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He L, Zhou J, Wang M, Chen J, Liu C, Shi J, Rui Y, Wu H. Clinical manifestations, diagnosis and treatment of hereditary fibrinogen Aα-chain renal amyloidosis: one case report and systematic review. Int Urol Nephrol 2024:10.1007/s11255-024-04236-w. [PMID: 39417966 DOI: 10.1007/s11255-024-04236-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 10/07/2024] [Indexed: 10/19/2024]
Abstract
PURPOSE We reported a confirmed case of Fibrinogen Aa-chain (AFib) amyloidosis and conducted systematic review of the genetic and protein mutation types, clinical manifestations, diagnostic methods and treatment for patients with this disease worldwide. METHODS We reported a case of AFib amyloidosis. Meanwhile, a systematic search was performed using defined terms and updated up to November 2023 in the Wanfang, China National Knowledge Infrastructure, VIP, PubMed, and Web of Science databases to identify reported cases of AFib renal amyloidosis worldwide, according to PRISMA guidelines. RESULTS A 46-year-old male patient was admitted for more than half a month because of oedematous lower limbs. Renal tissue mass spectrometry suggested an AFib type. Gene detection demonstrated that the patient carried the c.1673del (p.Lys558Argfs*10) locus heterozygous mutation of Fibrinogen Aα-chain gene (FGA). The patient was treated with haemodialysis because of uncontrollable hypertension. This systematic review comprised 46 cases. We found the onset age to be lower in women than in men (P < 0.05). All patients showed incipient symptoms including proteinuria; 10 (21.7%) patients progressed to end-stage renal disease (ESRD) or received renal replacement therapy (including dialysis and kidney transplantation) within 1 year; 18 (39.1%) patients progressed to ESRD or received renal replacement therapy within 1-5 years, and 4 (8.7%) patients did not progress to ESRD or received renal replacement therapy within 5 years. CONCLUSION AFib amyloidosis progresses rapidly. The diagnosis of this disease is primarily based on renal biopsy, mass spectrometry, and molecular gene detection. Reducing proteinuria is the main method of treating this disease. PROSPERO REGISTRATION NUMBER CRD42024516146.
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Affiliation(s)
- Linying He
- Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China
- Department of Nephrology, The First Hospital of Jiaxing, First Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Jiahui Zhou
- Department of Nephrology, The First Hospital of Jiaxing, First Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Miner Wang
- Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China
- Department of Nephrology, The First Hospital of Jiaxing, First Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Jianxiang Chen
- Department of Nephrology, The First Hospital of Jiaxing, First Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Chang Liu
- Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China
- Department of Nephrology, The First Hospital of Jiaxing, First Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Jiazhen Shi
- Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China
- Department of Nephrology, The First Hospital of Jiaxing, First Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Yanxia Rui
- Department of Nephrology, The First Hospital of Jiaxing, First Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China.
| | - Henglan Wu
- Department of Nephrology, The First Hospital of Jiaxing, First Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China.
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Zuo Y, Hanly F, Li D, Chavez E, Aljuboori O, Contreras G, Herrera GA. Unveiling renal pathology's potential: exploring a rare subtype of amyloid - apolipoprotein CII amyloidosis in the youngest patient: a case report and literature review. Ultrastruct Pathol 2024; 48:297-303. [PMID: 38769836 DOI: 10.1080/01913123.2024.2353397] [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: 04/03/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
In this clinical case report, we present a rare subtype of amyloidosis, apolipoprotein CII (apo CII), which was diagnosed through a renal biopsy and subsequently confirmed by identifying the p.K41T mutation via germline DNA sequencing. Upon reviewing the literature, five patients exhibiting identical mutation were identified via renal biopsy, while an additional patient was diagnosed through biopsies of the fat pad and bone marrow. Notably, our patient is the youngest recorded case. We pioneered the application of immunofluorescence and immunogold electron microscopy techniques for apo CII evaluation. Our report provides a detailed description of this case, supplemented by an extensive review encompassing apo CII, documented instances of apo CII amyloidosis with renal or systemic involvement, and potential underlying mechanisms.
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Affiliation(s)
- Yiqin Zuo
- Department of Pathology & Laboratory Medicine, University of Miami Hospital, Miami, FL, USA
| | - Fiona Hanly
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Duo Li
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Efren Chavez
- Katz Division of Nephrology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Omar Aljuboori
- Department of Pathology & Laboratory Medicine, University of Miami Hospital, Miami, FL, USA
| | - Gabriel Contreras
- Katz Division of Nephrology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
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Biederman LE, Dasgupta AD, Dreyfus DE, Nadasdy T, Satoskar AA, Brodsky SV. Kidney Biopsy Corner: Amyloidosis. GLOMERULAR DISEASES 2023; 3:165-177. [PMID: 37901698 PMCID: PMC10601942 DOI: 10.1159/000533195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/17/2023] [Indexed: 10/31/2023]
Abstract
Amyloidosis is an infiltrative disease caused by misfolded proteins depositing in tissues. Amyloid infiltrates the kidney in several patterns. There are, as currently described by the International Society of Amyloidosis, 14 types of amyloid that can involve the kidney, and these types may have different locations or clinical settings. Herein we report a case of AA amyloidosis occurring in a 24-year-old male with a history of intravenous drug abuse and provide a comprehensive review of different types of amyloids involving the kidney.
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Affiliation(s)
- Laura E. Biederman
- Department of Pathology, Ohio State Wexner Medical Center, Columbus, OH, USA
- Department of Pathology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Alana D. Dasgupta
- Department of Pathology, Ohio State Wexner Medical Center, Columbus, OH, USA
| | | | - Tibor Nadasdy
- Department of Pathology, Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Anjali A. Satoskar
- Department of Pathology, Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Sergey V. Brodsky
- Department of Pathology, Ohio State Wexner Medical Center, Columbus, OH, 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, Oliveira JP, Pinho A, Moreira L, Rocha L, Santos J, Pinheiro J, Costa PP, Lobato L. Unrecognized Fibrinogen A α-Chain Amyloidosis: Results From Targeted Genetic Testing. Am J Kidney Dis 2017; 70:235-243. [PMID: 28359658 DOI: 10.1053/j.ajkd.2017.01.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 01/03/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Fibrinogen A α-chain (AFib) amyloidosis results from autosomal-dominant mutations in the gene encoding AFib (FGA). Patients with this disorder typically present with proteinuria. Isolated cases of AFib amyloidosis, carrying the FGA p.Glu545Val variant, were identified in the district of Braga, in northwest Portugal. This observation led us to hypothesize that this disorder might be an unrecognized cause of kidney disease in that region and prompted us to carry out targeted genetic testing for the p.Glu545Val variant in the local hemodialysis population and family members of identified cases. STUDY DESIGN Case series. SETTING & PARTICIPANTS 3 groups of participants: (1) kidney biopsy registry, n=4; (2) hemodialysis facility, n=122 of 267 patients; and (3) genetically at-risk individuals; n=69 of 167 family members. OUTCOMES Kidney disease, kidney disease progression, and survival. RESULTS The p.Glu545Val variant was identified in all 4 patients of the biopsy registry, 12 of 122 (9.8%) hemodialysis patients tested, and 34 of 69 (49%) relatives tested. These 50 cases belonged to 13 unrelated families with kidney disease or amyloidosis identified in 61% of probands. 35 individuals presented with hypertension at a mean of 51.0±10.4 years. Of these, 30 developed kidney disease at a mean of 56.7±12.0 years, and 21 initiated dialysis therapy at a mean of 61.4±11.3 years. Heart, liver, spleen, colon, and ileum were involved along the progression of the disease. Kidney disease was formerly attributed to hypertension in 25% of patients with AFib amyloidosis undergoing hemodialysis. LIMITATIONS Retrospective data collection for patients with amyloidosis previously diagnosed. CONCLUSIONS AFib amyloidosis appears to be an under-recognized disorder in Braga, Portugal, where we found a high frequency of the FGA p.Glu545Val variant. Due to the nonspecific nature of its major clinical features, the diagnosis of AFib amyloidosis should have a high index of suspicion, particularly in populations in which hypertension is prevalent.
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Affiliation(s)
- Isabel Tavares
- Department of Nephrology, Centro Hospitalar de São João, Porto, Portugal; Group of Research and Development in Nephrology and Infectious Diseases, Institute of Biomedical Engineering-I(3)S, University of Porto, Porto, Portugal.
| | - João Paulo Oliveira
- Group of Research and Development in Nephrology and Infectious Diseases, Institute of Biomedical Engineering-I(3)S, University of Porto, Porto, Portugal; Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Pinho
- Department of Nephrology, Centro Hospitalar de São João, Porto, Portugal
| | - Luciana Moreira
- Department of Human Genetics, National Health Institute Doutor Ricardo Jorge, Porto, Portugal
| | - Liliana Rocha
- Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Josefina Santos
- Department of Nephrology, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal; Dialysis Clinic of Braga, NephroCare-Portugal, Braga, Portugal
| | | | - Paulo Pinho Costa
- Department of Human Genetics, National Health Institute Doutor Ricardo Jorge, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Luísa Lobato
- Department of Nephrology, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
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Sivalingam V, Patel BK. Familial mutations in fibrinogen Aα (FGA) chain identified in renal amyloidosis increase in vitro amyloidogenicity of FGA fragment. Biochimie 2016; 127:44-9. [DOI: 10.1016/j.biochi.2016.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/23/2016] [Indexed: 10/21/2022]
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Nasr SH, Dasari S, Hasadsri L, Theis JD, Vrana JA, Gertz MA, Muppa P, Zimmermann MT, Grogg KL, Dispenzieri A, Sethi S, Highsmith WE, Merlini G, Leung N, Kurtin PJ. Novel Type of Renal Amyloidosis Derived from Apolipoprotein-CII. J Am Soc Nephrol 2016; 28:439-445. [PMID: 27297947 DOI: 10.1681/asn.2015111228] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/09/2016] [Indexed: 11/03/2022] Open
Abstract
Amyloidosis is characterized by extracellular deposition of misfolded proteins as insoluble fibrils. Most renal amyloidosis cases are Ig light chain, AA, or leukocyte chemotactic factor 2 amyloidosis, but rare hereditary forms can also involve the kidneys. Here, we describe the case of a 61-year-old woman who presented with nephrotic syndrome and renal impairment. Examination of the renal biopsy specimen revealed amyloidosis with predominant involvement of glomeruli and medullary interstitium. Proteomic analysis of Congo red-positive deposits detected large amounts of the Apo-CII protein. DNA sequencing of the APOC2 gene in the patient and one of her children detected a heterozygous c.206A→T transition, causing an E69V missense mutation. We also detected the mutant peptide in the proband's renal amyloid deposits. Using proteomics, we identified seven additional elderly patients with Apo-CII-rich amyloid deposits, all of whom had kidney involvement and histologically exhibited nodular glomerular involvement. Although prior in vitro studies have shown that Apo-CII can form amyloid fibrils and that certain mutations in this protein promote amyloid fibrillogenesis, there are no reports of this type of amyloidosis in humans. We propose that this study reveals a new form of hereditary amyloidosis (AApoCII) that is derived from the Apo-CII protein and appears to manifest in the elderly and preferentially affect the kidneys.
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Affiliation(s)
- Samih H Nasr
- Departments of Laboratory Medicine and Pathology
| | | | | | | | | | - Morie A Gertz
- Internal Medicine, Mayo Clinic, Rochester, Minnesota; and
| | | | | | | | - Angela Dispenzieri
- Departments of Laboratory Medicine and Pathology.,Internal Medicine, Mayo Clinic, Rochester, Minnesota; and
| | | | | | - Giampaolo Merlini
- Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Nelson Leung
- Internal Medicine, Mayo Clinic, Rochester, Minnesota; and
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Abstract
Systemic hereditary amyloidoses are autosomal dominant diseases associated with mutations in genes encoding ten different proteins. The clinical phenotype has implications on therapeutic approach, but it is commonly variable and largely dependent on the type of mutation. Except for rare cases involving gelsolin or transthyretin, patients are heterozygous for the amyloidogenic variants. Here we describe the first patient identified worldwide as homozygous for a nephropathic amyloidosis, involving the fibrinogen variant associated with the fibrinogen alpha-chain E526V (p.Glu545Val) mutation. In 1989, a 44-year-old woman presented with hypertension, hepatosplenomegaly, nephrotic syndrome, and renal failure. She started hemodialysis in 1990 and 6 years later underwent isolated kidney transplantation from a deceased donor. Graft function and clinical status were unremarkable for 16 years, despite progressively increased left ventricular mass on echocardiography. In 2012, 4 months before death, she deteriorated rapidly with severe heart failure, precipitated by Clostridium difficile colitis and urosepsis. Affected family members developed nephropathy, on average, nearly three decades later, which may be explained by the gene dosage effects on the phenotype of E526V (p.Glu545Val) fibrinogen A alpha-chain amyloidosis.
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Loavenbruck AJ, Chaudhry V, Zeldenrust SR, Spinner RJ, Theis JD, Klein CJ. Mass spectrometry analysis reveals non-mutated apolipoprotein A1 lumbosacral radiculoplexus amyloidoma. Muscle Nerve 2012; 46:817-22. [PMID: 23055319 DOI: 10.1002/mus.23415] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION In rare instances, amyloidosis presents as a focal, macroscopic lesion involving peripheral neural tissues (amyloidoma). In all known reported cases, peripheral nerve amyloidomas have had immunoglobulin light-chain fibril composition and occurred in the context of paraproteinemia. METHODS A 46-year-old man presented with progressive insidious-onset right lumbosacral radiculoplexus neuropathy without paraproteinemia. MRI-targeted fascicular nerve biopsy was performed on an enlarged sciatic nerve after earlier distal fibular nerve biopsy was nondiagnostic. Laser dissected mass spectroscopy of the discovered amyloid protein was performed after immunohistochemistry failed to identify the specific amyloid protein. Complete gene sequencing of apolipoprotein A1 (ApoA1) was performed. RESULTS Only wild-type ApoA1 amyloid was found in the congophilic component in the nerve. CONCLUSIONS This case highlights the utility of MRI-guided fascicular nerve biopsy combined with laser-dissected mass spectrometric analysis. Importantly, the case expands the known causes of amyloidomas to include wild-type ApoA1.
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Affiliation(s)
- Adam J Loavenbruck
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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On Typing Amyloidosis Using Immunohistochemistry. Detailled Illustrations, Review and a Note on Mass Spectrometry. ACTA ACUST UNITED AC 2012; 47:61-132. [DOI: 10.1016/j.proghi.2012.03.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tavares I, Lobato L, Moreira L, Santos J, Lacerda P, Pinheiro J, Costa P. Long-term follow-up of patients with hereditary fibrinogen A alpha-chain amyloidosis. Amyloid 2011; 18 Suppl 1:221-2. [PMID: 21838495 DOI: 10.3109/13506129.2011.574354083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- I Tavares
- Unidade de I & D de Nefrologia (FCT – 725), Faculdade de Medicina do Porto, University of Porto, Porto, Portugal.
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Response: Hereditary fibrinogen A α-chain amyloidosis: phenotypic characterization and the role of liver transplantation. Blood 2010. [DOI: 10.1182/blood-2010-02-266445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hereditary fibrinogen A α-chain amyloidosis: phenotypic characterization of a systemic disease and the role of liver transplantation. Blood 2010; 115:2998-3007. [DOI: 10.1182/blood-2009-06-223792] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Variants of fibrinogen A α-chain (AFib) cause the most common type of hereditary renal amyloidosis in Europe and, possibly, the United States as well. Variant fibrinogen is produced in the liver, and solitary renal allografts fail within 1 to 7 years with recurrent amyloidosis. We assessed 22 AFib patients for combined liver and kidney transplantation (LKT) and report the clinical features and outcome. Twenty-one had E526V and 1, the R554L variant. Coronary atherosclerosis was identified in 68% and systemic atheromatosis in 55%. Vascular atheroma excised at endarterectomy and endomyocardial biopsies contained purely variant fibrinogen amyloid. Half had autonomic neuropathy. Six of 9 patients who underwent LKT are alive (67%), with good allograft function and no amyloidosis at median 67 months (range, 33-155 months) of follow-up. Serial technetium-99m–labeled dimercaptosuccinic acid (99mTc-DMSA) renal scintigraphy in 2 cases of preemptive LKT demonstrated preserved native kidney residual function at 5 years. Four explanted livers were used successfully for domino transplantation. Fibrinogen amyloidosis is a systemic amyloid disease with visceral, vascular, cardiac, and neurologic involvement. LKT is curative; however, cardiovascular amyloidosis may preclude this option. Our data encourage evaluation of preemptive solitary liver transplantation early in the course of amyloid nephropathy to prevent hemodialysis and kidney transplantation.
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Delabre JP, Pageaux GP, Le Quellec A, Raynaud P, Grateau G, Mourad G. Transplantation préemptive foie-rein pour une amylose rénale à fibrinogène Aα. Nephrol Ther 2009; 5:139-43. [DOI: 10.1016/j.nephro.2008.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 08/26/2008] [Accepted: 08/28/2008] [Indexed: 11/28/2022]
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Three German fibrinogen Aα-chain amyloidosis patients with the p.Glu526Val mutation. Virchows Arch 2008; 453:25-31. [DOI: 10.1007/s00428-008-0619-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 03/17/2008] [Accepted: 04/12/2008] [Indexed: 11/26/2022]
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Bouma B, Maas C, Hazenberg BPC, Lokhorst HM, Gebbink MFBG. Increased plasmin-alpha2-antiplasmin levels indicate activation of the fibrinolytic system in systemic amyloidoses. J Thromb Haemost 2007; 5:1139-42. [PMID: 17371485 DOI: 10.1111/j.1538-7836.2007.02457.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- B Bouma
- Laboratory for Thrombosis and Haemostasis, Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
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Tennent GA, Brennan SO, Stangou AJ, O'Grady J, Hawkins PN, Pepys MB. Human plasma fibrinogen is synthesized in the liver. Blood 2006; 109:1971-4. [PMID: 17082318 DOI: 10.1182/blood-2006-08-040956] [Citation(s) in RCA: 212] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Hereditary systemic amyloidosis caused by fibrinogen Aα-chain gene mutations is an autosomal dominant condition with variable penetrance, usually of late onset, and typically presents with nephropathy leading to renal failure. Amyloid deposits often develop rapidly in transplanted kidneys, and concomitant orthotopic liver transplantation has lately been performed in several patients with the hope of halting amyloid deposition. Fibrinogen is produced in vitro by hepatocytes but also by other human cell types, and although the liver is the source of plasma fibrinogen in vivo in rats, this is not known in humans. Transplantation of livers expressing wild-type fibrinogen into patients with variant fibrinogen amyloidosis provides a unique opportunity to establish the source of human plasma fibrinogen. We therefore characterized plasma fibrinogen Aα-chain allotypes by electrospray ionization mass spectrometry mapping of tryptic digests before and after liver transplantation. Before liver transplantation, fibrinogen amyloidosis patients with the Glu526Val Aα-chain variant had approximately equal proportions of peptide with the wild-type sequence TFPGFFSPMLGEFVSETESR, and with the amyloidogenic variant sequence TFPGFFSPMLGEFVSVTESR, as expected for individuals heterozygous for the mutation. After transplantation, only the wild-type sequence was detected, and the liver is thus the source of at least 98% of the circulation fibrinogen.
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Affiliation(s)
- Glenys A Tennent
- Centre for Amyloidosis & Acute Phase Proteins, Department of Medicine, Royal Free and University College Medical School, London, United Kingdom.
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Linke RP, Oos R, Wiegel NM, Nathrath WBJ. Classification of amyloidosis: misdiagnosing by way of incomplete immunohistochemistry and how to prevent it. Acta Histochem 2006; 108:197-208. [PMID: 16790262 DOI: 10.1016/j.acthis.2006.03.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Classification of every individual case of amyloid disease is necessary in order to recognize its origin and its possible pathogenesis for therapeutic consideration. Classification of the amyloids can be performed in different ways. One method primarily exploits serum proteins-but these are risk factors only, and therefore render only ancillary information. In principle, one cannot establish the diagnosis alone through their use. Another approach analyzes the origin of the deposited amyloids, either by extracting the amyloid proteins followed by immunochemical or chemical analysis, or by using immunohistochemistry. Based on chemical analysis of prototypes of amyloid fibril proteins, we have developed a profile of antibodies over the years that specifically identify amyloid in tissue sections. These antibodies have been used for years as a routine service for clinicians and pathologists in immunohistochemically classifying amyloid found in formalin-fixed tissue sections. The typing is always controlled by established amyloid classes. In several cases, we have been asked for a second opinion on a diagnosed amyloid class. Our own immunohistochemical data were then compared with those submitted. These submitted immunohistochemical results represented misdiagnoses of amyloid classes in most patients, since the technique performed was usually incomplete. It is the purpose of this report to analyze such cases and to document some of the typical mistakes. Here, we show how to avoid common pitfalls and how one can arrive at a correct diagnosis using immunohistochemistry appropriately.
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Affiliation(s)
- Reinhold P Linke
- Department of Structural Studies, Max-Planck-Institute of Biochemistry, Am Klopferspitz 18a, D-82152 Martinsried, Germany.
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