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Bézard M, Zaroui A, Kharoubi M, Lam F, Poullot E, Teiger E, Agbulut O, Damy T, Kordeli E. Internalisation of immunoglobulin light chains by cardiomyocytes in AL amyloidosis: what can biopsies tell us? Amyloid 2024:1-11. [PMID: 38973117 DOI: 10.1080/13506129.2024.2373748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Cardiac involvement in systemic light chain amyloidosis (AL) leads to chronic heart failure and is a major prognosis factor. Severe cellular defects are provoked in cardiac cells by tissue-deposited amyloid fibrils of misfolded free immunoglobulin light chains (LCs) and their prefibrillar oligomeric precursors. OBJECTIVE Understanding the molecular mechanisms behind cardiac cell cytotoxicity is necessary to progress in therapy and to improve patient management. One key question is how extracellularly deposited molecules exert their toxic action inside cardiac cells. Here we searched for direct evidence of amyloid LC uptake by cardiomyocytes in patient biopsies. METHODS We immunolocalized LCs in cardiac biopsies from four AL cardiac amyloidosis patients and analysed histopathological images by high resolution confocal microscopy and 3D image reconstruction. RESULTS We show, for the first time directly in patient tissue, the presence of LCs inside cardiomyocytes, and report their proximity to nuclei and to caveolin-3-rich areas. Our observations point to macropinocytosis as a probable mechanism of LC uptake. CONCLUSIONS Internalisation of LCs occurs in patient cardiomyocytes. This event could have important consequences for the pathogenesis of the cardiac disease by enabling interactions between amyloid molecules and cellular organelles inducing specific signalling pathways, and might bring new insight regarding treatment.
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Affiliation(s)
- Mélanie Bézard
- Sorbonne Université, Institut de Biologie Paris-Seine (IBPS), UMR CNRS 8256, INSERM U1164, Biological Adaptation and Ageing, Paris-France
- Department of Cardiology and French Referral Centre for Cardiac Amyloidosis, Henri-Mondor Hospital, AP-HP, Université Paris Est Creteil, Inserm U955, IMRB, Créteil, France
| | - Amira Zaroui
- Department of Cardiology and French Referral Centre for Cardiac Amyloidosis, Henri-Mondor Hospital, AP-HP, Université Paris Est Creteil, Inserm U955, IMRB, Créteil, France
| | - Mounira Kharoubi
- Department of Cardiology and French Referral Centre for Cardiac Amyloidosis, Henri-Mondor Hospital, AP-HP, Université Paris Est Creteil, Inserm U955, IMRB, Créteil, France
| | - France Lam
- Sorbonne Université, I2PS, Imaging Core Facility, Institut de Biologie Paris-Seine (IBPS), Paris-France
| | - Elsa Poullot
- Department of Anatomopathology, Henri-Mondor Hospital, AP-HP, Créteil, France
| | - Emmanuel Teiger
- Department of Cardiology and French Referral Centre for Cardiac Amyloidosis, Henri-Mondor Hospital, AP-HP, Université Paris Est Creteil, Inserm U955, IMRB, Créteil, France
| | - Onnik Agbulut
- Sorbonne Université, Institut de Biologie Paris-Seine (IBPS), UMR CNRS 8256, INSERM U1164, Biological Adaptation and Ageing, Paris-France
| | - Thibaud Damy
- Department of Cardiology and French Referral Centre for Cardiac Amyloidosis, Henri-Mondor Hospital, AP-HP, Université Paris Est Creteil, Inserm U955, IMRB, Créteil, France
| | - Ekaterini Kordeli
- Sorbonne Université, Institut de Biologie Paris-Seine (IBPS), UMR CNRS 8256, INSERM U1164, Biological Adaptation and Ageing, Paris-France
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Charalampous C, Dasari S, McPhail E, Theis JD, Vrana JA, Dispenzieri A, Leung N, Muchtar E, Gertz M, Ramirez-Alvarado M, Kourelis T. A proteomic atlas of kidney amyloidosis provides insights into disease pathogenesis. Kidney Int 2024; 105:484-495. [PMID: 38096952 PMCID: PMC10922603 DOI: 10.1016/j.kint.2023.11.023] [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: 03/28/2023] [Revised: 10/04/2023] [Accepted: 11/05/2023] [Indexed: 01/18/2024]
Abstract
The mechanisms of tissue damage in kidney amyloidosis are not well described. To investigate this further, we used laser microdissection-mass spectrometry to identify proteins deposited in amyloid plaques (expanded proteome) and proteins overexpressed in plaques compared to controls (plaque-specific proteome). This study encompassed 2650 cases of amyloidosis due to light chain (AL), heavy chain (AH), leukocyte chemotactic factor-2-type (ALECT2), secondary (AA), fibrinogen (AFib), apo AIV (AApoAIV), apo CII (AApoCII) and 14 normal/disease controls. We found that AFib, AA, and AApoCII have the most distinct proteomes predominantly driven by increased complement pathway proteins. Clustering of cases based on the expanded proteome identified two ALECT2 and seven AL subtypes. The main differences within the AL and ALECT2 subtypes were driven by complement proteins and, for AL only, 14-3-3 family proteins (a family of structurally similar phospho-binding proteins that regulate major cellular functions) widely implicated in kidney tissue dysfunction. The kidney AL plaque-specific proteome consisted of 24 proteins, including those implicated in kidney damage (α1 antitrypsin and heat shock protein β1). Hierarchical clustering of AL cases based on their plaque-specific proteome identified four clusters, of which one was associated with improved kidney survival and was characterized by higher overall proteomic content and 14-3-3 proteins but lower levels of light chains and most signature proteins. Thus, our results suggest that there is significant heterogeneity across and within amyloid types, driven predominantly by complement proteins, and that the plaque protein burden does not correlate with amyloid toxicity.
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Affiliation(s)
| | - Surendra Dasari
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Ellen McPhail
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason D Theis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Julie A Vrana
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Morie Gertz
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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Molecular Mechanisms of Cardiac Amyloidosis. Int J Mol Sci 2021; 23:ijms23010025. [PMID: 35008444 PMCID: PMC8744761 DOI: 10.3390/ijms23010025] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/18/2021] [Accepted: 12/18/2021] [Indexed: 12/22/2022] Open
Abstract
Cardiac involvement has a profound effect on the prognosis of patients with systemic amyloidosis. Therapeutic methods for suppressing the production of causative proteins have been developed for ATTR amyloidosis and AL amyloidosis, which show cardiac involvement, and the prognosis has been improved. However, a method for removing deposited amyloid has not been established. Methods for reducing cytotoxicity caused by amyloid deposition and amyloid precursor protein to protect cardiovascular cells are also needed. In this review, we outline the molecular mechanisms and treatments of cardiac amyloidosis.
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