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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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2
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Chen CC, Tseng PH, Hsueh HW, Chiang MC, Tzeng SR, Chiang TH, Wu MS, Hsieh ST, Chao CC. Altered gut microbiota in Taiwanese A97S predominant transthyretin amyloidosis with polyneuropathy. Sci Rep 2024; 14:6195. [PMID: 38486098 PMCID: PMC10940600 DOI: 10.1038/s41598-024-56984-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/13/2024] [Indexed: 03/18/2024] Open
Abstract
Increasing evidence suggests that gut microbiota alterations are related to development and phenotypes of many neuropsychiatric diseases. Here, we evaluated the fecal microbiota and its clinical correlates in patients with hereditary transthyretin amyloidosis (ATTRv) and polyneuropathy. Fecal microbiota from 38 ATTRv patients and 39 age-matched controls was analyzed by sequencing 16S V3-V4 ribosomal RNA, and its relationships with clinical characteristics of polyneuropathy and cardiomyopathy were explored. The familial amyloidotic polyneuropathy stage was stage I, II, and III in 13, 18, and 7 patients. 99mTc-PYP SPECT showed a visual score of 2 in 15 and 3 in 21 patients. The gut microbiota of ATTRv patients showed higher alpha diversity (ASV richness and Shannon effective numbers) and dissimilar beta diversity compared to controls. Relative abundance of microbiota was dominated by Firmicutes and decreased in Bacteroidetes in ATTRv patients than in controls. Patients with more myocardial amyloid deposition were associated with increased alpha diversity, and the abundance of Clostridia was significantly correlated with pathophysiology of polyneuropathy in ATTRv patients. These findings demonstrated alterations in the gut microbiota, especially Firmicutes, in ATTRv. The association between altered microbiota and phenotypes of cardiomyopathy and polyneuropathy might suggest potential contributions of gut microbiota to ATTRv pathogenesis.
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Affiliation(s)
- Chieh-Chang Chen
- Departments of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping-Huei Tseng
- Departments of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsueh-Wen Hsueh
- Departments of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Chang Chiang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shiou-Ru Tzeng
- Institute of Biochemistry and Molecular Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tsung Hsien Chiang
- Departments of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Shiang Wu
- Departments of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Tsang Hsieh
- Departments of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chi-Chao Chao
- Departments of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
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Gentile L, Diemberger I, Plante-Bordeneuve V, Mazzeo A, Dori A, Luigetti M, Di Paolantonio A, Dispenzieri A, Grogan M, Waddington Cruz M, Adams D, Inamo J, Kristen AV, Lino Cirami C, Chapman D, Gupta P, Glass O, Amass L. Phenotypic characteristics of F64L, I68L, I107V, and S77Y ATTRv genotypes from the Transthyretin Amyloidosis Outcomes Survey (THAOS). PLoS One 2024; 19:e0292435. [PMID: 38241252 PMCID: PMC10798432 DOI: 10.1371/journal.pone.0292435] [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: 05/26/2023] [Accepted: 09/20/2023] [Indexed: 01/21/2024] Open
Abstract
Transthyretin amyloidosis (ATTR amyloidosis) is a progressive, multi-systemic disease with wild-type (ATTRwt) and hereditary (ATTRv) forms. Over 130 variants associated with ATTRv amyloidosis have been identified, although little is known about the majority of these genotypes. This analysis examined phenotypic characteristics of symptomatic patients with ATTRv amyloidosis enrolled in the Transthyretin Amyloidosis Outcomes Survey (THAOS) with four less frequently reported pathogenic genotypes: F64L (c.250T>C, p.F84L), I68L (c.262A>T, p.I88L), I107V (c.379A>G; p.I127V), and S77Y (c.290C>A; p.S97Y). THAOS is the largest ongoing, global, longitudinal observational study of patients with ATTR amyloidosis, including both ATTRwt and ATTRv amyloidosis. This analysis describes the baseline demographic and clinical characteristics of untreated symptomatic patients with the F64L, I68L, I107V, or S77Y genotypes at enrollment in THAOS (data cutoff date: January 4, 2022). There were 141 symptomatic patients with F64L (n = 46), I68L (n = 45), I107V (n = 21), or S77Y (n = 29) variants at the data cutoff. Most patients were male and median age at enrollment was in the sixth decade for S77Y patients and the seventh decade for the others. A predominantly neurologic phenotype was associated with F64L, I107V, and S77Y genotypes, whereas patients with the I68L genotype presented with more pronounced cardiac involvement. However, a mixed phenotype was also reported in a considerable proportion of patients in each variant subgroup. This analysis from THAOS represents the largest study of ATTRv symptomatic patients with the F64L, I68L, I107V, and S77Y genotypes. These data add to the limited knowledge on the clinical profile of patients with specific ATTRv variants and emphasize the importance of comprehensive assessment of all patients. Trial registration ClinicalTrials.gov: NCT00628745.
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Affiliation(s)
- Luca Gentile
- Department of Clinical and Experimental Medicine, Università of Messina, Messina, Italy
| | - Igor Diemberger
- University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italy
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Violaine Plante-Bordeneuve
- Hopital Henri Mondor, Assistance Publique‐Hopitaux de Paris, East Paris‐Créteil University, Créteil, France
| | - Anna Mazzeo
- Department of Clinical and Experimental Medicine, Università of Messina, Messina, Italy
| | - Amir Dori
- Department of Neurology, Sheba Medical Center, Ramat Gan, and Tel-Aviv University, Tel-Aviv, Israel
| | - Marco Luigetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Di Paolantonio
- Universita Cattolica del Sacro Cuore, Rome, Italy
- U.O. Neurologia, Fondazione Poliambulanza, Brescia, Italy
| | - Angela Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Martha Grogan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Márcia Waddington Cruz
- National Amyloidosis Referral Center, CEPARM, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - David Adams
- Department of Neurology, CHU de Bicêtre, AP-HP, University Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jocelyn Inamo
- CHU de Fort de France, Fort de France, Martinique, France
| | - Arnt V. Kristen
- Department of Cardiology, Angiology, and Respiratory Medicine, Medical University of Heidelberg, Heidelberg, Germany
| | - Calogero Lino Cirami
- Nephrology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Doug Chapman
- Pfizer Inc, New York, New York, United States of America
| | - Pritam Gupta
- Pfizer Inc, New York, New York, United States of America
| | - Oliver Glass
- Pfizer Inc, New York, New York, United States of America
| | - Leslie Amass
- Pfizer Inc, New York, New York, United States of America
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Adams D, Sekijima Y, Conceição I, Waddington-Cruz M, Polydefkis M, Echaniz-Laguna A, Reilly MM. Hereditary transthyretin amyloid neuropathies: advances in pathophysiology, biomarkers, and treatment. Lancet Neurol 2023; 22:1061-1074. [PMID: 37863593 DOI: 10.1016/s1474-4422(23)00334-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/08/2023] [Accepted: 08/31/2023] [Indexed: 10/22/2023]
Abstract
Hereditary transthyretin (TTR) amyloid polyneuropathy is an autosomal dominant life-threatening disorder. TTR is produced mainly by the liver but also by the choroid plexus and retinal pigment epithelium. Detailed clinical characterisation, identification of clinical red flags for misdiagnosis, and use of biomarkers enable early diagnosis and treatment. In addition to liver transplantation and TTR stabilisers, three other disease-modifying therapies have regulatory approval: one antisense oligonucleotide (inotersen) and two small interfering RNAs (siRNAs; patisiran and vutrisiran). The siRNAs have been shown to stop progression of neuropathy and improve patients' quality of life. As none of the disease-modifying therapies can cross the blood-brain barrier, TTR deposition in the CNS, which can cause stroke and cognitive impairment, remains an important unaddressed issue. CRISPR-Cas9-based one-time TTR editing therapy is being investigated in a phase 1 clinical study. Identification of the earliest stages of pathogenesis in TTR variant carriers is a major challenge that needs addressing for optimal management.
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Affiliation(s)
- David Adams
- Department of Neurology, Bicêtre Centre Hospitalo Universitaire, AP-HP, INSERM U 1195, University Paris Saclay, Le Kremlin Bicetre, France.
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Isabel Conceição
- Department of Neurosciences and Mental Health, Centro Hospitalar Universitario Lisboas Norte-Hospital de Santa Maria and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Marcia Waddington-Cruz
- Centro de Estudos em Paramiloidose Antonio Rodrigues de Mello, National Amyloidosis Referral Center, University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michael Polydefkis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andoni Echaniz-Laguna
- Department of Neurology, Centre Hospitalo Universitaire, AP-HP, INSERM U 1195, University Paris Saclay, Le Kremlin Bicetre Cedex, France
| | - Mary M Reilly
- Department of Neuromuscular Disease, University College London Institute of Neurology and the National Hospital of Neurology and Neurosurgery, London, UK
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Planté-Bordeneuve V, Gorram F, Olsson M, Anan I, Mazzeo A, Gentile L, Cisneros-Barroso E, Gonzalez-Moreno J, Losada I, Waddington-Cruz M, Pinto LF, Parman Y, Fanen P, Alarcon F, Nuel G. A multicentric study of the disease risks and first manifestations in hereditary transthyretin amyloidosis (ATTRv): insights for an earlier diagnosis. Amyloid 2023; 30:313-320. [PMID: 36994840 DOI: 10.1080/13506129.2023.2178891] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/20/2023] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND In hereditary transthyretin amyloidosis (ATTRv), early manifestation and age at onset (AO) may vary strikingly. We assessed the disease'risk (penetrance), AO and initial features in ATTRv families to gain insights on the early disease presentation. METHODS Genealogical information, AO and first disease manifestations were collected in ATTRv families, from Sweden, Italy (Sicily), Spain (Mallorca), France, Turkey, Brazil. Penetrance was computed using a non-parametric survival method. RESULTS We analysed 258 TTRV30M kindreds and 84 carrying six other variants (TTRT49A, F64L, S77Y, S77F, E89Q, I107V). In ATTRV30M families, the earliest disease risk was found at age 20 years in the Portuguese and Mallorcan families and at age 30-35 years, in the French and Swedish groups. The risks were higher in men and in carriers of maternal descent. In families carrying TTR-nonV30M variants, the earliest disease risk ranged from 30 y-o in TTRT49A to 55 y-o in TTRI107V families. Peripheral neuropathy symptoms were the most frequent initial manifestations. Among patients carrying TTRnonV30M variants, about 25% had an initial cardiac phenotype, one third a mixed phenotype. CONCLUSION Our work provided solid data on the risks and early features of ATTRv in a spectrum of families to enhance an early diagnosis and treatment.
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Affiliation(s)
- Violaine Planté-Bordeneuve
- Department of Neurology, Henri Mondor University Hospital, APHP, Créteil, France
- Paris Est-Créteil University, Créteil, France
- Inserm U.955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Farida Gorram
- Department of Neurology, Henri Mondor University Hospital, APHP, Créteil, France
- Paris Est-Créteil University, Créteil, France
- Inserm U.955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Malin Olsson
- Department of Public Health and Clinical Medicine/Medicine, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Intissar Anan
- Department of Public Health and Clinical Medicine/Medicine, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Anna Mazzeo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Luca Gentile
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Eugenia Cisneros-Barroso
- Research Health Institute of the Balearic Islands (IdISBa), Internal Medicine Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Juan Gonzalez-Moreno
- Research Health Institute of the Balearic Islands (IdISBa), Internal Medicine Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Ines Losada
- Research Health Institute of the Balearic Islands (IdISBa), Internal Medicine Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Marcia Waddington-Cruz
- CEPARM, Federal University of Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Luiz Felipe Pinto
- CEPARM, Federal University of Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Yeşim Parman
- Department of Neurology, Neuromuscular Unit Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pascale Fanen
- Paris Est-Créteil University, Créteil, France
- Inserm U.955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Department of Genetics, Henri Mondor University Hospital, APHP, Créteil, France
| | - Flora Alarcon
- Laboratory MAP5 UMR CNRS 8145 Paris University, Paris, France
| | - Gregory Nuel
- Stochastics and Biology Group, Department of Probability and Statistics (LPSM, UMR CNRS 8001), Sorbonne University, Paris, France
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Mitochondrial transfer/transplantation: an emerging therapeutic approach for multiple diseases. Cell Biosci 2022; 12:66. [PMID: 35590379 PMCID: PMC9121600 DOI: 10.1186/s13578-022-00805-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/01/2022] [Indexed: 12/16/2022] Open
Abstract
Mitochondria play a pivotal role in energy generation and cellular physiological processes. These organelles are highly dynamic, constantly changing their morphology, cellular location, and distribution in response to cellular stress. In recent years, the phenomenon of mitochondrial transfer has attracted significant attention and interest from biologists and medical investigators. Intercellular mitochondrial transfer occurs in different ways, including tunnelling nanotubes (TNTs), extracellular vesicles (EVs), and gap junction channels (GJCs). According to research on intercellular mitochondrial transfer in physiological and pathological environments, mitochondrial transfer hold great potential for maintaining body homeostasis and regulating pathological processes. Multiple research groups have developed artificial mitochondrial transfer/transplantation (AMT/T) methods that transfer healthy mitochondria into damaged cells and recover cellular function. This paper reviews intercellular spontaneous mitochondrial transfer modes, mechanisms, and the latest methods of AMT/T. Furthermore, potential application value and mechanism of AMT/T in disease treatment are also discussed.
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Dispenzieri A, Coelho T, Conceição I, Waddington-Cruz M, Wixner J, Kristen AV, Rapezzi C, Planté-Bordeneuve V, Gonzalez-Moreno J, Maurer MS, Grogan M, Chapman D, Amass L. Clinical and genetic profile of patients enrolled in the Transthyretin Amyloidosis Outcomes Survey (THAOS): 14-year update. Orphanet J Rare Dis 2022; 17:236. [PMID: 35717381 PMCID: PMC9206752 DOI: 10.1186/s13023-022-02359-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transthyretin amyloidosis (ATTR amyloidosis) is a rare, life-threatening disease caused by the accumulation of variant or wild-type (ATTRwt amyloidosis) transthyretin amyloid fibrils in the heart, peripheral nerves, and other tissues and organs. METHODS Established in 2007, the Transthyretin Amyloidosis Outcomes Survey (THAOS) is the largest ongoing, global, longitudinal observational study of patients with ATTR amyloidosis, including both inherited and wild-type disease, and asymptomatic carriers of pathogenic TTR mutations. This descriptive analysis examines baseline characteristics of symptomatic patients and asymptomatic gene carriers enrolled in THAOS since its inception in 2007 (data cutoff: August 1, 2021). RESULTS This analysis included 3779 symptomatic patients and 1830 asymptomatic gene carriers. Symptomatic patients were predominantly male (71.4%) and had a mean (standard deviation [SD]) age of symptom onset of 56.3 (17.8) years. Val30Met was the most common genotype in symptomatic patients in South America (80.9%), Europe (55.4%), and Asia (50.5%), and more patients had early- versus late-onset disease in these regions. The majority of symptomatic patients in North America (58.8%) had ATTRwt amyloidosis. The overall distribution of phenotypes in symptomatic patients was predominantly cardiac (40.7%), predominantly neurologic (40.1%), mixed (16.6%), and no phenotype (2.5%). In asymptomatic gene carriers, mean (SD) age at enrollment was 42.4 (15.7) years, 42.4% were male, and 73.2% carried the Val30Met mutation. CONCLUSIONS This 14-year global overview of THAOS in over 5000 patients represents the largest analysis of ATTR amyloidosis to date and highlights the genotypic and phenotypic heterogeneity of the disease. CLINICALTRIALS gov Identifier: NCT00628745.
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Affiliation(s)
| | - Teresa Coelho
- Unidade Corino Andrade, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Isabel Conceição
- Department of Neurosciences, CHULN, Hospital de Santa Maria, Universidade de Lisboa, Lisbon, Portugal
| | - Márcia Waddington-Cruz
- University Hospital, Federal University of Rio de Janeiro, National Amyloidosis Referral Center, CEPARM, Rio de Janeiro, Brazil
| | - Jonas Wixner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Arnt V Kristen
- Department of Cardiology, Angiology, Respiratory Medicine, Medical University of Heidelberg, Heidelberg, Germany
| | - Claudio Rapezzi
- Cardiological Centre, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | | | - Juan Gonzalez-Moreno
- Servicio de Medicina Interna, Hospital Universitario Son Llatzer, Instituto de Investigación Sanitaria Illes Balears, Palma de Mallorca, Spain
| | - Mathew S Maurer
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Martha Grogan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Anan I, Suhr OB, Liszewska K, Mejia Baranda J, Pilebro B, Wixner J, Ihse E. Amyloid fibril composition type is consistent over time in patients with Val30Met (p.Val50Met) transthyretin amyloidosis. PLoS One 2022; 17:e0266092. [PMID: 35358243 PMCID: PMC8970372 DOI: 10.1371/journal.pone.0266092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 03/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background
We have previously shown that transthyretin (TTR) amyloidosis patients have amyloid fibrils of either of two compositions; type A fibrils consisting of large amounts of C-terminal TTR fragments in addition to full-length TTR, or type B fibrils consisting of only full-length TTR. Since type A fibrils are associated with an older age in ATTRVal30Met (p.Val50Met) amyloidosis patients, it has been discussed if the TTR fragments are derived from degradation of the amyloid deposits as the patients are aging. The present study aimed to investigate if the fibril composition type changes over time, especially if type B fibrils can shift to type A fibrils as the disease progresses.
Material and methods
Abdominal adipose tissue biopsies from 29 Swedish ATTRVal30Met amyloidosis patients were investigated. The fibril type in the patients´ initial biopsy taken for diagnostic purposes was compared to a biopsy taken several years later (ranging between 2 and 13 years). The fibril composition type was determined by western blot.
Results
All 29 patients had the same fibril composition type in both the initial and the follow-up biopsy (8 type A and 21 type B). Even patients with a disease duration of more than 12 years and an age over 75 years at the time of the follow-up biopsy had type B fibrils in both biopsies.
Discussion
The result clearly shows that the amyloid fibril composition containing large amounts of C-terminal fragments (fibril type A) is a consequence of other factors than a slow degradation process occurring over time.
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Affiliation(s)
- Intissar Anan
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Ole B. Suhr
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | - Björn Pilebro
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jonas Wixner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Elisabet Ihse
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- * E-mail:
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Pavlova Z, Sarafov S, Todorov T, Kirov A, Chamova T, Gospodinova M, Tournev I, Mitev V, Todorova A. Characterization of population genetic structure of hereditary transthyretin amyloidosis in Bulgaria. Amyloid 2021; 28:219-225. [PMID: 34076545 DOI: 10.1080/13506129.2021.1935230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The hereditary transthyretin amyloidosis (ATTRv amyloidosis) is an autosomal dominant genetic disease characterized by amyloid formation in different tissues due to pathogenic variants in the TTR gene. Great heterogeneity in the penetrance and manifestation of ATTRv amyloidosis is observed. In Bulgaria, the most common TTR pathogenic variant is Glu89Gln. Other TTR pathogenic variants are also found - Val30Met, Ser77Phe, Gly47Glu and Ser52Pro. There is a proven founder effect for the Glu89Gln variant, thus the aim of the present study is to investigate the founder effect for the other TTR pathogenic variants in Bulgaria. Haplotype analysis was performed by using microsatellite markers close to the TTR gene. DNA samples from ATTRv amyloidosis patients and their healthy relatives were analyzed. Theoretical haplotype reconstruction was done with Arlequin v.3.01 software. The age of the most recent common ancestor (hypothetical founder) for the studied variants was calculated with the DMLE 2.2 software. In addition, DBS screening among 100 Roma newborns was done for the Gly47Glu TTR variant via direct Sanger sequencing. The reconstructed haplotypes of the patients were compared to their healthy relatives and to a control group of 40 healthy individuals. The results showed a possible founder effect for each of the studied variants. The Val30Met haplotype was compared to published haplotype data for this variant and no similarity was found. The result from the DBS screening showed no pathogenic TTR variants in exon 2 of the gene, so we considered the presence of the Gly47Glu variant in our population a sporadic event. With this study, we succeeded to gain a more complete picture of the population genetics of ATTRv amyloidosis in Bulgaria and made another step towards a more detailed understanding of the disease epidemiology.
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Affiliation(s)
- Zornitsa Pavlova
- Independent Medico-Diagnostic Laboratory Genome Center "Bulgaria", Sofia, Bulgaria.,Genetic Medico-Diagnostic Laboratory Genica, Sofia, Bulgaria.,Department of Medical Chemistry and Biochemistry, Medical University Sofia, Sofia, Bulgaria
| | - Stayko Sarafov
- Clinic of Nervous Diseases, UMBAL Aleksandrovska, Department of Neurology, Medical University Sofia, Sofia, Bulgaria
| | - Tihomir Todorov
- Independent Medico-Diagnostic Laboratory Genome Center "Bulgaria", Sofia, Bulgaria.,Genetic Medico-Diagnostic Laboratory Genica, Sofia, Bulgaria
| | - Andrey Kirov
- Independent Medico-Diagnostic Laboratory Genome Center "Bulgaria", Sofia, Bulgaria.,Genetic Medico-Diagnostic Laboratory Genica, Sofia, Bulgaria.,Department of Medical Chemistry and Biochemistry, Medical University Sofia, Sofia, Bulgaria
| | - Teodora Chamova
- Clinic of Nervous Diseases, UMBAL Aleksandrovska, Department of Neurology, Medical University Sofia, Sofia, Bulgaria
| | | | - Ivailo Tournev
- Clinic of Nervous Diseases, UMBAL Aleksandrovska, Department of Neurology, Medical University Sofia, 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
- Independent Medico-Diagnostic Laboratory Genome Center "Bulgaria", Sofia, Bulgaria.,Genetic Medico-Diagnostic Laboratory Genica, Sofia, Bulgaria.,Department of Medical Chemistry and Biochemistry, Medical University Sofia, Sofia, Bulgaria
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10
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González-Moreno J, Losada-López I, Cisneros-Barroso E, Garcia-Pavia P, González-Costello J, Muñoz-Beamud F, Campistol JM, Fernandez-Torron R, Chapman D, Amass L. A Descriptive Analysis of ATTR Amyloidosis in Spain from the Transthyretin Amyloidosis Outcomes Survey. Neurol Ther 2021; 10:833-845. [PMID: 34331265 PMCID: PMC8571440 DOI: 10.1007/s40120-021-00267-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Transthyretin amyloidosis (ATTR amyloidosis) is a clinically heterogeneous disease caused by mutations in the transthyretin (TTR) gene or aggregation of wild-type transthyretin (ATTRwt). In Spain, there are two large endemic foci of ATTR amyloidosis caused by the Val30Met variant, with additional cases across the country; however, these data may be incomplete, as there is no centralized patient registry. The Transthyretin Amyloidosis Outcomes Survey (THAOS) is an ongoing, global, longitudinal, observational survey of patients with ATTR amyloidosis, including both inherited and wild-type disease, and asymptomatic patients with TTR mutations. This analysis aimed to gain a deeper understanding of the clinical profile of patients with ATTR amyloidosis in Spain. Methods This was a descriptive analysis of the demographic and clinical characteristics of symptomatic patients enrolled at six sites geographically dispersed throughout Spain (data cutoff: January 6, 2020). Patient data at enrollment, including genotype, demographics, and clinical presentation for symptomatic patients, were recorded. Patients were grouped by predominant phenotype based on clinical measures at enrollment: predominantly cardiac, predominantly neurologic, or mixed (cardiac and neurologic). Results There were 379 patients (58.0% male; 63.3% symptomatic) enrolled in the six THAOS sites in Spain. Predominant genotypes were the Val30Met mutation (69.1%) or ATTRwt (15.6%). Predominant phenotype distribution was neurologic (50.4%), mixed (35.8%), and cardiac (13.8%) for all symptomatic patients (n = 240); neurologic (67.8%), mixed (21.2%), and cardiac (11.0%) for symptomatic Val30Met (n = 146); and mixed (64.9%), cardiac (22.8%), and neurologic (12.3%) for symptomatic ATTRwt (n = 57). Symptomatic patients reported a range of ATTR amyloidosis signs and symptoms at enrollment, with autonomic neuropathy and sensory neuropathy common in all phenotypes. Conclusions These results from THAOS highlight the phenotypic heterogeneity associated with ATTR amyloidosis in Spain and the importance of comprehensive neurologic and cardiac evaluations in all patients with ATTR amyloidosis. Trial registration ClinicalTrials.gov: NCT00628745.
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Affiliation(s)
- Juan González-Moreno
- Servicio de Medicina Interna, Hospital Universitario Son Llatzer, Instituto de Investigación Sanitaria Illes Balears, Palma de Mallorca, Spain.
| | - Inés Losada-López
- Servicio de Medicina Interna, Hospital Universitario Son Llatzer, Instituto de Investigación Sanitaria Illes Balears, Palma de Mallorca, Spain
| | - Eugenia Cisneros-Barroso
- Servicio de Medicina Interna, Hospital Universitario Son Llatzer, Instituto de Investigación Sanitaria Illes Balears, Palma de Mallorca, Spain
| | - Pablo Garcia-Pavia
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Madrid, Spain.,Universidad Francisco de Vitoria, Pozuelo de Alarcon, Spain
| | - José González-Costello
- Servei de Cardiologia, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | - Josep Maria Campistol
- Department of Nephrology and Renal Transplantation of HCPB, Hospital Clinic, Barcelona, Spain
| | - Roberto Fernandez-Torron
- Biodonostia Health Research Institute, Neuromuscular Area, Hospital Donostia, Neurology Department, 20014, Donostia - San Sebastian, Spain
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11
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Gorram F, Olsson M, Alarcon F, Nuel G, Anan I, Planté-Bordeneuve V. New data on the genetic profile and penetrance of hereditary Val30Met transthyretin amyloidosis in Sweden. Amyloid 2021; 28:84-90. [PMID: 33146042 DOI: 10.1080/13506129.2020.1841623] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Hereditary transthyretin (ATTRv) amyloidosis is of autosomal dominant transmission, caused by a spectrum of mutations in the transthyretin (TTR) gene. The ATTRV30M (p.Val50Met) is the most frequent substitution in Europe. Northern Sweden is a known cluster for ATTRV30M amyloidosis patients due to high prevalence of the mutation rate, with homozygous cases. First symptoms occur generally during the 6th decade. Previous studies reported low penetrance in this area and possible anticipation in families. In order to refine our knowledge of the genetic aspects, penetrance and factors that influence the disease's risk, we performed a comprehensive study of ATTRV30M families in Sweden. METHODS To assess anticipation, well-established age at onset (AO) was compared in all informative parent-offspring pairs and in subgroups, after excluding ascertainment biases. Penetrance was estimated using a non-parametric method that enables to study covariates' effect on the disease's risk. RESULTS We analysed 114 ATTRV30M Swedish families, including 12 homozygous individuals. Among 131 parent-offspring pairs, we found an average anticipation of 11.7 [Standard Deviation (SD) =10.03] years, higher in case of maternal transmission (mean ± SD = 13.7 ± 8.4 years), compared to paternal transmission (mean ± SD = 7.9 ± 11.5 years, p < .003). Anticipation remained significant, after exclusion of ascertainment biases. In heterozygous ATTRV30M kindred, penetrance was low, estimated below 10% [95% confidence interval (CI) = 6-10] at 40 years-old, increasing to 71% [95% CI= 65-76] at age 90 years. The risk was found to be higher in male patients (p < .01) and in case of maternal transmission (p < .01), reflecting a parent of origin effect. We observed no difference of penetrance according the geographical origin. Finally, the disease risk was similar in heterozygous and homozygous ATTRV30M amyloidosis individuals. CONCLUSIONS Our study provides new data on the genetics of ATTRV30M families in Sweden, including the occurrence of anticipation and on penetrance. Both are increased in case of maternal inheritance and in male patients. Overall, gender seems to be a factor that substantially modulates the AO of the disease, in this area. Clinically, these findings are of importance to guide the management of sibships and the monitoring of mutation carriers.
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Affiliation(s)
- Farida Gorram
- Department of Neurology, Henri Mondor University Hospital, APHP, Créteil, France.,University Paris Est- Creteil, INSERM U955, Institut Mondor de Recherche Biomédicale(IMRB), Creteil, France
| | - Malin Olsson
- Department of Public Health and Clinical Medicine/Medicine, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Flora Alarcon
- Laboratory MAP5 UMR CNRS 8145, Paris Descartes University, Paris, France
| | - Gregory Nuel
- Stochastics and Biology Group, Department of Probability and Statistics (LPSM, CNRS 8001), Sorbonne University, Campus Pierre et Marie Curie, Paris, France
| | - Intissar Anan
- Department of Public Health and Clinical Medicine/Medicine, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Violaine Planté-Bordeneuve
- Department of Neurology, Henri Mondor University Hospital, APHP, Créteil, France.,University Paris Est- Creteil, INSERM U955, Institut Mondor de Recherche Biomédicale(IMRB), Creteil, France
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12
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Waddington-Cruz M, Wixner J, Amass L, Kiszko J, Chapman D, Ando Y. Characteristics of Patients with Late- vs. Early-Onset Val30Met Transthyretin Amyloidosis from the Transthyretin Amyloidosis Outcomes Survey (THAOS). Neurol Ther 2021; 10:753-766. [PMID: 34024024 PMCID: PMC8571445 DOI: 10.1007/s40120-021-00258-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/08/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Hereditary transthyretin amyloidosis (ATTRv amyloidosis) is a clinically heterogeneous disease caused by mutations in the transthyretin (TTR) gene. The most common mutation, Val30Met, can manifest as an early- or late-onset disease. METHODS The Transthyretin Amyloidosis Outcomes Survey (THAOS) is an ongoing, global, longitudinal, observational survey of patients with transthyretin amyloidosis, including both inherited and wild-type disease and asymptomatic patients with TTR mutations. This is a descriptive analysis of symptomatic patients with ATTRv Val30Met amyloidosis with late- (age at least 50 years) vs. early-onset (age less than 50 years) disease in THAOS (data cutoff August 1, 2019). RESULTS Of 1389 patients with ATTRv Val30Met amyloidosis, 491 (35.3%) had late-onset disease. Compared with early-onset, patients with late-onset were more likely to be male (66.2% vs. 53.6%) and have a longer mean (standard deviation [SD]) time from onset to diagnosis (3.8 [3.4] vs. 2.7 [4.1] years). Late-onset disease was associated with more severe neurological impairment at enrollment (median [10th, 90th percentile] derived Neuropathy Impairment Score in the Lower Limbs, 25.0 [4.0, 69.3] vs. 8.0 [0, 54.8]; Neurologic Composite Score, 42.0 [2.0, 155.0] vs. 21.0 [0, 102.0]). Cardiac findings were more prominent in late-onset disease. An overall interpretation of electrocardiogram as abnormal was reported in 72.1% of late-onset patients (vs. 44.3% early-onset). A left-ventricular septal thickness of at least 12 mm was reported in 69.7% of late-onset patients (vs. 14.6% early-onset). All differences were statistically significant (p < 0.001). CONCLUSION In THAOS, late-onset ATTRv Val30Met amyloidosis is common, presenting with more severe neurologic and cardiac findings at enrollment. Heterogeneity of disease may make it more difficult to diagnose. Increased recognition of late-onset ATTRv Val30Met amyloidosis could lead to more timely diagnosis and improve patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT00628745.
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Affiliation(s)
- Márcia Waddington-Cruz
- CEPARM, National Amyloidosis Referral Center, University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Jonas Wixner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | | | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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13
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Pasutharnchat N, Taychargumpoo C, Vorasettakarnkij Y, Amornvit J. Ala97Ser transthyretin amyloidosis-associated polyneuropathy, clinical and neurophysiological profiles in a Thai cohort. BMC Neurol 2021; 21:206. [PMID: 34022837 PMCID: PMC8140461 DOI: 10.1186/s12883-021-02243-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/13/2021] [Indexed: 12/18/2022] Open
Abstract
Background Ala97Ser transthyretin amyloidosis-associated polyneuropathy (ATTRA97S-PN) is a rare form of inherited polyneuropathy, usually manifesting with late-onset (> 50) progressive polyneuropathy. This mutation is mostly prevalent in Taiwanese and Han-Chinese individuals. The aim of this study was to describe the clinical and comprehensive neurophysiological profiles of ATTRA97S-PN in Thai patients. Methods The clinical profiles and serial neurophysiologic studies (nerve conduction study (NCS), quantitative sensory test (QST), and comprehensive autonomic function test (AFT)) of symptomatic ATTRA97S-PN patients who had been followed-up at King Chulalongkorn Memorial Hospital during 2010–2020 were retrospectively reviewed. Results Nine symptomatic patients (55.6 % were male) from four unrelated families were included. All were Thais of mixed Thai Chinese descent. The mean age of onset was 48.3 (32–60) years. The mean age at diagnosis was 54.8 (33–66) years. Three patients developed early-onset (< 40y) polyneuropathy. The mean Neuropathy Impairment Score was 41.33 (10–92) at diagnosis. Sensory (9/9) and autonomic (9/9) neuropathies were more frequent than motor neuropathy (5/9), which appeared in the late stage of disease. Hypoesthesia in the feet, and gastrointestinal autonomic symptoms were frequently reported as the initial symptoms. The course of neuropathy progressed over years to decades. The worsening of neuropathy tended to progress faster once motor nerves were affected in both clinical and neurophysiological aspects. Concurrent cardiac amyloidosis was found in 6/9 patients. NCS showed length-dependent sensorimotor axonal polyneuropathy in 5/9 patients, and median neuropathy at the wrist (mostly bilateral) in 7/9 patients. QST showed abnormalities in the vibratory detection threshold, the cold detection threshold and the heat pain sensation in 8/9, 8/9 and 7/7 tested patients, respectively. AFT results were abnormal in all. The mean composite autonomic severity score was 5 (3–9). Conclusions This clinical study is the first of ATTRA97S-PN in Thai patients. The mixed polyneuropathy-cardiopathy phenotype was the most common manifestation. In this cohort, the age of onset was lower, and the course of neuropathy was relatively longer, than that in previous studies. Some patients may develop early-onset polyneuropathy. This mutation has not yet been documented in any population other than Han Chinese-related populations, probably suggesting a founder effect. Further studies are warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02243-3.
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Affiliation(s)
- Nath Pasutharnchat
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
| | - Chamaiporn Taychargumpoo
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Jakkrit Amornvit
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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14
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Cisneros-Barroso E, González-Moreno J, Rodríguez A, Ripoll-Vera T, Álvarez J, Usón M, Figuerola A, Descals C, Montalá C, Ferrer-Nadal MA, Losada I. Anticipation on age at onset in kindreds with hereditary ATTRV30M amyloidosis from the Majorcan cluster. Amyloid 2020; 27:254-258. [PMID: 32633140 DOI: 10.1080/13506129.2020.1789580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hereditary transthyretin amyloidosis (ATTRV30M) is a rare disease caused by amyloid deposition and characterized by a heterogeneous presentation. Anticipation (AC) is described as the decrease in age at onset (AO) within each generation. Our aim was to study AC in a large number of ATTRV30M kindred from Majorca (Spain), and gain further insight into parent-of-origin effects. METHODS In a cohort of 262 subjects with ATTRV30M amyloidosis belonging to 51 families, we found 37 affected pairs. AO is defined as the age at the first symptom and AC (parent's age at disease onset minus that of the offspring) were calculated. Chi-square test, independent t-test and paired t-test were used for comparisons between groups. Association between AO of parents and offsprings were assessed by Pearson's correlation coefficient. RESULTS Offspring mean AO was 16 years lower than that of the parents (p < .001) regardless of the sex of the parents and the offspring. AC occurred in 31 out of the 37 pairs, with no differences related to the sex of parents or offspring. There was a moderate correlation (r = 0.49; p < .001) between AO of the parents and that of the offsprings. CONCLUSION AC was no uncommon in our cohort, and AO tended to decrease in successive generations.
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Affiliation(s)
- Eugenia Cisneros-Barroso
- Internal Medicine Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain.,Research Health Institute of the Balearic Islands (IdISBa), Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Juan González-Moreno
- Internal Medicine Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain.,Research Health Institute of the Balearic Islands (IdISBa), Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Adrian Rodríguez
- Internal Medicine Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain.,Research Health Institute of the Balearic Islands (IdISBa), Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Tomas Ripoll-Vera
- Research Health Institute of the Balearic Islands (IdISBa), Son Llàtzer University Hospital, Palma de Mallorca, Spain.,Cardiology Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Jorge Álvarez
- Research Health Institute of the Balearic Islands (IdISBa), Son Llàtzer University Hospital, Palma de Mallorca, Spain.,Cardiology Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Mercedes Usón
- Research Health Institute of the Balearic Islands (IdISBa), Son Llàtzer University Hospital, Palma de Mallorca, Spain.,Neurology/Neurophysiology Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Antonio Figuerola
- Research Health Institute of the Balearic Islands (IdISBa), Son Llàtzer University Hospital, Palma de Mallorca, Spain.,Neurology/Neurophysiology Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Cristina Descals
- Research Health Institute of the Balearic Islands (IdISBa), Son Llàtzer University Hospital, Palma de Mallorca, Spain.,Neurology/Neurophysiology Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Carles Montalá
- Research Health Institute of the Balearic Islands (IdISBa), Son Llàtzer University Hospital, Palma de Mallorca, Spain.,Neurology/Neurophysiology Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Maria Asunción Ferrer-Nadal
- Research Health Institute of the Balearic Islands (IdISBa), Son Llàtzer University Hospital, Palma de Mallorca, Spain.,Nephrology Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Ines Losada
- Internal Medicine Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain.,Research Health Institute of the Balearic Islands (IdISBa), Son Llàtzer University Hospital, Palma de Mallorca, Spain
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15
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Nevone A, Merlini G, Nuvolone M. Treating Protein Misfolding Diseases: Therapeutic Successes Against Systemic Amyloidoses. Front Pharmacol 2020; 11:1024. [PMID: 32754033 PMCID: PMC7366848 DOI: 10.3389/fphar.2020.01024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/24/2020] [Indexed: 12/20/2022] Open
Abstract
Misfolding and extracellular deposition of proteins is the hallmark of a heterogeneous group of conditions collectively termed protein misfolding and deposition diseases or amyloidoses. These include both localized (e.g. Alzheimer’s disease, prion diseases, type 2 diabetes mellitus) and systemic amyloidoses. Historically regarded as a group of maladies with limited, even inexistent, therapeutic options, some forms of systemic amyloidoses have recently witnessed a series of unparalleled therapeutic successes, positively impacting on their natural history and sometimes even on their incidence. In this review article we will revisit the most relevant of these accomplishments. Collectively, current evidence converges towards a crucial role of an early and conspicuous reduction or stabilization of the amyloid-forming protein in its native conformation. Such an approach can reduce disease incidence in at risk individuals, limit organ function deterioration, promote organ function recovery, improve quality of life and extend survival in diseased subjects. Therapeutic success achieved in these forms of systemic amyloidoses may guide the research on other protein misfolding and deposition diseases for which effective etiologic therapeutic options are still absent.
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Affiliation(s)
- Alice Nevone
- Amyloidosis Research and Treatment Center, Foundation IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Foundation IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Mario Nuvolone
- Amyloidosis Research and Treatment Center, Foundation IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
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16
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Pinto MV, Pinto LF, Dias M, Rosa RS, Mundayat R, Pedrosa RC, Waddington-Cruz M. Late-onset hereditary ATTR V30M amyloidosis with polyneuropathy: Characterization of Brazilian subjects from the THAOS registry. J Neurol Sci 2019; 403:1-6. [PMID: 31163298 DOI: 10.1016/j.jns.2019.05.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/06/2019] [Accepted: 05/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite growing numbers of patients diagnosed with late-onset hereditary ATTR V30M amyloidosis with polyneuropathy (ATTRv-PN), this condition remains poorly characterized in Brazil. OBJECTIVE Characterize late-onset V30M ATTRv-PN in Brazil. MATERIAL AND METHODS Demographic and clinical data at the time of enrolment for Brazilian subjects with symptomatic V30M ATTRv-PN were extracted from the ongoing, multinational, longitudinal, observational Transthyretin Amyloidosis Outcomes Survey (THAOS; cut-off date: January 30, 2017). Subjects were divided into those with symptom onset at age <50 years (EO-V30M), and at age ≥50 years (LO-V30M). RESULTS A total of 96 Val30Met patients were symptomatic. LO-V30M (n = 25, 26.0%) had a longer time to diagnosis (mean 5.1 vs. 2.8 yrs.; p = 0.006) and less frequently positive family history (40% vs. 95.8%; p < 0.0001) than EO-V30M. Clinically, subjects with LO-V30M had more imbalance (92% vs. 54.9%; p = 0.006), deep sensory loss (100% vs. 80%; p = 0.0178), electrocardiogram abnormalities (88.9% vs. 59.4; p = 0.0241), and interventricular septum hypertrophy (69.2% vs. 0%; p < 0001) and less frequently sensory dissociation (12% vs. 74%; p < 0.0001). Also, LO-V30M tended to have more severe mean Neurologic Composite Score (101 vs. 70 pts.; p = 0.1136). CONCLUSIONS LO-V30M ATTRv-PN is not unusual in Brazil, tending to be more difficult to diagnose and present with a more severe phenotype, with more large nerve fibers and cardiac involvement than EO-V30M. TRIAL REGISTRATION ClinicalTrials.gov: NCT00628745.
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Affiliation(s)
- Marcus Vinicius Pinto
- National Amyloidosis Referral Center, CEPARM, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - Luiz Felipe Pinto
- National Amyloidosis Referral Center, CEPARM, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Moises Dias
- National Amyloidosis Referral Center, CEPARM, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renata Santa Rosa
- National Amyloidosis Referral Center, CEPARM, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Roberto Coury Pedrosa
- National Amyloidosis Referral Center, CEPARM, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Waddington-Cruz
- National Amyloidosis Referral Center, CEPARM, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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17
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Koike H, Fukami Y, Nishi R, Kawagashira Y, Iijima M, Sobue G, Katsuno M. Clinicopathological spectrum and recent advances in the treatment of hereditary transthyretin amyloidosis. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/ncn3.12306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Haruki Koike
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Yuki Fukami
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Ryoji Nishi
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Yuichi Kawagashira
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Masahiro Iijima
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Gen Sobue
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
- Research Division of Dementia and Neurodegenerative Disease Nagoya University Graduate School of Medicine Nagoya Japan
| | - Masahisa Katsuno
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
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18
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Polimanti R, Nuñez YZ, Gelernter J. Increased Risk of Multiple Outpatient Surgeries in African-American Carriers of Transthyretin Val122Ile Mutation Is Modulated by Non-Coding Variants. J Clin Med 2019; 8:jcm8020269. [PMID: 30813263 PMCID: PMC6406512 DOI: 10.3390/jcm8020269] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 12/12/2022] Open
Abstract
Background: African-Americans (AAs) have a 3.5% carrier prevalence of Transthyretin (TTR) Val122Ile mutation (rs76992529), which is the genetic cause of a hereditary form of amyloidosis. Methods: We investigated the medical history of Val122Ile carriers and assessed the role of a non-coding variation in 4361 unrelated AAs. Results: We observed that the Ile122 allele was associated with a 6.8-fold increase in the odds of having 10 or more outpatient surgeries (p = 7.81 × 10−5). Stratifying the analysis by sex, the Ile122 allele was associated with a 15.2-fold increase in the odds of having 10 or more outpatient surgeries in men (p = 6.49 × 10−7). A similar sex difference was observed with respect to the association of Val122Ile with musculoskeletal and connective-tissue disorders in an independent cohort of British subjects (n = 361,194, p = 2.47 × 10−13; nmale = 167,020, pmale = 4.02 × 10−24). In Val122Ile African-American carriers, we observed that haplotypes in the upstream region regulating TTR hepatic expression are associated with having 10 or more outpatient surgeries (p = 2.56 × 10−9). Conclusions: TTR Val122Ile showed a large effect with respect to an extreme phenotype identified in medical history that may be related to osteoarthritis, an early sign of the disease. Additionally, the non-coding variation appears to accelerate the negative consequences associated with Val122Ile mutation via TTR expression regulation.
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Affiliation(s)
- Renato Polimanti
- Department of Psychiatry, Yale University School of Medicine and VA CT Healthcare Center, West Haven, CT 06516, USA.
| | - Yaira Z Nuñez
- Department of Psychiatry, Yale University School of Medicine and VA CT Healthcare Center, West Haven, CT 06516, USA.
| | - Joel Gelernter
- Department of Psychiatry, Yale University School of Medicine and VA CT Healthcare Center, West Haven, CT 06516, USA.
- Departments of Genetics and Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA.
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Ueda M, Yamashita T, Misumi Y, Masuda T, Ando Y. Origin of sporadic late-onset hereditary ATTR Val30Met amyloidosis in Japan. Amyloid 2018; 25:143-147. [PMID: 30486687 DOI: 10.1080/13506129.2018.1531842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hereditary transthyretin (ATTRm) amyloidosis, formerly known as familial amyloid polyneuropathy, is a major type of hereditary systemic amyloidosis, in which the disease is caused by mutant transthyretin (TTR). Although more than 140 different point mutations have been identified in the TTR gene, ATTRm amyloidosis patients with the TTR Val30Met mutation are most frequently found worldwide. Interestingly, the onset age of the ATTR Val30Met amyloidosis is highly varied among countries and regions. The reason for these differences in onset age and penetrance remains to be elucidated. We recently performed an epidemiological study to analyze the clinical and genetic characteristics of ATTRm amyloidosis patients in Japan. Our results led us to the following questions: Why did most of the non-endemic patients with the same TTR Val30Met mutation not have a family history of the disease, a typical autosomal dominant hereditary disorder? Why does ATTR Val30Met amyloidosis alone demonstrate foci of occurrence? Why is only this type of ATTRm amyloidosis nationally and globally distributed? In this mini-review, we discuss these unanswered questions based on recent genetic epidemiological studies on ATTR Val30Met amyloidosis.
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Affiliation(s)
- Mitsuharu Ueda
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
| | - Taro Yamashita
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
| | - Yohei Misumi
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
| | - Teruaki Masuda
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
| | - Yukio Ando
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
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Transthyretin familial amyloid polyneuropathy: an update. J Neurol 2017; 265:976-983. [PMID: 29249054 DOI: 10.1007/s00415-017-8708-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 12/18/2022]
Abstract
Transthyretin familial amyloid polyneuropathy (TTR-FAP) is a progressive, fatal, inherited disorder first identified in Portugal and now recognized in all continents. Over the past decade, thanks to the availability of the genetic test, our knowledge on the range of clinical expressions of this disorder has expanded, including different patterns and progression rates of the neuropathy, as well as aspects of the cardiomyopathy, which can be prominent. In the mean time, new tools are being developed to detect earlier TTR amyloid deposition such as cardiac scintigraphy with technetium-labelled pyrophosphate tracers or small nerve fiber alterations from skin biopsies, or using neurophysiological approaches as well as magnetic resonance neurography (MRN). Such refinements, along with an increased awareness of the disease, should reduce the diagnostic delay and facilitate early treatment. In this regard, thanks to a better understanding of the TTR amyloid formation, major advances have been made, allowing for therapeutic developments which are less invasive than liver transplantation (LT). TTR stabilizer drugs are safe and seem to delay the disease progression in some groups of patients. Indeed, positive results have just been released from 2 phase III trials on TTR gene modifiers, namely silencing RNA and antisense oligonucleotide therapies. These recent advances open a new area in the field with the hope that we can safely bring about long-term stabilization of the disease. Furthermore, immunotherapies targeting the amyloid deposits are being explored.
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