Current key issues
Many years after BSE and vCJD made their appearance in the UK, they remain a major public health concern. Action is taking place in the following areas:
The search for a diagnostic test
A suspected diagnosis of vCJD can be confirmed through examination of the brain but although much research is taking place in this area, there is still no simple non-invasive test that would detect it before the onset of symptoms. The Department of Health has allocated over £7.3 million to fund research for a test that could confirm a diagnosis and detect people who may be incubating the disease. The Chief Medical Officer also asked the Health Protection Agency to organise a seminar to discuss the ethical and social issues associated with the introduction of a screening test: this was due to take place by the end of March, 2005.
Treatment
At the moment there is no cure for any type of CJD. Drugs are available to ease the symptoms and help the patient feel more comfortable, but the disease is fatal. The search for a treatment is a major priority. Several new research projects into possible treatments have already started.
A recent study from the US has shown that quinacrine and chlorpromazine, used in humans for many years as antipsychotic and antimalarial drugs, can reduce prion synthesis in the test tube and thus may benefit patients suffering from vCJD. This work received a great deal of publicity in 2001 when a British patient travelled to the US to receive treatment and media reports suggested that she was beginning to recover. Following the reports, several doctors in the UK started treating patients with these drugs.
Sadly, subsequent clinical assessment of the patient could not detect any lasting improvement and she has now died. However the laboratory data were promising and a clinical trial of quinacrine started in 2004. The trial, funded by the Department of Health, is being managed by the Medical Research Council.
Another drug, pentosan polysulphate, is being used to treat some patients. As pentosan is not licensed for use in the UK, it can only be prescribed under a doctor's personal responsibility. Pentosan is one of a group of compounds shown to extend the incubation period - or in some cases to prevent the onset of clinical disease - when given prophylactically to animals experimentally infected with TSEs. The Committee on Safety of Medicines (CSM) said in 2003 that there still was not enough data to form a basis for prescribing pentosan as a preventative measure or treatment but it is keeping the subject under review.
