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AMYLOIDOSIS
94 ANANYA JOHN
96 P SRI SAI SANJANA
AMYLOIDS
• Misfolded proteins that deposit in extracellular spaces.
• Can be associated with inherited/inflammatory disorders.
• Deposits cause tissue damage.
• “Amyloids” because staining characteristics resemble amylose
• With progressive accumulation, amyloids can encroach & cause pressure
necrosis on adjacent cells.
CHARACTERISTICS
• Multiple proteins can aggregate to form amyloid. (It doesn’t have to be only 1
type of protein)
• Aggregated proteins usually have cross ß pleated sheath configuration.
• This makes them pick up Congo Red stain.
• Have Apple Green birefringence under polarized light.
Source: Pathoma – Fundamentals of
Pathology
CONGO RED STAIN
Amyloid
deposits
Blood
vessel
Source: Pathoma – Fundamentals of
Pathology
APPLE GREEN BIREFRINGENCE
PATHOGENESIS
• Generally, misfolded proteins are degraded
Intracellularly: in proteosomes
Extracellularly: in macrophages
• In amyloidosis, these degradation mechanisms fail.
CLASSIFICATION
Amyloidosis
Systemic Localized
Primary Secondary
Involving multiple organ
systems
Involving only 1 organ
Ex: Immunoglobulin
light chain
amyloidosis
Ex: Reactive
systemic
amyloidosis
Ex:
• Medullary carcinoma
of thyroid
• Senile cardiac
amyloidosis
Hemodialysis
associated
amyloidosis
IMMUNOGLOBULIN LIGHT CHAIN AMYLOIDOSIS
(PRIMARY)
• Deposition of AL amyloids.
• Derived from Ig light chains.
• Plasma cell abnormalities Abnormal overproduction of light chains
Deposition
• Not all free chains produce amyloids. Amyloidogenic potential of a light chain is
determined by its specific amino acid sequence.
REACTIVE SYSTEMIC AMYLOIDOSIS (SECONDARY)
• Deposition of AA protein
• Derived from SAA protein
• SAA is an acute phase reactant, i.e., its levels rise in chronic inflammation
• Ex: Rheumatoid arthritis, Ankylosing spondylitis, Crohn’s disease, Ulcerative colitis,
etc.
• Infections associated with pricking of skin in narcotic use can inc. risk of
amyloidosis.
AA levels rise
FAMILIAL MEDITERRANEAN FEVER
• Autoinflammatory syndrome
• Inc. cytokine IL-1 production
• Attacks of fever along with inflammation of serosal surfaces is seen. Rashes can also
be present.
Inc. IL-1
Inc. SAA
Inc. AA
Amyloidosis
HAEMODIALYSIS ASSOCIATED AMYLOIDOSIS
Long term hemodialysis
• In the past, B2- microglobulin could not be filtered through dialysis membranes, and
was retained in circulation. With new dialysis filters, this complication has been
reduced.
B2 microglobulin
deposition
Joints, muscles,
tendons/ligaments
affected
Common
presentation:
Carpal Tunnel
Syndrome
LOCALIZED AMYLOIDOSIS
1. Senile cardiac amyloidosis – non-mutated serum transthyretin deposited
2. Medullary carcinoma of thyroid – Procalcitonin deposited
3. Alzheimers – Aß protein gets deposited. Precursor: Amyloid precursor protein
4. Other endocrine amyloids – seen in Islets of Langerhans in Type 2 DM,
pheochromocytoma.
CLINICAL FEATURES
• Renal amyloidosis – Proteinuria, nephrotic syndrome
• Cardiac amyloidosis – Congestive heart failure
• Gastrointestinal amyloidosis – Generally asymptomatic
• Vascular amyloidosis – Vascular fragility
NORMAL GLOMERULUS GLOMERULUS AFFECTED
BY AL AMYLOIDOSIS
TESTS
• Tissue biopsy
• Abdominal fat pad and rectum are easily accessible
• Biopsy of bone marrow/affected organ can also be taken
• Echocardiogram (for heart related)
TREATMENT
MEDICATIONS:
• Chemotherapy and blood thinners
SURGICAL:
• Autologous blood stem cell transplant
• Dialysis – If kidney is affected
• Organ transplant – in cases of severe damage
Source: Robbins &
Cotran Pathological
Basis of Disease
OVERVIE
W:
REFERENCES
• Robbins & Cotran Pathological Basis of Diseases
• Pathoma: Fundamentals of Pathology
THANK YOU

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Amyloidosis

  • 1. AMYLOIDOSIS 94 ANANYA JOHN 96 P SRI SAI SANJANA
  • 2. AMYLOIDS • Misfolded proteins that deposit in extracellular spaces. • Can be associated with inherited/inflammatory disorders. • Deposits cause tissue damage. • “Amyloids” because staining characteristics resemble amylose • With progressive accumulation, amyloids can encroach & cause pressure necrosis on adjacent cells.
  • 3. CHARACTERISTICS • Multiple proteins can aggregate to form amyloid. (It doesn’t have to be only 1 type of protein) • Aggregated proteins usually have cross ß pleated sheath configuration. • This makes them pick up Congo Red stain. • Have Apple Green birefringence under polarized light.
  • 4. Source: Pathoma – Fundamentals of Pathology CONGO RED STAIN Amyloid deposits Blood vessel
  • 5. Source: Pathoma – Fundamentals of Pathology APPLE GREEN BIREFRINGENCE
  • 6. PATHOGENESIS • Generally, misfolded proteins are degraded Intracellularly: in proteosomes Extracellularly: in macrophages • In amyloidosis, these degradation mechanisms fail.
  • 7. CLASSIFICATION Amyloidosis Systemic Localized Primary Secondary Involving multiple organ systems Involving only 1 organ Ex: Immunoglobulin light chain amyloidosis Ex: Reactive systemic amyloidosis Ex: • Medullary carcinoma of thyroid • Senile cardiac amyloidosis Hemodialysis associated amyloidosis
  • 8. IMMUNOGLOBULIN LIGHT CHAIN AMYLOIDOSIS (PRIMARY) • Deposition of AL amyloids. • Derived from Ig light chains. • Plasma cell abnormalities Abnormal overproduction of light chains Deposition • Not all free chains produce amyloids. Amyloidogenic potential of a light chain is determined by its specific amino acid sequence.
  • 9. REACTIVE SYSTEMIC AMYLOIDOSIS (SECONDARY) • Deposition of AA protein • Derived from SAA protein • SAA is an acute phase reactant, i.e., its levels rise in chronic inflammation • Ex: Rheumatoid arthritis, Ankylosing spondylitis, Crohn’s disease, Ulcerative colitis, etc. • Infections associated with pricking of skin in narcotic use can inc. risk of amyloidosis. AA levels rise
  • 10. FAMILIAL MEDITERRANEAN FEVER • Autoinflammatory syndrome • Inc. cytokine IL-1 production • Attacks of fever along with inflammation of serosal surfaces is seen. Rashes can also be present. Inc. IL-1 Inc. SAA Inc. AA Amyloidosis
  • 11. HAEMODIALYSIS ASSOCIATED AMYLOIDOSIS Long term hemodialysis • In the past, B2- microglobulin could not be filtered through dialysis membranes, and was retained in circulation. With new dialysis filters, this complication has been reduced. B2 microglobulin deposition Joints, muscles, tendons/ligaments affected Common presentation: Carpal Tunnel Syndrome
  • 12. LOCALIZED AMYLOIDOSIS 1. Senile cardiac amyloidosis – non-mutated serum transthyretin deposited 2. Medullary carcinoma of thyroid – Procalcitonin deposited 3. Alzheimers – Aß protein gets deposited. Precursor: Amyloid precursor protein 4. Other endocrine amyloids – seen in Islets of Langerhans in Type 2 DM, pheochromocytoma.
  • 13. CLINICAL FEATURES • Renal amyloidosis – Proteinuria, nephrotic syndrome • Cardiac amyloidosis – Congestive heart failure • Gastrointestinal amyloidosis – Generally asymptomatic • Vascular amyloidosis – Vascular fragility
  • 14. NORMAL GLOMERULUS GLOMERULUS AFFECTED BY AL AMYLOIDOSIS
  • 15. TESTS • Tissue biopsy • Abdominal fat pad and rectum are easily accessible • Biopsy of bone marrow/affected organ can also be taken • Echocardiogram (for heart related)
  • 16. TREATMENT MEDICATIONS: • Chemotherapy and blood thinners SURGICAL: • Autologous blood stem cell transplant • Dialysis – If kidney is affected • Organ transplant – in cases of severe damage
  • 17. Source: Robbins & Cotran Pathological Basis of Disease OVERVIE W:
  • 18. REFERENCES • Robbins & Cotran Pathological Basis of Diseases • Pathoma: Fundamentals of Pathology