Contribution of human smooth muscle cells to amyloid angiopathy in AL (light-chain) amyloidosis

Objective: Amyloid light-chain (AL) amyloidosis is a disease process that often compromises the peripheral vascular system and leads to systemic end-organ dysfunction. Although amyloid formation in vessel walls is a multifaceted process, the assembly of the native light chains (LCs) into amyloid fibrils is central to its pathogenesis. Recent evidence suggests that endocytosis and endolysosomal processing of immunoglobin LCs by host cells is essential to the formation of amyloid fibrils that are deposited in at least some tissues. The aim of this study was to elucidate the role of vascular smooth muscle in amyloid angiopathy. Methods: Human coronary artery smooth muscle cells (SMCs) were grown on coverslips, four chamber glass slides, and growth factor-reduced Matrigel matrix in the presence of 10 µg/ml of ALs (λ and κ isotypes), nonamyloidogenic LCs, and culture medium (negative control) for 48 and 72 hours. Thereafter, a detailed light microscopic, immunohistochemical, and ultrastructural evaluation was conducted to verify amyloid deposition and characterize the role of SMCs in the formation of amyloid deposits in the various experimental conditions. Results: Amyloid deposits were detected extracellulary as early as 48 hours after exposure of vascular smooth muscle cells (VSMCs) to AL-LCs (amyloidogenic light chains) as confirmed by affinity to Congo red dye, thioflavin T fluorescence, and transmission electron microscopy. No amyloid was present in the cultures of SMCs treated with medium alone or nonamyloidogenic LCs. SMCs associated with amyloid deposits exhibited CD68, lysosome-associated membrane protein 1-1, and intracellular lambda light chain expression and only focal smooth muscle actin and muscle-specific actin positivity. Electron microscopy revealed these cells to have an expanded mature lysosomal compartment closely associated with deposits of newly formed amyloid fibrils. Conclusions: The interaction of amyloidogenic LCs with VSMCs is necessary for the formation of amyloid fibrils that are deposited in peripheral vessels. VSMCs participate in the formation of amyloid by the intracellular processing of AL-LCs, which is possible due to their transformation from a smooth muscle to a macrophage phenotype. The formation of amyloid fibrils occurs in the mature lysosomal compartment of transformed cells. The amyloid that is formed is then extruded into the extracellular matrix.     

Chain reaction of amyloid fibril formation with induction of basement membrane in familial amyloidotic polyneuropathy

Familial amyloidotic polyneuropathy (FAP) is characterized by extracellular deposition of amyloid fibrils caused by a point mutation in the transthyretin (TTR) gene. Despite data from a number of in vitro studies of TTR amyloidogenesis, many questions, including where and how these fibrils form in vivo and what is the impact of amyloid deposition on tissues, remain unanswered. Here, we analysed the relationship between amyloid fibril formation and micro‐environmental changes by using autopsy cardiac tissues from 11 patients with FAP and a smooth muscle cell line. Ultrastructural studies of cardiomyocytes and vascular smooth muscle cells showed that amyloid fibrils formed first at the basement membrane and that amorphous non‐fibrillar TTR deposits and premature fibrils predominated during the early stage of amyloid deposition. Immunohistochemical analyses revealed that expression of major components of the basement membrane, such as collagen IV, laminin, and fibronectin, increased in parallel with the accumulation of TTR amyloid fibrils. In vitro studies with a vascular smooth muscle cell line revealed that synthetic TTR aggregates increased expression of these basement membrane components. Serum levels of collagen IV in FAP patients were significantly higher than those in healthy controls. Our data thus indicate that TTR amyloid fibrils formed first at the basement membrane and that expression of basement membrane components that was induced by amyloid deposition contributed to further amyloid deposition. This chain reaction may have important implications for FAP pathogenesis. Copyright © 2009 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Nodular glomerulopathy associated with nonamyloidotic kappa light chain deposits and excess immunoglobulin light chain synthesis

A nodular glomerulopathy characterized by mesangial deposits of monoclonal kappa light chains was detected by immunofluorescence in a renal biopsy from a patient with proteinuria and hypertension. These nodules lacked the tinctorial and morphologic features of amyloid. Ultrastructurally, the nodules contained electron-dense granular deposits as well as fibrils in parallel arrangement. The fibrils measured 110-140 A in diameter. They were consistent in size with amyloid fibrils. However, they differed in lacking the randomly oriented network of typical amyloid fibrils and more closely resembled fibrils intrinsic to mesangial matrix. The patient had no bone marrow or X-ray evidence of myeloma and no evidence of free monoclonal light chains in serum or concentrated urines. Biosynthetic studies of the patient's bone marrow cells demonstrated unbalanced immunoglobulin synthesis with excess production of monoclonal kappa light chains. These observations suggest that the observed glomerulopathy results from direct deposition of monoclonal light chains. Deposits with kappa light chain determinants have been found in 7 other patients with similar nodular glomerulopathies, 4 of whom had diagnosed clinical myeloma. The lesion of nonamyloidotic nodular glomerulopathy previously described in 19 patients, nor examined by immunopathologic techniques or not shown to contain light chain determinants, may have a similar pathogenesis.     

Amyloid formation in prolactinoma

Amyloid deposits within a prolactin-secreting pituitary adenoma were investigated with light and electron microscopy. The appearance of amyloid with Congo red revealed amorphous and round green-yellow birefringence under polarized light. Spheroidal concretions disclosed prolactin-positive areas by immunohistochemistry. The amyloid commonly exhibited a structure of fine fibrils of 10 to 13 nm in width, with a hollow core. The fibrils were usually grouped in compact, stout bundles. Some bundles were present in extracellular space, others were obviously within the adenoma cells. Extracellular amyloid fibrils frequently gathered in a stellate arrangement to make a round body. The presence of intracellular amyloid fibrils in adenoma cells may represent that the source of the amyloid is neoplastic cells rather than mesenchymal cells. In addition, prolactin-positive parts in round bodies presumably exemplify that the amyloid fibrils are formed by hormone-relating proteins.     

Glomerulopathic Light Chain-Mesangial Cell Interactions Modulate in Vitro Extracellular Matrix Remodeling and Reproduce Mesangiopathic Findings Documented in Vivo

Glomerulopathic light chains (LCs) are associated with two distinct mesangiopathies: AL (light-chain-related) amyloidosis and light-chain deposition disease (LCDD) with immunomorphologic features that are well documented in the literature. Even though both conditions are caused by monoclonal LCs, these entities differ dramatically in their morphologic expressions. In AL amyloidosis the mesangial matrix is replaced by amyloid fibrils, while in LCDD the matrix increases as a consequence of deposition of excess extracellular matrix (ECM). The immunomorphologic mesangial alterations observed in biopsy material are closely reproduced in vitro when mesangial cells grown on an artificial matrix are incubated with monoclonal light chains obtained from the urine of patients with either condition. This article summarizes previously reported data, reports new findings, and focuses on integrating all the available information on the subject. When mesangial cells are incubated with LCDD-LCs, production of ECM proteins (collagen IV, laminin, fibronectin, and tenascin) is increased, with maximum effect at 72 hours post LC treatment. A concomitant decrease in collagenase IV activity further accentuates the accumulation of mesangial matrix. These effects are mediated through transforming growth factor-beta (TGF-beta) activation. In contrast, when mesangial cells are incubated with Am-LCs, a decrease in ECM protein production and a stimulatory effect on collagenase IV is observed, which results in matrix degradation and facilitates amyloid deposition. The decreased TGF-beta documented in the literature in this setting precludes adequate matrix repair. These findings substantiate the morphologic alterations observed in renal biopsy specimens and in the in vitro model. Using this in vitro model, it is then possible to delineate the LC interactions with putative receptors at the mesangial cell surface that regulate mesangial cell pathobiologic responses and mesangial matrix homeostasis.     

Fell Muir Lecture: Collagen fibril formation in vitro and in vivo

It is a great honour to be awarded the Fell Muir Prize for 2016 by the British Society of Matrix Biology. As recipient of the prize, I am taking the opportunity to write a minireview on collagen fibrillogenesis, which has been the focus of my research for 33 years. This is the process by which triple helical collagen molecules assemble into centimetre‐long fibrils in the extracellular matrix of animals. The fibrils appeared a billion years ago at the dawn of multicellular animal life as the primary scaffold for tissue morphogenesis. The fibrils occur in exquisite three‐dimensional architectures that match the physical demands of tissues, for example orthogonal lattices in cornea, basket weaves in skin and blood vessels, and parallel bundles in tendon, ligament and nerves. The question of how collagen fibrils are formed was posed at the end of the nineteenth century. Since then, we have learned about the structure of DNA and the peptide bond, understood how plants capture the sun's energy, cloned animals, discovered antibiotics and found ways of editing our genome in the pursuit of new cures for diseases. However, how cells generate tissues from collagen fibrils remains one of the big unsolved mysteries in biology. In this review, I will give a personal account of the topic and highlight some of the approaches that my research group are taking to find new insights.     

Fibrillary renal deposits and nephritis.

Fibrillary renal deposits and nephritis. The authors have studied 8 patients whose glomeruli contain abundant fibrils in their mesangial matrix and basement membranes. Although the location of these fibrils is very similar to that of amyloid, they are about twice the size of amyloid fibrils, averaging 20 nm in width, and fail to react as amyloid does with special stains. Immunofluorescence-microscopic studies are usually positive with antiserums to IgG, often IgM, and in some cases IgA, and also kappa and lambda light chains, C3, and C4. The fibrils are associated with diffuse mesangial widening and increased mesangial matrix strands. Although peripheral glomerular capillary walls appear to be spared initially, their eventual involvement leads to glomerular capillary collapse and glomerular obsolescence. Crescent formation occurred in 5 cases, focally in 3 and diffusely in 2. Tubular basement membrane involvement was seen in 1 case. These patients exhibit hematuria, and proteinuria, and often hypertension and renal insufficiency. Proteinuria was in the nephrotic range in 3 patients in whom involvement of glomerular capillary basement membranes was extensive. Unless electron microscopy is applied to renal biopsies, these cases may be considered to represent mesangiocapillary or rapidly progressive glomerulonephritis, or amyloidosis. The nature of these fibrils is as yet not determined. It is likely that they have been called "atypical amyloidosis" in the past.     

THE FINE STRUCTURE OF GLOMERULAR EPITHELIAL CELLS IN EXPERIMENTAL RENAL AMYLOIDOSIS

The fine structure of the three types of glomerular cells, especially glomerular epithelial cells was studied In experimental renal amyloidosis induced by both prolonged sensitization of focus antigens and casein.
The presence of cytoplasmic invaginations which contained a bundle of amyloid fibrils in almost parallel array and intracytoplasmlc membrane-surrounded amyloid fibrils were observed in the glomerular epithelial cells. They are quite comparable to those which were demonstrated in reticuloendothelial cells In other reports. The intracytoplasmlc invaginations opened at the plasma membrane either in the urinary space or in the basement membrane. By processing serial sections on the minimal deposition of amyloid, some of the Intracytoplasmlc membrane-surrounded amyloid fibrils were found to be connected with parallel arrayed extracellular amyloid fibrils.
Amyloid accumulated usually In large amount In mesangial matrix and along the basement membrane adjacent to the mesangium, but isolated depositions of amyloid, minimal though definite, were sometimes observed in the subepithelial and subendothelial areas, and in the epithelial cells far from the mesangium.     

Phenotypic plasticity of mesenchymal stem cells is crucial for mesangial repair in a model of immunoglobulin light chain-associated mesangial damage

Mesangiopathies produced by glomerulopathic monoclonal immunoglobulin light chains (GLCs) acting on the glomerular mesangium produce two characteristic lesions: AL-amyloidosis (AL-Am) and light chain deposition disease (LCDD). In both cases, the pathology is centered in the mesangium, where initial and progressive damage occurs. In AL-Am the mesangial matrix is destroyed and replaced by amyloid fibrils and in LCDD, the mesangial matrix is increased and remodeled. The collagen IV rich matrix is replaced by tenascin. In both conditions, mesangial cells (MCs) become apoptotic as a direct effect of the GLCs.

MCs were incubated in-vitro with GLCs and animal kidneys were perfused ex-vivo via the renal artery with GLCs, producing expected lesions, and then mesenchymal stem cells (MSCs) were added to both platforms. Each of the two platforms provided unique information that when put together created a comprehensive evaluation of the processes involved. A “cocktail” with growth and differentiating factors was used to study its effect on mesangial repair.

MSCs displayed remarkable phenotypic plasticity during the repair process. The first role of the MSCs after migrating to the affected areas was to dispose of the amyloid fibrils (in AL-Am), the altered mesangial matrix (in LCDD) and apoptotic MCs/debris. To accomplish this task, MSCs transformed into facultative macrophages acquiring an abundance of lysosomes and endocytotic capabilities required to engage in phagocytic functions. Once the mesangial cleaning was completed, MSCs transformed into functional MCs restoring the mesangium to normal. “Cocktail” made the repair process more efficient.     

Immunohistochemical, Electron Microscopic, and Immunoelectron Microscopic Features of Plasmacytoma of the Thyroid with Amyloid Deposition

A rare case of primary plasmacytoma of the thyroid with amyloid deposition is reported. The tumor consisted of diffuse proliferation of atypical plasma cells showing IgG lambda-type monoclonal growth. Amyloid deposition with focal giant cell reaction was also observed. Bone marrow aspiration and systemic skeletal radiographic surveys revealed no evidence of multiple myeloma and myelomatosis. Radial arrangement of amyloid bundles was observed ultrastructurally. By immunoelectron microscopic examination, δ chain was detected in the amyloid fibrils and rough endoplasmic reticulum of the tumor cells. Our findings suggest the following: amyloid fibrils originate from monoclonal light chains produced by tumor cells, and histiocytes contribute to amyloid deposition as well as to giant cell reaction in extramedullary plasmacytoma.     

Ubiquitin profile in inflammatory leukocytes and binding of ubiquitin to murine AA amyloid: Immunocytochemical and immunogold electron microscopic studies

Lysosomes in activated murine monocytoid cells have been implicated in AA amyloid formation. The pathophysiology of this process is not well understood. Previous studies into the nature of the relationship between ubiquitin (UB), possessing intrinsic amyloid enhancing factor (AEF) activity; serum amyloid A (SAA), the precursor protein of AA amyloid; and activated monocytoid cells have indicated a temporal and spatial relationship between these proteins and tissue AA amyloid deposits. To extend these findings, we have examined murine peritoneal leukocytes and splenic tissues during the early amyloid deposition phase by immunocytochemical and immunogold electron microscopic methods using monospecific anti-ubiquitin and anti-mouse AA amyloid antibodies. We show here enrichment of endosome–lysosome-like (EL) vesicles in the activated monocytoid cells with UB and SAA, and the presence of UB-bound AA amyloid fibrils in the EL vesicles, perikarya, and interstitial spaces. The importance of these findings is emphasized by the fact that activated monocytoid cells, containing UB in the EL vesicles, sequester and eventually localize SAA in their EL vesicles, and that UB binds to the EL-contained AA amyloid fibrils. These findings may also have functional consequences for studies on the role of EL and UB in amyloidogenesis.     

Intracellular and Extracellular Fibrillar Structures in Gastroduodenal Endocrine Tumors

Sixteen gastroduodenal endocrine tumors have been examined ultrastructurally for the presence of intracellular and extracellular fibrillar material. Intracellular juxtanuclear fibrillar bodies, often with intermingled secretory granules, were observed in one antral, one pyloric, and three duodenal tumors. In the pyloric tumor there were also extracellular fibrillar structures, which, in contrast to the intracellular fibrils, showed a green birefringence after staining with alkaline Congo red indicating the amyloid nature of these fibrils. One endocrine tumor localized to the fundus-corpus contained extracellular fibrillar bodies of a type typical of adenoid cystic carcinoma.     

Unusual Pigmented Vesical Lesion in a Middle-Aged Woman (UP 1990;14:529-535)

A rare case of primary plasmacytoma of the thyroid with amyloid deposition is reported. The tumor consisted of diffuse proliferation of atypical plasma cells showing IgG lambda-type monoclonal growth. Amyloid deposition with focal giant cell reaction was also observed. Bone marrow aspiration and systemic skeletal radiographic surveys revealed no evidence of multiple myeloma and myelomatosis. Radial arrangement of amyloid bundles was observed ultrastructurally. By immunoelectron microscopic examination, δ chain was detected in the amyloid fibrils and rough endoplasmic reticulum of the tumor cells. Our findings suggest the following: amyloid fibrils originate from monoclonal light chains produced by tumor cells, and histiocytes contribute to amyloid deposition as well as to giant cell reaction in extramedullary plasmacytoma.     

Acellular Scanning Electron Microscopy of Spicular Renal Amyloidosis

Two human renal biopsies containing glomerular amyloid deposits organized into spicular formations (spicular amyloid) were studied by scanning electron microscopy following removal of the cellular components (acellular SEM). Following SEM studies, portions of the same acellular tissue were embedded in paraffin and plastic for light microscopy and transmission electron microscopy, respectively. Spicular deposits by acellular SEM appear as tapering conical formations interconnected by a delicate branching network of fibrils, which imparts a higher degree of organization than previously appreciated by two-dimensional LM and TEM. Silver stains of paraffin-and plastic-embedded acellular tissue showed persistence of argyrophilia in spicular deposits, while acellular TEM showed that the spicules appeared comprised “purely” of amyloid fibrils without visible contaminating material. We conclude that the argyrophilia of spicular amyloid is an inherent feature of the parallel organization of fibrils rather than a result of incorporation of glomerular basement membrane or cell components and that spicular amyloid deposits have a higher degree of organization than is apparent by two-dimensional studies.     

Coexistence of Protein AA and Immunoglobulin Light-Chain Fragments in Amyloid Fibrils

Coexistence of amyloid fibril protein AA and homogeneous immunoglobulin light-chain fragments was found in the isolated amyloid fibrils of two patients with amyloidosis secondary to rheumatoid arthritis. The light-chain amyloid fibril protein showed antigenic identity with a light-chain amyloid from a patient with primary amyloidosis, which was identified as the VlambdaIV subgroup by amino acid sequence analysis. In the amyloid fibrils isolated from another patient with primary amyloidosis there was a mixture of VlambdaIV and VlambdaV homogeneous immunoglobulin light chains. Thus, a mixture of protein AA had lambda light chains or two different types of homogeneous light chains may be found in the amyloid fibrils of some patients.     

Pathogenesis of glomerulosclerosis in light chain deposition disease. Role for transforming growth factor-beta.

The glomerulopathy of monoclonal immunoglobulin light chain deposition disease is a progressive disorder characterized by accumulation of monoclonal light chains and matrix proteins in the mesangium. To define the role of light chains in this process, cultured rat mesangial cells were exposed to different light chains and human albumin. Two light chains were purified from the urine of patients who had biopsy-proven light chain deposition disease. These proteins inhibited mesangial cell proliferation and increased production of matrix proteins, including type IV collagen, laminin, and fibronectin. By immunocytochemistry and bioassay, transforming growth factor-beta (TGF-beta) production and activity increased when mesangial cells were exposed to these proteins. Furthermore, anti-TGF-beta antibody abolished the inhibition of cell proliferation and the increase of extracellular matrix protein production caused by these light chains. These findings were not observed in mesangial cells exposed to human albumin and two other light chains previously characterized to be tubulopathic. We concluded that the glomerulopathic light chains increased TGF-beta, which inhibited mesangial cell proliferation and increased matrix protein production. Together with overexpression of TGF-beta in affected glomeruli of light chain deposition disease, light chain-mediated stimulation of mesangial cells to produce TGF-beta appears to be a key pathological mechanism of this disease.     

Morphogenesis of amyloidosis]

Basing on the literature data and findings of their own investigations with the use of sophisticated methods of morphological analysis, the authors showed that morphogenesis of experimental amyloidosis comprised the following links: 1) cellular transformations of the reticulo-endothelial system with formation of a clone of amyloidoblasts; 2) synthesis by these cells of protein of amyloid fibrils; 3) aggregation of fibrils with formation of a "carcass" of amyloid substance; 4) combination of aggregated fibrils with proteins and glucoproteids of plasma and also with acid mucopolysaccharides of the tissue and formation of a complex glucoproteid -- amyloid. The sources of amyloblasts in various organs were precursors of different cells of mesenchymal nature: in the spleen -- reticular and endothelial cells; in the liver -- Kupffer's cells; in the kidney -- mesangial and endothelial cells. In the course of formation of amyloid fibrils, the latter being anomalous protein of the body, a "competition" started between the synthesis of fibrillar protein and its resorption (amyloidoclasia). It completed in favour of the synthesis, which may be explained by the development of immunological tolerance to amyloid protein. At the final stage of amyloidogenesis of particular importance was an increase in the tissue-vascular permeability, which ensured the extracellular formation of amyloid substance and inclusion therein of hematogenic "additions" (fibrin', immune complexes, etc.).     

Immunoglobulin Light Chains and the Kidney: An Overview

Monoclonal immunoglobulins and free immunoglobulin light chains are produced by plasma cells as a result of their clonal expansion in plasma cell dyscrasia. These proteins are pivotal in the development of pathologic and clinical symptoms of plasma cell dyscrasia and renal manifestations are frequently the presenting and leading features of this process. The spectrum of pathology associated with monoclonal light chains includes light-chain cast nephropathy and tissue deposits derived from the monoclonal light chain, ie, amyloid derived from the light chains and nonamyloidotic light chain deposition disease. The main diagnostic features, differential diagnosis, and pathogenesis are briefly reviewed.     

Immunoglobulin Light Chains and the Kidney: An Overview

Monoclonal immunoglobulins and free immunoglobulin light chains are produced by plasma cells as a result of their clonal expansion in plasma cell dyscrasia. These proteins are pivotal in the development of pathologic and clinical symptoms of plasma cell dyscrasia and renal manifestations are frequently the presenting and leading features of this process. The spectrum of pathology associated with monoclonal light chains includes light-chain cast nephropathy and tissue deposits derived from the monoclonal light chain, ie, amyloid derived from the light chains and nonamyloidotic light chain deposition disease. The main diagnostic features, differential diagnosis, and pathogenesis are briefly reviewed.     

Role of translational research advancing the understanding of the pathogenesis of light chain-mediated glomerulopathies

Glomerulopathic light chains engage in pathological interactions with mesangial cells resulting in alterations in glomerular homeostasis. The crucial pathological events are centered in the mesangium and, therefore, research dealing with pathogenesis of these disorders is focused on this glomerular compartment. Particular physicochemical characteristics of these light chains are responsible for their ability to alter mesangial milieu leading to glomerular damage. An in vitro model has been used to dissect the processes involved. This model has been instrumental in providing a solid platform from which to observe in a dynamic fashion how mesangial cells handle pathogenic light chains and the sequential steps that are involved in the progressive glomerular damage. Key steps amenable to possible modulation have been defined and should provide a solid platform to design and test therapeutic interventions. In the past significant difficulties have been encountered in the development of animal models of light chain-induced glomerular damage. However, in the last few years a new generation of animal models has emerged to address whether what has been documented in vitro retains significance in vivo. Preliminary observations appear to substantiate this.