The tissue specificity of fibrillar deposition in dialysis-related amyloidosis is most likely associated with the peculiar interaction of  2 -microglobulin ( 2 -m) with collagen fibers. However, other co-factors such as glycosaminoglycans might facilitate amyloid formation. In this study we have investigated the role of heparin in the process of collagen-driven amyloidogenesis. In fact, heparin is a well known positive effector of fibrillogenesis, and the elucidation of its potential effect in this type of amyloidosis is particularly relevant because heparin is regularly given to patients subject to hemodialysis to prevent blood clotting. We have monitored by atomic force microscopy the formation of  2 -m amyloid fibrils in the presence of collagen fibers, and we have discovered that heparin strongly accelerates amyloid deposition. The mechanism of this effect is still largely unexplained. Using dynamic light scattering, we have found that heparin promotes  2 -m aggregation in solution at pH 6.4. Morphology and structure of fibrils obtained in the presence of collagen and heparin are highly similar to those of natural fibrils. The fibril surface topology, investigated by limited proteolysis, suggests that the general assembly of amyloid fibrils grown under these conditions and in vitro at low pH is similar. The exposure of these fibrils to trypsin generates a cleavage at the C-terminal of lysine 6 and creates the 7-99 truncated form of  2 -m (⌬N6 2 -m) that is a ubiquitous constituent of the natural  2 -m fibrils. The formation of this  2 -m species, which has a strong propensity to aggregate, might play an important role in the acceleration of local amyloid deposition.
Dialysis-related amyloidosis (DRA),2 a severe disease arising as a complication of long term hemodialysis, involves the deposition of  2 -microglobulin ( 2 -m) amyloid fibrils in bones and ligaments.  2 -m constitutes the light chain of the major histocompatibility complex class I and CD1 (1), and in normal catabolism, it is continuously released in the serum and cleared from the circulation by the kidney. The replacement of renal function by hemodialysis does not efficiently remove  2 -m. The persistent increase of its plasma concentration is associated with  2 -m deposition in the osteotendineous system, which is the specific target tissue of this type of amyloidosis. Among extra-cerebral amyloidoses, DRA represents the most striking case of tissue-specific targeting. Although other organs can be involved, bones and ligaments never escape amyloid deposition. Homma (2) first pointed out that collagen might be involved in determining this tissue specificity and demonstrated a collagen/ 2 -m interaction.We have recently determined the binding properties governing the collagen/ 2 -m interaction, and we found that the latter is quite weak but is enhanced when  2 -m is truncated at the N-terminal end, and the pH is reduced from 7.4 to 6.4 (3). We subsequently demonstrated that fibrillar collagen (type I), which is abundant in skeletal...