The folding of ␤ 2 -microglobulin (␤ 2 -m), the protein forming amyloid deposits in dialysis-related amyloidosis, involves formation of a partially folded conformation named I 2 , which slowly converts into the native fold, N. Here we show that the partially folded species I 2 can be separated from N by capillary electrophoresis. Data obtained with this technique and analysis of kinetic data obtained with intrinsic fluorescence indicate that the I 2 conformation is populated to ϳ14 ؎ 8% at equilibrium under conditions of pH and temperature close to physiological. In the presence of fibrils extracted from patients, the I 2 conformer has a 5-fold higher propensity to aggregate than N, as indicated by the thioflavine T test and light scattering measurements. A mechanism of aggregation of ␤ 2 -m in vivo involving the association of the preformed fibrils with the fraction of I 2 existing at equilibrium is proposed from these results. The possibility of isolating and quantifying a partially folded conformer of ␤ 2 -m involved in the amyloidogenesis process provides new opportunities to monitor hemodialytic procedures aimed at the reduction of such species from the pool of circulating ␤ 2 -m but also to design new pharmaceutical approaches that consider such species as a putative molecular target.Dialysis-related amyloidosis represents an inevitable and severe complication of long term hemodialysis (1-4). Under this pathological condition, protein aggregates known as amyloid fibrils, accumulate in essential tissues, such as the skeletal muscle, interfering with their normal functions. A major constituent of the amyloid fibrils related to this pathological condition is ␤ 2 -microglobulin (␤ 2 -m).1 In its native form, this 99-residue protein is constituted by two ␤-sheets packed against each other to form a fold typical of the immunoglobulin superfamily (5). The two ␤-sheets, constituted by three and four strands, respectively, interact by means of hydrophobic interactions and a disulfide bridge that stabilizes further the ␤-sandwich structure.␤ 2 -m constitutes the light chain of the major histocompatibility complex class I (MHCI). A significant pool of ␤ 2 -m is also normally present in the plasma as a consequence of the constant release from the MHCI to allow the process of catabolic degradation in the kidney (1, 2). In chronic dialysis patients, the artificial membrane induces an inflammatory reaction, which causes the production and release of ␤ 2 -m to increase significantly (6). In addition, ␤ 2 -m cannot be filtered efficiently through the artificial membrane, resulting in an increase of the levels of soluble ␤ 2 -m from 0.3 to 30 g/ml, the range of concentrations observed within healthy individuals, to ϳ40 g/ml (7). The increase of free circulating ␤ 2 -m, the preferential substrate for amyloid deposition by this protein, is responsible, at least in part, for this form of amyloidosis in these patients (1, 2). Big efforts have been expended to improve the biocompatibility and performance of dialysis approaches. ...

Dialysis-related amyloidosis is a disease in which partial unfolding of beta(2)-microglobulin plays a key pathogenetic role in the formation of the amyloid fibrils. We have recently demonstrated that a partially unfolded conformer of beta(2)-microglobulin is involved in fibrillogenesis and that this species is significantly populated under physiological conditions. In this work capillary electrophoresis has been used to measure the equilibrium between the native protein and this conformer in samples known to have a higher or lower amyloidogenic potential, namely full-length beta(2)-microglobulin, two truncated species and a mutant, created by replacing histidine in position 31 with thyrosine. In addition, for all protein species folding stability experiments have been carried out by monitoring the secondary structure by circular dichroism at increasing concentrations of guanidinium chloride. The values of free energy of unfolding in the absence of denaturant, obtained by elaboration of these experiments, were found to be inversely correlated to the area percent of the partially unfolded conformer, as measured by capillary electrophoresis. Affinity capillary electrophoresis experiments have been also carried out under nondenaturing conditions to assess the affinity of copper and suramin to either the native form or the conformational intermediate of full-length beta(2)-microglobulin.

The group of diseases caused by abnormalities of the process of protein folding and unfolding is rapidly growing and includes diseases caused by loss of function as well as diseases caused by gain of function of misfolded proteins. Amyloidoses are caused by gain of function of certain proteins that lose their native structure and self-assemble into toxic insoluble, extracellular fibrils. This process requires the contribution of multiple factors of which only a few are established, namely the conformational modification of the amyloidogenic protein, protein's post-translational modifications and the co-deposition of glycosaminoglicans and of serum amyloid P component. In parallel with the exponential growth of biochemical data regarding the key events of the fibrillogenic process, several reports have shown that small molecules, through the interaction with either the amyloidogenic proteins or with the common constituents, can modify the kinetics of formation of amyloid fibrils or can facilitate amyloid reabsorption. These small molecules can be classified on the basis of their protein target and mechanism of action, according to the following properties. 1) molecules that stabilize the amyloidogenic protein precursor 2) molecules that prevent fibrillogenesis by acting on partially folded intermediates of the folding process as well as on low molecular weight oligomers populating the initial phase of fibril formation 3) molecules that interact with mature amyloid fibrils and weaken their structural stability 4) molecules that displace fundamental co-factors of the amyloid deposits like glycosaminoglycans and serum amyloid P component and favor the dissolution of the fibrillar aggregate.