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Khaja T, Truong L, Nassar G. De Novo Fibrinogen A Alpha Chain Amyloidosis in a Kidney Transplant Patient: Case Report and Literature Review. Can J Kidney Health Dis 2023; 10:20543581231209207. [PMID: 37920778 PMCID: PMC10619347 DOI: 10.1177/20543581231209207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023] Open
Abstract
Rationale De Novo transplant amyloidosis denotes the condition when a patient develops amyloidosis after transplantation but had not been diagnosed with the disease prior to transplantation. The incidence of de novo amyloidosis in kidney transplants is rare, but few published case reports have described the occurrence of de novo Amyloid A protein (AA) and Light Chain (AL) amyloidosis. However, de novo hereditary fibrinogen A alpha chain (AFib) has not been previously reported. Patient Presentation We present a 72-year-old man, a kidney transplant recipient, who developed progressive rise in his creatinine about 3 years after transplantation. He has long-standing diabetes mellitus type 2, obesity, and hypertension, so he did not have a kidney biopsy of his native kidneys prior to transplantation. Diagnosis A kidney transplant biopsy was done that showed amyloidosis. Mass spectrophotometry confirmed it as AFib amyloidosis. Genetic testing of the patient revealed that he has fibrinogen A alpha gene (FGA) point mutation with a p.E545V variant. Interventions Cardiac evaluation showed normal transthoracic echocardiogram. Cardiac magnetic resonance imaging (MRI) showed no involvement by amyloidosis. A peripheral nerve biopsy showed diabetic neuropathy. Thus, the kidney was the only organ involved by the disease. The kidney transplant was managed conservatively with blood pressure and diabetes control in addition to his usual immunosuppression regimen which was not altered. He is being treated with diuretics, angiotensin receptor inhibitors, and sodium glucose transport 2 inhibitors. Outcomes Kidney transplant function exhibited only slow progression over 18 months since the diagnosis was confirmed. This slow progression is likely because the p.E545V point mutation variant is less aggressive than other gene deletion mutations and because our patient was judged to have been diagnosed early in the course of his disease. Teaching Points In this case report, we illustrate the findings and testing that confirmed the diagnosis of AFib amyloidosis. We summarize the clinical aspects, outcomes of the disease, and treatment options. We believe this case report is interesting because it is the first reported case of AFib amyloidosis in a kidney transplant recipient who was not known to have the disease prior to kidney transplantation.
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Affiliation(s)
- Taqui Khaja
- Division of Nephrology, Department of Internal Medicine, Houston Methodist Hospital, Weill Cornell Medicine, TX, USA
| | - Luan Truong
- Department of Pathology, Houston Methodist Hospital, Weill Cornell Medicine, TX, USA
| | - George Nassar
- Division of Nephrology, Department of Internal Medicine, Houston Methodist Hospital, Weill Cornell Medicine, TX, USA
- Nephrology, Dialysis & Transplantation Associates, Houston, TX, USA
- Panoramic Health, Tempe, AZ, USA
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Li ZY, Wang S, Li DY, Liu D, Wang SX, Yu XJ, Liu G, Zhou FD, Zhao MH. Fibrinogen A Alpha-Chain Amyloidosis in Two Chinese Patients. Front Med (Lausanne) 2022; 9:869409. [PMID: 35572989 PMCID: PMC9096909 DOI: 10.3389/fmed.2022.869409] [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: 02/04/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Fibrinogen A alpha-chain amyloidosis (AFib amyloidosis) is the most common form of hereditary renal amyloidosis in the United Kingdom and Europe, but has rarely been reported in Asia. In this study, we reported two AFib amyloidosis patients in China, reviewing the literature and summarizing main characteristics of AFib amyloidosis in Asia. Methods Two unrelated Chinese patients were diagnosed with AFib amyloidosis by clinical presentation, renal biopsy, mass spectrometry and DNA sequencing in Peking University First Hospital of China from 2014 to 2016. Results Both of the patients presented with proteinuria, edema and hypertension. Renal biopsies of two patients showed extensive amyloid deposits (Congo red positive) in glomeruli, and focal tubulointerstitial amyloid deposits was also found in patient 1. Besides, hepatic involvement of amyloidosis has been detected by liver biopsy in patient 1. By electron microscopy, randomly arranged fibrils in a diameter of 8–12 nm was identified in mesangial matrix and subendothelial area of glomeruli. Immunohistochemistry demonstrated amyloid deposits were strongly positive for fibrinogen Aα in glomeruli and positive for LECT2 in the interstitium of renal medulla and the liver in Patient 1. Unevenly positive staining for both fibrinogen Aα and ApoA-I were found in Patient 2. Fibrinogen Aα was the most abundant amyloidogenic protein in both patients identified by laser microdissection and mass spectrometry-based proteomic analysis. Genetic analysis revealed the fibrinogen A a-chain gene (FGA) mutation in both patients, including a new deletion mutation [c.1639delA (p.Arg547Glyfs*21; NM_000508)] in Patient 2. Genetic analysis of the LECT2 gene in patient 1 revealed a codon change from ATC to GTC at position 172 [c.172A>G (p.Ile58Val; NM_002302)], which is a common polymorphism (SNP rs31517) in all ALECT2 amyloidosis patients. Conclusions We reported two AFib amyloidosis patients in China, one of them coexisted with ALECT2 amyloidosis simultaneously.
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Affiliation(s)
- Zhen-Yu Li
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China.,Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Renal Pathological Center, Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Shuang Wang
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China.,Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Renal Pathological Center, Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Dan-Yang Li
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China.,Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Renal Pathological Center, Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Dan Liu
- Proteomics Laboratory, Medical and Healthy Analytical Center, Peking University Health Science Center, Beijing, China
| | - Su-Xia Wang
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China.,Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Renal Pathological Center, Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Xiao-Juan Yu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Renal Pathological Center, Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Gang Liu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Renal Pathological Center, Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Fu-De Zhou
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Renal Pathological Center, Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Renal Pathological Center, Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
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Meyer L, Ulrich M, Ducloux D, Garrigue V, Vigneau C, Nochy D, Bobrie G, Ferlicot S, Colombat M, Boffa JJ, Clabault K, Mansour J, Mousson C, Azar R, Bacri JL, Dürrbach A, Duvic C, El Karoui K, Hoffmann M, Lionet A, Panescu V, Plaisier E, Ratsimbazafy A, Guerrot D, Vrigneaud L, Valleix S, François H. Organ Transplantation in Hereditary Fibrinogen A α-Chain Amyloidosis: A Case Series of French Patients. Am J Kidney Dis 2020; 76:384-391. [PMID: 32660897 DOI: 10.1053/j.ajkd.2020.02.445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/04/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Fibrinogen A α-chain amyloidosis (AFib amyloidosis) is a form of amyloidosis resulting from mutations in the fibrinogen A α-chain gene (FGA), causing progressive kidney disease leading to kidney failure. Treatment may include kidney transplantation (KT) or liver-kidney transplantation (LKT), but it is not clear what factors should guide this decision. The aim of this study was to characterize the natural history and long-term outcomes of this disease, with and without organ transplantation, among patients with AFib amyloidosis and various FGA variants. STUDY DESIGN Case series. SETTING & PARTICIPANTS 32 patients with AFib amyloidosis diagnosed by genetic testing in France between 1983 and 2014, with a median follow-up of 93 (range, 4-192) months, were included. RESULTS Median age at diagnosis was 51.5 (range, 12-77) years. Clinical presentation consisted of proteinuria (93%), hypertension (83%), and kidney failure (68%). Manifestations of kidney disease appeared on average at age 57 (range, 36-77) years in patients with the E526V variant, at age 45 (range, 12-59) years in those with the R554L variant (P<0.001), and at age 24.5 (range, 12-31) years in those with frameshift variants (P<0.001). KT was performed in 15 patients and LKT was performed in 4. In KT patients with the E526V variant, recurrence of AFib amyloidosis in the kidney graft was less common than with a non-E526V (R554L or frameshift) variant (22% vs 83%; P=0.03) and led to graft loss less frequently (33% vs 100%). Amyloid recurrence was not observed in patients after LKT. LIMITATIONS Analyses were based on clinically available historical data. Small number of patients with non-E526V and frameshift variants. CONCLUSIONS Our study suggests phenotypic variability in the natural history of AFib amyloidosis, depending on the FGA mutation type. KT appears to be a viable option for patients with the most common E526V variant, whereas LKT may be a preferred option for patients with frameshift variants.
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Affiliation(s)
- Lara Meyer
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Nephrology, Université Paris Descartes, Paris
| | - Marc Ulrich
- Department of Nephrology, Hôpital Jean Bernard, Valenciennes, France
| | - Didier Ducloux
- Department of Nephrology, Centre Hospitalier Universitaire de Besançon, France
| | - Valérie Garrigue
- Department of Nephrology, Hôpital Lapeyronie, Montpellier, France
| | - Cécile Vigneau
- Department of Nephrology, Centre Hospitalier Universitaire de Rennes, France
| | - Dominique Nochy
- Departments of Pathology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, Paris, France
| | - Guillaume Bobrie
- Departments of Hypertension, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, France
| | - Sophie Ferlicot
- Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, Paris, Department of Pathology, Hôpital Bicêtre, AP-HP, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Magalie Colombat
- Department of Pathology, Centre Hospitalier Universitaire de Toulouse, France
| | - Jean-Jacques Boffa
- Department of Nephrology and Dialysis, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France
| | | | | | - Christiane Mousson
- Department of Nephrology, Centre Hospitalier Unversitaire de Dijon, France
| | - Raymond Azar
- Department of Nephrology, Centre Hospitalier de Dunkerque, France
| | - Jean-Louis Bacri
- Department of Nephrology, Hôpital Jean Bernard, Valenciennes, France
| | - Antoine Dürrbach
- Department of Nephrology, Dialysis and Transplantation, Hôpital Bicêtre, AP-HP, Université Paris-Sud, Le Kremlin-Bicêtre
| | - Christian Duvic
- Department of Hemodialysis Clinique de Choisy, Le Gosier, Guadeloupe
| | | | - Maxime Hoffmann
- Department of Nephrology and Dialysis, Hôpital Privé La Louvière, Groupe Ramsay Générale de Santé, Lille
| | - Arnaud Lionet
- Department of Nephrology, and Transplantation, Centre Hospitalier Régional et Universitaire de Lille, France
| | - Victor Panescu
- Department of Nephrology and Hemodialysis, Polyclinique de Gentilly, Gentilly, France
| | - Emmanuelle Plaisier
- Department of Nephrology and Dialysis, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France
| | | | - Dominique Guerrot
- Department of Nephrology and Dialysis, Centre Hospitalier Bois Guillaume, Rouen
| | - Laurence Vrigneaud
- Department of Nephrology and Dialysis, Hôpital Privé La Louvière, Groupe Ramsay Générale de Santé, Lille
| | - Sophie Valleix
- Department of Genetic Necker Hospital, AP-HP, Université Paris Descartes, Paris AP-HP, France.
| | - Hélène François
- Department of Nephrology and Transplantation, Hôpital Tenon, Sorbonne Université, Paris, France.
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Chapman J, Dogan A. Fibrinogen alpha amyloidosis: insights from proteomics. Expert Rev Proteomics 2019; 16:783-793. [PMID: 31443619 PMCID: PMC6788741 DOI: 10.1080/14789450.2019.1659137] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/20/2019] [Indexed: 12/17/2022]
Abstract
Introduction: Systemic amyloidosis is a diverse group of diseases that, although rare, pose a serious health issue and can lead to organ failure and death. Amyloid typing is essential in determining the causative protein and initiating proper treatment. Mass spectrometry-based proteomics is currently the most sensitive and accurate means of typing amyloid. Areas covered: Amyloidosis can be systemic or localized, acquired or hereditary, and can affect any organ or tissue. Diagnosis requires biopsy, histological analysis, and typing of the causative protein to determine treatment. The kidneys are the most commonly affected organ in systemic disease. Fibrinogen alpha chain amyloidosis (AFib) is the most prevalent form of hereditary renal amyloidosis. Select mutations in the fibrinogen Aα (FGA) gene lead to AFib. Expert commentary: Mass spectrometry is currently the most specific and sensitive method for amyloid typing. Identification of the mutated fibrinogen alpha chain can be difficult in the case of 'private' frameshift mutations, which dramatically change the sequences of the expressed fibrinogen alpha chain. A combination of expert pathologist review, mass spectrometry, and gene sequencing can allow for confident diagnosis and determination of the fibrinogen alpha chain mutated sequence.
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Affiliation(s)
- Jessica Chapman
- Hematopathology Service, Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Ahmet Dogan
- Hematopathology Service, Memorial Sloan Kettering Cancer Center , New York , NY , USA
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Tavares I, Oliveira ME, Maia N, Moreira L, Castro Lacerda P, Santos J, Santos R, Pinho Costa P, Lobato L. Haplotype analysis of newly diagnosed Portuguese and Brazilian families with fibrinogen amyloidosis caused by the FGA p.Glu545Val variant. Amyloid 2019; 26:144-145. [PMID: 31343282 DOI: 10.1080/13506129.2019.1582500] [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: 10/26/2022]
Affiliation(s)
- Isabel Tavares
- a Department of Nephrology, Centro Hospitalar de São João , Porto , Portugal.,b Group of Research and Development in Nephrology and Infectious Diseases, Institute of Biomedical Engineering-I3S, University of Porto , Porto , Portugal
| | - Márcia E Oliveira
- c Unit of Molecular Genetics, Centre of Medical Genetics Dr. Jacinto Magalhães, Centro Hospitalar do Porto , Porto , Portugal.,d Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar, University of Porto , Porto , Portugal
| | - Nuno Maia
- c Unit of Molecular Genetics, Centre of Medical Genetics Dr. Jacinto Magalhães, Centro Hospitalar do Porto , Porto , Portugal.,d Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar, University of Porto , Porto , Portugal
| | - Luciana Moreira
- e Department of Human Genetics, National Health Institute Dr. Ricardo Jorge , Porto , Portugal
| | - Pedro Castro Lacerda
- e Department of Human Genetics, National Health Institute Dr. Ricardo Jorge , Porto , Portugal
| | - Josefina Santos
- d Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar, University of Porto , Porto , Portugal.,f Department of Nephrology, Hospital de Santo António, Centro Hospitalar do Porto , Porto , Portugal
| | - Rosário Santos
- c Unit of Molecular Genetics, Centre of Medical Genetics Dr. Jacinto Magalhães, Centro Hospitalar do Porto , Porto , Portugal.,d Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar, University of Porto , Porto , Portugal.,g Department of Biological Sciences, Faculty of Pharmacy, Laboratory of Biochemistry, UCIBIO/REQUIMTE, University of Porto , Porto , Portugal
| | - Paulo Pinho Costa
- d Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar, University of Porto , Porto , Portugal.,e Department of Human Genetics, National Health Institute Dr. Ricardo Jorge , Porto , Portugal
| | - Luísa Lobato
- d Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar, University of Porto , Porto , Portugal.,f Department of Nephrology, Hospital de Santo António, Centro Hospitalar do Porto , Porto , Portugal
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Tavares I, Silvano J, Moreira L, Oliveira ME, Silva R, Sampaio S, Costa PP, Lobato L. Short-term complications after renal transplantation in AFibE526V (p.Glu545Val) amyloidosis. Amyloid 2019; 26:162-163. [PMID: 31343301 DOI: 10.1080/13506129.2019.1583196] [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: 10/26/2022]
Affiliation(s)
- Isabel Tavares
- a Department of Nephrology, Centro Hospitalar São João , Porto , Portugal.,b Nephrology and Infectious Diseases Research and Development Group, INEB, I3S, University of Porto , Porto , Portugal
| | - José Silvano
- a Department of Nephrology, Centro Hospitalar São João , Porto , Portugal
| | - Luciana Moreira
- c Department of Human Genetics, National Health Institute Dr. Ricardo Jorge , Porto , Portugal
| | - Márcia E Oliveira
- d Unit of Molecular Genetics, Centre of Medical Genetics Dr. Jacinto Magalhães, Centro Hospitalar do Porto , Porto , Portugal
| | - Roberto Silva
- e Department of Pathology, Centro Hospitalar São João , Porto , Portugal
| | - Susana Sampaio
- a Department of Nephrology, Centro Hospitalar São João , Porto , Portugal.,b Nephrology and Infectious Diseases Research and Development Group, INEB, I3S, University of Porto , Porto , Portugal
| | - Paulo Pinho Costa
- c Department of Human Genetics, National Health Institute Dr. Ricardo Jorge , Porto , Portugal.,f Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar, University of Porto , Porto , Portugal
| | - Luísa Lobato
- f Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar, University of Porto , Porto , Portugal.,g Department of Nephrology, Hospital de Santo António, Centro Hospitalar do Porto , Porto , Portugal
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Hereditary Fibrinogen Aα-Chain Amyloidosis in Asia: Clinical and Molecular Characteristics. Int J Mol Sci 2018; 19:ijms19010320. [PMID: 29361747 PMCID: PMC5796263 DOI: 10.3390/ijms19010320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 02/07/2023] Open
Abstract
Hereditary fibrinogen Aα-chain amyloidosis (Aα-chain amyloidosis) is a type of autosomal dominant systemic amyloidosis caused by mutations in fibrinogen Aα-chain gene (FGA). Patients with Aα-chain amyloidosis have been mainly reported in Western countries but have been rarely reported in Asia, with only five patients with Aα-chain amyloidosis being reported in Korea, China, and Japan. Clinically, the most prominent manifestation in Asian patients with Aα-chain amyloidosis is progressive nephropathy caused by excessive amyloid deposition in the glomeruli, which is similar to that observed in patients with Aα-chain amyloidosis in Western countries. In molecular features in Asian Aα-chain amyloidosis, the most common variant, E526V, was found in only one Chinese kindred, and other four kindred each had a different variant, which have not been identified in other countries. These variants are located in the C-terminal region (amino acid residues 517–555) of mature Aα-chain, which was similar to that observed in patients with Aα-chain amyloidosis in other countries. The precise number of Asian patients with Aα-chain amyloidosis is unclear. However, patients with Aα-chain amyloidosis do exist in Asian countries, and the majority of these patients may be diagnosed with other types of systemic amyloidosis.
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