Summary
Review of the clinical and laboratory findings of 39 patients with amyloid polyneuropathy (AP) showed 12 cases to be hereditary and 12 to be associated with plasma cell dyscrasia (PCD). The remaining 15, termed “sporadic” AP, had neuropathy clinically indistinguishable from the other two groups but without a clinicopathologically identified PCD or positive family history. In an attempt to identify the type of amyloid in “sporadic” AP, the immunoreactivity of amyloid deposits was investigated using specific antisera raised against the following different chemical types of amyloid fibril proteins: variable regions of amyloid light chains κ (Aκ) and λ (Aλ), amyloid protein AA, and prealbumin. It was found that the amyloid in “sporadic” AP had Aλ antigenic determinants in ten cases, Aκ in one and prealbumin in three; in one case, the Aλ nature of amyloid was confirmed biochemically on the extracted amyloid fibrills. Thus, the most common type of AP in our population appears to be the “sporadic” form. In “sporadic” AP, the amyloid is most commonly of immunoglobulin light chain origin, even in the absence of overt PCD, and it can be rapidly categorized immunocytochemically to determine therapeutic directions or provide genetic guidance.
Similar content being viewed by others
References
Benson MD (1981) Partial amino acid sequence homology between an heredofamilial amyloid protein and human plasma prealbumin. J Clin Invest 67:1035–1041
Benson MD, Cohen AS, Brand KD, Cathcart ES (1975) Neuropathy M components and amyloid. Lancet I:10–13
Costa PP, Figueira AS, Bravo ER (1978) Amyloid fibril protein related to prealbumin in familial amyloidotic polyneuropathy. Proc Natl Acad Sci USA 75:4499–4503
Cohen AS, Benson MD (1975) Amyloid neuropathy. In: Dyck PJ, Thoma PK, Lambert EH (eds) Neuropathy. Saunders, Philadelphia, pp 1067–1091
Dalakas MC, Engel WK (1979) Role of immunoglobulin light chains in the pathogenesis of amyloid polyneuropathy associated with occult plasma-cell dyscrasia. Trans Am Neurol Assoc 104:227–229
Dalakas MC, Engel WK (1980) Immunoglobulin deposits in chronic relapsing polyneuropathies. Arch Neurol 37:637–640
Dalakas MC, Engel WK (1981a) Amyloid in hereditary amyloid polyneuropathy is related to prealbumin. Arch Neurol 38:420–422
Dalakas MC, Engel WK (1981b) Polyneuropathy with monoclonal gammopathies: Studies of 11 patients. Ann Neurol 10:45–52
Dalakas MC, Fujihara S, Askanas V, Engel WK, Glenner GG (1984) Nature of amyloid deposits in hypernephroma. Immunocytochemical studies in two cases associated with amyloid polyneuropathy. Am J Pathol 116:447–454
Dalakas MC, Papadopoulos NM (1984) Paraproteins in the spinal fluid of patients with paraproteinemic polyneuropathies. Ann Neurol 15:590–593
Ein D, Kimura S, Terry WD, Magnotto J, Glenner GG (1972) Amino acid sequence of an amyloid fibril protein of unknown origin. J Biol Chem 247:5653–5655
Fujihara S, Balow JE, Costa JC, Glenner GG (1980) Identification and classification of amyloid in formalin-fixed, paraffin-embedded tissue sections by the unlabeled immunoperoxidase method. Lab Invest 43:358–365
Fujihara S, Glenner GG (1981) Primary localized amyloidosis of the genitourinary tract. Immunohistochemical study on 11 cases. Lab Invest 44:55–60
Glenner GG (1980) Amyloid deposits and amyloidosis: β-fibrilloses. N Engl J Med 302:1283–1292; 1333–1343
Glenner GG, Terry WD, Harada M, Isersky C, Page DL (1971) Amyloid fibril proteins: proof of homology with immunoglobulin light chains by sequence analysis. Science 172:1150–1151
Glenner GG, Terry WD, Isersky C (1973) Amyloidosis: its nature and pathogenesis. Semin Hematol 10:65–86
Ii K, Itizawa K, Nunomura S Morizumi H (1984) Systemic amyloid myopathy — light-microscopic and fine-structured study of the skeletal muscles with histochemical and immunohistochemical study of amyloids. Acta Neuropathol (Berl) 64:114–121
Isersky C, Ein D, Page DL, Haradu M, Glenner GG (1972) Immunochemical cross-reactions of human amyloid proteins with human immunoglobulin light polypeptide chains. J Immunol 108:486–493
Kimura S, Guyer, R, Terry WD, Glenner GG (1972) Chemical evidence for λ-type amyloid fibril proteins. J Immunol 109:891–892
Linke RP, Sipe JD, Pollock S, Ignaczak TF, Glenner GG (1975) Isolation of a low molecular weight serum component antigenically related to an amyloid fibril protein of unknown origin. Proc Natl Acad Sci USA 72:1473–1476
Linke RP, Nartrath WBJ (1982) Immunochemical typing of amyloid from tissue biopsies Acta Histochem [Suppl XXV] 5:89–93
Linke RP (1983) Differentiation of amyloid syndromes in tissue sections using poly-and monoclonal antibodies. Immunology 165:311
Natvig JB, Wastermark P, Sletten K, Husby G, Michaelson T (1981) Further structural and antigenic studies of light-chain amyloid proteins. Scand J Immunol 14:89–93
Pras M, Franklin EC Prelli F, Frangrone B (1981) A variant of prealbumin from amyloid fibrils in familial polyneuropathy of Jewish origin. J Exp Med 154:989–993
Shoi S, Okano A (1981) Amyloid fibril protein in familial amyloid polyneuropathy Neurology 31:186–190
Sternberger LA (1979) Immunocytochemistry, 2nd edn. Wiley, New York, p 104
Trotter JL, Engel WK, Ignaczak TF (1977) Amyloidosis with plasma cell dyscrasia. An overlooked cause of adult onset sensorimotor neuropathy. Arch Neurol 34:209–214
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Dalakas, M.C., Cunningham, G. Characterization of amyloid deposits in biopsies of 15 patients with “sporadic” (non-familial or plasma cell dyscrasic) amyloid polyneuropathy. Acta Neuropathol 69, 66–72 (1986). https://doi.org/10.1007/BF00687040
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00687040