Successful use of the CER assay is largely dependent upon the quality of the substrate pairs used in conversion reactions. For this reason, following procedures to prepare CER substrate pairs, a quality control immunoblot should be performed (Figure 2). For both substrates, assay 10-25 μl by immunoblotting. PrPC should be easily detectable in each substrate and PrPC levels must be approximately the same between the two. Immunoreactivity will be mainly visible above 20 kDa, but smaller bands may also be evident. In our experience, the presence of smaller bands is species dependent. If lower molecular weight products are observed, their presence should be confirmed in both substrate pairs.
It is important to ensure that CER substrates are free from endogenous PrPres by treating substrates with PK (Figure 2). If PrPres is present, the animal used for substrate preparation may have been TSE-infected or subclinically-infected. Alternatively, the PrPC in the substrate may have misfolded to a PK-resistant state during denaturation or precipitation procedures. Independent from the reason, CER substrate containing PrPres is not acceptable for use in the conversion assay.
Laboratory mice are one of the most frequently used experimental animals in TSE research; as such, their susceptibility to most TSEs is well-characterized8, providing an in vivo benchmark against which to test the fidelity of the CER assay. Figure 3A presents results of CER assay conversion of PrPC from mouse (CD1 strain) substrate to PrPres by 1) the RML strain of mouse-passaged scrapie, an agent adapted to the mouse host18, 2) domestic sheep classical scrapie, an agent that can transmit to mice following a lengthy incubation period18, and 3) white-tailed deer (Odocoileus virginianus) CWD and 263K strain of hamster-passaged scrapie, agents to which mice are minimally or not susceptible19,20. Resulting PrPres levels were variable across mouse substrates denatured at pH 7.4 and seeded with the various TSE agents while PrPres was found in all substrates denatured at pH 3.5 and seeded with a TSE agent. Conversion ratios comparing the PrPres levels in the pH 7.4 and 3.5 substrates were independently calculated at least three times and means ± SD are shown in Figure 3B. For reactions seeded by RML, conversion ratios between pH 7.4 and 3.5 substrates were approximately 100%. For those seeded by scrapie, conversion in the pH 7.4 substrate was approximately 75% of that in the pH 3.5 substrate. CWD or 263K-induced conversion of the pH 7.4 substrate was minimal. A one-way analysis of variance could not distinguish a difference in the conversion ratios of RML and scrapie or CWD and 263K, however conversion ratios of RML and scrapie were significantly different from those of CWD and 263K.
The CER assay can be adapted for use with human tissues or with animal species where bioassays are too challenging or not ethical and transgenic mouse production is not desired. We have been using this assay to characterize the susceptibility of various wildlife species to CWD. As an example of the use of this assay, we present some preliminary results in Figure 4. Brains from hunter-trapped bobcats (Lynx rufus) were found to still contain detectable levels of PrPC and PrP breakdown products were not extensive, suggesting that these tissues could be an acceptable source for CER substrate (Figure 4A). Substrate pairs generated from bobcat brain showed PrP immunoreactivity of an appropriate molecular weight and did not contain endogenous PrPres (Figure 4B). When bobcat CER substrate pairs generated from two separate animals were incubated with the same white-tailed deer CWD agent used in the mouse CER assay described in Figure 3, we found substrates prepared at pH 7.4 had levels of PrPres compared to substrates prepared at pH 3.5 (Figure 4C), indicative of a minimal species barrier of bobcat PrPC to conversion by CWD. The CER for conversion of white-tailed deer PrPC by the same CWD isolate used to convert bobcat PrPC here, as a positive control, was previously reported as 95.2 ± 18.4% in Morawski et al. (2013)15.

Figure 1: Experimental overview of the CER assay. Two assay substrates are prepared by partially denaturing PrPC in non-prion infected brain tissue with chaotropic solutions at either pH 3.5 or pH 7.4. Substrates are seeded with PrPTSE from prion agent of interest and experimental samples are subjected to 24 hr incubation with shaking to allow PrPC to PrPTSE conversion in both pH 3.5 and 7.4 substrates. Following incubation, conversion is assessed by SDS-PAGE and immunoblotting. Signal densities are read by densitometry and the CER is calculated by the ratio of pH 7.4 to pH 3.5 signal densities for each experimental sample.

Figure 2: Quality control on CER substrates. (A) Prior to their use in the CER assay, mouse substrates prepared at either pH 7.4 or 3.5 are assayed by immunoblot in the 1) absence of PK treatment to assess PrPC content of each substrate pair (PrPC levels should be equivalent between pH 7.4 and 3.5 substrates for use in CER assay) and 2) presence of PK (100 µg/ml) treatment to test for pre-existing PrPres in tissues used to prepare substrates (any substrates that display pre-existing PrPres are not suitable for use in the CER assay). (B) To test for non-specific PrPres formation during the conversion assay, mouse PrPC substrates prepared at either pH 7.4 or 3.5 are seeded with conversion buffer, shaken for 24 hr at 1,000 rpm, 37 °C, and subsequently PK-treated (100 µg/ml) and assayed for PrPres by immunoblotting (right two lanes). Non-shaken, non-PK treated mouse substrates represent total PrPC content in assay reactions (left two lanes). For (B), irrelevant lanes have been cropped for clarity, but each immunoblot panel derives from the same gel, membrane and exposure. Immunoblots in all panels used monoclonal antibody SAF 83.

Figure 3: CER assay using laboratory mouse substrate. (A) Mouse CER assay substrate prepared at either pH 7.4 or 3.5 was incubated with RML mouse-adapted scrapie, domestic sheep classical scrapie, white-tailed deer chronic wasting disease (CWD) or 263K strain of hamster-adapted scrapie in the CER assay. Control samples (labeled “none”) contained only an equal amount of infectious agent and no mouse substrate. Samples were analyzed for the presence of PK-resistant prion protein (PrPres) by immunoblot with monoclonal antibody SAF 83. Raw densitometric values for each sample are displayed below each lane. (B) Bar graph indicating the average ratios (± standard deviation) between pH 7.4 and 3.5 mouse substrates for each infectious agent based on at least 3 independent assay runs. Lower-case letters refer to statistically homogenous subsets (analysis of variance with Tukey-Kramer minimum significance differences method; p <0.05). This figure has been modified from Morawski et al. 201315.

Figure 4: Sample use of CER assay to investigate bobcat susceptibility to CWD. Bobcat brain homogenate (A) and CER assay substrate (B) was tested by immunoblotting in the absence and presence of PK (100 µg/ml) to assess existing PrPC levels and the presence of pre-existing PrPres, respectively. (C) Bobcat substrates were seeded with conversion buffer and assayed in the CER assay to assess non-specific PrPres formation (left two lanes). Non-shaken, non-PK treated bobcat substrates represent total PrPC content in assay reactions (right two lanes). (D) Bobcat substrate prepared at either pH 7.4 or 3.5 was incubated with white-tailed deer CWD using the CER assay. The control sample (labeled “none”) contained an equal amount of CWD agent but no bobcat substrate. Raw densitometric values for each sample are displayed below each lane. Immunoblots in all panels used monoclonal antibody 3F4, which reacts with the feline prion protein21.