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Al Yaseen M, Al Zahid H, Al-Haroon S. Amyloid Deposits in the Ligamentum Flavum Related to Lumbar Spinal Canal Stenosis and Lumbar Disc Degeneration. Cureus 2022; 14:e26221. [PMID: 35911371 PMCID: PMC9313137 DOI: 10.7759/cureus.26221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Amyloidosis is a protein conformational disorder, with distinctive features of accumulation of protein fibrils in different body tissues, causing a wide range of signs and symptoms. These amyloid fibrils are usually derived from about 30 different precursor proteins that have been identified. Although the most common tissue for their accumulation is cardiac, amyloidosis may appear in many other tissues, though rarely cause symptoms. One of these extracardiac tissues is the ligamentum flavum (LF). Participants and Methods: Patients with lumbar spinal canal stenosis or lumbar disc degeneration, scheduled for surgery, were included in the study. A total of 17 LF specimens were obtained from 16 patients with lumbar spinal stenosis (two specimens were taken from two consecutive stenotic levels belonging to one patient), and 11 LF specimens were obtained from 11 patients with lumbar disc degeneration. Tissue biopsy was taken from the LF at the affected level and was stained with special immunohistochemical stain to detect transthyretin (TTR)-related amyloidosis (ATTR). The diameters of the lumbar canal and the LF thickness were measured at the affected level by a radiologist. Results: This study includes 22 LF specimens. Male to female ratio was 5.4:4.6 with the mean age comparatively equal (M = 46 years for men and 48 years for women). The patients were divided into two groups: lumbar canal stenosis and lumbar disc degeneration. The result of the immunohistochemical stain towards TTR amyloid was positive in five out of 22 (22%) samples and all were from the stenosis group. The relationship of the LF thickness to the canal diameter in the positively stained stenosis group specimens was significant (p = 0.001). All the positive specimens were taken from levels L3−4 and L4−5. Conclusion: There was a significant relationship between LF thickness and canal stenosis in the positively stained specimens (towards TTR amyloid) of the stenosis group. However, the disc degeneration group showed no relationship between canal diameter and LF thickness; moreover, all the specimens of that group stained negative. Middle-age patients with canal stenosis proved to have a significant relationship to amyloid deposit LF hypertrophy.
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Kaneko N, Mori W, Kurata M, Yamamoto T, Zako T, Masumoto J. Inflammasome assembly is required for intracellular formation of β2-microglobulin amyloid fibrils, leading to IL-1β secretion. Int J Immunopathol Pharmacol 2022; 36:3946320221104554. [PMID: 35615856 PMCID: PMC9152197 DOI: 10.1177/03946320221104554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Dialysis-related amyloidosis (DRA) caused by β2-microgloblin (B2M) fibrils is a serious complication for patients with kidney failure on long-term dialysis. Deposition of B2M amyloid fibrils is thought to be due not only to serum extracellular B2M but also to infiltrating inflammatory cells, which may have an important role in B2M amyloid deposition in osteoarticular tissues in patients with DRA. Here, we asked whether B2M amyloid fibrils activate the inflammasome and contribute to formation and deposition of amyloid fibrils in cells. METHODS Amyloid formation was confirmed by a thioflavin T (ThT) spectroscopic assay and scanning electron microscopy (SEM). Activation of inflammasomes was assessed by detecting interleukin (IL)-1β in culture supernatants from human embryonic kidney (HEK) 293T cells ectopically expressing inflammasome components. IL-1β secretion was measured by enzyme-linked immunosorbent assay. Expression and co-localization were analyzed by immunohistochemistry and dual immunofluorescence microscopy. RESULTS B2M amyloid fibrils interacted directly with NLRP3/Pyrin and to activate the NLRP3/Pyrin inflammasomes, resulting in IL-1β secretion. When HEK293T cells were transfected with inflammasome components NLRP3 or Pyrin, along with ASC, pro-caspase-1, pro-IL-1β, and B2M, ThT fluorescence intensity increased. This was accompanied by IL-1β secretion, which increased in line with the amount of transfected B2M. In this case, morphological glowing of amyloid fibrils was observed by SEM. In the absence of ASC, there was no increase in ThT fluorescence intensity or IL-1β secretion, or any morphological glowing of amyloid fibrils. NLRP3 or Pyrin and B2M were co-localized in a "speck" in HEK293T cells, and co-expressed in infiltrated monocytes/macrophages in the osteoarticular synovial tissues in a patient with DRA. CONCLUSION Taken together, these data suggest that inflammasome assembly is required for the subsequent triggering of intracellular formation of B2M amyloid fibrils, which may contribute to osteoarticular deposition of B2M amyloid fibrils and inflammation in patients with DRA.
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Affiliation(s)
- Naoe Kaneko
- Department of Pathology, Ehime University Graduate School of Medicine and Proteo-Science Center, Toon, Japan
| | - Wakako Mori
- Department of Chemistry and Biology, Ehime University Graduate School of Science and Engineering, Matsuyama, Japan
| | - Mie Kurata
- Department of Pathology, Ehime University Graduate School of Medicine and Proteo-Science Center, Toon, Japan
| | - Toshihiro Yamamoto
- Department of Pathology, Ehime University Graduate School of Medicine and Proteo-Science Center, Toon, Japan
| | - Tamotsu Zako
- Department of Chemistry and Biology, Ehime University Graduate School of Science and Engineering, Matsuyama, Japan
| | - Junya Masumoto
- Department of Pathology, Ehime University Graduate School of Medicine and Proteo-Science Center, Toon, Japan
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Bulyáki É, Kun J, Molnár T, Papp A, Micsonai A, Vadászi H, Márialigeti B, Kovács AI, Gellén G, Yamaguchi K, Lin Y, So M, Józsi M, Schlosser G, Lee YH, Liliom K, Goto Y, Kardos J. Pathogenic D76N Variant of β 2-Microglobulin: Synergy of Diverse Effects in Both the Native and Amyloid States. BIOLOGY 2021; 10:biology10111197. [PMID: 34827190 PMCID: PMC8614874 DOI: 10.3390/biology10111197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 01/13/2023]
Abstract
Simple Summary Elevated β2-microglobulin (β2m) serum levels cause serious complications in patients on long-term kidney dialysis by depositing in the form of amyloid fibrils in the osteoarticular system. Recently, a hereditary systemic amyloidosis was discovered, caused by a naturally occurring D76N β2m mutant exhibiting normal serum levels and a distinct, visceral deposition pattern. D76N β2m showed a structure remarkably similar to the wild-type (WT) protein, albeit with decreased thermodynamic stability and increased amyloidogenicity. Despite the extensive research, the molecular bases of the aberrant aggregation of β2m in vivo remains elusive. Here, using a variety of biophysical techniques, we investigated the role of the pathogenic D76N mutation in the amyloid formation of β2m by point mutations affecting the stabilizing ion-pairs of β2m. We found that, relative to WT β2m, the exceptional amyloidogenicity of the pathogenic D76N β2m variant is realized by the synergy of diverse effects of destabilized native structure, higher sensitivity to negatively charged amphiphilic molecules and polyphosphate, more effective fibril nucleation, higher conformational stability of fibrils, and elevated affinity for extracellular matrix proteins. Understanding the underlying molecular mechanisms might help to find target points for effective treatments against diseases associated with the deleterious aggregation of proteins. Abstract β2-microglobulin (β2m), the light chain of the MHC-I complex, is associated with dialysis-related amyloidosis (DRA). Recently, a hereditary systemic amyloidosis was discovered, caused by a naturally occurring D76N β2m variant, which showed a structure remarkably similar to the wild-type (WT) protein, albeit with decreased thermodynamic stability and increased amyloidogenicity. Here, we investigated the role of the D76N mutation in the amyloid formation of β2m by point mutations affecting the Asp76-Lys41 ion-pair of WT β2m and the charge cluster on Asp38. Using a variety of biophysical techniques, we investigated the conformational stability and partial unfolding of the native state of the variants, as well as their amyloidogenic propensity and the stability of amyloid fibrils under various conditions. Furthermore, we studied the intermolecular interactions of WT and mutant proteins with various binding partners that might have in vivo relevance. We found that, relative to WT β2m, the exceptional amyloidogenicity of the pathogenic D76N β2m variant is realized by the deleterious synergy of diverse effects of destabilized native structure, higher sensitivity to negatively charged amphiphilic molecules (e.g., lipids) and polyphosphate, more effective fibril nucleation, higher conformational stability of fibrils, and elevated affinity for extracellular components, including extracellular matrix proteins.
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Affiliation(s)
- Éva Bulyáki
- ELTE NAP Neuroimmunology Research Group, Department of Biochemistry, Institute of Biology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary; (É.B.); (J.K.); (A.M.); (H.V.)
| | - Judit Kun
- ELTE NAP Neuroimmunology Research Group, Department of Biochemistry, Institute of Biology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary; (É.B.); (J.K.); (A.M.); (H.V.)
| | - Tamás Molnár
- Department of Biochemistry, Institute of Biology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary; (T.M.); (B.M.); (A.I.K.)
| | - Alexandra Papp
- Complement Research Group, Department of Immunology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary; (A.P.); (M.J.)
| | - András Micsonai
- ELTE NAP Neuroimmunology Research Group, Department of Biochemistry, Institute of Biology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary; (É.B.); (J.K.); (A.M.); (H.V.)
| | - Henrietta Vadászi
- ELTE NAP Neuroimmunology Research Group, Department of Biochemistry, Institute of Biology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary; (É.B.); (J.K.); (A.M.); (H.V.)
| | - Borbála Márialigeti
- Department of Biochemistry, Institute of Biology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary; (T.M.); (B.M.); (A.I.K.)
| | - Attila István Kovács
- Department of Biochemistry, Institute of Biology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary; (T.M.); (B.M.); (A.I.K.)
| | - Gabriella Gellén
- Department of Analytical Chemistry, Institute of Chemistry, ELTE Eötvös Loránd University, 1117 Budapest, Hungary; (G.G.); (G.S.)
| | - Keiichi Yamaguchi
- Global Center for Medical Engineering and Informatics, Osaka University, Osaka 565-0871, Japan; (K.Y.); (Y.G.)
| | - Yuxi Lin
- Research Center of Bioconvergence Analysis, Korea Basic Science Institute (KBSI), Ochang 28119, Korea; (Y.L.); (Y.-H.L.)
| | - Masatomo So
- Institute for Protein Research, Osaka University, Osaka 565-0871, Japan; or
| | - Mihály Józsi
- Complement Research Group, Department of Immunology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary; (A.P.); (M.J.)
- MTA-ELTE Complement Research Group, Eötvös Loránd Research Network (ELKH), Department of Immunology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary
| | - Gitta Schlosser
- Department of Analytical Chemistry, Institute of Chemistry, ELTE Eötvös Loránd University, 1117 Budapest, Hungary; (G.G.); (G.S.)
| | - Young-Ho Lee
- Research Center of Bioconvergence Analysis, Korea Basic Science Institute (KBSI), Ochang 28119, Korea; (Y.L.); (Y.-H.L.)
- Bio-Analytical Science, University of Science and Technology (UST), Daejeon 34113, Korea
- Graduate School of Analytical Science and Technology (GRAST), Chungnam National University (CNU), Daejeon 34134, Korea
- Research Headquarters, Korea Brain Research Institute (KBRI), Daegu 41068, Korea
| | - Károly Liliom
- Department of Biophysics and Radiation Biology, Faculty of Medicine, Semmelweis University, 1094 Budapest, Hungary;
| | - Yuji Goto
- Global Center for Medical Engineering and Informatics, Osaka University, Osaka 565-0871, Japan; (K.Y.); (Y.G.)
- Institute for Protein Research, Osaka University, Osaka 565-0871, Japan; or
| | - József Kardos
- ELTE NAP Neuroimmunology Research Group, Department of Biochemistry, Institute of Biology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary; (É.B.); (J.K.); (A.M.); (H.V.)
- Correspondence:
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Tsuruya K, Arima H, Iseki K, Hirakata H. Association of dialysis-related amyloidosis with lower quality of life in patients undergoing hemodialysis for more than 10 years: The Kyushu Dialysis-Related Amyloidosis Study. PLoS One 2021; 16:e0256421. [PMID: 34428227 PMCID: PMC8384206 DOI: 10.1371/journal.pone.0256421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 08/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dialysis-related amyloidosis (DRA) commonly develops in patients undergoing long-term dialysis and can lead to a decline in activities of daily living and quality of life (QOL), mainly owing to orthopedic complications. METHODS First, we determined utility scores of the EuroQol 5-Dimensions 3-Levels (EQ-5D-3L) questionnaire in 1,323 patients with DRA who had undergone dialysis for more than 10 years and compared the score between those with and without DRA. Second, a 2-year follow-up was also performed, in which patients were divided into three groups: those complicated by DRA from the beginning, those with newly developed DRA within the 2-year period, and those not complicated by DRA throughout the survey period; changes in the EQ-5D-3L utility score were compared. In the group already complicated by DRA at the survey baseline, changes in the EQ-5D-3L utility score were compared according to the dialysis treatment method. RESULTS A total of 1,314 and 931 patients were included in the first and second studies, respectively. EQ-5D-3L utility scores among patients diagnosed with DRA were significantly lower than scores in those not diagnosed with DRA. The reduction in the EQ-5D-3L utility score over the 2-year follow-up was significantly greater in patients newly complicated by DRA during the follow-up period after enrollment but not in those complicated by DRA from the beginning, as compared with patients not complicated by DRA throughout the survey period. The reduction in utility score tended to be lower in patients routinely treated with a β2-microglobulin adsorption column than in untreated patients with DRA. CONCLUSION Complication by DRA in patients undergoing long-term hemodialysis was significantly associated with a decline in QOL.
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Affiliation(s)
- Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Kashihara, Japan
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Kunitoshi Iseki
- Clinical Research Support Center, Nakamura Clinic, Urasoe, Japan
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Hatano M, Kitajima I, Yamamoto S, Nakamura M, Isawa K, Suwabe T, Hoshino J, Sawa N, Ubara Y. Dialysis-related carpal tunnel syndrome in the past 40 years. Clin Exp Nephrol 2021; 26:68-74. [PMID: 34415463 PMCID: PMC8739450 DOI: 10.1007/s10157-021-02122-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022]
Abstract
Purpose and method Patients on hemodialysis develop carpal tunnel syndrome (CTS) due to an accumulation of dialysis-related β2 microglobulin (β2m) amyloid (DRA). In Japan, dialysis technology has progressed remarkably in the past 40 years and has increased the time until patients require surgery for CTS. However, unclear is whether the time from the start of hemodialysis to the first surgery for CTS is associated with β2m clearance by the different hemodialysis techniques. Therefore, we retrospectively evaluated β2m clearance, serum β2m levels, and the change in the length of this period in patients across 4 periods according to the year that first surgery for CTS was performed: period 1, 1982–1989; period 2, 1990–1999; period 3, 2000–2009; and period 4, 2010–2019. Result A total of 222 patients who met the selection criteria were included. Mean β2m clearance was −1.8 ± 16.7% in period 1, and improved to 65.4 ± 8.6% in period 3. Accordingly, the serum β2m value after hemodialysis decreased significantly. The time from the start of hemodialysis to the first surgery for CTS was 12.4 ± 2.9 years in period 1 but increased to 21.8 ± 6.3 years in period 3. In multivariable linear regression analysis, the significant factors contributing to β2m clearance were periods 2, 3, and 4. In particular, the relation between removal of β2m and the extension of the dialysis vintage in period 1 and 2 was remarkable compared with periods 3 and 4. Conclusion Our findings indicate that improvement of β2m clearance via advances in dialysis technology might result in a significant extension in the time between starting HD and the first surgery for CTS.
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Affiliation(s)
- Masaki Hatano
- Department of Orthopaedic Surgery, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
| | - Izuru Kitajima
- Department of Orthopaedic Surgery, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Seizo Yamamoto
- Department of Orthopaedic Surgery, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Masaki Nakamura
- Department of Orthopaedic Surgery, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Kazuya Isawa
- Department of Orthopaedic Surgery, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Minato City, Tokyo, Japan
| | - Junichi Hoshino
- Department of Nephrology, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Minato City, Tokyo, Japan
| | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Minato City, Tokyo, Japan
| | - Yoshifumi Ubara
- Department of Nephrology, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan. .,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Minato City, Tokyo, Japan.
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Tabata S, Kaneda F, Ohwada K, Nishiyama T, Kaneda H. Extended-Hours Hemodialysis without Dietary Restrictions Is Associated with Lower Risk for Developing of Dialysis-Related Amyloidosis. TOHOKU J EXP MED 2021; 253:241-248. [PMID: 33828023 DOI: 10.1620/tjem.253.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dialysis-related amyloidosis (DRA) is characterized by the deposition of amyloid consisting of beta2-microglobulin in the musculoskeletal system, causing carpal tunnel syndrome, destructive spondyloarthropathy, and/or bone cysts. Increased cystic radiolucency of the bones and tendon thickening due to inflammation are common findings in DRA. We have developed a new dialysis method, extended-hours hemodialysis without dietary restrictions for the aim of improving both hypertension and malnutrition. We retrospectively evaluated the clinical effects of dialysis time on the risk for developing of DRA. The study subjects were all of the 30 patients who had received this treatment for more than 11 years. They were divided into two groups according to the weekly dialysis hours: 15 patients ≥ 16.5 hours/week (L-group) and 15 patients ≤ 15.5 hours/week (S-group). Plain x-ray imaging and ultrasonography were used to assess cystic radiolucency of the bones and thickness/diameter of the soft tissues. The proportion of the carpal bone cystic radiolucency was lower in the L-group. The severity of median nerve compression at the wrist was significantly less in the L-group (right hand: p = 0.0082, left hand: p = 0.0137). Multivariate regression analysis showed that dialysis time was a predictor of median nerve compression (β = -0.559, p = 0.005). In conclusion, extended-hours hemodialysis without dietary restrictions contributes to lower the risk for developing of DRA at the wrist. We therefore propose that extended-hours hemodialysis without dietary restrictions is a preferred method which maintains the patients' quality of life compared with the conventional hemodialysis method.
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Portales-Castillo I, Yee J, Tanaka H, Fenves AZ. Beta-2 Microglobulin Amyloidosis: Past, Present, and Future. KIDNEY360 2020; 1:1447-1455. [PMID: 35372889 DOI: 10.34067/kid.0004922020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/21/2020] [Indexed: 11/27/2022]
Abstract
Almost half a century has elapsed since the first description of dialysis-related amyloidosis (DRA), a disorder caused by excessive accumulation of β-2 microglobulin (B2M). Within that period, substantial advances in RRT occurred. These improvements have led to a decrease in the incidence of DRA. In many countries, DRA is considered a "disappearing act" or complication. Although the prevalence of patients living with RRT increases, not all will have access to kidney transplantation. Consequently, the number of patients requiring interventions for treatment of DRA is postulated to increase. This postulate has been borne out in Japan, where the number of patients with ESKD requiring surgery for carpal tunnel continues to increase. Clinicians treating patients with ESKD have treatment options to improve B2M clearance; however, there is a need to identify ways to translate improved B2M clearance into improved quality of life for patients undergoing long-term dialysis.
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Affiliation(s)
- Ignacio Portales-Castillo
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jerry Yee
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan
| | - Hiroshi Tanaka
- Division of Nephrology, Department of Medicine, Mihara Red Cross Hospital, Mihara, Japan
| | - Andrew Z Fenves
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Huang C, Ren J, Ji F, Muyldermans S, Jia L. Nanobody-Based high-performance immunosorbent for selective beta 2-microglobulin purification from blood. Acta Biomater 2020; 107:232-241. [PMID: 32092428 DOI: 10.1016/j.actbio.2020.02.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 12/18/2022]
Abstract
Removing β2-microglobulin (β2M) from blood circulation is considered to be the most effective method to delay the occurrence of dialysis-related amyloidosis (DRA). The ideal extracorporeal β2M removal system should be cost-effective, highly specific and having a high capacity. However, the traditional technologies based on size exclusion do not have an adequate specificity, and alternative immunosorbents have limited applications due to low capacity and their high cost. Nanobodies (Nbs), the smallest functional recombinant antibody fragments, offer several advantages to overcome these obstacles. In this study, an anti-β2M Nb with a C-terminal thiol-tag was successfully prepared from E. coli for site-directed and oriented immobilization and usage as capture ligand in a β2M-selective immunosorbent. The prepared immunosorbent showed a high binding capacity of up to 7 mg β2M per mL resin, which is 17 times higher than that of previous studies using single-chain variable antibody fragments (scFv). Furthermore, an exceptional high specificity has been demonstrated as other human serum proteins were not adsorbed during dynamic adsorption experiments. About 80% of the original binding capacity of the immunosorbent was restored after four consecutive easy regenerations, whereas 90% of the original capacity was retained after 1-month storage of the resin. Moreover, the mathematical model fitted very well the in vitro perfusion. The results with this pioneering immunosorbent confirm its possible clinical application and is expected to reach the required clinical effect of immunoadsorption therapy. STATEMENT OF SIGNIFICANCE: Dialysis-related amyloidosis (DRA), associated with the accumulation of β2-microglobulin (β2M), is a serious complication of end-stage kidney disease. Removing β2M from blood circulation by extracorporeal blood purification is considered to be the most effective method to delay the occurrence of DRA. However, the existing methods are incapable to eliminate sufficient quantities of β2M from circulation, either because of lack of specificity, high cost or for low capacity. In this manuscript, we provide a practical and economic immunosorbent based on anti-β2M nanobody for DRA. The prepared immunosorbent was reusable and storable, and demonstrated high specificity and realized a high binding capacity of up to 7 mg β2M per mL resin, which is 17 times higher than that of the previous studies.
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Hattori Y, Miyazaki T, Seishima M. Subcutaneous Nodule at the Sacral Region as a Rare Skin Manifestation of Dialysis-Related Amyloidosis. Ther Apher Dial 2018; 22:674-676. [PMID: 30058254 DOI: 10.1111/1744-9987.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/23/2018] [Accepted: 05/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Yuki Hattori
- Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tatsuhiko Miyazaki
- Department of Diagnostic Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Mariko Seishima
- Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
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Yamamoto S. Molecular mechanisms underlying uremic toxin-related systemic disorders in chronic kidney disease: focused on β 2-microglobulin-related amyloidosis and indoxyl sulfate-induced atherosclerosis-Oshima Award Address 2016. Clin Exp Nephrol 2018; 23:151-157. [PMID: 29869756 PMCID: PMC6510801 DOI: 10.1007/s10157-018-1588-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/07/2018] [Indexed: 11/27/2022]
Abstract
Uremic toxins are linked to chronic kidney disease (CKD)-related systemic diseases. β2-Microglobulin (β2-m), a water-soluble, middle-sized molecule, is associated with mortality and dialysis-related amyloidosis (DRA). DRA occurs in long-term dialysis patients, with β2-m amyloid deposited mainly in osteoarticular tissues. We investigated a model of β2-m amyloid fibril extension at neutral pH in the presence of trifluoroethanol or sodium dodecyl sulfate. Using this model, some biological molecules, including glycosaminoglycans and lysophospholipids, were found to be chaperones for β2-m amyloid fibril extension. Several protein-bound solutes, such as indoxyl sulfate (IS) and p-cresyl sulfate, are independent risk factors for cardiovascular disease in CKD patients, especially those undergoing dialysis. We investigated kidney injury-induced acceleration of atherosclerosis in association with macrophage phenotypic change to a proinflammatory state as well as increased IS deposition in lesions in an animal model. IS directly induced macrophage inflammation and impaired cholesterol efflux to high-density lipoprotein (HDL) in vitro. In addition, a clinical study showed that HDL isolated from CKD patients induced proinflammatory reactions and impaired cholesterol efflux to macrophages. These findings suggest that protein-bound solutes, including IS, will induce dysfunction of both macrophages and HDL in atherosclerotic lesions. To remove uremic toxins efficiently, we demonstrated the potential efficacy of oral charcoal adsorbent and hexadecyl-immobilized cellulose beads in hemodialysis patients. These findings suggest that uremic toxins induce various CKD-related systemic disorders, and further therapeutic strategies will be needed to reduce uremic toxins enough and improve life expectancy in CKD patients.
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Affiliation(s)
- Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan.
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Rubin J, Alvarez J, Teruya S, Castano A, Lehman RA, Weidenbaum M, Geller JA, Helmke S, Maurer MS. Hip and knee arthroplasty are common among patients with transthyretin cardiac amyloidosis, occurring years before cardiac amyloid diagnosis: can we identify affected patients earlier? Amyloid 2017; 24:226-230. [PMID: 28906148 DOI: 10.1080/13506129.2017.1375908] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transthyretin cardiac amyloidosis (ATTR-CA) causes a restrictive cardiomyopathy in older adults, often diagnosed at advanced stages when emerging therapies in late phase clinical trials may not have clinical benefit. This investigation aimed to detect clinical entities that may provide more advanced warning of ATTR-CA. Since ATTR preferentially deposits in ligaments, tendons, and articular cartilage, we hypothesized that ATTR-CA patients have a greater prevalence of total hip (THA) and knee (TKA) arthroplasties compared with the general population, and that arthroplasty occurs significantly before ATTR-CA diagnosis. Three-hundred and thirteen patients with cardiac amyloidosis (172 with ATTR-CA, 141 with light-chain) from our institutional database were analyzed and compared to published data in over 300 million patients. Overall, 23.3% of patients with ATTR-CA and 9.2% of patients with light-chain cardiac amyloidosis (AL-CA) underwent lower extremity arthroplasty. Compared to the general population, both THA and TKA were significantly more common among patients with ATTR-CA (THA: RR 5.61, 95% CI 2.25-4.64; TKA: RR 3.32, 95% CI 2.25-4.64) but not those with AL-CA (THA: RR 1.87, 95% CI 0.85-4.08; TKA: RR 1.42, 95% CI 0.73-2.84). On an average, arthroplasty occurred 7.2 years before ATTR-CA diagnosis.
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Affiliation(s)
- Jonah Rubin
- a Clinical Cardiovascular Research Laboratory for the Elderly , Columbia University Medical Center, Allen Hospital of New York-Presbyterian Hospital , New York , NY , USA
| | - Julissa Alvarez
- a Clinical Cardiovascular Research Laboratory for the Elderly , Columbia University Medical Center, Allen Hospital of New York-Presbyterian Hospital , New York , NY , USA
| | - Sergio Teruya
- a Clinical Cardiovascular Research Laboratory for the Elderly , Columbia University Medical Center, Allen Hospital of New York-Presbyterian Hospital , New York , NY , USA
| | - Adam Castano
- a Clinical Cardiovascular Research Laboratory for the Elderly , Columbia University Medical Center, Allen Hospital of New York-Presbyterian Hospital , New York , NY , USA
| | - Ronald A Lehman
- b Department of Orthopedic Surgery , Columbia University Medical Center , New York , NY , USA
| | - Mark Weidenbaum
- b Department of Orthopedic Surgery , Columbia University Medical Center , New York , NY , USA
| | - Jeffrey A Geller
- b Department of Orthopedic Surgery , Columbia University Medical Center , New York , NY , USA
| | - Stephen Helmke
- a Clinical Cardiovascular Research Laboratory for the Elderly , Columbia University Medical Center, Allen Hospital of New York-Presbyterian Hospital , New York , NY , USA
| | - Mathew S Maurer
- a Clinical Cardiovascular Research Laboratory for the Elderly , Columbia University Medical Center, Allen Hospital of New York-Presbyterian Hospital , New York , NY , USA
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Han S, Yang K, Sun J, Liu J, Zhang L, Zhao J. Proteomics Investigations into Serum Proteins Adsorbed by High-Flux and Low-Flux Dialysis Membranes. Proteomics Clin Appl 2017; 11. [PMID: 28795537 DOI: 10.1002/prca.201700079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/06/2017] [Indexed: 01/05/2023]
Abstract
Hemodialysis is one of the most important therapies for patients with uremia, and the dialysis membrane is the predominant factor that impacts the efficiency of dialysis. Here, a protein adsorption on two different membranes is investigated to provide a basis for improving dialysis materials. Two cases treated with the Polyflux 14L low-flux dialyzer and the Polyflux 140H high-flux dialyzers during two continuous therapies are selected. Four used dialyzers from selected patients are infused with C12Im-Cl to elute the adsorbed proteins. Then labeled digested proteins adsorb by Polyflux 140H and Polyflux 14L with 13 CD2 O and NaCNBD3 (light labeling, L) and CD2 O and NaCNBH3 (heavy labeling, H), respectively. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is used to identify the proteins. According to the ratio (Light labeling/Heavy labeling), the eluted proteins are divided into three groups: significantly higher, significantly lower, and no significant differences with a ratio of >2, <0.5, and 0.5-2, respectively. A total of 668 proteins are identified by LC-MS/MS, among which 177 proteins are retained more by the Polyflux 140H membrane (ratio >2), 320 proteins are retained more by the Polyflux 14L membrane (ratio <0.5), and 171 proteins show no significant difference (ratio 0.5-2) between the two types of membranes. Statistical significance is shown in the percentage of adsorbed proteins with an isoelectric point (pI) ranging from 9 to 10 (19.08 versus 7.69%; χ2 = 11.87, p = 0.0006). Proteins with a molecular weight (MW) of 10-15 kDa tend to deposit on Polyflux 140H compared with Polyflux 14L (25 versus 9.23%; χ2 = 18.66, p = 0.0000) and proteins with a MW of 30-60 kDa tend to deposit on Polyflux 14L compared with Polyflux 140H (36.54 versus 22.37%; χ2 = 8.96, p = 0.0028). According to gene ontology analysis, the proteins adsorbed by dialysis membranes are closely related to activation of complement system and the coagulation cascade. The proteins adsorbed by Polyflux 140H and Polyflux 14L show significant differences in PI, MW, and protein class. Proteomic techniques are an effective approach for studying hemodialysis membranes.
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Affiliation(s)
- Shuai Han
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Kaiguang Yang
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Science, National Chromatographic Research and Analysis Center, Dalian, China
| | - Jingdi Sun
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jianhui Liu
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Science, National Chromatographic Research and Analysis Center, Dalian, China
| | - Lihua Zhang
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Science, National Chromatographic Research and Analysis Center, Dalian, China
| | - Jiuyang Zhao
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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13
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Long B, Koyfman A, Lee CM. Emergency medicine evaluation and management of the end stage renal disease patient. Am J Emerg Med 2017; 35:1946-1955. [PMID: 28893450 DOI: 10.1016/j.ajem.2017.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/02/2017] [Accepted: 09/03/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. OBJECTIVE This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population. DISCUSSION ESRD incidence is rapidly increasing, and patients commonly require renal replacement therapy including hemodialysis (HDS) or peritoneal dialysis (PD), each type with specific features. These patients possess greater risk of neurologic complications, cardiopulmonary pathology, infection, and access site complications. Focused history and physical examination are essential. Neurologic issues include uremic encephalopathy, cerebrovascular pathology, and several others. Cardiopulmonary complications include pericarditis, pericardial effusion/tamponade, acute coronary syndrome, sudden cardiac death, electrolyte abnormalities, pulmonary edema, and air embolism. Infections are common, with patients more commonly presenting in atypical fashion. Access site infections and metastatic infections must be treated aggressively. Access site complications include bleeding, aneurysm/pseudoaneurysm, thrombosis/stenosis, and arterial steal syndrome. Specific medication considerations are required for analgesics, sedatives, neuromuscular blocking agents, antimicrobials, and anticoagulants. CONCLUSIONS Consideration of renal physiology with complications in ESRD can assist emergency providers in the evaluation and management of these patients. ESRD affects many organ systems, and specific pharmacologic considerations are required.
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Affiliation(s)
- Brit Long
- San Antonio Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Courtney M Lee
- Joint Base Elmendorf Richardson Medical Center, Department of Emergency Medicine, 5955 Zeamer Ave, JBER, AK, 99506, United States
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Nishi S, Hoshino J, Yamamoto S, Goto S, Fujii H, Ubara Y, Motomiya Y, Morita H, Takaichi K, Yamagata K, Shigematsu T, Ueda M, Ando Y. Multicentre cross-sectional study for bone-articular lesions associated with dialysis related amyloidosis in Japan. Nephrology (Carlton) 2017; 23:640-645. [PMID: 28556529 DOI: 10.1111/nep.13077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/12/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Abstract
AIM Dialysis-related amyloidosis (DRA) exhibits multiple bone-articular lesions, such as carpal tunnel syndrome (CTS), trigger finger (TF), spinal canal stenosis (SCS), destructive spondyloarthropathy (DSA), bone cysts, and joint pains. DRA leads to a decrease in activities of daily living (ADL). We investigated the initiation of CTS and TF, and evaluated the relationship between walking disturbances and bone-articular lesions or joint pains. METHODS A multicentre cross-sectional study was performed. Eighty-two patients with clinical DRA from 20 hospitals in Japan were evaluated. RESULTS Of the 82 patients, the first symptom of DRA was CTS in 39 patients (47.6%) and TF in 21 (25.6%). The mean new-onset vintages of 21 earlier cases in the CTS and TF groups were 86.1 ± 36.3 and 133.2 ± 56.4 (mean ± SD) months, respectively (P = 0.0091). The development of SCS and DSA appeared to be later than CTS and TF. Multiple regression analysis revealed that knee joint pain was a significant contributor to walking disturbances. CONCLUSION Carpal tunnel syndrome appeared significantly earlier than TF since the initiation of dialysis. In the advanced phase, knee joint pain was a major cause of decreased ADL in patients with clinical DRA.
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Affiliation(s)
- Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Junichi Hoshino
- Department of Nephrology, Toranomon Hospital Kajigaya, Tokyo, Japan
| | - Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan
| | - Shunsuke Goto
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hideki Fujii
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yoshifumi Ubara
- Department of Nephrology, Toranomon Hospital Kajigaya, Tokyo, Japan
| | - Yoshihiro Motomiya
- Department of Laboratory Medicine, Suiyukai Clinic, Kashihara, Nara, Japan
| | | | | | - Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takashi Shigematsu
- Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
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15
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Yamamoto S, Kazama JJ, Wakamatsu T, Takahashi Y, Kaneko Y, Goto S, Narita I. Removal of uremic toxins by renal replacement therapies: a review of current progress and future perspectives. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0056-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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16
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Kazama JJ, Matsuo K, Iwasaki Y, Fukagawa M. Chronic kidney disease and bone metabolism. J Bone Miner Metab 2015; 33:245-52. [PMID: 25653092 DOI: 10.1007/s00774-014-0639-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/07/2014] [Indexed: 12/14/2022]
Abstract
Chronic kidney disease-related mineral and bone disease (CKD-MBD) is a syndrome defined as a systemic mineral metabolic disorder associated with CKD, and the term renal osteodystrophy indicates a pathomorphological concept of bone lesions associated with CKD-MBD. Cortical bone thinning, abnormalities in bone turnover and primary/secondary mineralization, elevated levels of circulating sclerostin, increased apoptosis in osteoblasts and osteocytes, disturbance of the coupling phenomenon, iatrogenic factors, accumulated micro-crackles, crystal/collagen disorientation, and chemical modification of collagen crosslinks are all possible candidates found in CKD that could promote osteopenia and/or bone fragility. Some of above factors are the consequences of abnormal systemic mineral metabolism but for others it seem unlikely. We have used the term uremic osteoporosis to describe the uremia-induced bone fragility which is not derived from abnormal systemic mineral metabolism. Interestingly, the disease aspect of uremic osteoporosis appears to be similar to that of senile osteoporosis.
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Affiliation(s)
- Junichiro James Kazama
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan,
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17
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Pharmacokinetic analysis of antibiotic adsorption (vancomycin and teicoplanin) by the Lixelle extracorporeal unit. Int J Artif Organs 2015; 38:8-12. [PMID: 25651463 DOI: 10.5301/ijao.5000383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE The pharmacokinetic properties of vancomycin (VAN) and teicoplanin (TEC) may be affected by adsorption during hemofiltration as well as hemoperfusion therapies. The aim of this in vitro study was to investigate VAN and TEC removal adsorption kinetics with mass balance analysis by direct hemoperfusion (DHP) with the Lixelle S-35 cartridge (Lixelle, Kaneka Corporation, Tokyo). METHODS Mock DHP was performed for 120 min using VAN and TEC solutions (46.08 ± 0.81 and 74.79 ± 1.24 mg/l per N = 6). Clinical plasma antibiotic concentrations were circulated in a closed circuit simulating DHP using an adsorption column (Lixelle S-35) at flow rate of 250 ml/min. Samples were collected at 10, 60, and 120 min through both arterial and venous ports; drug levels were measured with particle enhanced turbidimetric inhibition immunoassay and fluorescence polarization immunoassay. All tests were performed in triplicate. RESULTS Results subsequent to DHP at the primary assessment interval for VAN mass was 49.06 ± 1.47 mg, indicating a significant reduction of the starting mass (94.74 ± 1.63 mg). The observed reduction of TEC levels greatly exceeded that of VAN at the first interval (10 min). At 120 min of DHP, the estimated mass adsorption of VAN was 45.68 ± 2.26 mg, while the mesured total TEC mass adsorbed was 126.86 ± 0.91 mg. CONCLUSIONS A VAN adsorption plateau indicating the VAN loading dose may be required in patients receiving DHP with the Lixelle S-35. The total TEC mass was adsorbed subsequent to 60 min of circulation, so the loading dose should be closely considered. In addition, the Lixelle S-35 may represent an option as a rescue therapy in accidental overdose of TEC.
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18
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Amyloid deposits derived from transthyretin in the ligamentum flavum as related to lumbar spinal canal stenosis. Mod Pathol 2015; 28:201-7. [PMID: 25189643 DOI: 10.1038/modpathol.2014.102] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/23/2014] [Accepted: 05/28/2014] [Indexed: 11/08/2022]
Abstract
Amyloidosis is a protein conformational disorder with the distinctive feature of extracellular accumulation of amyloid fibrils that come from different proteins. In the ligamentum flavum of the lumbar spine, amyloid deposits were frequently found in elderly patients with lumbar spinal canal stenosis and were at least partially formed by wild-type transthyretin. However, how amyloid deposits in the ligamentum flavum affect lumbar spinal canal stenosis has remained unclear. In this study, we analyzed clinical, pathologic, and radiologic findings of patients with lumbar spinal canal stenosis who had amyloid deposits in the ligamentum flavum. We studied 95 ligamentum flavum specimens obtained from 56 patients with lumbar spinal canal stenosis and 21 ligamentum flavum specimens obtained from 19 patients with lumbar disk herniation. We evaluated histopathologic findings and clinicoradiologic manifestations, such as thickness of the ligamentum flavum and lumbar spinal segmental instability. We found that all 95 ligamentum flavum specimens resected from patients with lumbar spinal canal stenosis had amyloid deposits, which we classified into two types, transthyretin-positive and transthyretin-negative, and that transthyretin amyloid formation in the ligamentum flavum of patients with lumbar spinal canal stenosis was an age-associated phenomenon. The amount of amyloid in the ligamentum flavum was related to clinical manifestations of lumbar spinal canal stenosis, such as thickness of the ligamentum flavum and lumbar spinal segmental instability, in the patients with lumbar spinal canal stenosis with transthyretin-positive amyloid deposits. To our knowledge, this report is the first to show clinicopathologic correlations in transthyretin amyloid deposits of the ligamentum flavum. In conclusion, transthyretin amyloid deposits in the ligamentum flavum may be related to the pathogenesis of lumbar spinal canal stenosis in elderly patients.
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Abstract
BACKGROUND Senile systemic amyloidosis (SSA) derived from wild-type transthyretin is a fairly common condition of old individuals, particularly men. The main presentation is by cardiac involvement, which can lead to severe restrictive cardiomyopathy. SSA is, however, a systemic disease, and amyloid deposits may appear in many other tissues but are thought to be without clinical symptoms outside the heart. Amyloid is a very common finding in cartilage and ligaments of elderly subjects, and transthyretin has been demonstrated in some deposits. Lumbar spinal stenosis is also a condition of usually elderly individuals in whom narrowing of the lumbar spinal canal leads to compression of nerves to the lower limbs. RESULTS We questioned whether lumbar spinal stenosis sometimes could be a manifestation of undiagnosed SSA. In this first report we have studied the presence of amyloid in material obtained at surgery for spinal stenosis in 26 patients. Amyloid was found in 25 subjects. Transthyretin was demonstrated immunohistochemically in 5 out of 15 studied resected tissues. Four of the positive materials were analyzed with Western blot revealing both full-length transthyretin (TTR) and C-terminal TTR fragments, typically seen in SSA. CONCLUSION We conclude that lumbar spinal stenosis quite frequently may be a consequence of SSA and that further studies are warranted.
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Affiliation(s)
- Per Westermark
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Ole B. Suhr
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Svante Berg
- Stockholm Spine Centre, Löwenströmska Hospital, Upplands Väsby, Sweden
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20
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Watanabe K, Watanabe T, Nakayama M. Cerebro-renal interactions: impact of uremic toxins on cognitive function. Neurotoxicology 2014; 44:184-93. [PMID: 25003961 DOI: 10.1016/j.neuro.2014.06.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/13/2014] [Accepted: 06/27/2014] [Indexed: 01/21/2023]
Abstract
Cognitive impairment (CI) associated with chronic kidney disease (CKD) has received attention as an important problem in recent years. Causes of CI with CKD are multifactorial, and include cerebrovascular disease, renal anemia, secondary hyperparathyroidism, dialysis disequilibrium, and uremic toxins (UTs). Among these causes, little is known about the role of UTs. We therefore selected 21 uremic compounds, and summarized reports of cerebro-renal interactions associated with UTs. Among the compounds, uric acid, indoxyl sulfate, p-cresyl sulfate, interleukin 1-β, interleukin 6, TNF-α, and PTH were most likely to affect the cerebro-renal interaction dysfunction; however, sufficient data have not been obtained for other UTs. Notably, most of the data were not obtained under uremic conditions; therefore, the impact and mechanism of each UT on cognition and central nervous system in uremic state remains unknown. At present, impacts and mechanisms of UT effects on cognition are poorly understood. Clarifying the mechanisms and establishing novel therapeutic strategies for cerebro-renal interaction dysfunction is expected to be subject of future research.
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Affiliation(s)
- Kimio Watanabe
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Tsuyoshi Watanabe
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Masaaki Nakayama
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
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21
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Fukagawa M, Yokoyama K, Koiwa F, Taniguchi M, Shoji T, Kazama JJ, Komaba H, Ando R, Kakuta T, Fujii H, Nakayama M, Shibagaki Y, Fukumoto S, Fujii N, Hattori M, Ashida A, Iseki K, Shigematsu T, Tsukamoto Y, Tsubakihara Y, Tomo T, Hirakata H, Akizawa T. Clinical Practice Guideline for the Management of Chronic Kidney Disease-Mineral and Bone Disorder. Ther Apher Dial 2013; 17:247-88. [DOI: 10.1111/1744-9987.12058] [Citation(s) in RCA: 251] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Schiffl H. Impact of advanced dialysis technology on the prevalence of dialysis-related amyloidosis in long-term maintenance dialysis patients. Hemodial Int 2013; 18:136-41. [PMID: 23718290 DOI: 10.1111/hdi.12057] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Dialysis-related amyloidosis (DRA) is a unique type of amyloidosis (beta-2 microglobulin) predominantly in end-stage renal disease. Its clinical manifestations add to increased morbidity and reduced quality of life. There seems to be a relative risk reduction in DRA manifestations when hemodialysis (HD) patients are treated with advanced HD technology, but changes of the course of DRA are uncertain. The aim of our investigation was to evaluate the prevalence and severity of carpal tunnel syndrome (CTS) in long-term dialysis patients receiving either conventional or high-flux, online-produced ultrapure dialysis fluid. The cross-sectional study included 147 HD patients (at least 10 years). The definitive diagnosis of CTS was made histologically or by the coexistence of CTS with other radiological DRA manifestations (bone cysts, arthropathies). The two HD patient groups did not differ significantly in age at start of HD, gender, major co-morbid diseases, anuria, and dialysis vintage. The conventional HD group had significantly higher circulating beta-2 microglobulin and C-reactive protein (CRP) levels. The prevalence of DRA was 68% for the conventional HD group and 28% for the advanced HD group. Duration of dialysis treatment was the only significant risk factor for the development of clinical DRA manifestations in both study groups, but CTS, bone cysts, or arthropathies occurred significantly earlier in conventional HD patients. The prevalence and severity of DRA have decreased with advances in dialysis technology during the last two decades, although its occurrence is simply delayed.
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Affiliation(s)
- Helmut Schiffl
- Department of Internal Medicine IV, University Hospital, Munich, Germany
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23
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Mbarki H, Akrichi A, Lazrak A, Maaroufi C, El Midaoui A, Tachfouti N, Jellouli W, Arrayhani M, Belahsen MF, Sqalli T. [Carpal tunnel syndrome in chronic hemodialysis patients]. Pan Afr Med J 2013; 14:19. [PMID: 23504584 PMCID: PMC3597896 DOI: 10.11604/pamj.2013.14.19.387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 09/03/2012] [Indexed: 11/25/2022] Open
Abstract
Le syndrome du canal carpien (SCC) regroupe l'ensemble des signes et symptômes liés à la compression du nerf médian dans le canal carpien. Cette manifestation de l'amylose à béta2-microglobuline est une complication fréquente de l'hémodialyse au long cours. L'objectif de ce travail est d'analyser les caractéristiques du SCC et de déterminer les facteurs liés à sa survenue chez les hémodialysés chroniques. Nous rapportons une étude transversale monocentrique, menée au 3ème trimestre de l'année 2009, portant sur les patients adultes hémodialysés chroniques au service de Néphrologie-Hémodialyse au CHU de Fès. 59 patients ont accepté de participer à l'étude. Leurs âge moyen est de 48 ± 15 ans avec un sex-ratio de 0,9. Ils bénéficient tous de l'hémodialyse intermittente à raison de 10 à 12 heures par semaine, par une membrane de dialyse en polysulfone à basse perméabilité. La durée moyenne en hémodialyse est de 83 ± 6,5 mois. La prévalence du SCC dans notre centre est de 30,5%. L'électromyogramme (EMG) a confirmé la suspicion clinique du SCC chez 11 patients et a diagnostiqué un SCC chez 8 patients asymptomatiques. La comparaison statistique entre les deux groupes de patients avec et sans SCC a démontré que la survenue de ce syndrome est liée à: l'âge actuel, l'âge avancé à la mise en hémodialyse, le sexe féminin, l'excès pondéral, et l'abord vasculaire. Le SCC est une complication fréquente de l'hémodialyse chronique. L'amélioration de la qualité de dialyse permettrait de réduire le risque de survenue du SCC.
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Affiliation(s)
- Houda Mbarki
- Service de néphrologie, CHU Hassan II, Fès, Morocco
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Fissell R, Schulman G, Pfister M, Zhang L, Hung AM. Novel dialysis modalities: do we need new metrics to optimize treatment? J Clin Pharmacol 2012; 52:72S-8S. [PMID: 22232756 DOI: 10.1177/0091270011414576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Delivered dose of hemodialysis has long been an important predictor of mortality. The limitations of conventional hemodialysis treatments have led to a renewed interest in more frequent and longer hemodialysis treatments. As alternative hemodialysis schedules have become more prevalent, a need for modified metrics to measure adequacy has emerged. In addition, there is an interest in finding measures of hemodialysis adequacy that are more reliable in certain subgroups of patients, such as women, ethnic minority groups, or people with small body size. Finally, extended hemodialysis schedules suggest a need for metrics that can measure the clearance of solutes other than urea, such as middle-size molecules, and solutes for which clearance depends on intercompartmental transport across membranes. New metrics to quantify clearance in extended and alternate hemodialysis schedules are needed. As new metrics are developed, it is anticipated that they will also contribute to more accurate assessments of associations between clinical outcomes and delivered dose of dialysis in more intensive, nontraditional hemodialysis schedules. This review provides a historical prospective of dialysis dose and adequacy and describes the need for new metrics from both solute type and dialysis dose prospective as alternative hemodialysis schedules have emerged and become more prevalent.
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Affiliation(s)
- Rachel Fissell
- Glickman Urological/Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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25
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The Japanese Society for Dialysis Therapy. Clinical Practice Guideline for CKD-MBD. ACTA ACUST UNITED AC 2012. [DOI: 10.4009/jsdt.45.301] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Dialysis-related amyloidosis (DRA) is a clinical syndrome of pain, loss of function and other symptoms due to the deposition of amyloid consisting of β(2)-microglobulin (β(2)m) in the musculoskeletal system. The condition is seen in patients who suffer from chronic kidney disease and are treated with hemodialysis for a long time. Even though β(2)m easily can be manipulated to form amyloid in laboratory experiments under non-physiological conditions the precise mechanisms involved in the formation of β(2)m-amyloid in patients with DRA have been difficult to unravel. The current knowledge which is reviewed here indicates that conformational fluctuations centered around the D-strand, the DE-loop, and around the cis-configured Pro32 peptide bond are involved in β(2)m amyloidosis. Also required are highly increased concentrations of circulating β(2)m and possibly various post-translational modifications mediated by the pro-inflammatory environment in uremic blood, together with the influence of divalent metal ions (specifically Cu(2 +)), uremic toxins, and dialysis-enhanced redox-processes. It seems plausible that domain-swapped β(2)m dimers act as building blocks of β-spine cross-β -sheet fibrils consisting of otherwise globular, roughly natively folded protein. An activated complement system and cellular activation perpetuate these reactions which due to the affinity of β(2)m-amyloid for the collagen of synovial surfaces result in the DRA syndrome.
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Affiliation(s)
- Dorthe B Corlin
- Department of Clinical Biochemistry and Immunology, Division of Microbiology and Diagnostics, Statens Serum Institut, Bldg. 85/240, Artillerivej 5, 2300, Copenhagen S, Denmark,
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Busch M, Schwenzky A, Franke S, Stein G, Wolf G. Advanced Glycation End Products and ß2-Microglobulin as Predictors of Carpal Tunnel Syndrome in Hemodialysis Patients. Blood Purif 2012; 34:3-9. [DOI: 10.1159/000338923] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 04/17/2012] [Indexed: 11/19/2022]
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Yang TH, Lin BJ, Ma YL, Chou KJ. In Vitro Removal of Beta-2-Microglobulin From Uremic Blood With an Immunoadsorption Wall. Artif Organs 2011; 36:78-86. [DOI: 10.1111/j.1525-1594.2011.01294.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Renal co-morbidity is common in patients with rheumatic disease based on regular assessment of serum and urine parameters of renal function. When patients present with both arthritis and renal abnormalities the following questions have to be addressed. Is kidney disease a complication of rheumatic disease or its management, or are they both manifestations of a single systemic autoimmune disease? Is rheumatic disease a complication of kidney disease and its management? How do rheumatic disease and kidney disease affect each other even when they are unrelated? The present review provides an overview of how to address these questions in daily practice.
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Affiliation(s)
- Hans-Joachim Anders
- Medizinische Poliklinik, Klinikum der Universität München - Innenstadt, Pettenkoferstraße 8a, 80336 Munchen, Germany
| | - Volker Vielhauer
- Medizinische Poliklinik, Klinikum der Universität München - Innenstadt, Pettenkoferstraße 8a, 80336 Munchen, Germany
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Wang SSS, Hung YT, Wen WS, Lin KC, Chen GY. Exploring the inhibitory activity of short-chain phospholipids against amyloid fibrillogenesis of hen egg-white lysozyme. Biochim Biophys Acta Mol Cell Biol Lipids 2011; 1811:301-13. [DOI: 10.1016/j.bbalip.2011.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 01/22/2011] [Accepted: 02/04/2011] [Indexed: 01/27/2023]
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El-Wakil HS, Abou-Zeid AA, El-Gohary IE, Abou El-Seoud NA, Abou El-Yazeed MA, El-Leithy MA. Effect of high flux versus low flux hemodialysis on serum beta-2 microglobulin, advanced oxidation protein products and protein carbonyl. ALEXANDRIA JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.ajme.2011.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Hala S. El-Wakil
- Department of Internal Medicine , Faculty of Medicine, Alexandria University, Egypt
| | - Abla A. Abou-Zeid
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Egypt
| | - Iman E. El-Gohary
- Department of Internal Medicine , Faculty of Medicine, Alexandria University, Egypt
| | | | | | - Maha A. El-Leithy
- Alexandria, Sixth Year Students, Faculty of Medicine, Alexandria University, Egypt
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Sueyoshi T, Ueda M, Jono H, Irie H, Sei A, Ide J, Ando Y, Mizuta H. Wild-type transthyretin-derived amyloidosis in various ligaments and tendons. Hum Pathol 2011; 42:1259-64. [PMID: 21334722 DOI: 10.1016/j.humpath.2010.11.017] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 11/17/2010] [Accepted: 11/19/2010] [Indexed: 10/18/2022]
Abstract
Transthyretin-derived amyloid deposition is commonly found in intercarpal ligaments of patients with senile systemic amyloidosis. However, the frequency of transthyretin-derived amyloid deposits in ligaments of other tissues remains to be elucidated. This study aimed to determine the frequency of amyloid deposition and the precursor proteins of amyloid found in orthopedic disorders. We studied 111 specimens from patients with carpal tunnel syndrome (flexor tenosynovium specimens), rotator cuff tears (rotator cuff tendon specimens), and lumbar canal stenosis (yellow ligament specimens). To identify amyloid precursor proteins, we used immunohistochemical staining with antibodies that react with transthyretin, immunoglobulin light chain, amyloid A protein, and β(2)-microglobulin. By means of Congo red staining, we identified 47 (42.3%) amyloid-positive samples, 39 of which contained transthyretin-derived amyloid (18 flexor tenosynovium specimens, 5 rotator cuff tendon specimens, and 16 yellow ligament specimens). Genetic testing and/or clinical findings suggested that all patients with transthyretin amyloid deposits did not have familial amyloidotic polyneuropathy. The occurrence of amyloid deposition in those tissues depended on age. These results suggest that transthyretin-derived amyloid deposits may occur more frequently in various ligaments and tendons than originally expected. In the future, such amyloid deposits may aid determination of the pathogenesis of ligament and tendon disorders in older patients.
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Affiliation(s)
- Takanao Sueyoshi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
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Wang SSS, Liu KN, Han TC. Amyloid fibrillation and cytotoxicity of insulin are inhibited by the amphiphilic surfactants. Biochim Biophys Acta Mol Basis Dis 2010; 1802:519-30. [PMID: 20176106 DOI: 10.1016/j.bbadis.2010.02.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 01/30/2010] [Accepted: 02/16/2010] [Indexed: 11/26/2022]
Abstract
Amyloid fibrils have been associated with at least 25 different degenerative diseases. The 51-residue polypeptide hormone insulin, which is associated with type II diabetes, has been shown to self-assemble to form amyloid fibrils in vitro. With bovine insulin as a model, the research presented here explores the effects of two amphiphilic surfactants (1,2-dihexanoyl-sn-glycero-3-phosphocholine (di-C7-PC) and 1,2-diheptanoyl-sn-glycero-3-phosphocholine (di-C7-PC)) on the in vitro fibrillation process of bovine insulin at pH 2.0 and 55 degrees C. We demonstrated that insulin fibrillation may be inhibited by both surfactants in a dose-dependent fashion. The best inhibition of fibril formation is observed when insulin is incubated with 4mM di-C7-PC. Moreover, the addition of either surfactant at the concentrations studied attenuated insulin fibril-induced cytotoxicity in both PC12 and SH-SY5Y cell lines. The results from this work may contribute to the understanding of the molecular factors affecting amyloid fibrillation and the molecular mechanism(s) of the interactions between the membrane and amyloid proteins.
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Affiliation(s)
- Steven S-S Wang
- Department of Chemical Engineering, National Taiwan University, Taipei 10617, Taiwan.
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Smith AM, Scheibel T. Functional Amyloids Used by Organisms: A Lesson in Controlling Assembly. MACROMOL CHEM PHYS 2009. [DOI: 10.1002/macp.200900420] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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