Amyloid-β accumulation in the CNS in human growth hormone recipients in the UK

Acta Neuropathol. 2017 Aug;134(2):221-240. doi: 10.1007/s00401-017-1703-0. Epub 2017 Mar 27.


Human-to-human transmission of Creutzfeldt-Jakob disease (CJD) has occurred through medical procedures resulting in iatrogenic CJD (iCJD). One of the commonest causes of iCJD was the use of human pituitary-derived growth hormone (hGH) to treat primary or secondary growth hormone deficiency. As part of a comprehensive tissue-based analysis of the largest cohort yet collected (35 cases) of UK hGH-iCJD cases, we describe the clinicopathological phenotype of hGH-iCJD in the UK. In the 33/35 hGH-iCJD cases with sufficient paraffin-embedded tissue for full pathological examination, we report the accumulation of the amyloid beta (Aβ) protein associated with Alzheimer's disease (AD) in the brains and cerebral blood vessels in 18/33 hGH-iCJD patients and for the first time in 5/12 hGH recipients who died from causes other than CJD. Aβ accumulation was markedly less prevalent in age-matched patients who died from sporadic CJD and variant CJD. These results are consistent with the hypothesis that Aβ, which can accumulate in the pituitary gland, was present in the inoculated hGH preparations and had a seeding effect in the brains of around 50% of all hGH recipients, producing an AD-like neuropathology and cerebral amyloid angiopathy (CAA), regardless of whether CJD neuropathology had occurred. These findings indicate that Aβ seeding can occur independently and in the absence of the abnormal prion protein in the human brain. Our findings provide further evidence for the prion-like seeding properties of Aβ and give insights into the possibility of iatrogenic transmission of AD and CAA.

Keywords: Amyloid β; Cerebral amyloid angiopathy; Human growth hormone; Iatrogenic Creutzfeldt–Jakob disease; Neuropathology; Prion protein.

MeSH terms

  • Adolescent
  • Adult
  • Amyloid beta-Peptides / metabolism*
  • Amyloid beta-Protein Precursor / metabolism
  • Apolipoproteins E / genetics
  • Apolipoproteins E / metabolism
  • Central Nervous System / drug effects*
  • Central Nervous System / metabolism
  • Cohort Studies
  • Creutzfeldt-Jakob Syndrome / genetics
  • Creutzfeldt-Jakob Syndrome / pathology
  • Creutzfeldt-Jakob Syndrome / therapy*
  • DNA-Binding Proteins / metabolism
  • Exome Sequencing
  • Female
  • Human Growth Hormone / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Prion Proteins
  • Severity of Illness Index
  • Treatment Outcome
  • United Kingdom / epidemiology
  • Young Adult
  • tau Proteins / metabolism


  • Amyloid beta-Peptides
  • Amyloid beta-Protein Precursor
  • Apolipoproteins E
  • DNA-Binding Proteins
  • Prion Proteins
  • TARDBP protein, human
  • tau Proteins
  • Human Growth Hormone