Diagnostic Challenges and Solutions in Systemic Amyloidosis

Rivka Goldis, Batia Kaplan, Olga Kukuy, Michael Arad, Hila Magen, Efrat Shavit-Stein, Amir Dori, Avi Livneh*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Amyloidosis refers to a clinically heterogeneous group of disorders characterized by the extracellular deposition of amyloid proteins in various tissues of the body. To date, 42 different amyloid proteins that originate from normal precursor proteins and are associated with distinct clinical forms of amyloidosis have been described. Identification of the amyloid type is essential in clinical practice, since prognosis and treatment regimens both vary according to the particular amyloid disease. However, typing of amyloid protein is often challenging, especially in the two most common forms of amyloidosis, i.e., the immunoglobulin light chain amyloidosis and transthyretin amyloidosis. Diagnostic methodology is based on tissue examinations as well as on noninvasive techniques including serological and imaging studies. Tissue examinations vary depending on the tissue preparation mode, i.e., whether it is fresh-frozen or fixed, and they can be carried out by ample methodologies including immunohistochemistry, immunofluorescence, immunoelectron microscopy, Western blotting, and proteomic analysis. In this review, we summarize current methodological approaches used for the diagnosis of amyloidosis and discusses their utility, advantages, and limitations. Special attention is paid to the simplicity of the procedures and their availability in clinical diagnostic laboratories. Finally, we describe new methods recently developed by our team to overcome limitations existing in the standard assays used in common practice.

Original languageEnglish
Article number4655
JournalInternational Journal of Molecular Sciences
Issue number5
StatePublished - Mar 2023


  • Western blotting
  • amyloid typing
  • amyloidosis
  • free light chain dimers
  • free light chains
  • mass spectrometry
  • transthyretin


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