It has been proposed that a nucleation-dependent polymerization model may explain the general mechanisms of amyloid fibril formation both in vitro and in vivo, in various types of human as well as murine amyloidosis. This model consists of two phases, i.e., energetically unfavorable nucleation phase and energetically favorable extension phase. β
2-Microglobulin (β
2-m)-related amyloidosis is a common and serious complication in long-term hemodialysis patients. We previously reported that various types of glycosaminoglycans and proteoglycans, as well as apolipoprotein E, a representative amyloid-associated protein stabilizes β
2-m amyloid fibrils and inhibit their depolymerization at neutral pH. Lysophospholipids (LPLs) and non-esterified fatty acids (NEFAs) are candidate biological molecules that induce β
2-m amyloid fibril formation at neutral pH. Recently, we found that some LPLs, especially lysophosphatidic acid (LPA), as well as NEFAs induce the extension of β
2-m amyloid fibrils at neutral pH, by partially unfolding the compact structure of β
2-m to an amyloidogenic conformer, as well as by stabilizing the extended fibrils. We also observed that hemodialysis patients have significantly higher plasma concentrations of LPA than healthy subjects and that patient plasma samples with the highest LPA concentrations stabilize β
2-m amyloid fibrils more potently than normal plasma samples. Moreover, in patients receiving hemodialysis regularly, administration of heparin results in an acute increase in plasma NEFA, largely by the activation of lipoprotein lipase. These results suggest possible roles of LPLs and NEFAs in the development of β
2-m-related amyloidosis.
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