Immunoglobulin light (heavy)-chain deposition disease: from molecular medicine to pathophysiology-driven therapy

Clin J Am Soc Nephrol. 2006 Nov;1(6):1342-50. doi: 10.2215/CJN.01730506. Epub 2006 Oct 11.

Abstract

Light-, light- and heavy-, and heavy-chain deposition diseases belong to a family of diseases that include light-chain (AL)-amyloid, nonamyloid fibrillary and immunotactoid glomerulonephritis, and cryoglobulinemic glomerulonephritis, in which monoclonal Ig or their subunits become deposited in kidney. In clinical and pathologic terms, light-, light- and heavy-, and heavy-chain deposition diseases essentially are similar and are characterized by prominent renal involvement with severe renal failure; extrarenal manifestations; diabetes-like nodular glomerulosclerosis; marked thickening of tubular basement membranes; and monotypic deposits of light chain, mostly kappa, and/or heavy chain that feature a nonorganized granular, electron-dense appearance by electron microscopy. The most common cause is myeloma. Recent progress has been made in the understanding of the molecular pathomechanisms of Ig-chain deposition and extracellular matrix accumulation, which opens up new therapeutic avenues in addition to eradication of the Ig-secreting plasma cell clone. Because these diseases represent a model of glomerular and interstitial fibrosis that is induced by a single molecule species, a better understanding of their pathomechanisms may help to unravel the pathophysiology of kidney fibrosis and renal disease progression.

MeSH terms

  • Humans
  • Immunoglobulin Heavy Chains / metabolism*
  • Immunoglobulin Light Chains / metabolism*
  • Paraproteinemias / immunology*
  • Paraproteinemias / pathology
  • Paraproteinemias / physiopathology
  • Paraproteinemias / therapy
  • Stem Cell Transplantation

Substances

  • Immunoglobulin Heavy Chains
  • Immunoglobulin Light Chains