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The unresolved problem of beta-2 microglobulin amyloid deposits in the intervertebral discs of long-term dialysis

Tsung-Ting Tsai1, Arun-Kumar Kaliya-Perumal2,3, Chang-Chyi Jenq4

  • 1Department of Orthopaedic Surgery, Spine Division, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan. tsai1129@gmail.com.

Journal of Orthopaedic Surgery and Research
|December 23, 2017
PubMed
Abstract

Insights

Beta-2 microglobulin (β2M) amyloid deposits increase in intervertebral discs of long-term dialysis patients. This accumulation correlates with dialysis duration, indicating current dialysis methods are insufficient for β2M removal.

Area of Science:

  • Nephrology
  • Orthopedics
  • Pathology

Background:

  • Dialysis-related destructive spondyloarthropathy is a significant complication for long-term dialysis patients.
  • This condition is characterized by beta-2 microglobulin (β2M) amyloid deposits in intervertebral discs.
  • Current dialysis membranes may not effectively remove β2M.

Purpose of the Study:

  • To quantify β2M amyloid deposits in the intervertebral disc tissue of long-term dialysis patients.
  • To analyze the correlation between β2M accumulation and dialysis duration.

Main Methods:

  • Histological analysis, including immunohistochemistry (IHC) and Congo red staining, was performed on intervertebral disc tissue.
  • Two groups were studied: 29 long-term dialysis patients and 10 controls with no renal impairment.
  • Tissue sections were obtained during spinal surgery for degenerative spinal pathologies.

Main Results:

  • A statistically significant increase in β2M expression was observed in the disc tissue of long-term dialysis patients compared to controls.
  • Both IHC and Congo red staining showed significantly higher β2M levels in the dialysis group (p=0.012 and p=0.047, respectively).
  • A moderate positive correlation was found between dialysis duration and β2M deposition (r=0.39 for IHC, r=0.42 for Congo red).

Conclusions:

  • β2M amyloidosis in long-term dialysis patients is a persistent issue, even with high-flux membranes.
  • Existing dialysis modalities appear insufficient for effective β2M filtration.
  • Further research into improved dialysis strategies is warranted to address β2M-related complications.
Keywords:
AmyloidBeta-2 microglobulinCongo redDialysisIntervertebral discSpondyloarthropathy

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