Origins of a pervasive, erroneous idea: The "green birefringence" of Congo red-stained amyloid

Analysis of Amyloid Fibrillation of Two Family 1 Glycoside Hydrolases

The formation and analysis of amyloid fibers by two β-glucosidases, BglA and BglB, belonging to the GH1 enzyme family, are reported. Both proteins have the (β/α)8 TIM-barrel fold, which is characteristic of this family and is also the most common protein structure. BglA is an octamer, whereas BglB is a monomer. Amyloid fibrillation using pH and temperature as perturbing agents was investigated using fluorescence spectroscopy as a preliminary approach and corroborated using wide-field optical microscopy, confocal microscopy, and field-emission scanning electron microscopy. These analyses showed that both enzymes fibrillate at a wide range of acidic and alkaline conditions and at several temperature conditions, particularly at acidic pH (3-4) and at temperatures between 45 and 65 °C. Circular dichroism spectroscopy corroborated the transition from an α-helix to a β-sheet secondary structure of both proteins in conditions where fibrillation was observed. Overall, our results suggest that fibrillation is a rather common phenomenon caused by protein misfolding, driven by a transition from an α-helix to a β-sheet secondary structure, that many proteins can undergo if subjected to conditions that disturb their native conformation.

Congo Red Staining in Digital Pathology: The Streamlined Pipeline for Amyloid Detection Through Congo Red Fluorescence Digital Analysis

Renal amyloidosis is a rare condition caused by the progressive accumulation of misfolded proteins within glomeruli, vessels, and interstitium, causing functional decline and requiring prompt treatment due to its significant morbidity and mortality. Congo red (CR) stain on renal biopsy samples is the gold standard for diagnosis, but the need for polarized light is limiting the digitization of this nephropathology field. This study explores the feasibility and reliability of CR fluorescence on virtual slides (CRFvs) in evaluating the diagnostic accuracy and proposing an automated digital pipeline for its assessment. Whole-slide images from 154 renal biopsies with CR were scanned through a Texas red fluorescence filter (NanoZoomer S60, Hamamatsu) at the digital Nephropathology Center of the Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo, Monza, Italy, and evaluated double-blinded for the detection and quantification through the amyloid score and a custom ImageJ pipeline was built to automatically detect amyloid-containing regions. Interobserver agreement for CRFvs was optimal (k = 0.90; 95% CI, 0.81-0.98), with even better concordance when consensus-based CRFvs evaluation was compared to the standard CR birefringence (BR) (k = 0.98; 95% CI, 0.93-1). Excellent performance was achieved in the assessment of amyloid score overall by CRFvs (weighted k = 0.70; 95% CI, 0.08-1), especially within the interstitium (weighted k = 0.60; 95% CI, 0.35-0.84), overcoming the misinterpretation of interstitial and capsular collagen BR. The application of an automated digital pathology pipeline (Streamlined Pipeline for Amyloid detection through CR fluorescence Digital Analysis, SPADA) further increased the performance of pathologists, leading to a complete concordance with the standard BR. This study represents an initial step in the validation of CRFvs, demonstrating its general reliability in a digital nephropathology center. The computational method used in this study has the potential to facilitate the integration of spatial omics and artificial intelligence tools for the diagnosis of amyloidosis, streamlining its detection process.

Increased Diagnostic Specificity of Congo Red Stain for Amyloid: The Potential Role of Texas Red-Filtered Fluorescence Microscopy

CONTEXT.—

The tissue diagnosis of amyloidosis is traditionally suggested by hematoxylin-eosin stain and confirmed by Congo red stain, both examined by routine light microscopy. Both false-positive and false-negative congophilia are well documented, limiting the sensitivity and specificity of the Congo red stain for the diagnosis of amyloidosis. Examination of Congo red-stained tissue by Texas Red-filtered fluorescence microscopy (TRFM) is known to enhance the amyloid-specific congophilia, thus increasing the diagnostic sensitivity.

OBJECTIVE.—

To determine whether TRFM can mitigate the false positivity and thus improve the diagnostic specificity of the Congo red stain.

DESIGN.—

Ninety-two tissue samples were categorized into 3 groups. Group I included 15 samples with tissue deposition of amyloid. Group II consisted of 63 samples in which amorphous eosinophilic structures reminiscent of amyloid were seen on hematoxylin-eosin-stained tissue sections. Group III included 14 samples in which amyloid and amyloid-like tissue were seen side by side. The final diagnosis of presence or absence of amyloidosis in each case was established by clinicopathologic correlation. The congophilic areas in each case were identified by light microscopy. The same areas were then examined by TRFM.

RESULTS.—

TRFM enhanced congophilia, confirming the diagnosis of amyloidosis in all group I cases. Enhancement was not seen in 52 of the 63 group II cases. For group III cases, TRFM enhanced the amyloid-specific congophilia, but not the nonspecific congophilia, in all cases.

CONCLUSIONS.—

TRFM increases the diagnostic yield and specificity of Congo red-stained tissue sections for detection of amyloid.

ECAmyloid: An amyloid predictor based on ensemble learning and comprehensive sequence-derived features

Amyloid fibrils formed by the mis-aggregation of amyloid proteins can lead to neuronal degenerations in the Alzheimer's disease. Predicting amyloid proteins not only contributes to understanding physicochemical properties and formation mechanism of amyloid proteins, but also has significant implications in the amyloid disease treatment and the development of a new purpose for amyloid materials. In this study, an ensemble learning model with sequence-derived features, ECAmyloid, is proposed to identify amyloids. The sequence-derived features including Pseudo Position Specificity Score Matrix (Pse-PSSM), Split Amino Acid Composition (SAAC), Solvent Accessibility (SA), and Secondary Structure Information (SSI) are employed to incorporate sequence composition, evolutionary and structural information. The individual learners of the ensemble learning model are selected by an increment classifier selection strategy. The final prediction results are determined by voting of prediction results of multiple individual learners. In view of the imbalanced benchmark dataset, the Synthetic Minority Over-sampling Technique (SMOTE) is adopted to generate positive samples. To eliminate irrelevant features and redundant features, correlation-based feature subset (CFS) selection combined with a heuristic search strategy is performed to obtain the optimal feature subset. Experimental results indicate that the ensemble classifier achieves an accuracy of 98.29%, a sensitivity of 0.992, a specificity of 0.974 on the training dataset using the 10-fold cross validation, far higher than the results obtained by its individual learners. Compared with the original feature set, the accuracy, sensitivity, specificity, MCC, F1-score, G-Mean of the ensemble method trained by the optimal feature subset are improved by 1.05%, 0.012, 0.01, 0.021, 0.011 and 0.011, respectively. Moreover, the comparison results with existing methods on two same independent test datasets demonstrate that the proposed method is an effective and promising predictor for large-scale determination of amyloid proteins. The data and code used to develop ECAmyloid has been shared to Github, and can be freely downloaded at https://github.com/KOALA-L/ECAmyloid.git.

Bacterial Lectin FimH and Its Aggregation Hot-Spots: An Alternative Strategy against Uropathogenic Escherichia coli

Type I fimbriae are the main adhesive organelles of uropathogenic Escherichia coli (UPEC), consisting of four different subunits. Their component with the most important role in establishing bacterial infections is the FimH adhesin located at the fimbrial tip. This two-domain protein mediates adhesion to host epithelial cells through interaction with terminal mannoses on epithelial glycoproteins. Here, we propose that the amyloidogenic potential of FimH can be exploited for the development of therapeutic agents against Urinary Tract Infections (UTIs). Aggregation-prone regions (APRs) were identified via computational methods, and peptide-analogues corresponding to FimH lectin domain APRs were chemically synthesized and studied with the aid of both biophysical experimental techniques and molecular dynamic simulations. Our findings indicate that these peptide-analogues offer a promising set of antimicrobial candidate molecules since they can either interfere with the folding process of FimH or compete for the mannose-binding pocket.

Amyloidosis: What does pathology offer? The evolving field of tissue biopsy

Since the mid-nineteenth century pathology has followed the convoluted story of amyloidosis, recognized its morphology in tissues and made identification possible using specific staining. Since then, pathology studies have made a significant contribution and advanced knowledge of the disease, so providing valuable information on the pathophysiology of amyloid aggregation and opening the way to clinical studies and non-invasive diagnostic techniques. As amyloidosis is a heterogeneous disease with various organ and tissue deposition patterns, histology evaluation, far from offering a simple yes/no indication of amyloid presence, can provide a wide spectrum of qualitative and quantitative information related to and changing with the etiology of the disease, the comorbidities and the clinical characteristics of patients. With the exception of cardiac transthyretin related amyloidosis cases, which today can be diagnosed using non-biopsy algorithms when stringent clinical criteria are met, tissue biopsy is still an essential tool for a definitive diagnosis in doubtful cases and also to define etiology by typing amyloid fibrils. This review describes the histologic approach to amyloidosis today and the current role of tissue screening biopsy or targeted organ biopsy protocols in the light of present diagnostic algorithms and various clinical situations, with particular focus on endomyocardial and renal biopsies. Special attention is given to techniques for typing amyloid fibril proteins, necessary for the new therapies available today for cardiac transthyretin related amyloidosis and to avoid patients receiving inappropriate chemotherapy in presence of plasma cell dyscrasia unrelated to amyloidosis. As the disease is still burdened with high mortality, the role of tissue biopsy in early diagnosis to assure prompt treatment is also mentioned.

Systematic review of accuracy of reporting of Congo red-stained amyloid in 2010-2020 compared with earlier

BACKGROUND

Almost always, Congo red-stained amyloid between polariser and analyser is said to show "green birefringence" or "apple-green birefringence". In 2010, we found that not all published images showed green, and not all that did showed only green. This systematic review of more recent papers was to find if there had been any improvement in the accuracy of reporting.

MATERIALS AND METHODS

MEDLINE was searched on 15 March 2021 for papers published between 2010 and 2020 inclusive mentioning amyloid and Congo red. These were examined for descriptions of colours, which were compared with images. Papers were searched for mentions of anomalous colours, errors in physical optics, and misquotation of references about polarisation.

RESULTS

In 374 papers, there were 444 descriptions of colours, with 511 images in 257 papers. The commonest descriptions were apple-green, 249/444 (56%), and green, 105/444 (24%). The description agreed with colours seen in 116/511 images (23%) (previously 64/191, 34%). Green was seen in 342/511 images (67%) (previously 159/191, 83%), but not in 169/511 (33%), although each image was reported to show green. Green alone was seen in 103/511 images (20%) (previously 59/191, 31%), and was combined with at least one other colour in 239/511 (47%). Ten papers included the term anomalous. Eight papers incorrectly said that there was green dichroism, three incorrectly used the term green metachromasia, and two incorrectly mentioned green fluorescence. Twenty-seven papers misquoted references.

CONCLUSIONS

There is widespread and increasing inaccuracy of reporting of colours seen in Congo red-stained amyloid. People persist in saying "green birefringence" or "apple-green birefringence", even when no green is seen, or there are also other colours. Few appear to appreciate that the other colours are genuine, respectable, and helpful, the physical optical principles that explain the colours are now understood, and the best expression to use is anomalous colours.KEY MESSAGE"Green birefringence" and "apple-green birefringence" are inappropriate terms to describe the findings in amyloid stained with Congo red and examined between crossed polariser and analyser, because green is not always seen, and even when it is, other colours are commonly seen as well. The proportions of colour images showing any green and green alone, and the proportion of descriptions that agreed with illustrated colours, significantly decreased in 2010-2020 compared with earlier. The most appropriate and scientific description of the findings is anomalous colours.

Human RAD51 Protein Forms Amyloid-like Aggregates In Vitro

RAD51 is a central protein of homologous recombination and DNA repair processes that maintains genome stability and ensures the accurate repair of double-stranded breaks (DSBs). In this work, we assessed amyloid properties of RAD51 in vitro and in the bacterial curli-dependent amyloid generator (C-DAG) system. Resistance to ionic detergents, staining with amyloid-specific dyes, polarized microscopy, transmission electron microscopy (TEM), X-ray diffraction and other methods were used to evaluate the properties and structure of RAD51 aggregates. The purified human RAD51 protein formed detergent-resistant aggregates in vitro that had an unbranched cross-β fibrillar structure, which is typical for amyloids, and were stained with amyloid-specific dyes. Congo-red-stained RAD51 aggregates demonstrated birefringence under polarized light. RAD51 fibrils produced sharp circular X-ray reflections at 4.7 Å and 10 Å, demonstrating that they had a cross-β structure. Cytoplasmic aggregates of RAD51 were observed in cell cultures overexpressing RAD51. We demonstrated that a key protein that maintains genome stability, RAD51, has amyloid properties in vitro and in the C-DAG system and discussed the possible biological relevance of this observation.

Treatment of Localized Amyloid Light Chain Amyloidosis With External Beam Radiation Therapy

PURPOSE

Localized amyloidosis is a condition characterized by deposits of fibrillary proteins confined to a single organ. The most common subtype is amyloid light chain amyloidosis, which is caused by secretion of amyloidogenic light chain by a monoclonal population of plasma cells. We present a review and discussion of the literature in the context of a case presentation of localized amyloid light chain amyloidosis of the nasopharynx treated with radiation alone.

METHODS AND MATERIALS

We reviewed literature relevant to this topic from 1970 to the present. Relevant studies, reports, and articles were summarized in table form.

RESULTS

Surgical resection has historically been the primary therapeutic modality for these patients, with radiation being reserved for recurrent lesions or for those unfit for surgery. Although the data are limited to small retrospective series, radiation has been shown to provide good control with mild toxicity that is as good as or better than surgery. Doses range from 20 to 45 Gy, conventionally fractionated. There is no known risk of progression to systemic disease without local therapy.

CONCLUSIONS

We recommend local therapy for symptomatic patients after systemic disease has been excluded. We generally recommend radiation in the setting of recurrent lesions, unacceptable toxicity with surgery, poor surgical candidates, and as the initial modality in select patients (elderly individuals with bothersome but nonobstructive lesions).

Amyloid Aggregates Are Localized to the Nonadherent Detached Fraction of Aging Streptococcus mutans Biofilms

The number of bacterial species recognized to utilize purposeful amyloid aggregation within biofilms continues to grow. The oral pathogen Streptococcus mutans produces several amyloidogenic proteins, including adhesins P1 (also known as AgI/II, PAc) and WapA, whose truncation products, namely, AgII and AgA, respectively, represent the amyloidogenic moieties. Amyloids demonstrate common biophysical properties, including recognition by Thioflavin T (ThT) and Congo red (CR) dyes that bind to the cross β-sheet quaternary structure of amyloid aggregates. Previously, we observed amyloid formation to occur only after 60 h or more of S. mutans biofilm growth. Here, we extend those findings to investigate where amyloid is detected within 1- and 5-day-old biofilms, including within tightly adherent compared with those in nonadherent fractions. CR birefringence and ThT uptake demonstrated amyloid within nonadherent material removed from 5-day-old cultures but not within 1-day-old or adherent samples. These experiments were done in conjunction with confocal microscopy and immunofluorescence staining with AgII- and AgA-reactive antibodies, including monoclonal reagents shown to discriminate between monomeric protein and amyloid aggregates. These results also localized amyloid primarily to the nonadherent fraction of biofilms. Lastly, we show that the C-terminal region of P1 loses adhesive function following amyloidogenesis and is no longer able to competitively inhibit binding of S. mutans to its physiologic substrate, salivary agglutinin. Taken together, our results provide new evidence that amyloid aggregation negatively impacts the functional activity of a widely studied S. mutans adhesin and are consistent with a model in which amyloidogenesis of adhesive proteins facilitates the detachment of aging biofilms. IMPORTANCE Streptococcus mutans is a keystone pathogen and causative agent of human dental caries, commonly known as tooth decay, the most prevalent infectious disease in the world. Like many pathogens, S. mutans causes disease in biofilms, which for dental decay begins with bacterial attachment to the salivary pellicle coating the tooth surface. Some strains of S. mutans are also associated with bacterial endocarditis. Amyloid aggregation was initially thought to represent only a consequence of protein mal-folding, but now, many microorganisms are known to produce functional amyloids with biofilm environments. In this study, we learned that amyloid formation diminishes the activity of a known S. mutans adhesin and that amyloid is found within the nonadherent fraction of older biofilms. This finding suggests that the transition from adhesin monomer to amyloid facilitates biofilm detachment. Knowing where and when S. mutans produces amyloid will help in developing therapeutic strategies to control tooth decay and other biofilm-related diseases.

Amyloid deposition in granuloma of tuberculosis patients: A single-center pilot study

The formation of granuloma is one of the characteristic features of tuberculosis. Besides, elevated serum amyloid A (SAA) protein level is the indicator for chronic inflammation associated with tuberculosis. The linkage between tuberculosis and SAA-driven secondary amyloidosis is well documented. However, SAA-derived amyloid onset and deposition start sites are not well understood in tuberculosis. We hypothesized that granuloma could be a potential site for amyloid deposition because of the presence of SAA protein and proteases, cleaving SAA into aggregation-prone fragments. 150 tuberculosis patients were identified and biopsies were collected from the affected organs. Patients showing eosinophilic hyaline-rich deposits within granuloma and its periphery were further screened for the presence of amyloid deposits. Upon Congo red staining, these hyaline deposits exhibited characteristic apple-green birefringence under polarized light, confirming their amyloid nature in 20 patients. Further upon Immuno-histochemical staining with anti-SAA antibody, the amyloid enriched areas showed positive immunoreactivity. In this pilot study, we have shown granuloma as a potential site for serum amyloid A derived amyloid deposition in tuberculosis patients. This study would expand the clinical and fundamental research for understanding the mechanism of amyloid formation in granuloma underlying tuberculosis and other chronic inflammatory conditions.

Challenges in Experimental Methods

Experimental studies of amyloids encounter many challenges. There are many methods available for studying proteins, which can be applied to amyloids: from basic staining techniques, allowing visualization of fibers, to complex methods, e.g., AFM-IR used to their detailed biochemical and structural characterization in nanoscale. Which method is appropriate depends on the goal of an experiment: verification of aggregational properties of a peptide, distinguishing oligomers from mature fibers, or kinetic studies. Insolubility, rapid aggregation, and the need of using a high-purity peptide may be a limiting factor in studies involving amyloids. Moreover, the results obtained by various experimental methods often differ significantly, which may lead to misclassification of amyloid peptides. Due to ambiguity of experimental results, laborious and time-consuming analysis, bioinformatical methods become more widely used for amyloids.

C4d as a Practical Marker for Cutaneous Amyloidosis

ABSTRACT

Cutaneous amyloidosis (CA) is defined by the accumulation of amyloid in the dermis; it might be primary or secondary. The diagnosis is based on histopathological findings with the demonstration of amyloid deposits, confirmed by Congo red stain under the polarized light. Studies on other diagnostic markers are ongoing in the literature. The aim of this study was to demonstrate the utility of C4d staining in the recognition of amyloid in CA and using it as an alternative or substitute marker for the diagnosis. In this retrospective study, 199 skin biopsies with a clinical provisional diagnosis of CA were analyzed, the Congo red stain was performed, and, in a subgroup (n = 97) with histopathological findings probably for CA, C4d immunohistochemistry was assessed. Forty-eight cases of CA were detected. Congo red birefringence was positive in all cases, whereas in 14 cases, it was faded. In these 14 cases, the diagnosis of CA was made by means of Congo red fluorescence and Thioflavin T because the histopathological findings were highly suggestive for CA. All CA cases were positive with C4d, and in 12 of the 49 inflammatory dermatoses, C4d was positive. The interpretation of C4d immunohistochemistry can be performed more easily and rapidly than Congo red evaluation. The sensitivity and specificity of C4d were 100% and 75.5%, respectively. In our experience, C4d staining was a useful method for detecting amyloid deposits in CA. Although Congo red staining is the gold standard for amyloid detection, we propose C4d immunohistochemistry as a routine screening method or hybrid transition while further investigations are completed.

Amyloidosis: Multisystem Spectrum of Disease with Pathologic Correlation

Amyloidosis is a group of conditions defined by extracellular deposition of insoluble proteins that can lead to multiorgan dysfunction and failure. The systemic form of the disease is often associated with a plasma cell dyscrasia but may also occur in the setting of chronic inflammation, long-term dialysis, malignancy, or multiple hereditary conditions. Localized forms of the disease most often involve the skin, tracheobronchial tree, and urinary tract and typically require tissue sampling for diagnosis, as they may mimic many conditions including malignancy at imaging alone. Advancements in MRI and nuclear medicine have provided greater specificity for the diagnosis of amyloidosis involving the central nervous system and heart, potentially obviating the need for biopsy of the affected organ in certain circumstances. Specifically, a combination of characteristic findings at noninvasive cardiac MRI and skeletal scintigraphy in patients without an underlying plasma cell dyscrasia is diagnostic for cardiac transthyretin amyloidosis. Histologically, the presence of amyloid is denoted by staining with Congo red and a characteristic apple green birefringence under polarized light microscopy. The imaging features of amyloid vary across each organ system but share some common patterns, such as soft-tissue infiltration and calcification, that may suggest the diagnosis in the appropriate clinical context. The availability of novel therapeutics that target amyloid protein fibrils such as transthyretin highlights the importance of early diagnosis. Online supplemental material is available for this article. ^©RSNA, 2021.

Integrative Multi-Omics Analysis in Calcific Aortic Valve Disease Reveals a Link to the Formation of Amyloid-Like Deposits

Calcific aortic valve disease (CAVD) is the most prevalent valvular heart disease in the developed world, yet no pharmacological therapy exists. Here, we hypothesize that the integration of multiple omic data represents an approach towards unveiling novel molecular networks in CAVD. Databases were searched for CAVD omic studies. Differentially expressed molecules from calcified and control samples were retrieved, identifying 32 micro RNAs (miRNA), 596 mRNAs and 80 proteins. Over-representation pathway analysis revealed platelet degranulation and complement/coagulation cascade as dysregulated pathways. Multi-omics integration of overlapping proteome/transcriptome molecules, with the miRNAs, identified a CAVD protein–protein interaction network containing seven seed genes (apolipoprotein A1 (APOA1), hemoglobin subunit β (HBB), transferrin (TF), α-2-macroglobulin (A2M), transforming growth factor β-induced protein (TGFBI), serpin family A member 1 (SERPINA1), lipopolysaccharide binding protein (LBP), inter-α-trypsin inhibitor heavy chain 3 (ITIH3) and immunoglobulin κ constant (IGKC)), four input miRNAs (miR-335-5p, miR-3663-3p, miR-21-5p, miR-93-5p) and two connector genes (amyloid beta precursor protein (APP) and transthyretin (TTR)). In a metabolite–gene–disease network, Alzheimer’s disease exhibited the highest degree of betweenness. To further strengthen the associations based on the multi-omics approach, we validated the presence of APP and TTR in calcified valves from CAVD patients by immunohistochemistry. Our study suggests a novel molecular CAVD network potentially linked to the formation of amyloid-like structures. Further investigations on the associated mechanisms and therapeutic potential of targeting amyloid-like deposits in CAVD may offer significant health benefits.

Myocardial amyloidosis following multiple myeloma in a 38-year-old female patient: A case report

Multiple myeloma (MM) is an immunoglobulin-producing tumor of plasma cells, which occurs commonly in the elderly. The incidence of myocardial amyloidosis with MM is extremely low and early clinical manifestations are nonspecific. The diversity of clinical manifestations and first episode symptoms often cause misdiagnosis in young patients with myocardial amyloidosis following MM. In this study, we analyzed the clinical data of a young woman with MM and impaired cardiac function combined with echocardiography, electrocardiography (ECG), laboratory data, cell Congo Red staining, and other manifestations to diagnose amyloidosis. Considering the rapid progression, short survival, and poor prognosis in most patients, a clear, definitive, and timely diagnosis is essential for the treatment of patients with MM complicated with myocardial amyloidosis.

Origins of a pervasive, erroneous idea: The "green birefringence" of Congo red-stained amyloid

Congo red was discovered to stain amyloid by accident in 1922, and Congo red-stained amyloid was shown to be birefringent on polarization microscopy in 1927. Colours, namely green and yellow, were reported under these conditions in 1945, although these are only two of various anomalous colours that may be seen, depending on the optical set-up. In 1953 there began a dogmatic insistence that in Congo red-stained amyloid between crossed polarizer and analyser green alone should be seen, and the finding of any other colour was a mistake. The idea that green, and only green, is essential for the diagnosis of amyloid has persisted almost universally, and virtually all mentions of Congo red-stained amyloid say that it just shows "green birefringence" or "apple-green birefringence." This idea is wrong and is contrary to everyday experience, because green is seldom seen on its own under these conditions of microscopy, and often, there is no green at all. How observers maintain this unscientific position is explained by a study of its historical origins. Most of the early literature was in German or French and was usually quoted in English at second hand, which meant that misquotations, misattributions and misunderstandings were common. Few workers reported their findings accurately, hardly any attempted to explain them, and until 2008, none gave a completely satisfactory account of the physical optics. The history of Congo red-stained amyloid is an instructive example of how an erroneous belief can become widely established even when it is contradicted by simple experience.