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Altes und Neues zum Amyloidosenachweis in Nierenbiopsien

State of the art for diagnosing amyloidosis in renal biopsies

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Hintergrund

Amyloidosen sind charakterisiert durch die extrazelluläre Deposition abnorm gefalteter Proteine.

Ziel

Die exakte Typisierung renaler Amyloidosen ist essenziell, um Aussagen über die Prognose zu treffen, eine genetische Beratung durchzuführen und eine adäquate Therapie einzuleiten.

Material und Methoden

Zur Typisierung stehen aktuell im Wesentlichen zwei Methoden zur Verfügung – zum einen die Immunhistochemie, zum anderen die Massenspektrometrie (MS). Die Lasermikrodissektion, gefolgt von Liquid-Chromatographie und MS, stellt eine Methode dar, die in mehreren Labors bereits fest in der Routinediagnostik etabliert ist. Neben diesem Ansatz ist die MALDI („matrix-assisted laser desorption/ionization imaging“)-Methode geeignet zur Amyloidtypisierung an Paraffinmaterial.

Ergebnisse

Letztere Methode steht vor der klinischen Einführung und stellt eine sensitive und schnelle Technik dar, die nicht nur eine Klassifizierung, sondern auch eine sterische Zuordnung zu kongorotpositiven Arealen zulässt.

Diskussion

Limitierend ist bisher der hohe apparative Aufwand. In Zukunft könnte jedoch eine derartige Ausstattung zum Standard großer Institute für Pathologie gehören.

Abstract

Background

Amyloidosis is characterized by extracellular accumulation of misfolded proteins.

Aim

The exact subtyping of renal amyloidosis is essential for prognostic stratification, genetic counseling and therapeutic management.

Material and methods

Amyloidosis typing may be mainly achieved through two methods: immunohistochemistry and mass spectrometry (MS). Laser microdissection coupled to liquid chromatography/MS represents one possible method that is well established in the routine diagnostics in many laboratories. Additionally, matrix-assisted laser desorption/ionization imaging (MALDI) is available for diagnosis of amyloidosis in formalin-fixed paraffin embedded material.

Results

The latter method (MALDI) will be introduced into the clinical practice and is a sensitive and rapid technique not only for subtyping but also for a steric correlation with Congo red stained areas.

Discussion

Currently the general application in routine diagnostics is not yet feasible in most areas, as sophisticated technical equipment is needed. Nevertheless, in the future these applications may be the standard for subtyping of amyloidosis.

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Acknowledgements

Die vorgestellten eigenen Arbeiten zur Massenspektrometrie werden durch die Bruker Daltonik GmbH unterstützt.

Einhaltung ethischer Richtlinien

J. Kriegsmann erhält technische Unterstützung durch die Bruker Daltonik GmbH. R. Casadonte, M. Kriegsmann, K. Amann und D. Suckau geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Proteopath GmbH, Trier, Deutschland

    R. Casadonte &  J. Kriegsmann

  2. Institut für Pathologie, Universität Heidelberg, Heidelberg, Deutschland

    M. Kriegsmann

  3. Institut für Pathologie, Universität Erlangen, Erlangen, Deutschland

    K. Amann

  4. Bruker Daltonik GmbH, Bremen, Deutschland

    D. Suckau

  5. Zentrum für Histologie, Zytologie und Molekulare Diagnostik Trier, Max-Planck-Str. 5, 54296, Trier, Deutschland

    J. Kriegsmann

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  1. R. Casadonte
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Correspondence to J. Kriegsmann.

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Casadonte, R., Kriegsmann, M., Amann, K. et al. Altes und Neues zum Amyloidosenachweis in Nierenbiopsien. Nephrologe 10, 295–302 (2015). https://doi.org/10.1007/s11560-014-0956-z

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