Do serine proteases degrade amyloid A fibrils?

Plasma total prekallikrein/kallikrein activity in rheumatoid arthritis with and without amyloidosis. Increased kaolin-stimulated activity in patients with amyloidosis

Following exposure to kaolin, plasma samples were assayed for total prekallikrein/kallikrein activity in 19 patients with rheumatoid arthritis (RA), 39 patients with RA complicated by amyloidosis, 13 patients with nonamyloid nephropathy and 54 healthy subjects. Increased total kallikrein activity was found in RA patients with amyloidosis and in patients with nonamyloid nephropathy. The concentrations of the plasma kallikrein inhibitors C1-inactivator and alpha 2-macroglobulin were normal in RA patients without amyloidosis, whereas they were increased in patients with amyloidosis as well as in patients with nonamyloid nephropathy. The results suggest that the increased activity of plasma kaolin-stimulated kallikrein in RA patients with amyloidosis is due to the nephropathy per se and probably reflects increased levels of prekallikrein.

The pathogenesis of reactive systemic amyloidosis

The diagnosis of amyloidosis is based on the presence of extracellular tissue deposits of proteinaceous material that demonstrate a characteristic green color when stained with Congo red and viewed under polarized light. Several different proteins are amyloidogenic but, in domestic animals, spontaneously occurring systemic amyloidosis is reactive in nature and characterized by the presence of amyloid protein AA. This type of systemic amyloidosis may occur secondary to chronic inflammatory or neoplastic disease, but in many instances no predisposing disease is found. A sustained increase in the serum concentration of serum amyloid A protein (SAA) is necessary but not sufficient for the development of reactive amyloidosis. Other inherited and acquired host-related factors are likely to be important in the development of reactive amyloidosis because this condition develops in few patients with chronic inflammatory disease. The tissue tropism of amyloid deposits varies with the amyloid protein itself and species affected. The consequences of amyloidosis for the host depend upon the tissues involved and the response of these tissues to the presence of the amyloid deposits. In domestic animals, reactive systemic amyloidosis is nephropathic, leading to end-stage renal disease, and the clinical presentation is that of uremia.

Amyloidosis

Recent studies have provided new insight into the pathogenesis of amyloidosis and have broadened our knowledge of the mechanisms of deposition and resolution of amyloid. In particular, the structure, synthesis and plasma clearance of the inflammation-associated amyloid precursor, SAA, have been extensively studied and the precursor-product relationship between circulating SAA, protein AA and fibrillar amyloid A clarified. Information has been accumulating about the enzymatic processes involved in the cleavage of SAA and the degradation of protein AA and a new view has been presented on the possible role of amyloid P component in AA amyloidogenesis. The current model of AA pathogenesis emphasizes the dynamic character of amyloid.

Specific deposition of serum amyloid A protein 2 in the mouse

The homogenates of amyloid-laden spleens prepared from CBA mice were analysed by SDS-PAGE and immunoblotting employing rat anti-murine monoclonal antibody, MSA 4-26. The results showed that the precursor of amyloid A protein (AA), serum amyloid A protein 2 (SAA2), and SAA intermediates with molecular weights of 10,000, 9000, and 8000 were contained in amyloid-laden tissues. The experiment using sonicated spleen cells and acute phase murine sera showed a delay in the degradation rate of SAA2 on cell fragments and the remains of SAA1 in supernatants. This result can explain disappearance of SAA2 from the murine serum during amyloidogenesis in vivo.

Reactive (secondary) amyloidosis and its pathogenesis

Recent advances in amyloid research have broadened our understanding of amyloidogenesis in connection with chronic inflammatory and infectious conditions. Experimental and clinical studies have clarified many of the mechanisms of induction, synthesis and regulation of the amyloid-related serum component SAA and have shed light on the enzymatic processes involved in the cleavage of SAA and degradation of fibrillar AA protein. The current pathogenetic model emphasizes the dynamic character of amyloid disease.