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Journal of Virology, March 2002, p. 2510-2517, Vol. 76, No. 5
0022-538X/02/$04.00+0 DOI: 10.1128/jvi.76.5.2510-2517.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
Centre for Veterinary Science, Department of Clinical Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, United Kingdom,1 University Hospital Basel, Institute of Pathology, CH-4003 Basel,2 Institute of Neuropathology, University Hospital of Zürich, CH-8091 Zürich, Switzerland3
Received 24 September 2001/ Accepted 16 November 2001
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With respect to prion diseases, the term incubation period is usually defined as the length of time from inoculation to the appearance of clinical signs associated with terminal disease. The incubation period is dependent upon the species and strain of host, the inoculum, and the route of inoculation and is inversely related to the titer of inoculum (34, 36). During the progression of prion disease, infectivity and PrPSc accumulate in the central nervous system, and in lymphoid tissue following peripheral inoculation, within a clinically silent phase. Following a prion strain-specific incubation period, this preclinical phase usually precipitates into clinically evident terminal disease. However, prion-infected animals that harbor infectivity and appear grossly unaffected during their normal lifetimes following prion inoculation have been reported. Such individuals may be considered to have subclinical as opposed to preclinical infection (12). There are several examples in the literature of chronic subclinical prion infections. Frigg et al. (19) have reported immunodeficient mice with high prion and PrPSc levels which remain asymptomatic. Race and Chesebro (37) have shown that brain homogenates from mice inoculated with hamster prions harbor infectivity for hamsters, while Hill et al. (23) have demonstrated that hamster prions do indeed replicate in mice without causing clinical disease. A significant feature of all of these reports is that the resultant infectivity in animals with subclinical disease was seen after inoculation with a high dose of inoculum. One intriguing case of subclinical disease has been described by Taylor et al. (39), who have reported intermittent mild or early clinical signs in mice inoculated with low doses of ME7 prion inoculum.
The Prnpa mouse-passaged strains ME7 and Rocky Mountain Laboratory (RML) are the two principal mouse inocula which have been used to address which cell types of the immune system interact with or accumulate prions following peripheral prion inoculation (3, 27, 28). These two inocula both originate from scrapied sheep but from different tissues. RML is derived from experimental goats previously inoculated with the sheep scrapie brain homogenate SSBP/1 (8, 11), and ME7 is derived from the spleen of a scrapied sheep (5). Although RML and ME7 have specific incubation periods and induce distinct neuropathological characteristics when inoculated into nontransgenic (hereafter referred to as wild-type) mouse strains, they are similar in that their peripheral accumulation is dependent upon the presence of follicular dendritic cells (32). However, it remains to be resolved whether these two prion strains have subtle transmission characteristics that are manifested in differences in affinity for other target cells.
Here we have used the tga20 mouse strain (16) in our initial studies on the comparison of transmission of RML and ME7. This strain of mouse expresses high levels of Prnpa-derived PrP and has a relatively short incubation time for prion disease, thereby permitting a rapid disease assessment. We have established that tga20 mice are susceptible to both ME7 and RML inocula, with each producing distinct transmission characteristics. Significantly, we have found that low doses of either ME7 or RML induce subclinical disease in tga20 mice which is associated with high levels of infectivity and the presence of PrPSc. Our data suggest that events other than merely prion accumulation are responsible for triggering terminal prion disease.
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Genotyping of tga20 mice. The genotype of tga20 mice was verified by PCR using genomic DNA as a substrate. Genomic DNA was isolated by phenol-chloroform extraction from tail snip tissue previously digested in buffer comprising 500 mM Tris HCl (pH 8.0), 20 mM EDTA, 1.0% sodium dodecyl sulfate, 10 mM NaCl, and 150 µg of proteinase K (PK) per ml overnight at 37°C. PCR tubes contained 1.0 U of Taq polymerase, 100 ng of substrate DNA, 1x PCR buffer, 200 µM deoxynucleoside triphosphates, 0.1 nM each primer,1.5 mM MgCl2, and 10% dimethyl sulfoxide in a final volume of 25 µl. PCR was carried out in a thermal cycler for 30 cycles after an initial DNA melt of 94°C for 2 min, where one cycle comprised denaturation at 95°C for 1 min, annealing at 55°C for 1 min, and extension at 72°C for 1 min. The final extension was for 10 min at 72°C. PCR products were electrophoresed through a 1.5% agarose gel and visualized by ethidium bromide staining and UV transillumination. The primers were as follows: for PrP0/0, ATTCGCAGCGCATCGCCTTCTATCGCC; for P10 transgene, GTACCCATAATCAGTGGAACAAGCCCAGC; and for both Prnp0/0 and transgene, P3-NC (CCCTCCCCCAGCCTAGACCACGA).
Intracerebral inoculations and infectivity bioassay. Mice, either male or female, at 5 to 6 weeks of age were inoculated by intracerebral injection into the right parietal lobe at a depth of 4 to 5 mm. Serial 10-fold dilutions of either ME7 (TSE Resource Centre, Institute of Animal Health, Compton, United Kingdom) or RML brain homogenate were inoculated as a 20-µl volume diluted in phosphate-buffered saline (PBS) or PBS plus 5% bovine serum albumin, respectively. RML 5.0 is derived by passage of RML 4.1 in CD-1 mice. Control tga20 mice were mock injected with PBS or received uninfected CD-1, C57BL/6 brain homogenate, or, subsequently, brain homogenate from these control mice. Initial 10% homogenates were made up in 0.32 M sucrose prior to serial dilution. Inoculated mice were monitored daily for clinical signs of mouse prion disease. The diagnosis of prion disease was based upon that of Dickinson et al. (15). Mice were sacrificed at the point of neurological disease and dysfunction.
Histology and immunocytochemistry. Brain tissue from representative mice for all treatment groups was fixed in buffered formalin for 24 h, inactivated for 1 h with 98% formic acid, soaked in buffered formalin for a further 72 h, and then embedded in paraffin wax. Paraffin sections (5 µm in thickness) were subjected to conventional staining with hematoxylin and eosin. Brain sections from terminally sick mice were examined histologically to confirm scrapie pathology (microvacuolation). Reactive gliosis was confirmed by immunohistochemistry for glial fibrillary acidic protein (GFAP) diluted 1:200 (DAKO, Glostrup, Denmark) and developed with an avidin-biotin labeling kit (Vector Labs, Peterborough, United Kingdom).
Western blot analysis. Brain homogenates were made to 10% (wt/vol) with either homogenate buffer (0.5% Nonidet P-40 and 0.5% sodium deoxycholate in PBS) for RML samples or lysis buffer (0.5% Nonidet P-40, 0.5% sodium deoxycholate, 100 mM NaCl, 10 mM EDTA, and 10 mM Tris HCl [pH 7.4]) for ME7 samples. Samples were treated with PK at a final concentration of 25 µg/ml for 30 min at 37°C. Digestion was terminated by the addition of phenylmethylsulfonyl fluoride. Ten microliters for non-PK-treated samples or 15 µl for PK-treated samples (equivalent to 40 to 50 µg of total protein) was loaded and electrophoresed through a sodium dodecyl sulfate-16% polyacrylamide minigel. Proteins were transferred to nitrocellulose membranes by semidry blotting. Membranes were blocked with TBS-T (10 mM Tris HCl [pH 7.8], 100 mM NaCl, 0.05% Tween 20) plus 5% nonfat milk and subsequently incubated in 1% nonfat milk in TBS-T with XN polyclonal anti-mouse PrP serum (32) (1/1,000) for 1 h, followed by goat anti-rabbit immunoglobulin G-biotin (catalog no. B-7389; Sigma) (1/500) and finally extravidin-horseradish peroxidase (catalog no. E-2886; Sigma) (1/500). All dilutions of antibodies were in 1% nonfat milk in TBS-T. PrP bands were detected by enhanced chemiluminescence.
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50 copies of the PrP transgene and express
10-fold-higher levels of PrPc protein. The mice used here were confirmed as being tga20 mice by PCR using primers to detect the wild-type PrP transgene and the Neo-PrP targeting construct used to generate the original PrP0/0 line. Genomic DNA from tga20 mice contained the predicted wild-type PrP and Neo-PrP PCR products of 0.8 and 0.7 kb, respectively. Wild-type and PrP0/0 mice contain either the 0.8- or 0.7-kb band, respectively (data not shown). ME7 and RML inocula induce different clinical signs of terminal prion disease. Inoculation of tga20 mice intracerebrally with either ME7- or RML-infected brain homogenate resulted in mouse prion disease with clearly evident, progressive clinical signs, as described in Table 1. Prion disease induced by ME7 or RML normally began with similar early signs. Mice initially displayed dull, ruffled coats and developed hyperactive behavior associated with jerky and uncontrollable running movements. This was soon followed by kyphosis (hunched posture) and a high stepping gait coupled with a tendency to display a straight tail, held parallel to the ground. Head twitching became prominent in both ME7- and RML-infected mice, while those infected with RML were prone to hold their heads to one side (usually the right) when in motion. These early signs of prion disease were followed by neurological indicators of dysfunction. Mice developed proprioceptive deficits as evidenced by clasped feet when raised by the tail. Most mice eventually became extremely lethargic and listless, coupled with having a blank stare. The majority of mice subsequently carried their tails in a C shape. This was followed by mild ataxia which gradually became more severe, and mice progressively displayed a rolling gait. In the late stages of disease, tga20 mice inoculated with RML usually showed more hyperactive behavior than those inoculated with ME7. A significant feature of late terminal disease was that approximately 40% of the RML-infected mice developed pruritus, whereas those inoculated with ME7 showed no signs of scratching. All mice were sacrificed at a standard clinical end point once terminal scrapie symptoms had been established. All mice in individual groups reached terminal disease at very similar times. We compared prion incubation times in males and females to verify whether there was a sex-related difference and to maximize the use of all of the mice from the breeding colony. We found no significant difference in incubation times between males and females following intracerebral inoculation (data not shown). Control tga20 mice were inoculated with brain homogenate from uninfected brains of either C57BL/6 or CD-1 mice, which are the mouse strains used to passage ME7 or RML, respectively. All of the control inoculated tga20 mice remained healthy for the duration of the experiment and did not exhibit clinical signs at any time.
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TABLE 1. ME7- or RML-induced clinical signs in tga20 mice following intracerebral inoculation
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TABLE 2. Comparison of ME7 and RML titrations in tga20 micea
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FIG. 1. Regression analysis of ME7 and RML incubation times. The incubation times for different preparations of RML and ME7 in tga20 mice were plotted as a best-fit curve as described by Prusiner et al. (36). Regression analysis equations using the data from Table 2 were calculated using the least-squares method as described by Prusiner et al. (36). ME7a, ME7 acquired from the TSE Resource Centre, IAH, Compton, United Kingdom (supplied by the Neuropathogenesis Unit, Edinburgh, United Kingdom). ME7b, ME7 prepared at the Centre for Veterinary Science from terminally sick mice previously inoculated with ME7a. For incubation times, n = 10; for regression analysis, n = 5.
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TABLE 3. Mean incubation times for ME7- or RML-induced mouse scrapie following intracerebral inoculation into tga20, CD-1, or C57BL/6 micea
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TABLE 4. Prion infectivity in the central nervous systems of mice with subclinical ME7- or RML-induced diseasea
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TABLE 5. Control brain homogenates inoculated by the intracerebral route into tga20 micea
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FIG. 2. Histology and immunocytochemistry. Sections of brain tissue were subjected to conventional staining with hematoxylin and eosin (rows 1 and 3) and examined histologically to confirm prion pathology by the presence of microvacuolation. Reactive gliosis was confirmed by immunohistochemistry for glial fibrillary acidic protein (rows 2 and 4). Magnification, x250.
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FIG. 3. Western blot analysis of PrPSc in brain stem homogenates from ME7- or RML-infected mice with terminal and subclinical disease. Aliquots of 10% (wt/vol) brain stem homogenates prepared from ME7- or RML-inoculated mice were treated with PK, followed by Western blotting with XN polyclonal anti-mouse PrP serum and enhanced chemiluminescence. Ten microliters for non-PK-treated samples and 15 µl for PK-treated samples (equivalent to 40 to 50 µg of total protein) were loaded. The left-hand panels show the positive control sample from wild-type mice inoculated with a 10-1 dilution. ME7 (TSE Resource Centre) and RML 5.0 terminal and subclinical brain stem homogenates are shown. Numbers on the left are molecular masses in kilodaltons.
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Different transmission characteristics are evident for ME7 and RML in tga20 mice. RML induced the most rapid onset of terminal disease, which was reached after only 58 days of incubation following inoculation with a high dose of inoculum injected by the intracerebral route. In contrast, the highest dose of ME7 induced terminal disease after 74 days. These incubation times are considerably shorter, by approximately 50%, than those seen in the wild-type mice used to routinely passage these inocula. The differences in incubation times between ME7 and RML in tga20 mice was maintained between different preparations of each inoculum as seen by the comparison of regression analysis lines. On each occasion tested, the RML inoculum showed a higher titer than ME7, and our titer values are consistent with those seen by others. The RML inoculum routinely displays a titer of
109.5 50% lethal doses (LD50)/g of brain in tga20 mice (M. A. Klein and A. Aguzzi, unpublished data), while ME7 has a titer of
108 (39) in C57BL/6 mice. Collectively, our transmission studies show that tga20 mice can successfully be used to assess both ME7 and RML infectivities and that these different inocula induce terminal disease with a distinct set of clinical signs. Histological examination of brain sections from prion-inoculated tga20 mice with terminal disease revealed that ME7 caused a more general and extensive pattern of vacuolation than RML.
In experimentally inoculated mice, the onset of terminal disease is usually signaled by the appearance of early mild clinical signs, such as head shaking or excitability, which progress to late-stage signs, such as proprioceptive defects and severe ataxia. All of the mice inoculated in this study which developed ataxia invariably succumbed to terminal prion disease. However, careful observation of inoculated mice identified those which developed intermittent mild signs of disease but did not progress to ataxia. These mice had received a low dose of inoculum. Intermittent or reversible clinical signs in wild-type mice inoculated with low doses of ME7 have been described before (39). Here we report a similar finding following inoculation of tga20 mice with an ME7 or RML prion inoculum. However, in contrast to the study by Taylor et al. (39), where the oscillating clinical signs culminated in terminal disease, in the experiments reported here, the oscillating clinical signs have not reached terminal disease. Transmission of brain homogenates prepared from ME7- or RML-inoculated tga20 mice with subclinical disease induced terminal disease in additional tga20 mice and with incubation times similar to those for brain homogenates from mice with terminal disease. The level of infectivity in subclinical ME7 brain homogenates was
105 LD50/g of brain in both groups of mice tested, and this value was similar to that from mice that succumbed to terminal disease. All of these prion titers were significantly greater than the amount inoculated. A similar trend was seen following RML inoculation, although the amount of infectivity associated with subclinical brain homogenates titrated out in the dilutions tested. The failure of uninfected tga20 brain homogenate to cause any disease after inoculation into additional tga20 mice implies that the infectivity in animals with subclinical disease does represent authentic prion accumulation. There are further examples in the literature of chronic subclinical infections with prions. Mice heterozygous for PrP gene disruption show high prion and PrPSc levels but a delayed onset of disease (7), immunodeficient mice do not succumb to disease despite high levels of prions and PrPSc (19), and hamster prions can persist (37) and replicate (23) in mice in a clinically silent fashion. In all of these studies infectivity in animals with subclinical disease was seen after inoculation with relatively high doses of inoculum. The intriguing feature of the subclinical disease infectivity reported here is that it was induced by dilutions of inoculum that were below the end point of titration.
A second feature of our findings was the detection of PrPSc in the brains of tga20 mice with subclinical prion disease. When we assessed the levels of PrPSc in whole brain homogenates from the tga20 mice, we could detect only small amounts in the group with subclinical disease inoculated with RML at a dilution of 10-9 and in both groups with subclinical disease inoculated with ME7 (data not shown). We were routinely unable to detect significant levels of PrPSc in whole brain homogenates from the terminally sick mice for both prion strains. However, when we tested brain stem samples only, we were able to detect PrPSc in all groups of mice, as shown in Fig. 3. Unlike in tga20 mice, PrPSc was detectable in the whole brain homogenates of wild-type animals, which express normal levels of PrPc. Other reports have shown that while tga20 mice can succumb to terminal disease after a very short incubation time, PrPSc in whole brain homogenates was present at low levels (16); in our case it was undetectable when assessed by Western blotting. Several possibilities exist for this apparent lack of, or small amounts of, PrPSc in tga20 mice with terminal disease. First, disease may occur rapidly in tga20 mice prior to appreciable accumulation of PrPSc in regions of the brain other than the brain stem. Second, the resultant PrPSc may be highly sensitive to PK digestion, giving the impression that there is little, if any, of this form of PrP, as reported for other examples of prion disease (9, 24, 29, 30). In this respect, it is interesting that brain homogenates from tga20 mice inoculated via the sciatic nerve (20), which were associated with terminal disease incubation times of up to 90 days, did not show much if any PrPSc. It is possible that the higher levels of PrPSc which accumulate in the tga20 mice with subclinical disease do so as a consequence of the extended duration of the disease process. A third reason for lack of appreciable PrPSc formation in tga20 mice when whole brain homogenates were assessed is that the transgenic nature of PrP in these mice may render this material inherently unstable and/or readily metabolized. Although ME7 and RML required different buffers for efficient PK cleavage to detect PrPSc, the same buffer was effective for brain tissue from both tga20 mice with subclinical disease and wild-type mice with terminal disease. This suggests that ME7 and RML PrPSc retains some conformational similarity, and therefore stability, when expressed in the different mouse strains.
The accumulation of PrPSc is the only established by-product of prion disease, and its detection is routinely used for biochemical diagnosis of transmissible spongiform encephalopathies (26). Molecular analysis of PrPSc through quantitative assessment of the ratios of the different glycoforms and molecular mass measurement of unglycosylated proteins have been used to distinguish different prion inocula (2, 6, 10). However, while the PK and Western blot procedure is suggested to be of comparable sensitivity to heterologous bioassay for BSE or CJD material in mice, the test is essentially nonquantitative and difficult to standardize. A critical feature of the assay is the concentration of PK used. If the concentration of PK used is too high, the enzyme may remove small quantities of PrPSc. Conversely, too low a concentration of enzyme may not remove all of the relatively large amount of PrPc. Other markers of prion disease are required. Barnard et al. (1) have described a sensitive time-fluorescence immunoassay which distinguishes normal cattle from BSE-infected cattle by measurement of insoluble PrP, which increases during disease. Miele et al. (31) have reported that erythroid differentiation-related factor (EDRF) is decreased in spleen tissue and bone marrow of ME7-inoculated mice with terminal disease. Significantly, levels of EDRF mRNA were decreased well in advance of any clinical signs. Analysis of either insoluble PrP or EDRF RNA may aid the diagnosis of subclinical prion disease.
Collectively, our observations with tga20 mice suggest that events other than merely prion infectivity and PrPSc accumulation are responsible for triggering terminal prion disease. Our data also suggest that susceptibility to prion disease should not be judged solely by the development of terminal clinical signs. It is presently unknown if subclinical prion disease exists within individuals, either human or animal, with natural transmissible spongiform encephalopathies, and this is an important point to elucidate. Our data, here using same-species transmission, show that high levels of infectivity can accumulate within infected mice following exposure to extremely low doses of inoculum. It will be important to carry out similar low-dose prion transmission studies using xenogeneic inocula to assess the risks associated with cross-species prion infectivity. These data may have important implications for public health regarding iatrogenic transmission of variant CJD from apparently healthy individuals previously exposed to BSE-contaminated bovine products.
We are grateful to Charles Weissmann for providing the tga20 mice.
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