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  • Brief Communication
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Amyloid-β transmission or unexamined bias?

Nature volume 537, pages E7–E9 (2016)Cite this article

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ARISING FROM Z. Jaunmuktane et al. Nature 525, 247–250 (2015); doi:10.1038/nature15369

Jaunmuktane and colleagues reported on eight persons of short stature who had been treated with preparations of human-derived growth hormone and subsequently developed iatrogenic Creutzfeldt–Jakob disease (CJD)1. On autopsy, the authors found marked deposition of parenchymal and vascular amyloid-β (Aβ), which was unexpected given the relatively young age (36–51 years) of the patients. The selected comparator group included patients with sporadic CJD, who were not of short stature and did not receive any growth hormone treatment. These sporadic cases did not show marked Aβ pathology. Although the authors make an interesting case for iatrogenic transmission of Aβ pathology, their findings could also be explained by two notable differences between the eight growth-hormone-treated patients and the comparator group: the indication for growth hormone treatment and the treatment itself. There is a Reply to this Brief Communication Arising by Collinge, J. et al. Nature 537, http://dx.doi.org/10.1038/nature19087 (2016).

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Figure 1: Causal diagram depicting the proposed causal pathways, the authors’ interpretation, the two confounding biases and the inconclusive conditioning on presence of prion disease.

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Authors and Affiliations

  1. Department of Epidemiology, Erasmus MC, Rotterdam, 3015 CE, The Netherlands

    Hieab H. H. Adams, Sonja A. Swanson, Albert Hofman & M. Arfan Ikram

  2. Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, 3015 CE, The Netherlands

    Hieab H. H. Adams & M. Arfan Ikram

  3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, 02115, Massachusetts, USA

    Sonja A. Swanson & Albert Hofman

  4. Department of Neurology, Erasmus MC, Rotterdam, 3015 CE, The Netherlands

    M. Arfan Ikram

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  1. Hieab H. H. Adams
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All authors contributed to the study and to the writing of this Brief Communication Arising.

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Correspondence to M. Arfan Ikram.

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H. Adams, H., A. Swanson, S., Hofman, A. et al. Amyloid-β transmission or unexamined bias?. Nature 537, E7–E9 (2016). https://doi.org/10.1038/nature19086

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