A critical concern in the transmission of prion diseases, including chronic wasting disease (CWD) of cervids, is the potential presence of prions in body fluids. To address this issue directly, we exposed cohorts of CWD-naïve deer to saliva, blood, or urine and feces from CWD-positive deer. We found infectious prions capable of transmitting CWD in saliva (by the oral route) and in blood (by transfusion). The results help to explain the facile transmission of CWD among cervids and prompt caution concerning contact with body fluids in prion infections.

Key to understanding the epidemiology and pathogenesis of prion diseases, including chronic wasting disease (CWD) of cervids, is determining the mode of transmission from one individual to another. We have previously reported that saliva and blood from CWD-infected deer contain sufficient infectious prions to transmit disease upon passage into naïve deer. Here we again use bioassays in deer to show that blood and saliva of pre-symptomatic deer contain infectious prions capable of infecting naïve deer and that naïve deer exposed only to environmental fomites from the suites of CWD-infected deer acquired CWD infection after a period of 15 months post initial exposure. These results help to further explain the basis for the facile transmission of CWD, highlight the complexities associated with CWD transmission among cervids in their natural environment, emphasize the potential utility of blood-based testing to detect pre-clinical CWD infection, and could augur similar transmission dynamics in other prion infections.

Substantial evidence for prion transmission via blood transfusion exists for many transmissible spongiform encephalopathy (TSE) diseases. Determining which cell phenotype(s) is responsible for trafficking infectivity has important implications for our understanding of the dissemination of prions, as well as their detection and elimination from blood products. We used bioassay studies of native white-tailed deer and transgenic cer- Chronic wasting disease (CWD) is an infectious proteinmisfolding disease, or transmissible spongiform encephalopathy (TSE), affecting cervids in North America (59, 76-79) and one Asian country (41,68). CWD is unique among prion diseases in affecting free-ranging wildlife populations (deer, elk, and moose). Early and subsequent observations made by Williams and Miller (58,79) related CWD transmission to direct contact with clinically affected deer, as well as indirect contact with environments previously populated by infected deer (57). Bioassay studies of white-tailed deer have demonstrated that body fluids and excreta (saliva, urine, feces, and blood) contain infectious prions (53, 54). Both clinical and preclinical CWDinfected deer harbored sufficient infectious prions to produce CWD in naïve white-tailed deer following ingestion of saliva or transfusion of whole blood (53, 54).The detection of blood-borne infectious prions has important implications for our understanding of the spread of prions among and within individuals, as well as for the elimination of prions from blood products (13,15,33,45), given the evidence for Creutzfeldt-Jakob disease (CJD) transmission via blood transfusion (16,29,47,50,62,72,73). Identifying the cell phenotype or cell-free protein fractions that harbor prion infectivity would contribute importantly to this understanding and to the development of blood-based assays to detect prion infection. We undertook the present studies to address these issues. MATERIALS AND METHODSBioassay studies of white-tailed deer. White-tailed deer fawns were provided by the Warnell School of Forestry and Natural Resources, University of Georgia, Athens-a region in which CWD has not been detected. The deer fawns were hand raised and human and indoor adapted before overnight transport directly to the Colorado State University (CSU) CWD research indoor isolation facility without contact with the native Colorado environment. The 4-month-old fawns were adapted to the facility housing conditions and diet for 2 months before the study start.Genotyping. All white-tailed deer were genotyped to determine their GG/GS (codon 96) status by the laboratory of Katherine O'Rourke, USDA-ARS, Pullman, WA. Deer were allocated into inoculation cohorts (n ϭ 4) without knowledge of their G96 genotypes.Biocontainment protocols. Protocols to preclude extraneous exposure and cross contamination between cohorts of animals as previously described (53, 54) incorporated protective shower-in requirements, Tyvek clothing, masks, head covers, and footwear while maintaining stringent husbandry. Tonsil biopsy ...

cWhile the facile transmission of chronic wasting disease (CWD) remains incompletely elucidated, studies in rodents suggest that exposure of the respiratory mucosa may be an efficient pathway. The present study was designed to address this question in the native cervid host. Here, we demonstrate aerosol transmission of CWD to deer with a prion dose >20-fold lower than that used in previous oral inoculations. Inhalation of prions may facilitate transmission of CWD and, perhaps, other prion infections.

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