Evaluation of potential infectivity of Alzheimer and Parkinson disease proteins in recipients of cadaver-derived human growth hormone

• Published in: JAMA neurology Vol. 70; no. 4; p. 462
• Main Authors: Irwin, David J, Abrams, Joseph Y, Schonberger, Lawrence B, Leschek, Ellen Werber, Mills, James L, Lee, Virginia M-Y, Trojanowski, John Q
• Format: Journal Article
• Language: English
• Published: United States 01-04-2013
• Subjects: alpha-Synuclein - metabolism; Alzheimer Disease - pathology; Amyloid beta-Peptides - metabolism; Cadaver; Cohort Studies; Databases, Factual - statistics & numerical data; Female; Human Growth Hormone - adverse effects; Humans; Male; Neurites - metabolism; Neurites - pathology; Neurons - pathology; Parkinson Disease - pathology; Pituitary Gland - metabolism; Pituitary Gland - pathology; tau Proteins - metabolism; United States; United States Public Health Service; United States
• ISSN: 2168-6157
• DOI: 10.1001/jamaneurol.2013.1933

Growing evidence of cell-to-cell transmission of neurodegenerative disease (ND)-associated proteins (NDAPs) (ie, tau, Aβ, and α-synuclein) suggests possible similarities to the infectious prion protein (PrPsc) in spongiform encephalopathies. There are limited data on the potential human-to-human transmission of NDAPs associated with Alzheimer disease (AD) and other non-PrPsc ND.
To examine evidence for human-to-human transmission of AD, Parkinson disease (PD), and related NDAPs in cadaveric human growth hormone (c-hGH) recipients.
We conducted a detailed immunohistochemical analysis of pathological NDAPs other than PrPsc in human pituitary glands. We also searched for ND in recipients of pituitary-derived c-hGH by reviewing the National Hormone and Pituitary Program (NHPP) cohort database and medical literature.
University-based academic center and agencies of the US Department of Health and Human Services.
Thirty-four routine autopsy subjects (10 non-ND controls and 24 patients with ND) and a US cohort of c-hGH recipients in the NHPP.
Detectable NDAPs in human pituitary sections and death certificate reports of non-PrPsc ND in the NHPP database.
We found mild amounts of pathological tau, Aβ, and α-synuclein deposits in the adeno/neurohypophysis of patients with ND and control patients. No cases of AD or PD were identified, and 3 deaths attributed to amyotrophic lateral sclerosis (ALS) were found among US NHPP c-hGH recipients, including 2 of the 796 decedents in the originally confirmed NHPP c-hGH cohort database.
Despite the likely frequent exposure of c-hGH recipients to NDAPs, and their markedly elevated risk of PrPsc-related disease, this population of NHPP c-hGH recipients does not appear to be at increased risk of AD or PD. We discovered 3 ALS cases of unclear significance among US c-hGH recipients despite the absence of pathological deposits of ALS-associated proteins (TDP-43, FUS, and ubiquilin) in human pituitary glands. In this unique in vivo model of human-to-human transmission, we found no evidence to support concerns that NDAPs underlying AD and PD transmit disease in humans despite evidence of their cell-to-cell transmission in model systems of these disorders. Further monitoring is required to confirm these conclusions.