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amyloidosis 39 anaphylactic shock
Amyloidosis: mesangial areas of glomerulus.
Amyloidosis: kidney.
amyloidosis
A constellation of diseases characterized by the extracellular
deposition of fibrillar material that has a homogeneous
and eosinophilic appearance in conventional staining methods.
Amyloidosis may compromise the functions of vital
organs. Diseases with which it is associated may be inflammatory,
hereditary, or neoplastic. All types of amyloid link
to Congo red and manifest an apple green birefrigence when
viewed by polarizing light microscopy after first staining
with Congo red. Under electron microscopy, amyloid has
a major fibrillar component and a minor rod-like structure
shaped like a pentagon with a hollow core when observed
on end (the P component). All forms of amyloid share the
P component in common. It is found as a soluble serum
protein (SAP) in the circulation. Amyloid has a β-pleated
sheet structure; it is insoluble in physiologic saline but
soluble in distilled water. The classification of amyloidosis
depends upon the clinical presentation, anatomic distribution,
and chemical content of the amyloid. In the United
States, AL amyloid is the most common type of amyloidosis
and occurs in association with multiple myeloma and
Waldenström’s macroglobulinemia. Patients demonstrate
free light chain production in association with the development
of Bence–Jones proteins in myeloma. The light chain
quality and degradation mechanisms are critical in determining
whether Bence–Jones proteins will be deposited as
amyloid. Chronic inflammation leads to increased levels of
serum amyloid-associated (SAA) protein, produced by the
liver following IL-6 and IL-1 stimulation. Normally, SAA
is degraded by the enzymes of monocytes. Thus, individuals
with defects in the degradation process may generate
insoluble AA molecules. Likewise, there may be a defect in
the degradation of immunoglobulin light chains in subjects
who develop AL amyloidosis. Amyloidosis secondary to
chronic inflammation is severe, with kidney, liver, spleen,
lymph node, adrenal, and thyroid involvement. These
secondary amyloidosis deposits consist of amyloid A (AA)
protein that makes up 85 to 90% of the deposits and serum
amyloid P component that account for the remainder of the
deposit. The AL type of amyloidosis more often involves
the heart, gastrointestinal tract, respiratory tract, peripheral
nerves, and tongue. Amyloidosis may also be heredofamilial
or associated with aging.
ANA
Abbreviation for antinuclear antibodies.
ANAE (α-naphthyl acetate esterase)
Refer to nonspecific esterase.
anaINH
Anaphylatoxin inhibitor.
anakinra (injection)
A recombinant nonglycosylated form of human interleukin-1
receptor antagonist (IL-1Ra). It differs from native
IL-1Ra in its possession of a single methionine residue at its
amino terminus. Anakinra is comprised of 153 amino acids
and has a molecular weight of 17.3 kDa. It is synthesized by
recombinant DNA technology employing an Escherichia
coli bacterial expression system. It blocks the biological
activity of IL-1 by inhibiting IL-1 binding to the IL-1 type
I receptor (IL-1RI). IL-1 is synthesized in response to
inflammatory stimuli and has a wide spectrum of activities
including cartilage degradation by its induction of the rapid
loss of proteoglycans and stimulation of bone resorption.
Levels of naturally occurring IL-1Ra in synovial fluid from
RA patients are not sufficient to compete with the increased
mass of locally produced IL-1.
anamnesis
Immunologic memory. Refers to the elevated immune
response following secondary or tertiary administration of
immunogen to a recipient previously primed or sensitized to
the immunogen (i.e., the secondary response).
anamnestic
The recall response of immunologic memory that results in
a rapid rise in antibody production following re-exposure to
the same antigen.
anamnestic response
Accentuated immune response that occurs following
exposure of immunocompetent cells to an immunogen to
which they have been exposed earlier; commonly called
the secondary or anamnestic response. It occurs rapidly
(within hours) following secondary immunogen inoculation
and does not have the lag period observed with primary
immunization. Immunologic memory is involved in the
production of this response that generally consists of immunoglobulin
G (IgG) antibodies of high titer and high affinity.
There may also be heightened T cell (cell-mediated)
immune reactivity. Also called memory or booster response
or secondary immune response.
anaphylactic shock
Cardiovascular collapse and suffocation attributable to
tracheal swelling that results from a systemic anaphylactic
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