Clinical characteristics and prognostic value of renal immune complex deposition in patients with light chain amyloidosis

Abstract

Although patients with light chain amyloidosis (AL) may present with co-deposition of amyloid and immune complexes (ICs) in renal biopsies, data on clinical characteristics and prognostic value of renal IC deposition are limited. A total of 73 patients with AL amyloidosis who were newly diagnosed by renal biopsy in Xijing Hospital (Xi’an, China) were divided into two groups (IC and non-IC groups). As a result, renal IC deposition was found in 26% of patients. Patients with IC deposition were associated with more urinary protein excretion and lower serum albumin. Notably, patients in the non-IC group achieved higher hematological overall response rate (81.5% vs. 47.4%, p = 0.007) and ≥VGPR rate (75.9% vs. 39.8%, p = 0.004) compared with those in IC group. Renal response rate was also higher in the non-IC group (63% vs. 31.6%, p = 0.031). With the median follow-up time of 19 months, a significantly worse overall survival was observed in patients with the IC group as compared with those without renal IC deposition in the Kaplan–Meier analysis (p = 0.036). Further multivariate analysis demonstrated that renal immune complex deposition was associated with worse overall survival in patients with AL amyloidosis (HR 5.927, 95% CI 2.148–16.356, p = 0.001).

Single-Cell Heterogeneity Restorative Chimeric Engineering Nanoparticles for Alleviating Antibody-Mediated Allograft Injury

“…18 Furthermore, the mere conversion of free antibodies to adsorbed complexes instead results in granular or clump-like deposition of immune complexes and a rebound activation of the pro-inflammatory transcriptional profile of immune cells. 19 Therefore, the strategy that can adsorb across lineages and degrade DSA complexes to restore the single-cell transcriptional heterogeneity in an allograft is urgently needed. Disruption of single-cell transcriptional heterogeneity is an inevitable consequence of persistent multilineage DSA production and allosensitization.…”

“…Cell-membrane-coated nanoparticles, as a new type of nanocarrier, have shown considerable potential for clinical application especially with membrane protein genetic engineering, typically composed of a polymer core and a naturally derived outer layer of the cell membrane. , However, it is difficult to achieve the adsorption of multiple immunoglobulin types with a single engineering strategy due to the large span of DSA repertoires . Furthermore, the mere conversion of free antibodies to adsorbed complexes instead results in granular or clump-like deposition of immune complexes and a rebound activation of the pro-inflammatory transcriptional profile of immune cells . Therefore, the strategy that can adsorb across lineages and degrade DSA complexes to restore the single-cell transcriptional heterogeneity in an allograft is urgently needed.…”