Macromolecular crowding and supersaturation protect hemodialysis patients from the onset of dialysis-related amyloidosis

Kichitaro Nakajima, Keiichi Yamaguchi, Masahiro Noji, César Aguirre, Kensuke Ikenaka, Hideki Mochizuki, Lianjie Zhou, Hirotsugu Ogi, Toru Ito, Ichiei Narita, Fumitake Gejyo, Hironobu Naiki, Suguru Yamamoto () and Yuji Goto ()
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Kichitaro Nakajima: Osaka University, Suita
Keiichi Yamaguchi: Osaka University, Suita
Masahiro Noji: Kyoto University, Yoshidahonmatsu-cho, Sakyo-ku
César Aguirre: Osaka University, Suita
Kensuke Ikenaka: Osaka University, Suita
Hideki Mochizuki: Osaka University, Suita
Lianjie Zhou: Osaka University, Suita
Hirotsugu Ogi: Osaka University, Suita
Toru Ito: Niigata University
Ichiei Narita: Niigata University
Fumitake Gejyo: Niigata University of Pharmacy and Applied Life Sciences
Hironobu Naiki: University of Fukui
Suguru Yamamoto: Niigata University
Yuji Goto: Osaka University, Suita

Nature Communications, 2022, vol. 13, issue 1, 1-13

Abstract: Abstract Dialysis-related amyloidosis (DRA), a serious complication among long-term hemodialysis patients, is caused by amyloid fibrils of β2-microglobulin (β2m). Although high serum β2m levels and a long dialysis vintage are the primary and secondary risk factors for the onset of DRA, respectively, patients with these do not always develop DRA, indicating that there are additional risk factors. To clarify these unknown factors, we investigate the effects of human sera on β2m amyloid fibril formation, revealing that sera markedly inhibit amyloid fibril formation. Results from over 100 sera indicate that, although the inhibitory effects of sera deteriorate in long-term dialysis patients, they are ameliorated by maintenance dialysis treatments in the short term. Serum albumin prevents amyloid fibril formation based on macromolecular crowding effects, and decreased serum albumin concentration in dialysis patients is a tertiary risk factor for the onset of DRA. We construct a theoretical model assuming cumulative effects of the three risk factors, suggesting the importance of monitoring temporary and accumulated risks to prevent the development of amyloidosis, which occurs based on supersaturation-limited amyloid fibril formation in a crowded milieu.

Date: 2022
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DOI: 10.1038/s41467-022-33247-3

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