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Journal of Virology, November 2001, p. 10106-10112, Vol. 75, No. 21
0022-538X/01/$04.00+0 DOI: 10.1128/JVI.75.21.10106-10112.2001
Long-Term Subclinical Carrier State Precedes Scrapie Replication
and Adaptation in a Resistant Species: Analogies to Bovine Spongiform
Encephalopathy and Variant Creutzfeldt-Jakob Disease in
Humans
Richard
Race,
Anne
Raines,
Gregory J.
Raymond,
Byron
Caughey, and
Bruce
Chesebro*
Laboratory of Persistent Viral Diseases,
Rocky Mountain Laboratories, Hamilton, Montana 59840
Received 24 May 2001/Accepted 31 July 2001
 |
ABSTRACT |
Cattle infected with bovine spongiform encephalopathy (BSE) appear
to be a reservoir for transmission of variant Creutzfeldt-Jakob disease
(vCJD) to humans. Although just over 100 people have developed clinical
vCJD, millions have probably been exposed to the infectivity by
consumption of BSE-infected beef. It is currently not known whether
some of these individuals will develop disease themselves or act as
asymptomatic carriers of infectivity which might infect others in the
future. We have studied agent persistence and adaptation after
cross-species infection using a model of mice inoculated with hamster
scrapie strain 263K. Although mice inoculated with hamster scrapie do
not develop clinical disease after inoculation with 10 million hamster
infectious doses, hamster scrapie infectivity persists in brain and
spleen for the life span of the mice. In the present study, we were
surprised to find a 1-year period postinfection with hamster scrapie
where there was no evidence for replication of infectivity in mouse
brain. In contrast, this period of inactive persistence was followed by
a period of active replication of infectivity as well as adaptation of
new strains of agent capable of causing disease in mice. In most mice,
neither the early persistent phase nor the later replicative phase
could be detected by immunoblot assay for protease-resistant prion
protein (PrP). If similar asymptomatic carriers of infection arise
after exposure of humans or animals to BSE, this could markedly
increase the danger of additional spread of BSE or vCJD infection by
contaminated blood, surgical instruments, or meat. If such subclinical
carriers were negative for protease-resistant PrP, similar to our mice,
then the recently proposed screening of brain, tonsils, or other
tissues of animals and humans by present methods such as immunoblotting
or immunohistochemistry might be too insensitive to identify these individuals.
 |
INTRODUCTION |
Recent transmission of bovine
spongiform encephalopathy (BSE) to humans in Great Britain greatly
heightened concern among scientists and the public about the risk posed
by transmissible spongiform encephalopathies (TSE). In addition to
direct induction of clinical disease, cross-species TSE infection may
in some cases result in a subclinical carrier infection. Infectious
agent present in such a carrier state might eventually adapt to a more
virulent form. The possibility that this scenario could occur in humans exposed to BSE has led to great concern about contamination of the
blood supply and surgical instruments. The situation is complicated by
the possibility that BSE has spread to sheep in Europe
(12). There is no epidemiologic evidence for the
transmission of sheep scrapie to humans, but nothing is known about the
potential risk that sheep-derived BSE may present to humans or other
species. Similarly, in the United States the risk posed by chronic
wasting disease (CWD) of elk and deer to humans, wildlife, and
livestock is not clear (21). In spite of the lack of
evidence for natural spread of CWD to cattle or humans, the possibility
that there might be infected asymptomatic carriers in animal or human
populations remains a subject of increasing concern.
Cross-species transmission of TSE infectivity leading to clinical
disease has been observed in a variety of animal species. Usually, the
incubation period is lengthened in the first few passages but
eventually stabilizes to a predictable value in the new host. Absence
of cross-species transmission to host species which are not globally
resistant to all TSE agents has been observed in only a few situations.
These include BSE infection of hamsters (10), CWD
infection of hamsters (2), transmissible mink
encephalopathy infection of mice (22), and hamster scrapie
strain 263K infection of mice (15). In these experiments,
absence of transmission was usually based on the lack of clinical
disease within the life span of the recipient, although in some cases a
lack of typical central nervous system pathological changes was also
documented. Only in the hamster 263K-mouse model was infectivity
directly assayed by inoculation back into hamsters to search for the
existence of asymptomatic carrier mice. Some carrier mice were in fact
detected in the first passage but not in the second or third mouse
passages, leading to the conclusion that 263K infectivity detected in
the first-passage mice was merely the original inoculum and that
replication had not occurred (17). In our previous
experiments, we found that hamster 263K scrapie persisted in mouse
brain and spleen for up to 2 years without causing clinical disease
(18). This persistence required the expression of the
mouse prion protein (PrP) gene and implied that the foreign scrapie
agent might have replicated, since PrP was required and is a known
susceptibility factor for scrapie replication. This possibility was
also supported by recent experiments analyzing infectivity from mice
infected with 263K hamster scrapie (11). In this earlier
work, infectivity in two scrapie-inoculated mice was analyzed, and one
mouse showed a significant increase in titer consistent with
replication. In the present experiments, we analyzed infectivity and
protease-resistant PrP (PrP-res) in 23 mice with asymptomatic carrier
infections at various times following infection with 263K hamster
scrapie in order to define precisely the kinetics of replication which might occur after cross-species infection. The results indicated that
the original hamster scrapie agent persisted without detectable replication for over 1 year. However, during the second year
significant replication of hamster agent as well as adaptation to a
form virulent for mice was observed.
 |
MATERIALS AND METHODS |
Scrapie inoculations.
Primary C57BL/10 weanling mice were
inoculated intracerebrally with 50 µl of a 1% hamster brain
suspension containing 107 50% infective doses of
hamster scrapie strain 263K. Clinical disease refers to signs of
clinical scrapie including somnolence, kyphosis, tremors, stilted gait,
and ataxia. Mice with these signs usually progressed to a moribund
status within 2 weeks. Incubation period was the time from inoculation
until development of obvious clinical disease. Secondary- and
tertiary-passage mice and hamsters were inoculated intracerebrally with
50 µl of a 1% brain suspension from primary or secondary mice
sacrificed at the indicated number of days postinoculation.
Immunoblot detection of PrP.
As described previously
(20), hamster PrP-res was detected by immunoblotting using
a hamster PrP-reactive monoclonal antibody (3F4) (14),
which does not react with mouse PrP. Mouse PrP-res was detected by
immunoblotting in samples negative for hamster PrP-res using a rabbit
anti-PrP peptide serum (R30) (19).
 |
RESULTS |
Analysis of brain PrP-res after cross-species infection.
At
several times after inoculation of mice with hamster scrapie strain
263K, mice were killed, and their brains were analyzed for the presence
of PrP-res (20). First, we tested for hamster PrP-res
using monoclonal antibody 3F4, which reacts with hamster PrP but not
with mouse PrP (14). Hamster PrP-res was detected by
immunoblotting in brains of mice at 2 h after infection but not
thereafter, suggesting that this material was derived from the inoculum
(Table 1). The brains that were negative
for hamster PrP-res were then tested for mouse PrP-res using a
polyclonal anti-PrP peptide serum (R30), capable of reacting with both
mouse and hamster PrP (19). In the first passage, mouse
PrP-res was not detected until 310 days postinoculation (dpi).
Between 310 and 782 dpi, brain homogenates from 13 out of 36 first-passage mice were positive (Table 1). Because of its appearance
so late (310 days) after scrapie inoculation, this newly generated
mouse PrP-res should not have been derived from the original hamster inoculum. Instead, this result suggested that the inoculated agent had
replicated in these mice. There was never evidence of clinical signs of
scrapie in these first-passage mice; however, this may have been
because the amount of mouse PrP-res detected in these mice was 4- to
100-fold lower than the amount usually associated with clinical disease
in mice infected with Chandler/RML scrapie agent.
Detection of scrapie infectivity for hamsters.
Because of the
association between PrP-res and infectivity, mice expressing detectable
PrP-res were likely to have high amounts of infectivity. However, we
were interested to determine whether propagation of infectivity also
occurred in asymptomatic PrP-res-negative mice. Such carrier mice would
be detectable only by infectivity transmission experiments and would be
a model for a possible situation which could develop after
cross-species infection with BSE-contaminated feeds. Accordingly, brain
suspensions prepared from PrP-res-negative first-passage mice
sacrificed at various days postinoculation were inoculated into
hamsters. All samples produced typical scrapie when inoculated into
hamsters (Fig. 1a);
however, the amount of infectivity varied greatly. For example, based
on a 100% incidence of positive recipients and a short incubation
period, high levels of infectivity were detected in mice sacrificed at
0.1 and 5 dpi. By 20 dpi, there was a marked broadening in the range of
incubation periods (140 to 390 days), indicating a lower titer of
infectivity. From 60 to 240 dpi, infectivity levels were very low as
demonstrated by lower than 100% incidence of clinical disease in
recipient hamsters. These results appear to be consistent with a
partial eclipse phase seen in many viral infections. However, at
subsequent times from 463 to 782 dpi all recipient hamsters became ill,
and the range of incubation periods was lowered to 120 to 230 days, suggesting that infectivity titers were now higher. Furthermore, when
homogenates from 574- and 693-dpi donors were diluted an additional
10-fold, there was no significant broadening of the incubation periods
in hamsters, and still all recipients became ill. These results
indicated that a greater-than-100-fold increase in the level of
hamster-tropic infectivity occurred in the second year of this first
passage into mice.

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FIG. 1.
(a) Incubation period analysis in hamsters of first
mouse passage of hamster scrapie strain 263K. At various times after
scrapie inoculation, two mice ( and ) were sacrificed at each
time point except 782 dpi, at which only one mouse was sacrificed.
Eight to 12 secondary hamsters were inoculated intracerebrally with 50 µl of a 1% brain suspension from each donor mouse. Homogenates from
donors at 574 and 693 dpi were also diluted 10-fold before inoculation
of additional hamsters ( and ). (b) Incubation period analysis in
hamsters of original hamster scrapie strain 263K. Hamsters were
inoculated intracerebrally with 50 µl of serial 10-fold dilutions of
a pooled brain suspension from hamsters inoculated with hamster scrapie
strain 263K. Data from four independent titrations ( , , , and
) are shown for comparison. Note the narrow range of incubation
periods observed for all dilutions until the point at which less than
100% of animals were clinically infected. ID50, 50%
infective dose.
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|
The rather broad range of incubation periods seen for both dilutions of
the homogenates from 574- and 693-dpi donors contrasted
markedly with
what was observed in hamsters inoculated with the
original strain 263K,
where incubation periods remained tightly
grouped except for the high
dilutions which killed less than 100%
of the animals (Fig.
1b). These
differences suggested that the
scrapie infectivity derived from some of
the first-passage mice
was no longer identical to that of the original
hamster scrapie
strain
263K.
Detection of infectivity by passage in mice.
Brain suspensions
from some of the PrP-res-negative first-passage mice were also
inoculated into mice to test for the presence of mouse-adapted
infectivity. In contrast to the high incidence of clinical disease seen
when hamsters were inoculated with these first-passage extracts (Fig.
1a), clinical disease was not induced in mice by any extract except
that from the 782-dpi donor (Table 2).
Interestingly, this extract also caused disease in hamsters with a
brief incubation period, similar to 263K (Fig. 1a), suggesting that it
might contain a mixture of 263K and mouse-adapted scrapie strains.
The second-passage mice were also monitored for the generation of
PrP-res. Brain extracts from PrP-res-negative primary mice
sacrificed
at 130 dpi were not able to induce generation of PrP-res
in the 650- to
750-day observation period (Table
2). In contrast,
brains from
PrP-res-negative primary mice sacrificed at later
times (463 to 693 dpi) were able to induce detectable mouse PrP-res
in 20 out of 36 recipients (Table
2). This indicated that a subclinical
PrP-res-negative scrapie infection in these first-passage mice
had been
transferred to some second-passage mice. Therefore, only
at these late
times postinoculation were both replication of hamster
scrapie
infectivity and adaptation of the infectivity to mice
detectable in
these asymptomatic first-passage mice. Mice which
received brain from
the 782-dpi PrP-res-positive first-passage
donor developed both brain
PrP-res and clinical disease consistent
with scrapie (Table
2). The
recipients of this inoculum died
at 457 ± 15 days, compared to
hamsters receiving the same inoculum,
which died between 122 and 134 days (Fig.
1a).
In order to analyze the further evolution of mouse and hamster scrapie
infectivity in these experiments, at 650 to 750 dpi
eight of the
second-passage mice were sacrificed and brain homogenates
were analyzed
for infectivity by inoculation of both mice and
hamsters. At present,
these experiments have been monitored for
over 400 days. No infectivity
was detected in second-passage donors
1 and 2 derived from
first-passage mice sacrificed at 130 days
(Table
3). Thus, at 130 dpi in the first passage
the infectivity
present was capable of transmission to hamsters (Fig.
1a) but
not to mice (Tables
2 and
3). Infectivity from three of the
second-passage donors maintained the ability to cause disease
in 100%
of hamsters (donors 1 and 2 from 574 dpi and donor 1 from
782 dpi,
Table
3), and for two of these donors, 574-2 and 782-1,
the infectivity
was also 100% lethal for mice (Table
3). In these
donors, it was
unclear whether there was a single new strain with
dual tropism or
whether separate strains infectious for mice or
hamsters had coevolved.
In contrast to these results, the infectivity
in brain homogenate from
donor 1 from 693 dpi was poorly infectious
for hamsters and appeared to
have adapted nearly completely to
mice (incubation period of 183 ± 22 days) (Table
3). Material
from two of these third-passage mice
was passaged a fourth time
in mice and gave incubation periods of
118 ± 3 and 120 ± 3 days
and no detectable disease in
hamsters (data not shown), suggesting
continuing adaptation of this
strain toward virulence for mice.
Sizing and ratios of PrP-res glycoforms on gels have previously been
observed to be a possible distinguishing feature of scrapie
strains
(
4,
9,
13). To search for possible changes in
PrP
glycoforms, we analyzed PrP-res from first-, second-, and
third-passage
mice derived from the 574-, 693-, and 782-dpi donors
described in Table
3. The banding pattern of PrP-res from the
mice was variable and could
usually be distinguished from that
seen in 263K-infected hamsters and
in Chandler/RML-infected mice
(Fig.
2a).
When specimens from groups of third-passage mice were
quantitated by
PhosphorImager, the percentage of PrP-res in the
bands from the 693-1 donor was significantly different from those
in both the 574-2 and
782-1 donors (Fig.
2b), lending possible
support to the conclusion that
new strains had evolved in these
passages.

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FIG. 2.
(a) Immunoblot detection of PrP-res in mouse brain after
one, two, or three mouse passages of hamster scrapie from the original
574-, 693-, and 782-dpi mice. First-passage lanes contain 15-mg
equivalents of brain, second-passage lanes contain 5-mg equivalents,
and third-passage lanes contain 1-mg equivalents. Lane 10 (Ha) contains
a 1-mg equivalent of brain from a Syrian hamster with clinical scrapie
induced by hamster strain 263K, and lane 11 (Mo) contains a 1-mg
equivalent of brain from a mouse with clinical scrapie induced by the
Chandler/RML strain. (b) Glycoform ratios of PrP-res from third-passage
recipient mice. The means and standard errors of the percentages of
PrP-res found in the upper (diglycosylated) ( ), middle
(monoglycosylated) ( ), and lower (unglycosylated) ( ) bands from
multiple (n = 5 or 6) third-passage mice inoculated
with homogenates from second-passage donors 574-2, 693-1, and 782-1 are
shown. The values for the upper and lower bands for donor 693-1 differed significantly by the Mann-Whitney U test
(P < 0.001) from the corresponding values for the
other two donors. Hamsters inoculated with strain 263K and mice
inoculated with the Chandler/RML scrapie isolate are shown for
comparison. Note that for Chandler/RML scrapie the middle band is the
most abundant, and this distinguished it from all the others tested.
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Histopathological analysis was also done on several of the
third-passage mice to search for possible alterations in the regional
distribution of pathology or PrP-res, which has previously been
associated with scrapie strain differences (
6). Mice
studied
were recipients of homogenates from the second passage of
donors
574-2, 693-1, and 782-1 described in Table
3. All mice showed
similar pathological changes with extensive spongiosis and astrogliosis
in the brain stem, posterior colliculus, and thalamus, whereas
there
was less pathology in the hippocampus, cerebral cortex,
and cerebellar
cortex. In the recipients of the homogenate from
the 693-1 donor,
deposition of PrP-res was primarily in the thalamus
and posterior
colliculus, whereas in the other recipients heavy
deposition of PrP-res
was also seen in the hypothalamus, hippocampus,
or brain stem (Table
4). These results provided additional
support
for the conclusion that different scrapie strains were evolving
in these different recipients.
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TABLE 4.
Distribution of PrP-res in various brain regions of
third-passage mice inoculated with three different second-passage
isolatesa
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 |
DISCUSSION |
In the present experiments, hamster-derived scrapie infectivity
replicated in mice for two serial passages over nearly 4 years. The
present results are in marked contrast to the earlier results of
Kimberlin et al. (17), who concluded that 263K
hamster scrapie could not replicate in mice and that only the original
inoculum could persist. One likely reason for the difference with our
results is that in these earlier experiments serial mouse passages were done at 319, 158, and 152 days and in our studies infectivity for
second-passage mice was not detected until after 463 days (Table 2).
Our present results extended those in a recent study (11).
In this earlier work, brains of two mice infected with hamster scrapie
were analyzed for infectivity titer. In one of these mice, which was
negative for PrP-res, the infectivity level was 1/20 of the original
amount inoculated and thus might be residual inoculum. However, in the
other mouse, which was positive for PrP-res, there was fivefold-more
infectivity than originally inoculated, indicating that in this
individual replication had probably occurred. In our analysis of
infectivity in 23 mice during more than 2 years of observation, there
was no evidence for replication of hamster scrapie agent for the first
year postinoculation. The original inoculum was detectable several
hours after infection and steadily decreased over the following months.
Only after 463 days was there evidence of an increase in infectivity
compared to that for the preceding days studied (Fig. 1a), and at this
point there was still no detectable PrP-res. Later, there was evidence
for further increases in infectivity as well as gradual adaptation
toward increasing virulence for mice. Thus, in the present experiments two distinct phases were identified in asymptomatic PrP-res-negative mice, a persistent phase followed by a replicative phase, and PrP-res
was not a reliable marker for either of these phases.
Apparently, adaptation for serial mouse passage is a slow process
requiring extensive time in the first-passage mice. However, once in
progress the adaptation that we observed was similar to that seen by
Kimberlin and coworkers using this same system (15-17). At least two different strains appear to have evolved in our mice. One
strain was infectious for mice but lost its virulence for hamsters
(Table 3, donor 693). Another strain was virulent for hamsters but
could be distinguished from the original 263K inoculum since it gave a
longer incubation period in hamsters (180 to 197days) while still
killing 100% of the hamsters (Table 3, donors 574-2 and 782).
Infectivity for mice was also found in these same animals, giving an
incubation period of 314 to 320 days. This could be either a separate
strain or a manifestation of virulence for both species by a single new
strain. Limiting dilution cloning will be required to distinguish
between these possibilities (15).
Although adaptation of hamster scrapie to mice was noted in the second
year after infection in the present experiments (Table 2), most of the
infectivity present in first-passage mice maintained its virulence for
hamsters. Furthermore, replication of this infectivity occurred in
spite of the absence of detectable hamster PrP-res. These data would be
easy to explain if the agent were known to be a conventional virus with
a nucleic acid genome capable of mutation to allow adaptation to a new
species. However, they are more difficult to reconcile with the
protein-only hypothesis, where PrP-res might be the agent and the
species tropism might be dependent on the species of the PrP used to
generate the new PrP-res (8). To remain consistent with
this hypothesis, one would have to speculate that the incoming hamster
PrP-res would have to imprint its unique structural properties on the
new PrP-res generated from mouse protease-sensitive PrP during
the replication occurring over the 2-year period of these experiments
(1, 3-5, 7, 9, 23). At present, there is insufficient
structural information on PrP-res to be able to either validate or
exclude this possibility.
The ability of TSE infectivity to both persist and adapt over such long
periods may be common to many TSE agents. Furthermore, in both wildlife
and agricultural settings where TSE diseases might be transferred
across species barriers there could be other situations which lead to
subclinical infection and unexpected adaptation or spread to additional
species. For example, although sheep scrapie is thought to present no
risk to humans, it may be the source of BSE in Europe (24,
25) and possibly also of CWD in the United States. If BSE were
derived from sheep scrapie, then adaptation during passage in cattle
may have increased its pathogenicity for humans. A similar situation
could occur with CWD. CWD transmission to other cervids or livestock
could change its characteristics, including its potential for
transmission to people.
Although humans exposed to BSE-infected beef may be somewhat
resistant to development of clinical variant Creutzfeldt-Jakob disease, as evidenced by the low number of clinically diseased people
compared to the number potentially infected, there is concern that a
subclinical carrier state might occur in many of these asymptomatic
individuals. By analogy with the present results, this would certainly
be a possibility, and if true, the danger of replication, adaptation,
and further spread of the agent from these people to others might even
increase at longer times postexposure. Furthermore, in the absence of
precise information on the infectious dose of BSE for humans it is
impossible to predict the number of possible subclinical carriers in
the population. Because of the low levels of agent expressed, such a
subclinical state might be detectable only by transfer of infectivity
and might escape detection by present biochemical methods. Therefore,
such subclinical carrier patients might pose a serious risk for
contamination of surgical instruments, tissue transplants, and blood
products. It will be important to be aware of these new potential risks in designing policies to prevent further spread of BSE and other TSE
diseases in the coming years.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: Laboratory of
Persistent Viral Diseases, Rocky Mountain Laboratories, 903 South
Fourth St., Hamilton, MT 59840-2999. Phone: (406) 363-9354. Fax: (406) 363-9286. E-mail: bchesebro{at}nih.gov.
 |
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