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Yuan H, Lin Y, Wang J, Li J, Chen X, Guo Y, Tang J. Hypertrophic cardiomyopathy caused by a heterozygous variant in TTR gene: A case report. Medicine (Baltimore) 2023; 102:e33752. [PMID: 37335747 DOI: 10.1097/md.0000000000033752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
RATIONALE We report a rare case of hypertrophic cardiomyopathy (HCM) caused by a heterozygous variant in TTR gene. PATIENT CONCERNS The proband had been vomiting without obvious inducement since the age of 27, accompanied by the expulsion of stomach contents. At the age of 28, she began to suddenly syncope. DIAGNOSIS Cardiac magnetic resonance showed thickening of the right ventricular lateral wall and ventricular septum. The left ventricular diastolic function was limited. Targeted Sanger sequencing validates the presence of mutation p.Leu75Pro in TTR gene. INTERVENTIONS AND OUTCOMES After admission to hospital for syncope, she was given metoprolol tablets 25 mg bid, spironolactone tablets 20 mg qd, and trimetazidine 20 mg tid. Her symptoms improved after taking the medicine. LESSONS The results of this case show that HCM caused by TTR mutation is not easy to be identified and treatment is easy to be delayed. Therefore, high-risk patients with amyloidosis should be evaluated as soon as possible. Timely diagnosis of HCM caused by TTR mutation before irreversible organ damage is essential for proper treatment and better outcomes.
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Affiliation(s)
- Huayuan Yuan
- Department of Cardiology, Fuwai Yunnan Cardiovascular Hospital, Kunming, Yunnan Province, China
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Grasso D, Galderisi S, Santucci A, Bernini A. Pharmacological Chaperones and Protein Conformational Diseases: Approaches of Computational Structural Biology. Int J Mol Sci 2023; 24:ijms24065819. [PMID: 36982893 PMCID: PMC10054308 DOI: 10.3390/ijms24065819] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Whenever a protein fails to fold into its native structure, a profound detrimental effect is likely to occur, and a disease is often developed. Protein conformational disorders arise when proteins adopt abnormal conformations due to a pathological gene variant that turns into gain/loss of function or improper localization/degradation. Pharmacological chaperones are small molecules restoring the correct folding of a protein suitable for treating conformational diseases. Small molecules like these bind poorly folded proteins similarly to physiological chaperones, bridging non-covalent interactions (hydrogen bonds, electrostatic interactions, and van der Waals contacts) loosened or lost due to mutations. Pharmacological chaperone development involves, among other things, structural biology investigation of the target protein and its misfolding and refolding. Such research can take advantage of computational methods at many stages. Here, we present an up-to-date review of the computational structural biology tools and approaches regarding protein stability evaluation, binding pocket discovery and druggability, drug repurposing, and virtual ligand screening. The tools are presented as organized in an ideal workflow oriented at pharmacological chaperones' rational design, also with the treatment of rare diseases in mind.
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Affiliation(s)
- Daniela Grasso
- Department of Biotechnology, Chemistry, and Pharmacy, University of Siena, 53100 Siena, Italy
| | - Silvia Galderisi
- Department of Biotechnology, Chemistry, and Pharmacy, University of Siena, 53100 Siena, Italy
| | - Annalisa Santucci
- Department of Biotechnology, Chemistry, and Pharmacy, University of Siena, 53100 Siena, Italy
| | - Andrea Bernini
- Department of Biotechnology, Chemistry, and Pharmacy, University of Siena, 53100 Siena, Italy
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Hikishima S, Sakai K, Akagi A, Yamaguchi H, Shibata S, Hayashi K, Nakano H, Kanemoto M, Usui Y, Taniguchi Y, Komatsu J, Nakamura-Shindo K, Nozaki I, Hamaguchi T, Ono K, Iwasa K, Yamada M. Deterioration after Liver Transplantation and Transthyretin Stabilizer Administration in a Patient with ATTRv Amyloidosis with a Leu58Arg (p.Leu78Arg) TTR Variant. Intern Med 2022; 61:2347-2351. [PMID: 35283385 PMCID: PMC9424092 DOI: 10.2169/internalmedicine.8945-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We herein report a 44-year-old Japanese man with hereditary transthyretin amyloidosis (ATTRv amyloidosis) harboring the variant Leu58Arg (p.Leu78Arg) in TTR in whom we conducted an observational study with liver transplantation (LT) and transthyretin (TTR) stabilizers (tafamidis and diflunisal) for 9 years. This patient showed gradual deterioration of sensory, motor, and autonomic neuropathy symptoms after LT. Furthermore, cardiac amyloidosis gradually developed. Although the present case showed deterioration of the symptoms after disease-modifying treatments, LT might be suitable in patients with the same variant if they are young and in good condition due to a long survival after LT.
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Affiliation(s)
- Sadao Hikishima
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Kenji Sakai
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Akio Akagi
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Hiroki Yamaguchi
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Shutaro Shibata
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Koji Hayashi
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Hiroto Nakano
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Mizuki Kanemoto
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Yuta Usui
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Yu Taniguchi
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Junji Komatsu
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Keiko Nakamura-Shindo
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Ichiro Nozaki
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Tsuyoshi Hamaguchi
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Kenjiro Ono
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Kazuo Iwasa
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Masahito Yamada
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Japan
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Jennings MJ, Lochmüller A, Atalaia A, Horvath R. Targeted Therapies for Hereditary Peripheral Neuropathies: Systematic Review and Steps Towards a 'treatabolome'. J Neuromuscul Dis 2021; 8:383-400. [PMID: 32773395 PMCID: PMC8203235 DOI: 10.3233/jnd-200546] [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] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Hereditary peripheral neuropathies are inherited disorders affecting the peripheral nervous system, including Charcot-Marie-Tooth disease, familial amyloid polyneuropathy and hereditary sensory and motor neuropathies. While the molecular basis of hereditary peripheral neuropathies has been extensively researched, interventional trials of pharmacological therapies are lacking. Objective: We collated evidence for the effectiveness of pharmacological and gene-based treatments for hereditary peripheral neuropathies. Methods: We searched several databases for randomised controlled trials (RCT), observational studies and case reports of therapies in hereditary peripheral neuropathies. Two investigators extracted and analysed the data independently, assessing study quality using the Oxford Centre for Evidence Based Medicine 2011 Levels of Evidence in conjunction with the Jadad scale. Results: Of the 2046 studies initially identified, 119 trials met our inclusion criteria, of which only 34 were carried over into our final analysis. Ascorbic acid was shown to have no therapeutic benefit in CMT1A, while a combination of baclofen, naltrexone and sorbitol (PXT3003) demonstrated some efficacy, but phase III data are incomplete. In TTR-related amyloid polyneuropathy tafamidis, patisiran, inotersen and revusiran showed significant benefit in high quality RCTs. Smaller studies showed the efficacy of L-serine for SPTLC1-related hereditary sensory neuropathy, riboflavin for Brown-Vialetto-Van Laere syndrome (SLC52A2/3) and phytanic acid-poor diet in Refsum disease (PHYH). Conclusions: The ‘treatable’ variants highlighted in this project will be flagged in the treatabolome database to alert clinicians at the time of the diagnosis and enable timely treatment of patients with hereditary peripheral neuropathies.
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Affiliation(s)
- Matthew J Jennings
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Antonio Atalaia
- Center of Research in Myology, Sorbonne Université - Inserm UMRS 974, Institut de Myologie, G.H. Pitie-Salpetriere, Paris, France
| | - Rita Horvath
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Canadian Guidelines for Hereditary Transthyretin Amyloidosis Polyneuropathy Management. Can J Neurol Sci 2021; 49:7-18. [PMID: 33631091 DOI: 10.1017/cjn.2021.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hereditary transthyretin-mediated (hATTR) amyloidosis is a progressive disease caused by mutations in the TTR gene leading to multisystem organ dysfunction. Pathogenic TTR aggregation, misfolding, and fibrillization lead to deposition of amyloid in multiple body organs and frequently involve the peripheral nerve system and the heart. Common neurologic manifestations include: sensorimotor polyneuropathy (PN), autonomic neuropathy, small-fiber PN, and carpal tunnel syndrome. Many patients have significant progression due to diagnostic delays as hATTR PN is not considered within the differential diagnosis. Recently, two effective novel disease-modifying therapies, inotersen and patisiran, were approved by Health Canada for the treatment of hATTR PN. Early diagnosis is crucial for the timely introduction of these disease-modifying treatments that reduce impairments, improve quality of life, and extend survival. In this guideline, we aim to improve awareness and outcomes of hATTR PN by making recommendations directed to the diagnosis, monitoring, and treatment in Canada.
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Xu J, Yang M, Pan X, Yu X, Xie J, Ren H, Li X, Chen N. Transthyretin-related hereditary amyloidosis with recurrent vomiting and renal insufficiency as the initial presentation: A case report. Medicine (Baltimore) 2017; 96:e5737. [PMID: 28272196 PMCID: PMC5348144 DOI: 10.1097/md.0000000000005737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Hereditary amyloidosis is diagnosed worldwidely with an increasing incidence. As the most common form, transthyretin-related hereditary amyloidosis (ATTR amyloidosis) is an autosomal dominant inherited disease due to mutations of TTR. Over the past several decades, more than 130 mutations have been reported. Previous studies suggested that ATTR amyloidosis initially showed polyneuropathy and autonomic dysfunction but later involving many visceral organs, such as kidney. PATIENT CONCERNS A young proband carrying TTR p.Leu75Pro mutation, a reported aggressive variant, initially presenting repeat vomiting and impaired renal function was described in a Chinese family. DIAGNOSES ATTR amyloidosis patient was diagnosed by renal biopsy and gene sequencing. INTERVENTIONS Allograft liver transplantation (LT). OUTCOMES Symptom relief but serum creatinine increased. LESSONS SUBSECTIONS This case illustrated the clinical and pathologic phenotype of an ATTR amyloidosis patient who initially presented impaired renal function and p.Leu75Pro variant was found by sequencing the coding region of TTR gene. Kidney is one of the most common and vulnerable organs of amyloidosis, and renal function should be closely monitored.
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Nomura T, Yamashita T, Misumi Y, Ueda M, Masuda T, Tasaki M, Ando Y. A case with a novel variant transthyretin A36D presenting cardiac phenotype. Amyloid 2017; 24:100. [PMID: 28434360 DOI: 10.1080/13506129.2017.1287072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Toshiya Nomura
- 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
| | - Mitsuharu Ueda
- 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
| | - Masayoshi Tasaki
- 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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Matalonga L, Gort L, Ribes A. Small molecules as therapeutic agents for inborn errors of metabolism. J Inherit Metab Dis 2017; 40:177-193. [PMID: 27966099 DOI: 10.1007/s10545-016-0005-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 01/03/2023]
Abstract
Most inborn errors of metabolism (IEM) remain without effective treatment mainly due to the incapacity of conventional therapeutic approaches to target the neurological symptomatology and to ameliorate the multisystemic involvement frequently observed in these patients. However, in recent years, the therapeutic use of small molecules has emerged as a promising approach for treating this heterogeneous group of disorders. In this review, we focus on the use of therapeutically active small molecules to treat IEM, including readthrough agents, pharmacological chaperones, proteostasis regulators, substrate inhibitors, and autophagy inducers. The small molecules reviewed herein act at different cellular levels, and this knowledge provides new tools to set up innovative treatment approaches for particular IEM. We review the molecular mechanism underlying therapeutic properties of small molecules, methodologies used to screen for these compounds, and their applicability in preclinical and clinical practice.
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Affiliation(s)
- Leslie Matalonga
- Secció Errors Congènits del Metabolisme-IBC. Servei de Bioquímica i Genètica Molecular, Hospital Clínic, CIBERER-U737; IDIBAPS, C/ Mejía Lequerica s/n, 08028, Barcelona, Spain.
| | - Laura Gort
- Secció Errors Congènits del Metabolisme-IBC. Servei de Bioquímica i Genètica Molecular, Hospital Clínic, CIBERER-U737; IDIBAPS, C/ Mejía Lequerica s/n, 08028, Barcelona, Spain
| | - Antonia Ribes
- Secció Errors Congènits del Metabolisme-IBC. Servei de Bioquímica i Genètica Molecular, Hospital Clínic, CIBERER-U737; IDIBAPS, C/ Mejía Lequerica s/n, 08028, Barcelona, Spain
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Yamashita T, Ueda M, Saga N, Nanto K, Tasaki M, Masuda T, Misumi Y, Oda S, Fujimoto A, Amano T, Takamatsu K, Yamashita S, Obayashi K, Matsui H, Ando Y. Hereditary amyloidosis with cardiomyopathy caused by the novel variant transthyretin A36D. Amyloid 2016; 23:207-208. [PMID: 27646980 DOI: 10.1080/13506129.2016.1202228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Taro Yamashita
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan.,b Diagnostic Unit for Amyloidosis, Kumamoto University Hospital , Kumamoto , Japan
| | - Mitsuharu Ueda
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | | | - Kiyonori Nanto
- d Department of Cardiology , Kansai Rosai Hospital , Amagasaki , Japan
| | - Masayoshi Tasaki
- 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
| | - Yohei Misumi
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | | | - Akiko Fujimoto
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Tomoko Amano
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Kotaro Takamatsu
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Satoshi Yamashita
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | | | - Hirotaka Matsui
- g Department of Morphological and Physiological Sciences , 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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