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Karam S, Kaushal A, Abu Amer N, Royal V, KItchlu A. Non-Immunoglobulin Amyloidosis-Mediated Kidney Disease: Emerging Understanding of Underdiagnosed Entities. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:334-345. [PMID: 39084759 DOI: 10.1053/j.akdh.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 08/02/2024]
Abstract
Amyloidosis is a complex group of rare disorders characterized by the deposition of misfolded proteins in the extracellular space of various tissues and organs, leading to progressive organ dysfunction. The kidneys constitute a very common site affected, most notably by immunoglobulin-mediated (light chain, heavy chain, and light and heavy chain amyloidosis), but other types that include serum amyloid A (AA) amyloidosis and leukocyte chemotactic factor 2 amyloidosis, along with mutant proteins in several hereditary forms of amyloidosis such as transthyretin, fibrinogen α-chain, gelsolin, lysozyme, and apolipoproteins AI/AII/AIV/CII/CIII amyloidosis have been incriminated as well. The clinical presentation is variable and can range from minimal proteinuria for leukocyte chemotactic factor 2 amyloidosis to a full-blown nephrotic syndrome for AA amyloidosis. Clinical correlation, genetic analysis, and adequate tissue typing through a kidney biopsy are essential to make the correct diagnosis, especially when a family history of amyloidosis is absent. Except for AA and transthyretin amyloidosis, the treatment is usually purely supportive. Kidney transplantation is an acceptable form of treatment for end-stage kidney disease in all types of non-Ig-mediated renal amyloidosis.
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Affiliation(s)
- Sabine Karam
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis.
| | - Amit Kaushal
- Division of Nephrology, West Virginia University, Morgantown, WV
| | - Nabil Abu Amer
- Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Virginie Royal
- Division of Pathology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Canada
| | - Abhijat KItchlu
- Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
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2
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Namba N, Ohgita T, Tamagaki-Asahina H, Nishitsuji K, Shimanouchi T, Sato T, Saito H. Amyloidogenic 60-71 deletion/ValThr insertion mutation of apolipoprotein A-I generates a new aggregation-prone segment that promotes nucleation through entropic effects. Sci Rep 2023; 13:18514. [PMID: 37898709 PMCID: PMC10613298 DOI: 10.1038/s41598-023-45803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/24/2023] [Indexed: 10/30/2023] Open
Abstract
The N-terminal fragment of apolipoprotein A-I (apoA-I), comprising residues 1-83, contains three segments prone to aggregation: residues 14-22, 53-58, and 67-72. We previously demonstrated that residues 14-22 are critical in apoA-I fibril formation while residues 53-58 entropically drove the nucleation process. Here, we investigated the impact of amyloidogenic mutations (Δ60-71/VT, Δ70-72, and F71Y) located around residues 67-72 on fibril formation by the apoA-I 1-83 fragment. Thioflavin T fluorescence assay demonstrated that the Δ60-71/VT mutation significantly enhances both nucleation and fibril elongation rates, whereas the Δ70-72 and F71Y mutations had minimal effects. Circular dichroism measurements and microscopic observations revealed that all variant fragments formed straight fibrils, transitioning from random coils to β-sheet structures. Kinetic analysis demonstrated that primary nucleation is the dominant step in fibril formation, with fibril elongation reaching saturation at high protein concentrations. Thermodynamically, both nucleation and fibril elongation were enthalpically and entropically unfavorable in all apoA-I 1-83 variants, in which the entropic barrier of nucleation was almost eliminated for the Δ60-71/VT variant. Taken together, our results suggest the presence of new aggregation-prone segment in the Δ60-71/VT variant that promotes nucleation through entropic effects.
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Affiliation(s)
- Norihiro Namba
- Laboratory of Biophysical Chemistry, Kyoto Pharmaceutical University, 5 Misasagi-Nakauchi-cho, Yamashina-ku, Kyoto, 607-8414, Japan
| | - Takashi Ohgita
- Laboratory of Biophysical Chemistry, Kyoto Pharmaceutical University, 5 Misasagi-Nakauchi-cho, Yamashina-ku, Kyoto, 607-8414, Japan
| | - Hiroko Tamagaki-Asahina
- Division of Liberal Arts Sciences, Kyoto Pharmaceutical University, 5 Misasagi-Nakauchi-cho, Yamashina-ku, Kyoto, 607-8414, Japan
| | - Kazuchika Nishitsuji
- Department of Biochemistry, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Toshinori Shimanouchi
- Graduate School of Environmental and Life Science, Okayama University, Okayama, 700-8530, Japan
| | - Takeshi Sato
- Division of Liberal Arts Sciences, Kyoto Pharmaceutical University, 5 Misasagi-Nakauchi-cho, Yamashina-ku, Kyoto, 607-8414, Japan
| | - Hiroyuki Saito
- Laboratory of Biophysical Chemistry, Kyoto Pharmaceutical University, 5 Misasagi-Nakauchi-cho, Yamashina-ku, Kyoto, 607-8414, Japan.
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3
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Tomasoni D, Aimo A, Adamo M, Nardi M, Lombardi CM, Regazzoni V, De Angelis MG, Fabiani I, Merlini G, Mussinelli R, Obici L, Panichella G, Vergaro G, Passino C, Scolari F, Perlini S, Emdin M, Metra M. Echocardiographic findings in subjects with an amyloidogenic apolipoprotein A1 pathogenic variant. Amyloid 2023; 30:335-345. [PMID: 36988111 DOI: 10.1080/13506129.2023.2190003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Very small case series of patients with apolipoprotein A1 (ApoA1) amyloidosis are available. METHODS We described the clinical and echocardiographic characteristics of individuals with the pathogenic APOA1 variant Leu75Pro (p. Leu99Pro), referred for cardiac screening. RESULTS We enrolled 189 subjects, 54% men, median age 55 years (interquartile range 42-67), 39% with concomitant renal disease and 31% with liver disease. Median left ventricular ejection fraction was 60% (55-66). Overall, these subjects did not show overt diastolic dysfunction nor left ventricular (LV) hypertrophy. Age correlated with interventricular septal (IVS) thickness (r = 0.484), LV mass index (r = 0.459), E/e' (r = 0.501), and right ventricular free wall thickness (r = 0.594) (all p < 0.001). Some individuals displayed red flags for cardiac amyloidosis (CA), and 14% met non-invasive criteria for CA. Twenty-nine subjects died over 5.8 years (4.1-8.0), with 10 deaths for cardiovascular causes. Individuals meeting echocardiographic criteria for CA had a much higher risk of all-cause death (p = 0.009), cardiovascular death (p = 0.001), cardiovascular death or heart failure (HF) hospitalisation (p < 0.001). Subjects with both renal and liver involvement had a more prominent cardiac involvement, and shortest survival. CONCLUSIONS Subjects with the APOA1 Leu75Pro variant displayed minor echocardiographic signs of cardiac involvement, but 14% met echocardiographic criteria for CA. Subjects with suspected CA had a worse outcome.
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Affiliation(s)
- Daniela Tomasoni
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Aimo
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Matilde Nardi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Carlo Mario Lombardi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Maria Grazia De Angelis
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Iacopo Fabiani
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pavia, Italy
| | - Roberta Mussinelli
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pavia, Italy
| | - Laura Obici
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pavia, Italy
| | - Giorgia Panichella
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giuseppe Vergaro
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Claudio Passino
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesco Scolari
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Division of Nephrology and Dialysis, University of Brescia and ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Stefano Perlini
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pavia, Italy
| | - Michele Emdin
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Muchtar E, Dasari S, Theis JD, Ongie L, Cabral HT, McPhail ED, Dispenzieri A, Gertz MA, Rech KL. A novel APOA1 frameshift mutation Glu120Glyfs*60 with upper gastrointestinal involvement and an indolent course. Amyloid 2023; 30:353-355. [PMID: 36919584 DOI: 10.1080/13506129.2023.2187679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Eli Muchtar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Surendra Dasari
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jason D Theis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Laura Ongie
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Huong T Cabral
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ellen D McPhail
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Angela Dispenzieri
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karen L Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Frustaci A, Verardo R, Russo MA, Caldarulo M, Alfarano M, Galea N, Miraldi F, Chimenti C. Infiltration of Conduction Tissue Is a Major Cause of Electrical Instability in Cardiac Amyloidosis. J Clin Med 2023; 12:jcm12051798. [PMID: 36902585 PMCID: PMC10003445 DOI: 10.3390/jcm12051798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The pathology of conduction tissue (CT) and relative arrhythmias in living subjects with cardiac amyloid have never been reported. AIMS To report CT pathology and its arrhythmic correlations in human cardiac amyloidosis. METHODS AND RESULTS In 17 out of 45 cardiac amyloid patients, a left ventricular endomyocardial biopsy included conduction tissue sections. It was identified by Aschoff-Monckeberg histologic criteria and positive immunostaining for HCN4. The degree of conduction tissue infiltration was defined as mild when ≤30%, moderate when 30-70% and severe when >70% cell area was replaced. Conduction tissue infiltration was correlated with ventricular arrhythmias, maximal wall thickness and type of amyloid protein. Mild involvement was observed in five cases, moderate in three and severe in nine. Involvement was associated with a parallel infiltration of conduction tissue artery. Conduction infiltration correlated with the severity of arrhythmias (Spearman rho = 0.8, p < 0.001). In particular, major ventricular tachyarrhythmias requiring pharmacologic treatment or ICD implantation occurred in seven patients with severe, one patient with moderate and none with mild conduction tissue infiltration. Pacemaker implantation was required in three patients, with complete conduction section replacement. No significant correlation was observed between the degree of conduction infiltration and age, cardiac wall thickness or type of amyloid protein. CONCLUSIONS Amyloid-associated cardiac arrhythmias correlate with the extent of conduction tissue infiltration. Its involvement is independent from type and severity of amyloidosis, suggesting a variable affinity of amyloid protein to conduction tissue.
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Affiliation(s)
- Andrea Frustaci
- Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Via Portuense 292, 00149 Rome, Italy
- Correspondence: ; Tel.: +39-06-5517-0520
| | - Romina Verardo
- Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Via Portuense 292, 00149 Rome, Italy
| | - Matteo Antonio Russo
- MEBIC Consortium, San Raffaele Open University, 00166 Rome, Italy
- Cellular and Molecular Pathology, IRCCS San Raffaele, 00166 Rome, Italy
| | - Marina Caldarulo
- Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Via Portuense 292, 00149 Rome, Italy
| | - Maria Alfarano
- Department of Clinical Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, 00185 Rome, Italy
| | - Nicola Galea
- Department of Experimental Medicine, Sapienza University, 00185 Rome, Italy
| | - Fabio Miraldi
- Department of Clinical Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, 00185 Rome, Italy
| | - Cristina Chimenti
- Department of Clinical Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, 00185 Rome, Italy
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6
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Del Giudice R, Lindvall M, Nilsson O, Monti DM, Lagerstedt JO. The Apparent Organ-Specificity of Amyloidogenic ApoA-I Variants Is Linked to Tissue-Specific Extracellular Matrix Components. Int J Mol Sci 2022; 24:318. [PMID: 36613763 PMCID: PMC9820410 DOI: 10.3390/ijms24010318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Apolipoprotein A-I (ApoA-I) amyloidosis is a rare protein misfolding disease where fibrils of the N-terminal domain of the protein accumulate in several organs, leading to their failure. Although ApoA-I amyloidosis is systemic, the different amyloidogenic variants show a preferential tissue accumulation that appears to correlate with the location of the mutation in the protein sequence and with the local extracellular microenvironment. However, the factors leading to cell/tissues damage, as well as the mechanisms behind the observed organ specificity are mostly unknown. Therefore, we investigated the impact of ApoA-I variants on cell physiology and the mechanisms driving the observed tissue specificity. We focused on four ApoA-I amyloidogenic variants and analyzed their cytotoxicity as well as their ability to alter redox homeostasis in cell lines from different tissues (liver, kidney, heart, skin). Moreover, variant-specific interactions with extracellular matrix (ECM) components were measured by synchrotron radiation circular dichroism and enzyme-linked immunosorbent assay. Data indicated that ApoA-I variants exerted a cytotoxic effect in a time and cell-type-specific manner that seems to be due to protein accumulation in lysosomes. Interestingly, the ApoA-I variants exhibited specific preferential binding to the ECM components, reflecting their tissue accumulation pattern in vivo. While the binding did not to appear to affect protein conformations in solution, extended incubation of the amyloidogenic variants in the presence of different ECM components resulted in different aggregation propensity and aggregation patterns.
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Affiliation(s)
- Rita Del Giudice
- Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Mikaela Lindvall
- Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Oktawia Nilsson
- Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Daria Maria Monti
- Department of Chemical Sciences, University of Napoli Federico II, Complesso Universitario Monte Sant’Angelo, 80126 Napoli, Italy
- Istituto Nazionale di Biostrutture e Biosistemi (INBB), 00136 Rome, Italy
| | - Jens O. Lagerstedt
- Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
- Islet Cell Exocytosis, Lund University Diabetes Centre, Department of Clinical Sciences Malmö, Lund University, 20506 Malmö, Sweden
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Gorshkova IN, Meyers NL, Herscovitz H, Mei X, Atkinson D. Human apoA-I[Lys107del] mutation affects lipid surface behavior of apoA-I and its ability to form large nascent HDL. J Lipid Res 2022; 64:100319. [PMID: 36525992 PMCID: PMC9926306 DOI: 10.1016/j.jlr.2022.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 11/18/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
Population studies have found that a natural human apoA-I variant, apoA-I[K107del], is strongly associated with low HDL-C but normal plasma apoA-I levels. We aimed to reveal properties of this variant that contribute to its unusual phenotype associated with atherosclerosis. Our oil-drop tensiometry studies revealed that compared to WT, recombinant apoA-I[K107del] adsorbed to surfaces of POPC-coated triolein drops at faster rates, remodeled the surfaces to a greater extent, and was ejected from the surfaces at higher surface pressures on compression of the lipid drops. These properties may drive increased binding of apoA-I[K107del] to and its better retention on large triglyceride-rich lipoproteins, thereby increasing the variant's content on these lipoproteins. While K107del did not affect apoA-I capacity to promote ABCA1-mediated cholesterol efflux from J774 cells, it impaired the biogenesis of large nascent HDL particles resulting in the formation of predominantly smaller nascent HDL. Size-exclusion chromatography of spontaneously reconstituted 1,2-dimyristoylphosphatidylcholine-apoA-I complexes showed that apoA-I[K107del] had a hampered ability to form larger complexes but formed efficiently smaller-sized complexes. CD analysis revealed a reduced ability of apoA-I[K107del] to increase α-helical structure on binding to 1,2-dimyristoylphosphatidylcholine or in the presence of trifluoroethanol. This property may hinder the formation of large apoA-I[K107del]-containing discoidal and spherical HDL but not smaller HDL. Both factors, the increased content of apoA-I[K107del] on triglyceride-rich lipoproteins and the impaired ability of the variant to stabilize large HDL particles resulting in reduced lipid:protein ratios in HDL, may contribute to normal plasma apoA-I levels along with low HDL-C and increased risk for CVD.
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8
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Cohen OC, Blakeney IJ, Law S, Ravichandran S, Gilbertson J, Rowczenio D, Mahmood S, Sachchithanantham S, Wisniowski B, Lachmann HJ, Whelan CJ, Martinez-Naharro A, Fontana M, Hawkins PN, Gillmore JD, Wechalekar AD. The experience of hereditary apolipoprotein A-I amyloidosis at the UK National Amyloidosis Centre. Amyloid 2022; 29:237-244. [PMID: 35502644 DOI: 10.1080/13506129.2022.2070741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Hereditary apolipoprotein A-I (AApoAI) amyloidosis is a rare heterogeneous disease with variable age of onset and organ involvement. There are few series detailing the natural history and outcomes of solid organ transplantation across a range of causative APOA1 gene mutations. METHODS We identified all patients with AApoAI amyloidosis who presented to the National Amyloidosis Centre (NAC) between 1986 and 2019. RESULTS In total, 57 patients with 14 different APOA1 mutations were identified including 18 patients who underwent renal transplantation (5 combined liver-kidney (LKT) and 2 combined heart-kidney (HKT) transplants). Median age of presentation was 43 years and median time from presentation to referral was 3 (0-31 years). Involvement of the kidneys, liver and heart by amyloid was detected in 81%, 67% and 28% of patients, respectively. Renal amyloidosis was universal in association with the most commonly identified variant (Gly26Arg, n = 28). Across all variants, patients with renal amyloidosis had a median creatinine of 159 µmol/L and median urinary protein of 0.3 g/24 h at the time of diagnosis of AApoAI amyloidosis and median time from diagnosis to end-stage renal disease was 15.0 (95% CI: 10.0-20.0) years. Post-renal transplantation, median allograft survival was 22.0 (13.0-31.0) years. There was one early death following transplantation (infection-related at 2 months post-renal transplant) and no episodes of early rejection leading to graft failure. Liver transplantation led to regression of amyloid in all four cases in whom serial 123I-SAP scintigraphy was performed. CONCLUSIONS AApoAI amyloidosis is a slowly progressive disease that is challenging to diagnose. The outcomes of transplantation are encouraging and graft survival is excellent.
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Affiliation(s)
- Oliver C Cohen
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Iona J Blakeney
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Steven Law
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Sriram Ravichandran
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Janet Gilbertson
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Dorota Rowczenio
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Shameem Mahmood
- National Amyloidosis Centre, University College London, London, United Kingdom
- University College Hospital, London, United Kingdom
| | - Sajitha Sachchithanantham
- National Amyloidosis Centre, University College London, London, United Kingdom
- University College Hospital, London, United Kingdom
| | - Brendan Wisniowski
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Helen J Lachmann
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Carol J Whelan
- National Amyloidosis Centre, University College London, London, United Kingdom
| | | | - Marianna Fontana
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London, London, United Kingdom
- University College Hospital, London, United Kingdom
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9
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Bhale AS, Venkataraman K. Leveraging knowledge of HDLs major protein ApoA1: Structure, function, mutations, and potential therapeutics. Biomed Pharmacother 2022; 154:113634. [PMID: 36063649 DOI: 10.1016/j.biopha.2022.113634] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/02/2022] Open
Abstract
Apolipoprotein A1 (ApoA1) is a member of the Apolipoprotein family of proteins. It's a vital protein that helps in the production of high-density lipoprotein (HDL) particles, which are crucial for reverse cholesterol transport (RCT). It also has anti-inflammatory, anti-atherogenic, anti-apoptotic, and anti-thrombotic properties. These functions interact to give HDL particles their cardioprotective characteristics. ApoA1 has recently been investigated for its potential role in atherosclerosis, diabetes, neurological diseases, cancer, and certain infectious diseases. Since ApoA1's discovery, numerous mutations have been reported that affect its structural integrity and alter its function. Hence these insights have led to the development of clinically relevant peptides and synthetic reconstituted HDL (rHDL) that mimics the function of ApoA1. As a result, this review has aimed to provide an organized explanation of our understanding of the ApoA1 protein structure and its role in various essential pathways. Furthermore, we have comprehensively reviewed the important ApoA1 mutations (24 mutations) that are reported to be involved in various diseases. Finally, we've focused on the therapeutic potentials of some of the beneficial mutations, small peptides, and synthetic rHDL that are currently being researched or developed, since these will aid in the development of novel therapeutics in the future.
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Affiliation(s)
- Aishwarya Sudam Bhale
- Centre for Bio-Separation Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - Krishnan Venkataraman
- Centre for Bio-Separation Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India.
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10
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Del Giudice R, Imbimbo P, Pietrocola F, Martins I, De Palma FDE, Bravo-San Pedro JM, Kroemer G, Maiuri MC, Monti DM. Autophagy Alteration in ApoA-I Related Systemic Amyloidosis. Int J Mol Sci 2022; 23:ijms23073498. [PMID: 35408859 PMCID: PMC8998969 DOI: 10.3390/ijms23073498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 02/06/2023] Open
Abstract
Amyloidoses are characterized by the accumulation and aggregation of misfolded proteins into fibrils in different organs, leading to cell death and consequent organ dysfunction. The specific substitution of Leu 75 for Pro in Apolipoprotein A-I protein sequence (ApoA-I; L75P-ApoA-I) results in late onset amyloidosis, where deposition of extracellular protein aggregates damages the normal functions of the liver. In this work, we describe that the autophagic process is inhibited in the presence of the L75P-ApoA-I amyloidogenic variant in stably transfected human hepatocyte carcinoma cells. The L75P-ApoA-I amyloidogenic variant alters the redox status of the cells, resulting into excessive mitochondrial stress and consequent cell death. Moreover, L75P-ApoA-I induces an impairment of the autophagic flux. Pharmacological induction of autophagy or transfection-enforced overexpression of the pro-autophagic transcription factor EB (TFEB) restores proficient proteostasis and reduces oxidative stress in these experimental settings, suggesting that pharmacological stimulation of autophagy could be a promising target to alleviate ApoA-I amyloidosis.
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Affiliation(s)
- Rita Del Giudice
- Department of Chemical Sciences, University of Napoli Federico II, Complesso Universitario Monte Sant’Angelo, 80126 Napoli, Italy; (R.D.G.); (P.I.)
| | - Paola Imbimbo
- Department of Chemical Sciences, University of Napoli Federico II, Complesso Universitario Monte Sant’Angelo, 80126 Napoli, Italy; (R.D.G.); (P.I.)
| | - Federico Pietrocola
- Department of Biosciences and Nutrition, Karolinska Institute, 14157 Huddinge, Sweden;
| | - Isabelle Martins
- Centre de Recherche des Cordeliers, INSERM U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France; (I.M.); (F.D.E.D.P.); (G.K.); (M.C.M.)
- Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Fatima Domenica Elisa De Palma
- Centre de Recherche des Cordeliers, INSERM U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France; (I.M.); (F.D.E.D.P.); (G.K.); (M.C.M.)
- CEINGE-Biotecnologie Avanzate s.c.a.r.l., 80145 Napoli, Italy
- Department of Molecular Medicine and Medical Biotechnologies, University of Napoli Federico II, 80131 Napoli, Italy
| | | | - Guido Kroemer
- Centre de Recherche des Cordeliers, INSERM U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France; (I.M.); (F.D.E.D.P.); (G.K.); (M.C.M.)
- Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, 94805 Villejuif, France
- Institut Universitaire de France, 75005 Paris, France
- Pôle de Biologie, Hôpital Européen Georges Pompidou, Ap-hp, 75015 Paris, France
| | - Maria Chiara Maiuri
- Centre de Recherche des Cordeliers, INSERM U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France; (I.M.); (F.D.E.D.P.); (G.K.); (M.C.M.)
- Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, 94805 Villejuif, France
- Pharmacy Department, University of Napoli Federico II, 80131 Napoli, Italy
| | - Daria Maria Monti
- Department of Chemical Sciences, University of Napoli Federico II, Complesso Universitario Monte Sant’Angelo, 80126 Napoli, Italy; (R.D.G.); (P.I.)
- Istituto Nazionale di Biostrutture e Biosistemi (INBB), 00136 Rome, Italy
- Correspondence:
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11
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Trusova V, Tarabara U, Zhytniakivska O, Vus K, Gorbenko G. Fӧrster resonance energy transfer analysis of amyloid state of proteins. BBA ADVANCES 2022; 2:100059. [PMID: 37082586 PMCID: PMC10074846 DOI: 10.1016/j.bbadva.2022.100059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
The Förster resonance energy transfer (FRET) is a well-established and versatile spectroscopic technique extensively used for exploring a variety of biomolecular interactions and processes. The present review is intended to cover the main results of our FRET studies focused on amyloid fibrils, a particular type of disease-associated protein aggregates. Based on the examples of several fibril-forming proteins including insulin, lysozyme and amyloidogenic variants of N-terminal fragment of apolipoprotein A-I, it was demonstrated that: (i) the two- and three-step FRET with the classical amyloid marker Thioflavin T as an input donor has a high amyloid-sensing potential and can be used to refine the amyloid detection assays; (ii) the intermolecular time-resolved and single-molecule pulse interleaved excitation FRET can give quantitative information on the nucleation of amyloid fibrils; (iii) FRET between the membrane fluorescent probes and protein-associated intrinsic or extrinsic fluorophores is suitable for monitoring the membrane binding of fibrillar proteins, exploring their location relative to lipid-water interface and restructuring on a lipid matrix; (iv) the FRET-based distance estimation between fibril-bound donor and acceptor fluorophores can serve as one of the verification criteria upon structural modeling of amyloid fibrils.
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12
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Gottwald J, Röcken C. The amyloid proteome: a systematic review and proposal of a protein classification system. Crit Rev Biochem Mol Biol 2021; 56:526-542. [PMID: 34311636 DOI: 10.1080/10409238.2021.1937926] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Amyloidosis is a disease caused by pathological fibril aggregation and deposition of proteins in different tissues and organs. Thirty-six fibril-forming proteins have been identified. So far, proteomic evaluation of amyloid focused on the detection and characterization of fibril proteins mainly for diagnostic purposes or to find novel fibril-forming proteins. However, amyloid deposits are a complex mixture of constituents that show organ-, tissue-, and amyloid-type specific patterns, that is the amyloid proteome. We carried out a comprehensive literature review on publications investigating amyloid via liquid chromatography coupled to tandem mass spectrometry, including but not limited to sample preparation by laser microdissection. Our review confirms the complexity and dynamics of the amyloid proteome, which can be divided into four functional categories: amyloid proteome-category 1 (APC1) includes exclusively fibrillary proteins found in the patient; APC2 includes potential fibril-forming proteins found in other types of amyloid; and APC3 and APC4 summarizes non-fibril proteins-some being amyloid signature proteins. Our categorization may help to systemically explore the nature and role of the amyloid proteome in the manifestation, progression, and clearance of disease. Further exploration of the amyloid proteome may form the basis for the development of novel diagnostic tools, thereby enabling the development of novel therapeutic targets.
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Affiliation(s)
- Juliane Gottwald
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
| | - Christoph Röcken
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
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13
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Tasaki M, Okada M, Yanagisawa A, Nomura T, Matsushita H, Ueda A, Inoue Y, Masuda T, Misumi Y, Yamashita T, Nakamura T, Miyamoto T, Obayashi K, Ando Y, Ueda M. Apolipoprotein AI amyloid deposits in the ligamentum flavum in patients with lumbar spinal canal stenosis. Amyloid 2021; 28:107-112. [PMID: 33305623 DOI: 10.1080/13506129.2020.1858404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Amyloidosis is a protein-misfolding disease characterised by insoluble amyloid deposits in the extracellular space of various organs and tissues, such as the brain, heart, kidneys, and ligaments. We previously reported the frequent occurrence of amyloid deposits in the ligament flavum in the presence of lumbar spinal canal stenosis (LSCS), which is a common spinal disorder in older individuals. Our earlier clinicopathological studies revealed that amyloid deposits derived from transthyretin (TTR) were involved in the pathogenesis of LSCS. ATTR amyloid was the most common form in the ligamentum flavum, but amyloid deposits that were not identified still existed in more than 50% of patients with LSCS. In this study, we found apolipoprotein AI (AApoAI) amyloid deposits in the ligamentum flavum of patients with LSCS. The deposits occurred in 12% of patients with LSCS. Biochemical studies revealed that the amyloid deposits consisted mainly of full-length ApoAI. As a notable finding, the lumbar ligamentum flavum of patients who had LSCS with double-positive amyloid deposits-positive for both ATTR and AApoAI-was significantly thicker than that of patients who had LSCS with single-positive-that is, positive for either ATTR or AApoAI-amyloid deposits. We thus suggest that lumbar AApoAI amyloid formation may enhance the pathological changes of lumbar ATTR amyloidosis in patients with LSCS.
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Affiliation(s)
- Masayoshi Tasaki
- Department of Morphological and Physiological Sciences, Graduate School of Health Sciences, Kumamoto University, Kumamoto, Japan.,Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masamitsu Okada
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Toshiya Nomura
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroaki Matsushita
- Department of Amyloidosis Research, Nagasaki International University, Sasebo, Japan
| | - Akihiko Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuteru Inoue
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Teruaki Masuda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yohei Misumi
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Taro Yamashita
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takayuki Nakamura
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takeshi Miyamoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Konen Obayashi
- Department of Morphological and Physiological Sciences, Graduate School of Health Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukio Ando
- Department of Amyloidosis Research, Nagasaki International University, Sasebo, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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14
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Multi-omic analyses in Abyssinian cats with primary renal amyloid deposits. Sci Rep 2021; 11:8339. [PMID: 33863921 PMCID: PMC8052419 DOI: 10.1038/s41598-021-87168-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 03/19/2021] [Indexed: 02/02/2023] Open
Abstract
The amyloidoses constitute a group of diseases occurring in humans and animals that are characterized by abnormal deposits of aggregated proteins in organs, affecting their structure and function. In the Abyssinian cat breed, a familial form of renal amyloidosis has been described. In this study, multi-omics analyses were applied and integrated to explore some aspects of the unknown pathogenetic processes in cats. Whole-genome sequences of two affected Abyssinians and 195 controls of other breeds (part of the 99 Lives initiative) were screened to prioritize potential disease-associated variants. Proteome and miRNAome from formalin-fixed paraffin-embedded kidney specimens of fully necropsied Abyssinian cats, three affected and three non-amyloidosis-affected were characterized. While the trigger of the disorder remains unclear, overall, (i) 35,960 genomic variants were detected; (ii) 215 and 56 proteins were identified as exclusive or overexpressed in the affected and control kidneys, respectively; (iii) 60 miRNAs were differentially expressed, 20 of which are newly described. With omics data integration, the general conclusions are: (i) the familial amyloid renal form in Abyssinians is not a simple monogenic trait; (ii) amyloid deposition is not triggered by mutated amyloidogenic proteins but is a mix of proteins codified by wild-type genes; (iii) the form is biochemically classifiable as AA amyloidosis.
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15
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Abstract
PURPOSE OF REVIEW Amyloidosis is caused by the deposition of misfolded aggregated proteins called amyloid fibrils that in turn cause organ damage and dysfunction. In this review, we aim to summarize the genetic, clinical, and histological findings in apolipoprotein-associated hereditary amyloidosis and the growing list of mutations and apolipoproteins associated with this disorder. We also endeavor to summarize the features of apolipoproteins that have led them to be overrepresented among amyloidogenic proteins. Additionally, we aim to distinguish mutations leading to amyloidosis from those that lead to inherited dyslipidemias. RECENT FINDINGS Apolipoproteins are becoming increasingly recognized in hereditary forms of amyloidosis. Although mutations in APOA1 and APOA2 have been well established in hereditary amyloidosis, new mutations are still being detected, providing further insight into the pathogenesis of apolipoprotein-related amyloidosis. Furthermore, amyloidogenic mutations in APOC2 and APOC3 have more recently been described. Although no hereditary mutations in APOE or APOA4 have been described to date, both protein products are amyloidogenic and frequently found within amyloid deposits. SUMMARY Understanding the underlying apolipoprotein mutations that contribute to hereditary amyloidosis may help improve understanding of this rare but serious disorder and could open the door for targeted therapies and the potential development of new treatment options.
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Affiliation(s)
- Natasha Jeraj
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Robert A Hegele
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Amanda J Berberich
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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16
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Ohgita T, Furutani Y, Nakano M, Hattori M, Suzuki A, Nakagawa M, Naniwa S, Morita I, Oyama H, Nishitsuji K, Kobayashi N, Saito H. Novel conformation‐selective monoclonal antibodies against apoA‐I amyloid fibrils. FEBS J 2021. [DOI: 10.1111/febs.15487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Takashi Ohgita
- Department of Biophysical Chemistry Kyoto Pharmaceutical University Japan
| | - Yuki Furutani
- Department of Biophysical Chemistry Kyoto Pharmaceutical University Japan
| | - Miyu Nakano
- Department of Biophysical Chemistry Kyoto Pharmaceutical University Japan
| | - Megumi Hattori
- Department of Biophysical Chemistry Kyoto Pharmaceutical University Japan
| | - Ayane Suzuki
- Department of Biophysical Chemistry Kyoto Pharmaceutical University Japan
| | - Miho Nakagawa
- Department of Biophysical Chemistry Kyoto Pharmaceutical University Japan
| | - Sera Naniwa
- Department of Bioanalytical Chemistry Kobe Pharmaceutical University Japan
| | - Izumi Morita
- Department of Bioanalytical Chemistry Kobe Pharmaceutical University Japan
| | - Hiroyuki Oyama
- Department of Bioanalytical Chemistry Kobe Pharmaceutical University Japan
| | | | - Norihiro Kobayashi
- Department of Bioanalytical Chemistry Kobe Pharmaceutical University Japan
| | - Hiroyuki Saito
- Department of Biophysical Chemistry Kyoto Pharmaceutical University Japan
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17
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Muchtar E, Dispenzieri A, Magen H, Grogan M, Mauermann M, McPhail ED, Kurtin PJ, Leung N, Buadi FK, Dingli D, Kumar SK, Gertz MA. Systemic amyloidosis from A (AA) to T (ATTR): a review. J Intern Med 2021; 289:268-292. [PMID: 32929754 DOI: 10.1111/joim.13169] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/15/2020] [Indexed: 01/09/2023]
Abstract
Systemic amyloidosis is a rare protein misfolding and deposition disorder leading to progressive organ failure. There are over 15 types of systemic amyloidosis, each caused by a different precursor protein which promotes amyloid formation and tissue deposition. Amyloidosis can be acquired or hereditary and can affect various organs, including the heart, kidneys, liver, nerves, gastrointestinal tract, lungs, muscles, skin and soft tissues. Symptoms are usually insidious and nonspecific resulting in diagnostic delay. The field of amyloidosis has seen significant improvements over the past decade in diagnostic accuracy, prognosis prediction and management. The advent of mass spectrometry-based shotgun proteomics has revolutionized amyloid typing and has led to the discovery of new amyloid types. Accurate typing of the precursor protein is of paramount importance as the type dictates a specific management approach. In this article, we review each type of systemic amyloidosis to provide the practitioner with practical tools to improve diagnosis and management of these rare disorders.
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Affiliation(s)
- E Muchtar
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - H Magen
- Hematology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - M Grogan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - M Mauermann
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - E D McPhail
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - P J Kurtin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
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18
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Yoshinaga T, Katoh N, Yazaki M, Sato M, Kametani F, Yasuda H, Watanabe K, Kawata K, Nakagawa M, Sekijima Y. Giant Hepatomegaly with Spleno-testicular Enlargement in a Patient with Apolipoprotein A-I Amyloidosis: An Uncommon Type of Amyloidosis in Japan. Intern Med 2021; 60:575-581. [PMID: 32999221 PMCID: PMC7946490 DOI: 10.2169/internalmedicine.5126-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hereditary systemic amyloidosis aside from transthyretin-related familial amyloid polyneuropathy is quite uncommon in Japan. We herein report a sporadic case of hereditary apolipoprotein A-I (apoAI) amyloidosis. The patient was a 43-year-old Japanese man who exhibited marked hepatomegaly with spleno-testicular enlargement. While he was initially thought to have primary AL amyloidosis, a proteomics analysis revealed that the amyloid was composed of variant apoAI with an E34K variant. To date, only one patient with apoAI amyloidosis has been reported in Japan. However, our study suggests that more patients may be present in Japan, and the majority may have been diagnosed with other types of amyloidosis due to its clinical similarity.
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Affiliation(s)
- Tsuneaki Yoshinaga
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
- Institute for Biomedical Sciences, Shinshu University, Japan
| | - Nagaaki Katoh
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Masahide Yazaki
- Institute for Biomedical Sciences, Shinshu University, Japan
- Clinical Laboratory Science Division, Shinshu University Graduate School of Medicine (Health Sciences), Japan
| | - Mitsuto Sato
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Fuyuki Kametani
- Department of Dementia and Higher Brain Function, Tokyo Metropolitan Institute of Medical Science, Japan
| | - Hideo Yasuda
- First Depatment of Medicine, Hamamatsu University School of Medicine, Japan
| | | | - Kazuhito Kawata
- Hepatology Division, Department of Internal Medicine II, Hamamatsu University School of Medicine, Japan
| | - Mayuko Nakagawa
- Institute for Biomedical Sciences, Shinshu University, Japan
- Clinical Laboratory Science Division, Shinshu University Graduate School of Medicine (Health Sciences), Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
- Institute for Biomedical Sciences, Shinshu University, Japan
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19
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Sagawa T, Kogiso T, Ito T, Yasuda H, Katoh N, Yoshinaga T, Yazaki M, Kato T, Omori A, Kotera Y, Egawa H, Yamamoto M, Tokushige K. Hereditary Apolipoprotein A-1 Amyloidosis With Glu34Lys Mutation Treated by Liver Transplantation: A Case Report. Transplant Proc 2021; 53:1327-1332. [PMID: 33573822 DOI: 10.1016/j.transproceed.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022]
Abstract
Hereditary apolipoprotein A-1 (ApoA-1) amyloidosis is a rare disease characterized by progressive deposition of amyloid fibrils in the kidney, heart, and liver. We observed a 45-year-old male patient with liver failure. Liver dysfunction was detected at 30 years of age during an annual health check-up. At 35 years of age, renal dysfunction was also found. At 40 years of age, the pathologic findings of the liver revealed amyloid deposition. A testis biopsy specimen taken at 42 years of age to identify the cause of male infertility showed amyloid accumulation. At 43 years of age, the amyloid results and genetic profile led to a definitive diagnosis of hereditary ApoA-1 amyloidosis caused by Glu34Lys mutation. A family history was absent. Liver failure showed Budd-Chiari-like formation, including enlargement of the caudate lobe and liver congestion. Although the patient showed end-stage liver cirrhosis and renal failure, only liver transplant was performed considering the burden for a living donor. The enlarged liver (4.9 kg) showed amyloid deposition in parenchyma and the space of Disse. Amyloid also accumulated in the giant spleen. The APOA1 mutation Glu34Lys is extremely rare, and in this case hepatic failure was successfully treated by liver transplant to both replace organ function and reduce production of the amyloidogenic ApoA-1-variant protein. Careful observation for reaccumulation of amyloidosis in the organ is required.
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Affiliation(s)
- Takaomi Sagawa
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomomi Kogiso
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Taito Ito
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideo Yasuda
- Hamamatsu University School of Medicine, Internal Medicine, Hamamatsu, Shizuoka, Japan
| | - Nagaaki Katoh
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tsuneaki Yoshinaga
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Masahide Yazaki
- Department of Biomedical Laboratory Sciences, Shinshu University School of Health Sciences, Matsumoto, Nagano, Japan; Institute for Biomedical Sciences, Shinshu University, Matsumoto, Nagano, Japan
| | - Takaaki Kato
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Akiko Omori
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshihito Kotera
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsutoshi Tokushige
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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20
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Nilsson O, Lindvall M, Obici L, Ekström S, Lagerstedt JO, Del Giudice R. Structure dynamics of ApoA-I amyloidogenic variants in small HDL increase their ability to mediate cholesterol efflux. J Lipid Res 2020; 62:100004. [PMID: 33410751 PMCID: PMC7890215 DOI: 10.1194/jlr.ra120000920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/04/2020] [Accepted: 11/17/2020] [Indexed: 01/17/2023] Open
Abstract
Apolipoprotein A-I (ApoA-I) of high density lipoproteins (HDLs) is essential for the transportation of cholesterol between peripheral tissues and the liver. However, specific mutations in ApoA-I of HDLs are responsible for a late-onset systemic amyloidosis, the pathological accumulation of protein fibrils in tissues and organs. Carriers of these mutations do not exhibit increased cardiovascular disease risk despite displaying reduced levels of ApoA-I/HDL cholesterol. To explain this paradox, we show that the HDL particle profiles of patients carrying either L75P or L174S ApoA-I amyloidogenic variants show a higher relative abundance of the 8.4-nm versus 9.6-nm particles and that serum from patients, as well as reconstituted 8.4- and 9.6-nm HDL particles (rHDL), possess increased capacity to catalyze cholesterol efflux from macrophages. Synchrotron radiation circular dichroism and hydrogen-deuterium exchange revealed that the variants in 8.4-nm rHDL have altered secondary structure composition and display a more flexible binding to lipids than their native counterpart. The reduced HDL cholesterol levels of patients carrying ApoA-I amyloidogenic variants are thus balanced by higher proportion of small, dense HDL particles, and better cholesterol efflux due to altered, region-specific protein structure dynamics.
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Affiliation(s)
- Oktawia Nilsson
- Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Mikaela Lindvall
- Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Laura Obici
- Amyloidosis Research & Treatment Centre, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simon Ekström
- BioMS - Swedish National Infrastructure for Biological Mass Spectrometry, Lund University, Lund, Sweden
| | - Jens O Lagerstedt
- Department of Experimental Medical Science, Lund University, Lund, Sweden; Lund Institute of Advanced Neutron and X-ray Science (LINXS), Lund, Sweden.
| | - Rita Del Giudice
- Department of Experimental Medical Science, Lund University, Lund, Sweden.
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21
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Asiri MMH, Engelsman S, Eijkelkamp N, Höppener JWM. Amyloid Proteins and Peripheral Neuropathy. Cells 2020; 9:E1553. [PMID: 32604774 PMCID: PMC7349787 DOI: 10.3390/cells9061553] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022] Open
Abstract
Painful peripheral neuropathy affects millions of people worldwide. Peripheral neuropathy develops in patients with various diseases, including rare familial or acquired amyloid polyneuropathies, as well as some common diseases, including type 2 diabetes mellitus and several chronic inflammatory diseases. Intriguingly, these diseases share a histopathological feature-deposits of amyloid-forming proteins in tissues. Amyloid-forming proteins may cause tissue dysregulation and damage, including damage to nerves, and may be a common cause of neuropathy in these, and potentially other, diseases. Here, we will discuss how amyloid proteins contribute to peripheral neuropathy by reviewing the current understanding of pathogenic mechanisms in known inherited and acquired (usually rare) amyloid neuropathies. In addition, we will discuss the potential role of amyloid proteins in peripheral neuropathy in some common diseases, which are not (yet) considered as amyloid neuropathies. We conclude that there are many similarities in the molecular and cell biological defects caused by aggregation of the various amyloid proteins in these different diseases and propose a common pathogenic pathway for "peripheral amyloid neuropathies".
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Affiliation(s)
- Mohammed M. H. Asiri
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (M.M.H.A.); (S.E.); (J.W.M.H.)
- The National Centre for Genomic Technology, Life Science and Environment Research Institute, King Abdulaziz City for Science and Technology, P.O. Box 6086, 11461 Riyadh, Saudi Arabia
| | - Sjoukje Engelsman
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (M.M.H.A.); (S.E.); (J.W.M.H.)
| | - Niels Eijkelkamp
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (M.M.H.A.); (S.E.); (J.W.M.H.)
| | - Jo W. M. Höppener
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (M.M.H.A.); (S.E.); (J.W.M.H.)
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands
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22
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Gaddi GM, Gisonno RA, Rosú SA, Curto LM, Prieto ED, Schinella GR, Finarelli GS, Cortez MF, Bauzá L, Elías EE, Ramella NA, Tricerri MA. Structural analysis of a natural apolipoprotein A-I variant (L60R) associated with amyloidosis. Arch Biochem Biophys 2020; 685:108347. [DOI: 10.1016/j.abb.2020.108347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 01/11/2023]
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23
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Papathanasiou M, Carpinteiro A, Rischpler C, Hagenacker T, Rassaf T, Luedike P. Diagnosing cardiac amyloidosis in every-day practice: A practical guide for the cardiologist. IJC HEART & VASCULATURE 2020; 28:100519. [PMID: 32373710 PMCID: PMC7191222 DOI: 10.1016/j.ijcha.2020.100519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 01/15/2023]
Abstract
Cardiac amyloidosis (CA) has emerged as a previously underestimated cause of heart failure and mortality. Underdiagnosis resulted mainly from unawareness of the true disease prevalence and the non-specific symptoms of the disease. CA results from extracellular deposition of misfolded protein fibrils, commonly derived from transthyretin (ATTR) or immunoglobulin light chains (AL). A significant proportion of older patients with heart failure and other extracardiac manifestations suffer from ATTR-CA, whereas AL-CA is still considered a rare disease. This article provides an overview of CA with a special focus on current and emerging diagnostic modalities. Furthermore, we provide a diagnostic algorithm for the evaluation of patients with suspected CA in every-day practice.
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Key Words
- 99mTc-DPD, 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid
- AA, amyloid A amyloidosis
- AApoA-1, apolipoprotein A-1 amyloidosis
- AL, light chain amyloidosis
- ATTR, transthyretin amyloidosis
- ATTRv, variant transthyretin amyloidosis
- ATTRwt, wild type transthyretin amyloidosis
- Amyloidosis
- CA, cardiac amyloidosis
- Cardiomyopathy
- ECV, Extracellular volume
- EMB, endomyocardial biopsy
- Heart failure
- LGE, late gadolinium enhancement
- LV, left ventricular/ left ventricular
- Light chains
- MGUS, monoclonal gammopathy of undetermined significance
- MRI, magnetic resonance imaging
- NT-proBNP, N-terminal pro B-type natriuretic peptide
- PET, positron-emission tomography
- SPECT, single photon emission computed tomography
- Transthyretin
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Affiliation(s)
- Maria Papathanasiou
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.,West German Amyloidosis Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Alexander Carpinteiro
- Department of Hematology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.,West German Amyloidosis Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.,West German Amyloidosis Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Tim Hagenacker
- Department of Neurology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.,West German Amyloidosis Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.,West German Amyloidosis Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.,West German Amyloidosis Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
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24
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Colombat M, Aldigier JC, Rothschild PR, Javaugue V, Desport E, Frouget T, Goujon JM, Rioux-Leclercq N, Quellard N, Rerolle JP, Paraf F, Beugnet C, Tiple A, Durrbach A, Samuel D, Brézin A, Bridoux F, Valleix S. New clinical forms of hereditary apoA-I amyloidosis entail both glomerular and retinal amyloidosis. Kidney Int 2020; 98:195-208. [PMID: 32571483 DOI: 10.1016/j.kint.2020.03.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/01/2020] [Accepted: 03/16/2020] [Indexed: 12/19/2022]
Abstract
Apolipoprotein A1 amyloidosis (ApoAI) results from specific mutations in the APOA1 gene causing abnormal accumulation of amyloid fibrils in diverse tissues. The kidney is a prominent target tissue in ApoAI amyloidosis with a remarkable selectivity for the renal medulla. Here, we investigated six French families with ApoAI Glu34Lys, p.His179Profs∗47, and a novel p.Thr185Alafs∗41 variant revealing unprecedented clinical association of a glomerular with a retinal disease. Comprehensive clinicopathological, molecular and proteomics studies of numerous affected tissues ensured the correlation between clinical manifestations, including novel unrecognized phenotypes, and apoA-I amyloid deposition. These ophthalmic manifestations stemmed from apoA-I amyloid deposition, highlighting that the retina is a previously unrecognized tissue affected by ApoAI amyloidosis. Our study provides the first molecular evidence that a significant fraction of ApoAI amyloidosis cases with no family history result from spontaneous neomutations rather than variable disease penetrance. Finally, successful hepatorenal transplantation resulted in a life- and vision-saving measure for a 32-year-old man with a hitherto unreported severe ApoAI amyloidosis caused by the very rare Glu34Lys variant. Our findings reveal new modes of occurrence and expand the clinical spectrum of ApoAI amyloidosis. The awareness of glomerular and ocular manifestations in ApoAI amyloidosis should enable earlier diagnosis and avoid misdiagnosis with other forms of renal amyloidosis. Thus, documented apoA-I amyloid deposition in the retina offers new biological information about this disease and may change organ transplantation practice to reduce retinal damage in patients with ApoAI amyloidosis.
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Affiliation(s)
- Magali Colombat
- Service d'Anatomopathologie, Institut Universitaire du Cancer Toulouse Oncopole, Centre Hospitalo-Universitaire Toulouse, Toulouse, France
| | - Jean-Claude Aldigier
- Service de Néphrologie et de transplantation rénale, Centre Hospitalo-Universitaire Dupuytren, Limoges, France
| | - Pierre-Raphael Rothschild
- Service d'Ophtalmologie, OphtalmoPôle, Hôpital Cochin, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Javaugue
- Service de Néphrologie, Hémodialyse et Transplantation Rénale, Centre Hospitalo-Universitaire Poitiers, Poitiers, France
| | - Estelle Desport
- Service de Néphrologie, Hémodialyse et Transplantation Rénale, Centre Hospitalo-Universitaire Poitiers, Poitiers, France
| | - Thierry Frouget
- Service de Néphrologie, Centre Hospitalo-Universitaire Pontchaillou, Rennes, France
| | - Jean-Michel Goujon
- Service d'Anatomie Pathologique, Unité de microscopie électronique, Centre Hospitalo-Universitaire La Miletrie, Centre de Référence National Amylose AL et autres maladies de dépôts d'immunoglobulines monoclonales, Université de Poitiers, Poitiers, France
| | - Nathalie Rioux-Leclercq
- Laboratoire d'Anatomopathologie, Centre Hospitalo-Universitaire Pontchaillou, Rennes, France
| | - Nathalie Quellard
- Service d'Anatomie Pathologique, Unité de microscopie électronique, Centre Hospitalo-Universitaire La Miletrie, Centre de Référence National Amylose AL et autres maladies de dépôts d'immunoglobulines monoclonales, Université de Poitiers, Poitiers, France
| | - Jean Philippe Rerolle
- Service de Néphrologie et de transplantation rénale, Centre Hospitalo-Universitaire Dupuytren, Limoges, France
| | - François Paraf
- Laboratoire d'anatomopathologie, Centre Hospitalo-Universitaire Dupuytren, Limoges, France
| | - Caroline Beugnet
- Laboratoire de Génétique Moléculaire, Fédération de Génétique, Hôpital Necker-Enfants Malades, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélien Tiple
- Service de Néphrologie et Transplantation, Centre Hospitalier Jacques Lacarin de Vichy, Vichy, France
| | - Antoine Durrbach
- Service de Néphrologie, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Didier Samuel
- Centre hépato-biliare, Hôpital Paul Brousse, Assistance Publique Hôpitaux de Paris, Villejuif, France
| | - Antoine Brézin
- Service d'Ophtalmologie, OphtalmoPôle, Hôpital Cochin, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frank Bridoux
- Service de Néphrologie, Hémodialyse et Transplantation Rénale, Centre Hospitalo-Universitaire Poitiers, Poitiers, France
| | - Sophie Valleix
- Laboratoire de Génétique Moléculaire, Fédération de Génétique, Hôpital Necker-Enfants Malades, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France.
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25
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Zanoni P, von Eckardstein A. Inborn errors of apolipoprotein A-I metabolism: implications for disease, research and development. Curr Opin Lipidol 2020; 31:62-70. [PMID: 32022753 DOI: 10.1097/mol.0000000000000667] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW We review current knowledge regarding naturally occurring mutations in the human apolipoprotein A-I (APOA1) gene with a focus on their clinical complications as well as their exploitation for the elucidation of structure-function-(disease) relationships and therapy. RECENT FINDINGS Bi-allelic loss-of-function mutations in APOA1 cause HDL deficiency and, in the majority of patients, premature atherosclerotic cardiovascular disease (ASCVD) and corneal opacities. Heterozygous HDL-cholesterol decreasing mutations in APOA1 were associated with increased risk of ASCVD in several but not all studies. Some missense mutations in APOA1 cause familial amyloidosis. Structure-function-reationships underlying the formation of amyloid as well as the manifestion of amyloidosis in specific tissues are better understood. Lessons may also be learnt from the progress in the treatment of amyloidoses induced by transthyretin variants. Infusion of reconstituted HDL (rHDL) containing apoA-I (Milano) did not cause regression of atherosclerosis in coronary arteries of patients with acute coronary syndrome. However, animal experiments indicate that rHDL with apoA-I (Milano) or apoA-I mimetic peptides may be useful for the treatment of heart failure of inflammatory bowel disease. SUMMARY Specific mutations in APOA1 are the cause of premature ASCVD or familial amyloidosis. Synthetic mimetics of apoA-I (mutants) may be useful for the treatment of several diseases beyond ASCVD.
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Affiliation(s)
- Paolo Zanoni
- Institute of Medical Genetics, University of Zurich
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26
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Li D, Liu D, Xu H, Yu XJ, Zhou FD, Zhao MH, Wang SX. Typing of hereditary renal amyloidosis presenting with isolated glomerular amyloid deposition. BMC Nephrol 2019; 20:476. [PMID: 31870425 PMCID: PMC6929319 DOI: 10.1186/s12882-019-1667-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 12/18/2019] [Indexed: 12/03/2022] Open
Abstract
Background The commonly used methods for amyloid typing include immunofluorescence or immunohistochemistry (IHC), which sometimes may come with diagnostic pitfalls. Mass spectrometry (MS)-based proteomics has been recognized as a reliable technique in amyloid typing. Case presentation We reported two middle-aged patients who presented with proteinuria, hypertension and normal renal function, and both had a family history of renal diseases. The renal biopsies of both patients revealed renal amyloidosis with the similar pattern by massive exclusively glomerular amyloid deposition. The IHC was performed by using a panel of antibodies against the common types of systemic amyloidosis, and demonstrated co-deposition of fibrinogen Aα chain and apolipoprotein A-I in the glomerular amyloid deposits of each patient. Then the MS on amyloid deposits captured by laser microdissection (LMD/MS) and genetic study of gene mutations were investigated. The large spectra corresponding to ApoA-I in case 1, and fibrinogen Aα chain in case 2 were identified by LMD/MS respectively. Further analysis of genomic DNA mutations demonstrated a heterozygous mutation of p. Trp74Arg in ApoA-I in case 1, and a heterozygous mutation of p. Arg547GlyfsTer21 in fibrinogen Aα chain in case 2. Conclusions The current study revealed that IHC was not reliable for accurate amyloid typing, and that MS-based proteomics and genetic analysis were essential for typing of hereditary amyloidosis.
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Affiliation(s)
- Danyang Li
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, 100034, People's Republic of China
| | - Dan Liu
- Proteomics Laboratory, Medical and Healthy Analytical Center, Peking University Health Science Center, Beijing, 100191, People's Republic of China
| | - Hui Xu
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, 100034, People's Republic of China
| | - Xiao-Juan Yu
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, People's Republic of China
| | - Fu-de Zhou
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, People's Republic of China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, People's Republic of China
| | - Su-Xia Wang
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, 100034, People's Republic of China.
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27
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Di Giovanni B, Gustafson D, Adamson MB, Delgado DH. Hiding in Plain Sight: Cardiac Amyloidosis, an Emerging Epidemic. Can J Cardiol 2019; 36:373-383. [PMID: 32145865 DOI: 10.1016/j.cjca.2019.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 12/13/2022] Open
Abstract
Amyloidosis is a term used to describe a group of rare heterogeneous diseases that ultimately result in the deposition and accumulation of misfolded proteins. These misfolded proteins, known as amyloids, are associated with a variety of precursor proteins that have amyloidogenic potential. Ultimately, the specific type of amyloidosis is dependent on multiple factors including genetic variability of precursor proteins and the tissue or organ in which the amyloid accumulates. Several types of amyloid have a predilection for the heart and thus contribute to cardiac amyloidosis, a major cause of restrictive cardiomyopathy. Individuals with cardiac amyloidosis present clinically with heart failure with preserved ejection fraction. Although improved diagnostics and increased awareness of cardiac amyloidosis have led to a relative increase in diagnosis, cardiac amyloidosis remains an underrecognized and underdiagnosed cause of heart failure with preserved ejection fraction. It is essential to properly identify cases of cardiac amyloidosis and determine the pathology responsible for the formation of amyloid to appropriately provide management. This review aims to encourage physician awareness of cardiac amyloidosis by focusing on clinical presentation and the distinctions between types. Furthermore, epidemiology is central to understanding the affected demographics and sometimes hereditary nature of the disease. Improved understanding of cardiac amyloidosis will ideally lead to earlier diagnosis and interventions to improve patient outcomes.
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Affiliation(s)
- Bennett Di Giovanni
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Dakota Gustafson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Mitchell B Adamson
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Diego H Delgado
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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28
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Cottini F, Bott C, Nadasdy T, Brodsky SV, Benson D. A novel APOA1 mutation in a patient with renal amyloidosis: unveiling amyloid by next-generation sequencing. Amyloid 2019; 26:253-254. [PMID: 31482740 DOI: 10.1080/13506129.2019.1660157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Francesca Cottini
- Division of Hematology, Department of Medicine, The Ohio State University , Columbus , OH , USA
| | - Cherri Bott
- Pathology Department, Ohio State University , Columbus , OH , USA
| | - Tibor Nadasdy
- Pathology Department, Ohio State University , Columbus , OH , USA
| | - Sergey V Brodsky
- Pathology Department, Ohio State University , Columbus , OH , USA
| | - Don Benson
- Division of Hematology, Department of Medicine, The Ohio State University , Columbus , OH , USA
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29
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Gorbenko G, Trusova V, Deligeorgiev T, Gadjev N, Mizuguchi C, Saito H. Two-step FRET as a tool for probing the amyloid state of proteins. J Mol Liq 2019. [DOI: 10.1016/j.molliq.2019.111675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Pande M, Srivastava R. Molecular and clinical insights into protein misfolding and associated amyloidosis. Eur J Med Chem 2019; 184:111753. [PMID: 31622853 DOI: 10.1016/j.ejmech.2019.111753] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 12/13/2022]
Abstract
The misfolding of normally soluble proteins causes their aggregation and deposition in the tissues which disrupts the normal structure and function of the corresponding organs. The proteins with high β-sheet contents are more prone to form amyloids as they exhibit high propensity of self-aggregation. The self aggregated misfolded proteins act as template for further aggregation that leads to formation of protofilaments and eventually amyloid fibrils. More than 30 different types of proteins are known to be associated with amyloidosis related diseases. Several aspects of the amyloidogenic behavior of proteins remain elusive. The exact reason that causes misfolding of the protein and its association into amyloid fibrils is not known. These misfolded intermediates surpass the over engaged quality control system of the cell which clears the misfolded intermediates. This promotes the self-aggregation, accumulation and deposition of these misfolded species in the form of amyloids in the different parts of the body. The amyloid deposition can be localized as in Alzheimer disease or systemic as reported in most of the amyloidosis. The amyloidosis can be of acquired type or familial. The current review aims at bringing together recent updates and comprehensive information about protein amyloidosis and associated diseases at one place.
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Affiliation(s)
- Monu Pande
- Department of Biochemistry, Institute of Medical Science, Banaras Hindu University, Varanasi, 221005, India
| | - Ragini Srivastava
- Department of Biochemistry, Institute of Medical Science, Banaras Hindu University, Varanasi, 221005, India.
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31
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Chabert M, Rousset X, Colombat M, Lacasa M, Kakanakou H, Bourderioux M, Brousset P, Burlet-Schiltz O, Liepnieks JJ, Kluve-Beckerman B, Lambert G, Châtelet FP, Benson MD, Kalopissis AD. A transgenic mouse model reproduces human hereditary systemic amyloidosis. Kidney Int 2019; 96:628-641. [PMID: 31200944 DOI: 10.1016/j.kint.2019.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
Amyloidoses are rare life-threatening diseases caused by protein misfolding of normally soluble proteins. The fatal outcome is predominantly due to renal failure and/or cardiac dysfunction. Because amyloid fibrils formed by all amyloidogenic proteins share structural similarity, amyloidoses may be studied in transgenic models expressing any amyloidogenic protein. Here we generated transgenic mice expressing an amyloidogenic variant of human apolipoprotein AII, a major protein of high density lipoprotein. According to amyloid nomenclature this variant was termed STOP78SERApoAII. STOP78SER-APOA2 expression at the physiological level spontaneously induced systemic amyloidosis in all mice with full-length mature STOP78SER-ApoAII identified as the amyloidogenic protein. Amyloid deposits stained with Congo red were extracellular, and consisted of fibrils of approximately 10 nm diameter. Renal glomerular amyloidosis was a major feature with onset of renal insufficiency occurring in mice older than six months of age. The liver, heart and spleen were also greatly affected. Expression of STOP78SER-APOA2 in the liver and intestine in mice of the K line but not in other amyloid-laden organs showed they present systemic amyloidosis. The amyloid burden was a function of STOP78SER-APOA2 expression and age of the mice with amyloid deposition starting in two-month-old high-expressing mice that died from six months onwards. Because STOP78SER-ApoAII conserved adequate lipid binding capacity as shown by high STOP78SER-ApoAII amounts in high density lipoprotein of young mice, its decrease in circulation with age suggests preferential deposition into preformed fibrils. Thus, our mouse model faithfully reproduces early-onset hereditary systemic amyloidosis and is ideally suited to devise and test novel therapies.
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Affiliation(s)
- Michèle Chabert
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France; EPHE PSL, Paris, France
| | - Xavier Rousset
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Magali Colombat
- Centre Hospitalo-Universitaire (CHU), Département d'Anatomopathologie, Toulouse, France
| | - Michel Lacasa
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Hermine Kakanakou
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Mathilde Bourderioux
- Centre Hospitalo-Universitaire (CHU), Département d'Anatomopathologie, Toulouse, France
| | - Pierre Brousset
- Centre Hospitalo-Universitaire (CHU), Département d'Anatomopathologie, Toulouse, France
| | - Odile Burlet-Schiltz
- CNRS, Institut de Pharmacologie et de Biologie Structurale (IPBS), Université de Toulouse, Toulouse, France
| | - Juris J Liepnieks
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Barbara Kluve-Beckerman
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gilles Lambert
- Inserm UMRS 1188 DéTROI, Université de La Réunion, Sainte Clotilde, France
| | - François P Châtelet
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Merrill D Benson
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Athina D Kalopissis
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France.
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32
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Spodzieja M, Rodziewicz-Motowidło S, Szymanska A. Hyphenated Mass Spectrometry Techniques in the Diagnosis of Amyloidosis. Curr Med Chem 2019; 26:104-120. [DOI: 10.2174/0929867324666171003113019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/25/2016] [Accepted: 09/01/2016] [Indexed: 12/18/2022]
Abstract
Amyloidoses are a group of diseases caused by the extracellular deposition of proteins forming amyloid fibrils. The amyloidosis is classified according to the main protein or peptide that constitutes the amyloid fibrils. The most effective methods for the diagnosis of amyloidosis are based on mass spectrometry. Mass spectrometry enables confirmation of the identity of the protein precursor of amyloid fibrils in biological samples with very high sensitivity and specificity, which is crucial for proper amyloid typing. Due to the fact that biological samples are very complex, mass spectrometry is usually connected with techniques such as liquid chromatography or capillary electrophoresis, which enable the separation of proteins before MS analysis. Therefore mass spectrometry constitutes an important part of the so called “hyphenated techniques” combining, preferentially in-line, different analytical methods to provide comprehensive information about the studied problem. Hyphenated methods are very useful in the discovery of biomarkers in different types of amyloidosis. In systemic forms of amyloidosis, the analysis of aggregated proteins is usually performed based on the tissues obtained during a biopsy of an affected organ or a subcutaneous adipose tissue. In some cases, when the diagnostic biopsy is not possible due to the fact that amyloid fibrils are formed in organs like the brain (Alzheimer’s disease), the study of biomarkers presented in body fluids can be carried out. Currently, large-scale studies are performed to find and validate more effective biomarkers, which can be used in diagnostic procedures. We would like to present the methods connected with mass spectrometry which are used in the diagnosis of amyloidosis based on the analysis of proteins occurring in tissues, blood and cerebrospinal fluid.
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Affiliation(s)
- Marta Spodzieja
- Department of Biomedical Chemistry, Faculty of Chemistry, University of Gdansk, Wita Stwosza 63, 80-308 Gdansk, Poland
| | - Sylwia Rodziewicz-Motowidło
- Department of Biomedical Chemistry, Faculty of Chemistry, University of Gdansk, Wita Stwosza 63, 80-308 Gdansk, Poland
| | - Aneta Szymanska
- Department of Biomedical Chemistry, Faculty of Chemistry, University of Gdansk, Wita Stwosza 63, 80-308 Gdansk, Poland
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Moutafi M, Ziogas DC, Michopoulos S, Bagratuni T, Vasileiou V, Verga L, Merlini G, Palladini G, Matsouka C, Dimopoulos MA, Kastritis E. A new genetic variant of hereditary apolipoprotein A-I amyloidosis: a case-report followed by discussion of diagnostic challenges and therapeutic options. BMC MEDICAL GENETICS 2019; 20:23. [PMID: 30665372 PMCID: PMC6341640 DOI: 10.1186/s12881-019-0755-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/15/2019] [Indexed: 11/14/2022]
Abstract
Background Hereditary amyloidosis refers to a wide spectrum of rare diseases with different causative mutations in the genes of various proteins including transthyretin, apolipoprotein AI and AII, gelsolin, lysozyme, cystatin C, fibrinogen Aα-chain, β2-microglobulin, apolipoprotein CII and CIII. Case presentation Among hereditary amyloidosis subtypes, we describe here a specific case of Apolipoprotein AI amyloidosis (AApoAI), where the diagnosis began from an almost asymptomatic hepatomegaly followed by the development of primary hypogonadism. Baseline laboratory tests showed increased liver enzymes, while imaging tests revealed a suspected infiltrative liver disease. Patient underwent into liver biopsy and histological examination detected the presence of periodic acid-Schiff (−) and Congo-red (+) amorphous eosinophilic material within normal liver tissue. In the typing of amyloid by immunoelectron microscopy, the liver appeared heavily infiltrated by anti-apoAI (+) amyloid fibrils. Gene sequencing and mutational analysis revealed a single-base mutation at position c.251 T > C resulting in an amino acid substitution from leucine to proline in the mature ApoAI protein. This amino acid change led to lower cleavage and ApoAI deposition into the involved organs. Few years later, our patient remaining without treatment, came with symptoms consistent with primary hypogonadism but testicular involvement with ApoAI deposits could not be proven since the patient refused testicular biopsy. Based on this case, we recap the diagnostic challenges, the clinical manifestations, and the potential treatment options for this indolent hereditary amyloidosis subtype. Conclusions This case-report enlarges the clinical picture of ApoAI-driven disease and its complex genetic background and in parallel suggests for a more systematic approach in any case with strong suspicion of hereditary amyloidosis.
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Affiliation(s)
- Myrto Moutafi
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, 80 Vas Sofias Avenue, 11528, Athens, Greece
| | - Dimitrios C Ziogas
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, 80 Vas Sofias Avenue, 11528, Athens, Greece.
| | - Spyros Michopoulos
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, 80 Vas Sofias Avenue, 11528, Athens, Greece
| | - Tina Bagratuni
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, 80 Vas Sofias Avenue, 11528, Athens, Greece
| | - Vassiliki Vasileiou
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, 80 Vas Sofias Avenue, 11528, Athens, Greece
| | - Laura Verga
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Giovanni Palladini
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Charis Matsouka
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, 80 Vas Sofias Avenue, 11528, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, 80 Vas Sofias Avenue, 11528, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, 80 Vas Sofias Avenue, 11528, Athens, Greece
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Del Giudice R, Lagerstedt JO. High-efficient bacterial production of human ApoA-I amyloidogenic variants. Protein Sci 2018; 27:2101-2109. [PMID: 30291643 PMCID: PMC6237697 DOI: 10.1002/pro.3522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 12/17/2022]
Abstract
Apolipoprotein A-I (ApoA-I)-related amyloidosis is a rare disease caused by missense mutations in the APOA1 gene. These mutations lead to protein aggregation and abnormal accumulation of ApoA-I amyloid fibrils in heart, liver, kidneys, skin, nerves, ovaries, or testes. Consequently, the carriers are at risk of single- or multi-organ failure and of need of organ transplantation. Understanding the basic molecular structure and function of ApoA-I amyloidogenic variants, as well as their biological effects, is, therefore, of great interest. However, the intrinsic low stability of this type of proteins makes their overexpression and purification difficult. To overcome this barrier, we here describe an optimized production and purification procedure for human ApoA-I amyloidogenic proteins that efficiently provides between 46 mg and 91 mg (depending on the protein variant) of pure protein per liter of Escherichia coli culture. Structural integrity of the amyloidogenic and native ApoA-I proteins were verified by circular dichroism spectroscopy and intrinsic fluorescence analysis, and preserved functionality was demonstrated by use of a lipid clearance assay as well as by reconstitution of high-density lipoprotein (HDL) particles. In conclusion, the use of the described high-yield protein production system to obtain amyloidogenic ApoA-I proteins, and their native counterpart, will enable molecular and cellular experimental studies aimed to explain the molecular basis for this rare disease.
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Affiliation(s)
- Rita Del Giudice
- Department of Experimental Medical ScienceLund UniversityS‐221 84LundSweden
| | - Jens O. Lagerstedt
- Department of Experimental Medical ScienceLund UniversityS‐221 84LundSweden
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35
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Morgado I, Panahi A, Burwash AG, Das M, Straub JE, Gursky O. Molecular Insights into Human Hereditary Apolipoprotein A-I Amyloidosis Caused by the Glu34Lys Mutation. Biochemistry 2018; 57:5738-5747. [PMID: 30184436 PMCID: PMC11259198 DOI: 10.1021/acs.biochem.8b00817] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hereditary apolipoprotein A-I (apoA-I) amyloidosis is a life-threatening incurable genetic disorder whose molecular underpinnings are unclear. In this disease, variant apoA-I, the major structural and functional protein of high-density lipoprotein, is released in a free form, undergoes an α-helix to intermolecular cross-β-sheet conversion along with a proteolytic cleavage, and is deposited as amyloid fibrils in various organs, which can cause organ damage and death. Glu34Lys is the only known charge inversion mutation in apoA-I that causes human amyloidosis. To elucidate the structural underpinnings of the amyloidogenic behavior of Glu34Lys apoA-I, we generated its recombinant globular N-terminal domain (residues 1-184) and compared the conformation and dynamics of its lipid-free form with those of two other naturally occurring apoA-I variants, Phe71Tyr (amyloidogenic) and Leu159Arg (non-amyloidogenic). All variants showed reduced structural stability and altered aromatic residue packing. The greatest decrease in stability was observed in the non-amyloidogenic variant, suggesting that amyloid formation is driven by local structural perturbations at sensitive sites. Molecular dynamics simulations revealed local helical unfolding and suggested that transient opening of the Trp72 side chain induced mutation-dependent structural perturbations in a sensitive region, including the major amyloid hot spot residues Leu14-Leu22. We posit that a shift from the "closed" to the "open" orientation of the Trp72 side chain modulates structural protection of amyloid hot spots, suggesting a previously unknown early step in the protein misfolding pathway.
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Affiliation(s)
- Isabel Morgado
- Department of Physiology & Biophysics, Boston University School of Medicine, Boston, Massachusetts 02118-2526, United States
| | - Afra Panahi
- Department of Chemistry, Boston University, Boston, Massachusetts 02215-2521, United States
| | - Andrew G. Burwash
- Department of Chemistry, Boston University, Boston, Massachusetts 02215-2521, United States
| | - Madhurima Das
- Department of Physiology & Biophysics, Boston University School of Medicine, Boston, Massachusetts 02118-2526, United States
| | - John E. Straub
- Department of Chemistry, Boston University, Boston, Massachusetts 02215-2521, United States
| | - Olga Gursky
- Department of Physiology & Biophysics, Boston University School of Medicine, Boston, Massachusetts 02118-2526, United States
- Amyloidosis Treatment and Research Center, Boston University School of Medicine, Boston, Massachusetts 02118, United States
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36
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Sneha P, Panda PK, Gharemirshamlu FR, Bamdad K, Balaji S. Structural discordance in HIV-1 Vpu from brain isolate alarms amyloid fibril forming behavior- a computational perspective. J Theor Biol 2018; 451:35-45. [PMID: 29705491 DOI: 10.1016/j.jtbi.2018.04.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/14/2018] [Accepted: 04/25/2018] [Indexed: 11/15/2022]
Abstract
HIV-1 being the most widespread type worldwide, its accounts for almost 95% of all infections including HIV associated dementia (HAD) that triggers neurological dysfunction and neurodegeneration in patients. The common features associated with HAD and other neurodegenerative diseases are accumulation of amyloid plaques, neuronal loss and deterioration of cognitive abilities, amongst which amyloid fibrillation is considered to be a hallmark. The success of effective therapeutics lies in the understanding of mechanisms leading to neurotoxicity. Few viral proteins like gp-120 are known to be involved in aggregation and enhancement of viral infectivity while comprehending the neurotoxic role of some other proteins is still underway. In the current study, amyloidogenic potential of HIV-1 Vpu protein from brain isolate is investigated through computational approaches. The aggregation propensity of brain derived HIV-1 Vpu was assessed by several amyloid prediction servers that projected the region 4-35 to be amyloidogenic. The protein structure was modeled and subjected to 70 ns molecular dynamics (MD) simulation to investigate the transformation of α-helical conformation of the predicted aggregate region into β-sheet, proposing the protein's ability to initiate fibril formation that is central to amyloidogenic proteins. The structural features of brain derived HIV-1 Vpu were consistent with the in silico amyloid prediction results that depicts the conformational change in the region 8-28 of which residues Ala8, Ile9, Val10, Ala19, Ile20 and Val21 constitutes β-sheet formation. The α-helix/β-sheet discordance of the predicted region was reflected in the simulation study highlighting the possible structural transition associated with HIV-1 Vpu protein of brain isolate.
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Affiliation(s)
- Patil Sneha
- School of Biotechnology and Bioinformatics, D.Y. Patil deemed to be University, CBD Belapur, Sector 15, Navi Mumbai, Maharashtra 400614, India; Research and Development Centre, Bharathiar University, Coimbatore 641046 India
| | - Pritam Kumar Panda
- School of Biotechnology and Bioinformatics, D.Y. Patil deemed to be University, CBD Belapur, Sector 15, Navi Mumbai, Maharashtra 400614, India
| | | | - Kourosh Bamdad
- Faculty of Science(,) Payame Noor University, 19395-4697 Iran
| | - Seetharaman Balaji
- Department of Biotechnology, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, 576104 Karnataka, India.
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37
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Gorbenko GP, Trusova V, Mizuguchi C, Saito H. Lipid Bilayer Interactions of Amyloidogenic N-Terminal Fragment of Apolipoprotein A-I Probed by Förster Resonance Energy Transfer and Molecular Dynamics Simulations. J Fluoresc 2018; 28:1037-1047. [DOI: 10.1007/s10895-018-2267-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/10/2018] [Indexed: 11/25/2022]
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38
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Wilson CJ, Das M, Jayaraman S, Gursky O, Engen JR. Effects of Disease-Causing Mutations on the Conformation of Human Apolipoprotein A-I in Model Lipoproteins. Biochemistry 2018; 57:4583-4596. [PMID: 30004693 DOI: 10.1021/acs.biochem.8b00538] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Plasma high-density lipoproteins (HDLs) are protein-lipid nanoparticles that transport lipids and protect against atherosclerosis. Human apolipoprotein A-I (apoA-I) is the principal HDL protein whose mutations can cause either aberrant lipid metabolism or amyloid disease. Hydrogen-deuterium exchange (HDX) mass spectrometry (MS) was used to study the apoA-I conformation in model discoidal lipoproteins similar in size to large plasma HDL. We examined how point mutations associated with hereditary amyloidosis (F71Y and L170P) or atherosclerosis (L159R) influence the local apoA-I conformation in model lipoproteins. Unlike other apoA-I forms, the large particles showed minimal conformational heterogeneity, suggesting a fully extended protein conformation. Mutation-induced structural perturbations in lipid-bound protein were attenuated compared to the free protein and indicated close coupling between the two belt-forming apoA-I molecules. These perturbations propagated to distant lipoprotein sites, either increasing or decreasing their protection. This HDX MS study of large model HDL, compared with previous studies of smaller particles, ascertained that apoA-I's central region helps accommodate the protein conformation to lipoproteins of various sizes. This study also reveals that the effects of mutations on lipoprotein conformational dynamics are much weaker than those in a lipid-free protein. Interestingly, the mutation-induced perturbations propagate to distant sites nearly 10 nm away and alter their protection in ways that cannot be predicted from the lipoprotein structure and stability. We propose that long-range mutational effects are mediated by both protein and lipid and can influence lipoprotein functionality.
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Affiliation(s)
- Christopher J Wilson
- Department of Chemistry and Chemical Biology , Northeastern University , 360 Huntington Avenue , Boston , Massachusetts 02115 , United States
| | - Madhurima Das
- Department of Physiology & Biophysics , Boston University School of Medicine , 700 Albany Street , Boston , Massachusetts 02118 , United States
| | - Shobini Jayaraman
- Department of Physiology & Biophysics , Boston University School of Medicine , 700 Albany Street , Boston , Massachusetts 02118 , United States
| | - Olga Gursky
- Department of Physiology & Biophysics , Boston University School of Medicine , 700 Albany Street , Boston , Massachusetts 02118 , United States.,Amyloidosis Research Center , Boston University School of Medicine , Boston , Massachusetts 02118 , United States
| | - John R Engen
- Department of Chemistry and Chemical Biology , Northeastern University , 360 Huntington Avenue , Boston , Massachusetts 02115 , United States
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39
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Horike K, Takeda A, Tsujita M, Goto N, Watarai Y, Uchida K, Katayama A, Nishihira M, Shimizu A, Nozu K, Morozumi K. Two novel APOA1
gene mutations in a Japanese renal transplant recipient with recurrent apolipoprotein A-I related amyloidosis. Nephrology (Carlton) 2018; 23 Suppl 2:17-21. [DOI: 10.1111/nep.13278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Keiji Horike
- Department of Kidney Center; Masuko Memorial Hospital; Nagoya Japan
| | - Asami Takeda
- Department of Kidney Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Makoto Tsujita
- Department of Kidney Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Norihiko Goto
- Department of Kidney Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Yoshihiko Watarai
- Department of Kidney Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Kazuharu Uchida
- Department of Kidney Center; Masuko Memorial Hospital; Nagoya Japan
| | - Akio Katayama
- Department of Kidney Center; Masuko Memorial Hospital; Nagoya Japan
| | | | - Akira Shimizu
- Department of Pathology; Nippon Medical College; Tokyo Japan
| | - Kandai Nozu
- Department of Pediatrics; Kobe University; Kobe Japan
| | - Kunio Morozumi
- Department of Kidney Center; Masuko Memorial Hospital; Nagoya Japan
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40
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Pané A, Ruiz S, Orois A, Martínez D, Squarcia M, Sastre L, Ruiz P, Caballería J, Mora M, Hanzu FA, Halperin I. Primary adrenal insufficiency due to hereditary apolipoprotein AI amyloidosis: endocrine involvement beyond hypogonadism. Amyloid 2018; 25:75-78. [PMID: 29446975 DOI: 10.1080/13506129.2018.1438390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Several mutations in the gene encoding apolipoprotein AI (apoAI) have been described as a cause of familial amyloidosis. Individuals with apoAI-derived (AApoAI) amyloidosis frequently manifest with liver, kidney, laryngeal, skin and myocardial involvement. Although primary hypogonadism (PH) is considered almost pathognomonic of this disease, until now, primary adrenal insufficiency (PAI) has not been described as a common clinical feature. Here, we report the first kindred with AApoAI amyloidosis in which PAI is well-documented. All family members with the Leu60_Phe71delins60Val_61Thr heterozygous mutation who were regularly followed-up at our centre were considered. Nineteen individuals had the confirmed APOA1 deletion/insertion mutation, with detailed medical records available in 11 cases. Of these, 6 had PAI and 3 (all males) had PH. Among them, one 47-year-old man, not previously diagnosed with PAI, developed adrenal crisis after liver transplantation, precipitated by an opportunistic infection. Transplantation due to organ failure, which necessitates use of immunosuppressive medication such as corticosteroids, is frequently required during the course of hereditary amyloidosis. Consequently, PAI can remain masked, being discovered only when an adrenal crisis develops. Therefore, according to the present evidence, patients with AApoAI amyloidosis should be submitted to regular testing of corticotrophin and cortisol levels in order to avoid delaying corticosteroid replacement.
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Affiliation(s)
- Adriana Pané
- a Department of Endocrinology and Nutrition , Hospital Clínic , Barcelona , Spain
| | - Sabina Ruiz
- a Department of Endocrinology and Nutrition , Hospital Clínic , Barcelona , Spain
| | - Aida Orois
- a Department of Endocrinology and Nutrition , Hospital Clínic , Barcelona , Spain
| | - Daniel Martínez
- b Department of Anatomic Pathology , Hospital Clínic , Barcelona , Spain
| | - Mattia Squarcia
- c Department of Radiology , Hospital Clínic , Barcelona , Spain
| | - Lydia Sastre
- d Department of Hepatology , Hospital Clínic , Barcelona , Spain
| | - Pablo Ruiz
- d Department of Hepatology , Hospital Clínic , Barcelona , Spain
| | - Joan Caballería
- d Department of Hepatology , Hospital Clínic , Barcelona , Spain.,e Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) , Barcelona , Spain.,f Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) , Madrid , Spain
| | - Mireia Mora
- a Department of Endocrinology and Nutrition , Hospital Clínic , Barcelona , Spain
| | - Felicia A Hanzu
- a Department of Endocrinology and Nutrition , Hospital Clínic , Barcelona , Spain.,e Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) , Barcelona , Spain
| | - Irene Halperin
- a Department of Endocrinology and Nutrition , Hospital Clínic , Barcelona , Spain
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Townsend D, Hughes E, Akien G, Stewart KL, Radford SE, Rochester D, Middleton DA. Epigallocatechin-3-gallate remodels apolipoprotein A-I amyloid fibrils into soluble oligomers in the presence of heparin. J Biol Chem 2018; 293:12877-12893. [PMID: 29853648 PMCID: PMC6102129 DOI: 10.1074/jbc.ra118.002038] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/25/2018] [Indexed: 11/06/2022] Open
Abstract
Amyloid deposits of WT apolipoprotein A-I (apoA-I), the main protein component of high-density lipoprotein, accumulate in atherosclerotic plaques where they may contribute to coronary artery disease by increasing plaque burden and instability. Using CD analysis, solid-state NMR spectroscopy, and transmission EM, we report here a surprising cooperative effect of heparin and the green tea polyphenol (-)-epigallocatechin-3-gallate (EGCG), a known inhibitor and modulator of amyloid formation, on apoA-I fibrils. We found that heparin, a proxy for glycosaminoglycan (GAG) polysaccharides that co-localize ubiquitously with amyloid in vivo, accelerates the rate of apoA-I formation from monomeric protein and associates with insoluble fibrils. Mature, insoluble apoA-I fibrils bound EGCG (KD = 30 ± 3 μm; Bmax = 40 ± 3 μm), but EGCG did not alter the kinetics of apoA-I amyloid assembly from monomer in the presence or absence of heparin. EGCG selectively increased the mobility of specific backbone and side-chain sites of apoA-I fibrils formed in the absence of heparin, but the fibrils largely retained their original morphology and remained insoluble. By contrast, fibrils formed in the presence of heparin were mobilized extensively by the addition of equimolar EGCG, and the fibrils were remodeled into soluble 20-nm-diameter oligomers with a largely α-helical structure that were nontoxic to human umbilical artery endothelial cells. These results argue for a protective effect of EGCG on apoA-I amyloid associated with atherosclerosis and suggest that EGCG-induced remodeling of amyloid may be tightly regulated by GAGs and other amyloid co-factors in vivo, depending on EGCG bioavailability.
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Affiliation(s)
- David Townsend
- Department of Chemistry, Lancaster University, Lancaster LA1 4YB
| | - Eleri Hughes
- Department of Chemistry, Lancaster University, Lancaster LA1 4YB
| | - Geoffrey Akien
- Department of Chemistry, Lancaster University, Lancaster LA1 4YB
| | - Katie L Stewart
- Astbury Centre for Structural Molecular Biology, School of Molecular and Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Sheena E Radford
- Astbury Centre for Structural Molecular Biology, School of Molecular and Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - David Rochester
- Department of Chemistry, Lancaster University, Lancaster LA1 4YB
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Effect of Phosphatidylserine and Cholesterol on Membrane-mediated Fibril Formation by the N-terminal Amyloidogenic Fragment of Apolipoprotein A-I. Sci Rep 2018; 8:5497. [PMID: 29615818 PMCID: PMC5882889 DOI: 10.1038/s41598-018-23920-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/22/2018] [Indexed: 01/31/2023] Open
Abstract
Here, we examined the effects of phosphatidylserine (PS) and cholesterol on the fibril-forming properties of the N-terminal 1‒83 fragment of an amyloidogenic G26R variant of apoA-I bound to small unilamellar vesicles. A thioflavin T fluorescence assay together with microscopic observations showed that PS significantly retards the nucleation step in fibril formation by apoA-I 1‒83/G26R, whereas cholesterol slightly enhances fibril formation. Circular dichroism analyses demonstrated that PS facilitates a structural transition from random coil to α-helix in apoA-I 1‒83/G26R with great stabilization of the α-helical structure upon lipid binding. Isothermal titration calorimetry measurements revealed that PS induces a marked increase in capacity for binding of apoA-I 1‒83/G26R to the membrane surface, perhaps due to electrostatic interactions of positively charged amino acids in apoA-I with PS. Such effects of PS to enhance lipid interactions and inhibit fibril formation of apoA-I were also observed for the amyloidogenic region-containing apoA-I 8‒33/G26R peptide. Fluorescence measurements using environment-sensitive probes indicated that PS induces a more solvent-exposed, membrane-bound conformation in the amyloidogenic region of apoA-I without affecting membrane fluidity. Since cell membranes have highly heterogeneous lipid compositions, our findings may provide a molecular basis for the preferential deposition of apoA-I amyloid fibrils in tissues and organs.
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43
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Abstract
"Cardiac amyloidosis" is the term commonly used to reflect the deposition of abnormal protein amyloid in the heart. This process can result from several different forms, most commonly from light-chain (AL) amyloidosis and transthyretin (ATTR) amyloidosis, which in turn can represent wild-type (ATTRwt) or genetic form. Regardless of the origin, cardiac involvement is usually associated with poor prognosis, especially in AL amyloidosis. Although several treatment options, including chemotherapy, exist for different forms of the disease, cardiac transplantation is increasingly considered. However, high mortality on the transplantation list, typical for patients with amyloidosis, and suboptimal post-transplant outcomes are major issues. We are reviewing the literature and summarizing pros and cons of listing patients with amyloidosis for cardiac or combine organ transplant, appropriate work-up, and intermediate and long-term outcomes. Both AL and ATTR amyloidosis are included in this review.
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44
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Visualization of multiple organ amyloid involvement in systemic amyloidosis using 11C-PiB PET imaging. Eur J Nucl Med Mol Imaging 2017; 45:452-461. [DOI: 10.1007/s00259-017-3814-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/21/2017] [Indexed: 12/20/2022]
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45
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Del Giudice R, Domingo-Espín J, Iacobucci I, Nilsson O, Monti M, Monti DM, Lagerstedt JO. Structural determinants in ApoA-I amyloidogenic variants explain improved cholesterol metabolism despite low HDL levels. Biochim Biophys Acta Mol Basis Dis 2017; 1863:3038-3048. [PMID: 28887204 DOI: 10.1016/j.bbadis.2017.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 11/19/2022]
Abstract
Twenty Apolipoprotein A-I (ApoA-I) variants are responsible for a systemic hereditary amyloidosis in which protein fibrils can accumulate in different organs, leading to their failure. Several ApoA-I amyloidogenic mutations are also associated with hypoalphalipoproteinemia, low ApoA-I and high-density lipoprotein (HDL)-cholesterol plasma levels; however, subjects affected by ApoA-I-related amyloidosis do not show a higher risk of cardiovascular diseases (CVD). The structural features, the lipid binding properties and the functionality of four ApoA-I amyloidogenic variants were therefore inspected in order to clarify the paradox observed in the clinical phenotype of the affected subjects. Our results show that ApoA-I amyloidogenic variants are characterized by a different oligomerization pattern and that the position of the mutation in the ApoA-I sequence affects the molecular structure of the formed HDL particles. Although lipidation increases ApoA-I proteins stability, all the amyloidogenic variants analyzed show a lower affinity for lipids, both in vitro and in ex vivo mouse serum. Interestingly, the lower efficiency at forming HDL particles is compensated by a higher efficiency at catalysing cholesterol efflux from macrophages. The decreased affinity of ApoA-I amyloidogenic variants for lipids, together with the increased efficiency in the cholesterol efflux process, could explain why, despite the unfavourable lipid profile, patients affected by ApoA-I related amyloidosis do not show a higher CVD risk.
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Affiliation(s)
- Rita Del Giudice
- Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden.
| | - Joan Domingo-Espín
- Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Ilaria Iacobucci
- Department of Chemical Sciences, University of Naples Federico II, 80126 Naples, Italy; CEINGE Biotecnologie Avanzate, 80145 Naples, Italy
| | - Oktawia Nilsson
- Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Maria Monti
- Department of Chemical Sciences, University of Naples Federico II, 80126 Naples, Italy; Istituto Nazionale di Biostrutture e Biosistemi (INBB), Rome, Italy
| | - Daria Maria Monti
- Department of Chemical Sciences, University of Naples Federico II, 80126 Naples, Italy; Istituto Nazionale di Biostrutture e Biosistemi (INBB), Rome, Italy
| | - Jens O Lagerstedt
- Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden.
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Lu C, Zuo K, Lu Y, Liang S, Huang X, Zeng C, Zhang J, An Y, Wang J. Apolipoprotein A-1-related amyloidosis 2 case reports and review of the literature. Medicine (Baltimore) 2017; 96:e8148. [PMID: 28953655 PMCID: PMC5626298 DOI: 10.1097/md.0000000000008148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Apolipoprotein A-1 (ApoA-1)-related amyloidosis is characterized by the deposition of ApoA-1 in various organs and can be either hereditary or nonhereditary. It is rare and easily misdiagnosed. Renal involvement is common in hereditary ApoA-1 amyloidosis, but rare in the nonhereditary form. PATIENT CONCERNS We reported two cases with ApoA-1 amyloidosis, a 64-year-old man suffering from nephrotic syndrome and a 40-year-old man with nephrotic syndrome and splenomegaly. Renal biopsies revealed glomerular, interstitial and vascular amyloid deposits and positive phospholipase A2 receptor staining in the glomerular capillary loop in case 1, and mesangial amyloid deposits in case 2. DIAGNOSES After immunostaining failed to determine the specific amyloid protein, proteomic analysis of amyloid deposits by mass spectrometry was performed and demonstrated the ApoA-1 origin of the amyloid. Genetic testing revealed no mutation of the APOA1 gene in case 1 but a heterozygous mutation, Trp74Arg, in case 2. Case 1 was thus diagnosed as nonhereditary ApoA-1 associated renal amyloidosis with membranous nephropathy, and case 2 as hereditary ApoA-1 amyloidosis with multiorgan injuries (kidney and spleen) and a positive family history. INTERVENTIONS Case 1 was treated with glucocorticoid combined with cyclosporine. Case 2 was treated with calcitriol and angiotensin converting enzyme inhibitors. OUTCOMES Two cases were followed up for 5 months and 2 years, respectively; and case 1 was found to have attenuated proteinuria while case 2 had an elevation of cholestasis indices along with renal insufficiency. LESSONS Proteomic analysis by mass spectrometry of the amyloid deposits combined with genetic analysis can provide accurate diagnosis of ApoA-1 amyloidosis. Besides, these 2 cases expand our knowledge of ApoA-1-related renal amyloidosis.
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Pathology and diagnosis of renal non-AL amyloidosis. J Nephrol 2017; 31:343-350. [DOI: 10.1007/s40620-017-0426-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/29/2017] [Indexed: 02/01/2023]
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Townsend D, Hughes E, Hussain R, Siligardi G, Baldock S, Madine J, Middleton DA. Heparin and Methionine Oxidation Promote the Formation of Apolipoprotein A-I Amyloid Comprising α-Helical and β-Sheet Structures. Biochemistry 2017; 56:1632-1644. [DOI: 10.1021/acs.biochem.6b01120] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- David Townsend
- Department of Chemistry, Lancaster University, Lancaster LA1 4YB, United Kingdom
| | - Eleri Hughes
- Department of Chemistry, Lancaster University, Lancaster LA1 4YB, United Kingdom
| | - Rohanah Hussain
- Diamond Light Source Ltd., Diamond House, Harwell Science & Innovation Campus, Didcot OX11 0DE, Oxon, England
| | - Giuliano Siligardi
- Diamond Light Source Ltd., Diamond House, Harwell Science & Innovation Campus, Didcot OX11 0DE, Oxon, England
| | - Sarah Baldock
- Department of Chemistry, Lancaster University, Lancaster LA1 4YB, United Kingdom
| | - Jillian Madine
- Department of Biochemistry, Institute
of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - David A. Middleton
- Department of Chemistry, Lancaster University, Lancaster LA1 4YB, United Kingdom
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Abstract
Amyloidoses are a spectrum of disorders caused by abnormal folding and extracellular deposition of proteins. The deposits lead to tissue damage and organ dysfunction, particularly in the heart, kidneys, and nerves. There are at least 30 different proteins that can cause amyloidosis. The clinical management depends entirely on the type of protein deposited, and thus on the underlying pathogenesis, and often requires high-risk therapeutic intervention. Application of mass spectrometry-based proteomic technologies for analysis of amyloid plaques has transformed the way amyloidosis is diagnosed and classified. Proteomic assays have been extensively used for clinical management of patients with amyloidosis, providing unprecedented diagnostic and biological information. They have shed light on the pathogenesis of different amyloid types and have led to identification of numerous new amyloid types, including ALECT2 amyloidosis, which is now recognized as one of the most common causes of systemic amyloidosis in North America.
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Affiliation(s)
- Ahmet Dogan
- Departments of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065;
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Renal Amyloidosis Associated With 5 Novel Variants in the Fibrinogen A Alpha Chain Protein. Kidney Int Rep 2016; 2:461-469. [PMID: 29142973 PMCID: PMC5678610 DOI: 10.1016/j.ekir.2016.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/08/2016] [Accepted: 11/13/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction Fibrinogen A alpha chain amyloidosis is an autosomal dominant disease associated with mutations in the fibrinogen A alpha chain (FGA) gene, and it is the most common cause of hereditary renal amyloidosis in the UK. Patients typically present with kidney impairment and progress to end-stage renal disease over a median time of 4.6 years. Methods Six patients presented with proteinuria, hypertension, and/or lower limb edema and underwent detailed clinical and laboratory investigations. Results A novel FGA gene mutation was identified in each case: 2 frameshift mutations F521Sfs*27 and G519Efs*30 and 4 single base substitutions G555F, E526K, E524K, R554H. In 5 subjects, extensive amyloid deposits were found solely within the glomeruli, which stained specifically with antibodies to fibrinogen A alpha chain, and in one of these cases, we found coexistent fibrinogen A alpha chain amyloidosis and anti-glomerular basement membrane antibody disease. One patient was diagnosed with light-chain amyloidosis after a bone marrow examination revealed a small clonal plasma cell population, and laser microdissection of the amyloid deposits followed by liquid chromatography and tandem mass spectrometry identified kappa light chain as the fibril protein. Discussion We report 6 novel mutations in the FGA gene: 5 were associated with renal fibrinogen A alpha chain amyloidosis and 1 was found to be incidental to light-chain amyloid deposits discovered in a patient with a plasma cell dyscrasia. Clinical awareness and suspicion of hereditary amyloidosis corroborated by genetic analysis and adequate typing using combined immunohistochemistry and laser microdissection and mass spectrometry is valuable to avoid misdiagnosis, especially when a family history of amyloidosis is absent.
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