AL amyloidosis enhances development of amyloid A amyloidosis.

摘要

Sir, In the April issue of this journal, Rekhtman et oi. describe an interesting case of a patient with concomitant AL (also referred to as primary or myeloma-associated amyloidosis) and amyloid A (AA) amyloidosis. The authors state that 'the pathogenesis of dual amyloidosis is not clear nor is the relationship of dual deposits with rapid progression'. However, our recent advances in the knowledge of the padiogenesis of amyloidosis may explain both enigmas. The amyloidoses constitute a group of disorders that are characterized by deposition of protein fibrils in organs and tissues leading to organ dysfunction. The fibrils are aggregates of a precursor protein that has a typical beta-pleated-sheet conformation. So far at least 23 different precursor proteins have been identified that can aggregate into fibrils, including A(beta) peptide in Alzheimer plaques and beta2 microglobulin In haemo-dialysis-associated amyloidosis. Amyloidosis develops when