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Basset M, Schönland SO, Obici L, Günther J, Riva E, Dittrich T, Milani P, Ferretti VV, Pasquinucci E, Foli A, Kimmich C, Nanci M, Bellofiore C, Benigna F, Beimler J, Benvenuti P, Fabris F, Mussinelli R, Nuvolone M, Klersy C, Albertini R, Merlini G, Hegenbart U, Palladini G, Blank N. Development and Validation of Staging Systems for AA Amyloidosis. J Am Soc Nephrol 2024; 35:782-794. [PMID: 38512269 PMCID: PMC11164117 DOI: 10.1681/asn.0000000000000339] [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: 03/28/2023] [Accepted: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
Key Points Patients with AA amyloidosis and age ≥65 years, eGFR <45 ml/min per 1.73 m2, and N -terminal type-B natriuretic peptide >1000 ng/L and/or type-B natriuretic peptide >130 ng/L at diagnosis have poorer survival. Proteinuria >3.0 g/24 hours and eGFR <35 ml/min per 1.73 m2 identify patients at high risk of progression to end-stage kidney failure. Prognostic stratification in AA amyloidosis can be easily made by staging systems, similarly to AL and transthyretin amyloidosis. Background The kidney is involved in almost 100% of cases of AA amyloidosis, a rare disease caused by persistent inflammation with long overall survival but frequent progression to kidney failure. Identification of patients with advanced disease at diagnosis is difficult, given the absence of validated staging systems. Methods Patients with newly diagnosed AA amyloidosis from the Pavia (n =233, testing cohort) and Heidelberg (n =243, validation cohort) centers were included in this study. Cutoffs of continuous variables were determined by receiver operating characteristic analysis predicting death or dialysis at 24 months. Prognostic factors included in staging systems were identified by multivariable models in the testing cohort. Results Age ≥65 years, eGFR <45 ml/min per 1.73 m2, and elevated natriuretic peptides (type-B natriuretic peptide >130 ng/L and/or N -terminal type-B natriuretic peptide >1000 ng/L) were associated with overall survival and included in the staging system (all with simplified coefficients 1). Mean 36-month overall survival was lower with higher staging system scores (score 0–1: 92%; score 2: 72%; score 3: 32%). These results were confirmed in the validation cohort. For kidney failure, variables selected to enter in the staging system model were proteinuria >3 g/24 hour and eGFR <35 ml/min per 1.73 m2 (both with simplified coefficients 1). The 36-month cumulative incidence of kidney failure was higher with higher staging system scores (score 0: 0%; score 1: 24%; score 2: 51%). Again, similar results were obtained in validation cohort. Conclusions We identified and validated biomarker-based staging systems for overall survival and kidney failure in AA amyloidosis.
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Affiliation(s)
- Marco Basset
- Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo,” Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Stefan O. Schönland
- Division of Hematology, Oncology and Rheumatology, Amyloidosis Center, Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Laura Obici
- Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo,” Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Janine Günther
- Division of Hematology, Oncology and Rheumatology, Amyloidosis Center, Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Eloisa Riva
- Hematology Department, Facultad de Medicina, Hospital de Clinicas, Montevideo, Uruguay
| | - Tobias Dittrich
- Division of Hematology, Oncology and Rheumatology, Amyloidosis Center, Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Paolo Milani
- Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo,” Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Virginia Valeria Ferretti
- Biostatistics and Clinical Trial Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | | | - Andrea Foli
- Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo,” Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Christoph Kimmich
- Department of Oncology and Hematology, Klinikum Oldenburg, University Medicine Oldenburg, Oldenburg, Germany
| | - Martina Nanci
- Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo,” Pavia, Italy
| | - Claudia Bellofiore
- Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo,” Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Hematology Unit, Ospedale Garibaldi, Catania, Italy
| | - Francesca Benigna
- Laboratory of Clinical Chemistry, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Jörg Beimler
- Division of Nephrology, Amyloidosis Center, Department of Internal Medicine I, Heidelberg University Hospital, Heidelberg, Germany
| | - Pietro Benvenuti
- Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo,” Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Francesca Fabris
- Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo,” Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Institute of Cardiology, Maggiore Hospital, Crema, Italy
| | - Roberta Mussinelli
- Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo,” Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Mario Nuvolone
- Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo,” Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Biostatistics and Clinical Trial Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Riccardo Albertini
- Laboratory of Clinical Chemistry, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo,” Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Ute Hegenbart
- Division of Hematology, Oncology and Rheumatology, Amyloidosis Center, Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Giovanni Palladini
- Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo,” Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Norbert Blank
- Division of Hematology, Oncology and Rheumatology, Amyloidosis Center, Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
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Merashli M, Bucci T, Pastori D, Pignatelli P, Ames PRJ. Intima media thickness of carotid arteries in familial Mediterranean fever: a systematic review and meta-analysis. Clin Rheumatol 2022; 41:3769-3776. [PMID: 35933450 DOI: 10.1007/s10067-022-06326-5] [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: 06/14/2022] [Revised: 07/17/2022] [Accepted: 08/01/2022] [Indexed: 11/03/2022]
Abstract
AIM To perform a systematic review and meta-analysis of studies reporting data on atherosclerosis and inflammatory markers in familial Mediterranean fever (FMF). METHODS EMBASE and PubMed databases were screened according to PRISMA guidelines from inception to January 2022 for articles reporting measurements of the intima media thickness (IMT) of carotid arteries and eventually carotid plaques; random effect meta-analyses for continuous outcomes and Peto's odds ratio for rare events were employed. RESULTS The screening and selection search strategy yielded 18 case controls studies (16 full papers and 2 abstracts); the IMT was greater in FMF (n = 1112) than in controls (n = 901) (p < 0.0001) with wide heterogeneity (I2 = 86.4%); a sensitivity analysis according to mean age of participants, male to female ratio, disease duration, C-reactive protein (CRP), serum amyloid A (SAA), fibrinogen (FNG), atherogenic index of plasma (AIP), colchicine use and NOQAS revealed that the heterogeneity variance was partly explained by CRP (p = 0.01) and to a much lesser extent by the AIP (p = 0.10). The pooled prevalence of carotid plaques was greater in FMF (n = 137) than in controls (n = 156) (19% vs 8.3%, p = 0.02) with low heterogeneity. CONCLUSION FMF is characterised by premature atherosclerosis expressed as a thicker intima media and a greater prevalence of carotid plaques, partially related to the C-reactive protein, as expected by the autoinflammatory nature of FMF. Key Points • Familial Mediterranean fever is characterised by premature atherosclerosis. • C-reactive protein relates to intima media thickness in keeping with the autoinflammatory nature Familial Mediterranean fever. • Targeting the inter-critical low-grade inflammation may be relevant to minimise the additional cardiovascular risk posed by premature atherosclerosis.
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Affiliation(s)
- Mira Merashli
- Department of Rheumatology, American University of Beirut, Beirut, Lebanon
| | - Tommaso Bucci
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Daniele Pastori
- Department of Clinical, Internal, Anesthesiological & Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Pasquale Pignatelli
- Department of Clinical, Internal, Anesthesiological & Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Paul R J Ames
- Immune Response & Vascular Disease Unit, Nova University Lisbon, Rua Camara Pestana, Lisbon, Portugal.
- Department of Haematology, Dumfries Royal Infirmary, Cargenbridge, Dumfries, DG2 7AH, Scotland, UK.
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Romano M, Garcia-Bournissen F, Piskin D, Rodoplu U, Piskin L, Elzagallaai AA, Tuncer T, Sezer S, Ucuncuoglu D, Honca T, Poddighe D, Yavuz I, Stenvinkel P, Yilmaz MI, Demirkaya E. Anti-Inflammatory, Antioxidant, and Anti-Atherosclerotic Effects of Natural Supplements on Patients with FMF-Related AA Amyloidosis: A Non-Randomized 24-Week Open-Label Interventional Study. Life (Basel) 2022; 12:life12060896. [PMID: 35743929 PMCID: PMC9228597 DOI: 10.3390/life12060896] [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: 05/17/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to evaluate the effect of a combination of natural products on parameters related to inflammation, endothelial dysfunction, and oxidative stress in a cohort of familial Mediterranean fever (FMF) patients with Serum Amyloid A amyloidosis, in a non-randomized, 24-week open-label interventional study. Morinda citrifolia (anti-atherosclerotic-AAL), omega-3 (anti-inflammatory-AIC), and extract with Alaskan blueberry (antioxidant-AOL) were given to patients with FMF-related biopsy-proven AA amyloidosis. Patients were >18 years and had proteinuria (>3500 mg/day) but a normal estimated glomerular filtration rate (eGFR). Arterial flow-mediated dilatation (FMD), carotid intima media thickness (CIMT), and serum biomarkers asymmetric dimethylarginine (ADMA), high sensitivity C-reactive protein (hs-CRP), pentraxin (PTX3), malondialdehyde (MDA), Cu/Zn-superoxide dismutase (Cu/Zn-SOD), and glutathione peroxidase (GSH-Px) were studied at baseline and after 24 weeks of treatment. A total of 67 FMF-related amyloidosis patients (52 male (77.6%); median age 36 years (range 21−66)) were enrolled. At the end of a 24-week treatment period with AAL, AIC, and AOL combination therapy, ADMA, MDA, PTX3, hsCRP, cholesterol, and proteinuria were significantly decreased compared to baseline, while CuZn-SOD, GSH-Px, and FMD levels were significantly increased. Changes in inflammatory markers PTX3, and hsCRP were negatively correlated with FMD change, and positively correlated with decreases in proteinuria, ADMA, MDA, cholesterol, and CIMT. Treatment with AAL, AIC and AOL combination for 24 weeks were significantly associated with reduction in inflammatory markers, improved endothelial functions, and oxidative state. Efficient control of these three mechanisms can have long term cardiovascular and renal benefits for patients with AA amyloidosis.
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Affiliation(s)
- Micol Romano
- Department of Paediatrics, Division of Paediatric Rheumatology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5W9, Canada; (M.R.); (E.D.)
- Canadian Behcet and Autoinflammatory Disease Center (CAN BE AID), Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - Facundo Garcia-Bournissen
- Department of Paediatrics, Division of Paediatric Clinical Pharmacology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5W9, Canada;
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada
| | - David Piskin
- Canadian Behcet and Autoinflammatory Disease Center (CAN BE AID), Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5W9, Canada;
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Ulkumen Rodoplu
- Emergency Medicine Association of Turkey of All, 35220 Izmir, Turkey;
| | - Lizzy Piskin
- Robarts Research Institute, University of Western Ontario, London, ON N6A 3K7, Canada;
| | - Abdelbaset A. Elzagallaai
- Schulich School of Medicine & Dentistry, Physiology and Pharmacology, University of Western Ontario, London, ON N6A 3K7, Canada;
| | - Tunc Tuncer
- Unit of Biochemistry, Epigenetic Health Solutions, 06810 Ankara, Turkey;
| | - Siren Sezer
- Division of Nephrology, Faculty of Medicine, Atilim University, 06830 Ankara, Turkey;
| | - Didar Ucuncuoglu
- Department of Food Engineering, Faculty of Engineering, Cankiri Karatekin University, 18100 Cankiri, Turkey;
| | - Tevfik Honca
- Unit of Biochemistry, Gur Life Hospital, 26320 Eskisehir, Turkey;
| | - Dimitri Poddighe
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan;
- Clinical Academic Department of Pediatrics, National Research Center of Maternal and Child Health, University Medical Center, Nur-Sultan 010000, Kazakhstan
| | - Izzet Yavuz
- Department of Nephrology, Lokman Hekim University, 06510 Ankara, Turkey;
| | - Peter Stenvinkel
- Department of Renal Medicine M99, Karolinska Institute, Karolinska University Hospital, 17164 Stockholm, Sweden;
| | - Mahmut Ilker Yilmaz
- Unit of Nephrology, Center for Epigenetic Health Solutions, 06810 Ankara, Turkey
- Correspondence:
| | - Erkan Demirkaya
- Department of Paediatrics, Division of Paediatric Rheumatology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5W9, Canada; (M.R.); (E.D.)
- Canadian Behcet and Autoinflammatory Disease Center (CAN BE AID), Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5W9, Canada;
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada
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Sahin S, Romano M, Guzel F, Piskin D, Poddighe D, Sezer S, Kasapcopur O, Appleton CT, Yilmaz I, Demirkaya E. Assessment of Surrogate Markers for Cardiovascular Disease in Familial Mediterranean Fever-Related Amyloidosis Patients Homozygous for M694V Mutation in MEFV Gene. Life (Basel) 2022; 12:life12050631. [PMID: 35629299 PMCID: PMC9146909 DOI: 10.3390/life12050631] [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: 03/05/2022] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular disease (CVD) remains underestimated in familial Mediterranean fever-associated AA amyloidosis (FMF-AA). We aimed to compare early markers of endothelial dysfunction and atherosclerosis in FMF-AA with a homozygous M694V mutation (Group 1 = 76 patients) in the Mediterranean fever (MEFV) gene and in patients with other genotypes (Group 2 = 93 patients). Measures of increased risk for future CVD events and endothelial dysfunction, including flow-mediated dilatation (FMD), pentraxin-3 (PTX3), and carotid intima-media thickness (cIMT), and fibroblast growth factor 23 (FGF23) as a marker of atherosclerotic vascular disease were compared between groups. The frequency of clinical FMF manifestations did not differ between the two groups apart from arthritis (76.3% in Group 1 and 59.1% in Group 2, p < 0.05). FMD was significantly lower in Group 1 when compared with Group 2 (MD [95% CI]: −0.6 [(−0.89)−(−0.31)]). cIMT, FGF23, and PTX3 levels were higher in Group 1 (cIMT MD [95% CI]: 0.12 [0.08−0.16]; FGF23 MD [95% CI]: 12.8 [5.9−19.6]; PTX3 MD [95% CI]: 13.3 [8.9−17.5]). In patients with FMF-AA, M694V homozygosity is associated with lower FMD values and higher cIMT, FGF23, and PTX3 levels, suggesting increased CVD risk profiles. These data suggest that a genotype−phenotype association exists in terms of endothelial dysfunction and atherosclerosis in patients with FMF-AA.
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Affiliation(s)
- Sezgin Sahin
- Department of Paediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey;
- Correspondence:
| | - Micol Romano
- Division of Paediatric Rheumatology, Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada; (M.R.); (E.D.)
- Canadian Behcet and Autoinflammatory Disease Center (CAN-BE-AID), University of Western Ontario, London, ON N6A 5C1, Canada;
| | - Ferhat Guzel
- Molecular Genetics Laboratories, Genetics Research and Genome Center, Department of Research and Development, Ant Biotechnology, Istanbul 34775, Turkey;
| | - David Piskin
- Lawson Health Research Institute, London Health Sciences Center, London, ON N6C 2R5, Canada;
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada
| | - Dimitri Poddighe
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan;
- Clinical Academic Department of Pediatrics, National Research Center of Maternal and Child Health, University Medical Center, Nur-Sultan 010000, Kazakhstan
| | - Siren Sezer
- Division of Nephrology, Atilim University Faculty of Medicine, Ankara 06830, Turkey;
| | - Ozgur Kasapcopur
- Department of Paediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey;
| | - C. Thomas Appleton
- Canadian Behcet and Autoinflammatory Disease Center (CAN-BE-AID), University of Western Ontario, London, ON N6A 5C1, Canada;
- Lawson Health Research Institute, London Health Sciences Center, London, ON N6C 2R5, Canada;
- Division of Rheumatology, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada
| | - Ilker Yilmaz
- Epigenetic Health Solutions, Unit of Nephrology, Ankara 06810, Turkey;
| | - Erkan Demirkaya
- Division of Paediatric Rheumatology, Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada; (M.R.); (E.D.)
- Canadian Behcet and Autoinflammatory Disease Center (CAN-BE-AID), University of Western Ontario, London, ON N6A 5C1, Canada;
- Lawson Health Research Institute, London Health Sciences Center, London, ON N6C 2R5, Canada;
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Sinha N, Thakur AK. Likelihood of amyloid formation in COVID-19-induced ARDS. Trends Microbiol 2021; 29:967-969. [PMID: 33795156 PMCID: PMC8007089 DOI: 10.1016/j.tim.2021.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/02/2022]
Abstract
Severe coronavirus disease 2019 (COVID-19) infection leads to multifactorial acute respiratory distress syndrome (ARDS), with little therapeutic success. The pathophysiology associated with ARDS or post-ARDS is not yet well understood. We hypothesize that amyloid formation occurring due to protein homeostasis disruption can be one of the complications associated with COVID-19-induced-ARDS.
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Affiliation(s)
- Nabodita Sinha
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, UP 208016, India
| | - Ashwani K Thakur
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, UP 208016, India.
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