On typing amyloidosis using immunohistochemistry. Detailled illustrations, review and a note on mass spectrometry

Every amyloid disease needs to be assessed for chemical composition of its amyloid because amyloid is pathogenetically diverse and each of the chemical amyloid types requires a different therapy. Basically four different approaches are being applied for typing of amyloid using immunohistochemistry, immunochemistry, mass spectrometry and chemistry. It is shown here how an easy immunohistochemical procedure has been developed over the years that can be used to classify specifically amyloid proteins for clinico-pathologic routine use. A larger number of tissues with chemically or immunochemically typed amyloids served as prototypes for developing a set of validated amyloid antibodies. These were examined for their performance to classify a larger number of tissues of patients submitted to us and other institutions allowing independent evaluation. The data reveal that out of 663 patients, including 15 different amyloid types, all 119 prototype Amyloids (100%) have been classified correctly and 97.9% of consecutive 581 unknown amyloid tissues submitted for typing to our laboratory of whom 37 became later prototypes. Twelve samples (2.1%) could not be classified. By using appropriate amyloid antibodies in a comparative manner, this procedure is accurate. It identifies the respective amyloid type and excludes simultaneously other amyloids. Its improved performance leads to an accurate amyloid diagnosis in most cases and provides a diagnostic marker which is independend of any other information for therapeutic considerations. These results can be obtained within a day in institutes competent in performing immunohistochemistry. This is the first report on immunhistochemical typing of amyloid providing detailed illustrations of the original results for training purposes. When the immunohistochemical method presented here was compared with mass spectrometry, a more recent method for amyloid typing, the advantages and failures of both methods became apparent in an international blinded comparison.