title: Postmortem findings in a case of variant Creutzfeldt-Jakob disease treated with intraventricular pentosan polysulfate.
abstract: BACKGROUND
  A small number of patients with variant Creutzfeldt-Jakob disease (vCJD) have been treated with intraventicular pentosan polysulfate (iPPS) and extended survival has been reported in some cases. To date, there have been no reports on the findings of postmortem examination of the brain in treated patients and the reasons for the extended survival are uncertain. We report on the neuropathological findings in a case of vCJD treated with PPS.
  
  
  METHODS
  Data on survival in vCJD is available from information held at the National CJD Research and Surveillance Unit and includes the duration of illness in 176 cases of vCJD, five of which were treated with iPPS. One of these individuals, who received iPPS for 8 years and lived for 105 months, underwent postmortem examination, including neuropathological examination of the brain.
  
  
  RESULTS
  The mean survival in vCJD is 17 months, with 40 months the maximum survival in patients not treated with PPS. In the 5 patients treated with PPS survival was 16 months, 45 months, 84 months, 105 months and 114 months. The patient who survived 105 months underwent postmortem examination which confirmed the diagnosis of vCJD and showed severe, but typical, changes, including neuronal loss, astrocytic gliosis and extensive prion protein (PrP) deposition in the brain. The patient was also given PPS for a short period by peripheral infusion and there was limited PrP immunostaining in lymphoreticular tissues such as spleen and appendix.
  
  
  CONCLUSIONS
  Treatment with iPPS did not reduce the overall neuropathological changes in the brain. The reduced peripheral immunostaining for PrP may reflect atrophy of these tissues in relation to chronic illness rather than a treatment effect. The reason for the long survival in patients treated with iPPS is unclear, but a treatment effect on the disease process cannot be excluded.
authors.affiliation: Department of Neurology, James Cook University Hospital, Middlesborough, UK.
authors.forename: P K
authors.initials: PK
authors.lastname: Newman
authors.affiliation: Department of Neurosurgery, Northern Medical Services, Newcastle, UK.
authors.forename: N V
authors.initials: NV
authors.lastname: Todd
authors.affiliation: Department of Neurology, James Cook University Hospital, Middlesborough, UK.
authors.forename: D
authors.initials: D
authors.lastname: Scoones
authors.affiliation: National Prion Clinic, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mead
authors.affiliation: National CJD Research and Surveillance Unit, Western General Hospital, Edinburgh, UK.
authors.forename: R S G
authors.initials: RS
authors.lastname: Knight
authors.affiliation: National CJD Research and Surveillance Unit, Western General Hospital, Edinburgh, UK.
authors.forename: R G
authors.initials: RG
authors.lastname: Will
authors.affiliation: National CJD Research and Surveillance Unit, Western General Hospital, Edinburgh, UK.
authors.forename: J W
authors.initials: JW
authors.lastname: Ironside
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D001344:Autopsy; D001921:Brain / Q000473:pathology; D007562:Creutzfeldt-Jakob Syndrome / Q000188:drug therapy* / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007276:Injections, Intraventricular; D010426:Pentosan Sulfuric Polyester / Q000008:administration & dosage / Q000627:therapeutic use*; D011328:Prions / Q000378:metabolism; D013534:Survival
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D011328:Prions; D010426:Pentosan Sulfuric Polyester
keywords: CREUTZFELDT-JAKOB DISEASE; NEUROPATHOLOGY; PRION