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Fargeot G, Echaniz-Laguna A, Labeyrie C, Svahn J, Camdessanché JP, Cintas P, Chanson JB, Esselin F, Piedvache C, Verstuyft C, Genestet S, Lagrange E, Magy L, Péréon Y, Sacconi S, Signate A, Nadaj-Pakleza A, Taithe F, Viala K, Tard C, Poinsignon V, Cauquil C, Attarian S, Adams D. Hereditary transthyretin amyloidosis in middle-aged and elderly patients with idiopathic polyneuropathy: a nationwide prospective study. Amyloid 2024; 31:62-69. [PMID: 37855400 DOI: 10.1080/13506129.2023.2270661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Hereditary transthyretin amyloidosis (ATTRv) is an adult-onset autosomal dominant disease resulting from TTR gene pathogenic variants. ATTRv often presents as a progressive polyneuropathy, and effective ATTRv treatments are available. METHODS In this 5 year-long (2017-2021) nationwide prospective study, we systematically analysed the TTR gene in French patients with age >50 years with a progressive idiopathic polyneuropathy. RESULTS 553 patients (70% males) with a mean age of 70 years were included. A TTR gene pathogenic variant was found in 15 patients (2.7%), including the Val30Met TTR variation in 10 cases. In comparison with patients with no TTR gene pathogenic variants (n = 538), patients with TTR pathogenic variants more often presented with orthostatic hypotension (53 vs. 21%, p = .007), significant weight loss (33 vs 11%, p = .024) and rapidly deteriorating nerve conduction studies (26 vs. 8%, p = .03). ATTRv diagnosis led to amyloid cardiomyopathy diagnosis in 11 cases, ATTRv specific treatment in all cases and identification of 15 additional ATTRv cases among relatives. CONCLUSION In this nationwide prospective study, we found ATTRv in 2.7% of patients with age >50 years with a progressive polyneuropathy. These results are highly important for the early identification of patients in need of disease-modifying treatments.
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Affiliation(s)
- Guillaume Fargeot
- Neurology Department, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - Andoni Echaniz-Laguna
- Neurology Department, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (NNERF), Le-Kremlin-Bicêtre, France
- Inserm U1195, Paris-Saclay University, Le-Kremlin-Bicêtre, France
| | - Céline Labeyrie
- Neurology Department, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (NNERF), Le-Kremlin-Bicêtre, France
| | - Juliette Svahn
- Electroneuromyography and Neuromuscular Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Pascal Cintas
- Department of Neurology, AOC (Atlantique-Occitanie-Caraïbes) Reference Centre for Neuromuscular Diseases, Pierre Paul Riquet Hospital, CHU Toulouse, Toulouse, France
| | - Jean-Baptiste Chanson
- Neurology Department, CHU de Strasbourg, Strasbourg, and Neuromuscular Reference Center Nord/Est/Ile de France (NEIF), Strasbourg, France
| | - Florence Esselin
- Explorations Neurologiques et Centre SLA, CHU et Université de Montpellier, INSERM, Montpellier, France
| | - Céline Piedvache
- Unité de Recherche Clinique Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Céline Verstuyft
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Centre de Ressources Biologiques Paris Saclay, AP-HP, GH Paris Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Steeve Genestet
- Reference Centre for Neuromuscular Diseases AOC, University Hospital of Brest, Brest, France
| | - Emmeline Lagrange
- Department of Neurology, Grenoble Alpes University Hospital, Grenoble, France
| | - Laurent Magy
- Service de Neurologie, Centre de Référence Neuropathies Périphériques Rares, NNerf, UR 20218 NeurIT, CHU de Limoges, Hôpital Dupuytren, Limoges, France
| | - Yann Péréon
- CHU Nantes, Reference Centre for Neuromuscular Diseases AOC, Hôtel-Dieu, Filnemus, Euro-NMD, Nantes, France
| | - Sabrina Sacconi
- Department of Clinical Neurosciences, Neuromuscular Diseases Centre, University Hospital of Nice (CHU), Nice, France
| | - Aissatou Signate
- Department of Neurology, CHU Martinique (University Hospital of Martinique), Fort de France, France
| | - Aleksandra Nadaj-Pakleza
- Neurology Department, CHU de Strasbourg, Strasbourg, and Neuromuscular Reference Center Nord/Est/Ile de France (NEIF), Strasbourg, France
| | - Frédéric Taithe
- Department of Neurology, University Hospital of Clermont-Ferrand (CHU Clermont-Ferrand - Gabriel Montpied Hospital), Clermont-Ferrand, FT, France
| | - Karine Viala
- Neurophysiology Department, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Céline Tard
- Centre de référence des maladies Neuromusculaires Nord/Est/Ile-de-France, U1172, CHU de Lille, Lille, France
| | - Vianney Poinsignon
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Cécile Cauquil
- Neurology Department, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (NNERF), Le-Kremlin-Bicêtre, France
| | - Shahram Attarian
- Centre de Référence des Maladies Neuromusculaires et de la SLA, APHM, CHU Timone, Marseille, France
| | - David Adams
- Neurology Department, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (NNERF), Le-Kremlin-Bicêtre, France
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Žebrauskienė D, Sadauskienė E, Masiulienė R, Aidietienė S, Šiaudinienė A, Pečeliūnas V, Žukauskaitė G, Žurauskas E, Valevičienė N, Barysienė J, Preikšaitienė E. Rare c.302C>T TTR Variant Associated with Transthyretin Amyloidosis. Medicina (Kaunas) 2024; 60:237. [PMID: 38399526 PMCID: PMC10890320 DOI: 10.3390/medicina60020237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Hereditary transthyretin amyloidosis (ATTRv) is a rare disease caused by pathogenic variants in the transthyretin (TTR) gene. More than 140 different disease-causing variants in TTR have been reported. Only a few individuals with a rare TTR variant, c.302C>T, p.(Ala101Val) (historically known as p.(Ala81Val)), primarily associated with cardiac ATTRv, have been described. Therefore, our aim was to analyze the clinical characteristics of individuals with the identified c.302C>T TTR variant at our center. Materials and Methods: We analyzed data from individuals with ATTRv who were diagnosed and treated at Vilnius University Hospital Santaros Klinikos. ATTRv was confirmed by negative hematological analysis for monoclonal protein, positive tissue biopsy or bone scintigraphy and a pathogenic TTR variant. Results: During 2018-2021, the TTR NM_000371.3:c.302C>T, NP_000362.1:p.(Ala101Val) variant was found in one individual in a homozygous state and in three individuals in a heterozygous state. The age of onset of symptoms ranged from 44 to 74 years. The earliest onset of symptoms was in the individual with the homozygous variant. A history of carpal tunnel syndrome was identified in two individuals. On ECG, three individuals had low QRS voltage in limb leads. All individuals had elevated NT-proBNP and hsTroponine I levels on baseline laboratory tests and concentric left ventricular hypertrophy on transthoracic echocardiography. The individual with the homozygous c.302C>T TTR variant had the most pronounced polyneuropathy with tetraparesis. Other patients with the heterozygous variant had more significant amyloid cardiomyopathy. When screening family members, the c.302C>T TTR variant was identified in two phenotypically negative relatives at the ages of 33 and 47 years. Conclusions: c.302C>T is a rare TTR variant associated with ATTRv cardiomyopathy. The homozygous state of this variant was not reported before, and is associated with earlier disease onset and neurological involvement compared to the heterozygote state.
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Affiliation(s)
- Dovilė Žebrauskienė
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Eglė Sadauskienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Rūta Masiulienė
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Sigita Aidietienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Agnė Šiaudinienė
- Center of Haematology, Oncology and Transfusion Medicine, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Valdas Pečeliūnas
- Center of Haematology, Oncology and Transfusion Medicine, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
- Clinic of Internal Medicine, Family Medicine and Oncology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Gabrielė Žukauskaitė
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Edvardas Žurauskas
- National Center of Pathology, Vilnius University Hospital Santaros Klinikos, LT-08406 Vilnius, Lithuania
| | - Nomeda Valevičienė
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Jūratė Barysienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Eglė Preikšaitienė
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
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da Costa CM, Amador AF, Calvão J, Vasconcelos Porto A, Fernandes S, Martins E, Macedo F. First description of Portuguese patients with cardiac amyloidosis and p.Val142Ile: more evidence of an "African variant" in Caucasians. SCAND CARDIOVASC J 2023; 57:2197183. [PMID: 37029471 DOI: 10.1080/14017431.2023.2197183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Objectives. Hereditary transthyretin amyloidosis caused by the (ATTRv) p. Val142Ile variant is a common cause of cardiac amyloidosis among Western African countries and Afro-Americans populations. However, in recent years, Caucasian patients have been identified in greater numbers, raising the question of whether this variant has been undeappreciated in this population. We now have new cases of cardiac amyloidosis caused by the p.Val142Ile from a center in northern Portugal. In addition, we reviewed and discussed the published data concerning p.Val142Ile in Caucasians. Design. Patients diagnosed with cardiac amyloidosis underwent genetic testing using TTR gene sequencing and their relatives were recommended for genetic counsellingand testing if a pathogenic TTR variant was found. In our center, we reviewed the clinical data of patients who had the p.Val142Ile variant. A review of published cases of p.Val142Ile in Caucasians was also performed, to which our data was compared. Results. We found three ATTRv patients with the p.Val142Ile variant (one homozygotic), all Caucasian males with a median age at diagnosis of 69 years old. All of them had heart failure and arrhythmias. During the follow-up period, two patients died. There were 47 unrelated unrelated Caucasian cases of ATTRv p.Val142Ile variant reported worldwide until May 2022. Conclusions. Our findings add to the mounting evidence that the global prevalence of p.Val142Ile is likely understated. This highlights the importance of the systematic screening of the TTR gene in amyloidosis and phenocopies, as well as larger epidemiologic studies to determine the true ATTRv p.Val142Ile prevalence in non-African communities.
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Affiliation(s)
| | - Ana Filipa Amador
- Department of Cardiology, Centro Hospitalar Universitário Hospitalar São João, Porto, Portugal
| | - João Calvão
- Department of Cardiology, Centro Hospitalar Universitário Hospitalar São João, Porto, Portugal
| | - Alice Vasconcelos Porto
- Medical Genetics Service, Centro Hospitalar Universitário Hospitalar São João, Porto, Portugal
| | - Susana Fernandes
- Medical Genetics Service, Centro Hospitalar Universitário Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Elisabete Martins
- Department of Cardiology, Centro Hospitalar Universitário Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Filipe Macedo
- Department of Cardiology, Centro Hospitalar Universitário Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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Allinovi M, Bergesio F, Cappelli F, Chiappini MG, Santostefano M, Argirò A, Catalucci T, Parise A, Zampieri M, Perfetto F. Is Hereditary Transthyretin Amyloidosis the Third Leading Cause of Monogenic Chronic Kidney Disease, Only Behind ADPKD and Alport Disease? Am J Nephrol 2022; 53:624-627. [PMID: 36349760 DOI: 10.1159/000526955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/08/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Marco Allinovi
- Regional Referral Center for Systemic Amyloidosis, Careggi University Hospital, Florence, Italy
| | - Franco Bergesio
- Regional Referral Center for Systemic Amyloidosis, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Regional Referral Center for Systemic Amyloidosis, Careggi University Hospital, Florence, Italy
| | - Maria Grazia Chiappini
- Centro Regionale di Riferimento delle Amiloidosi, Ospedale Fatebenefratelli, Roma, Italy
| | | | - Alessia Argirò
- Regional Referral Center for Systemic Amyloidosis, Careggi University Hospital, Florence, Italy
| | - Tullio Catalucci
- Regional Referral Center for Systemic Amyloidosis, Careggi University Hospital, Florence, Italy
| | - Alberto Parise
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Mattia Zampieri
- Regional Referral Center for Systemic Amyloidosis, Careggi University Hospital, Florence, Italy
| | - Federico Perfetto
- Regional Referral Center for Systemic Amyloidosis, Careggi University Hospital, Florence, Italy
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5
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Santos Silva C, Oliveira Santos M, Gromicho M, Pronto-Laborinho A, Conceição I, de Carvalho M. Motor neuron disease in three asymptomatic pVal50Met TTR gene carriers. Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:627-629. [PMID: 35142241 DOI: 10.1080/21678421.2022.2029899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
We describe three unrelated patients with sporadic motor neuron disease (MND) and hereditary amyloid transthyretin (ATTRv) amyloidosis family history, who were asymptomatic carriers of the pVal50Met mutation of transthyretin (TTR) gene. Patients 1 and 2 were a 43-year-old man with a spinal-onset of ALS and a 37-year-old woman with a bulbar-onset of ALS, who died due to respiratory complications five and two years after disease onset, respectively. Patient 3 is a 52-year-old woman, with a two-year history of a probable primary lateral sclerosis, and a frontotemporal dysfunction. Imaging, cerebrospinal fluid (CSF) and nerve conduction and small fiber tests were normal in all. Genetic testing for ALS was negative in the two patients tested. Previous studies in MND patients have identified reduced TTR levels in CSF and neuronal gene overexpression, suggesting a neuroprotective role of TTR. The association of MND in patients with TTR gene mutations has not yet been described.
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Affiliation(s)
- Cláudia Santos Silva
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisbon, Portugal.,Faculdade de Medicina- Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Miguel Oliveira Santos
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisbon, Portugal.,Faculdade de Medicina- Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Marta Gromicho
- Faculdade de Medicina- Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Pronto-Laborinho
- Faculdade de Medicina- Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Isabel Conceição
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisbon, Portugal.,Faculdade de Medicina- Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Mamede de Carvalho
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisbon, Portugal.,Faculdade de Medicina- Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
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Alves-Ferreira M, Azevedo A, Coelho T, Santos D, Sequeiros J, Alonso I, Sousa A, Lemos C. Beyond Val30Met transthyretin (TTR): variants associated with age-at-onset in hereditary ATTRv amyloidosis. Amyloid 2021; 28:100-106. [PMID: 33461327 DOI: 10.1080/13506129.2020.1857236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES V30M in transthyretin (TTR) gene is causative for hereditary ATTRv amyloidosis (familial amyloid polyneuropathy). ATTRv amyloidosis shows a wide variation in age-at-onset (AO) between clusters, families, and among generations. We aim at identifying genetic modifiers of disease onset that may contribute to this variability in Portuguese patients by identifying other variants in TTR locus, beyond the ATTRv amyloidosis causing variant that could play a regulatory role in its expression level. METHODS We analysed DNA samples of 330 ATTRV30M carriers (299 patients, 31 aged-asymptomatic carriers aged >40 years) from 120 families currently under follow-up. A generalised estimating equation analysis (GEE) was used to take into account non-independency of AO between relatives. An intensive in silico analysis was performed in order to understand a possible regulation of gene expression. RESULTS We found 11 rare variants in the promoter, coding and intron/exon boundaries of the TTR gene associated with the onset of symptoms before and after age 40 years, namely 2 novel ones and a tandem CA-dinucleotide repeat. Furthermore, of the 4 common variants found, one was significantly associated with AO and may influence the constitutive splicing of TTR pre-mRNA. The seven ATTRV30M/V30M homozygous do not carry any of the variants identified in this study, including the common ones. In silico analysis disclosed significant alterations in the mechanism of splicing, transcription factors and miRNAs binding. CONCLUSIONS Variants within the promoter region may modify disease expressivity and variants in the 3'UTR can impact the efficacy of novel therapeutic interventions. Importantly, the putative mechanisms of regulation of gene expression within the TTR gene deserve to be better explored, in order to be used in the future as potential therapeutical targets.
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Affiliation(s)
- Miguel Alves-Ferreira
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Ana Azevedo
- ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Teresa Coelho
- Unidade Corino de Andrade (UCA), Centro Hospitalar do Porto (CHP), Porto, Portugal
| | - Diana Santos
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Jorge Sequeiros
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Isabel Alonso
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Alda Sousa
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Carolina Lemos
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Yordanova I, Pavlova Z, Kirov A, Todorov T, Alexiev A, Sarafov S, Mateva L, Chamova T, Gospodinova M, Mitev V, Tournev I, Todorova A. Monoallelic expression of the TTR gene as a contributor to the age at onset and penetrance of TTR-related amyloidosis. Gene 2019; 705:16-21. [PMID: 30981840 DOI: 10.1016/j.gene.2019.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 11/18/2022]
Abstract
TTR-related amyloidosis (ATTR) is manifested in two allelic forms: familial amyloid polyneuropathy (TTR-FAP) and cardiomyopathy (TTR-FAC), both caused by mutations in the TTR gene. The most prevalent mutation in Bulgaria is p.Glu89Gln. Markedly different age at onset and disease penetrance is noticed in Bulgarian p.Glu89Gln cases even in a single family or between genetically identical twins. The present study aimed to evaluate the transcription profile of the TTR gene in order to better understand the difference in disease onset and penetrance. Six p.Glu89Gln positive families were selected from our registry, based on intrafamilial differences in disease onset and penetrance. Plasma and urine specimens were collected from 13 patients and subjected to transcription analysis. Both mutant and wild type transcripts were visualized in a mixed transcription profile, which is the traditional model of autosomal gene expression. The results from a relative quantification of the mutant versus wild type transcript showed presence of the mutant transcript between 0.14 and 1.14 times against the wild type. In addition, monoallelic expression signature was also detected. Based on our results we propose a model of natural selection, which includes age-related allele exclusion or suppression: predominant expression of a wild type (at an early age) and mutant (at the process of ageing) alleles. The intrafamilial differences in disease onset and penetrance need to be considered in genetic counselling and in follow-up of mutation carriers.
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Affiliation(s)
- Iglika Yordanova
- Genetic Medico-Diagnostic Laboratory Genica, Sofia, Bulgaria; IMDL Genome Center "Bulgaria", Sofia, Bulgaria
| | - Zornitza Pavlova
- IMDL Genome Center "Bulgaria", Sofia, Bulgaria; Department of Medical Chemistry and Biochemistry, Medical University Sofia, Sofia, Bulgaria
| | | | - Tihomir Todorov
- Genetic Medico-Diagnostic Laboratory Genica, Sofia, Bulgaria; IMDL Genome Center "Bulgaria", Sofia, Bulgaria
| | - Assen Alexiev
- Clinic of Gastroenterology, University Hospital "St. Ivan Rilski", Medical University-Sofia, Bulgaria
| | - Stayko Sarafov
- Clinic of Nervous Diseases, University Hospital "Alexandrovska", Department of Neurology, Medical University Sofia, Sofia, Bulgaria
| | - Lyudmila Mateva
- Clinic of Gastroenterology, University Hospital "St. Ivan Rilski", Medical University-Sofia, Bulgaria
| | - Teodora Chamova
- Clinic of Nervous Diseases, University Hospital "Alexandrovska", Department of Neurology, Medical University Sofia, Sofia, Bulgaria
| | | | - Vanyo Mitev
- Department of Medical Chemistry and Biochemistry, Medical University Sofia, Sofia, Bulgaria
| | - Ivailo Tournev
- Clinic of Nervous Diseases, University Hospital "Alexandrovska", Department of Neurology, Medical University Sofia, Sofia, Bulgaria; Department for Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria
| | - Albena Todorova
- Genetic Medico-Diagnostic Laboratory Genica, Sofia, Bulgaria; IMDL Genome Center "Bulgaria", Sofia, Bulgaria; Department of Medical Chemistry and Biochemistry, Medical University Sofia, Sofia, Bulgaria
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8
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Gebus O, Fleury M, Chanson JB, Anheim M, Tranchant C, Echaniz-Laguna A. Mitochondrial disease and amyloidosis in a patient with familial polyneuropathy. Eur J Neurol 2018; 25:e118-e119. [PMID: 30306720 DOI: 10.1111/ene.13767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/10/2018] [Indexed: 11/30/2022]
Affiliation(s)
- O Gebus
- Département de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - M Fleury
- Département de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - J-B Chanson
- Département de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - M Anheim
- Département de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,IGBMC, INSERM-U964/CNRS-UMR7104/UDS, Illkirch, France
| | - C Tranchant
- Département de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,IGBMC, INSERM-U964/CNRS-UMR7104/UDS, Illkirch, France
| | - A Echaniz-Laguna
- Département de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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9
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Abstract
RNA interference (RNAi) is a naturally existing endogenous mechanism for post-transcriptional gene regulation, nowadays commonly utilized for functional characterization of genes and development of potential treatment strategies for diseases. RNAi-based studies for therapy, after being examined for over a decade, are finally in the pipeline for developing a potential treatment for the mutated transthyretin (TTR) gene, which gives rise to a dysfunctional TTR protein. This dysfunctional protein causes TTR amyloidosis (ATTR), an inherited, progressively incapacitating, and often fatal genetic disorder. TTR is a protein produced in the liver, and functions as a carrier for retinol-binding protein and also thyroxine. This protein facilitates the transport of vitamin A around the human body. A mutation or misprint in the code of this protein results in an abnormal folding of the protein. Therefore, not only does the transportation of the vitamin A become disabled, but also there will be formation of clusters called amyloid deposits, which attack the heart and the nerves causing some patients to be unconditionally bound to bed. ATTR is a hereditary autosomal dominant disease with a 50% chance of inheritance by offspring, even with just one of the parents having a single defective allele of this gene. Alnylam Pharmaceuticals worked on the concept of RNAi therapy for years, which led to the introduction of lipid nanoparticles encircling small interfering RNAs. The drug showed extremely positive results since the first trial, and a great percentage of defective protein reduction. This drug was later named Patisiran.
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Affiliation(s)
- Malak Rizk
- Molecular Biology and Genetics Program, Department of Biological Sciences, Faculty of Arts and Sciences, Eastern Mediterranean University (EMU), Famagusta, North Cyprus, Turkey
| | - Şükrü Tüzmen
- Molecular Biology and Genetics Program, Department of Biological Sciences, Faculty of Arts and Sciences, Eastern Mediterranean University (EMU), Famagusta, North Cyprus, Turkey
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