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Histological analysis of the ligamentum flavum of patients with dialysis-related spondyloarthropathy

Journal of Orthopaedic Science, ISSN: 0949-2658, Vol: 9, Issue: 3, Page: 285-290
2004
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Article Description

Dialysis-related spondyloarthropathy (DRS) is a severe complication of long-term hemodialysis that ultimately leads to functional disability of the upper and lower extremities. Although the cause of this disease is still unknown, it is thought that amyloid deposits are involved. β2-Microglobulin (β2M) is a major component of amyloid fibrils, some of which are modified with the advanced glycation end-product (AGE). To clarify the pathophysiology of DRS we histologically examined the ligamentum flavum of the cervical spine in 15 patients with DRS. The mean duration of hemodialysis was 20 years (12–27 years). In addition to the congo red stain for amyloid, β2M and AGE were detected by immunohistochemical methods. Macrophages were stained with CD68 antibody. Amyloid deposits were found in tissues, although the extent of the stained area differed among the patients. Part of the amyloid deposit area was positively immunostained for β2M and AGE. In 10 cases macrophages positive for CD68 infiltrated around the amyloid deposits. Comparing these histological findings with the dialysis duration, more positive staining areas for β2M and AGE were found in the tissue from patients with long-term dialysis. These findings suggest that both β2M and AGE play roles in the pathogenesis of DRS.

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