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(American Journal of Pathology. 2000;156:1911-1917.)
© 2000 American Society for Investigative Pathology

Regular Articles

Apolipoprotein AI and Transthyretin as Components of Amyloid Fibrils in a Kindred with apoAI Leu178His Amyloidosis

Mónica Mendes de Sousa^*, Claude Vital, Dominique Ostler^*, Rui Fernandes^*, Jean Pouget-Abadie^§, Dominique Carles^§ and Maria João Saraiva^*

From the Amyloid Unit,^*
Instituto de Biologia Molecular e Celular, and the Instituto de Ciências Biomédicas Abel Salazar,
Universidade do Porto, Porto, Portugal; the Laboratoire d’Anatomie Pathologique et Neuropathologique,
Faculté de Médecine Paul Broca, Bordeaux, France; and the Médecine Interne,^§
Hôpital de Niort, Niort, France

We found a new C-terminal amyloidogenic variant of apolipoprotein AI (apoAI), Leu178His in a French kindred, associated with cardiac and larynx amyloidosis and skin lesions with onset during the fourth decade. This single-point mutation in exon 4 of the apoAI gene was detected by DNA sequencing of polymerase chain reaction amplified material and restriction fragment length polymorphism analysis in two siblings. Blood, larynx, and skin biopsies were available from one sibling. Anti-apoAI immunoblotting of isoelectric focusing of plasma showed a +1 alteration in the charge of the protein. Extraction of fibrils from the skin biopsy revealed both full-length and N-terminal fragments of apoAI and transthyretin (TTR). ApoAI and TTR co-localized in amyloid deposits as demonstrated by immunohistochemistry. The present report, together with the first recently described C-terminal amyloidogenic variant of apoAI, Arg173Pro, shows that amyloidogenicity of apoAI is not a feature exclusive to N-terminal variants. The most striking characteristic of amyloid fibrils in Leu178His is that wild-type TTR is co-localized with apoAI in the fibrils. We have previously determined that a fraction of plasma TTR circulates in plasma bound to high-density lipoprotein and that this interaction occurs through binding to apoAI. Therefore we hypothesize that nonmutated TTR might influence deposition of apoAI as amyloid.

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