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Ferreira LF, Hernández ALDCC, Baima JPS, Martins Lino AM. Teaching NeuroImage: Scalloped Pupils in a Transplant Patient With Hereditary Transthyretin Amyloidosis. Neurology 2024; 103:e209720. [PMID: 39058965 DOI: 10.1212/wnl.0000000000209720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
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Stalley E, Verheyden MJ, Eykman E, Deveza L. Hereditary transthyretin amyloidosis as a mimic of giant cell arteritis: a case report. Rheumatology (Oxford) 2024; 63:e107-e109. [PMID: 37773995 DOI: 10.1093/rheumatology/kead530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/12/2023] [Accepted: 09/27/2023] [Indexed: 10/01/2023] Open
Affiliation(s)
- Eliza Stalley
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Matthew J Verheyden
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Elizabeth Eykman
- Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Leticia Deveza
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia
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Westin O, Butt JH, Heegaard S, Fosbøl EL, Gustafsson F. Glaucoma is probably not useful as a red flag for amyloidosis. SCAND CARDIOVASC J 2023; 57:2181389. [PMID: 36825614 DOI: 10.1080/14017431.2023.2181389] [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: 02/25/2023]
Abstract
Purpose. Transthyretin is produced in the retina and approximately one quarter of patients with variant transthyretin amyloidosis (ATTRv) develop ocular involvement. Glaucoma is the most important ocular manifestation, leading to rapid loss of vision. The usefulness of glaucoma as a red flag for cardiac amyloidosis is unknown. Materials and Methods. On a national scale, we investigated the association between glaucoma and development of amyloidosis, compared to an age- and sex-matched population from the general population. Results. The study population included 365,496 subjects (1:1 ratio). Adjusted Cox-models showed no significant association between glaucoma and future diagnosis of amyloidosis (hazard ratio: 1.16 [0.80-1.70], p = .44). Conclusion. We conclude that while ocular involvement is a possible early manifestation of ATTRv, nationwide data suggest that glaucoma is probably not useful as a red flag for cardiac amyloidosis.
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Affiliation(s)
- Oscar Westin
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Jawad H Butt
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Emil L Fosbøl
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Finn Gustafsson
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
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Kitahara J, Yoshinaga T, Kakihara S, Hirano T, Imai A, Miyahara T, Yazaki M, Sekijima Y, Murata T. Ocular findings in patients with acquired ATTRv amyloidosis following domino liver transplantation. PLoS One 2023; 18:e0291716. [PMID: 37713404 PMCID: PMC10503697 DOI: 10.1371/journal.pone.0291716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE To investigate the presence of amyloidosis-related ocular findings in patients who received domino liver transplantation from ATTRv amyloidosis donors. METHODS We reviewed the ocular findings in patients who had previously undergone domino liver transplantation and received ophthalmologic examinations between January 2009 and March 2023. The presence of amyloidosis-related ocular findings was retrospectively assessed by two ophthalmologists. RESULTS During the study period, a total of 7 patients with 14 eyes were examined. All patients were considered as acquired ATTRv amyloidosis. The mean age at the final visit was 64.6±8.4 years (52-75 years), and the mean time since domino liver transplantation was 167.6±76.2 months (69-257 months). The two evaluators' assessments for amyloidosis-related ocular findings were completely identical. No amyloid fibril deposition was observed in the pupil, lens, or vitreous. Five patients (10 eyes) had a Schirmer test result of 5mm or less than 5 mm, and four patients with a total of 8 eyes underwent fluorescein angiography and indocyanine green angiography, and no evidence of retinal amyloid angiopathy was found on fluorescein angiography. However, three patients with 6 eyes showed choroidal amyloid angiopathy on indocyanine green angiography. CONCLUSION While cases of choroidal amyloid angiopathy were observed, serious amyloidosis-related ocular complications such as vitreous opacity or secondary glaucoma did not occur even in the long term after domino liver transplantation.
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Affiliation(s)
- Junya Kitahara
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Tsuneaki Yoshinaga
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Nagano, Japan
- Institute for Biomedical Sciences, Shinshu University, Nagano, Japan
| | - Shinji Kakihara
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Takao Hirano
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Akira Imai
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Teruyoshi Miyahara
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Masahide Yazaki
- Institute for Biomedical Sciences, Shinshu University, Nagano, Japan
- Clinical Laboratory Sciences Division, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Nagano, Japan
- Institute for Biomedical Sciences, Shinshu University, Nagano, Japan
| | - Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
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Kitahara J, Kakihara S, Mukawa S, Hirano T, Imai A, Miyahara T, Murata T. Long-term surgical results of trabeculectomy for secondary glaucoma in Val30Met hereditary transthyretin amyloidosis. Sci Rep 2023; 13:12755. [PMID: 37550352 PMCID: PMC10406936 DOI: 10.1038/s41598-023-40029-4] [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: 03/24/2023] [Accepted: 08/03/2023] [Indexed: 08/09/2023] Open
Abstract
This study reports the long-term results of trabeculectomy (LEC) for secondary glaucoma in hereditary transthyretin (ATTRv) amyloidosis patients and its correlation with prior vitrectomy. A retrospective case series was conducted involving 31 consecutive eyes of 20 ATTRv amyloidosis patients who underwent LEC between 2007 and 2020. The mean follow-up period was 73.2 ± 37.0 months (range: 20-181 months). Postoperative intraocular pressures (IOPs) were evaluated based on the following criteria: (a) IOP between 6 and 21 mmHg without additional glaucoma surgeries, except for laser suture lysis, (b) IOP between 6 and 15 mmHg without additional glaucoma surgeries, except for laser suture lysis, and (c) IOP between 6 and 21 mmHg without additional glaucoma surgeries, except for needling and laser suture lysis. Kaplan-Meier analysis revealed survival rates after LEC of 0.52 at 36 months, 0.42 at 60 months, and 0.25 at 84 months under criterion (a); 0.49 at 36 months, 0.27 at 60 months, and 0.11 at 84 months under criterion (b); and 0.76 at 36 months, 0.71 at 60 months, and 0.65 at 84 months under criterion (c). Eyes with a history of small gauge transconjunctival vitrectomy (SGTV) exhibited a tendency towards lower survival rates, although no statistically significant difference was observed (log-rank test; p = 0.193 under criterion (a) and p = 0.0553 under criterion (b)). Our findings suggest that LEC and additional needling procedures can provide some control over IOP; however, the overall postoperative outcomes of LEC for ATTRv amyloidosis remain unsatisfactory, even in the era of SGTV with reduced conjunctival scarring.
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Affiliation(s)
- Junya Kitahara
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shinji Kakihara
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Shuji Mukawa
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takao Hirano
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Akira Imai
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Teruyoshi Miyahara
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Hudson JL, Schwartz SG, Davis JL. AN 82-YEAR-OLD WOMAN WITH RETINAL VASCULAR SHEATHING AND VITREOUS HEMORRHAGE. Retin Cases Brief Rep 2023; 17:S36-S40. [PMID: 35993733 DOI: 10.1097/icb.0000000000001318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE This report describes a case of hereditary transthyretin amyloidosis in an 82-year-old woman who presented with bilateral retinal arteriolar vascular sheathing and vitreous hemorrhage in one eye. METHODS The patient underwent a full history, physical examination, genetic workup, and cardiac imaging to establish the diagnosis. Fundus photographs, optical coherence tomography, fluorescein angiography, and indocyanine green angiography were performed throughout the patient's treatment course. RESULTS Fundus examination demonstrated segmental sheathing of the retinal arterioles, telangiectasias, and intraretinal hemorrhages in both eyes without neovascularization. Fluorescein angiography revealed delayed filling of the nasal retinal arterioles in the right eye with severe temporal nonperfusion and areas hyperfluorescent segmental sheathing in both eyes. Ocular coherence tomography demonstrated retinal vessels with hyperreflective thickened walls. Cardiac amyloid nuclear scan was consistent with transthyretin-mediated amyloidosis amyloid heart disease, and genetic testing confirmed a heterozygous pathogenic transthyretin mutation: c.290 C>A (p.Ser97Tyr) also known as Ser77Tyr. CONCLUSION Amyloidosis should be considered in the differential of vasculitis and vitreous hemorrhage with or without significant vitreous opacities. Ophthalmologists aware of this diagnosis should complete a full review of systems with specific focus on cardiac history and symptoms of peripheral neuropathy when amyloidosis is in the differential.
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Affiliation(s)
- Julia L Hudson
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Miami, Florida
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OPHTHALMOLOGIC INVOLVEMENT IN PATIENTS WITH HEREDITARY TRANSTHYRETIN AMYLOIDOSIS. Retina 2023; 43:49-56. [PMID: 36228151 DOI: 10.1097/iae.0000000000003641] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/17/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to determine the ophthalmologic involvement in patients with hereditary transthyretin amyloidosis and its correlation with the mutations described in the literature. METHODS Cross-sectional, noninterventional study. Fifty-two eyes of 26 consecutive patients diagnosed with hereditary transthyretin amyloidosis who visited the Puerta de Hierro-Majadahonda University Hospital from September 2019 to March 2022. All patients underwent complete ophthalmologic examination and multimodal imaging. Cardiologic, neurologic, digestive, and renal examinations were also recorded. RESULTS Eighteen eyes of the total (34.61%) showed amyloid-related ocular involvement, vitreous amyloid deposits being the most common ocular manifestation (18/52). Statistically significant differences were found for the presence of vitreous amyloid deposits ( P < 0.01), crystalline amyloid deposits ( P < 0.05), parenchymal amyloid deposits ( P < 0.01), and vascular alterations ( P < 0.01) when comparing affected and unaffected eyes. Moreover, affected eyes showed worse best-corrected visual acuity ( P < 0.01). CONCLUSION Ocular manifestations are present in a substantial number of patients with ATTR that could potentially lead to devastating consequences to patients' best-corrected visual acuity and quality of life. Therefore, it is important to emphasize the importance of multidisciplinary management and ophthalmologic assessment, follow-up and surgical treatment when necessary. To the best of our knowledge, this represents the largest series in Spain of amyloidosis' ophthalmologic involvement.
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Cambieri C, Marenco M, Colasanti T, Mancone C, Corsi A, Riminucci M, Libonati L, Moret F, Chimenti C, Lambiase A, Conti F, Garibaldi M, Inghilleri M, Ceccanti M. Does Patisiran Reduce Ocular Transthyretin Synthesis? A Pilot Study of Two Cases. Curr Neuropharmacol 2023; 21:2543-2549. [PMID: 37357518 PMCID: PMC10616919 DOI: 10.2174/1570159x21666230623094710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Variant transthyretin-mediated amyloidosis (ATTR-v) is a well-characterized disease affecting the neurologic and cardiovascular systems. Patisiran has been approved for neurologic involvement as it reduces hepatic synthesis of transthyretin (TTR). Eye involvement is a lateonset feature increasing the risk of glaucoma and cataracts in patients. AIMS The aim of this case series was to assess whether patisiran can effectively reduce TTR synthesis in such a barrier-protected organ as the eye. METHODS Two patisiran-treated ATTR-v patients underwent serum and aqueous humor sampling to measure TTR levels detected by SDS-PAGE and immunoblotting. Serum samples were compared to healthy control (HC), whereas aqueous humor samples were compared to non-amyloidotic subjects affected by cataracts and glaucoma. RESULTS Serum TTR levels representative of hepatic synthesis were sharply lower in treated patients if compared to the HC (-87.5% and -93.75%, respectively). Aqueous humor TTR levels showed mild-tono reduction in treated patients compared to non-amyloidotic subjects with cataracts (-34.9% and +8.1%, respectively) and glaucoma (-41.1% and -2.1%). CONCLUSION Patisiran does not seem to be as effective in inhibiting ocular TTR synthesis as it is in inhibiting hepatic synthesis. Re-engineering the envelope could allow the drug to target RPE cells thus avoiding any ocular involvement.
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Affiliation(s)
- Chiara Cambieri
- Department of Human Neuroscience, Centre for Rare Neuromuscular Disease, Sapienza University of Rome, Rome, Italy
| | - Marco Marenco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Tania Colasanti
- Department of Clinical Internal, Rheumatology Unit, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Carmine Mancone
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Corsi
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Mara Riminucci
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Libonati
- Department of Human Neuroscience, Centre for Rare Neuromuscular Disease, Sapienza University of Rome, Rome, Italy
| | - Federica Moret
- Department of Human Neuroscience, Centre for Rare Neuromuscular Disease, Sapienza University of Rome, Rome, Italy
| | - Cristina Chimenti
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy
| | | | - Fabrizio Conti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Matteo Garibaldi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Maurizio Inghilleri
- Department of Human Neuroscience, Centre for Rare Neuromuscular Disease, Sapienza University of Rome, Rome, Italy
| | - Marco Ceccanti
- Department of Human Neuroscience, Centre for Rare Neuromuscular Disease, Sapienza University of Rome, Rome, Italy
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Microhook ab interno trabeculotomy for secondary glaucoma in patients with hereditary transthyretin amyloidosis. Jpn J Ophthalmol 2023; 67:84-90. [PMID: 36441264 DOI: 10.1007/s10384-022-00966-5] [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: 08/09/2022] [Accepted: 10/20/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To report surgical outcomes of a Microhook ab interno trabeculotomy (µLOT) procedure for glaucoma secondary to hereditary transthyretin amyloidosis (ATTRv). STUDY DESIGN Retrospective case series. METHODS Medical records of patients with glaucoma secondary to ATTRv with transthyretin Val30Met variant, who underwent µLOT, were retrospectively reviewed. Surgical success was categorized according to the postoperative intraocular pressures (IOPs, mmHg) as follows: (a) 6 ≤ IOP ≤ 21; (b) 6 ≤ IOP ≤ 18; and (c) 6 ≤ IOP ≤ 15, without light perception loss or additional glaucoma surgery. Secondary outcomes were glaucoma medication scores and postoperative complications. RESULTS This study included 18 eyes (13 patients, 6 men). The mean follow-up period was 25.2±9.8 months (7-38 months). Kaplan-Meier analysis indicated success rates of (a) 1.00 at 6, 1.00 at 12, and 0.43 at 24 months; (b), 1.00 at 6, 0.93 at 12, and 0.43 at 24 months; (c) 0.94 at 6, 0.75 at 12, and 0.27 at 24 months after operation. Postoperative IOPs were significantly reduced from the baseline of 25.2±5.8 mmHg to 11.5±2.7 at 3, 12.3±4.1 at 6, and 13.8±3.9 at 12 months (Dunnett's test). Medication scores were also improved at 3 and 6 months but without a significant reduction at 12 months. There were no severe complications requiring surgical intervention except for additional glaucoma surgery. CONCLUSION µLOT for secondary glaucoma in ATTRv is safe and effective 1 year after surgery, but the effects diminish after 2 years.
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Gawor M, Holcman K, Franaszczyk M, Lipowska M, Michałek P, Teresińska A, Bilińska ZT, Rubiś P, Kostkiewicz M, Szot W, Podolec P, Grzybowski J. Spectrum of transthyretin gene mutations and clinical characteristics of Polish patients with cardiac transthyretin amyloidosis. Cardiol J 2022; 29:985-993. [PMID: 32789836 PMCID: PMC9788745 DOI: 10.5603/cj.a2020.0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Transthyretin amyloidosis (ATTR) is a rare, life-threatening systemic disorder. We present first findings on the cardiac hereditary ATTR in Poland. METHODS Sixty-eight consecutive patients with suspected or known cardiac amyloidosis were evaluated, including blood tests, standard 12-lead electrocardiography (ECG) and transthoracic echocardiography. ATTR was confirmed histologically or non-invasively using 99mTc-DPD scintigraphy. Transthyretin (TTR) gene sequencing was performed. RESULTS In 2017-2019, 10 unrelated male patients were diagnosed with hereditary ATTR. All patients had very uncommon TTR gene mutations: 7 patients had p.Phe53Leu mutation, 2 patients had p.Glu109Lys mutation and 1 patient had p.Ala101Val mutation. The age of onset ranged from 49 to 67 years (mean [SD] age, 58.7 [6.4] years). On ECG, most patients (70%) had pseudoinfarct pattern and/or low QRS voltage. The maximal wall thickness (MWT) on echocardiography varied considerably among the patients from moderate (16 mm) to massively increased (30 mm). Most patients (90%) had decreased left ventricular ejection fraction (mean [SD], 43 [11] %). On follow-up, we observed progressive heart failure in almost all cases. The first patient with p.Phe53Leu mutation died of heart failure, the second died suddenly, the third successfully underwent combined heart and liver transplant with 15 months survival from the surgery. The patient with p.Ala101Val mutation died of stroke. CONCLUSIONS According to available data, this is the first time that the types of TTR mutations and the clinical characteristics of Polish patients with cardiac hereditary ATTR have been described. Previous literature data about Polish background in families with p.Phe53Leu mutation and the present results, suggest that this TTR mutation might be endemic in the Polish population.
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Affiliation(s)
- Monika Gawor
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Katarzyna Holcman
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Maria Franaszczyk
- Department of Medical Biology, Institute of Cardiology, Warsaw, Poland
| | - Marta Lipowska
- Department of Neurology, Medical University of Warsaw, Poland
| | - Piotr Michałek
- Rapid Diagnosis Department, Emergency Room, Institute of Cardiology, Warsaw, Poland
| | - Anna Teresińska
- Department of Nuclear Medicine, Institute of Cardiology, Warsaw, Poland
| | - Zofia T. Bilińska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Kostkiewicz
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland,Department of Nuclear Medicine, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Szot
- Department of Nuclear Medicine, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
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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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12
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Suture trabeculotomy ab interno for secondary glaucoma in Japanese patients with Val30Met hereditary transthyretin amyloidosis. Sci Rep 2022; 12:19330. [PMID: 36369333 PMCID: PMC9652217 DOI: 10.1038/s41598-022-23150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
We retrospectively evaluated surgical outcomes of suture trabeculotomy (SLOT) ab interno for secondary glaucoma in 18 eyes of 12 patients with hereditary transthyretin (ATTRv) amyloidosis with Val30Met mutation. SLOT ab interno was performed between May 2015 and January 2020. All the participants were followed up for at least 12 months. The primary outcome measure was Kaplan-Meier survival. Failure of this treatment was defined as an intraocular pressure (IOP) of ≥ 22 mmHg and a < 20% IOP reduction with or without medication or as additional operations needed to reduce IOP. The mean postoperative follow-up period was 3.5 years (1.2-6.1 years). The SLOT ab interno procedure alone was performed in 17 eyes (94%). Fifteen eyes (83%) had a 360° incision made in Schlemm's canal and 3 eyes (17%) had a 180° incision performed. Cumulative survival values were 0.83, 0.63, and 0.22 at 1, 2, and 3 years, respectively. Ten eyes (56%) needed additional surgery, such as repeated SLOT ab interno, Ahmed glaucoma valve implantation, or MicroPulse transscleral cyclophotocoagulation. Our results here, as well as our previous results with trabeculectomy, suggest that SLOT ab interno may not have a sufficiently long-term effect on secondary glaucoma because of ATTRv amyloidosis.
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de Frutos F, Ochoa JP, Gómez-González C, Reyes-Leiva D, Aróstegui JI, Casasnovas C, Barriales-Villa R, Sevilla T, Gonzalez-Lopez E, Ramil E, Galan L, González-Costello J, García-Álvarez A, Rojas-Garcia R, Espinosa MA, Garcia-Pavia P. Phenotype and clinical outcomes of Glu89Lys hereditary transthyretin amyloidosis: a new endemic variant in Spain. Amyloid 2022:1-9. [PMID: 36343383 DOI: 10.1080/13506129.2022.2142110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The p.Glu109Lys variant (Glu89Lys) is a rare cause of hereditary transthyretin amyloidosis (ATTRv) for which clinical spectrum remains unresolved. We sought to describe the clinical characteristics and outcomes of ATTR Glu89Lys amyloidosis and assess a potential founder effect in Spain. METHODS Patients with the p.Glu109Lys ATTRv variant from 14 families were recruited at 7 centres. Demographics, complementary tests and clinical course were analysed. Haplotype analysis was performed in 7 unrelated individuals. RESULTS Thirty-eight individuals (13 probands, mean age 40.4 ± 13.1 years) were studied. After median follow-up of 5.1 years (IQR 1.7-9.6), 7 patients died and 7 required heart transplantation (median age at transplantation 50.5 years). Onset of cardiac and neurological manifestations occurred at a mean age of 48.4 and 46.8 years, respectively. Median survival from birth was 61.6 years and no individual survived beyond 65 years. Patients treated with disease-modifying therapies exhibited better prognosis (p < 0.001). Haplotype analysis revealed a common origin from an ancestor who lived ∼500 years ago in southeast Spain. CONCLUSIONS Glu89Lys ATTRv is a TTR variant with a founder effect in Spain. It is associated with near complete penetrance, early onset and mixed cardiac and neurologic phenotype. Patients have poor prognosis, particularly if not treated with disease-modifying therapies.
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Affiliation(s)
- Fernando de Frutos
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,European Reference Network for Rare and Low Prevalence, Complex Diseases of the Heart, Amsterdam, The Netherlands
| | - Juan Pablo Ochoa
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,European Reference Network for Rare and Low Prevalence, Complex Diseases of the Heart, Amsterdam, The Netherlands.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Cristina Gómez-González
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - David Reyes-Leiva
- Neuromuscular Disease Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital de Sant Pau (IIB-Sant Pau), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Juan I Aróstegui
- Department of Immunology, Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Carlos Casasnovas
- Neuromuscular Unit, Neurology Department, Hospital Universitario Ballvitge, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Roberto Barriales-Villa
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Unidad de Cardiopatías Familiares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Teresa Sevilla
- Department of Neurology, Hospital Universitari i Politècnic La Fe & IIS La Fe, Neuromuscular Diseases Unit, Valencia, Spain.,Universitat de València, Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,European Reference Network for Rare Neuromuscular Diseases (ERN EURO-NMD), Paris, France
| | - Esther Gonzalez-Lopez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,European Reference Network for Rare and Low Prevalence, Complex Diseases of the Heart, Amsterdam, The Netherlands
| | - Elvira Ramil
- Unidad de Secuenciación de ADN y Biología Molecular, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain
| | - Lucia Galan
- Neurology Department, Clínico San Carlos Hospital. IdiSSC, Madrid, Spain
| | - Jose González-Costello
- Unidad de Cardiopatías Familiares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain.,Department of Cardiology, Hospital Universitari de Bellvitge. BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana García-Álvarez
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.,Department of Cardiology, ICCV, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ricard Rojas-Garcia
- Neuromuscular Disease Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital de Sant Pau (IIB-Sant Pau), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Maria Angeles Espinosa
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,European Reference Network for Rare and Low Prevalence, Complex Diseases of the Heart, Amsterdam, The Netherlands.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
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Kakihara S, Hirano T, Kitahara J, Matsuda Y, Imai A, Miyahara T, Murata T. Application of optical coherence tomography angiography to assess systemic severity in patients with hereditary transthyretin amyloidosis. PLoS One 2022; 17:e0275180. [PMID: 36156600 PMCID: PMC9512205 DOI: 10.1371/journal.pone.0275180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 09/12/2022] [Indexed: 11/19/2022] Open
Abstract
Hereditary transthyretin amyloidosis is an autosomal dominant form of amyloidosis caused by an abnormality in transthyretin, with various ocular manifestations. Among these, ocular amyloid angiopathy has attracted attention because of its direct link to visual impairment and its correlation with systemic severity. We hypothesized that optical coherence tomography angiographic parameters would be useful biomarkers of amyloidosis systemic severity and investigated their correlation with the systemic severity score. The primary outcome was the correlation between the systemic severity score and choriocapillaris flow deficit percentage. Secondary outcomes were the correlations between the systemic severity score and retinal optical coherence tomography angiographic parameters, including foveal avascular zone size and circularity and superficial/deep/total retinal perfusion and vessel densities. The choroidal and retinal vasculature was quantified in 36 eyes from 36 patients (age, 51.8±12.1 years; disease duration, 13.4±6.2 years). Ten eyes had a history of vitrectomy for vitreous opacity. Choriocapillaris flow deficit percentage was not significantly correlated with the systemic severity score (Spearman’s rank correlation: r = 2.96×10−2, p = 0.863). Similarly, foveal avascular zone size and circularity, and superficial/deep/total retinal perfusion and vessel densities were not significantly correlated with the systemic severity score. These results may indicate that optical coherence tomography angiographic parameters are not sufficient to predict amyloidosis severity.
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Affiliation(s)
- Shinji Kakihara
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
- * E-mail:
| | - Takao Hirano
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Junya Kitahara
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yorishige Matsuda
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Akira Imai
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Teruyoshi Miyahara
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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15
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Transthyretin Cardiac Amyloidosis. Cardiol Clin 2022; 40:541-558. [DOI: 10.1016/j.ccl.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Pané Foix M, Fernandez Calvo D, Condom I Mundó E, Suarez Novo JF, Merino Serra E, Garcia Benett JR, Gomà Gàllego M, Yun Viladomat S, Vigués Julià F, Vidal I Bel A. Clinical relevance of amyloid in prostate samples: a report on 40 patients. Histopathology 2022; 81:363-370. [PMID: 35788982 DOI: 10.1111/his.14717] [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: 04/07/2022] [Revised: 06/15/2022] [Accepted: 07/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the clinical findings in patients with incidental prostatic amyloidosis. PATIENTS AND METHODS Retrospective search in the database of the Department of Pathology, Hospital de Bellvitge, for prostate specimens with amyloid. Congo red and immunohistochemical staining of the sections. Review of the patients' clinical charts for symptoms attributable to systemic amyloidosis. RESULTS Amyloid deposition in the prostate was identified and reported in 40 patients between 2001 and 2022. Median age was 76.5 years (range 62-90). Prostate cancer was diagnosed in 25 patients. Only 4 patients had a previous diagnosis of amyloidosis. In the remaining 36 the prostate sample (31 needle biopsies, two transurethral resections (TUR), two simple prostatectomies, one radical cystectomy for bladder cancer) provided the initial diagnosis. Amyloid deposits were mainly located in the wall of small vessels and rarely in the prostatic stroma. Immunohistochemistry was available in 32 cases, 26 of which were positive for TTR. All patients showed at least one symptom indicative of systemic amyloidosis, the most frequent being hearing loss (55%), carpal tunnel syndrome (42,5%) or other osteoarticular symptoms (tendinopathies, osteoarthritis), cataracts (37.5%), and cardiac symptoms (32.5%), among others. CONCLUSION The prostate is a target tissue for amyloid deposition. The incidental finding of amyloid in prostate corresponds, in the majority of cases, to previously undiagnosed systemic TTR amyloidosis in patients lacking signs of heart involvement but having mainly osteoarticular symptoms, hearing and visual impairment.
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Affiliation(s)
- Maria Pané Foix
- Department of Pathology, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona
| | - Davinia Fernandez Calvo
- Department of Pathology, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona
| | - Enric Condom I Mundó
- Department of Pathology, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona
| | - José Francisco Suarez Novo
- Department of Urology, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona
| | - Eva Merino Serra
- Department of Radiology, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona
| | - Josep Ronald Garcia Benett
- Department of Radiology, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona
| | - Montserrat Gomà Gàllego
- Department of Pathology, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona
| | - Sergi Yun Viladomat
- Community Heart Failure Program, Department of Internal Medicine, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona
| | - Francesc Vigués Julià
- Department of Urology, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona
| | - August Vidal I Bel
- Department of Pathology, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona
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17
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Marques JH, Coelho J, Menéres MJ, Melo Beirão J. Monitoring the Patient with Retinal Angiopathy Associated with Hereditary Transthyretin Amyloidosis: Current Perspectives. Clin Ophthalmol 2022; 16:2227-2233. [PMID: 35844663 PMCID: PMC9278722 DOI: 10.2147/opth.s359312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Retinal angiopathy associated with hereditary transthyretin amyloidosis (ATTRv), if untreated, may lead to irreversible vision loss. Our purpose was to systematically review the clinical and imaging features of retinal angiopathy associated with ATTRv and assemble a monitoring approach for these patients. All types of original research studies reporting clinical and imaging findings on retinal angiopathy associated with ATTRv were included. The most common clinical findings were tortuous retinal vessels, microaneurysms, retinal hemorrhages, sheathing of retinal vessels, whitish amyloid deposits along retinal arteries, obliteration of retinal vessels, vitreous hemorrhage, retinal and iris neovascularization. The most relevant imaging findings were hyperautofluorescence of perivessel amyloid deposits; delayed arterial filling, vascular leakage, and retinal ischemia on fluorescein angiography; late hypercyanescence along the choroidal arteries on indocyanine green angiography; perivascular hyperreflective material, needle-shaped deposits on the retinal surface and macular edema on optical coherence tomography (OCT) and attenuated retinal vascular network on OCT-angiography. ATTRv patients should be strictly followed to detect and treat retinal angiopathy, avoiding complications. Both panretinal photocoagulation and intravitreal anti-vascular endothelial growth factor have been used to treat retinal angiopathy in ATTRv. In an individual that presents with retinal angiopathy of unknown etiology, ATTRv should be considered as in the differential diagnosis, even out of the initial core countries. The prognostic value of subclinical findings, namely in OCT-A, is not yet established.
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Affiliation(s)
- João Heitor Marques
- Serviço de Oftalmologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Correspondence: João Heitor Marques, Serviço de Oftalmologia, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, Porto, Portugal, Tel +351913680736, Email
| | - João Coelho
- Serviço de Oftalmologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Maria João Menéres
- Serviço de Oftalmologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - João Melo Beirão
- Serviço de Oftalmologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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18
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Chen J, Cao D, Fortmann SD, Curcio CA, Feist RM, Crosson JN. Transthyretin proteoforms of intraocular origin in human subretinal fluid. Exp Eye Res 2022; 222:109163. [PMID: 35760119 DOI: 10.1016/j.exer.2022.109163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/24/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022]
Abstract
Understanding the molecular composition of ocular tissues and fluids could inform new approaches to prevalent causes of blindness. Subretinal fluid accumulating between the photoreceptor outer segments and retinal pigment epithelium (RPE) is potentially a rich source of proteins and lipids normally cycling among outer retinal cells and choroid. Herein, intact post-translationally modified proteins (proteoforms) were extracted from subretinal fluids of five patients with rhegmatogenous retinal detachment (RRD), analyzed by tandem mass spectrometry, and compared to published data on these same proteins as synthesized by other organs. Single-nuclei transcriptomic data from non-diseased human retina/RPE were used to identify whether proteins in subretinal fluid were of potential ocular origin. Two human donor eyes with normal maculas were immunoprobed for transthyretin (TTR) with appropriate controls. The three most abundant proteins detected in subretinal fluid were albumin, TTR, and apolipoprotein A-I. Remarkably, TTR relative to the other proteins was more abundant than its serum counterpart, suggestive of TTR being synthesized predominantly locally. Six post-translationally modified protein forms (proteoforms) of TTR were detected, with the relative amount of glutathionylated TTR being much higher in the subretinal fluid (12-43%) than values reported for serum (<5%) and cerebrospinal fluid (0.4-13%). Moreover, a putative glycosylated TTR dimer of 32,428 Da was detected as the fourth most abundant protein. The high abundance of TTR and putative TTR dimer in subretinal fluid was supported by analysis of available single-nuclei transcriptomic data, which showed strong and specific signal for TTR in RPE. Immunohistochemistry further showed strong diffuse TTR immunoreactivity in choroidal stroma that contrasted with vertically aligned signal in the outer segment zone of the subretinal space and negligible signal in RPE cell bodies. These results suggest that TTR in the retina is synthesized intraocularly, and glutathionylation is crucial for its normal function. Further studies on the composition, function, and quantities of TTR and other proteoforms in subretinal fluid could inform mechanisms, diagnostic methods, and treatment strategies for age-related macular degeneration, familial amyloidosis, and other retinal diseases involving dysregulation of physiologic lipid transfer and oxidative stress.
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Affiliation(s)
- Jianzhong Chen
- Department of Optometry and Vision Science, The University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Dongfeng Cao
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Seth D Fortmann
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Richard M Feist
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jason N Crosson
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, AL, United States
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19
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Choroidal Amyloid Deposition: A Multicenter Study of Amyloid Lesions Identified in Late Indocyanine Green Angiography. Retina 2022; 42:1989-1994. [DOI: 10.1097/iae.0000000000003551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Daniszewski M, Senabouth A, Liang HH, Han X, Lidgerwood GE, Hernández D, Sivakumaran P, Clarke JE, Lim SY, Lees JG, Rooney L, Gulluyan L, Souzeau E, Graham SL, Chan CL, Nguyen U, Farbehi N, Gnanasambandapillai V, McCloy RA, Clarke L, Kearns LS, Mackey DA, Craig JE, MacGregor S, Powell JE, Pébay A, Hewitt AW. Retinal ganglion cell-specific genetic regulation in primary open-angle glaucoma. CELL GENOMICS 2022; 2:100142. [PMID: 36778138 PMCID: PMC9903700 DOI: 10.1016/j.xgen.2022.100142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 03/08/2021] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
To assess the transcriptomic profile of disease-specific cell populations, fibroblasts from patients with primary open-angle glaucoma (POAG) were reprogrammed into induced pluripotent stem cells (iPSCs) before being differentiated into retinal organoids and compared with those from healthy individuals. We performed single-cell RNA sequencing of a total of 247,520 cells and identified cluster-specific molecular signatures. Comparing the gene expression profile between cases and controls, we identified novel genetic associations for this blinding disease. Expression quantitative trait mapping identified a total of 4,443 significant loci across all cell types, 312 of which are specific to the retinal ganglion cell subpopulations, which ultimately degenerate in POAG. Transcriptome-wide association analysis identified genes at loci previously associated with POAG, and analysis, conditional on disease status, implicated 97 statistically significant retinal ganglion cell-specific expression quantitative trait loci. This work highlights the power of large-scale iPSC studies to uncover context-specific profiles for a genetically complex disease.
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Affiliation(s)
- Maciej Daniszewski
- Department of Anatomy and Physiology, The University of Melbourne, Parkville, VIC 3010, Australia,Department of Surgery, The University of Melbourne, Parkville, VIC 3010, Australia,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
| | - Anne Senabouth
- Garvan Weizmann Centre for Cellular Genomics, Garvan Institute of Medical Research, The Kinghorn Cancer Centre, Darlinghurst, NSW 2010, Australia
| | - Helena H. Liang
- Department of Surgery, The University of Melbourne, Parkville, VIC 3010, Australia,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
| | - Xikun Han
- QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Grace E. Lidgerwood
- Department of Anatomy and Physiology, The University of Melbourne, Parkville, VIC 3010, Australia,Department of Surgery, The University of Melbourne, Parkville, VIC 3010, Australia,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
| | - Damián Hernández
- Department of Anatomy and Physiology, The University of Melbourne, Parkville, VIC 3010, Australia,Department of Surgery, The University of Melbourne, Parkville, VIC 3010, Australia,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
| | - Priyadharshini Sivakumaran
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
| | - Jordan E. Clarke
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
| | - Shiang Y. Lim
- Department of Surgery, The University of Melbourne, Parkville, VIC 3010, Australia,O’Brien Institute Department of St Vincent’s Institute of Medical Research, Melbourne, Fitzroy, VIC 3065, Australia
| | - Jarmon G. Lees
- O’Brien Institute Department of St Vincent’s Institute of Medical Research, Melbourne, Fitzroy, VIC 3065, Australia,Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Louise Rooney
- Department of Anatomy and Physiology, The University of Melbourne, Parkville, VIC 3010, Australia,Department of Surgery, The University of Melbourne, Parkville, VIC 3010, Australia,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
| | - Lerna Gulluyan
- Department of Anatomy and Physiology, The University of Melbourne, Parkville, VIC 3010, Australia,Department of Surgery, The University of Melbourne, Parkville, VIC 3010, Australia,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
| | - Emmanuelle Souzeau
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Stuart L. Graham
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Chia-Ling Chan
- Garvan Weizmann Centre for Cellular Genomics, Garvan Institute of Medical Research, The Kinghorn Cancer Centre, Darlinghurst, NSW 2010, Australia
| | - Uyen Nguyen
- Garvan Weizmann Centre for Cellular Genomics, Garvan Institute of Medical Research, The Kinghorn Cancer Centre, Darlinghurst, NSW 2010, Australia
| | - Nona Farbehi
- Garvan Weizmann Centre for Cellular Genomics, Garvan Institute of Medical Research, The Kinghorn Cancer Centre, Darlinghurst, NSW 2010, Australia
| | - Vikkitharan Gnanasambandapillai
- Garvan Weizmann Centre for Cellular Genomics, Garvan Institute of Medical Research, The Kinghorn Cancer Centre, Darlinghurst, NSW 2010, Australia
| | - Rachael A. McCloy
- Garvan Weizmann Centre for Cellular Genomics, Garvan Institute of Medical Research, The Kinghorn Cancer Centre, Darlinghurst, NSW 2010, Australia
| | - Linda Clarke
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
| | - Lisa S. Kearns
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
| | - David A. Mackey
- Lions Eye Institute, Centre for Vision Sciences, University of Western Australia, Crawley, WA 6009, Australia,School of Medicine, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7005, Australia
| | - Jamie E. Craig
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Stuart MacGregor
- QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Joseph E. Powell
- Garvan Weizmann Centre for Cellular Genomics, Garvan Institute of Medical Research, The Kinghorn Cancer Centre, Darlinghurst, NSW 2010, Australia,UNSW Cellular Genomics Futures Institute, University of New South Wales, Sydney, NSW 2052, Australia,Corresponding author
| | - Alice Pébay
- Department of Anatomy and Physiology, The University of Melbourne, Parkville, VIC 3010, Australia,Department of Surgery, The University of Melbourne, Parkville, VIC 3010, Australia,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia,Corresponding author
| | - Alex W. Hewitt
- Department of Surgery, The University of Melbourne, Parkville, VIC 3010, Australia,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia,School of Medicine, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7005, Australia,Corresponding author
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21
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Carroll A, Dyck PJ, de Carvalho M, Kennerson M, Reilly MM, Kiernan MC, Vucic S. Novel approaches to diagnosis and management of hereditary transthyretin amyloidosis. J Neurol Neurosurg Psychiatry 2022; 93:668-678. [PMID: 35256455 PMCID: PMC9148983 DOI: 10.1136/jnnp-2021-327909] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/12/2022] [Indexed: 12/27/2022]
Abstract
Hereditary transthyretin amyloidosis (ATTRv) is a severe, adult-onset autosomal dominant inherited systemic disease predominantly affecting the peripheral and autonomic nervous system, heart, kidney and the eyes. ATTRv is caused by mutations of the transthyretin (TTR) gene, leading to extracellular deposition of amyloid fibrils in multiple organs including the peripheral nervous system. Typically, the neuropathy associated with ATTRv is characterised by a rapidly progressive and disabling sensorimotor axonal neuropathy with early small-fibre involvement. Carpal tunnel syndrome and cardiac dysfunction frequently coexist as part of the ATTRv phenotype. Although awareness of ATTRv polyneuropathy among neurologists has increased, the rate of misdiagnosis remains high, resulting in significant diagnostic delays and accrued disability. A timely and definitive diagnosis is important, given the emergence of effective therapies which have revolutionised the management of transthyretin amyloidosis. TTR protein stabilisers diflunisal and tafamidis can delay the progression of the disease, if treated early in the course. Additionally, TTR gene silencing medications, patisiran and inotersen, have resulted in up to 80% reduction in TTR production, leading to stabilisation or slight improvement of peripheral neuropathy and cardiac dysfunction, as well as improvement in quality of life and functional outcomes. The considerable therapeutic advances have raised additional challenges, including optimisation of diagnostic techniques and management approaches in ATTRv neuropathy. This review highlights the key advances in the diagnostic techniques, current and emerging management strategies, and biomarker development for disease progression in ATTRv.
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Affiliation(s)
- Antonia 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, New South Wales, Australia
| | - P James Dyck
- Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mamede de Carvalho
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Department of Neurosciences and Mental Health, Hospital de Santa Maria, Lisboa, Portugal
| | - Marina Kennerson
- Northcott Neuroscience Laboratory, ANZAC Research Institute, Molecular Medicine Laboratory Concord Repatriation General Hospital, and Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Mary M Reilly
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Matthew C Kiernan
- Bushell Chair of Neurology, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Steve Vucic
- Brain and Nerve Research Center, Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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22
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Meduri A, Oliverio GW, Valastro A, Azzaro C, Camellin U, Franchina F, Inferrera L, Roszkowska A, Aragona P. Neurotrophic Keratopathy in Systemic Diseases: A Case Series on Patients Treated With rh-NGF. Front Med (Lausanne) 2022; 9:920688. [PMID: 35707524 PMCID: PMC9189296 DOI: 10.3389/fmed.2022.920688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To evaluate the prevalence, clinical ocular presentation and corneal healing in moderate and severe neurotrophic keratopathy (NK) caused by systemic diseases and treated with rh-NGF. Setting Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, University of Messina, Italy. Design Retrospective observational study of case series. Materials and Methods In this retrospective observational study 11 patients (five female and six males) aged from 24 to 88 years (55.4 ± 21.3 years) with moderate and severe NK caused by systemic diseases were enrolled. The VAS questionnaire was dispensed. The ocular examination comprised slit lamp evaluation, ocular surface assessment with Keratograph 5M (Oculus, Germany), corneal sensitivity with Cochet-Bonnet esthesiometer (Lunneaux, France) and corneal thickness measurement with AC-OCT (DRI, Triton, Topcon, Japan). The underlying systemic causes of NK were determined. Results The main cause of NK was post-neuroma surgery (36%), followed by diabetes (18%). The remaining causes were rheumatoid arthritis (9%), post-traumatic (9%), post-surgery (9%), atopia (9%), Graves' disease (9%). Seven eyes presented severe grade of NK with corneal ulcer and in four a moderate grade was registered. The rh-NGF (Cenegermin) was administered with a standard protocol one drop six times daily for 8 weeks. The complete healing of all corneal defects was registered at the end of the treatment. Conclusions The post-neuroma surgery was the most common cause of NK and severe grade was clinically more represented. The rh-NGF proved effective to promote corneal recovery with all defects healed after the treatment.
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Affiliation(s)
- Alessandro Meduri
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Giovanni William Oliverio
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
- *Correspondence: Giovanni William Oliverio
| | - Antonio Valastro
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Claudia Azzaro
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Umberto Camellin
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Francesco Franchina
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Leandro Inferrera
- Department of Medical, Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - Anna Roszkowska
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Pasquale Aragona
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
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23
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Ocular Manifestations in a Chinese Pedigree of Familial Amyloidotic Polyneuropathy Carrying the Transthyretin Mutation c.401A>G (p.Tyr134Cys). Genes (Basel) 2022; 13:genes13050886. [PMID: 35627273 PMCID: PMC9140613 DOI: 10.3390/genes13050886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 02/05/2023] Open
Abstract
Familial amyloid polyneuropathy (FAP) caused by a genetic mutation in transthyretin (TTR) is an autosomal dominant hereditary disease. The retrospective, observational case series study presents the ocular clinicopathological findings of five cases carrying the TTR mutation c.401A>G (p.Tyr134Cys). Multimodal retinal imaging and electrophysiological examination, Congo red staining and immunohistochemical analysis of specimens, and genetic analyses were performed. Cases 1 and 2 were symptomatic with vitreous and retinal amyloid deposition and poor visual recovery. Case 3 had a symptomatic vitreous haze in the left eye with good postoperative visual recovery. The right eye of case 3 and the eyes of cases 4 and 5 were asymptomatic. Thicker retinal nerve fiber layer, retinal venous tortuosity with prolonged arteriovenous passage time on fluorescein angiography and retinal dysfunction detected by multifocal electroretinogram occurred even in asymptomatic eyes. Moreover, the internal limiting membrane from patients with FAP was stained positive for Congo red and transforming growth factor-β1. The results highlight the amyloid deposition of mutant TTR in the optic disc and retina, even in the asymptomatic stage. The deposited amyloid leads to increased resistance to venous return and retinal functional abnormalities. Therefore, careful follow-up of structural and functional changes in the retina is needed, even in asymptomatic patients with FAP.
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24
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Dalma-Weiszhausz J, Chacón-Camacho O, Chevez-Barrios P, Zenteno JC, Franco-Cárdenas V, García-Montaño LA, Pérez-Bravo J, García-Montalvo IA, Jiménez-Sierra JM, Dalma A. AUTOSOMAL DOMINANT MÜLLER CELL SHEEN DYSTROPHY: Clinical, Histopathologic, and Genetic Assessment in an Extended Family With Long Follow-Up. Retina 2022; 42:981-991. [PMID: 35125479 DOI: 10.1097/iae.0000000000003413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Autosomal dominant Müller cell dystrophy is a rare condition we described in 1991. It is characterized by a striking sheen appearance on the retinal surface with progressive retinal changes leading to disorganization and atrophy with a decreased b-wave electroretinograms. MATERIALS AND METHODS We examined 45 members of a 4-generation family. Fifteen subjects from three generations were found with the disease, without gender predilection. Seven patients underwent ophthalmic examination including fundus examination, intravenous fluorescein angiogram, spectral-domain optical coherence tomography, and electroretinogram. Six patients have a 30-year follow-up. Histopathology examination was performed on eyes of the eldest patient. Whole exome sequencing was done in four affected subjects. RESULTS Findings include a decreased visual acuity, abnormal cellophane-like sheen of the vitreoretinal interface, a "plush" nerve fiber layer, and characteristic macular changes. Electroretinogram showed a selective b-wave diminution. Intravenous fluorescein angiogram presented perifoveal hyperfluorescence and capillary leakage. Spectral-domain optical coherence tomography revealed cavitations involving inner and later outer retinal layers with later disorganization. Histopathologic findings included Müller cell abnormalities with cystic disruption of inner retinal layers, pseudoexfoliation in anterior segment, and amyloidosis of extraocular vessels. Pedigree analysis suggests an autosomal dominant inheritance with late onset. DNA analysis demonstrated a previously undescribed heterozygous missense p.Glu109Val mutation in transthyretin. CONCLUSION To the best of our knowledge, this is the first family reported with this disorder. Our data support the hypothesis that autosomal dominant Müller cell dystrophy is a distinct retinal dystrophy affecting Müller cells. Mutations in transthyretin gene may manifest as a predominantly retinal disorder.
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Affiliation(s)
- José Dalma-Weiszhausz
- Dr. Alejandro Dalma y Asociados, SC Mexico City, Mexico
- Retina Department, Asociación para Evitar la Ceguera en México, Mexico City, Mexico
| | - Oscar Chacón-Camacho
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | | | - Juan C Zenteno
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Biochemistry Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico; and
| | - Valentina Franco-Cárdenas
- Dr. Alejandro Dalma y Asociados, SC Mexico City, Mexico
- Retina Department, Asociación para Evitar la Ceguera en México, Mexico City, Mexico
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
- Biochemistry Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico; and
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de México Campus Oaxaca (TECNM/ITO), Oaxaca, Mexico
| | - Leopoldo A García-Montaño
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de México Campus Oaxaca (TECNM/ITO), Oaxaca, Mexico
| | - Jehieli Pérez-Bravo
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Iván A García-Montalvo
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de México Campus Oaxaca (TECNM/ITO), Oaxaca, Mexico
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25
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Astafurov KV, Barkmeier AJ. Angiographic dark choroid in systemic non-hereditary amyloidosis. Am J Ophthalmol Case Rep 2022; 25:101334. [PMID: 35198799 PMCID: PMC8851078 DOI: 10.1016/j.ajoc.2022.101334] [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: 02/08/2021] [Revised: 09/16/2021] [Accepted: 01/20/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose To describe a novel finding of angiographic dark choroid in a patient with systemic non-hereditary amyloidosis. Observation A 43-year old female with systemic light-chain amyloidosis associated with advanced kidney disease presented with metamorphopsia and blurry vision in both eyes of 1 year duration. Examination revealed subretinal yellowish deposits in the central macula and mid-periphery with patchy RPE mottling bilaterally. OCT demonstrated thickened choroid with a widened hyporeflective sub-Bruch's choriocapillaris band. FAF showed hypoautofluorescence of the central maculae with hyperautofluorescence flecks perifoveally. Fluorescein angiography demonstrated normal vascular filling without leakage and peripheral microaneurysms. The FA also revealed a strikingly diminished diffuse lack of choroidal fluorescence throughout all angiographic phases in both eyes which has not been previously described in this condition. Conclusionsand Importance This case demonstrates that patients with systemic amyloidosis may exhibit attenuation of choroidal signal (“dark choroid”) on fluorescein angiography, possibly due to accumulation of amyloid material in the sub-RPE space.
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26
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Li Z, Du K, Chu X, Lv H, Zhang W, Wang Z, Yuan Y, Meng L. TTR Gly83Arg Mutation: Beyond Familial Vitreous Amyloidosis. Front Neurol 2022; 12:821003. [PMID: 35185758 PMCID: PMC8850374 DOI: 10.3389/fneur.2021.821003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Gly83Arg variation is a type of TTR mutation specific to the Chinese population. Patients of hereditary transthyretin amyloidosis (ATTR) with Gly83Arg variation predominantly present with blurred vision and most of these cases are reported by ophthalmologists. There is currently no systematic assessment of extraocular features of ATTR with Gly83Arg variation. METHODS Six patients and two asymptomatic carriers with molecularly confirmed Gly83Arg variation of ATTR from three unrelated families were identified by sequencing the TTR gene. The clinical, electrophysiological, ultrasonic, and pathological data were collected and analyzed. RESULTS This study included six patients and two carriers with TTR Gly83Arg mutation, all of whom came from the Han nationality of China. The average age of onset for the six patients was 39 years, and the course of disease ranged from 5 to 19 years. All the patients started with blurred vision, which was diagnosed as vitreous opacity (VO). Most of the patients developed sensory-motor polyneuropathies over years or even more than a decade (4-15 years) after VO. However, the heterogeneity of peripheral neuropathies among these patients remained large between families. Autonomic impairment also occurred after VO, with varying degrees of abnormalities seen in the associated autonomic assessments. None of the patients had any symptoms of cardiac impairment, but abnormal results were found in examinations. A combined biopsy of the sural nerve and muscle was also performed. Nerve pathology revealed the moderately reduced myelinated nerve fiber density and muscle pathology showed predominant neurogenic impairment accompanied by possible myogenic impairment. CONCLUSIONS This is a detailed account of Gly83Arg mutation-related ATTR, focusing on the extraocular presentations of this special variant in Chinese. Clinical features of this variant are early-onset, ocular involvement predominance, neurological, and cardiac involvement along with the disease, and relatively long survival.
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Affiliation(s)
- Zhenxian Li
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Kang Du
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Xujun Chu
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - He Lv
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Lingchao Meng
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
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27
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Choi KJ, Son KY, Kang SW, Kim D, Choi JO, Kim HJ, Kim JS, Jeon ES, Kim AY, Kang MC, Kim SJ. OCULAR MANIFESTATIONS OF ASP38ALA AND THR59LYS FAMILIAL TRANSTHYRETIN AMYLOIDOSIS. Retina 2022; 42:396-403. [PMID: 34483316 DOI: 10.1097/iae.0000000000003296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the ophthalmic manifestations of familial transthyretin amyloidosis (FTA) mutations, including Asp38Ala and Thr59Lys, which have not been previously reported to have ocular involvement. METHODS This is an observational case series of prospectively collected data of 16 patients with FTA who were taking tafamidis for mild peripheral neuropathy and underwent a comprehensive ophthalmic examination at a single tertiary center, between January 2013 and March 2020. The ocular involvement of each FTA mutation type and the specific manifestations were the main outcome measures. RESULTS Six of 16 patients with FTA manifested ocular involvement. Ocular involvement was noted in two of three patients with Glu89Lys mutations having retinal deposits, retinal hemorrhages, and corneal opacity. Three of nine patients with Asp38Ala mutations and one of two patients with Thr59Lys mutations showed ocular involvement that had not been previously described. The ophthalmic findings included glaucoma, anterior lens capsule opacity, vitreous opacity, and retinal deposits. The decrease in vascular flow due to perivascular cuffing of the amyloid deposits was detected by optical coherence tomography angiography. CONCLUSION The current study newly described that two transthyretin mutation types of FTA, Asp38Ala and Thr59Lys, may manifest with ocular findings such as anterior lens capsule opacity and retinal deposits.
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Affiliation(s)
- Kyung Jun Choi
- Department of Ophthalmology, Samsung Medical Center, School of Medicine, Sungkyunkwan University Seoul, Republic of Korea
| | - Ki Young Son
- Department of Ophthalmology, Samsung Medical Center, School of Medicine, Sungkyunkwan University Seoul, Republic of Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, School of Medicine, Sungkyunkwan University Seoul, Republic of Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jin Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jung Sun Kim
- Department of Pathology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea; and
| | - Eun Seok Jeon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - A Young Kim
- Department of Ophthalmology, Ewha Womans University Medical Center, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Min Chae Kang
- Department of Ophthalmology, Samsung Medical Center, School of Medicine, Sungkyunkwan University Seoul, Republic of Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, School of Medicine, Sungkyunkwan University Seoul, Republic of Korea
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Xu Q, Wang X, Zhang Z, Li J, Liu H, Ji S, Qiao L, Gong C, Feng R, Li S. Case Report: Vitreous Amyloidosis Caused by a TTR Lys55Asn Mutation With Intraoperative Suprachoroidal Hemorrhage. Front Med (Lausanne) 2022; 8:797223. [PMID: 35141244 PMCID: PMC8818993 DOI: 10.3389/fmed.2021.797223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
We report a vitreous amyloidosis patient with white vitreous opacities (footplates) adhering to the posterior lens capsule. A positive Congo-red stain and transthyretin (TTR) Lys55Asn mutation confirmed the diagnosis of vitreous amyloidosis. Optical coherence tomography (OCT) revealed fern-like material adhering to the the posterior pole retinal surface in both eyes. Visual acuity significantly improved after the first vitrectomy, but vitreous opacities recurred 4 years later. The patient appeared to have aggravated sensorimotor neuropathy and severe autonomic dysfunction at the same time. He developed intraoperative suprachoroidal hemorrhage during the second vitrectomy.
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Patil NS, Iqbal MM, Bursztyn LLCD. Conjunctival lymphangiectasia and retinal angiopathy in hereditary transthyretin amyloidosis. Int J Retina Vitreous 2022; 8:4. [PMID: 34991732 PMCID: PMC8734248 DOI: 10.1186/s40942-021-00357-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hereditary transthyretin amyloidosis (ATTR amyloidosis) is a rare condition where a mutation in the transthyretin gene leads to systemic deposition of amyloid. The manifestations and prognosis of ATTR amyloidosis depends on the specific ATTR mutation, with over 100 mutations reported in the literature. The manifestations of many rare forms of ATTR amyloidosis have not been well described, particularly the late-onset ophthalmic findings. Case presentation We present the case of a 43-year-old Caucasian male with a diagnosis of ATTRD18E amyloidosis confirmed by fat pad biopsy. He had diffuse systemic involvement, including cardiovascular, pulmonary, and gastrointestinal symptoms. He also had significant ocular involvement including vitreous opacities, retinal angiopathy, and conjunctival lymphangiectasia. These ocular findings modestly progressed at 2-year follow-up. Discussion The ATTRD18E mutation is a rare variant, with few described cases. To our knowledge, this is the first documented case of ATTRD18E amyloidosis with significant ocular involvement. These ocular findings may serve as a relevant biomarker for severe disease prognosis in ATTRD18E amyloidosis. With improving treatments addressing the systemic symptoms of ATTR amyloidosis, a better understanding of the late-onset ocular symptoms is becoming increasingly relevant.
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Affiliation(s)
- Nikhil S Patil
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Munir M Iqbal
- Department of Ophthalmology, Western University, London, ON, Canada
| | - Lulu L C D Bursztyn
- Department of Ophthalmology, Western University, London, ON, Canada. .,Clinical Neurological Sciences, Western University, London, ON, Canada.
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Adams D, Algalarrondo V, Polydefkis M, Sarswat N, Slama MS, Nativi-Nicolau J. Expert opinion on monitoring symptomatic hereditary transthyretin-mediated amyloidosis and assessment of disease progression. Orphanet J Rare Dis 2021; 16:411. [PMID: 34602081 PMCID: PMC8489116 DOI: 10.1186/s13023-021-01960-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/18/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Hereditary transthyretin-mediated amyloidosis, also known as ATTRv amyloidosis (v for variant), is a rare, autosomal dominant, fatal disease, in which systemic amyloid progressively impairs multiple organs, leading to disability and death. The recent approval of disease-modifying therapies offers the hope of stabilization or eventual reversal of disease progression, and yet highlights a lack of disease-management guidance. A multidisciplinary panel of expert clinicians from France and the US came to consensus on monitoring the disease and identifying progression through a clinical opinion questionnaire, a roundtable meeting, and multiple rounds of feedback. MONITORING DISEASE AND PROGRESSION A multidisciplinary team should monitor ATTRv amyloidosis disease course by assessing potential target organs at baseline and during follow-up for signs and symptoms of somatic and autonomic neuropathy, cardiac dysfunction and restrictive cardiomyopathy, and other manifestations. Variability in penetrance, symptoms, and course of ATTRv amyloidosis requires that all patients, regardless of variant status, undergo regular and standardized assessment in all these categories. Progression in ATTRv amyloidosis may be indicated by: worsening of several existing quantifiable symptoms or signs; the appearance of a new symptom; or the worsening of a single symptom that results in a meaningful functional impairment. CONCLUSIONS We suggest that a multisystem approach to monitoring the signs and symptoms of ATTRv amyloidosis best captures the course of the disease. We hope this work will help form the basis of further, consensus-based guidance for the treatment of ATTRv amyloidosis.
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Affiliation(s)
- David Adams
- Université Paris-Saclay, U1195, INSERM, Le Kremlin Bicêtre, France
- Neurology Department, AP-HP, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Vincent Algalarrondo
- Cardiology Department, CHU Bichat-Claude-Bernard, 46 rue Henri Huchard, 75018, Paris, France
| | - Michael Polydefkis
- Department of Neurology, Johns Hopkins Hospital, 855 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Nitasha Sarswat
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Michel S Slama
- Cardiology Department, CHU Bichat-Claude-Bernard, 46 rue Henri Huchard, 75018, Paris, France
| | - Jose Nativi-Nicolau
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
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31
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Minnella AM, Rissotto R, Antoniazzi E, Di Girolamo M, Luigetti M, Maceroni M, Bacherini D, Falsini B, Rizzo S, Obici L. Ocular Involvement in Hereditary Amyloidosis. Genes (Basel) 2021; 12:955. [PMID: 34206500 PMCID: PMC8304974 DOI: 10.3390/genes12070955] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/06/2021] [Accepted: 06/18/2021] [Indexed: 12/27/2022] Open
Abstract
The term amyloidosis describes a group of rare diseases caused by protein conformation abnormalities resulting in extracellular deposition and accumulation of insoluble fibrillar aggregates. So far, 36 amyloid precursor proteins have been identified, and each one is responsible for a specific disease entity. Transthyretin amyloidosis (ATTRv) is one of the most common forms of systemic and ocular amyloidosis, due to the deposition of transthyretin (TTR), which is a transport protein mainly synthesized in the liver but also in the retinal pigment epithelial cells. ATTRv amyloidosis may be misdiagnosed with several other conditions, resulting in a significant diagnostic delay. Gelsolin and keratoepithelin are other proteins that, when mutated, are responsible for a systemic amyloid disease with significant ocular manifestations that not infrequently appear before systemic involvement. The main signs of ocular amyloid deposition are in the cornea, irido-corneal angle and vitreous, causing complications related to vasculopathy and neuropathy at the local level. This review aims at describing the main biochemical, histopathological and clinical features of systemic amyloidosis associated with eye involvement, with particular emphasis on the inherited forms. We discuss currently available treatments, focusing on ocular involvement and specific ophthalmologic management and highlighting the importance of a prompt treatment for the potential sight-threatening complications derived from amyloid deposition in ocular tissues.
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Affiliation(s)
- Angelo Maria Minnella
- Dipartimento Universitario Testa-Collo Rgani di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (M.M.); (B.F.); (S.R.)
- UOC Oculistica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Roberta Rissotto
- Eye Clinic, San Paolo Hospital, University of Milan, 20142 Milan, Italy
| | - Elena Antoniazzi
- Institute of Ophthalmolgy, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Marco Di Girolamo
- Former Director “Presidio Ambulatoriale per le Amiloidosi Sistemiche” Fatebenefratelli “San Giovanni Calibita” Hospital, 00135 Rome, Italy;
| | - Marco Luigetti
- Fondazione Policlinico A. Gemelli IRCCS. UOC Neurologia, 00168 Rome, Italy;
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Martina Maceroni
- Dipartimento Universitario Testa-Collo Rgani di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (M.M.); (B.F.); (S.R.)
| | - Daniela Bacherini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, 50139 Florence, Italy;
| | - Benedetto Falsini
- Dipartimento Universitario Testa-Collo Rgani di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (M.M.); (B.F.); (S.R.)
- UOC Oculistica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Stanislao Rizzo
- Dipartimento Universitario Testa-Collo Rgani di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (M.M.); (B.F.); (S.R.)
- UOC Oculistica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Laura Obici
- Amyloidosis Research and Treatment Centre, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
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Mano F, Dispenzieri A, Kusaka S, Pavesio C, Khalid H, Keane PA, Pulido JS. ASSOCIATION BETWEEN CHOROIDAL CHARACTERISTICS AND SYSTEMIC SEVERITY IN AMYLOIDOSIS. Retina 2021; 41:1037-1046. [PMID: 32826787 DOI: 10.1097/iae.0000000000002961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aimed to describe the choroidal features of ocular amyloidosis using multimodal imaging, to correlate these findings with systemic involvement, and to propose a choroidal grading system. METHODS Eleven patients with systemic amyloidosis were reviewed retrospectively. Each case was assigned a grade according to the severity of choroidal findings as determined by both enhanced depth imaging optical coherence tomography and indocyanine green angiography. The severity of systemic amyloidosis was then correlated with the choroidal involvement. RESULTS On indocyanine green angiography, all patients exhibited hyperfluorescent spots in the late stage and were classified according to preexisting criteria. On enhanced depth imaging optical coherence tomography, hyperreflective foci were seen in the choriocapillaris and Sattler's layer in Grade 1, partial loss of Sattler's layer was additionally seen in Grade 2, and a dense hyperreflective Haller's layer was seen in Grade 3. Choroidal grading scores were significantly correlated with the systemic severity score (P = 0.0014, Pearson's correlation coefficient; ρ = 0.83). CONCLUSION With ocular amyloidosis, evaluation of choroidal characteristics using multimodal imaging may serve as a biomarker for systemic involvement.
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Affiliation(s)
- Fukutaro Mano
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
- Department of Ophthalmology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | | | - Shunji Kusaka
- Department of Ophthalmology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Carlos Pavesio
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Hagar Khalid
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota; and
- Department of Ophthalmology, Wills Eye Hospital, Jefferson Kimmel Medical School, Philadelphia, Pennsylvania
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Du K, Li F, Wang H, Miao Y, Lv H, Zhang W, Wang Z, Yuan Y, Meng L. Hereditary transthyretin amyloidosis in mainland China: a unicentric retrospective study. Ann Clin Transl Neurol 2021; 8:831-841. [PMID: 33739616 PMCID: PMC8045954 DOI: 10.1002/acn3.51328] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/31/2021] [Accepted: 02/06/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE This study aims to report the genotypes and phenotypes of hereditary transthyretin amyloidosis (ATTR) in a large Chinese cohort, yet the clinical and genetic profiles of ATTR remain elusive in mainland China. METHODS Fifty-four patients with molecularly confirmed ATTR from 39 unrelated families were identified by sequencing the TTR gene. Sural nerve biopsies were performed in 40 of these cases. The clinical and electrophysiological data were retrospectively collected and analyzed. RESULTS The male/female ratio was 42:12. The average age of patients at the onset of the disease was 47.8 ± 13.0 years. The late-onset type occurred in 29 cases (53.7%). Twenty-two probands (56.4%) had a family history with ATTR. The initial symptoms were limb paresthesia in 33 cases (61.1%), autonomic dysfunction in 15 cases (27.8%), and blurred vision in 6 cases (11.1%). A total of 22 different TTR mutations were identified, including Val30Met (25.6%) in 10 families in North China and Ala97Ser in 4 families (10.3%) in South China. Electrophysiological studies revealed general sensorimotor axonal polyneuropathy in 33/44 cases (75.0%), mixed neuropathy with axonal and demyelinating impairment features in 9/44 cases (20.5%) and isolated carpal tunnel syndrome in two cases. Sural nerve biopsies revealed positive Congo red staining in 16/40 cases (40.0%). CONCLUSION Chinese patients with ATTR exhibited heterogeneous TTR genotypes and clinical phenotypes. Val30Met remains the most common mutation type in mainland China.
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Affiliation(s)
- Kang Du
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - Fan Li
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - Hui Wang
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - Yuanfeng Miao
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - He Lv
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - Wei Zhang
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - Zhaoxia Wang
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - Yun Yuan
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - Lingchao Meng
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
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Thiagasorupan P, Barreau E, Gendron G, Frau E, Cauquil C, Adams D, Labetoulle M, Rousseau A. Specific postoperative complications of vitrectomy in hereditary transthyretin amyloidosis. Eur J Ophthalmol 2021; 32:11206721211006569. [PMID: 33781115 DOI: 10.1177/11206721211006569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Vitrectomy may improve visual acuity of hereditary transthyretin amyloidosis (ATTRv) patients presenting with vitreous opacities but is associated with severe complications. The objective of this study is to report visual outcomes, early and late complications of a series of ATTRv patients who underwent vitrectomy in the French ATTRv reference center. METHODS This retrospective, single-center study, included all ATTRv patients who underwent vitrectomy between 2002 and 2017. Data were collected on pre and postoperative best corrected visual acuity (BCVA) and early and late postoperative complications. RESULTS A total of 21 eyes from 15 patients were included. The mean postoperative follow-up was 40 ± 20 months (6-160 months). BCVA increased from 0.7 ± 0.4 LogMAR preoperatively to 0.3 ± 0.4 LogMAR (p = 0.003) at last postoperative visit. During follow-up, all initially glaucomatous eyes worsened, with three eyes (37%) requiring filtering surgery and two eyes (25%) had further vision loss. Among non-glaucomatous patients, four eyes (31%) developed glaucoma with two requiring trabeculectomy and one eye (8%) had further vision loss. Three eyes (three patients) presented with complications of amyloid angiopathy. Three eyes (three patients) experienced recurrence of vitreous deposits requiring surgical revision. CONCLUSION Due to the potential complications, vitrectomy in ATTRv requires specific perioperative management and life-long postoperative monitoring.
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Affiliation(s)
- Pathma Thiagasorupan
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
| | - Emmanuel Barreau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
| | - Gaël Gendron
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
- Department of Ophthalmology, Centre Hospitalier National Ophtalmologique des XV-XX, Paris, France
| | - Eric Frau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
- Centre Ophtalmologique Saint-Sulpice, Paris, France
| | - Cécile Cauquil
- Department of Neurology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), Le Kremlin-Bicêtre, France
| | - David Adams
- Department of Neurology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), Le Kremlin-Bicêtre, France
| | - Marc Labetoulle
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
| | - Antoine Rousseau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
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Marques JH, Malheiro L, Malheiro J, Oliveira L, Menéres MJ, Beirão JM. Pupillometry: An objective test to assess endocular hereditary transthyretin amyloidosis. Eur J Ophthalmol 2021; 32:637-642. [PMID: 33601896 DOI: 10.1177/1120672121997294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To automatically study the pupillary light reflex in patients with hereditary transthyretin-associated amyloidosis (hATTR). METHODS Prospective cross-sectional observational study in patients with hATTR with unilateral scalloped iris. Pupillary light reflex of scalloped iris eyes (21 eyes) were compared with non-scalloped iris eyes (21 eyes, paired eyes of the same patients) and also with a control group of 20 healthy eyes, using static and dynamic pupillometry with the Metrovision® MonPack One. RESULTS No patient presented evident neurological involvment of the cranial nerves. No significant differences were found in the pupillary diameters under standardized lighting conditions (static pupillometry) among groups. In dynamic pupillometry, the amplitude of contraction, the velocity of contraction and the velocity of dilation were statistically significantly lower in eyes with scalloped iris, comparing both with the contralateral non-scalloped iris eyes (p < 0.001 for all) and with eyes from healthy subjects (p < 0.05 for all). CONCLUSION A scalloped iris reflects a more advanced endocular hATTR and it is associated with an altered pupillary light reflex. Pupillometry may be a quick, simple, and portable test to objectively evaluate ocular amyloid deposition in hATTR eyes. Pupillary light reflex may not be reliable to evaluate neurological dysfunction in these patients.
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Affiliation(s)
- João Heitor Marques
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Luísa Malheiro
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jorge Malheiro
- Nephrology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Luís Oliveira
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Maria João Menéres
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Melo Beirão
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Hu WF, Yoon MK, Wolkow N. Slowly Progressive Unilateral Blepharoptosis in a 37-Year-Old Woman. JAMA Ophthalmol 2021; 138:704-705. [PMID: 32324201 DOI: 10.1001/jamaophthalmol.2020.0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Wen Fan Hu
- Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Michael K Yoon
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Natalie Wolkow
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston.,David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston
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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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Kakihara S, Hirano T, Matsuda Y, Takano D, Imai A, Miyahara T, Murata T. Deposits on Retinal Surface Seen on OCT in Ocular Amyloidosis. Ophthalmol Retina 2021; 5:1005-1008. [PMID: 33422693 DOI: 10.1016/j.oret.2020.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/26/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the tomographic features in patients with hereditary amyloidosis transthyretin (hATTR). DESIGN Retrospective case series and analysis of B-scan OCT images. PARTICIPANTS A total of 120 patients (240 eyes) diagnosed with hATTR. METHODS We performed a retrospective review of the treatment history and retrospective analysis of the OCT images of patients with hATTR. The parameters analyzed were the age at which the last OCT was performed, presence of ocular amyloidosis, history of pars plana vitrectomy (PPV), systemic treatment, and genetic mutations. Two independent evaluators evaluated the OCT images for characteristic needle-shaped pattern deposits on the retinal surface, and a third evaluator resolved any differences in their evaluations. MAIN OUTCOME MEASURES The frequency of characteristic needle-shaped deposits on the retinal surface seen on OCT. RESULTS The mean age at the time of the last OCT was 56.5 ± 14.9 years. Ninety-nine patients had gene encoding transthyretin (TTR) with the Val30Met mutation, and 21 patients had other mutations. Of 240 eyes, 128 had signs of ocular amyloidosis. Fifty of 73 eyes (68.5%) with a history of PPV for vitreous opacities exhibited characteristic deposits on OCT. Four of 31 eyes with vitreous opacity but without a history of PPV showed deposits on the retinal surface. No eyes without a history of vitreous opacities revealed the characteristic needle-shaped deposits. CONCLUSIONS Characteristic needle-shaped deposits on the retinal surface seen on OCT are significant because they are seen in most of the vitrectomized eyes presenting with ocular amyloidosis.
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Affiliation(s)
- Shinji Kakihara
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Takao Hirano
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yorishige Matsuda
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Daiki Takano
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Akira Imai
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Teruyoshi Miyahara
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Park KS, Kim KN, Lee HM, Koo HM, Kim CS. Secondary Open-angle Glaucoma and Vitreous Opacity as Presenting Manifestations of Familial Amyloid Polyneuropathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.11.1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Baerveldt glaucoma drainage implant surgery for secondary glaucoma in patients with transthyretin-related familial amyloid polyneuropathy. Jpn J Ophthalmol 2020; 64:533-538. [DOI: 10.1007/s10384-020-00753-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 05/14/2020] [Indexed: 01/10/2023]
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Colombat M, Aldigier JC, Rothschild PR, Javaugue V, Desport E, Frouget T, Goujon JM, Rioux-Leclercq N, Quellard N, Rerolle JP, Paraf F, Beugnet C, Tiple A, Durrbach A, Samuel D, Brézin A, Bridoux F, Valleix S. New clinical forms of hereditary apoA-I amyloidosis entail both glomerular and retinal amyloidosis. Kidney Int 2020; 98:195-208. [PMID: 32571483 DOI: 10.1016/j.kint.2020.03.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/01/2020] [Accepted: 03/16/2020] [Indexed: 12/19/2022]
Abstract
Apolipoprotein A1 amyloidosis (ApoAI) results from specific mutations in the APOA1 gene causing abnormal accumulation of amyloid fibrils in diverse tissues. The kidney is a prominent target tissue in ApoAI amyloidosis with a remarkable selectivity for the renal medulla. Here, we investigated six French families with ApoAI Glu34Lys, p.His179Profs∗47, and a novel p.Thr185Alafs∗41 variant revealing unprecedented clinical association of a glomerular with a retinal disease. Comprehensive clinicopathological, molecular and proteomics studies of numerous affected tissues ensured the correlation between clinical manifestations, including novel unrecognized phenotypes, and apoA-I amyloid deposition. These ophthalmic manifestations stemmed from apoA-I amyloid deposition, highlighting that the retina is a previously unrecognized tissue affected by ApoAI amyloidosis. Our study provides the first molecular evidence that a significant fraction of ApoAI amyloidosis cases with no family history result from spontaneous neomutations rather than variable disease penetrance. Finally, successful hepatorenal transplantation resulted in a life- and vision-saving measure for a 32-year-old man with a hitherto unreported severe ApoAI amyloidosis caused by the very rare Glu34Lys variant. Our findings reveal new modes of occurrence and expand the clinical spectrum of ApoAI amyloidosis. The awareness of glomerular and ocular manifestations in ApoAI amyloidosis should enable earlier diagnosis and avoid misdiagnosis with other forms of renal amyloidosis. Thus, documented apoA-I amyloid deposition in the retina offers new biological information about this disease and may change organ transplantation practice to reduce retinal damage in patients with ApoAI amyloidosis.
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Affiliation(s)
- Magali Colombat
- Service d'Anatomopathologie, Institut Universitaire du Cancer Toulouse Oncopole, Centre Hospitalo-Universitaire Toulouse, Toulouse, France
| | - Jean-Claude Aldigier
- Service de Néphrologie et de transplantation rénale, Centre Hospitalo-Universitaire Dupuytren, Limoges, France
| | - Pierre-Raphael Rothschild
- Service d'Ophtalmologie, OphtalmoPôle, Hôpital Cochin, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Javaugue
- Service de Néphrologie, Hémodialyse et Transplantation Rénale, Centre Hospitalo-Universitaire Poitiers, Poitiers, France
| | - Estelle Desport
- Service de Néphrologie, Hémodialyse et Transplantation Rénale, Centre Hospitalo-Universitaire Poitiers, Poitiers, France
| | - Thierry Frouget
- Service de Néphrologie, Centre Hospitalo-Universitaire Pontchaillou, Rennes, France
| | - Jean-Michel Goujon
- Service d'Anatomie Pathologique, Unité de microscopie électronique, Centre Hospitalo-Universitaire La Miletrie, Centre de Référence National Amylose AL et autres maladies de dépôts d'immunoglobulines monoclonales, Université de Poitiers, Poitiers, France
| | - Nathalie Rioux-Leclercq
- Laboratoire d'Anatomopathologie, Centre Hospitalo-Universitaire Pontchaillou, Rennes, France
| | - Nathalie Quellard
- Service d'Anatomie Pathologique, Unité de microscopie électronique, Centre Hospitalo-Universitaire La Miletrie, Centre de Référence National Amylose AL et autres maladies de dépôts d'immunoglobulines monoclonales, Université de Poitiers, Poitiers, France
| | - Jean Philippe Rerolle
- Service de Néphrologie et de transplantation rénale, Centre Hospitalo-Universitaire Dupuytren, Limoges, France
| | - François Paraf
- Laboratoire d'anatomopathologie, Centre Hospitalo-Universitaire Dupuytren, Limoges, France
| | - Caroline Beugnet
- Laboratoire de Génétique Moléculaire, Fédération de Génétique, Hôpital Necker-Enfants Malades, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélien Tiple
- Service de Néphrologie et Transplantation, Centre Hospitalier Jacques Lacarin de Vichy, Vichy, France
| | - Antoine Durrbach
- Service de Néphrologie, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Didier Samuel
- Centre hépato-biliare, Hôpital Paul Brousse, Assistance Publique Hôpitaux de Paris, Villejuif, France
| | - Antoine Brézin
- Service d'Ophtalmologie, OphtalmoPôle, Hôpital Cochin, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frank Bridoux
- Service de Néphrologie, Hémodialyse et Transplantation Rénale, Centre Hospitalo-Universitaire Poitiers, Poitiers, France
| | - Sophie Valleix
- Laboratoire de Génétique Moléculaire, Fédération de Génétique, Hôpital Necker-Enfants Malades, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Coppock JD, Dusenbery AC, Elghawy O, Fellenstein LA, Frierson HF, Shildkrot Y. Cytodiagnosis and protein typing of amyloid from a vitreous washing: initial diagnostic workup of hereditary amyloidosis. J Am Soc Cytopathol 2020; 9:173-176. [PMID: 32113804 DOI: 10.1016/j.jasc.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 11/24/2022]
Abstract
Hereditary amyloidosis is a challenging but critical diagnosis, with serious implications with regard to treatment and disease surveillance for both patients and their families. Systemic symptomology is often vague. As vitreous amyloid deposition is strongly linked to the systemic, hereditary disease, its cytodiagnosis in the vitreous may be the incipient finding of hereditary amyloidosis. We describe a 64-year-old man with a history of heart disease and peripheral neuropathy who presented with asymmetric visual disturbances and vitreous opacities, leading to diagnostic vitrectomy. Amyloid was identified on a ThinPrep slide of the vitreous sample via Congo red stain. Creation of a cell block from the residual ThinPrep sample allowed for amyloid protein typing, identifying ATTR (transthyretin)-type amyloid and strongly suggesting hereditary amyloidosis. Subsequent sequencing of the patient's TTR gene identified a pathogenic variant that is associated with autosomal dominant hereditary transthyretin-mediated amyloidosis.
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Affiliation(s)
- Joseph D Coppock
- Department of Pathology, University of Virginia, Charlottesville, Virginia.
| | - Anna C Dusenbery
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Omar Elghawy
- School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Lynn A Fellenstein
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Henry F Frierson
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Yevgeniy Shildkrot
- Department of Ophthalmology, University of Virginia, Charlottesville, Virginia
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Bunod R, Adams D, Cauquil C, Francou B, Labeyrie C, Bourenane H, Adam C, Algalarrondo V, Slama M, Darce-Bello M, Barreau E, Labetoulle M, Rousseau A. Conjunctival lymphangiectasia as a biomarker of severe systemic disease in Ser77Tyr hereditary transthyretin amyloidosis. Br J Ophthalmol 2020; 104:1363-1367. [PMID: 31949094 DOI: 10.1136/bjophthalmol-2019-315381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/10/2019] [Accepted: 12/26/2019] [Indexed: 12/12/2022]
Abstract
AIMS To investigate the relationship between the ophthalmic and systemic phenotypes in patients with hereditary transthyretin amyloidosis with the S77Y mutation (ATTRS77Y). METHODS In this cross-sectional study, patients with genetically confirmed ATTRS77Y amyloidosis were enrolled. All patients underwent complete neurological examination, including staging with the Neuropathy Impairment Score (NIS), Polyneuropathy Disability (PND) score; complete cardiological evaluation, including echocardiography, cardiac MRI and/or cardiac scintigraphy and complete ophthalmic evaluation, including slit lamp examination and fundus examination. Ocular ancillary tests (fluorescein and indocyanine green angiography, and anterior segment optical coherence tomography) were performed in cases with abnormal findings. The Kruskal-Wallis test was used for quantitative outcomes and Fisher's exact test for qualitative outcomes. Statistical significance was indicated by p<0.05 (two tailed). RESULTS The study sample was composed of 24 ATTRS77Y patients. The mean patient age was 58.4±12.4 years. None of the patients presented with amyloid deposits in the anterior chamber, secondary glaucoma or vitreous amyloidosis. Retinal angiopathy was observed in four patients, complicated with retinal ischaemia in one patient. Conjunctival lymphangiectasia (CL) was detected in 13 patients (54%), associated with perilymphatic amyloid deposits. The presence of CL was statistically associated with more severe neurological disease (NIS=43.3±31.9 vs 18.9±20.4; PND=2.6±1.0 vs 1.4±0.7 in patients with and without CL, respectively; both p<0.05) and amyloid cardiomyopathy (p=0.002). CONCLUSION In ATTRS77Y patients, CL is common and could serve as a potential biomarker for severe systemic disease. There were neither anterior chamber deposits, secondary glaucoma nor vitreous deposits in ATTRS77Y patients.
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Affiliation(s)
- Roxane Bunod
- Ophhalmology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - David Adams
- Neurology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Cécile Cauquil
- Neurology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Bruno Francou
- Molecular Biology and Genetics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Céline Labeyrie
- Neurology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Halima Bourenane
- Neurology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Clovis Adam
- Pathology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Vincent Algalarrondo
- Cardiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Diderot University, French Reference Center for FAP (NNERF), Paris, France
| | - Michel Slama
- Cardiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Diderot University, French Reference Center for FAP (NNERF), Paris, France
| | - Martha Darce-Bello
- Plateforme d'expertise Maladies Rares, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Emmanuel Barreau
- Ophhalmology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Marc Labetoulle
- Ophhalmology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Antoine Rousseau
- Ophhalmology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
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Dammacco R, Merlini G, Lisch W, Kivelä TT, Giancipoli E, Vacca A, Dammacco F. Amyloidosis and Ocular Involvement: an Overview. Semin Ophthalmol 2019; 35:7-26. [PMID: 31829761 DOI: 10.1080/08820538.2019.1687738] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose: To describe the ophthalmic manifestations of amyloidosis and the corresponding therapeutic measures.Methods: The 178 patients included in the study had different types of amyloidosis, diagnosed at a single internal medicine institution (Bari, Italy). To provide a comprehensive review of the types of amyloidosis that can be associated with ocular involvement, the images and clinical descriptions of patients with amyloidosis structurally related to gelsolin, keratoepithelin and lactoferrin were obtained in collaborations with the ophthalmology departments of hospitals in Mainz (Germany) and Helsinki (Finland).Results: Overall, ocular morbidity was detected in 41 of the 178 patients with amyloidosis (23%). AL amyloidosis was diagnosed in 18 patients with systemic disease, 3 with multiple myeloma, and 11 with localized amyloidosis. AA amyloidosis was detected in 2 patients with rheumatoid arthritis and 3 with Behçet syndrome, and transthyretin amyloidosis in 4 patients. The treatment of AL amyloidosis is based on chemotherapy to suppress the production of amyloidogenic L-chains and on surgical excision of orbital or conjunctival masses. AA amyloidosis is managed by targeting the underlying condition. Vitreous opacities and additional findings of ocular involvement in patients with transthyretin amyloidosis indicate the need for pars plana vitrectomy. Gelsolin amyloidosis, characterized by lattice corneal amyloidosis and polyneuropathy, results in recurrent keratitis and corneal scarring, such that keratoplasty is inevitable. In patients with lattice corneal dystrophies associated with amyloid deposits of keratoepithelin fragments, corneal transparency is compromised by deposits of congophilic material in the subepithelial layer and deep corneal stroma. Patients with established corneal opacities are treated by corneal transplantation, but the prognosis is poor because recurrent corneal deposits are possible after surgery. In patients with gelatinous drop-like dystrophy, the amyloid fibrils that accumulate beneath the corneal epithelium consist of lactoferrin and can severely impair visual acuity. Keratoplasty and its variants are performed for visual rehabilitation.Conclusion: A routine ophthalmic follow-up is recommended for all patients with established or suspected amyloidosis, independent of the biochemical type of the amyloid. Close collaboration between the ophthalmologist and the internist will facilitate a more precise diagnosis of ocular involvement in amyloidosis and allow the multidisciplinary management of these patients.Abbreviations: CD: corneal dystrophy; CLA: corneal lattice amyloidosis; CNS: central nervous system; CT: computed tomography; FAP: familial amyloidotic polyneuropathy; GDLCD: gelatinous drop-like corneal dystrophy; GLN: gelsolin; LCD: lattice corneal dystrophy; MRI: magnetic resonance imaging; OLT: orthotopic liver transplantation; TEM: transmission electron microscopy; TGFBI: transforming growth factor β induced; TTR: transthyretin.
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Affiliation(s)
- Rosanna Dammacco
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Walter Lisch
- Department of Ophthalmology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tero T Kivelä
- Department of Ophthalmology, University of Helsinki, Helsinki, Finland.,Helsinki University Central Hospital, Helsinki, Finland
| | - Ermete Giancipoli
- Department of Biomedical Sciences, Ophthalmology Unit, University of Sassari, Sassari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
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Affiliation(s)
- Shanshan Yu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guandong Province, PR China
| | - Yue Xu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guandong Province, PR China
| | - Xiaoling Liang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guandong Province, PR China
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De Lillo A, De Angelis F, Di Girolamo M, Luigetti M, Frusconi S, Manfellotto D, Fuciarelli M, Polimanti R. Phenome-wide association study of TTR and RBP4 genes in 361,194 individuals reveals novel insights in the genetics of hereditary and wildtype transthyretin amyloidoses. Hum Genet 2019; 138:1331-1340. [DOI: 10.1007/s00439-019-02078-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/22/2019] [Indexed: 12/30/2022]
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Manolis AS, Manolis AA, Manolis TA, Melita H. Cardiac amyloidosis: An underdiagnosed/underappreciated disease. Eur J Intern Med 2019; 67:1-13. [PMID: 31375251 DOI: 10.1016/j.ejim.2019.07.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022]
Abstract
Cardiac amyloidosis or amyloid cardiomyopathy (ACM), commonly resulting from extracellular deposition of amyloid fibrils consisted of misfolded immunoglobulin light chain (AL) or transthyretin (TTR) protein, is an underestimated cause of heart failure and cardiac arrhythmias. Among the three types of cardiac amyloidosis (wild-type or familial TTR and light-chain), the wild-type (Wt) TTR-related amyloidosis (ATTR) is an increasingly recognized cause of heart failure with preserved ejection fraction (HFpEF), and amyloidosis should be considered in the differential diagnosis of this heart failure group of patients. Recent advances in the diagnosis and drug treatment of ACM have ushered in a new era in early disease detection and better management of these patients. Certain clues in cardiac and extracardiac manifestations of ACM may heighten clinical suspicion and guide further confirmatory testing. Newer noninvasive imaging methods (strain echocardiography, cardiac magnetic resonance and bone scintigraphy) may obviate the need for endomyocardial biopsy in ATTR patients, while newer targeted therapies may alter the adverse prognosis in these patients. Early recognition of ACM is crucial in halting the disease process before irreversible organ damage occurs. Chemotherapy and stem-cell transplantation combined with immunomodulatory therapy may also favorably affect the course and prognosis of light chain ACM. Finally, in select patients with end-stage disease, heart transplantation may render results comparable to non-ACM patients. All these issues are herein reviewed.
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Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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Hayek S, Adam C, Adams D, Cauquil C, Barreau E, Guiochon-Mantel A, Labetoulle M, Rousseau A. Conjunctival lymphangiectasia: a novel ocular manifestation of hereditary transthyretin amyloidosis. Amyloid 2019; 26:94-95. [PMID: 31074309 DOI: 10.1080/13506129.2019.1594760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Stéphanie Hayek
- a Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, DHU Vision & Handicaps, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), French Reference Network for Rare Ophthalmic Diseases (OPHTARA) , Paris-Sud University , Le Kremlin-Bicêtre , France
| | - Clovis Adam
- b Department of Pathology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, French Reference Center for Familial Amyloid Polyneuropathies (NNERF) , Paris-Sud University , Le Kremlin-Bicêtre , France
| | - David Adams
- c Department of Neurology, Bicêtre Hospital, APHP, INSERM U 1195, French Reference Center for FAP (NNERF) , Paris-Sud University , Le Kremlin-Bicêtre , France
| | - Cécile Cauquil
- c Department of Neurology, Bicêtre Hospital, APHP, INSERM U 1195, French Reference Center for FAP (NNERF) , Paris-Sud University , Le Kremlin-Bicêtre , France
| | - Emmanuel Barreau
- a Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, DHU Vision & Handicaps, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), French Reference Network for Rare Ophthalmic Diseases (OPHTARA) , Paris-Sud University , Le Kremlin-Bicêtre , France
| | - Anne Guiochon-Mantel
- d Department of Molecular Genetics, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, French Reference Center for Familial Amyloid Polyneuropathies (NNERF) , Paris-Sud University , Le Kremlin-Bicêtre , France
| | - Marc Labetoulle
- a Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, DHU Vision & Handicaps, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), French Reference Network for Rare Ophthalmic Diseases (OPHTARA) , Paris-Sud University , Le Kremlin-Bicêtre , France
| | - Antoine Rousseau
- a Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, DHU Vision & Handicaps, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), French Reference Network for Rare Ophthalmic Diseases (OPHTARA) , Paris-Sud University , Le Kremlin-Bicêtre , France
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50
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Finsterer J, Iglseder S, Wanschitz J, Topakian R, Löscher WN, Grisold W. Hereditary transthyretin-related amyloidosis. Acta Neurol Scand 2019; 139:92-105. [PMID: 30295933 DOI: 10.1111/ane.13035] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/09/2018] [Accepted: 09/04/2018] [Indexed: 12/15/2022]
Abstract
Hereditary transthyretin(TTR)-related amyloidosis (ATTRm amyloidosis) is an endemic/non-endemic, autosomal-dominant, early- and late-onset, rare, progressive disorder, predominantly manifesting as length-dependent, small fiber dominant, axonal polyneuropathy and frequently associated with cardiac disorders and other multisystem diseases. ATTRm amyloidosis is due to variants in the TTR gene, with the substitution Val30Met as the most frequent mutation. TTR mutations lead to destabilization and dissociation of TTR tetramers into variant TTR monomers, and formation of amyloid fibrils, which are consecutively deposited extracellularly in various tissues, such as nerves, heart, brain, eyes, intestines, kidneys, or the skin. Neuropathy may not only include large nerve fibers but also small fibers, and not only sensory and motor fibers but also autonomic fibers. Types of TTR variants, age at onset, penetrance, and clinical presentation vary between geographical areas. Suggestive of a ATTRm amyloidosis are a sensorimotor polyneuropathy, positive family history, autonomic dysfunction, cardiomyopathy, carpal tunnel syndrome, unexplained weight loss, and resistance to immunotherapy. If only sensory A-delta or C fibers are affected, small fiber neuropathy ensues. Diagnostic tests for small fiber neuropathy include determination of intraepidermal nerve fiber density, laser-evoked potentials, heat- and cold-detection thresholds, and measurement of the electrochemical skin conductance. Therapy currently relies on liver transplantation and TTR-stabilizers (tafamidis, diflunisal).
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Affiliation(s)
| | | | - Julia Wanschitz
- Department of Neurology; Medical University Innsbruck; Innsbruck Austria
| | - Raffi Topakian
- Department of Neurology; Klinikum Wels-Grieskirchen; Wels Austria
| | | | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental und Clinical Traumatology; Vienna Austria
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