Propagation of transmissible spongiform encephalopathies is believed to involve the conversion of cellular prion protein, PrP C , into a misfolded oligomeric form, PrPSc . An important step toward understanding the mechanism of this conversion is to elucidate the folding pathway(s) of the prion protein. We reported recently (Apetri, A. C., and Surewicz, W. K. (2002) J. Biol. Chem. 277, 44589 -44592) that the folding of wild-type prion protein can best be described by a three-state sequential model involving a partially folded intermediate. Here we have performed kinetic stopped-flow studies for a number of recombinant prion protein variants carrying mutations associated with familial forms of prion disease. Analysis of kinetic data clearly demonstrates the presence of partially structured intermediates on the refolding pathway of each PrP variant studied. In each case, the partially folded state is at least one order of magnitude more populated than the fully unfolded state. The present study also reveals that, for the majority of PrP variants tested, mutations linked to familial prion diseases result in a pronounced increase in the thermodynamic stability, and thus the population, of the folding intermediate. These data strongly suggest that partially structured intermediates of PrP may play a crucial role in prion protein conversion, serving as direct precursors of the pathogenic PrP Sc isoform.Prions are infectious pathogens that cause a group of fatal neurodegenerative diseases known as transmissible spongiform encephalopathies (1-4). These diseases can be sporadic, inherited, or acquired by infection. The human forms of prion disorders include Creutzfeldt-Jacob disease, GerstmannStraussler-Scheinker disease, fatal familial insomnia, and kuru, whereas the animal diseases encompass bovine spongiform encephalopathy in cattle, chronic wasting disorders in deer and elk, and scrapie in sheep. The histopathological marker of all prion diseases is the accumulation in the brain of an abnormal isoform of prion protein, PrP Sc . 1 This protein is derived by a post-translational mechanism from the normal (cellular) prion protein, PrP C . According to the protein-only hypothesis, PrP Sc is the sole component of the infectious prion agent (1, 5). It is also believed that when introduced into a normal host PrP Sc induces the conversion of endogenous PrP C into PrP Sc , and that this conversion is the central event in the propagation of the disease. Although the ultimate proof for the protein-only model is still missing (6), the central role of prion protein in the propagation of transmissible spongiform encephalopathies is documented by a wealth of biochemical data as well as animal studies (1-7). Furthermore, the notion that proteins can act as infectious agents is supported by studies on prion-like phenomena in yeast and fungi (8 -10).Human PrP C is a 209-residue glycoprotein that contains a single disulfide bond and is attached to the plasma membrane via a glycosylphosphatidylinositol anchor. NMR structural studies hav...