Sporadic Creutzfeldt-Jakob disease: Real-Time Quaking-Induced Conversion (RT-QuIC) assay represents a major diagnostic advance

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare and fatal neurodegenerative disorder with an incidence of 1.5 to 2 cases per million population/year. The disease is caused by a proteinaceous infectious agent, named prion (or PrP(Sc)), which arises from the conformational conversion of the cellular prion protein (Pr(PC)). Once formed, PrP(Sc) interacts with the normally folded Pr(PC) coercing it to undergo similar structural rearrangement. The disease is highly heterogeneous from a clinical and neuropathological point of view. The origin of this variability lies in the aberrant structures acquired by PrP(Sc). At least six different sCJD phenotypes have been described and each of them is thought to be caused by a peculiar PrP(Sc) strain. Definitive sCJD diagnosis requires brain analysis with the aim of identifying intracerebral accumulation of PrP(Sc) which currently represents the only reliable biomarker of the disease. Clinical diagnosis of sCJD is very challenging and is based on the combination of several clinical, instrumental and laboratory tests representing surrogate disease biomarkers. Thanks to the advent of the ultrasensitive Real-Time Quaking-Induced Conversion (RT-QuIC) assay, PrP(Sc) was found in several peripheral tissues of sCJD patients, sometimes even before the clinical onset of the disease. This discovery represents an important step forward for the clinical diagnosis of sCJD. In this manuscript, we present an overview of the current applications and future perspectives of RT-QuIC in the field of sCJD diagnosis.