1
|
Fernandes F, Luzuriaga GDCJ, da Fonseca GWP, Correia EB, Carvalho AAS, Macedo AVS, Coelho-Filho OR, Scheinberg P, Antunes MO, Schwartzmann PV, Mangini S, Marques W, Simões MV. Clinical and genetic profiles of patients with hereditary and wild-type transthyretin amyloidosis: the Transthyretin Cardiac Amyloidosis Registry in the state of São Paulo, Brazil (REACT-SP). Orphanet J Rare Dis 2024; 19:273. [PMID: 39033298 PMCID: PMC11264909 DOI: 10.1186/s13023-024-03281-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/03/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Transthyretin amyloidosis (ATTR) is a multisystem disease caused by the deposition of fibrillar protein in organs and tissues. ATTR genotypes and phenotypes are highly heterogeneous. We present data on physical signs and symptoms, cardiac and neurological assessments and genetic profile of patients enrolled in the Transthyretin Cardiac Amyloidosis Registry of the State of São Paulo, Brazil. RESULTS Six hundred-forty-four patients were enrolled, 505 with the variant form (ATTRv) and 139 with wild-type (ATTRwt). Eleven different mutations were detected, the most common being Val50Met (47.5%) and V142Ile (39.2%). Overall, more than half of the patients presented cardiac involvement, and the difference in this proportion between the ATTRv and ATTRwt groups was significant (43.9 vs. 89.9%; p < 0.001). The prevalence of the neurological phenotype also differed between ATTRv and ATTRwt (56.8 vs. 31.7%; p < 0.001). The mixed phenotype was found in 25.6% of the population, without a significant difference between ATTRv and ATTRwt groups. A group of patients remained asymptomatic (10.4%), with a lower proportion of asymptomatic ATTRwt patients. CONCLUSIONS This study details the clinical and genetic spectrum of patients with ATTR in São Paulo, Brazil. This preliminary analysis highlights the considerable phenotypic heterogeneity of neurological and cardiac manifestations in patients with variant and wild-type ATTR.
Collapse
Affiliation(s)
- Fábio Fernandes
- Academic Research Organization, Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
- Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | | | - Guilherme Wesley Peixoto da Fonseca
- Academic Research Organization, Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Wilson Marques
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Marcus Vinicius Simões
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
| |
Collapse
|
2
|
Plantone D, Primiano G, Righi D, Romano A, Luigetti M, De Stefano N. Current Evidence Supporting the Role of Immune Response in ATTRv Amyloidosis. Cells 2023; 12:2383. [PMID: 37830598 PMCID: PMC10572348 DOI: 10.3390/cells12192383] [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: 08/16/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
Hereditary transthyretin (ATTRv) amyloidosis with polyneuropathy, also known as familial amyloid polyneuropathy (FAP), represents a progressive, heterogeneous, severe, and multisystemic disease caused by pathogenic variants in the TTR gene. This autosomal-dominant neurogenetic disorder has an adult onset with variable penetrance and an inconstant phenotype, even among subjects carrying the same mutation. Historically, ATTRv amyloidosis has been viewed as a non-inflammatory disease, mainly due to the absence of any mononuclear cell infiltration in ex vivo tissues; nevertheless, a role of inflammation in its pathogenesis has been recently highlighted. The immune response may be involved in the development and progression of the disease. Fibrillary TTR species bind to the receptor for advanced glycation end products (RAGE), probably activating the nuclear factor κB (NF-κB) pathway. Moreover, peripheral blood levels of several cytokines, including interferon (IFN)-gamma, IFN-alpha, IL-6, IL-7, and IL-33, are altered in the course of the disease. This review summarizes the current evidence supporting the role of the immune response in ATTRv amyloidosis, from the pathological mechanisms to the possible therapeutic implications.
Collapse
Affiliation(s)
- Domenico Plantone
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (D.R.); (N.D.S.)
| | - Guido Primiano
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (A.R.); (M.L.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Delia Righi
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (D.R.); (N.D.S.)
| | - Angela Romano
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (A.R.); (M.L.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marco Luigetti
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (A.R.); (M.L.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (D.R.); (N.D.S.)
| |
Collapse
|
3
|
Tozza S, Severi D, Palumbo G, Provitera V, Ruggiero L, Dubbioso R, Iodice R, Nolano M, Manganelli F. Quantitative Sensory Testing in Late-Onset ATTRv Presymptomatic Subjects: A Single Center Experience. Biomedicines 2022; 10:2877. [PMID: 36359398 PMCID: PMC9687694 DOI: 10.3390/biomedicines10112877] [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: 10/19/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2023] Open
Abstract
Backgrounds Hereditary transthyretin amyloidosis (ATTRv) presymptomatic subjects undergo multidisciplinary evaluation to detect, as early as possible, a subclinical involvement of multisystem disease. Quantitative sensory testing (QST) that investigates and discriminates the function of C, Aδ and Aβ fibers is included as an instrumental test to monitor nerve fiber function. The purpose of this study was to evaluate the role of QST in the context of the multidisciplinary evaluation in late onset carriers. Methods Four-teen presymptomatic (namely carriers) were enrolled. Subjects underwent thermal [cold and warm detection threshold (CDT, WDT), cold and heat pain (CP and HP)] and tactile QST in four body sites: foot dorsum, distal lateral leg, distal thigh, hand dorsum. Results Overall, presymptomatic subject showed a significant difference in all thermal QST findings compared to the control group. All subjects had at least one altered thermal QST finding; the sites more frequently altered were foot and leg, whilst the thermal modalities which were more frequently abnormal were CDT, WDT and CP. Conclusions Our study highlights the importance of performing thermal QST in subjects carrying TTR mutation, given the high frequency of abnormal findings. Notably, performing both innocuous and painful stimulation in foot and/or leg increases the chance of detecting nerve fiber dysfunction. Moreover, the investigation of the hand may provide useful information in monitoring disease progression before the Predicted Age of Disease Onset (PADO).
Collapse
Affiliation(s)
- Stefano Tozza
- Department of Neuroscience, Reproductive Science and Odonstomatology, University “Federico II”, 80131 Naples, Italy
| | - Daniele Severi
- Department of Neuroscience, Reproductive Science and Odonstomatology, University “Federico II”, 80131 Naples, Italy
| | - Giovanni Palumbo
- Department of Neuroscience, Reproductive Science and Odonstomatology, University “Federico II”, 80131 Naples, Italy
| | - Vincenzo Provitera
- Neurology Department, Skin Biopsy Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, 82037 Telese Terme, Italy
| | - Lucia Ruggiero
- Department of Neuroscience, Reproductive Science and Odonstomatology, University “Federico II”, 80131 Naples, Italy
| | - Raffaele Dubbioso
- Department of Neuroscience, Reproductive Science and Odonstomatology, University “Federico II”, 80131 Naples, Italy
| | - Rosa Iodice
- Department of Neuroscience, Reproductive Science and Odonstomatology, University “Federico II”, 80131 Naples, Italy
| | - Maria Nolano
- Department of Neuroscience, Reproductive Science and Odonstomatology, University “Federico II”, 80131 Naples, Italy
- Neurology Department, Skin Biopsy Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, 82037 Telese Terme, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Science and Odonstomatology, University “Federico II”, 80131 Naples, Italy
| |
Collapse
|
4
|
Karadagi A, Romano A, Renneus Guthrie V, Kjaernet F, Ericzon BG, Nowak G. Effects of a Domino Liver Transplantation Program on Patient Survival and Waiting List Time: A Single-Center Retrospective Study. Transplant Proc 2021; 53:2983-2992. [PMID: 34749995 DOI: 10.1016/j.transproceed.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/22/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
Explanted livers from patients with familial amyloid polyneuropathy have often been used for domino liver transplantation (DLT). This has expanded the organ pool for liver transplantation. We evaluated the effects of a single-center DLT program on waiting list duration and patient survival. Liver transplants conducted from 2007 to 2017 were analyzed. Selected patients, all liver transplant candidates above the age of 60 years and patients with hepatocellular carcinoma, were offered DLT. Survival, time on waiting list, and operative factors were evaluated. The study group included 485 patients transplanted with grafts from deceased donors (conventional liver transplantation) and 149 patients who were offered and accepted a potential DLT, of whom 34 underwent DLT and 115 did not; these patients received a deceased donor graft (non-DLT). Five-year and overall estimated survival rates respectively were 79% and 54.4% for DLT and 67.6% and 46.7% for non-DLT (P = .67, log rank test). No differences were noted in survival (P = .816) or waiting times (P = 1.0) between DLT and non-DLT groups. As expected, survival time in the conventional liver transplantation group was longer (84.7% and 60.6%, P < .001). Donor age and ischemia time were significantly different between DLT and non-DLT (P < .001). DLT has enabled 6% additional transplantations without affecting waiting time or survival (34/600).
Collapse
Affiliation(s)
- Ahmad Karadagi
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden; Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
| | - Antonio Romano
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Viktor Renneus Guthrie
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Felicia Kjaernet
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Bo-Göran Ericzon
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden; Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Greg Nowak
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden; Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
5
|
Tozza S, Severi D, Spina E, Iovino A, Aruta F, Ruggiero L, Dubbioso R, Iodice R, Nolano M, Manganelli F. The neuropathy in hereditary transthyretin amyloidosis: A narrative review. J Peripher Nerv Syst 2021; 26:155-159. [PMID: 33960565 PMCID: PMC8360044 DOI: 10.1111/jns.12451] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/26/2021] [Accepted: 05/01/2021] [Indexed: 01/10/2023]
Abstract
Hereditary transthyretin amyloidosis (ATTRv) is a condition with adult onset, caused by mutation of the transthyretin (TTR) gene and characterized by extracellular deposition of amyloid fibrils in tissue, especially in the peripheral nervous system (PNS) and heart. PNS involvement leads to a rapidly progressive and disabling sensory‐motor axonal neuropathy. Although awareness among neurologists increased in recent years thanks to new treatment options, ATTRv is frequently misdiagnosed, and thus a correct diagnosis can be delayed by several years. This review aims to draw the history and features of polyneuropathy in ATTRv based on pathological and electrophysiological correlates. We assessed original articles and case reports based on their relevance to ATTRv neuropathy and we included those appropriate for the scheme of this narrative review. Amyloid fibrils initially deposit in ganglia, causing an axonal neuropathy without amyloid deposits in distal segments (eg, sural nerve biopsy). Over time, amyloid fibrils spread along the nerves, leading to some demyelinating features in the context of severe axonal loss. This review highlights how the features of neuropathy change based on type of ATTRv (early vs late onset) and stage of disease.
Collapse
Affiliation(s)
- Stefano Tozza
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Daniele Severi
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Emanuele Spina
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Aniello Iovino
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Francesco Aruta
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Lucia Ruggiero
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Raffaele Dubbioso
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Rosa Iodice
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Maria Nolano
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| |
Collapse
|
6
|
Yamamoto H, Sugawara Y, Sambommatsu Y, Shimata K, Yoshii D, Isono K, Honda M, Yamashita T, Matsushita S, Inomata Y, Hibi T. Living donor domino liver transplantation in a hepatitis C virus/human immunodeficiency virus-coinfected hemophilia patient: a case report. Surg Case Rep 2020; 6:184. [PMID: 32728812 PMCID: PMC7391454 DOI: 10.1186/s40792-020-00944-4] [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: 05/13/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Outcome of the liver transplantation (LT) is worse in hepatitis C virus (HCV)/human immunodeficiency virus (HIV)-coinfected patients compared to patients infected with HCV alone. We report the world’s first case of living donor domino liver transplantation (LDDLT) using a familial amyloid polyneuropathy (FAP) liver in a coinfected recipient with HCV-related liver cirrhosis. Case presentation The recipient was a 43-year-old male with a CD4 cell count of 52/μL and undetectable HIV-RNA at the time of LT. He received a domino liver graft from a 41-year-old female with FAP. No acute cellular rejection or infection occurred after LT. HCV recurrence was confirmed histologically on the posttransplant day 34. Peginterferon/ribavirin therapy resulted in non-response; however, the patient achieved a sustained viral response with sofosbuvir (SOF)/ledipasvir (LDV). Currently, HCV and HIV testing are negative, and symptomatic de novo amyloidosis has not occurred. Conclusions LDDLT allows successful LT in HCV/HIV-coinfected patients; posttransplant HCV recurrence can be successfully treated with anti-viral therapy.
Collapse
Affiliation(s)
- Hidekazu Yamamoto
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Yasuhiko Sugawara
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuzuru Sambommatsu
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Keita Shimata
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Daiki Yoshii
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kaori Isono
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masaki Honda
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Taro Yamashita
- Department of Neurology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, 860-8556, Japan
| | - Shuzo Matsushita
- Center for AIDS Research, Kumamoto University, Kumamoto, 860-8556, Japan
| | - Yukihiro Inomata
- Department of Surgery, Kumamoto Rosai Hospital, Kumamoto, 866-8533, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| |
Collapse
|
7
|
Current update in domino liver transplantation. Int J Surg 2020; 82S:163-168. [PMID: 32244002 DOI: 10.1016/j.ijsu.2020.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 12/14/2022]
Abstract
Orthotopic liver transplantation is an established treatment for end stage liver diseases as well as for some severe metabolic disorders. With increasing number of patients on the waiting list and the ongoing shortage of livers available, domino liver transplantation (DLT) became an option to further expand the organ donor pool. DLT utilizes the explanted liver of one liver transplant recipient as a donor graft in another patient. Despite being a surgically, and logistically demanding procedure, excellent results could be achieved in experienced high-volume transplant centers. In this review we present the current world status of DLT.
Collapse
|
8
|
Misumi Y, Ueda M, Masuda T, Tsuda Y, Nomura T, Okada M, Inoue Y, Tasaki M, Obayashi K, Yamashita T, Ando Y. Characteristics of acquired transthyretin amyloidosis: A case series and review of the literature. Neurology 2019; 93:e1587-e1596. [PMID: 31511348 DOI: 10.1212/wnl.0000000000008360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/16/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To elucidate the clinical characteristics of acquired ATTR amyloidosis after domino liver transplantation (DLT) with liver grafts explanted from patients with hereditary variant ATTR (ATTRv) amyloidosis. METHODS We evaluated the presence of amyloid deposits and clinical symptoms in 30 recipients of domino liver transplants (24 men and 6 women) who underwent DLT with liver grafts explanted from patients with ATTRv amyloidosis. We analyzed symptoms and measures of 7 cases of symptomatic acquired ATTR amyloidosis and compared those with 30 patients with ATTRv amyloidosis who were the domino liver donors. We also reviewed the literature on case studies of acquired ATTR amyloidosis. RESULTS We found amyloid deposition in 13 of our 30 domino liver recipients. A Kaplan-Meier analysis estimated that the median time from DLT to the first detection of amyloid was 8.5 years. In the literature review, the mean time was 7.3 years, with a wide range of 0.5-13 years. Our 7 symptomatic cases and the literature cases with acquired ATTR amyloidosis presented with clinical features that differed from patients with ATTRv amyloidosis who were the domino liver donors. Patients with acquired ATTR amyloidosis showed markedly milder autonomic disturbance, which is one of the main symptoms of ATTRv amyloidosis. CONCLUSIONS Careful monitoring is required for DLT recipients of ATTRv liver grafts because the time from DLT to disease onset has a wide range and the clinical picture of these DLT recipients is distinct from that of liver donors.
Collapse
Affiliation(s)
- Yohei Misumi
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan.
| | - Mitsuharu Ueda
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Teruaki Masuda
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Yukimoto Tsuda
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Toshiya Nomura
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Masamitsu Okada
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Yasuteru Inoue
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Masayoshi Tasaki
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Konen Obayashi
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Taro Yamashita
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Yukio Ando
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| |
Collapse
|
9
|
Acquired transthyretin amyloidosis after domino liver transplant: Phenotypic correlation, implication of liver retransplantation. J Neurol Sci 2017; 379:192-197. [DOI: 10.1016/j.jns.2017.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/08/2017] [Accepted: 06/12/2017] [Indexed: 12/31/2022]
|
10
|
Lopes RA, Coelho T, Barros A, Sousa M. Corino de Andrade disease: mechanisms and impact on reproduction. JBRA Assist Reprod 2017; 21:105-114. [PMID: 28609277 PMCID: PMC5473703 DOI: 10.5935/1518-0557.20170025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Familial amyloid polyneuropathy was first described by Corino de Andrade in 1952
in Northern Portugal. It is a fatal autosomal dominant neurodegenerative
disorder characterized by a progression of neurologic symptoms, beginning early
in the reproductive life. The Transthyretin gene mutation originates a mutated
protein that precipitates in the connective tissue as amyloid deposits. This
disease is presently named Transthyretin-related hereditary amyloidosis. We
performed an extensive review on this disease based on searches in Medical
databases and in paper references. In this review, we briefly summarize the
epidemiology and the mechanisms involved on amyloid deposition; we detailed how
to evaluate the mechanisms implicated on the development of the major signs and
symptoms associated with reproductive dysfunction; and we discuss the mechanisms
involved in secondary sexual dysfunction after psychological treatments.
Treatment of the disease is directed towards relieving specific symptoms in
association with liver transplant, and molecular and genetic therapeutics.
Although the current clinical trials indicate symptoms relief, no data on the
reproductive function was reported. Thus, preimplantation genetic diagnosis is
presently the only available technique that eradicates the disease as it avoids
the birth of new patients.
Collapse
Affiliation(s)
- Rita A Lopes
- Laboratory of Cell Biology, Department of Microscopy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Portugal
| | - Teresa Coelho
- Department of Neurophysiology, Research Center of Corino de Andrade (Paramyloidosis), Hospital Centre of Porto, Portugal
| | - Alberto Barros
- Centre for Reproductive Genetics Prof. Alberto Barros (CGR), Porto, Portugal.,Department of Genetics - School of Medicine, Institute of Health Research and Innovation, University of Porto
| | - Mário Sousa
- Laboratory of Cell Biology, Department of Microscopy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Portugal
| |
Collapse
|
11
|
Masuda T, Ueda M, Suenaga G, Misumi Y, Tasaki M, Izaki A, Yanagisawa Y, Inoue Y, Motokawa H, Matsumoto S, Mizukami M, Arimura A, Deguchi T, Nishio Y, Yamashita T, Inomata Y, Obayashi K, Ando Y. Early skin denervation in hereditary and iatrogenic transthyretin amyloid neuropathy. Neurology 2017; 88:2192-2197. [DOI: 10.1212/wnl.0000000000004016] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/16/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:To elucidate early skin denervation in hereditary transthyretin (TTR) amyloidosis and iatrogenic TTR amyloidosis.Methods:We investigated intraepidermal nerve fiber density (IENFD) and clinical findings in 32 patients with hereditary TTR amyloidosis, 11 asymptomatic mutation carriers, 6 patients with iatrogenic TTR amyloidosis, and 23 healthy volunteers.Results:IENFD values were reduced in patients with the V30M mutation (1.9 ± 2.1 per 1 mm), patients with non-V30M mutations (5.8 ± 3.2 per 1 mm), and patients with iatrogenic TTR amyloidosis (3.5 ± 1.8 per 1 mm) compared with healthy volunteers (11.8 ± 3.2 per 1 mm) (p < 0.01). Skin denervation also occurred, even in presymptomatic V30M mutation carriers (5.0 ± 2.2 per 1 mm). The IENFD was correlated with disease duration (ρ = −0.533, p = 0.002) and various peripheral neuropathy parameters such as sensory impairment in the Kumamoto clinical score (ρ = −0.575, p = 0.001), heat-pain detection threshold (ρ = −0.704, p < 0.001), and sural sensory nerve action potential (ρ = 0.481, p = 0.005). TTR amyloid deposits frequently occurred in connective tissues and vessels of the dermal reticular layer in patients with hereditary TTR amyloidosis and those with iatrogenic TTR amyloidosis.Conclusions:Patients with hereditary TTR amyloidosis and those with iatrogenic TTR amyloidosis may show early skin denervation even in the presymptomatic stage. IENFD may thus be useful for early diagnosis and may serve as a biomarker in clinical trials for hereditary and iatrogenic TTR amyloidosis.
Collapse
|
12
|
Misumi Y, Oshima T, Ueda M, Yamashita T, Tasaki M, Masuda T, Obayashi K, Ando Y. Occurrence factors and clinical picture of iatrogenic transthyretin amyloidosis after domino liver transplantation. Amyloid 2017; 24:123-124. [PMID: 28434312 DOI: 10.1080/13506129.2017.1278690] [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: 10/19/2022]
Affiliation(s)
- Yohei Misumi
- a Department of Neurology , Graduate School of Medical Sciences , Kumamoto , Japan and
| | - Toshinori Oshima
- a Department of Neurology , Graduate School of Medical Sciences , Kumamoto , Japan and
| | - Mitsuharu Ueda
- a Department of Neurology , Graduate School of Medical Sciences , Kumamoto , Japan and
| | - Taro Yamashita
- a Department of Neurology , Graduate School of Medical Sciences , Kumamoto , Japan and
| | - Masayoshi Tasaki
- a Department of Neurology , Graduate School of Medical Sciences , Kumamoto , Japan and.,b Department of Morphological and Physiological Sciences , Graduate School of Health Sciences, Kumamoto University , Kumamoto , Japan
| | - Teruaki Masuda
- a Department of Neurology , Graduate School of Medical Sciences , Kumamoto , Japan and
| | - Konen Obayashi
- b Department of Morphological and Physiological Sciences , Graduate School of Health Sciences, Kumamoto University , Kumamoto , Japan
| | - Yukio Ando
- a Department of Neurology , Graduate School of Medical Sciences , Kumamoto , Japan and
| |
Collapse
|
13
|
Mnatsakanova D, Živković SA. Iatrogenic amyloid polyneuropathy after domino liver transplantation. World J Hepatol 2017; 9:126-130. [PMID: 28217248 PMCID: PMC5295145 DOI: 10.4254/wjh.v9.i3.126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/04/2016] [Accepted: 12/09/2016] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation has been used in treatment of transthyretin amyloidosis, and some patients undergo domino liver transplantation (DLT) with explanted liver being transplanted to another patient with liver failure as the liver is otherwise usually functionally normal. Until end of 2015, there were 1154 DLT performed worldwide. DLT for transthyretin amyloidosis is associated with the risk of developing de novo systemic amyloidosis and amyloid neuropathy, and the risk may be greater with some non-Val30Met mutations. De novo amyloid neuropathy has been described in up to 23% of transplant recipients. Neuropathy may be preceded by asymptomatic amyloid deposition in various tissues and symptoms of neuropathy started after a median of 7 years following DLT (5.7 ± 3.2 years; range 2 mo to 10 years). Typical initial symptoms include neuropathic pain and sensory loss, while dysautonomia usually starts later. Progression of neuropathy may necessitate liver re-transplantation, and subsequent improvement of neuropathy has been reported in some patients. Explant allograft recipients need close monitoring for signs of systemic amyloidosis, neuropathy and dysautonomia as progressive symptoms may require re-transplantation.
Collapse
|
14
|
Rapidly Progressive Transthyretin-Mediated Amyloidosis in a Domino Liver Transplant Recipient of a Ser23Asn Donor. J Clin Neuromuscul Dis 2016; 17:142-5. [PMID: 26905915 DOI: 10.1097/cnd.0000000000000110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Domino liver transplantation, in which the liver of a patient with transthyretin-mediated amyloidosis is transplanted into another patient, has been an established procedure performed at several centers across the world. The risk of developing systemic amyloidosis in transthyretin-mediated amyloidosis liver transplant recipients is a topic of ongoing investigation. We report a case of rapidly progressive transthyretin amyloidosis in a patient who received a liver from a donor with a rare Ser23Asn mutation. We advise exercising caution when considering domino liver transplantation in patients with this particular mutation.
Collapse
|
15
|
|
16
|
Misumi Y, Narita Y, Oshima T, Ueda M, Yamashita T, Tasaki M, Obayashi K, Isono K, Inomata Y, Ando Y. Recipient aging accelerates acquired transthyretin amyloidosis after domino liver transplantation. Liver Transpl 2016; 22:656-64. [PMID: 26600212 DOI: 10.1002/lt.24371] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 11/02/2015] [Accepted: 11/04/2015] [Indexed: 12/31/2022]
Abstract
Domino liver transplantation (DLT) with liver grafts from patients with hereditary transthyretin (TTR) amyloidosis has been performed throughout the world because of a severe liver graft shortage. Reports of acquired systemic TTR amyloidosis in domino liver recipients have been increasing; however, the precise pathogenesis and clinical course of acquired TTR amyloidosis remains unclear. We analyzed the relationship between the occurrence of acquired amyloidosis and clinical features in 22 consecutive domino liver donors with hereditary TTR amyloidosis (10 males and 12 females; mean age at DLT: 37.2 years; TTR mutations: V30M [n = 19], Y114C [n = 1], L55P [n = 1], and S50I [n = 1]) and 22 liver recipients (16 males and 6 females; mean age at DLT, 46.2 years). The mean times from DLT to amyloid first appearance and transplant recipient symptom onset were 8.2 years and 9.9 years, respectively. Kaplan-Meier analysis and quantification of the amyloid deposition revealed aging of recipients correlated with early de novo amyloid deposition. The sex of donors and recipients and the age, disease duration, and disease severity of donors had no significant effect on the latency of de novo amyloid deposition. In conclusion, our results demonstrate that recipient aging is associated with the early onset de novo amyloidosis. Because acquired amyloidosis will likely increase, careful follow-up for early amyloidosis detection and new treatments, including TTR stabilizers and gene-silencing therapies, are required. Liver Transplantation 22 656-664 2016 AASLD.
Collapse
Affiliation(s)
- Yohei Misumi
- Departments of Neurology, Kumamoto University, Kumamoto, Japan
| | - Yasuko Narita
- Departments of Transplantation and Pediatric Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Mitsuharu Ueda
- Departments of Neurology, Kumamoto University, Kumamoto, Japan
| | - Taro Yamashita
- Departments of Neurology, Kumamoto University, Kumamoto, Japan
| | - Masayoshi Tasaki
- Departments of Neurology, Kumamoto University, Kumamoto, Japan.,Departments of Morphological and Physiological Sciences, Graduate School of Health Sciences, Kumamoto University, Kumamoto, Japan
| | - Konen Obayashi
- Departments of Morphological and Physiological Sciences, Graduate School of Health Sciences, Kumamoto University, Kumamoto, Japan
| | - Kaori Isono
- Departments of Transplantation and Pediatric Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukihiro Inomata
- Departments of Transplantation and Pediatric Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukio Ando
- Departments of Neurology, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
17
|
Yoshinaga T, Yazaki M, Sekijima Y, Kametani F, Miyashita K, Hachiya N, Tanaka T, Kokudo N, Higuchi K, Ikeda SI. The pathological and biochemical identification of possible seed-lesions of transmitted transthyretin amyloidosis after domino liver transplantation. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2016; 2:72-9. [PMID: 27499917 PMCID: PMC4907057 DOI: 10.1002/cjp2.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/16/2015] [Indexed: 11/23/2022]
Abstract
The most serious issue in domino liver transplantation (DLT) using liver grafts from patients with transthyretin (TTR)‐related familial amyloid polyneuropathy (FAP) is the development of iatrogenic transmitted amyloidosis (de novo amyloidosis) in DLT‐recipients. However, little is known regarding the mechanisms of the initial stage of amyloid formation in these recipients. We detected initial lesions (possible seed‐lesions) of this iatrogenic amyloidosis in two recipients following liver grafting from FAP patients. Patient 1 underwent DLT at age 65 from an FAP patient with a Val30Met TTR variant and patient 2 received DLT from an FAP patient with a Val30Leu TTR variant at age 32. Patient 2 was started on diflunisal administration from 4 years after DLT. While neither patient had symptoms of FAP, small amyloid deposits were detected on the gastroduodenal mucosae 14 months and 12 years after DLT in patient 1 and patient 2, respectively. The amyloid was analyzed using a laser microdissection system and tandem mass spectrometry. Biochemical analysis indicated that the amyloid was composed mostly of variant TTR produced from the transplanted liver in both patients. In patient 1, wild‐type TTR amyloid was detectable in the duodenal mucosa obtained 2 years after DLT. This is the first study to successfully capture the pathological and biochemical features of initial‐stage amyloid lesions in DLT recipients. The findings clearly indicate that amyloid deposition can start by deposition of variant TTR followed by deposition of wild‐type TTR, and blocking of amyloid seed formation from variant TTR may be a key to prevent or delay the development of DLT‐associated amyloidosis.
Collapse
Affiliation(s)
- Tsuneaki Yoshinaga
- Department of Medicine (Neurology and Rheumatology) Shinshu University School of Medicine Matsumoto Japan
| | - Masahide Yazaki
- Department of Medicine (Neurology and Rheumatology)Shinshu University School of MedicineMatsumotoJapan; Department of Biological Sciences for Intractable Neurological Diseases, Institute for Biomedical Sciences, Shinshu UniversityMatsumotoJapan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology)Shinshu University School of MedicineMatsumotoJapan; Department of Biological Sciences for Intractable Neurological Diseases, Institute for Biomedical Sciences, Shinshu UniversityMatsumotoJapan
| | - Fuyuki Kametani
- Department of Dementia and Higher Brain Function, Tokyo Metropolitan Institute of Medical Science Tokyo Japan
| | - Kana Miyashita
- Department of Neurophysiology Tokyo Medical University Tokyo Japan
| | - Naomi Hachiya
- Department of Neurophysiology Tokyo Medical University Tokyo Japan
| | - Tomohiro Tanaka
- Department of Organ Transplantation Service The University of Tokyo Hospital Tokyo Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of TokyoTokyoJapan; Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of TokyoTokyoJapan
| | - Keiichi Higuchi
- Department of Biological Sciences for Intractable Neurological Diseases, Institute for Biomedical Sciences, Shinshu UniversityMatsumotoJapan; Department of Aging BiologyInstitute of Pathogenesis and Disease Prevention, Shinshu University Graduate School of MedicineMatsumotoJapan
| | - Shu-Ichi Ikeda
- Department of Medicine (Neurology and Rheumatology)Shinshu University School of MedicineMatsumotoJapan; Department of Biological Sciences for Intractable Neurological Diseases, Institute for Biomedical Sciences, Shinshu UniversityMatsumotoJapan
| |
Collapse
|
18
|
da Costa G, Ribeiro-Silva C, Ribeiro R, Gilberto S, Gomes RA, Ferreira A, Mateus É, Barroso E, Coelho AV, Freire AP, Cordeiro C. Transthyretin Amyloidosis: Chaperone Concentration Changes and Increased Proteolysis in the Pathway to Disease. PLoS One 2015; 10:e0125392. [PMID: 26147092 PMCID: PMC4492746 DOI: 10.1371/journal.pone.0125392] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/24/2015] [Indexed: 11/18/2022] Open
Abstract
Transthyretin amyloidosis is a conformational pathology characterized by the extracellular formation of amyloid deposits and the progressive impairment of the peripheral nervous system. Point mutations in this tetrameric plasma protein decrease its stability and are linked to disease onset and progression. Since non-mutated transthyretin also forms amyloid in systemic senile amyloidosis and some mutation bearers are asymptomatic throughout their lives, non-genetic factors must also be involved in transthyretin amyloidosis. We discovered, using a differential proteomics approach, that extracellular chaperones such as fibrinogen, clusterin, haptoglobin, alpha-1-anti-trypsin and 2-macroglobulin are overrepresented in transthyretin amyloidosis. Our data shows that a complex network of extracellular chaperones are over represented in human plasma and we speculate that they act synergistically to cope with amyloid prone proteins. Proteostasis may thus be as important as point mutations in transthyretin amyloidosis.
Collapse
Affiliation(s)
- Gonçalo da Costa
- Centro de Química e Bioquímica, FCUL, Campo Grande, Lisboa, Portugal
| | | | - Raquel Ribeiro
- Centro de Química e Bioquímica, FCUL, Campo Grande, Lisboa, Portugal
| | - Samuel Gilberto
- Centro de Química e Bioquímica, FCUL, Campo Grande, Lisboa, Portugal
| | - Ricardo A Gomes
- Instituto de Tecnologia Química e Biológica, Av. da República Estação Agronómica Nacional, Oeiras, Portugal
| | - António Ferreira
- Centro de Química e Bioquímica, FCUL, Campo Grande, Lisboa, Portugal
| | - Élia Mateus
- Unidade de Transplantação, Hospital Curry Cabral, Lisboa, Portugal
| | - Eduardo Barroso
- Unidade de Transplantação, Hospital Curry Cabral, Lisboa, Portugal
| | - Ana V Coelho
- Instituto de Tecnologia Química e Biológica, Av. da República Estação Agronómica Nacional, Oeiras, Portugal
| | - Ana Ponces Freire
- Centro de Química e Bioquímica, FCUL, Campo Grande, Lisboa, Portugal
| | - Carlos Cordeiro
- Centro de Química e Bioquímica, FCUL, Campo Grande, Lisboa, Portugal
| |
Collapse
|
19
|
Marcacuzco Quinto AA, Manrique Municio A, Jimenez Romero LC, Loinaz Segurola C, Calvo Pulido J, Justo Alonso I, Garcia-Sesma Perez-F A, Abradelo de Usera M, Cambra Molero F, Caso M O, Moreno Gonzalez E. [Liver transplantation as treatment of familial amyloid polyneuropathy in patients older than 60 years]. Med Clin (Barc) 2015; 144:385-8. [PMID: 24746275 DOI: 10.1016/j.medcli.2014.02.022] [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: 02/12/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Familial amyloid polyneuropathy (FAP) is the most prevalent type of hereditary systemic amyloidosis. It is an autosomal dominant disease characterized by the deposition of an abnormal variant transthyretin. It has a worldwide distribution, with localized endemic areas in Portugal, Sweden and Japan. In Spain there is an endemic focus, located in Mallorca. Liver transplantation is the only curative option for patients with FAP. The aim of this study was to describe the clinical and demographic characteristics of patients transplanted with a diagnosis of PAF. MATERIAL AND METHOD Six patients with PAF underwent liver transplantation between April 1986 and December 2012. RESULTS The mean age was 57.7+16 years, patients of Spanish origin were older than 60 years. All patients had progressive symptoms as mixed polyneuropathy. In 2 patients, combined heart-liver transplants sequentially were performed. Patient survival and graft was 80% at one, 3 and 5 years. CONCLUSIONS The only effective treatment for etiologic PAF is liver transplantation. Early detection is the key to the treatment and control, avoiding the irreversible organ damage.
Collapse
Affiliation(s)
- Alberto A Marcacuzco Quinto
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España.
| | - Alejandro Manrique Municio
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Luis C Jimenez Romero
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Carmelo Loinaz Segurola
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Jorge Calvo Pulido
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Iago Justo Alonso
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Alvaro Garcia-Sesma Perez-F
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Manuel Abradelo de Usera
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Felix Cambra Molero
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Oscar Caso M
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Enrique Moreno Gonzalez
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| |
Collapse
|
20
|
Carvalho A, Rocha A, Lobato L. Liver transplantation in transthyretin amyloidosis: issues and challenges. Liver Transpl 2015; 21:282-92. [PMID: 25482846 DOI: 10.1002/lt.24058] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/26/2014] [Indexed: 12/25/2022]
Abstract
Hereditary transthyretin amyloidosis (ATTR) is a rare worldwide autosomal dominant disease caused by the systemic deposition of an amyloidogenic variant of transthyretin (TTR), which is usually derived from a single amino acid substitution in the TTR gene. More than 100 mutations have been described, with V30M being the most prevalent. Each variant has a different involvement, although peripheral neuropathy and cardiomyopathy are the most common. Orthotopic liver transplantation (OLT) was implemented as the inaugural disease-modifying therapy because the liver produces the circulating unstable TTR. In this review, we focus on the results and long-term outcomes of OLT for ATTR after more than 2063 procedures and 23 years of experience. After successful OLT, neuropathy and organ impairment are not usually reversed, and in some cases, the disease progresses. The overall 5-year survival rate is approximately 100% for V30M patients and 59% for non-ATTR V30M patients. Cardiac-related death and septicemia are the main causes of mortality. Lower survival is related to malnutrition, a longer duration of disease, cardiomyopathy, and a later onset (particularly for males). Deposits, which are composed of a mixture of truncated and full-length TTR (type A) fibrils, have been associated with posttransplant myocardial dysfunction. A higher incidence of early hepatic artery thrombosis of the graft has also been documented for these patients. Liver-kidney/heart transplantation is an alternative for patients with advanced renal disease or heart failure. The sequential procedure, in which ATTR livers are reused in patients with liver disease, reveals that neuropathy in the recipient may appear as soon as 6 years after OLT, and ATTR deposits may appear even earlier. Long-term results of trials with amyloid protein stabilizers or disrupters, silencing RNA, and antisense oligonucleotides will highlight the value and limitations of liver transplantation.
Collapse
|
21
|
Sekijima Y. Recent progress in the understanding and treatment of transthyretin amyloidosis. J Clin Pharm Ther 2015; 39:225-33. [PMID: 24749898 DOI: 10.1111/jcpt.12145] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 01/29/2014] [Indexed: 01/03/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Transthyretin (TTR) is a representative amyloidogenic protein in humans. Rate-limiting tetramer dissociation and rapid monomer misfolding and misassembly of variant TTR result in autosomal dominant familial amyloidosis. Analogous misfolding of wild-type TTR results in senile systemic amyloidosis (SSA) presenting as sporadic amyloid disease in the elderly. The objective of this review is to summarize recent progress in our understanding and treatment of TTR amyloidosis. METHODS Literature searches were conducted on the topics of transthyretin, familial amyloid polyneuropathy and clinical trials, using PubMed, the United States clinical trials directory, pharmaceutical company websites and news reports. The information was collected, evaluated for relevance and quality, critically assessed and summarized. RESULTS AND DISCUSSION The current standard first-line treatment of familial TTR amyloidosis is liver transplantation. However, large numbers of patients are not suitable transplant candidates. Recently, the clinical effects of TTR tetramer stabilizers, tafamidis and diflunisal, were demonstrated in randomized clinical trials, and tafamidis has been approved for the treatment of FAP in European countries and Japan. In addition, gene therapies with antisense oligonucleotides and small interfering RNAs are promising strategies to ameliorate TTR amyloidoses and are currently in clinical trials. WHAT IS NEW AND CONCLUSIONS Liver transplantation to treat the familial TTR amyloidosis will likely be replaced by other less invasive therapies, such as TTR tetramer stabilizers and possibly gene therapy approaches. These newly developed therapies are expected to be effective for not only familial TTR amyloidosis but also SSA, based on their mechanisms of action.
Collapse
Affiliation(s)
- Y Sekijima
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| |
Collapse
|
22
|
Gonçalves NP, Vieira P, Saraiva MJ. Interleukin-1 signaling pathway as a therapeutic target in transthyretin amyloidosis. Amyloid 2014; 21:175-84. [PMID: 24918964 PMCID: PMC4196507 DOI: 10.3109/13506129.2014.927759] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 04/24/2014] [Accepted: 05/21/2014] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Inflammation is a key pathological hallmark of several neurodegenerative disorders including Alzheimer's disease, Parkinson's disease and familial amyloidotic polyneuropathy (FAP). Among all inflammatory cytokines associated with FAP, IL-1β, in particular, has been implicated in playing a key pathogenic role. In the present study, we sought to investigate whether blocking IL-1β signaling provides disease-modifying benefits in an FAP mouse model. METHODS We assessed the effect of chronic administration of Anakinra, an IL-1 antagonist, on FAP pathogenesis in vivo, using real-time polymerase chain reaction (qPCR), semi-quantitative immunohistochemistry (SQ-IHC), western blot and nerve morphometric analyses. RESULTS We found that treatment with Anakinra prevents transthyretin (TTR) extracellular deposition in sciatic nerve, protecting unmyelinated nerve fibers from aggregate-induced degeneration. Moreover, Anakinra administration significantly suppressed IL-1 signaling pathway and inhibited apoptosis and nitrative stress. CONCLUSIONS The present work highlights the relevance of the IL-1 signaling pathway in the pathophysiology of FAP. Our results bring to light the importance of non-amyloid targets in the therapeutic strategies for this disorder. Thus, we propose the use of Anakinra as a potential therapeutic agent for TTR-related amyloidosis.
Collapse
MESH Headings
- Amyloid Neuropathies, Familial/drug therapy
- Amyloid Neuropathies, Familial/immunology
- Amyloid Neuropathies, Familial/pathology
- Animals
- Apoptosis
- Disease Models, Animal
- Ganglia, Spinal/drug effects
- Ganglia, Spinal/immunology
- Ganglia, Spinal/pathology
- Gene Expression
- Injections, Subcutaneous
- Interleukin 1 Receptor Antagonist Protein/pharmacology
- Interleukin-1beta/antagonists & inhibitors
- Interleukin-1beta/immunology
- Mice
- Mice, Transgenic
- Nerve Fibers, Unmyelinated/drug effects
- Nerve Fibers, Unmyelinated/immunology
- Nerve Fibers, Unmyelinated/pathology
- Oxidative Stress
- Prealbumin/chemistry
- Prealbumin/genetics
- Protein Aggregates
- Protein Aggregation, Pathological/drug therapy
- Protein Aggregation, Pathological/immunology
- Protein Aggregation, Pathological/pathology
- Sciatic Nerve/drug effects
- Sciatic Nerve/immunology
- Sciatic Nerve/pathology
- Signal Transduction/drug effects
- Signal Transduction/immunology
- Transgenes
Collapse
Affiliation(s)
- Nádia Pereira Gonçalves
- Department of Molecular Neurobiology, Institute for Molecular and Cell Biology, Rua do Campo AlegrePortoPortugal
- Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do PortoPortoPortugal
| | - Paulo Vieira
- Unité du Développement des Lymphocytes, Département d’Immunologie, Institut PasteurParis, CEDEXFrance
| | - Maria João Saraiva
- Department of Molecular Neurobiology, Institute for Molecular and Cell Biology, Rua do Campo AlegrePortoPortugal
- Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do PortoPortoPortugal
| |
Collapse
|
23
|
Abdelfatah MM, Hayman SR, Gertz MA. Domino liver transplantation as a cause of acquired familial amyloid polyneuropathy. Amyloid 2014; 21:136-7. [PMID: 24517476 DOI: 10.3109/13506129.2014.885894] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
24
|
Misumi Y, Ando Y, Gonçalves NP, Saraiva MJ. Fibroblasts endocytose and degrade transthyretin aggregates in transthyretin-related amyloidosis. J Transl Med 2013; 93:911-20. [PMID: 23817086 DOI: 10.1038/labinvest.2013.83] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/24/2013] [Accepted: 06/03/2013] [Indexed: 12/12/2022] Open
Abstract
Transthyretin (TTR)-related amyloidosis is a fatal disorder characterized by systemic extracellular deposition of TTR amyloid fibrils. Mutations in the TTR gene cause an autosomal dominant form of the disease-familial amyloidotic polyneuropathy (FAP). Wild-type (WT) TTR can also form amyloid fibrils in elderly patients with senile systemic amyloidosis. Regression of amyloid deposits in FAP patients who undergo liver transplantation to remove the main source of mutant TTR suggests the existence of mechanisms for the clearance of TTR deposits from the extracellular matrix (ECM), but the precise mechanisms are largely unknown. Because fibroblasts are abundant, playing a central role in the maintenance of the ECM and because the skin is one of the major sites of soluble TTR catabolism, in the present study, we analyzed their role in clearance of TTR aggregates. In vitro studies with a fibroblast cell line revealed that fibroblasts endocytosed and degraded aggregated TTR. Subcutaneous injection of soluble and aggregated TTR into WT mice showed internalization and clearance over time by both fibroblasts and macrophages. Immunohistochemical studies of skin biopsies from V30M patients, asymptomatic carriers, recipients of domino FAP livers as well as transgenic mice for human V30M showed intracellular TTR immunoreactivity in fibroblasts and macrophages that increased with clinical status and with age in transgenic mice. Overall, the present in vitro and in vivo data show that fibroblasts endocytose and degrade TTR aggregates. The function or dysfunction of TTR clearance by fibroblasts may have important implications for the development, progression, and regression of TTR deposition in the ECM.
Collapse
Affiliation(s)
- Yohei Misumi
- Molecular Neurobiology, IBMC-Instituto de Biologia Molecular e Celular, Porto, Portugal
| | | | | | | |
Collapse
|
25
|
Ando Y, Coelho T, Berk JL, Cruz MW, Ericzon BG, Ikeda SI, Lewis WD, Obici L, Planté-Bordeneuve V, Rapezzi C, Said G, Salvi F. Guideline of transthyretin-related hereditary amyloidosis for clinicians. Orphanet J Rare Dis 2013; 8:31. [PMID: 23425518 PMCID: PMC3584981 DOI: 10.1186/1750-1172-8-31] [Citation(s) in RCA: 485] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/01/2013] [Indexed: 02/07/2023] Open
Abstract
Transthyretin amyloidosis is a progressive and eventually fatal disease primarily characterized by sensory, motor, and autonomic neuropathy and/or cardiomyopathy. Given its phenotypic unpredictability and variability, transthyretin amyloidosis can be difficult to recognize and manage. Misdiagnosis is common, and patients may wait several years before accurate diagnosis, risking additional significant irreversible deterioration. This article aims to help physicians better understand transthyretin amyloidosis—and, specifically, familial amyloidotic polyneuropathy—so they can recognize and manage the disease more easily and discuss it with their patients. We provide guidance on making a definitive diagnosis, explain methods for disease staging and evaluation of disease progression, and discuss symptom mitigation and treatment strategies, including liver transplant and several pharmacotherapies that have shown promise in clinical trials.
Collapse
Affiliation(s)
- Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Benson MD. Liver transplantation and transthyretin amyloidosis. Muscle Nerve 2012; 47:157-62. [PMID: 23169427 DOI: 10.1002/mus.23521] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2012] [Indexed: 12/20/2022]
Abstract
Liver transplantation as a specific treatment of transthyretin amyloidosis was first performed in 1990. The rationale for this treatment was that removal of the source (liver) of the amyloid precursor protein (mutated transthyretin) would stop progression of the disease. Indeed, after orthotopic liver transplantation (OLT), mutant transthyretin (TTR) is rapidly cleared from circulation. In the last 20 years, >2000 familial amyloidotic polyneuropathy (FAP) patients have received liver transplants. For these patients, prospective monitoring has shown prolongation of life compared with FAP patients who have not undergone liver transplantation. The most favorable results have been for FAP patients with the Val30Met TTR mutation. Less favorable results have been seen for patients with other TTR mutations where progression of amyloid tissue deposition has been documented as the result of amyloid fibril formation from normal (wild-type) TTR. Although it is obvious that OLT has benefited many FAP patients, there remains a need for further therapies.
Collapse
Affiliation(s)
- Merrill D Benson
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| |
Collapse
|
27
|
|
28
|
Beirão M, Matos E, Beirão I, Pinho-Costa P, Torres P. No ocular involvement in familial amyloidotic polyneuropathy ATTR V30M domino liver recipients. Transpl Int 2012; 25:646-51. [PMID: 22443165 DOI: 10.1111/j.1432-2277.2012.01467.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In many transplantation centers domino liver transplantation is an established procedure, increasing the number of available liver grafts. Increasingly, grafts from familial amyloidotic polyneuropathy (FAP) patients are used. Ocular involvement is a well known manifestation of FAP, and can be vision-threatening. The aim of this study was to evaluate the risk of development of familial amyloidotic polyneuropathy ocular manifestations in domino liver recipients. Forty-four cirrhotic patients submitted to liver transplantation were studied, with an average of 6 years of follow up after the procedure. Twenty two patients had received a liver from a FAP donor (Group 1) and 22 had received a liver from a non-FAP cadaveric donor (Group 2). Both groups were similar for mean age and gender. Routine ophthalmological examinations with particular attention to amyloid deposition in the anterior segment and vitreous, peripheral retina state, lacrimal functions tests (Schirmer and tear break-up time) and pupillometry (dynamic and static) were performed. No statistically significant differences were observed in all studied ophthalmic parameters between the two groups. No FAP related ophthalmic manifestations were detected after 6 years of domino liver transplantation, but further prospective regular ophthalmological examinations are necessary to detect the eventual development of late ocular manifestations.
Collapse
Affiliation(s)
- Melo Beirão
- Ophthalmology, Hospital de Santo António, Porto, Portugal.
| | | | | | | | | |
Collapse
|
29
|
Kitchens WH. Domino liver transplantation: indications, techniques, and outcomes. Transplant Rev (Orlando) 2011; 25:167-77. [PMID: 21803558 DOI: 10.1016/j.trre.2011.04.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 04/26/2011] [Indexed: 02/07/2023]
Abstract
The long-term shortage of livers available for transplantation has spurred the development of many strategies to bolster the donor organ supply. One particularly innovative strategy is domino liver transplantation in which a select group of liver transplant recipients can donate their explanted native livers for use as liver grafts in other patients. Several hereditary metabolic diseases (such as familial amyloid polyneuropathy, maple syrup urine disease, and familial hypercholesterolemia) are caused by aberrant or deficient protein production in the liver, and these conditions can be cured with an orthotopic liver transplant. Although their native livers eventually caused severe systemic disease in these patients, these livers are otherwise structurally and functionally normal, and they have been used successfully in domino liver transplants for the past 15 years. This article will review the indications for donating or receiving a domino liver transplant, the surgical techniques necessary to perform these transplants, as well as the recently revealed long-term outcomes and risks of domino transplantation.
Collapse
|
30
|
Jiao Y, Zhang J, Yan J, Stuart J, Gibson G, Lu L, Willaims R, Wang YJ, Gu W. Differential gene expression between wild-type and Gulo-deficient mice supplied with vitamin C. Genet Mol Biol 2011; 34:386-95. [PMID: 21931508 PMCID: PMC3168176 DOI: 10.1590/s1415-47572011005000031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 02/17/2011] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to test the hypothesis that hepatic vitamin C (VC) levels in VC deficient mice rescued with high doses of VC supplements still do not reach the optimal levels present in wild-type mice. For this, we used a mouse scurvy model (sfx) in which the L-gulonolactone oxidase gene (Gulo) is deleted. Six age- (6 weeks old) and gender- (female) matched wild-type (WT) and sfx mice (rescued by administering 500 mg of VC/L) were used as the control (WT) and treatment (MT) groups (n = 3 for each group), respectively. Total hepatic RNA was used in triplicate microarray assays for each group. EDGE software was used to identify differentially expressed genes and transcriptomic analysis was used to assess the potential genetic regulation of Gulo gene expression. Hepatic VC concentrations in MT mice were significantly lower than in WT mice, even though there were no morphological differences between the two groups. In MT mice, 269 differentially expressed transcripts were detected (≥ twice the difference between MT and WT mice), including 107 up-regulated and 162 down-regulated genes. These differentially expressed genes included stress-related and exclusively/predominantly hepatocyte genes. Transcriptomic analysis identified a major locus on chromosome 18 that regulates Gulo expression. Since three relevant oxidative genes are located within the critical region of this locus we suspect that they are involved in the down-regulation of oxidative activity in sfx mice.
Collapse
Affiliation(s)
- Yan Jiao
- Department of Orthopaedic Surgery, Campbell Clinic, and Pathology, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Lladó L, Baliellas C, Casasnovas C, Ferrer I, Fabregat J, Ramos E, Castellote J, Torras J, Xiol X, Rafecas A. Risk of transmission of systemic transthyretin amyloidosis after domino liver transplantation. Liver Transpl 2010; 16:1386-92. [PMID: 21117248 DOI: 10.1002/lt.22174] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Recent reports of the transmission of systemic transthyretin (TTR) amyloidosis after domino liver transplantation (DLT) using grafts from patients with familial amyloid polyneuropathy (FAP) have raised concerns about the procedure. The aim of this study was to evaluate the transmission incidence of systemic TTR amyloidosis after DLT with a complete clinical, neurological, and pathological assessment. At our institution, DLT has been performed 31 times with livers from patients with FAP. Seventeen of the 19 patients still alive in 2008 agreed to enter the study. This cross-sectional study of this cohort of patients included clinical assessments, rectal biopsy, and electroneuromyography (as well as sural nerve biopsy when it was indicated). The mean follow-up at the time of the study was 62.6 ± 2.9 months. Clinically, 3 patients complained of weak dysesthesia. When a focused study was performed, 8 patients reported some kind of neurological and/or gastrointestinal disturbance. Six of the rectal biopsy samples showed amyloid deposits (TTR-positive). Electromyography (EMG) showed signs of mild sensorimotor neuropathy in 3 cases and moderate to severe sensorimotor neuropathy in 1 case. Only 2 of the 4 patients with EMG signs of polyneuropathy showed amyloid deposits in their rectal biopsy samples. Sural nerve biopsy revealed amyloid deposits (TTR-positive) in all 4 patients with EMG signs of polyneuropathy. Two patients with normal EMG findings had TTR-positive amyloid deposits in their sural nerve biopsy samples. In conclusion, de novo systemic amyloidosis after DLT may be more frequent and appear earlier than was initially thought. In our opinion, however, the graft shortage still justifies DLT in selected patients, despite the risk of de novo systemic amyloidosis. Sural nerve biopsy with EMG and clinical correlation is mandatory for confirming the disease. Indeed, other causes of neuropathy should be excluded.
Collapse
Affiliation(s)
- Laura Lladó
- Departments of Surgery, Liver Transplant Unit, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Adly MA. Analysis of the expression pattern of the carrier protein transthyretin and its receptor megalin in the human scalp skin and hair follicles: hair cycle-associated changes. Histochem Cell Biol 2010; 134:591-602. [PMID: 21104416 DOI: 10.1007/s00418-010-0763-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2010] [Indexed: 11/28/2022]
Abstract
Transthyretin is a serum and cerebrospinal fluid protein synthesized early in development by the liver, choroid plexus and several other tissues. It is a carrier protein for the antioxidant vitamins, retinol, and thyroid hormones. Transthyretin helps internalize thyroxine and retinol-binding protein into cells by binding to megalin, which is a multi-ligand receptor expressed on the luminal surface of various epithelia. We investigated the expression of transthyretin and its receptor megalin in the human skin; however, their expression pattern in the hair follicle is still to be elucidated. This study addresses this issue and tests the hypothesis that "the expression of transthyretin and megalin undergoes hair follicle cycle-dependent changes." A total of 50 normal human scalp skin biopsies were examined (healthy females, 53-62 years) using immunofluorescence staining methods and real-time PCR. In each case, 50 hair follicles were analyzed (35, 10, and 5 follicles in anagen, catagen, and telogen, respectively). Transthyretin and megalin were prominently expressed in the human scalp skin and hair follicles, on both gene and protein levels. The concentrations of transthyretin and megalin were 0.12 and 0.03 Ul/ml, respectively, as indicated by PCR. The expression showed hair follicle cycle-associated changes i.e., strong expression during early and mature anagen, very weak expression during catagen and moderate expression during telogen. The expression values of these proteins in the anagen were statistically significantly higher than those of either catagen or telogen hair follicles (P ≤ 0.001). This study provides the first morphologic indication that transthyretin and megalin are variably expressed in the human scalp skin and hair follicles. It also reports variations in the expression of these proteins during hair follicle cycling. The clinical ramifications of these findings are open for further investigations.
Collapse
Affiliation(s)
- Mohamed A Adly
- Department of Zoology, Faculty of Science, Sohag University, Sohag, Egypt.
| |
Collapse
|
33
|
Conceição I, Evangelista T, Castro J, Pereira P, Silvestre A, Coutinho CA, de Carvalho M. Acquired amyloid neuropathy in a Portuguese patient after domino liver transplantation. Muscle Nerve 2010; 42:836-9. [PMID: 20928908 DOI: 10.1002/mus.21806] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Familial amyloid polyneuropathy (FAP) is a progressive neuropathy with autonomic dysfunction. Domino liver transplantation (DLT), in which the liver of an FAP patient is transplanted into another patient, is routinely applied to compensate for the shortage of available organs. We report a patient who developed a clinical picture of FAP 9 years after a DLT from an FAP donor. Electrophysiological, neuropathological, and autonomic tests were administered. The patient presented with typical clinical features of FAP. Electrophysiological investigation confirmed a moderate sensorimotor axonal and autonomic neuropathy. Sural nerve biopsy confirmed the presence of amyloid deposits in the endoneurium. Skin biopsy at the ankle showed reduced intraepidermal nerve fiber density. Our report shows that FAP can develop in a recipient of an FAP liver. This suggests that careful longitudinal study is required to evaluate the risk of FAP polyneuropathy in patients who undergo domino liver transplantation.
Collapse
Affiliation(s)
- Isabel Conceição
- Department of Neurosciences, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.
| | | | | | | | | | | | | |
Collapse
|
34
|
Transthyretin internalization by sensory neurons is megalin mediated and necessary for its neuritogenic activity. J Neurosci 2009; 29:3220-32. [PMID: 19279259 DOI: 10.1523/jneurosci.6012-08.2009] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Mutated transthyretin (TTR) causes familial amyloid polyneuropathy, a neurodegenerative disorder characterized by TTR deposition in the peripheral nervous system (PNS). The origin/reason for TTR deposition in the nerve is unknown. Here we demonstrate that both endogenous mouse TTR and TTR injected intravenously have access to the mouse sciatic nerve. We previously determined that in the absence of TTR, both neurite outgrowth in vitro and nerve regeneration in vivo were impaired. Reinforcing this finding, we now show that local TTR delivery to the crushed sciatic nerve rescues the regeneration phenotype of TTR knock-out (KO) mice. As the absence of TTR was unrelated to neuronal survival, we further evaluated the Schwann cell and inflammatory response to injury, as well as axonal retrograde transport, in the presence/absence of TTR. Only retrograde transport was impaired in TTR KO mice which, in addition to the neurite outgrowth impairment, might account for the decreased regeneration in this strain. Moreover, we show that in vitro, in dorsal root ganglia neurons, clathrin-dependent megalin-mediated TTR internalization is needed for TTR neuritogenic activity. Supporting this observation, we demonstrate that in vivo, decreased levels of megalin lead to decreased nerve regeneration and that megalin's action as a regeneration enhancer is dependent on TTR. In conclusion, our work unravels the mechanism of TTR action during nerve regeneration. Additionally, TTR presence in the nerve, as is here shown, may underlie its preferential deposition in the PNS of familial amyloid polyneuropathy patients.
Collapse
|
35
|
England JD, Gronseth GS, Franklin G, Carter GT, Kinsella LJ, Cohen JA, Asbury AK, Szigeti K, Lupski JR, Latov N, Lewis RA, Low PA, Fisher MA, Herrmann D, Howard JF, Lauria G, Miller RG, Polydefkis M, Sumner AJ. Evaluation of distal symmetric polyneuropathy: the role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review). Muscle Nerve 2009; 39:106-15. [PMID: 19086069 DOI: 10.1002/mus.21227] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, nerve biopsy, and skin biopsy for the assessment of polyneuropathy. A literature review using MEDLINE, EMBASE, Science Citation Index, and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence. (1) Autonomic testing may be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). (2) Nerve biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a nerve biopsy may be useful in the evaluation of DSP (Level U). (3) Skin biopsy is a validated technique for determining intraepidermal nerve fiber (IENF) density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy.
Collapse
Affiliation(s)
- J D England
- Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Activation of the heat shock response in familial amyloidotic polyneuropathy. J Neuropathol Exp Neurol 2008; 67:449-55. [PMID: 18431252 DOI: 10.1097/nen.0b013e31816fd648] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The heat shock proteins (Hsps) have been implicated in a variety of neurodegenerative diseases in which the underlying pathology is protein aggregation. Here, we studied the heat shock response in familial amyloidotic polyneuropathy (FAP), a neurodegenerative disease caused by aggregation and extracellular tissue deposition of mutated transthyretin (TTR). We observed greater expression of Hsp27 and Hsp70 related to the presence of extracellular TTR aggregates in human FAP nerve, skin, and salivary gland biopsies than in normal controls. Transthyretin aggregates did not colocalize with Hsp, suggesting that extracellular TTR tissue deposits induce an intracellular stress response. Moreover, the heat shock transcription factor 1 was upregulated and localized to nuclei in affected tissues. Transgenic mice expressing the V30M mutant form of TTR similarly showed the presence of TTR deposits, induced activation of heat shock transcription factor 1, and increased synthesis of Hsp. Furthermore, the addition of toxic TTR aggregates to cultures of human and rodent neuroblastoma cell lines induced upregulation of Hsp70 and Hsp27. Taken together, these novel findings suggest new avenues for research on pathogenic mechanisms in FAP and identify the heat shock response as a potential pharmacologic treatment target for FAP.
Collapse
|
37
|
Wilczek HE, Larsson M, Yamamoto S, Ericzon BG. Domino liver transplantation. ACTA ACUST UNITED AC 2008; 15:139-48. [DOI: 10.1007/s00534-007-1299-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 12/10/2007] [Indexed: 11/29/2022]
|
38
|
Yamamoto S, Wilczek HE, Iwata T, Larsson M, Gjertsen H, Söderdahl G, Solders G, Ericzon BG. Long-term consequences of domino liver transplantation using familial amyloidotic polyneuropathy grafts. Transpl Int 2007; 20:926-33. [PMID: 17623052 DOI: 10.1111/j.1432-2277.2007.00516.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Domino liver transplantation (DLT) using grafts from patients with familial amyloidotic polyneuropathy (FAP) is an established procedure at many transplantation centers. However, data evaluating the long-term outcome of DLT are limited. The aim of the present study was to analyze the risk of de novo polyneuropathy, possibly because of amyloidosis, and the patient survival after DLT. At our department, 28 DLT using FAP grafts were conducted between January 1997 and December 2005. One patient was twice subjected to DLT. Postoperative neurological monitoring of peripheral nerve function was performed with electroneurography (ENeG) in 20 cases. An ENeG index based on 12 parameters was calculated and correlated to age and/or height. Three patients developed ENeG signs of polyneuropathy 2-5 years after the DLT, but with no clinical symptoms. The 1-, 3- and 5-year actuarial patient survival in hepatocellular carcinoma (HCC) patients (n = 12) and non-HCC patients (n = 15) was 67%, 15%, 15% and 93%, 93%, 80%, respectively (P = 0.001). Development of impaired nerve conduction in a proportion of patients may indicate that de novo amyloidosis occurs earlier than previously expected. Survival after DLT was excellent except in patients with advanced HCC.
Collapse
Affiliation(s)
- Shinji Yamamoto
- Division of Transplantation surgery, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Ericzon BG. Domino transplantation using livers from patients with familial amyloidotic polyneuropathy: should we halt? Liver Transpl 2007; 13:185-7. [PMID: 17256776 DOI: 10.1002/lt.21073] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
40
|
Takei YI, Gono T, Yazaki M, Ikeda SI, Ikegami T, Hashikura Y, Miyagawa SI, Hoshii Y. Transthyretin-derived amyloid deposition on the gastric mucosa in domino recipients of familial amyloid polyneuropathy liver. Liver Transpl 2007; 13:215-8. [PMID: 17029284 DOI: 10.1002/lt.20954] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Familial amyloid polyneuropathy (FAP) is a form of hereditary generalized amyloidosis. Liver tissue explanted from FAP patients has normal structure and function, except for the production of amyloidogenic variant transthyretin (TTR), and domino liver transplantation (DLT) using grafts from FAP patients was first performed in 1995. FAP symptoms usually develop in genetically determined individuals after the age of 20, but it is difficult to estimate when FAP symptoms will appear in domino recipients. Concerning this problem, histological findings showing amyloid deposition have recently been obtained in a few domino recipients of FAP livers. This study investigated the presence of de novo amyloid deposition in the gastroduodenal mucosa of domino recipients transplanted at our institution. Biopsy of gastroduodenal mucosa was carried out in 5 recipients of FAP livers and TTR-derived amyloid deposits were detected in 2 patients, both of whom had undergone DLT 47 months previously. In FAP liver recipients, de novo systemic amyloid deposition may begin much sooner than previously supposed. Therefore, careful follow-up of domino recipients of FAP livers is required.
Collapse
Affiliation(s)
- Yo-ichi Takei
- Department of Internal Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
INTRODUCTION Familial amyloid polyneuropathy designates a group of dominantly inherited neuropathies, with extracellular deposition of amyloid substance in various tissues. BACKGROUND The 3 main precursor proteins encountered in these disorders are transthyretin, apolipoprotein A1 or gelsolin. Among them, transthyretin neuropathies are by far the most frequent type with a severe sensori-motor and autonomic neuropathy as the hallmark of the disease, most often associated with cardiac manifestations. First described in Portugal, the affection was subsequently reported across the world, although Portugal, Japan and Sweden are the 3 main areas of prevalence. In the past years, an increasing number of mutations have been identified in the TTR gene, along with a larger clinical spectrum than initially thought. Variable age of onset and penetrance are also largely reported with unclear phenotypic-genotypic correlations. Indeed, the contribution of the molecular genetics is important to ensure the diagnosis at an early stage, but also for predictive diagnosis, in the setting of genetic counselling. PERSPECTIVES Over the last 15 years, liver transplantation (LT) has enabled improved prognosis of this devastating condition. FUTURE PROSPECTS at present, such procedure should be performed in Val30Met patients, as early as possible in the course of the disease. Experience with such procedure in patients with other TTR variants remains scarce. Other therapeutic strategies are awaited. CONCLUSION This review summarizes the recent data on the diagnosis and management of patients and families affected with TTR amyloid neuropathy.
Collapse
Affiliation(s)
- V Planté-Bordeneuve
- Service de Neurologie et Laboratoire Louis Ranvier, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris et Université Paris XI.
| |
Collapse
|
42
|
Goto T, Yamashita T, Ueda M, Ohshima S, Yoneyama K, Nakamura M, Nanjo H, Asonuma K, Inomata Y, Watanabe S, Uchino M, Tanaka K, Ando Y. Iatrogenic amyloid neuropathy in a Japanese patient after sequential liver transplantation. Am J Transplant 2006; 6:2512-5. [PMID: 16889603 DOI: 10.1111/j.1600-6143.2006.01484.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A 57-year-old woman in Japan, the first recipient of part of a liver from a 58-year-old man with familial amyloidotic polyneuropathy (FAP) amyloidogenic transthyretin Val30Met who had had sensorimotor polyneuropathy in the lower limbs for 3 years, started to develop sensory neuropathy 7 years after transplantation. Before the July 1998 sequential transplantation, she had been in a hepatic coma at the terminal stage of primary biliary cirrhosis and waiting for deceased donor liver transplantation. In September 2004, biopsy samples of her duodenum first showed amyloid deposition. Although biopsy materials in 2005 and 2006 showed no changes in amyloid deposition, decreased temperature sensation and pain in fingertips and toes were detected at a neurologic examination in March 2006. Thus, clinical symptoms of FAP appeared about 2 years after amyloid deposition started. Nerve conduction velocity studies revealed mild to moderate axonal sensory polyneuropathy without demyelination. Our findings confirmed iatrogenic sensory neuropathy induced by amyloid deposition 7 years after sequential liver transplantation.
Collapse
Affiliation(s)
- T Goto
- Department of Gastroenterology, Central Clinical Facilites, Akita University School of Medicine, 1-1-1 Hond, Akita 010-8543, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Ikeda S. [Liver transplantation for familial amyloidosis]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2006; 95:1863-9. [PMID: 17037328 DOI: 10.2169/naika.95.1863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
|
44
|
Takei YI, Ikeda SI, Ikegami T, Hashikura Y, Miyagawa SI, Ando Y. Ten years of experience with liver transplantation for familial amyloid polyneuropathy in Japan: outcomes of living donor liver transplantations. Intern Med 2005; 44:1151-6. [PMID: 16357452 DOI: 10.2169/internalmedicine.44.1151] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We summarize 10 years of experience with liver transplantation for FAP patients in Japan and review the current opinions regarding this treatment for FAP. METHODS AND PATIENTS All basic report data on patients at the time of transplantation were registered with the Japanese Liver Transplantation Society (JLTS). Based on the JLST report data, more detailed information on FAP patients was requested from each center. RESULTS Living donor liver transplantation (LDLT) for FAP patients was first performed in Japan in 1993. LDLT has since been performed in 41 FAP patients, including nine cases of temporary auxiliary partial orthotopic liver transplantation (APOLT). Orthotopic liver transplantation (OLT) from cadaveric donors for FAP patients began in 1999, but only one FAP patient has subsequently undergone this procedure. Of these total of 43 FAP patients, 36 are currently alive: the one-year survival rate of patients after transplantation was 93%, and the five-year survival rate of these cases was 77%. Preoperative clinical severity and the nutritional status of patients are correlated with their outcome after liver transplantation. Domino (sequential) liver transplantation has been carried out in 20 domino recipients with end-stage liver diseases. Of the 20 domino recipients, 12 are currently alive. CONCLUSION For FAP patients, these outcomes after the operation were very similar to those of OLT from cadaveric donors reported in other countries. Therefore, we concluded that for the treatment of FAP, LDLT from a living donor is equally effective as OLT from a cadaveric donor.
Collapse
Affiliation(s)
- Yo-Ichi Takei
- Third Department of Medicine, Shinshu University School of Medicine, Matsumoto
| | | | | | | | | | | |
Collapse
|
45
|
Stangou AJ, Heaton ND, Hawkins PN. Transmission of systemic transthyretin amyloidosis by means of domino liver transplantation. N Engl J Med 2005; 352:2356. [PMID: 15930432 DOI: 10.1056/nejm200506023522219] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
46
|
Affiliation(s)
- Estela Monteiro
- Liver Transplant Centre, Curry Cabral Hospital, Rua Beneficencia, 1069-166 Lisbon, Portugal.
| | | | | |
Collapse
|