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Wang J, Chen D, Dong F, Chi H. Diagnostic Sensitivity of Abdominal Fat Aspiration Biopsy for Cardiac Amyloidosis: A Systematic Review and Meta-Analysis. Int J Surg Pathol 2024; 32:286-293. [PMID: 37282575 DOI: 10.1177/10668969231177603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Introduction. Cardiac amyloidosis is a lethal disease, the incidence of which is increasing every year. Early diagnosis and treatment are the keys to reducing the mortality of this disease. Methods. Relevant English literature published in Embase, PubMed, Cochrane Library, and Web of Science were searched until December 1, 2022. Meta-analysis was performed with Stata 17.0 software. Results. A total of 1060 patients with 5 articles were included in this study. The sensitivity of abdominal fat aspiration biopsy for the diagnosis of cardiac amyloidosis was 0.66 (0.48-0.84) and the sensitivity for light chain amyloidosis cardiomyopathy and transthyretin amyloidosis cardiomyopathy was 0.90 (0.80-0.97) and 0.39 (0.18-0.60), respectively. Conclusion. Abdominal fat aspiration biopsy has high sensitivity and clinical value in the diagnosis of light chain amyloidosis cardiomyopathy, whereas there are limitations in the diagnosis of transthyretin amyloidosis cardiomyopathy.
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Affiliation(s)
- Jiaqi Wang
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dong Chen
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fang Dong
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haochen Chi
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
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Pinedo Pichilingue A, Thayyil A, Dai DF, Rastogi P. Diagnostic performance of fluorescence microscopy with a tetramethylrhodamine isothiocyanate filter in identifying renal amyloidosis. Histopathology 2023; 83:722-732. [PMID: 37501637 DOI: 10.1111/his.15014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Renal amyloidosis (RA) has a worldwide incidence of 5-13 cases per million person-years and is expected to rise in upcoming years due to growing awareness, plus improvement of diagnostic modalities. Diagnosing RA remains challenging, especially when encountering very small, focal, or early amyloid deposits. Since delays in diagnosis portends poor prognosis, high morbidity, and mortality, it is crucial to evaluate the performance of commonly used diagnostic modalities. This is the first study that presents a full picture of the diagnostic performance of fluorescence microscopy (FM) with a tetramethylrhodamine isothiocyanate (TRITC) filter to diagnose RA in general and stratified by compartments. MATERIALS AND METHODS A retrospective double-blind diagnostic accuracy study of FM-TRITC filter was performed. The presence or absence of amyloid in the vascular, interstitial, and glomerular compartments was established in 316 representative Congo red-stained core biopsies with an FM-TRITC filter. This was contrasted with polarized microscopy (PM) showing apple-green birefringence as the gold standard. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and the receiver operating characteristic (ROC) curve were obtained using STATA13. RESULTS The prevalence of RA was 6.01%, comparable with that reported in the literature. Reciprocity with regard to the location and pattern of fluorescence and birefringence between the two diagnostic modalities was seen. The FM-TRITC filter has a sensitivity of 100%, specificity of 97.64%, and a positive and negative predictive value of 73.08% and 100%, respectively. The positive likelihood ratio was 42.37, and the negative was 0.00. Overall accuracy was 97.78%. The area under the ROC curve was 0.98. The Diagnostic performance of the FM-TRITC filter stratified by compartments is shown in Table 1. The area under the ROC curve was 0.99, 0.98, and 0.99 for the vascular, interstitial, and glomerular compartment, respectively. All patients with RA (n = 19) were correctly identified; this included one new case, one case with small and focal amyloid, and two early cases with less dense amyloid where birefringence was ambiguous by PM. DISCUSSION The FM-TRITC filter is a highly accurate, sensitive, specific, with excellent predictive values, time-efficient, easy to perform, and suitable to reproduce diagnostic modality for RA. It can accurately rule out RA in all compartments, and in most cases concomitant use of PM should not be indispensable. The diagnosis of vascular, interstitial, and glomerular amyloid deposits can be done using only the FM-TRITC filter with Congo red-stained slides. Exceptionally, a few cases of interstitial amyloidosis could be overdiagnosed due to interferences (e.g. artefacts), these cases could be further assessed with a second diagnostic modality if positive fluorescence is seen. Routine use of the FM-TRITC filter can aid in the diagnosis of early RA, even when the deposits are inconspicuous by PM.
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Affiliation(s)
| | - Abdullah Thayyil
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Dao-Fu Dai
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Prerna Rastogi
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Xue N, Kuang W, Zhang X, Ruan M, Wang J, Zeng X. Amyloidosis initially only manifesting as oral mucosal hemorrhagic lesions: a case series report. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:e133-e138. [PMID: 37648556 DOI: 10.1016/j.oooo.2023.07.017] [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: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 09/01/2023]
Abstract
Amyloidosis is a heterogeneous series of diseases associated with extracellular amyloid protein depositions, which can involve multiple organs and tissues, leading to tissue structure alterations and organ dysfunction. The tongue is the most frequently involved site of oral amyloidosis, and one of its characteristic clinical presentations is macroglossia. Here, we report 3 extremely rare cases of amyloidosis exclusively appearing as multiple blood blisters, petechiae, and ecchymoses of the oral mucosa, in the absence of common clinical manifestations of oral and systemic amyloidosis. In a word, we highlight the possibility of oral mucosal hemorrhagic lesions as the initial clinical signs of systemic amyloidosis and the significance of the early and timely diagnosis of amyloidosis.
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Affiliation(s)
- Ningning Xue
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Wenjing Kuang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Xiaoling Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Minhui Ruan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jiongke Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Xin Zeng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
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Bergantim R, Caetano A, Silva FF, Tavares I, Ferreira M, Jaime AR, Esteves GV. Diagnosis and referral of patients with AL amyloidosis in Portugal: results from a Delphi panel. Porto Biomed J 2023; 8:e231. [PMID: 37846303 PMCID: PMC10575365 DOI: 10.1097/j.pbj.0000000000000231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 10/18/2023] Open
Abstract
Light chain amyloidosis (AL) is a complex disorder defined by the extracellular deposition of insoluble amyloid fibrils formed by intact or fragmented immunoglobulin light chains, leading to cell dysfunction, rapid organ deterioration, and, ultimately, death. Although the clinical presentation of AL is directly connected to organ involvement, signs and symptoms of AL are frequently nonspecific, misinterpreted, and late recognized. Thus, an early diagnosis combined with effective therapies to cease disease progression and rescue organ function is essential. The aim of this study was to assess the knowledge and characterize the current clinical practice regarding AL diagnosis and referral among Portuguese physicians. A Delphi-like panel (one round only) with a group of national experts from different medical specialties (cardiology, hematology, internal medicine, nephrology, and neurology) was carried out online, in which 30 statements were classified using a 4-point Likert scale. For each statement, the consensus level was set at 70% for "fully agree/disagree" and the majority level was defined as >70% in agreement or disagreement. Although the results suggest the existence of adequate general knowledge of AL amyloidosis, they also disclosed the necessity to raise awareness for this disease. Overall, this Delphi panel revealed a high lack of consensus regarding the diagnosis and early management of patients with AL among different specialties despite the qualified majority obtained in 26 statements. An optimized strategy for AL early diagnosis, transversal to several medical fields, is urgently needed. Moreover, referral centers with access to diagnostic technology and a network of diverse specialties should be established to foster an early diagnosis and better disease approach to boost the possibility of a better outcome for patients with AL.
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Affiliation(s)
- Rui Bergantim
- Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
- i3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
- Cancer Drug Resistance Group, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Department of Hematology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - André Caetano
- Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | | | - Isabel Tavares
- Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
- i3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
- Nephrology Service, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Manuela Ferreira
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ana R. Jaime
- Medical Department—Hematology, Janssen-Cilag, S.A., Lisbon, Portugal
| | - Graça V. Esteves
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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Shehabeldin A, Hussey C, Aggad R, Truong L. Increased Diagnostic Specificity of Congo Red Stain for Amyloid: The Potential Role of Texas Red-Filtered Fluorescence Microscopy. Arch Pathol Lab Med 2023; 147:907-915. [PMID: 36343375 DOI: 10.5858/arpa.2021-0512-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 07/28/2023]
Abstract
CONTEXT.— The tissue diagnosis of amyloidosis is traditionally suggested by hematoxylin-eosin stain and confirmed by Congo red stain, both examined by routine light microscopy. Both false-positive and false-negative congophilia are well documented, limiting the sensitivity and specificity of the Congo red stain for the diagnosis of amyloidosis. Examination of Congo red-stained tissue by Texas Red-filtered fluorescence microscopy (TRFM) is known to enhance the amyloid-specific congophilia, thus increasing the diagnostic sensitivity. OBJECTIVE.— To determine whether TRFM can mitigate the false positivity and thus improve the diagnostic specificity of the Congo red stain. DESIGN.— Ninety-two tissue samples were categorized into 3 groups. Group I included 15 samples with tissue deposition of amyloid. Group II consisted of 63 samples in which amorphous eosinophilic structures reminiscent of amyloid were seen on hematoxylin-eosin-stained tissue sections. Group III included 14 samples in which amyloid and amyloid-like tissue were seen side by side. The final diagnosis of presence or absence of amyloidosis in each case was established by clinicopathologic correlation. The congophilic areas in each case were identified by light microscopy. The same areas were then examined by TRFM. RESULTS.— TRFM enhanced congophilia, confirming the diagnosis of amyloidosis in all group I cases. Enhancement was not seen in 52 of the 63 group II cases. For group III cases, TRFM enhanced the amyloid-specific congophilia, but not the nonspecific congophilia, in all cases. CONCLUSIONS.— TRFM increases the diagnostic yield and specificity of Congo red-stained tissue sections for detection of amyloid.
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Affiliation(s)
- Ahmed Shehabeldin
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Shehabeldin, Hussey, Truong)
| | - Caroline Hussey
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Shehabeldin, Hussey, Truong)
| | - Roaa Aggad
- The School of Public Health, Texas A&M University, College Station (Aggad). Shehabeldin is currently at the Pathology Department, MD Anderson Cancer Center, Houston, Texas
| | - Luan Truong
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Shehabeldin, Hussey, Truong)
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George J, Khan H, Masood I, Akhtar Z. Localized nasopharyngeal amyloidosis: A case report. Radiol Case Rep 2022; 17:4506-4509. [PMID: 36189163 PMCID: PMC9519499 DOI: 10.1016/j.radcr.2022.08.070] [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: 04/14/2022] [Revised: 08/15/2022] [Accepted: 08/20/2022] [Indexed: 12/01/2022] Open
Abstract
Amyloidosis is a rare condition on its own but finding localized amyloidosis of a site such as the nasopharynx is an extremely rare condition with very few cases described in the literature. The condition occurs due to the accumulation of misfolded proteins in the extracellular space disrupting the cell architecture and causing eventual dysfunction. In this case report we discuss the pathophysiology, symptoms, and imaging findings of a patient initially thought to have giant cell arteritis, but who was found on CT to have a mass later determined to be localized nasopharyngeal amyloidosis. Evaluation will require biopsy as it is the gold standard, but there are many other tests and even reasons to consider the use of interventional radiology to sample other tissues rather than the primary target site for amyloid deposition in conjunction with nuclear imaging.
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Renal Amyloidosis: Epidemiological, Clinical, and Laboratory Profile in Adults from One Nephrology Center. Int J Nephrol 2022; 2022:8493479. [PMID: 35898389 PMCID: PMC9314002 DOI: 10.1155/2022/8493479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/13/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background Renal amyloidosis is one of the main differential diagnoses of nephrotic proteinuria in adults and the elderly. The aim of this study with the most important series in our country is to contribute to the epidemiological, clinical, and etiological study of the renal amyloidosis. Methods In a retrospective study carried out between 1975 and 2019, 310 cases of histologically proven and typed renal amyloidosis were selected for this study. Results There were 209 men and 101 women with a mean age of 53.8 ± 15.4 years (range, 17–84 years). Of the 310 cases, 255 (82.3%) were diagnosed with AA renal amyloidosis and 55 (17.7%) with non-AA amyloidosis. Infections were the main cause of AA amyloidosis, and tuberculosis was the most frequent etiology. The period from the onset of the underlying disease to diagnosis of the renal amyloidosis was an average of 177 months. The most frequent manifestations at the time of diagnosis were nephrotic syndrome (84%), chronic renal failure (30.3%), and end-stage renal disease (37.8%). After a medium follow-up of 16 months (range, 0–68 months), mortality occurred in 60 cases. Conclusions Given the high frequency of AA amyloidosis in our country, awareness of the proper management of infectious and chronic inflammatory diseases remains a priority in reducing the occurrence of this serious disease.
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Jamshidi P, Levi J, Suarez MJ, Rivera R, Mahoney N, Eberhart CG, Rosenberg A, Rodriguez FJ. Clinicopathologic and Proteomic Analysis of Amyloidomas Involving the Ocular Surface and Adnexa. Am J Clin Pathol 2022; 157:620-627. [PMID: 34698334 PMCID: PMC8973273 DOI: 10.1093/ajcp/aqab161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Ocular amyloidoma is a rare disorder characterized by deposition of insoluble proteinaceous fibrils in the extracellular space of the ocular adnexa. This study details the clinicopathologic features and proteomic characteristics of periocular amyloid deposition. METHODS Specimens (1991-2020) were retrieved and reviewed. All available H&E slides and special stains were reviewed. Proteomic analysis was performed using immunohistochemistry (IHC) for IgG, IgG4, IgA, IgD, IgM, CD20, CD3, CD138, and κ/λ, as well as chromatography-electrospray tandem mass spectrometry on formalin-fixed, paraffin-embedded tissue. RESULTS There were 14 patients (7 men, 7 women). The depositions involved eyelid (n = 3), conjunctiva (n = 8), and orbit (n = 3). All patients were adults with a median age at diagnosis of 56 (range, 39-88) years. The deposits were predominantly λ light chain restricted (n = 6) and mixed light chains (n = 2), and one case was κ predominant. Two of the cases with a mixture of κ and λ light chains had an excess of transthyretin by mass spectrometry. Four of the cases did not have adequate material for proteomic subtyping. CONCLUSIONS Amyloidomas involving ocular adnexa contain a variety of amyloid-related and immunoglobulin-associated peptides. The λ light chain predominates as in other body sites, but mixed patterns and rarely κ light chain restriction may be encountered.
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Affiliation(s)
- Pouya Jamshidi
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, IL, USA
| | | | - Maria Jose Suarez
- Department of Infectious Diseases, Maimonides Medical Center, Brooklyn, NY, USA
| | - Roxana Rivera
- Cincinnati Eye Institute, Cincinnati and Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA
| | - Nicholas Mahoney
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Charles G Eberhart
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Fausto J Rodriguez
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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9
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Stelmach-Gołdyś A, Zaborek-Łyczba M, Łyczba J, Garus B, Pasiarski M, Mertowska P, Małkowska P, Hrynkiewicz R, Niedźwiedzka-Rystwej P, Grywalska E. Physiology, Diagnosis and Treatment of Cardiac Light Chain Amyloidosis. J Clin Med 2022; 11:jcm11040911. [PMID: 35207184 PMCID: PMC8880759 DOI: 10.3390/jcm11040911] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023] Open
Abstract
AL (light-chain) amyloidosis is a systemic disease in which amyloid fibers are formed from kappa or lambda immunoglobulin light chains, or fragments thereof, produced by a neoplastic clone of plasmocytes. The produced protein is deposited in tissues and organs in the form of extracellular deposits, which leads to impairment of their functions and, consequently, to death. Despite the development of research on pathogenesis and therapy, the mortality rate of patients with late diagnosed amyloidosis is 30%. The diagnosis is delayed due to the complex clinical picture and the slow progression of the disease. This is the type of amyloidosis that most often contributes to cardiac lesions and causes cardiac amyloidosis (CA). Early diagnosis and correct identification of the type of amyloid plays a crucial role in the planning and effectiveness of therapy. In addition to standard histological studies based on Congo red staining, diagnostics are enriched by tests to determine the degree of cardiac involvement. In this paper, we discuss current diagnostic methods used in cardiac light chain amyloidosis and the latest therapies that contribute to an improved patient prognosis.
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Affiliation(s)
- Agnieszka Stelmach-Gołdyś
- Department of Immunology, Faculty of Health Sciences, Jan Kochanowski University, 25-317 Kielce, Poland; (A.S.-G.); (B.G.); (M.P.)
- Department of Hematology, Holy Cross Cancer Centre, 25-734 Kielce, Poland
| | - Monika Zaborek-Łyczba
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (M.Z.-Ł.); (J.Ł.); (P.M.); (E.G.)
| | - Jakub Łyczba
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (M.Z.-Ł.); (J.Ł.); (P.M.); (E.G.)
| | - Bartosz Garus
- Department of Immunology, Faculty of Health Sciences, Jan Kochanowski University, 25-317 Kielce, Poland; (A.S.-G.); (B.G.); (M.P.)
- Department of Hematology, Holy Cross Cancer Centre, 25-734 Kielce, Poland
| | - Marcin Pasiarski
- Department of Immunology, Faculty of Health Sciences, Jan Kochanowski University, 25-317 Kielce, Poland; (A.S.-G.); (B.G.); (M.P.)
- Department of Hematology, Holy Cross Cancer Centre, 25-734 Kielce, Poland
| | - Paulina Mertowska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (M.Z.-Ł.); (J.Ł.); (P.M.); (E.G.)
| | - Paulina Małkowska
- Institute of Biology, University of Szczecin, 71-412 Szczecin, Poland; (P.M.); (R.H.)
| | - Rafał Hrynkiewicz
- Institute of Biology, University of Szczecin, 71-412 Szczecin, Poland; (P.M.); (R.H.)
| | | | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (M.Z.-Ł.); (J.Ł.); (P.M.); (E.G.)
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Meng S, Xia W, Xia L, Zhou L, Xu J, Pan X, Meng L. A Pilot Study of Rare Renal Amyloidosis Based on FFPE Proteomics. Molecules 2021; 26:molecules26237234. [PMID: 34885818 PMCID: PMC8659071 DOI: 10.3390/molecules26237234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 11/21/2022] Open
Abstract
Renal amyloidosis typically manifests albuminuria, nephrotic-range proteinuria, and ultimately progresses to end-stage renal failure if diagnosed late. Different types of renal amyloidosis have completely different treatments and outcomes. Therefore, amyloidosis typing is essential for disease prognosis, genetic counseling and treatment. Thirty-six distinct proteins currently known to cause amyloidosis that have been described as amyloidogenic precursors, immunohistochemistry (IHC) or immunofluorescence (IF), can be challenging for amyloidosis typing especially in rare or hereditary amyloidosis in clinical practice. We made a pilot study that optimized the proteomics pre-processing procedures for trace renal amyloidosis formalin-fixed paraffin-embedded (FFPE) tissue samples, combined with statistical and bioinformatics analysis to screen out the amyloidosis-related proteins to accurately type or subtype renal amyloidosis in order to achieve individual treatment. A sensitive, specific and reliable FFPE-based proteomics analysis for trace sample manipulation was developed for amyloidosis typing. Our results not only underlined the great promise of traditional proteomics and bioinformatics analysis using FFPE tissues for amyloidosis typing, but also proved that retrospective diagnosis and analysis of previous cases laid a solid foundation for personalized treatment.
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Affiliation(s)
- Shuang Meng
- Department of Core Facility of Basic Medical Sciences, Shanghai Jiao Tong University School of Basic Medicine, Shanghai 200025, China; (S.M.); (L.X.); (L.Z.)
| | - Wenwen Xia
- Department of Pathology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China;
| | - Li Xia
- Department of Core Facility of Basic Medical Sciences, Shanghai Jiao Tong University School of Basic Medicine, Shanghai 200025, China; (S.M.); (L.X.); (L.Z.)
| | - Li Zhou
- Department of Core Facility of Basic Medical Sciences, Shanghai Jiao Tong University School of Basic Medicine, Shanghai 200025, China; (S.M.); (L.X.); (L.Z.)
| | - Jing Xu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
| | - Xiaoxia Pan
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
- Correspondence: (X.P.); (L.M.); Tel.: +86-21-64370045 (X.P.); +86-21-63846590 (L.M.)
| | - Liyuan Meng
- Department of Core Facility of Basic Medical Sciences, Shanghai Jiao Tong University School of Basic Medicine, Shanghai 200025, China; (S.M.); (L.X.); (L.Z.)
- Correspondence: (X.P.); (L.M.); Tel.: +86-21-64370045 (X.P.); +86-21-63846590 (L.M.)
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Menè P, Moioli A, Stoppacciaro A, Lai S, Festuccia F. Acute Kidney Injury in Monoclonal Gammopathies. J Clin Med 2021; 10:jcm10173871. [PMID: 34501317 PMCID: PMC8432219 DOI: 10.3390/jcm10173871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 01/07/2023] Open
Abstract
Monoclonal gammopathies (MG) encompass a variety of disorders related to clonal expansion and/or malignant transformation of B lymphocytes. Deposition of free immunoglobulin (Ig) components (light or heavy chains, LC/HC) within the kidney during MG may result over time in multiple types and degrees of injury, including acute kidney injury (AKI). AKI is generally a consequence of tubular obstruction by luminal aggregates of LC, a pattern known as “cast nephropathy”. Monoclonal Ig LC can also be found as intracellular crystals in glomerular podocytes or proximal tubular cells. Proliferative glomerulonephritis with monoclonal Ig deposits is another, less frequent form of kidney injury with a sizable impact on renal function. Hypercalcemia (in turn related to bone reabsorption triggered by proliferating plasmacytoid B cells) may lead to AKI via functional mechanisms. Pharmacologic treatment of MG may also result in additional renal injury due to local toxicity or the tumor lysis syndrome. The present review focuses on AKI complicating MG, evaluating predictors, risk factors, mechanisms of damage, prognosis, and options for treatment.
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Affiliation(s)
- Paolo Menè
- Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, 00189 Rome, Italy
- Division of Nephrology, Sant’Andrea University Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy; (A.M.); (F.F.)
- Correspondence: ; Tel.: +39-(06)-3377-5949
| | - Alessandra Moioli
- Division of Nephrology, Sant’Andrea University Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy; (A.M.); (F.F.)
| | - Antonella Stoppacciaro
- Division of Pathology, Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, 00189 Rome, Italy;
| | - Silvia Lai
- Division of Nephrology, Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Francescaromana Festuccia
- Division of Nephrology, Sant’Andrea University Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy; (A.M.); (F.F.)
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12
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Barreca A, Bottasso E, Veneziano F, Giarin M, Nocifora A, Martinetti N, Attanasio A, Biancone L, Benevolo G, Roccatello D, Cassoni P, Papotti MG. Immunohistochemical typing of amyloid in fixed paraffin-embedded samples by an automatic procedure: Comparison with immunofluorescence data on fresh-frozen tissue. PLoS One 2021; 16:e0256306. [PMID: 34428239 PMCID: PMC8384180 DOI: 10.1371/journal.pone.0256306] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/03/2021] [Indexed: 11/19/2022] Open
Abstract
Amyloidosis comprises a spectrum of disorders characterized by the extracellular deposition of amorphous material, originating from an abnormal serum protein. The typing of amyloid into its many variants represents a pivotal step for a correct patient management. Several methods are currently used, including mass spectrometry, immunofluorescence, immunohistochemistry, and immunogold labeling. The aim of the present study was to investigate the accuracy and reliability of immunohistochemistry by means of a recently developed amyloid antibody panel applicable on fixed paraffin-embedded tissues in an automated platform. Patients with clinically and pathologically proven amyloidosis were divided into two cohorts: a pilot one, which included selected amyloidosis cases from 2009 to 2018, and a retrospective one (comprising all consecutive amyloidosis cases analyzed between November 2018 and May 2020). The above-referred panel of antibodies for amyloid classification was tested in all cases using an automated immunohistochemistry platform. When fresh-frozen material was available, immunofluorescence was also performed. Among 130 patients, a total of 143 samples from different organs was investigated. They corresponded to 51 patients from the pilot cohort and 79 ones from the retrospective cohort. In 82 cases (63%), fresh-frozen tissue was tested by immunofluorescence, serving to define amyloid subtype only in 30 of them (36.6%). On the contrary, the automated immunohistochemistry procedure using the above-referred new antibodies allowed to establish the amyloid type in all 130 cases (100%). These included: ALλ (n = 60, 46.2%), ATTR (n = 29, 22.3%), AA (n = 19, 14.6%), ALκ (n = 18, 13.8%), ALys (n = 2, 1.5%), and Aβ2M amyloidosis (n = 2, 1.5%). The present immunohistochemistry antibody panel represents a sensitive, reliable, fast, and low-cost method for amyloid typing. Since immunohistochemistry is available in most pathology laboratories, it may become the new gold standard for amyloidosis classification, either used alone or combined with mass spectrometry in selected cases.
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Affiliation(s)
- Antonella Barreca
- Pathology Unit, City of Health and Science Hospital, Turin, Italy
- * E-mail:
| | - Emanuel Bottasso
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Manuela Giarin
- Pathology Unit, City of Health and Science Hospital, Turin, Italy
| | | | - Nadia Martinetti
- Pathology Unit, City of Health and Science Hospital, Turin, Italy
| | - Angelo Attanasio
- Pathology Unit, City of Health and Science Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luigi Biancone
- Department of Medical Sciences, University of Turin, Turin, Italy
- Division of Nephrology Dialysis and Transplantation, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Giulia Benevolo
- Division of Hematology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Dario Roccatello
- CMID, Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, and Nephrology and Dialysis Unit (ERK-net Member), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, City of Health and Science Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mauro G. Papotti
- Pathology Unit, City of Health and Science Hospital, Turin, Italy
- Department of Oncology, University of Turin, Turin, Italy
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13
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Al-Obaidy KI, Grignon DJ. Primary Amyloidosis of the Genitourinary Tract. Arch Pathol Lab Med 2021; 145:699-703. [PMID: 32383975 DOI: 10.5858/arpa.2020-0102-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Amyloidosis is caused by the deposition of misfolded proteins as insoluble eosinophilic material in the extracellular tissues of the body, leading to impairment of organ function. It can be systemic or localized. Localized genitourinary tract amyloidosis is rare and can be incidentally seen; however, in some cases, it can be the only presenting disease. OBJECTIVE.— To review the clinical presentation and pathologic findings related to primary amyloidosis of the urogenital system and highlight some of the associated pathologic findings based on our personal experience. DATA SOURCES.— Published peer-reviewed literature and personal experience of the senior author. CONCLUSIONS.— Primary localized amyloidosis within the urogenital tract can present as a neoplastic process and may be clinically and radiologically considered as a mass. Awareness of primary amyloidosis by pathologists and clinicians is required for accurate diagnosis and proper patient management.
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Affiliation(s)
- Khaleel I Al-Obaidy
- From the Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis
| | - David J Grignon
- From the Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis
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14
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Wu B, Pak DM, Smith KD, Shinohara MM. Utility of abdominal skin punch biopsy for detecting systemic amyloidosis. J Cutan Pathol 2021; 48:1342-1346. [PMID: 34075607 DOI: 10.1111/cup.14070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/26/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early and accurate diagnosis of systemic amyloidosis (SA) is critical for optimal patient outcomes. Biopsy of clinically uninvolved skin and subcutaneous tissue including abdominal skin punch biopsy (ASPB) is often used as a surrogate for affected organ sampling. There is a lack of published data on the sensitivity and specificity of ASPB for diagnosing SA. METHODS Retrospective chart review between 2000 and 2020 of all ASPB was performed to diagnose SA. Amyloid deposition was confirmed by Congo red stain. Study group includes patients with histopathologically and clinically confirmed diagnosis of SA. Control group includes patients without histopathology of amyloid deposition and no clinical SA. RESULTS Forty-one patients meeting inclusion criteria were analyzed; 23 study group and 18 control group patients. The overall diagnostic sensitivity of ASPB was 43% (95% CI 23%-66%) and the specificity 100% (95% CI 81%-100%). The AL amyloidosis diagnostic sensitivity was 64% (95% CI 35%-87%). ASPB >10 mm in depth had 100% (95% CI 54%-100%) sensitivity compared to 24% for depth ≤10 mm (P = .002). CONCLUSIONS ASPB is a minimally invasive and highly specific method of diagnosing SA. It is particularly sensitive for diagnosing AL amyloidosis and the diagnostic sensitivity can be significantly improved with adequate biopsy depth and diameter.
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Affiliation(s)
- Bicong Wu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Daniel M Pak
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Kelly D Smith
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Michi M Shinohara
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.,Division of Dermatology, University of Washington, Seattle, Washington, USA
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15
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Gibier JB, Perbet R, Lopez B, Colombat M, Dubois R, Humez S, Terriou L, Copin MC, Gnemmi V. Paraffin Immunofluorescence Increases Light-Chain Detection in Extra-Renal Light Chain Amyloidosis and Other Light-Chain-Associated Diseases. Arch Pathol Lab Med 2021; 145:352-358. [PMID: 32539437 DOI: 10.5858/arpa.2020-0018-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Distinguishing the different types of amyloid is clinically important because treatments and outcomes are different. Mass spectrometry is the new gold standard for amyloid typing, but it is costly and not widely available. Therefore, immunolabeling remains the first step in identifying the most common types of amyloidosis. In amyloid subtyping, direct immunofluorescence works well when applied to frozen sections, but immunohistochemistry on formalin-fixed, paraffin-embedded material often yields poor results, particularly for light chain amyloidosis. Recently, paraffin immunofluorescence has been described as a valuable salvage technique in renal pathology when frozen sections are not available but it has not been evaluated for extra-renal diseases. OBJECTIVES.— To evaluate the use of paraffin immunofluorescence for light-chain detection in extra-renal amyloidosis and other light-chain-associated diseases. DESIGN.— First, we compared the staining intensity of both light chains between paraffin immunofluorescence and immunohistochemistry on a retrospective cohort of 28 cases of amyloidosis that have been previously typed. Then, we studied the role of paraffin immunofluorescence as an addition to our classical immunohistochemistry panel for amyloidosis typing. RESULTS.— In the retrospective cohort, we found that paraffin immunofluorescence outperformed immunohistochemistry for light-chain detection. Then, in the prospective part of the study, we showed that the proportion of correctly classified cases increased from 50% to 71.9% with the adjunction of second-intention paraffin immunofluorescence to the immunohistochemistry procedure. CONCLUSIONS.— We therefore view paraffin immunofluorescence as a significant addition to the routine workflow for detection of light-chain-related diseases.
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Affiliation(s)
- Jean-Baptiste Gibier
- From the Université de Lille, CNRS, Inserm, CHU Lille, Pathology Department, Centre de Biologie Pathologie, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France (Gibier, Gnemmi)
| | - Romain Perbet
- Université de Lille, CHU Lille, Pathology Department, Centre de Biologie Pathologie, F-59000 Lille, France (Perbet, Dubois, Humez, Copin)
| | - Benjamin Lopez
- Laboratoire de Biologie Médicale, Centre Hospitalier de Dunkerque, Dunkerque, France (Lopez)
| | - Magali Colombat
- Institut Universitaire du Cancer (IUCT), CHU de Toulouse, Pathology Department, Toulouse, France (Colombat)
| | - Romain Dubois
- Université de Lille, CHU Lille, Pathology Department, Centre de Biologie Pathologie, F-59000 Lille, France (Perbet, Dubois, Humez, Copin)
| | - Sarah Humez
- Université de Lille, CHU Lille, Pathology Department, Centre de Biologie Pathologie, F-59000 Lille, France (Perbet, Dubois, Humez, Copin)
| | - Louis Terriou
- Université de Lille, Hematology Department, Hôpital Claude Huriez, CHU Lille, F-59000, Lille, France (Terriou)
| | - Marie-Christine Copin
- Université de Lille, CHU Lille, Pathology Department, Centre de Biologie Pathologie, F-59000 Lille, France (Perbet, Dubois, Humez, Copin)
| | - Viviane Gnemmi
- From the Université de Lille, CNRS, Inserm, CHU Lille, Pathology Department, Centre de Biologie Pathologie, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France (Gibier, Gnemmi)
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16
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Masson Trichrome and Sulfated Alcian Blue Stains Distinguish Light Chain Deposition Disease From Amyloidosis in the Lung. Am J Surg Pathol 2021; 45:405-413. [PMID: 33002919 DOI: 10.1097/pas.0000000000001593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Light chain deposition disease, characterized by nonamyloidogenic deposits of immunoglobulin light chains, is rare in the lung and possibly underdiagnosed due to low clinical suspicion and lack of readily accessible tests. We encountered a case of pulmonary light chain deposition disease (PLCDD) in which light chain deposits appeared crimson red with a Masson trichrome (MT) stain and salmon pink with a sulfated Alcian blue (SAB) stain. This prompted us to characterize a series of PLCDD cases and assess the utility of MT and SAB stains to distinguish them from amyloidosis. From the pathology archives of 2 institutions spanning 10 years, we identified 11 cases of PLCDD, including 7 diagnosed as such and 4 determined retrospectively. The deposits in all cases of PLCDD stained crimson red with MT and salmon pink with SAB, while the cases of pulmonary amyloid (n=10) stained blue-gray and blue-green, respectively. The immunoglobulin light chain nature of the deposits was confirmed in 10 of 11 cases by either immunofluorescence microscopy (n=5) or mass spectrometry (n=5). Transmission electron microscopy revealed osmiophilic, electron-dense deposits in all cases analyzed (n=3). An extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type was diagnosed in 10 cases and 1 represented a plasma cell neoplasm. Our study highlights the importance of considering PLCDD in the differential diagnosis of amyloid-like deposits in the lung and the value of performing MT and SAB stains to distinguish between PLCDD and amyloidosis.
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17
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Withers B, McCaughan G, Hayward C, Kotlyar E, Jabbour A, Rainer S, De Angelis E, Horvath N, Milliken S, Dogan A, MacDonald P, Moore J. Clinical characteristics and prognosis of cardiac amyloidosis defined by mass spectrometry-based proteomics in an Australian cohort. Intern Med J 2020; 52:69-78. [PMID: 32981138 DOI: 10.1111/imj.15072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
Cardiac amyloidosis has a very poor prognosis, but it is the nature of the involved precursor protein that ultimately dictates treatment and survival. We report the clinical characteristics and survival of 47 cardiac amyloid patients across 2 Australian centres including 39 patients evaluated for definitive amyloid subtype utilising laser microdissection and tandem mass spectrometry (LMD-MS). A quarter of patients (n=12) were classified as wild type transthyretin amyloidosis (ATTRwt), 33 patients as light or heavy chain amyloidosis (AL or AH), and 2 as hereditary mutant transthyretin amyloidosis (ATTRv). Greater left ventricular hypertrophy (IV septum 22 vs. 15 mm, p=0.005) and history of cardiac arrhythmia (75% vs. 31%, p=0.016) were significantly associated with ATTRwt patients compared with AL/AH patients. AL patients demonstrated significantly shorter median survival compared to ATTRwt patients (3.5 vs. 37 months, (P=0.007)). New York heart association (NYHA) class III-IV symptoms or plasma cells ≥ 10% at diagnosis, were the only independent predictors of worse survival in AL patients on multivariate analysis. In the era of novel therapies for both AL amyloid and ATTR, identification of the correct amyloid subtype is essential in making therapeutic decisions and providing accurate prognostic information to patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Barbara Withers
- Department of Haematology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Georgia McCaughan
- Department of Haematology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Christopher Hayward
- Department of Cardiology, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Eugene Kotlyar
- Department of Cardiology, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Andrew Jabbour
- Department of Cardiology, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Stephen Rainer
- Department of Anatomical Pathology, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Enzo De Angelis
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Noemi Horvath
- Department of Haematology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sam Milliken
- Department of Haematology, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Ahmet Dogan
- Departments of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | - Peter MacDonald
- Department of Cardiology, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - John Moore
- Department of Haematology, St Vincent's Hospital, Darlinghurst, NSW, Australia
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18
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Gertz MA. Immunoglobulin light chain amyloidosis: 2020 update on diagnosis, prognosis, and treatment. Am J Hematol 2020; 95:848-860. [PMID: 32267020 DOI: 10.1002/ajh.25819] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 01/10/2023]
Abstract
DISEASE OVERVIEW Immunoglobulin light chain amyloidosis is a clonal, nonproliferative plasma cell disorder in which fragments of immunoglobulin light or heavy chain are deposited in tissues. Clinical features depend on organs involved but can include heart failure with preserved ejection fraction, nephrotic syndrome, hepatic dysfunction, peripheral/autonomic neuropathy, and "atypical smoldering multiple myeloma or monoclonal gammopathy undetermined significance (MGUS)." DIAGNOSIS Tissue biopsy stained with Congo red demonstrating amyloid deposits with apple-green birefringence is required for diagnosis. Invasive organ biopsy is not required in 85% of patients. Verification that amyloid is composed of immunoglobulin light chains is mandatory. The gold standard is laser capture mass spectroscopy. PROGNOSIS N-terminal pro-brain natriuretic peptide (NT-proBNP), serum troponin T, and difference between involved and uninvolved immunoglobulin free light chain (FLC) values are used to classify patients into four groups of similar size; median survivals are 94.1, 40.3, 14.0, and 5.8 months. THERAPY All patients with a systemic amyloid syndrome require therapy to prevent deposition of amyloid in other organs and prevent progressive organ failure. Stem cell transplant (SCT) is preferred, but only 20% of patients are eligible. Requirements for safe SCT include systolic blood pressure >90 mmHg, troponin T < 0.06 ng/mL and serum creatinine ≤1.7 mg/dL. Nontransplant candidates can be offered cyclophosphamide-bortezomib-dexamethasone or daratumumab-containing regimens as it appears to be highly active in AL amyloidosis. FUTURE CHALLENGES Delayed diagnosis remains a major obstacle to initiating effective therapy prior to the development of end-stage organ failure.
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Affiliation(s)
- Morie A. Gertz
- Division of HematologyMayo Clinic Rochester Minnesota USA
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19
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Menè P, De Alexandris L, Moioli A, Raffa S, Stoppacciaro A. Monoclonal Gammopathies of Renal Significance: Renal Biopsy and Beyond. Cancers (Basel) 2020; 12:cancers12071741. [PMID: 32629844 PMCID: PMC7407125 DOI: 10.3390/cancers12071741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 12/27/2022] Open
Abstract
Monoclonal Gammopathies of Renal Significance (MGRS) are a rather heterogeneous group of renal disorders caused by a circulating monoclonal (MC) immunoglobulin (Ig) component, often in the absence of multiple myeloma (MM) or another clinically relevant lymphoproliferative disorder. Nevertheless, substantial kidney damage could occur, despite the "benign" features of the bone-marrow biopsy. One example is renal amyloidosis, often linked to a small clone of plasma cells, without the invasive features of MM. However, patients with amyloidosis may present with a nephrotic syndrome and renal failure, eventually leading to end-stage kidney disease. At the same time, other organs, such as the heart and the liver, may be severely damaged by Ig light chains or amyloid deposits, occasionally resulting in fatal arrhythmias and/or organ failure. Acute kidney injury (AKI) may as well result from massive excretion of MC proteins, with deposition disease in glomeruli or renal tubules, not rarely obstructed by luminal aggregates, or "casts". Proliferative glomerulonephritis with monoclonal Ig deposits is another, less frequent clinical presentation of an MGRS. The present review deals with the implications of MGRS for renal function and prognosis, and the potential of tools, such as the renal biopsy, for assessing clinical risk and guiding therapy of the underlying condition.
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Affiliation(s)
- Paolo Menè
- Division of Nephrology, Sant’Andrea University Hospital, Via di Grottarossa 1035–1039, 00189 Rome, Italy
- Correspondence: ; Tel.: +39-(06)-3377-5949
| | - Lorenzo De Alexandris
- Divisions of Nephrology, General Pathology, and Pathology, Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, 00189 Rome, Italy; (L.D.A.); (A.M.); (S.R.); (A.S.)
| | - Alessandra Moioli
- Divisions of Nephrology, General Pathology, and Pathology, Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, 00189 Rome, Italy; (L.D.A.); (A.M.); (S.R.); (A.S.)
| | - Salvatore Raffa
- Divisions of Nephrology, General Pathology, and Pathology, Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, 00189 Rome, Italy; (L.D.A.); (A.M.); (S.R.); (A.S.)
| | - Antonella Stoppacciaro
- Divisions of Nephrology, General Pathology, and Pathology, Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, 00189 Rome, Italy; (L.D.A.); (A.M.); (S.R.); (A.S.)
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20
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Bianco C, Sánchez-Cordón PJ, Verin R, Godinho A, Weyer U, Lesellier S, Spiropoulos J, Floyd T, Everest D, Núñez A. Investigation into the Pathology of Idiopathic Systemic Amyloidosis in Four Captive Badgers (Meles meles). J Comp Pathol 2020; 176:128-132. [PMID: 32359625 DOI: 10.1016/j.jcpa.2020.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 11/26/2022]
Abstract
Systemic idiopathic amyloidosis was described in four captive badgers (Meles meles). Two animals (B1 and B2) were not enrolled in any trial, while animals B3 and B4 took part in a vaccine efficacy study and had been challenged with Mycobacterium bovis. A full set of tissues was collected and processed routinely for histopathological, immunohistochemical and ultrastructural studies. Splenomegaly was found in three out of four animals. Histopathological evaluation revealed congophilic, permanganate-resistant systemic amyloid deposits in the tissues of all badgers. Animals B2 and B4 displayed a marked granulomatous response to amyloid within the spleen. Animals B1 and B2 also displayed clinicopathological findings suggestive of chronic kidney disease. Ultrastructural examination identified peculiar star-shaped arrays of amyloid. Immunohistochemical studies were unrewarding. Systemic amyloidosis should be considered among the differentials of wasting in captive badgers.
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Affiliation(s)
- C Bianco
- Pathology Department, Animal and Plant Health Agency, Lasswade, UK.
| | | | - R Verin
- Department of Comparative Biomedicine and Food Science, University of Padova, Padova, Italy
| | - A Godinho
- Pathology Department, Animal and Plant Health Agency, Weybridge, UK; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
| | - U Weyer
- Animal and Plant Health Agency, Weybridge, UK
| | - S Lesellier
- Animal and Plant Health Agency, Weybridge, UK
| | - J Spiropoulos
- Pathology Department, Animal and Plant Health Agency, Weybridge, UK
| | - T Floyd
- Pathology Department, Animal and Plant Health Agency, Weybridge, UK
| | - D Everest
- Pathology Department, Animal and Plant Health Agency, Weybridge, UK
| | - A Núñez
- Pathology Department, Animal and Plant Health Agency, Weybridge, UK
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21
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Musat G, Evsei A, Calina D, Docea AO, Doukas SG, Vageli DP, Nepka C, Spandidos DA, Mitroi M. Rare amyloidoma of the tongue base: A case report and review of the literature. Mol Clin Oncol 2020; 12:258-262. [PMID: 32064103 PMCID: PMC7016517 DOI: 10.3892/mco.2020.1972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/08/2020] [Indexed: 11/06/2022] Open
Abstract
Localized amyloidosis is a rare condition characterized by the deposition of misfolding protein in a tissue, without other systemic manifestations. Only a small number of cases of localized amyloidosis of the tongue have been reported to date, in contrast to systemic amyloidosis, in which localization on the tongue is common. This study presents a rare case of localized amyloidosis of the tongue (amyloidoma) and provides a summary of the known literature of localized amyloidosis. This study describes the case of a 36-year-old female who presented with a swelling of the tongue base. The diagnosis of amyloidoma was made based on the findings of the physical examination, head and neck MRI findings and the histopathological examination with Congo red stain under polarized light. The histopathological diagnosis was as follows: Localized lambda light-chain amyloidosis. A thorough physical examination was performed by the ENT and Hematology/Oncology departments, without revealing signs of systemic disease. A series of hematological and imaging tests were also performed to verify that there was no sign of systemic involvement. The patient declined surgical excision and the 2-year follow-up did not reveal any changes in tumor dimension. Although the etiology of localized amyloidosis is yet not clear, the prolonged reaction of tissue plasma cells to environmental antigens may be a causative factor for the initiation of the neoplastic process.
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Affiliation(s)
- Gabriela Musat
- Department of Otorhinolaryngology, University of Medicine and Pharmacy ‘Carol Davila’, 050474 Bucharest, Romania
| | - Anca Evsei
- Laboratory of Anatomy-Histology, ‘Saint Mary’ Clinic Hospital, 011172 Bucharest, Romania
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Sotirios G. Doukas
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ 08901, USA
- Department of Forensic Sciences and Laboratory of Toxicology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Dimitra P. Vageli
- Department of Surgery, The Yale Larynx Laboratory, New Haven, CT 06510, USA
| | - Charitini Nepka
- Department of Cytopathology, University Hospital of Larissa, 41110 Larissa, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Mihaela Mitroi
- Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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22
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Rana M, Pareek A, Bhardwaj S, Arya G, Nimesh S, Arya H, Bhatt TK, Yaragorla S, Sharma AK. Aryldiazoquinoline based multifunctional small molecules for modulating Aβ42aggregation and cholinesterase activity related to Alzheimer's disease. RSC Adv 2020; 10:28827-28837. [PMID: 35520091 PMCID: PMC9055851 DOI: 10.1039/d0ra05172a] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022] Open
Abstract
Novel series of aryldiazoquinoline multifunctional molecules controls amyloid formation and neuro-protective role by inhibiting esterase enzymes.
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Affiliation(s)
- Monika Rana
- Department of Chemistry
- Central University of Rajasthan
- Ajmer
- India
| | - Abhishek Pareek
- School of Chemistry
- University of Hyderabad
- P.O. Central University
- Hyderabad
- India
| | - Shivani Bhardwaj
- Department of Chemistry
- Central University of Rajasthan
- Ajmer
- India
| | - Geeta Arya
- Department of Biotechnology
- Central University of Rajasthan
- Ajmer
- India
| | - Surendra Nimesh
- Department of Biotechnology
- Central University of Rajasthan
- Ajmer
- India
| | - Hemant Arya
- Department of Biotechnology
- Central University of Rajasthan
- Ajmer
- India
| | - Tarun K. Bhatt
- Department of Biotechnology
- Central University of Rajasthan
- Ajmer
- India
| | | | - Anuj K. Sharma
- Department of Chemistry
- Central University of Rajasthan
- Ajmer
- India
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23
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Zhu Z, Yue C, Sun Y, Li X, Li M. Light-chain amyloidosis with renal involvement: renal outcomes and validation of two renal staging systems in the Chinese population. Amyloid 2019; 26:186-191. [PMID: 31339366 DOI: 10.1080/13506129.2019.1639149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Renal involvement is one of the most common complications of light-chain (AL) amyloidosis. For evaluating renal prognosis, two staging systems for renal involvement have been proposed, one in 2014 and one in 2017. However, the two staging systems have not yet been compared and widely used in clinic. Methods: A total of 76 patients with newly diagnosed AL amyloidosis and renal involvement proven by renal biopsy were included and followed up with an endpoint developing to dialysis. The renal outcome and two criteria were explored. Results: We confirmed the prognostic value of the 2014 renal staging system based on estimated glomerular filtration rate (eGFR) (<50 ml/min/1.73 m2) and proteinuria (>5 g/day) at diagnosis (p = 0.003). For the 2017 system, none of the patients progressed to dialysis in both stage 1 (24 h proteinuria to eGFR <30 mg/ml/min/1.73 m2) and stage 2 (24 h proteinuria to eGFR 30-99 mg/ml/min/1.73 m2). A significant difference in terms of requiring dialysis was seen only between stage 3 (24 h proteinuria to eGFR ≥100 mg/ml/min/1.73 m2) and the two other stages (p = 0.008). Conclusions: The prognostic value of the criteria based on eGFR and 24-hour proteinuria for predicting dialysis has been confirmed. These results might benefit guiding clinical treatment.
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Affiliation(s)
- Zixuan Zhu
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
| | - Cai Yue
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
| | - Ying Sun
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
| | - Mingxi Li
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
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24
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Martins E, Urbano J, Leite S, Pinto A, Garcia R, Bergantim R, Rodrigues-Pereira P, Costa PP, Osório H, Tavares I. Cardiac Amyloidosis Associated with Apolipoprotein A-IV Deposition Diagnosed by Mass Spectrometry-Based Proteomic Analysis. Eur J Case Rep Intern Med 2019; 6:001237. [PMID: 31893197 PMCID: PMC6936921 DOI: 10.12890/2019_001237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/20/2019] [Indexed: 01/15/2023] Open
Abstract
Amyloidosis is a group of disorders characterised by the accumulation of extracellular deposits of insoluble protein aggregates. Clinical management depends on the accurate identification of the amyloid precursor and underlying cause. We describe a rare case of apolipoprotein A-IV cardiac amyloidosis, the diagnosis of which required mass spectrometry-based proteomic analysis.
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Affiliation(s)
- Elisabete Martins
- Faculty of Medicine, University of Porto, Portugal.,Department of Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal.,i3S-Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Joana Urbano
- Department of Internal Medicine, Centro Hospitalar do Alto Minho, Viana do Castelo, Portugal
| | - Sérgio Leite
- Department of Cardiology, Hospital Nossa Senhora Oliveira, Guimarães, Portugal
| | - Adriana Pinto
- Department of Nuclear Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Raquel Garcia
- Department of Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Rui Bergantim
- Department of Hematology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Paulo Pinho Costa
- Department of Human Genetics, National Health Institute Doutor Ricardo Jorge, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Portugal
| | - Hugo Osório
- Faculty of Medicine, University of Porto, Portugal.,i3S-Institute for Research and Innovation in Health, University of Porto, Porto, Portugal.,IPATIMUP -Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Isabel Tavares
- Department of Nephrology, Centro Hospitalar Universitário São João, Porto, Portugal.,Group of Research and Development in Nephrology and Infectious Diseases, Institute of Biomedical Engineering - i3S, University of Porto, Portugal
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25
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Amyloidosis of the bladder and association with urothelial carcinoma: report of 29 cases. Hum Pathol 2019; 93:48-53. [DOI: 10.1016/j.humpath.2019.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 12/27/2022]
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26
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Conceição I, Damy T, Romero M, Galán L, Attarian S, Luigetti M, Sadeh M, Sarafov S, Tournev I, Ueda M. Early diagnosis of ATTR amyloidosis through targeted follow-up of identified carriers of TTR gene mutations. Amyloid 2019; 26:3-9. [PMID: 30793974 DOI: 10.1080/13506129.2018.1556156] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Diagnosis in the early stages of hereditary transthyretin (ATTR) amyloidosis is imperative to support timely treatment to prevent or delay disease progression. Genetic testing in the setting of genetic counselling enables identification of carriers of a TTR gene mutation who are therefore at risk of developing TTR-associated disease. Knowledge of different genotypes and how they manifest in symptomatic disease should facilitate development of a structured and targeted approach to enable diagnosis of symptomatic disease in ATTR amyloidosis mutation carriers on the first manifestation of the earliest detectable sign or symptom. A group of experts from across Europe, Israel and Japan met to reach a consensus on such an approach. The proposed approach involves establishing a baseline for key clinical parameters, determination of the timing and frequency of follow-up in TTR mutation carriers based on a predicted age of disease onset, and recognition of the likely initial clinical signs and symptoms aligned with the phenotype of the specific TTR gene mutation and family history. Minimum criteria for diagnosis of symptomatic disease have been agreed, which it is hoped will ensure diagnosis of ATTR amyloidosis at the earliest possible stage in people with a known TTR mutation.
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Affiliation(s)
- Isabel Conceição
- a CHLN-Hospital Santa Maria, IMM, Universidade de Lisboa , Lisbon , Portugal
| | - Thibaud Damy
- b Referral Center for Cardiac Amyloidosis, Department of Cardiology, Amyloid Research Institute, DHU A-TVB, Henri Mondor Hospital, APHP, IMRB and UPEC, Créteil, France
| | - Manuel Romero
- c Hospital Universitario Virgen de la Victoria , Malaga , Spain
| | - Lucía Galán
- d Hospital Clinico San Carlos , Madrid , Spain
| | | | - Marco Luigetti
- f UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,g Universita Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stayko Sarafov
- i Clinic of Neurology, Alexandrovska Hospital, Department of Neurology , Medical University , Sofia , Bulgaria
| | - Ivailo Tournev
- i Clinic of Neurology, Alexandrovska Hospital, Department of Neurology , Medical University , Sofia , Bulgaria.,j Department of Cognitive Science and Psychology , New Bulgarian University , Sofia , Bulgaria
| | - Mitsuharu Ueda
- k Department of Neurology , Kumamoto University , Kumamoto , Japan
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27
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Marin DM, Sreedhar H, Walsh MJ, Picken MM. Detection of amyloidosis in human tissues using mid-infrared spectroscopic imaging. Amyloid 2019; 26:93-94. [PMID: 31343366 DOI: 10.1080/13506129.2019.1583181] [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: 10/26/2022]
Affiliation(s)
- David Martinez Marin
- a Department of Pathology, University of Illinois at Chicago , Chicago , IL , USA
| | - Hari Sreedhar
- a Department of Pathology, University of Illinois at Chicago , Chicago , IL , USA
| | - Michael J Walsh
- a Department of Pathology, University of Illinois at Chicago , Chicago , IL , USA
| | - Maria M Picken
- b Department of Pathology, Loyola University Medical Center , Maywood , IL , USA
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28
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Wahid NW, Abed T, Meghji S, Gilbertson J, Barnes M. Localized Sinonasal Amyloidosis. ALLERGY & RHINOLOGY 2019; 10:2152656719860821. [PMID: 31321117 PMCID: PMC6611016 DOI: 10.1177/2152656719860821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Localized amyloidosis involving the nasal mucosa is rare, with only 38 published cases reported to date. We report a case of amyloidosis localized to the sinonasal tract. A 61-year-old man presented with a 1-year history of left-sided nasal obstruction. Endoscopic examination and computed tomography revealed the presence of a nasal mass originating from the left inferior turbinate. The patient subsequently underwent an examination under anesthesia and an excision biopsy of the nasal mass. Histology confirmed amyloidosis with no immunospecific stains. Systemic amyloidosis testing was negative, leading to a diagnosis of localized sinonasal amyloidosis of nonamyloid A (AA) subtype. To our knowledge, this is the second reported case of non-AA subtype of the sinonasal tract. The patient was managed conservatively and is currently under close follow-up.
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Affiliation(s)
| | - Tarik Abed
- ENT Department, Southend University Hospital, Westcliff-on-Sea, UK
| | - Sheneen Meghji
- ENT Department, Southend University Hospital, Westcliff-on-Sea, UK
| | - Janet Gilbertson
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
| | - Martyn Barnes
- ENT Department, Southend University Hospital, Westcliff-on-Sea, UK
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29
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Han SH, Kim YD, Woo KI. Primary Localized Amyloidosis in Extraocular Muscles. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.12.1301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sun Hyup Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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30
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Binmadi N, Intapa C, Chaisuparat R, Akeel S, Sindi A, Meiller T. Immunophenotyping Oral Amyloidosis for the Precise Identification of the Biochemical Forms: A Retrospective Study. Open Dent J 2018. [DOI: 10.2174/1874210601812011036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background:Amyloidosis refers to a group of systemic and localized disorders associated with the accumulation of misfolded protein aggregates called amyloids in different parts of the body. Owing to the existence of multiple forms of amyloids with similar tertiary structures, precise identification of their biochemical form is critical for correct therapy.Objective:This retrospective study aimed to determine whether typing of oral amyloid deposits can help diagnose a serious systemic condition in the early phase of the diseaseMethods:All histopathologically confirmed cases of amyloidosis managed over a 14-year period (January 1, 1997 to December 31, 2011) were retrieved for analysis. Two board-certified oral and maxillofacial pathologists reviewed the histopathological findings of amyloidosis on the basis of its classic Congo red staining characteristics. This was followed by immunohistochemical analysis of biopsy samples using a panel of antibodies specific for different forms of amyloidosis.Results:The most common location of amyloidosis was the tongue, and women were more commonly affected than men. The patient age ranged from 11 to 83 years (average 59.3 years). In patient 9, light-chain and pre-albumin (transthyretin) antibodies were related to arthritis and senile amyloidosis, respectively. The biopsy sample of patient 10, who was reported to have multiple myeloma, was positive for light chains and β2 microglobulin. All other samples exhibited localized (solitary) amyloidosis.Conclusion:Histological analysis coupled with immunostaining with a panel of specific antibodies might assist in identifying early systemic amyloidosis in patients with localized oral forms of the disease.
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31
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Ryšavá R. AL amyloidosis: advances in diagnostics and treatment. Nephrol Dial Transplant 2018; 34:1460-1466. [DOI: 10.1093/ndt/gfy291] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Indexed: 12/19/2022] Open
Abstract
Abstract
AL amyloidosis (light chain; previously also called primary amyloidosis) is a systemic disease characterized by an amyloid deposition process affecting many organs, and which still has unsatisfactory survival of patients. The monoclonal light chains kappa (κ) or lambda (λ) or their fragments form the fibrils that deposit and accumulate in different tissues. Renal involvement is very frequent in AL amyloidosis and can lead to the development of nephrotic syndrome followed by renal failure in some cases. AL amyloidosis ultimately leads to destruction of tissues and progressive disease. With recent advances in the treatment, the importance of an early diagnosis of amyloidosis and correct assessment of its type is high. Histologic confirmation is based on Congo red detection of amyloid deposits in tissues but AL amyloidosis must also be distinguished from other systemic forms of amyloidoses with renal involvement, such as AA amyloidosis, amyloidosis with heavy chain deposition, fibrinogen Aα or ALECT2 (leukocyte chemotactic factor 2) deposition. Immunofluorescence (IF) plays a key role here. IF on formalin-fixed paraffin-embedded tissue after protease digestion, immunohistochemistry or laser microdissection with mass spectrometry should complete the diagnosis in unclear cases. Standard treatment with melphalan and prednisolone or with cyclophosphamide and dexamethasone has been replaced with newer drugs used for the treatment of multiple myeloma—bortezomib, carfilzomib and ixazomib or thalidomide, lenalidomide and pomalidomide. High-dose melphalan supported by autologous stem cell transplantation remains the therapeutic option for patients with low-risk status. These new treatment options prolong survival from months to years and improve the prognosis in a majority of patients.
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Affiliation(s)
- Romana Ryšavá
- Department of Nephrology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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32
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Gertz MA. Immunoglobulin light chain amyloidosis: 2018 Update on diagnosis, prognosis, and treatment. Am J Hematol 2018; 93:1169-1180. [PMID: 30040145 DOI: 10.1002/ajh.25149] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/11/2018] [Accepted: 05/11/2018] [Indexed: 11/10/2022]
Abstract
DISEASE OVERVIEW Immunoglobulin light chain amyloidosis is a clonal, nonproliferative plasma cell disorder in which fragments of immunoglobulin light or heavy chain are deposited in tissues. Clinical features depend on organs involved but can include restrictive cardiomyopathy, nephrotic syndrome, hepatic dysfunction, peripheral/autonomic neuropathy, and "atypical multiple myeloma." DIAGNOSIS Tissue biopsy stained with Congo red demonstrating amyloid deposits with apple-green birefringence is required for diagnosis. Invasive organ biopsy is not required because amyloid deposits can be found in bone marrow, salivary gland, or subcutaneous fat aspirate in 85% of patients. Verification that amyloid is composed of immunoglobulin light chains is mandatory. The gold standard is laser capture mass spectroscopy. PROGNOSIS N-terminal pro-brain natriuretic peptide (NT-proBNP), serum troponin T, and difference between involved and uninvolved immunoglobulin free light chain values are used to classify patients into four groups of similar size; median survivals are 94.1, 40.3, 14.0, and 5.8 months. THERAPY All patients with a systemic amyloid syndrome require therapy to prevent deposition of amyloid in other organs and prevent progressive organ failure. Stem cell transplant (SCT) is preferred, but only 20% of patients are eligible. Requirements for safe SCT include systolic blood pressure >90 mm Hg, troponin T < 0.06 ng/mL, age < 70 years, and serum creatinine ≤1.7 mg/dL. Nontransplant candidates can be offered melphalan-dexamethasone or cyclophosphamide-bortezomib-dexamethasone. Daratumumab appears to be highly active in AL amyloidosis. Antibodies designed to dissolve existing amyloid deposits are under study. FUTURE CHALLENGES Delayed diagnosis remains a major obstacle to initiating effective therapy. EDUCATIONAL OBJECTIVES Upon completion of this educational activity, participants will be better able to: Master recognition of clinical presentations that should raise suspicion of amyloidosis. Understand simple techniques for confirming the diagnosis and providing material to classify the protein subunit. Recognize that a tissue diagnosis of amyloidosis does not indicate whether the amyloid is systemic or of immunoglobulin light chain origin. Understand the roles of the newly introduced chemotherapeutic and investigational antibody regimens for the therapy of light chain amyloidosis.
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Affiliation(s)
- Morie A. Gertz
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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33
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Snow WM, Dale R, O'Brien-Moran Z, Buist R, Peirson D, Martin M, Albensi BC. In Vivo Detection of Gray Matter Neuropathology in the 3xTg Mouse Model of Alzheimer's Disease with Diffusion Tensor Imaging. J Alzheimers Dis 2018; 58:841-853. [PMID: 28505976 DOI: 10.3233/jad-170136] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
A diagnosis of Alzheimer's disease (AD), a neurodegenerative disorder accompanied by severe functional and cognitive decline, is based on clinical findings, with final confirmation of the disease at autopsy by the presence of amyloid-β (Aβ) plaques and neurofibrillary tangles. Given that microstructural brain alterations occur years prior to clinical symptoms, efforts to detect brain changes early could significantly enhance our ability to diagnose AD sooner. Diffusion tensor imaging (DTI), a type of MRI that characterizes the magnitude, orientation, and anisotropy of the diffusion of water in tissues, has been used to infer neuropathological changes in vivo. Its utility in AD, however, is still under investigation. The current study used DTI to examine brain regions susceptible to AD-related pathology; the cerebral cortex, entorhinal cortex, and hippocampus, in 12-14-month-old 3xTg AD mice that possess both Aβ plaques and neurofibrillary tangles. Mean diffusivity did not differ between 3xTg and control mice in any region. Decreased fractional anisotropy (p < 0.01) and axial diffusivity (p < 0.05) were detected only in the hippocampus, in which both congophilic Aβ plaques and hyperphosphorylated tau accumulation, consistent with neurofibrillary tangle formation, were detected. Pathological tau accumulation was seen in the cortex. The entorhinal cortex was largely spared from AD-related neuropathology. This is the first study to demonstrate DTI abnormalities in gray matter in a mouse model of AD in which both pathological hallmarks are present, suggesting the feasibility of DTI as a non-invasive means of detecting brain pathology in vivo in early-stage AD.
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Affiliation(s)
- Wanda M Snow
- Division of Neurodegenerative Disorders, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada.,Department of Pharmacology & Therapeutics, University of Manitoba, Winnipeg, MB, Canada
| | - Ryan Dale
- Division of Neurodegenerative Disorders, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada.,Department of Pharmacology & Therapeutics, University of Manitoba, Winnipeg, MB, Canada
| | | | - Richard Buist
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
| | - Danial Peirson
- Division of Neurodegenerative Disorders, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada.,Department of Pharmacology & Therapeutics, University of Manitoba, Winnipeg, MB, Canada
| | - Melanie Martin
- Department of Pharmacology & Therapeutics, University of Manitoba, Winnipeg, MB, Canada.,Department of Physics, University of Winnipeg, Winnipeg, MB, Canada.,Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
| | - Benedict C Albensi
- Division of Neurodegenerative Disorders, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada.,Department of Pharmacology & Therapeutics, University of Manitoba, Winnipeg, MB, Canada
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34
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Rana M, Cho HJ, Roy TK, Mirica LM, Sharma AK. Azo-dyes based small bifunctional molecules for metal chelation and controlling amyloid formation. Inorganica Chim Acta 2018; 471:419-429. [PMID: 30344337 PMCID: PMC6191838 DOI: 10.1016/j.ica.2017.11.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Chemical tools are needed to discover new effective drugs for tackling multifaceted complex neurodegenerative diseases like Alzheimer's disease (AD). Multifunctional nature of two compounds, 5-((4-nitro-phenyl)diazenyl)quinolin-8-ol (HL1) and 4-((4-nitrophenyl)diazenyl)benzene-1,3-diol (HL2) is reported w.r.t. their ability to bind Cu2+ ions and amyloid aggregates related to AD. HL1 and HL2 have half congo-red type azo-stilbene structural framework incorporated with metal chelating groups, designed to chelate metal ions from metal-amyloid species. Metal binding studies of HL1 and HL2 are established by the methods of Job's Plot, UV-vis spectra with metal ions and stability constant determination. In addition, their metal complexes are isolated, purity checked by elemental analysis, spectroscopically characterized and their structural analyses were obtained from DFT based calculations including binding energy determination. Chicken egg white Lysozyme (CEWL) was used as a model peptide for fibrillation studies. HL1 is found as an excellent colorimetric sensor for amyloid fibrils. Inhibitory effect of HL1 and HL2 and their isolated metal complexes L1-Cu and L2-Cu on CEWL fibrillation was studied using ThT and ANS fluorescence assay along with TEM imaging. In addition, the cell toxicity studies on these compounds suggest that although azo dyes may be non-toxic but having a nitro-substitution lead to significant cell toxicity. Overall, these results suggest that this new class of multifunctional small molecules can interact with amyloids as well as metal ions and could be potential anti-aggregation metal chelating agents.
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Affiliation(s)
- Monika Rana
- Department of Chemistry, Central University of Rajasthan, NH-8,
Bandarsindri, Ajmer, Rajasthan 305817, India
| | - Hong-Jun Cho
- Department of Chemistry, Washington University, One Brookings Drive,
St. Louis, MO 63130-4899, United States
| | - Tapta Kanchan Roy
- Department of Chemistry and Chemical Sciences, Central University of
Jammu, Jammu 180011, India
| | - Liviu M. Mirica
- Department of Chemistry, Washington University, One Brookings Drive,
St. Louis, MO 63130-4899, United States
| | - Anuj K. Sharma
- Department of Chemistry, Central University of Rajasthan, NH-8,
Bandarsindri, Ajmer, Rajasthan 305817, India
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Winter M, Tholey A, Kristen A, Röcken C. MALDI Mass Spectrometry Imaging: A Novel Tool for the Identification and Classification of Amyloidosis. Proteomics 2018; 17. [PMID: 28994248 PMCID: PMC5725723 DOI: 10.1002/pmic.201700236] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/27/2017] [Indexed: 12/12/2022]
Abstract
Amyloidosis is a group of diseases caused by extracellular accumulation of fibrillar polypeptide aggregates. So far, diagnosis is performed by Congo red staining of tissue sections in combination with polarization microscopy. Subsequent identification of the causative protein by immunohistochemistry harbors some difficulties regarding sensitivity and specificity. Mass spectrometry based approaches have been demonstrated to constitute a reliable method to supplement typing of amyloidosis, but still depend on Congo red staining. In the present study, we used matrix-assisted laser desorption/ionization mass spectrometry imaging coupled with ion mobility separation (MALDI-IMS MSI) to investigate amyloid deposits in formalin-fixed and paraffin-embedded tissue samples. Utilizing a novel peptide filter method, we found a universal peptide signature for amyloidoses. Furthermore, differences in the peptide composition of ALλ and ATTR amyloid were revealed and used to build a reliable classification model. Integrating the peptide filter in MALDI-IMS MSI analysis, we developed a bioinformatics workflow facilitating the identification and classification of amyloidosis in a less time and sample-consuming experimental setup. Our findings demonstrate also the feasibility to investigate the amyloid's protein composition, thus paving the way to establish classification models for the diverse types of amyloidoses and to shed further light on the complex process of amyloidogenesis.
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Affiliation(s)
- Martin Winter
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
| | - Andreas Tholey
- Systematic Proteome Research & Bioanalytics, Institute of Experimental Medicine, Christian-Albrechts-University, Kiel, Germany
| | - Arnt Kristen
- Department of Cardiology, Angiology, and Respiratory Medicine, University of Heidelberg, Heidelberg, Germany
| | - Christoph Röcken
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
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36
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A case of localized amyloidosis of the eyelid misdiagnosed as recurrent chalazion. Saudi J Ophthalmol 2017; 31:180-182. [PMID: 28860919 PMCID: PMC5569331 DOI: 10.1016/j.sjopt.2017.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 04/29/2017] [Accepted: 05/08/2017] [Indexed: 11/23/2022] Open
Abstract
Localized amyloidosis of the eyelid is uncommon and is classically associated with systemic manifestations. We present an interesting case of a localized eyelid mass misdiagnosed as a recurrent chalazion presenting in an 85-year-old Saudi gentleman with no definite associate findings suggestive of an underlying systemic amyloid disease. Debulking surgery was subsequently performed. Proper diagnosis was reached based on the histopathologic examination of the excised tissue, which demonstrated the typical Congo red staining of the amyloid deposits.
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37
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Gammapatías monoclonales de significado renal. Nefrologia 2017; 37:465-477. [DOI: 10.1016/j.nefro.2017.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 01/02/2023] Open
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38
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Abstract
PURPOSE OF REVIEW Transthyretin (TTR)-related cardiac amyloidosis is a progressive infiltrative cardiomyopathy that mimics hypertensive, hypertrophic heart disease and may go undiagnosed. Transthyretin-derived amyloidosis accounts for 18% of all cases of cardiac amyloidosis. Thus, the study's purpose is to provide a comprehensive review of transthyretin cardiac amyloidosis. RECENT FINDINGS Wild-type transthyretin (ATTRwt) protein causes cardiac amyloidosis sporadically, with 25 to 36% of the population older than 80 years of age are at risk to develop a slowly progressive, infiltrative amyloid cardiomyopathy secondary to ATTRwt. In contrast, hereditary amyloidosis (ATTRm) is an autosomal dominant inherited disease associated with more than 100 point mutations in the transthyretin gene and has a tendency to affect the heart and nervous system. Up to 4% of African-Americans carry the Val122Ile mutation in the transthyretin gene, the most prevalent cause of hereditary cardiac amyloidosis in the USA. Identifying transthyretin cardiac amyloidosis requires increased awareness of the prevalence, signs and symptoms, and diagnostic tools available for discrimination of this progressive form of cardiomyopathy associated with left ventricular hypertrophy. While there are no FDA-approved medical treatments, investigation is underway on agents to reduce circulating mutated transthyretin.
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Affiliation(s)
- Anit K Mankad
- Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA.
| | - Keyur B Shah
- The Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
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Shah KB, Mankad AK, Castano A, Akinboboye OO, Duncan PB, Fergus IV, Maurer MS. Transthyretin Cardiac Amyloidosis in Black Americans. Circ Heart Fail 2017; 9:e002558. [PMID: 27188913 DOI: 10.1161/circheartfailure.115.002558] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 02/10/2016] [Indexed: 12/20/2022]
Abstract
Transthyretin-related cardiac amyloidosis is a progressive infiltrative cardiomyopathy that mimics hypertensive and hypertrophic heart disease and often goes undiagnosed. In the United States, the hereditary form disproportionately afflicts black Americans, who when compared with whites with wild-type transthyretin amyloidosis, a phenotypically similar condition, present with more advanced disease despite having a noninvasive method for early identification (genetic testing). Although reasons for this are unclear, this begs to consider the inadequate access to care, societal factors, or a biological basis. In an effort to improve awareness and explore unique characteristics, we review the pathophysiology, epidemiology, and therapeutic strategies for transthyretin amyloidosis and highlight diagnostic pitfalls and clinical pearls for identifying patients with amyloid heart disease.
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Affiliation(s)
- Keyur B Shah
- From the Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond (K.B.S., A.K.M., P.B.D.); Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA (A.K.M.); Division of Cardiology, Columbia University Medical Center, New York, NY (A.C., M.S.M.); Queens Heart Institute, Rosedale, NY (O.O.A.); Cardiac Health Management Network, Chester, VA (P.B.D.); and Division of Cardiology, Mount Sinai Medical Center, New York, NY (I.V.F.).
| | - Anit K Mankad
- From the Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond (K.B.S., A.K.M., P.B.D.); Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA (A.K.M.); Division of Cardiology, Columbia University Medical Center, New York, NY (A.C., M.S.M.); Queens Heart Institute, Rosedale, NY (O.O.A.); Cardiac Health Management Network, Chester, VA (P.B.D.); and Division of Cardiology, Mount Sinai Medical Center, New York, NY (I.V.F.)
| | - Adam Castano
- From the Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond (K.B.S., A.K.M., P.B.D.); Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA (A.K.M.); Division of Cardiology, Columbia University Medical Center, New York, NY (A.C., M.S.M.); Queens Heart Institute, Rosedale, NY (O.O.A.); Cardiac Health Management Network, Chester, VA (P.B.D.); and Division of Cardiology, Mount Sinai Medical Center, New York, NY (I.V.F.)
| | - Olakunle O Akinboboye
- From the Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond (K.B.S., A.K.M., P.B.D.); Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA (A.K.M.); Division of Cardiology, Columbia University Medical Center, New York, NY (A.C., M.S.M.); Queens Heart Institute, Rosedale, NY (O.O.A.); Cardiac Health Management Network, Chester, VA (P.B.D.); and Division of Cardiology, Mount Sinai Medical Center, New York, NY (I.V.F.)
| | - Phillip B Duncan
- From the Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond (K.B.S., A.K.M., P.B.D.); Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA (A.K.M.); Division of Cardiology, Columbia University Medical Center, New York, NY (A.C., M.S.M.); Queens Heart Institute, Rosedale, NY (O.O.A.); Cardiac Health Management Network, Chester, VA (P.B.D.); and Division of Cardiology, Mount Sinai Medical Center, New York, NY (I.V.F.)
| | - Icilma V Fergus
- From the Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond (K.B.S., A.K.M., P.B.D.); Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA (A.K.M.); Division of Cardiology, Columbia University Medical Center, New York, NY (A.C., M.S.M.); Queens Heart Institute, Rosedale, NY (O.O.A.); Cardiac Health Management Network, Chester, VA (P.B.D.); and Division of Cardiology, Mount Sinai Medical Center, New York, NY (I.V.F.)
| | - Mathew S Maurer
- From the Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond (K.B.S., A.K.M., P.B.D.); Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA (A.K.M.); Division of Cardiology, Columbia University Medical Center, New York, NY (A.C., M.S.M.); Queens Heart Institute, Rosedale, NY (O.O.A.); Cardiac Health Management Network, Chester, VA (P.B.D.); and Division of Cardiology, Mount Sinai Medical Center, New York, NY (I.V.F.)
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Agis H. News in AL Amyloidosis ASH 2016: A rapidly evolving field of investigation. MEMO 2017; 10:66-71. [PMID: 28725274 PMCID: PMC5493729 DOI: 10.1007/s12254-017-0332-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/18/2017] [Indexed: 12/25/2022]
Abstract
Amyloidosis is a rare but life-threatening protein misfolding disease. The early diagnosis and enrollment of patients into multicentre trials is of great importance, as is the need for intensive collaboration between multiple medical departments and experienced specialists. In the following review, the most interesting abstracts from the annual American Society of Hematology (ASH) meeting in 2016 are presented. The topics include the limitations of established biomarkers in risk assessment and response evaluation, the introduction of a new biomarker, the comparison of different treatment sequences and the efficacy of a multiple drug regimen in light-chain (AL) amyloidosis.
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Affiliation(s)
- Hermine Agis
- Department of Internal Medicine I, Division of Oncology, Medical University Vienna, Währinger Gürtel 10–20, 1090 Vienna, Austria
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Mankad AK, Sesay I, Shah KB. Light-chain cardiac amyloidosis. Curr Probl Cancer 2017; 41:144-156. [DOI: 10.1016/j.currproblcancer.2016.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/14/2016] [Indexed: 12/17/2022]
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Małyszko J, Kozłowska K, Małyszko JS. Amyloidosis: A cancer-derived paraproteinemia and kidney involvement. Adv Med Sci 2017; 62:31-38. [PMID: 28153807 DOI: 10.1016/j.advms.2016.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 05/28/2016] [Accepted: 06/28/2016] [Indexed: 12/15/2022]
Abstract
Amyloidosis is the general term describing the extracellular tissue deposition of fibrils composed of low molecular weight subunits of a variety of proteins. There are multiple different human protein precursors of amyloid fibrils. Amyloid deposits are stained using Congo Red and show typical apple-green birefringence in polarized microscopy. Nowadays, a novel technique LMD/MS technique or laser microdissection combined with mass spectrometry help to diagnose amyloidosis. Amyloidosis of the kidney is typically classified as being either one of two types: AL or AA. Less common is the hereditary amyloidosis. Clinical manifestations are usually determined by the type of precursor protein, the tissue distribution, and the amount of amyloid deposition. Renal manifestation is usually present as asymptomatic proteinuria or clinically apparent nephrotic syndrome. In some patients clinical presentation include impaired kidney function with no or mild proteinuria. Patients with renal amyloidosis who progress to end-stage renal disease (ESRD) can be treated with either dialysis or renal transplantation. Diagnosis of amyloidosis is prerequisite to consider treatment options to avoid unnecessary chemotherapy. Treatment of amyloidosis is aimed at decreasing the precursors of fibrillary proteins and/or decrease in synthesis/deposition of amyloid fibrils. It depends upon the type of amyloidosis and cause of excess fibril production.
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Karafiatova L, Pika T. Amyloid cardiomyopathy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:117-127. [PMID: 28145535 DOI: 10.5507/bp.2017.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/09/2017] [Indexed: 11/23/2022] Open
Abstract
Amyloidosis is a heterogeneous group of diseases characterized by the deposition of amyloid. It is caused by extracellular deposition of insoluble fibrils with beta-pleated sheet configuration. The protein misfolding abnormalities result in amyloid fibrils and may manifest as primary, secondary, or familial amyloidosis. Amyloid deposition can occur in multiple organs (eg, heart, liver, kidney, skin, eyes, lungs, nervous system) resulting in a variety of clinical manifestations. Cardiac involvement can occur as part of a systemic disease or as a localized phenomenon. Cardiac involvement in all types of amyloidosis represents a major negative prognostic factor. Early diagnosis, multi-disciplinary cooperation and proper therapy are key aspects of care for patients with amyloid cardiomyopathy. Early diagnosis is crucial, especially in AL amyloidosis, as patients with advanced heart disease are unsuitable candidates for modern, effective hematological treatment including autologous stem cell transplantation. Despite signal development in diagnostics and therapy, the prognosis for patients with advanced cardiac involvement remains poor. This article is an overview of amyloidosis, providing information about the characteristics of cardiac amyloidosis, and present a structured approach to diagnosis, treatment and prognosis of this condition.
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Affiliation(s)
- Lucie Karafiatova
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Tomas Pika
- Department of Hemato-Oncology, University Hospital Olomouc, Czech Republic
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Zumbo G, Sadeghi-Alavijeh O, Hawkins PN, Fontana M. New and developing therapies for AL amyloidosis. Expert Opin Pharmacother 2016; 18:139-149. [DOI: 10.1080/14656566.2016.1274971] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Giulia Zumbo
- National Amyloidosis Centre, University College London, London, UK
| | | | | | - Marianna Fontana
- National Amyloidosis Centre, University College London, London, UK
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Antimonova OI, Grudinina NA, Egorov VV, Polyakov DS, Il’in VV, Shavlovskii MM. Interaction of the dye Congo red with fibrils of lysozyme, beta2-microglobulin, and transthyretin. ACTA ACUST UNITED AC 2016. [DOI: 10.1134/s1990519x1606002x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Gertz MA. Immunoglobulin light chain amyloidosis: 2016 update on diagnosis, prognosis, and treatment. Am J Hematol 2016; 91:947-56. [PMID: 27527836 DOI: 10.1002/ajh.24433] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/22/2016] [Indexed: 02/01/2023]
Abstract
DISEASE OVERVIEW Immunoglobulin light chain amyloidosis is a clonal, nonproliferative plasma cell disorder in which fragments of immunoglobulin light chain are deposited in tissues. Clinical features depend on organs involved but can include restrictive cardiomyopathy, nephrotic syndrome, hepatic failure, peripheral/autonomic neuropathy, and atypical multiple myeloma. DIAGNOSIS Tissue biopsy stained with Congo red demonstrating amyloid deposits with applegreen birefringence is required for diagnosis. Invasive organ biopsy is not required because amyloid deposits can be found in bone marrow biopsy or subcutaneous fat aspirate in 85% of patients. Verification that amyloid is composed of immunoglobulin light chains is mandatory. PROGNOSIS N-terminal pro-brain natriuretic peptide (NTproBNP), serum troponin T, and difference between involved and uninvolved immunoglobulin free light chain values are used to classify patients into four groups of similar size; median survivals are 94.1, 40.3, 14.0, and 5.8 months. THERAPY All patients with a systemic amyloid syndrome require therapy to prevent deposition of amyloid in other organs and prevent progressive organ failure of involved sites. Stem cell transplant (SCT) is preferred, but only 20% of patients are eligible. Requirements for safe SCT include systolic blood pressure >90 mmHg, troponin T <0.06 ng mL21, age <70 years, and serum creatinine 1.7 mg dL21. Nontransplant candidates can be offered melphalan-dexamethasone or cyclophosphamide-bortezomib-dexamethasone. Other combinations of chemotherapy with agents such as cyclophosphamide-thalidomide (or lenalidomide)-dexamethasone, bortezomib-dexamethasone, and melphalan-prednisone-lenalidomide have documented activity. Antibodies designed to dissolve existing amyloid deposits are under study for previously treated and untreated patients. Late diagnosis remains a major obstacle to initiating effective therapy. Am. J. Hematol., 2016. © 2016 Wiley Periodicals, Inc. Am. J. Hematol. 91:948-956, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Morie A. Gertz
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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Pilley J, Lane J, Ravichandran P. Prevalence of amyloid and positive Congo red frequency among routine surgical specimens. J Histotechnol 2016. [DOI: 10.1080/01478885.2016.1164934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bonderman D, Agis H, Kain R, Mascherbauer J. Amyloid in the heart: an under-recognized threat at the interface of cardiology, haematology, and pathology. Eur Heart J Cardiovasc Imaging 2016; 17:978-80. [DOI: 10.1093/ehjci/jew130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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LoRicco JG, Xu CS, Neidleman J, Bergkvist M, Greene WC, Roan NR, Makhatadze GI. Gallic Acid Is an Antagonist of Semen Amyloid Fibrils That Enhance HIV-1 Infection. J Biol Chem 2016; 291:14045-14055. [PMID: 27226574 DOI: 10.1074/jbc.m116.718684] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Indexed: 12/22/2022] Open
Abstract
Recent in vitro studies have demonstrated that amyloid fibrils found in semen from healthy and HIV-infected men, as well as semen itself, can markedly enhance HIV infection rates. Semen fibrils are made up of multiple naturally occurring peptide fragments derived from semen. The best characterized of these fibrils are SEVI (semen-derived enhancer of viral infection), made up of residues 248-286 of prostatic acidic phosphatase, and the SEM1 fibrils, made up of residues 86-107 of semenogelin 1. A small molecule screen for antagonists of semen fibrils identified four compounds that lowered semen-mediated enhancement of HIV-1 infectivity. One of the four, gallic acid, was previously reported to antagonize other amyloids and to exert anti-inflammatory effects. To better understand the mechanism by which gallic acid modifies the properties of semen amyloids, we performed biophysical measurements (atomic force microscopy, electron microscopy, confocal microscopy, thioflavin T and Congo Red fluorescence assays, zeta potential measurements) and quantitative assays on the effects of gallic acid on semen-mediated enhancement of HIV infection and inflammation. Our results demonstrate that gallic acid binds to both SEVI and SEM1 fibrils and modifies their surface electrostatics to render them less cationic. In addition, gallic acid decreased semen-mediated enhancement of HIV infection but did not decrease the inflammatory response induced by semen. Together, these observations identify gallic acid as a non-polyanionic compound that inhibits semen-mediated enhancement of HIV infection and suggest the potential utility of incorporating gallic acid into a multicomponent microbicide targeting both the HIV virus and host components that promote viral infection.
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Affiliation(s)
- Josephine G LoRicco
- Center for Biotechnology and Interdisciplinary Studies and Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, New York 12180
| | - Changmingzi Sherry Xu
- Center for Biotechnology and Interdisciplinary Studies and Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, New York 12180
| | - Jason Neidleman
- Gladstone Institute of Virology and Immunology, San Francisco, California 94158
| | - Magnus Bergkvist
- Colleges of Nanoscale Science and Engineering, SUNY Polytechnic Institute, Albany, New York 12203
| | - Warner C Greene
- Gladstone Institute of Virology and Immunology, San Francisco, California 94158
| | - Nadia R Roan
- Gladstone Institute of Virology and Immunology, San Francisco, California 94158,; Department of Urology, University of California, San Francisco, California 94158.
| | - George I Makhatadze
- Center for Biotechnology and Interdisciplinary Studies and Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, New York 12180,.
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