The human prion diseases, kuru, Creutzfeldt-Jakob disease, Gerstmann--Str~iussler-Scheinker syndrome (1), fatal familial insomnia (2), and atypical dementia with octapeptide inserts (3), are slow, degenerative, transmissible dementing, fatal amyloidoses of the central nervous system (CNS). The worldwide incidence is generally thought to be approximately one per million people per year. The normal human prion protein, designated by PrP c, is encoded by a gene on chromosome 20. PrP C appears necessary for normal CNS synaptic function and is also expressed peripherally, although its function in the periphery is unknown. It is thought, however, to be involved in cell signalling and adhesion (4). PrP c has a very low beta sheet content, but is convertible by a conformational change to a protease resistant form denoted by PrP sC. This has a high beta sheet content, prpsC can aggregate to form brain amyloid deposits resistant to degradation (1). Current hypotheses suggest that the spreading pathology of prion diseases is due to recruitment of prpSC from the PrP c of host brain cells. But exactly how does this spreading pathology proceed? Some clues might be gained from the example of Alzheimer disease. The amyloid of Alzheimer disease starts with the extracellular deposition of ~-amyloid protein (BAP), thought to be derived from amyloid precursor protein produced in neurons. BAP can activate complement (5), and the activated fragments richly decorate senile plaques (6). Activated complement components can cause autodestruction of host tissue by generation of the membrane attack complex (6) and by stimulating microglial cells to generate toxic oxygen free radicals (7). Activated microglial cells are embedded in Alzheimer disease senile plaques and are well positioned to carry out such an attack (6). Degeneration of neuronal processes by these mechanisms can generate more extracellular BAP, resulting in an everexpanding autodestructive cycle. Anti-inflammatory agents appear capable of arresting this cycle. Multiple epidemiological studies now indicate that patients taking anti-inflammatory drugs, or suffering from diseases such as arthritis, in which such drugs are widely used, are relatively spared from Alzheimer disease (8-11). In a pilot clinical trial, indomethacin caused an apparent arrest of disease progression (12). The amyloid deposits of kuru, Creutzfeldt-Jakob disease and the Gerstmann-Striiussler-Scheinker syndrome have been reported to be associated with microglial cells (13-15). The presence of complement proteins in Creutzfeldt-Jakob amyloid deposits has also been reported (16). Taken together, these data suggest that a somewhat analogous autodestructive process may be occurring in these prion-associated disorders. Activation of complement would result in generation of the membrane attack complex as well as toxic oxygen species. The point of attack on neurons could be different from that in Alzheimer disease, result-
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