title: Wild-type transthyretin-derived amyloidosis in various ligaments and tendons.
abstract: Transthyretin-derived amyloid deposition is commonly found in intercarpal ligaments of patients with senile systemic amyloidosis. However, the frequency of transthyretin-derived amyloid deposits in ligaments of other tissues remains to be elucidated. This study aimed to determine the frequency of amyloid deposition and the precursor proteins of amyloid found in orthopedic disorders. We studied 111 specimens from patients with carpal tunnel syndrome (flexor tenosynovium specimens), rotator cuff tears (rotator cuff tendon specimens), and lumbar canal stenosis (yellow ligament specimens). To identify amyloid precursor proteins, we used immunohistochemical staining with antibodies that react with transthyretin, immunoglobulin light chain, amyloid A protein, and β(2)-microglobulin. By means of Congo red staining, we identified 47 (42.3%) amyloid-positive samples, 39 of which contained transthyretin-derived amyloid (18 flexor tenosynovium specimens, 5 rotator cuff tendon specimens, and 16 yellow ligament specimens). Genetic testing and/or clinical findings suggested that all patients with transthyretin amyloid deposits did not have familial amyloidotic polyneuropathy. The occurrence of amyloid deposition in those tissues depended on age. These results suggest that transthyretin-derived amyloid deposits may occur more frequently in various ligaments and tendons than originally expected. In the future, such amyloid deposits may aid determination of the pathogenesis of ligament and tendon disorders in older patients.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan.
authors.forename: Takanao
authors.initials: T
authors.lastname: Sueyoshi
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Ueda
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Jono
authors.forename: Hiroki
authors.initials: H
authors.lastname: Irie
authors.forename: Akira
authors.initials: A
authors.lastname: Sei
authors.forename: Junji
authors.initials: J
authors.lastname: Ide
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ando
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mizuta
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000682:Amyloid / Q000378:metabolism; D028227:Amyloid Neuropathies, Familial / Q000473:pathology; D000686:Amyloidosis / Q000473:pathology*; D002349:Carpal Tunnel Syndrome / Q000473:pathology; D005260:Female; D006801:Humans; D008022:Ligaments / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D058225:Plaque, Amyloid; D011228:Prealbumin / Q000235:genetics*; D017006:Rotator Cuff / Q000473:pathology; D000070636:Rotator Cuff Injuries; D013130:Spinal Stenosis / Q000473:pathology; D013710:Tendons / Q000473:pathology*
chemical_list: D000682:Amyloid; D011228:Prealbumin