Alzheimer protein can be transmitted

A study into proteins linked to Alzheimer’s disease has flagged the contamination of surgical instruments during brain operations, after researchers found that the proteins could potentially be transmitted.

The current study, done by a team, follows up on one conducted in 2015 when researchers examined brains of individuals who had died due to Creutzfeldt-Jakob Disease (CJD). These individuals had been treated with growth hormones in their childhood, and until 1985, such hormones were derived from the brains of deceased persons.

The 2015 findings found links between the growth hormone injections and deposits of beta-amyloid proteins in the individuals. Such deposits are regarded as a hallmark of the Alzheimer’s disease.

For the current study, the researchers tracked down old stocks of the growth hormone and found some of the samples to contain significant levels of beta-amyloid proteins and tau proteins — presence of both these proteins is crucial for diagnosis of Alzheimer’s disease. In further experiments, the team injected the contaminated hormones into the brain of mice that had been genetically modified. The mice brain later developed clumps of protein typical of Alzheimer’s.

Groups of the same mice that had been injected with synthetic growth hormone showed no such patterns. These findings support the hypothesis that beta-amyloid proteins were accidentally transmitted to patients through this medical treatment, which is now defunct.

"It is well known that the abnormal proteins seen in Creutzfeldt-Jakob disease have been transmitted between patients by certain medical and surgical procedures. We have been investigating whether the same can be true for amyloid beta," says one of the authors of the study.

“We have found new evidence that amyloid beta pathology may be transmissible. This does not mean that Alzheimer's disease can be transmitted, as we did not find any significant amount of pathological tau protein which is the other hallmark protein of Alzheimer's disease. Our findings relate to neurosurgical procedures done a long time ago. Nevertheless, the possibility of pathological protein transmission, while rare, should factor into reviews of sterilisation and safety practices for surgical procedures."

One of the authors, adds in a press note: “It is most important to emphasise that there is no suggestion in our work that you can catch Alzheimer’s disease (or CJD) by contact with a person with the disease. Our findings highlight the need to do further research in this area.”

He says further: “We suggested that the human growth hormone—which prior to 1985 was prepared from human tissue—may have been contaminated with seeds of this material as well as the prions causing CJD… We have now provided experimental evidence to support our hypothesis that amyloid beta pathology can be transmitted to people from contaminated materials.

We cannot yet confirm whether medical or surgical procedures have ever caused Alzheimer’s disease itself in people, or how common it might be to acquire amyloid pathology in this way. It will be important to review risks of transmission of amyloid pathology by other medical procedures still done today, including instruments used in brain surgery, drawing on other research and what we already know about accidental CJD transmission.”

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Brain-maiming protein may have spread via surgery

A dangerous protein that attacks the brain's blood vessels may have infected children via poorly sterilized surgical instruments decades before the onset of harmful bleeding, researchers reported recently.

Investigating a quartet of mysterious cases in Britain of brain lesions caused by amyloid beta deposits in young adult patients, they found that all four had undergone brain surgery as kids, suggesting a causal link.

"It is introduced into children, takes 30 years to develop, and then -- when they are in their 30s -- the blood vessels are completely loaded with amyloid beta, which destroys the vessels," a professor of Neurology and lead author of a study detailing the findings, told the media.

"This is a very well-known phenomenon in the elderly, but it is unknown in young people."

A large-scale review of medical registries -- already in the pipeline -- will be needed to confirm the deadly protein can be spread by dirty surgical instruments, he added.

Amyloid beta is one of the signature proteins of Alzheimer's, but there were no signs of the disease in the cases examined, according to the study published recently.

"We didn't find any significant amount of the pathological tau protein, which is the other hallmark protein of Alzheimer's," the lead author said.

Previous work with lab animals had shown that tiny amounts of amyloid beta can stick to steel wires and transmit the pathology into animals' brains.

In 2015, the researchers uncovered amyloid beta deposits in the brains of people who had been treated as children with growth hormones extracted from human cadavers, another indication the protein can jump from one person to another.

It has also long been known that the brain-wasting protein that causes Creutzfeldt-Jakob disease, the human variant of "mad cow" sickness, can be passed on via medical procedures, or by eating infected brain matter.

Hospitals sterilize surgical equipment with high-pressure steam and chemicals that kill viruses and bacteria, but the new findings suggest these methods may not always be adequate.

'Just sterile dirt'

"What we didn't know at the time is that proteins can still be transmitted," said the researcher, who worked as a neurosurgeon for several years in the early 1990s.

He recalled one surgeon at work holding up a stainless steel instrument that had residue from a previous operation.

"'Don't worry,' the nurse in charge of sterilisation said through her mask, 'it's just sterile dirt'."

Hygiene standards are more stringent now, but the capacity of brain-attacking proteins to withstand sterilization is still unknown.

The incidence of infection during surgery with amyloid beta may be far higher than suspected, the researcher said.

But if the protein is transmitted into an adult and doesn't show up until late in life, it then becomes impossible to know whether it comes from the brain operation or the natural ageing process.

Unlike Creutzfeldt-Jakob disease, which causes one death per million people each year, amyloid beta build-up is very common among the elderly, even when there are no signs of dementia.

"So that means that there might a lot more cases of contamination, but that we simply can't tell them apart," the researcher said.

Outside experts said the results were suggestive but needed to be backed up by more research.

"This study provides strong, if circumstantial, evidence for an association between neurosurgery in childhood and the development in late adult life of cerebral amyloid angiopathy (CAA)," said  a clinical psychiatrist, using the clinical name of the disease caused by the protein.

The chief scientific officer at Alzheimer's Research , made a similar assessment, adding: "Any potential link will need to be explored in much larger studies."
The researcher said he has already gotten a green light from ethics watchdogs to comb through neuropathology records.

"We plan to identify those brain biopsies of people 50 or younger who -- for any reason -- had a brain bleed caused by amyloid beta," he explained.

"Then we'll go to the clinical notes to check if they had a surgical procedure in their childhood."

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