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Hirata A, Hayashi A, Yamazaki S, Hanada H, Nakamura S, Ogino A. Dynamic Reconstruction Using Bilateral Lengthening Temporalis Myoplasty for Facial Palsies in Patients with Hereditary Skin Laxity. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5618. [PMID: 38375370 PMCID: PMC10876247 DOI: 10.1097/gox.0000000000005618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024]
Abstract
Hereditary skin laxity is a rare condition, some cases of which are also referred to as cutis laxa, and those involving facial skin are considered a target for treatment by plastic surgery as patients present with an aged face, which can reduce their quality of life. In some of these patients, the facial nerve and muscles may be affected, and cause weakness of mimetic muscles. We performed one-stage bilateral lengthening temporalis myoplasty reanimation, followed by lower facial contouring with partial lower lip excision and hammock-shaped fascia grafting in two patients with hereditary facial skin laxity coexisting with facial palsy. The patient was a 63-year-old woman with hereditary gelsolin amyloidosis and a 64-year-old man who was diagnosed with oculopharyngeal muscular dystrophy. Postoperatively, a symmetrical facial contour was achieved in repose, and smiling with and without biting was possible. To our knowledge, there are no reports of dynamic smile reconstruction for facial weakness in patients with hereditary facial skin laxity. Although these patients may experience progressive loss of function of the trigeminal nerve and its innervating muscles, the static suspension effect of lengthening temporalis myoplasty can be expected to continue even if the temporal muscles lose their function in the future. We believe that, with careful patient selection, dynamic reconstruction is an option for progressive facial paralysis. In this article, we present the chronological history of two patients who underwent multiple plastic surgery procedures and discuss the importance of the role of plastic surgery in improving the quality of life under these conditions.
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Affiliation(s)
- Akiko Hirata
- From the Department of Plastic and Reconstructive Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Akiteru Hayashi
- Department of Plastic and Reconstructive Surgery, Toho University Sakura Medical Center, Chiba, Japan
| | - Shun Yamazaki
- Department of Plastic and Reconstructive Surgery, Toho University Sakura Medical Center, Chiba, Japan
| | - Hayato Hanada
- From the Department of Plastic and Reconstructive Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Syogo Nakamura
- Department of Plastic and Reconstructive Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Akihiro Ogino
- Department of Plastic and Reconstructive Surgery, Toho University Omori Medical Center, Tokyo, Japan
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Mendelson L, Prokaeva T, Lau KHV, Sanchorawala V, McCausland K, Spencer B, Dasari S, McPhail ED, Kaku MC. Hereditary gelsolin amyloidosis: a rare cause of cranial, peripheral and autonomic neuropathies linked to D187N and Y447H substitutions. Amyloid 2023; 30:357-363. [PMID: 37140928 DOI: 10.1080/13506129.2023.2204999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/11/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Hereditary gelsolin (AGel) amyloidosis is a systemic disease that is characterised by neurologic, ophthalmologic, dermatologic, and other organ involvements. We describe the clinical features with a focus on neurological manifestations in a cohort of patients with AGel amyloidosis referred to the Amyloidosis Centre in the United States. METHODS Fifteen patients with AGel amyloidosis were included in the study between 2005 and 2022 with the permission of the Institutional Review Board. Data were collected from the prospectively maintained clinical database, electronic medical records and telephone interviews. RESULTS Neurologic manifestations were featured in 15 patients: cranial neuropathy in 93%, peripheral and autonomic neuropathy in 57% and bilateral carpal tunnel syndrome in 73% of cases. A novel p.Y474H gelsolin variant featured a unique clinical phenotype that differed from the one associated with the most common variant of AGel amyloidosis. DISCUSSION We report high rates of cranial and peripheral neuropathy, carpal tunnel syndrome and autonomic dysfunction in patients with systemic AGel amyloidosis. The awareness of these features will enable earlier diagnosis and timely screening for end-organ dysfunction. The characterisation of pathophysiology will assist the development of therapeutic options in AGel amyloidosis.
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Affiliation(s)
- Lisa Mendelson
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
- Section of Hematology and Oncology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Tatiana Prokaeva
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - K H Vincent Lau
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
- Neurology Department, Boston Medical Center, Boston, MA, USA
| | - Vaishali Sanchorawala
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
- Section of Hematology and Oncology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Brian Spencer
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
| | - Surendra Dasari
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Ellen D McPhail
- Department of Laboratory of Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Michelle C Kaku
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
- Neurology Department, Boston Medical Center, Boston, MA, USA
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Yamakawa K, Nishijima H, Kubota A, Naruse H, Baba S, Fujimaki Y, Kondo K, Toda T, Yamasoba T. Clinical and electrophysiological findings of facial palsy in a case of hereditary gelsolin amyloidosis. Auris Nasus Larynx 2023; 50:305-308. [PMID: 35241298 DOI: 10.1016/j.anl.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/31/2022] [Accepted: 02/13/2022] [Indexed: 11/26/2022]
Abstract
Hereditary gelsolin amyloidosis (HGA) is an autosomal dominant systemic amyloidosis, characterized by cranial and sensory peripheral neuropathy, corneal lattice dystrophy, and cutis laxa. We report a case of HGA presenting with bilateral facial palsy. A 70-year-old Japanese man presented with slowly progressive bilateral facial palsy and facial twitching, which had started in his 40s. His mother also had the same symptoms due to an unknown cause but rest of the family did not. He showed incomplete facial palsy with no frontal muscle movement and partial movement of the orbicularis oris and orbicularis oculi muscles. The patient showed no synkinesis. Electroneurography revealed symmetric low compound motor action potential amplitude of the orbicularis oris muscle, and a nerve excitability test showed a symmetric increase in the response threshold. Despite the partial voluntary movement of the orbicularis oculi muscle, bilateral blink reflexes were absent. He also showed facial spasms after contraction of the orbicularis oris muscle. Genetic testing revealed a heterozygous c.640G>A mutation (p. Asp214Asn); therefore, the patient was diagnosed with HGA. HGA related facial palsy showed moderate bilateral, upper blanch-dominant axonal degeneration of the facial nerve without reinnervation, and trigeminal nerve neuropathy.
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Affiliation(s)
- Kaoru Yamakawa
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan.
| | | | - Akatsuki Kubota
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | - Hiroya Naruse
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | - Shintaro Baba
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Yoko Fujimaki
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Tatsushi Toda
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
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da Silva Batista JA, Carrera LR, Viriato AR, Novaes MAC, de Morais RJL, Oliveira FT, Marques W, Machado- Costa MC. Involvement of cranial nerves in ATTR Ile127Val amyloidosis. Eur J Med Genet 2022; 65:104524. [DOI: 10.1016/j.ejmg.2022.104524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/26/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
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Danni multipli dei nervi cranici. Neurologia 2022. [DOI: 10.1016/s1634-7072(21)46000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Bollati M, Diomede L, Giorgino T, Natale C, Fagnani E, Boniardi I, Barbiroli A, Alemani R, Beeg M, Gobbi M, Fakin A, Mastrangelo E, Milani M, Presciuttini G, Gabellieri E, Cioni P, de Rosa M. A novel hotspot of gelsolin instability triggers an alternative mechanism of amyloid aggregation. Comput Struct Biotechnol J 2021; 19:6355-6365. [PMID: 34938411 PMCID: PMC8649582 DOI: 10.1016/j.csbj.2021.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 01/02/2023] Open
Abstract
Gelsolin comprises six homologous domains, named G1 to G6. Single point substitutions in this protein are responsible for AGel amyloidosis, a hereditary disease causing progressive corneal lattice dystrophy, cutis laxa, and polyneuropathy. Although several different amyloidogenic variants of gelsolin have been identified, only the most common mutants present in the G2 domain have been thoroughly characterized, leading to clarification of the functional mechanism. The molecular events underlying the pathological aggregation of 3 recently identified mutations, namely A551P, E553K and M517R, all localized at the interface between G4 and G5, are here explored for the first time. Structural studies point to destabilization of the interface between G4 and G5 due to three structural determinants: β-strand breaking, steric hindrance and/or charge repulsion, all implying impairment of interdomain contacts. Such rearrangements decrease the temperature and pressure stability of gelsolin but do not alter its susceptibility to furin cleavage, the first event in the canonical aggregation pathway. These variants also have a greater tendency to aggregate in the unproteolysed forms and exhibit higher proteotoxicity in a C. elegans-based assay. Our data suggest that aggregation of G4G5 variants follows an alternative, likely proteolysis-independent, pathway.
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Affiliation(s)
- Michela Bollati
- Istituto di Biofisica, Consiglio Nazionale delle Ricerche, Milano, Italy
| | - Luisa Diomede
- Department of Molecular Biochemistry and Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Toni Giorgino
- Istituto di Biofisica, Consiglio Nazionale delle Ricerche, Milano, Italy
| | - Carmina Natale
- Department of Molecular Biochemistry and Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Elisa Fagnani
- Istituto di Biofisica, Consiglio Nazionale delle Ricerche, Milano, Italy
| | - Irene Boniardi
- Istituto di Biofisica, Consiglio Nazionale delle Ricerche, Milano, Italy
| | - Alberto Barbiroli
- Dipartimento di Scienze per gli Alimenti, la Nutrizione e l'Ambiente, Università degli Studi di Milano, Milano, Italy
| | - Rebecca Alemani
- Istituto di Biofisica, Consiglio Nazionale delle Ricerche, Milano, Italy
| | - Marten Beeg
- Department of Molecular Biochemistry and Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Marco Gobbi
- Department of Molecular Biochemistry and Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Ana Fakin
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Eloise Mastrangelo
- Istituto di Biofisica, Consiglio Nazionale delle Ricerche, Milano, Italy
| | - Mario Milani
- Istituto di Biofisica, Consiglio Nazionale delle Ricerche, Milano, Italy
| | | | - Edi Gabellieri
- Istituto di Biofisica, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Patrizia Cioni
- Istituto di Biofisica, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Matteo de Rosa
- Istituto di Biofisica, Consiglio Nazionale delle Ricerche, Milano, Italy
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Mustonen T, Sivonen V, Atula S, Kiuru-Enari S, Sinkkonen ST. Hearing problems in patients with hereditary gelsolin amyloidosis. Orphanet J Rare Dis 2021; 16:448. [PMID: 34689817 PMCID: PMC8543933 DOI: 10.1186/s13023-021-02077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Gelsolin amyloidosis (AGel amyloidosis) is a hereditary form of systemic amyloidosis featuring ophthalmological, neurological and cutaneous symptoms. Previous studies based mainly on patients' self-reporting have indicated that hearing impairment might also be related to the disease, considering the progressive cranial neuropathy characteristic for AGel amyloidosis. In order to deepen the knowledge of possible AGel amyloidosis-related hearing problems, a clinical study consisting of the Speech, Spatial and Qualities of Hearing Scale (SSQ) questionnaire, clinical examination, automated pure-tone audiometry and a speech-in-noise test was designed. RESULTS Of the total 46 patients included in the study, eighteen (39%) had self-reported hearing loss. The mean scores in the SSQ were 8.2, 8.3 and 8.6 for the Speech, Spatial and Qualities subscales, respectively. In audiometry, the mean pure tone average (PTA) was 17.1 (SD 12.2) and 17.1 (SD 12.3) dB HL for the right and left ears, respectively, with no difference to gender- and age-matched, otologically normal reference values. The average speech reception threshold in noise (SRT) was - 8.2 (SD 1.5) and - 8.0 (SD 1.7) dB SNR for the right and left ears, respectively, which did not differ from a control group with a comparable range in PTA thresholds. CONCLUSION Although a significant proportion of AGel amyloidosis patients experience subjective difficulties in hearing there seems to be no peripheral or central hearing impairment at least in patients up to the age of 60 years.
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Affiliation(s)
- Tuuli Mustonen
- Clinical Neurosciences, Neurology, Helsinki University Hospital and University of Helsinki, HYKS, Tornisairaala, Neupkl, Haartmaninkatu 4, 00029, Helsinki, Finland.
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Ville Sivonen
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sari Atula
- Clinical Neurosciences, Neurology, Helsinki University Hospital and University of Helsinki, HYKS, Tornisairaala, Neupkl, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Sari Kiuru-Enari
- Clinical Neurosciences, Neurology, Helsinki University Hospital and University of Helsinki, HYKS, Tornisairaala, Neupkl, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Saku T Sinkkonen
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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8
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Cheong EN, Paik W, Choi YC, Lim YM, Kim H, Shim WH, Park HJ. Clinical Features and Brain MRI Findings in Korean Patients with AGel Amyloidosis. Yonsei Med J 2021; 62:431-438. [PMID: 33908214 PMCID: PMC8084699 DOI: 10.3349/ymj.2021.62.5.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE AGel amyloidosis is systemic amyloidosis caused by pathogenic variants in the GSN gene. In this study, we sought to characterize the clinical and brain magnetic resonance image (MRI) features of Korean patients with AGel amyloidosis. MATERIALS AND METHODS We examined 13 patients with AGel amyloidosis from three unrelated families. Brain MRIs were performed in eight patients and eight age- and sex-matched healthy controls. Therein, we analyzed gray and white matter content using voxel-based morphometry (VBM), tract-based spatial statistics (TBSS), and FreeSurfer. RESULTS The median age at examination was 73 (interquartile range: 64-76) years. The median age at onset of cutis laxa was 20 (interquartile range: 15-30) years. All patients over that age of 60 years had dysarthria, cutis laxa, dysphagia, and facial palsy. Two patients in their 30s had only mild cutis laxa. The median age at dysarthria onset was 66 (interquartile range: 63.5-70) years. Ophthalmoparesis was observed in three patients. No patient presented with muscle weakness of the limbs. Axial fluid-attenuated inversion recovery images of the brain showed no significant differences between the patient and control groups. Also, analysis of VBM, TBSS, and FreeSurfer revealed no significant differences in cortical thickness between patients and healthy controls at the corrected significance level. CONCLUSION Our study outlines the clinical manifestations of prominent bulbar palsy and early-onset cutis laxa in 13 Korean patients with AGel amyloidosis and confirms that AGel amyloidosis mainly affects the peripheral nervous system rather than the central nervous system.
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Affiliation(s)
- E Nae Cheong
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Medical Science and Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wooyul Paik
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Young Chul Choi
- Department of Neurology, Rehabilitation Institute of Neuromuscular Disease, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Hyun Shim
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Medical Science and Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Hyung Jun Park
- Department of Neurology, Rehabilitation Institute of Neuromuscular Disease, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
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Pinto MV, Dyck PJB, Liewluck T. Neuromuscular amyloidosis: Unmasking the master of disguise. Muscle Nerve 2021; 64:23-36. [PMID: 33458861 DOI: 10.1002/mus.27150] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022]
Abstract
Amyloidosis refers to an etiologically heterogeneous group of protein misfolding diseases, pathologically characterized by extracellular amyloid fibrils producing congophillic amorphous deposits in organs and tissues, which may lead to severe organ dysfunction and mortality. Clinical presentations vary and are often nonspecific, depending on what organs or tissues are affected. In systemic amyloidosis, the peripheral nervous system is commonly affected, whereas the skeletal muscles are only rarely involved. Immunoglobulin light chain (AL) amyloidosis and hereditary transthyretin (ATTRv) amyloidosis are the most frequent types of systemic amyloidosis involving the neuromuscular system. Localized amyloidosis can occur in skeletal muscle, so-called isolated amyloid myopathy. Amyloid neuropathy typically involves small myelinated and unmyelinated sensory and autonomic nerve fibers early in the course of the disease, followed by large myelinated fiber sensory and motor deficits. The relentlessly progressive nature with motor, painful sensory and severe autonomic dysfunction, profound weight loss, and systemic features are distinct characteristics of amyloid neuropathy. Amyloid myopathy presentation differs between systemic amyloidosis and isolated amyloid myopathy. Long-standing symptoms, distal predominant myopathy, markedly elevated creatine kinase level, and lack of peripheral neuropathy or systemic features are highly suggestive of isolated amyloid myopathy. In ATTR and AL amyloidosis, early treatment correlates with favorable outcomes. Therefore, awareness of these disorders and active screening for amyloidosis in patients with neuropathy or myopathy are crucial in detecting these patients in the everyday practice of neuromuscular medicine. Herein, we review the clinical manifestations of neuromuscular amyloidosis and provide a diagnostic approach to this disorder.
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Affiliation(s)
- Marcus V Pinto
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Federal University of Rio de Janeiro, National Amyloidosis Referral Center (CEPARM), Rio de Janeiro, Brazil
| | - P James B Dyck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Teerin Liewluck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Friedhofer H, Vassiliadis AH, Scarpa MB, Luitgards BF, Gemperli R. Meretoja Syndrome: General Considerations and Contributions of Plastic Surgery in Surgical Treatment. Aesthet Surg J 2017; 38:NP10-NP15. [PMID: 29149274 DOI: 10.1093/asj/sjx172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Henri Friedhofer
- Plastic Surgery Division, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Rolf Gemperli
- Plastic Surgery Division, University of São Paulo Medical School, São Paulo, Brazil
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Caress JB, Johnson JO, Abramzon YA, Hawkins GA, Gibbs JR, Sullivan EA, Chahal CS, Traynor BJ. Exome sequencing establishes a gelsolin mutation as the cause of inherited bulbar-onset neuropathy. Muscle Nerve 2017; 56:1001-1005. [PMID: 28039894 DOI: 10.1002/mus.25550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2016] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Progressive bulbar motor neuropathy is primarily caused by bulbar-onset ALS. Hereditary amyloidosis type IV also presents with a bulbar neuropathy that mimics motor neuron disease. The disease is prevalent in Finland only and is not commonly included in the differential diagnosis of ALS. METHODS We studied 18 members of a family in which some had bulbar motor neuropathy, and we performed exome sequencing. RESULTS Five affected family members were found to have a D187Y substitution in the GSN gene known to cause hereditary amyloidosis type IV. CONCLUSIONS This American family presented with progressive bulbar neuropathy due to a gelsolin mutation not found in Finland. Hereditary amyloidosis type IV presents with bulbar motor neuropathy and not with peripheral neuropathy as occurs with common forms of amyloidosis. This report demonstrates the power of exome sequencing to determine the cause of rare hereditary diseases with incomplete or atypical phenotypes. Muscle Nerve 56: 1001-1005, 2017.
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Affiliation(s)
- James B Caress
- Department of Neurology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, North Carolina, 27157, USA
| | - Janel O Johnson
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Yevgeniya A Abramzon
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom.,Neuromuscular Diseases Research Section Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Gregory A Hawkins
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC
| | - J Raphael Gibbs
- Computational Biology Core, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA.,Department of Molecular Neuroscience, MRC Centre for Neuromuscular Diseases and the Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, Queen Square, London, United Kingdom
| | | | | | - Bryan J Traynor
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
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Sagnelli A, Piscosquito G, Di Bella D, Fadda L, Melzi L, Morico A, Ciano C, Taroni F, Facchetti D, Salsano E, Pareyson D. Hereditary gelsolin amyloidosis (HGA): a neglected cause of bilateral progressive or recurrent facial palsy. J Peripher Nerv Syst 2017; 22:59-63. [DOI: 10.1111/jns.12200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/08/2016] [Accepted: 12/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Sagnelli
- Department of Clinical Neurosciences; IRCCS Foundation, “C. Besta” Neurological Institute; Milan Italy
| | - Giuseppe Piscosquito
- Department of Clinical Neurosciences; IRCCS Foundation, “C. Besta” Neurological Institute; Milan Italy
| | - Daniela Di Bella
- Department of Diagnostic and Applied Technology; IRCCS Foundation, “C. Besta” Neurological Institute; Milan Italy
| | - Laura Fadda
- Department of Neurology; University of Cagliari; Cagliari Italy
| | - Lisa Melzi
- Department of Ophthalmology, Neuro-ophthalmology Unit; Milan Italy
| | - Antonio Morico
- Department of Ophthalmology, Corneal Service; IRCCS Istituto Auxologico Italiano; Milan Italy
| | - Claudia Ciano
- Department of Diagnostic and Applied Technology; IRCCS Foundation, “C. Besta” Neurological Institute; Milan Italy
| | - Franco Taroni
- Department of Diagnostic and Applied Technology; IRCCS Foundation, “C. Besta” Neurological Institute; Milan Italy
| | - Dante Facchetti
- Department of Neurology; ASST Niguarda Hospital; Milan Italy
| | - Ettore Salsano
- Department of Clinical Neurosciences; IRCCS Foundation, “C. Besta” Neurological Institute; Milan Italy
| | - Davide Pareyson
- Department of Clinical Neurosciences; IRCCS Foundation, “C. Besta” Neurological Institute; Milan Italy
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Pihlamaa T, Suominen S, Kiuru-Enari S, Tanskanen M. Increasing amount of amyloid are associated with the severity of clinical features in hereditary gelsolin (AGel) amyloidosis. Amyloid 2016; 23:225-233. [PMID: 27879149 DOI: 10.1080/13506129.2016.1238355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with hereditary gelsolin (AGel) amyloidosis (HGA) present with hanging skin (cutis laxa) and bilateral cranial neuropathy, and require symptomatic plastic surgery. Our clinical observation of tissue fragility prompted us to design a prospective study. METHODS Twenty-nine patients with HGA undergoing surgery were interviewed and clinically examined. The height and thickness of skin folds in standard anatomical localizations were measured. The presence and distribution of amyloid in skin samples were analyzed using Congo red staining and immunohistochemistry using antibodies against gelsolin amyloid (AGel) subunit. RESULTS The measured skin folds stretched more in patients with HGA (e.g. skin over olecranon, p < 0.001). The skin folds were thinner in patients with HGA (e.g. forehead skin, p < 0.001). The skin and subcutaneous fat were abnormally fragile during surgery. The total amount of AGel amyloid, and its presence in the deep layers of the skin and subcutaneous fat correlated with the measurements of skin folds, age and extent of cranial neuropathy. CONCLUSIONS The AGel amyloid in the skin and subcutis, together with morphologic changes in the dermal stroma and skin adnexa contribute to the atrophied and fragile structure of HGA skin. This is the first study to demonstrate the correlation between AGel amyloid accumulation and clinical disease severity.
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Affiliation(s)
- Tiia Pihlamaa
- a Department of Plastic and Reconstructive Surgery , Helsinki University Hospital , Helsinki , Finland
| | - Sinikka Suominen
- a Department of Plastic and Reconstructive Surgery , Helsinki University Hospital , Helsinki , Finland
| | - Sari Kiuru-Enari
- b Department of Neurology , Clinical Neurosciences, University of Helsinki , Helsinki , Finland , and
| | - Maarit Tanskanen
- c Department of Pathology , University of Helsinki and HUSLAB , Helsinki , Finland
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Koskelainen S, Pihlamaa T, Suominen S, Zhao F, Salo T, Risteli J, Baumann M, Kalimo H, Kiuru-Enari S. Gelsolin amyloid angiopathy causes severe disruption of the arterial wall. APMIS 2016; 124:639-48. [PMID: 27198069 DOI: 10.1111/apm.12554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/18/2016] [Indexed: 11/26/2022]
Abstract
Hereditary gelsolin amyloidosis (HGA) is a dominantly inherited systemic disease reported worldwide. HGA is characterized by ophthalmological, neurological, and dermatological manifestations. AGel amyloid accumulates at basal lamina of epithelial and muscle cells, thus amyloid angiopathy is encountered in nearly every organ. HGA patients have cardiovascular, hemorrhagic, and potentially vascularly induced neurological problems. To clarify pathomechanisms of AGel angiopathy, we performed histological, immunohistochemical, and electron microscopic analyses on facial temporal artery branches from 8 HGA patients and 13 control subjects. We demonstrate major pathological changes in arteries: disruption of the tunica media, disorganization of vascular smooth muscle cells, and accumulation of AGel fibrils in arterial walls, where they associate with the lamina elastica interna, which becomes fragmented and diminished. We also provide evidence of abnormal accumulation and localization of collagen types I and III and an increase of collagen type I degradation product in the tunica media. Vascular smooth muscle cells appear to be morphologically and semi-quantitatively normal, only their basal lamina is often thickened. In conclusion, angiopathy in HGA results in severe disruption of arterial walls, characterized by prominent AGel deposition, collagen derangement and severe elastolysis, and it may be responsible for several, particularly hemorrhagic, disease manifestations in HGA.
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Affiliation(s)
- Susanna Koskelainen
- Meilahti Clinical Proteomics Core Facility, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tiia Pihlamaa
- Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Sinikka Suominen
- Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Fang Zhao
- Advanced Microscopy Unit, Medicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuula Salo
- Research Group of Cancer and Translational Medicine, Medical Faculty, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Juha Risteli
- Research Group of Cancer and Translational Medicine, Medical Faculty, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Marc Baumann
- Meilahti Clinical Proteomics Core Facility, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hannu Kalimo
- Department of Pathology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Forensic Medicine, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Sari Kiuru-Enari
- Clinical Neurosciences, Neurology, University of Helsinki, Helsinki, Finland
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