1. ILOs of the fourth lecture
-What is amyloidosis?
-What is the chemical nature of amyloid protein?
-What is the physical nature of amyloid protein?
-What are the types of amyloidosis?
-What is the gross, microscopic picture of amyloidosis?
-What are the investigations of amyloidosis?

2. Amyloidosis

3. AMYLOIDOSIS Oid amyl starch Osis process similar
Protein (amyloid protein) + mucopolysaccharrhides
Interstitial tissues +wall of blood vessels
Pressure atrophy May lead to organ failure

5. Microscopic appearance
CONGO RED + Flourescent M
CONGO RED EM

6. CONGO RED + POLRIZED LIGHT MICROSCOPY

7. Physical nature of amyloid protein

8. Chemical nature of amyloid protein
-95% Fibril protein
-5% P component
Amyloid light chain
Amyloid associated protein
Transthyretin
beta2 microglobulin
Beta amyloid protein
Others

9. Pathogenesis of Alzheimer’s disease

10. Primary amyloidosis Kidney, liver, spleen
Multiple myeloma
Just increase plasma cells in bone marrow
Heart, skin, respiratory
Tract, peripheral nerves, tongue
Excess kappa and lambda light chains (Bence Jones proteins) excreted in the urine +
Defect in enzymatic degradation
Kidney, liver, spleen

11. Secondary amyloidosis
Kidney, liver, spleen, LNs, adrenal
Tuberculosis,
Bronchiectasis,
Rheumatoid arthritis
Renal cell carcinoma
Excess amyloid associated protein+ defect enzymatic degredation

12. Gross Microscopic Electron microscope non branching fibrils Size
enlarged
Surface
flat
Colour
brown
Consistency
Firm waxy
Edge
sharp
Microscopic
Homogenous eosinophilic material in
Blood vessel wall + interstitial tissue
Special stain
Congo red +polarized light apple green
Electron microscope non branching fibrils

13. Examples of organs affection Clinical presentation
Kidney nephrotic syndrome renal failure
Liver Hepatomegaly
Spleen sago spleen or diffuse spleen
HHeart restrictive cardiomyopathy
Others , macroglssia, malabsorption, carpal tunnel syndrome

14. Generalized amyloidosis poor prognosis
Diagnosis of Amyloidosis
Clinical symptoms and signs
Microscopic
Congo red stain
Rectal and gingival biopsies
Generalized amyloidosis poor prognosis