A slow virus is a virus, or a viruslike agent, etiologically associated with a slow virus disease. A slow virus disease is a disease that, after an extended period of latency, follows a slow, progressive course spanning months to years, frequently involves the central nervous system, and in most cases progresses inexorably to death. Examples of slow virus diseases include subacute sclerosing panencephalitis which is the rare result of a measles virus infection, as well as Paget's Disease of Bone (Osteitis Deformans) which seems to be associated with paramyxoviruses, especially the measles virus and the human respiratory syncytial virus.
Every infectious agent is different, but in general, slow viruses:
- Cause an asymptomatic primary infection
- Have a long incubation period ranging from months to years
- Follow a slow but relentless progressive course leading to death
- Tend to have a genetic predisposition
- Often re-emerge from latency if the host becomes immuno-compromised
Additionally, the immune system seems to plays a limited role, or no role, in protection from many of these slow viruses. This may be due to the slow replication rates some of these agents exhibit, preexisting immunosupression (as in the cases of JC virus and BK virus),., or, in the case of prions the identity of the agent involved.
Some Examples of Viral Agents
|Virus||Virus family||Disease||Typical latency||Transmitted by|
|JC virus||Polyomavirus||Progressive multifocal leukoencephalopathy||Years to Life§||Unknown; Possibly contaminated water|
|BK virus||Polyomavirus||BK Nephropathy||Years to life§||Unknown; Possibly respiratory spread/urine Possibly contaminated water|
|Measles virus||Paramyxovirus||Subacute Sclerosing Panencephalitis||1–10 years||Respiratory droplets|
|Rubella virus||Togaviridae||Progressive Rubella Panencephalitis||10–20 years||Respiratory droplets|
|Rabies virus||Rhabdoviridae||Rabies||3–12 weeks||Bite of an infected animal|
- §JC virus & BK virus only cause disease in immunocompromised patients
Prions: "atypical slow viruses"
Transmissible spongiform encephalopathies (TSEs), including Kuru and Creutzfeldt–Jakob disease of humans, scrapie of sheep, and bovine spongiform encephalopathy (BSE) of cattle, were previously classified as slow virus diseases as well. However, TSEs are more correctly classified as prion diseases. Prions are misfolded proteins that are "infectious" because they can induce misfolding in other previously normal proteins, but they contain no DNA or RNA so they are not viruses. Before scientists knew the cause of spongiform encephalopathies, they hypothesized that small virus particles, which they termed virions, were to blame. Once it was discovered that prions were the real cause of TSEs and that prions contained no nucleic acid, the term virions was discarded and these particles were renamed prions. A minority of researchers still believe, however, that prion diseases are caused by an as-yet unidentified slow virus, although there is little evidence to support this finding
Prions are so named because they appear to contain only protein. No evidence of nucleic acid has been found in any prion particle studied. Treatments that destroy protein, like denaturation, destroy prion infectivity, but treatments that destroy nucleic acids, like UV radiation, do not destroy prion infectivity.
The prion protein is known as PrP and is a cell surface glycophosphatidylinositol(GPI)-anchored protein. Its normal function in the body is unknown, though presumably it serves, or served, some purpose because it is coded for by a host gene. The infectious form of PrP has the same amino acid sequence and the same post-translational modifications as the normal form, but it has a different tertiary conformation. The normal PrP contains many alpha-helices, whereas the disease-associated form contains many beta-pleated sheets. It is this conformational change from mostly alpha-helices to mostly beta-pleated sheets that gives the prion its infectious ability.
The disease-associated form of the prion protein is commonly referred to as PrPsc because it was first found in scrapie infections in sheep. The diseased form is also occasionally called PrPres because it is more resistant to protease than the normal, non-disease associated form.
In some cases, the cause of prion diseases is known. Ingestion of a copy of an abnormally folded, infectious PrP can induce a spongiform encephalopathy in the consumer. For example, Kuru is passed through the ritual consumption of brain material in some tribal cultures, and bovine spongiform encephalopathy is thought to have developed from the use of prion-infected sheep protein in cattle feed. However, some cases of spongeform encephalopathies appear to be sporadic, and it is not known in these cases what causes the first prion protein to change its conformation and become infectious. Once one abnormal prion protein exists, however, it can induce the conformational change from predominantly α-helix to predominately β-pleated sheet in neighboring proteins.
The clinical presentation of prion diseases will vary from patient to patient. However, some general characteristics of prion diseases are listed below.
- cause diseases that are confined to the CNS
- have a prolonged incubation period
- follow a slow, progressive, fatal course of disease
- produce a spongiform encephalopathy
- characteristically result in vacuolation of neurons
- can cause formation of fibrillar aggregates, which contain PrP and have amyloid-like characteristics
Some Examples of Prion Diseases
|Disease||Typical length of progression to death||Species affected|
|Kuru Disease||30-50 years||Humans|
|Fatal Familial Insomnia||8-75 months||Humans|
|Bovine Spongiform Encephalopathy||1-3 years||Cows, Humans|
- PubMed Health "Subacute Sclerosing Panencephalitis". Retrieved February 10, 2012.
- The Journal of Clinical Investigation "Paget's Disease of Bone". Retrieved February 2, 2018.
- Chapter 44 of Medical Microbiology by Warren Levinson "Slow Viruses & Prions". Retrieved February 2, 2018.
- The Journal of Virology "Underwhelming the Immune Response: Effect of Slow Virus Growth on CD8+-T-Lymphocyte Responses". Retrieved February 2, 2018.
- The Journal of Infectious Disease "BK and JC virus: a review". Retrieved February 2, 2018.
- Viruses "Prion Disease and the Innate Immune System". Retrieved February 2, 2018.
- The Postgraduate Medical Journal "Subacute sclerosing panencephalitis". Retrieved February 2, 2018.
- Nihon Rinsho. Japanese Journal of Clinical Medicine "Progressive rubella panencephalitis". Retrieved February 2, 2018.
- Lancet Neurology "Human rabies: neuropathogenesis, diagnosis, and management.". Retrieved February 2, 2018.
- Centers for Disease Control and Prevention "Prion Diseases". Retrieved February 10, 2012
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- Hunt, Margaret (October 2006). "Virology Chapter 23 — Slow Virus Diseases of the Nervous System". Microbiology and Immunology On-line. University of South Carolina School of Medicine. Retrieved 2012-02-10.
- The Lancet "Kuru in the 21st century—an acquired human prion disease with very long incubation periods". Retrieved February 2, 2018.
- Sleep Medicine Reviews "Fatal familial insomnia: a model disease in sleep physiopathology". Retrieved February 2, 2018.