1
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Berends M, Brunger AF, Bijzet J, Kroesen BJ, Drost G, Lange F, Teunissen CE, In 't Veld S, Vrancken AF, Gans ROB, Hazenberg BPC, van der Zwaag PA, Nienhuis HLA. Longitudinal analysis of serum neurofilament light chain levels as marker for neuronal damage in hereditary transthyretin amyloidosis. Amyloid 2024; 31:132-141. [PMID: 38477065 DOI: 10.1080/13506129.2024.2327342] [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: 11/14/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To evaluate serum neurofilament light chain (sNfL) as biomarker of disease onset, progression and treatment effect in hereditary transthyretin (ATTRv) amyloidosis patients and TTR variant (TTRv) carriers. METHODS sNfL levels were assessed longitudinally in persistently asymptomatic TTRv carriers (N = 12), persistently asymptomatic ATTRv amyloidosis patients (defined as asymptomatic patients but with amyloid detectable in subcutaneous abdominal fat tissue) (N = 8), in TTRv carriers who developed polyneuropathy (N = 7) and in ATTRv amyloidosis patients with polyneuropathy on treatment (TTR-stabiliser (N = 20) or TTR-silencer (N = 18)). Polyneuropathy was confirmed by nerve conduction studies or quantitative sensory testing. sNfL was analysed using a single-molecule array assay. RESULTS sNfL increased over 2 years in persistently asymptomatic ATTRv amyloidosis patients, but did not change in persistently asymptomatic TTRv carriers. In all TTRv carriers who developed polyneuropathy, sNfL increased from 8.4 to 49.8 pg/mL before the onset of symptoms and before polyneuropathy could be confirmed neurophysiologically. In symptomatic ATTRv amyloidosis patients on a TTR-stabiliser, sNfL remained stable over 2 years. In patients on a TTR-silencer, sNfL decreased after 1 year of treatment. CONCLUSION sNfL is a biomarker of early neuronal damage in ATTRv amyloidosis already before the onset of polyneuropathy. Current data support the use of sNfL in screening asymptomatic TTRv carriers and in monitoring of disease progression and treatment effect.
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Affiliation(s)
- Milou Berends
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
| | - Anne F Brunger
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rheumatology & Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Johan Bijzet
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart-Jan Kroesen
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea Drost
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Fiete Lange
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Charlotte E Teunissen
- Department of Laboratory Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sjors In 't Veld
- Department of Laboratory Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Reinold O B Gans
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
| | - Bouke P C Hazenberg
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rheumatology & Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul A van der Zwaag
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
- Department of Medical Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Hans L A Nienhuis
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
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2
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Carroll AS, Razvi Y, O'Donnell L, Veleva E, Heslegrave A, Zetterberg H, Vucic S, Kiernan MC, Rossor AM, Gillmore JD, Reilly MM. Serum neurofilament light chain in hereditary transthyretin amyloidosis: validation in real-life practice. Amyloid 2024; 31:95-104. [PMID: 38348665 DOI: 10.1080/13506129.2024.2313218] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/27/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND Neurofilament light chain (NfL) has emerged as a sensitive biomarker in hereditary transthyretin amyloid polyneuropathy (ATTRv-PN). We hypothesise that NfL can identify conversion of gene carriers to symptomatic disease, and guide treatment approaches. METHODS Serum NfL concentration was measured longitudinally (2015-2022) in 59 presymptomatic and symptomatic ATTR variant carriers. Correlations between NfL and demographics, biochemistry and staging scores were performed as well as longitudinal changes pre- and post-treatment, and in asymptomatic and symptomatic cohorts. Receiver-operating analyses were performed to determine cut-off values. RESULTS NfL levels correlated with examination scores (CMTNS, NIS and MRC; all p < .01) and increased with disease severity (PND and FAP; all p < .05). NfL was higher in symptomatic and sensorimotor converters, than asymptomatic or sensory converters irrespective of time (all p < .001). Symptomatic or sensorimotor converters were discriminated from asymptomatic patients by NfL concentrations >64.5 pg/ml (sensitivity= 91.9%, specificity = 88.5%), whereas asymptomatic patients could only be discriminated from sensory or sensorimotor converters or symptomatic individuals by a NfL concentration >88.9 pg/ml (sensitivity = 62.9%, specificity = 96.2%) However, an NfL increment of 17% over 6 months could discriminate asymptomatic from sensory or sensorimotor converters (sensitivity = 88.9%, specificity = 80.0%). NfL reduced with treatment by 36%/year and correlated with TTR suppression (r = 0.64, p = .008). CONCLUSIONS This data validates the use of serum NfL to identify conversion to symptomatic disease in ATTRv-PN. NfL levels can guide assessment of disease progression and response to therapies.
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Affiliation(s)
- Antonia S Carroll
- Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
- Centre for Neuromuscular disease, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Yousuf Razvi
- National Amyloidosis Centre, UCL Division of Medicine, Royal Free Hospital, London, UK
| | - Luke O'Donnell
- Centre for Neuromuscular disease, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Elena Veleva
- UK Dementia Research Institute at UCL, London, UK
| | - Amanda Heslegrave
- UK Dementia Research Institute at UCL, London, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Henrik Zetterberg
- UK Dementia Research Institute at UCL, London, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- WI Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Steve Vucic
- Brain and Nerve Research Centre, Concord Hospital, University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Alexander M Rossor
- Centre for Neuromuscular disease, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, UCL Division of Medicine, Royal Free Hospital, London, UK
| | - Mary M Reilly
- Centre for Neuromuscular disease, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
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3
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Baka P, Steenken L, Escolano‐Lozano F, Steffen F, Papagianni A, Sommer C, Pogatzki‐Zahn E, Hirsch S, Protopapa M, Bittner S, Birklein F. Studying serum neurofilament light chain levels as a potential new biomarker for small fiber neuropathy. Eur J Neurol 2024; 31:e16192. [PMID: 38189534 PMCID: PMC11235889 DOI: 10.1111/ene.16192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND PURPOSE Diagnosing small fiber neuropathies can be challenging. To address this issue, whether serum neurofilament light chain (sNfL) could serve as a potential biomarker of damage to epidermal Aδ- and C-fibers was tested. METHODS Serum NfL levels were assessed in 30 patients diagnosed with small fiber neuropathy and were compared to a control group of 19 healthy individuals. Electrophysiological studies, quantitative sensory testing and quantification of intraepidermal nerve fiber density after skin biopsy were performed in both the proximal and distal leg. RESULTS Serum NfL levels were not increased in patients with small fiber neuropathy compared to healthy controls (9.1 ± 3.9 and 9.4 ± 3.8, p = 0.83) and did not correlate with intraepidermal nerve fiber density at the lateral calf or lateral thigh or with other parameters of small fiber impairment. CONCLUSION Serum NfL levels cannot serve as a biomarker for small fiber damage.
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Affiliation(s)
- Panoraia Baka
- Department of NeurologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Livia Steenken
- Department of NeurologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Fabiola Escolano‐Lozano
- Department of NeurologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Falk Steffen
- Department of NeurologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | | | - Claudia Sommer
- Department of NeurologyUniversity Hospital of WürzburgWürzburgGermany
| | - Esther Pogatzki‐Zahn
- Department of Anaesthesiology, Intensive Care and Pain MedicineUniversity Hospital MünsterMünsterGermany
| | - Silke Hirsch
- Department of NeurologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Maria Protopapa
- Department of NeurologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Stefan Bittner
- Department of NeurologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Frank Birklein
- Department of NeurologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
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4
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Romano A, Guglielmino V, Bisogni G, Di Paolantonio A, Truini A, Minnella AM, Sciarrone MA, Vitali F, Maceroni M, Galosi E, Sabatelli M, Luigetti M. Early detection of nerve involvement in presymptomatic TTR mutation carriers: exploring potential markers of disease onset. Neurol Sci 2024; 45:1675-1684. [PMID: 37938457 PMCID: PMC10942905 DOI: 10.1007/s10072-023-07177-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Hereditary transthyretin (ATTRv) amyloidosis is a heterogeneous, progressive, multisystemic disease with a life-threatening course if left untreated. Given the current availability of effective therapies, close follow-up of presymptomatic TTR mutation carriers is essential to recognize disease onset at the earliest sign. In addition to routine techniques, in recent years several novel tools have been proposed, although a consensus on their use has not been reached yet. In this paper, we aimed to evaluate possible markers of neuropathic disease onset intended to discriminate clinically asymptomatic carriers from early symptomatic patients, thus allowing timely treatment initiation. METHODS Thirty-eight presymptomatic carriers were enrolled. Clinical and electrophysiological findings at first evaluation and follow-up were collected. All carriers underwent an extensive clinical and instrumental evaluation according to the standard clinical practice. One or more non-routine investigations, whose use in this field is not yet validated (henceforth "unconventional"), were additionally assessed in a subgroup of individuals. RESULTS Based on the exclusive use of routine investigations, it was possible to define disease onset in 4/38 carriers during the follow-up. Employing additionally one or more "unconventional" tests, abnormal findings, indicative of a possible "conversion" to symptomatic disease, were detected in further 12 cases. More than half of our study cohort showed findings suggestive of small nerve fiber (SF) involvement at either invasive or non-invasive tests. CONCLUSIONS A close, multidisciplinary monitoring of presymptomatic TTR mutation carriers is fundamental, and diagnostic workup should include both routine and "unconventional" tests. Assessment of SF involvement is important also in non-endemic countries.
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Affiliation(s)
- Angela Romano
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Valeria Guglielmino
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Bisogni
- Centro Clinico NeMO Adulti, Fondazione Serena Onlus-Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Angelo Maria Minnella
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Oftalmologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Francesca Vitali
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Maceroni
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Oftalmologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Eleonora Galosi
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Mario Sabatelli
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico NeMO Adulti, Fondazione Serena Onlus-Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Luigetti
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy.
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5
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Berends M, Nienhuis HLA, Adams D, Karam C, Luigetti M, Polydefkis M, Reilly MM, Sekijima Y, Hazenberg BPC. Neurofilament Light Chains in Systemic Amyloidosis: A Systematic Review. Int J Mol Sci 2024; 25:3770. [PMID: 38612579 PMCID: PMC11011627 DOI: 10.3390/ijms25073770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/08/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Peripheral and autonomic neuropathy are common disease manifestations in systemic amyloidosis. The neurofilament light chain (NfL), a neuron-specific biomarker, is released into the blood and cerebrospinal fluid after neuronal damage. There is a need for an early and sensitive blood biomarker for polyneuropathy, and this systematic review provides an overview on the value of NfL in the early detection of neuropathy, central nervous system involvement, the monitoring of neuropathy progression, and treatment effects in systemic amyloidosis. A literature search in PubMed, Embase, and Web of Science was performed on 14 February 2024 for studies investigating NfL levels in patients with systemic amyloidosis and transthyretin gene-variant (TTRv) carriers. Only studies containing original data were included. Included were thirteen full-text articles and five abstracts describing 1604 participants: 298 controls and 1306 TTRv carriers or patients with or without polyneuropathy. Patients with polyneuropathy demonstrated higher NfL levels compared to healthy controls and asymptomatic carriers. Disease onset was marked by rising NfL levels. Following the initiation of transthyretin gene-silencer treatment, NfL levels decreased and remained stable over an extended period. NfL is not an outcome biomarker, but an early and sensitive disease-process biomarker for neuropathy in systemic amyloidosis. Therefore, NfL has the potential to be used for the early detection of neuropathy, monitoring treatment effects, and monitoring disease progression in patients with systemic amyloidosis.
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Affiliation(s)
- Milou Berends
- Department of Internal Medicine, Amyloidosis Center of Expertise, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (M.B.); (H.L.A.N.)
| | - Hans L. A. Nienhuis
- Department of Internal Medicine, Amyloidosis Center of Expertise, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (M.B.); (H.L.A.N.)
| | - David Adams
- Service de Neurologie, CHU Bicêtre, Assistance Publique—Hôpitaux de Paris, University Paris-Saclay, CERAMIC, Le Kremlin-Bicêtre, 94270 Paris, France;
| | - Chafic Karam
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Marco Luigetti
- UOC Neurologia, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Michael Polydefkis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Mary M. Reilly
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK;
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto 390-8621, Japan;
| | - Bouke P. C. Hazenberg
- Department of Rheumatology & Clinical Immunology, Amyloidosis Center of Expertise, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
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6
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Karam C, Mauermann ML, Gonzalez-Duarte A, Kaku MC, Ajroud-Driss S, Brannagan TH, Polydefkis M. Diagnosis and treatment of hereditary transthyretin amyloidosis with polyneuropathy in the United States: Recommendations from a panel of experts. Muscle Nerve 2024; 69:273-287. [PMID: 38174864 DOI: 10.1002/mus.28026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024]
Abstract
Hereditary transthyretin (ATTRv; v for variant) amyloidosis is a rare, multisystem, progressive, and fatal disease in which polyneuropathy is a cardinal manifestation. Due to a lack of United States (US)-specific guidance on ATTRv amyloidosis with polyneuropathy, a panel of US-based expert clinicians convened to address identification, monitoring, and treatment of this disease. ATTRv amyloidosis with polyneuropathy should be suspected in unexplained progressive neuropathy, especially if associated with systemic symptoms or family history. The diagnosis is confirmed through genetic testing, biopsy, or cardiac technetium-based scintigraphy. Treatment should be initiated as soon as possible after diagnosis, with gene-silencing therapeutics recommended as a first-line option. Consensus is lacking on what represents "disease progression" during treatment; however, the aggressive natural history of this disease should be considered when evaluating the effectiveness of any therapy.
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Affiliation(s)
- Chafic Karam
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Alejandra Gonzalez-Duarte
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
| | - Michelle C Kaku
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Senda Ajroud-Driss
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Thomas H Brannagan
- Department of Neurology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Michael Polydefkis
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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7
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Ticau S, Aldinc E, Polydefkis M, Adams D, Coelho T, Ueda M, Hale C, Vest J, Nioi P. Treatment response and neurofilament light chain levels with long-term patisiran in hereditary transthyretin-mediated amyloidosis with polyneuropathy: 24-month results of an open-label extension study. Amyloid 2024; 31:1-11. [PMID: 37469249 DOI: 10.1080/13506129.2023.2232520] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Longitudinal changes in neurofilament light chain (NfL) levels were evaluated alongside prespecified clinical assessments 24 months into the patisiran Global open-label extension (OLE) study in patients with ATTRv amyloidosis with polyneuropathy. METHODS All patients enrolled in the Global OLE, from phase III APOLLO and phase II OLE parent studies, received patisiran. Assessments included measures of polyneuropathy (modified Neuropathy Impairment Score+7 (mNIS+7)), quality of life (QOL; Norfolk QOL-Diabetic Neuropathy questionnaire (Norfolk QOL-DN)), and plasma NfL. RESULTS Patients receiving patisiran in the parent study (APOLLO-patisiran, n = 137; phase II OLE-patisiran, n = 25) demonstrated sustained improvements in mNIS+7 (mean change from parent study baseline (95% confidence interval): APOLLO-patisiran -4.8 (-8.9, -0.6); phase II OLE-patisiran -5.8 (-10.5, -1.2)) and Norfolk QOL-DN (APOLLO-patisiran -2.4 (-7.2, 2.3)), and maintained reduced NfL levels at Global OLE 24 months. After initiating patisiran in the Global OLE, APOLLO-placebo patients (n = 49) demonstrated stabilized mNIS+7, improved Norfolk QOL-DN, and significantly reduced NfL levels. Patisiran continued to demonstrate an acceptable safety profile. Earlier patisiran initiation was associated with a lower exposure-adjusted mortality rate. CONCLUSIONS Long-term patisiran treatment led to sustained improvements in neuropathy and QOL, with NfL demonstrating potential as a biomarker for disease progression and treatment response in ATTRv amyloidosis with polyneuropathy.
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Affiliation(s)
| | | | - Michael Polydefkis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Adams
- Neurology Department, AP-HP, CHU Bicêtre, Université Paris-Saclay, Paris-Saclay, France
| | - Teresa Coelho
- Centro Hospitalar Universitário Santo António, European Reference Network - EUroNMD, Porto, Portugal
| | - Mitsuharu Ueda
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - John Vest
- Alnylam Pharmaceuticals, Cambridge, MA, USA
| | - Paul Nioi
- Alnylam Pharmaceuticals, Cambridge, MA, USA
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8
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González-Moreno J, Gragera-Martínez Á, Rodríguez A, Borrachero-Garro C, García-Garrido S, Barceló C, Manovel-Sánchez A, Ribot-Sansó MA, Ibargüen-González L, Gomila R, Muñoz-Beamud F, Losada-López I, Cisneros-Barroso E. Biomarkers of axonal damage to favor early diagnosis in variant transthyretin amyloidosis (A-ATTRv). Sci Rep 2024; 14:581. [PMID: 38182630 PMCID: PMC10770310 DOI: 10.1038/s41598-023-50212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/16/2023] [Indexed: 01/07/2024] Open
Abstract
Early identification of ATTRv amyloidosis disease onset is still often delayed due to the lack of validated biomarkers of this disease. Light chain neurofilament (NfL) have shown promising results in early diagnosis in this disease, but data is still needed, including with alternative measuring methods. Our aim was to study the levels of NfL measured by ELISA. Furthermore, interstitial matrix metalloproteinase type 1 (MMP-1) serum levels were measured as a potential new biomarker in ATTRv. Serum NfL and MMP-1 were measured using ELISA assays in 90 participants (29 ATTR-V30M patients, 31 asymptomatic V30M-TTR variant carriers and 30 healthy controls). Median NfL levels among ATTRv amyloidosis patients were significantly higher (116 pg/mL vs 0 pg/mL in both comparison groups). The AUC comparing ATTRv amyloidosis patients and asymptomatic carriers was 0.90 and the NfL concentration of 93.55 pg/mL yielded a sensitivity of 79% and a specificity of 87%. NfL levels had a significant positive correlation with NIS values among patients. We found a negative significant correlation between eGFR and NfL levels. Finally, MMP1 levels were not different between groups. Evidence of NfL use for early diagnosis of ATTR-PN amyloidosis is growing. ELISA seems a reliable and available technique for it quantification. Decreased GFR could influence NfL plasma levels.
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Affiliation(s)
- Juan González-Moreno
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, Spain
- Internal Medicine Department, Hospital Universitario Son Llàtzer, Crta Manacor Km 4, 07198, Palma, Balearic Islands, Spain
| | - Álvaro Gragera-Martínez
- Clinical Analysis Department, Genetic Unit, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
- Cardiology Department, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Adrián Rodríguez
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, Spain
| | - Cristina Borrachero-Garro
- Internal Medicine Department, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
- Cardiology Department, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | | | - Carles Barceló
- Translational Pancreatic Cancer Oncogenesis Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Ana Manovel-Sánchez
- Cardiology Department, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
- Multidisciplinary ATTR Unit, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Maria Antonia Ribot-Sansó
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, Spain
- Internal Medicine Department, Hospital Universitario Son Llàtzer, Crta Manacor Km 4, 07198, Palma, Balearic Islands, Spain
| | - Lesly Ibargüen-González
- Translational Pancreatic Cancer Oncogenesis Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Rosa Gomila
- Department of Chemistry, Universitat de les Illes Balears, Crta de Valldemossa Km 7.5, 07122, Palma de Mallorca, Baleares, Spain
| | - Francisco Muñoz-Beamud
- Internal Medicine Department, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
- Cardiology Department, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Inés Losada-López
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, Spain
- Internal Medicine Department, Hospital Universitario Son Llàtzer, Crta Manacor Km 4, 07198, Palma, Balearic Islands, Spain
| | - Eugenia Cisneros-Barroso
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, Spain.
- Servicio de Medicina Interna, Hospital Universitario Son Llàtzer, Crta Manacor Km 4, 07198, Palma, Spain.
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9
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Romano A, Primiano G, Antonini G, Ceccanti M, Fenu S, Forcina F, Gentile L, Inghilleri M, Leonardi L, Manganelli F, Obici L, Sabino A, Sciarrone MA, Tozza S, Vitali F, Luigetti M. Serum neurofilament light chain: a promising early diagnostic biomarker for hereditary transthyretin amyloidosis? Eur J Neurol 2024; 31:e16070. [PMID: 37724995 PMCID: PMC11235699 DOI: 10.1111/ene.16070] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/26/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND AND PURPOSE Hereditary transthyretin amyloidosis (ATTRv) is a life-threatening disease caused by mutations in the gene encoding transthyretin (TTR). The recent therapeutic advances have underlined the importance of easily accessible, objective biomarkers of both disease onset and progression. Preliminary evidence suggests a potential role in this respect for neurofilament light chain (NfL). In this study, the aim was to determine serum NfL (sNfL) levels in a late-onset ATTRv population and evaluate whether it might represent a reliable biomarker of disease onset (i.e., 'conversion' from the asymptomatic status to symptomatic disease in TTR mutation carriers). METHODS In all, 111 individuals harbouring a pathogenic TTR variant (61 symptomatic ATTRv patients and 50 presymptomatic carriers) were consecutively enrolled. Fifty healthy volunteers were included as the control group. Ella™ apparatus was used to assess sNfL levels. RESULTS Serum NfL levels were increased in ATTRv patients compared to both presymptomatic carriers and healthy controls, whilst not differing between carriers and healthy controls. An sNfL cut-off of 37.10 pg/mL could discriminate between asymptomatic and symptomatic individuals with high diagnostic accuracy (area under the curve 0.958; p < 0.001), sensitivity (81.4%) and specificity (100%). CONCLUSIONS Serum NfL seems to be a promising biomarker of peripheral nerve involvement in ATTRv amyloidosis and might become a reliable, objective measure to detect the transition from the presymptomatic stage to the onset of symptomatic disease. Further longitudinal studies are needed to confirm such a role and determine whether it could equally represent a biomarker of disease progression and response to therapy.
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Affiliation(s)
- Angela Romano
- Dipartimento di NeuroscienzeOrgani di Senso e ToraceFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Guido Primiano
- Dipartimento di NeuroscienzeOrgani di Senso e ToraceFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
- Dipartimento di NeuroscienzeUniversità Cattolica del Sacro CuoreRomeItaly
| | - Giovanni Antonini
- Dipartimento di NeuroscienzeSalute Mentale e Organi di Senso (NESMOS)Sapienza Università di RomaRomeItaly
| | - Marco Ceccanti
- Dipartimento di Neuroscienze UmaneSapienza Università di RomaRomeItaly
| | - Silvia Fenu
- S.C. Malattie Neurologiche RareDipartimento di Neuroscienze ClinicheFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Francesca Forcina
- Dipartimento di NeuroscienzeSalute Mentale e Organi di Senso (NESMOS)Sapienza Università di RomaRomeItaly
| | - Luca Gentile
- U.O.C. Neurologia e Malattie NeuromuscolariDipartimento di Medicina Clinica e SperimentaleUniversità degli Studi di MessinaMessinaItaly
| | | | - Luca Leonardi
- Dipartimento di NeuroscienzeSalute Mentale e Organi di Senso (NESMOS)Sapienza Università di RomaRomeItaly
| | - Fiore Manganelli
- Department of NeuroscienceReproductive and Odontostomatological ScienceUniversity of Naples ‘Federico II’NaplesItaly
| | - Laura Obici
- Centro per lo Studio e la Cura delle Amiloidosi SistemicheFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Andrea Sabino
- Dipartimento di NeuroscienzeUniversità Cattolica del Sacro CuoreRomeItaly
| | | | - Stefano Tozza
- Department of NeuroscienceReproductive and Odontostomatological ScienceUniversity of Naples ‘Federico II’NaplesItaly
| | - Francesca Vitali
- Dipartimento di NeuroscienzeUniversità Cattolica del Sacro CuoreRomeItaly
| | - Marco Luigetti
- Dipartimento di NeuroscienzeOrgani di Senso e ToraceFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
- Dipartimento di NeuroscienzeUniversità Cattolica del Sacro CuoreRomeItaly
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10
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Lefaucheur JP. The value of electrochemical skin conductance measurement by Sudoscan® for assessing autonomic dysfunction in peripheral neuropathies beyond diabetes. Neurophysiol Clin 2023; 53:102859. [PMID: 36966705 DOI: 10.1016/j.neucli.2023.102859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/28/2023] Open
Abstract
The diagnosis and follow-up of peripheral neuropathies involving small-diameter nerve fibers require specific examinations beyond conventional nerve conduction studies which only concern large-diameter nerve fibers. Among these tests, some are dedicated to the investigation of cutaneous innervation by the autonomic nervous system, mainly by unmyelinated sympathetic C fibers. To this end, various laboratory tests have been proposed, but the measurement of electrochemical skin conductance (ESC) by Sudoscan® is increasingly becoming the most widely used technique, because it allows a quick and simple assessment of the sudomotor function of the limb extremities. This technique is based on the principles of reverse iontophoresis and chronoamperometry and since its introduction in 2010, has been the source of nearly 200 publications. In the clinical field, most of these publications concern the evaluation of diabetic polyneuropathy, for which the value of Sudoscan® no longer needs to be demonstrated. However, there is also evidence for a role for Sudoscan® in the testing of the autonomic nervous system in various peripheral neuropathies of other origins or diseases primarily affecting the central nervous system. In this article, a comprehensive review of the literature on the clinical value of Sudoscan® outside of diabetes is presented, detailing ESC changes in neuropathies associated with various clinical conditions, such as hereditary amyloidosis or other genetic pathologies, chemotherapy neurotoxicity, dysimmune or infectious disorders, fibromyalgia, parkinsonism or other neurodegenerative diseases.
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11
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Di Stefano V, Thomas E, Alonge P, Giustino V, Pillitteri G, Leale I, Torrente A, Pignolo A, Norata D, Iacono S, Lupica A, Palma A, Battaglia G, Brighina F. Patisiran Enhances Muscle Mass after Nine Months of Treatment in ATTRv Amyloidosis: A Study with Bioelectrical Impedance Analysis and Handgrip Strength. Biomedicines 2022; 11:biomedicines11010062. [PMID: 36672570 PMCID: PMC9855676 DOI: 10.3390/biomedicines11010062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/30/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND AIMS Hereditary transthyretin amyloidosis with polyneuropathy (ATTRv) is caused by mutations in the TTR gene, leading to misfolded monomers that aggregate generating amyloid fibrils. The clinical phenotype is heterogeneous, characterized by a multisystemic disease affecting the sensorimotor, autonomic functions along with other organs. Patisiran is a small interfering RNA acting as a TTR silencer approved for the treatment of ATTRv. Punctual and detailed instrumental biomarkers are on demand for ATTRv to measure the severity of the disease and monitor progression and response to treatment. METHODS Fifteen patients affected by ATTRv amyloidosis (66.4 ± 7.8 years, six males) were evaluated before the start of therapy with patisiran and after 9-months of follow-up. The clinical and instrumental evaluation included body weight and height; Coutinho stage; Neuropathy Impairment Score (NIS); Karnofsky performance status (KPS); Norfolk QOL Questionnaire; Six-minute walking test (6 MWT); nerve conduction studies; handgrip strength (HGS); and bioimpedance analysis (BIA). RESULTS Body composition significantly changed following the 9-months pharmacological treatment. In particular, the patients exhibited an increase in fat free mass, body cell mass, and body weight with a decrease in fat mass. A significant increase after 9 months of treatment was observed for the 6 MWT. Coutinho stage, KPS, NIS, NIS-W, nerve conduction studies, Norfolk, COMPASS-31 scale, and HGS remained unchanged. CONCLUSIONS BIA might represent a useful tool to assess the effects of multiorgan damage in ATTRv and to monitor disease progression and response to treatments. More evidence is still needed for HGS. Patisiran stabilizes polyneuropathy and preserves motor strength by increasing muscle mass after 9 months of treatment.
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Affiliation(s)
- Vincenzo Di Stefano
- Neurology Unit, Department of Biomedicine, Neuroscience, and Advanced Diagnostics (BiND), University of Palermo, 90129 Palermo, Italy
- Correspondence: ; Tel.: +39-09-1655-4780
| | - Ewan Thomas
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90127 Palermo, Italy
| | - Paolo Alonge
- Neurology Unit, Department of Biomedicine, Neuroscience, and Advanced Diagnostics (BiND), University of Palermo, 90129 Palermo, Italy
| | - Valerio Giustino
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90127 Palermo, Italy
| | - Guglielmo Pillitteri
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90127 Palermo, Italy
| | - Ignazio Leale
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90127 Palermo, Italy
| | - Angelo Torrente
- Neurology Unit, Department of Biomedicine, Neuroscience, and Advanced Diagnostics (BiND), University of Palermo, 90129 Palermo, Italy
| | - Antonia Pignolo
- Neurology Unit, Department of Biomedicine, Neuroscience, and Advanced Diagnostics (BiND), University of Palermo, 90129 Palermo, Italy
| | - Davide Norata
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, 60121 Ancona, Italy
| | - Salvatore Iacono
- Neurology Unit, Department of Biomedicine, Neuroscience, and Advanced Diagnostics (BiND), University of Palermo, 90129 Palermo, Italy
| | - Antonino Lupica
- Neurology Unit, Department of Biomedicine, Neuroscience, and Advanced Diagnostics (BiND), University of Palermo, 90129 Palermo, Italy
| | - Antonio Palma
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90127 Palermo, Italy
| | - Giuseppe Battaglia
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90127 Palermo, Italy
| | - Filippo Brighina
- Neurology Unit, Department of Biomedicine, Neuroscience, and Advanced Diagnostics (BiND), University of Palermo, 90129 Palermo, Italy
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12
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Luigetti M, Guglielmino V, Romano A, Sciarrone MA, Vitali F, Sabino A, Gervasoni J, Primiano A, Santucci L, Moroni R, Primiano G. A Metabolic Signature of Hereditary Transthyretin Amyloidosis: A Pilot Study. Int J Mol Sci 2022; 23:ijms232416133. [PMID: 36555770 PMCID: PMC9783933 DOI: 10.3390/ijms232416133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Hereditary transthyretin amyloidosis is the most common form of hereditary amyloidosis, with an autosomal dominant inheritance and a variable penetrance. ATTRv amyloidosis can present as a progressive, axonal sensory autonomic and motor neuropathy or as an infiltrative cardiomyopathy. The definition of biomarkers for the early diagnosis of ATTRv is particularly important in the current era of emerging treatments. In this sense, metabolomics could be an instrument able to provide metabolic profiles with their related metabolic pathways, and we would propose them as possible fluid biomarkers. The aim of this study is to identify altered metabolites (free fatty acids and amino acids) in subjects with a confirmed pathogenic TTR variant. Out of the studied total free fatty acids and amino acids, the serum values of palmitic acid are significantly lower in the ATTRv patients compared to the recruited healthy subjects. The metabolic remodeling identified in this neurogenetic disorder could be the manifestation of pathophysiological processes of the disease, such as mitochondrial dysfunction and neuroinflammation, and contribute to explaining some of its clinical manifestations.
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Affiliation(s)
- Marco Luigetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-3015-4435
| | | | - Angela Romano
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | | | | | - Andrea Sabino
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Jacopo Gervasoni
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Aniello Primiano
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Lavinia Santucci
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Rossana Moroni
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Guido Primiano
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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13
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Cutaneous silent period in ATTRv carriers: a possible early marker of nerve damage? Neurol Sci 2022; 43:6979-6982. [PMID: 35943637 DOI: 10.1007/s10072-022-06317-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/02/2022] [Indexed: 02/03/2023]
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14
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Romano A, Guglielmino V, Di Paolantonio A, Bisogni G, Sabatelli M, Della Marca G, Minnella AM, Maceroni M, Bellavia S, Scala I, Sabatelli E, Rollo E, Luigetti M. Pupillometric findings in ATTRv patients and carriers: results from a single-centre experience. Amyloid 2022; 29:270-275. [PMID: 36066019 DOI: 10.1080/13506129.2022.2117601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Hereditary transthyretin amyloidosis (ATTRv) is a treatable multisystemic disease with great phenotypic heterogeneity. Among extra-neurological features, pupillary abnormalities have been reported, either related to amyloid deposition in the eye or to a progressive autonomic neuropathy. OBJECTIVE To evaluate the role of automated pupillometry, a non-invasive and rapid test able to provide objective and reproducible data on pupil size and reactivity, as a marker of disease severity in late-onset ATTRv patients. PATIENTS AND METHODS We performed automated pupillometry on a cohort of ATTRv patients and pre-symptomatic TTR mutation carriers and compared results to healthy controls. An exhaustive clinical and instrumental evaluation was performed on all enrolled subjects. RESULTS A statistically significant difference in most pupillometry parameters was found in ATTRv patients as compared to both carriers and healthy controls. Moreover, in ATTRv patients, we found a significant correlation between many pupillometry findings and disease duration, as well as widely accepted clinical scales and investigations (NIS, Sudoscan from feet, and Norfolk QoL-DN questionnaire). CONCLUSIONS We suggest pupillometry may play a role as a reliable and non-invasive biomarker to evaluate ATTRv disease severity and monitor its progression.
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Affiliation(s)
- Angela Romano
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valeria Guglielmino
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Giulia Bisogni
- Centro Clinico NeMO Adulti, Fondazione Serena Onlus-Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mario Sabatelli
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy.,Centro Clinico NeMO Adulti, Fondazione Serena Onlus-Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giacomo Della Marca
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Maria Minnella
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Oftalmologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Martina Maceroni
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Oftalmologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Simone Bellavia
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Irene Scala
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora Sabatelli
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora Rollo
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Luigetti
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
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15
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Hood CJ, Hendren NS, Pedretti R, Roth LR, Saelices L, Grodin JL. Update on Disease-Specific Biomarkers in Transthyretin Cardiac Amyloidosis. Curr Heart Fail Rep 2022; 19:356-363. [PMID: 35930129 PMCID: PMC10132942 DOI: 10.1007/s11897-022-00570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE OF REVIEW Transthyretin cardiac amyloidosis (ATTR-CM) is an infiltrative cardiomyopathy and an increasingly recognized cause of morbidity and mortality. There remains substantial delay between initial symptoms and diagnosis. With the recent emergence of various targeted therapies proven to reduce morbidity and mortality, there is an imperative to diagnose subclinical disease. Biomarkers may be well-suited for this role. RECENT FINDINGS Conventional markers of heart failure, such as natriuretic peptides and cardiac troponins, and estimated glomerular filtration rate are associated with risk in ATTR-CM. Circulating transthyretin (TTR) levels parallel TTR kinetic stability, correlate with disease severity, and may serve as indirect markers of ATTR-CM disease activity and response to targeted treatment. There is also growing evidence for the correlation of TTR to retinol-binding protein 4, a biomarker which independently associates with this disease. The rate-limiting step for ATTR pathogenesis is dissociation of the TTR homotetramer, which may be quantified using subunit exchange to allow for early risk assessment, prognostication, and assessment of treatment response. The protein species that result from the dissociation and misfolding of TTR are known as nonnative transthyretin (NNTTR). NNTTR is quantifiable via peptide probes and is a specific biomarker whose reduction is positively correlated with improvement in neuropathic ATTR amyloidosis. Neurofilament light chain (NfL) is released into the blood after axonal damage and correlates with neuropathic ATTR amyloidosis, but its clinical use in ATTR-CM is uncertain. Conventional markers of heart failure, transthyretin, retinol-binding protein 4, transthyretin kinetic stability, nonnative transthyretin, peptide probes, and neurofilament light chain have potential as biomarkers to enable early, subclinical diagnosis in patients with transthyretin cardiac amyloidosis.
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Affiliation(s)
- Caleb J Hood
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital System, Dallas, TX, USA
| | - Nicholas S Hendren
- Parkland Health and Hospital System, Dallas, TX, USA
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Ste. E5.310F, Dallas, TX, 75390-8830, USA
| | - Rose Pedretti
- Center for Alzheimer's and Neurodegenerative Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lori R Roth
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Ste. E5.310F, Dallas, TX, 75390-8830, USA
| | - Lorena Saelices
- Center for Alzheimer's and Neurodegenerative Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Justin L Grodin
- Parkland Health and Hospital System, Dallas, TX, USA.
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Ste. E5.310F, Dallas, TX, 75390-8830, USA.
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16
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Luigetti M, Guglielmino V, Romozzi M, Romano A, Di Paolantonio A, Bisogni G, Sabatelli E, Modoni A, Sabatelli M, Servidei S, Lo Monaco M. Nerve Conduction Studies of Dorsal Sural Nerve: Normative Data and Its Potential Application in ATTRv Pre-Symptomatic Subjects. Brain Sci 2022; 12:brainsci12081037. [PMID: 36009100 PMCID: PMC9406159 DOI: 10.3390/brainsci12081037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of the study is to provide age-related normative values for dorsal sural nerve (DSN) and to analyse its application during follow-up of hereditary transthyretin amyloidosis (ATTRv) pre-symptomatic subjects. We consecutively recruited ATTRv pre-symptomatic carriers in which clinical examination, cardiological evaluation, and nerve conduction studies of the sural nerve and DSN were performed. To provide normative data of DSN, neurophysiologic parameters from healthy controls referred to our service were entered into linear regression analyses to check the relative influence of age and height. A correction grid was then derived. We collected 231 healthy subjects: the mean DSN sensory nerve action potential (SNAP) amplitude was 9.99 ± 5.48 μV; the mean conduction velocity was 49.01 ± 5.31 m/s. Significant correlations were found between age and height with DSN SNAP amplitude. Fifteen ATTRv pre-symptomatic carriers were examined. Sural nerve NCS were normal in 12/15 and revealed low/borderline values in three subjects. Considering our correction grid, we found an abnormal DNS amplitude in 9/15 subjects and low/borderline values in 2/15. In ATTRv, early detection of peripheral nerve damage is crucial to start a disease-modifying treatment. DSN may be easily and reliably included in the routine neurophysiological follow-up of ATTRv pre-symptomatic subjects.
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Affiliation(s)
- Marco Luigetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia, 00168 Rome, Italy
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-30154435
| | - Valeria Guglielmino
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marina Romozzi
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Angela Romano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia, 00168 Rome, Italy
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Di Paolantonio
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulia Bisogni
- Centro Clinico NEMO, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Eleonora Sabatelli
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Anna Modoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia, 00168 Rome, Italy
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Mario Sabatelli
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Centro Clinico NEMO, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Serenella Servidei
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurofisiopatologia, 00168 Rome, Italy
| | - Mauro Lo Monaco
- MiA Onlus (“Miotonici in Associazione”), 80055 Portici, Italy
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