title: Primary local orbital amyloidosis: biochemical identification of the immunoglobulin light chain kappaIII subtype in a small formalin fixed, paraffin wax embedded tissue sample.
abstract: BACKGROUND
  Amyloidosis refers to a heterogeneous group of disorders associated with the deposition of chemically distinct amyloid fibril proteins. Precise determination of chemical amyloid type has diagnostic, therapeutic, and prognostic relevance. Although immunohistochemical techniques are used routinely to determine the amyloid type, the results can be negative or inconclusive, so that biochemical characterisation is often required. The development and application of new biochemical microtechniques suitable for examination of extremely small tissue samples is essential for precise identification of the deposited amyloid proteins.
  
  
  OBJECTIVE
  To investigate biochemically the amyloid proteins present in a formalin fixed paraffin wax embedded orbital tissue from a patient with localised orbital amyloidosis in whom immunohistochemistry was not helpful in the determination of amyloid type.
  
  
  METHODS
  Extraction of amyloid proteins from fixed tissue and their identification was carried out by a recently developed microtechnique. An extremely small tissue sample was dewaxed and extracted with formic acid. The extracted material was analysed using electrophoresis, western blotting, and amino acid sequencing.
  
  
  RESULTS
  Biochemical examination of the extracted proteins showed the presence of immunoglobulin (Ig) derived amyloid proteins, which were composed of the N-terminal fragments of the Ig light chain kappaIII subtype (AL-kappaIII) (16, 8, and 3 kDa).
  
  
  CONCLUSIONS
  This is the first chemically proved AL case reported in association with primary localised orbital amyloidosis. The biochemical microtechnique used was useful in achieving a precise diagnosis of amyloid disease, in a case where the results of routine immunohistochemical examination of amyloid were inconclusive.
authors.affiliation: Heller Institute of Medical Research, Sheba Medical Centre, Tel-Hashomer, 52621, Israel. kaplanb@sheba.health.gov.il
authors.forename: B
authors.initials: B
authors.lastname: Kaplan
authors.forename: B M
authors.initials: BM
authors.lastname: Martin
authors.forename: H I
authors.initials: HI
authors.lastname: Cohen
authors.forename: J
authors.initials: J
authors.lastname: Manaster
authors.forename: Y
authors.initials: Y
authors.lastname: Kassif
authors.forename: U
authors.initials: U
authors.lastname: Rehany
authors.forename: A
authors.initials: A
authors.lastname: Livneh
mesh_terms: D000328:Adult; D000595:Amino Acid Sequence; D000682:Amyloid / Q000032:analysis*; D000686:Amyloidosis / Q000378:metabolism* / Q000473:pathology; D005136:Eye Proteins / Q000032:analysis*; D006801:Humans; D007135:Immunoglobulin Variable Region / Q000032:analysis; D007145:Immunoglobulin kappa-Chains / Q000032:analysis*; D007150:Immunohistochemistry / Q000379:methods; D009916:Orbital Diseases / Q000378:metabolism* / Q000473:pathology; D016612:Paraffin Embedding / Q000379:methods
chemical_list: D000682:Amyloid; D005136:Eye Proteins; D007135:Immunoglobulin Variable Region; D007145:Immunoglobulin kappa-Chains