Neurosurgery Could Spread Protein Linked To Alzheimer's, Study Finds (theguardian.com)

An anonymous reader quotes a report from The Guardian: Surgical instruments used in brain operations should be treated to ensure they are not contaminated with proteins linked to Alzheimer's disease, according to scientists who found evidence that they may be spread by certain medical procedures. The researchers urged doctors to decontaminate neurosurgical tools more thoroughly as a precautionary measure to reduce the potential risk of spreading abnormal proteins known to build up in the brains of Alzheimer's patients. Prof John Collinge, director of the Medical Research Council prion unit at University College London, said that while Alzheimer's disease was not contagious, there was a slim risk that harmful proteins that drive the disease could spread through brain surgery and other rare procedures.

Comments

Protein?

[PopeRatzo]

Please excuse what is probably a dumb question, but I don't know biology. When they say this protein could be "spread", is it like a bacteria or virus?

I read another article about Alzheimers that I didn't really understand that talked about researchers following the possibility that it is bacteria-based. Is this related to that? If I wasn't halfway into my third beer, watching the football game, I might try to figure it out, but I doubt I'd get very far unless one of you kind Slashdot souls helps me.

Re:Protein?

[Anonymous Coward]

They're suggesting that Alzheimer's spreads like a prion disease once started.

Re:Protein?

[Anonymous Coward]

The shape of a protein determines a lot of its characteristics and effects. A protein could have different shapes depending on how the elements that make it up are linked, and how its folded. Sometimes a misfolded protein can encourage other proteins of the same kind to misfold themselves. These misfolded proteins are called prions, and are usually very stable which means they are difficult for the body to get rid of. They're also difficult to destroy in the environment.

Naturally we evolved some capability to deal with prions, there are cellular processes dedicating to getting rid of proteins that are no longer needed. Its often some combination of these malfunctioning along with exposure to a pathogenic prion that ends up causing a particular prion disease.

Re:Protein?

[msauve]

"When they say this protein could be "spread", is it like a bacteria or virus?"

Google "prion".

Re:Protein?

[PopeRatzo]

Google "prion [wikipedia.org]".

Thank you, friend.

Re:Protein?

[Anonymous Coward]

Creutzfeldt-Jakob disease (CJD) is the human equivalent of Mad Cow disease. It is caused by prions, where defective proteins invade the brain and induce other prion protein molecules to misfold in a self-sustaining feedback loop. It can be transmitted by surgical instruments or eating contaminated tissue, and there is no easy way to sterilize it.

The researchers are suggesting that cerebral amyloid angiopathy (CAA), a condition similar to Alzheimer's disease, could be spread by amyloid and tau proteins on surgical instruments and transfusions. Mice that were modified to make human amyloid beta proteins and injected with the CJD-contaminated hormone developed clumps of amyloid beta and cerebral amyloid angiopathy.

Re:Protein?

[ShanghaiBill]

Prions are misfolded proteins that appear to catalyse other proteins to misfold in a chain reaction. "Mad Cow Disease" and CJD (mad cow disease for humans) are the most well known types. It is not clear if Alzheimer's is caused by, or related to prions, but that is one hypothesis.

The point of TFA is that normal sterilization techniques such as heat, alcohol, or chlorine bleach, work fine on bacteria and viruses, but may not destroy prions. Proteins can be much tougher than DNA. We may need to use higher heat and/or harsher chemicals.

Here is a joke my daughter told me after she had a big fight with her boyfriend:
Her: Why don't men get mad cow disease?
My: Why?
Her: Because they're pigs.

Re:Protein?

[dunkelfalke]

That implies that women are cows, though.

Re:Protein?

[pereric]

No.

Re:Protein?

[MikeRT]

Thank you, friend.

"Anytime, buddy!" - Google

Re:Protein?

[HiThere]

Well, they're considering the possibility that it might be prion based. Nobody knows what causes it, and mis-folded proteins can't be ruled out.

So far the evidence supporting the idea that it's prion based is quite weak, but promising approaches seem to keep failing. So it's unreasonable to just dismiss the idea.

Creutzfeldt-Jakob Disease

[LagFlag]

This has been an issue for years since the recognition of Creutzfeldt-Jakob Disease as a prion disease. Hospitals are more and more moving to disposable equipment, although this is not yet possible for neurosurgical instruments. Special cleaning procedures are already in place for surgeries having a high risk of contamination.

Deja Vu

[phaserbanks]

Almost identical Guardian article from 2015.

https://www.theguardian.com/sc...

pernicious: an apt term for prions

[swell]

Not sure why they left out the more ominous method by which these proteins can spread: eye surgery. Eye surgery is fairly common and not normally associated with such grave dangers. Those affected by these proteins (they are called 'prions'), invariably have them living in optical neural tissues. Surgeons, who may schedule multiple operations per day, need to find a better way to sterilize their instruments as the proteins are resistant to normal techniques. These discoveries seem to be new for some reason.

This has been my first opportunity to use the word 'pernicious', an exquisite word that has somehow escaped my notice until today. Thank you, dear Slashdot readers, for allowing me this occasion.

Re:pernicious: an apt term for prions

[mentil]

Can't spell 'pernicious' without 'prions'.
Or 'Prius' for that matter...

Re:pernicious: an apt term for prions

[Gilgaron]

Interesting... I'd have thought eye surgery would involve disposable blades due to the sharpness required, which instruments get reused?

Re:pernicious: an apt term for prions

[HiThere]

Sorry, but you've been affected by selective reporting (at multiple levels).

Prions are necessary for life. Much of the dry intra-cellular fluid is prions. Not all proteins are built initially in the active form, they often need a chaperon to cause them to fold correctly. These are prions just as much as the ones that cause incorrect folding. And without it no mammalian, I suspect no eucaryotic, life would exist.

For more details you need to consult a real expert, I'm just a sometimes interested layman, (A real expert would know which phyla require prions to live. My suspicion that it's the eucaryotes, and only the eucaryotes, is based on quite uncertain reasoning.)

Re:pernicious: an apt term for prions

[HiThere]

The useful ones are exactly the same as the deleterious ones except in the particular way they fold a particular protein. They are equally infectious. They are equally proteinaceous.

Re: pernicious: an apt term for prions

[Anonymous Coward]

And you just might be wholly wrong

How clean is clean enough for brain surgery?

[drew_92123]

If they're concerned about the spread of proteins then they aren't properly cleaning their instruments to begin with. Anything that can't be put in an autoclave or cleaned using chemicals that break down organic matter completely should be disposed of.... the fact that this isn't happening already, especially for brain surgery, is deeply concerning.

Re:How clean is clean enough for brain surgery?

[dex22]

The problem with your statement is that prions survive autoclaving and generally require incineration at temps exceeding the melting point of most surgical metals.

Re:How clean is clean enough for brain surgery?

[guruevi]

Some surgical instruments cost a lot of money. A simple micro instrument could cost ~$1000. If you need to throw them out, you're looking at padding the bill by another $50-100k.

Re:How clean is clean enough for brain surgery?

[HiThere]

Wellllll.....
At the end of the day, they're just specialized alloys of metal bent, cut, and specially heat-treated into fancy shapes. You could probably make them for less than $100 each, if the demand was high enough.

But "high enough" means a continuously active production line, that you don't shut down every other month. How much brain surgery do you plan on that specialized tools used in only particular variants of the operation will be cheap?

I'll grant that there is a huge mark-up, because the system has removed any decent feed-back mechanism, but that's not the only reason those things are expensive.

Re:How clean is clean enough for brain surgery?

[HiThere]

Wouldn't immersion in anhydrous ethyl alcohol solution of concentrated potassium hydroxide work? Of course, when we were cleaning glassware we preceded that by a bath in concentrated nitric acid, and followed it by a rinse in distilled water. We were, however, working with glassware that we wanted to remove proteins from...but we weren't worried about infection, merely analysis.

That said, it seems to me that there are a lot of protein cleaving enzymes that could be used in a pre-treatment bath. So the problem is to ensure that the sugar-coat that they're likely to be wearing is stripped off before the cleansing agent is applied. But there are other enzymes that are good against multiple varieties of sugar, and you wouldn't need to worry about it being safe internally, so you could use the wide-spectrum ones.

So this doesn't seem a process that's inherently impossible. Just one that's different and difficult (and expensive) to set up properly. (Of course, I'm no expert in the field.) It would probably also lengthen the turn around in how quickly you could re-use the tool. But once it's set up, it could probably be done by any lab tech with minimal training.

"Slim risk", "rare procedures". Why is this news?

[gweihir]

Seriously, panic much?

What was the article about again?

[Arzaboa]

Which brain tool is the problem? The drill, the scalpel, the cracker, or the cauterizer?

--
What's important is that you have a faith in people, that they're basically good and smart, and if you give them tools, they'll do wonderful things with them. - Steve Jobs

Re:What was the article about again?

[93 Escort Wagon]

The blackjack.

it's more of a reminder than news

[clovis]

I think what this is about is that it is really old news, and because it's rare and been a long time since then, newly trained doctors don't have this on their radar.
The much larger risk is from transfusions and graft material, a few hundred of those have occurred vs the 6 or so from surgical instruments over the last few decades.

overview
https://www.ncbi.nlm.nih.gov/p...
https://www.cdc.gov/prions/cjd...

Here's the WHO guidelines from 1999 for avoiding and decontamination
https://www.who.int/csr/resour...

Re:"Slim risk", "rare procedures". Why is this new

[mentil]

A 'slim risk' is one ambulance-chaser away from a "known risk that should've been mitigated."

Comment removed

[account_deleted]

Comment removed based on user account deletion

Why is this an issue?

[in10se]

I'm sorry, but why aren't they cleaning the equipment properly to begin with? And why is it news that using dirty equipment for surgery can cause problems for the patient?

"Properly" has changed

[tepples]

It happens when the definition of "properly" changes to accommodate new evidence about how infection spreads.

explains a lot

[guygo]

Well that explains Ben Carson

Re:WTF? They can't even sterilise instruments?

[spth]

Sterilization sufficient to kill / destroy usual pathogens like bacteria or viruses is not sufficient for prions.

Prions are much tougher. They can easily withstand a few hundred degrees Celsius, prolonged immersion in formaldehyde or high doses of ionizing radiation.

Re:Sterilize my wallet

[omnichad]

Or at least cauterize it so nothing else comes out.

Re:I thought that with 3D printers

[FormOfActionBanana]

They couldn't really be sterile, could they?

Re:"Slim risk", "rare procedures". Why is this new

[gweihir]

A slim risk in a rare case is "you get run over a car while crossing a road". Not something that prevents you from crossing roads, is it?

Re:"Slim risk", "rare procedures". Why is this new

[gweihir]

Almost half of all adults are expected to get a nuero-degenerative disease in the course of their life.

And that is the wrong number. How many adults do get brain-surgery? Right...

cbd

[KolesnikovaAnna]

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