The circulating profile of beta-2-microglobulin (B2M) was determined in 8 end-stage renal disease patients on long-term dialysis (6 on hemodialysis, 2 on CAPD) by measuring B2M in different fractions after molecular sieve separation of their sera. Four patients had carpal tunnel syndrome with demonstrated amyloid in excised wrist tissues of which 2 were positive for B2M. In all patients despite very high blood levels (34.3–63.1 mg/l), B2M eluted exclusively as a single peak in the molecular weight region of about 12,000 daltons on a calibrated Sephacryl S-200 column. Recoveries from within the peak accounted for 96% of the applied B2M serum concentrations. These results were confirmed by molecular sieve separation of the enriched B2M-containing fractions by high-pressure liquid chromatography. We conclude that immunoreactive B2M in dialysis patients circulates as an intact monomer without evidence for the formation of aggregates or fragments. The pathogenesis of tissue deposition of this low-molecular-weight protein and its polymerisation to form a specific amyloid remains to be defined.

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