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Kim C, Simon B, Vaidya N, Kirk S, Estes K, Ghadiali L, Kontosis A, Yoo D. Contrasting presentations of the same disease: A comparison of two cases of amyloidosis presenting with eyelid involvement. Am J Ophthalmol Case Rep 2022; 28:101714. [PMID: 36217437 PMCID: PMC9547226 DOI: 10.1016/j.ajoc.2022.101714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 07/26/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose Localized amyloidosis can affect numerous tissues throughout the body and can also affect a variety of peri-ocular tissues including the conjunctiva, extra-ocular muscles, peri-orbital soft tissue, and lacrimal gland. We report two cases of amyloidosis presenting with eyelid involvement. Observations The first case represented a more subtle presentation of skin thickening with a pre-septal cellulitis, while the second case had a dramatic presentation of edema evolving into tissue dehiscence and spontaneous hemorrhage with ongoing angioedema and systemic coagulopathy. Conclusions and importance The two cases of biopsy-proven orbital/peri-ocular amyloidosis demonstrate the different clinical presentations that may go from the subtle to dramatic, depending on which peri-ocular tissues are affected and to what degree. Standards for treatment of amyloidosis remain conservative initially with surgery or radiation recommended only for refractory cases, but additional therapies are under investigation. Clinicians should have high clinical suspicion for amyloidosis with findings such as skin thickening or significant periorbital edema and should always consider tissue biopsy and further workup for amyloidosis if the findings worsen or do not resolve with treatment of more common conditions such as cellulitis.
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Affiliation(s)
- Christian Kim
- Loyola University Medical Center Department of Ophthalmology, Building 102/Room 2605, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL, 60153, United States
- Corresponding author.
| | - Brian Simon
- Loyola University Medical Center Department of Ophthalmology, Building 102/Room 2605, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL, 60153, United States
| | - Neel Vaidya
- Loyola University Medical Center Department of Ophthalmology, Building 102/Room 2605, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL, 60153, United States
| | - Suzanne Kirk
- Loyola University Medical Center Department of Ophthalmology, Building 102/Room 2605, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL, 60153, United States
| | - Kimberly Estes
- Loyola University Medical Center Department of Ophthalmology, Building 102/Room 2605, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL, 60153, United States
| | - Larissa Ghadiali
- Loyola University Medical Center Department of Ophthalmology, Building 102/Room 2605, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL, 60153, United States
| | - Andreas Kontosis
- Loyola University Medical Center Department of Pathology, Building 2160 S. First Avenue, Maywood, IL, 60153, United States
| | - David Yoo
- Loyola University Medical Center Department of Ophthalmology, Building 102/Room 2605, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL, 60153, United States
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Treviño-Herrera AB, Bustamante-Vargas AP, Lisker-Cervantes A, Ríos Y Valles Valles D, Villanueva-Mendoza C, González-Duarte A, Concha-Del-Río LE. Vitreous involvement as initial presentation of hereditary transthyretin amyloidosis related to the rare TTR Ile107Met (p.Ile127Met) pathogenic variant. Ophthalmic Genet 2022; 43:413-419. [PMID: 35038954 DOI: 10.1080/13816810.2022.2025606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hereditary transthyretin amyloidosis (ATTR) is a multisystemic disease with autosomal dominant inheritance, characterized by the deposition of amyloid-insoluble proteins. We describe a case of vitreous amyloidosis as the initial presentation of ATTRv amyloidosis resulting from the rare Ile107Met (p.Ile127Met) pathogenic variant. MATERIALS AND METHODS Ophthalmic examination, multimodal imaging, vitreous biopsy, and genetic testing were performed to confirm the diagnosis. RESULTS A 44-year-old woman presented with blurred vision and floaters in both eyes (OU) for 1 year. The vitreous showed numerous strand-like opacities that were predominant in the anterior vitreous of OU. After a systemic workup and excluding malignancy, vitreous amyloidosis was suspected. Pars plana vitrectomy (PPV) of the left eye (OS) was performed, and a vitreous sample was obtained for histopathology. Homogeneous eosinophilic granular and filamentous deposits that showed an orange-red color with Congo red special stain were observed in the vitreous material, confirming vitreous amyloidosis. A PPV for the right eye (OD) was performed, and her vision at discharge was 20/20 OU. Systemic evaluation discarded neurologic or other systemic manifestations; however, there was familiar involvement in three generations with neurologic symptomatology, confirming an autosomal dominant inheritance pattern. Molecular analysis of the TTR gene showed a likely pathogenic variant Ile107Met (p.Ile127Met). CONCLUSIONS The present report describes a patient with ATTRv amyloidosis with initial vitreous involvement and the pathogenic variant Ile107Met (p.Ile127Met). It is important to consider vitreous amyloidosis as part of the non-malignant, non-infectious uveitis masquerade syndromes.
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Affiliation(s)
- Alan Baltazar Treviño-Herrera
- Inflammatory Eye Disease Clinic, Asociación Para Evitar La Ceguera En México, México City, México.,Inflammatory Eye Disease Clinic, Asociación Para Evitar La Ceguera En México, Mexico
| | | | - Andrés Lisker-Cervantes
- Inflammatory Eye Disease Clinic, Asociación Para Evitar La Ceguera En México, México City, México.,Retina and Vitreous Department, Asociación Para Evitar La Ceguera En México, Mexico City, Mexico
| | - Dolores Ríos Y Valles Valles
- Inflammatory Eye Disease Clinic, Asociación Para Evitar La Ceguera En México, México City, México.,Pathology Department, Asociación Para Evitar La Ceguera En México, Mexico City, Mexico
| | - Cristina Villanueva-Mendoza
- Inflammatory Eye Disease Clinic, Asociación Para Evitar La Ceguera En México, México City, México.,Genetics Department, Asociación Para Evitar La Ceguera En México, Mexico City, Mexico
| | - Alejandra González-Duarte
- Neurology and Psychiatry Department, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Luz Elena Concha-Del-Río
- Inflammatory Eye Disease Clinic, Asociación Para Evitar La Ceguera En México, México City, México.,Inflammatory Eye Disease Clinic, Asociación Para Evitar La Ceguera En México, Mexico
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Debourdeau E, Zagroun C, Daien V. [Familial amyloid polyneuropathy: Case report]. J Fr Ophtalmol 2021; 44:1084-1086. [PMID: 34226086 DOI: 10.1016/j.jfo.2020.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- E Debourdeau
- Service d'ophtalmologie, hôpital Gui de Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 38054 Montpellier, France; Université Montpellier 1, U1061, Montpellier, France.
| | - C Zagroun
- Service d'ophtalmologie, hôpital Gui de Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 38054 Montpellier, France; Université Montpellier 1, U1061, Montpellier, France
| | - V Daien
- Service d'ophtalmologie, hôpital Gui de Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 38054 Montpellier, France; Université Montpellier 1, U1061, Montpellier, France; Inserm, U1061, Montpellier, France
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4
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Minnella AM, Rissotto R, Antoniazzi E, Di Girolamo M, Luigetti M, Maceroni M, Bacherini D, Falsini B, Rizzo S, Obici L. Ocular Involvement in Hereditary Amyloidosis. Genes (Basel) 2021; 12:955. [PMID: 34206500 PMCID: PMC8304974 DOI: 10.3390/genes12070955] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/06/2021] [Accepted: 06/18/2021] [Indexed: 12/27/2022] Open
Abstract
The term amyloidosis describes a group of rare diseases caused by protein conformation abnormalities resulting in extracellular deposition and accumulation of insoluble fibrillar aggregates. So far, 36 amyloid precursor proteins have been identified, and each one is responsible for a specific disease entity. Transthyretin amyloidosis (ATTRv) is one of the most common forms of systemic and ocular amyloidosis, due to the deposition of transthyretin (TTR), which is a transport protein mainly synthesized in the liver but also in the retinal pigment epithelial cells. ATTRv amyloidosis may be misdiagnosed with several other conditions, resulting in a significant diagnostic delay. Gelsolin and keratoepithelin are other proteins that, when mutated, are responsible for a systemic amyloid disease with significant ocular manifestations that not infrequently appear before systemic involvement. The main signs of ocular amyloid deposition are in the cornea, irido-corneal angle and vitreous, causing complications related to vasculopathy and neuropathy at the local level. This review aims at describing the main biochemical, histopathological and clinical features of systemic amyloidosis associated with eye involvement, with particular emphasis on the inherited forms. We discuss currently available treatments, focusing on ocular involvement and specific ophthalmologic management and highlighting the importance of a prompt treatment for the potential sight-threatening complications derived from amyloid deposition in ocular tissues.
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Affiliation(s)
- Angelo Maria Minnella
- Dipartimento Universitario Testa-Collo Rgani di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (M.M.); (B.F.); (S.R.)
- UOC Oculistica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Roberta Rissotto
- Eye Clinic, San Paolo Hospital, University of Milan, 20142 Milan, Italy
| | - Elena Antoniazzi
- Institute of Ophthalmolgy, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Marco Di Girolamo
- Former Director “Presidio Ambulatoriale per le Amiloidosi Sistemiche” Fatebenefratelli “San Giovanni Calibita” Hospital, 00135 Rome, Italy;
| | - Marco Luigetti
- Fondazione Policlinico A. Gemelli IRCCS. UOC Neurologia, 00168 Rome, Italy;
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Martina Maceroni
- Dipartimento Universitario Testa-Collo Rgani di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (M.M.); (B.F.); (S.R.)
| | - Daniela Bacherini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, 50139 Florence, Italy;
| | - Benedetto Falsini
- Dipartimento Universitario Testa-Collo Rgani di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (M.M.); (B.F.); (S.R.)
- UOC Oculistica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Stanislao Rizzo
- Dipartimento Universitario Testa-Collo Rgani di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (M.M.); (B.F.); (S.R.)
- UOC Oculistica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Laura Obici
- Amyloidosis Research and Treatment Centre, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
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Thiagasorupan P, Barreau E, Gendron G, Frau E, Cauquil C, Adams D, Labetoulle M, Rousseau A. Specific postoperative complications of vitrectomy in hereditary transthyretin amyloidosis. Eur J Ophthalmol 2021; 32:11206721211006569. [PMID: 33781115 DOI: 10.1177/11206721211006569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Vitrectomy may improve visual acuity of hereditary transthyretin amyloidosis (ATTRv) patients presenting with vitreous opacities but is associated with severe complications. The objective of this study is to report visual outcomes, early and late complications of a series of ATTRv patients who underwent vitrectomy in the French ATTRv reference center. METHODS This retrospective, single-center study, included all ATTRv patients who underwent vitrectomy between 2002 and 2017. Data were collected on pre and postoperative best corrected visual acuity (BCVA) and early and late postoperative complications. RESULTS A total of 21 eyes from 15 patients were included. The mean postoperative follow-up was 40 ± 20 months (6-160 months). BCVA increased from 0.7 ± 0.4 LogMAR preoperatively to 0.3 ± 0.4 LogMAR (p = 0.003) at last postoperative visit. During follow-up, all initially glaucomatous eyes worsened, with three eyes (37%) requiring filtering surgery and two eyes (25%) had further vision loss. Among non-glaucomatous patients, four eyes (31%) developed glaucoma with two requiring trabeculectomy and one eye (8%) had further vision loss. Three eyes (three patients) presented with complications of amyloid angiopathy. Three eyes (three patients) experienced recurrence of vitreous deposits requiring surgical revision. CONCLUSION Due to the potential complications, vitrectomy in ATTRv requires specific perioperative management and life-long postoperative monitoring.
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Affiliation(s)
- Pathma Thiagasorupan
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
| | - Emmanuel Barreau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
| | - Gaël Gendron
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
- Department of Ophthalmology, Centre Hospitalier National Ophtalmologique des XV-XX, Paris, France
| | - Eric Frau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
- Centre Ophtalmologique Saint-Sulpice, Paris, France
| | - Cécile Cauquil
- Department of Neurology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), Le Kremlin-Bicêtre, France
| | - David Adams
- Department of Neurology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), Le Kremlin-Bicêtre, France
| | - Marc Labetoulle
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
| | - Antoine Rousseau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
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6
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Tasiopoulou A, Ong D, Lightman S. Characteristic Needle-Shaped Pattern Seen on OCT in a Patient with Ocular Amyloidosis. ACTA ACUST UNITED AC 2021; 5:99-101. [DOI: 10.1016/j.oret.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
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Affiliation(s)
- Shanshan Yu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guandong Province, PR China
| | - Yue Xu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guandong Province, PR China
| | - Xiaoling Liang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guandong Province, PR China
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RE-INTERVENTION IN DE NOVO VITREOUS OPACITIES AFTER PARS PLANA VITRECTOMY IN FAMILIAL AMYLOIDOTIC POLYNEUROPATHY TTR VAL30METPORTUGUESE PATIENTS. Retin Cases Brief Rep 2019; 13:273-278. [PMID: 28333852 DOI: 10.1097/icb.0000000000000578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To report management of de novo vitreous amyloid opacities after previous pars plana vitrectomy in familial amyloidotic polyneuropathy transthyretin Val30Met. METHODS This work is a retrospective observational consecutive case series of five eyes of four patients. Demographic data, transthyretin mutation involved, age at the beginning of disease, duration of disease, treatment (liver transplant or tafamidis), time between vitrectomy and re-intervention, and ophthalmologic changes were evaluated. Surgical re-intervention included phacoemulsification with intraocular lens implantation in phakic eyes, re-vitrectomy as complete as possible with posterior capsulectomy, and internal limiting membrane peeling if wrinkling of internal retinal surface was present. RESULTS All patients had transthyretin Val30Met mutation, and three were women. Mean age of onset of the disease was 52 ± 11.0 years, and average evolution time of the disease was 8 years. Three patients had been submitted to liver transplant 4, 9, and 15 years before. Time between first vitrectomy and surgical re-intervention was longer than 2 years in all cases. Two eyes had amyloid deposits on anterior lens surface and pupillary border with scalloped pupil. Two eyes were phakic. Glaucoma was present in two eyes; one of them had previous trabeculectomy. All cases had vitreous opacities behind posterior lens capsule and at vitreous base area. After re-intervention, no further recurrence was observed (average follow-up of 10 months). CONCLUSION De novo vitreous amyloid opacities may occur several years after pars plana vitrectomy. Amyloid deposition in vitreous cavity was observed only in strong vitreous adherence locations (behind posterior lens capsule and at vitreous base area). The authors expect that this procedure, an extensive re-vitrectomy associated with posterior capsulectomy, will prevent de novo vitreous amyloid opacities.
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Mansukhani SA, Pulido JS, Khanna SS. Nd:YAG capsulotomy for the management of posterior capsular amyloidosis. Am J Ophthalmol Case Rep 2018; 13:50-52. [PMID: 30560216 PMCID: PMC6289944 DOI: 10.1016/j.ajoc.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/11/2018] [Accepted: 11/05/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To describe the accumulation of amyloid in Berger's space. Observations A 35-year-old man with autosomal-dominant, familial transthyretin-associated amyloidosis and bilateral vitreous opacities had a recurrence of amyloidosis following vitrectomy. The recurrent amyloid was attached to the posterior capsule of the lens. Phacoemulsification followed by neodymium:yttrium-aluminum-garnet (Nd:YAG) capsulotomy was helpful in restoring vision. Conclusions and importance Amyloid can reaccumulate in Berger's space, which is difficult to reach in phakic eyes during vitrectomy and can then cause decreased vision. Recognition of this interesting anatomic problem will allow for faster visual rehabilitation of the patient.
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Lopes A, Fonseca I, Sousa A, Branco M, Rodrigues C, Coelho T, Sequeiros J, Freitas P. Psychopathological Dimensions in Portuguese Subjects with Transthyretin Familial Amyloid Polyneuropathy. Biomed Hub 2017; 2:1-14. [PMID: 31988916 PMCID: PMC6945894 DOI: 10.1159/000485118] [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: 05/22/2017] [Accepted: 11/09/2017] [Indexed: 11/21/2022] Open
Abstract
Background Transthyretin familial amyloid polyneuropathy (TTR-FAP) is a fatal, chronic, progressive disease. It is a rare hereditary amyloidosis, which manifests as a sensorimotor neuropathy and autonomic dysfunction. It begins during adulthood. Aims and Methods Our aim is to evaluate psychopathological dimensions in a population attending a consultation center for TTR-FAP. Two hundred and nine subjects (symptomatic and asymptomatic carriers), 84 men and 127, women participated in the study. Most subjects were married (67.1%) and most of them were still working; 33% were retired from work or on a sick leave. A sociodemographic questionnaire and The Brief Symptom Inventory (BSI) were applied. Statistical analysis was performed (descriptive analysis, Mann-Whitney, Wilcoxon, and Spearman tests). Results The Global Symptom Index (GSI) was significantly higher in patients (p = 0.001). Considering GSI, 32.7% of total subjects were above the median for general population. When subgroups were evaluated, 25.6% of symptomatic carriers, 26.3% of subjects without established diagnosis, and 39.1% of patients were above median. GSI was significantly higher in patients (p = 0.001). Some BSI dimensions were also significantly higher in the patient group (somatization, depression, anxiety, and psychoticism) when compared with carriers. Women scored higher than men. Sick women scored higher for all dimensions except somatization. Asymptomatic carriers scored statistically higher for phobic anxiety (p = 0.01), interpersonal sensitivity, anxiety, and depression. In patients, most dimensions and GSI (rho = 0.33, p = 0.002) had positive correlations with years of disease. Conclusions TTR-FAP patients and carriers are a very vulnerable group for psychological distress and psychopathological problems. Women and patients are at higher risk.
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Affiliation(s)
- Alice Lopes
- Unidade Corino de Andrade, Serviço de Psiquiatria e Saúde Mental, Centro Hospitalar do Porto, Porto, Portugal.,ICBAS - Instituto de Ciências Biomédicos Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Isabel Fonseca
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal.,EPIUnit and Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal
| | - Alexandra Sousa
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal
| | - Margarida Branco
- Unidade Corino de Andrade, Serviço de Psiquiatria e Saúde Mental, Centro Hospitalar do Porto, Porto, Portugal
| | - Carla Rodrigues
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Coelho
- Unidade Corino de Andrade, Serviço de Neurofisiologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Jorge Sequeiros
- ICBAS - Instituto de Ciências Biomédicos Abel Salazar, Universidade do Porto, Porto, Portugal.,IBMC - Institute for Molecular and Cell Biology and i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- ICBAS - Instituto de Ciências Biomédicos Abel Salazar, Universidade do Porto, Porto, Portugal
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Reynolds MM, Veverka KK, Gertz MA, Dispenzieri A, Zeldenrust SR, Leung N, Pulido JS. Ocular Manifestations of Familial Transthyretin Amyloidosis. Am J Ophthalmol 2017; 183:156-162. [PMID: 28911993 DOI: 10.1016/j.ajo.2017.09.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/29/2017] [Accepted: 09/01/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE Among patients with familial amyloidosis, mutation in the transthyretin (TTR) protein is the most common type. Patients with TTR amyloidosis have been noted to have ocular, especially vitreous, involvement. In this report, an analysis of the types and frequency of ocular manifestations in TTR amyloidosis is presented. DESIGN Observational case series. METHODS Two hundred and sixty-three patients who presented to Mayo Clinic with TTR amyloidosis between January 1, 1970, and November 1, 2014, consented to be included in the Mayo Clinic amyloidosis database maintained by the Department of Hematology. Fifty-four patients had ocular examinations at a mean of 4.25 ± 3.93 months after systemic symptoms. RESULTS Of 108 examined eyes in 54 patients with TTR amyloidosis, there were 26 eyes (24%) in 13 patients with ocular involvement. Patients with ocular involvement were more likely to be women than those without ocular involvement (46% vs 15%, respectively, P = .008) and have significantly worse visual acuity (VA) at presentation (logMAR 0.24 [Snellen equivalent 20/30] vs logMAR 0.00 [Snellen equivalent 20/20], P = .017). The ophthalmic findings included vitreous amyloid (26/26, 100%), neurotrophic keratitis (2/26, 8%), glaucoma (5/26, 19%), and tortuous retinal vessels (4/26, 15%). The glaucoma was classified as open-angle (2/26), exfoliative (2/26), and neovascular following central retinal vein occlusion from amyloidosis (1/26). Ten patients underwent vitrectomy for visually significant vitreous amyloidosis, which significantly improved VA from a baseline of logMAR 0.70 (Snellen equivalent 20/100) to logMAR 0.05 (Snellen equivalent ∼20/20), P = .003. Three TTR mutations, Glu89Lys, Gly47Arg, and homozygous Gly6Ser, not previously described, were associated with vitreous amyloid. CONCLUSION In this large cohort of patients with TTR amyloidosis, female sex and decreased VA were associated with ocular amyloid. Three mutations that have not been previously reported to have vitreous involvement were described: Glu89Lys, Gly47Arg, and homozygous Gly6Ser.
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Affiliation(s)
| | | | - Morie A Gertz
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Nelson Leung
- Department of Nephrology, Mayo Clinic, Rochester, Minnesota
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
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Lopes A, Sousa A, Fonseca I, Branco M, Rodrigues C, Coelho T, Sequeiros J, Freitas P. Life paths of patients with transthyretin-related familial amyloid polyneuropathy Val30Met: a descriptive study. J Community Genet 2017; 9:93-99. [PMID: 29052096 DOI: 10.1007/s12687-017-0338-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 10/02/2017] [Indexed: 11/26/2022] Open
Abstract
Transthyretin-related familial amyloid polyneuropathy Val30Met is a fatal progressive disease. It is a rare hereditary amyloidosis, manifesting as a sensorimotor neuropathy and autonomic dysfunction. It begins during adulthood and is a disabling disease, posing a great psychological burden to patients and their families. Our aim was to describe and characterize life events related to the disease and discuss its psychosocial implications. Social and demographic data and a questionnaire on history of family and personal disease, and biographic events, were applied to 209 subjects attending an outpatient specialized clinic. Descriptive and statistical analyses were performed. They were 84 men and 127 women belonging to three groups: pre-symptomatic carriers, patients, and subjects with no established diagnosis. Most subjects were married/lived with a partner and had children (mean of 4). Most (96.3%) had contact with the disease before having a diagnosis; the affected or at-risk parent was the mother in 53.8% and the father in 43.3%; 71.8% of these had deceased. At their parent's death, many subjects were aged under 10 (9.9%), 10-14 (15.5%), or 15-24 years (31.7%). Most were under age 14 (44.9%) at their parent's disease onset; 37.2% referred this brought life changes with psychological and familial impact; most had been parent's caregivers; 7.5% had not been raised by the parents. Some (8.4%) declined to know their genetic tests results for over 1 year. Parent's disease and death are very common early in these patient's lives. During childhood or youth, many subjects became caregivers, implying changes in family roles. This disease and its life implications pose a significant psychosocial burden since childhood. TTR-FAP patients and their relatives are highly vulnerable to emotional stress and psychopathology during their lifetime. Psychological and psychiatric support, implying a multidisciplinary group, must thus be available for all of them.
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Affiliation(s)
- Alice Lopes
- Serviço de Psiquiatria e Saúde Mental do Centro Hospitalar do Porto, Porto, Portugal.
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal.
| | - Alexandra Sousa
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal
| | - Isabel Fonseca
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal
- EPIUnit and Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Margarida Branco
- Serviço de Psiquiatria e Saúde Mental do Centro Hospitalar do Porto, Porto, Portugal
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal
| | - Carla Rodrigues
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Coelho
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal
- Serviço de Neurofisiologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Jorge Sequeiros
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Instituto for Molecular and Cell Biology and i3s- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- Serviço de Psiquiatria e Saúde Mental do Centro Hospitalar do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Rossetti A, Alberto R, Spedicato L, Luigi S, Fassina A, Ambrogio F, Doro D, Daniele D. Bilateral optic neuropathy and intraretinal deposits after pars plana vitrectomy in amyloidosis. Indian J Ophthalmol 2016; 63:72-4. [PMID: 25686071 PMCID: PMC4363966 DOI: 10.4103/0301-4738.151481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pathological examination of material from a nonextensive pars plana vitrectomy (PPV) in the right eye provided a diagnosis of nonfamilial amyloidosis in a 68-year-old woman, who presented with bilateral glass wool-like vitreous opacities. Genetic testing revealed a Tyr114Cys mutation in the transthyretin gene. Six months after PPV, perimetry showed intense constriction with a temporal island and central scotoma in the right eye. An extensive PPV was performed in the left eye. Spectral domain optical coherence tomography evidenced bilateral epimacular amyloid deposits and unreported reflective spots within the inner retina. One year later, visual acuity had decreased to 20/400 in the left eye, with mild vitreous opacity, pale cupped optic disc and inferior altitudinal field defect. Bilateral diurnal intraocular pressure, transiently increased after PPV, never exceeded 16 mmHg with medication. Our patient presented optic nerve blood supply impairment, due to amyloidosis, which caused optic atrophy. Epiretinal and intraretinal deposit detection could aid in diagnosing patients with suspected amyloidosis.
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Simões CJV, Almeida ZL, Costa D, Jesus CSH, Cardoso AL, Almeida MR, Saraiva MJ, Pinho E Melo TMVD, Brito RMM. A novel bis-furan scaffold for transthyretin stabilization and amyloid inhibition. Eur J Med Chem 2016; 121:823-840. [PMID: 27020050 DOI: 10.1016/j.ejmech.2016.02.074] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 02/26/2016] [Accepted: 02/29/2016] [Indexed: 12/22/2022]
Abstract
The design and synthesis of a novel bis-furan scaffold tailored for high efficiency at inhibiting transthyretin amyloid formation is reported. In vitro results show that the discovered compounds are more efficient inhibitors of amyloid formation than tafamidis, a drug currently used in the treatment of familial amyloid polyneuropathy (FAP), despite their lower molecular weight and lipophilicity. Moreover, ex vivo experiments with the strongest inhibitor in the series, conducted in human blood plasma from normal and FAP Val30Met-transthyretin carriers, disclose remarkable affinity and selectivity profiles. The promises and challenges facing further development of this compound are discussed under the light of increasing evidence implicating transthyretin stability as a key factor not only in transthyretin amyloidoses and several associated co-morbidities, but also in Alzheimer's disease.
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Affiliation(s)
- Carlos J V Simões
- BSIM(2) - Drug Discovery, Parque Tecnológico de Cantanhede, 3060-197 Cantanhede, Portugal; Centro de Química de Coimbra and Departamento de Química, Universidade de Coimbra, 3004-535 Coimbra, Portugal.
| | - Zaida L Almeida
- Centro de Química de Coimbra and Departamento de Química, Universidade de Coimbra, 3004-535 Coimbra, Portugal; Center for Neuroscience and Cell Biology, Universidade de Coimbra, 3004-504 Coimbra, Portugal
| | - Dora Costa
- Centro de Química de Coimbra and Departamento de Química, Universidade de Coimbra, 3004-535 Coimbra, Portugal
| | - Catarina S H Jesus
- Centro de Química de Coimbra and Departamento de Química, Universidade de Coimbra, 3004-535 Coimbra, Portugal; Center for Neuroscience and Cell Biology, Universidade de Coimbra, 3004-504 Coimbra, Portugal
| | - Ana L Cardoso
- Centro de Química de Coimbra and Departamento de Química, Universidade de Coimbra, 3004-535 Coimbra, Portugal
| | - Maria R Almeida
- I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto; ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| | - Maria J Saraiva
- I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto
| | - Teresa M V D Pinho E Melo
- Centro de Química de Coimbra and Departamento de Química, Universidade de Coimbra, 3004-535 Coimbra, Portugal
| | - Rui M M Brito
- Centro de Química de Coimbra and Departamento de Química, Universidade de Coimbra, 3004-535 Coimbra, Portugal; Center for Neuroscience and Cell Biology, Universidade de Coimbra, 3004-504 Coimbra, Portugal.
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Yin J, Xia X, Shi Y, Lu Y, Zhao C, Huang Z, Tian N. Chinese familial transthyretin amyloidosis with vitreous involvement is associated with the transthyretin mutation Gly83Arg: a case report and literature review. Amyloid 2014; 21:140-2. [PMID: 24601824 DOI: 10.3109/13506129.2014.892871] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jie Yin
- Department of Ophthalmology and
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Seca M, Ferreira N, Coelho T. Vitreous Amyloidosis as the Presenting Symptom of Familial Amyloid Polyneuropathy TTR Val30Met in a Portuguese Patient. Case Rep Ophthalmol 2014; 5:92-7. [PMID: 24748873 PMCID: PMC3985800 DOI: 10.1159/000360790] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Familial amyloid polyneuropathy (FAP) is a group of disorders characterized by the extracellular deposition of amyloid substance in various tissues. The peripheral nervous system and the heart are the main target organs, but the eye may also be involved. We report a case of vitreous amyloidosis as the first manifestation of FAP in a 66-year-old Portuguese man without a family history.
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Affiliation(s)
- Mariana Seca
- Ophthalmology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Natália Ferreira
- Ophthalmology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Coelho
- Familial Amyloid Polyneuropathy Clinical Unit, Centro Hospitalar do Porto, Porto, Portugal ; Neurophysiology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
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17
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Lv W, Chen J, Chen W, Hou P, Pang CP, Chen H. Multimodal retinal imaging in a Chinese kindred with familial amyloid polyneuropathy secondary to transthyretin Ile107Met mutation. Eye (Lond) 2014; 28:452-8. [PMID: 24480837 DOI: 10.1038/eye.2014.10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 12/10/2013] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To investigate the ocular phenotype and gene mutation of a Chinese pedigree with familial amyloid polyneuropathy (FAP) and vitreous amyloidosis. METHODS A Chinese pedigree with familial amyloid polyneuropathy and vitreous amyloidosis was recruited. Combined phacoemulsification, vitrectomy and intraocular lens implantation were performed on the right eye of the index patient. Ophthalmic investigations were performed before and after surgery. The DNA from the pedigree was sequenced for the transthyretin (TTR) gene. RESULTS After vitrectomy, the best-corrected visual acuity of the patient improved from counting finger to 20/20. Red-free confocal ophthalmoscopy demonstrated perifoveal ring and several perivessel white sheaths. Optical coherence tomography (OCT) revealed cotton wool like reflections on the vitreoretinal interface. Electroretinogram and autofluorescence was normal. Amyloid was present in the vitreous specimen. A substitution of T to G at nucleotide 381 in exon 4 of TTR DNA (Ile107Met) was found. This mutation co-segregated with phenotype in the pedigree and was not detected in 200 controls. CONCLUSIONS TTR Ile107Met mutation is associated with vitreous amyloidosis and FAP. OCT and red-free imaging are helpful in identifying amyloid deposits in the retina.
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Affiliation(s)
- W Lv
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - J Chen
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - W Chen
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - P Hou
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - C P Pang
- 1] Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China [2] Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
| | - H Chen
- 1] Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China [2] Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
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Beirão NM, Matos ME, Meneres MJ, Beirão IM, Costa PP, Torres PA. Vitreous surgery impact in glaucoma development in liver transplanted familial amyloidosis ATTR V30M Portuguese patients. Amyloid 2012; 19:146-51. [PMID: 22856884 DOI: 10.3109/13506129.2012.710669] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Familial amyloidosis with polyneuropathy (FAP) sometimes courses with vitreous amyloid. The aim of this study was to evaluate the incidence of glaucoma after vitrectomy in FAP patients. METHODS A total of 79 eyes of 42 liver transplanted FAP patients and 16 eyes of 16 non-FAP patients with rhegmatogenous retina detachment were collected. The patients were divided in to three groups: Group I - FAP patients with vitreous opacities submitted to vitrectomy, Group II - FAP patients without vitreous opacities and not submitted to vitrectomy and, Group III - non-FAP patients with rhegmatogenous retinal detachment submitted to vitrectomy. The Group I was subdivided into: Ia - "complete" vitrectomy; Ib - "incomplete" vitrectomy. The onset of glaucoma was considered when the intraocular pressure level was higher than 21 mmHg, with concomitant visual field abnormalities and optic nerve cupping. RESULTS Post vitrectomy glaucoma was more frequent in Group I (56.1%) than in Group III (12.5%) and in Group II (10.5%). We observed a higher incidence of glaucoma in the Ia than in the Ib subgroup (86.4 vs. 21.1%) and earlier appearance in subgroup Ia (7.9 ± 3.6 vs. 39.5 ± 6.6 months). CONCLUSION Vitrectomy induced the development of glaucoma in FAP patients.
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Affiliation(s)
- Nuno M Beirão
- Opthalmology Department, Hospital de Santo António-Centro Hospitalar do Porto, Porto, Portugal.
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Chen LY, Lu L, Li YH, Zhong H, Fang W, Zhang L, Li WL. Transthyretin Arg-83 mutation in vitreous amyloidosis. Int J Ophthalmol 2011; 4:329-31. [PMID: 22553674 DOI: 10.3980/j.issn.2222-3959.2011.03.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 04/10/2011] [Indexed: 11/02/2022] Open
Abstract
Both of the patients in the report had floaters and progressive vision loss for years. Two cases of familial vitreous amyloidosis occurred in three generations with typical white fibrilar opacities in the vitreous body. Pars plana vitrectomy was performed in the two patients. The vitreous specimens were subjected to histopathological examination. The specimens showed typical microscopic features of amyloidosis with Congo red stain and non-branching fibrils were seen randomly distributed with 5-10nm in diameter on a transmission electron microscope. All of the exons of the transthyretin gene were amplified with DNA isolated from the peripheral blood cells. Bi-directional sequencing of the transthyretin gene revealed a single base-pair substitution, which results in an amino acid substitution at position83, glycine to arginine (transthyretin Arg-83).
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Affiliation(s)
- Ling-Yan Chen
- Department of Ophthalmology, Shenzhen Childrens' Hospital, 7019 Yitian Road, Shenzhen 518026, Guangdong Province, China
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