Current treatment of AL amyloidosis

Abstract

Several effective chemotherapy regimens have been developed during the last decade significantly improving the outlook of patients with AL amyloidosis. Drs. Palladini and Merlini describe our current knowledge in the field and examine future perspectives. See related article on page 1094.

Figure 1.

Typing amyloid deposits in subcutaneous adipose tissue. The 10–30 mg fine needle fat aspirate can be used for: (A) Congo red staining and analysis under polarized light showing the diagnostic green birefringence (upper left panel, Nikon Eclipse E600, magnification x 200); (B) for typing the amyloid deposits using electron-microscopy immunohistochemistry, in this case the amyloid fibrils are decorated by a gold- labeled antibody recognizing an anti-κ antibody (central upper panel, TEM Philips CM12, magnification x 22000, gold particles are 15 nm in diameter); and for proteomic analysis by bidimensional- PAGE and mass spectrometry. Comparison with control adipose tissue (C1) allowed location of prominent novel spots (squared in green) in patient (C2). Spots corresponding to fragments or post-translational modifications of the amyloidogenic protein were also observed. Identification of the novel spots, and thus amyloid typing, was obtained by MALDI-TOF mass spectrometry and peptide mass fingerprinting.