Sunday, February 14, 2016
Antemortem detection of chronic wasting disease prions in nasal brush 
collections and rectal biopsies from white-tailed deer by real time 
quaking-induced conversion 
Nicholas J. Haleya#, Chris Siepkera, W. David Walterb, Bruce V. Thomsenc, 
Justin J. Greenleed, Aaron D. Lehmkuhlc and Jürgen A. Richta 
+ Author Affiliations Department of Diagnostic Medicine and Pathobiology, 
College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USAa 
U.S. Geological Survey, Pennsylvania Cooperative Fish and Wildlife Research 
Unit, Pennsylvania State University, University Park, Pennsylvania, USAb 3USDA, 
APHIS, VS, STAS, National Veterinary Service Laboratories, Ames, Iowa, USAc 
Virus and Prion Research Unit, National Animal Disease Center, ARS, USDA, Ames, 
Iowa, USAd 
ABSTRACT
Chronic wasting disease (CWD), a transmissible spongiform encephalopathy of 
cervids, was first documented nearly fifty years ago in Colorado and Wyoming, 
and has since spread to cervids in 23 states, two Canadian provinces, and the 
Republic of Korea. The expansion of this disease makes the development of 
sensitive diagnostic assays and antemortem sampling techniques crucial for the 
mitigation of spread; this is especially true in cases of 
relocation/reintroduction of farmed or free-ranging deer and elk, or 
surveillance studies in private or protected herds where depopulation is 
contraindicated. This study sought to evaluate the sensitivity of the real-time 
quaking-induced conversion (RT-QuIC) assay using recto-anal mucosa associated 
lymphoid tissue (RAMALT) biopsies and nasal brush samples collected antemortem 
from farmed white-tailed deer (n=409). Antemortem findings were then compared to 
results from ante- and postmortem samples (RAMALT, brainstem and medial 
retropharyngeal lymph nodes) evaluated using the current gold standard in vitro 
assay, immunohistochemistry (IHC). We hypothesized the sensitivity of RT-QuIC 
would be comparable to IHC in antemortem tissues, and would correlate with both 
genotype and stage of clinical disease. Our results showed that RAMALT testing 
by RT-QuIC had the highest sensitivity (69.8%) when compared to postmortem 
testing, with a specificity of >93.9%. These data suggest that RT-QuIC, like 
IHC, is an effective assay for detection of PrPCWD in rectal biopsies and other 
antemortem samples, and with further research to identify more sensitive 
tissues, bodily fluids, or experimental conditions, has potential for large 
scale and rapid automated testing for CWD diagnosis. 
 FOOTNOTES
↵#Address correspondence to Nicholas J. Haley, nicholas.j.haley@gmail.com. 
Copyright © 2016, American Society for Microbiology. All Rights Reserved. 
Friday, August 14, 2015 
*** Susceptibility of cattle to the agent of chronic wasting disease from 
elk after intracranial inoculation
Friday, August 14, 2015 
Carcass Management During a Mass Animal Health Emergency Draft Programmatic 
Environmental Impact Statement—August 2015 
Tuesday, September 22, 2015 
*** Host Determinants of Prion Strain Diversity Independent of Prion 
Protein Genotype 
Friday, August 28, 2015 
*** Chronic Wasting Disease CWD TSE Prion Diagnostics and subclinical 
infection 
Saturday, February 6, 2016 
Secretary's Advisory Committee on Animal Health; Meeting [Docket No. 
APHIS-2016-0007] Singeltary Submission 
Friday, February 05, 2016 
Report of the Committee on Wildlife Diseases FY2015 CWD TSE PRION 
Detections in Farmed Cervids and Wild 
Friday, February 05, 2016 
TEXAS NEW CHRONIC WASTING DISEASE CWD CASE DISCOVERD AT CAPTIVE DEER 
RELEASE SITE
TSS
    


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