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Adams D, Algalarrondo V, Echaniz-Laguna A. Hereditary transthyretin amyloidosis in the era of RNA interference, antisense oligonucleotide, and CRISPR-Cas9 treatments. Blood 2023; 142:1600-1612. [PMID: 37624911 DOI: 10.1182/blood.2023019884] [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: 03/13/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Hereditary transthyretin amyloidosis (ATTRv) is a rare autosomal dominant adult-onset disorder caused by point mutations in the transthyretin (TTR) gene encoding TTR, also known as prealbumin. ATTRv survival ranges from 3 to 10 years, and peripheral nervous system and heart are usually the 2 main tissues affected, although central nervous system and eye may also be involved. Because the liver is the main TTR protein secretor organ, it has been the main target of treatments developed these last years, including liver transplantation, which has been shown to significantly increase survival in a subset of patients carrying the so-called "early-onset Val30Met" TTR gene mutation. More recently, treatments targeting hepatic TTR RNA have been developed. Hepatic TTR RNA targeting is performed using RNA interference (RNAi) and antisense oligonucleotide (ASO) technologies involving lipid nanoparticle carriers or N-acetylgalactosamine fragments. RNAi and ASO treatments induce an 80% decrease in TTR liver production for a period of 1 to 12 weeks. ASO and RNAi phase 3 trials in patients with TTR-related polyneuropathy have shown a positive impact on neuropathy clinical scores and quality of life end points, and delayed RNAi treatment negatively affects survival. Clinical trials specifically investigating RNAi therapy in TTR cardiomyopathy are underway. Hepatic RNA targeting has revolutionized ATTRv treatment and may allow for the transforming a fatal disease into a treatable disorder. Because retina and choroid plexus secrete limited quantities of TTR protein, both tissues are now seen as the next targets for fully controlling the disease.
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Affiliation(s)
- David Adams
- Neurology Department, Bicêtre Hospital, INSERM U 1195, CERAMIC, Assistance Publique-Hôpitaux de Paris, University of Paris Saclay, Paris, France
| | - Vincent Algalarrondo
- Cardiology Department, CERAMIC, Bichat Claude Bernard Hospital, University of Paris-Cité, Paris, France
| | - Andoni Echaniz-Laguna
- Neurology Department, Bicêtre Hospital, INSERM U 1195, CERAMIC, Assistance Publique-Hôpitaux de Paris, University of Paris Saclay, Paris, France
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Su G, Chen XW, Pan JL, Li H, Xie B, Cai SJ. Clinical features of retinal amyloid angiopathy with transthyretin Gly83Arg variant. Int J Ophthalmol 2023; 16:128-134. [PMID: 36659956 PMCID: PMC9815990 DOI: 10.18240/ijo.2023.01.19] [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: 07/12/2022] [Accepted: 10/25/2022] [Indexed: 12/29/2022] Open
Abstract
AIM To report on the clinical features of patients with retinal amyloid angiopathy (RAA) who were identified to be caused by the transthyretin (TTR) Gly83Arg variant. METHODS Case series of five patients diagnosed with RAA was collected at Affiliated Hospital of Zunyi Medical University from January 2010 to December 2021. The clinical features, therapeutic strategies, and prognoses of all patients were reviewed. RESULTS Five patients with a mean age of 52.00±7.23y were diagnosed as RAA. These patients were previously diagnosed with hereditary transthyretin amyloidosis caused by the TTR Gly83Arg variant. Vitreous opacity was found in all 10 eyes, and 7 eyes developed RAA 2 to 20y after the onset of hereditary transthyretin amyloidosis. The clinical manifestations were recurrent vitreous hemorrhage in 2 eyes (29%), neovascular glaucoma in 2 eyes (29%), and iris neovascularization in 1 eye (14%). Microangioma lesions were found in all affected eyes that underwent fundus fluorescein angiography (FFA) in this group of cases, and the incidence of the retinal non-perfusion area was 67%. Although no cases of retinal neovascularization were found, the prognosis of visual acuity was not ideal. CONCLUSION This is the first report of RAA in patients with the TTR Gly83Arg variant. Complications such as RAA and glaucoma will seriously affect the visual prognosis of patients. Thereafter, regular ophthalmic follow-up of patients with hereditary transthyretin amyloidosis is essential. And FFA after vitrectomy is very important, which can help ophthalmologists detect RAA earlier and treat it in time.
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Affiliation(s)
- Gang Su
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China,Guizhou Eye Hospital, Zunyi 563000, Guizhou Province, China,Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi 563000, Guizhou Province, China
| | - Xing-Wang Chen
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China,Guizhou Eye Hospital, Zunyi 563000, Guizhou Province, China,Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi 563000, Guizhou Province, China,Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi 563000, Guizhou Province, China
| | - Jun-Lin Pan
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China,Guizhou Eye Hospital, Zunyi 563000, Guizhou Province, China,Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi 563000, Guizhou Province, China
| | - Hong Li
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China,Guizhou Eye Hospital, Zunyi 563000, Guizhou Province, China,Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi 563000, Guizhou Province, China,Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi 563000, Guizhou Province, China
| | - Bing Xie
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China,Guizhou Eye Hospital, Zunyi 563000, Guizhou Province, China,Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi 563000, Guizhou Province, China,Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi 563000, Guizhou Province, China
| | - Shan-Jun Cai
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China,Guizhou Eye Hospital, Zunyi 563000, Guizhou Province, China,Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi 563000, Guizhou Province, China,Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi 563000, Guizhou Province, China
| | - Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China; Guizhou Eye Hospital, Zunyi 563000, Guizhou Province, China; Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi 563000, Guizhou Province, China
| | - Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China; Guizhou Eye Hospital, Zunyi 563000, Guizhou Province, China; Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi 563000, Guizhou Province, China; Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi 563000, Guizhou Province, China
| | - Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China; Guizhou Eye Hospital, Zunyi 563000, Guizhou Province, China; Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi 563000, Guizhou Province, China; Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi 563000, Guizhou Province, China
| | - Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China; Guizhou Eye Hospital, Zunyi 563000, Guizhou Province, China; Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi 563000, Guizhou Province, China; Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi 563000, Guizhou Province, China
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Shen J, Yu H, Lin J, Zhang L, Pan X, Chen Z. Case Report: Hereditary transthyretin (ATTRv) amyloidosis: The p.G103R mutation of the transthyretin gene in a Han Chinese family is associated with vitreous hemorrhage. Front Genet 2022; 13:972501. [PMID: 36186469 PMCID: PMC9520364 DOI: 10.3389/fgene.2022.972501] [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: 06/18/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Hereditary transthyretin (ATTRv) amyloidosis is a rare disease caused by transthyretin gene (TTR) mutation. We identified that the p.G103R mutation of the TTR gene in a Han Chinese family was associated with vitreous hemorrhage. The proband was a 48-year-old woman who had progressive visual impairment in both eyes for 12 years. A Glass wool–like posterior vitreous cortex attached to the posterior retinal surface of both eyes was found using ocular coherence tomography. Visual acuity improved after the first vitrectomy. Two years later, the patient underwent two more vitrectomies because of vitreous opacity recrudescence. Four years later, she presented with vitreous hemorrhage in the right eye. The vitreous fluids acquired during the vitrectomy showed increased vascular endothelial growth factor, basic fibroblast growth factor, interleukin-6, interleukin-10, vascular cell adhesion molecule, and interleukin-8. Mutation sequencing revealed a heterozygous mutation in nucleotide c.307G > C (p.G103R) in exon 3 of the TTR gene in the proband (IV-13), her daughter (IV-9), and her fourth sister (III-11). To our knowledge, this is the first case of ATTRv amyloidosis caused by a p.G103R mutation of the TTR gene associated with vitreous hemorrhage in China.
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Affiliation(s)
- Junhui Shen
- Eye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hao Yu
- Department of Neurology and Department of Medical Genetics in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Jijian Lin
- Eye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Zhang
- Eye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaohong Pan
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiqing Chen
- Eye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Zhiqing Chen,
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