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Chompoopong P, Mauermann ML, Siddiqi H, Peltier A. Amyloid Neuropathy: From Pathophysiology to Treatment in Light-Chain Amyloidosis and Hereditary Transthyretin Amyloidosis. Ann Neurol 2024; 96:423-440. [PMID: 38923548 DOI: 10.1002/ana.26965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/20/2024] [Accepted: 05/02/2024] [Indexed: 06/28/2024]
Abstract
Amyloid neuropathy is caused by deposition of insoluble β-pleated amyloid sheets in the peripheral nervous system. It is most common in: (1) light-chain amyloidosis, a clonal non-proliferative plasma cell disorder in which fragments of immunoglobulin, light or heavy chain, deposit in tissues, and (2) hereditary transthyretin (ATTRv) amyloidosis, a disorder caused by autosomal dominant mutations in the TTR gene resulting in mutated protein that has a higher tendency to misfold. Amyloid fibrils deposit in the endoneurium of peripheral nerves, often extensive in the dorsal root ganglia and sympathetic ganglia, leading to atrophy of Schwann cells in proximity to amyloid fibrils and blood-nerve barrier disruption. Clinically, amyloid neuropathy is manifested as a length-dependent sensory predominant neuropathy associated with generalized autonomic failure. Small unmyelinated nerves are involved early and prominently in early-onset Val30Met ATTRv, whereas other ATTRv and light-chain amyloidosis often present with large- and small-fiber involvement. Nerve conduction studies, quantitative sudomotor axon testing, and intraepidermal nerve fiber density are useful tools to evaluate denervation. Amyloid deposition can be demonstrated by tissue biopsy of the affected organ or surrogate site, as well as bone-avid radiotracer cardiac imaging. Treatment of light-chain amyloidosis has been revolutionized by monoclonal antibodies and stem cell transplantation with improved 5-year survival up to 77%. Novel gene therapy and transthyretin stabilizers have revolutionized treatment of ATTRv, improving the course of neuropathy (less change in the modified Neuropathy Impairment Score + 7 from baseline) and quality of life. With great progress in amyloidosis therapies, early diagnosis and presymptomatic testing for ATTRv family members has become paramount. ANN NEUROL 2024;96:423-440.
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Affiliation(s)
| | | | - Hasan Siddiqi
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda Peltier
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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Carvalho E, Dias A, Coelho T, Sousa A, Alves-Ferreira M, Santos M, Lemos C. Hereditary transthyretin amyloidosis: a myriad of factors that influence phenotypic variability. J Neurol 2024:10.1007/s00415-024-12509-8. [PMID: 38907862 DOI: 10.1007/s00415-024-12509-8] [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: 04/30/2024] [Revised: 06/02/2024] [Accepted: 06/07/2024] [Indexed: 06/24/2024]
Abstract
Hereditary transthyretin-related amyloidosis (ATTRv amyloidosis) is a rare and progressively debilitating disease characterized by the deposition of transthyretin (TTR) amyloid fibrils in various organs and tissues, most commonly in the heart and peripheral nerves. This pathological deposition can lead to significant organ dysfunction and, ultimately, organ failure. ATTRv amyloidosis exhibits a broad range of clinical presentations, from purely neurological symptoms to purely cardiac manifestations, as well as mixed phenotypes which result from both neurological and cardiac implications. This wide phenotypical spectrum realistically challenges disease diagnosis and prognosis, especially in individuals without or with an unknown family history. Multiple factors are thought to contribute to this variability, including genetic, epigenetic, and even environmental influences. Understanding these factors is crucial, as they can significantly affect disease expression and progression. This review aims to summarize each of these contributing factors, to help elucidate the current knowledge on the phenotypical variability of ATTRv amyloidosis.
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Affiliation(s)
- Estefânia Carvalho
- Instituto de Investigação e Inovação Em Saúde (i3S), University of Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Andreia Dias
- Instituto de Investigação e Inovação Em Saúde (i3S), University of Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Teresa Coelho
- Unidade Corino de Andrade (UCA), Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal
| | - Alda Sousa
- Instituto de Investigação e Inovação Em Saúde (i3S), University of Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Miguel Alves-Ferreira
- Instituto de Investigação e Inovação Em Saúde (i3S), University of Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Center for Preditive and Preventive Genetics (CGPP), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigação e Inovação Em Saúde (i3S), University of Porto, Porto, Portugal
| | - Mariana Santos
- Instituto de Investigação e Inovação Em Saúde (i3S), University of Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Institute for Molecular and Cell Biology (IBMC), Instituto de Investigação e Inovação Em Saúde (i3S), University of Porto, Porto, Portugal
| | - Carolina Lemos
- Instituto de Investigação e Inovação Em Saúde (i3S), University of Porto, Porto, Portugal.
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal.
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Unchagi A, Rao S, Nagappa M, Nandeesh BN, Yasha TC, Taly AB, Mahadevan A. Clinicopathological Features of Amyloid Neuropathy: A Four Decade Experience. Neurol India 2024; 72:597-602. [PMID: 39041979 DOI: 10.4103/neuroindia.ni_303_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/31/2021] [Indexed: 07/24/2024]
Abstract
BACKGROUND Peripheral neuropathy is one of the manifestations of primary or familial amyloidosis. Published studies from India are limited. MATERIALS AND METHODS We reviewed the clinical and pathological features of amyloid neuropathy diagnosed at our Institute over the last 39 years. RESULTS Fifty-five cases of amyloid neuropathies were diagnosed between 1981 and 2019, constituting 0.28% of peripheral nerve biopsies (55/19,081). Age at presentation ranged from 24 to 81 years (mean-48 years) with male preponderance [M:F = 3.58:1]. Duration of symptoms at presentation varied from 3 months to 10 years (mean-2.31 years). Majority presented with small fiber neuropathy (85%). Pure sensory symptoms predominated in 23%, while 72% had sensorimotor neuropathy and 35.8% had autonomic involvement, with isolated autonomic failure in one patient. Amyloid neuropathy was clinically suspected in 22.6% of nonfamilial cases. Familial amyloid neuropathy was suspected in eight patients. Genetic testing detected ATTR and gelsolin mutation in one each of tested patients. Nerve biopsies revealed characteristic birefringent amyloid deposits stained mahogany brown by Congo red predominantly surrounding endoneurial microvessels (34.5%), also in perineurium and epineurium in 25.45% cases. Preferential loss of small diameter myelinated fibers was noted. Axonal degeneration or regeneration was conspicuously absent. CONCLUSION Amyloid neuropathy is uncommon (0.28% of nerve biopsies in our series). Nerve biopsy is essential for the diagnosis. We report our experience of amyloid neuropathy and underscore the importance of making an assiduous search for amyloid deposits in the appropriate setting. Awareness of this entity is important for early diagnosis in the light of emerging therapeutic advances.
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Affiliation(s)
- Asha Unchagi
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Madhu Nagappa
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Bevinahalli N Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Arun B Taly
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Ticau S, Aldinc E, Polydefkis M, Adams D, Coelho T, Ueda M, Hale C, Vest J, Nioi P. Treatment response and neurofilament light chain levels with long-term patisiran in hereditary transthyretin-mediated amyloidosis with polyneuropathy: 24-month results of an open-label extension study. Amyloid 2024; 31:1-11. [PMID: 37469249 DOI: 10.1080/13506129.2023.2232520] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Longitudinal changes in neurofilament light chain (NfL) levels were evaluated alongside prespecified clinical assessments 24 months into the patisiran Global open-label extension (OLE) study in patients with ATTRv amyloidosis with polyneuropathy. METHODS All patients enrolled in the Global OLE, from phase III APOLLO and phase II OLE parent studies, received patisiran. Assessments included measures of polyneuropathy (modified Neuropathy Impairment Score+7 (mNIS+7)), quality of life (QOL; Norfolk QOL-Diabetic Neuropathy questionnaire (Norfolk QOL-DN)), and plasma NfL. RESULTS Patients receiving patisiran in the parent study (APOLLO-patisiran, n = 137; phase II OLE-patisiran, n = 25) demonstrated sustained improvements in mNIS+7 (mean change from parent study baseline (95% confidence interval): APOLLO-patisiran -4.8 (-8.9, -0.6); phase II OLE-patisiran -5.8 (-10.5, -1.2)) and Norfolk QOL-DN (APOLLO-patisiran -2.4 (-7.2, 2.3)), and maintained reduced NfL levels at Global OLE 24 months. After initiating patisiran in the Global OLE, APOLLO-placebo patients (n = 49) demonstrated stabilized mNIS+7, improved Norfolk QOL-DN, and significantly reduced NfL levels. Patisiran continued to demonstrate an acceptable safety profile. Earlier patisiran initiation was associated with a lower exposure-adjusted mortality rate. CONCLUSIONS Long-term patisiran treatment led to sustained improvements in neuropathy and QOL, with NfL demonstrating potential as a biomarker for disease progression and treatment response in ATTRv amyloidosis with polyneuropathy.
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Affiliation(s)
| | | | - Michael Polydefkis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Adams
- Neurology Department, AP-HP, CHU Bicêtre, Université Paris-Saclay, Paris-Saclay, France
| | - Teresa Coelho
- Centro Hospitalar Universitário Santo António, European Reference Network - EUroNMD, Porto, Portugal
| | - Mitsuharu Ueda
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - John Vest
- Alnylam Pharmaceuticals, Cambridge, MA, USA
| | - Paul Nioi
- Alnylam Pharmaceuticals, Cambridge, MA, USA
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Pinton S, Vacchi E, Chiaro G, Raimondi A, Tzankov A, Gerber B, Gobbi C, Kaelin-Lang A, Melli G. Amyloid detection and typing yield of skin biopsy in systemic amyloidosis and polyneuropathy. Ann Clin Transl Neurol 2023; 10:2347-2359. [PMID: 37849451 PMCID: PMC10723241 DOI: 10.1002/acn3.51924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE Disease-modifying therapies are available for amyloidosis but are ineffective if end-organ damage is severe. As small fiber neuropathy is an early and common feature of amyloidosis, we assessed detection and typing yield of skin biopsy for amyloid in patients with confirmed systemic amyloidosis and neuropathic symptoms. METHODS In this case-control study, patients with transthyretin and light chain amyloidosis (ATTRv, ATTRwt, and AL) were consecutively recruited. They were sex and age-matched to three control groups (1) non-neuropathic controls (NNC), (2) monoclonal gammopathy of undetermined significance (MGUS), and (3) other neuropathic disease controls (ONC). Patients underwent a double 3 mm skin biopsy in proximal and distal leg. Amyloid index and burden, protein typing by immuno-electron microscopy, intraepidermal nerve fiber density, electroneuromyography, and clinical characteristics were analyzed. RESULTS We studied 15 subjects with confirmed systemic amyloidosis, 20 NNC, 18 MGUS, and 20 ONC. Amyloid was detected in 100% of patients with amyloidosis (87% in ankle and 73% in thigh). It was not detected in any of the control groups. A small fiber neuropathy was encountered in 100% of amyloidosis patients, in 80% of MGUS, and in 78% of ONC. Amyloid burden was higher in ATTRv, followed by AL and ATTRwt. The ultrastructural examination allowed the identification of the precursor protein by immunotyping in most of the cases. INTERPRETATION Skin biopsy is a minimally invasive test with optimal sensitivity for amyloid. It allows amyloid typing by electron microscope to identify the precursor protein. The diagnostic work up of systemic amyloidosis should include a skin biopsy.
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Affiliation(s)
- Sandra Pinton
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Neurodegenerative disorders lab, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Elena Vacchi
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Neurodegenerative disorders lab, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giacomo Chiaro
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Neurodegenerative disorders lab, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Andrea Raimondi
- Institute for Research in Biomedicine, Università della Svizzera italiana, Bellinzona, Switzerland
- Experimental Imaging Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alexandar Tzankov
- Histopathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Claudio Gobbi
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Alain Kaelin-Lang
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Neurodegenerative disorders lab, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giorgia Melli
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Neurodegenerative disorders lab, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Razvi Y, Porcari A, Di Nora C, Patel RK, Ioannou A, Rauf MU, Masi A, Law S, Chacko L, Rezk T, Ravichandran S, Gilbertson J, Rowczenio D, Blakeney IJ, Kaza N, Hutt DF, Lachmann H, Wechalekar A, Moody W, Lim S, Chue C, Whelan C, Venneri L, Martinez-Naharro A, Merlo M, Sinagra G, Livi U, Hawkins P, Fontana M, Gillmore JD. Cardiac transplantation in transthyretin amyloid cardiomyopathy: Outcomes from three decades of tertiary center experience. Front Cardiovasc Med 2023; 9:1075806. [PMID: 36741843 PMCID: PMC9894650 DOI: 10.3389/fcvm.2022.1075806] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/23/2022] [Indexed: 01/20/2023] Open
Abstract
Aims Transthyretin cardiac amyloidosis (ATTR-CM) is a progressive and fatal cardiomyopathy. Treatment options in patients with advanced ATTR-CM are limited to cardiac transplantation (CT). Despite case series demonstrating comparable outcomes with CT between patients with ATTR-CM and non-amyloid cardiomyopathies, ATTR-CM is considered to be a contraindication to CT in some centers, partly due to a perceived risk of amyloid recurrence in the allograft. We report long-term outcomes of CT in ATTR-CM at two tertiary centers. Materials and methods and Results We retrospectively evaluated ATTR-CM patients across two tertiary centers who underwent transplantation between 1990 and 2020. Pre-transplantation characteristics were determined and outcomes were compared with a cohort of non-transplanted ATTR-CM patients. Fourteen (12 male, 2 female) patients with ATTR-CM underwent CT including 11 with wild-type ATTR-CM and 3 with variant ATTR-CM (ATTRv). Median age at CT was 62 years and median follow up post-CT was 66 months. One, three, and five-year survival was 100, 92, and 90%, respectively and the longest surviving patient was Censored > 19 years post CT. No patients had recurrence of amyloid in the cardiac allograft. Four patients died, including one with ATTRv-CM from complications of leptomeningeal amyloidosis. Survival among the cohort of patients who underwent CT was significantly prolonged compared to UK patients with ATTR-CM generally (p < 0.001) including those diagnosed under age 65 years (p = 0.008) or with early stage cardiomyopathy (p < 0.001). Conclusion CT is well-tolerated, restores functional capacity and improves prognosis in ATTR-CM. The risk of amyloid recurrence in the cardiac allograft appears to be low.
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Affiliation(s)
- Yousuf Razvi
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Aldostefano Porcari
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
- Cardiovascular Department, Centre for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Concetta Di Nora
- Department of Cardiothoracic Science, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Rishi K. Patel
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Adam Ioannou
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Muhammad U. Rauf
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Ambra Masi
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Steven Law
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Liza Chacko
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Tamer Rezk
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Sriram Ravichandran
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Janet Gilbertson
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Dorota Rowczenio
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Iona J. Blakeney
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | | | - David F. Hutt
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Helen Lachmann
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Ashutosh Wechalekar
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - William Moody
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Sern Lim
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Colin Chue
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Carol Whelan
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Lucia Venneri
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Ana Martinez-Naharro
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Marco Merlo
- Cardiovascular Department, Centre for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Centre for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Ugolino Livi
- Department of Cardiothoracic Science, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Philip Hawkins
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Marianna Fontana
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Julian D. Gillmore
- Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
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Poda A, Klevor R, Salym A, Sarih I, Salhi S, Nissrine L, Kissani N. Etiological profile of peripheral neuropathies in an academic hospital in southern Morocco. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:97. [PMID: 36033924 PMCID: PMC9391624 DOI: 10.1186/s41983-022-00531-4] [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: 03/31/2022] [Accepted: 07/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Peripheral neuropathies constitute a common complaint in general and neurology practice, and are a source of handicap to patients. Epidemiological data in the Middle East and North Africa region as well as in the African continent are sparse. Nevertheless, regional etiological profiles are crucial in navigating the diagnostic maze of neuropathies. This study outlines the etiological profile of peripheral neuropathies in an academic hospital in southern Morocco. Results A total of 180 cases were recorded in a span of 8 years (22.5 cases per year). The mean age of patients was 42.35 years. Male gender was predominant (68.88%), with a sex ratio of 2.2. Motor symptoms were the most frequently reported (86.6%). The axonal form (40.56%) was the most frequently encountered electrophysiologic form. The most frequent etiologies in the study were diabetes (26.7%), acute polyradiculoneuropathy (26.1%) and amyotrophic lateral sclerosis (16.1%). Alcohol neuropathy was found in 2.2% of the cohort. No cause was found in 5% of cases. Outcome was mostly favorable under treatment, although 10 deaths due to acute polyradiculoneuropathy were recorded (mortality = 21.3%). Conclusions Knowledge of the etiological profile of peripheral neuropathies should guide clinicians to an early diagnosis and aid in an adapted management of patients. Supplementary Information The online version contains supplementary material available at 10.1186/s41983-022-00531-4.
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He S, Gou D, Yuan M, Guo J, Lv X, Liu Z, Ma X, Han Y. A Study of Familial Amyloid Polyneuropathy Induced by the TTR Val30Leu Mutation in China. Eur Neurol 2022; 85:486-491. [PMID: 35830843 DOI: 10.1159/000525444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/06/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Familial amyloid polyneuropathy is currently prevalent worldwide as the transthyretin (TTR) Val30Met mutation, and there are other types of mutations. The purpose of this study was to understand the clinical manifestations, electrophysiological characteristics, and outcomes of hormone-related therapy in patients with the TTR Val30Leu mutation in China. METHODS Clinical data were collected from 9 members of a family with the TTR Val30Leu mutation in China, and blood samples of 7 members of the family were sequenced. The electrophysiological examinations of 4 of them were collected and analysed. RESULTS A total of 7 people had the TTR gene c.148G>T missense mutation and the TTR protein Val30Leu mutation in this family, and the positive members all had similar symptoms, such as limb paraesthesia and gastrointestinal symptoms. In addition, electrophysiological examination showed abnormal nerve conduction velocity in all 4 patients. CONCLUSIONS The clinical manifestations of this mutation involve mainly limb sensory or motor disorders or gastrointestinal symptoms or both, and the electrophysiological examination shows neurogenic damage.
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Affiliation(s)
- Sha He
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dongyun Gou
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mengwei Yuan
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jihong Guo
- Department of Neuroelectrophysiology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiujuan Lv
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ziqian Liu
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaowei Ma
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yancong Han
- Department of Internal Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
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Wang S, Sun J, Lu Q, Li H, Zhang Y. Late-Onset Hereditary Transthyretin Amyloidosis Val30Met in an Elderly Person in a Non-Endemic Area. Int Med Case Rep J 2022; 15:299-306. [PMID: 35734096 PMCID: PMC9208636 DOI: 10.2147/imcrj.s357236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Shun Wang
- Department of Cardiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, People’s Republic of China
- Correspondence: Shun Wang, Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, People’s Republic of China, Email
| | - Jingping Sun
- Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, OH, USA
- Jingping Sun, Cardiology Department, The Cleveland Clinic Foundation, Cleveland, OH, USA, Tel +1 346-719-7412, Email
| | - Qun Lu
- Department of Cardiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, People’s Republic of China
| | - Hao Li
- ICU, The First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, People’s Republic of China
| | - Yun Zhang
- Department of Imaging Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, People’s Republic of China
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10
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Anti-Ma2 Antibody-Associated Paraneoplastic Neurological Syndromes: A Pilot Study. Brain Sci 2021; 11:brainsci11121577. [PMID: 34942879 PMCID: PMC8699657 DOI: 10.3390/brainsci11121577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/10/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022] Open
Abstract
Paraneoplastic neurologic syndromes (PNSs) are a heterogeneous group of disorders caused by the remote effects of cancer with immune-mediated pathogenesis. Anti-Ma2 antibody was defined as one of the well-characterized onconeural antibodies that could help establish a definite PNS diagnosis. We aimed to report and explore patients with anti-Ma2 antibody-associated paraneoplastic neurologic syndrome (Ma2-PNS) who frequently exhibit sensorimotor neuropathy (SMN) using a new method of factor analysis of mixed data (FAMD). Clinical data from a case series of eight patients with definite diagnoses were retrospectively reviewed. FAMD conducted further analyses with a comprehensive visualization in R software. Our cohort, with a predominance of females (5/8), presented more frequently with SMN (4/8), followed by limbic encephalitis (LE) (3/8). Two patients with LE were found to have a testicular germ-cell tumor and a thymoma, respectively. In addition, a patient who developed chronic SMN was diagnosed with multiple myeloma (MM) involving multiple organs. FAMD exhibited the overall features into a two-dimensional coordinate and located each individual into their corresponding position with high relevance. It provided a clue for determining their potential relationships and predictors. Our findings indicated that Ma2-PNS could frequently involve the peripheral nervous system, MM might be one of its associated cancers with a presentation of chronic SMN, and FAMD might be a clinically valuable tool.
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11
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Adams D, Algalarrondo V, Polydefkis M, Sarswat N, Slama MS, Nativi-Nicolau J. Expert opinion on monitoring symptomatic hereditary transthyretin-mediated amyloidosis and assessment of disease progression. Orphanet J Rare Dis 2021; 16:411. [PMID: 34602081 PMCID: PMC8489116 DOI: 10.1186/s13023-021-01960-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/18/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Hereditary transthyretin-mediated amyloidosis, also known as ATTRv amyloidosis (v for variant), is a rare, autosomal dominant, fatal disease, in which systemic amyloid progressively impairs multiple organs, leading to disability and death. The recent approval of disease-modifying therapies offers the hope of stabilization or eventual reversal of disease progression, and yet highlights a lack of disease-management guidance. A multidisciplinary panel of expert clinicians from France and the US came to consensus on monitoring the disease and identifying progression through a clinical opinion questionnaire, a roundtable meeting, and multiple rounds of feedback. MONITORING DISEASE AND PROGRESSION A multidisciplinary team should monitor ATTRv amyloidosis disease course by assessing potential target organs at baseline and during follow-up for signs and symptoms of somatic and autonomic neuropathy, cardiac dysfunction and restrictive cardiomyopathy, and other manifestations. Variability in penetrance, symptoms, and course of ATTRv amyloidosis requires that all patients, regardless of variant status, undergo regular and standardized assessment in all these categories. Progression in ATTRv amyloidosis may be indicated by: worsening of several existing quantifiable symptoms or signs; the appearance of a new symptom; or the worsening of a single symptom that results in a meaningful functional impairment. CONCLUSIONS We suggest that a multisystem approach to monitoring the signs and symptoms of ATTRv amyloidosis best captures the course of the disease. We hope this work will help form the basis of further, consensus-based guidance for the treatment of ATTRv amyloidosis.
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Affiliation(s)
- David Adams
- Université Paris-Saclay, U1195, INSERM, Le Kremlin Bicêtre, France
- Neurology Department, AP-HP, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Vincent Algalarrondo
- Cardiology Department, CHU Bichat-Claude-Bernard, 46 rue Henri Huchard, 75018, Paris, France
| | - Michael Polydefkis
- Department of Neurology, Johns Hopkins Hospital, 855 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Nitasha Sarswat
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Michel S Slama
- Cardiology Department, CHU Bichat-Claude-Bernard, 46 rue Henri Huchard, 75018, Paris, France
| | - Jose Nativi-Nicolau
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
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12
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Minnella AM, Rissotto R, Maceroni M, Romano A, Fasciani R, Luigetti M, Sabatelli M, Rizzo S, Falsini B. Ocular Involvement in Hereditary Transthyretin Amyloidosis: A Case Series Describing Novel Potential Biomarkers. Genes (Basel) 2021; 12:genes12060927. [PMID: 34207092 PMCID: PMC8234990 DOI: 10.3390/genes12060927] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 01/15/2023] Open
Abstract
Hereditary transthyretin amyloidosis (hATTR) is a rare disease caused by a point mutation in the transthyretin (TTR) gene and inherited in an autosomal dominant fashion. TTR is a plasma protein that functions as a carrier for thyroxine (T4) and retinol (vitamin A). Ophthalmological manifestations are due to both the hepatic and ocular production of mutated TTR. In this case series, we report the ocular manifestations of hATTR in eighteen eyes of nine consecutive patients. Corneal nerve abnormalities as well as morphological and functional changes in the retina were investigated. The study was a single-center, retrospective, observational, clinical case series. In all patients, corneal confocal microscopy (CCM), multimodal imaging of the retina, including fundus photography and Optical Coherence Tomography (OCT), as well as rod and cone electroretinography (ERG) were performed. Eight patients had active disease and one was an unaffected carrier. In all study eyes, corneal nerve plexa examined with CCM were poorly represented or absent. Mixed rod-cone and cone ERG b-wave amplitudes were reduced, and photopic b-wave responses were significantly delayed. Photopic Negative Response (PhNR) amplitude was significantly reduced, while PhNR latency was significantly augmented. In 13/18 eyes, vitreous opacities and abnormalities of vitreo-retinal interface were found. The current results highlight the presence of corneal nerve damage. Functional retinal abnormalities, detected by ERG, can be found even in the presence of minimal or absent structural retinal damage. These findings support the use of CCM and ERGs to detect early biomarkers for primary hATTR.
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Affiliation(s)
- Angelo Maria Minnella
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (R.R.); (S.R.); (B.F.)
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy; (R.F.); (M.L.)
| | - Roberta Rissotto
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (R.R.); (S.R.); (B.F.)
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy; (R.F.); (M.L.)
| | - Martina Maceroni
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (R.R.); (S.R.); (B.F.)
- Correspondence: ; Tel.: +06-301-549-2
| | - Angela Romano
- Institute of Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.R.); (M.S.)
| | - Romina Fasciani
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy; (R.F.); (M.L.)
| | - Marco Luigetti
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy; (R.F.); (M.L.)
- Institute of Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.R.); (M.S.)
| | - Mario Sabatelli
- Institute of Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.R.); (M.S.)
- Centro Clinico NEMO Adulti, Sede di Roma, 00168 Rome, Italy
| | - Stanislao Rizzo
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (R.R.); (S.R.); (B.F.)
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy; (R.F.); (M.L.)
| | - Benedetto Falsini
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (R.R.); (S.R.); (B.F.)
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy; (R.F.); (M.L.)
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13
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Nakov R, Suhr OB, Ianiro G, Kupcinskas J, Segal JP, Dumitrascu DL, Heinrich H, Mikolasevic I, Stojkovic-Lalosevic M, Barbov I, Sarafov S, Tournev I, Nakov V, Wixner J. Recommendations for the diagnosis and management of transthyretin amyloidosis with gastrointestinal manifestations. Eur J Gastroenterol Hepatol 2021; 33:613-622. [PMID: 33394808 DOI: 10.1097/meg.0000000000002030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Transthyretin amyloid (ATTR) amyloidosis is an adult-onset, rare systemic disorder characterized by the accumulation of misfolded fibrils in the body, including the peripheral nerves, the heart and the gastrointestinal tract. Gastrointestinal manifestations are common in hereditary (ATTRv) amyloidosis and are present even before the onset of the polyneuropathy in some cases. Delays in diagnosis of ATTRv amyloidosis with gastrointestinal manifestations commonly occur because of fragmented knowledge among gastroenterologists and general practitioners, as well as a shortage of centers of excellence and specialists dedicated to disease management. Although the disease is becoming well-recognized in the societies of Neurology and Cardiology, it is still unknown for most gastroenterologists. This review presents the recommendations for ATTRv amyloidosis with gastrointestinal manifestations elaborated by a working group of European gastroenterologists and neurologists, and aims to provide digestive health specialists with an overview of crucial aspects of ATTRv amyloidosis diagnosis to help facilitate rapid and accurate identification of the disease by focusing on disease presentation, misdiagnosis and management of gastrointestinal symptoms.
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Affiliation(s)
- Radislav Nakov
- Department of Gastroenterology, Clinic of Gastroenterology, Tsaritsa Joanna University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Ole B Suhr
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Gianluca Ianiro
- Department of Gastroenterology, Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Juozas Kupcinskas
- Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jonathon P Segal
- Department of Gastroenterology and Hepatology, St Mary's Hospital, London, UK
| | - Dan L Dumitrascu
- Second Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Henriette Heinrich
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | | | | | - Ivan Barbov
- Department of Neurology, University Clinic for Neurology, Skopje, Republic of North Macedonia
| | - Stayko Sarafov
- Department of Neurology, Expert Center for Hereditary Neurological and Metabolic Disorders, ATTR Amyloidosis Expert Center, Clinic of Nervous Diseases, Alexandrovska University Hospital, Medical University of Sofia
| | - Ivailo Tournev
- Department of Neurology, Expert Center for Hereditary Neurological and Metabolic Disorders, ATTR Amyloidosis Expert Center, Clinic of Nervous Diseases, Alexandrovska University Hospital, Medical University of Sofia
- Department of Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria
| | - Ventsislav Nakov
- Department of Gastroenterology, Clinic of Gastroenterology, Tsaritsa Joanna University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Jonas Wixner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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14
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Pinto MV, Dyck PJB, Liewluck T. Neuromuscular amyloidosis: Unmasking the master of disguise. Muscle Nerve 2021; 64:23-36. [PMID: 33458861 DOI: 10.1002/mus.27150] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022]
Abstract
Amyloidosis refers to an etiologically heterogeneous group of protein misfolding diseases, pathologically characterized by extracellular amyloid fibrils producing congophillic amorphous deposits in organs and tissues, which may lead to severe organ dysfunction and mortality. Clinical presentations vary and are often nonspecific, depending on what organs or tissues are affected. In systemic amyloidosis, the peripheral nervous system is commonly affected, whereas the skeletal muscles are only rarely involved. Immunoglobulin light chain (AL) amyloidosis and hereditary transthyretin (ATTRv) amyloidosis are the most frequent types of systemic amyloidosis involving the neuromuscular system. Localized amyloidosis can occur in skeletal muscle, so-called isolated amyloid myopathy. Amyloid neuropathy typically involves small myelinated and unmyelinated sensory and autonomic nerve fibers early in the course of the disease, followed by large myelinated fiber sensory and motor deficits. The relentlessly progressive nature with motor, painful sensory and severe autonomic dysfunction, profound weight loss, and systemic features are distinct characteristics of amyloid neuropathy. Amyloid myopathy presentation differs between systemic amyloidosis and isolated amyloid myopathy. Long-standing symptoms, distal predominant myopathy, markedly elevated creatine kinase level, and lack of peripheral neuropathy or systemic features are highly suggestive of isolated amyloid myopathy. In ATTR and AL amyloidosis, early treatment correlates with favorable outcomes. Therefore, awareness of these disorders and active screening for amyloidosis in patients with neuropathy or myopathy are crucial in detecting these patients in the everyday practice of neuromuscular medicine. Herein, we review the clinical manifestations of neuromuscular amyloidosis and provide a diagnostic approach to this disorder.
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Affiliation(s)
- Marcus V Pinto
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Federal University of Rio de Janeiro, National Amyloidosis Referral Center (CEPARM), Rio de Janeiro, Brazil
| | - P James B Dyck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Teerin Liewluck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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15
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Losada I, González-Moreno J, Rodriguez A, Uson M, Ripoll-Vera T, Ferrer-Nadal A, Rigo E, Andreu H, Figuerola A, Montalà JC, Descals C, Álvarez J, Vega-Mañés F, Roig A, Cisneros-Barroso E. Multidisciplinary approach in the management of hATTR. Eur J Clin Invest 2020; 50:e13296. [PMID: 32474919 DOI: 10.1111/eci.13296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/16/2020] [Accepted: 05/17/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Ines Losada
- Internal Medicine Service, Hospital Universitario Son Llàtzer, Palma, Spain.,Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
| | - Juan González-Moreno
- Internal Medicine Service, Hospital Universitario Son Llàtzer, Palma, Spain.,Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
| | - Adrian Rodriguez
- Internal Medicine Service, Hospital Universitario Son Llàtzer, Palma, Spain.,Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
| | - Mercedes Uson
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain.,Neurology Service, Hospital Universitario Son Llàtzer, Palma, Spain
| | - Tomas Ripoll-Vera
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain.,Cardiology Service, Hospital Universitario Son Llàtzer, Palma, Spain
| | - Asuncion Ferrer-Nadal
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain.,Neurology Service, Hospital Universitario Son Llàtzer, Palma, Spain
| | - Elena Rigo
- Ophthalmology Service, Hospital Universitario Son Llàtzer, Palma, Spain
| | - Hernan Andreu
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain.,Hepatology Service, Hospital Universitario Son Llàtzer, Palma, Spain
| | - Antoni Figuerola
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain.,Neurology Service, Hospital Universitario Son Llàtzer, Palma, Spain
| | - Juan Carles Montalà
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain.,Neurology Service, Hospital Universitario Son Llàtzer, Palma, Spain
| | - Cristina Descals
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain.,Neurology Service, Hospital Universitario Son Llàtzer, Palma, Spain
| | - Jorge Álvarez
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain.,Cardiology Service, Hospital Universitario Son Llàtzer, Palma, Spain
| | - Francisco Vega-Mañés
- Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain.,Ophthalmology Service, Hospital Universitario Son Llàtzer, Palma, Spain
| | - Antonia Roig
- Gynecology and Obstetrics Service, Hospital Universitario Son Llàtzer, Palma, Spain
| | - Eugenia Cisneros-Barroso
- Internal Medicine Service, Hospital Universitario Son Llàtzer, Palma, Spain.,Balearic Research Group in Genetic Cardiopathies, Sudden Death and TTR Amyloidosis, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
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16
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Nakov R, Sarafov S, Gospodinova M, Kirov A, Chamova T, Todorov T, Todorova A, Tournev I. Transthyretin amyloidosis: Testing strategies and model for center of excellence support. Clin Chim Acta 2020; 509:228-234. [PMID: 32564944 DOI: 10.1016/j.cca.2020.06.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
Appropriate testing strategies and strict model for Center Of Excellence (CoE) support are essential for the correct diagnosis, follow-up strategy and treatment plan for transthyretin (ATTR) amyloidosis. CoE is defined as a programme within a healthcare institution established to provide an exceptionally high concentration of expertise and related resources centred on a particular area of medicine, delivering associated care in a comprehensive, interdisciplinary fashion to afford the best patient outcome. Ideally, CoEs provide regular education and training for healthcare professionals and share knowledge and learning with other CoEs and specialists to ensure the highest standards of care. CoEs and testing strategies are of significant value to those with rare diseases and their families, as there is naturally low awareness among healthcare professionals, a phenomenon that potentially delays diagnosis and treatment. In this review, we focus on the importance of performing the most appropriate testing strategies for ATTR amyloidosis and establishing a CoE for this rare disease. We highlight our experience in establishing a CoE in Sofia, Bulgaria and define the fundamental steps needed to successfully launch a programme.
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Affiliation(s)
- Radislav Nakov
- Clinic of Gastroenterology, Tsaritsa Joanna University Hospital, Medical University - Sofia, Bulgaria.
| | - Stayko Sarafov
- Clinic of Nervous Diseases, Alexandrovska University Hospital, Medical University - Sofia, Bulgaria
| | - Mariana Gospodinova
- Clinic of Cardiology, Medical Institute of Ministry of Interior, Sofia, Bulgaria
| | - Andrey Kirov
- Genetic and Medico-diagnostic Laboratory "Genica", Sofia, Bulgaria; Department of Medical Chemistry and Biochemistry, Medical University - Sofia, Bulgaria
| | - Teodora Chamova
- Clinic of Gastroenterology, Tsaritsa Joanna University Hospital, Medical University - Sofia, Bulgaria
| | - Tihomir Todorov
- Genetic and Medico-diagnostic Laboratory "Genica", Sofia, Bulgaria
| | - Albena Todorova
- Genetic and Medico-diagnostic Laboratory "Genica", Sofia, Bulgaria; Department of Medical Chemistry and Biochemistry, Medical University - Sofia, Bulgaria
| | - Ivailo Tournev
- Clinic of Nervous Diseases, Alexandrovska University Hospital, Medical University - Sofia, Bulgaria; Department of Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria
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17
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Bunod R, Adams D, Cauquil C, Francou B, Labeyrie C, Bourenane H, Adam C, Algalarrondo V, Slama M, Darce-Bello M, Barreau E, Labetoulle M, Rousseau A. Conjunctival lymphangiectasia as a biomarker of severe systemic disease in Ser77Tyr hereditary transthyretin amyloidosis. Br J Ophthalmol 2020; 104:1363-1367. [PMID: 31949094 DOI: 10.1136/bjophthalmol-2019-315381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/10/2019] [Accepted: 12/26/2019] [Indexed: 12/12/2022]
Abstract
AIMS To investigate the relationship between the ophthalmic and systemic phenotypes in patients with hereditary transthyretin amyloidosis with the S77Y mutation (ATTRS77Y). METHODS In this cross-sectional study, patients with genetically confirmed ATTRS77Y amyloidosis were enrolled. All patients underwent complete neurological examination, including staging with the Neuropathy Impairment Score (NIS), Polyneuropathy Disability (PND) score; complete cardiological evaluation, including echocardiography, cardiac MRI and/or cardiac scintigraphy and complete ophthalmic evaluation, including slit lamp examination and fundus examination. Ocular ancillary tests (fluorescein and indocyanine green angiography, and anterior segment optical coherence tomography) were performed in cases with abnormal findings. The Kruskal-Wallis test was used for quantitative outcomes and Fisher's exact test for qualitative outcomes. Statistical significance was indicated by p<0.05 (two tailed). RESULTS The study sample was composed of 24 ATTRS77Y patients. The mean patient age was 58.4±12.4 years. None of the patients presented with amyloid deposits in the anterior chamber, secondary glaucoma or vitreous amyloidosis. Retinal angiopathy was observed in four patients, complicated with retinal ischaemia in one patient. Conjunctival lymphangiectasia (CL) was detected in 13 patients (54%), associated with perilymphatic amyloid deposits. The presence of CL was statistically associated with more severe neurological disease (NIS=43.3±31.9 vs 18.9±20.4; PND=2.6±1.0 vs 1.4±0.7 in patients with and without CL, respectively; both p<0.05) and amyloid cardiomyopathy (p=0.002). CONCLUSION In ATTRS77Y patients, CL is common and could serve as a potential biomarker for severe systemic disease. There were neither anterior chamber deposits, secondary glaucoma nor vitreous deposits in ATTRS77Y patients.
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Affiliation(s)
- Roxane Bunod
- Ophhalmology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - David Adams
- Neurology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Cécile Cauquil
- Neurology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Bruno Francou
- Molecular Biology and Genetics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Céline Labeyrie
- Neurology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Halima Bourenane
- Neurology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Clovis Adam
- Pathology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Vincent Algalarrondo
- Cardiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Diderot University, French Reference Center for FAP (NNERF), Paris, France
| | - Michel Slama
- Cardiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Diderot University, French Reference Center for FAP (NNERF), Paris, France
| | - Martha Darce-Bello
- Plateforme d'expertise Maladies Rares, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Emmanuel Barreau
- Ophhalmology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Marc Labetoulle
- Ophhalmology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
| | - Antoine Rousseau
- Ophhalmology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, French Reference Center for Familial Amyloid Polyneuropathies (NNERF), Le Kremlin-Bicêtre, France
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18
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Expert consensus recommendations to improve diagnosis of ATTR amyloidosis with polyneuropathy. J Neurol 2020; 268:2109-2122. [PMID: 31907599 PMCID: PMC8179912 DOI: 10.1007/s00415-019-09688-0] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022]
Abstract
Amyloid transthyretin (ATTR) amyloidosis with polyneuropathy (PN) is a progressive, debilitating, systemic disease wherein transthyretin protein misfolds to form amyloid, which is deposited in the endoneurium. ATTR amyloidosis with PN is the most serious hereditary polyneuropathy of adult onset. It arises from a hereditary mutation in the TTR gene and may involve the heart as well as other organs. It is critical to identify and diagnose the disease earlier because treatments are available to help slow the progression of neuropathy. Early diagnosis is complicated, however, because presentation may vary and family history is not always known. Symptoms may be mistakenly attributed to other diseases such as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), idiopathic axonal polyneuropathy, lumbar spinal stenosis, and, more rarely, diabetic neuropathy and AL amyloidosis. In endemic countries (e.g., Portugal, Japan, Sweden, Brazil), ATTR amyloidosis with PN should be suspected in any patient who has length-dependent small-fiber PN with autonomic dysfunction and a family history of ATTR amyloidosis, unexplained weight loss, heart rhythm disorders, vitreous opacities, or renal abnormalities. In nonendemic countries, the disease may present as idiopathic rapidly progressive sensory motor axonal neuropathy or atypical CIDP with any of the above symptoms or with bilateral carpal tunnel syndrome, gait disorders, or cardiac hypertrophy. Diagnosis should include DNA testing, biopsy, and amyloid typing. Patients should be followed up every 6–12 months, depending on the severity of the disease and response to therapy. This review outlines detailed recommendations to improve the diagnosis of ATTR amyloidosis with PN.
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Kirov A, Sarafov S, Pavlova Z, Todorov T, Chamova T, Gospodinova M, Tournev I, Mitev V, Todorova A. Founder effect of the Glu89Gln TTR mutation in the Bulgarian population. Amyloid 2019; 26:181-185. [PMID: 31353960 DOI: 10.1080/13506129.2019.1634539] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hereditary transthyretin amyloidosis is an autosomal dominant genetic disorder caused by missense mutations in the TTR gene resulting in amyloid formation of the transthyretin protein. Depending on the system affection, the manifestations may be different and high heterogeneity in the penetrance is observed. An endemic region in Bulgaria exists where the TTR mutation Glu89Gln is found with high frequency. This is a rare mutation and was probably introduced in the population by a common ancestor. This phenomenon, called "founder effect" was proved in carrier families by haplotype analysis of microsatellite markers showing linkage disequilibrium. Allele frequencies were analyzed and haplotype reconstruction was done with Arlequin v.3.01 software. The common ancestry of the carriers was demonstrated using additional data for their genealogies and microsatellite data from a control group of non-affected individuals. The results show that the mutation Glu89Gln is linked to one haplotype, called "hypothetical founder haplotype" which was compared to published haplotype data from other European patients and no similarity was found. Further population genetics studies of carriers of the Glu89Gln mutation from other endemic regions are required in order to clarify the geographical distribution of the mutation.
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Affiliation(s)
- Andrey Kirov
- Genetic Medico-Diagnostic Laboratory Genica , Sofia , Bulgaria
| | - Stayko Sarafov
- Clinic of Nervous Diseases, UMBAL Aleksandrovska , Sofia , Bulgaria.,Department of Neurology, Medical University Sofia , Sofia , Bulgaria
| | - Zornitza Pavlova
- Genetic Medico-Diagnostic Laboratory Genica , Sofia , Bulgaria.,Genome Center "Bulgaria" , Sofia , Bulgaria.,Department of Medical Chemistry and Biochemistry, Medical University Sofia , Sofia , Bulgaria
| | - Tihomir Todorov
- Genetic Medico-Diagnostic Laboratory Genica , Sofia , Bulgaria.,Genome Center "Bulgaria" , Sofia , Bulgaria
| | - Teodora Chamova
- Clinic of Nervous Diseases, UMBAL Aleksandrovska , Sofia , Bulgaria
| | | | - Ivailo Tournev
- Clinic of Nervous Diseases, UMBAL Aleksandrovska , Sofia , Bulgaria.,Department for Cognitive Science and Psychology, New Bulgarian University , Sofia , Bulgaria
| | - Vanyo Mitev
- Department of Medical Chemistry and Biochemistry, Medical University Sofia , Sofia , Bulgaria
| | - Albena Todorova
- Genetic Medico-Diagnostic Laboratory Genica , Sofia , Bulgaria.,Genome Center "Bulgaria" , Sofia , Bulgaria.,Department of Medical Chemistry and Biochemistry, Medical University Sofia , Sofia , Bulgaria
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20
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Giannini G, Nast CC. An Organ System-Based Approach to Differential Diagnosis of Amyloid Type in Surgical Pathology. Arch Pathol Lab Med 2019; 144:379-387. [PMID: 31697170 DOI: 10.5858/arpa.2018-0509-ra] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Amyloidosis is an uncommon but important entity. A protein-based classification of amyloidosis defines the underlying disease process, directing clinical management and providing prognostic information. However, in routine surgical pathology there often is no attempt to classify amyloid other than staining to determine light chain-associated amyloidosis. Systemic and localized amyloidosis vary with respect to frequency of organ involvement by different amyloid types, and most amyloid proteins have commercial antibodies available for identification. OBJECTIVE.— To provide a guide for the likelihood of amyloid type by organ system. DATA SOURCES.— Literature review based on PubMed searches containing the word amyloid, specifically addressing the prevalence and significance of amyloid proteins in each organ system other than the brain, and the authors' practice experience. CONCLUSIONS.— In patients with amyloidosis, determination of the responsible protein is critical for appropriate patient care. In large subspecialty practices and reference laboratories with experience in using and analyzing relevant immunohistochemistry, most amyloid proteins can be identified with an organ-specific algorithm. Referring to an organ-based algorithm may be helpful in providing clinicians with a more specific differential diagnosis regarding amyloid type to help guide clinical evaluation and treatment. When the protein cannot be characterized, mass spectrometry can be performed to definitively classify the amyloid type.
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Affiliation(s)
- Gabriel Giannini
- From the Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Cynthia C Nast
- From the Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California
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21
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Minà C, Bagnato S, Sant'Angelo A, Falletta C, Gesaro GD, Agnese V, Tuzzolino F, Galardi G, Clemenza F. Risk Factors Associated With Peripheral Neuropathy in Heart Failure Patients Candidates for Transplantation. Prog Transplant 2019; 28:36-42. [PMID: 29592634 DOI: 10.1177/1526924818765091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Peripheral neuropathy can affect patients with heart failure, though its prevalence is unknown. After heart transplantation, it can influence the postoperative course and quality of life, but screening for neuromuscular disease is not routinely performed. OBJECTIVE The aim of this study was to identify the factors associated with neuropathy in a population of patients with heart failure who are candidates for heart transplantation. STUDY DESIGN Data regarding patients' clinical history, including recent hospitalizations, were collected. All patients underwent a complete neurological examination and a neurophysiological protocol including nerve conduction studies and concentric needle electromyography. RESULTS Thirty-two patients were included in the study, and neuropathy was diagnosed in 10 (31.3%). Neuropathy was associated with the number of admissions ( P = .023; odds ratio [OR]: 1.96) and the total number of days of hospitalization in the year prior to inclusion in the study ( P = .010; OR: 1.03). The majority of hospitalizations occurred in the step-down unit (85%), with acute heart failure the leading cause of admission (42%). CONCLUSIONS This study shows that neuropathy is frequent in patients with advanced heart failure and that hospitalization for cardiac care, also in the absence of intensive care, is a marker of high risk of neurologic damage. These data can help physicians in selecting and managing candidates for transplantation and can guide decisions on the best immunosuppressive regimen or rehabilitation strategy.
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Affiliation(s)
- Chiara Minà
- 1 Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Sergio Bagnato
- 2 Unit of Neurophysiology and Rehabilitation Department, Foundation Institute G. Giglio, Cefalù, Italy
| | - Antonino Sant'Angelo
- 2 Unit of Neurophysiology and Rehabilitation Department, Foundation Institute G. Giglio, Cefalù, Italy
| | - Calogero Falletta
- 1 Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Gabriele Di Gesaro
- 1 Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Valentina Agnese
- 1 Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Fabio Tuzzolino
- 3 Research Office, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Giuseppe Galardi
- 2 Unit of Neurophysiology and Rehabilitation Department, Foundation Institute G. Giglio, Cefalù, Italy
| | - Francesco Clemenza
- 1 Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
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Prevalence of hereditary transthyretin amyloid polyneuropathy in idiopathic progressive neuropathy in conurban areas. Neurol Res Pract 2019; 1:30. [PMID: 33324896 PMCID: PMC7650113 DOI: 10.1186/s42466-019-0035-z] [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: 05/15/2019] [Accepted: 07/25/2019] [Indexed: 12/18/2022] Open
Abstract
Background Hereditary transthyretin amyloidosis (ATTR amyloidosis) is a rare, genetically heterogenous, and clinically variable autosomal dominant disease that severely reduces life expectancy. As treatment options grow, a proper diagnostic approach is mandatory especially in non-endemic regions with diverse genetic backgrounds. Methods We examined 102 neuropathy patients at a German neuromuscular centre. Common causes of polyneuropathy were ruled out by medical history and extensive laboratory testing to define a cohort of patients with progressive polyneuropathy classified as idiopathic. Molecular genetic testing of the entire TTR gene was performed, and the detected amyloidogenic and non-amyloidogenic variants were associated with the observed clinical phenotypes and results of prior diagnostic testing. Results Two of 102 patients tested positive for amyloidogenic mutations (p.Ile127Val and p.Glu81Lys), while a variant of unknown significance, p.Glu26Ser, was found in 10 cases. In both positive cases, previous negative biopsy results were proved by gene sequencing to be false negative. In case of the p.Glu81Lys mutation we detected clinical presentation (combination of severe polyneuropathy and cardiomyopathy), ethnic background (patient of polish origin, mutation only reported in Japanese families before), and disease course clearly differed from well-known cases of the same mutation in the literature. Conclusions In conclusion, transthyretin hereditary amyloid polyneuropathy (ATTR-PN) should be considered in cases of otherwise idiopathic polyneuropathy. Sequencing of the four exons of the TTR gene should be considered the key step in diagnosis, while tissue biopsy possibly leads to false negative results.
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El-Meanawy A, Mueller C, Iczkowski KA. Improving sensitivity of amyloid detection by Congo red stain by using polarizing microscope and avoiding pitfalls. Diagn Pathol 2019; 14:57. [PMID: 31200733 PMCID: PMC6567537 DOI: 10.1186/s13000-019-0822-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/10/2019] [Indexed: 11/25/2022] Open
Abstract
Systemic amyloidosis is a devastating group of disorders for which there is no current cure. The treatment goal is to reduce the burden of amyloidogenic protein precursors. The treatment is only effective if applied early in the disease process before significant and irreversible end organ damage has taken place. Congo red is still the standard stain used in most histopathology laboratories to identify amyloid material in tissues. The identification of Congophilic amyloid material is challenging because of multiple interfering factors. Here we describe improved sensitivity of identifying Congophilic materials in histologic sections using a metallurgical polarized microscope specifically constructed for polarized microscopy. The microscope is equipped with strain-free optics, matching polarizers, dis-integrated compensators, and a circular mobile stage. Compared to a standard clinical microscope, this setup significantly improves sensitivity of identifying amyloid material in Congo red-stained slides. We also describe the deleterious effect of plastic coverslip which can interfere with the ability to examine the slides under polarized light. We present a series of 10 different patients who had cardiac, brain, and salivary gland biopsies that were either equivocal or deemed negative using a standard clinical microscope but were positive using the equipment described above. These samples were confirmed to be positive by other methods including electron microscopy. We conclude that use of the correct equipment is needed before ruling out amyloidosis in tissue sections.
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Affiliation(s)
- Ashraf El-Meanawy
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| | - Christopher Mueller
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
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Ibrahim RB, Liu YT, Yeh SY, Tsai JW. Contributions of Animal Models to the Mechanisms and Therapies of Transthyretin Amyloidosis. Front Physiol 2019; 10:338. [PMID: 31001136 PMCID: PMC6454033 DOI: 10.3389/fphys.2019.00338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/13/2019] [Indexed: 01/01/2023] Open
Abstract
Transthyretin amyloidosis (ATTR amyloidosis) is a fatal systemic disease caused by amyloid deposits of misfolded transthyretin, leading to familial amyloid polyneuropathy and/or cardiomyopathy, or a rare oculoleptomeningeal amyloidosis. A good model system that mimic the disease phenotype is crucial for the development of drugs and treatments for this devastating degenerative disorder. The present models using fruit flies, worms, rodents, non-human primates and induced pluripotent stem cells have helped researchers understand important disease-related mechanisms and test potential therapeutic options. However, the challenge of creating an ideal model still looms, for these models did not recapitulates all symptoms, particularly neurological presentation, of ATTR amyloidosis. Recently, knock-in techniques was used to generate two humanized ATTR mouse models, leading to amyloid deposition in the nerves and neuropathic manifestation in these models. This review gives a recent update on the milestone, progress, and challenges in developing different models for ATTR amyloidosis research.
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Affiliation(s)
- Ridwan Babatunde Ibrahim
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Taiwan International Graduate Program in Interdisciplinary Neuroscience, National Yang-Ming University and Academia Sinica, Taipei, Taiwan
| | - Yo-Tsen Liu
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center and Biophotonics and Molecular Imaging Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ssu-Yu Yeh
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Wu Tsai
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center and Biophotonics and Molecular Imaging Research Center, National Yang-Ming University, Taipei, Taiwan
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25
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Kopishinskaya SV. [Transthyretin familial amyloid polyneuropathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:82-89. [PMID: 30499502 DOI: 10.17116/jnevro201811810182] [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: 11/18/2022]
Abstract
Transthyretin family amyloid polyneuropathy (TTR-FAP) is a progressive, ultimately fatal disease. It manifests itself primarily with sensory, motor and autonomic polyneuropathy and/or cardiomyopathy and is caused by extracellular deposition of insoluble amyloid fibrils in the endoneurium. The cause of TTR-FAP is the mutation in the gene encoding transthyretin, more than 100 types of mutations are known. Given the phenotypic diversity of TTR-FAP, it is difficult for clinicians to make this diagnosis. An erroneous diagnosis is a frequent occurrence, risking the onset of an organ pathology. The paper addresses the issues of the pathogenesis, diagnosis and treatment of TTR-FAP.
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Affiliation(s)
- S V Kopishinskaya
- Federal State Budget Educational Establishment of Higher Education Nizhny Novgorod State Medical Academy of the Ministry of Public Health of the Russian Federation, Nizhny Novgorod, Russia
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26
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Rousseau A, Terrada C, Touhami S, Barreau E, Rothschild PR, Valleix S, Benoudiba F, Errera MH, Cauquil C, Guiochon-Mantel A, Adams D, Labetoulle M. Angiographic Signatures of the Predominant Form of Familial Transthyretin Amyloidosis (Val30Met Mutation). Am J Ophthalmol 2018; 192:169-177. [PMID: 29859145 DOI: 10.1016/j.ajo.2018.05.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE To describe abnormalities in choroidal and retinal vasculature associated with Val30Met familial transthyretin amyloidosis (V30M-FTA) using fluorescein and indocyanine green (ICG) angiography. DESIGN Prospective, cross-sectional study. METHODS This study was conducted at the French National Reference Center for FTA. We included 18 consecutive genetically confirmed V30M-FTA patients (36 eyes) who underwent complete neurologic examination, including staging with polyneuropathy disability (PND) score, and complete ophthalmic evaluation, including staging of intraocular amyloid deposits and fluorescein and ICG angiograms (ICG-A). The grading of choroidal and retinal angiopathy, and their association with neurologic functional impairment, were the main outcome measures. RESULTS Eleven men and 7 women, mean age 61.6 ± 12.1 years, were included. Retinal amyloid angiopathy (RAA) was detected in 24 eyes (92%) of 13 patients, with microaneurysms, retinal hemorrhages, and retinal ischemia of variable extent. Three patients (5 eyes) had neovascular glaucoma and 2 (2 eyes) had preretinal neovascularization. ICG-A indicated choroidal amyloid angiopathy (CAA) in all patients, with 3 distinct patterns-diffuse (9/18 patients), focal (5/18 patients), or punctiform (4/18 patients)-based on the extent of late hypercyanescence along the choroidal arteries. PND scores were significantly higher in patients with diffuse CAA (firework pattern) compared to those with limited CAA (focal and punctiform patterns) (2.89 vs 1.78, P = .045). CONCLUSION RAA is a frequent and severe complication of V30M-FTA that may lead to anterior and posterior segment neovascularization. CAA was detected in all patients, with a late hypercyanescent delineation of the choroidal arterial vasculature, which was more extensive with increased disease severity.
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Kollmer J, Weiler M, Purrucker J, Heiland S, Schönland SO, Hund E, Kimmich C, Hayes JM, Hilgenfeld T, Pham M, Bendszus M, Hegenbart U. MR neurography biomarkers to characterize peripheral neuropathy in AL amyloidosis. Neurology 2018; 91:e625-e634. [DOI: 10.1212/wnl.0000000000006002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/16/2018] [Indexed: 12/31/2022] Open
Abstract
ObjectiveTo detect, localize, and quantify peripheral nerve lesions in amyloid light chain (AL) amyloidosis by magnetic resonance neurography (MRN) in correlation with clinical and electrophysiologic findings.MethodsWe prospectively examined 20 patients with AL-polyneuropathy (PNP) and 25 age- and sex-matched healthy volunteers. After detailed neurologic and electrophysiologic testing, the patient group was subdivided into mild and moderate PNP. MRN in a 3.0 tesla scanner with anatomical coverage from the lumbosacral plexus and proximal thigh down to the tibiotalar joint was performed by using T2-weighted and dual-echo 2-dimensional sequences with spectral fat saturation and a 3-dimensional, T2-weighted inversion recovery sequence. Besides evaluation of nerve T2-weighted signal, detailed quantification of nerve injury by morphometric (nerve caliber) and microstructural MRN markers (proton spin density, T2 relaxation time) was conducted.ResultsNerve T2-weighted signal increase correlated with disease severity: moderate (420.2 ± 60.1) vs mild AL-PNP (307.2 ± 17.9; p = 0.0003) vs controls (207.0 ± 6.4; p < 0.0001). Proton spin density was also higher in moderate (tibial: 525.5 ± 53.0; peroneal: 553.6 ± 64.5; sural: 492.0 ± 56.6) and mild AL-PNP (tibial: 431.6 ± 22.0; peroneal: 457.6 ± 21.7; sural: 404.8 ± 25.2) vs controls (tibial: 310.5 ± 14.1; peroneal: 313.6 ± 11.6; sural: 261.7 ± 11.0; p < 0.0001 for all nerves). T2 relaxation time was elevated in moderate AL-PNP only (tibial: p = 0.0106; peroneal: p = 0.0070; sural: p = 0.0190). Tibial nerve caliber was higher in moderate (58.0 ± 8.8 mm3) vs mild AL-PNP (46.5 ± 2.5 mm3; p = 0.008) vs controls (39.1 ± 1.2 mm3; p < 0.0001).ConclusionsMRN detects and quantifies peripheral nerve injury in AL-PNP in vivo with high sensitivity and in close correlation with the clinical stage. Quantitative parameters are feasible new imaging biomarkers for the detection of early AL-PNP and might help to monitor microstructural nerve tissue changes under treatment.
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Gonzalez-Duarte A. Autonomic involvement in hereditary transthyretin amyloidosis (hATTR amyloidosis). Clin Auton Res 2018; 29:245-251. [PMID: 29511897 DOI: 10.1007/s10286-018-0514-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/21/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Hereditary transthyretin amyloidosis (hATTR amyloidosis) is a progressive disease primarily characterized by adult-onset sensory, motor, and autonomic neuropathy. In this article, we discuss the pathophysiology and principal findings of autonomic neuropathy in hATTR amyloidosis, the most common methods of assessment and progression, and its relation as a predictive risk factor or a measure of progression in the natural history of the disease. METHODS A literature search was performed using the terms "autonomic neuropathy," "dysautonomia," and "autonomic symptoms" in patients with hereditary transthyretin amyloidosis and familial amyloid polyneuropathy. RESULTS Various scales to measure autonomic function have been employed, particularly within the major clinical trials, to assess novel therapies for the disease. Most of the evaluations were taken from diabetic clinical trials. Questionnaires include the COMPASS-31 and Norfolk QOL autonomic nerve function domain, whereas clinical evaluations comprise HRDB and the orthostatic tolerance test. Several treatment options are being employed although only diflunisal and tafamidis have reported improvement in the autonomic abnormalities. CONCLUSIONS Autonomic nerves are often affected before motor nerve impairment, and dysautonomia may support the diagnosis of hATTR amyloidosis when differentiating from other adult-onset progressive neuropathies and from other types of amyloidosis. Most of the progression of autonomic dysfunction is seen in early stages of the disease, commonly before motor impairment or affection of the overall quality of life. Unfortunately, there is no current single standardized approach to evaluate dysautonomia in hATTR amyloidosis.
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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: 85] [Impact Index Per Article: 14.2] [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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31
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Ebenezer GJ, Liu Y, Judge DP, Cunningham K, Truelove S, Carter ND, Sebastian B, Byrnes K, Polydefkis M. Cutaneous nerve biomarkers in transthyretin familial amyloid polyneuropathy. Ann Neurol 2017; 82:44-56. [DOI: 10.1002/ana.24972] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 01/04/2023]
Affiliation(s)
| | - Ying Liu
- Department of Neurology; Johns Hopkins University
| | | | | | - Shaun Truelove
- Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore MD
| | | | | | - Kelly Byrnes
- Department of Neurology; Johns Hopkins University
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Liu G, Ni W, Wang H, Li H, Zhang Y, Wang N, Wu Z. Clinical features of familial amyloid polyneuropathy carrying transthyretin mutations in four Chinese kindreds. J Peripher Nerv Syst 2017; 22:19-26. [PMID: 27859927 DOI: 10.1111/jns.12196] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Gonglu Liu
- Department of Neurology and Research Center of Neurology, Collaborative Innovation Center for Brain Science; Zhejiang University School of Medicine Second Affiliated Hospital; Hangzhou China
| | - Wang Ni
- Department of Neurology and Research Center of Neurology, Collaborative Innovation Center for Brain Science; Zhejiang University School of Medicine Second Affiliated Hospital; Hangzhou China
| | - Hongxia Wang
- Department of Neurology; First Affiliated Hospital of Soochow University; Suzhou China
| | - Hongfu Li
- Department of Neurology and Research Center of Neurology, Collaborative Innovation Center for Brain Science; Zhejiang University School of Medicine Second Affiliated Hospital; Hangzhou China
| | - Yue Zhang
- Department of Neurology, Institute of Neurology; Huashan Hospital Fudan University; Shanghai China
| | - Ning Wang
- Department of Neurology, Institute of Neurology; First Affiliated Hospital of Fujian Medical University; Fuzhou China
| | - Zhiying Wu
- Department of Neurology and Research Center of Neurology, Collaborative Innovation Center for Brain Science; Zhejiang University School of Medicine Second Affiliated Hospital; Hangzhou China
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Koike H, Ikeda S, Takahashi M, Kawagashira Y, Iijima M, Misumi Y, Ando Y, Ikeda SI, Katsuno M, Sobue G. Schwann cell and endothelial cell damage in transthyretin familial amyloid polyneuropathy. Neurology 2016; 87:2220-2229. [DOI: 10.1212/wnl.0000000000003362] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/05/2016] [Indexed: 11/15/2022] Open
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First European consensus for diagnosis, management, and treatment of transthyretin familial amyloid polyneuropathy. Curr Opin Neurol 2016; 29 Suppl 1:S14-26. [PMID: 26734952 PMCID: PMC4739312 DOI: 10.1097/wco.0000000000000289] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose of review Early and accurate diagnosis of transthyretin familial amyloid polyneuropathy (TTR-FAP) represents one of the major challenges faced by physicians when caring for patients with idiopathic progressive neuropathy. There is little consensus in diagnostic and management approaches across Europe. Recent findings The low prevalence of TTR-FAP across Europe and the high variation in both genotype and phenotypic expression of the disease means that recognizing symptoms can be difficult outside of a specialized diagnostic environment. The resulting delay in diagnosis and the possibility of misdiagnosis can misguide clinical decision-making and negatively impact subsequent treatment approaches and outcomes. Summary This review summarizes the findings from two meetings of the European Network for TTR-FAP (ATTReuNET). This is an emerging group comprising representatives from 10 European countries with expertise in the diagnosis and management of TTR-FAP, including nine National Reference Centres. The current review presents management strategies and a consensus on the gold standard for diagnosis of TTR-FAP as well as a structured approach to ongoing multidisciplinary care for the patient. Greater communication, not just between members of an individual patient's treatment team, but also between regional and national centres of expertise, is the key to the effective management of TTR-FAP.
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Sixty years of transthyretin familial amyloid polyneuropathy (TTR-FAP) in Europe: where are we now? A European network approach to defining the epidemiology and management patterns for TTR-FAP. Curr Opin Neurol 2016; 29 Suppl 1:S3-S13. [PMID: 26734951 PMCID: PMC4739317 DOI: 10.1097/wco.0000000000000288] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Purpose of review Transthyretin familial amyloid polyneuropathy (TTR-FAP) is a highly disabling, life-threatening disease characterized by progressive sensorimotor and autonomic neuropathy. The profile of the disease across Europe is inadequately understood at present. Recent findings The incidence and clinical presentation of TTR-FAP varies widely within Europe, with early and late-onset disease subtypes. In those regions in which the disease is endemic (Portugal, Sweden, Cyprus, and Majorca), a Val30Met substitution in the TTR gene is the predominant genetic cause, whereas in the rest of Europe, cases of TTR-FAP are mainly sporadic with genetic heterogeneity. Current management strategies lack cohesion and patients can experience years of misdiagnosis and suboptimal treatment. Summary The article aims to disseminate the findings and recommendations from two recent meetings of the European Network for TTR-FAP (ATTReuNET), a panel comprising representatives from 10 European countries (Bulgaria, Cyprus, France, Germany, Italy, the Netherlands, Portugal, Spain, Sweden, and Turkey) with expertise in the diagnosis and management of TTR-FAP. We explore the epidemiology and genetic mark of TTR-FAP across Europe and assess current management strategies, with a view to developing an alternative framework – a networked approach to disease management with an emphasis on collaboration and sharing of best practice.
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Adams D, Beaudonnet G, Adam C, Lacroix C, Théaudin M, Cauquil C, Labeyrie C. Familial amyloid polyneuropathy: When does it stop to be asymptomatic and need a treatment? Rev Neurol (Paris) 2016; 172:645-652. [DOI: 10.1016/j.neurol.2016.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
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Rajabally YA, Adams D, Latour P, Attarian S. Hereditary and inflammatory neuropathies: a review of reported associations, mimics and misdiagnoses. J Neurol Neurosurg Psychiatry 2016; 87:1051-60. [PMID: 27010614 DOI: 10.1136/jnnp-2015-310835] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/28/2016] [Indexed: 02/03/2023]
Abstract
Distinguishing between hereditary and inflammatory neuropathy is usually straightforward on clinical grounds with the help of a family history. There are nevertheless cases where the distinction is less clear. The advent of molecular genetics has in the past several years aided confirmatory diagnosis for an increasing proportion of patients with genetic neuropathy. Various reports have described associations of Charcot-Marie-Tooth disease with a suspected or confirmed inflammatory neuropathy occasionally responding to immunotherapy. Possible predisposition to an inflammatory component was suggested in a subset of patients. Such reports have, however, been relatively few in number, suggesting the rarity of such associations and of such a predisposition if it exists. There have been a number of publications detailing clinical presentations suggestive of inflammatory neuropathy in patients with a known or later proven genetic aetiology, and subsequently felt to be part of the phenotype rather than representing an association. A number of genetically mediated multisystemic diseases with neuropathy have otherwise been reported as mimicking chronic inflammatory demyelinating polyneuropathy (CIDP). The most common example is that of familial amyloid polyneuropathy, of particular concern for the clinician when misdiagnosed as CIDP, in view of the therapeutic implications. We review the literature on reported associations, mimics and misdiagnoses of hereditary and inflammatory neuropathy and attempt to determine a practical approach to the problem in clinical practice using clinical features, electrophysiology, histopathology and targeted early genetic testing. The issue of attempting immunomodulatory therapy is discussed in view of the published literature.
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Affiliation(s)
- Yusuf A Rajabally
- School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, UK Regional Neuromuscular Clinic, Queen Elizabeth Hospital, University Hospitals of Birmingham, Birmingham, UK
| | - David Adams
- Department of Neurology, National Reference Centre for FAP and other rare peripheral neuropathies (NNERf) APHP, CHU Bicêtre, HUPS, INSERM U1195, Université Paris Sud, Le Kremlin-Bicêtre, France FILNEMUS, Filière nationale des Maladies neuromusculaires, Marseille, France
| | - Philippe Latour
- Laboratoire de Neurogénétique Moléculaire, Groupe Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Shahram Attarian
- FILNEMUS, Filière nationale des Maladies neuromusculaires, Marseille, France Reference Centre for Neuromuscular Diseases and ALS, Centre Hospitalier Universitaire La Timone, Marseille, France Inserm UMR_S 910 Medical Genetics and Functional Genomics, Aix-Marseille University, Marseille, France
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Pruppers MHJ, Merkies ISJ, Faber CG, Da Silva AM, Costa V, Coelho T. The Val30Met familial amyloid polyneuropathy specific Rasch-built overall disability scale (FAP-RODS(©) ). J Peripher Nerv Syst 2016; 20:319-27. [PMID: 26115039 DOI: 10.1111/jns.12120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 05/04/2015] [Accepted: 06/10/2015] [Indexed: 11/28/2022]
Abstract
Familial amyloid polyneuropathy (FAP) is a chronic debilitating multi-organic disorder, mainly assessed using ordinal-based impairment measures. To date, no outcome measure at the activity and participation level has been constructed in FAP. The current study aimed to design an interval activity/participation scale for FAP through Rasch methodology. A preliminary FAP Rasch-built overall disability scale (pre-FAP-RODS) containing 146 activity/participation items was assessed twice (interval: 2-4 week; test-retest reliability) in 248 patients with Val30Met FAP examined in Porto, Portugal, of which 65.7% have received liver transplantation. An ordinal-based 24-item FAP-symptoms inventory questionnaire (FAP-SIQ) was also assessed (validity purposes). The pre-FAP-RODS and FAP-SIQ data were subjected to Rasch analyses. The pre-FAP-RODS did not meet model's expectations. On the basis of requirements such as misfit statistics, differential item functioning, and local dependency, items were systematically removed until a final 34-item FAP-RODS(©) was constructed fulfilling all Rasch requirements. Acceptable reliability/validity scores were demonstrated. In conclusion, the 34-item FAP-RODS(©) is a disease-specific interval measure suitable for detecting activity and participation restrictions in patients with FAP. The use of the FAP-RODS(©) is recommended for future international clinical trials in patients with Val30Met FAP determining its responsiveness and its cross-cultural validation. Its expansion to other forms of FAP should also be focus of future clinical studies.
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Affiliation(s)
- Mariëlle H J Pruppers
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ingemar S J Merkies
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurology, Spaarne Hospital, Hoofddorp, The Netherlands
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ana M Da Silva
- Unidade Clinica de Paramiloidose, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Vanessa Costa
- Unidade Clinica de Paramiloidose, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Coelho
- Unidade Clinica de Paramiloidose, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
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39
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Butler JS, Chan A, Costelha S, Fishman S, Willoughby JLS, Borland TD, Milstein S, Foster DJ, Gonçalves P, Chen Q, Qin J, Bettencourt BR, Sah DW, Alvarez R, Rajeev KG, Manoharan M, Fitzgerald K, Meyers RE, Nochur SV, Saraiva MJ, Zimmermann TS. Preclinical evaluation of RNAi as a treatment for transthyretin-mediated amyloidosis. Amyloid 2016; 23:109-18. [PMID: 27033334 PMCID: PMC4898164 DOI: 10.3109/13506129.2016.1160882] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
ATTR amyloidosis is a systemic, debilitating and fatal disease caused by transthyretin (TTR) amyloid accumulation. RNA interference (RNAi) is a clinically validated technology that may be a promising approach to the treatment of ATTR amyloidosis. The vast majority of TTR, the soluble precursor of TTR amyloid, is expressed and synthesized in the liver. RNAi technology enables robust hepatic gene silencing, the goal of which would be to reduce systemic levels of TTR and mitigate many of the clinical manifestations of ATTR that arise from hepatic TTR expression. To test this hypothesis, TTR-targeting siRNAs were evaluated in a murine model of hereditary ATTR amyloidosis. RNAi-mediated silencing of hepatic TTR expression inhibited TTR deposition and facilitated regression of existing TTR deposits in pathologically relevant tissues. Further, the extent of deposit regression correlated with the level of RNAi-mediated knockdown. In comparison to the TTR stabilizer, tafamidis, RNAi-mediated TTR knockdown led to greater regression of TTR deposits across a broader range of affected tissues. Together, the data presented herein support the therapeutic hypothesis behind TTR lowering and highlight the potential of RNAi in the treatment of patients afflicted with ATTR amyloidosis.
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Affiliation(s)
| | - Amy Chan
- a Alnylam Pharmaceuticals , Cambridge , MA , USA
| | - Susete Costelha
- b Instituto de Investigação e Inovação em Saúde, Universidade do Porto , Porto , Portugal .,c Molecular Neurobiology, IBMC - Institute for Molecular and Cell Biology Porto , Porto , Portugal
| | | | | | | | | | | | - Paula Gonçalves
- b Instituto de Investigação e Inovação em Saúde, Universidade do Porto , Porto , Portugal .,c Molecular Neurobiology, IBMC - Institute for Molecular and Cell Biology Porto , Porto , Portugal
| | - Qingmin Chen
- a Alnylam Pharmaceuticals , Cambridge , MA , USA
| | - June Qin
- a Alnylam Pharmaceuticals , Cambridge , MA , USA
| | | | - Dinah W Sah
- a Alnylam Pharmaceuticals , Cambridge , MA , USA
| | - Rene Alvarez
- a Alnylam Pharmaceuticals , Cambridge , MA , USA
| | | | | | | | | | | | - Maria J Saraiva
- b Instituto de Investigação e Inovação em Saúde, Universidade do Porto , Porto , Portugal .,c Molecular Neurobiology, IBMC - Institute for Molecular and Cell Biology Porto , Porto , Portugal
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40
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Meng LC, Lyu H, Zhang W, Liu J, Wang ZX, Yuan Y. Hereditary Transthyretin Amyloidosis in Eight Chinese Families. Chin Med J (Engl) 2016; 128:2902-5. [PMID: 26521788 PMCID: PMC4756886 DOI: 10.4103/0366-6999.168048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Mutations of transthyretin (TTR) cause the most common type of autosomal-dominant hereditary systemic amyloidosis, which occurs worldwide. To date, more and more mutations in the TTR gene have been reported. Some variations in the clinical presentation are often observed in patients with the same mutation or the patients in the same family. The purpose of this study was to find out the clinicopathologic and genetic features of Chinese patients with hereditary TTR amyloidosis. Methods: Clinical and necessary examination materials were collected from nine patients of eight families with hereditary TTR amyloidosis at Peking University First Hospital from January 2007 to November 2014. Sural nerve biopsies were taken for eight patients and skin biopsies were taken in the calf/upper arm for two patients, for light and electron microscopy examination. The TTR genes from the nine patients were analyzed. Results: The onset age varied from 23 to 68 years. The main manifestations were paresthesia, proximal and/or distal weakness, autonomic dysfunction, cardiomyopathy, vitreous opacity, hearing loss, and glossohypertrophia. Nerve biopsy demonstrated severe loss of myelinated fibers in seven cases and amyloid deposits in three. One patient had skin amyloid deposits which were revealed from electron microscopic examination. Genetic analysis showed six kinds of mutations of TTR gene, including Val30Met, Phe33Leu, Ala36Pro, Val30Ala, Phe33Val, and Glu42Gly in exon 2. Conclusions: Since the pathological examinations of sural nerve were negative for amyloid deposition in most patients, the screening for TTR mutations should be performed in all the adult patients, who are clinically suspected with hereditary TTR amyloidosis.
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Affiliation(s)
| | | | | | | | | | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
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41
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Chan ACY, Wilder-Smith EP. Small fiber neuropathy: Getting bigger! Muscle Nerve 2016; 53:671-82. [PMID: 26872938 DOI: 10.1002/mus.25082] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 12/13/2022]
Abstract
Etiological and clinical heterogeneity of small fiber neuropathy (SFN) precludes a unifying approach and necessitates reliance on recognizable clinical syndromes. Symptoms of SFN arise from dysfunction in nociception, temperature, and autonomic modalities. This review focuses on SFN involving nociception and temperature, examining epidemiology, etiology, clinical presentation, diagnosis, pathophysiology, and management. Prevalence of SFN is 52.95 per 100,000 population, and diabetes and idiopathic are the most common etiologies. Dysesthesia, allodynia, pain, burning, and coldness sensations frequently present in a length-dependent pattern. Additional autonomic features in gastrointestinal, urinary, or cardiovascular systems are frequent but poorly objectified. SFN is diagnosed by intraepidermal nerve fiber density and quantitative sensory and autonomic tests in combination with normal nerve conduction. Pathophysiological understanding centers on sodium channel dysfunction, and genetic forms are beginning to be understood. Treatment is directed at the underlying etiology supported by symptomatic treatment using antidepressants and anticonvulsants. Little is known about long-term outcomes, and systematic cohort studies are needed.
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Affiliation(s)
- Amanda C Y Chan
- Division of Neurology, National University Hospital, Level 10 Tower Block, University Medicine Cluster, 1E Kent Ridge Road, 119228, Singapore
| | - Einar P Wilder-Smith
- Division of Neurology, National University Hospital, Level 10 Tower Block, University Medicine Cluster, 1E Kent Ridge Road, 119228, Singapore.,Neurology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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42
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Adams D, Cauquil C, Labeyrie C, Beaudonnet G, Algalarrondo V, Théaudin M. TTR kinetic stabilizers and TTR gene silencing: a new era in therapy for familial amyloidotic polyneuropathies. Expert Opin Pharmacother 2016; 17:791-802. [PMID: 26800456 DOI: 10.1517/14656566.2016.1145664] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Transthyretin Familial Amyloid Polyneuropathy (TTR-FAP) is a rare disease with autosomal dominant transmission due to a point mutation of the TTR gene. By removing the main source of systemic mutant TTR, liver transplantation (LT) has become the reference therapy of this severe and fatal polyneuropathy of adult-onset, stopping disease progression in subgroup of patients. Recently, new therapeutic strategies have emerged, which intend to stabilize TTR or to silence the TTR gene. Amongst them, the TTR kinetic stabilizer tafamidis is the first drug approved in the EU. AREAS COVERED We shall review the natural history of TTR-FAP and the best indications for LT. Data on the efficacy, safety and tolerability of the TTR kinetic stabilizers, tafamidis and diflunisal, have been reviewed, from the pivotal Phase III clinical trials published in PubMed medical journals or presented at international meetings. We will review the ongoing phase III clinical trials of TTR gene silencing with RNAi therapeutics and ASO published in clinicaltrialgov. EXPERT OPINION Due to the data on efficacy, tolerability, safety, tafamidis and diflunisal became the first line anti-amyloid treatment in stage 1 TTR-FAP. Both drugs slow progression of the disease. Only tafamidis got marketing authorization. We are waiting for results of the 2 phase III clinical trials of TTR gene silencing in varied stages of the disease.
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Affiliation(s)
- David Adams
- a Neurology , CHU Bicêtre, APHP , Le Kremlin Bicêtre , France.,b National reference Center for FAP (NNERF) , Le Kremlin Bicêtre , France.,c FILNEMUS Filière nationale des maladies neuromusculaires , Marseille , France
| | - Cecile Cauquil
- a Neurology , CHU Bicêtre, APHP , Le Kremlin Bicêtre , France.,b National reference Center for FAP (NNERF) , Le Kremlin Bicêtre , France.,c FILNEMUS Filière nationale des maladies neuromusculaires , Marseille , France
| | - Céline Labeyrie
- a Neurology , CHU Bicêtre, APHP , Le Kremlin Bicêtre , France.,b National reference Center for FAP (NNERF) , Le Kremlin Bicêtre , France.,c FILNEMUS Filière nationale des maladies neuromusculaires , Marseille , France
| | - Guillemette Beaudonnet
- b National reference Center for FAP (NNERF) , Le Kremlin Bicêtre , France.,c FILNEMUS Filière nationale des maladies neuromusculaires , Marseille , France.,d Neurophysiology , CHU Bicêtre, APHP , Le Kremlin Bicêtre , France
| | - Vincent Algalarrondo
- b National reference Center for FAP (NNERF) , Le Kremlin Bicêtre , France.,c FILNEMUS Filière nationale des maladies neuromusculaires , Marseille , France.,e Cardiology , CHU A Beclere, APHP , Clamart , France
| | - Marie Théaudin
- a Neurology , CHU Bicêtre, APHP , Le Kremlin Bicêtre , France.,b National reference Center for FAP (NNERF) , Le Kremlin Bicêtre , France.,c FILNEMUS Filière nationale des maladies neuromusculaires , Marseille , France
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Abstract
Peripheral neuropathies are frequent in association with systemic diseases as well as isolated disorders. Recent advances in the therapy of specific neuropathies led to the approval of new drugs/treatments. This review selected those peripheral neuropathies where the most recent approvals were provided and revised the potential future developments in diabetic and toxic-induced neuropathies, although they do not have a currently available causal therapy in view of their epidemiological and social relevance. Data have been extracted from the most important published trials and from clinical experience. In addition, data from the Food and Drug Administration and European Medicine Agency indications on the treatment of the selected peripheral neuropathies and from recently updated international guidelines have also been included. The website of the U.S. National Institutes of Health www.clinicaltrials.gov registry has been used as the reference database for phase III clinical trials not yet published or ongoing. This review gives a general overview of the most recent advances in the treatment of amyloid, inflammatory, and paraproteinemic peripheral neuropathies. Moreover, it briefly describes the unmet medical need in disabling and frequent conditions, such as diabetic and chemotherapy-induced neuropathy, highlighting the most promising therapeutic approaches to their treatment.
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Affiliation(s)
- Paola Marmiroli
- a Experimental Neurology Unit, School of Medicine and Surgery and Milan Center for Neuroscience , University of Milano-Bicocca , Monza , Italy
| | - Guido Cavaletti
- a Experimental Neurology Unit, School of Medicine and Surgery and Milan Center for Neuroscience , University of Milano-Bicocca , Monza , Italy
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44
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Hawkins PN, Ando Y, Dispenzeri A, Gonzalez-Duarte A, Adams D, Suhr OB. Evolving landscape in the management of transthyretin amyloidosis. Ann Med 2015; 47:625-38. [PMID: 26611723 PMCID: PMC4720049 DOI: 10.3109/07853890.2015.1068949] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/30/2015] [Indexed: 12/12/2022] Open
Abstract
Transthyretin (TTR) amyloidosis (ATTR amyloidosis) is a multisystemic, multigenotypic disease resulting from deposition of insoluble ATTR amyloid fibrils in various organs and tissues. Although considered rare, the prevalence of this serious disease is likely underestimated because symptoms can be non-specific and diagnosis largely relies on amyloid detection in tissue biopsies. Treatment is guided by which tissues/organs are involved, although therapeutic options are limited for patients with late-stage disease. Indeed, enthusiasm for liver transplantation for familial ATTR amyloidosis with polyneuropathy was dampened by poor outcomes among patients with significant neurological deficits or cardiac involvement. Hence, there remains an unmet medical need for new therapies. The TTR stabilizers tafamidis and diflunisal slow disease progression in some patients with ATTR amyloidosis with polyneuropathy, and the postulated synergistic effect of doxycycline and tauroursodeoxycholic acid on dissolution of amyloid is under investigation. Another therapeutic approach is to reduce production of the amyloidogenic protein, TTR. Plasma TTR concentration can be significantly reduced with ISIS-TTR(Rx), an investigational antisense oligonucleotide-based drug, or with patisiran and revusiran, which are investigational RNA interference-based therapeutics that target the liver. The evolving treatment landscape for ATTR amyloidosis brings hope for further improvements in clinical outcomes for patients with this debilitating disease.
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Affiliation(s)
- Philip N. Hawkins
- National Amyloidosis Centre, Royal Free Hospital, University College London, London, UK
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences Kumamoto University, Kumamoto, Japan
| | | | | | - David Adams
- National Reference Centre for FAP, APHP, CHU Bicêtre, Université Paris-Sud, INSERM U788, Paris, France
| | - Ole B. Suhr
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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45
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Chen JJ, Genereux JC, Wiseman RL. Endoplasmic reticulum quality control and systemic amyloid disease: Impacting protein stability from the inside out. IUBMB Life 2015; 67:404-13. [PMID: 26018985 DOI: 10.1002/iub.1386] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/27/2015] [Indexed: 11/11/2022]
Abstract
The endoplasmic reticulum (ER) is responsible for regulating proteome integrity throughout the secretory pathway. The ER protects downstream secretory environments such as the extracellular space by partitioning proteins between ER protein folding, trafficking, and degradation pathways in a process called ER quality control. In this process, ER quality control factors identify misfolded, aggregation-prone protein conformations and direct them toward ER protein folding or degradation, reducing their secretion to the extracellular space where they could further misfold or aggregate into proteotoxic conformations. Despite the general efficiency of ER quality control, many human diseases, such as the systemic amyloidoses, involve aggregation of destabilized, aggregation-prone proteins in the extracellular space. A common feature for all systemic amyloid diseases is the ability for amyloidogenic proteins to evade ER quality control and be efficiently secreted. The efficient secretion of these amyloidogenic proteins increases their serum concentrations available for the distal proteotoxic aggregation characteristic of these diseases. This indicates that ER quality control, and the regulation thereof, is a critical determinant in defining the onset and pathology of systemic amyloid diseases. Here, we discuss the pathologic and potential therapeutic relationship between ER quality control, protein secretion, and distal deposition of amyloidogenic proteins involved in systemic amyloid diseases. Furthermore, we present evidence that the unfolded protein response, the stress-responsive signaling pathway that regulates ER quality control, is involved in the pathogenesis of systemic amyloid diseases and represents a promising emerging therapeutic target to intervene in this class of human disease.
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Affiliation(s)
- John J Chen
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA.,Department of Chemical Physiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Joseph C Genereux
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA.,Department of Chemical Physiology, The Scripps Research Institute, La Jolla, CA, USA
| | - R Luke Wiseman
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA.,Department of Chemical Physiology, The Scripps Research Institute, La Jolla, CA, USA
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46
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Barreiros AP, Otto G, Kahlen B, Teufel A, Galle PR. Familial amyloidosis: great progress for an orphan disease. J Hepatol 2015; 62:483-5. [PMID: 25220252 DOI: 10.1016/j.jhep.2014.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 08/19/2014] [Accepted: 09/04/2014] [Indexed: 12/04/2022]
Affiliation(s)
- Ana Paula Barreiros
- Department of Internal Medicine I, Universitätsmedizin of the Johannes Gutenberg-University Mainz, Germany; Department of Internal Medicine I, Universitätsklinikum of the University Regensburg, Germany.
| | - Gerd Otto
- Department of Hepatobiliary and Transplantation Surgery, Universitätsmedizin of the Johannes Gutenberg-University Mainz, Germany
| | - Bita Kahlen
- Department of Internal Medicine I, Universitätsmedizin of the Johannes Gutenberg-University Mainz, Germany
| | - Andreas Teufel
- Department of Internal Medicine I, Universitätsmedizin of the Johannes Gutenberg-University Mainz, Germany; Department of Internal Medicine I, Universitätsklinikum of the University Regensburg, Germany
| | - Peter R Galle
- Department of Internal Medicine I, Universitätsmedizin of the Johannes Gutenberg-University Mainz, Germany
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Mead S, Reilly MM. A new prion disease: relationship with central and peripheral amyloidoses. Nat Rev Neurol 2015; 11:90-7. [DOI: 10.1038/nrneurol.2014.263] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Iorio A, De Angelis F, Di Girolamo M, Luigetti M, Pradotto L, Mauro A, Manfellotto D, Fuciarelli M, Polimanti R. Most recent common ancestor of TTR Val30Met mutation in Italian population and its potential role in genotype-phenotype correlation. Amyloid 2015; 22:73-8. [PMID: 25510352 DOI: 10.3109/13506129.2014.994597] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Transthyretin (TTR)-related amyloidosis is characterized by autosomal transmission of amyloidogenic mutated TTR. Val30Met is one of the most common amyloidogenic TTR mutations, showing a worldwide distribution with phenotypic heterogeneity among human populations. Multiple founder mutations for Val30Met foci have been hypothesized and the different origins may explain the phenotypic variability. The aim of our study is to determine the origin of Italian Val30Met and to analyze the genetic relationship of other Val30Met foci. METHODS We analyzed the origin of Italian Val30Met through 11 microsatellite markers around the TTR gene in 29 patients and 34 healthy controls. RESULTS Our genetic analysis showed an estimated age of origin of 34-36 generations ago for the Italian Val30Met. Comparing Italian Val30Met haplotypes with those from Sweden and Portugal highlights relevant differences that seem to be consistent with an independent origin of Italian Val30Met mutation. This genetic evidence agrees with the disease phenotypic variation in these populations. DISCUSSION AND CONCLUSIONS Italian Val30Met mutation should have originated before the Portuguese and Swedish Val30Met ones (which arose through independent mutational events). This indicates a genetic diversity in the surrounding regions of three different Val30Met mutations, supporting the hypothesis that TTR non-coding regions may contribute to phenotypic heterogeneity.
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Affiliation(s)
- Andrea Iorio
- Department of Biology, University of Rome "Tor Vergata" , Rome , Italy
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Schänzer A, Kimmich C, Röcken C, Haverkamp T, Weidner I, Acker T, Krämer HH. A woman with a rare p.Glu74Gly transthyretin mutation presenting exclusively with a rapidly progressive neuropathy: a case report. J Med Case Rep 2014; 8:403. [PMID: 25471118 PMCID: PMC4289209 DOI: 10.1186/1752-1947-8-403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 10/06/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Familial amyloid polyneuropathy is a rare autosomal dominant disorder caused by mutations in the transthyretin gene, TTR. Diagnosis can be challenging, especially if other family members are not affected or an obvious systemic involvement is lacking. The patients are often misdiagnosed, leading to a delay in the initiation of therapy. Case presentation A 35-year-old woman of Turkish origin presented to our outpatient clinic with severe polyneuropathy associated with distally pronounced tetraparesis and hypesthesia of 2 to 3 years’ duration. In addition, small nerve fiber involvement with impaired detection of cold temperatures and tingling pain in the lower legs was reported. She did not complain of autonomic dysfunction or visual disturbance. Her family history was empty regarding neuromuscular disorders. The routine diagnostic work-up was unremarkable. A sural nerve biopsy disclosed amyloid deposits, which led to the identification of a rare heterozygous transthyretin mutation (p.Glu74Gly; old classification: p.Glu54Gly). Conclusions Few cases with this very heterozygous mutation can be found in the literature. In contrast to the case of our patient, all of the previously described patients in the literature presented with additional severe autonomic symptoms, involvement of the eyes and a positive family history. In this case report, we emphasize that, in patients with progressive neuropathy with small fiber involvement, an amyloid neuropathy should be considered in the differential diagnosis, even if the family history is empty and other organs are not affected.
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Affiliation(s)
- Anne Schänzer
- Institute of Neuropathology, Justus Liebig University, Arndstrasse 16, 35392 Giessen, Germany.
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Jerabek-Willemsen M, André T, Wanner R, Roth HM, Duhr S, Baaske P, Breitsprecher D. MicroScale Thermophoresis: Interaction analysis and beyond. J Mol Struct 2014. [DOI: 10.1016/j.molstruc.2014.03.009] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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