, Labor, and Pensions 
(HELP) Committee Ranking Member Patty Murray (D-WA) wrote a letter to Karl 
Watanabe, President of Olympus Corporation of the Americas, raising questions 
about the company’s actions to protect patients treated with Olympus 
duodenoscopes, which are medical devices linked to an outbreak of 
antibiotic-resistant infections at Virginia Mason Medical Center in Seattle, 
Washington. Duodenoscopes manufactured by Olympus, Pentax Medical, and Fujifilm 
have also been linked to antibiotic-resistant infections at other hospitals 
nationwide. 
 
 Murray expressed serious concern about reports that Olympus knew its 
cleaning and reprocessing standards were ineffective, but failed to 
appropriately warn patients and providers in the United States of the potential 
for antibiotic-resistant infections. Murray requested that Olympus provide 
information on the timeline of events and the company’s response to reports of 
infections related to their duodenoscopes by June 19, 2015. 
 
 “As questions continue to arise regarding your company’s actions to 
adequately protect patients treated with your duodenoscopes, I write to seek 
more information and express my serious and growing concern,” Murray wrote in 
the letter. “I am committed to ensuring that the families impacted by these 
tragic outbreaks in Washington state and across the country get answers and 
accountability.” 
 
 Murray also sent letters to Pentax Medical and Fujifilm requesting similar 
information. Earlier this year, Murray called for a full FDA review of practices 
surrounding duodenoscopes, and also urged the agency to provide health care 
professionals with updated safety guidance and best practices, which the agency 
has now done. 
 
 Full text of Senator Murray’s letter to Olympus: 
 
 Dear Mr. Watanabe: 
 
 As questions continue to arise regarding your company’s actions to 
adequately protect patients treated with your duodenoscopes, I write to seek 
more information and express my serious and growing concern. As you are aware, 
between late 2012 and January 2014, Virginia Mason hospital in Seattle, 
Washington experienced an outbreak of deadly carbapenem-resistant 
Enterobacteriaceae (CRE) infections which were subsequently traced to 
duodenoscopes manufactured by Olympus. In all, 32 individuals were infected with 
CRE, an additional 7 people developed a separate E coli infection, and 18 of 
those who developed infections later died. 
 
 In addition, multiple cases of CRE infections traced back to Olympus 
duodenoscopes have now been confirmed at two other hospitals in 2014, as well as 
a series of CRE infections involving an Olympus duodenoscope in Florida in 2009. 
In all, the Food and Drug Administration (FDA) confirmed at the recently 
convened Advisory Committee Meeting of the Gastroenterology-Urology Devices 
Panel that there have been at least nine hospital outbreaks of 
multidrug-resistant infections traced to duodenoscopes in the United States, and 
that six of those outbreaks are traceable to scopes manufactured by Olympus. 
Olympus is reported to have told health care professionals in February that the 
company was aware of 95 complaints of infection in patients who had undergone 
procedures with TJF-Q180V, the “closed elevator” duodenoscope sold since 2010, 
without Olympus seeking FDA approval or clearance before marketing. 
 
 Overall, FDA has informed me it received 139 separate reports of 
contamination or infection related medical device reports, or adverse event 
reports involving duodenoscopes between 2011 and 2014, including 69 reports 
affecting 135 patients in 2014 alone. Ninety-four percent of these reports were 
received directly from the manufacturers, which include Olympus (85 percent 
market share of duodenoscopes), Fujifilm, and Pentax Medical. 
 
 I have become increasingly concerned by the failure of Olympus to 
proactively warn patients and providers in the United States of the potential 
for infections. It is my understanding that in November of 2013, at the 
invitation of officials at Virginia Mason concerned about the CRE infections at 
the hospital, an endoscopy support specialist from Olympus spent two days at the 
hospital and validated that the hospital was properly cleaning Olympus 
duodenoscopes between uses. That review by Olympus staff demonstrated that 
“endoscope reprocessing procedures at [the hospital] were above the industry 
standard, and all technicians performed manual endoscope cleaning in a manner 
consistent with manufacturer guidelines.” Olympus officials subsequently removed 
a number of the scopes in use at Virginia Mason for repair. 
 
 Thus, as early as November 2013, it appears that Olympus knew or should 
have known that even in cases where hospital staff were carefully executing 
Olympus’ instructions for cleaning, duodenoscopes continued to be contaminated 
with CRE and other bacteria. Further, it strongly suggests that Olympus knew its 
current cleaning and reprocessing standards were insufficient, and that use of 
the company’s duodenoscopes, particularly the TJF-Q180V model sold since 2010 
and featuring a “closed elevator,” were placing patients undergoing procedures 
at risk of multi-bacteria resistant infections. Moreover, although medical 
device manufacturers are required to file reports of possible safety risks 
within 30 days, press reports suggest that Olympus did not even file the 
required Medical Device Report with the FDA in connection with the Virginia 
Mason infections until August 2014. And as recently as February of this year, 
more than a year after the Virginia Mason CRE outbreak, I understand that the 
Olympus manager of infection control told a meeting of health care professionals 
that “endoscopes reprocessed properly pose virtually no risk of patient-borne or 
environmental organisms.” 
 
 This stands in marked contrast to the actions taken by Olympus in Europe. 
According to press reports, as early as January 2013, Olympus is reported to 
have issued “important safety advice” to European hospitals instructing staff to 
use a specific brush supplied by Olympus to clean duodenoscopes. This action is 
reported to have been taken following a series of infections at Erasmus 
University in Rotterdam in early 2012. Dr. Margreet Vos provided testimony at 
the recent FDA Advisory Committee meeting that in 2012 independent reviewers 
found bacteria present in reprocessed Olympus scopes. 
 
 Again in August 2014, Olympus is reported to have sent a second safety 
alert to European hospitals that asked hospital staff to sign and return an 
acknowledgement that the warning had been shared with staff. No such alert was 
sent in this country until February of this year, and the cleaning brushes 
apparently sent to European hospitals in early 2013 were not provided to U.S. 
hospitals until last month. 
 
 These facts build upon my existing concerns regarding Olympus’ 2010 
failure to seek clearance or approval from the FDA prior to marketing TJF-Q180V, 
the “closed elevator” duodenoscope at issue in a number of the infections. I 
find it very troubling that when Olympus became aware of increased reports of 
infections linked to the TJF-Q180V, the company appears not to have taken 
additional steps to alert health professionals and regulators in the United 
States to the risks this particular device posed. Moreover, when asked by the 
FDA in the spring of 2014 to provide the data that validated that Olympus 
duodenoscopes could be cleaned of bacteria within acceptable safety margins 
using recommended procedures, Olympus (as well as Fujifilm and Pentax Medical) 
was unable to do so through two rounds of testing. New cleaning guidance was 
finally approved by FDA in March 2015. 
 
 I find it similarly troubling that Olympus (as well as Fujifilm and Pentax 
Medical) declined to participate in the subsequently convened FDA Advisory 
Committee Meeting on “Effective Reprocessing of Endoscopes used in Endoscopic 
Retrograde Cholangiopancreatography (ERCP) Procedures,” despite manufacturing 85 
percent of the scopes used in these procedures. But at the same time, the 
company was apparently able to have representatives present at two large 
professional conferences in Washington, D.C. that same week. Just days before 
the FDA Advisory Panel meeting, Olympus announced that the company was reducing 
its expected earnings forecast for this year as a result of an ongoing 
investigation by the Department of Justice into potential violations of the 
Anti-Kickback Statute, and last week Olympus announced that it is under 
investigation by the United States Attorney for the District of New Jersey 
relating to the duodenoscope infections. 
 
 Even with enhanced cleaning procedures adopted earlier this year, these 
necessary and important devices must be handled with extreme care to help 
prevent infections. At the FDA panel meeting, two-thirds of hospitals reported 
that scope cultures were positive for organisms after reprocessing. While 
representatives of Virginia Mason explained that the hospital has established a 
protocol requiring that, after a duodenoscope has been thoroughly cleaned and 
reprocessed, it is cultured for bacteria, this process requires a 48-hour 
waiting period between uses of a scope, and has required the hospital to 
purchase additional scopes. Yet the hospital believes it has little alternative 
to purchasing additional scopes given that they continue to experience a 3 
percent contamination rate. 
 
 I am committed to ensuring that the families impacted by these tragic 
outbreaks in Washington State and across the country get answers and 
accountability. In order to better understand the timeline of events and your 
company’s response to reports of infections related to duodenoscopes 
manufactured by Olympus, including the TJF-160, TJF-Q180V-1 and TJF-Q180V-2, 
please provide the following information by June 19, 2015.
 
 1.Copies of all alerts, cleaning guidance, safety advice or warnings 
provided to any hospital or regulatory agency, foreign or domestic, mentioning 
any scope manufactured by Olympus used in Endoscopic Retrograde 
Cholangiopancreatography Procedures from 2005-2015.
 
 1.Unredacted copies of all medical device reports or adverse event reports 
sent by Olympus to FDA regarding the TJF-Q180V-1 and TJF-Q180V-2 or any other 
scope used in Endoscopic Retrograde Cholangiopancreatography Procedures between 
2005 and present.
 
 1.Copies of all documents between 2010 and present that reference or refer 
to CRE or other infections and any endoscope, including any duodenoscope, 
manufactured by Olympus. 
 
 
 FDA Executive Summary Prepared for the May 14-15, 2015 meeting of the 
Gastroenterology-Urology Devices Panel of the Medical Devices Advisory Committee 
Effective Reprocessing of Endoscopes used in Endoscopic Retrograde 
Cholangiopancreatography (ERCP) Procedures
 
 
 March 26, 2015
 
URGENT SAFETY NOTIFICATION IMPORTANT UPDATED LABELING INFORMATION: NEW 
REPROCESSING INSTRUCTIONS FOR THE OLYMPUS TJF-Q180V DUODENOSCOPE
 
ATTENTION: Endoscopy Department, Risk Management and Reprocessing 
Units
 
Dear Health Care Professional: 
 
 
Senate report faults hospitals, device makers, FDA for deadly ‘superbug’ 
outbreaks
 
January 14, 2016 By Brad Perriello —Leave a Comment 
 
superbug-scope-3x2A report by Democrats on the U.S. Senate’s health 
committee issued this week blames hospitals, medical device companies and the 
FDA for the deadly outbreaks of so-called “superbug” infections linked to 
duodenoscopes.
 
The devices are used for a procedure called endoscopic retrograde 
cholangiopancreatography, in which a reusable tube-like camera is inserted into 
the throat of a patient. More than 500,000 ERCPs using the devices are performed 
in the U.S. annually. Hospitals in Connecticut, Virginia, California and 
Washington state all reported superbug outbreaks in February and March 2014, 
some of which led to patients’ deaths.
 
Staffers under Sen. Patty Murray (D-Wash.), the ranking member of the 
Senate Health, Education, Pensions & Labor Committee, found that it took 17 
months for ‘scope makers Olympus (TYO:7733), Fujifilm Holdings‘ (TSE:4901) and 
Hoya (TYO:7741) subsidiary Pentax to raise the alarm about the infections.
 
“At least 68 patients in 7 different hospitals in the U.S. were infected 
with antibiotic-resistant bacteria linked to duodenoscopes during this period,” 
according to the HELP panel’s report. “Between 2012 and spring 2015, 
closed-channel duodenoscopes were linked to at least 25 different incidents of 
antibiotic-resistant infections that sickened at least 250 patients 
worldwide.”
 
The report also found that Olympus, which owns some 85% of the U.S. market 
for duodenoscopes, knew as early as 2013 that a new “closed-channel” design 
allowed the devices to harbor and spread bacteria even after sterilization 
procedures.
 
“Olympus never brought this information to FDA, and did not alert 
hospitals, physicians or patients in the U.S. to the risk of infection until 
February 2015,” according to the report.
 
Mark Miller, corporate & medical communications VP at Olympus, said in 
prepared remarks that the company spent several months cooperating with the 
Senate panel’s enquiry.
 
“We appreciate that the staff report noted Olympus’ cooperation and that 
the report demonstrates the shared responsibilities of duodenoscope 
manufacturers, hospitals, manufacturers of automated endoscope reprocessors, and 
the FDA, each of which can contribute to increasing patient safety. Although we 
do not agree with all of the report’s conclusions, we are closely reviewing the 
recommendations in the report as part of Olympus’ ongoing efforts to increase 
patient safety associated with use of Olympus duodenoscopes,” Miller said.
 
The Senate report also found that Olympus, Fujifilm, Pentax and automated 
sterilization provider Custom Ultrasonics “failed to meet the obligations placed 
upon them by the current regulatory system.”
 
“Two of the manufacturers failed to seek FDA clearance before selling the 
‘closed-channel’ duodenoscopes, all failed to adequately test whether the scopes 
could be cleaned reliably in real-world settings, and fully comply with adverse 
events reporting requirements,” according to the report.
 
But the companies were not solely to blame for the superbug outbreaks, 
according to the report.
 
“Additionally, although at least 16 separate U.S. hospitals traced 
antibiotic-resistant infections directly to duodenoscopes, the hospitals 
generally did not raise alarms about these infections with federal regulators. 
It appears that not a single hospital that experienced infection outbreaks tied 
to the duodenoscopes sent the required adverse event form to the device 
manufacturers,” Murray’s aides wrote. “When hospitals did take required action 
to report adverse events to device manufacturers it was often late, notification 
was made informally by phone or email, and reports were not inclusive of all the 
information necessary for the manufacturers to themselves submit accurate and 
complete information to FDA.”
 
And the FDA played its part in the deadly fiasco, they wrote, citing the 
safety watchdog’s often-maligned Manufacturer & User Facility Device 
Experience database, which is designed to track adverse events linked to medical 
devices.
 
“Problems with FDA’s outmoded adverse event device database, as well as 
slow and incomplete reporting by manufacturers and hospitals, appear to have 
left FDA staff unable to develop an accurate sense of the frequency and severity 
of the infection outbreaks. FDA was also unaware that by early 2013, 2 
independent labs in Europe had documented the Olympus closed-channel 
duodenoscope remaining contaminated after repeated cleaning, or that a Dutch 
Health Ministry report in 2013 had already concluded that Olympus did not have 
the data to show their cleaning instructions worked consistently and 
effectively,” according to the report.
 
In March 2014, hospitals in Los Angeles and Connecticut reported superbug 
outbreaks linked to the scopes. Cedars-Sinai Medical Center reported 4 
infections and 67 more at-risk patients. coinciding with a hospital in Hartford, 
Conn., reporting a similar outbreak involving at least 5 infections and more 
than 280 potential exposures.
 
The Cedars-Sinai cases, like the larger number of infections and potential 
exposures reported in February at the UCLA Ronald Reagan Medical Center in Los 
Angeles, involved a family of germs called carbapenem-resistant 
Enterobacteriaceae. The bacteria identified in the Hartford Hospital outbreak 
was a drug-resistant strain of E.coli. Seven patients were infected with CRE 
during endoscopies at the UCLA teaching hospital between Oct. 3 and Jan. 28, and 
2 died. Officials warned at the time that as many as 179 people may have been 
exposed to the so-called superbug.
 
Between 2012 and 2014, at least 32 patients at Virginia Mason Medical 
Center were infected with strains of multidrug-resistant E. coli bacteria spread 
through contaminated scopes that had been sterilized to the manufacturer’s 
guidelines, according to state health officials. At least 11 people eventually 
died, though the role of the superbug in their demise was unclear because all 
the patients were critically ill at the time of their infection, Washington 
state public health officials said.
 
The outbreaks prompted the FDA to inspect 11 plants where the 3 companies 
make the endoscopes, leading to the August 12 warning letters to Olympus, 
Fujifilm and Pentax. The FDA said it found numerous violations at the plants, 
ranging from inadequate quality controls to failures to report serious adverse 
events, including deaths. The violations turned up at plants in Japan, New 
Jersey, Pennsylvania and California, according to the FDA. 
 
Filed Under: Endoscopic / Arthroscopic
 
Tagged With: Capitol Hill, Fujifilm Holdings, Hoya Corp., Olympus, Pentax 
 
 
More infections from dirty scopes, Sen. Murray investigation finds 
 
Originally published January 12, 2016 at 9:00 pm | Updated January 13, 2016 
at 10:24 am 
 
At least 250 people, mostly in the U.S., have contracted potentially deadly 
infections spread by contaminated medical scopes in the past three years, 
according to a new report commissioned by Sen. Patty Murray. 
 
 
 
how can it be, HOW CAN IT BE $$$ not a word about CJD GSS FFI VPSPR TSE 
Prions that I saw...absolutely crazy! 
 
 
*** Transmission of Creutzfeldt-Jakob disease to a chimpanzee by electrodes 
contaminated during neurosurgery ***
 
Gibbs CJ Jr, Asher DM, Kobrine A, Amyx HL, Sulima MP, Gajdusek DC. 
Laboratory of Central Nervous System Studies, National Institute of Neurological 
Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892.
 
Stereotactic multicontact electrodes used to probe the cerebral cortex of a 
middle aged woman with progressive dementia were previously implicated in the 
accidental transmission of Creutzfeldt-Jakob disease (CJD) to two younger 
patients. The diagnoses of CJD have been confirmed for all three cases. More 
than two years after their last use in humans, after three cleanings and 
repeated sterilisation in ethanol and formaldehyde vapour, the electrodes were 
implanted in the cortex of a chimpanzee. Eighteen months later the animal became 
ill with CJD. This finding serves to re-emphasise the potential danger posed by 
reuse of instruments contaminated with the agents of spongiform 
encephalopathies, even after scrupulous attempts to clean them.
 
 
98 | Veterinary Record | January 24, 2015
 
EDITORIAL
 
Scrapie: a particularly persistent pathogen
 
Cristina Acín
 
Resistant prions in the environment have been the sword of Damocles for 
scrapie control and eradication. Attempts to establish which physical and 
chemical agents could be applied to inactivate or moderate scrapie infectivity 
were initiated in the 1960s and 1970s,with the first study of this type focusing 
on the effect of heat treatment in reducing prion infectivity (Hunter and 
Millson 1964). Nowadays, most of the chemical procedures that aim to inactivate 
the prion protein are based on the method developed by Kimberlin and 
collaborators (1983). This procedure consists of treatment with 20,000 parts per 
million free chlorine solution, for a minimum of one hour, of all surfaces that 
need to be sterilised (in laboratories, lambing pens, slaughterhouses, and so 
on). Despite this, veterinarians and farmers may still ask a range of questions, 
such as ‘Is there an official procedure published somewhere?’ and ‘Is there an 
international organisation which recommends and defines the exact method of 
scrapie decontamination that must be applied?’
 
From a European perspective, it is difficult to find a treatment that could 
be applied, especially in relation to the disinfection of surfaces in lambing 
pens of affected flocks. A 999/2001 EU regulation on controlling spongiform 
encephalopathies (European Parliament and Council 2001) did not specify a 
particular decontamination measure to be used when an outbreak of scrapie is 
diagnosed. There is only a brief recommendation in Annex VII concerning the 
control and eradication of transmissible spongiform encephalopathies (TSE 
s).
 
Chapter B of the regulation explains the measures that must be applied if 
new caprine animals are to be introduced to a holding where a scrapie outbreak 
has previously been diagnosed. In that case, the statement indicates that 
caprine animals can be introduced ‘provided that a cleaning and disinfection of 
all animal housing on the premises has been carried out following 
destocking’.
 
Issues around cleaning and disinfection are common in prion prevention 
recommendations, but relevant authorities, veterinarians and farmers may have 
difficulties in finding the specific protocol which applies. The European Food 
and Safety Authority (EFSA ) published a detailed report about the efficacy of 
certain biocides, such as sodium hydroxide, sodium hypochlorite, guanidine and 
even a formulation of copper or iron metal ions in combination with hydrogen 
peroxide, against prions (EFSA 2009). The report was based on scientific 
evidence (Fichet and others 2004, Lemmer and others 2004, Gao and others 2006, 
Solassol and others 2006) but unfortunately the decontamination measures were 
not assessed under outbreak conditions.
 
The EFSA Panel on Biological Hazards recently published its conclusions on 
the scrapie situation in the EU after 10 years of monitoring and control of the 
disease in sheep and goats (EFSA 2014), and one of the most interesting findings 
was the Icelandic experience regarding the effect of disinfection in scrapie 
control. The Icelandic plan consisted of: culling scrapie-affected sheep or the 
whole flock in newly diagnosed outbreaks; deep cleaning and disinfection of 
stables, sheds, barns and equipment with high pressure washing followed by 
cleaning with 500 parts per million of hypochlorite; drying and treatment with 
300 ppm of iodophor; and restocking was not permitted for at least two years. 
Even when all of these measures were implemented, scrapie recurred on several 
farms, indicating that the infectious agent survived for years in the 
environment, even as many as 16 years after restocking (Georgsson and others 
2006).
 
In the rest of the countries considered in the EFSA (2014) report, 
recommendations for disinfection measures were not specifically defined at the 
government level. In the report, the only recommendation that is made for sheep 
is repopulation with sheep with scrapie-resistant genotypes. This reduces the 
risk of scrapie recurrence but it is difficult to know its effect on the 
infection.
 
Until the EFSA was established (in May 2003), scientific opinions about TSE 
s were provided by the Scientific Steering Committee (SSC) of the EC, whose 
advice regarding inactivation procedures focused on treating animal waste at 
high temperatures (150°C for three hours) and high pressure alkaline hydrolysis 
(SSC 2003). At the same time, the TSE Risk Management Subgroup of the Advisory 
Committee on Dangerous Pathogens (ACDP) in the UK published guidance on safe 
working and the prevention of TSE infection. Annex C of the ACDP report 
established that sodium hypochlorite was considered to be effective, but only if 
20,000 ppm of available chlorine was present for at least one hour, which has 
practical limitations such as the release of chlorine gas, corrosion, 
incompatibility with formaldehyde, alcohols and acids, rapid inactivation of its 
active chemicals and the stability of dilutions (ACDP 2009).
 
In an international context, the World Organisation for Animal Health (OIE) 
does not recommend a specific disinfection protocol for prion agents in its 
Terrestrial Code or Manual. Chapter 4.13 of the Terrestrial Code, General 
recommendations on disinfection and disinsection (OIE 2014), focuses on 
foot-and-mouth disease virus, mycobacteria and Bacillus anthracis, but not on 
prion disinfection. Nevertheless, the last update published by the OIE on bovine 
spongiform encephalopathy (OIE 2012) indicates that few effective 
decontamination techniques are available to inactivate the agent on surfaces, 
and recommends the removal of all organic material and the use of sodium 
hydroxide, or a sodium hypochlorite solution containing 2 per cent available 
chlorine, for more than one hour at 20ºC.
 
The World Health Organization outlines guidelines for the control of TSE s, 
and also emphasises the importance of mechanically cleaning surfaces before 
disinfection with sodium hydroxide or sodium hypochlorite for one hour (WHO 
1999).
 
Finally, the relevant agencies in both Canada and the USA suggest that the 
best treatments for surfaces potentially contaminated with prions are sodium 
hydroxide or sodium hypochlorite at 20,000 ppm. This is a 2 per cent solution, 
while most commercial household bleaches contain 5.25 per cent sodium 
hypochlorite. It is therefore recommended to dilute one part 5.25 per cent 
bleach with 1.5 parts water (CDC 2009, Canadian Food Inspection Agency 
2013).
 
So what should we do about disinfection against prions? First, it is 
suggested that a single protocol be created by international authorities to 
homogenise inactivation procedures and enable their application in all 
scrapie-affected countries. Sodium hypochlorite with 20,000 ppm of available 
chlorine seems to be the procedure used in most countries, as noted in a paper 
summarised on p 99 of this issue of Veterinary Record (Hawkins and others 2015). 
But are we totally sure of its effectiveness as a preventive measure in a 
scrapie outbreak? Would an in-depth study of the recurrence of scrapie disease 
be needed?
 
What we can conclude is that, if we want to fight prion diseases, and 
specifically classical scrapie, we must focus on the accuracy of diagnosis, 
monitoring and surveillance; appropriate animal identification and control of 
movements; and, in the end, have homogeneous and suitable protocols to 
decontaminate and disinfect lambing barns, sheds and equipment available to 
veterinarians and farmers. Finally, further investigations into the resistance 
of prion proteins in the diversity of environmental surfaces are required.
 
References
 
snip...
 
98 | Veterinary Record | January 24, 2015
 
 
Original Article 
 
Effect of heating on the stability of amyloid A (AA) fibrils and the intra- 
and cross-species transmission of AA amyloidosis 
 
DOI:10.3109/13506129.2015.1095735Saki Ogawaa, Tomoaki Murakamib, Yasuo 
Inoshimaa & Naotaka Ishiguroa*
 
Publishing models and article dates explained
 
Received: 5 May 2015 Accepted: 14 Sep 2015 Published online: 20 Nov 2015 
.
 
Abstract 
 
Amyloid A (AA) amyloidosis is a protein misfolding disease characterized by 
extracellular deposition of AA fibrils. AA fibrils are found in several tissues 
from food animals with AA amyloidosis. For hygienic purposes, heating is widely 
used to inactivate microbes in food, but it is uncertain whether heating is 
sufficient to inactivate AA fibrils and prevent intra- or cross-species 
transmission. We examined the effect of heating (at 60 °C or 100 °C) and 
autoclaving (at 121 °C or 135 °C) on murine and bovine AA fibrils using Western 
blot analysis, transmission electron microscopy (TEM), and mouse model 
transmission experiments. TEM revealed that a mixture of AA fibrils and 
amorphous aggregates appeared after heating at 100 °C, whereas autoclaving at 
135 °C produced large amorphous aggregates. AA fibrils retained antigen 
specificity in Western blot analysis when heated at 100 °C or autoclaved at 121 
°C, but not when autoclaved at 135 °C. Transmissible pathogenicity of murine and 
bovine AA fibrils subjected to heating (at 60 °C or 100 °C) was significantly 
stimulated and resulted in amyloid deposition in mice. Autoclaving of murine AA 
fibrils at 121 °C or 135 °C significantly decreased amyloid deposition. 
Moreover, amyloid deposition in mice injected with murine AA fibrils was more 
severe than that in mice injected with bovine AA fibrils. Bovine AA fibrils 
autoclaved at 121 °C or 135 °C did not induce amyloid deposition in mice. These 
results suggest that AA fibrils are relatively heat stable and that similar to 
prions, autoclaving at 135 °C is required to destroy the pathogenicity of AA 
fibrils. These findings may contribute to the prevention of AA fibril 
transmission through food materials to different animals and especially to 
humans. 
 
AA amyloidosis, AA fibrils, Image J software, immunohistochemistry, prion, 
silver nitrate, transmission electron microscopy, Western blot analysis 
 
 
*** These results suggest that AA fibrils are relatively heat stable and 
that similar to prions, autoclaving at 135 °C is required to destroy the 
pathogenicity of AA fibrils. 
 
*** These findings may contribute to the prevention of AA fibril 
transmission through food materials to different animals and especially to 
humans. 
 
New studies on the heat resistance of hamster-adapted scrapie agent: 
Threshold survival after ashing at 600°C suggests an inorganic template of 
replication 
 
The infectious agents responsible for transmissible spongiform 
encephalopathy (TSE) are notoriously resistant to most physical and chemical 
methods used for inactivating pathogens, including heat. It has long been 
recognized, for example, that boiling is ineffective and that higher 
temperatures are most efficient when combined with steam under pressure (i.e., 
autoclaving). As a means of decontamination, dry heat is used only at the 
extremely high temperatures achieved during incineration, usually in excess of 
600°C. It has been assumed, without proof, that incineration totally inactivates 
the agents of TSE, whether of human or animal origin. 
 
 
Prion Infected Meat-and-Bone Meal Is Still Infectious after Biodiesel 
Production 
 
Histochemical analysis of hamster brains inoculated with the solid residue 
showed typical spongiform degeneration and vacuolation. Re-inoculation of these 
brains into a new cohort of hamsters led to onset of clinical scrapie symptoms 
within 75 days, suggesting that the specific infectivity of the prion protein 
was not changed during the biodiesel process. The biodiesel reaction cannot be 
considered a viable prion decontamination method for MBM, although we observed 
increased survival time of hamsters and reduced infectivity greater than 6 log 
orders in the solid MBM residue. Furthermore, results from our study compare for 
the first time prion detection by Western Blot versus an infectivity bioassay 
for analysis of biodiesel reaction products. We could show that biochemical 
analysis alone is insufficient for detection of prion infectivity after a 
biodiesel process. 
 
 
Detection of protease-resistant cervid prion protein in water from a 
CWD-endemic area 
 
The data presented here demonstrate that sPMCA can detect low levels of 
PrPCWD in the environment, corroborate previous biological and experimental data 
suggesting long term persistence of prions in the environment2,3 and imply that 
PrPCWD accumulation over time may contribute to transmission of CWD in areas 
where it has been endemic for decades. This work demonstrates the utility of 
sPMCA to evaluate other environmental water sources for PrPCWD, including 
smaller bodies of water such as vernal pools and wallows, where large numbers of 
cervids congregate and into which prions from infected animals may be shed and 
concentrated to infectious levels. 
 
 
A Quantitative Assessment of the Amount of Prion Diverted to Category 1 
Materials and Wastewater During Processing 
 
Keywords:Abattoir;bovine spongiform encephalopathy;QRA;scrapie;TSE 
 
In this article the development and parameterization of a quantitative 
assessment is described that estimates the amount of TSE infectivity that is 
present in a whole animal carcass (bovine spongiform encephalopathy [BSE] for 
cattle and classical/atypical scrapie for sheep and lambs) and the amounts that 
subsequently fall to the floor during processing at facilities that handle 
specified risk material (SRM). BSE in cattle was found to contain the most oral 
doses, with a mean of 9864 BO ID50s (310, 38840) in a whole carcass compared to 
a mean of 1851 OO ID50s (600, 4070) and 614 OO ID50s (155, 1509) for a sheep 
infected with classical and atypical scrapie, respectively. Lambs contained the 
least infectivity with a mean of 251 OO ID50s (83, 548) for classical scrapie 
and 1 OO ID50s (0.2, 2) for atypical scrapie. The highest amounts of infectivity 
falling to the floor and entering the drains from slaughtering a whole carcass 
at SRM facilities were found to be from cattle infected with BSE at rendering 
and large incineration facilities with 7.4 BO ID50s (0.1, 29), intermediate 
plants and small incinerators with a mean of 4.5 BO ID50s (0.1, 18), and 
collection centers, 3.6 BO ID50s (0.1, 14). The lowest amounts entering drains 
are from lambs infected with classical and atypical scrapie at intermediate 
plants and atypical scrapie at collection centers with a mean of 3 × 10−7 OO 
ID50s (2 × 10−8, 1 × 10−6) per carcass. The results of this model provide key 
inputs for the model in the companion paper published here. 
 
 
*** Infectious agent of sheep scrapie may persist in the environment for at 
least 16 years *** 
 
Gudmundur Georgsson1, Sigurdur Sigurdarson2 and Paul Brown3 
 
 
PL1 
 
Using in vitro prion replication for high sensitive detection of prions and 
prionlike proteins and for understanding mechanisms of transmission.
 
Claudio Soto
 
Mitchell Center for Alzheimer's diseases and related Brain disorders, 
Department of Neurology, University of Texas Medical School at Houston.
 
Prion and prion-like proteins are misfolded protein aggregates with the 
ability to selfpropagate to spread disease between cells, organs and in some 
cases across individuals. I n T r a n s m i s s i b l e s p o n g i f o r m 
encephalopathies (TSEs), prions are mostly composed by a misfolded form of the 
prion protein (PrPSc), which propagates by transmitting its misfolding to the 
normal prion protein (PrPC). The availability of a procedure to replicate prions 
in the laboratory may be important to study the mechanism of prion and 
prion-like spreading and to develop high sensitive detection of small quantities 
of misfolded proteins in biological fluids, tissues and environmental samples. 
Protein Misfolding Cyclic Amplification (PMCA) is a simple, fast and efficient 
methodology to mimic prion replication in the test tube. PMCA is a platform 
technology that may enable amplification of any prion-like misfolded protein 
aggregating through a seeding/nucleation process. In TSEs, PMCA is able to 
detect the equivalent of one single molecule of infectious PrPSc and propagate 
prions that maintain high infectivity, strain properties and species 
specificity. Using PMCA we have been able to detect PrPSc in blood and urine of 
experimentally infected animals and humans affected by vCJD with high 
sensitivity and specificity. Recently, we have expanded the principles of PMCA 
to amplify amyloid-beta (Aβ) and alphasynuclein (α-syn) aggregates implicated in 
Alzheimer's and Parkinson's diseases, respectively. Experiments are ongoing to 
study the utility of this technology to detect Aβ and α-syn aggregates in 
samples of CSF and blood from patients affected by these diseases.
 
=========================
 
***Recently, we have been using PMCA to study the role of environmental 
prion contamination on the horizontal spreading of TSEs. These experiments have 
focused on the study of the interaction of prions with plants and 
environmentally relevant surfaces. Our results show that plants (both leaves and 
roots) bind tightly to prions present in brain extracts and excreta (urine and 
feces) and retain even small quantities of PrPSc for long periods of time. 
Strikingly, ingestion of prioncontaminated leaves and roots produced disease 
with a 100% attack rate and an incubation period not substantially longer than 
feeding animals directly with scrapie brain homogenate. Furthermore, plants can 
uptake prions from contaminated soil and transport them to different parts of 
the plant tissue (stem and leaves). Similarly, prions bind tightly to a variety 
of environmentally relevant surfaces, including stones, wood, metals, plastic, 
glass, cement, etc. Prion contaminated surfaces efficiently transmit prion 
disease when these materials were directly injected into the brain of animals 
and strikingly when the contaminated surfaces were just placed in the animal 
cage. These findings demonstrate that environmental materials can efficiently 
bind infectious prions and act as carriers of infectivity, suggesting that they 
may play an important role in the horizontal transmission of the disease.
 
========================
 
Since its invention 13 years ago, PMCA has helped to answer fundamental 
questions of prion propagation and has broad applications in research areas 
including the food industry, blood bank safety and human and veterinary disease 
diagnosis. 
 
 
Wednesday, December 16, 2015 
 
Objects in contact with classical scrapie sheep act as a reservoir for 
scrapie transmission 
 
Objects in contact with classical scrapie sheep act as a reservoir for 
scrapie transmission 
 
Timm Konold1*, Stephen A. C. Hawkins2, Lisa C. Thurston3, Ben C. Maddison4, 
Kevin C. Gough5, Anthony Duarte1 and Hugh A. Simmons1 
 
1 Animal Sciences Unit, Animal and Plant Health Agency Weybridge, 
Addlestone, UK, 2 Pathology Department, Animal and Plant Health Agency 
Weybridge, Addlestone, UK, 3 Surveillance and Laboratory Services, Animal and 
Plant Health Agency Penrith, Penrith, UK, 4 ADAS UK, School of Veterinary 
Medicine and Science, University of Nottingham, Sutton Bonington, UK, 5 School 
of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, 
UK 
 
Classical scrapie is an environmentally transmissible prion disease of 
sheep and goats. Prions can persist and remain potentially infectious in the 
environment for many years and thus pose a risk of infecting animals after 
re-stocking. In vitro studies using serial protein misfolding cyclic 
amplification (sPMCA) have suggested that objects on a scrapie affected sheep 
farm could contribute to disease transmission. This in vivo study aimed to 
determine the role of field furniture (water troughs, feeding troughs, fencing, 
and other objects that sheep may rub against) used by a scrapie-infected sheep 
flock as a vector for disease transmission to scrapie-free lambs with the prion 
protein genotype VRQ/VRQ, which is associated with high susceptibility to 
classical scrapie. When the field furniture was placed in clean accommodation, 
sheep became infected when exposed to either a water trough (four out of five) 
or to objects used for rubbing (four out of seven). This field furniture had 
been used by the scrapie-infected flock 8 weeks earlier and had previously been 
shown to harbor scrapie prions by sPMCA. Sheep also became infected (20 out of 
23) through exposure to contaminated field furniture placed within pasture not 
used by scrapie-infected sheep for 40 months, even though swabs from this 
furniture tested negative by PMCA. This infection rate decreased (1 out of 12) 
on the same paddock after replacement with clean field furniture. Twelve grazing 
sheep exposed to field furniture not in contact with scrapie-infected sheep for 
18 months remained scrapie free. The findings of this study highlight the role 
of field furniture used by scrapie-infected sheep to act as a reservoir for 
disease re-introduction although infectivity declines considerably if the field 
furniture has not been in contact with scrapie-infected sheep for several 
months. PMCA may not be as sensitive as VRQ/VRQ sheep to test for environmental 
contamination. 
 
snip... 
 
Discussion 
 
Classical scrapie is an environmentally transmissible disease because it 
has been reported in naïve, supposedly previously unexposed sheep placed in 
pastures formerly occupied by scrapie-infected sheep (4, 19, 20). Although the 
vector for disease transmission is not known, soil is likely to be an important 
reservoir for prions (2) where – based on studies in rodents – prions can adhere 
to minerals as a biologically active form (21) and remain infectious for more 
than 2 years (22). Similarly, chronic wasting disease (CWD) has re-occurred in 
mule deer housed in paddocks used by infected deer 2 years earlier, which was 
assumed to be through foraging and soil consumption (23). 
 
Our study suggested that the risk of acquiring scrapie infection was 
greater through exposure to contaminated wooden, plastic, and metal surfaces via 
water or food troughs, fencing, and hurdles than through grazing. Drinking from 
a water trough used by the scrapie flock was sufficient to cause infection in 
sheep in a clean building. Exposure to fences and other objects used for rubbing 
also led to infection, which supported the hypothesis that skin may be a vector 
for disease transmission (9). The risk of these objects to cause infection was 
further demonstrated when 87% of 23 sheep presented with PrPSc in lymphoid 
tissue after grazing on one of the paddocks, which contained metal hurdles, a 
metal lamb creep and a water trough in contact with the scrapie flock up to 8 
weeks earlier, whereas no infection had been demonstrated previously in sheep 
grazing on this paddock, when equipped with new fencing and field furniture. 
When the contaminated furniture and fencing were removed, the infection rate 
dropped significantly to 8% of 12 sheep, with soil of the paddock as the most 
likely source of infection caused by shedding of prions from the 
scrapie-infected sheep in this paddock up to a week earlier. 
 
This study also indicated that the level of contamination of field 
furniture sufficient to cause infection was dependent on two factors: stage of 
incubation period and time of last use by scrapie-infected sheep. Drinking from 
a water trough that had been used by scrapie sheep in the predominantly 
pre-clinical phase did not appear to cause infection, whereas infection was 
shown in sheep drinking from the water trough used by scrapie sheep in the later 
stage of the disease. It is possible that contamination occurred through 
shedding of prions in saliva, which may have contaminated the surface of the 
water trough and subsequently the water when it was refilled. Contamination 
appeared to be sufficient to cause infection only if the trough was in contact 
with sheep that included clinical cases. Indeed, there is an increased risk of 
bodily fluid infectivity with disease progression in scrapie (24) and CWD (25) 
based on PrPSc detection by sPMCA. Although ultraviolet light and heat under 
natural conditions do not inactivate prions (26), furniture in contact with the 
scrapie flock, which was assumed to be sufficiently contaminated to cause 
infection, did not act as vector for disease if not used for 18 months, which 
suggest that the weathering process alone was sufficient to inactivate prions. 
 
PrPSc detection by sPMCA is increasingly used as a surrogate for 
infectivity measurements by bioassay in sheep or mice. In this reported study, 
however, the levels of PrPSc present in the environment were below the limit of 
detection of the sPMCA method, yet were still sufficient to cause infection of 
in-contact animals. In the present study, the outdoor objects were removed from 
the infected flock 8 weeks prior to sampling and were positive by sPMCA at very 
low levels (2 out of 37 reactions). As this sPMCA assay also yielded 2 positive 
reactions out of 139 in samples from the scrapie-free farm, the sPMCA assay 
could not detect PrPSc on any of the objects above the background of the assay. 
False positive reactions with sPMCA at a low frequency associated with de novo 
formation of infectious prions have been reported (27, 28). This is in contrast 
to our previous study where we demonstrated that outdoor objects that had been 
in contact with the scrapie-infected flock up to 20 days prior to sampling 
harbored PrPSc that was detectable by sPMCA analysis [4 out of 15 reactions 
(12)] and was significantly more positive by the assay compared to analogous 
samples from the scrapie-free farm. This discrepancy could be due to the use of 
a different sPMCA substrate between the studies that may alter the efficiency of 
amplification of the environmental PrPSc. In addition, the present study had a 
longer timeframe between the objects being in contact with the infected flock 
and sampling, which may affect the levels of extractable PrPSc. Alternatively, 
there may be potentially patchy contamination of this furniture with PrPSc, 
which may have been missed by swabbing. The failure of sPMCA to detect 
CWD-associated PrP in saliva from clinically affected deer despite confirmation 
of infectivity in saliva-inoculated transgenic mice was associated with as yet 
unidentified inhibitors in saliva (29), and it is possible that the sensitivity 
of sPMCA is affected by other substances in the tested material. In addition, 
sampling of amplifiable PrPSc and subsequent detection by sPMCA may be more 
difficult from furniture exposed to weather, which is supported by the 
observation that PrPSc was detected by sPMCA more frequently in indoor than 
outdoor furniture (12). A recent experimental study has demonstrated that 
repeated cycles of drying and wetting of prion-contaminated soil, equivalent to 
what is expected under natural weathering conditions, could reduce PMCA 
amplification efficiency and extend the incubation period in hamsters inoculated 
with soil samples (30). This seems to apply also to this study even though the 
reduction in infectivity was more dramatic in the sPMCA assays than in the sheep 
model. Sheep were not kept until clinical end-point, which would have enabled us 
to compare incubation periods, but the lack of infection in sheep exposed to 
furniture that had not been in contact with scrapie sheep for a longer time 
period supports the hypothesis that prion degradation and subsequent loss of 
infectivity occurs even under natural conditions. 
 
In conclusion, the results in the current study indicate that removal of 
furniture that had been in contact with scrapie-infected animals should be 
recommended, particularly since cleaning and decontamination may not effectively 
remove scrapie infectivity (31), even though infectivity declines considerably 
if the pasture and the field furniture have not been in contact with 
scrapie-infected sheep for several months. As sPMCA failed to detect PrPSc in 
furniture that was subjected to weathering, even though exposure led to 
infection in sheep, this method may not always be reliable in predicting the 
risk of scrapie infection through environmental contamination. These results 
suggest that the VRQ/VRQ sheep model may be more sensitive than sPMCA for the 
detection of environmentally associated scrapie, and suggest that extremely low 
levels of scrapie contamination are able to cause infection in susceptible sheep 
genotypes. 
 
Keywords: classical scrapie, prion, transmissible spongiform 
encephalopathy, sheep, field furniture, reservoir, serial protein misfolding 
cyclic amplification 
 
 
 03-025IF 03-025IF-631 Linda A. Detwiler [PDF] Page 1. 03-025IF 
03-025IF-631 Linda A. Detwiler 
 
Intestine 
 
The scenario describe above is essentially true for the intestine. 
Infectivity was readily detectable in the distal ileum of cattle infected with 
BSE. While certain additional sections of the intestine were tested with no 
infectivity identified, not every section of the intestine was included in the 
bioassays. Positive immunostaining for Prpres was identified along the length of 
the intestine providing evidence for the entire intestine to be considered as 
SRM per EU regulations. (personal communication Danny Matthews, UK, VLA). The 
International Advisory Committee appointed by Secretary Veneman also recommended 
that the SRM ban in the US be amended to the entire intestine from duodenum to 
rectum. I recommend that the USDA adjust the definition of SRM to include the 
entire intestine from the duodenum to the rectum . 
 
snip... 
 
see full text ; 
 
 
Linda A. Detwiler, DVM 
 
225 Hwy 35 
 
Red Bank, New Jersey 07701 
 
Phone: 732-741-2290 
 
Cell: 732-580-9391 
 
Fax: 732-741-7751 
 
June 22, 2005 
 
FSIS Docket Clerk 
 
U.S. Department of Agriculture Food Safety and Inspection Service 300 12th 
Street, SW. Room 102 Cotton Annex Washington, DC 20250 
 
RE: DEPARTMENT OF AGRICULTURE Food Safety and Inspection Service 
 
9 CFR Parts 301, 309, 310, 311, 313, 318, 319 and 320 
 
Prohibition of the Use of Specified Risk Materials for Human Food and 
Requirements for the Disposition of Non-Ambulatory Disabled Cattle; Meat 
Produced by Advanced Meat/Bone Separation Machinery and Meat Recovery (AMR) 
Systems; 
 
Prohibition of the Use of Certain Stunning Devices Used To Immobilize 
Cattle During Slaughter; Bovine Spongiform Encephalopathy (BSE) Surveillance 
Program 
 
Docket Number 03-025IF: Prohibition of the Use of Specified Risk Materials 
for Human Food and Requirements for the Disposition of Nonambulatory Disabled 
Cattle 
 
I am writing to clarify a comment I submitted to the above mentioned docket 
on May 7, 2004. I had previously written that the entire length of the intestine 
should be excluded as SRM. I still hold this opinion and submit the same 
recommendation, however one of the reasons behind this opinion needs to be 
further clarified. I had misunderstood comments made by Dr. Danny Matthews in 
that immunostaining (of PrPbse) was not found throughout the entire length of 
the intestine. There was however immunostaining in the myenteric plexus of the 
distal ileum in both naturally infected and experimentally challenged cattle 
with BSE. (Terry et al.,2003) Given that the myenteric plexus exists throughout 
the intestine one cannot eliminate the possibility of infectivity being in other 
sections. In fact this was some of the thought behind the designation of the 
entire intestine as SRM in the EU: 
 
In its opinion of 7-8 December 2000 (EC 2000), the SSC concluded that the 
entire bovine intestine is a risk issue and Commission Regulation (EC) No. 
 
270/2002 (14th February 2002) ANNEX II designates “the entire intestines 
from the duodenum to the rectum and the mesentery of bovine animals of all 
ages;” as SRM. Also, in the SSC opinion of 28-29 JUNE 2001, Adipose tissue 
associated with the digestive tract of cattle, sheep and goats: an appreciation 
of possibleTSE risks (EC 2001) the view was expressed that for cattle, “due to 
the infectivity titre that could be theoretically reached in nervous tissues and 
in some parts of intestine, and due to the risk of contamination with intestine 
tissue…. 
 
The International Advisory Committee appointed by Secretary Veneman also 
recommended that the SRM ban in the US be amended to the entire intestine from 
duodenum to rectum. 
 
Although certain additional sections of the intestine were tested with no 
infectivity identified, not every section of the intestine was included in the 
bioassays. In addition, the study involving immunostaining was also extremely 
limited in regard to the testing of tissues other than the distal ileum. 
Specifically, other sections of intestinal tissues (excluding the distal ileum 
work) were limited to those collected from 3 calves inoculated with BSE at a 
timeframe of 6 months post inoculation. Instead of assuming that the untested 
sections are devoid of infectivity, it is my belief that we should err on the 
side of caution when it comes to protecting public health. Hence I maintain my 
opinion that the entire intestine should be considered SRM. 
 
This clarification is also intended for my comments submitted to the FDA’s 
ANPR. 
 
Thank you for the opportunity to clarify my comments. 
 
Linda A. Detwiler, DVM 
 
REFERENCES 
 
Terry, L. A.., Marsh, S., Ryder, S. J., Hawkins, S. A. C., Wells, G. H., 
and Spencer, Y. I. (2003) Detection of disease-specific PrP in the distal ileum 
of cattle exposed orally to the agent of bovine spongiform encephalopathy. Vet 
Rec., 152, 387-392 Wells G.A.H., Dawson M., Hawkins, S.A.C., Green R. B., Dexter 
I., Francis M. E., Simmons M. M., Austin A. R., & Horigan M. W. (1994) 
Infectivity in the ileum of cattle challenged orally with bovine spongiform 
encephalopathy. Vet. Rec., 135, 40-41. Wells G.A.H., Hawkins, S.A.C., Green R. 
B., Austin A. R., Dexter I., Spencer, Y. I., Chaplin, M. J., Stack, M. J., & 
Dawson, M. (1998) Preliminary observations on the pathogenesis of experimental 
bovine spongiform encephalopathy (BSE): an update. Vet. Rec., 142, 103-106. 
 
 
see full text ; 
 
 
 
*** Interpretation ***
 
Our findings suggest that the possible risk of vCJD linked to endoscopic 
procedures might be currently underestimated. Human iatrogenic vCJD cases 
infected intravenously raise the same public-health concerns as primary cases 
and need the same precautionary measures with respect to blood and tissue 
donations and surgical procedures. 
 
We noted that PrPres was present in lymphoreticular tissues such as spleen 
and tonsils and in the entire gut from the duodenum to the rectum. 
 
 
 
FDA Says Endoscope Makers Failed to Report Superbug Problems OLYMPUS... 
Prions, iatrogenic, what if?
 
Monday, August 17, 2015 
 
FDA Says Endoscope Makers Failed to Report Superbug Problems OLYMPUS 
 
 
 I told Olympus 15 years ago about these risk factors from endoscopy 
equipment, disinfection, even spoke with the Doctor at Olympus, this was back in 
1999. I tried to tell them that they were exposing patients to dangerous 
pathogens such as the CJD TSE prion, because they could not properly clean them. 
even presented my concern to a peer review journal GUT, that was going to 
publish, but then it was pulled by Professor Michael Farthing et al... see ; 
 
 some old history on Endoscopy equipment and CJD TSE Prion concerns ; 
 
 1999 
 
 Subject: CJD * Olympus Endoscope 
 
 Date: Sun, 10 Oct 1999 16:41:49 –0500 
 
 From: "Terry S. Singeltary Sr." 
 
 To: GOLDSS@... 
 
 Dear Dr. Goldstine, 
 
 Hello Sir, I understand that Olympus has issued a letter to the medical 
institutions and the CDC, about the dangers of _not_ being able to decontaminate 
the instruments (endoscope's) via modern autoclaving techniques (boil 3 minutes 
in 3% SDS or another ionic detergent and autoclave for 1 hour at 134 degrees C). 
I understand that; "Olympus" has issued a warning, _not_ to attempt to 
decontaminate the instrument, that they are instructed to destroy them. 
 
 (very very wise move); 
 
 Please Sir, it is imminent that I receive a copy of this letter, it is 
very important. This could lead to other company's following through, and lead 
to awareness of the potential health threats from human T.S.E.'s and the risks 
through surgery, and not just from endoscopes. It would be most appreciated, if 
you could send a copy of this document to; 
 
 Fax: xxxxx 
 
 I look forward, to hearing back from you.... 
 
 Many Thanks, 
 
 Terry S. Singeltary Sr./ Mom DOD 12-14-97 hvCJD 
 
 Subject: Re: CJD * Olympus Endoscope 
 
 Date: Tue, 12 Oct 1999 15:57:03 –0500 
 
 From: "Terry S. Singeltary Sr." 
 
 To: GOLDSS@... 
 
 References: 1 
 
 Dear Mr. Goldstine, Hello again, I hope the CDC has not changed your mind, 
since our phone call, about sending me the information, in which we spoke of. I 
am still waiting for the information, re-fax. Someone had told me, you would not 
send me the information, but I told them you would, due to the importance of it 
pertaining to public safety, and the fact, you are a Doctor. I hope you don't 
disappoint me, and the rest of the public, and hide the facts, as the CDC and 
NIH have for years. Olympus can be part of the Truth, or you can be part of the 
cover-up. We are going to find out, sooner or later. 
 
 I already know, as do many more. 
 
 
 Still waiting, 
 
 Kind Regards, 
 
 Terry S. Singeltary Sr. 
 
 "Terry S. Singeltary Sr." wrote: 
 
 Dear Dr. Goldstine, 
 
 Hello Sir, I understand that Olympus has issued a letter to the medical 
institutions and the CDC, about the dangers of _not_ being able to decontaminate 
the instruments (endoscope's) via modern autoclaving techniques (boil 3 minutes 
in 3% SDS or another ionic detergent and autoclave for 1 hour at 134 degrees C). 
I understand that; "Olympus" has issued a warning, _not_ to attempt to 
decontaminate the instrument, that they are instructed to destroy them. 
 
 (very very wise move); 
 
 Please Sir, it is imminent that I receive a copy of this letter, it is 
very important. This could lead to other company's following through, and lead 
to awareness of the potential health threats from human T.S.E.'s and the risks 
through surgery, and not just from endoscopes. It would be most appreciated, if 
you could send a copy of this document to; 
 
 Fax: xxxxxxx 
 
 I look forward, to hearing back from you.... 
 
 Many Thanks, 
 
 Terry S. Singeltary Sr./ Mom DOD 12-14-97 hvCJD 
 
 ================================================================= 
 
 Something I submitted to GUT previously; 
 
 Subject: Re: gutjnl_el;21 Terry S. Singeltary Sr. (3 Jun 2002) "CJDs (all 
human TSEs) and Endoscopy Equipment" 
 
 Date: Thu, 20 Jun 2002 16:19:51 –0700 
 
 From: "Terry S. Singeltary Sr." 
 
 To: Professor Michael Farthing 
 
 CC: lcamp@BMJgroup.com 
 
 References: 001501c21099$5c8bc620$7c58d182@mfacdean1.cent.gla.ac.uk 
 
 Greetings again Professor Farthing and BMJ, 
 
 I was curious why my small rebuttal of the article described below was not 
listed in this month's journal of GUT? I had thought it was going to be 
published, but I do not have full text access. Will it be published in the 
future? Regardless, I thought would pass on a more lengthy rebuttal of mine on 
this topic, vCJD vs sCJDs and endoscopy equipment. I don't expect it to be 
published, but thought you might find it interesting, i hope you don't mind and 
hope to hear back from someone on the questions I posed... 
 
 Here is my short submission I speak of, lengthy one to follow below that: 
 
 Date submitted: 3 Jun 2002 
 
 >> eLetter ID: gutjnl_el;21 
 
 >> >> Gut eLetter for Bramble and Ironside 50 (6): 888 
 
 >> >>Name: Terry S. Singeltary Sr. 
 
 >>Email: flounder@wt.net 
 
 >>Title/position: disabled {neck injury} 
 
 >>Place of work: CJD WATCH 
 
 >>IP address: 216.119.162.85 
 
 >>Hostname: 216-119-162-85.ipset44.wt.net 
 
 >>Browser: Mozilla/5.0 (Windows; U; Win98; en-US; rv:0.9.4) 
 
 >>Gecko/20011019 Netscape6/6.2 
 
 >> >>Parent ID: 50/6/888 
 
 >>Citation: 
 
 >> Creutzfeldt-Jakob disease: implications for gastroenterology 
 
 >> M G Bramble and J W Ironside 
 
 >> Gut 2002; 50: 888-890 (Occasional viewpoint) 
 
 
 
 >>----------------------------------------------------------------- 
 
 >>"CJDs (all human TSEs) and Endoscopy Equipment" 
 
 >>----------------------------------------------------------------- 
 
 regarding your article; 
 
 Creutzfeldt-Jakob disease: implications for gastroenterology 
 
 >>I belong to several support groups for victims and relatives 
 
 >>of CJDs. Several years ago, I did a survey regarding 
 
 >>endoscopy equipment and how many victims of CJDs have 
 
 >>had any type of this procedure done. To my surprise, many 
 
 >>victims had some kind of endoscopy work done on them. 
 
 >>As this may not be a smoking gun, I think it should 
 
 >>warrant a 'red flag' of sorts, especially since data now 
 
 >>suggests a substantial TSE infectivity in the gut wall 
 
 >>of species infected with TSEs. If such transmissions 
 
 >>occur, the ramifications of spreading TSEs from 
 
 >>endoscopy equipment to the general public would be 
 
 >>horrible, and could potential amplify the transmission 
 
 >>of TSEs through other surgical procedures in that 
 
 >>persons life, due to long incubation and sub-clinical 
 
 >>infection. Science to date, has well established 
 
 >>transmission of sporadic CJDs with medical/surgical 
 
 >>procedures. 
 
 Terry S. Singeltary Sr. >>CJD WATCH 
 
 Again, many thanks, Kindest regards, 
 
 Terry S. Singeltary Sr. P.O. Box 42 Bacliff, Texas USA 77518 
flounder@wt.net CJD WATCH 
 
 [scroll down past article for my comments] 
 
 snip... 
 
 were not all CJDs, even nvCJD, just sporadic, until proven otherwise? 
 
 Terry S. Singeltary Sr., P.O. BOX 42, Bacliff, Texas 77518 USA 
 
 
 Professor Michael Farthing wrote: Louise Send this to Bramble (author) for 
a comment before we post. Michael 
 
 ======================================================= 
 
 snip... see full text ; 
 
 2003 
 
 Evidence For CJD TSE Transmission Via Endoscopes 1-24-3 re-Singeltary to 
Bramble et al 
 
 Evidence For CJD/TSE Transmission Via Endoscopes 
 
 From Terry S. Singletary, Sr flounder@wt.net 1-24-3 
 
 
 Monday, December 26, 2011 
 
 Prion Uptake in the Gut: Identification of the First Uptake and 
Replication Sites 
 
 
 Friday, August 10, 2012 
 
 Incidents of Potential iatrogenic Creutzfeldt-Jakob disease (CJD) biannual 
update (July 2012) 
 
 
 SNIP... 
 
 see more history here ; 
 
 OLYMPUS ENDOSCOPY CJD 
 
 
 
 Tuesday, May 26, 2015 
 
 Minimise transmission risk of CJD and vCJD in healthcare settings 
 
 Last updated 15 May 2015 
 
 
 Saturday, February 21, 2015 
 
 Design of Endoscopic Retrograde Cholangiopancreatography (ERCP) 
Duodenoscopes May Impede Effective Cleaning: FDA Safety Communication 
 
 
 
Thursday, September 10, 2015 
 
*** 25th Meeting of the Transmissible Spongiform Encephalopathies Advisory 
Committee Food and Drug Administration Silver Spring, Maryland June 1, 2015 
 
 
Congress is all set to give NIH it's largest increase in 12 years. 
 
Included in the bill: $350 million increase for Alzheimer’s research and an 
$85 million increase for the BRAIN Initiative, the project to map the human 
brain. 
 
 
great news, with not a minute to spare... 
 
Evidence for human transmission of amyloid-β pathology and cerebral amyloid 
angiopathy 
 
 
07 02:27 AM 
 
Terry S. Singeltary Sr. said: 
 
re-Evidence for human transmission of amyloid-? pathology and cerebral 
amyloid angiopathy 
 
Nature 525, 247?250 (10 September 2015) doi:10.1038/nature15369 Received 26 
April 2015 Accepted 14 August 2015 Published online 09 September 2015 Updated 
online 11 September 2015 Erratum (October, 2015) 
 
 
I would kindly like to comment on the Nature Paper, the Lancet reply, and 
the newspaper articles.
 
snip...
 
see Singeltary full text ; 
 
 
Subject: 1992 IN CONFIDENCE TRANSMISSION OF ALZHEIMER TYPE PLAQUES TO 
PRIMATES POSSIBILITY ON A TRANSMISSIBLE PRION REMAINS OPEN 
 
BSE101/1 0136 
 
IN CONFIDENCE 
 
CMO 
 
From: . Dr J S Metiers DCMO 
 
4 November 1992 
 
TRANSMISSION OF ALZHEIMER TYPE PLAQUES TO PRIMATES 
 
1. Thank you for showing me Diana Dunstan's letter. I am glad that MRC have 
recognised the public sensitivity of these findings and intend to report them in 
their proper context. 'This hopefully will avoid misunderstanding and possible 
distortion by the media to portray the results as having more greater 
significance than the findings so far justify. 
 
2. Using a highly unusual route of transmission (intra-cerebral injection) 
the researchers have demonstrated the transmission of a pathological process 
from two cases one of severe Alzheimer's disease the other of 
Gerstmann-Straussler disease to marmosets. However they have not demonstrated 
the transmission of either clinical condition as the "animals were behaving 
normally when killed". As the report emphasises the unanswered question is 
whether the disease condition would have revealed itself if the marmosets had 
lived longer. They are planning further research to see if the conditions, as 
opposed to the partial pathological process, is transmissible. 
 
what are the implications for public health? 
 
3. The route 'of transmission is very specific and in the natural state of 
things highly unusual. However it could be argued that the results reveal a 
potential risk, in that brain tissue from these two patients has been shown to 
transmit a pathological process. Should therefore brain tissue from such cases 
be regarded as potentially infective? Pathologists, morticians, neuro surgeons 
and those assisting at neuro surgical procedures and others coming into contact 
with "raw" human brain tissue could in theory be at risk. However, on a priori 
grounds given the highly specific route of transmission in these experiments 
that risk must be negligible if the usual precautions for handling brain tissue 
are observed. 
 
1 
 
92/11.4/1.1 
 
BSE101/1 0137 
 
4. The other dimension to consider is the public reaction. To some extent 
the GSS case demonstrates little more than the transmission of BSE to a pig by 
intra-cerebral injection. If other prion diseases can be transmitted in this way 
it is little surprise that some pathological findings observed in GSS were also 
transmissible to a marmoset. But the transmission of features of Alzheimer's 
pathology is a different matter, given the much greater frequency of this 
disease and raises the unanswered question whether some cases are the result of 
a transmissible prion. The only tenable public line will be that "more research 
is required’’ before that hypothesis could be evaluated. The possibility on a 
transmissible prion remains open. In the meantime MRC needs carefully to 
consider the range and sequence of studies needed to follow through from the 
preliminary observations in these two cases. Not a particularly comfortable 
message, but until we know more about the causation of Alzheimer's disease the 
total reassurance is not practical. 
 
J S METTERS Room 509 Richmond House Pager No: 081-884 3344 Callsign: DOH 
832 llllYc!eS 2 92/11.4/1.2 
 
 
>>> The only tenable public line will be that "more research is 
required’’ <<<
 
>>> possibility on a transmissible prion remains 
open<<<
 
O.K., so it’s about 23 years later, so somebody please tell me, when is 
"more research is required’’ enough time for evaluation ?
 
Self-Propagative Replication of Ab Oligomers Suggests Potential 
Transmissibility in Alzheimer Disease
 
Received July 24, 2014; Accepted September 16, 2014; Published November 3, 
2014
 
 
*** Singeltary comment PLoS ***
 
Alzheimer’s disease and Transmissible Spongiform Encephalopathy prion 
disease, Iatrogenic, what if ? 
 
Posted by flounder on 05 Nov 2014 at 21:27 GMT
 
 
again, sporadic and familial is a red herring, in my opinion. 
 
also, in my opinion, when you start have disease such as sporadic Fatal 
Familial Insomnia, (and or sporadic GSS, or the VPSPr type prion disease), and 
there is NO familial genetic linkage to the family of the diseased, I have 
serious questions there as to a familial type disease, and thus, being defined 
as such. 
 
*UPDATE* NOVEMBER 16, 2014 
 
vpspr, sgss, sffi, TSE, an iatrogenic by-product of gss, ffi, familial type 
prion disease, what it ??? 
 
Friday, January 10, 2014 
 
Greetings again Friends, Neighbors, and Colleagues, 
 
snip...see ; 
 
 
Friday, October 09, 2015 
 
*** An alarming presentation level II trauma center of Creutzfeldt-Jakob 
disease following a self-inflicted gunshot wound to the head 
 
 
Saturday, December 12, 2015 
 
CREUTZFELDT JAKOB DISEASE CJD TSE PRION REPORT DECEMBER 14, 2015
 
 
Thursday, December 24, 2015 
 
Revisiting the Heidenhain Variant of Creutzfeldt-Jakob Disease: Evidence 
for Prion Type Variability Influencing Clinical Course and Laboratory Findings 
 
Article type: Research Article
 
 
Wednesday, January 06, 2016 
 
CREUTZFELDT JAKOB DISEASE SURVEILLANCE IN THE U.K. 23rd ANNUAL REPORT 2014 
(published 18th November 2015) 
 
 
Diagnosis and Reporting of Creutzfeldt-Jakob Disease 
 
Singeltary, Sr et al. JAMA.2001; 285: 733-734. Vol. 285 No. 6, February 14, 
2001 JAMA 
 
Diagnosis and Reporting of Creutzfeldt-Jakob Disease 
 
To the Editor: In their Research Letter, Dr Gibbons and colleagues1 
reported that the annual US death rate due to Creutzfeldt-Jakob disease (CJD) 
has been stable since 1985. These estimates, however, are based only on reported 
cases, and do not include misdiagnosed or preclinical cases. It seems to me that 
misdiagnosis alone would drastically change these figures. An unknown number of 
persons with a diagnosis of Alzheimer disease in fact may have CJD, although 
only a small number of these patients receive the postmortem examination 
necessary to make this diagnosis. Furthermore, only a few states have made CJD 
reportable. Human and animal transmissible spongiform encephalopathies should be 
reportable nationwide and internationally. 
 
Terry S. Singeltary, Sr Bacliff, Tex 
 
1. Gibbons RV, Holman RC, Belay ED, Schonberger LB. Creutzfeldt-Jakob 
disease in the United States: 1979-1998. JAMA. 2000;284:2322-2323. 
 
 
26 March 2003 
 
Terry S. Singeltary, retired (medically) CJD WATCH 
 
I lost my mother to hvCJD (Heidenhain Variant CJD). I would like to comment 
on the CDC's attempts to monitor the occurrence of emerging forms of CJD. 
Asante, Collinge et al [1] have reported that BSE transmission to the 
129-methionine genotype can lead to an alternate phenotype that is 
indistinguishable from type 2 PrPSc, the commonest sporadic CJD. However, CJD 
and all human TSEs are not reportable nationally. CJD and all human TSEs must be 
made reportable in every state and internationally. I hope that the CDC does not 
continue to expect us to still believe that the 85%+ of all CJD cases which are 
sporadic are all spontaneous, without route/source. We have many TSEs in the USA 
in both animal and man. CWD in deer/elk is spreading rapidly and CWD does 
transmit to mink, ferret, cattle, and squirrel monkey by intracerebral 
inoculation. With the known incubation periods in other TSEs, oral transmission 
studies of CWD may take much longer. Every victim/family of CJD/TSEs should be 
asked about route and source of this agent. To prolong this will only spread the 
agent and needlessly expose others. In light of the findings of Asante and 
Collinge et al, there should be drastic measures to safeguard the medical and 
surgical arena from sporadic CJDs and all human TSEs. I only ponder how many 
sporadic CJDs in the USA are type 2 PrPSc? 
 
 
 2 January 2000 
 
 British Medical Journal 
 
 U.S. Scientist should be concerned with a CJD epidemic in the U.S., as 
well 
 
 
 15 November 1999 
 
 British Medical Journal 
 
 vCJD in the USA * BSE in U.S. 
 
 
Saturday, December 12, 2015 
 
CHRONIC WASTING DISEASE CWD TSE PRION REPORT DECEMBER 14, 2015 
 
 
========================================== 
 
***our findings suggest that possible transmission risk of H-type BSE to 
sheep and human. Bioassay will be required to determine whether the PMCA 
products are infectious to these animals. 
 
========================================== 
 
PRION 2015 CONFERENCE FT. COLLINS CWD RISK FACTORS TO HUMANS 
 
*** LATE-BREAKING ABSTRACTS PRION 2015 CONFERENCE *** 
 
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 
 
*** 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.*** 
 
================== 
 
P.105: RT-QuIC models trans-species prion transmission 
 
Kristen Davenport, Davin Henderson, Candace Mathiason, and Edward Hoover 
Prion Research Center; Colorado State University; Fort Collins, CO USA 
 
Conversely, FSE maintained sufficient BSE characteristics to more 
efficiently convert bovine rPrP than feline rPrP. Additionally, human rPrP was 
competent for conversion by CWD and fCWD. 
 
***This insinuates that, at the level of protein:protein interactions, the 
barrier preventing transmission of CWD to humans is less robust than previously 
estimated. 
 
================ 
 
***This insinuates that, at the level of protein:protein interactions, the 
barrier preventing transmission of CWD to humans is less robust than previously 
estimated.*** 
 
================ 
 
 
THE EPIDEMIOLOGY OF CREUTZFELDT-JAKOB DISEASE 
 
R. G. WILL 
 
1984 
 
*** 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). (SEE LINK IN REPORT HERE...TSS) PLUS, THE CDC DID NOT PUT 
THIS WARNING OUT FOR THE WELL BEING OF THE DEER AND ELK ; 
 
snip... 
 
 
*** These results would seem to suggest that CWD does indeed have zoonotic 
potential, at least as judged by the compatibility of CWD prions and their human 
PrPC target. Furthermore, extrapolation from this simple in vitro assay suggests 
that if zoonotic CWD occurred, it would most likely effect those of the PRNP 
codon 129-MM genotype and that the PrPres type would be similar to that found in 
the most common subtype of sCJD (MM1).*** 
 
 
*** 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. 
 
 
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 
 
=============== 
 
 
Research Project: TRANSMISSION, DIFFERENTIATION, AND PATHOBIOLOGY OF 
TRANSMISSIBLE SPONGIFORM ENCEPHALOPATHIES 
 
Title: Transmission of scrapie prions to primate after an extended silent 
incubation period 
 
Authors 
 
item Comoy, Emmanuel - item Mikol, Jacqueline - item Luccantoni-Freire, 
Sophie - item Correia, Evelyne - item Lescoutra-Etchegaray, Nathalie - item 
Durand, Valérie - item Dehen, Capucine - item Andreoletti, Olivier - item 
Casalone, Cristina - item Richt, Juergen item Greenlee, Justin item Baron, 
Thierry - item Benestad, Sylvie - item Hills, Bob - item Brown, Paul - item 
Deslys, Jean-Philippe - 
 
Submitted to: Scientific Reports Publication Type: Peer Reviewed Journal 
Publication Acceptance Date: May 28, 2015 Publication Date: June 30, 2015 
Citation: Comoy, E.E., Mikol, J., Luccantoni-Freire, S., Correia, E., 
Lescoutra-Etchegaray, N., Durand, V., Dehen, C., Andreoletti, O., Casalone, C., 
Richt, J.A., Greenlee, J.J., Baron, T., Benestad, S., Brown, P., Deslys, J. 
2015. Transmission of scrapie prions to primate after an extended silent 
incubation period. Scientific Reports. 5:11573. 
 
Interpretive Summary: 
 
The transmissible spongiform encephalopathies (also called prion diseases) 
are fatal neurodegenerative diseases that affect animals and humans. The agent 
of prion diseases is a misfolded form of the prion protein that is resistant to 
breakdown by the host cells. Since all mammals express prion protein on the 
surface of various cells such as neurons, all mammals are, in theory, capable of 
replicating prion diseases. One example of a prion disease, bovine spongiform 
encephalopathy (BSE; also called mad cow disease), has been shown to infect 
cattle, sheep, exotic undulates, cats, non-human primates, and humans when the 
new host is exposed to feeds or foods contaminated with the disease agent. The 
purpose of this study was to test whether non-human primates (cynomologous 
macaque) are susceptible to the agent of sheep scrapie. After an incubation 
period of approximately 10 years a macaque developed progressive clinical signs 
suggestive of neurologic disease. Upon postmortem examination and microscopic 
examination of tissues, there was a widespread distribution of lesions 
consistent with a transmissible spongiform encephalopathy. This information will 
have a scientific impact since it is the first study that demonstrates the 
transmission of scrapie to a non-human primate with a close genetic relationship 
to humans. This information is especially useful to regulatory officials and 
those involved with risk assessment of the potential transmission of animal 
prion diseases to humans. 
 
Technical Abstract: 
 
Classical bovine spongiform encephalopathy (c-BSE) is an animal prion 
disease that also causes variant Creutzfeldt-Jakob disease in humans. Over the 
past decades, c-BSE's zoonotic potential has been the driving force in 
establishing extensive protective measures for animal and human health. In 
complement to the recent demonstration that humanized mice are susceptible to 
scrapie, we report here the first observation of direct transmission of a 
natural classical scrapie isolate to a macaque after a 10-year incubation 
period. Neuropathologic examination revealed all of the features of a prion 
disease: spongiform change, neuronal loss, and accumulation of PrPres throughout 
the CNS. 
 
***This observation strengthens the questioning of the harmlessness of 
scrapie to humans, at a time when protective measures for human and animal 
health are being dismantled and reduced as c-BSE is considered controlled and 
being eradicated. Our results underscore the importance of precautionary and 
protective measures and the necessity for long-term experimental transmission 
studies to assess the zoonotic potential of other animal prion strains. 
 
 
O35
 
J. Mikol1, S. Luccantoni-Freire1, E. Correia1, N. Lescoutra-Etchegaray1, V. 
Durand1, C. Dehen1, J.P. Deslys1, E. Comoy1
 
1Institute of Emerging Diseases and Innovative Therapies, Service of Prion 
Diseases, Atomic Energy Commission, 18 Route du Panorama 92265 Fontenayaux- 
Roses, France
 
E-mail: jacqueline.mikol@wanadoo.fr
 
Uncommon prion disease induced in macaque ten years after scrapie 
inoculation
 
Introduction: Bovine Spongiform Encephalopathy (BSE) is the single animal 
prion disease reputed to be zoonotic, inducing variant of Creutzfeldt-Jakob 
Disease (vCJD) in man, and therefore strongly conditioned the protective 
measures. Among different sources of animal prion diseases, we show here that 
after more than ten years of incubation, intracerebral injection of a sheep 
scrapie isolate can induce a prion disease in cynomolgus macaque, a relevant 
model of human situation towards several prion strains. Neuropathological 
studies showed classical and uncommon data.
 
Material and method: The cynomolgus macaque was intracerebrally exposed to 
a classical scrapie isolate issued from a naturally infected sheep flock. Upon 
onset of clinical signs, euthanasia was performed for ethical reasons. Classical 
methods of biochemistry and neuropathology were used.
 
Results: The three elements of the triad were present:
 
spongiosis was predominant in the cortex, the striatum, the cerebellum. 
Neuronal loss and gliosis were moderate. 
 
The notable data were the following 
 
(i) the brain was small, the atrophy involved mostly the temporal lobe in 
which axonal loss was histologically demonstrated
 
(ii) the spongiosis of the Purkinje cells was so intense that most of them 
were destroyed 
 
(iii) there was a neuronal loss and a massive gliosis of the dorsomedialis 
nucleus of the thalamus
 
(iv) iron deposits were present in the lenticular nucleus. PrPres heavily 
distributed in the cortex, the basal ganglia and the cerebellum consisted in 
synaptic deposits and aggregates. Western Blot exhibited a type 1 PrPres in all 
parts of the brain.
 
Conclusion: We described here the successful transmission of a scrapie 
prion disease to a non-human primate after an extended incubation period, 
leading to a fatal, non-relapsing neurological disease with all the features of 
a prion disease. The cerebral lesional profile we observed was original in 
comparison to other animal prion diseases (c-BSE, L-type BSE, TME) we previously 
experimentally transmitted in this model.
 
 
Tuesday, December 16, 2014 
 
Evidence for zoonotic potential of ovine scrapie prions 
 
Hervé Cassard,1, n1 Juan-Maria Torres,2, n1 Caroline Lacroux,1, Jean-Yves 
Douet,1, Sylvie L. Benestad,3, Frédéric Lantier,4, Séverine Lugan,1, Isabelle 
Lantier,4, Pierrette Costes,1, Naima Aron,1, Fabienne Reine,5, Laetitia 
Herzog,5, Juan-Carlos Espinosa,2, Vincent Beringue5, & Olivier Andréoletti1, 
Affiliations Contributions Corresponding author Journal name: Nature 
Communications Volume: 5, Article number: 5821 DOI: doi:10.1038/ncomms6821 
Received 07 August 2014 Accepted 10 November 2014 Published 16 December 2014 
Article tools Citation Reprints Rights & permissions Article metrics 
 
Abstract 
 
Although Bovine Spongiform Encephalopathy (BSE) is the cause of variant 
Creutzfeldt Jakob disease (vCJD) in humans, the zoonotic potential of scrapie 
prions remains unknown. Mice genetically engineered to overexpress the human 
prion protein (tgHu) have emerged as highly relevant models for gauging the 
capacity of prions to transmit to humans. These models can propagate human 
prions without any apparent transmission barrier and have been used used to 
confirm the zoonotic ability of BSE. Here we show that a panel of sheep scrapie 
prions transmit to several tgHu mice models with an efficiency comparable to 
that of cattle BSE. 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
 
 
why do we not want to do TSE transmission studies on chimpanzees $ 
 
5. A positive result from a chimpanzee challenged severly would likely 
create alarm in some circles even if the result could not be interpreted for 
man. I have a view that all these agents could be transmitted provided a large 
enough dose by appropriate routes was given and the animals kept long enough. 
Until the mechanisms of the species barrier are more clearly understood it might 
be best to retain that hypothesis. 
 
snip... 
 
R. BRADLEY 
 
 
***there goes the damn bacon too...tss
 
Saturday, January 9, 2016
 
Transmission of sheep-bovine spongiform encephalopathy to pigs 
 
Research article 
 
 
Sunday, October 18, 2015 
 
World Organisation for Animal Health (OIE) and the Institut Pasteur 
Cooperating on animal disease and zoonosis research 
 
 
Thursday, December 17, 2015 
 
Annual report of the Scientific Network on BSE-TSE 2015 EFSA-Q-2015-00738 
10 December 2015 
 
 
Saturday, December 12, 2015 
 
*** BOVINE SPONGIFORM ENCEPHALOPATHY BSE TSE PRION REPORT DECEMBER 14, 2015 
 
 
Friday, January 1, 2016 
 
South Korea Lifts Ban on Beef, Veal Imports From Canada
 
 
US CONGRESS, another failed entity...tss
 
Tuesday, December 29, 2015 
 
*** Congress repeals country-of-origin labeling rule for beef and pork 
 
 
December 28, 2015 at 2:21am 
 
*** Australian government assessing risk of importing beef from US, Japan 
and the Netherlands 
 
 
Thursday, December 24, 2015 
 
Infectious disease spread is fueled by international trade 
 
 
*** you can find some history of the BSE cases in Canada and Klein’s BSE 
SSS policy comment here ;
 
 
Monday, January 4, 2016 
 
Long live the OIE, or time to close the doors on a failed entity? 
 
 
sporadic cjd, 85%+ of all human TSE prion disease, sporadic simply meaning 
_unknown_ route, source, ... iatrogenic, what if ?
 
iatrogenic medical surgical tissue friendly fire mode of transmission i.e. 
second hand transmission. it’s real folks, just not documented much, due to lack 
of trace back efforts. all iatrogenic cjd is, is sporadic cjd, until the 
iatrogenic event is tracked down and documented, and put into the academic and 
public domain, which very seldom happens. ...