The immune system and prion diseases: a relationship of complicity and blindness

In most documented infectious forms of transmissible spongiform encephalopathies, prions must transit through the lymphoreticular compartment before invading the central nervous system. A major goal has been to identify the cell susbsets that support replication and propagation of prions from sites of penetration to sites of neuroinvasion. The conclusions, still fragmentary and confusing, point at a few candidates: follicular dendritic cells (FDCs) and more recently, dendritic cells (DCs). It is clear, however, that lymphoinvasion does not depend on a single-cell type but needs a coordinated network of cells. Discrepancies between models suggest that the actors may vary according to prion strains. A second center of interest has emerged following reports that anti-prion protein (PrP) antibodies blocked in vitro cell conversion of normal PrP into pathological PrP and cured infected cell lines. As isoform conversion is a critical event in prion propagation and formation of lesions, the identification of immune agents capable of inhibiting the reaction is of major importance. In vivo experiments suggest that antibodies produced in transgenic mice or an ongoing immune reaction induced by peptides can prevent PrP conversion and retard disease progression. These results do not say whether clinical disease can be durably delayed and if immunological tolerance to PrP can be easily broken in infected individuals. Altogether, these results suggest that the unconventional relationship between prions and the immune system is on the eve of new and fascinating developments. Whether they will provide innovative strategies for early diagnosis and preventive treatments is still an open question.