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340    Chapter  Nine


                 (a)
                                              10 nm


                Monomeric native insulin

                                                                   13 Å
                                                                     (d)
                                                             (c) Fibrillation

                 Partially unfolded
                              (b) Misfolding &
                                    oligomerization




                   Unfolded

               FIGURE 9.6  Schematic drawing of the formation of amyloid fi brils. (a) Monomeric
               insulin having an α-helical conformation. (b) β-sheet (arrows) rich oligomers
               are being formed. (c) Amyloid fi brils having a diameter around 10 nm are
               being formed. (d) Higher magnifi cation of the intrinsic repetitive β-pleated
               sheet structure of the amyloid fi bril. The pictures were taken by transmission
               electron microscopy (TEM).



               there are many fundamental questions regarding this aggregation
                                           93
               process that remain unanswered.  The full elucidation of the aggrega-
               tion process requires the identification of all the conformational states
               and oligomeric structures adopted by the polypeptide chain during the
               process. It also entails characterizing each of the transitions in molecu-
               lar detail and identifying the residues or regions of the sequence that
               are involved in and promote the various aggregation steps. The identi-
               fication and characterization of prefibrillar states, such as oligomers,
               preceding the formation of well-defined fibrils are of particular interest
               because of an increasing awareness that these species are likely to play
               a critical role in the pathogenesis of protein deposition diseases (see
               Sec. 9.3.2).
                   Amyloid fibril formation has many characteristics of a “nucle-
               ated growth” mechanism, and the time course of the conversion of
               a peptide or protein into its fibrillar form typically includes a lag
               phase that is followed by a rapid exponential growth phase and a
               plateau phase (Fig. 9.7, Sec. 9.4.1). The lag phase is assumed to be
               the time required for “nuclei” to form, and once a nucleus is formed,
               fibril growth is thought to proceed rapidly by further association of
               either monomers or oligomers with the nucleus. As with many other
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