In hereditary cystatin C amyloid angiopathy (HCCAA), presence of the Leu68
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Glnsubstitution in cystatin C is coupled to a decreased concentration of this major cysteine proteinase inhibitorin cerebrospinal fluid and leads to its amyloid deposition in the brain. We established a high-yieldexpression system for L68Q cystatin C in
Escherichia coli resulting in inclusion body accumulation at alevel of 40% of the total cellular protein. Refolding of protein from purified inclusion bodies yielded apure, almost completely monomeric and active inhibitor. CD and NMR spectroscopy demonstrated thatso produced L68Q cystatin C is folded, conformationally homogeneous, and structurally very similar towild-type cystatin C. Incubation at pH 7.0-5.5 caused the cystatin C variant to dimerize rapidly. Themolecular form present at pH 6.0 displayed a slightly increased amount of hydrophobic parts on thesurface as measured by 1-anilinonaphthalene-8-sulfonic acid (ANS) binding. NMR results showed thatthe dimer has a structure similar to that of the wild-type cystatin C dimer formed as a result of slightdenaturation. Under more acidic conditions, at pH 4.5, another stable unfolding intermediate of L68Qcystatin C was identified. This molecular form exists in a monomeric state, is characterized by changesin secondary structure according to far UV CD spectroscopy, and shows an altered ANS binding resemblingthat of a molten globule state. The acidic pH also caused an almost complete monomerization of preformeddimers. The state of denaturation of L68Q cystatin C in vivo is thus a critical factor for the concentrationof active cysteine proteinase inhibitor in cerebrospinal fluid and likely also for the development ofamyloidosis, in HCCAA patients.