Specific imaging of dialysis-related amyloid deposits using 131I-beta-2-microglobulin.
Dialysis-related amyloidosis (DRA), characterized by its association with beta 2-microglobulin (beta 2m), has become a major concern in long-term hemodialysis patients. Hitherto the diagnosis was based on histological examinations of tissue obtained by biopsy or during surgery. In this preliminary study a new noninvasive diagnostic method was developed using the affinity of beta 2m for its derived fibrils. 3 patients on long-term hemodialysis for 10-16 years with biopsy-proven DRA and 1 patient on chronic hemodialysis for only 6 months were examined after intravenous injection of 131I-labelled beta 2m. Specific local accumulation of radioactivity was noted in the DRA patients after 48 h, persisting for further 96 h and corresponding to clinically or radiologically evident sites of amyloid deposition and to several other hitherto unsuspected sites. Examination of an excised amyloid tumor subsequent to in vivo labelling confirmed a highly specific accumulation of radioactivity in the amyloid tissue but not in control tissue. In the patient on chronic hemodialysis for only 6 months, no specific local accumulation was detected even after 1 week. These findings provide in vivo evidence in man that a specific uptake of circulating amyloid precursor molecules into deposits occurs and that this uptake may be used to radiolabel even small tissue infiltrates of amyloid. This method therefore may not only allow an objective, noninvasive detection of DRA but may also be used to obtain new pathophysiologic insights into amyloid formation in man, as well as permitting the evaluation of preventive therapeutic strategies in prospective studies on new patients.
Floege
J
J
Department of Nephrology, Medizinische Hochschule Hannover, FRG.
Nonnast-Daniel
B
B
Gielow
P
P
Brandis
A
A
Spindler
E
E
Hundeshagen
H
H
Koch
K M
KM
Shaldon
S
S
D000686:Amyloidosis / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D007457:Iodine Radioisotopes; D011877:Radionuclide Imaging; D006435:Renal Dialysis / Q000009:adverse effects*; D001613:beta 2-Microglobulin
D007457:Iodine Radioisotopes; D001613:beta 2-Microglobulin