BSE: can we predict the future?

Prion diseases are transmissible neurodegenerative disorders of humans and animals. The prion protein (PRPc) gene is expressed to some extent in many cell types but principally in neurons. Normal PrPc may contribute in the protection of neurons and are protease sensitive. Abnormal prions consist of a post-translationally modified form of PrP, PrPsc, which is partly protease resistant. PrPsc is a protein with high resistance to inactivation by irradiation, heat and harsh chemical treatments. It is currently proposed that PrPsc is an infectious protein that propagates by inducing the normal PrPc to become the abnormal PrPsc. PrPsc cause transmissible spongiform encephalopathies (TSE), an unusual group of degenerative brain diseases that can be transmitted by inoculation or ingestion of diseased brain or other tissues. The human diseases occur in an inherited, acquired and sporadic forms. Transmission of prion diseases between species is limited by a species barrier, determined in part by the degree of sequence homology between the host PrPsc and inoculated PrPsc. The epidemic of bovine spongiform encephalopathy (BSE) in the United Kingdom is a new disease that has affected over 160,000 cattle and has presumably arisen from dietary exposure to PrPsc from sheep with scrapie. Until shown otherwise we must assume that oral consumption of infectious BSE protein is a new factor for Creutzfeld-Jakob (CJD) disease in man. This disease is a new variant of CJD (nVCJD) and has a different clinical picture. Early diagnostic markers to facilitate the diagnosis and screen blood and organ donors are not available. The control of the disease relies on the measures to eradicate the spread of BSE by banning the use of ruminant tissues in ruminant feed and slaughter and rendering procedures to ensure inactivation of prions of all infected animals. The control of nVCJD is based on reduction of exposure to BSE by banning a variety of tissues for consumption. A surveillance worldwide is increased for both BSE and nV-CJD and the WHO update regularly recommendations to limit the risk of transmitting the disease. The extent of the size of the nVCJD will depend on different factors among others the dose of infectious material, the route of infection, the genetic susceptibility of the person. Therefore is not possible to predict how important the disease will be.