Although COVID-19 is considered to be primarily a respiratory disease, SARS-CoV-2 affects multiple organ systems including the central nervous system (CNS). Yet, there is no consensus on the consequences of CNS infections. Here, we used three independent approaches to probe the capacity of SARS-CoV-2 to infect the brain. First, using human brain organoids, we observed clear evidence of infection with accompanying metabolic changes in infected and neighboring neurons. However, no evidence for type I interferon responses was detected. We demonstrate that neuronal infection can be prevented by blocking ACE2 with antibodies or by administering cerebrospinal fluid from a COVID-19 patient. Second, using mice overexpressing human ACE2, we demonstrate SARS-CoV-2 neuroinvasion in vivo. Finally, in autopsies from patients who died of COVID-19, we detect SARS-CoV-2 in cortical neurons and note pathological features associated with infection with minimal immune cell infiltrates. These results provide evidence for the neuroinvasive capacity of SARS-CoV-2 and an unexpected consequence of direct infection of neurons by SARS-CoV-2.

Although COVID-19 is considered to be primarily a respiratory disease, SARS-CoV-2 affects multiple organ systems including the central nervous system (CNS). Reports indicate that 30-60% of patients with COVID-19 suffer from CNS symptoms. Yet, there is no consensus whether the virus can infect the brain, or what the consequences of infection are. Following SARS-CoV-2 infection of human brain organoids, clear evidence of infection was observed, with accompanying metabolic changes in the infected and neighboring neurons. Further, no evidence for the type I interferon responses was detected. We demonstrate that neuronal infection can be prevented either by blocking ACE2 with antibodies or by administering cerebrospinal fluid from a COVID-19 patient. Finally, using mice overexpressing human ACE2, we demonstrate in vivo that SARS-CoV-2 neuroinvasion, but not respiratory infection, is associated with mortality. These results provide evidence for the neuroinvasive capacity of SARS-CoV2, and an unexpected consequence of direct infection of neurons by SARS-CoV2.

More than 100,000 genetic variants are reported to cause Mendelian disease in humans, but the penetrance - the probability that a carrier of the purported disease-causing genotype will indeed develop the disease - is generally unknown. Here we assess the impact of variants in the prion protein gene (PRNP) on the risk of prion disease by analyzing 16,025 prion disease cases, 60,706 population control exomes, and 531,575 individuals genotyped by 23andMe, Inc. We show that missense variants in PRNP previously reported to be pathogenic are at least 30× more common in the population than expected based on genetic prion disease prevalence. While some of this excess can be attributed to benign variants falsely assigned as pathogenic, other variants have genuine effects on disease susceptibility but confer lifetime risks ranging from <0.1% to ~100%. We also show that truncating variants in PRNP have position-dependent effects, with true loss-of-function alleles found in healthy older individuals, supporting the safety of therapeutic suppression of prion protein expression.

Sporadic Creutzfeldt-Jakob disease (sCJD) is a fatal and potentially transmissible neurodegenerative disease caused by misfolded prion proteins. To date, effective therapeutics are not available and accurate diagnosis can be challenging. Clinical diagnostic criteria employ a combination of characteristic cerebrospinal fluid (CSF) 14-3-3 proteins, MRI findings, EEG changes, and neuropsychiatric symptoms. Supportive biomarkers such as high CSF total Tau may aid the diagnostic process. However, discordant results of studies have led to controversies about the clinical value of established surrogate biomarkers. The recent development and clinical application of disease-specific protein aggregation and amplification assays such as Real-time Quaking Induced Conversion (RT-QuIC) have constituted major breakthroughs for the confident pre-mortem diagnosis of sCJD. Updated criteria for the biomarker-based diagnosis of sCJD including RT-QuIC will improve early clinical confirmation, disease surveillance, assessment of potential tissue infectivity, and trial monitoring. Further, potential pre-symptomatic, prognostic, and blood-based biomarker candidates have been identified in recent years.

IntroductionWe recently identi®ed the 37-kDa laminin receptor precursor (LRP) as an interactor for the prion protein (PrP) (Rieger et al., 1997; for reviews see Rieger et al., 1999;Gauczynski et al., 2001a). Employing a series of neuronal and non-neuronal cells, we proved that the 37-kDa LRP/67-kDa high-af®nity laminin receptor (LR) acts as the receptor for the cellular PrP (Gauczynski et al., 2001b). In the present manuscript we used the yeast twohybrid system and cell-binding studies on neuronal as well as non-neuronal cells involving the Semliki Forest virus (SFV) system (for reviews see Liljestrom and Garoff, 1991;Tubulekas et al., 1997) to identify domains on the PrP and the LRP involved in the PrP±LRP interaction on the cell surface. We identi®ed two binding domains for LRP on PrP termed PrPLRPbd1 and PrPLRPbd2. The ®rst one binds directly to LRP, whereas the second one depends on the presence of heparan sulfate proteoglycans (HSPGs) on the cell surface. The yeast two-hybrid system and cell-binding assays on wild-type and mutant HSPGde®cient Chinese hamster ovary (CHO) cells also identi®ed two binding domains for PrP on LRP.The relationship between 37-kDa LRP and 67-kDa LR is not yet fully understood and has been explained with homodimerization of 37-kDa LRP (Landowski et al., 1995) or an additional factor, such as a polypeptide (Castronovo et al., 1991), which might bind to 37-kDa LRP to form the 67-kDa form of the receptor. The 67-kDa heterodimer might be stabilized by hydrophobic interactions mediated by fatty acids such as palmitate, oleate and stearate bound to 37-kDa LRP and to a galectin-3 (gal-3) cross reacting polypeptide (Landowski et al., 1995;Buto et al., 1998). However, we recently proved that the b-galactoside lectin gal-3 is not present on the surface of neuronal or non-neuronal cells used for PrP-binding/ internalization studies (Gauczynski et al., 2001b) and antigal-3 antibodies failed to compete for the 37-kDa LRP/67-kDa LR-mediated binding and internalization of the cellular PrP (Gauczynski et al., 2001b), suggesting that gal-3 is not a partner of the 37-kDa LRP in this context. In this study we investigated by a yeast two-hybrid system analysis whether gal-3 interacts with 37-kDa LRP and/or the cellular PrP. In addition, we investigated whether 37-kDa LRP interacts with itself in the yeast two-hybrid and analysed the monomer/dimer status of the receptor by sizeexclusion chromatography. Both PrP (Gabizon et al., 1993;Caughey et al., 1994;Chen,S.G. et al., 1995;Brimacombe et al., 1999) and the 37-kDa/67-kDa LR (Guo et al., 1992;Kazmin et al., 2000) bind to heparan sulfates. HSPGs are required for the binding of the ®broblast growth factor (FGF) to its FGFR receptor (Yayon et al., 1991;Spivak et al., 1994;Venkataraman et al., 1999) and act as initial attachment receptors for bacteria (Chen,T. et al., 1995) and viruses including alphaviruses (Byrnes and Grif®n, 1998), human immunode®ciency virus (HIV) type 1 (Mondor et al., 1998) and vaccinia virus (Chung et al., 1998). Heparan sulfates are...

BackgroundThe evolution of the variant Creutzfeldt-Jakob disease (vCJD) epidemic is hazardous to predict due to uncertainty in ascertaining the prevalence of infection and because the disease might remain asymptomatic or produce an alternate, sporadic-like phenotype.Methodology/Principal FindingsTransgenic mice were produced that overexpress human prion protein with methionine at codon 129, the only allele found so far in vCJD-affected patients. These mice were infected with prions derived from variant and sporadic CJD (sCJD) cases by intracerebral or intraperitoneal route, and transmission efficiency and strain phenotype were analyzed in brain and spleen. We showed that i) the main features of vCJD infection in humans, including a prominent involvement of the lymphoid tissues compared to that in sCJD infection were faithfully reproduced in such mice; ii) transmission of vCJD agent by intracerebral route could lead to the propagation of either vCJD or sCJD-like prion in the brain, whereas vCJD prion was invariably propagated in the spleen, iii) after peripheral exposure, inefficient neuroinvasion was observed, resulting in an asymptomatic infection with life-long persistence of vCJD prion in the spleen at stable and elevated levels.Conclusion/SignificanceOur findings emphasize the possibility that human-to-human transmission of vCJD might produce alternative neuropathogical phenotypes and that lymphoid tissue examination of CJD cases classified as sporadic might reveal an infection by vCJD-type prions. They also provide evidence for the strong propensity of this agent to establish long-lasting, subclinical vCJD infection of lymphoreticular tissues, thus amplifying the risk for iatrogenic transmission.

α-secretase-mediated cleavage of amyloid precursor protein (APP) precludes formation of neurotoxic amyloid-β (Aβ) peptides, and α-cleavage of cellular prion protein (PrP(C)) prevents its conversion into misfolded, pathogenic prions (PrP(Sc)). The mechanisms leading to decreased α-secretase activity in Alzheimer's and prion disease remain unclear. Here, we find that tumor necrosis factor-α-converting enzyme (TACE)-mediated α-secretase activity is impaired at the surface of neurons infected with PrP(Sc) or isolated from APP-transgenic mice with amyloid pathology. 3-phosphoinositide-dependent kinase-1 (PDK1) activity is increased in neurons infected with prions or affected by Aβ deposition and in the brains of individuals with Alzheimer's disease. PDK1 induces phosphorylation and caveolin-1-mediated internalization of TACE. This dysregulation of TACE increases PrP(Sc) and Aβ accumulation and reduces shedding of TNF-α receptor type 1 (TNFR1). Inhibition of PDK1 promotes localization of TACE to the plasma membrane, restores TACE-dependent α-secretase activity and cleavage of APP, PrP(C) and TNFR1, and attenuates PrP(Sc)- and Aβ-induced neurotoxicity. In mice, inhibition or siRNA-mediated silencing of PDK1 extends survival and reduces motor impairment following PrP(Sc) infection and in APP-transgenic mice reduces Alzheimer's disease-like pathology and memory impairment.

BACKGROUND Prions, the infectious agents responsible for transmissible spongiform encephalopathies, consist mainly of the misfolded prion protein (PrPSc). The unique mechanism of transmission and the appearance of a variant form of Creutzfeldt–Jakob disease, which has been linked to consumption of prion-contaminated cattle meat, have raised concerns about public health. Evidence suggests that variant Creutzfeldt–Jakob disease prions circulate in body fluids from people in whom the disease is silently incubating. METHODS To investigate whether PrPSc can be detected in the urine of patients with variant Creutzfeldt–Jakob disease, we used the protein misfolding cyclic amplification (PMCA) technique to amplify minute quantities of PrPSc, enabling highly sensitive detection of the protein. We analyzed urine samples from several patients with various transmissible spongiform encephalopathies (variant and sporadic Creutzfeldt–Jakob disease and genetic forms of prion disease), patients with other degenerative or nondegenerative neurologic disorders, and healthy persons. RESULTS PrPSc was detectable only in the urine of patients with variant Creutzfeldt–Jakob disease and had the typical electrophoretic profile associated with this disease. PrPSc was detected in 13 of 14 urine samples obtained from patients with variant Creutzfeldt–Jakob disease and in none of the 224 urine samples obtained from patients with other neurologic diseases and from healthy controls, resulting in an estimated sensitivity of 92.9% (95% confidence interval [CI], 66.1 to 99.8) and a specificity of 100.0% (95% CI, 98.4 to 100.0). The PrPSc concentration in urine calculated by means of quantitative PMCA was estimated at 1×10−16 g per milliliter, or 3×10−21 mol per milliliter, which extrapolates to approximately 40 to 100 oligomeric particles of PrPSc per milliliter of urine. CONCLUSIONS Urine samples obtained from patients with variant Creutzfeldt–Jakob disease contained minute quantities of PrPSc. (Funded by the National Institutes of Health and others.)