Gene Therapy for Prion Diseases

Prion diseases are relatively rare in humans. The most common, Creutzfeldt-Jakob disease (CJD), afflicts only about one in every million people. Despite their low prevalence, however, these diseases (also known as transmissible spongiform encephalopathies, or TSEs) receive a fair amount of attention from the media and the scientific community. This interest is probably due to their enigmatic mechanism, potential for epidemic spreading, frightening neurodegenerative features, and (as of yet) incurability.

TSEs are neurodegenerative diseases thought to be the result of a prion infection. This distinguishes them from most other sicknesses, which are caused by microbial infections. Prions are infectious agents made up entirely of proteins (the word itself comes from a combination of proteinaceous and infectious).

A prion protein called PrPC (the C stands for cellular) is commonly present on the membranes of our cells, although its function has not yet been fully resolved. PrPSc (the Sc is for Scrapie, the first identified prion disease—in sheep) is an isoform of PrPC and the toxic form of PrP. When it enters the brain it can cause conformational changes in PrPC, turning it into PrPSc.

PrPSc is extremely resistant to being broken down. Thus, it accumulates in the brain, forming protein aggregates known as amyloid fibers. These are toxic to brain cells, and eventually kill them. Astrocytes, which perform a number of supporting functions in the cell (one of which is cleaning up), find the dead neurons and digest them.

This creates actual holes in the brain, giving it a sponge-like appearance (and the reason for these disorders being referred to as spongiform). This continued neurodegeneration leads to a number of clinical symptoms, like changes in personality, depression, involuntary movements, lack of coordination, dementia, and eventually the complete loss of the ability to move or speak. TSEs are currently incurable, and an effective method of therapeutic treatment has not been found. The aggregation of PrPScs occurs over a long period of time, giving the diseases incubation periods that range from 10-60 years depending on the disease type.

TSEs can be the result of genetic or sporadic (non-genetic) causes. A mutation in the prion protein (PRNP) gene can cause the production of PrPSc instead of PrPC, leading to a prion disease. TSEs are also contagious—not through the air or normal contact, but through exposure to infected tissue, body fluids, or contaminated medical instruments (due to the durability of prions, they can survive normal sterilization procedures).

Unfortunately, we have learned about how TSEs are spread by witnessing several deadly epidemics. Around the middle of the twentieth century, a TSE arose in a New Guinean tribal people called the Fore. It is thought to have spread through cannibalistic ritual practices, and killed over 1,000 of their people. In the 1980s 60 deaths were linked to the transmission of CJD through contaminated medical instruments. Around the same time, 85 people died after receiving prion-infected growth hormone injections. In the 1990s, a type of CJD called variant CJD (vCJD) was linked to eating beef infected with the bovine form of TSE, bovine spongiform encephalitis (BSE), or mad cow’s disease. vCJD has a shorter incubation period than CJD, with the median age at death being 28, versus 68 for CJD. The illness also has a longer duration, with a median of 15 months for vCJD and only 4-5 months for CJD. Up to 200 people worldwide have died from vCJD.

BSE is thought to be caused by feeding cattle the remains of other infected cattle. This practice was stopped in 1989. Due to the long incubation period of the disease, however, some fear that the real mad cow disease epidemic has yet to manifest itself.

An article in PloS One this month addresses a possible way to control such an outbreak, with the successful application of a gene therapy treatment for TSEs. A natural resistance to prion diseases has been discovered in both animals and humans, and specific mutant forms of the mouse Prnp gene have been found to reduce the replication of prions in infected cells.

The researchers involved in the study injected this mutant gene into the brains of mice infected with prions. In order to make the study more relevant to human TSEs, they did this during late stages of the disease, at 80 and 95 days post infection. This increases relevance because, due to the long incubation period of TSEs, most people are unaware they have contracted them until serious symptoms develop.

They found that, after two injections, treated mice survived 20% longer than non-treated mice. They exhibited substantial improvements in behavioral symptoms, as well as a significant reduction of spongiosis and astrocytic activity in the brain.

The authors suggest this effect occurred because the mutated Prpn gene produces a protein that cannot be converted into PrPSc. Additionally, the protein it makes competes with PrPC for PrPSc, slowing the conversion of existing PrPC to the toxic form. Basically, this means that the PrPSc doesn’t realize the new proteins can’t be transformed, and still attaches itself to them. This delays the overall disease progression, as many of these PrPScs are busy trying to make conformational changes to no avail.

These results are promising not only because they slow down the aggregation of toxic prions, but because the effect was demonstrated at such a late stage of disease. Unfortunately, the disease was slowed but not cured. Regardless, the hint of a successful method of treatment for prion diseases might be comforting to nervous meat eaters who are fearing a future vCJD outbreak. I’m a vegetarian (and have been for a long time), so as long as the soybeans in my tofu weren’t grown with meat and bone meal fertilizer, I feel reasonably safe.

Karine Toupet, Valérie Compan, Carole Crozet, Chantal Mourton-Gilles, Nadine Mestre-Francés, Françoise Ibos, Pierre Corbeau, Jean-Michel Verdier, Véronique Perrier, Alfred Lewin (2008). Effective Gene Therapy in a Mouse Model of Prion Diseases. PLoS ONE, 3 (7), 0- DOI:10.1371/journal.pone.0002773