Light Chain Deposition Disease (Nodular Glomerulopathy, K Light Chain Deposition Disease): A Case Report

A typical case of K light chain deposition disease is detailed. Clinical and pathological findings are described. The discussion focuses on the diagnostic challenges encountered in the diagnosis of monoclonal light chain-related renal diseases. Experimental models have played a relevant role in clarifying and elucidating fundamental questions of diagnostic significance.     

Structural Relationship of λ-Type Light Chains with AL Amyloidosis

Three human amyloidogenic Bence Jones proteins, NIG76 VλII, NIG204 VλI, and NIG250 VλV, were characterized. In a comparative study, three amino acids, Ser-25a, Thr-68, and Val-95, were found to be common to amyloidogenic proteins of the VλII subgroup. NIG204 had an insertion of Pro residue following position 30 (30a). Proteins having an insertion at this position are invariantly amyloidogenic. NIG250 had a characteristic VλVV_Ldomain, with Mcg⁺and KERN⁺C_Ldomain isotypes. Following the protein DEL, this is the second example of this subgroup. No common residue is found in the other subgroup proteins but unique substitutions do occur. It would seem that any substitution that causes an alteration in the protein conformation may lead to its being more prone to association with the amyloid processes.     

Immunoglobulin G(κ) [IgG(κ)] and IgG(λ) Paraproteinemia in a Child with AIDS and Response to Highly Active Antiretroviral Therapy

We report an 8-year-old boy with AIDS, extremely elevated serum immunoglobulin G (IgG) concentration and IgG kappa [IgG(κ)] and IgG lambda [IgG(λ)] paraproteinemia. This paraproteinemia partially responded to highly active antiretroviral therapy. This case emphasizes the importance of controlling B-cell activation.     

Primary localized amyloidosis of the eyelid: two cases of immunoglobulin light chain-derived proteins, subtype λV respectively λVI

Primary localized amyloidosis has been described in many different organs in the body. Studies by immunohistochemical techniques have suggested an immunoglobulin light chain origin of the amyloid material. Only in a limited number of cases has the amyloid protein been characterized by amino acid sequence analysis as subtypes of immunoglobulin light chain or heavy chain. In this report, two cases of primary localized amyloidosis of the eyelid are presented. The amyloid substance has been extracted and a major fibril protein subjected to amino acid sequence analysis. Both amyloid proteins were part of the variable region of immunoglobulin light chains, subtype λV and subtype λVI, respectively. While λVI has been shown to be a common subtype in systemic immunoglobulin light chain-amyloidosis, it has never been demonstrated in localized amyloid. Very few λV immunoglobulin light chains have been characterized and the subgroup has never been found in amyloid before.     

Prognostic Significance of Stringent Complete Response after Stem Cell Transplantation in Immunoglobulin Light Chain Amyloidosis

Hematologic response has emerged as a powerful prognostic factor for survival in patients with immunoglobulin light chain (AL) amyloidosis. Patients achieving a complete response (CR), based on serum and urine analysis, survive longest. However, data regarding the impact of bone marrow features post-therapy on response and survival are limited. We evaluated the impact of achieving a stringent CR (sCR), defined as undetectable bone marrow clonal plasma cells by flow cytometry, in patients with AL amyloidosis receiving an autologous stem cell transplant. A total of 573 consecutive patients transplanted for AL amyloidosis at the Mayo Clinic between April 2002 and August 2016 were included in the analysis. Of 540 patients in whom response was assessable, 220 patients (41%) achieved a CR, of whom 212 (96%) had a bone marrow biopsy at time of response assessment and were further analyzed for determination of sCR; 166 patients (78%) with a CR achieved an sCR, representing 31% of the whole cohort. Patients achieving a CR had a higher median percentage of bone marrow plasma cells (10% for CR versus 6% for sCR, P = .03), more patients with bone marrow plasma cells ≥ 10% (50% for CR versus 33% for sCR, P = .04), and were less likely to receive chemotherapy before transplantation (30% for CR versus 49% for sCR, P = .03) compared with those achieving sCR. Median overall survival for all patients achieving a CR was 175 months and was not statistically different between those achieving an sCR compared with those achieving a CR only (median not reached for sCR versus 175 months for CR, P = .65). Progression-free survival, however, was significantly shorter in patients failing to achieve an sCR (151 months for sCR versus 72 months for CR, P = .0003). Bone marrow examination post-transplant in AL amyloidosis is important and identifies patients who fail to achieve an sCR and progress earlier.     

Prognostic Impact of Serum Immunoglobulin Heavy/Light Chain Ratio in Patients with Multiple Myeloma in Complete Remission after Autologous Stem Cell Transplantation

Immunoglobulin heavy/light chain (HLC) ratios were studied in 37 patients with multiple myeloma in complete remission after autologous hematopoietic stem cell transplantation. Increased IgAκ/IgAλ and IgMκ/IgMλ ratios were associated with longer progression-free survival (P = .006 and .01, respectively). A?statistical trend toward a longer overall survival was also observed for the IgAκ/IgAλ ratio (P = .068). Considering the original immunoglobulin isotype, our results indicate that an increased κ/λ ratio of the uninvolved isotype is associated with longer progression-free survival and overall survival. This is the first report demonstrating the association between the HLC ratio and sustained complete remission in patients with multiple myeloma. Our results suggest that the HLC ratio is a surrogate marker of immune recovery after myeloablative transplantation, rather than as a marker of minimal residual disease.     

Free Immunoglobulin Light Chains as Criteria of Extracorporeal Hemocorrection in Patients with Monoclonal Gammopathies

Bulletin of Experimental Biology and Medicine - Elimination of free immunoglobulin light chains with the use of EMic2 selective filters was carried out in 12 patients with monoclonal gammopathies...     

Complete Amino Acid Sequence of the Variable Regions of Two Highly Related Heavy and Light Chains of Human IgG (SFL) and IgM (RIV) Rheumatoid Factors

The complete amino acid structure of the variable regions of two monoclonal human rheumatoid factors (RF), antibodies that bind to the Fc portion of IgG, is presented. Although these RFs are of different isotypes, IgG (SFL) and IgM (RIV), they are highly related. They probably derive from the same KIII light chain variable region used, but the heavy chains are derived from genes of the VHIII family that are probably evolutionarily related. An analysis of the level of somatic mutation reveals that antigen selection was probably involved in the maturation of these clones. These antibodies, although highly related, are not merely IgM to IgG switch variants which occurred independently in different individuals. Little is currently known about the structure of IgG RFs and this study indicates that the level of somatic mutation of SFL is similar to other autoantibodies or antiviral antibodies of the IgG isotype.     

Analysis of Somatic Hypermutation and Antigenic Selection in the Clonal B Cell in Immunoglobulin Light Chain Amyloidosis (AL)

Light chain amyloidosis (AL) is a protein folding disorder with an underlying B cell neoplasia where the monoclonal immunoglobulin light chains (LCs) produced from insoluble amyloid fibrils. The deposition of these fibrillar aggregates in vital organs causes severe organ dysfunction over time and is associated with high mortality. We have identified the postgerminal center status of the B cell clone by evaluating the presence of somatic hypermutation in the variable region of the LC gene in 27 (13 of the lambda and 14 of the kappa subtype) AL patients. Seven of the 27 clones showed statistically significant evidence of antigenic selection, using a multinomial algorithm. The framework region mutations were selected for conservation of protein structure in 13 of the 27 patients. Additionally, mutational clusterspots were identified at specific positions in the nucleotide and deduced protein sequence that could potentially contribute to destabilizing interactions resulting in a propensity to form amyloid.     

A λ5-cylotriphosphazene with nitroxyl groups as model for a paramagnetic poly(organo-λ5-phosphazene)

Reaction of hexachlorocyclotriphosphazene (syst. name: 2,2,4,4,6,6-hexachloro-1,3,5,2λ⁵,4λ⁵,6λ⁵-triazatriphosphorine) ( 1 ) with 4-hydroxy-2,2,6,6-tetramethylpiperidin-1-oxyl (2a) gave the hexa-substituted λ⁵-cyclotriphosphazene 3a. Electron paramagnetic resonance spectra at low concentrations (10^?5 mol/L) showed a singlet only (no triplet) due to spin-spin exchange in the molecule. The paramagnetic molar susceptibility amounts to 7229 · 10^?6 cm³/mol at 300 K and does not depend on the magnetic field strength. 3a obeyed the Curie-Weiss law between 36 and 296 K demonstrating that there is no antiferromagnetic spin exchange.     

Non-Aβ Component of Alzheimer’s Disease Amyloid (NAC) Revisited : NAC and α-Synuclein Are Not Associated with Aβ Amyloid

alpha-Synuclein (alphaSN), also termed the precursor of the non-Abeta component of Alzheimer's disease (AD) amyloid (NACP), is a major component of Lewy bodies and Lewy neurites pathognomonic of Parkinson's disease (PD) and dementia with Lewy bodies (DLB). A fragment of alphaSN termed the non-Abeta component of AD amyloid (NAC) had previously been identified as a constituent of AD amyloid plaques. To clarify the relationship of NAC and alphaSN with Abeta plaques, antibodies were raised to three domains of alphaSN. All antibodies produced punctate labeling of human cortex and strong labeling of Lewy bodies. Using antibodies to alphaSN(75-91) to label cortical and hippocampal sections of pathologically proven AD cases, we found no evidence for NAC in Abeta amyloid plaques. Double labeling of tissue sections in mixed DLB/AD cases revealed alphaSN in dystrophic neuritic processes, some of which were in close association with Abeta plaques restricted to the CA1 hippocampal region. In brain homogenates alphaSN was predominantly recovered in the cytosolic fraction as a 16-kd protein on Western analysis; however, significant amounts of aggregated and alphaSN fragments were also found in urea extracts of SDS-insoluble material from DLB and PD cases. NAC antibodies identified an endogenous fragment of 6 kd in the cytosolic and urea-soluble brain fractions. This fragment may be produced as a consequence of alphaSN aggregation or alternatively may accelerate aggregation of the full-length alphaSN.     

Primary Role of Interleukin-1α and Interleukin-1β in Lipopolysaccharide-Induced Hypoglycemia in Mice

Within a few hours of its injection into mice, lipopolysaccharide (LPS) induces hypoglycemia and the production of various cytokines. We previously found that interleukin-1α (IL-1α), IL-1β, and tumor necrosis factor alpha (TNF-α) induce hypoglycemia and that the minimum effective dose of IL-1α or IL-1β is about 1/1,000 that of TNF-α. In the present study, we examined the contribution made by IL-1 to the hypoglycemic action of LPS. Nine other cytokines tested were all inactive at inducing hypoglycemia. LPS produced hypoglycemia in mice deficient in either IL-1α or IL-1β but not in mice deficient in both cytokines (IL-1α and -1β knockout [IL-1α/β KO] mice). IL-1α, IL-1β, and TNF-α induced hypoglycemia in IL-1α/β KO mice, as they did in normal control mice. The LPS-induced elevation of serum cortisol was weaker in IL-1α/β KO mice than in control mice, and, in the latter, serum cortisol was markedly raised while blood glucose was declining. IL-1α decreased blood glucose both in NOD mice (which have impaired insulin production) and in KK-Ay mice (insulin resistant). These results suggest that (i) cortisol may not be involved in mediating the resistance of IL-1α/β KO mice to the hypoglycemic action of LPS, (ii) as a mediator, IL-1 is a prerequisite for the hypoglycemic action of LPS, (iii) IL-1α and IL-1β perform mutual compensation, and (iv) IL-1 plays a role as the primary stimulator of the many anabolic reactions required for the elaboration of immune responses against infection.     

Altered complement component C''3A(β1C–β1A) in patients with glomerulonephritis

1. The altered form of the complement component C'_3A(β_1C–β_1A) was found in the fresh plasma of patients with acute glomerulo-nephritis (with or without low complement levels), and some patients with nephrotic syndrome due to proliferative glomerulonephritis and membranous glomerulonephritis.

2. This provides direct evidence that the complement has been involved in an immunological reaction.

3. The possible practical implications are discussed.

     

Complete Sequences of the Neuraminidase Genes of Swine Influenza Viruses (H1N1) Associated with the Respiratory Disease in Pigs

The complete nucleotide sequences of neuraminidase (NA) of two swine influenza viruses (H1N1) are presented. A/Sw/Quebec/5393/91 (SwQc91) virus, associated with the chronic respiratory disease and A/Sw/Quebec/192/81 (SwQc81) virus, associated with the acute respiratory disease, were used. The deduced amino acid sequences of NA of SwQc91 and SwQc81 viruses showed a high degree (>95%) of similarity. The NA gene of both viruses was a single open reading frame of 1459 nucleotides coding for 469 aa with a 5′ noncoding region of 21 nucleotides and a 3′ noncoding region of 28 nucleotides. The comparison of two sequences showed that there were 23 differences recorded for SwQc91 strain, of which 5, 6, and 12 differences were recorded in the hydrophobic, stalk and head regions, respectively. A potential antigenic determinant changed from Ala to Thr at position 453 and there was a new potential glycosylation site present at position 88 for SwQc91 strain whereas it was absent at position 50 when compared with SwQc81 strain. Estimates of genetic distance and phylogenic tree analysis showed that SwQc91 and SwQc81 viruses were closely related with each other and with the American strain, A/Sw/Wisconsin/4754/94. However, the swine viruses represented a distinct group that was considerably divergent from the group of human viruses. This revised version was published online in July 2006 with corrections to the Cover Date.     

Two myeloma globulins IgG1-κ and IgG1-λ, from a single patient (Im): Their common cellular origin as revealed by immunofluorescence studies

The patient's (Im) serum contained two myeloma proteins possessing the same heavy chains (γl) and different light chains (κ or λ).     

Modulation of Endotoxin- and Enterotoxin-Induced Cytokine Release by In Vivo Treatment with β-(1,6)-Branched β-(1,3)-Glucan

Leukocytes activated by endotoxin or enterotoxins release proinflammatory cytokines, thereby contributing to the cascade of events leading to septic shock. In the present studies, we analyzed the effects of in vivo administration of a soluble immunomodulator, β-(1,6)-branched β-(1,3)-glucan (soluble β-glucan), on toxin-stimulated cytokine production in monocytes and lymphocytes isolated from treated mice. In vitro stimulation of lymphocytes isolated from soluble β-glucan-treated mice with lipopolysaccharide (LPS) resulted in enhanced production of interleukin-6 (IL-6) and suppressed production of tumor necrosis factor alpha (TNF-α), while stimulation of these cells with staphylococcal enterotoxin B (SEB) or toxic shock syndrome toxin 1 (TSST-1) resulted in enhanced production of gamma interferon (IFN-γ) and suppressed production of IL-2 and TNF-α compared to that in cells isolated from untreated mice. In vitro stimulation of monocytes isolated from soluble β-glucan-treated mice with LPS also resulted in suppressed TNF-α production, while stimulation of these cells with SEB or TSST-1 resulted in suppressed IL-6 and TNF-α production compared to that in cells isolated from untreated mice. Thus, the overall cytokine pattern of leukocytes from soluble β-glucan-treated mice reflects suppressed production of proinflammatory cytokines, especially TNF-α. Taken together, our results suggest that treatment with soluble β-glucan can modulate the induction cytokines during sepsis, resulting in an overall decrease in host mortality.