1
|
Adams D, Cintas P, Solé G, Tard C, Labeyrie C, Echaniz-Laguna A, Cauquil C, Pereon Y, Magy L, Morales RJ, Antoine JC, Lagrange E, Petiot P, Mallaret M, Francou B, Guiochon-Mantel A, Coste A, Demarcq O, Geffroy C, Famelart V, Rudant J, Bartoli M, Donal E, Lairez O, Eicher JC, Kharoubi M, Oghina S, Trochu JN, Inamo J, Habib G, Roubille F, Hagège A, Morio F, Cariou E, Adda J, Slama MS, Charron P, Algalarrondo V, Damy T, Attarian S. Transthyretin amyloid polyneuropathy in France: A cross-sectional study with 413 patients and real-world tafamidis meglumine use (2009-2019). Rev Neurol (Paris) 2024:S0035-3787(24)00489-2. [PMID: 38643028 DOI: 10.1016/j.neurol.2024.02.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE We aimed to describe characteristics of patients with ATTR variant polyneuropathy (ATTRv-PN) and ATTRv-mixed and assess the real-world use and safety profile of tafamidis meglumine 20mg. METHODS Thirty-eight French hospitals were invited. Patient files were reviewed to identify clinical manifestations, diagnostic methods, and treatment compliance. RESULTS Four hundred and thirteen patients (296 ATTRv-PN, 117 ATTRv-mixed) were analyzed. Patients were predominantly male (68.0%) with a mean age of 57.2±17.2 years. Interval between first symptom(s) and diagnosis was 3.4±4.3 years. First symptoms included sensory complaints (85.9%), dysautonomia (38.5%), motor deficits (26.4%), carpal tunnel syndrome (31.5%), shortness of breath (13.3%), and unexplained weight loss (16.0%). Mini-invasive accessory salivary gland or punch skin and nerve biopsies were most common, with a performance of 78.8-100%. TTR genetic sequencing, performed in all patients, revealed 31 TTR variants. Tafamidis meglumine was initiated in 156/214 (72.9%) ATTRv-PN patients at an early disease stage. Median treatment duration was 6.00 years in ATTRv-PN and 3.42 years in ATTRv-mixed patients. Tafamidis was well tolerated, with 20 adverse events likely related to study drug among the 336 patients. CONCLUSION In France, ATTRv patients are usually identified early thanks to the national network and the help of diagnosis combining genetic testing and mini-invasive biopsies.
Collapse
Affiliation(s)
- D Adams
- Department of Neurology, French Reference Center for Familial Amyloid Polyneuropathy, AP-HP, CHU de Bicêtre, University Paris-Saclay, Inserm U 1195, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - P Cintas
- Centre de référence neuromusculaire, CHU de Toulouse, Toulouse, France
| | - G Solé
- Referral Center for Neuromuscular Diseases, Pellegrin Hospital, Bordeaux, France
| | - C Tard
- Centre de référence des maladies neuromusculaires, CHU de Lille, Lille, France
| | - C Labeyrie
- Department of Neurology, French Reference Center for Familial Amyloid Polyneuropathy, AP-HP, CHU de Bicêtre, University Paris-Saclay, Inserm U 1195, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - A Echaniz-Laguna
- Department of Neurology, French Reference Center for Familial Amyloid Polyneuropathy, AP-HP, CHU de Bicêtre, University Paris-Saclay, Inserm U 1195, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - C Cauquil
- Department of Neurology, French Reference Center for Familial Amyloid Polyneuropathy, AP-HP, CHU de Bicêtre, University Paris-Saclay, Inserm U 1195, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Y Pereon
- Centre de référence maladies neuromusculaire rares, CHU Nantes, Nantes, France
| | - L Magy
- Centre de référence neuropathies périphériques rares, CHU de Limoges, Limoges, France
| | - R Juntas Morales
- Neurology Department, ALS center, University Hospital of Montpellier, Montpellier, France
| | - J C Antoine
- Centre de référence maladies neuromusculaires rares, CHU de Saint-Étienne, Saint-Étienne, France
| | - E Lagrange
- Neurology Department, CHU Michallon, Grenoble, France
| | - P Petiot
- Medicine, 64, avenue Rockefeller, Lyon, France
| | - M Mallaret
- Neurology Department, CHU Michallon, Grenoble, France
| | - B Francou
- Molecular Genetics Pharmacogenomics and Hormonology Department, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - A Guiochon-Mantel
- Molecular Genetics Pharmacogenomics and Hormonology Department, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - A Coste
- Pfizer, Paris cedex 14, France
| | | | | | | | | | | | - E Donal
- University of Rennes, CHU de Rennes, Rennes, France
| | - O Lairez
- Cardiology Department, Rangueil Hospital, Toulouse, France
| | - J C Eicher
- Cardiology Department, University Hospital of Dijon, Dijon, France
| | - M Kharoubi
- Referral Center for Cardiac Amyloidosis, CHU Henri-Mondor, Créteil, France
| | - S Oghina
- Referral Center for Cardiac Amyloidosis, CHU Henri-Mondor, Créteil, France
| | - J N Trochu
- Institut du thorax, CHU de Nantes, Nantes, France
| | - J Inamo
- Cardiology Department, CHU de Martinique, Martinique, France
| | - G Habib
- Cardiology Department, La Timone Hospital, AP-HM, Marseille, France
| | - F Roubille
- Cardiology Department, CHU de Montpellier, Montpellier, France
| | - A Hagège
- Cardiology Department, hôpital européen Georges-Pompidou, Paris, France
| | - F Morio
- Institut du thorax, CHU de Nantes, Nantes, France
| | - E Cariou
- Cardiology Department, Rangueil Hospital, Toulouse, France
| | - J Adda
- Cardiology Department, hôpital Bichat, Paris, France
| | - M S Slama
- Cardiology Department, hôpital Bichat, Paris, France
| | - P Charron
- Hôpital Pitié-Salpêtrière, Sorbonne université, Paris, France
| | | | - T Damy
- Referral Center for Cardiac Amyloidosis, CHU Henri-Mondor, Créteil, France
| | - S Attarian
- Neurology Department, La Timone Hospital, AP-HM, Marseille, France
| |
Collapse
|
2
|
Ouchi K, Isono K, Ohya Y, Shiraki N, Tasaki M, Inomata Y, Ueda M, Era T, Kume S, Ando Y, Jono H. Characterization of heterozygous ATTR Tyr114Cys amyloidosis-specific induced pluripotent stem cells. Heliyon 2024; 10:e24590. [PMID: 38312695 PMCID: PMC10835262 DOI: 10.1016/j.heliyon.2024.e24590] [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: 08/31/2023] [Revised: 12/31/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
Hereditary transthyretin (TTR) amyloidosis (ATTRv amyloidosis) is autosomal dominant and caused by mutation of TTR gene. Heterozygous ATTR Tyr114Cys (p.Tyr134Cys) amyloidosis is a lethal disease with a life expectancy of about 10 years after onset of the disease. However, the molecular pathogenesis of ATTR Tyr114Cys amyloidosis is still largely unknown. In this study, we took advantage of disease-specific induced pluripotent stem (iPS) cells and generated & characterized the heterozygous ATTR Tyr114Cys amyloidosis-specific iPS cells (Y114C iPS cells), to determine whether Y114C iPS cells could be useful for elucidating the pathogenesis of ATTR Tyr114Cys amyloidosis. We successfully differentiated heterozygous Y114C iPS cells into hepatocyte like cells (HLCs) mainly producing TTR protein. On day 27 after differentiation, the expression of hepatocyte maker albumin was detected, and TTR expression was significantly increased in HLCs differentiated from Y114C iPS cells. LC-MS/MS analysis showed that both WT TTR & ATTR Y114C protein were indeed expressed in the HLCs differentiated from Y114C iPS cells. Notably, the number of detected peptides derived from ATTR Y114C protein was lower than that of WT TTR protein, indeed indicating the clinical phenotype of ATTR Tyr114Cys amyloidosis. Taken together, we first reported the heterozygous Y114C iPS cells generated from patient with ATTR Tyr114Cys amyloidosis, and suggested that Y114C iPS cells could be a potential pathological tool, which may contribute to elucidating the molecular pathogenesis of heterozygous ATTR Tyr114Cys amyloidosis.
Collapse
Affiliation(s)
- Kenta Ouchi
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, 2-2-1 Honjo, Chuo Ward, Kumamoto City, Kumamoto Prefecture, 860-8556, Japan
| | - Kaori Isono
- Department of Transplantation and Paediatric Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo Ward, Kumamoto City, Kumamoto Prefecture, 860-8556, Japan
| | - Yuki Ohya
- Department of Transplantation and Paediatric Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo Ward, Kumamoto City, Kumamoto Prefecture, 860-8556, Japan
- Department of Pediatric Surgery, Kumamoto Rosai Hospital, 1670 Takehara-cho, Yatsushiro City, Kumamoto Prefecture, 866-0826, Japan
| | - Nobuaki Shiraki
- School of Life Science and Technology, Tokyo Institute of Technology, 4259 Nagatsuta-cho, Midori Ward, Yokohama City, Kanagawa Prefecture, 226-8501, Japan
| | - Masayoshi Tasaki
- Department of Biomedical Laboratory Sciences, Graduate School of Health Sciences, Kumamoto University, Kumamoto, 1-1-1 Honjo, Chuo Ward, Kumamoto City, Kumamoto Prefecture, 860-8556, Japan
- Department of Neurology, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo Ward, Kumamoto City, Kumamoto Prefecture, 860-8556, Japan
| | - Yukihiro Inomata
- Department of Pediatric Surgery, Kumamoto Rosai Hospital, 1670 Takehara-cho, Yatsushiro City, Kumamoto Prefecture, 866-0826, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo Ward, Kumamoto City, Kumamoto Prefecture, 860-8556, Japan
| | - Takumi Era
- Department of Cell Modulation, Institute of Molecular Embryology and Genetics, Kumamoto University, 2-2-1 Honjo, Chuo Ward, Kumamoto City, Kumamoto Prefecture, 860-8556, Japan
| | - Shoen Kume
- School of Life Science and Technology, Tokyo Institute of Technology, 4259 Nagatsuta-cho, Midori Ward, Yokohama City, Kanagawa Prefecture, 226-8501, Japan
| | - Yukio Ando
- Department of Amyloidosis Research, Nagasaki International University, 2825-7 Huis Ten Bosch Cho, Sasebo City, Nagasaki Prefecture, 859-3298, Japan
| | - Hirofumi Jono
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, 2-2-1 Honjo, Chuo Ward, Kumamoto City, Kumamoto Prefecture, 860-8556, Japan
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1 Honjo, Chuo Ward, Kumamoto City, Kumamoto Prefecture, 860-8556, Japan
| |
Collapse
|
3
|
Ando Y, Waddington-Cruz M, Sekijima Y, Koike H, Ueda M, Konishi H, Ishii T, Coelho T. Optimal practices for the management of hereditary transthyretin amyloidosis: real-world experience from Japan, Brazil, and Portugal. Orphanet J Rare Dis 2023; 18:323. [PMID: 37828588 PMCID: PMC10571420 DOI: 10.1186/s13023-023-02910-3] [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: 04/10/2023] [Accepted: 09/05/2023] [Indexed: 10/14/2023] Open
Abstract
Hereditary transthyretin (ATTRv) amyloidosis is a rare and autosomal dominant disorder associated with mutations in the transthyretin gene. Patients present with diverse symptoms related to sensory, motor, and autonomic neuropathy, as well as gastrointestinal, ocular, cardiac, renal and orthopedic symptoms, resulting from the deposition of transthyretin amyloid fibrils in multiple organs. The progressive nature of ATTRv amyloidosis necessitates pre- and post-onset monitoring of the disease. This review article is primarily based on a collation of discussions from a medical advisory board meeting in August 2021. In this article, we summarize the best practices in amyloidosis centers in three major endemic countries for ATTRv amyloidosis (Japan, Brazil, and Portugal), where most patients carry the Val30Met mutation in the transthyretin gene and the patients' genetic background was proven to be the same. The discussions highlighted the similarities and differences in the management of asymptomatic gene mutation carriers among the three countries in terms of the use of noninvasive tests and tissue biopsies and timing of starting the investigations. In addition, this article discusses a set of practical tests and examinations for monitoring disease progression applicable to neurologists working in diverse medical settings and generalizable in non-endemic countries and areas. This set of assessments consists of periodic (every 6 to 12 months) evaluations of patients' nutritional status and autonomic, renal, cardiac, ophthalmologic, and neurological functions. Physical examinations and patient-reported outcome assessments should be also scheduled every 6 to 12 months. Programs for monitoring gene mutation carriers and robust referral networks can aid in appropriate patient management in pre- to post-onset stages. For pre- and post-symptom onset testing for ATTRv amyloidosis, various noninvasive techniques are available; however, their applicability differs depending on the medical setting in each country and region, and the optimal option should be selected in view of the clinical settings, medical environment, and available healthcare resources in each region.
Collapse
Affiliation(s)
- Yukio Ando
- Department of Amyloidosis Research, Faculty of Pharmaceutical Sciences, Nagasaki International University, 2825-7 Huis Ten Bosch Machi, Sasebo City, Nagasaki, 859-3298, Japan.
| | - Marcia Waddington-Cruz
- Hospital Universitário Clementino Fraga Filho, Centro de Estudos em Paramiloidose Antônio Rodrigues de Mello, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | | | - Teresa Coelho
- Andrade's Center for Familial Amyloidosis, Hospital Santo António, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| |
Collapse
|
4
|
Inada Y, Ono Y, Okazaki K, Yamashita T, Kawaguchi T, Kawano S, Kobashigawa Y, Shinya S, Kojima C, Shuto T, Kai H, Morioka H, Sato T. Hydrogen bonds connecting the N-terminal region and the DE loop stabilize the monomeric structure of transthyretin. J Biochem 2023; 174:355-370. [PMID: 37400978 DOI: 10.1093/jb/mvad049] [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: 03/02/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023] Open
Abstract
Transthyretin (TTR) is a homo-tetrameric serum protein associated with sporadic and hereditary systemic amyloidosis. TTR amyloid formation proceeds by the dissociation of the TTR tetramer and the subsequent partial unfolding of the TTR monomer into an aggregation-prone conformation. Although TTR kinetic stabilizers suppress tetramer dissociation, a strategy for stabilizing monomers has not yet been developed. Here, we show that an N-terminal C10S mutation increases the thermodynamic stability of the TTR monomer by forming new hydrogen bond networks through the side chain hydroxyl group of Ser10. Nuclear magnetic resonance spectrometry and molecular dynamics simulation revealed that the Ser10 hydroxyl group forms hydrogen bonds with the main chain amide group of either Gly57 or Thr59 on the DE loop. These hydrogen bonds prevent the dissociation of edge strands in the DAGH and CBEF β-sheets during the unfolding of the TTR monomer by stabilizing the interaction between β-strands A and D and the quasi-helical structure in the DE loop. We propose that introducing hydrogen bonds to connect the N-terminal region to the DE loop reduces the amyloidogenic potential of TTR by stabilizing the monomer.
Collapse
Affiliation(s)
- Yuki Inada
- Department of Analytical and Biophysical Chemistry, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Yuichiro Ono
- Department of Analytical and Biophysical Chemistry, School of Pharmacy, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Kyo Okazaki
- Department of Analytical and Biophysical Chemistry, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Takuma Yamashita
- Department of Analytical and Biophysical Chemistry, School of Pharmacy, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Tomoyuki Kawaguchi
- Department of Analytical and Biophysical Chemistry, School of Pharmacy, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Shingo Kawano
- Department of Analytical and Biophysical Chemistry, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Yoshihiro Kobashigawa
- Department of Analytical and Biophysical Chemistry, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Shoko Shinya
- Laboratory of Molecular Biophysics, Institute for Protein Research, Osaka University, 3-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Chojiro Kojima
- Laboratory of Molecular Biophysics, Institute for Protein Research, Osaka University, 3-2 Yamadaoka, Suita, Osaka 565-0871, Japan
- Division of Materials Science and Chemical Engineering, Graduate School of Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama 240-8501, Japan
| | - Tsuyoshi Shuto
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Hirofumi Kai
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Hiroshi Morioka
- Department of Analytical and Biophysical Chemistry, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Takashi Sato
- Department of Analytical and Biophysical Chemistry, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| |
Collapse
|
5
|
Nomura T, Fujiki F, Ueda M. Popeye Sign in Hereditary Transthyretin Amyloidosis. JAMA Neurol 2023; 80:998-999. [PMID: 37399023 DOI: 10.1001/jamaneurol.2023.1975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
This case report describes a 63-year-old man who developed dysesthesia in his feet and was misdiagnosed with chronic inflammatory demyelinating polyradiculoneuropathy.
Collapse
Affiliation(s)
- Toshiya Nomura
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Fujio Fujiki
- Department of Neurology, Hara-Sanshin Hospital, Fukuoka, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
6
|
Ikeda K, Yamamoto D, Usui K, Takeuchi H, Oka N, Katoh N, Yazaki M, Kametani F, Nishino I, Hisahara S. Transthyretin Variant Amyloidosis with a TTR A97D (p.A117D) Mutation Manifesting Remarkable Asymmetric Neuropathy. Intern Med 2023; 62:2261-2266. [PMID: 36543209 PMCID: PMC10465283 DOI: 10.2169/internalmedicine.0798-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022] Open
Abstract
We herein report a 68-year-old Japanese man with sporadic variant transthyretin (ATTRv) amyloidosis harboring the novel variant A97D (p.A117D) in TTR. He had slow development of asymmetric neuropathy, unintentional weight loss, mild autonomic failure and mild cardiomyopathy. TTR amyloid deposition on the gastric duodenal mucosa was detected. In silico analyses predicted that TTR A97D (p.A117D) altered the structure and function of the TTR protein. ATTRv amyloidosis is often difficult to diagnose in non-endemic regions due to its diverse phenotypes, such as atypical peripheral nerve involvement and a rare family history.
Collapse
Affiliation(s)
- Kazuna Ikeda
- Department of Neurology, Sapporo Medical University School of Medicine, Japan
| | - Daisuke Yamamoto
- Department of Neurology, Sapporo Medical University School of Medicine, Japan
- Department of Neurology, Sunagawa City Medical Center, Japan
| | - Keiko Usui
- Department of Systems Neuroscience, Sapporo Medical University School of Medicine, Japan
| | - Hiroki Takeuchi
- Department of Neurology, National Hospital Organization Minami Kyoto Hospital, Japan
| | | | - Nagaaki Katoh
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Masahide Yazaki
- Institute for Biomedical Sciences, Shinshu University, Japan
- Clinical Laboratory Sciences Division, Shinshu University Graduate School of Medicine, Japan
| | | | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, and Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry, Japan
| | - Shin Hisahara
- Department of Neurology, Sapporo Medical University School of Medicine, Japan
| |
Collapse
|
7
|
Zampino S, Sheikh FH, Vaishnav J, Judge D, Pan B, Daniel A, Brown E, Ebenezer G, Polydefkis M. Phenotypes Associated With the Val122Ile, Leu58His, and Late-Onset Val30Met Variants in Patients With Hereditary Transthyretin Amyloidosis. Neurology 2023; 100:e2036-e2044. [PMID: 36941075 PMCID: PMC10186220 DOI: 10.1212/wnl.0000000000207158] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/20/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hereditary transthyretin amyloidosis (hATTR) is a rare autosomal dominant systemic disease with variable penetrance and heterogeneous clinical presentation. Several effective treatments can reduce mortality and disability, though diagnosis remains challenging, especially in the United States where disease is nonendemic. Our aim is to describe the neurologic and cardiac characteristics of common US ATTR variants V122I, L58H, and late-onset V30M at presentation. METHODS We conducted a retrospective case series of patients with a new diagnosis of ATTRv between January 2008 and January 2020 to characterize features of prominent US variants. The neurologic (examination, EMG, and skin biopsy), cardiac (echo), and laboratory assessments (pro b-type natriuretic peptide [proBNP] and reversible neuropathy screens) are described. RESULTS A total of 56 patients with treatment-naïve ATTRv with symptoms/signs of peripheral neuropathy (PN) or cardiomyopathy and confirmatory genetic testing presenting with Val122Ile (N = 31), late-onset Val30Met (N = 12), and Leu58His ATTRv (N = 13) were included. The age at onset and sex distributions were similar (V122I: 71.5 ± 8.0, V30M: 64.8 ± 2.6, and L58H: 62.4 ± 9.8 years; 26, 25, 31% female). Only 10% of patients with V122I and 17% of patients with V30M were aware of an ATTRv family history, while 69% of patients with L58H were aware. PN was present in all 3 variants at diagnosis (90%, 100%, and 100%), though neurologic impairment scores differed: V122I: 22 ± 16, V30M: 61 ± 31, and L58H: 57 ± 25. Most points (deficits) were attributed to loss of strength. Carpal tunnel syndrome (CTS) and a positive Romberg sign were common across all groups (V122I: 97%, 39%; V30M: 58%, 58%; and L58H: 77%, 77%). ProBNP levels and interventricular septum thickness were highest among patients with V122I (5,939 ± 962 pg/mL, 1.70 ± 0.29 cm), followed by V30M (796 ± 970 pg/mL, 1.42 ± 0.38 cm) and L58H (404 ± 677 pg/mL, 1.23 ± 0.36 cm). Atrial fibrillation was present among 39% of cases with V122I and only 8% of cases with V30M and L58H. Gastrointestinal symptoms were rare (6%) among patients with V122I and common in patients with V30M (42%) and L58H (54%). DISCUSSION Important clinical differences exist between ATTRv genotypes. While V122I is perceived to be a cardiac disease, PN is common and clinically relevant. Most patients with V30M and V122I were diagnosed de novo and therefore require clinical suspicion for diagnosis. A history of CTS and a positive Romberg sign are helpful diagnostic clues.
Collapse
Affiliation(s)
- Serena Zampino
- From the Department of Neurology (S.Z., B.P., A.D., G.E., M.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Cardiology (F.H.S.), MedStar Medical Group, Washington, DC; Division of Cardiology (J.V., D.J., E.B.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Cardiology (D.J.), Medical University of South Carolina, Charleston
| | - Farooq H Sheikh
- From the Department of Neurology (S.Z., B.P., A.D., G.E., M.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Cardiology (F.H.S.), MedStar Medical Group, Washington, DC; Division of Cardiology (J.V., D.J., E.B.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Cardiology (D.J.), Medical University of South Carolina, Charleston
| | - Joban Vaishnav
- From the Department of Neurology (S.Z., B.P., A.D., G.E., M.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Cardiology (F.H.S.), MedStar Medical Group, Washington, DC; Division of Cardiology (J.V., D.J., E.B.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Cardiology (D.J.), Medical University of South Carolina, Charleston
| | - Daniel Judge
- From the Department of Neurology (S.Z., B.P., A.D., G.E., M.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Cardiology (F.H.S.), MedStar Medical Group, Washington, DC; Division of Cardiology (J.V., D.J., E.B.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Cardiology (D.J.), Medical University of South Carolina, Charleston
| | - Baohan Pan
- From the Department of Neurology (S.Z., B.P., A.D., G.E., M.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Cardiology (F.H.S.), MedStar Medical Group, Washington, DC; Division of Cardiology (J.V., D.J., E.B.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Cardiology (D.J.), Medical University of South Carolina, Charleston
| | - Amrita Daniel
- From the Department of Neurology (S.Z., B.P., A.D., G.E., M.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Cardiology (F.H.S.), MedStar Medical Group, Washington, DC; Division of Cardiology (J.V., D.J., E.B.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Cardiology (D.J.), Medical University of South Carolina, Charleston
| | - Emily Brown
- From the Department of Neurology (S.Z., B.P., A.D., G.E., M.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Cardiology (F.H.S.), MedStar Medical Group, Washington, DC; Division of Cardiology (J.V., D.J., E.B.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Cardiology (D.J.), Medical University of South Carolina, Charleston
| | - Gigi Ebenezer
- From the Department of Neurology (S.Z., B.P., A.D., G.E., M.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Cardiology (F.H.S.), MedStar Medical Group, Washington, DC; Division of Cardiology (J.V., D.J., E.B.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Cardiology (D.J.), Medical University of South Carolina, Charleston
| | - Michael Polydefkis
- From the Department of Neurology (S.Z., B.P., A.D., G.E., M.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Cardiology (F.H.S.), MedStar Medical Group, Washington, DC; Division of Cardiology (J.V., D.J., E.B.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Cardiology (D.J.), Medical University of South Carolina, Charleston.
| |
Collapse
|
8
|
Takahashi K, Hiratsuka Y, Sasaki D, Sakaue T, Enomoto D, Morioka H, Uemura S, Okura T, Ikeda S, Kono T, Iwamura T, Yamamura N, Kitazawa S, Ueda M. 99mTc-Pyrophosphate Scintigraphy Can Image Tracer Uptake in Skeletal Trunk Muscles of Transthyretin Cardiac Amyloidosis. Clin Nucl Med 2023; 48:18-24. [PMID: 36469058 DOI: 10.1097/rlu.0000000000004397] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE 99mTc-pyrophosphate (99mTc-PYP) uptake in the skeletal muscles is minimal in patients with transthyretin cardiac amyloidosis (ATTR-CA) when assessed qualitatively and quantitatively. We previously demonstrated moderate- to high-grade 99mTc-PYP uptake in the subcutaneous abdominal fat of some patients with ATTR-CA and showed that this abnormal finding could reflect the regional amyloid burden of this tissue. We aimed to investigate the frequency of 99mTc-PYP uptake in skeletal trunk muscles of patients with ATTR-CA. METHODS Chest- and abdomen-centered 99mTc-PYP scintigraphy images were obtained 2 hours after IV injections of the tracer (20 mCi) in 36 patients with ATTR-CA. The frequency of 99mTc-PYP uptake in the following 11 skeletal trunk muscles was investigated: pectoralis major, deltoid, subscapularis, infraspinatus, trapezius, latissimus dorsi, erector spinae, psoas major, abdominal oblique, rectus abdominis, and the gluteus muscles. RESULTS Ten of the 11 muscles were involved in patients with the highest number of 99mTc-PYP uptake in the skeletal trunk muscles examined, whereas no muscle was involved in a patient with the least uptake. The muscle with the highest rate of 99mTc-PYP uptake, observed in 34 of 36 patients (94.4%), was the abdominal oblique. No tracer uptake was observed in the psoas major. The frequency of radiotracer uptake in the remaining examined muscles was between those of abdominal oblique and psoas major muscles. CONCLUSIONS Radiotracer uptake was often detectable in some skeletal trunk muscles of ATTR-CA, although the muscles of patients examined and the skeletal trunk muscles of 1 patient showed heterogeneity in the uptake of 99mTc-PYP.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Sohei Kitazawa
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Ehime
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
9
|
Characteristics of Patients with Hereditary Transthyretin Amyloidosis-Polyneuropathy (ATTRv-PN) in NEURO-TTRansform, an Open-label Phase 3 Study of Eplontersen. Neurol Ther 2022; 12:267-287. [PMID: 36525140 PMCID: PMC9837340 DOI: 10.1007/s40120-022-00414-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Hereditary transthyretin (ATTRv) amyloidosis is a rare, severe, progressive, debilitating, and ultimately fatal disease caused by systemic deposition of transthyretin (TTR) amyloid fibrils. ATTRv amyloidosis occurs in both males and females. Eplontersen (ION-682884), a ligand-conjugated antisense oligonucleotide designed to degrade hepatic TTR mRNA, is being evaluated for the treatment of ATTRv amyloidosis with polyneuropathy (ATTRv-PN) in the phase 3, international, multicenter, open-label NEURO-TTRansform study (NCT04136184). To describe the study population of this pivotal trial, here we report the baseline characteristics of patients enrolled in the NEURO-TTRansform study. METHODS Patients eligible for NEURO-TTRansform were 18-82 years old with a diagnosis of ATTRv-PN and Coutinho stage 1 (ambulatory without assistance) or stage 2 (ambulatory with assistance) disease; documented TTR gene variant; signs and symptoms consistent with neuropathy associated with ATTRv; no prior liver transplant; and New York Heart Association (NYHA) functional class I or II. RESULTS The NEURO-TTRansform study enrolled 168 patients across 15 countries/territories (North America, 15.5%; Europe, 38.1%; South America/Australia/Asia, 46.4%). At baseline, the study cohort had a mean age of 52.8 years, 69.0% of patients were male, and 78.0% of patients were White. The V30M variant was most prevalent (60.1% of patients), and prevalence varied by region. Overall, 56.5% and 17.3% of patients had received previous treatment with tafamidis or diflunisal, respectively. A majority of patients (79.2%) had Coutinho stage 1 disease (unimpaired ambulation) and early (before age 50) disease onset (53.0%). Time from diagnosis to enrollment was 46.6 (57.4) months (mean [standard deviation]). Most patients had a baseline polyneuropathy disability (PND) score of I (40.5%) or II (41.1%), and the mean modified Neuropathy Impairment Score + 7 (mNIS + 7) was 79.0. CONCLUSION The recruited population in the ongoing NEURO-TTRansform study has global representation characteristic of contemporary clinical practice. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04136184.
Collapse
|
10
|
Hereditary Transthyretin-Related Amyloidosis: Genetic Heterogeneity and Early Personalized Gene Therapy. Biomedicines 2022; 10:biomedicines10102394. [PMID: 36289657 PMCID: PMC9598525 DOI: 10.3390/biomedicines10102394] [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: 08/30/2022] [Revised: 09/14/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
Point mutations of the transthyretin (TTR) gene are related with hereditary amyloidosis (hATTR). The number of people affected by this rare disease is only partially estimated. The real impact of somatic mosaicism and other genetic factors on expressivity, complexity, progression, and transmission of the disease should be better investigated. The relevance of this rare disease is increasing and many efforts have been made to improve the time to diagnosis and to estimate the real number of cases in endemic and non-endemic areas. In this context, somatic mosaicism should be better investigated to explain the complexity of the heterogeneity of the hATTR clinical features, to better estimate the number of new cases, and to focus on early and personalized gene therapy. Gene therapy can potentially improve the living conditions of affected individuals and is one of the central goals in research on amyloidosis related to the TTR gene, with the advantage of overcoming liver transplantation as the sole treatment for hATTR disease.
Collapse
|
11
|
The hydrophobic residue Leu73 is crucial for the high stability and low aggregation properties of murine transthyretin. Biochem J 2022; 479:1999-2011. [PMID: 36098398 DOI: 10.1042/bcj20220203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022]
Abstract
Destabilization of human transthyretin leads to its aggregation into amyloid fibrils, which causes a rare, progressive and fatal systemic disorder called ATTR amyloidosis. By contrast, murine transthyretin is known to be very stable and therefore does not aggregate into amyloid fibrils in vivo or in vitro. We examined the hydrophobic residues responsible for the high-stability and low-aggregation properties of murine transthyretin using site-directed mutagenesis. Urea-induced unfolding and thioflavin T fluorescence aggregation assay revealed that Leu73 of murine transthyretin largely contributes to its high stability and low aggregation properties: the I73L mutation stabilized human transthyretin, while the L73I mutation destabilized murine transthyretin. In addition, the I26V/I73L mutation stabilized the amyloidogenic V30M mutant of human transthyretin to the same degree as the suppressor mutation T119M, which protects transthyretin against amyloid fibril aggregation. The I73L mutation resulted in no significant differences in the overall structure of the transthyretin tetramer or the contacts of side-chains in the hydrophobic core of the monomer. We also found that Leu73 of murine transthyretin is conserved in many mammals, while Ile73 of human transthyretin is conserved in monkeys and cats. These studies will provide new insights into the stability and aggregation properties of transthyretin from various mammals.
Collapse
|
12
|
Oginezawa S, Ishihara T, Iwafuchi Y, Hatano Y, Kashimura K, Onodera O. [ATTRv amyloidosis with early improvement demonstrated by the 6-minute walk test following Patisiran therapy: a case report]. Rinsho Shinkeigaku 2022; 62:375-379. [PMID: 35474286 DOI: 10.5692/clinicalneurol.cn-001693] [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: 06/14/2023]
Abstract
We report the case of a 65-year-old man who gradually developed numbness in both hands, lower limb muscle weakness and atrophy, and orthostatic hypotension over two and a half years. These symptoms indicated hereditary ATTR amyloidosis (ATTRv amyloidosis), and the final diagnosis was established through proof of TTR gene mutation (V30M). We initiated patisiran therapy, and a continuous 6-minute walking test performed 3 weeks from the start of therapy demonstrated improvement in the walking distance. This is a single case report showing the improvement in the motor and sensory function on administration of patisiran monotherapy from an early stage.
Collapse
Affiliation(s)
- Shinya Oginezawa
- Department of Neurology, Brain Research Institute, Niigata University
| | - Tomohiko Ishihara
- Department of Neurology, Brain Research Institute, Niigata University
| | - Yohei Iwafuchi
- Department of Neurology, Brain Research Institute, Niigata University
| | - Yuya Hatano
- Department of Neurology, Brain Research Institute, Niigata University
| | - Ken Kashimura
- Department of Cardiology, Niigata University Medical and Dental Hospital
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University
| |
Collapse
|
13
|
Tereshchenko SN, Zhirov IV, Moiseeva OM, Adasheva TV, Ansheles AA, Barbarash OL, Galyavich AS, Gudkova AI, Zateyshchikov DA, Kostareva AA, Nasonova SN, Nedogoda SV, Pecherina TB, Ryzhkova DV, Sergienko VB. Practical guidelines for the diagnosis and treatment of transthyretin amyloid cardiomyopathy (ATTR-CM or transthyretin cardiac amyloidosis). TERAPEVT ARKH 2022; 94:584-595. [DOI: 10.26442/00403660.2022.04.201465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 11/22/2022]
Abstract
This paper summarizes the data from updated international protocols and guidelines for diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM). The invasive and non-invasive diagnosis techniques and their combinations are briefly reviewed; the evidentiary foundations for each diagnostic option and tool are analyzed. The paper describes a customized algorithm for sequential diagnosis and differential diagnosis of patients with suspected ATTR-CM with allowance for the combination of clinical signs and diagnostic findings. Along with the awareness of primary care providers about the red flags of the disease and visualization criteria, as well as providing information to the patients about the possibility of performing therapy of ATTR amyloidosis and the risks of delayed diagnosis, the proposed algorithm enables timely patient routing and prescribing specific treatment.
Collapse
|
14
|
Ueda M. Transthyretin: Its function and amyloid formation. Neurochem Int 2022; 155:105313. [PMID: 35218869 DOI: 10.1016/j.neuint.2022.105313] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/20/2022] [Accepted: 02/20/2022] [Indexed: 10/19/2022]
Abstract
Transthyretin (TTR), which is one of the major amyloidogenic proteins in systemic amyloidosis, forms extracellular amyloid deposits in the systemic organs such as nerves, ligaments, heart, and arterioles, and causes two kinds of systemic amyloidosis, hereditary ATTR (ATTRv) amyloidosis induced by variant TTR and aging-related wild-type ATTR (ATTRwt) amyloidosis. More than 150 different mutations, most of which are amyloidogenic, have been reported in the TTR gene. Since most disease-associated mutations affect TTR tetramer dissociation rates, destabilization of TTR tetramers is widely believed to be a critical step in TTR amyloid formation. Recently, effective disease-modifying therapies such as TTR tetramer stabilizers and TTR gene silencing therapies have been developed for ATTR amyloidosis. This study reviews the clinical phenotypes of ATTR amyloidosis, TTR features, and recent progress in promising therapies for ATTR amyloidosis.
Collapse
Affiliation(s)
- Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-0811, Japan.
| |
Collapse
|
15
|
Ikura H, Kitakata H, Endo J, Moriyama H, Sano M, Tsujikawa H, Sawano M, Masuda T, Ohki T, Ueda M, Kosaki K, Fukuda K. Three patients of transthyretin amyloidosis in a Japanese family with amyloidogenic transthyretin Thr49Ser (p.Thr69Ser) variant. Eur J Med Genet 2022; 65:104451. [PMID: 35149236 DOI: 10.1016/j.ejmg.2022.104451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/20/2022] [Accepted: 02/06/2022] [Indexed: 11/03/2022]
Abstract
Transthyretin (TTR)-related hereditary amyloidosis (ATTRv) is a rare autosomal dominant disorder that is caused by pathogenic missense mutation of the TTR gene. As of today, more than 150 TTR gene variants have been reported to occur as causal mutations. Herein, we present three familial patients of ATTRv caused by the Thr49Ser (p.Thr69Ser) variant, including their phenotypes and penetrance. The first patient was a 68-year-old woman with a history of carpal tunnel syndrome, who was referred to our department with heart failure symptoms. Echocardiography, 99mTechnetium (Tc)-pyrophosphate scintigraphy, and myocardial biopsy confirmed her diagnosis as TTR-related amyloidosis. Genetic testing for the TTR gene was performed, which confirmed the presence of a Thr49Ser (p.Thr69Ser) variant. The second patient, a 45-year-old woman, who was the niece of the first patient, presented with dyspnea on exertion. Her clinical manifestations included cardiac symptoms in addition to polyneuropathy. Similarly, myocardial biopsy showed TTR amyloid deposition within cardiac tissues, and TTR gene sequencing detected the presence of a Thr49Ser (p.Thr69Ser) variant. The final patient was a 42-year-old man, who was the nephew of the first patient, presented with numbness in his hands. Abdominal wall fat pad biopsy showed TTR amyloid deposition, and TTR gene sequencing was performed considering the familial history to confirm the presence of Thr49Ser (p.Thr69Ser) variant. No cardiac symptoms or dysfunctions have been observed yet, but imaging has detected TTR amyloid deposition in the heart. The present three patients with Thr49Ser (p.Thr69Ser) variant showed variation in phenotypes including cardiac and neurological manifestations at a fairly young age. In addition, the familial relationship in this report suggested that this variant is highly penetrant. Early genetic diagnosis due to collecting the genetic information from family medical history may be beneficial to improve patient prognosis via early therapeutic intervention.
Collapse
Affiliation(s)
- Hidehiko Ikura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Kitakata
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Jin Endo
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
| | - Hidenori Moriyama
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Motoaki Sano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hanako Tsujikawa
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Teruaki Masuda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takahiro Ohki
- Department of Cardiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenjiro Kosaki
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
16
|
Koutsis G, Kastritis E, Kontogeorgiou Z, Kartanou C, Kokotis P, Rentzos M, Breza M, Kleopa KA, Christodoulou K, Oikonomou E, Anastasakis A, Angelidakis P, Sarmas I, Kargiotis O, Tzagournissakis M, Zaganas I, Foukarakis E, Sachpekidis V, Papathoma A, Panas M, Stefanis L, Dimopoulos MA, Karadima G. Variant transthyretin amyloidosis (ATTRv) polyneuropathy in Greece: a broad overview with a focus on non-endemic unexplored regions of the country. Neuromuscul Disord 2021; 31:1251-1258. [PMID: 34740514 DOI: 10.1016/j.nmd.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
Comprehensive data on variant transthyretin amyloidosis polyneuropathy (ATTRv-PN) in Greece are lacking. We presently provide an overview of ATTRv-PN in Greece, focusing on unexplored non-endemic regions of the country. In total, we identified 57 cases of ATTRv-PN diagnosed over the past 25 years, including 30 from the island of Crete, an apparent endemic region. Patients carried 10 different TTR mutations (C10R; P24S; V30M; R34G; R34T; I68L; A81T; E89Q; E89K and V94A). Carriers of the common V30M mutation constituted 54.3 % of the cohort. A known founder effect for the V30M mutation was present on the island of Crete. Non-endemic cases identified outside the island of Crete are presently reported in more detail. The age of onset ranged from 25 to 77 years, with a mean of 51.1 years. A mean diagnostic delay of 3.2 years was observed. V30M patients had earlier onset and less cardiac involvement than patients carrying other mutations. Genotype-phenotype correlations were largely consistent with published data. We conclude that, with the exception of the Cretan cluster, ATTRv-PN is not endemic in the Greek population. This makes timely diagnosis more challenging, yet absolutely essential given the availability of therapies that can alter the long-term course of the disease.
Collapse
Affiliation(s)
- Georgios Koutsis
- Neurogenetics Unit, 1st Department of Neurology, Eginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece;.
| | - Efstathios Kastritis
- Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoi Kontogeorgiou
- Neurogenetics Unit, 1st Department of Neurology, Eginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrisoula Kartanou
- Neurogenetics Unit, 1st Department of Neurology, Eginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Kokotis
- 1st Department of Neurology, Eginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Rentzos
- 1st Department of Neurology, Eginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianthi Breza
- Neurogenetics Unit, 1st Department of Neurology, Eginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kleopas A Kleopa
- Department of Neuroscience and Center for Neuromuscular Disorders, The Cyprus Institute of Neurology and Genetics and Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | - Kyproula Christodoulou
- Neurogenetics Department, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Evangelos Oikonomou
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Athens, Greece
| | | | - Ioannis Sarmas
- Neurosurgical Institute, University of Ioannina School of Medicine, Ioannina, Greece; Department of Neurology, University Hospital of Ioannina, Ioannina, Greece
| | | | | | - Ioannis Zaganas
- Neurology Department, University Hospital of Crete, Heraklion, Crete, Greece
| | - Emmanouil Foukarakis
- Department of Cardiology, "Venizeleio" General Hospital of Heraklion, Heraklion, Crete, Greece
| | | | | | - Marios Panas
- Neurogenetics Unit, 1st Department of Neurology, Eginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Eginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios Athanasios Dimopoulos
- Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Karadima
- Neurogenetics Unit, 1st Department of Neurology, Eginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
17
|
Ichimata S, Hata Y, Nishida N. Effects of sporadic transthyretin amyloidosis frequently on the gallbladder and the correlation between amyloid deposition in the gallbladder and heart: A forensic autopsy-based histopathological evaluation. Pathol Int 2021; 71:530-537. [PMID: 34154032 DOI: 10.1111/pin.13127] [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: 04/14/2021] [Accepted: 05/14/2021] [Indexed: 11/30/2022]
Abstract
The aim of the study is to evaluate the clinicopathological features of cholecystic ATTR deposition in patients with cardiac involvement, investigate the correlation of amyloid deposition severity in the gallbladder and the heart, and compare its prevalence in the gallbladder and other organs. Fifty patients with sporadic ATTR amyloidosis were identified. Of these, we evaluated 15 patients who underwent gallbladder sampling accurately. Among 10 patients (67%) with cholecystic deposition, six exhibited detectable deposition in the hematoxylin and eosin-stained specimens, and all of them displayed obstructive vascular deposition (VD). The severity of gall bladder VD was statistically correlated with that of cardiac VD and atrial interstitial deposition (ID). Additionally, all patients exhibiting cholecystic ID displayed severe ventricular and atrial IDs. In visceral organs excluding the heart, amyloid deposition was commonly observed in the lungs (93%), followed by the gastrointestinal tract (47%-80%), liver (60%) and periosteal tissues (53%). The involvement of the gallbladder was prevalent and comparable to that of the gastrointestinal tract. Moreover, the severity of cholecystic deposition was correlated with that of cardiac deposition. Therefore, pathologists should be aware that sporadic ATTR amyloidosis is a common condition and should not be overlooked.
Collapse
Affiliation(s)
- Shojiro Ichimata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yukiko Hata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Naoki Nishida
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| |
Collapse
|
18
|
Ichimata S, Hata Y, Hirono K, Yamaguchi Y, Nishida N. Clinicopathological features of clinically undiagnosed sporadic transthyretin cardiac amyloidosis: a forensic autopsy-based series. Amyloid 2021; 28:125-133. [PMID: 33554665 DOI: 10.1080/13506129.2021.1882979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the clinicopathological features of sporadic amyloid transthyretin (ATTR) amyloidosis. METHODS We evaluated 1698 serial Japanese forensic autopsy patients. The extent and amount of ATTR deposition in the 16 cardiac regions, including the conduction system, were semiquantitatively evaluated. Ward's hierarchical cluster analysis was applied to classify the cases into subgroups. Also, the relationship between ATTR and amyloid atrial natriuretic factor (AANF) was evaluated. RESULTS Forty-four cardiac ATTR amyloidosis patients (mean age 85.4 ± 5.7 years; 22 men) without history of hereditary polyneuropathy were identified (2.6% of all patients, 8.8% of those aged ≥80 years). All the 44 patients were not in the bedridden state and died-out-of-hospital scenarios. Of these, 10 (23%) were sudden death. Cluster analysis classified the patients into three groups (mild, atria-predominant and the severe deposition group). Amyloid deposition had already started simultaneously from each atrium and ventricle; however, the atrial septum and basilar ventricular septum were the sites that revealed the most frequent deposition. Also, a possible association between ATTR and AANF deposits was identified. CONCLUSIONS Sporadic ATTR amyloidosis patients might already be susceptible to a risk for sudden death even from an early-phase. Also, ATTR amyloid deposition in such cases might progress with a certain degree of regularity.
Collapse
Affiliation(s)
- Shojiro Ichimata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yukiko Hata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | - Naoki Nishida
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| |
Collapse
|
19
|
Clinical and genetic features of transthyretin-related familial amyloid polyneuropathy in China. Chin Med J (Engl) 2021; 133:2616-2618. [PMID: 32925285 PMCID: PMC7722615 DOI: 10.1097/cm9.0000000000001094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
|
20
|
Du K, Li F, Wang H, Miao Y, Lv H, Zhang W, Wang Z, Yuan Y, Meng L. Hereditary transthyretin amyloidosis in mainland China: a unicentric retrospective study. Ann Clin Transl Neurol 2021; 8:831-841. [PMID: 33739616 PMCID: PMC8045954 DOI: 10.1002/acn3.51328] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/31/2021] [Accepted: 02/06/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE This study aims to report the genotypes and phenotypes of hereditary transthyretin amyloidosis (ATTR) in a large Chinese cohort, yet the clinical and genetic profiles of ATTR remain elusive in mainland China. METHODS Fifty-four patients with molecularly confirmed ATTR from 39 unrelated families were identified by sequencing the TTR gene. Sural nerve biopsies were performed in 40 of these cases. The clinical and electrophysiological data were retrospectively collected and analyzed. RESULTS The male/female ratio was 42:12. The average age of patients at the onset of the disease was 47.8 ± 13.0 years. The late-onset type occurred in 29 cases (53.7%). Twenty-two probands (56.4%) had a family history with ATTR. The initial symptoms were limb paresthesia in 33 cases (61.1%), autonomic dysfunction in 15 cases (27.8%), and blurred vision in 6 cases (11.1%). A total of 22 different TTR mutations were identified, including Val30Met (25.6%) in 10 families in North China and Ala97Ser in 4 families (10.3%) in South China. Electrophysiological studies revealed general sensorimotor axonal polyneuropathy in 33/44 cases (75.0%), mixed neuropathy with axonal and demyelinating impairment features in 9/44 cases (20.5%) and isolated carpal tunnel syndrome in two cases. Sural nerve biopsies revealed positive Congo red staining in 16/40 cases (40.0%). CONCLUSION Chinese patients with ATTR exhibited heterogeneous TTR genotypes and clinical phenotypes. Val30Met remains the most common mutation type in mainland China.
Collapse
Affiliation(s)
- Kang Du
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - Fan Li
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - Hui Wang
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - Yuanfeng Miao
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - He Lv
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - Wei Zhang
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - Zhaoxia Wang
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - Yun Yuan
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| | - Lingchao Meng
- Department of NeurologyPeking University First Hospital8 Xishiku StreetXicheng DistrictBeijing100034China
| |
Collapse
|
21
|
Burton A, Castaño A, Bruno M, Riley S, Schumacher J, Sultan MB, See Tai S, Judge DP, Patel JK, Kelly JW. Drug Discovery and Development in Rare Diseases: Taking a Closer Look at the Tafamidis Story. Drug Des Devel Ther 2021; 15:1225-1243. [PMID: 33776421 PMCID: PMC7987260 DOI: 10.2147/dddt.s289772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/20/2021] [Indexed: 12/25/2022] Open
Abstract
Rare diseases are increasingly recognized as a global public health priority. Governments worldwide currently provide important incentives to stimulate the discovery and development of orphan drugs for the treatment of these conditions, but substantial scientific, clinical, and regulatory challenges remain. Tafamidis is a first-in-class, disease-modifying transthyretin (TTR) kinetic stabilizer that represents a major breakthrough in the treatment of transthyretin amyloidosis (ATTR amyloidosis). ATTR amyloidosis is a rare, progressive, and fatal systemic disorder caused by aggregation of misfolded TTR and extracellular deposition of amyloid fibrils in various tissues and organs, including the heart and nervous systems. In this review, we present the successful development of tafamidis spanning 3 decades, marked by meticulous laboratory research into disease mechanisms and natural history, and innovative clinical study design and implementation. These efforts established the safety and efficacy profile of tafamidis, leading to its regulatory approval, and enabled post-approval initiatives that further support patients with ATTR amyloidosis.
Collapse
Affiliation(s)
| | | | | | - Steve Riley
- Clinical Pharmacology, Pfizer Inc, Groton, CT, USA
| | | | - Marla B Sultan
- Global Product Development, Pfizer Inc, New York, NY, USA
| | - Sandi See Tai
- Global Product Development, Pfizer Inc, Collegeville, PA, USA
| | - Daniel P Judge
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jignesh K Patel
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Jeffery W Kelly
- Department of Chemistry, The Scripps Research Institute, La Jolla, CA, USA
| |
Collapse
|
22
|
Dohrn MF, Auer-Grumbach M, Baron R, Birklein F, Escolano-Lozano F, Geber C, Grether N, Hagenacker T, Hund E, Sachau J, Schilling M, Schmidt J, Schulte-Mattler W, Sommer C, Weiler M, Wunderlich G, Hahn K. Chance or challenge, spoilt for choice? New recommendations on diagnostic and therapeutic considerations in hereditary transthyretin amyloidosis with polyneuropathy: the German/Austrian position and review of the literature. J Neurol 2020; 268:3610-3625. [PMID: 32500375 PMCID: PMC8463516 DOI: 10.1007/s00415-020-09962-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023]
Abstract
Hereditary transthyretin amyloidosis is caused by pathogenic variants (ATTRv) in the TTR gene. Alongside cardiac dysfunction, the disease typically manifests with a severely progressive sensorimotor and autonomic polyneuropathy. Three different drugs, tafamidis, patisiran, and inotersen, are approved in several countries, including the European Union and the United States of America. By stabilizing the TTR protein or degrading its mRNA, all types of treatment aim at preventing amyloid deposition and stopping the otherwise fatal course. Therefore, it is of utmost importance to recognize both onset and progression of neuropathy as early as possible. To establish recommendations for diagnostic and therapeutic procedures in the follow-up of both pre-symptomatic mutation carriers and patients with manifest ATTRv amyloidosis with polyneuropathy, German and Austrian experts elaborated a harmonized position. This paper is further based on a systematic review of the literature. Potential challenges in the early recognition of disease onset and progression are the clinical heterogeneity and the subjectivity of sensory and autonomic symptoms. Progression cannot be defined by a single test or score alone but has to be evaluated considering various disease aspects and their dynamics over time. The first-line therapy should be chosen based on individual symptom constellations and contra-indications. If symptoms worsen, this should promptly implicate to consider optimizing treatment. Due to the rareness and variability of ATTRv amyloidosis, the clinical course is most importantly directive in doubtful cases. Therefore, a systematic follow-up at an experienced center is crucial to identify progression and reassure patients and carriers.
Collapse
Affiliation(s)
- Maike F Dohrn
- Neuromuscular Outpatient Clinic, Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Michaela Auer-Grumbach
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Frank Birklein
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Fabiola Escolano-Lozano
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Christian Geber
- Department of Neurology, Red Cross Pain Centre Mainz, Mainz, Germany
| | - Nicolai Grether
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Tim Hagenacker
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Ernst Hund
- Amyloidosis Center Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Schilling
- Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Münster, Germany
| | - Jens Schmidt
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Wilhelm Schulte-Mattler
- Department of Psychiatry and Psychotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Markus Weiler
- Amyloidosis Center Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gilbert Wunderlich
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Rare Diseases, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Katrin Hahn
- Department of Neurology, Charité University Medicine, Berlin, Germany
| |
Collapse
|
23
|
González-Duarte A, Conceição I, Amass L, Botteman MF, Carter JA, Stewart M. Impact of Non-Cardiac Clinicopathologic Characteristics on Survival in Transthyretin Amyloid Polyneuropathy. Neurol Ther 2020; 9:135-149. [PMID: 32232748 PMCID: PMC7229108 DOI: 10.1007/s40120-020-00183-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Hereditary (variant) transthyretin amyloidosis (ATTRv) with polyneuropathy (ATTR-PN) is a rare genetic disorder that causes progressive autonomic and sensorimotor neuropathy, severe disability, and death within 10 years of onset. Previous studies have primarily focused on how baseline cardiac characteristics affect mortality, but the impact of non-cardiac baseline characteristics is less defined. METHODS We systematically searched PubMed/Medline (1990-2019) to identify studies that assessed the impact of baseline ATTR-PN characteristics on survival. Outcomes were first summarized descriptively. Extracted survival data were then disaggregated, and parametric mixture models were used to assess survival differences among patient groups defined by factors known to affect survival. RESULTS The search yielded 1193 records, of which 35 were retained for analysis. Median survival ranged from 0.5 to > 25 years. The largest survival differences were between cohorts who underwent liver transplantation (LTx) versus those who did not. Among LTx cohorts, pre-LTx ATTR-PN disease duration ≥ 7 years, poor nutritional status, and late disease onset reduced median survival by 13, 12, and 10 years, respectively. Other prognostic survival factors included non-Val30Met genotype and baseline presence of urinary incontinence, erectile dysfunction, or muscle weakness. CONCLUSION Survival in patients with ATTR-PN is highly variable and affected by non-cardiac baseline characteristics, such as autonomic dysfunction, large fiber involvement, late-onset disease, and non-Val30Met mutation. Careful interpretation of these findings is warranted given that this synthesis did not control for differences between studies. Survival in patients with ATTR-PN remains poor among those who are untreated or with delayed diagnosis.
Collapse
Affiliation(s)
| | - Isabel Conceição
- Department of Neurosciences and Mental Health, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte (CHULN), Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | | | | | | |
Collapse
|
24
|
Expert consensus recommendations to improve diagnosis of ATTR amyloidosis with polyneuropathy. J Neurol 2020; 268:2109-2122. [PMID: 31907599 PMCID: PMC8179912 DOI: 10.1007/s00415-019-09688-0] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022]
Abstract
Amyloid transthyretin (ATTR) amyloidosis with polyneuropathy (PN) is a progressive, debilitating, systemic disease wherein transthyretin protein misfolds to form amyloid, which is deposited in the endoneurium. ATTR amyloidosis with PN is the most serious hereditary polyneuropathy of adult onset. It arises from a hereditary mutation in the TTR gene and may involve the heart as well as other organs. It is critical to identify and diagnose the disease earlier because treatments are available to help slow the progression of neuropathy. Early diagnosis is complicated, however, because presentation may vary and family history is not always known. Symptoms may be mistakenly attributed to other diseases such as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), idiopathic axonal polyneuropathy, lumbar spinal stenosis, and, more rarely, diabetic neuropathy and AL amyloidosis. In endemic countries (e.g., Portugal, Japan, Sweden, Brazil), ATTR amyloidosis with PN should be suspected in any patient who has length-dependent small-fiber PN with autonomic dysfunction and a family history of ATTR amyloidosis, unexplained weight loss, heart rhythm disorders, vitreous opacities, or renal abnormalities. In nonendemic countries, the disease may present as idiopathic rapidly progressive sensory motor axonal neuropathy or atypical CIDP with any of the above symptoms or with bilateral carpal tunnel syndrome, gait disorders, or cardiac hypertrophy. Diagnosis should include DNA testing, biopsy, and amyloid typing. Patients should be followed up every 6–12 months, depending on the severity of the disease and response to therapy. This review outlines detailed recommendations to improve the diagnosis of ATTR amyloidosis with PN.
Collapse
|
25
|
Misumi Y, Ueda M, Masuda T, Tsuda Y, Nomura T, Okada M, Inoue Y, Tasaki M, Obayashi K, Yamashita T, Ando Y. Characteristics of acquired transthyretin amyloidosis: A case series and review of the literature. Neurology 2019; 93:e1587-e1596. [PMID: 31511348 DOI: 10.1212/wnl.0000000000008360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/16/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To elucidate the clinical characteristics of acquired ATTR amyloidosis after domino liver transplantation (DLT) with liver grafts explanted from patients with hereditary variant ATTR (ATTRv) amyloidosis. METHODS We evaluated the presence of amyloid deposits and clinical symptoms in 30 recipients of domino liver transplants (24 men and 6 women) who underwent DLT with liver grafts explanted from patients with ATTRv amyloidosis. We analyzed symptoms and measures of 7 cases of symptomatic acquired ATTR amyloidosis and compared those with 30 patients with ATTRv amyloidosis who were the domino liver donors. We also reviewed the literature on case studies of acquired ATTR amyloidosis. RESULTS We found amyloid deposition in 13 of our 30 domino liver recipients. A Kaplan-Meier analysis estimated that the median time from DLT to the first detection of amyloid was 8.5 years. In the literature review, the mean time was 7.3 years, with a wide range of 0.5-13 years. Our 7 symptomatic cases and the literature cases with acquired ATTR amyloidosis presented with clinical features that differed from patients with ATTRv amyloidosis who were the domino liver donors. Patients with acquired ATTR amyloidosis showed markedly milder autonomic disturbance, which is one of the main symptoms of ATTRv amyloidosis. CONCLUSIONS Careful monitoring is required for DLT recipients of ATTRv liver grafts because the time from DLT to disease onset has a wide range and the clinical picture of these DLT recipients is distinct from that of liver donors.
Collapse
Affiliation(s)
- Yohei Misumi
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan.
| | - Mitsuharu Ueda
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Teruaki Masuda
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Yukimoto Tsuda
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Toshiya Nomura
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Masamitsu Okada
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Yasuteru Inoue
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Masayoshi Tasaki
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Konen Obayashi
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Taro Yamashita
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Yukio Ando
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| |
Collapse
|
26
|
Yamashita T, Ueda M, Nomura T, Okazaki T, Okada M, Tsuda Y, Inoue Y, Masuda T, Misumi Y, Takamatsu K, Obayashi K, Inomata Y, Hibi T, Ando Y. Natural history and long-term effects of variant protein reduction in non-V30M ATTR amyloidosis. Neurology 2019; 93:714-716. [PMID: 31562191 DOI: 10.1212/wnl.0000000000008320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 07/23/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Taro Yamashita
- From the Department of Neurology (T.Y., M.U., T.N., T.O., M.O., Y.T., Y. Inoue, T.M., Y.M., K.T., Y.A.), Graduate School of Medical Sciences, Kumamoto University; Amyloidosis Medical Practice Center (T.Y.), Kumamoto University Hospital; Department of Morphological and Physiological Sciences (K.O., T.H.), Graduate School of Medical Sciences, Kumamoto University; and Department of Transplantation and Pediatric Surgery (Y. Inomata), Graduate School of Medical Sciences, Kumamoto University, Japan.
| | - Mitsuharu Ueda
- From the Department of Neurology (T.Y., M.U., T.N., T.O., M.O., Y.T., Y. Inoue, T.M., Y.M., K.T., Y.A.), Graduate School of Medical Sciences, Kumamoto University; Amyloidosis Medical Practice Center (T.Y.), Kumamoto University Hospital; Department of Morphological and Physiological Sciences (K.O., T.H.), Graduate School of Medical Sciences, Kumamoto University; and Department of Transplantation and Pediatric Surgery (Y. Inomata), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Toshiya Nomura
- From the Department of Neurology (T.Y., M.U., T.N., T.O., M.O., Y.T., Y. Inoue, T.M., Y.M., K.T., Y.A.), Graduate School of Medical Sciences, Kumamoto University; Amyloidosis Medical Practice Center (T.Y.), Kumamoto University Hospital; Department of Morphological and Physiological Sciences (K.O., T.H.), Graduate School of Medical Sciences, Kumamoto University; and Department of Transplantation and Pediatric Surgery (Y. Inomata), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Takahiro Okazaki
- From the Department of Neurology (T.Y., M.U., T.N., T.O., M.O., Y.T., Y. Inoue, T.M., Y.M., K.T., Y.A.), Graduate School of Medical Sciences, Kumamoto University; Amyloidosis Medical Practice Center (T.Y.), Kumamoto University Hospital; Department of Morphological and Physiological Sciences (K.O., T.H.), Graduate School of Medical Sciences, Kumamoto University; and Department of Transplantation and Pediatric Surgery (Y. Inomata), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Masamitsu Okada
- From the Department of Neurology (T.Y., M.U., T.N., T.O., M.O., Y.T., Y. Inoue, T.M., Y.M., K.T., Y.A.), Graduate School of Medical Sciences, Kumamoto University; Amyloidosis Medical Practice Center (T.Y.), Kumamoto University Hospital; Department of Morphological and Physiological Sciences (K.O., T.H.), Graduate School of Medical Sciences, Kumamoto University; and Department of Transplantation and Pediatric Surgery (Y. Inomata), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Yukimoto Tsuda
- From the Department of Neurology (T.Y., M.U., T.N., T.O., M.O., Y.T., Y. Inoue, T.M., Y.M., K.T., Y.A.), Graduate School of Medical Sciences, Kumamoto University; Amyloidosis Medical Practice Center (T.Y.), Kumamoto University Hospital; Department of Morphological and Physiological Sciences (K.O., T.H.), Graduate School of Medical Sciences, Kumamoto University; and Department of Transplantation and Pediatric Surgery (Y. Inomata), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Yasuteru Inoue
- From the Department of Neurology (T.Y., M.U., T.N., T.O., M.O., Y.T., Y. Inoue, T.M., Y.M., K.T., Y.A.), Graduate School of Medical Sciences, Kumamoto University; Amyloidosis Medical Practice Center (T.Y.), Kumamoto University Hospital; Department of Morphological and Physiological Sciences (K.O., T.H.), Graduate School of Medical Sciences, Kumamoto University; and Department of Transplantation and Pediatric Surgery (Y. Inomata), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Teruaki Masuda
- From the Department of Neurology (T.Y., M.U., T.N., T.O., M.O., Y.T., Y. Inoue, T.M., Y.M., K.T., Y.A.), Graduate School of Medical Sciences, Kumamoto University; Amyloidosis Medical Practice Center (T.Y.), Kumamoto University Hospital; Department of Morphological and Physiological Sciences (K.O., T.H.), Graduate School of Medical Sciences, Kumamoto University; and Department of Transplantation and Pediatric Surgery (Y. Inomata), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Yohei Misumi
- From the Department of Neurology (T.Y., M.U., T.N., T.O., M.O., Y.T., Y. Inoue, T.M., Y.M., K.T., Y.A.), Graduate School of Medical Sciences, Kumamoto University; Amyloidosis Medical Practice Center (T.Y.), Kumamoto University Hospital; Department of Morphological and Physiological Sciences (K.O., T.H.), Graduate School of Medical Sciences, Kumamoto University; and Department of Transplantation and Pediatric Surgery (Y. Inomata), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Kotaro Takamatsu
- From the Department of Neurology (T.Y., M.U., T.N., T.O., M.O., Y.T., Y. Inoue, T.M., Y.M., K.T., Y.A.), Graduate School of Medical Sciences, Kumamoto University; Amyloidosis Medical Practice Center (T.Y.), Kumamoto University Hospital; Department of Morphological and Physiological Sciences (K.O., T.H.), Graduate School of Medical Sciences, Kumamoto University; and Department of Transplantation and Pediatric Surgery (Y. Inomata), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Konen Obayashi
- From the Department of Neurology (T.Y., M.U., T.N., T.O., M.O., Y.T., Y. Inoue, T.M., Y.M., K.T., Y.A.), Graduate School of Medical Sciences, Kumamoto University; Amyloidosis Medical Practice Center (T.Y.), Kumamoto University Hospital; Department of Morphological and Physiological Sciences (K.O., T.H.), Graduate School of Medical Sciences, Kumamoto University; and Department of Transplantation and Pediatric Surgery (Y. Inomata), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Yukihiro Inomata
- From the Department of Neurology (T.Y., M.U., T.N., T.O., M.O., Y.T., Y. Inoue, T.M., Y.M., K.T., Y.A.), Graduate School of Medical Sciences, Kumamoto University; Amyloidosis Medical Practice Center (T.Y.), Kumamoto University Hospital; Department of Morphological and Physiological Sciences (K.O., T.H.), Graduate School of Medical Sciences, Kumamoto University; and Department of Transplantation and Pediatric Surgery (Y. Inomata), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Taizo Hibi
- From the Department of Neurology (T.Y., M.U., T.N., T.O., M.O., Y.T., Y. Inoue, T.M., Y.M., K.T., Y.A.), Graduate School of Medical Sciences, Kumamoto University; Amyloidosis Medical Practice Center (T.Y.), Kumamoto University Hospital; Department of Morphological and Physiological Sciences (K.O., T.H.), Graduate School of Medical Sciences, Kumamoto University; and Department of Transplantation and Pediatric Surgery (Y. Inomata), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Yukio Ando
- From the Department of Neurology (T.Y., M.U., T.N., T.O., M.O., Y.T., Y. Inoue, T.M., Y.M., K.T., Y.A.), Graduate School of Medical Sciences, Kumamoto University; Amyloidosis Medical Practice Center (T.Y.), Kumamoto University Hospital; Department of Morphological and Physiological Sciences (K.O., T.H.), Graduate School of Medical Sciences, Kumamoto University; and Department of Transplantation and Pediatric Surgery (Y. Inomata), Graduate School of Medical Sciences, Kumamoto University, Japan
| |
Collapse
|
27
|
Koike H, Fukami Y, Nishi R, Kawagashira Y, Iijima M, Sobue G, Katsuno M. Clinicopathological spectrum and recent advances in the treatment of hereditary transthyretin amyloidosis. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/ncn3.12306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Haruki Koike
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Yuki Fukami
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Ryoji Nishi
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Yuichi Kawagashira
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Masahiro Iijima
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Gen Sobue
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
- Research Division of Dementia and Neurodegenerative Disease Nagoya University Graduate School of Medicine Nagoya Japan
| | - Masahisa Katsuno
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| |
Collapse
|
28
|
Ultrastructure in Transthyretin Amyloidosis: From Pathophysiology to Therapeutic Insights. Biomedicines 2019; 7:biomedicines7010011. [PMID: 30764529 PMCID: PMC6466231 DOI: 10.3390/biomedicines7010011] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/20/2019] [Accepted: 01/24/2019] [Indexed: 01/04/2023] Open
Abstract
Transthyretin (TTR) amyloidosis is caused by systemic deposition of wild-type or variant amyloidogenic TTR (ATTRwt and ATTRv, respectively). ATTRwt amyloidosis has traditionally been termed senile systemic amyloidosis, while ATTRv amyloidosis has been called familial amyloid polyneuropathy. Although ATTRwt amyloidosis has classically been regarded as one of the causes of cardiomyopathy occurring in the elderly population, recent developments in diagnostic techniques have significantly expanded the concept of this disease. For example, this disease is now considered an important cause of carpal tunnel syndrome in the elderly population. The phenotypes of ATTRv amyloidosis also vary depending on the mutation and age of onset. Peripheral neuropathy usually predominates in patients from the conventional endemic foci, while cardiomyopathy or oculoleptomeningeal involvement may also become major problems in other patients. Electron microscopic studies indicate that the direct impact of amyloid fibrils on surrounding tissues leads to organ damage, whereas accumulating evidence suggests that nonfibrillar TTR, such as oligomeric TTR, is toxic, inducing neurodegeneration. Microangiopathy has been suggested to act as an initial lesion, increasing the leakage of circulating TTR. Regarding treatments, the efficacy of liver transplantation has been established for ATTRv amyloidosis patients, particularly patients with early-onset amyloidosis. Recent phase III clinical trials have shown the efficacy of TTR stabilizers, such as tafamidis and diflunisal, for both ATTRwt and ATTRv amyloidosis patients. In addition, a short interfering RNA (siRNA), patisiran, and an antisense oligonucleotide (ASO), inotersen, have been shown to be effective for ATTRv amyloidosis patients. Given their ability to significantly reduce the production of both wild-type and variant TTR in the liver, these gene-silencing drugs seem to be the optimal therapeutic option for ATTR amyloidosis. Hence, the long-term efficacy and tolerability of novel therapies, particularly siRNA and ASO, must be determined to establish an appropriate treatment program.
Collapse
|
29
|
Yamashita T, Ohnishi K, Ueda M, Masuda T, Inoue Y, Misumi Y, Ueda A, Obayashi K, Takeya M, Ando Y. Transthyretin amyloid-related cerebral angiitis after liver transplantation. Amyloid 2019; 26:11-12. [PMID: 31343330 DOI: 10.1080/13506129.2019.1583179] [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)
- Taro Yamashita
- a Department of Neurology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan.,b Amyloidosis Medical Practice Center, Kumamoto University Hospital , Kumamoto , Japan
| | - Koji Ohnishi
- c Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Mitsuharu Ueda
- a Department of Neurology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Teruaki Masuda
- a Department of Neurology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Yasuteru Inoue
- a Department of Neurology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Yohei Misumi
- a Department of Neurology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Akihiko Ueda
- a Department of Neurology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Konen Obayashi
- d Department of Morphological and Physiological Sciences, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Motohiro Takeya
- c Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Yukio Ando
- a Department of Neurology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| |
Collapse
|
30
|
Tsuda Y, Yamanaka K, Toyoshima R, Ueda M, Masuda T, Misumi Y, Ogura T, Ando Y. Development of transgenic Caenorhabditis elegans expressing human transthyretin as a model for drug screening. Sci Rep 2018; 8:17884. [PMID: 30552363 PMCID: PMC6294829 DOI: 10.1038/s41598-018-36357-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/19/2018] [Indexed: 01/09/2023] Open
Abstract
Familial amyloid polyneuropathy is a hereditary systemic amyloidosis caused by a mutation in the transthyretin (TTR) gene. Amyloid deposits in tissues of patients contain not only full-length TTR but also C-terminal TTR fragments. However, in vivo models to evaluate the pathogenicity of TTR fragments have not yet been developed. Here, we generated transgenic Caenorhabditis elegans strains expressing several types of TTR fragments or full-length TTR fused to enhanced green fluorescent protein in the body wall muscle cells and analyzed the phenotypes of the worms. The transgenic strain expressing residues 81-127 of TTR, which included the β-strands F and H, formed aggregates and caused defective worm motility and a significantly shortened lifespan compared with other strains. These findings suggest that the C-terminal fragments of TTR may contribute to cytotoxicity of TTR amyloidosis in vivo. By using this C. elegans model system, we found that (-)-epigallocatechin-3-gallate, a major polyphenol in green tea, significantly inhibited the formation of aggregates, the defective motility, and the shortened lifespan caused by residues 81-127 of TTR. These results suggest that our newly developed C. elegans model system will be useful for in vivo pathological analyses of TTR amyloidosis as well as drug screening.
Collapse
Affiliation(s)
- Yukimoto Tsuda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kunitoshi Yamanaka
- Department of Molecular Cell Biology, Institute of Molecular Embryology and Genetics, Kumamoto University, 2-2-1 Honjo, Chuo-ku, Kumamoto, 860-0811, Japan.
| | - Risa Toyoshima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Teruaki Masuda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yohei Misumi
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Teru Ogura
- Department of Molecular Cell Biology, Institute of Molecular Embryology and Genetics, Kumamoto University, 2-2-1 Honjo, Chuo-ku, Kumamoto, 860-0811, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| |
Collapse
|
31
|
Koike H, Nakamura T, Nishi R, Ikeda S, Kawagashira Y, Iijima M, Katsuno M, Sobue G. Widespread Cardiac and Vasomotor Autonomic Dysfunction in Non-Val30Met Hereditary Transthyretin Amyloidosis. Intern Med 2018; 57:3365-3370. [PMID: 29984770 PMCID: PMC6306549 DOI: 10.2169/internalmedicine.1113-18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The autonomic functions of hereditary transthyretin (ATTRm) amyloidosis, traditionally referred to as familial amyloid polyneuropathy, have primarily been investigated in patients with Val30Met mutations, and information regarding non-Val30Met patients is scarce. The aim of this study was to systematically investigate the cardiac and peripheral vasomotor autonomic functions in non-Val30Met patients. Methods The coefficient of variation of R-R intervals (CVR-R), responses to the Valsalva manoeuvre, head-up tilt test results, noradrenaline infusion test results, and the (123) I-metaiodobenzylguanidine (MIBG) uptake on myocardial scintigraphy were assessed in five patients. The predominant manifestations were neuropathy in three patients (Val94Gly, Val71Ala, and Pro24Ser), cardiomyopathy in one (Thr60Ala), and oculoleptomeningeal involvement in one (Tyr114Cys). Results Although one patient with predominant cardiomyopathy did not manifest orthostatic hypotension during the head-up tilt test, the CVR-R, responses to the Valsalva manoeuvre, and myocardial MIBG uptake indicated the presence of cardiac sympathetic and parasympathetic dysfunction in all patients. The total peripheral resistance at 60° tilt did not increase from the baseline values in any of the examined patients. An infusion of low-dose noradrenaline induced an increase in the systolic blood pressure, except in one patient with mild neuropathy. Conclusion Cardiac and peripheral vasomotor autonomic dysfunctions were prevalent in non-Val30Met patients, irrespective of their phenotype, suggesting a common pathology of autonomic involvement. However, the vasoconstrictor function was preserved, even in a patient with advanced neuropathy.
Collapse
Affiliation(s)
- Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Tomohiko Nakamura
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Ryoji Nishi
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Shohei Ikeda
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Yuichi Kawagashira
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Masahiro Iijima
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Gen Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
- Research Division of Dementia and Neurodegenerative Disease, Nagoya University Graduate School of Medicine, Japan
| |
Collapse
|
32
|
Hirakawa K, Takashio S, Marume K, Yamamoto M, Hanatani S, Yamamoto E, Sakamoto K, Izumiya Y, Kaikita K, Oda S, Utsunomiya D, Shiraishi S, Ueda M, Yamashita T, Yamashita Y, Ando Y, Tsujita K. Non-Val30Met mutation, septal hypertrophy, and cardiac denervation in patients with mutant transthyretin amyloidosis. ESC Heart Fail 2018; 6:122-130. [PMID: 30284755 PMCID: PMC6352919 DOI: 10.1002/ehf2.12361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/30/2018] [Accepted: 09/02/2018] [Indexed: 11/20/2022] Open
Abstract
Aims Mutant transthyretin (ATTRm) amyloidosis is a systemic disease caused by the deposition of amyloid fibrils derived from mutated transthyretin. Although cardiac involvement impacts the prognosis of patients with ATTRm amyloidosis, the incidence of cardiac events, such as bradyarrhythmia, ventricular tachycardia, and heart failure, has not been fully elucidated. The aim of this study was to evaluate the prognosis and predictors of clinical outcomes, including cardiac events, in patients with ATTRm amyloidosis in Japan. Methods and results We evaluated 90 consecutive patients with ATTRm amyloidosis at Kumamoto University. ATTRm amyloidosis was diagnosed by the observation of both amyloid fibril deposition on tissue biopsy and a transthyretin mutation on sequential analysis. Sympathetic nerve activity was evaluated in 59 patients using 123‐iodine metaiodobenzylguanidine (123I‐MIBG) imaging. The endpoint was a composite of all‐cause death, hospitalization for heart failure, and implantation of a pacemaker, implantable cardioverter defibrillator, or cardiac resynchronization therapy defibrillator. Sixty‐seven patients had the Val30Met mutation (74%). The composite endpoint occurred in 23 patients (26%): all‐cause death (n = 6), hospitalization for worsening heart failure (n = 1), and implantation of an implantable cardioverter defibrillator (n = 6), cardiac resynchronization therapy defibrillator (n = 3), or pacemaker (n = 7). The 5‐year incident rate for clinical outcomes was 19%. In a multivariate Cox hazard analysis, age [hazard ratio (HR): 1.07, 95% confidence interval (95% CI): 1.01–1.12, P = 0.015], PQ interval (HR: 1.01, 95% CI: 1.00–1.02, P = 0.042), interventricular septum thickness in diastole (HR: 1.25, 95% CI: 1.09–1.42, P = 0.001), and non‐Val30Met mutation (HR: 4.31, 95% CI: 1.53–12.16, P = 0.006) were independent predictive factors of clinical outcomes. Kaplan–Meier analysis demonstrated a significantly higher probability of the composite endpoint in the non‐Val30Met group than in the Val30Met group (log‐rank test: P = 0.002) and in patients with left ventricular hypertrophy than in patients without left ventricular hypertrophy (log‐rank test: P < 0.001). In patients who underwent 123I‐MIBG imaging, a delayed heart‐to‐mediastinum (HM) ratio <1.6 was a significant predictive factor of the composite endpoint (HR: 4.98, 95% CI: 1.73–14.37, P = 0.003) in the univariate Cox hazard analyses. Kaplan–Meier curve analysis showed that a delayed HM ratio <1.6 was associated with a poor prognosis (log‐rank test: P = 0.001). Conclusions Non‐Val30Met mutation, septal hypertrophy, and a delayed HM ratio are useful predictors of clinical outcomes in patients with ATTRm amyloidosis in Japan. These results suggest that it is important to evaluate cardiac involvement in terms of morphological (left ventricular hypertrophy) and functional (cardiac denervation) perspectives using echocardiography and 123I‐MIBG imaging, respectively.
Collapse
Affiliation(s)
- Kyoko Hirakawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kyohei Marume
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masahiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinsuke Hanatani
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinya Shiraishi
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Taro Yamashita
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
33
|
Ueda M, Yamashita T, Misumi Y, Masuda T, Ando Y. Origin of sporadic late-onset hereditary ATTR Val30Met amyloidosis in Japan. Amyloid 2018; 25:143-147. [PMID: 30486687 DOI: 10.1080/13506129.2018.1531842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hereditary transthyretin (ATTRm) amyloidosis, formerly known as familial amyloid polyneuropathy, is a major type of hereditary systemic amyloidosis, in which the disease is caused by mutant transthyretin (TTR). Although more than 140 different point mutations have been identified in the TTR gene, ATTRm amyloidosis patients with the TTR Val30Met mutation are most frequently found worldwide. Interestingly, the onset age of the ATTR Val30Met amyloidosis is highly varied among countries and regions. The reason for these differences in onset age and penetrance remains to be elucidated. We recently performed an epidemiological study to analyze the clinical and genetic characteristics of ATTRm amyloidosis patients in Japan. Our results led us to the following questions: Why did most of the non-endemic patients with the same TTR Val30Met mutation not have a family history of the disease, a typical autosomal dominant hereditary disorder? Why does ATTR Val30Met amyloidosis alone demonstrate foci of occurrence? Why is only this type of ATTRm amyloidosis nationally and globally distributed? In this mini-review, we discuss these unanswered questions based on recent genetic epidemiological studies on ATTR Val30Met amyloidosis.
Collapse
Affiliation(s)
- Mitsuharu Ueda
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
| | - Taro Yamashita
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
| | - Yohei Misumi
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
| | - Teruaki Masuda
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
| | - Yukio Ando
- a Department of Neurology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
| |
Collapse
|
34
|
Choi K, Seok JM, Kim BJ, Choi YC, Shin HY, Sunwoo IN, Kim DS, Sung JJ, Lee GY, Jeon ES, Kim NH, Min JH, Oh J. Characteristics of South Korean Patients with Hereditary Transthyretin Amyloidosis. J Clin Neurol 2018; 14:537-541. [PMID: 30198232 PMCID: PMC6172511 DOI: 10.3988/jcn.2018.14.4.537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/24/2018] [Accepted: 06/25/2018] [Indexed: 12/20/2022] Open
Abstract
Background and Purpose This retrospective cross-sectional study included 18 patients from unrelated families harboring mutations of the transthyretin gene (TTR), and analyzed their characteristics and geographical distribution in South Korea. Methods The included patients had a diagnosis of systemic amyloidosis, clinical symptoms, such as amyloid neuropathy or cardiomyopathy, and confirmation of a TTR gene mutation using genetic analysis recorded between April 1995 and November 2014. Results The mean age at disease onset was 49.6 years, and the mean disease duration from symptom onset to diagnosis was 3.67 years. Fifteen of the 18 patients were classified as mixed phenotype, 2 as the neurological phenotype, and only 1 patient as the cardiac phenotype. The most-common mutation pattern in South Korea was Asp38Ala, which was detected in eight patients. Thirteen patients reported their family hometowns, and five of the eight harboring the Asp38Ala mutation were from the Gyeongsang province in southeast Korea. The other eight patients exhibited a widespread geographical distribution. A particularly noteworthy finding was that the valine at position 30 (Val30Met) mutation, which was previously reported as the most-common TTR mutation worldwide and also the most common in the Japanese population, was not detected in the present South Korean patients. Conclusions South Korean patients with hereditary TTR amyloidosis exhibited heterogeneous TTR genotypes and clinical phenotypes. The findings of this study suggest that the distribution of TTR amyloidosis in South Korea is due to de novo mutations and/or related to the other countries in East Asia.
Collapse
Affiliation(s)
- Kyomin Choi
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jin Myoung Seok
- Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Cheol Choi
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | | | - Dae Seong Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Jung Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ga Yeon Lee
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Seoul, Korea
| | - Eun Seok Jeon
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Seoul, Korea
| | - Nam Hee Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Ju Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
| |
Collapse
|