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Fernandez-Ramirez MDC, Nguyen BA, Singh V, Afrin S, Evers B, Basset P, Wang L, Pękała M, Ahmed Y, Singh P, Canepa J, Wosztyl A, Li Y, Saelices L. Multi-organ structural homogeneity of amyloid fibrils in ATTRv-T60A amyloidosis patients, revealed by Cryo-EM. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.14.594218. [PMID: 38798519 PMCID: PMC11118364 DOI: 10.1101/2024.05.14.594218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
ATTR amyloidosis is a degenerative disorder characterized by the systemic deposition of the protein transthyretin. These amyloid aggregates of transthyretin (ATTR) can deposit in different parts of the body causing diverse clinical manifestations. Our laboratory aims to investigate a potential relationship between the different genotypes, organ of deposition, clinical phenotypes, and the structure of ATTR fibrils. Using cryo-electron microscopy, we have recently described how the neuropathic related mutations ATTRv-I84S and ATTRv-V122∆ can drive structural polymorphism in ex vivo fibrils. Here we question whether the mutation ATTRv-T60A, that commonly triggers cardiac and neuropathic symptoms, has a similar effect. To address this question, we extracted and determined the structure of ATTR-T60A fibrils from multiple organs (heart, thyroid, kidney, and liver) from the same patient and from the heart of two additional patients. We have found a consistent conformation among all the fibril structures, acquiring the "closed-gate morphology" previously found in ATTRwt and others ATTRv related to cardiac or mixed manifestations. The closed-gate morphology is composed by two segments of the protein that interact together forming a polar channel, where the residues glycine 57 to isoleucine 68 act as a gate of the polar cavity. Our study indicates that ATTR-T60A fibrils present in peripheral organs adopt the same structural conformation in all patients, regardless of the organ of deposition.
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Affiliation(s)
- Maria del Carmen Fernandez-Ramirez
- Center for Alzheimer’s and Neurodegenerative Diseases, Department of Biophysics, Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center (UTSW), Dallas, TX, USA
| | - Binh A. Nguyen
- Center for Alzheimer’s and Neurodegenerative Diseases, Department of Biophysics, Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center (UTSW), Dallas, TX, USA
| | - Virender Singh
- Center for Alzheimer’s and Neurodegenerative Diseases, Department of Biophysics, Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center (UTSW), Dallas, TX, USA
| | - Shumaila Afrin
- Center for Alzheimer’s and Neurodegenerative Diseases, Department of Biophysics, Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center (UTSW), Dallas, TX, USA
| | - Bret Evers
- Department of Pathology, University of Texas Southwestern Medical Center (UTSW), Dallas, TX, USA
- Department of Ophthalmology, University of Texas Southwestern Medical Center (UTSW), Dallas, TX, USA
| | - Parker Basset
- Center for Alzheimer’s and Neurodegenerative Diseases, Department of Biophysics, Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center (UTSW), Dallas, TX, USA
| | - Lanie Wang
- Center for Alzheimer’s and Neurodegenerative Diseases, Department of Biophysics, Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center (UTSW), Dallas, TX, USA
| | - Maja Pękała
- Center for Alzheimer’s and Neurodegenerative Diseases, Department of Biophysics, Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center (UTSW), Dallas, TX, USA
| | - Yasmin Ahmed
- Center for Alzheimer’s and Neurodegenerative Diseases, Department of Biophysics, Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center (UTSW), Dallas, TX, USA
| | - Preeti Singh
- Center for Alzheimer’s and Neurodegenerative Diseases, Department of Biophysics, Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center (UTSW), Dallas, TX, USA
| | - Jacob Canepa
- Graduate School of Biomedical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aleksandra Wosztyl
- Graduate School of Biomedical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yang Li
- Department of Biophysics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Lorena Saelices
- Center for Alzheimer’s and Neurodegenerative Diseases, Department of Biophysics, Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center (UTSW), Dallas, TX, USA
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Mattig I, Heidecker B, Tschöpe C, Messroghli D, Eurich D, Kleefeld F, Gaedeke J, Stenzel W, Schmidt HHJ, Röcken C, Knebel F, Hahn K. Progressive Hereditary Transthyretin-Related Amyloidosis (ATTRv) Aggravated by ATTR Wild-Type and Complement Activation. J Neuropathol Exp Neurol 2022; 81:299-303. [DOI: 10.1093/jnen/nlab138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Isabel Mattig
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Campus Charité Mitte, Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Berlin, Germany
| | - Bettina Heidecker
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medizinische Klinik für Kardiologie, Campus Benjamin Franklin, Berlin, Germany
| | - Carsten Tschöpe
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medizinische Klinik mit Schwerpunkt Kardiologie, Virchow Klinikum Campus, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Daniel Messroghli
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Berlin, Germany
- Deutsches Herzzentrum Berlin, Klinik für Innere Medizin—Kardiologie, Germany
| | - Dennis Eurich
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Chirurgische Klinik, Campus Virchow Klinikum, Berlin, Germany
| | - Felix Kleefeld
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie mit Experimenteller Neurologie, Charité Campus Mitte, Berlin, Germany
| | - Jens Gaedeke
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Berlin, Germany
| | - Werner Stenzel
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Neuropathologie, Berlin, Germany
| | - Hartmut H -J Schmidt
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Germany
| | - Christoph Röcken
- Department of Pathology, University Hospital Schleswig-Holstein, Campus, Kiel, Germany
| | - Fabian Knebel
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Campus Charité Mitte, Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
- Sana Klinikum Lichtenberg, Innere Medizin II: Schwerpunkt Kardiologie, Berlin, Germany
| | - Katrin Hahn
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie mit Experimenteller Neurologie, Charité Campus Mitte, Berlin, Germany
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Abstract
Objectives: Previous clinical studies have shown frequent cardiac symptoms in patients with hereditary gelsolin (AGel) amyloidosis, possibly related to amyloid deposition in the heart and other internal organs. Previous studies on internal organ amyloid deposition in AGel amyloidosis have been based on small patient series. Methods: Paraffin-embedded tissue sections from 25 autopsied individuals (age at death 44.4-88.6 years) with AGel amyloidosis were stained with HE, Congo red and Herovici stains and immunohistochemistry against the low molecular weight gelsolin fraction was performed. The amount of amyloid was estimated semi-quantitatively. Results: AGel-based amyloid deposits were found in the myocardium and cardiac blood vessels in every patient. The deposits were mainly small and co-localized with regions with excess fibrosis in the myocardium. The lungs were positive for amyloid in 79%, renal parenchyma in 54% and renal blood vessels in 71% of the cases. The amount of myocardial, renal and hepatic amyloid correlated with age at death of the patients. Conclusions: We show the constant presence of AGel amyloid in the hearts of patients with AGel amyloidosis. Although the deposits were mainly small, the co-localization of amyloid with fibrosis may amplify the effect of pure amyloid deposition, possibly leading to clinical signs and symptoms.
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Affiliation(s)
- Eeva-Kaisa Schmidt
- a Department of Neurosciences, Faculty of Medicine, University of Helsinki , Helsinki , Finland
| | - Sari Kiuru-Enari
- a Department of Neurosciences, Faculty of Medicine, University of Helsinki , Helsinki , Finland
| | - Sari Atula
- a Department of Neurosciences, Faculty of Medicine, University of Helsinki , Helsinki , Finland.,b Department of Neurology, Helsinki University Hospital , Helsinki , Finland
| | - Maarit Tanskanen
- c Department of Pathology, HUSLAB, Helsinki University Hospital , Helsinki , Finland.,d Department of Pathology, Faculty of Medicine, University of Helsinki , Helsinki , Finland
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Mestre-Torres J, Lorenzo-Bosquet C, Cuberas-Borrós G, Gironella M, Solans-Laque R, Fernández-Codina A, Bujan-Rivas S, Castell-Conesa J, Martínez-Valle F. Utility of the 18F-Florbetapir positron emission tomography in systemic amyloidosis. Amyloid 2018; 25:109-114. [PMID: 29706127 DOI: 10.1080/13506129.2018.1467313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Amyloidosis comprises a group of heterogeneous conditions. To ascertain the burden of disease is important because it can determine the treatment as well as the evolution of the disease. Recent reports have shown good results in diagnosing cardiac amyloidosis using 18F-florbetapir. We hypothesize that combining whole body PET/CT with 18F-Florbetapir can be useful to characterize the burden of the disease. We included 25 patients, 13 of them with different types of amyloidosis, and 12 with Alzheimer's disease as controls. Target-to-background ratio was computed for multiple organ using maximum standardized uptake values. Organ involvement was described (standardized techniques versus PET) according to different kinds of amyloidosis showing promising results in AA and AL types. Heart involvement showed poorer results when compared to tongue, lung or thyroid gland. Multiple organ involvement in patients previously labelled as having negative organ affectation could be identified. This is the first study to evaluate the utility of 18F-florbetapir in the assessment of the global extension of disease. Our results show that this technique is useful for its diagnosis.
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Affiliation(s)
- Jaume Mestre-Torres
- a Internal Medicine Department , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | | | - Gemma Cuberas-Borrós
- b Nuclear Medicine Department , Hospital Universitari Vall d'Hebron , Barcelona , Spain.,c Institut de Diagnòstic per la Imatge (IDI), Parc Sanitari Pere Virgili , Barcelona , Spain
| | - Mercedes Gironella
- d Hematology Department , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Roser Solans-Laque
- a Internal Medicine Department , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | | | - Segundo Bujan-Rivas
- a Internal Medicine Department , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Joan Castell-Conesa
- b Nuclear Medicine Department , Hospital Universitari Vall d'Hebron , Barcelona , Spain
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Sekijima Y, Ueda M, Koike H, Misawa S, Ishii T, Ando Y. Diagnosis and management of transthyretin familial amyloid polyneuropathy in Japan: red-flag symptom clusters and treatment algorithm. Orphanet J Rare Dis 2018; 13:6. [PMID: 29343286 PMCID: PMC5773042 DOI: 10.1186/s13023-017-0726-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/23/2017] [Indexed: 01/05/2023] Open
Abstract
Hereditary ATTR (ATTRm) amyloidosis (also called transthyretin-type familial amyloid polyneuropathy [ATTR-FAP]) is an autosomal-dominant, adult-onset, rare systemic disorder predominantly characterized by irreversible, progressive, and persistent peripheral nerve damage. TTR gene mutations (e.g. replacement of valine with methionine at position 30 [Val30Met (p.Val50Met)]) lead to destabilization and dissociation of TTR tetramers into variant TTR monomers, which form amyloid fibrils that deposit in peripheral nerves and various organs, giving rise to peripheral and autonomic neuropathy and several non-disease specific symptoms. Phenotypic and genetic variability and non–disease-specific symptoms often delay diagnosis and lead to misdiagnosis. Red-flag symptom clusters simplify diagnosis globally. However, in Japan, types of TTR variants, age of onset, penetrance, and clinical symptoms of Val30Met are more varied than in other countries. Hence, development of a Japan-specific red-flag symptom cluster is warranted. Presence of progressive peripheral sensory-motor polyneuropathy and ≥1 red-flag sign/symptom (e.g. family history, autonomic dysfunction, cardiac involvement, carpal tunnel syndrome, gastrointestinal disturbances, unexplained weight loss, and immunotherapy resistance) suggests ATTR-FAP. Outside of Japan, pharmacotherapeutic options are first-line therapy. However, because of positive outcomes (better life expectancy and higher survival rates) with living donor transplant in Japan, liver transplantation remains first-line treatment, necessitating a Japan-specific treatment algorithm. Herein, we present a consolidated review of the ATTR-FAP Val30Met landscape in Japan and summarize findings from a medical advisory board meeting held in Tokyo on 18th August 2016, at which a Japan-specific ATTR-FAP red-flag symptom cluster and treatment algorithm was developed. Beside liver transplantation, a TTR-stabilizing agent (e.g. tafamidis) is a treatment option. Early diagnosis and timely treatment using the Japan-specific red-flag symptom cluster and treatment algorithm might help guide clinicians regarding apt and judicious use of available treatment modalities.
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Affiliation(s)
- Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan
| | - Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sonoko Misawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan.
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